Article

Association of Military Deployment of a Parent or Spouse and Changes in Dependent Use of Health Care Services

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Abstract

U.S. Armed Forces members and spouses report increased stress associated with combat deployment. It is unknown, however, whether these deployment stressors lead to increased dependent medication use and health care utilization. To determine whether the deployment of Army active duty members (sponsors) is associated with changes in dependent health care utilization. A quasi-experimental, pre-post study of health care patterns of more than 55,000 nonpregnant spouses and 137,000 children of deployed sponsors and a comparison group of dependents. Changes in dependent total utilization in the military health system, and separately in military-provided and purchased care services in the year following the sponsors' deployment month for office visit services (generalist, specialist); emergency department visits; institutional stays; psychotropic medication (any, antidepressant, antianxiety, antistimulant classes). Sponsor deployment was associated with net increased use of specialist office visits (relative percent change 4.2% spouses; 8.8% children), antidepressants (6.7% spouses; 17.2% children), and antianxiety medications (14.2% spouses; 10.0% children; P<0.01) adjusting for group differences. Deployment was consistently associated with increased use of purchased care services, partially, or fully offset by decreased use of military treatment facilities. These results suggest that emotional or behavioral issues are contributing to increased specialist visits and reliance on medications during sponsors' deployments. A shift to receipt of services from civilian settings raises questions about coordination of care when families temporarily relocate, family preferences, and military provider capacity during deployment phases. Findings have important implications for the military health system and community providers who serve military families, especially those with children.

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... A statistically significantly smaller proportion of mil itary family members had a record for receiving the in fluenza vaccine, compared to the civilian reference group; however, the absolute difference was only 1% (15.5% vs. 16.5%) and not clinically meaningful. ...
... A limited number of studies in the United States have investigated the impact of military spouse/ parent deployment on the use of health care services for the non-military family members. 16 Larson et al. (2012) demonstrated that deployment changes the range of health care services used and shifts access points from military-specific providers, to private service provision. Eide et al. (2010) concluded that in single parent mili tary families, dependent medical health care utilization decreases when the military spouse is deployed and uti lization increases during the same time period in two parent families. ...
... A limited number of studies in the United States have investigated the impact of military spouse/ parent deployment on the use of health care services for the non-military family members. 16 Larson et al. (2012) demonstrated that deployment changes the range of health care services used and shifts access points from military-specific providers, to private service provision. Eide et al. (2010) concluded that in single parent mili tary families, dependent medical health care utilization decreases when the military spouse is deployed and uti lization increases during the same time period in two parent families. ...
Article
Introduction: Canadian military spouses have reported issues accessing and maintaining high quality health care. There is no Canadian research quantifying the scope of the problem. Methods: This is a retrospective cohort study using administrative data. We included military spouses and dependents relocated to Ontario between January 8, 2008 and March 31, 2013, along with a matched civilian reference group. We measured hospitalizations, emergency department (ED) visits, and physician visits. Comparisons of first health care contact, medical health services use, and time to first health services use controlled for age, sex, and geography. Results: The cohort included 7,508 military family members and 30,032 matched civilians. Point of first health care system contact differed between military family members and the civilian reference group ( p < 0.001). Military family members had a longer time to their first health care contact than the civilian reference group (median 118 days vs. 84 days, p < 0.001). Similarities and differences between military family and civilian health services use existed. For example, military children and youth were less likely to see a paediatrician than the civilian reference group (17.7% vs. 26.0%, p < 0.001), and less likely to receive non-influenza vaccinations (23.2% vs. 32.3%, p < 0.001). Discussion: This study provides evidence supporting the hypothesis that military families have different access to, and use of, provincial health services than the general Ontario population and suggests support during relocations is needed. It is important to further understand how these patterns impact health outcomes and continuity of care and to contextualize these findings with potential differences in the underlying need for health services.
... Across studies, deployment was generally defined as the service members' departure from home to engage in combat or other activities related to the OEF/OIF/OND campaigns. One study (Larson et al., 2012) offered specific inclusion criteria for defining deployment (i.e., deployment periods of 6 months or longer), although most did not. Some studies also examined the periods surrounding the deployment (i.e., pre-and post-deployment) although inclusion criteria for defining these periods were not typically reported. ...
