Restricted accessResearch articleFirst published online 2017-7
The Role of PTSD,Depression,and Alcohol Misuse Symptom Severity in Linking Deployment Stressor Exposure and Post-Military Work and Family Outcomes in Male and Female Veterans
Exposure to stressors during military deployment puts veterans at risk for reduced post-military quality of life. Stress-related mental health problems may lead to decreased well-being within work and family domains, yet few studies have explored associations in the context of gender. We examined relationships between deployment stressors and post-military functioning and satisfaction in the domains of work and family, with a focus on posttraumatic stress disorder (PTSD), depression, and alcohol misuse symptomatology as potential mediators. Participants included 522 male and female Iraq and Afghanistan war veterans assessed longitudinally. Structural equation models supported several direct and indirect pathways linking deployment stressors to work and family outcomes for both men and women. PTSD had an important role in these associations. Depression also played a significant role, particularly for women. These findings build on prior research by elucidating potential gender-specific risk, which may be applied to better tailor services to veterans’ unique needs.
AdlerD. A.PossematoK.MavandadiS.LernerD.ChangH.KlausJ., . . . OslinD. W. (2011). Psychiatric status and work performance of veterans of Operations Enduring Freedom and Iraqi Freedom. Psychiatric Services, 62, 39–46. doi:10.1176/appi.ps.62.1.39
2.
AllenE. S.RhoadesG. K.StanleyS. M.MarkmanH. J. (2010). Hitting home: Relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for army couples. Journal of Family Psychology, 24, 280–288. doi:10.1037/a0019405
3.
BaborT. F.GrantM. (1989). From clinical research to secondary prevention: International collaboration in the development of the Alcohol Use Disorders Identification Test (AUDIT). Alcohol Health and Research World, 13, 371–374.
4.
Bean-MayberryB.YanoE. M.WashingtonD. L.GoldzweigC.BatumanF.HuangC., . . . ShekelleP. G. (2011). Systematic review of women veterans’ health: Update of successes and gaps. Women’s Health Issues, 21, S84–S97. doi:10.1016/j.whi.2011.04.022
5.
BeckA. T.SteerR. A.BallR.CiervoC. A.KabatM. (1997). Use of the Beck Anxiety and Depression Inventories for primary care with medical outpatients. Assessment, 4, 211–219. doi:10.1177/107319119700400301
6.
BeckA. T.WardC. H.MendelsonM.MockJ.ErbaughJ. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. doi:10.1001/archpsyc.1961.01710120031004
7.
BentlerP. M. (1990). Comparative fit indexes in structural models. Quantitative Methods in Psychology, 107, 238–246. doi:10.1037/0033–2909.107.2.238
8.
BollenK.LennoxR. (1991). Conventional wisdom on measurement: A structural equation perspective. Psychological Bulletin, 110, 305–314. doi:10.1037/0033–2909.110.2.305
9.
BradleyK. A.DeBenedettiA. F.VolkR. J.WilliamsE. C.FrankD.KivlahanD. R. (2007). AUDIT-C as a brief screen for alcohol misuse in primary care. Alcoholism: Clinical & Experimental Research, 3, 1208–1217. doi:10.1111/j.1530-0277.2007.00403.x
10.
BrownT. A. (2006). Confirmatory factor analysis for applied research. New York, NY: Guilford.
11.
BrowneM. W.CudeckR. (1993). Alternative ways of assessing model fit. In BollenK. A.LongJ. S. (Eds.), Testing structural equation models (Vol. 154, pp. 136–162). Newbury Park, CA: Sage.
12.
BushK.KivlahanD. R.McDonnellM. B.FihnS. D.BradleyK. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158, 1789–1795. doi:10.1001/archinte.158.16.1789
13.
ByrneB. M. (1994). Structural equation modeling with EQS and EQS/Windows: Basic concepts, applications, and programming. Thousand Oaks, CA: Sage.
14.
CigrangJ. A.Wayne TalcottG.TatumJ.BakerM.CassidyD.SonnekS., . . . Smith SlepA. M. (2014). Intimate partner communication from the war zone: A prospective study of relationship functioning, communication frequency, and combat effectiveness. Journal of Marital and Family Therapy, 40, 332–343. doi:10.1111/jmft.12043
15.
ConybeareD.BeharE.SolomonA.NewmanM. G.BorkovecT. D. (2012). The PTSD Checklist–Civilian Version: Reliability, validity, and factor structure in a nonclinical sample. Journal of Clinical Psychology, 68, 699–713.
16.
CrawfordE. F.FultonJ. J.SwinkelsC. M.BeckhamJ. C.CalhounP. S. (2013). Diagnostic efficiency of the AUDIT-C in U.S. veterans with military service since September 11, 2001. Drug and Alcohol Dependence, 132, 101–106.
