Spouses and Children of U.S. Military Personnel: Substance Use and Mental Health Profile from the 2015 National Survey on Drug Use and Health

Introduction

The families of military personnel are a resilient group of men, women, and children who endure many hardships for their country.¹ Hardships experienced by military families may include adjusting to extended periods of separation from their military family member, facing the uncertainty of when the next separation may occur and how long it will last, and coping with the risk of serious injury to or death of the spouse or parent who is serving in the military.² These and other military-related hardships typically do not occur in the same combination or frequency for civilian occupations. Although there are many positive aspects to being part of a military family, the hardships may affect the well-being of military family members, such as by elevating their risk for substance use or mental health issues.

In 2013, the U.S. military included about 1.4 million individuals who were on active military duty and about 1.1 million who were in the National Guard or a Reserve component.³ There were about 3.0 million U.S. military family members in 2013 (i.e., spouses, children, and adult dependents), including about 1.1 million spouses and 1.9 million children of military personnel.^4,5 Given the hardships that military families can experience, the Substance Abuse and Mental Health Services Administration's (SAMHSA's) mission includes supporting military families by identifying the factors that affect their health and well-being. However, there is a lack of nationally representative data on substance use and mental health issues in military families. Consequently, it is difficult to assess the extent of substance use and mental health issues in military families.

As part of a strategic initiative to support the well-being of military families, SAMHSA sought to respond to this gap in the availability of nationally representative data on substance use and mental health issues among military families. SAMHSA sponsors the National Survey on Drug Use and Health (NSDUH), which is the primary source for statistical information on illicit drug use, alcohol use, substance use disorders (SUDs), and mental health issues for the civilian, noninstitutionalized population of the United States. Starting in 2015, NSDUH included questions to identify military family members.⁶

Identifying Military Families in a National Household Survey

Two sets of questions were added to the 2015 NSDUH to identify whether respondents had immediate family members who were currently serving in the U.S. military (i.e., individuals serving in one of the branches of the U.S. Armed Forces, in a Reserve component, or in the National Guard) (Table 1). First, all 2015 NSDUH respondents were asked whether anyone in their immediate family was currently serving in the U.S. military, regardless of where those family members were currently living. Second, respondents who reported that one or more immediate family members were currently serving in the U.S. military identified their relationships to the family members who were serving (see Table 1).⁷ Adult respondents who were currently married and who selected "My spouse" from the list of family relationships were defined as military spouses for this report. For the purpose of this report, respondents who selected "Unmarried partner" were not categorized as a military spouse. Respondents aged 12 to 17 who selected "My mother" or "My father" met the criteria for being defined as military children for this report.⁸

For several reasons, this may be a difficult pair of questions for many people to answer. For example, respondents were asked to consider family members who were living elsewhere as well as family members who were currently living in the same household. Family members can live elsewhere for many reasons, such as work, marital separation, and blended families. Military families have additional reasons for family members living somewhere other than the same household, such as deployments, geographically remote assignments, and extended training periods. Thus, it may be challenging for respondents to think about all immediate family members who are not living in the same household, particularly when they also are asked to consider their family members' military status. Respondents with immediate family members who are not living with them may not know whether these family members are currently serving in the military. For example, respondents may not maintain frequent contact with family members who are living somewhere else.

Deciding what constitutes current military service could also be a source of confusion. Respondents had the option to see a definition of military service; however, not all respondents may have accessed this definition or understood who was included as "currently serving" in the U.S. military. Furthermore, it may be especially difficult for adolescent respondents to know whether family members who are living somewhere else are currently serving in the National Guard or in a Reserve component.

Although the military family questions were tested prior to inclusion in the 2015 NSDUH, approximately 9 percent of respondents had missing data for these items, which is high when compared with percentages of respondents with missing data for other NSDUH questions.⁹ Nonresponse to these items can influence the representativeness of the data and the types of analyses that are feasible. The combination of higher-than-expected nonresponse and low percentages of people in the general population who are military spouses or military children has limited the number of estimates of substance use and mental health from the 2015 NSDUH that can be presented in this report with confidence. Once additional years of data are available, further analyses and the generation of additional estimates will be feasible.

Survey Background

NSDUH is an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older.¹⁰ The survey covers residents of households and individuals in noninstitutional group quarters (e.g., shelters, boarding houses, college dormitories, migratory workers' camps, halfway houses). The survey excludes people with no fixed address (e.g., homeless people not in shelters), military personnel on active duty, and residents of institutional group quarters, such as jails, nursing homes, mental institutions, and long-term care hospitals.

NSDUH employs a stratified multistage area probability sample that is designed to be representative of both the nation as a whole and for each of the 50 states and the District of Columbia. The 2015 NSDUH annual target sample size of 67,500 interviews was distributed across three age groups, with 25 percent allocated to adolescents aged 12 to 17, 25 percent allocated to young adults aged 18 to 25, and 50 percent allocated to adults aged 26 or older. From 2002 through 2013, the NSDUH sample was allocated equally across these three age groups. Although military personnel on active duty were not eligible for the survey, military installations were included in the NSDUH sample because civilians living on military bases, such as spouses and children of military personnel, were eligible to be interviewed.

NSDUH is a face-to-face household interview survey that is conducted in two phases: the screening phase and the interview phase. The interviewer conducts a screening of the eligible household with an adult resident (aged 18 or older) in order to determine whether zero, one, or two residents aged 12 or older should be selected for the interview.¹¹ NSDUH collects data using audio computer-assisted self interviewing (ACASI) in which respondents read or listen to the questions on headphones, then enter their answers directly into a NSDUH laptop computer. ACASI is designed for accurate reporting of information by providing respondents with a highly private and confidential mode for responding to questions about illicit drug use, mental health, and other sensitive behaviors. NSDUH also uses computer-assisted personal interviewing (CAPI) in which interviewers read less sensitive questions to respondents and enter the respondents' answers into a NSDUH laptop computer.