... Nine studies examined the associations between deployment and indicators of parent distress, family functioning, and spouses' health care utilization (Allen et al., 2011;Chartrand et al., 2008;Cozza et al., 2010;Everson et al., 2013;Flake et al., 2009;Gewirtz et al., 2010Gewirtz et al., , 2014aLarson et al., 2012;Wilson et al., 2014). Overall, more frequent and lengthier deployments appear to be associated with greater levels of parent stress and depressive symptoms (Barker & Berry, 2009;Chartrand et al., 2008;Gewirtz et al., 2014a), poorer family or couple functioning (Allen et al., 2011;Cozza et al., 2010;Gewirtz et al., 2010), poorer general wellbeing Everson et al., 2013), and greater use of mental health services for the military spouse (Larson et al., 2012). ...
... Nine studies examined the associations between deployment and indicators of parent distress, family functioning, and spouses' health care utilization (Allen et al., 2011;Chartrand et al., 2008;Cozza et al., 2010;Everson et al., 2013;Flake et al., 2009;Gewirtz et al., 2010Gewirtz et al., , 2014aLarson et al., 2012;Wilson et al., 2014). Overall, more frequent and lengthier deployments appear to be associated with greater levels of parent stress and depressive symptoms (Barker & Berry, 2009;Chartrand et al., 2008;Gewirtz et al., 2014a), poorer family or couple functioning (Allen et al., 2011;Cozza et al., 2010;Gewirtz et al., 2010), poorer general wellbeing Everson et al., 2013), and greater use of mental health services for the military spouse (Larson et al., 2012). Mental health problems were particularly high among military spouses raising young children alone during deployment periods (Barker & Berry, 2009). ...
Article
Purpose: To examine perceptions of what mothers of young children (birth to 5 years old) need to be a "good parent" while their military spouse is deployed. Design: Q methodology was used to uncover different views on military spouses' parenting needs. Methods: In Phase 1, 18 statements related to military spouses' parenting needs were elicited based on review of existing literature and seven supplementary qualitative interviews. In Phase 2, 143 military-connected mothers completed an anonymous online Q-sort to rank the importance of the 17 statements from least to most important for being a good parent during deployment. Written comments explaining rankings were also collected. Findings: Across respondents, the most important needs during deployment were making sure their children were happy and healthy, keeping themselves and their children connected with the deployed parent, and being financially stable. Three unique views were uncovered, which differed by mothers' reliance on their family versus the military community for support, and the importance of self-care. Conclusions: Results highlighted the extent to which mothers of young children enter "survival mode" during their spouse's deployment, and differences were found in what was most important for being a good parent during this stressful period. Clinical relevance: Findings underscore the complexity of creating programs to support military parents whose different backgrounds, experiences, and expectations are likely to affect service uptake and benefit.
... 15,16 Afghanistan and Iraq deployments are also associated with increased MHS purchased care, specialist office visits, and use of antidepressants and antianxiety medications in military spouses and children. 17 Based on outpatient visits from direct and purchased care records, women with spouses who were deployed for up to 11 mo received more diagnoses of mood, sleep, anxiety, acute stress, and adjustment disorders than women whose spouses were not deployed between 2003 and 2006. 18 Military children are more likely to have behavioral health problems than their same-aged peers 19 and parental deployment was associated with increased outpatient visits for adjustment and mood disorders, and acute stress reaction between 2003 and 2006. ...
... During OEF/OIF, military children, spouses, and service members experienced behavioral and emotional difficulties, anxiety, mood, suicidal ideation, and substance use problems 19,27,28,[29][30][31] that increased need and demand for behavioral health care. 17,32 In this study, adolescents (12)(13)(14)(15)(16)(17) and adults under age 60 were more likely to be treated for suicidal ideation and nondependent drug abuse than older adults, which is consistent with previous research, indicating military adolescents and service members experienced high rates of suicidal behaviors and unhealthy substance use during these wars. 33,29,34 Additionally, adult MHS beneficiaries under age 60 were more likely to be treated for opioid/combination opioid dependence compared with those age 60 and older. ...
