Guided by the World Health Organization’s (WHO) Social Determinants of Health (SDH) conceptual framework the purpose of this study was to explore the SDH among military spouses, who have universal access to health care. Two research questions guided this study: (1) What SDH factors are significantly associated with Army wives’ self-reported health, and (2) What SDH level of factors best explains Army wives’ self-rated health. The present study is a secondary analysis of survey data collected in 2012 from 327 U.S. Army wives. Bivariate pairwise correlations and hierarchical linear regressions (HLR) were used to examine determinant categories outlined in the SDH framework. Results suggest significant bivariate associations in most determinant categories. The best-fitting HLR models were those with all determinant categories. These preliminary findings suggest that although universal health care can improve mental and physical health equity, other SDH factors within and across multiple determinant categories can contribute to persistent inequities.
BarfieldW. D.WiseP. H.RustF. P.RustK. J.GouldJ. B.GortmakerS. L. (1996). Racial disparities in outcomes of military and civilian births in California. Archives of Pediatrics and Adolescent Medicine, 150(10), 1062–1067. https://doi.org/10.1001/archpedi.1996.02170350064011
BogardK.MurryV. M. B.AlexanderC. (2023). Perspectives on health equity and social determinants of health. The National Academies Press. https://doi.org/10.17226/27117
4.
BorahE.FinaB. (2017). Military spouses speak up: A qualitative study of military and Veteran spouses’ perspectives. Journal of Family Social Work, 20(2), 144–161. https://doi.org/10.1080/10522158.2017.1284702
CrouchC. L.AdrianA. L.AdlerA. B.WoodM. D.ThomasJ. L. (2017). Military spouses stationed overseas: Role of social connectedness on health and well-being. Military Behavioral Health, 5(2), 129–136. https://doi.org/10.1080/21635781.2016.1272014
DonohoC. J.LeardMannC.O’MalleyC. A.WalterK. H.RiviereL. A.CurryJ. F.AdlerA. B. (2018). Depression among military spouses: Demographic, military, and service member psychological health risk factors. Depression and Anxiety, 35(12), 1137–1144. https://doi.org/10.1002/da.22820
9.
DonohoC. J.RiviereL. A.AdlerA. B. (2017). The association of deployment-related mental health, community support, and spouse stress in military couples. Military Behavioral Health, 5(2), 109–116. https://doi.org/10.1080/21635781.2016.1272015
10.
FaulF.ErdfelderE.BuchnerA.LangA.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160. https://doi.org/10.3758/BRM.41.4.1149
11.
FroneM. R.RussellM.CooperM. L. (1997). Relation of work-family conflict to health outcomes: A four-year longitudinal study of employed parents. Journal of Occupational and Organizational Psychology, 70(4), 325–335. https://doi.org/10.1111/j.2044-8325.1997.tb00652.x
GardnerK. A.CutronaC. E. (2004). Social support communication in families. In LEA’s communication series. Handbook of family communication (pp. 495–512). Lawrence Erlbaum Associates Publishers. https://psycnet.apa.org/record/2004-00165-022
14.
GeisslerK.RanchoffB. L.CooperM. I.AttanasioL. B. (2020). Association of insurance status with provision of recommended services during comprehensive postpartum visits. JAMA Network Open, 3(11), Article e2025095. https://doi.org/10.1001/jamanetworkopen.2020.25095
15.
GelmanA.HillJ. (2007). Data analysis using regression and multilevel/hierarchical models (AlvarezM.BeckN.WuL., Eds.). Cambridge University Press.
16.
Godier-McbardL. R.IbbitsonL.HooksC.FosseyM. (2019). Military spouses with deployed partners are at greater risk of poor perinatal mental health: A scoping review. Journal of the Royal Army Medical Corps, 165, 363–370. https://doi.org/10.1136/jramc-2018-001069
17.
HeymanR. E.BaucomK. J. W.XuS.Smith SlepA. M.SnarrJ. D.ForanH. M.LorberM. F.WojdaA. K.LinkhD. J. (2020). High sensitivity and specificity screening for clinically significant Intimate Partner Violence. Journal of Family Psychology, 35, 80–91. https://doi.org/10.1037/fam0000781
18.
