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Division of Neuropsychiatry and U.S. Army Medical Research Unit-Europe; Walter Reed Army Institute of Research; U.S. Army Medical Research and Materiel Command

The Military Family Living in Europe with a High OPTEMPO

Environment: Report I

Walter Reed Army Institute of ResearchWashington, DC

2Division of Neuropsychiatry and U.S. Army Medical Research Unit-Europe; Walter Reed Army Institute of Research; U.S. Army Medical Research and Materiel Command

Outline• Summary of key findings• Introduction

– Study Objectives– OPTEMPO Family Research Model

• Study Design• Demographics• Measures

– Personal Characteristics (e.g., Health and Well-being)– Family Characteristics (e.g., Children)– Impact of Army Life (e.g., Geographic Mobility)

• Results– Geographic Mobility– Living Overseas– Fear of Soldier Injury or Death– Deployments – Separations

• Discussion Points


Summary of Key Findings (1 of 3)

• Findings are based on surveys (n= 78) and interviews (n= 50) with U.S. Army spouses living in Europe.

• The findings indicate that spouses are generally in good health.• The focus of this brief is on the four unique demands of Army life described by

Segal in 1988. These include: geographic mobility, residence in a foreign country, fear of soldier injury or death, and deployments and separations.

Geographic Mobility• On average, the spouses reported living in Europe for 21 months.• Sixty-four percent of spouses reported that the sponsorship program in Europe

does not function well.• Spouses who moved more reported better health, greater satisfaction with the

Army, and wanted their soldier to remain in the Army. However, most spouses reported moving only two or fewer times.

• Those spouses who had a better perception of moving had better physical and psychological health and greater satisfaction with the Army.

• Having a worse perception of moving was associated with the spouses being more likely to want the soldier to leave the Army than to remain.



Residence in a Foreign Country (Living Overseas)• Most spouses liked living in Europe but many reported that they were

anxious to go back to the States.• Spouses with a better perception of living in Europe had better

psychological health and greater satisfaction with the Army.Fear of Soldier Injury or Death• While eighty-four percent of spouses felt that their soldier was well

trained to handle the dangers of deployment, seventy-eight percent worried about their soldier being injured on a deployment and fifty-six percent worried about their soldier being killed.

• Increased fears regarding injury and death were associated with poorer health, less satisfaction with the Army and wanting the soldier to leave the Army.

• Despite these fears, the majority were not prepared in terms of having wills or powers of attorney.



Deployments

• Those spouses who were better able to handle deployments had less depression, better well-being, and greater satisfaction with the Army.

• However, the spouses’ ability to handle deployments was not related to their retention preferences.

Separations

• Spouses who felt less independence and more negative emotions during and following separations reported more psychological and physical symptoms as well as less satisfaction with the Army.

• Spouses who felt less independence were more likely to want their soldier to leave the Army than to remain. However, emotions were not significantly related to retention preference.


• Determine how OPTEMPO impacts the health and well-being of the family as well as soldier retention and readiness.

• Determine the social and psychological factors that promote family health and well-being when living outside the United States in a high OPTEMPO environment.

• Standardize and validate unique assessment tools that measure family health and well-being, to include the following scales:

Soldier Commitment MovingLiving in Europe Quality of Life in EuropeDeployments SeparationsFear of Injury or Death Army Support

Study Objectives


OPTEMPO Family Research Model

Predictors Moderators/Mediators

Outcomes

Demographics

Geographic Mobility

Residence in a Foreign Country

Fear of Soldier Injury/Death

Deployments/Separations

Employment Status

Social Support

Soldier Commitment to Family

Work/Family and Family/Work Conflict

Health and Well-being

Satisfaction with Army

Spouses’ Retention Preference


• Sample - Spouses from the 10 companies (4 Division, 2 Corps, 4 Echelon above Corps) in the USAMRU-E USAREUR OPTEMPO soldier study.

• Study Design

Year 1:

– Pre-tested the survey

– Administered the survey

– Interviewed persons across enlisted, non-commissioned officer, and officer ranks from the following categories: 1) civilian spouses, 2) military spouses, 3) spouses with Exceptional Family Member Program, and 4) single parents.