... During OEF/OIF, military children, spouses, and service members experienced behavioral and emotional difficulties, anxiety, mood, suicidal ideation, and substance use problems 19,27,28,[29][30][31] that increased need and demand for behavioral health care. 17,32 In this study, adolescents (12)(13)(14)(15)(16)(17) and adults under age 60 were more likely to be treated for suicidal ideation and nondependent drug abuse than older adults, which is consistent with previous research, indicating military adolescents and service members experienced high rates of suicidal behaviors and unhealthy substance use during these wars. 33,29,34 Additionally, adult MHS beneficiaries under age 60 were more likely to be treated for opioid/combination opioid dependence compared with those age 60 and older. ...
Article
Full-text available
Introduction Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014. Materials and Methods Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study. Results From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78.8%) and care was most often received in EDs (56%). Most commonly treated diagnoses included mood, tobacco use, and alcohol use disorders. ED visits were associated with being treated for anxiety (excluding post-traumatic stress disorder; Adjusted odds ratio [AOR]: 9.14 [95% confidence interval (CI): 8.26, 10.12]), alcohol use disorders (AOR = 1.67 [95% CI: 1.53, 1.83]), tobacco use (AOR = 1.16 [95% CI: 1.06, 1.26]), nondependent cocaine abuse (AOR = 5.47 [95% CI: 3.28, 9.12]), nondependent mixed/unspecified drug abuse (AOR = 7.30 [95% CI: 5.11, 10.44]), and psychosis (AOR = 1.38 [95% CI: 1.20, 1.58]). Compared with adults age 60 yr and older, adolescents (ages 12–17 yr), and adults under age 60 yr were more likely to be treated for suicidal ideation, adjustment, mood, bipolar, post-traumatic stress disorder, nondependent cocaine, and mixed/unspecified drug abuse. Adults under age 60 yr also had increased odds of being treated for tobacco use disorders, alcohol use disorders, and opioid/combination opioid dependence compared with adults age 60 yr and older. Conclusions Over the past 15 yr, purchased behavioral health care received by MHS beneficiaries in acute care facilities increased significantly. MHS beneficiaries received the majority of purchased behavioral health care for mental health disorders and were treated most often in the ED. Receiving behavioral health care in civilian EDs raises questions about access to outpatient behavioral health care and patient-centered care coordination between civilian and military facilities. Given the influx of new Veterans Health Administration users from the MHS, findings have implications for military, veteran, and civilian facilities providing behavioral health care to military and veteran populations.
... Across studies, deployment was generally defined as the service members' departure from home to engage in combat or other activities related to the OEF/OIF/OND campaigns. One study (Larson et al., 2012) offered specific inclusion criteria for defining deployment (i.e., deployment periods of 6 months or longer), although most did not. Some studies also examined the periods surrounding the deployment (i.e., pre-and post-deployment) although inclusion criteria for defining these periods were not typically reported. ...
... Nine studies examined the associations between deployment and indicators of parent distress, family functioning, and spouses' health care utilization (Allen et al., 2011;Chartrand et al., 2008;Cozza et al., 2010;Everson et al., 2013;Flake et al., 2009;Gewirtz et al., 2010Gewirtz et al., , 2014aLarson et al., 2012;Wilson et al., 2014). Overall, more frequent and lengthier deployments appear to be associated with greater levels of parent stress and depressive symptoms (Barker & Berry, 2009;Chartrand et al., 2008;Gewirtz et al., 2014a), poorer family or couple functioning (Allen et al., 2011;Cozza et al., 2010;Gewirtz et al., 2010), poorer general wellbeing Everson et al., 2013), and greater use of mental health services for the military spouse (Larson et al., 2012). ...
