Psychology of Violence © 2014 American Psychological Association

2014, Vol. 4, No. 2, 128 –142 2152-0828/14/$12.00 DOI: 10.1037/a0034536

Emotional Abuse and Its Unique Ecological Correlates Among

Military Personnel and Spouses

Heather M. Foran Richard E. Heyman

University of Braunschweig and Amy M. Smith Slep
New York University

United States Air Force Family Advocacy Research Program

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Lackland Air Force Base, San Antonio, Texas

This document is copyrighted by the American Psychological Association or one of its allied publishers.

Objective: Identify unique correlates of clinically significant emotional abuse (CS-EA) in a

large representative U.S. sample of men and women. Method: Active duty members of the
U.S. Air Force in relationships (N ⫽ 42,744) and civilian spouses (N ⫽ 17,266) from 82
bases worldwide completed an anonymous online survey on CS-EA, individual, family,
community, and workplace risk factors. Results: Relationship dissatisfaction, poor self-
efficacy, financial stress, and alcohol problems were among the strongest correlates of
emotional abuse among the 21 factors examined. In addition, community factors such as
support from neighbors and community cohesion independently related to men’s CS-EA,
whereas workplace factors were uniquely related to victimization among active duty and
civilian women. The strength of bivariate associations with CS-EA for several family,
workplace, and community factors differed by military/civilian status, gender, and marital
status, but overall ecological models replicated across gender. Conclusions: Although
many workplace and community factors were related to CS-EA bivariately, only a select
few were related after accounting for individual and family factors. CS-EA is an under-
studied but important public health problem and the current study helps to identify key
correlates of CS-EA that can help inform prevention and treatment efforts aimed at reducing
partner violence.

Keywords: domestic violence, psychological abuse, intimate partner violence, marriage, socio-
ecological model

Emotional abuse among intimate partners is
prevalent and a strong predictor of physical
abuse in longitudinal studies (Murphy &
O’Leary, 1989; Schumacher & Leonard, 2005).
In one of the first studies comparing the relative
impact of emotional and physical abuse,
Follingstad and colleagues found that 72% of
female victims reported that the emotional
abuse had a more negative impact on them than
physical abuse (Follingstad, Rutledge, Berg,
Hause, & Polek, 1990). In more recent studies,
emotional abuse was associated with poorer
mental and physical health after controlling for
physical abuse in both male and female victims

Heather M. Foran, Institute for Psychology, University of
Braunschweig, Braunschweig, Germany; Richard E. Heyman
and Amy M. Smith Slep, Department of Cardiology and
Comprehensive Care, New York University; United States
Air Force Family Advocacy Research Program, Lackland Air
Force Base, San Antonio, Texas.
We would like to thank the personnel at the local Air
Force sites who were responsible for promoting the survey,
to Caliber Associates (especially Dr. Chris Spera) for ad-
ministering the Web survey, and to the active duty mem-
bers and their spouses who took time to complete it.
Additionally, we thank Ava Berman and Lisanne Bulling
for their help with preparation of this article. This research
was supported by Centers for Disease Control R01 Grant
1R49CE00091901. The opinions expressed in this article
are solely those of the authors and do not necessarily
represent the official views of the U.S. Government, the
Department of Defense, or the Department of the Air
Force. The authors have no financial or other conflicts of
interest regarding this article.
Correspondence concerning this article should be ad-
dressed to Heather M. Foran, Institute for Psychology,
University of Braunschweig, 33 Humboldtstr., Braun-
schweig, Germany. E-mail: hforan@tu-braunschweig.de