HeymanR. E.SlepA. M. S.SnarrJ. D.ForanH. M. (2013). Practical tools for assessing partner maltreatment in clinical practice and public health settings. In ForanH. M.BeachS. R. H.SlepA. M. S.HeymanR. E.WamboldtM. Z. (Eds.), Family problems and family violence: Reliable assessment and the ICD-11 (pp. 41–70). Springer.
19.
Hill-BriggsF.FitzpatrickS. L. (2023). Overview of social determinants of health in the development of diabetes. Diabetes Care, 46(9), 1590–1598. https://doi.org/10.2337/dci23-0001
20.
HollidayS. B.HaasA.ShihR. A.TroxelW. M. (2016). Prevalence and consequences of sleep problems in military wives. Sleep Health, 2(2), 116–122. https://doi.org/10.1016/j.sleh.2016.03.004
21.
Holt-LunstadJ. (2018). Why social relationships are important for physical health: A systems approach to understanding and modifying risk and protection. Annual Review of Psychology, 69(1), 437–458. https://doi.org/10.1146/annurev-psych-122216-011902
22.
HuffmanA. H.CulbertsonS. S.CastroC. A. (2008). Family-friendly environments and U.S. Army soldier performance and work outcomes. Military Psychology, 20(4), 253–270. https://doi.org/10.1080/08995600802345162
23.
JonesA. D. (2012). Intimate partner violence in military couples: A review of the literature. Aggression and Violent Behavior, 17(2), 147–157. https://doi.org/10.1016/j.avb.2011.12.002
24.
KroenkeK.SpitzerR. L.WilliamsJ. B. W. (2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64(2), 258–266.
25.
KroenkeK.WuJ.YuZ.BairM. J.KeanJ.StumpT.MonahanP. O. (2016). Patient Health Questionnaire anxiety and depression scale: Initial validation in three clinical trials. Psychosomatic Medicine, 78(6), 716–727. https://doi.org/10.1097/PSY.0000000000000322
26.
LambertJ. E.EnghR.HasbunA.HolzerJ. (2012). Impact of Posttraumatic Stress Disorder on the relationship quality and psychological distress of intimate partners: A meta-analytic review. Journal of Family Psychology, 26(5), 729–737. https://doi.org/10.1037/a0029341
27.
LesterP.AralisH.SinclairM.KiffC.LeeK. H.MustilloS.WadsworthS. M. D. (2016). The Impact of deployment on parental, family and child adjustment in military families. Child Psychiatry and Human Development, 47(6), 938–349. https://doi.org/10.1007/s10578-016-0624-9
LukkahataiN.RodneyT.LingC.DanielB.HanH. R. (2023). Long COVID in the context of social determinants of health. Frontiers in Public Health, 11, Article 1098443. https://doi.org/10.3389/fpubh.2023.1098443
30.
LundquistJ.EloI.BarfieldW.XuZ. (2014). Racial disparities in US infant birth outcomes: A protective effect of military affiliation?Race and Social Problems, 6(2), 161–180. https://doi.org/10.1007/s12552-013-9108-8
31.
LundquistJ.XuZ.BarfieldW.EloI. (2014). Do Black–White racial disparities in breastfeeding persist in the military community?Maternal and Child Health Journal, 19(2), 419–427. https://doi.org/10.1007/s10995-014-1524-x
32.
MariniC. M.CollinsC. L.MacDermid WadsworthS. M. (2018). Examining multiple rhythms of military and veteran family life. Journal of Family Theory and Review, 10(3), 516–534. https://doi.org/10.1111/jftr.12275
33.
McLaughlinR.NielsenL.WallerM. (2008). An evaluation of the effect of military service on mortality: Quantifying the healthy soldier effect. Annals of Epidemiology, 18(12), 928–936. https://doi.org/10.1016/j.annepidem.2008.09.002
34.
MeadowsS. O.TanielianT.KarneyB.SchellT.GriffinB. A.JaycoxL. H.FriedmanE. M.TrailT. E.BeckmanR.RamchandR.HengstebeckN.TroxelW. M.AyerL.VaughanC. A. (2017). The deployment life study: Longitudinal analysis of military families across the deployment cycle. Rand Health Quarterly, 6(2), 7. https://www.rand.org/pubs/research_reports/RR1388.html
35.
MerinoS. (2014). Social support and the religious dimensions of close ties. Journal for the Scientific Study of Religion, 53(3), 595–612.