... Nine studies examined the associations between deployment and indicators of parent distress, family functioning, and spouses' health care utilization (Allen et al., 2011;Chartrand et al., 2008;Cozza et al., 2010;Everson et al., 2013;Flake et al., 2009;Gewirtz et al., 2010Gewirtz et al., , 2014aLarson et al., 2012;Wilson et al., 2014). Overall, more frequent and lengthier deployments appear to be associated with greater levels of parent stress and depressive symptoms (Barker & Berry, 2009;Chartrand et al., 2008;Gewirtz et al., 2014a), poorer family or couple functioning (Allen et al., 2011;Cozza et al., 2010;Gewirtz et al., 2010), poorer general wellbeing Everson et al., 2013), and greater use of mental health services for the military spouse (Larson et al., 2012). Mental health problems were particularly high among military spouses raising young children alone during deployment periods (Barker & Berry, 2009). ...
Article
Full-text available
More than 40% of children in military families are <6 years old, a period when children are most dependent on their parents' physical and emotional availability. This systematic review describes the impact of deployment since 9/11 on the mental health of military families with young children, evaluates evidence-based interventions for military parents with young children, and identifies gaps in the science limiting our ability to support the needs of these families. Databases were reviewed from 2001 to 2014 using preferred reporting items for systematic reviews and meta-analyses approach; 26 studies met review criteria. Deployment was associated with increased parent stress, child behavior problems, health care utilization, and child maltreatment. Few studies tested interventions or focused on racial/ethnic minority or veteran families. A number of methodological limitations are noted. More research using multiple methods, stronger designs, and more diverse samples is needed to understand and address the needs of military families with young children. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
... It is also notable that many of the studies of service members and their spouses focus on broad measures of health, such as self-rated health 12 or health-related behaviors, 21 or rely on medical records for information about diagnosis 22 or service utilization. 23 Therefore, there is a need to better understand the impact of deployment on more specific aspects of health, including markers or risk factors for downstream health consequences. To address this gap, this study examines the relationship between deployment length and stress-related markers of inflammation and ambulatory blood pressure (BP) in military veteran couples. ...
... On average, the veterans enrolled in this study had last deployed approximately 4 years ago. Some studies have demonstrated a more immediate impact of deployment on the health of spouses 21,23 ; however, this study demonstrates that deployment may continue to affect the health of veterans and military spouses years after the deployment has ended. Early life stress is linked to health-related outcomes in adulthood, including BP and inflammatory processes. ...
Article
Introduction: Changes in the frequency, duration, and nature of military deployments over the past 14 years have spurred efforts to understand the effects of deployment on the health of military service members and their spouses. However, few studies have examined the impact of deployments on health outcomes in both veterans and their partners. This study aims to examine the association between deployment length and health, including ambulatory blood pressure (BP) and stress-related markers of inflammation, in military veterans and their spouses. Materials and methods: This study includes 32 male veterans and 29 female civilian partners. Veterans reported about their deployment and military experiences, including deployment length, combat exposure, and post-traumatic stress disorder (PTSD) symptoms. Plasma measures of inflammatory markers, C-reactive protein (CRP) and interleukin 6 (IL-6), were collected from veterans and spouses. Participants also completed 48 hours of BP monitoring for calculation of mean arterial pressure (MAP) during wakefulness and sleep, and sleep/wake MAP ratio, as an indicator BP nondipping. Regression models examined the association between deployment length and each outcome in the combined sample of veterans and their spouses, including tests of interactions between gender and deployment length, controlling for age, gender, waist circumference, current PTSD, and combat exposure. Results: Longer deployment length was associated with higher CRP levels in veterans and their spouses, although this effect became nonsignificant when limiting analyses to individuals with CRP ≤10 mg/L. There was a significant gender by deployment length interaction effect on MAP ratio, such that longer deployments were associated with higher MAP ratios in female spouses. There was no significant effect of combat exposure in these models. Conclusion: Longer deployments are associated with health-related markers in military veterans as well as their spouses. These results suggest the importance of monitoring health during and postdeployment, and of finding ways to mitigate the adverse impact of deployment on health in both members of military couples.