In 2015, screening was completed at 132,210 addresses, and 68,073 completed interviews were obtained, including 16,955 interviews from adolescents aged 12 to 17 and 51,118 interviews from adults aged 18 or older. Weighted response rates for household screening and for interviewing were 79.7 and 69.3 percent, respectively, for an overall response rate of 55.2 percent for people aged 12 or older. The weighted interview response rates were 77.7 percent for adolescents and 68.4 percent for adults.¹² Further details about the 2015 NSDUH design and methods can be found on the web at https://www.samhsa.gov/data/.¹³

Data Presentation and Interpretation

This report contains the first release of NSDUH estimates on substance use and mental health issues for wives aged 18 to 49 and children aged 12 to 17 of U.S. military personnel. As noted previously, spouses of military personnel were defined for this report as civilian adults aged 18 or older who were married to a person currently serving in the U.S. military. There were approximately 300 completed interviews in the 2015 NSDUH from female respondents who self-identified as civilian spouses of military personnel (also referred to in this report as "military wives") and who were between the ages of 18 and 49. Analysis of data for male spouses of military personnel or for female spouses aged 50 or older requires a larger pool of respondents for adequate statistical precision.

As noted previously, military children were defined for this report as youths aged 12 to 17 with a parent who is currently serving in the U.S. military. There were approximately 400 completed interviews from adolescent respondents aged 12 to 17 who self-identified as children of military personnel. Estimates for children of military personnel focus on youths aged 12 to 17 because NSDUH does not collect information from youths under the age of 12. Although adult respondents aged 18 or older could report that a parent was currently serving in the military, they were not included in the analyses for this report.

All estimates (e.g., percentages and numbers) presented in the report are derived from NSDUH survey data that are subject to sampling errors. The estimates presented in this report have met the criteria for statistical precision. Estimates that do not meet these criteria are not shown.¹⁴ For military wives aged 18 to 49, substance use and mental health estimates are compared with estimates for the overall population of married women aged 18 to 49. For military children, substance use and mental health estimates are compared with estimates for the overall population of youths aged 12 to 17.^15,16

Statistical tests also have been conducted for comparisons that appear in the text of the report. Statistically significant differences are described using terms such as "higher" or "lower." Estimates are described as "similar" when a difference is not statistically significant. Because relatively small numbers of respondents reported that they were military spouses or military children, the corresponding estimates based on these respondents are considerably less precise than most other NSDUH estimates, and statistical tests are less powerful.

Graphics and tables contain estimates that support the statements in this report. Appendix A and Appendix B contain supplementary tables of estimated percentages and their standard errors for military spouses and for military children, respectively. Graphics in this report present 95 percent confidence intervals along with each estimate.

Demographic Characteristics of Spouses and Children of Military Personnel

One of SAMHSA's responsibilities when new questions are added to NSDUH is to evaluate the quality and utility of these items. In order to assess the quality and representativeness of the data for military family members, NSDUH population estimates for military families in 2015 were compared with Department of Defense (DoD) personnel records. The DoD personnel records included family records for members of the military serving on active duty, in the National Guard, or in a Reserve component.¹⁷

DoD data for military spouses include all spouses aged 18 and older. NSDUH estimates for military spouses are very similar to totals available from the DoD records. According to the 2013 DoD personnel records, there were about 1.0 million civilian spouses of military personnel.¹⁸ In 2015, NSDUH estimated that 1.4 million civilians had a spouse in the military, including 1.1 million women and 242,000 men (which, following NSDUH conventions, rounded to a total of 1.4 million). Focusing on military spouses aged 18 to 49, NSDUH estimated that there were slightly less than 1.1 million civilians aged 18 to 49 with a spouse in the military in 2015, including 910,000 women and 147,000 men who were military spouses.

According to the 2015 NSDUH, there were an estimated 524,000 military children aged 12 to 17. The 2013 DoD personnel records indicated that there were 1.9 million military children in 2013, ranging from infants to the age of 22, including 466,000 children aged 12 to 18. Thus, the NSDUH estimates reasonably approximate the number of military children aged 12 to 17 based on the DoD records.

Military Spouse Demographics

Key demographic characteristics of military spouses aged 18 to 49 based on the 2015 NSDUH are presented in Table 2. As noted previously, estimates from NSDUH indicate that 147,000 military spouses aged 18 to 49 in 2015 were male (13.9 percent of military spouses in this age group), and 910,000 (86.1 percent) were female.

The age distribution of military wives aged 18 to 49 differs from the distribution for all married women aged 18 to 49. For example, 17.8 percent of military spouses were young adults aged 18 to 25 compared with 7.1 percent of all married women. Additional demographic characteristics of military spouses aged 18 to 49 are shown in Table A.1B in Appendix A. Military wives aged 18 to 49 were less likely than all married women aged 18 to 49 to be Hispanic or Latino (11.3 vs. 19.5 percent) or to have less than a high school education (2.3 vs. 10.5 percent). Military wives aged 18 to 49 were less likely to be employed full time (40.4 percent) and more likely to be in the "other" employment category (37.7 percent)¹⁹ compared with all married women aged 18 to 49 (52.6 percent employed full time and 27.5 percent in the "other" category).

