Key issues for military families—and their service members’ propensity to continue serving—were inextricably linked to their well-being in 2023, according to a new report from the Military Family Advisory Network.

“Our country, our national security, our democracy counts on those who serve,” the group’s 2023 Military Family Support Programming Survey found. “They count on their families, and this report has shown that their well-being—the whole family—and propensity to recommend military service are not mutually exclusive.”

The newly released report analyzed more than 10,149 responses from military spouses, veterans and service members between October and December 2023. It focuses on four aspects of military and veteran family well-being, and nearly half of responses came from soldiers and their spouses.

Nearly 60% of military and veteran family respondents said that they would recommend military life to someone who was considering it. The propensity to recommend service has declined by just over 5% since the 2021 survey.

An active-duty Army spouse said in the survey that they would recommend service in the military, but “they need to understand what this life is all about and the realities of it. Military life has greatly helped set my family up for success. It has provided a good and stable life, but it is not an easy one by any means.”

Nearly half of military families reported moderate well-being, but the share of families that reported poor well-being nearly doubled since 2021. Respondents cited general hardship as a top reason for not recommending military life, and loneliness also is on the rise among military and veteran families.

“It’s difficult being away from each other during deployments. This is our fifth deployment as a family, and it hasn’t gotten any easier,” an active-duty Army spouse said. “We’re resilient but we’re exhausted.”

Though some actively serving families reported very positive, positive or neutral experiences related to health care, provider availability remains a critical problem, the survey found.

“Providers who accept TRICARE and have availability are ... in short supply. Faced with multiple barriers and or crises that cannot wait, many respondents resorted to paying out of pocket,” Shanna Smith, the Military Family Advisory Network’s associate director of research, said during the data release. “Those who cannot afford the cost of mental health care reported going without [mental health care].”

Safeguarding military and veteran families’ well-being requires a “fully integrated approach,” said Shannon Razsadin, the Military Family Advisory Network’s CEO and the spouse of a retired service member, during the data release.

“Our data consistently shows the interconnectedness of key issues tied to the experience and well-being of [service members, veterans] and their families,” Razsadin said. “They are connected, and we must look at them and address them in a fully integrated approach.”

Read the full report here.