... According to Alfano et al. (2016), several studies revealed that parental deployment has a significant impact on a child's level of stress, mental and behavioral health concerns, and academic performance. The overall stress of deployment on children is associated with increased visits for mental health concerns (Gorman et al., 2010;Mansfield et al., 2011), including increased visits to a specialty provider (mostly mental health) and increased prescriptions given for psychotropic medication (Larson et al., 2012). The risk for child maltreatment also increases with parental deployment Rentz et al., 2007). ...
Article
Full-text available
Military-connected children are forced to manage the unique challenges that characterize military life. These experiences include frequent relocations, deployments, recovery from combat, and sometimes the death or injury of their caregiver. Although military-connected children are known to be very resilient, they are faced with the difficult task of adjusting to frequent changes and coping with experiences of grief and loss, particularly in the case of combat-realted death. In addition, military-connected children face constant disruptions of attachment bonds, which can complicate the grief process. In order to promote a secure attachment after a combat-related loss, military-connected children would benefit from a family-based and attachment-based play therapy approach that centers on rebuilding the parent–child relationship, repairing disruptions and ruptures in parental attachment, and restoring attachment bonds. Child–Parent Relationship Therapy (CPRT) is one approach that focuses on repairing the parent–child relationship by using the parent as the therapeutic agent of change, hope, and healing. Through CPRT, military-connected children can repair and restore disruptions and ruptures of attachment.
... Increased operational tempo, defined as the families experiencing multiple sequential deployments, puts them at high risk of behavioral health problems, parental divorce, family violence and consequences of family stress [28][29][30][31][32]. A study comparing active duty Army families revealed a varied pattern comparing soldiers deployed once and those deployed twice. ...
Article
Full-text available
Child maltreatment is an unfortunate aspect of our society, afflicting civilian and military families alike. However, unlike their civilian counterparts, military families bear additional burdens inherent to military service that can exacerbate some of the root causes of child abuse. For this reason, the U.S. Department of Defense is committed to ensuring not only a highly disciplined and ready force, but also a healthy force — the foundation of which is healthy families. Therefore, understanding the military health care system, how it functions and how it collects data is a necessary first step in evaluating the efficacy of current programs and identifying opportunities for improvement. Moving beyond treatment and prevention, the military also boasts an independent judicial system designed to promote the dual interests of justice and good order as well as discipline in the armed forces, and this also contributes to a distinct culture. These two independent systems, often viewed as having diametrically opposed interests, can work together synergistically to promote the ultimate goal of fewer instances of child maltreatment in the military.
... 19 Larson et al. 20 found increased rates of pediatric specialist visits for psychiatric conditions with a 12% (under age 12) and 18% (over age 12) increase for military children of deployed service members. Afghanistan and Iraq deployments were also associated with a 17.2% increase in antidepressant prescriptions and a 10% increase in antianxiety prescriptions for children of active duty service members, but a decrease in use of health care in military treatment facilities (MTFs), 21 suggesting increased behavioral health service utilization during parental deployments in civilian medical facilities. Despite a wealth of evidence on behavioral health problems military children experience, few studies focus on behavioral health treatment received by military children. ...
Article
Medical claims were analyzed from 2810 military children who visited a civilian emergency department (ED) or hospital from 2000 to 2014 with behavioral health as the primary diagnosis and TRICARE as the primary/secondary payer. Visit prevalence was estimated annually and categorized: 2000–2002 (pre-deployment), 2003–2008 (first post-deployment), 2009–2014 (second post-deployment). Age was categorized as follows: preschoolers (0–4 years), school-aged (5–11 years), adolescents (12–17 years). During Afghanistan and Iraq wars, 2562 military children received 4607 behavioral health visits. School-aged children’s mental health visits increased from 61 to 246 from pre-deployment to the second post-deployment period. Adolescents’ substance use disorder (SUD) visits increased almost 5-fold from pre-deployment to the first post-deployment period. Mental disorders had increased odds (OR = 2.93, 95% CI 1.86–4.61) of being treated during hospitalizations than in EDs. Adolescents had increased odds of SUD treatment in EDs (OR = 2.92, 95% CI 1.85–4.60) compared to hospitalizations. Implications for integrated behavioral health and school behavioral health interventions are discussed.