Year 2:– Survey spouses who participated in year 1 as well as spousesnewly arrived in-country– Interview spouses interviewed in year 1 as well as spouses newly arrived in-country

Research Design


Location of Families The 10 units in this study are located throughout USAREUR.

B / 5-7 ADA Hanau C / 1-4 CAV

Schweinfurt

C / 201st FSB

Vilseck

B / 6-6 AVN Illesheim

Heidelberg

512th Maint Co

51st Maint BnMannheim

HQ, 1st TMCAKaiserslautern

C / 2-6 INFBaumholder

D / 501 MIDexheim

13th MP, 22nd ASGA / 1-508th ABCT

Vicenza

Stuttgart


Survey Sample

January 2001- 361 surveys sent out to spouses in 10 companies - 57 surveys undelivered, incomplete _____

304 surveys delivered 78 surveys completed (26% response rate)

Interview Sample: Analysis in Progress

April-June 2001- 50 interviews conducted12 EFMP

6 Single Parents 7 Dual Military

25 Civilian Spouses

Sample: Survey and Interviews


Demographics

• On average, spouses in this sample were older and more educated than the

Army average.

Gender: Female 97% (n= 76) Average age: 29 years Male- 3% (n= 2) Average number of years married: 6 (n= 78)

Ethnicity/race: White-76% (n= 56)Hispanic-10% (n= 7)

African-American 8%(n= 6)Asian-5% (n= 4)Other 1% (n= 1)

Education: 5% less than high school (n= 4) 16% GED or high school graduate (n= 12) 68% college or technical training or college graduate (n= 51) 11% graduate training or graduate degree (n= 8)

Military Brat: 20% (n= 15) Percent with children: 72% (n = 56)


Personal Characteristics

Employment

Social Support

Health-related Behaviors

Psychological Health and Well-being*

Physical Health Symptoms*

Family Characteristics

Marital Satisfaction

ChildrenFinancesSoldier Commitment to Family

Work/family;Family/work conflict

Categories of Survey Measures

Characteristics of Army Life

Geographic Mobility*

Residence in a Foreign Country*

Separations/deployments*

Risk of injury/death of Soldier*

Spouse Satisfaction with the Army*

Retention Preferences*

*Indicates measures that will be the focus of the presentation


Well-being and Depression

General Health Questionnaire Sample Scale Items

•Been able to concentrate•Been able to enjoy your day to day activities•Been able to face up to your problems•Felt that you are playing a useful part in things• Felt capable of making decisions

•Scale: 1(not at all)-4(much more than usual)•Mean= 32.2;Median=32.5 •Score range: 12-48 (high is good)

Centers for Epidemiological Studies Depression Scale Sample Scale Items

•Had trouble getting to or staying asleep•Felt sad•Felt lonely•Felt you couldn’t get going•Felt everything was an effort

•Scale: 0-7 days•Mean= 10.8; Median= 8.0 •Score range: 0-49 (low is good)

• Spouses did not experiencea great deal of depression.

• Spouses were in general good health.


Psychological and Physical Health

Brief Symptom Inventory 18 Sample Scale Items

• Feeling tense or keyed up• Feeling lonely• Feeling blue• Feeling no interest in things• Nervousness or shakiness

• Scale: 1= (none)-5 (extreme)

• Mean= 27.4; Median= 25.0

• Score range: 18-90 (low is good)

• Spouses reported minimal general distress.

• Spouses reported few physical symptoms.

Physical Symptom ChecklistSample Scale Items

•Headaches•Back problems•Weight loss/gain•Cough•Muscle aches or cramps

•Scale 1-5 where 1 = no symptoms experienced at all during the past month and 5 = symptoms that were experienced very often•Mean = 41.3; Median = 39.5•Score range: 22-110 (low is good)


Satisfaction with the Army

• Most spouses reported that they would be satisfied if their soldier made the Army a career.• However, most spouses were not satisfied with the respect and concern that the Army shows for them.