128
 EMOTIONAL ABUSE CORRELATES
(Taft et al., 2006). Emotional abuse also pre-
dicted mental symptoms after controlling for
physical abuse in a longitudinal study of cou-
ples followed for 3 years (Lawrence, Yoon,
Langer, & Ro, 2009). Further, emotional abuse,
but not physical abuse, predicted treatment
dropout in a program designed to reduce both
forms of abuse (Brown, O’Leary, & Feldbau,
1997). Emotional abuse is associated with a
variety of negative health problems including
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depressive symptoms, posttraumatic stress dis-
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order, marital problems, substance abuse disor-
ders, suicide, and physical health problems (e.
g., Coker et al., 2002; Stuart & Holtzworth-
Munroe, 2005). Forms of emotional abuse from
family members (i.e., expressed emotion) have
also been associated with increased risk for
relapse from a number of mental health prob-
lems (Hooley, Miklowitz, & Beach, 2006).
Hence, emotional abuse is an important risk
factor for a variety of mental health problems
that could be targeted with prevention and in-
tervention work. Emotional abuse may repre-
sent an etiological precursor, not only to phys-
ical abuse, but to a wide array of other mental
health problems associated with it.
Study Goals
Examine Correlates of Clinically
Significant Emotional Abuse With New
Measurement Criteria
Given the clinical importance of emotional
abuse, further systematic identification of key
correlates is needed. A number of studies have
identified correlates of emotional abuse in both
clinical and community samples, but implica-
tions of these studies have been hampered by
limitations in the measurement of emotional
abuse (Schumacher, Slep, & Heyman, 2001).
Mild and severe acts of emotional abuse are
clustered together and impact is not assessed.
Mild emotionally aggressive acts occur in
nearly all couples (75% of couples each year)
and estimates of severe forms occur in 6%–9%
of couples each year (Foran, Slep et al., 2011;
Straus & Sweet, 1992). Severe emotional abuse,
rather than mild forms, is a clearer public health
target. The current study improves on past stud-
ies of severe emotional abuse by using new
criteria to operationalize “clinically significant”
emotional abuse (CS-EA)— emotional abuse
129
that results in significant and impairing fear,
stress, or sadness/depression (e.g., Foran, Slep
et al., 2011).
Identify Correlates Within and Across
Ecological Levels Among Military Families
Individual, family, workplace, and commu-
nity level correlates are examined to provide a
more comprehensive evaluation of key corre-
lates for CS-EA using very large samples of
active duty military personnel (N ⫽ 42,744) and
civilian spouses (N ⫽ 17,226). An ecological
perspective to understanding key correlates of
violence has been widely utilized as a way to
integrate findings by leading violence preven-
tion agencies (e.g., Centers for Disease Control,
2011) and the rationale for this theoretical per-
spective has been reviewed elsewhere (e.g.,
Heise, 1998; Krug, Dahlberg, Mercy, Zwi, &
Loranzo, 2002; Stith, Smith, Penn, Ward, &
Tritt, 2004). Given the lack of epidemiological
literature on CS-EA, the ecological approach
provides an attractive, broad exploratory frame-
work to integrate the key correlates of CS-EA
detected. Thus, although there have been other
studies that examined emotional abuse corre-
lates, most previous studies have relied on small
samples and assessed a limited number of cor-
relates restricting implications for understand-
ing how correlates relate from an ecological
framework. This information can be used to
inform interventions operating at different eco-
logical levels (e.g., individual therapy, commu-
nity prevention).
In particular, what is needed is more un-
derstanding of the role of how more distal
ecological factors may contribute to under-
standing victimization. Much research has ex-
amined individual and family level factors,
but less is known about workplace and com-
munity factors. Examining these types of fac-
tors in an intact organization such as the U.S.
Air Force is particularly informative for help-
ing leaders identify broader organization or
community-wide factors that could be tar-
geted.
The quality of the workplace/organization
environment has been associated with risk for
mental health problems and family conflict
(Ford, Heinen, & Langkamer, 2007; Wright,
Foran, Wood, Eckford, & McGurk, 2012).
Among military families, deployments and
 130 FORAN ET AL.
long work hours may increase stress and fam-
ily conflict (e.g., McCarroll et al., 2000).
Quality of leadership, overall job satisfaction,
and relationships with coworkers may also
place strain on families, leading to more re-
lationship conflict, and in turn, more emo-
tional victimization by partners. Although
these workplace factors have been identified
as potential risk factors for family strain,
there has little research on which factors are
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most important to emotional victimization
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among military personnel and spouses.
In addition to specific workplace factors,
the broader support structure of the military
community may provide valuable resources
that help military families reduce risk for
emotional victimization. This community
support may come in the form or general
social support, military-specific support from
formal agencies or for youth, or support from
neighbors (Bowen, Mancini, Martin, Ware, &
Nelson, 2003). Other factors such as sense of
belonging and cohesion within the military
community may lead to improved coping with
military stressors and less family conflict and
victimization. Further, similar to studies with
civilians, low levels of community safety and
high community stressors may increase vic-
timization rates (Little & Kaufman, 2002;
Pinchevsky & Wright, 2012).
Taken together, a main goal of this study
was to examine which community and work-
place factors contribute after accounting for
well-known individual (e.g., alcohol prob-
lems) and family level (e.g., relationship dis-
satisfaction) correlates of victimization. No-
tably, many individual and family factors
such as relationship dissatisfaction, self-
efficacy, and alcohol problems, may function
as a risk factor, consequence, or both. Given
the cross-sectional nature of the study, we are
not able to address the question of direction-
ality, but rather address the question of which
factors appear to relate uniquely to CS-EA
using large samples and testing within and
across ecological levels. Which work and
community factors relate uniquely in the con-
text of other individual and family factors can
help identify what factors deserve further at-
tention in terms of prevention research and
longitudinal studies.
Test Gender Differences and
Generalizability Across Marital Status
The current study examined ecological cor-
relates of CS-EA in a large sample of Air
Force active duty members and civilian
spouses. There has been little research on
CS-EA among military personnel and spouses
and it is unclear whether similar ecological
factors will play a role for active duty mem-
bers and spouses. Thus, a range of correlates
identified in past civilian samples (e.g., alco-
hol problems, relationship dissatisfaction,
community safety) and correlates specific to
the military environment were included (e.g.,
spouse support for deployments, weeks de-
ployed, years in the military).
Among active duty members, significant
unique correlates of CS-EA detected in the cur-
rent study were tested for generalizability across
marital status given some evidence that rela-
tionship violence may differ for married and
nonmarried couples (Campbell et al., 2003). All
results were computed separately for men and
women due to previous empirical and theoreti-
cal literature that suggests gender differences in
victimization (e.g., Coker et al., 2002; Yllo,
1993). Further, there is limited literature on
male victims of CS-EA and it is unclear whether
the same factors will be important for both men
and women.
Method
Participants
Active duty (AD) members (N ⫽ 128,950) of
the United States Air Force (AF) and all civilian
spouses of AF AD members (N ⫽ 157,455)
were invited to complete the 2006 Community
Assessment (CA); this is a biennial, anonymous
survey conducted at 82 Air Force sites world-
wide. A total of 54,543 AD members and
19,722 spouses responded to the invitations,
resulting in a response rate of 44.7% for AD
members and 12.3% for spouses. The AD sam-
ple and civilian spouse sample represented two
separate samples of individuals rather than cou-
ples. Prior to analyses, one member of all iden-
tifiable couples (dual AD couples or AD mem-
ber/civilian couples n ⫽ 1595) were removed
from the dataset due to their nonindependence).
For the present study, only those in current
 EMOTIONAL ABUSE CORRELATES
relationships were eligible; this resulted in an
analytical sample of AD members that included
34,713 men and 8,031 women in current rela-
tionships with the majority of participants being
married (88.4%). The AD sample was weighted
on marital status, base, ethnicity, religion, mil-
itary rank, and job type to be representative of
the U.S. Air Force and account for oversam-
pling at small bases and differential response
rates (see Foran, Slep et al., 2011 for un-
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weighted demographic characteristics).
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After data cleaning, the civilian spouse sam-
ple included 879 men and 16,347 women. The
mean age was 38.37 (SD ⫽ 9.95) for men and
33.08 (SD ⫽ 7.67) for women. Employment
status of spouses was as follows: full-time
(45.7% men; 12.1% women), part-time (13.5%
men; 32.4% women), and unemployed (40.7%
men; 51.3% women). The majority of the sam-
ple had at least one child living with them
(76.3% men; 74.2% women). The spouse sam-
ple was not weighted due to a lack of informa-
tion on population marginals for spouses of AD
members.
As reported in detail previously (Slep, Foran,
Heyman, Snarr, & U.S. Air Force Family Ad-
vocacy Program, 2011), over 75% of partici-
pants completed the full survey and the remain-
der had missing survey responses on at least one
question. Fifty iterations of multiple imputation
were conducted, with every tenth resulting da-
taset saved, resulting in five imputed datasets
for analysis.
Procedure
The 2006 CA was administered by Caliber
Associates. The survey was entirely Web-
based; each AD member selected to participate
was sent an e-mailed invitation containing the
Web link to the survey, as well as an access
code. Weekly e-mails were sent reminding AD
members to participate; each base also con-
ducted community-wide campaigns to encour-
age participation. All civilian spouses of AF AD
members were also sent three postcard invita-
tions.
Measures
Clinically significant emotional intimate
partner violence (CS-EA; Heyman & Slep,
2009). CS-EA was assessed with a series of
questions to assess both acts of emotional abuse
131
and impact. First, participants were asked
whether they experiencing significant depres-
sion/sadness, stress, and/or fear in the past 12
months as a result of their partners’ behavior
(11 items; e.g., “During the past 12 months,
were you so stressed that it affected you almost
every day for 2 weeks?” “How much of this
stress was related to things your partner said or
did?”). If they endorsed experiencing one of the
impacts due to their partner’s behavior, they
were then presented with a list of 10 specific
acts and asked how often (in the past year) their
partners had committed them (e.g., “put me
down or humiliated me,” “stalked me,” “grilled
or interrogated me about where I had been, what
I had done, etc.”). If at least one act was re-
ported, participants were presented with a list of
all endorsed acts and asked whether the acts had
caused or contributed to the depression, stress,
and/or fear they had reported earlier. Responses
to the “write-in” item (i.e., “Did another similar
behavior not listed here. . .”) were later coded
for whether they described an act of emotional
aggression. CS-EA was operationalized as (a) at
least one reported emotionally aggressive act
that caused (b) significant stress, depression, or
fear (for the victim’s own safety or that of
someone s/he cared about) that interfered with
the functioning. Internal consistency of the 10
acts of partner emotional abuse among active
duty members (.80 for men and .76 for women)
and spouses (.76 men and .76 women) was
comparable with the Conflict Tactics Scale-2
(CTS2; e.g., O’Leary & Williams, 2006).
This measure assesses victimization, rather
than perpetration; emotional/psychological im-
pacts on victims are not reliably reported by
those perpetrating the emotional violence be-
cause they may not be aware of the impacts on
their partner. Understandably, individuals who
are victims of CS-EA may not want to disclose
the emotional impact to their abusive partner for
fear that it could be used as ammunition for
future emotional abuse.
Overall, the results obtained by Heyman et al.
(2012) largely supported the validity of the
measure. Respondents were invited to record
oral descriptions/explanations of the behaviors
and impacts (if any) they had endorsed on the
questionnaire. Independent ratings of these au-
dio recordings, made by trained coders, indi-
cated no “false negatives” on the questionnaire
for CS-EA. Heyman et al., 2012 also demon-