... Additionally, a shift from military treatment facilities to civilian facilities during deployment was observed, which may be indicative of a temporary family relocation while the active duty service member was deployed. 38 Finally, research has shown a 7% increase in outpatient visits for children younger than 2 years during the deployment of a parent 37 as well as an increased effect of deployment on children if it occurred during the developmental or attachment period. 39 ...
Article
Children in US military families share common experiences and unique challenges, including parental deployment and frequent relocation. Although some of the stressors of military life have been associated with higher rates of mental health disorders and increased health care use among family members, there are various factors and interventions that have been found to promote resilience. Military children often live on or near military installations, where they may attend Department of Defense-sponsored child care programs and schools and receive medical care through military treatment facilities. However, many families live in remote communities without access to these services. Because of this wide geographic distribution, military children are cared for in both military and civilian medical practices. This clinical report provides a background to military culture and offers practical guidance to assist civilian and military pediatricians caring for military children.
... This finding demonstrates the importance of ensuring access to the specialty civilian health sector and in coordinating care between military and civilian providers for high utilizers. 17 The 2015 National Defense Authorization Act (NDAA) made statutory changes in TRICARE's mental health benefits to enhance access to needed behavioral health services. It is the first major change to benefits in over 20 years, and will increase the number of institutional and individual behavioral health providers, remove historic caps on covered services, reduce cost-sharing, and remove many quantitative and qualitative limits in the spirt of benefit parity. ...
Article
Background: Studies have examined utilization of health care services by civilian children with chronic conditions but not utilization among child dependents of military personnel. Objective: To identify children with chronic conditions among military members and retirees and examine their health care utilization and its association with type of condition. Methods: We derived our sample from child dependents ages birth to 18 years of military personnel with health care enrollment in FY2011. We defined chronic conditions based on diagnoses and repeated specialty care visits. We accrued one year of health care utilization for each child starting with the date of first diagnosis that qualified (i.e., 2 + visits). Health care utilization measures were any inpatient stay; number of outpatient visits (excluding emergency department [ED] visits), ED visits, and number of psychotropic and non-psychotropic prescriptions. Results: Conditions with the highest prevalence were ADHD/conduct disorders (41.2%), other behavioral health (BH) disorders (30.4%), asthma (25.3%) and arthritis (23.8%). Boys and children ages 6-18 were more likely to have BH conditions. Twelve percent had inpatient stays, 63% used the ED, and mean ED visits was 4.6. The mean outpatient visits was 27.9. Utilization was consistently higher for children with both BH and physical health (PH) conditions, children under age 5 (except for number of psychotropic prescriptions), and those enrolled in the military's Extended Health Care Options (ECHO) program. Conclusions: Prevalence and utilization findings provide data for future service planning and highlight subgroups of children with chronic conditions who may need better access to supportive military programs.
... Deployment has been clearly associated with increased use of specialist office visits for both spouses and children, as well as increased use of antidepressant and anti-anxiety medications (10). Children of young, single, military parents were seen less frequently for acute or well-child care when their parent was deployed (11). ...
Article
Military families experience a number of life stressors, such as frequent geographical moves, long periods of separation within the family, geographic isolation from extended family support systems and deployments to high-risk areas of the world. While children and youth in military families experience all the same developmental and motivational trajectories as their civilian counterparts, they must also contend with more unusual developmental pressures and stressors placed on them by the unique demands of military life. The effects of the military life on families and children are beginning to be recognized and characterized more fully. Understanding the unique concerns of children and youth from military families and mobilizing specific resources to support them are critical for meeting the health care needs of this population.
... Among 3 to 8 year-olds, outpatient mental health services have been found to increase during periods of deployment specifically (Gorman, Eide, & Hisle-Gorman, 2010). Even among children with a parent who deployed during the previous year an increase in specialist office visits, including mental health visits, has been reported (Larson et al., 2012). The same study found a 17% increase in antidepressant prescriptions and a 10% increase in antianxiety prescriptions among children. ...