17.
CreechS. K.SwiftR.ZlotnickC.TaftC.StreetA. E. (2015). Combat exposure, mental health, and relationship functioning among women veterans of the Afghanistan and Iraq wars. Journal of Family Psychology, 30, 43–51. doi:10.1037/fam0000145
18.
DillmanD. A.SmythJ. D.ChristianL. (2009). Internet, mail, and mixed-mode surveys: The tailored design method. Hoboken, NJ: John Wiley.
19.
ErbesC. R.KalerM. E.SchultT.PolusnyM. A.ArbisiP. A. (2011). Mental health diagnosis and occupational functioning in National Guard/Reserve veterans returning from Iraq. Journal of Rehabilitation Research and Development, 48, 1159–1170. doi:10.1682/jrrd.2010.11.0212
20.
FangS. C.SchnurrP. P.KulishA. L.HolowkaD. W.MarxB. P.KeaneT. M.RosenR. (2015). Psychosocial functioning and health-related quality of life associated with posttraumatic stress disorder in male and female Iraq and Afghanistan war veterans: The VALOR registry. Journal of Women’s Health, 24, 1038–1046. doi:10.1089/jwh.2014.5096
21.
GewirtzA. H.PolusnyM. A.DeGarmoD. S.KhaylisA.ErbesC. R. (2010). Posttraumatic stress symptoms among National Guard soldiers deployed to Iraq: Associations with parenting behaviors and couple adjustment. Journal of Consulting and Clinical Psychology, 78, 599–610. doi:10.1037/a0020571
22.
GoffB. S.CrowJ. R.ReisbigA. M.HamiltonS. (2007). The impact of individual trauma symptoms of deployed soldiers on relationship satisfaction. Journal of Family Psychology, 21, 344–353. doi:10.1037/0893-3200.21.3.344
23.
GoldzweigC. L.BalekianT. M.RolónC.YanoE. M.ShekelleP. G. (2006). The state of women veterans’ health research: Results of a systematic literature review. Journal of General Internal Medicine, 21, S82–S92. doi:10.1111/j.1225-1497.2006.00380.x
24.
HendrickS. S. (1988). A generic measure of relationship satisfaction. Journal of Marriage and Family, 50, 93–98. doi:10.2307/352430
25.
HuL.BentlerP. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424–453. doi:10.1037/1082-989X.3.4.424
26.
IronsonG. H.SmithP. C.BrannickM. T.GibsonW. M.PaulK. B. (1989). Construction of a Job in General Scale: A comparison of global, composite, and specific measures. Journal of Applied Psychology, 74, 193–200.
27.
JaccardJ.WanC. K. (1996). LISREL approaches to interaction effects in multiple regression. Thousand Oaks, CA: Sage.
28.
KachadourianL. K.SmithB. N.TaftC. T.VogtD. (2015). The impact of infidelity on combat-exposed service members. Journal of Traumatic Stress, 28, 418–425. doi:10.1002/jts.22033
29.
KangH.DalagerN.MahanC.IshiiE. (2005). The role of sexual assault on the risk of PTSD among Gulf War veterans. Annals of Epidemiology, 15, 191–195. doi:10.1016/j.annepidem.2004.05.009
30.
KimerlingR.GimaK.SmithM. W.StreetA.FrayneS. (2007). The Veterans Health Administration and military sexual trauma. American Journal of Public Health, 97, 2160–2166. doi:10.2105/AJPH.2006.092999
31.
KingD. W.KingL. A.FoyD. W.KeaneT. M.FairbankJ. A. (1999). Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: Risk factors, war-zone stressors, and resilience-recovery variables. Journal of Abnormal Psychology, 108, 164–170. doi:110.1037//0021-1843X.1108.1031.1164.
32.
KristonL.HolzelL.WeiserA. K.BernerM. M.HarterM. (2008). Meta-analysis: Are 3 questions enough to detect unhealthy alcohol use?Annals of Internal Medicine, 149, 879–888. doi:10.7326/0003-4819-149-12-200812160-00007
33.
LittleT. D.CunninghamW. A.ShaharG.WidamanK. F. (2002). To parcel or not to parcel: Exploring the question, weighing the merits. Structural Equation Modeling, 9, 151–173. doi:10.1207/S15328007SEM0902_1
34.
MacCallumR. C.BrowneM. W. (1993). The use of causal indicators in covariance structure models: Some practical issues. Psychological Bulletin, 114, 533–541. doi:10.1037/0033-2909.114.3.533
35.
MaguenS.LuxtonD. D.SkoppN. A.MaddenE. (2012). Gender differences in traumatic experiences and mental health in active duty soldiers redeployed from Iraq and Afghanistan. Journal of Psychiatric Research, 46, 311–316. doi:10.1016/j.jpsychires.2011.11.007
36.
