SOLDIERS & THEIR CIVILIAN PARTNERS: TRAUMA, COPING & DISTRESS

Problem focused coping partially mediates the relationship between soldiers’ sub-clinical

trauma symptoms and psychological distress in their civilian partners

Much correlational research has reported on the relationship that exists between clinically

verified trauma symptoms in returning soldiers and self-reports of distress in their civilian partners.

Subclinical trauma, despite being much more prevalent in returning military personnel, however has

rarely been examined in relation to civilian partners’ psychological functioning; the role of mediating

variables has also been scarcely considered. This study aimed to fill this gap. A sample of (N=26)

soldiers that had returned from a tour of duty in the last three years completed questionnaires

assessing: (a) military variables (e.g., total tours of duty, exposure to active combat) and (b)

subclinical trauma symptoms. Soldiers’ civilian partners completed questionnaires assessing: (c)

problem focused (PF) and disengaged (DS) coping behaviours, and (d) psychological distress.

Civilian partners of returning soldiers experiencing greater subclinical trauma used fewer PF coping

behaviours, thus resulting in elevated distress scores. These findings provide a clearly definable target

for clinical intervention; by increasing the use of PF coping behaviours, civilian partners of trauma

affected military husbands might be relatively protected against psychological distress.

Key words: civilian partners, coping; psychological distress; soldiers; subclinical trauma

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SOLDIERS & THEIR CIVILIAN PARTNERS: TRAUMA, COPING & DISTRESS

Problem focused coping partially mediates the relationship between soldiers’ subclinical trauma

symptoms and psychological distress in their civilian partners

The psychological impact of military trauma on returning soldiers has been well documented.

Psychological maladjustment, as evidenced by higher levels of anxiety and depression, has been

widely observed in soldiers returning from conflict in Iraq and Afghanistan (Eisen, Schultz, Vogt,

Glickman, & Elwy, 2011; Hoge et al., 2004; Reijnen, Rademaker, Vermetten, & Geuzeet, 2015).

Risk for developing post-traumatic stress disorder (PTSD), a condition characterised by avoidance

(i.e., of family/friends), hyperarousal (which often manifests as anger/irritability) and re-experiencing

(e.g., flashbacks/nightmares), has also been shown to be high; 12-20% of soldiers returning from Iraq

or Afghanistan satisfied clinical criteria for PTSD diagnosis (Fink et al., 2016; Spivey, 2010).

Military related trauma, while exacting a considerable psychological toll on returning soldiers

(Bonde et al., 2016), has also been shown to affect psychological outcomes in their civilian partners.

A plethora of correlational research has reported on the positive relationship that exists between

clinically verified trauma symptoms in returning soldiers and psychological symptoms such as

anxiety, loneliness and depression in their civilian partners (Ahmadi, Azampoor-Afshar, Karami, &

Mokhtari,, 2011; Lev-Wiesel & Amir, 2001; Renshaw, Rodebaugh, & Rodrigues, 2010; Manguino-

Mire et al., 2007). That military related trauma is dyadically influential was also evidenced in a recent

meta-analysis, in which the association between returning soldiers’ PTSD scores and civilian partners’

reports of psychological distress fell within the moderate range (Lambert, Engh, Hasbun, & Holzer,

2012). Secondary traumatic stress (STS), described by Figley (1995) as ‘stress resulting from helping

or wanting to help a traumatised person’ (p.7), has also been shown to be problematic for military

partners. The predictive value of soldiers’ trauma symptoms for psychological adjustment difficulties,

particularly STS, in their civilian partners has been evidenced in research by Nelson-Goff, Crow,

Reisberg, & Hamilton (2009) and more recently, Bjornestead, Schweinle, & Elhai (2014). Most

recently, Weinberg, Besser, Ataria, & Neria (in press) also reported on the positive relationship that

exists between returning soldiers’ PTSD scores and their partners’ reports of STS.

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SOLDIERS & THEIR CIVILIAN PARTNERS: TRAUMA, COPING & DISTRESS

To date, much research involving military dyads has considered how clinically verified

trauma symptoms (i.e., PTSD) in returning soldiers’ might directly relate to distress outcomes in their

intimate partners. Far fewer studies however have considered possible indirect effects. Coping,

particularly problem focused (PF) and disengaged (DS) behaviours, seem to offer one plausible

pathway that links soldiers’ experience of military trauma with their partners reports of distress. PF

coping behaviours such as emotional expression and information seeking are intended to alter the

source of stress, while DS behaviours such as wishful thinking, avoidance and distraction are intended

to divert attention away from stressful experiences (Folkman & Lazarus, 1985). Research exploring

coping behaviours in relation to the psychological adjustment of military couples has been scarce.