... Furthermore, rates of behavioral and mental health care visits for older children within this age group increased the most. Health care use in 137,000 children (mean age 7 years) and spouses of active duty component service members with a deployment in the last year revealed that deployment was associated with a decrease in primary care visits, but an 8.8% increase in specialist office visits (the majority of which were for mental health), a 17.2% increase in prescriptions of antidepressants, and a 10% increase in antianxiety prescriptions for children (Larson et al., 2012). Interestingly, deployment was also linked to decreases in use of military facility health care, suggesting a shift to civilian providers. ...
Article
Full-text available
Hundreds of thousands of children have had at least 1 parent deploy as part of military operations in Iraq (Operation Iraqi Freedom; OIF; Operation New Dawn; OND) and Afghanistan (Operation Enduring Freedom; OEF). However, there is little knowledge of the impact of deployment on the relationship of parents and their children. This systematic review examines findings from 3 areas of relevant research: the impact of deployment separation on parenting, and children's emotional, behavioral, and health outcomes; the impact of parental mental health symptoms during and after reintegration; and current treatment approaches in veteran and military families. Several trends emerged. First, across all age groups, deployment of a parent may be related to increased emotional and behavioral difficulties for children, including higher rates of health-care visits for psychological problems during deployment. Second, symptoms of PTSD and depression may be related to increased symptomatology in children and problems with parenting during and well after reintegration. Third, although several treatments have been developed to address the needs of military families, most are untested or in the early stages of implementation and evaluation. This body of research suggests several promising avenues for future research.
... Research on treatment initiation and retention with military families is sparse, in part because of the relatively new emphasis on the needs of MC spouses, partners, and children in the context of the deployment cycle. Prevalence of mental health and emergency room visits increase substantially in both spouses and children when a service member has deployed (Gorman, Eide, & Hisle-Gorman, 2010; Larson et al., 2012). Data on help-seeking among military families with very young children are also limited, primarily because few militaryspecific interventions exist for this demographic. ...
Article
Full-text available
For more than a decade, the long wars in Afghanistan and Iraq have placed tremendous and cumulative strain on U.S. military personnel and their families. The high operational tempo, length, and number of deployments-and greater in-theater exposure to threat-have resulted in well-documented psychological health concerns among service members and veterans. In addition, there is increasing and compelling evidence describing the significant deleterious impact of the deployment cycle on family members, including children, in military-connected families. However, rates of engagement and service utilization in prevention and intervention services continue to lag far below apparent need among service members and their families, because of both practical and psychological barriers. The authors describe the dynamic and ultimately successful process of engaging military families with young children in a home-based reintegration program designed to support parenting and strengthen parent-child relationships as service member parents move back into family life. In addition to the integration of existing evidence-based engagement strategies, the authors applied a strengths-based approach to working with military families and worked from a community-based participatory foundation to enhance family engagement and program completion. Implications for engagement of military personnel and their loved ones are discussed.
... Among 3 to 8 year-olds, outpatient mental health services have been found to increase during periods of deployment specifically (Gorman, Eide, & Hisle-Gorman, 2010). Even among children with a parent who deployed during the previous year an increase in specialist office visits, including mental health visits, has been reported (Larson et al., 2012). The same study found a 17% increase in antidepressant prescriptions and a 10% increase in antianxiety prescriptions among children. ...
Article
Introduction Stress experienced during pregnancy is associated with adverse birth outcomes including preterm delivery (PTD) and low birth weight (LBW). Pregnant spouses and partners of deployed military personnel can experience heightened stress due to several factors associated with the military lifestyle. This systematic review aims to ascertain whether deployment at the time of delivery increases the risk of PTD and/or LBW in babies born to pregnant spouses or partners of deployed service persons. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method by searching EMBASE, Medline, PubMed and Global Health databases from inception to March 2021. Keyword searches were used to identify primary research, English language journal articles, that included any military branch and reported a measure of PTD and/or LBW of babies born to spouses/partners of deployed service persons. Risk of bias was assessed with validated tools appropriate for study type and a narrative synthesis was performed. Results Three cohort or cross-sectional studies fulfilled the eligibility criteria. All three studies were conducted in the US military, were published between 2005 and 2016 and included a cumulative total of 11 028 participants. Evidence suggests that spousal deployment may be a risk factor for PTD, although strength of evidence is weak. No association between spousal deployment and LBW was found. Conclusion Pregnant spouses and partners of deployed military personnel may be at increased risk of PTD. The strength of evidence is limited by a paucity of rigorous research in this area. No studies were identified that included service women in the UK Armed Forces. Further research is required to understand the perinatal needs of pregnant spouses/partners of deployed service persons and to understand if there are unmet clinical or social needs in this population.