 132 FORAN ET AL.
strated that the questionnaire converges well
with the CTS2 (Straus, Hamby, Boney-McCoy,
& Sugarman, 1996). Specifically, yes/no agree-
ment between the CS-EA measure and CTS2
for emotionally aggressive acts was 81%. Fur-
ther, in a 41-site field trial of the CS-EA oper-
ational definition, there was high agreement be-
tween field site reviewers (primarily clinical
social workers) and master reviewers (93%,
Heyman & Slep, 2009).
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Notably, most participants who reported ele-
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vated depressive symptoms (as defined by Cen-
ter for Epidemiological Studies Depression
Scale; Radloff, 1977, scores greater than 14) did
not meet criteria for CS-EA (AD members:
69.8% of men and 68.6% of women; spouses:
66.1% men, 66.0% women), and many partici-
pants who experiencing CS-EA did not endorse
the depression/sadness impact item (AD mem-
bers: 70.0% of men, 50.8% of women; spouses:
77.5% of men, 76.6% of women). In other
words, the majority of the sample endorsed
other impacts of emotional abuse such as stress
and fear rather than depression/sadness.
Self-efficacy. Nine items assessed partici-
pants’ ability to cope with stress and to manage
work and family demands (e.g., “I can usually
handle whatever comes my way”). This mea-
sure included the six highest loading items from
the General Self-Efficacy Scale (Scholz, Guti-
errez, Sud, & Schwarzer, 2002), and three items
developed for an earlier CA (␣ ⫽ .84 AD mem-
bers; ␣ ⫽ .85 spouses). This measure has been
used in other studies with military samples and
is negatively associated with mental health
symptoms (Foran, Heyman, Slep, & U.S. AF
Family Advocacy Program., 2011).
Physical well-being. The physical health
subscale of the Short Form-8 Health Survey
(Ware, Kosinski, Dewey, & Gandek, 2001)
adapted for use in military populations assessed
overall current health, pain, energy levels, sleep,
diet, and exercise patterns (six items, ␣ ⫽ .65
AD members; ␣ ⫽ .67 spouses). The Short
Form Health Survey is a widely used and well-
validated measure of health status and has been
used for epidemiological research in many
countries.
Perceived financial stress. Five items
were drawn from the Social Change in Canada
Survey (Krause & Baker, 1992), a financial
strain scale (Vinokur, Price, & Caplan, 1996),
and a measure of family economic pressure
(Conger et al., 1993). The items (e.g., “How
much difficulty do you have paying your bills
each month?”) were rated on a Likert scale from
1 to 5 with higher scores indicating more finan-
cial stress. This scale has a stable one factor
structure (Snarr, Heyman, & Slep, 2006) and
good internal consistency (␣ ⫽ .90 AD mem-
bers; ␣ ⫽ .84 spouses).
Alcohol problems. The 10-item Alcohol
Use Disorders Identification Test (AUDIT;
Rumpf, Hampke, Meyer, & John, 2002) was
administered. Scores range from 0 to 40 with
higher scores indicating more alcohol problems.
This measure has been validated against other
clinical assessments of alcohol problems
(Rumpf et al., 2002; ␣ ⫽ .85 AD members; ␣ ⫽
.80 spouses).
Family income. Active duty member’s in-
come was calculated using salary statistics for
individuals with particular pay grades and years
of military experience provided by the U.S. Air
Force for 2006. Additional income from second
jobs, housing allowances, and subsistence al-
lowances were added to the base salary. Spouse
income was estimated from information pro-
vided on average income based on spouse gen-
der and whether the spouse worked full- or
part-time (U.S. Census Bureau, 2006). This es-
timated spouse income was added to AD mem-
ber’s income to create an estimate of overall
family income.
Relationship satisfaction. Four items from
the widely used Quality of Marriage Index
(QMI; Norton, 1983) were administered. Three
items asked AD members to rate how much
they agree with statements about their relation-
ship on a 6-point scale. The fourth item asked
AD members to rate their level of happiness in
their relationship, all things considered, on a
scale ranging from 1 to 9. Scores across the four
items were averaged to yield a range of scores
from 1 to 6.5 (␣ ⫽ .92 AD members; ␣ ⫽ .95
spouses).
Career support from significant other.
This was assessed with three face-valid ques-
tions asking respondents to rate their partners’
levels of understanding and support for the re-
spondents’ AF jobs and careers (e.g., “My part-
ner is understanding of the demands of my Air
Force job” from almost never to most of the
time; ␣ ⫽ .77 AD members; ␣ ⫽ .77 spouses).
This measure is moderately correlated with
 EMOTIONAL ABUSE CORRELATES
other indices of relationship functioning (Slep
et al., 2011).
Ability of spouse to cope with deployment.
Two items inquired about spouses’ preparation
to handle family matters in the case of the AD
member’s deployment, as well as difficulty the
spouses would likely experience in the case of
deployment (see Spera, 2009, for more details
on this measure among military personnel; ␣ ⫽
.63 AD members; ␣ ⫽ .66 spouses).
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Family coping. Three items assessed fam-
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ilies’ ability to work together as a team, keep
positive perspectives during rough times, and
directly confront problems or challenges rated
on a 6-point scale from almost never to almost
always (e.g., “When my family faces a chal-
lenge or difficulty, we confront the problem
directly”). This measure was developed and val-
idated as part of the 2003 CA (Bowen et al.,
2003); it correlates with other measures of fam-
ily functioning, has a stable one factor structure
across four validation samples (all items load-
ing greater than .77; Snarr et al., 2006), and has
good internal consistency (␣ ⫽ .89 AD mem-
bers; ␣ ⫽ .88 spouses).
Weeks deployed. Respondents were asked
to report how much time they spent deployed or
on temporary duty assignments in the 12
months prior to survey participation.
Work group cohesion/preparedness. This
scale, completed by AD members only, com-
prised six questions, adapted from an Army
Family Research Program individual readiness
measure (U.S. Army Community & Support
Center, 1989) that elicited ratings of various
indicators of squadron cohesion (e.g., sticking
together, working together as a team, having
high morale). This measure correlates with
other work measures (Slep et al., 2011) and had
good internal consistency in this sample (␣ ⫽
.88 AD members).
Satisfaction with the Air Force. Five
items assessed satisfaction with the Air Force as
a way of life for AD members and their families
(␣ ⫽ .88 AD members). This measure was
developed for the 2003 CA and expanded to
improve validity in the 2006 CA (Snarr et al.,
2006).
Work relationships. Three items assessed
the quality of AD members’ relationships with
coworkers, supervisors, and supervisees. This
measure, developed for this study, was com-
pleted by AD members only (␣ ⫽ .85 AD
133
members). This measure correlates with other
indices of work quality and negatively corre-
lates with time deployed (Slep et al., 2011).
Support from leadership. Seventeen
items, developed and evaluated as part of the
CA, assessed the level of support received from
various AF leaders and the preparation received
before and support received after a deployment.
For spouses, the same questions were asked in
reference to leaders in their husband’s/wife’s
unit but only included the questions before and
after the deployment (14 items; ␣ ⫽ .94 AD
members; ␣ ⫽ .90 spouses). Low support from
leadership is associated with poorer mental
health among military personnel (Slep et al.,
2011).
Support from formal agencies. Six items
measured satisfaction with the abilities of for-
mal community agencies to meet member and
family needs, and with official base programs
and services. This scale, developed and refined
based on a previous CA, has excellent internal
consistency, a stable factor structure, and cor-
relates with other community measures of sup-
port (Snarr et al., 2006; ␣ ⫽ .95 AD members;
␣ ⫽ .96 spouses).
Social support. Social support was as-
sessed with a series of five questions, adapted
from the 1989 Army Soldier and Family Survey
(Research Triangle Institute, 1990), that in-
quired about the availability of tangible support
from various sources (e.g., friends, neighbors,
coworkers, relatives) across a number of differ-
ent realms (␣ ⫽ .94 AD members; ␣ ⫽ .95
spouses).
Community safety. Six items assessed
perceived safety. Four of the items were
adapted from the Knight Community Indicators
Survey (Princeton Survey Research Associates,
1999). This measure has good structural validity
and relates to other measures of community
health (Foran, Heyman et al., 2011; Snarr et al.,
2006; ␣ ⫽ .77 AD members; ␣ ⫽ .78 spouses).
Community stress. Sixteen questions, de-
veloped and validated in a previous CA (Snarr
et al., 2006), assessed the availability, quality,
and affordability of community resources (e.g.,
housing, health care, child care, transportation;
␣ ⫽ .89 AD members; ␣ ⫽ .91 spouses).
Community cohesion. Twenty-one items
assessed members’ senses of shared mission,
teamwork, unity, and connectedness in the com-
munity (Bowen et al., 2003). Low community
 134 FORAN ET AL.
cohesion is a predictor of neighborhood disor-
der and a risk factor of family violence (e.g.,
Bowen et al., 2003; Slep et al., 2011). Items are
rated on a 6-point scale from strongly disagree
to strongly agree (e.g., “Civilian spouses/active
duty members find it easy to make connections
with other families”; ␣ ⫽ .95 AD members;
␣ ⫽ .96 spouses).
Support from neighbors. Six items as-
sessed support from people in the neighbor-
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hood, and one question (adapted from the Social
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Capital Benchmark Survey, 2000) asked how
often neighbors get together to fix or improve
something. This measure is moderately corre-
lated with other support measures (Slep et al.,
2011) and has excellent internal consistency
(␣ ⫽ .93 AD members; ␣ ⫽ .93 spouses).
Results
The prevalence of CS-EA (as reported previ-
ously, Foran, Slep et al., 2011) was 6% for men
and 8.5% for women AD women. The preva-
lence among spouses was 6.5% for men and
10.7% for women.
Analytical Strategy
The active duty sample was randomly split
into a development sample and validation sam-
ple to permit cross-validation analyses. This
resulted in a development sample of 17,247
men and 4,016 women and a validation sample
of 17,466 men and 4,015 women. The spouse
sample was analyzed separately to elucidate
potential differences between spouses and AD
member populations; it consisted of 879 men
and 16,347 women.
Bivariate Level Analyses
Analyses of bivariate relationships between
CS-EA and each of the study variables were
conducted using logistic regression with the de-
velopment sample of AD members and the
civilian spouse sample separately. Logistic re-
gression coefficients, odds ratios, and confi-
dence intervals are presented in Table 1.
To explore potential gender differences and
differences between same gender AD and civil-
ian samples further, coefficients were tested for
differences in strength of associations using the
formula provided by Altman and Bland (2003).
Significant differences are shown in Table 1 as
indicated by paired superscripts. Significant
gender differences were found between AD
men and AD women for three family level
variables and one organization/work level vari-
able. Poorer family coping and having more
children were more strongly associated with
CS-EA for women (family coping: z ⫽ 2.83,
p ⫽ .005; number of children: z ⫽ ⫺2.61, p ⫽
.009) and lower family income and poorer work
relations were more strongly associated with
CS-EA for men (family income: z ⫽ ⫺2.65,
p ⫽ .008; work relations ⫽ z ⫽ ⫺2.53, p ⫽
.12). There were no significant gender differ-
ences between civilian men and women, but
sample sizes for all comparisons between civil-
ian men and other groups were unbalanced,
limiting ability to detect differences. Similarly,
among AD men and civilian men, there was
only one significant difference; poor family
coping was more strongly associated with
CS-EA among AD men compared to civilian
men (z ⫽ 1.97, p ⫽ .049).
In contrast, there were several differences in
strength of associations between AD and civil-
ian women. Poor physical well-being (z ⫽ 2.52,
p ⫽ .012) and lower family income (z ⫽ 4.38,
p ⫽ .000) were more strongly associated with
more CS-EA among civilian than AD women.
Not surprisingly, women’s report of received
deployment support from their husbands (AD
women) was more related to their own lower
emotional victimization than women’s report of
provided deployment support to their husbands
(civilian women; z ⫽ ⫺2.36, p ⫽ .018). Fur-
ther, among AD women, having more children
was more strongly related to higher CS-EA than
for civilian women (z ⫽ 4.49, p ⫽ .013).
Ecological Models for Active Duty
Members
Backward stepwise logistic regression analy-
ses were conducted for each ecological level for
men and women on the development sub-
sample. The specific variables entered for each
ecological level are listed in Table 1. The final
models of the variables that made a unique
contribution in accounting for variance in
CS-EA within the work and community level in
the development subsamples are presented in
Table 2. The unique variables at the work and
community level were then added to a com-
 EMOTIONAL ABUSE CORRELATES 135