Military Child Demographics

In 2015, an estimated 524,000 youths aged 12 to 17 were children of military personnel. The demographic characteristics of military children aged 12 to 17 based on NSDUH data are presented in Table 3. The age distribution of military children aged 12 to 17 did not differ statistically from all adolescents aged 12 to 17. The racial and ethnic characteristics of military children aged 12 to 17 generally were similar to those for all youths aged 12 to 17 (Table B.1B in Appendix B), except that military children were less likely than all youths aged 12 to 17 to be Hispanic or Latino (14.3 vs. 23.1 percent).²⁰ Other differences may not be apparent due to the small sample size of military children in 2015; additional years of NSDUH data will be helpful in determining if there are other differences.

The remainder of this report presents substance use and mental health estimates for military wives aged 18 to 49 and for military children aged 12 to 17. Estimates for military wives are compared with estimates for all married women aged 18 to 49. Estimates for military children are compared with estimates for all youths aged 12 to 17. Because of differences in the demographic composition of the population of military wives and the population of all married women, statistical comparisons between these populations should be interpreted with caution. For example, military wives were more likely than all married women aged 18 to 49 to be young adults aged 18 to 25, and young adults historically have been more likely than people in other age groups to have substance use and mental health issues.^21,22,23 Thus, any estimates of substance use or mental health issues that are higher among military wives than among all married women aged 18 to 49 could be attributable to the disproportionate representation of young adults among military wives.

Illicit Drug Use

NSDUH obtains information on 10 categories of illicit drugs: marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, and methamphetamine, as well as the misuse of prescription pain relievers, tranquilizers, stimulants, and sedatives. In NSDUH, misuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one's own; use in greater amounts, more often, or longer than told to take a drug; or use in any other way not directed by a doctor. Estimates of "illicit drug use" reported from NSDUH reflect the data from these 10 drug categories. NSDUH produces estimates of lifetime, past year, and past month illicit drug use. This section focuses on the use of illicit drugs in the past year (i.e., within the 12 months prior to the interview date).

Illicit Drug Use among Military Spouses

In 2015, 12.8 percent of military wives aged 18 to 49 used illicit drugs in the past year (Figure 1), which corresponds to about 116,000 military wives. This percentage of military wives aged 18 to 49 who used illicit drugs in the past year was similar to the percentage among all married women in this age group (12.9 percent). However, military wives were less likely than all married women to have used marijuana in the past year (5.1 vs. 8.0 percent). The percentages of military wives and all married women who misused prescription psychotherapeutic drugs in the past year were not significantly different (7.8 and 5.9 percent, respectively); however, this comparison should be reevaluated with additional years of data to determine whether differences become statistically significant when estimates are based on a larger sample of military spouses.

Illicit Drug Use among Military Children

In 2015, about 1 in 5 military children aged 12 to 17 (19.6 percent) used illicit drugs in the past year (Figure 2), which corresponds to about 103,000 military children. This percentage of military children who were past year illicit drug users was similar to the percentage among all youths aged 12 to 17 who used illicit drugs in the past year (17.5 percent). In addition, similar percentages of military children and all youths aged 12 to 17 used marijuana in the past year (10.7 and 12.6 percent, respectively) and misused prescription psychotherapeutic drugs in that period (7.6 and 5.9 percent, respectively). Possible differences in substance use between military children and all youths aged 12 to 17 should be reevaluated with additional years of data to determine whether differences become statistically significant when estimates are based on a larger sample of military children.

Cigarette Use

NSDUH asks respondents about their tobacco use in the 30 days before the interview. NSDUH collects information on several tobacco products, such as cigarettes, chewing tobacco, snuff, cigars, and pipe tobacco. This report presents estimates of cigarette use because most tobacco users in the past month smoked cigarettes in that period.²¹ Cigarette use is defined in NSDUH as smoking part or all of a cigarette.

Cigarette Use among Military Spouses

In 2015, 16.2 percent of military wives aged 18 to 49 smoked cigarettes in the past month (Figure 3), which corresponds to about 147,000 military wives. This percentage of military wives who smoked cigarettes in the past month was similar to the percentage among all married women aged 18 to 49 (15.8 percent).

Cigarette Use among Military Children

In 2015, 3.2 percent of military children aged 12 to 17 smoked cigarettes in the past month (Figure 4), which corresponds to about 17,000 military children. This percentage of military children who smoked cigarettes was similar to the percentage for all youths aged 12 to 17 (4.2 percent).

Alcohol Use

NSDUH asks respondents about their alcohol use in the 30 days prior to the interview, which is also referred to as current alcohol use.²⁴ In addition to measuring any alcohol use, NSDUH collects information on binge alcohol use. Binge drinking is defined for males as drinking five or more drinks on an occasion on at least 1 day in the past 30 days and for females as drinking four or more drinks on an occasion on at least 1 day in that period. Any alcohol use and binge drinking are not mutually exclusive categories of use. Binge use is included in estimates of current use.

Alcohol Use among Military Spouses

In 2015, about two thirds of military wives aged 18 to 49 (67.8 percent) drank alcohol in the past month, and about one third (31.5 percent) engaged in binge drinking in that period (Figure 3). Among the military wives in this age group, these percentages correspond to 617,000 current alcohol users and 286,000 who engaged in binge drinking. Military wives were more likely than all married women aged 18 to 49 to drink any alcohol in the past month (67.8 vs. 53.8 percent) and to binge drink (31.5 vs. 22.7 percent).

Alcohol Use among Military Children

In 2015, about 49,000 military children aged 12 to 17 drank alcohol in the past month, including 24,000 who engaged in binge drinking. As shown in Figure 4, similar percentages of military children and all youths aged 12 to 17 drank any alcohol in the past month (9.3 and 9.6 percent, respectively) and engaged in binge drinking (4.6 and 5.8 percent, respectively).