Findings from recent qualitative studies suggest that military wives use a combination of both PF and

DS behaviours to cope with military related stressors such as deployment and reintegration (Cafferky

& Lin, 2015; Wheeler & Torres-Stone, 2010). In terms of frequency, findings have been

contradictory. Some studies have reported that civilian partners use more PF behaviours to cope with

stressors such as military deployment (Blank, Adams, Kittelson, Connors, & Padden, 2010; Dimeceli,

Steinhardt, & Smith, 2010); other studies have suggested the opposite, that civilian partners are more

likely to use DS behaviours to cope with military related stressors (Mamocha, 2012).

A plethora of studies involving non-military populations have demonstrated beneficial effects

of PF coping for psychological functioning, with the opposite typically found for DS behaviours

(Compas et al., 2014; Penley, Tomaka, & Wiebe, 2002; Lovell & Wetherell, 2015). In addition,

coping behaviours have been shown to be associated with the psychological reactions of soldiers’

civilian partners to a range of military stressors. For example, in response to deployment (Dimeceli et

al., 2010; Padden, Connors, & Agazio, 2011) and re-integration (Marini, Wadsworth, Christ, &

Franks, 2015), civilian partners who used more PF (and fewer DS) behaviours were found to report

better psychological adjustment.

To date, civilian partners’ use of PF and DS coping behaviours have been shown to be

independently related to both their own psychological health as well as trauma symptoms in their

military husbands. This study is, we believe, first to bring these variables together in a mediational

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SOLDIERS & THEIR CIVILIAN PARTNERS: TRAUMA, COPING & DISTRESS

model; it was hypothesised that PF and DS coping might partially mediate the effect of soldiers’ sub-

clinical trauma on psychological adjustment in their civilian partners.

METHODS

Participants & procedure

A sample of N=39 military dyads were sought via adverts posted on military support

pages/forums of social media sites. All participants were recruited according to strict criteria; for

soldiers, these included: (a) returned from a tour of duty in the last three years, (b) not experiencing

any long term medical problems (e.g., heart disease, diabetes, cancer) and (c), not having received a

clinical diagnosis with PTSD. To date, research exploring the psychological and familial impact of

military related stress has recruited almost exclusively on the basis on clinically verified levels of

trauma, i.e., PTSD. However, despite being much more prevalent (Korte, Gros, & Acierno, 2016),

few studies have examined the psychological impact of soldiers’ subclinical trauma on their civilian

partners (Monk & Nelson-Goff, 2014). To add to the paucity of work in this area, only soldiers

experiencing self-disclosed subclinical trauma (i.e., no clinical diagnosis with or being treated for

PTSD) were recruited. Civilian partners were recruited based on: (a) being the spouse/co-habiting

partner of a returning soldier, (b) not experiencing other long term stressors (e.g., familial caregiving,

bereavement) and (c), not managing long term medical problems. The study was approved by the

institutional ethics review board. Military dyads received no recompense for taking part.

Returning soldiers were asked to complete an online survey assessing: (a) military variables

(e.g., length of time served, deployment history, exposure to active combat) and (b) sub-clinical

trauma symptoms. Civilian partners completed an online survey assessing: (a) problem focused (PF)

and disengaged (DS) coping behaviours, and (b) psychological distress. In order that data could be

linked together, each military dyad was provided a unique code word to incorporate into survey

completion. Of the (N=39) couples who consented to take part, one or both members of N=9 dyads

failed to incorporate the code word into the survey, thus meaning data could not be linked together.

As such, data for these couples was removed, as was data for N=4 where survey data was available

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SOLDIERS & THEIR CIVILIAN PARTNERS: TRAUMA, COPING & DISTRESS

for one member of the dyad only. Statistical analysis therefore was conducted on a final sample of

N=26.

As has been the case in previous studies, although not excluded, no female soldiers consented

to take part (Nelson-Goff, Crow, Reisberg, & Hamilton, 2007). Most soldiers were aged 18-33 years

(88.5%), not married (61.5%), but had been cohabiting for more than one year (80.8%). Most soldiers

had served between 1-7 years in the military (80.8%), with the majority exposed to active combat at

some point (61.9%). Number of deployments ranged from 1-10 (mean = 2.3, SD = 2.1), with the

majority being to Iraq or Afghanistan (64.3%). ‘Private’ was the highest reported military rank (57%).

