Background Previous research indicates an association between adverse childhood experiences (ACES) and health outcomes; however, most of these studies rely on variable-centered techniques. This study implemented a person-centered approach to provide a more nuanced understanding of these relations. Methods The sample consisted of 3611 male Marines who completed two surveys, one prior to service and another during or after service. A series of latent class analyses were conducted to identify homogenous subgroups, using ACE categories as indicators. Hierarchical regressions were conducted to examine the relationships between classes, deployment experiences, depression and PTSD, and social support problems. Results Five classes were identified: Low Adversity (48.8 %), Low Adversity – Parental Separation (PS; 33.1 %), Elevated Adversity (7.0 %), Moderate Adversity – Violence/Safety (5.7 %), and Moderate Adversity – Parental Loss (PL; 5.4 %). Several classes were associated with outcomes; in reference to Low Adversity, Moderate Adversity – PL was associated with depression and PTSD, Elevated Adversity was associated with PTSD and social support problems, and Low Adversity – PS was associated with social support problems. Experiencing moderate to high combat appeared to modify the associations between Moderate Adversity – PL and depression and PTSD. Limitations Study sample was limited to U.S. Marines; ACEs indicators were limited to specific categories, not allowing for a full range of potential childhood traumatic experiences. Conclusions Findings suggest a nuanced connection between ACEs and mental health; using specific patterns of ACEs, particularly multifaceted indicators of adversity that are inclusive of parental absence may have more utility than the sheer number of ACEs as an indicator for those who may at a heightened risk for mental health concerns.
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Identifying at-risk marines: A person-centered approach to adverse childhood experiences, mental health, and social support
APA Citation:
Reed-Fitzke, K., LeardMann, C. A., Wojciak, A. S., Ferraro, A. J., Hamilton, A., Duncan, J. M., & Rull, R. P. (2023). Identifying at-risk marines: A person-centered approach to adverse childhood experiences, mental health, and social support. Journal of Affective Disorders, 325, 721–731. https://doi.org/10.1016/j.jad.2023.01.020
Focus:
Mental health
Trauma
Branch of Service:
Marine Corps
Military Affiliation:
Active Duty
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research
Reed-Fitzke, Kayla; LeardMann, Cynthia A.; Wojciak, Armeda Stevenson; Ferraro, Anthony J.; Hamilton, Alexus; Duncan, James M.; Rull, Rudolph P.
2023
A person-centered approach to identifying at-risk U.S. Army soldiers-in-training based on adverse childhood experiences
APA Citation:
Reed-Fitzke, K., Duncan, J. M., Wojciak, A. S., Ferraro, A J., Sánchez, J., & Smith, K. M. (2023). A person-centered approach to identifying at-risk U.S. Army soldiers-in-training based on adverse childhood experiences. Traumatology, 29(4), 481–492. https://doi.org/10.1037/trm0000395
Focus:
Child maltreatment
Mental health
Trauma
Branch of Service:
Army
Military Affiliation:
Active Duty
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
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Research & Summary
Reed-Fitzke, Kayla; Duncan, James M.; Wojciak, Armeda S.; Ferraro, Anthony J.; Sánchez, Jennifer; Smith, Kevin M.
2023
Military service members are confronted with numerous stressors as they progress through their career. Given the military’s desire to maintain mission readiness, it is imperative to identify areas of early intervention to promote optimal functioning and health. This study used the stress process framework and a person-centered approach to identify subgroups of soldiers-in-training based on adverse childhood experiences (ACEs). Specifically, two questions were addressed: (a) Are there distinct profiles of ACEs among soldiers-in-training, and (b) who are the most at-risk soldiers-in-training? The sample consisted of 30,836 soldiers-in-training from the Army study to Assess Risk and Resilience in Servicemembers. Five subgroups were identified using latent profile analysis: low adversity, moderate emotional adversity, elevated emotional adversity, moderate structural adversity, and high cumulative adversity. Results from a multivariate and univariate analyses of variance indicated significant small main effects of profile membership in anxiety, depression, posttraumatic stress disorder, and resilient mindset. Those with high cumulative adversity and elevated emotional adversity appeared to be the most at-risk regarding mental health, yet those with high cumulative adversity had similar levels of resilient mindset as the lower adversity groups. Those with elevated emotional adversity had the lowest levels of resilient mindset. Findings provide a more holistic understanding of unique combinations of ACEs among individuals’ as they enter military service. ACEs profiles may help providers identify those who may benefit from targeted supports (e.g., trauma-informed mental health providers) prior to or during service for those who may be most vulnerable to poor outcomes.