National Academies of Sciences Engineering and Medicine. (2019). Strengthening the military family readiness system for a changing American society. National Academies Press. https://doi.org/10.17226/25380
39.
NetemeyerR. G.BolesJ. S.McMurrianR. (1996). Development and validation of work-family conflict and family-work conflict scales. Journal of Applied Psychology, 81(4), 400–410. https://doi.org/10.1037/0021-9010.81.4.400
40.
O’DonnellM. L.VarkerT.HolmesA. C.EllenS.WadeD.CreamerM.SiloveD.McFarlaneA.BryantR. A.ForbesD. (2013). Disability after injury: The cumulative burden of physical and mental health. Journal of Clinical Psychiatry, 74(2), e137–e143. https://doi.org/10.4088/JCP.12m08011
Pierre-LouisB. J.MooreA. D.HamiltonJ. B. (2015). The military health care system may have the potential to prevent health care disparities. Journal of Racial and Ethnic Health Disparities, 2(3), 280–289. https://doi.org/10.1007/S40615-014-0067-6/TABLES/5
43.
SaltzmanW. R.LesterP.BeardsleeW. R.LayneC. M.WoodwardK.NashW. P. (2011). Mechanisms of risk and resilience in military families: Theoretical and empirical basis of a family-focused resilience enhancement program. Clinical Child and Family Psychology Review, 14(3), 213–230. https://doi.org/10.1007/s10567-011-0096-1
44.
SatyanarayanaV. A.ChandraP. S.VaddipartiK. (2015). Mental health consequences of violence against women and girls. Current Opinion in Psychiatry, 28(5), 350–356. https://doi.org/10.1097/YCO.0000000000000182
SinclairR. R.PaulsonA. L.RiviereL. A. (2019). The resilient spouse: Understanding factors associated with dispositional resilience among military spouses. Military Behavioral Health, 7(4), 376–390. https://doi.org/10.1080/21635781.2019.1608876
49.
SoetersJ. L.WinslowD. J.WeibullA. (2006). Military culture. In CaforioG. (Ed.), Handbook of the sociology of the military (pp. 237–254). Springer. https://doi.org/10.1007/0-387-34576-0_14
50.
SolarO.IrwinA. (2010). A conceptual framework for action on the social determinants of health. World Health Organization.
51.
SullivanK. S.HawkinsS. A.GilreathT. D.CastroC. A. (2021). Mental health outcomes associated with profiles of risk and resilience among US Army spouses. Journal of Family Psychology, 35(1), 33.
52.
SullivanK. S.ParkY.ClelandC. M.MerrillJ. C.Clarke-WalperK.RiviereL. A. (2021). Association between cumulative risk and protective factors with mental distress among female military spouses. American Journal of Orthopsychiatry, 91(6), 789–799.
53.
SullivanK. S.ParkY.RiviereL. A. (2022). Military and nonmilitary stressors associated with mental health outcomes among female military spouses. Family Relations, 71(1), 371–388.
54.
SumnerJ.BoisvertD.AndersenJ. P. (2016). The effects of stress and social support on externalizing behaviors among children in military families. Deviant Behavior, 37(3), 242–262. https://doi.org/10.1080/01639625.2015.1012403
55.
TrailT.SimsC.TankardM. (2019). Today’s Army Spouse Survey: How Army families address life’s challenges. RAND Corporation. https://doi.org/10.7249/RR3224
56.
WadsworthS. M.SouthwellK. (2011). Military families: Extreme work and extreme “work-family.”The ANNALS of the American Academy of Political and Social Science, 638(1), 163–183. https://doi.org/10.1177/0002716211416445
57.
WangM.-C.NyutuP.TranK.SpearsA. (2015). Finding resilience: The mediation effect of sense of community on the psychological well-being of military spouses. Journal of Mental Health Counseling, 37(2), 164–174. https://doi.org/10.17744/mehc.37.2.07054x614489204m
58.
WoodallK. A.RichardsonS. M.PfliegerJ. C.HawkinsS. A.StanderV. A. (2020). Influence of work and life stressors on marital quality among dual and nondual military couples. Journal of Family Issues, 4(11), 2045–2064. https://doi.org/10.1177/0192513X20903377
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