Table 1
Bivariate Logistic Regression Analyses of CS-EA Victimization
Military personnel Civilian spouses
Men Women Men Women
OR CI OR CI OR CI OR CI
Individual level
Alcohol problems 1.34 [1.26, 1.33] 1.34 [1.17, 1.53] 1.51 [1.12, 2.04] 1.35 [1.27, 1.43]
Financial stress 1.58 [1.49, 1.67] 1.37 [1.21, 1.56] 1.54 [1.25, 1.91] 1.57 [1.50, 1.63]
Self-efficacy 0.61 [0.57, 0.65] 0.67 [0.61, 0.75] 0.59 [0.46, 0.76] 0.60 [0.57, 0.63]
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Physical well-being 0.65 [0.60, 0.69] 0.70a [0.63, 0.79] 0.66 [0.53, 0.82] 0.60a [0.57, 0.63]
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Years in the military 0.84 [0.77, 0.92] 0.87 [0.73, 1.02] 0.83 [0.59, 1.18] 0.78 [0.73, 0.83]
Family level
Support from sign. other 0.64 [0.60, 0.68] 0.62 [0.55, 0.69] 0.62 [0.49, 0.79] 0.66 [0.63, 0.69]
Relationship satisfaction 0.39 [0.36, 0.42] 0.41 [0.35, 0.47] 0.38 [0.29, 0.49] 0.39 [0.37, 0.42]
Number of children 1.01a [0.93, 1.09] 1.23ab [1.08, 1.39] 1.19 [0.90, 1.57] 1.03b [0.98, 1.09]
Family income 0.86a [0.78, 0.95] 1.04ab [0.94, 1.16] 0.89 [0.58, 1.36] 0.79b [0.75, 0.84]
Marital length 0.82 [0.74, 0.91] 0.81 [0.65, 1.01] 0.89 [0.66, 1.18] 0.77 [0.72, 0.83]
Family coping 0.58ab [0.54, 0.62] 0.47a [0.42, 0.54] 0.42b [0.30, 0.58] 0.45 [0.42, 0.48]
Spouse deploy. support 0.64 [0.59, 0.69] 0.65a [0.58, 0.73] 0.73 [0.58, 0.92] 0.76a [0.73, 0.80]
Work level
Support from leadership 0.74 [0.70, 0.78] 0.77 [0.69, 0.86] 0.79 [0.64, 0.96] 0.75 [0.72, 0.79]
Satisfaction with AF 0.71 [0.66, 0.77] 0.76 [0.68, 0.85] — — — —
Workgroup cohesion 0.76 [0.71, 0.81] 0.82 [0.72, 0.94] — — — —
Work relations 0.74a [0.69, 0.80] 0.89a [0.79, 1.01] — — — —
Weeks deployed 0.97 [0.90, 1.04] 0.98 [0.84, 1.14] 0.88 [0.65, 1.17] 0.97 [0.92, 1.02]
Hours worked 1.11 [1.05, 1.18] 1.21 [1.08, 1.36] 0.91 [0.55, 1.07] 1.13 [1.07, 1.18]
Community level
Community cohesion 0.72 [0.68, 0.76] 0.82 [0.72, 0.93] 0.76 [0.61, 0.94] 0.78 [0.74, 0.81]
Support from neighbors 0.76 [0.71, 0.80] 0.85 [0.76, 0.94] 0.82 [0.63, 1.06] 0.80 [0.76, 0.83]
Support formal agencies 0.76 [0.71, 0.82] 0.82 [0.73, 0.92] 0.75 [0.57, 0.97] 0.81 [0.77, 0.85]
Social support 0.78 [0.73, 0.83] 0.87 [0.78, 0.98] 0.83 [0.64, 1.08] 0.79 [0.76, 0.83]
Community safety 0.81 [0.76, 0.86] 0.88 [0.79, 0.98] 0.84 [0.65, 1.10] 0.79 [0.75, 0.83]
Community stressors 0.76 [0.71, 0.81] 0.86 [0.76, 0.98] 1.31 [1.06, 1.62] 1.31 [1.25, 1.37]
Note. ORs ⫽ Odds Ratios. CI ⫽ 95th percentile Confidence Interval. Military personnel sample in development sample:
n ⫽ 17,247 men and n ⫽ 4,016 women for all variables except those that were only answerable by married individuals
(marital length, family coping, spouse deployment support: n ⫽ 14,909 men and n ⫽ 2,937 women). Spouse sample: n ⫽
879 men; n ⫽ 16,347 women.
a,b
⫽ paired subscripts indicate parameter estimates are significantly different between men and women or between same
gender military personnel and spouses, p ⬍ .05.