MaozH.GoldwinY.LewisY. D.BlockY. (2016). Exploring reliability and validity of the Deployment Risk and Resilience Inventory–2 among a sample of discharged soldiers following mandatory military service. Journal of Traumatic Stress, 29, 556–562.
37.
McQuaidJ. R.MarxB. P.RosenM. I.BufkaL. F.TenhulaW.CookH.KeaneT. M. (2012). Mental health assessment in rehabilitation research. Journal of Rehabilitation Research and Development, 49, 121–138. doi:10.1682/jrrd.2010.08.0143
MuthénL. K.MuthénB. O. (1998–2015). Mplus user’s guide (7th ed.). Los Angeles, CA: Muthén & Muthén.
40.
NegrusaS.NegrusaB.HosekJ. (2014). Gone to war: Have deployments increased divorces?Journal of Population Economics, 27, 473–496.doi:10.1007/s00148-013-0485-5
41.
O’BrienC.KeithJ.ShoemakerL. (2015). Don’t tell: Military culture and male rape. Psychological Services, 12, 357–365. doi:10.1037/ser0000049
42.
PietrzakR. H.GoldsteinM. B.MalleyJ. C.RiversA. J.JohnsonD. C.MorganC. A.IIISouthwickS. M. (2010). Posttraumatic growth in veterans of Operations Enduring Freedom and Iraqi Freedom. Journal of Affective Disorders, 126, 230–235. doi:10.1016/j.jad.2010.03.021
43.
PietrzakR. H.GoldsteinM. B.MalleyJ. C.RiversA. J.SouthwickS. M. (2010). Structure of posttraumatic stress disorder symptoms and psychosocial functioning in veterans of Operations Enduring Freedom and Iraqi Freedom. Psychiatry Research, 178, 323–329. doi:10.1016/j.psychres.2010.04.039
44.
PolusnyM. A.KumpulaM. J.MeisL. A.ErbesC. R.ArbisiP. A.MurdochM., . . . JohnsonA. K. (2014). Gender differences in the effects of deployment-related stressors and pre-deployment risk factors on the development of PTSD symptoms in National Guard soldiers deployed to Iraq and Afghanistan. Journal of Psychiatric Research, 49, 1–9. doi:10.1016/j.jpsychires.2013.09.016
45.
ReinertD. F.AllenJ. P. (2007). The Alcohol Use Disorders Identification Test: An update of research findings. Alcoholism: Clinical & Experimental Research, 31, 185–199.
46.
RodriguezP.HolowkaD. W.MarxB. P. (2012). Assessment of posttraumatic stress disorder-related functional impairment: A review. Journal of Rehabilitation Research and Development, 49, 649–666. doi:10.1682/jrrd.2011.09.0162
47.
RussellS. S.SpitzmullerC.LinL. F.StantonJ. M.SmithP. C.IronsonG. H. (2004). Shorter can also be better: The Abridged Job in General Scale. Educational and Psychological Measurement, 64, 878–893.
48.
SayersS. L.FarrowV. A.RossJ.OslinD. W. (2009). Family problems among recently returned military veterans referred for a mental health evaluation. Journal of Clinical Psychiatry, 70, 163–170. doi:10.4088/JCP.07m03863
49.
SchnurrP. P.LunneyC. A. (2008). Exploration of gender differences in how quality of life relates to posttraumatic stress disorder in male and female veterans. Journal of Rehabilitation Research and Development, 45, 383–394. doi:10.1682/jrrd.2007.06.0099
50.
SchnurrP. P.LunneyC. A. (2011). Work-related quality of life and posttraumatic stress disorder symptoms among female veterans. Women’s Health Issues, 21, S169–S175. doi:10.1016/j.whi.2011.04.013
51.
SchnurrP. P.LunneyC. A. (2012). Work-related outcomes among female veterans and service members after treatment of posttraumatic stress disorder. Psychiatric Services, 63, 1072–1079. doi:10.1176/appi.ps.201100415
52.
SchnurrP. P.LunneyC. A.BovinM. J.MarxB. P. (2009). Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan. Clinical Psychology Review, 29, 727–735. doi:10.1016/j.cpr.2009.08.006
53.
SheaM. T.ReddyM. K.TyrkaA. R.SevinE. (2013). Risk factors for post-deployment posttraumatic stress disorder in National Guard/Reserve service members. Psychiatry Research, 210, 1042–1048. doi:10.1016/j.psychres.2013.08.039
54.
SheaM. T.VujanovicA. A.MansfieldA. K.SevinE.LiuF. (2010). Posttraumatic stress disorder symptoms and functional impairment among OEF and OIF National Guard and Reserve veterans. Journal of Traumatic Stress, 23, 100–107. doi:10.1002/jts.20497
55.