Receipt of Substance Use Treatment

NSDUH respondents who used alcohol or illicit drugs in their lifetime are asked whether they received treatment for their use of alcohol or illicit drugs in the 12 months prior to the interview date (i.e., the past year). Substance use treatment refers to treatment or counseling that was received for illicit drug or alcohol use or for medical problems associated with the use of illicit drugs or alcohol. Receipt of any substance use treatment includes treatment that was received in the past year at any location, such as a hospital (inpatient), rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, prison or jail, or a self help group (e.g., Alcoholics Anonymous or Narcotics Anonymous). People could report receiving treatment at more than one location.

Substance Use Treatment among Military Spouses

In 2015, 0.9 percent of military wives aged 18 to 49 received any substance use treatment within the past year (Table A.5B in Appendix A), or about 8,000 military wives. Among all married women aged 18 to 49, 0.7 percent received treatment in the past year; the difference in 2015 between military wives aged 18 to 49 and all married women in this age group was not statistically significant. Additional years of data would be useful for generating reliable estimates for the receipt of substance use treatment at a specialty facility²⁵ and the receipt of treatment among military spouses who needed substance use treatment.^26,27

Substance Use Treatment among Military Children

Among both military children and all youths aged 12 to 17 in 2015, 0.8 percent received substance use treatment within the past year (Table B.6B in Appendix B). The percentage of military children who received substance use treatment in the past year corresponds to about 4,000 military children. Additional years of data would be useful for generating reliable estimates for the receipt of substance use treatment at a specialty facility²⁵ and the receipt of treatment among military children who needed substance use treatment.^26,27

Any Mental Illness

Mental disorders are generally characterized by changes in mood, thought, or behavior. They can make carrying out daily activities difficult and can impair an individual's ability to work or function in school, interact with family, and fulfill other major life functions. NSDUH provides estimates of any mental illness (AMI) for adults aged 18 or older.²⁸ An adult with AMI was defined as having any mental, behavioral, or emotional disorder in the past year that met the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), excluding developmental disorders and substance use disorder.²⁷ AMI does not take into account whether the mental, behavioral, or emotional disorder substantially interfered with or limited adults' ability to carry out major life activities.²⁹ In this section, estimates for AMI are presented only for military spouses because NSDUH provides estimates of AMI only for adults aged 18 or older. However, NSDUH collects data on the presence of a major depressive episode (MDE) in the past year among both adults and adolescents (see the section below on MDE).

Any Mental Illness among Military Spouses

In 2015, an estimated 264,000 military wives aged 18 to 49 were identified as having AMI in the past year. As shown in Figure 5, military wives were more likely than all married women aged 18 to 49 to be identified as having AMI in the past year (29.1 vs. 19.7 percent). The percentage of military wives identified as having AMI within the past year compared with the percentage for all married women should be monitored as additional years of NSDUH data become available to determine whether this difference remains significant in future years and with a larger sample of military spouses. Additional years of data will also be useful for generating estimates of serious mental illness (SMI) among military spouses, which is defined as the presence of a mental, behavioral, or emotional disorder that substantially interfered with or limited adults' ability to carry out major life activities.

Major Depressive Episode (MDE)

NSDUH also provides estimates of having a past year MDE among adults and adolescents. MDE is defined using the diagnostic criteria from the DSM-IV.²⁷ The wordings to some of the questions for adolescents were designed to make them more developmentally appropriate for youths. Respondents were defined as having an MDE if they had a period of 2 weeks or longer in the past 12 months when they experienced a depressed mood or loss of interest or pleasure in daily activities and if they had at least some additional symptoms, such as problems with sleep, eating, energy, concentration, and self-worth.^30,31,32 Additionally, adults were defined as having an MDE with severe impairment if their depression caused severe problems with their ability to manage at home, manage well at work, have relationships with others, or have a social life. Adolescents were defined as having an MDE with severe impairment if their depression caused severe problems with their ability to do chores at home, do well at work or school, get along with their family, or have a social life.

MDE among Military Spouses

In 2015, about 107,000 military wives aged 18 to 49 had at least one MDE in the past year, including 59,000 who had an MDE with severe impairment in the past year. These numbers correspond to 11.8 percent of military wives who had an MDE in the past year and 6.5 percent who had an MDE with severe impairment (Figure 6). The percentages were not significantly different between military wives and all married women aged 18 to 49 for an MDE in the past year (11.8 and 7.3 percent, respectively) or for an MDE with severe impairment (6.5 and 4.6 percent, respectively). However, these comparisons should be reevaluated with additional years of data to determine whether differences become statistically significant when estimates are based on a larger sample of military spouses. Additional years of data will also allow for estimation of treatment for depression among military spouses who had a past year MDE and among those who had an MDE with severe impairment.

MDE among Military Children

In 2015, about 85,000 military children aged 12 to 17 had at least one MDE in the past year, including 63,000 who had an MDE with severe impairment in the past year. These numbers correspond to 16.7 percent of military children who had a past year MDE and 12.3 percent who had a past year MDE with severe impairment (Figure 7). The percentages were not significantly different between military children and all youths aged 12 to 17 for an MDE in the past year (16.7 and 12.5 percent, respectively) or an MDE with severe impairment (12.3 and 8.8 percent, respectively). However, these comparisons should be reevaluated with additional years of data to determine whether differences become statistically significant when estimates are based on a larger sample of military children. Additional years of data will also allow for estimation of treatment for depression among military children who had a past year MDE and among those who had an MDE with severe impairment.

Mental Health Service Use

In this section, estimates of mental health service use are presented separately for military wives and children because NSDUH uses age-specific questions to collect mental health service use information from adults and adolescents. The mental health service use questions for adults and adolescents are described below.

