Diversity in U.S. Military Families: An Environmental Scan of the Peer-Reviewed Literature on Race and Ethnic Variation for Select Well-Being Outcomes

by Sarah O. Meadows, Sierra Smucker, Dionne Barnes-Proby, Julia Vidal Verástegui, Rosemary Li, Elliott Brennan

This Article

RAND Health Quarterly, 2023; 10(2):7


Researchers explore the literature on race and ethnicity (R/E) in relation to U.S. military service member well-being in the areas of mental health, behavioral health, family violence, marital satisfaction, and financial stress to uncover whether past research has focused on R/E differences in outcomes as a driving research question; the variables used to capture R/E; and the quality of research in terms of design, data, and analysis. The Department of Defense (DoD) has expressed commitment to improving diversity and inclusion in the military. If leaders seek to do this based on existing evidence, they will find that information about how R/E intersects with the well-being of service members and their families is extremely limited. DoD should consider developing a deliberate, strategic, and comprehensive research agenda on R/E diversity in service member and family well-being outcomes. This will help DoD identify where differences exist and where policies and programs can address those gaps.

For more information, see RAND RR-A1093-1 at https://www.rand.org/pubs/research_reports/RRA1093-1.html

Full Text

Key Findings

  • Existing articles on service member well-being lack a focus on R/E in core research questions. Although researchers often recognize that R/E could affect the outcome of interest, the most common approach to addressing this impact is to control for the variation associated with R/E instead of specifically exploring it. This leads to fragmented development of knowledge, which makes it difficult for researchers to consolidate and use that knowledge to develop policies and programs.
  • The existing body of research includes a limited variety of analytic methods. Specifically, the work does not include qualitative approaches that could tell us why R/E outcome differences occur. An investment in understanding the why behind R/E variation in outcomes is essential to supporting a diverse group of service members and their families and developing effective evidence-based policies and programs.
  • A substantial number of articles relied on convenience samples to answer research questions. These articles lacked generalizability to broader service member and family populations and were unable to sufficiently answer questions about R/E. For research designed to address R/E well-being questions, ensuring that quantitative analyses have a broad and representative sample across R/E groups is critical.
  • The existing literature on R/E and well-being lacks attention to the spouses and children of service members. Only a handful of articles included children and spouses of service members, and many of those did not separate their findings across these unique groups. This leaves the reader with no appreciation for how R/E might differentially affect children, service members, and spouses.

Military leadership has increasingly recognized the importance of supporting a diverse workforce and the deficits in efforts to support service members of color (Burns and Baldor, 2021). In a recent memo, former U.S. Secretary of Defense Mark Esper outlined a set of immediate actions to stop discrimination, prejudice, and bias in the ranks of the U.S. armed forces (Esper, 2020). For example, the memo directed the services to remove photographs from consideration by promotion boards, add bias awareness and bystander intervention training, and develop educational requirements about unintentional bias. The memo reflects a growing commitment to diversifying the force and encouraging service members of color and women to pursue positions in higher ranks, which remain dominated by white men.

These efforts are important steps toward supporting diverse service members, but more work is needed to ensure those supports extend to military families, including spouses and children. A service member's family plays a critical role in their ability to serve (Le Menestrel and Kizer, 2019). Family members provide support to services members while they serve and often care for service members as they recover from physical and mental health injuries (Institute of Medicine, 2013). Issues within a family can also cause stress for service members and might interfere with their readiness (Keller et al., 2018; Meyers, 2018; Schneider and Martin, 1994; Sims et al., 2017; Strong et al., 2021). Moreover, family well-being is often a consideration when service members face retention decisions (Keller et al., 2018; Meyers, 2018). Therefore, ensuring the health and well-being of military families must be a priority for the Department of Defense (DoD).

While research on the relationship between race, ethnicity, and family well-being is well developed in the civilian literature (e.g., mental and physical health: Luo and Waite, 2005; Williams et al., 1997; marital satisfaction: Dillaway and Broman, 2001; family violence: Cho, 2012; financial stress: Al-Bahrani, Weathers, and Patel, 2019), there is a gap in our knowledge about the role of race and ethnicity (R/E) in well-being outcomes among service members and their families. Going forward, military leaders and policymakers need evidence to inform their efforts to support a diverse population of military families. This study begins to fill this gap. Our research objective was to broadly review and synthesize existing literature to better understand what researchers have found about how one specific aspect of diversity—R/E—is related to military family well-being. Specifically, we were interested in (1) whether researchers focused on R/E differences in outcomes as a driving research question (not just as a control variable); (2) the variables used to capture R/E; and (3) the quality of research in terms of design, data, and analysis.

