Family Resilience Matters: How Individual and Family Resilience Improve Health Outcomes for Veterans with Complex Conditions

Introduction Veterans with traumatic brain injury (TBI), epilepsy, and other complex comorbidities often face increased risks of long-term physical and mental difficulties. Prior research has highlighted benefits of individual resilience among Veterans with respect to maintaining positive health outcomes in the face of stress and adversity. However, 1 area that has been underexplored is how family resilience may also contribute to better well-being post-deployment, especially when facing complex conditions like TBI or other post-traumatic sequelae. Considering the efforts of the Department of Defense to increase family resilience training as part of the Military Family Readiness System, there is a need to understand how family resilience factors into long-term outcomes. The current study examined how individual and family resilience were each associated with physical and mental well-being among Post-9/11 Veterans. Materials and methods We conducted a secondary data analysis with N = 2603 Veterans (Mage = 42.02, 66.2% White, 69.3% men, 66.1% Army) who had previously received Veterans Health Administration (VHA) care and had diagnoses of TBI and/or epilepsy. Surveys were administered between September 2017 and February 2019 and included measures of individual resilience (Connor-Davidson Resilience Scale; CD-RISC2); family resilience (Family Resilience Scale for Veterans; FRS-V); the Veterans RAND 12-item Health Survey (VR-12); and Quality of Life after Traumatic Brain Injury Overall Scale (QOLIBRI-OS). Primary analyses consisted of multiple linear regression analyses with individual resilience, family resilience, and their respective interaction as simultaneous predictors of well-being (physical and mental health components of the VR-12 and QOLIBRI-OS). Subsequent linear regression analyses sequentially added different blocks of covariates: (a) health comorbidities (i.e., TBI/epilepsy status, PTSD); (b) military history (i.e., combat exposure, branch, component, rank); and (c) demographics (i.e., age, sex, race/ethnicity, education level, marital status). This study received Institutional Review Board (IRB) approval as minimal risk (IRB #00107411). Results For the VR-12, our results showed that higher individual resilience, but not family resilience, was associated with better self-reported physical health, but that both individual resilience and family resilience were positively associated with better self-reported mental health. There was also a significant interaction, such that the positive association between individual resilience and mental health was greater at higher levels of family resilience. The same pattern of results was seen for the QOLIBRI-OS. All results held after controlling for health status, military history, and demographic covariates. Conclusion These results suggest that high individual resilience combined with high family resilience may have a stronger combined effect on mental health and quality of life among Veterans with TBI, epilepsy, and other complex comorbidities. These results underscore the need for military leaders, clinicians, and veteran transition support programs to consider resilience more holistically by incorporating both individual and social resources for coping with stress and adversity. The cross-sectional nature of these data prevents us from making causal claims or assumptions about the long-term effects of individual and family resilience on well-being. Future research should examine the -implications of different types of resilience over time and across various well-being domains (e.g., vocational and social well-being).