bined model with the unique individual and
family level variables. The final model across
ecological level for the full sample and those
who were married is also shown in Table 2.
Models were tested separately across genders,
but all variables that made a contribution to the
model for men or women are included so that
the model can be compared across gender.
Several work and community level vari-
ables were uniquely related to CS-EA for men
and women. When individual and family level
variables were also included in the model (see
Across Ecological Levels in Table 2), one
work variable—number of hours worked—
accounted for additional variance over and
above individual and family factors among
married women such that more work hours
was associated with more CS-EA. For men,
two community factors also added uniquely to
the overall model even after accounting for
individual and family factors (more support
from neighbors and community cohesion, less
CS-EA). As expected, the strongest correlates
tended to be individual and family level vari-
ables (e.g., lower relationship satisfaction,
more alcohol problems, more CS-EA).
 136 FORAN ET AL.

Table 2
Logistic Regression Analyses of Emotional Victimization and Tests for Cross-Validation and
Generalizability Across Marital Status and Gender for Active Duty Members
Men Women
Development sample CV MS Development sample CV MS Gender
Wald’s Wald’s
b SE statistic Rubin’s Fa b SE statistic Rubin’s Fa
Work level
Satisfaction with AF ⫺0.23 0.04 27.11ⴱⴱⴱ 0.42 4.88ⴱⴱⴱ ⫺0.21 0.06 11.28ⴱⴱ 0.42 2.56 2.37
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Work relations ⫺0.16 0.04 14.53ⴱⴱⴱ ⫺0.03 0.07 0.18