To accomplish this goal, we conducted an environmental scan of the literature across five key components of well-being: mental health, behavioral health, family violence, marital satisfaction, and financial stress.1 The five domains represent a diverse set of outcomes that have been examined in the peer-reviewed literature on military family well-being. Working with a librarian, we developed a search strategy to facilitate our scan. The review was limited to English-language, peer-reviewed articles and reports published between 2000 and early 2021. The search itself occurred between February and June 2021.

Summary of Findings

We identified 110 unique articles that met the inclusion criteria for our well-being outcome domains. We identified 75 articles that were included in the mental health domain, 54 articles that were included in the behavioral health domain, seven articles that were included in the family violence domain, four articles that were included in the marital satisfaction domain, and one article that was included in the financial stress domain.2 The remainder of this section describes these articles’ most common attributes, including designs, population, outcomes, and investigation of differences by R/E across service members and their families. Table 1 provides a summary of the most common features of these articles, although the examples are not exhaustive.

Table 1. Examples of Common Article Features Across Domains

Outcome Domain Data Sources Population and Sample Analytic Approach Outcomes
Mental health
  • Behavioral Health Needs Assessment Survey, the Millennium Cohort Study
  • Data from existing articles, such as the Study to Assess Risk and Resilience in Servicemembers or Operation Worth Living
  • Administrative data from the Defense Medical Surveillance System
  • Original surveys developed by researchers
  • Active duty service members from all branches and often targeted based on their base location or deployment history (where they served, their medical condition when they returned)
  • Air Force Medical Personnel
  • Children of service members
  • Univariate and multivariate regression models
  • Descriptive statistics (chi-square test, t-test)
  • Posttraumatic stress disorder (PTSD) symptoms or diagnoses
  • Depression symptoms or diagnoses
  • Suicidality
  • Anxiety symptoms or diagnoses
Behavioral health
  • Claims from TRICARE
  • Data from the Millennium Cohort Study
  • Data from an outpatient traumatic brain injury (TBI) rehabilitation clinic at a military treatment facility
  • Enrollees at the Tripler Army Medical Center
  • Univariate and multivariate regression models
  • Descriptive statistics (chi-square test, t-test)
  • Smoking
  • Alcohol use
  • Sleep
Family violence
  • Original survey data
  • Existing articles for systematic review
  • TRICARE medical records
  • Post-Deployment Health Reassessment (PDHRA) Survey
  • Clinical records from the Army Central Registry
  • Married service members
  • Civilian spouses
  • Children of service members
  • Female service members
  • Univariate and multivariate regression models
  • Descriptive statistics (chi-square test, t-test)
  • Spousal aggression
  • Social adjustment
  • Rape knowledge, empathy, rape myth acceptance
  • Types of child neglect
Marital satisfaction
  • PDHRA Survey
  • Original survey data
  • The Defense Enrollment Eligibility Reporting System
  • Army soldiers who were identified as married
  • Civilians married to Army men and women
  • Married couples with at least one spouse serving in the military
  • Univariate and multivariate regression models
  • Descriptive statistics (chi-square test, t-test)
  • Interpersonal conflict
  • Spousal aggression
  • Divorce or risk of divorce
  • Communication skills
  • Positive bonding
Financial stress
  • American Community Survey
  • Participants of the American Community Survey who were members of the National Guard or Reserve, active duty military personnel, or veterans
  • Descriptive statistics (chi-square test, t-test)
  • Supplemental Nutrition Assistance Program (SNAP) use

Data Sources

The included articles used a variety of data sources. Most commonly, articles drew from large secondary data sets familiar to the fields of military behavioral health research, such as the Millennium Cohort Article (e.g., Ursano et al., 2016), Army Study to Assess Risk and Resilience in Servicemembers (e.g., Ursano et al., 2016, 2018; Ursano, Kessler, Heeringa, et al., 2015), the American Community Survey (e.g., London and Heflin, 2015), and medical or insurance records based on TRICARE usage and diagnoses (e.g., Schmied, Highfill-McRoy, and Larson, 2012). The samples and populations from these sources were often representative of the military population (or statistical methods were used to make them representative). However, many articles also used data from convenience samples. For example, an article by Steele, Germain, and Campbell (2017) used anonymous self-report surveys collected by a U.S. Navy Mobile Care team. These convenience samples were not representative of the broader population of service members and their families.