31

35

38

43

57

0 20 40 60

Percent Satisfied/Very Satisfied

How would you feel if your spouse were to make the Army a career

The kind of family life you can have in the Army

The respect the Army shows spouses

The concern your spouse’s unit has for families

The Army as a way of life


Retention Preference

16%

8%

15%

5%

36%

20%

• Almost two-thirds (61%) of spouses want their soldiers to remain in the Army at least beyond their present obligation.• Only 24% of spouses wanted their soldier to leave the Army.

Definitely leave upon Current obligation

Probably leave uponCurrent obligation

Undecided

Definitely stay in until retirement

Probably stay in until retirement

Definitely stay in beyondpresent obligation, but not necessarilyuntil retirement


Geographic Mobility

25 27

10

38

0

10

20

30

40

50

1 year orless

2 years orless

3 years orless

More than3 years

Per

cen

t• On average spouses have lived in Europe for 21 months which approximates the average length of time spouses have lived in one place (22 months).

• Spouses have moved an average of three times since their soldier has been in the Army, and the average number of moves to overseas locations has been two times.

• Graph indicates the percent of spouses who have lived in one location per number of years.


Geographic Mobility

11

22

31

34

43

49

59

0 20 40 60

Percent Agree/Strongly Agree

Moving has made it difficult to find a good job

One of the benefits of being a military spouse is getting to move

Moving is difficult on our children

Our arrival in Europe was a pleasant experience

We move more frequently than I would like

Moving has had a positive impact on my family

The sponsorship program in Europe functions well

• The majority of spouses did not feel like their move to Europe was a positive experience and cite general difficulties with the moving process.• Although moving is viewed as a benefit to being in the military, almost one third report they move more than they prefer to.


Number of Moves: Health and Army Satisfaction

8

14

25

29

16

13

0

5

10

15

20

25

30

35

Low Number ofMoves (1-2)

High Number ofMoves (3 or more)

Depression

Psychological Well-Being

Army Satisfaction

Mea

n S

core

s• In general, spouses with three or more moves reported higher psychological well-being, higher satisfaction with the Army and fewer depression symptoms (Median splits: (t’s >2.08 , df < 76, p’s <.05).

• However, spouses with three or more moves were more likely to be older and their spouse to have been in the Army longer.


Number of Moves: Retention

45

78

34

14

21

8

0

10

20

30

40

50

60

70

80

90

Low Number of Moves (0-2) High Number of Moves ( 3 ormore)

Stay

Leave

Undecided

Per

cen

t

• Overall, spouses with more moves were more likely to want their soldier to remain in the Army than those with fewer moves. (X2 = (2, n=

75)=8.95, p = .01). However, those with more moves will generally have been in service longer.


Geographic Mobility: Health and Army Satisfaction

7

14

24

30

38

44

17

13

0

5

10

15

20

25

30

35

40

45

50

Negative perception of moving(17-37)

Positive perception of moving(38-59)

Depression


Physical Symptoms

Army Satisfaction

Mea

n S

core

s

• Spouses perceptions towards moving is related to their health and Army satisfaction.• Spouses with positive perceptions of moving reported less depression symptoms, better psychological well-being, fewer physical health symptoms and higher Army satisfaction Median splits: (t’s >2.48 , df < 76, p’s < .02 ).


Geographic Mobility: Retention

48

77

32

14

20

9

0

10

20

30

40

50

60

70

80

90

Negative perception ofmoving (17-37)

Positive perception of moving(38-59)

Stay

Leave

Undecided

Per

cen

t• Spouses perception of moving was related to their attitudes toward their soldier remaining in the military.• Spouses with positive perceptions of moving were more likely to want their soldier to remain in the Army than those with negative perceptions of the Army. (X2 = (2, n= 75)=6.92, p = .03)


Living Overseas

26

34

42

45

68

83

62

0 20 40 60 80 100

Percent Agree/StronglyAgree

Feel isolated since living here

Feel comfortable using language

People in country are friendly to soldiers and families

Hardly wait to get back to states

Being away from friends and relatives is hard for me

I like living in Europe

I like shopping on the economy

• A high majority of spouses liked living in Europe; however, they missed friends and relatives and were anxious to get back to the states.