SheppardS. C.HicklingE. J.EarleywineM.HoytT.RussoA. R.DonatiM. R.KipK. E. (2015). Preliminary data suggest rates of male military sexual trauma may be higher than previously reported. Psychological Services, 12, 344–347. doi:10.1037/ser0000047
56.
SteigerJ. H. (1990). Structural model evaluation and modification: An interval estimation approach. Multivariate Behavioral Research, 25, 173–180. doi:10.1207/s15327906mbr2502_4
57.
StreetA. E.GradusJ. L.GiassonH. L.VogtD.ResickP. A. (2013). Gender differences among veterans deployed in support of the wars in Afghanistan and Iraq. Journal of General Internal Medicine, 28, S556–S562. doi:10.1007/s11606-013-2333-4
58.
StreetA. E.VogtD.DutraL. (2009). A new generation of women veterans: Stressors faced by women deployed to Iraq and Afghanistan. Clinical Psychology Review, 29, 685–694.
59.
TanielianT.JaycoxL. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND.
60.
TsaiJ.El-GabalawyR.SledgeW. H.SouthwickS. M.PietrzakR. H. (2015). Post-traumatic growth among veterans in the USA: Results from the National Health and Resilience in Veterans Study. Psychological Medicine, 45, 165–179. doi:10.1017/S0033291714001202
61.
TsaiJ.Harpaz-RotemI.PietrzakR. H.SouthwickS. M. (2012). The role of coping, resilience, and social support in mediating the relation between PTSD and social functioning in veterans returning from Iraq and Afghanistan. Psychiatry, 75, 135–149. doi:10.1521/psyc.2012.75.2.135
62.
TsaiJ.SippelL. M.MotaN.SouthwickS. M.PietrzakR. H. (2016). Longitudinal course of posttraumatic growth among U.S. military veterans: Results from the National Health and Resilience in Veterans Study. Depression and Anxiety, 33, 9–18. doi:10.1002/da.22371
U.S. Department of Health & Human Services, National Institutes of Health, Office of Research on Women’s Health. (2010). Moving into the future with new dimensions and strategies: A vision for 2020 for women’s health research (NIH Pub. No. 10-7606). Retrieved from https://orwh.od.nih.gov/resources/pdf/ORWH_StrategicPlan2020_Vol1.pdf
65.
U.S. Department of Labor, Bureau of Labor Statistics. (2016). Employment situation of veterans—2015 (News release). Retrieved from http://www.bls.gov/news.release/pdf/vet.pdf
66.
van SaaneN.SluiterJ. K.VerbeekJ. H. A. M.Frings-DresenM. H. W. (2003). Reliability and validity of instruments measuring job satisfaction—A systematic review. Occupational Medicine, 53, 191–200. doi:10.1093/occmed/kqg038
67.
VaughnM. J.Matyastik BaierM. E. (1999). Reliability and validity of the relationship assessment scale. American Journal of Family Therapy, 27, 137–147.
68.
VogtD.SmithB. N.ElwyR.MartinJ.SchultzM.DrainoniM. L.EisenS. (2011). Predeployment, deployment, and postdeployment risk factors for posttraumatic stress symptomatology in female and male OEF/OIF veterans. Journal of Abnormal Psychology, 120, 819–831. doi:10.1037/a0024457
69.
VogtD.SmithB. N.FoxA. B.AmorosoT.TavernaE. C.SchnurrP. P. (2016). Consequences of PTSD for the work and family quality of life of female and male U.S. Afghanistan and Iraq war veterans. Social Psychiatry and Psychiatric Epidemiology. Advance online publication.
70.
VogtD.SmithB. N.KingL. A.KingD. W.KnightJ.VasterlingJ. J. (2013). Deployment Risk and Resilience Inventory–2 (DRRI-2): An updated tool for assessing psychosocial risk and resilience factors among service members and veterans. Journal of Traumatic Stress, 26, 710–717. doi:10.1002/jts.21868
71.
VogtD.VaughnR.GlickmanM. E.SchultzM.DrainoniM. L.ElwyR.EisenS. (2011). Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of US OEF/OIF veterans. Journal of Abnormal Psychology, 120, 797–806. doi:10.1037/a0023452
72.
WeathersF. W.LitzB. T.HermanD. S.HuskaJ. A.KeaneT. M. (1993, October). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.
73.
WickramaK. A.CongerR. D.LorenzF. O.MatthewsL. (1995). Role identity, role satisfaction, and perceived physical health. Social Psychology Quarterly, 58, 270–283. doi:10.2307/2787128
74.
WilkinsK. C.LangA. J.NormanS. B. (2011). Synthesis of the psychometric properties of the PTSD Checklist (PCL) Military, Civilians, and Specific versions. Depression and Anxiety, 28, 596–606.