Identifying risk and resilience factors associated with the likelihood of seeking mental health care among U.S. Army Soldiers-in-training
APA Citation:
Duncan, J. M., Reed-Fitzke, K., Ferraro, A. J., Wojciak, A. S., Smith, K. M., & Sánchez, J. (2020). Identifying risk and resilience factors associated with the likelihood of seeking mental health care among US Army soldiers-in-training. Military Medicine, 185(7-8), e1247-e1254. https://doi.org/10.1093/milmed/usz483.
Focus:
Mental health
Trauma
Branch of Service:
Army
Military Affiliation:
Active Duty
Guard
Reserve
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
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Research & Summary
Duncan, James M.; Reed-Fitzke, Kayla; Ferraro, Anthony J.; Wojciak, Armeda S.; Smith, Kevin M.; Sánchez, Jennifer
2020
INTRODUCTION: The Department of Defense aims to maintain mission readiness of its service members. Therefore, it is important to understand factors associated with treatment seeking in order to identify areas of prevention and intervention early in a soldier's career that can promote positive functioning and increase their likelihood of seeking mental health care when necessary. METHOD: Using a theory of planned behavior lens, this study identified potential barriers (risk) and facilitators (resilience) to treatment seeking among 24,717 soldiers-in-training who participated in the New Soldiers Study component of the "Army Study to Assess Risk and Resilience in Servicemembers" (Army STARRS). Approval for this study was granted by the University of Iowa IRB # 201706739. Hierarchal linear regression modeling and independent samples t-tests were used to examine associations between demographics and study variables, intersections of risk and resilience, and to explore differences in the likelihood of seeking help based on mental health diagnoses. RESULTS: A four-stage hierarchical linear regression was conducted, using likelihood of help-seeking as the dependent variable, to identify the most salient factors related to help-seeking. "Step one" of the analysis revealed soldiers-in-training who identified as female, Hispanic or Other ethnicity, and married, divorced, or separated reported a greater likelihood of seeking help. "Step two" of the analysis indicated soldiers-in-training with a history of sexual trauma, experience of impaired parenting, and clinical levels of mental health symptomatology (anxiety, depression, PTSD) reported a greater likelihood of seeking help. Inversely, soldiers-in-training with a history of emotional trauma and parental absence/separation reported a lower likelihood of seeking help. "Step three" of the analysis demonstrated soldiers-in-training with a prior history of seeking help and larger social networks had a greater likelihood of seeking help. "Step four" of the analysis revealed several interactive effects between risk and resilience factors. Specifically, soldiers-in-training who reported greater depressive symptomatology in combination with prior history of treatment seeking reported a greater likelihood of help seeking, whereas soldiers-in-training who reported prior sexual trauma and PTSD in combination with large social networks reported a lower likelihood of seeking help. Finally, a greater percentage of soldiers-in-training with clinical levels of anxiety, depression, and PTSD indicated they would likely seek help in comparison to soldiers-in-training without clinical symptoms. CONCLUSION: Findings suggest few soldiers-in-training are likely to seek help when experiencing a problem. General efforts to encourage help-seeking when needed are warranted with particular focus on subsets of soldiers-in-training (eg, men, those with a history of some adverse childhood experiences). Strengths of this study include the examination of a large sample of soldiers-in-training to identify possible leverage points for early intervention or prevention prior to entering stressful military operating environments. Limitations of this study include the examination of only one military branch and exclusion of soldiers not "in-training." Future studies could consider replicating the current study using a sample of military personnel longitudinally to track behavioral trends as well as looking at military populations outside of basic combat training.
Coping and mental health differences among active duty service members and their spouses with high and low levels of marital warmth
APA Citation:
Lucier-Greer, M., Quichocho, D., Frye-Cox, N., Sherman, H., Burke, B., & Duncan, J. M. (2020). Coping and mental health differences among active duty service members and their spouses with high and low levels of marital warmth. Military Psychology, 32, 425-431. https://doi.org/10.1080/08995605.2020.1803724
Focus:
Couples
Mental health
Parents
Branch of Service:
Multiple branches
Military Affiliation:
Active Duty
Population:
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research & Summary
Lucier-Greer, Mallory; Quichocho, Davina; Frye-Cox, Nicky; Sherman, Haley; Burke, Benjamin; Duncan, James M.
2020
This study examined the relationship between marital warmth (e.g., openly expressing affection, supportive behaviors) and assessments of coping (i.e., challenges coping with military life and self-efficacy in the context of stress) and mental health (i.e., depressive symptoms and anxiety symptoms) in a sample of active duty men and their spouses/romantic partners (N = 234 military couples). Results from a series of multivariate analysis of variance tests indicate that service members and spouses who reported higher levels of marital warmth also reported better coping skills and mental health compared to individuals in couple relationships that demonstrated lower levels of marital warmth. Intervention and prevention implications targeting social support and marital warmth are provided.