Sample Populations

Sample populations were largely service members themselves. Six articles focused on children of service members and five articles included spouses. Articles often included individuals from a variety of R/E backgrounds. However, it was not possible to compare across articles because researchers used different levels of specificity when it came to R/E to describe their sample. For example, some researchers provided information only on the percentage of white service members in their population, considering the remaining population “other race,” while other articles included a variety of categories for R/E (e.g., Gibbs, Clinton-Sherrod, and Johnson, 2012).

Analytic Approach

Most articles used regression analysis (e.g., logistic, multivariate) and descriptive statistics (e.g., chi-square tests, t-tests) to answer their research questions. This is consistent with researchers’ focus on large secondary data sources. The one exception was systematic reviews, which used a systematized process for selecting and abstracting data from existing research (e.g., O'Keefe and Reger, 2017; Jones et al., 2020).

Measuring Race and Ethnicity

Measures of R/E lacked consistency and varied widely across articles. The least detailed definition of race was simply minority versus nonminority (or white versus non-white) while the most detailed measure included a “select all that apply” race item (e.g., Black/African American, white/Caucasian, Asian, Pacific Islander, Native American) and a separate item for Hispanic ethnicity, usually indicated by a yes or no. This more-detailed measure of race allowed authors to include multiracial and “other” as derived categories. Although rare, some articles measured only race and did not measure Hispanic ethnicity. Generally, when “Hispanic” was included in analyses, the other racial groups were defined as “non-Hispanic.” That is, hierarchically, Hispanic ethnicity took precedence over all other racial categories. The most commonly used R/E measures in analyses were Black/white/Hispanic/other and Black/white/Hispanic/Asian and Pacific Islander/other. The ability to disaggregate the “other” race category was largely a function of sample size, but in most cases, authors did not explicitly explain why they collapsed certain groups.


Researchers focused on a variety of outcomes within each domain; however, some outcomes were more common than others. The most common outcomes studied across domains were PTSD and suicidality, including both risk and ideation. Other outcomes included general measures of mental health (e.g., Waitzkin et al., 2018), interpersonal conflict between service members and spouses (e.g., Gibbs, Clinton-Sherrod, and Johnson, 2012), substance use (e.g., Chaudhary et al., 2019), and sleep (e.g., Hill et al., 2020). Some articles also included measures of military readiness, such as unit cohesion (Dickstein et al., 2010), resilience (Vyas et al., 2016), and retention (Taylor, Hernández, and Clinton-Sherrod, 2021).


Al-Bahrani, Abdullah, Jamie Weathers, and Darshak Patel, "Racial Differences in the Returns to Financial Literacy Education," Journal of Consumer Affairs, Vol. 53, No. 2, 2019, pp. 572–599.

Burns, Robert, and Lolita C. Baldor, Top US General Urges Greater Racial Diversity in Military, Associated Press, May 5, 2021.

Chaudhary, Muhammad A., Nizar Bhulani, Elzerie C. de Jager, Stuart Lipsitz, Nicollette K. Kwon, Daniel J. Sturgeon, Quoc-Dien Trinh, Tracey Koehlmoos, Adil H. Haider, and Andrew J. Schoenfeld, "Development and Validation of a Bedside Risk Assessment for Sustained Prescription Opioid Use After Surgery," JAMA Network Open, Vol. 2, No. 7, e196673, July 2019.

Cho, Hyunkag, "Racial Differences in the Prevalence of Intimate Partner Violence Against Women and Associated Factors," Journal of Interpersonal Violence, Vol. 27, No. 2, 2012, pp. 344–363.

Dickstein, Benjamin D., Carmen P. McLean, Jim Mintz, Lauren M. Conoscenti, Maria M. Steenkamp, Trisha A. Benson, William C. Isler, Alan L. Peterson, and Brett T. Litz, "Unit Cohesion and PTSD Symptom Severity in Air Force Medical Personnel," Military Medicine, Vol. 175, No. 7, July 2010, pp. 482–486.

Dillaway, Heather, and Clifford Broman, "Race, Class, and Gender Differences in Marital Satisfaction and Divisions of Household Labor Among Dual-Earner Couples: A Case for Intersectional Analysis," Journal of Family Issues, Vol. 22, No. 3, 2001, pp. 309–327.

