Publications
Research Publication 2
Title Publication Date/Location
The Millennium Cohort Family Study: A prospective evaluation of the health and well-being of military service members and their families International Journal of Methods in Psychiatric Research 2014 Sep;23(3):320-30

Crum-Cianflone NF, Fairbank JA, Marmar CR, Schlenger W

The Millennium Cohort Family Study is the largest prospective, epidemiologic study of military families in US history, and includes dyads of service members and their spouses. This paper provides a comprehensive description of this landmark study including details of the research objectives, study methodology, survey instrument, ancillary data sets, and plans for dissemination of research findings. The Family Study offers a unique opportunity to define the challenges that military families experience and advance the understanding of protective factors that will benefit military families today and into the future.

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Comparison of Posttraumatic Stress Disorder Checklist Instruments from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition vs Fifth Edition in a Large Cohort of US Military Service Members and Veterans JAMA Network Open 2021 April; 4(4): e218072

LeardMann CA, McMaster HS, Warner S, Esquivel AP, Porter B, Powell TM, Tu XM, Lee WW, Rull RP, Hoge CW

To assist in the longitudinal assessment of PTSD spanning the transition between the DSM-IV and DSM-V, we compared the PTSD Checklist-Civilian version (PCL-C) with the PCL for DSM-5 (PCL-5) in a sample of 1,921 participants from the Millennium Cohort Study. There was substantial to excellent agreement when comparing individual items, frequency of probably PTSD, and sum scores; and nearly identical associations with comorbid conditions. Our results provide support that PTSD can be successfully assessed and compared over time with either PCL instrument in veteran and military populations.

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Military life stressors, family communication and satisfaction: Associations with children’s psychosocial outcomes Journal of Child & Adolescent Trauma 2019 May;13(1):75-87

Briggs EC, Fairbank JA, Tunno AM, Lee RC, Corry NH, Pflieger JC, Stander VA, Murphy RA

The purpose of this study was to examine facets of military life and family factors that may impact child psychosocial and mental health functioning. Using baseline data from the Millennium Cohort Family Study, this study examined family demographics and composition (age, number of children), military life stressors (injury, family, and deployment stressors), family communication and satisfaction, parental social functioning, and child mental health and behavioral functioning. Injury- and family-related military stressors were significant indicators of heightened risk for child mental health conditions, whereas greater levels of parental social functioning and family satisfaction were associated with lower risk of child mental health conditions. Differential associations were found in child functioning when military-related variables (e.g., service component), sociodemographic, and family composition factors (number and age of the children in the home) were examined. These findings underscore the importance of examining the “whole child” within the broader ecological and military family context to understand factors associated with children’s mental and behavioral health. The results have considerable implications for the development of policies to support children and families encountering multiple stressors related to a parent’s military service.

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Patterns of strengths in U.S. military couples Journal of Child and Family Studies 2019 Sep;29:1249–1263

Pflieger JC, Porter B, Carballo CE, Stander VA, Corry NH

This study examined patterns of strengths among military couples in the Millennium Cohort Family Study (n = 9,642), including beliefs (self-mastery, positive outlook, spirituality), social support, and family communication. Results supported five patterns of strengths, with 58.4% of couples exhibiting a pattern of high strengths; 33.6% of couples exhibiting two patterns in which one member of the couple was higher on strengths than the other member; 5.1% of couples exhibiting a pattern of low strengths; and 2.9% of couples exhibiting a pattern of moderately high beliefs and social support, yet very low family communication. Higher spouse education level and service member officer rank consistently distinguished patterns of high strengths, whereas couples with lower mental health, marital quality, and military satisfaction were more likely to exhibit patterns of low strengths. These results provide a snapshot of couples early in the military career cycle and highlight the need to adopt a family-centered perspective in military resilience programs and policies.

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Mental health of children of deployed and non-deployed US military service members: The Millennium Cohort Family Study Journal of Developmental & Behavioral Pediatrics 2018 Dec;39(9):683-692

Fairbank JA, Briggs EC, Lee RC, Corry NH, Pflieger JC, Gerrity ET, Amaya-Jackson LM, Stander VA, Murphy RA

Prior research has found that youth in military families were significantly more likely to report higher rates of major depression and use of illicit drugs in comparison to their non-military counterparts. The present study investigated the associations between service member deployment experiences and family demographic factors and children’s mental health and psychological functioning, utilizing data collected from 9,872 Service members/military spouses through both online and mail survey options. The results from the Family Study indicated that while most spouses did not report that their children had mental health, emotional, or behavioral difficulties regardless of parental deployment status, a significant minority of children whose parents had been combat deployed were more likely to have been diagnosed with ADD/ADHD and depression by a doctor or health professional in comparison to youth without a deployed parent. Children with a non-combat deployed service member parent were also more likely to have been assigned a diagnosis of depression in comparison to youth without a deployed parent.