Mental Health Service Use among Military Spouses

Adults in NSDUH are asked whether they received treatment or counseling for any problem with emotions, "nerves," or mental health in the past year in any inpatient or outpatient setting or whether they used prescription medication in the past year for a mental or emotional condition. All adults are asked these questions about their use of mental health services (i.e., not just those with mental illness). Respondents are asked not to include treatment for use of alcohol or illicit drugs. The questions about the receipt of treatment or counseling for mental health issues do not ask specifically about treatment for a particular mental disorder. Consequently, treatment or counseling for any problem with emotions, nerves, or mental health are defined broadly as "mental health service use."

In 2015, an estimated 204,000 military wives aged 18 to 49 received mental health services in the past year, which corresponds to 22.6 percent of military wives in this age group (Figure 5). The percentages of military wives and all married women aged 18 to 49 who received mental health services in the past year were not significantly different (22.6 and 16.9 percent, respectively); however, this comparison should be reevaluated with additional years of data to determine whether differences become statistically significant when estimates are based on a larger sample of military spouses. Additional years of data will also allow for estimation of the receipt of specific types of mental health services (i.e., in an inpatient or outpatient setting or the use of prescription medication for a mental health condition) and the receipt of mental health services among military spouses with AMI or SMI.

Mental Health Service Use among Military Children

NSDUH includes questions for adolescents aged 12 to 17 that ask about the receipt of services for emotional and behavioral problems that were not caused by substance use. The youth mental health service utilization section of the interview asks respondents aged 12 to 17 whether they received any treatment or counseling within the 12 months prior to the interview for problems with emotions or behavior. These items are repeated for each of several treatment settings: (a) the specialty mental health setting (inpatient or outpatient care); (b) the education setting (talked with a school social worker, psychologist, or counselor about an emotional or behavioral problem; participated in a program for students with emotional or behavioral problems while in a regular school; or attended a school for students with emotional or behavioral problems); (c) the general medical setting (care from a pediatrician or family physician for emotional or behavioral problems); (d) the juvenile justice setting (services for an emotional or behavioral problem in a detention center, prison, or jail); or (e) the child welfare setting (foster care or therapeutic foster care). Adolescent respondents could report receiving services in more than one setting.

Given the small number of military children in the NSDUH sample, this section focuses on the receipt of mental health services in specialty mental health settings (inpatient or outpatient care) and in nonspecialty settings (i.e., education, general medical, or child welfare settings). This section also presents estimates for the receipt of mental health services in two of the nonspecialty settings: education settings and general medical settings. Additional years of data will allow for the analysis of data on military children's receipt of mental health services in other specific nonspecialty settings.

In 2015, 93,000 military children aged 12 to 17 received mental health services within the past 12 months in specialty mental health settings (inpatient or outpatient care), and 91,000 received mental health services in nonspecialty settings (i.e., education, general medical, or child welfare settings).³³ These numbers correspond to 17.8 percent of military children who received services in each type of setting (Figure 8). Among all youths aged 12 to 17, 13.3 percent received mental health services in the past year in specialty mental health settings, and 15.2 percent received services in nonspecialty settings.

The 91,000 military children who received mental health services in nonspecialty settings (i.e., education, general medical, or child welfare settings) included 74,000 military children who received mental health services in education settings (14.5 percent of military children) and 27,000 who received mental health services in general medical settings (5.2 percent). Among all youths aged 12 to 17, 13.2 percent received services in education settings, and 2.7 percent received services in general medical settings.

The percentages in this section for the receipt of mental health services were not significantly different between military children and all youths aged 12 to 17. These comparisons should be reevaluated with additional years of data to determine whether differences become statistically significant when estimates are based on a larger sample of military children.

Using NSDUH Data to Understand Substance Use and Mental Health Issues in Military Families

As noted in the "Data Presentation and Interpretation" section at the beginning of the report, this report presents the first set of findings from NSDUH for substance use and mental health issues among military spouses and military children. Although the NSDUH estimates in this report provide important new information about substance use and mental health issues among military families, the relatively small numbers of respondents in the 2015 NSDUH who were military spouses or children limit the depth of the analyses that are statistically feasible with this single year of NSDUH data. Additionally, analysis of the NSDUH data for military spouses was limited to women with a spouse in the military because there were not enough male respondents in the 2015 NSDUH with a spouse in the military to generate reliable estimates for husbands of military personnel.

Also, a number of mental health estimates were in the direction of being greater for military wives or military children compared with all married women aged 18 to 49 or all youths aged 12 to 17, but the differences were not statistically significant. Stated another way, apparent (but not statistically significant) differences between subgroups of military family members and the corresponding members of the overall population may not reflect "real" differences. Rather, these findings could have been explained by chance in how individuals were selected for the survey and in the resulting answers from the individuals who responded.

Nevertheless, the 2015 NSDUH estimates had sufficient precision to indicate some noteworthy differences between military wives and all married women aged 18 to 49. Specifically, military wives aged 18 to 49 were less likely than all married women in this age group to have used marijuana in the past year, but they were more likely than all married women to be binge alcohol users in the past month or to have AMI in the past year. However, the disproportionately higher representation of young adults aged 18 to 25 among military wives may contribute to the greater likelihood of military wives to be binge alcohol users. In 2015, for example, 39.0 percent of young adults were binge drinkers in the past month compared with 24.8 percent of adults aged 26 or older.³⁴ Although there were no statistically significant differences between military children aged 12 to 17 and all children aged 12 to 17 for any of the substance use and mental health measures, these data provide insights about military children; prior to 2015, nationally representative data were not available from any source on substance use and mental health issues among military children.