Esper, Mark, Immediate Actions to Address Diversity, Inclusion, and Equal Opportunity in the Military Services, Secretary of Defense Memo, July 14, 2020.

Gibbs, Deborah A., A. Monique Clinton-Sherrod, and Ruby E. Johnson, "Interpersonal Conflict and Referrals to Counseling Among Married Soldiers Following Return from Deployment," Military Medicine, Vol. 177, No. 10, October 2012, pp. 1178–1183.

Graham, Paul, Trina Evitts, and Roane Thomas-MacLean, "Environmental Scans: How Useful Are They for Primary Care Research?" Canadian Family Physician, Vol. 54, No. 7, July 2008, pp. 1022–1023.

Hill, Christopher G., Matthew R. Beymer, Brantley P. Jarvis, Jacob D. Smith, Jerrica N. Nichols, Vincent Mysliwiec, Joseph A. Pecko, and Eren Youmans Watkins, "A Cross-Sectional Examination of the Association Between Social Media Use and Sleep Among a Sample of U.S. Army Soldiers," Military Medicine, Vol. 185, No. 5/6, May/June 2020, pp. e694–e702.

Institute of Medicine, Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families, National Academies Press, 2013.

Jones, Chelsea, Antonio Miguel-Cruz, Lorraine Smith-MacDonald, Emily Cruikshank, Delaram Baghoori, Avneet Kaur Chohan, Alexa Laidlaw, Allison White, Cao Bo, Vincent Agyapong, Lisa Burback, Olga Winkler, Phillip R. Sevigny, Liz Dennett, Martin Ferguson-Pell, Andrew Greenshaw, and Suzette Brémault-Phillips, "Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel with Posttraumatic Stress Injury: Systematic Scoping Review," JMIR mHealth uHealth, Vol. 8, No. 9, September 2020.

Keller, Kristen M., Kimberly Curry Hall, Miriam Matthews, Leslie Adrienne Payne, Lisa Saum-Manning, Douglas Yeung, David Schulker, Stefan Zavislan, and Nelson Lim, Addressing Barriers to Female Officer Retention in the Air Force, RAND Corporation, RR-2073-AF, 2018. As of November 23, 2021:

Le Menestrel, Suzanne, and Kenneth W. Kizer, eds., Strengthening the Military Family Readiness System for a Changing American Society, National Academies Press, 2019.

London, Andrew S., and Colleen M. Heflin, "Supplemental Nutrition Assistance Program (SNAP) Use Among Active-Duty Military Personnel, Veterans, and Reservists," Population Research and Policy Review, Vol. 34, No. 6, December 2015, pp. 805–826.

Luo, Ye, and Linda J. Waite, "The Impact of Childhood and Adult SES on Physical, Mental, and Cognitive Well-Being in Later Life," Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol. 60, No. 2, 2005, pp. S93–S101.

Meyers, J., memo prepared for the Committee on the Well-Being of Military Families, Defense Advisory Committee on Women in the Services, August 2018.

O'Keefe, Victoria M., and Greg M. Reger, "Suicide Among American Indian/Alaska Native Military Service Members and Veterans," Psychological Services, Vol. 14, No. 3, August 2017, pp. 289–294.

Schmied, Emily A., Robyn M. Highfill-McRoy, and Gerald E. Larson, "Mental Health and Turnover Following an Initial Term of Military Service," Military Medicine, Vol. 177, No. 7, July 2012, pp. 766–772.

Schneider, R. J., and J. A. Martin, "Military Families and Combat Readiness," in Franklin D. Jones, Linette R. Sparacino, Victoria L. Wilcox, and Joseph M. Rothberg, eds., Military Psychiatry: Preparing in Peace for War, TMM Publications, 1994, pp. 19–30.

Sims, Carra S., Thomas E. Trail, Emily K. Chen, and Laura L. Miller, Today's Soldier: Assessing the Needs of Soldiers and Their Families, RAND Corporation, RR-1893-A, 2017. As of April 5, 2022:

Steele, Marshall, Anne Germain, and Justin S. Campbell, "Mediation and Moderation of the Relationship Between Combat Experiences and Post-Traumatic Stress Symptoms in Active Duty Military Personnel," Vol. 182, No. 5/6, May/June 2017, pp. e1632–e1639.