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Influence of work and life stressors on marital quality among dual and non-dual military couples Journal of Family Issues 2020 Nov;41(11):2045-2064

Woodall KA, Richardson SM, Pflieger JC, Hawkins SA, Stander VA

Maintaining a healthy marriage may be challenging for military couples as they attempt to balance the demands of work and family; for dual-military couples, this can be even more challenging. Using data from the Millennium Cohort Family Study, we examined whether military stress experiences negatively impact marital quality through the mediation of work-family conflict. Spouse gender and dual-military status were included as moderators. Results demonstrated that more military stress experiences was related to lower marital quality, which was mediated by work-family conflict. Additionally, female dual spouses reported lower marital quality than male dual spouses and civilian spouses. Findings from this study highlight the importance of providing support to military spouses for stressful military events and potentially tailoring support services for female dual spouses to improve marital quality.

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The impact of military and nonmilitary experiences on marriage: Examining the military spouses' perspective Journal of Traumatic Stress 2018 Oct;31(5):719-729

Pflieger JC, LeardMann CA, McMaster HS, Donoho CJ, Riviere LA

This study examined the impact of military experiences and nonmilitary family stressors on the military spouse’s perception of marital quality. After adjusting for demographic, relationship, and military characteristics, results indicated that most military experiences did not have a direct association with low marital quality, with the exception of service member posttraumatic stress. Rather, nonmilitary experiences of the military spouse, including lack of social support, caregiver burden, work-family conflict, and financial strain, increased odds of low marital quality. These findings suggest that providing additional supports to address nonmilitary family stressors experienced by spouses may strengthen military marriages.

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Posttraumatic stress disorder symptom clusters in service members predict new-onset depression among military spouses Journal of Traumatic Stress Epub ahead of print

Walter KH, LeardMann CA, Carballo CE, McMaster HM, Donoho CJ, Stander VA

Among spouses of service members with probable posttraumatic stress disorder (PTSD), 14% met criteria for new-onset depression over a 3-year period. The service member’s PTSD symptom cluster of effortful avoidance was associated with an increased risk of new-onset depression in spouses, underscoring the impact of service member psychological symptoms on the spouse.

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A Model of Deployment Readiness among Military Spouses: The Role of Mental Health and Deployment-Related Personal Growth Military Behavioral Health 2020 Oct; 8(4): 378-395

Richardson SM, Pflieger JC, Woodall KA, Stander VA, Riviere LA

The purpose of the current investigation was to examine deployment-related risks, resources, and mediators contributing to military spouse perception of readiness for future service member deployments. Findings indicated that service member combat and injury negatively impacted spouse perception of deployment readiness through detriments to service member and spouse mental health. However, informal support and deployment communication were positively related to mental health for both partners, leading to improved spouse-perceived deployment readiness.

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The Role of Posttraumatic Stress Symptoms and Negative Affect in Predicting Substantiated Intimate Partner Violence Incidents Among Military Personnel Military Behavioral Health ePub ahead of print; 2021 Aug

Stander VA, Woodall KA, Richardson SM, Thomsen CJ, Milner JS, McCarroll JE, Riggs DS, Cozza SJ, for the Millennium Cohort Research Team.

Increasing rates of posttraumatic stress disorder (PTSD) in military populations may indicate heightened risk for aggression, including aggression among domestic partners. Using longitudinal data from the Millennium Cohort Study, we evaluated the association of PTSD symptom clusters and comorbid conditions as predictors of incidents of met criteria incidents of domestic abuse (physical and psychological) from DoD Family Advocacy Program (FAP) Central Registry data. Among 54,667 active-duty personnel who responded to the 2011 survey, FAP records documented 501 participants (1%) with incidents of emotional or physical met criteria incidents of aggression in the data collection period. Results showed that certain aspects of PTSD and behavioral health problems predicted incidents. In particular, general PTSD symptoms (e.g., anger/irritability, sleep disruption) and comorbid alcohol dependence were stronger predictors than trauma-specific PTSD symptomology (e.g., reexperiencing, hypervigilance). These results indicate that clinicians should consider the interpersonal consequences of PTSD and related behavioral problems.

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