Living Overseas: Health and Army Satisfaction

8

14

24

30

37

45

1613

0

5

10

15

20

25

30

35

40

45

50

Negative perception of overseasliving (14-36)

Positive perception of overseasliving (37-50)

Depression

PsychologicalWell-Being

PhysicalSymptoms

Army Satisfaction

Mea

n S

core

s

• Spouses with positive perceptions of living overseas reported fewer depression symptoms, fewer psychological and physical health symptoms, and were more satisfied with the Army (Median splits: (t’s >2.38 ,

df <75, p’s <.02 ).


Living Overseas: Retention

56

70

32

121218

0

10

20

30

40

50

60

70

80

Negative perception ofoverseas living (14-36)

Positive perception ofoverseas living (37-50)

Stay

Leave

Undecided

Per

cen

t• Spouses with positive perceptions of living overseas were no more likely to want their soldier to remain in the Army than those with negative perceptions of living overseas. (X2 = (2, n= 74)=4.04, p = .13)


Fear of Soldier Injury or Death

• Although the majority of spouses felt that their soldiers were well trained to handle the dangers of deployment, many still feared that their soldier might be injured or killed on a deployment. • Less than half of the spouses had confidence that the leadership would take care of their soldier’s safety while on deployment.

48

53

56

61

78

84

0 20 40 60 80 100


I worry about my spouse being killed on a deployment

I worry about my spouse being injured while on deployment

I feel that my spouse is well trained to handle the dangers of deployment

I’m confident the leadership will take care of my spouse’s safety while on deployment

There is a strong possibility that my spouse will be in combat during a deployment

Given my spouse’s job, there is a higher risk for injury or death


Fear of Soldier Injury/Death: Health and Army Satisfaction

15

7

31

25

47

38

12

16

0

5

10

15

20

25

30

35

40

45

50

Low fear (14-26) High fear (27-36)

Depression


Physical Symptoms

Army Satisfaction

Mea

n S

core

s

• Spouses with higher fear levels were more depressed, had more psychiatric symptoms, had more physical symptoms and were less satisfied with the Army (Median splits:(t’s >3.23 , df <69, p’s < .002).


Fear of Soldier Injury/Death: Retention

77

45

1520

8

35

0

10

20

30

40

50

60

70

80

90

Low fear (14-26) High fear (27-36)

Stay

Leave

Undecided

Per

cen

t

• Spouses with lower fear levels were more likely to want their soldier to remain in the Army than those with higher fear levels (X2 =(2, n=68)= 7.41, p= .025).


Fear of Soldier Injury or Death Readiness

• Most spouses and soldiers did not have the legal documents needed in case of injury or death.• Only 40% of spouses reported that they have a general power of attorney. • However, approximately two-thirds (64%) of the spouses reported that their soldier had a will.

Both my spouse and I

have (%)

I have (%) My spouse

has (%)

Neither my spouse nor

I have (%)

General Power of Attorney 19 21 46 14

Medical Power of Attorney 12 4 4 80

Will 30 2 34 34

Living Will

(Advanced Directive)

14 4 4 78


Training and Deployments

32

6

62

0

10

20

30

40

50

60

70

3 months or less 4-6 months More than 6 months

• On average, spouses reported that in the last year their soldier had been gone for almost 3 months for either training or on deployment.• Although 63% of spouses agreed that they received sufficient notice when their soldier was going on a training or field exercise only 42% agreed that they received sufficient notice when the soldier was leaving for a deployment and even fewer (31%) reported that they knew when the soldier would return from a deployment or training.

Per

cen

t

• Graph indicates the percent of soldiers who have gone for training or field exercises in the last year by months.


Deployments

26

37

38

63

70

74

0 20 40 60 80


I want my spouse to get out of the Army because there are too many deployments

The frequency of deployments is too intense

The number of deployments has put a strain on our family

The deployments are too long

• Spouses feel that the separations from their soldier are stressful on the family, particularly the children. • Spouses also report that deployments are too long, over a quarter (26%) report that this is a reason for them to leave the military.

The separations from my spouse are stressful

I worry about the effects of my spouse’s deploying on our children


Deployments: Health and Army Satisfaction

6

17

33

29

17

13

0

5

10

15

20

25

30

35

40

Negative perception (8-20)

Positive perception (21-35)

• Spouses with positive perceptions of deployments and who reported more positive impacts of the deployments reported fewer depression symptoms, had higher psychological well-being and were more satisfied with the Army (Median splits; (t’s > 2.42, df <42, p’s < .02).