Consistency in the target population, sample design, and survey measures across time are important strengths of NSDUH. For example, NSDUH rarely adds new questions or redesigns the questionnaire. The addition of new questions is typically preceded by in-depth methodological testing of respondent understanding of the new questions and is followed by early evaluation of the potential effects of new questions on other survey estimates. This methodological stability allows for pooling of multiple years of NSDUH data to facilitate the analysis of rare events, such as the use of specific illicit substances, and analysis of data for smaller subpopulations, such as military families. Where possible, additional investigations will be important not only for describing differences between military and nonmilitary families with respect to key substance use and mental health indicators, but also for understanding the factors that are related to apparent differences. With additional years of pooled NSDUH data, it will be possible to expand on the analyses in this report to broaden the understanding of substance use and mental health issues among military and civilian families. Ultimately, these additional analyses are likely to be used by policymakers, researchers, and health care providers in the development of more focused prevention efforts and treatment interventions for the potentially vulnerable population of military families.

Finally, NSDUH is not a survey that is specifically geared toward military families. Therefore, the survey is limited in the range of available information about military families. For example, NSDUH does not include questions to identify whether military spouses or parents had a recent period of military deployment and therefore cannot provide data on the impact of deployment on the well-being of military families. However, the analysis of pooled years of NSDUH data on military families will provide potentially useful data that should enable policymakers, researchers, and health care providers to answer and respond to several critical questions about military families, such as whether being a military family member appears to reduce the risk for certain substance use or mental health issues, whether military family members are particularly vulnerable to specific substance use or mental health issues, and whether military family members have differential access to or make differential use of substance use treatment or mental health services. Understanding these topics could inform policies and practices to improve the lives of military families and benefit the personnel who serve.

Author Affiliations

Rachel N. Lipari, Barbara Forsyth, and Jonaki Bose are with the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, Rockville, MD. Larry A. Kroutil and Marian E. Lane are with RTI International (a registered trademark and a trade name of Research Triangle Institute), Research Triangle Park, NC.

Acknowledgments of Reviewers

The authors would like to thank Struther Van Horn at SAMHSA and Tricia Adams, Elizabeth A. P. Copello, Erica Hirsch, and Jeremy D. Porter at RTI International for reviewing previous drafts of this Data Review.

Suggested Citation

Lipari, R. N., Forsyth, B., Bose, J., Kroutil, L. A., & Lane, M. E. (2016, November). Spouses and children of U.S. military personnel: Substance use and mental health profile from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. Retrieved from https://www.samhsa.gov/data/

Endnotes

Appendix A: Supplemental Tables of Estimates for Spouses of Military Personnel and Married Adults Aged 18 to 49

Appendix B: Supplemental Tables of Estimates for Children of Military Personnel and Youths Aged 12 to 17

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Long Descriptions – Figures

Long description, Figure 1: Figure 1 is titled "Past Year Illicit Drug Use among Wives of Military Personnel and All Married Women Aged 18 to 49: Percentages, 2015." It is a bar graph where three drug groups (illicit drugs, marijuana, and misuse of psychotherapeutics) are shown on the horizontal axis and the percentage of women using in the past year is shown on the vertical axis. For each drug use, the figure shows a set of two bars representing the group of married women. The first set of bars shows the percentage of women using illicit drugs in the past year. The second set of bars shows the percentage of women using marijuana in the past year. The third set of bars shows the percentage of women misusing psychotherapeutics in the past year. Each set of bars has a bar that shows the 95 percent confidence interval. Tests of statistical significance at the .05 level were performed between wives of military personnel and all married women aged 18 to 49; significant results are indicated where appropriate.

Among women aged 18 to 49 in 2015, 12.8 percent of wives of military personnel used illicit drugs in the past year with a 95 percent confidence interval of 8.7 percent to 18.3 percent, and 12.9 percent of all married women used illicit drugs in the past year with a 95 percent confidence interval of 12.1 percent to 13.8 percent.

Among women aged 18 to 49 in 2015, 5.1 percent of wives of military personnel used marijuana in the past year with a 95 percent confidence interval of 2.9 percent to 9.0 percent, and 8.0 percent of all married women used marijuana in the past year with a 95 percent confidence interval of 7.4 percent to 8.8 percent. The difference between the estimate for wives of military personnel and the estimate for all married women aged 18 to 49 is statistically significant at the .05 level.

Among women aged 18 to 49 in 2015, 7.8 percent of wives of military personnel misused psychotherapeutics in the past year with a 95 percent confidence interval of 4.7 percent to 12.7 percent, and 5.9 percent of all married women misused psychotherapeutics in the past year with a 95 percent confidence interval of 5.3 percent to 6.6 percent.

Long description end. Return to Figure 1.

Long description, Figure 2: Figure 2 is titled "Past Year Illicit Drug Use among Children of Military Personnel and All Youths Aged 12 to 17: Percentages, 2015." It is a bar graph where three drug groups (illicit drugs, marijuana, and misuse of psychotherapeutics) are shown on the horizontal axis and the percentage of youths using in the past year is shown on the vertical axis. For each drug use, the figure shows a set of two bars representing the group of youths. The first set of bars shows the percentage of youths using illicit drugs in the past year. The second set of bars shows the percentage of youths using marijuana in the past year. The third set of bars shows the percentage of youths misusing psychotherapeutics in the past year. Each set of bars has a bar that shows the 95 percent confidence interval.

Among youths aged 12 to 17 in 2015, 19.6 percent of children of military personnel used illicit drugs in the past year with a 95 percent confidence interval of 14.9 percent to 25.5 percent, and 17.5 percent of all youths used illicit drugs in the past year with a 95 percent confidence interval of 16.7 percent to 18.2 percent.

