Development and Validation of the AMSM for Military-Connected Adolescents

Military-connected adolescents are at increased risk of adverse behavioral and mental health outcomes compared to civilian peers, a finding which may be explained by exposure to unique military-specific stressors. Existing measures of adolescent stress fail to account for these stressors, potentially underestimating stress experienced by these youth. To fill this gap, the present study describes the development of the Adolescent Military Stress Measure (AMSM) and examines its psychometric properties. Qualitative data from individual Life History Calendar interviews (n = 24) and a focus group (n = 5) informed AMSM item development. Focus group cognitive interviews (n = 17) and advisory board input were used to refine the measure, which was piloted on the California Health Kids Survey with military-connected youth (n = 410) in one school district. Exploratory and confirmatory factor analysis indicated a four-factor structure (deployment, relocation, social support, ongoing socioecological stressors). Cronbach’s alphas for the 23-item scale (0.86) and four subscales (0.69 - 0.83) provided evidence of good reliability. Logistic regression suggested each additional stressor on the AMSM was associated with an increase of 7% in feeling sad/hopeless (OR = 1.07, 95% CI = 1.01-1.12) and 6% in suicidal thoughts (OR = 1.06, CI = 1.03-1.12). In a structural equation model, the ongoing sociological stressors subscale significantly predicted suicidality (b = 0.67, p = 0.05). The AMSM has sound psychometric properties and may be used to identify common combinations of stressors as well as risk behaviors associated with stress, which may inform school- and community-based supports around military-related stressors to improve the quality of research with this population.