Vulnerability and resilience within military families: Deployment experiences, reintegration, and family functioning
APA Citation:
O'Neal, C. W., Lucier-Greer, M., Duncan, J. M., Mallette, J. K., Arnold, A. L., & Mancini, J. A. (2018). Vulnerability and resilience within military families: Deployment experiences, reintegration, and family functioning. Journal of Child and Family Studies, 27(10), 3250-3261. https://doi.org/10.1007/s10826-018-1149-6
Focus:
Couples
Deployment
Parents
Youth
Branch of Service:
Army
Military Affiliation:
Active Duty
Population:
Adolescence (13 - 17 yrs)
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research & Summary
O'Neal, Catherine Walker; Lucier-Greer, Mallory; Duncan, James M.; Mallette, Jacquelyn K.; Arnold, A. Laura; Mancini, Jay A.
2018
This study examined how family factors that diminish feelings of loss (frequent communication) and reflect system-level adaptation (effective household management) during deployment were associated with enhanced resilience and fewer vulnerabilities during reintegration and, ultimately, the promotion of family functioning following deployment. Multiple reporters from active duty (AD) military families (N = 214 families; 642 individuals) were examined, including AD members, civilian spouses, and their adolescent offspring. Most service members were men and enlisted personnel (95.3% male; 87.9% enlisted). Most AD and civilian spouses were between the ages of 31 and 40 (68.2% and 72.4%, respectively). Adolescent gender was relatively equal between boys (46.3%) and girls (53.7%), and their average age was 13.58. A SEM assessed the influence of communication frequency (reported by both AD and civilian spouses) and household management during deployment (reported by civilian spouses) on subsequent family functioning (reported by AD spouse, civilian spouse, and adolescent). The mediating role of positive and negative aspects of post-deployment family reintegration (reported by AD spouse, civilian spouse, and adolescent) was also assessed, as indicators of family resilience and vulnerability. Communication during deployment and civilian spouses' household management during deployment were associated with multiple family members' reintegration experiences. In turn, reintegration experiences were linked to self-perceptions of subsequent family functioning and, in some cases, other family members' perceptions of family functioning. Similarities and differences among family members are discussed. While deployment and reintegration create systemic family changes and challenges, results indicated opportunity for growth that can reinforce connections between family members.
Consensus recommendations for common data elements for operational stress research and surveillance: Report of a federal interagency working group
APA Citation:
Nash, W. P., Vasterling, J., Ewing-Cobbs, L., Horn, S., Gaskin, T., Golden, J., … Baker, D. G. (2010). Consensus recommendations for common data elements for operational stress research and surveillance: Report of a federal interagency working group. Archives of Physical Medicine & Rehabilitation, 91(11), 1673–1683.
Focus:
Deployment
Mental health
Branch of Service:
Air Force
Army
Coast Guard
Marine Corps
Multiple branches
Navy
Military Affiliation:
Veteran
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research
Nash, William P.; Vasterling, Jennifer; Ewing-Cobbs, Linda; Horn, Sarah; Gaskin, Thomas; Golden, John; Riley, William T.; Bowles, Stephen V.; Favret, James; Lester, Patricia; Koffman, Robert; Farnsworth, Laura C.; Baker, Dewleen G.
2010
Empirical studies and surveillance projects increasingly assess and address potentially adverse psychological health outcomes from the stress of military operations, but no standards yet exist for common concept definitions, variable categories, and measures. This article reports the consensus recommendations of the federal interagency Operational Stress Working Group for common data elements to be used in future operational stress research and surveillance with the goal of improving comparability across studies. Operational stress encompasses more than just combat; it occurs everywhere service members and their families live and work. Posttraumatic stress is not the only adverse mental or behavioral health outcome of importance. The Operational Stress Working Group contends that a primary goal of operational stress research and surveillance is to promote prevention of adverse mental and behavioral outcomes, especially by recognizing the preclinical and subclinical states of distress and dysfunction that portend a risk for failure of role performance or future mental disorders. Recommendations for data elements are divided into 3 tiers: core, supplemental, and emerging, including variable domains and specific measures for assessing operational stressor exposures, stress outcomes, moderating factors, and mediating processes. Attention is drawn to the emerging construct of stress injury as a generic term for subclinical operational stress, and to emerging data elements addressing biological, psychological, and spiritual mediators of risk. Methodologies are needed for identifying preclinical and subclinical states of distress or dysfunction that are markers of risk for failure of role performance and future clinical mental disorders, so that targeted prevention interventions can be developed and evaluated.
1 LIFE AFTER DEPLOYMENT
Posted by Duncan, James
JAMES DUNCAN, PHD – MILITARY REACH CONTENT EXPERT
Posted on April 17, 2020