Among youths aged 12 to 17 in 2015, 10.7 percent of children of military personnel used marijuana in the past year with a 95 percent confidence interval of 7.5 percent to 15.1 percent, and 12.6 percent of all youths used marijuana in the past year with a 95 percent confidence interval of 12.0 percent to 13.3 percent.

Among youths aged 12 to 17 in 2015, 7.6 percent of children of military personnel misused psychotherapeutics in the past year with a 95 percent confidence interval of 4.7 percent to 12.1 percent, and 5.9 percent of all youths misused psychotherapeutics in the past year with a 95 percent confidence interval of 5.4 percent to 6.4 percent.

Long description end. Return to Figure 2.

Long description, Figure 3: Figure 3 is titled "Past Month Cigarette and Alcohol Use among Wives of Military Personnel and All Married Women Aged 18 to 49: Percentages, 2015." It is a bar graph where three cigarette and alcohol use groups (cigarettes, alcohol, and binge alcohol use) are shown on the horizontal axis and the percentage of women using in the past month is shown on the vertical axis. For each cigarette and alcohol use, the figure shows a set of two bars representing the group of women. The first set of bars shows the percentage of women using cigarettes in the past month. The second set of bars shows the percentage of women using alcohol in the past month. The third set of bars shows the percentage of women with binge alcohol use in the past month. Each set of bars has a bar that shows the 95 percent confidence interval. Tests of statistical significance at the .05 level were performed between wives of military personnel and all married women aged 18 to 49; significant results are indicated where appropriate. There is a note under the figure that says, "In 2015, the threshold for determining binge alcohol use for females changed from five or more drinks on an occasion to four or more drinks on an occasion."

Among women aged 18 to 49 in 2015, 16.2 percent of wives of military personnel used cigarettes in the past month with a 95 percent confidence interval of 11.4 percent to 22.5 percent, and 15.8 percent of all married women used cigarettes in the past month with a 95 percent confidence interval of 14.8 percent to 16.7 percent.

Among women aged 18 to 49 in 2015, 67.8 percent of wives of military personnel used alcohol in the past month with a 95 percent confidence interval of 60.5 percent to 74.3 percent, and 53.8 percent of all married women used alcohol in the past month with a 95 percent confidence interval of 52.4 percent to 55.2 percent. The difference between the estimate for wives of military personnel and the estimate for all married women aged 18 to 49 is statistically significant at the .05 level.

Among women aged 18 to 49 in 2015, 31.5 percent of wives of military personnel had binge alcohol use in the past month with a 95 percent confidence interval of 24.9 percent to 38.9 percent, and 22.7 percent of all married women had binge alcohol use in the past month with a 95 percent confidence interval of 21.6 percent to 23.8 percent. The difference between the estimate for wives of military personnel and the estimate for all married women aged 18 to 49 is statistically significant at the .05 level.

Long description end. Return to Figure 3.

Long description, Figure 4: Figure 4 is titled "Past Month Cigarette and Alcohol Use among Children of Military Personnel and All Youths Aged 12 to 17: Percentages, 2015." It is a bar graph where three cigarette and alcohol use groups (cigarettes, alcohol, and binge alcohol use) are shown on the horizontal axis and the percentage of youths using in the past month is shown on the vertical axis. For each cigarette and alcohol use, the figure shows a set of two bars representing the group of youths. The first set of bars shows the percentage of youths using cigarettes in the past month. The second set of bars shows the percentage of youths using alcohol in the past month. The third set of bars shows the percentage of youths with binge alcohol use in the past month. Each set of bars has a bar that shows the 95 percent confidence interval. There is a note under the figure that says, "In 2015, the threshold for determining binge alcohol use for females changed from five or more drinks on an occasion to four or more drinks on an occasion."

Among youths aged 12 to 17 in 2015, 3.2 percent of children of military personnel used cigarettes in the past month with a 95 percent confidence interval of 1.7 percent to 5.7 percent, and 4.2 percent of all youths used cigarettes in the past month with a 95 percent confidence interval of 3.8 percent to 4.6 percent.

Among youths aged 12 to 17 in 2015, 9.3 percent of children of military personnel used alcohol in the past month with a 95 percent confidence interval of 6.1 percent to 13.7 percent, and 9.6 percent of all youths used alcohol in the past month with a 95 percent confidence interval of 9.1 percent to 10.2 percent.

Among youths aged 12 to 17 in 2015, 4.6 percent of children of military personnel had binge alcohol use in the past month with a 95 percent confidence interval of 2.5 percent to 8.2 percent, and 5.8 percent of all youths had binge alcohol use in the past month with a 95 percent confidence interval of 5.4 percent to 6.3 percent.

Long description end. Return to Figure 4.

Long description, Figure 5: Figure 5 is titled "Any Mental Illness in the Past Year and Receipt of Mental Health Services in the Past Year among Wives of Military Personnel and All Married Women Aged 18 to 49: Percentages, 2015." It is a bar graph where two mental health measure groups (any mental illness and received mental health services) are shown on the horizontal axis and the percentage of women with select mental health measures in the past year are shown on the vertical axis. For each mental health measure, the figure shows a set of two bars representing the group of women. The first set of bars shows the percentage of women with any mental illness in the past year. The second set of bars shows the percentage of women who received mental health services in the past year. Each set of bars has a bar that shows the 95 percent confidence interval. Tests of statistical significance at the .05 level were performed between wives of military personnel and all married women aged 18 to 49; significant results are indicated where appropriate. There is a note under the figure that says, "Mental health services is defined as having received inpatient care or outpatient care or having used prescription medication for problems with emotions, nerves, or mental health."