9.79ⴱⴱ 10.78ⴱⴱ
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Hours worked 0.10 0.03 0.19 0.06

Support from leadership ⫺0.15 0.04 15.95ⴱⴱⴱ ⫺0.19 0.06 9.22ⴱⴱ
Community level
Community cohesion ⫺0.20 0.04 20.56ⴱⴱⴱ 0.81 2.08 ⫺0.15 0.05 9.40ⴱⴱ 0.19 0.57 2.51
Support from neighbors ⫺0.10 0.04 7.23ⴱⴱ ⫺0.12 0.03 12.78ⴱⴱⴱ
Social support ⫺0.09 0.04 5.37ⴱ ⫺0.10 0.06 3.00
Community safety ⫺0.09 0.03 7.41ⴱⴱ ⫺0.08 0.04 4.43ⴱ
Support formal agencies 0.06 0.05 1.37 0.03 0.05 0.38
Across ecological levels
Relationship satisfaction ⫺0.81 0.04 510.10ⴱⴱⴱ 0.12 1.66 ⫺0.78 0.08 103.17ⴱⴱⴱ 0.47 0.67 1.04
Financial stress 0.23 0.04 43.78ⴱⴱⴱ 0.07 0.08 0.79
Self-efficacy ⫺0.18 0.04 20.02ⴱⴱⴱ ⫺0.14 0.07 4.10ⴱ
Alcohol problems 0.11 0.03 11.49ⴱⴱ 0.21 0.08 8.14ⴱⴱ
Physical well-being ⫺0.11 0.05 6.22ⴱ ⫺0.13 ⫺.07 3.77
Support from neighbors ⫺0.08 0.04 4.94ⴱ ⫺0.05 0.06 0.63
Support from sign. other ⫺0.07 0.03 3.87ⴱ ⫺0.12 0.06 3.55
Number of children 0.01 0.04 0.02 0.22 0.07 8.88ⴱⴱ
Across ecological levels
married sample
Relationship satisfaction ⫺0.87 0.04 485.65ⴱⴱⴱ 0.37 NA ⫺0.82 0.91 81.44ⴱⴱⴱ 1.29 NA 2.45
Financial stress 0.23 0.04 31.99ⴱⴱⴱ ⫺0.03 0.09 0.00
Self-efficacy ⫺0.18 0.04 18.28ⴱⴱⴱ ⫺0.20 0.08 7.05ⴱⴱ
Spouse deploy. support ⫺0.18 0.04 17.18ⴱⴱⴱ ⫺0.23 0.07 9.88ⴱⴱ
Community cohesion ⫺0.13 0.04 10.35ⴱⴱ 0.02 0.11 0.04
Alcohol problems 0.11 0.04 9.34ⴱⴱ 0.23 0.09 6.99ⴱⴱ
Hours worked ⫺0.06 0.05 1.60 0.21 0.10 4.54ⴱ
Note. Development Sample: n ⫽ 17,247 men, n ⫽ 4,016 women. Validation Sample: n ⫽ 17,466 men, n ⫽ 4,015. Across
Ecological Level ⫽ all significant unique predictors for men and women in relationships. Across Ecological Levels
Married ⫽ all significant unique predictors for married men and women (n ⫽ 29,992 men, n ⫽ 5,861 women). Support from
Sign. Other ⫽ Career Support from Significant Other. Spouse Deploy. Support ⫽ Spouse Support for Deployment. CV ⫽
cross-validation of model results across development and validation samples. MS ⫽ comparisons of model results across
married versus nonmarried individuals. Gender ⫽ comparison of model results across gender.
a
Significant Rubin’s F indicates strength of risk factors are different across groups.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001.