Strong, Jessica D., Jennifer L. Akin, Kim D. Hunt, Drew S. Brazer, Kathleen Farace, Karly Howell, Carrie Carter, Rosalinda V. Maury, Rachel K. Linsner, and Jeanette Yih Harvie, 2020 Blue Star Families Military Family Lifestyle Survey, Blue Star Families, 2021.

Taylor, Marcus K., Lisa M. Hernández, and A. Monique Clinton-Sherrod, "Toward a 'Dashboard' Indicator of Retention in U.S. Navy Personnel," Military Medicine, Vol. 186, No. 1/2, January/February 2021, pp. 119–126.

Ursano, Robert J., Ronald C. Kessler, Steven G. Heeringa, Kenneth L. Cox, James A. Naifeh, Carol S. Fullerton, Nancy A. Sampson, Tzs-Cheg Kao, Pablo A. Aliaga, Patti Vegella, Holly Herberman Mash, Christina Buckley, Lisa J. Colpe, Michael Schoenbaum, Murray B. Stein, and Army STARRS collaborators, "Nonfatal Suicidal Behaviors in U.S. Army Administrative Records, 2004–2009: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)," Psychiatry, Vol. 78, No. 1, May 2015, pp. 1–21.

Ursano, Robert J., Ronald C. Kessler, James A. Naifeh, Holly Herberman Mash, Carol S. Fullerton, Pablo A. Aliaga, Gary H. Wynn, Tsz Hin H. Ng, Hieu M. Dinh, Nancy A. Sampson, Tzu-Cheg Kao, Paul D. Bliese, and Murray B. Stein, "Associations of Time-Related Deployment Variables with Risk of Suicide Attempt Among Soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)," JAMA Psychiatry, Vol. 75, No. 6, June 2018, pp. 596–604.

Ursano, Robert J., Ronald C. Kessler, Murray B. Stein, James A. Naifeh, Pablo A. Aliaga, Carol S. Fullerton, Gary H. Wynn, Patti L. Vegella, Tsz Hin Hinz Ng, Bailey G. Zhang, Christina L. Wryter, Nancy A. Sampson, Tzu-Cheg Kao, Lisa J. Colpe, Michael Schoenbaum, James E. McCarroll, Kenneth L. Cox, and Steven G. Heeringa, "Risk Factors, Methods, and Timing of Suicide Attempts Among US Army Soldiers," JAMA Psychiatry, Vol. 73, No. 7, July 2016, pp. 741–749.

Vyas, Kartavya J., Susan F. Fesperman, Bonnie J. Nebeker, Steven K. Gerard, Nicholas D. Boyd, Eileen M. Delaney, Jennifer A. Webb-Murphy, and Scott L. Johnson, "Preventing PTSD and Depression and Reducing Health Care Costs in the Military: A Call for Building Resilience Among Service Members," Military Medicine, Vol. 181, No. 10, October 2016, pp. 1240–1247.

Waitzkin, Howard, Mario Cruz, Bryant Shuey, Daniel Smithers, Laura Muncy, and Marylou Noble, "Military Personnel Who Seek Health and Mental Health Services Outside the Military," Military Medicine, Vol. 183, No. 5/6, May/June 2018, pp. e232–e240.

Williams, D. R., Yu Yan, James S. Jackson, and Norman B. Anderson, "Racial Differences in Physical and Mental Health: Socio-Economic Status, Stress and Discrimination," Journal of Health Psychology, Vol. 2, No. 3, 1997, pp. 335–351.


  • 1 An environmental scan is a research technique used to identify the existing landscape of a problem or issue; the results of the scan can then be used to guide future research efforts, develop evidence-based policy, or create new programs or services (see Graham, Evitts, and Thomas-MacLean, 2008).
  • 2 Several of these articles were included in more than one of the outcome domains; thus, the sum of the number of articles for each domain is higher than the total number of articles included in this review. In the mental health domain, 26 articles were co-listed with other outcome domains (behavioral health: 25; family violence: 3; marital satisfaction: 1). In the behavioral health domain, 25 articles were co-listed with other outcome domains (mental health: 25; family violence: 2; marital satisfaction: 1). In the family violence domain, four articles were co-listed with other outcome domains (mental health: 3; behavioral health: 2; marital satisfaction: 2). In the marital satisfaction domain, two articles were co-listed with other outcome domains (mental health: 1; behavioral health: 1; family violence: 2). No articles were co-listed in the financial stress domain.

This research was sponsored by the Office of the Secretary of Defense and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

RAND Health Quarterly is produced by the RAND Corporation. ISSN 2162-8254.