Among women aged 18 to 49 in 2015, 29.1 percent of wives of military personnel had any mental illness in the past year with a 95 percent confidence interval of 22.4 percent to 36.7 percent, and 19.7 percent of all married women had any mental illness in the past year with a 95 percent confidence interval of 18.7 percent to 20.8 percent. The difference between the estimate for wives of military personnel and the estimate for all married women aged 18 to 49 is statistically significant at the .05 level.

Among women aged 18 to 49 in 2015, 22.6 percent of wives of military personnel received mental health services in the past year with a 95 percent confidence interval of 16.9 percent to 29.4 percent, and 16.9 percent of all married women received mental health services in the past year with a 95 percent confidence interval of 16.0 percent to 17.9 percent.

Long description end. Return to Figure 5.

Long description, Figure 6: Figure 6 is titled "Major Depressive Episode (MDE) and MDE with Severe Impairment in the Past Year among Wives of Military Personnel and All Married Women Aged 18 to 49: Percentages, 2015." It is a bar graph where two MDE measure groups (MDE and MDE with severe impairment) are shown on the horizontal axis and the percentage of women with MDE or MDE with severe impairment in the past year are shown on the vertical axis. For each mental health measure, the figure shows a set of two bars representing the group of women. The first set of bars shows the percentage of women who had MDE in the past year. The second set of bars shows the percentage of women who had MDE with severe impairment in the past year. Each set of bars has a bar that shows the 95 percent confidence interval.

Among women aged 18 to 49 in 2015, 11.8 percent of wives of military personnel had MDE in the past year with a 95 percent confidence interval of 7.8 percent to 17.5 percent, and 7.3 percent of all married women had MDE in the past year with a 95 percent confidence interval of 6.7 percent to 8.0 percent.

Among women aged 18 to 49 in 2015, 6.5 percent of wives of military personnel had MDE with severe impairment in the past year with a 95 percent confidence interval of 4.0 percent to 10.6 percent, and 4.6 percent of all married women had MDE with severe impairment in the past year with a 95 percent confidence interval of 4.1 percent to 5.2 percent.

Long description end. Return to Figure 6.

Long description, Figure 7: Figure 7 is titled "Major Depressive Episode (MDE) and MDE with Severe Impairment in the Past Year among Children of Military Personnel and All Youths Aged 12 to 17: Percentages, 2015." It is a bar graph where two MDE measure groups (MDE and MDE with severe impairment) are shown on the horizontal axis and the percentage of youths with MDE or MDE with severe impairment in the past year are shown on the vertical axis. For each mental health measure, the figure shows a set of two bars representing the group of youths. The first set of bars shows the percentage of youths who had MDE in the past year. The second set of bars shows the percentage of youths who had MDE with severe impairment in the past year. Each set of bars has a bar that shows the 95 percent confidence interval.

Among youths aged 12 to 17 in 2015, 16.7 percent of children of military personnel had MDE in the past year with a 95 percent confidence interval of 12.4 percent to 21.9 percent, and 12.5 percent of all youths had MDE in the past year with a 95 percent confidence interval of 11.9 percent to 13.2 percent.

Among youths aged 12 to 17 in 2015, 12.3 percent of children of military personnel had MDE with severe impairment in the past year with a 95 percent confidence interval of 9.0 percent to 16.6 percent, and 8.8 percent of all youths had MDE with severe impairment in the past year with a 95 percent confidence interval of 8.3 percent to 9.3 percent.

Long description end. Return to Figure 7.

Long description, Figure 8: Figure 8 is titled "Sources of Mental Health Services in the Past Year among Children of Military Personnel and All Youths Aged 12 to 17: Percentages, 2015." It is a bar graph where four sources of mental health services (specialty mental health setting, nonspecialty setting, education setting, and general medical setting) are shown on the horizontal axis and the percentage of youths who used sources of mental health services in the past year are shown on the vertical axis. For each source of mental health service, the figure shows a set of two bars representing the group of youths. The first set of bars represents the percentage of youths who received mental health services in a specialty mental health setting in the past year. The second set of bars represents the percentage of youths who received mental health services in a nonspecialty setting in the past year. The third set of bars represents the percentage of youths who received mental health services in an education setting in the past year. The fourth set of bars represents the percentage of youths who received mental health services in a general medical setting in the past year. Each set of bars has a bar that shows the 95 percent confidence interval. There is a note below the figure that says, "Nonspecialty setting includes education, general medical, juvenile justice, and child welfare settings."

Among youths aged 12 to 17 in 2015, 17.8 percent of children of military personnel received mental health services in a specialty mental health setting in the past year with a 95 percent confidence interval of 13.5 percent to 23.2 percent, and 13.3 percent of all youths received mental health services in a specialty mental health setting in the past year with a 95 percent confidence interval of 12.6 percent to 13.9 percent.

Among youths aged 12 to 17 in 2015, 17.8 percent of children of military personnel received mental health services in a nonspecialty setting in the past year with a 95 percent confidence interval of 13.4 percent to 23.3 percent, and 15.2 percent received mental health services in a nonspecialty setting in the past year with a 95 percent confidence interval of 14.6 percent to 16.0 percent.

Among youths aged 12 to 17 in 2015, 14.5 percent of children of military personnel received mental health services in an education setting in the past year with a 95 percent confidence interval of 10.6 percent to 19.5 percent, and 13.2 percent of all youths received mental health services in an education setting in the past year with a 95 percent confidence interval of 12.6 percent to 13.9 percent.

Among youths aged 12 to 17 in 2015, 5.2 percent of children of military personnel received mental health services in a general medical setting in the past year with a 95 percent confidence interval of 2.8 percent to 9.5 percent, and 2.7 percent of all youths received mental health services in a general medical setting in the past year with a 95 percent confidence interval of 2.4 percent to 3.0 percent.

Long description end. Return to Figure 8.