Cross-Validation and Generalizability Mplus 5.1 statistical software (Muthén and

Across Marital Status and Gender—Active
Duty Members
After the logistic regressions were performed
on the development subsamples, the final models
were tested to see whether the results cross-
validated in the independent sample and to see
whether results were generalizable across marital
status and gender among active duty members.
Muthén, 2007) was used for the analyses. The
final logistic regression models were tested con-
straining the regression coefficients to be equal
across validation or generalizability groups (e.g.,
married vs. unmarried, development vs. validation
samples, men vs. women). The models were run a
second time with the regression coefficients free
to vary across validation or generalizability
groups. The chi-square difference test was used to
 EMOTIONAL ABUSE CORRELATES 137

calculate whether the chi-square from the con-
strained to be equal analyses differed significantly
from the chi-square from the unconstrained anal-
yses. A significant scaled Satorra-Bentler chi-
square difference test indicates there is a signifi-
cant difference in model fit across validation
groups, gender, or marital status. The chi-square
values across the five imputed datasets were com-
bined using the formula provided by Rubin and
Schenker (1991) that takes into account differ-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
tors indicated that satisfaction with the Air
Force and support from leadership were not
significant predictors for unmarried men’s emo-
tional abuse but were for married men such that
married men who reported higher satisfaction
with the Air Force and support from leadership
reported lower emotional abuse (Rubin’s F ⫽
9.07, p ⬍ .001). The difference between men’s
hours worked and work relations association
with victimization was not significantly differ-

ences in variance across imputed datasets. ent for unmarried or married men (Rubin’s F ⫽
This document is copyrighted by the American Psychological Association or one of its allied publishers.

As can be seen in Table 2, the chi-square 1.27, p ⫽ .31).

difference test was not significant (p ⬎ .05) in
the tests for cross-validation, indicating that
constraining the coefficients across the develop-
ment and validation samples did not signifi-
cantly worsen model fit. Hence, all the models
cross-validated in the hold-out samples for men
and women. The regression coefficients were
also not significantly different across gender,
indicating that the work, community, and across
the ecological level models all generalized
across gender (p ⬎ .05).
The work level model for men did not, how-
ever, generalize across married and unmarried
men. Pairwise comparison of work level predic-
Ecological Models for Civilian Spouses
Lastly, to identify which ecological variables
related to CS-EA among the separate samples of
civilian spouses, backward stepwise regression
analyses were run on the civilian spouse sam-
ples of men and women and are presented in
Table 3. As apparent from the bivariate analyses
presented in Table 1, patterns of association for
AD members and civilian spouses were not
identical and, therefore, testing the models in-
dependently was preferred. Notably, there were
fewer unique correlates of CS-EA for civilian