Measures

Potential confounds

Data were collected with respect to a range of military variables that might be related to

civilian partners’ psychological distress. These included: number of deployments, length of time

served, exposure to active combat and military rank (Ahmadi et al., 2011; Renshaw et al., 2010). Data

was also collected with respect to soldiers’ and partners’ age, and relationship duration.

Trauma symptoms

Trauma symptoms were assessed using the Trauma Symptoms Checklist (TSC-40), a 40 item

questionnaire that uses a five point Likert type scale (0, Never - 3, Often) to quantify trauma

symptomology over the previous two months (Briere, 1996). The TSC-40, though not a diagnostic

instrument, has been found to be strongly correlated with more clinically focused (e.g., PPTSD-R)

measures of trauma (Nelson-Goff et al., 2007). A total score can range from 0-120, with higher scores

reflecting greater subclinical trauma symptoms. The TSC-40 has shown good internal consistency (α

= .94) in other recent studies of a similar nature (Monk & Nelson-Goff, 2014); concurrent validity in

the current sample was also good (α = .96).

Coping behaviours

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SOLDIERS & THEIR CIVILIAN PARTNERS: TRAUMA, COPING & DISTRESS

Civilian partners completed the Coping Strategies Inventory Short-Form (CSI-S), a 32 item

questionnaire that incorporates a five point Likert type scale (0, not at all - 4, very often) to quantify

responses to stressful life events using two subscales: Disengaged Coping (e.g., ‘I hoped a miracle

would happen’) and Problem Focused Coping (e.g., ‘I worked on solving the problems in the

situation') (Tobin, 1989). Scores for each subscale range from 0-80, with higher scores reflecting

greater use of respective coping behaviours. As was the case in other recent studies (Lovell &

Wetherell, 2015), reliability for PF and DS subscales was good (all alphas > .84).

Psychological distress

The Hospital Anxiety and Depression Scale (HADS), a 14 item self-report measure

incorporating a four point Likert Type scale (0 = Never to 3 = Considerable), was used to assess

psychological distress (Zigmond & Snaith, 1983). Seven items reflect Anxiety (e.g., I feel tense or

wound up) and seven reflect Depression (e.g., I feel as if I am slowed down). Subscale scores range

from 0-21, with higher scores reflecting greater psychological distress. Data revealed anxiety and

depression scores to be highly correlated (r = .87, p < .001). As such, subscale scores were averaged

to create a composite for psychological distress. The HADS, which achieved good psychometrics (α =

.86) in other recent studies involving military dyads (Evans, Cowlishaw, Forbes, Parslow, & Lewis,

2010), showed good internal consistency in the current sample (α = .92).

Statistical analysis

First, bivariate correlations were used to examine whether civilian partners’ reports of

psychological distress might be related to military variables, coping behaviours and soldiers’ trauma

symptoms. The SPSS PROCESS macro (model 4) with bootstrapping (INDIRECT), as per Hayes

(2012), was used to assess direct and indirect relationships between soldiers’ trauma symptoms,

coping behaviours and reports of distress in civilian partners.

RESULTS

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SOLDIERS & THEIR CIVILIAN PARTNERS: TRAUMA, COPING & DISTRESS

Preliminary analysis

Civilian partners’ reports of psychological distress were unrelated to age (all ps > .26),

relationship duration (r = .14, p = .50), length of time served (r = .08, p = .69) and number of tours of

duty (r = .16, p = .48). No effect of military rank or exposure to active combat on psychological

distress was observed (all ps > .74). As such, none of these variables were taken forward for

subsequent analyses. PF (r = -.39, p = .05) and DS coping behaviours (r = .46, p = .02) were

associated with soldiers’ trauma symptoms, as were partners’ reports of distress (r = .52, p = <. 01).

PF behaviours were positively associated with psychological distress (r = -.66, p < .001); no

relationship emerged for DS coping (r = .24, p = .25). As such, DS coping was not taken forward for

mediation testing. Means (standard deviations) and range for trauma symptoms, coping and

psychological distress are presented in Table 1.

INSERT TABLE 1 HERE

Mediation

The total effect of soldiers’ trauma symptoms on partners’ psychological distress was

significant (β = .11, SE = .04, p = .006). The association between soldiers’ trauma symptoms and PF

coping was significant (β = -.33, SE = .16, p = .05), as was the relationship between PF coping and

partners’ distress scores after adjusting for soldiers’ trauma symptoms (β = -.14, SE = .04, p = .003).