*Note: Higher scores on the Well-being scale mean better well-being.

5

13

34

30

18

14

0

5

10

15

20

25

30

35

40

Negative impact (4-11) Positive impact (12-16)

Depression

General Well-beingArmy Satisfaction

Mea

n S

core

s


Deployments: Retention

12

0

18

6

70

94

59

90

23

5

18

5

0

10

20

30

40

50

60

70

80

90

100

Negativeperception (8-20)

Positiveperception (21-35)

Negative Impact(4-11)

Positive Impact(12-16)

Stay

Leave

Undecided

Per

cen

t• Spouses who had positive perceptions of deployments and felt less impact were no more likely to want their soldier to stay in the Army compared to those spouses who reported negative perceptions and negative impacts (X2’s =(2, n<43) < 5.57, p < .17).


Separations

15

31

44

73

79

89

0 20 40 60 80 100


During the separation, I felt lonely

There were greater feelings of closeness when my spouse returned

During the separation, I became more independent

During the separation, I realized how much I depended on my spouse

Upon his/her return I participated more in decision making

During the separation there was suspicion and mistrust between my spouse and me

• Although many spouses felt lonely during separations due to training exercises and military deployments, many became more independent and experienced greater closeness after the separations.


Separations: Health and Army Satisfaction

7

14

2629

4144

18

11

05

10

1520253035

404550

High independenceproblems (12-17)

Low independenceproblems (4-11)

Mea

n Sc

ores

• Overall, spouses with fewer independence problems and higher positive emotions regarding military separations due to training and deployments reported fewer psychological and physical health symptoms and higher satisfaction with the Army (Median splits;(t’s > 2.02, df <

63, p’s < .05).

129

3126

4541

13 15

05

10

1520253035

404550

Negative Emotions(9-17)

Positive Emotions(4-8)

Depression

Psychological Well-BeingPhysical Symptoms

Army Satisfaction


Separations: Retention

6862

21

11

45

79

18

38

6

201715

0

10

20

30

40

50

60

70

80

90

HighIndependence

Problems (12-17)

Low IndependenceProblems (4-11)

NegativeEmotions (9-17)

Positive Emotions(4-8)

Stay

Leave

Undecided

Per

cen

t

• Those spouses who felt more independence due to separations were more likely to want their soldier to stay in the Army than those who felt less independence. (X2 = (2, n= 63)=10.80, p = .005).

• Spouses with negative emotions were not significantly different from those with positive emotions with regard to retention preference.


Discussion

The findings presented here show that:• The unique constellation of military family life style variables, moving,

living overseas, military separations, and fears regarding soldier harm, are significantly associated with the spouses’ health, satisfaction with the military, and their desire for their soldiers to remain in the military.

Future research will:• Link spouse data to soldier data from the USAREUR OPTEMPO study

to assess the role of the spouse in maintaining soldier readiness. • Determine if family types (dual military, EFMP, single parents, or

civilian spouse) differ in their influence on readiness.• Assess the impact of spouse employment on family readiness. • Include National Guard and Reserve family members.• Seek to increase the sample size.End State:• Provide scientifically validated recommendations to the Army for

improving family readiness in both CONUS and OCONUS environments for both active duty and reserves.


Points of Contact

Doris Briley Durand, Ph.D.WRAIRWashington, DC 20307-5100

Phone: DSN 285-9148 Commercial (301)319-9148Fax: DSN 285-9484 Commercial (301) 319-9484Email: [email protected]

LTC Carl A. Castro, Ph.D.WRAIRWashington, DC 20307-5100

Phone: DSN 285-9174 Commercial (301) 319-9174Fax: DSN: 285-9484 Commercial (301) 319-9484Email: [email protected]

Authors of Report: CPT Lolita Burrell, LTC Carl Castro and Dr. Doris Durand

USAMRUE-Staff: Ms. Valerie Frey and Dr. Kathleen Wright

WRAIR Staff: Dr. Gary Adams and Ms. Wanda Cook