Table 3
Logistic Regression Analyses of Civilian Spouses’ Emotional Victimization
Men Women
b SE Wald’s statistic b SE Wald’s statistic
Work level
Support from leadership ⫺0.23 0.10 5.33ⴱ ⫺0.28 0.03 123.10ⴱⴱⴱ
Hours worked 0.10 0.03 15.08ⴱⴱⴱ
Community level
Community cohesion ⫺0.12 0.03 16.06ⴱⴱⴱ
Support from neighbors ⫺0.07 0.03 6.67ⴱ
Social support ⫺0.10 0.03 12.60ⴱⴱⴱ
Community safety ⫺0.11 0.03 13.62ⴱⴱⴱ
Community stress 0.26 0.11 5.98ⴱ 0.10 0.03 11.58ⴱⴱ
Across ecological levels
Relationship satisfaction ⫺0.88 0.14 40.96ⴱⴱⴱ ⫺0.77 0.04 408.40ⴱⴱⴱ
Alcohol problems 0.28 0.14 3.92ⴱ 0.22 0.03 44.34ⴱⴱⴱ
Financial stress 0.23 0.11 4.43ⴱ 0.18 0.03 38.54ⴱⴱⴱ
Marital length ⫺0.18 0.04 15.40ⴱⴱⴱ
Family coping ⫺0.19 0.05 16.68ⴱⴱⴱ
Spouse deploy. support ⫺0.09 0.03 9.59ⴱⴱ
Family income ⫺0.09 0.04 6.09ⴱ
Physical well-being ⫺0.22 0.03 48.71ⴱⴱⴱ
Support from leadership ⫺0.07 0.03 4.68ⴱ
Note. n ⫽ 879 men, n ⫽ 16,347 women. Spouse Deploy. Support ⫽ Spouse Support for Deployment. Across Ecological
Levels ⫽ all significant unique predictors for civilian spouses.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001.
 138 FORAN ET AL.
men than for women, but the power to detect
differences was also much stronger for the
women sample due to the larger sample size.
Gender differences for the models in Table 3
were not tested due to the large differences in
sample size for men and women and dissimi-
larity in the models found. Similar to the results
for AD members, individual and family level
variables were the strongest correlates of CS-
EA. Among women civilians, the work level
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variable—support from leadership—was also
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uniquely associated with reduced CS-EA.
Discussion
The current study examined correlates of
men’s and women’s clinically significant emo-
tional abuse using a large epidemiological mil-
itary sample. Most previous work on emotional
abuse has not examined clinically significant
levels and little is known about which factors
are most related to men’s and women’s CS-EA
victimization within and across ecological lev-
els. Findings of this study contribute to the
literature on severe emotional abuse and inform
prevention and treatment operating at different
ecological levels.
At the bivariate level, nearly all individual,
family, workplace, and community factors were
significant related to CS-EA. However, only a
subset of these factors accounted for unique
variance in CS-EA. Consistent with expecta-
tions, most factors that accounted for unique
variance were individual and family level fac-
tors such as relationship dissatisfaction, per-
ceived financial stress, alcohol problems, and
self-efficacy. In addition, a set of work and
community factors were uniquely related to
CS-EA even after accounting for the individual
and family factors, highlighting potential targets
for prevention at the organization and military
community levels. More support from neigh-
bors and community cohesion were uniquely
related to reduced risk of CS-EA for AD men
and less hours worked was uniquely related to
reduced risk of CS-EA for AD women. Among
civilian women, more support from leadership
related to lower CS-EA across ecological levels.
Interestingly, all multivariate models for ac-
tive duty members were not significantly differ-
ent across gender and only the work factors
differed across marital status. This suggests that
factors that relate to CS-EA and could be tar-
geted in prevention planning, may be similar
across genders and for different relationship
types (dating or married). However, in terms of
the strength of the bivariate relationships, some
factors were stronger for specific subgroups.
Physical well-being was more related to CS-EA
of civilian women than AD women. This may
relate to differences between the two popula-
tions in that a minimum level of physical health
is required for active duty service. It may be that
the emphasis on being physically fit related to
their occupation protects them from victimiza-
tion common to civilian women related to phys-
ical health and weight (e.g., being called fat by
their partner). Alternatively, it may also be that
female spouses of AD men are more susceptible
to emotional abuse related to health issues (such
as weight gain) due to their partners being more
focused on physical health as a part of their
occupation.
Another interesting finding was that high
family income was related to less CS-EA
among AD men and civilian women than for
AD women whereas having children was asso-
ciated with more CS-EA among AD women
than either AD men or civilian women. Previ-
ous research has suggested that AD women, in
particular, may be vulnerable to marital conflict
and dissolution compared with other groups
(Karney & Crown, 2007). It may be that they
face risk for victimization due to existing gen-
der biases against women not conforming to the
traditional gender roles (e.g., working rather
than staying at home with the children). Al-
though family income tended to ease the risk of
CS-EA for other groups, why the positive im-
pact of family income was less for AD women
needs to be explored further. It may be related
to a suppressing effect of gender biases against
women earners or other reasons not assessed.
Limitations
Exploratory approaches (stepwise regression
analyses) have been criticized methodologically
for lack of replicability, limiting confidence in
the findings derived from such methods without
cross-validation (e.g., Greenland, 2008). Al-
though the use of exploratory techniques is a
limitation of the current study, cross-validation
of the results, analyses across four separate
samples of AD men, AD women, civilian men,
and civilian women, and examination of gener-
 EMOTIONAL ABUSE CORRELATES
alizability across marital status at least partially
addresses concerns about replicability of the
findings. Clearly, results will need to be con-
firmed with other community samples.
Further, there may be differences not ac-
counted for that limit generalizability outside a
military context. In particular, the sample in the
current study was younger than the U.S. popu-
lation and findings may differ for older couples.
This sample also differed from the U.S. popu-
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lation in that all households had at least one
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member with a full-time job. Thus, the study
findings are representative of couples with one
or both members of the dyad working, but not
necessarily families in which both members are
unemployed. Additionally, the sample only as-
sessed current CS-EA of those in relationships
and does not assess those who may have expe-
rienced CS-EA in the past, but are no longer in
that relationship. The sample also only included
heterosexual couples and the generalizability to
same-sex military couples in unknown.
Causality cannot be inferred from the cur-
rent cross-sectional study and some of the
factors examined may precede the abuse,
whereas other factors may be consequences of
the abuse or have bidirectional effects (e.g.,
Kim, Laurent, Capaldi, & Feingold, 2008).
Longitudinal research would be needed to
address directionality and, thus, these results
can only highlight which factors relate to
CS-EA for further study. For example, alco-
hol problems may lead to relationship conflict
about drinking behavior and victimization,
but may also increase following the victim-
ization as a way to cope with the victimiza-
tion. Individuals with low self-efficacy may
be more likely to stay in a relationship in
which their victimized and the victimization,
may in turn, further decrease their self-
efficacy.
Finally, there are notable differences between
military branches that should be considered in
interpreting the generalizability of the findings.
Although approximately half of the active duty
members in this sample had deployed in the
past, the deployments in the Air Force are usu-
ally shorter than in other branches and less
frequently see direct ground combat. Air Force
military personnel also have lower mental
health symptoms than found in other branches
(e.g., alcohol problems, Bray et al., 2003).
139
Research Implications
Theoretical models of intimate partner vio-
lence (IPV; e.g., Yllo, 1993) have primarily
focused on women’s victimization given wom-
en’s heightened risk for severe physical injury
(Breiding, Black, & Ryan, 2008), but to more
fully understand IPV for both men and women,
theories should incorporate more consideration
of gender similarities and differences to provide
a framework for future empirical studies (e.g.,
Hamel, 2009).
Given that most research has focused on
physical, rather than emotional, IPV there is
only a limited research literature to compare
with the current findings. In a previous study of
clinically significant physical abuse perpetra-
tion with the same AD sample used in the
current study (Slep et al., 2011), only individual
and family factors contributed across ecological
levels to explaining perpetration, whereas work-
place and community factors were found to
explain unique variance in CS-EA in the current
study. This highlights the importance of assess-
ing different types of IPV separately (perpetra-
tion vs. victimization, emotional vs. physical) to
best inform prevention efforts rather than using
a composite measure that collapses IPV into one
category. The need for research on emotional
abuse is apparent, as there are a growing num-
ber of studies that have found emotional abuse
is related to negative mental and physical health
outcomes over and above physical IPV (e.g.,
Coker et al., 2002; Lawrence, Yoon, Langer, &
Ro, 2009; Taft et al., 2006). Clearly, treatment
and prevention programming aimed at victims
and perpetrators needs to be tailored to the
unique factors that relate to each. Thus, the
current exploratory study fills a gap in the lit-
erature by identifying, cross-validating, and
testing the generalizability of key unique corre-
lates of CS-EA within and across ecological
levels.
Clinical and Policy Implications
The current study has potential to inform
clinical practice and prevention efforts by pro-
viding information on which factors should be
assessed among those with CS-EA. Large epi-
demiological studies of CS-EA, such as this
one, are a particularly important first step in
informing community level public health inter-
 140 FORAN ET AL.
ventions. Although there are many studies that
examine forms of emotional abuse and correlates,
fewer studies have taken an epidemiological per-
spective relevant to large-scale intervention plan-
ning (e.g., using large samples, cross-validating,
and assessing generalizability).
Results tended to generalize across marital
status and gender, but there were also differ-
ences that may need to be considered in devel-
oping interventions and prevention planning.
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For example, a set of workplace factors were
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more strongly related to CS-EA particularly for
married AD men compared with unmarried
men. Further, individual level variables tended
to relate to CS-EA similarly across genders, but
several gender differences in the role of fam-
ily and workplace level variables were de-
tected. Taken together, these results suggest
the interplay between occupational role (AD,
civilian), family status, and gender needs to
be considered in addressing CS-EA among
military families. Although community-wide
programs designed to reduce CS-EA could
target some risk factors that appear universal
(e.g., relationship dissatisfaction via marital
therapy and prevention programs), they may
also need to be tailored to address other risk
factors for specific groups (e.g., married men,
AD women, civilian spouses).
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Received June 18, 2012
Revision received June 18, 2013
Accepted June 19, 2013 䡲

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