Crucially, these data satisfy criteria for mediation as per Baron and Kenny (1986). Data indicated the

relationship between soldiers’ trauma symptoms and partners’ psychological distress occurred

indirectly via PF coping behaviours (CI95 = .01, .12). Moreover, after adjusting for PF coping, trauma

symptoms in returning soldiers no longer predicted partners’ psychological distress scores (β = .07,

SE = .03, p = .06), with a 40.3% reduction in the observed effect size. The regression model was

found to predict 51.3% of the variance in partners’ psychological distress (F (2, 23) = 12.1, p

= .0003).

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SOLDIERS & THEIR CIVILIAN PARTNERS: TRAUMA, COPING & DISTRESS

DISCUSSION

That soldiers’ experience of trauma is directly related to psychological adjustment difficulties

in their civilian partners has been widely evidenced (Ahmadi et al., 2011; Lambert et al., 2012).

Findings reported here however are more nuanced, with PF coping behaviours found to partially

mediate the impact of returning soldiers’ trauma symptoms on the psychological functioning of

civilian partners. That is, civilian partners of soldiers experiencing greater trauma were less likely to

use PF coping behaviours, thus resulting in increased psychological distress.

Findings are commensurate with studies in which psychological responses to other stressful

life events were also found to occur indirectly via coping. For example, like military wives caring for

trauma affected husbands, spousal dementia caregivers also experience the chronic stress associated

with caring for a loved one affected by illness (Lovell & Wetherell, 2011). In fact, researchers have

noted similarities between the groups in terms of psychological functioning; both groups display

elevated feelings of caregiving burden (Etters, Goodall, & Harrison, 2008; Maguino-Mire et al.,

2007). Behavioural symptoms of the care recipient were, via association with PF coping behaviours,

found to predict caregivers’ reports of distress (Mausbach et al., 2006). As revealed in qualitative

studies, civilian partners cope with military stressors such as deployment and reintegration with a

combination of PF and DS behaviours (Cafferky & Lin, 2015). Data reported here indicates that

civilian partners were less likely to use PF behaviours (and more likely to use DS behaviours) in the

context of soldiers’ experiences of trauma. This might not be altogether surprising. PF coping is less

likely to be used in response to stressors characterised by low controllability (Patterson et al., 1990),

and feeling loss of control and helplessness have emerged as prominent themes in qualitative studies

exploring the lived experiences of military wives (Cobley, 2015). In the current study therefore, it

might be that civilian partners appraised soldiers’ trauma symptoms to be outside their control, thus

making PF strategies less likely. That greater use of PF behaviours predicts better psychological

functioning has been observed in the context of several military related stressors (Kim, Keum, Kim,

Park, & Park, 2013; Marini et al., 2015).

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SOLDIERS & THEIR CIVILIAN PARTNERS: TRAUMA, COPING & DISTRESS

That PF coping might partially mediate the impact of soldiers’ trauma symptoms on the

psychological adjustment of their civilian partners provides a clearly definable target for intervention.

To date, positive psychological changes such as fewer trauma symptoms (in the soldier) and lower

levels of anxiety (in civilian partners) have been observed in military dyads who participated in a

conjoint CBT intervention (Devilly, 2002; Monson, Schnurr, Stevens, & Guthrie, 2004).

Psychotherapeutic initiatives such as CBT might, by reducing soldiers’ trauma symptoms, be effective

for increasing civilian partners’ PF coping behaviours, and this might provide one mechanism that

underpins partners’ positive psychological adjustments. This might provide a basis for future research.

Findings reported here must be considered in the context of study limitations. First, the cross

sectional design of the study is not well suited for testing mediation effects; moreover, this also

precludes drawing causal inferences. Second, the small size of the sample requires that findings be

considered preliminary and interpreted with caution. Post-hoc power analysis indicated N=77 would

be required to provide adequate power (80%; a = 0.05) to detect a moderate effect size (f2 = 0.15).

The sample size here was N=26. However, despite being underpowered, relationships between

soldiers’ trauma symptoms and civilian partners’ coping, and reports of psychological distress were

significant, as were tests of mediation. Third, the study recruited on the basis of subclinical trauma; as

such, findings should not be generalised to civilian partners of soldiers with clinically verified levels

of trauma (i.e., PTSD). Finally, we failed to capture data on number of potential confounds; most

notable among these was time that had elapsed between soldiers’ return from deployment and data

collection. It might be argued that civilian partners’ psychological adjustment to soldiers’ experience

of trauma changes as a function of this variable, and this data should have been collected here.

In conclusion, PF coping behaviours partially mediated the effect of trauma symptoms in

returning soldiers’ on reports of psychological distress in their civilian partners. These findings, which

expand those demonstrating direct relationships between military stressors and the well-being of

civilian partners’, might inform relevant, evidence based interventions for improving quality of life in

returning soldiers and their families.

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