Chapter
While many aspects of military life can introduce stress into family systems, deployments are often described by military families as the most stressful. Since the start of the Global War on Terror in 2001, over 2.7 million service members have experienced more than 3.3 million wartime deployments. The impact of deployment on service members has been extensively researched; these may include physical injuries, mental health symptomatology, substance use, and suicidality, problems which may be exacerbated by barriers to seeking treatment. A smaller but growing body of evidence explores the impact that deployments have on the spouses, children, and families of service members. Findings from empirical research with this population suggest that the majority of families weather the stressors of deployment successfully, but a subset of families may be struggling and at risk of adverse outcomes. This chapter discusses the impact of deployment experiences on military-connected spouses, children, and families; this impact is considered distinct from the potential effects experienced during the reintegration period following deployment. While these are undoubtedly intertwined, deployment is time bound while reintegration is a subjective experience that can vary significantly in length depending on the adaptive capacities of the service member and their family.KeywordsMilitary familyMental healthDeploymentMilitary spouseParenting
Article
The spouses of military members experience frequent geographic mobility, absences, risk, and other lifestyle dimensions that may cause a greater need for mental health services and barriers to their use, relative to civilians. This was a retrospective, matched cohort study of female spouses of Canadian Armed Forces (CAF) members posted between 04/01/2008 and 03/31/2013 with follow-up to 03/31/2017. 3,358 military-connected spouses were identified and 13,342 civilians matched 4:1 on age, sex, and region of residence. Psychiatric hospitalizations and emergency department (ED) visits, psychiatrist visits, and mental health-related primary care visits were studied. Almost one third of spouses of CAF members visited a family physician for mental health reasons, while a minority visited an ED, a psychiatrist or were hospitalized. Spouses of CAF members were as likely to see a primary care physician, less likely to visit a psychiatrist, visited all measured outpatient sources of mental health services less frequently than the general population and had a longer interval to their first psychiatrist visit than the general population. Information on how mental health services are accessed in the public health system are critical to understanding pathways of care, and the planning and delivery of mental health services to military-connected families.
Article
Army family member health and resilience directly impact soldier readiness and are critical to maintaining a deployable force. Military families face unique stressors, including combat deployments, that can negatively impact child and family functioning. In 2014, the Army implemented the Child and Family Behavioral Health System (CAFBHS), one of 11 standardized behavioral health (BH) programs supporting soldiers and their families. CAFBHS is a comprehensive model of care consisting of five interrelated components that function in a synchronous manner: 1) BH providers located in CAFBHS clinics within Military Treatment Facilities supporting and collaborating with Patient-Centered Medical Homes; 2) School BH that embeds BH providers in on-post schools; 3) Community Outreach which organizes military and civilian resources to support soldiers and families; 4) Standardized evidence-based/informed training curricula for BH providers and primary care managers (PCMs) in treating common pediatric BH disorders; and 5) Regional-level Tele-behavioral Health Consultation in support of PCMs. Patient report of therapeutic alliance is high and outcomes for depression, anxiety and posttraumatic stress disorder for adult family members exceed Army standards. This paper describes the implementation of CAFBHS and provides lessons learned to successfully sustain and expand this integrated BH model of care across the military health care system.
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The present study’s aims were to compare reports provided by deployed military husbands and their at-home wives of their communication and well-being during deployment, and to determine whether the quantity and quality of their communication are uniquely linked to their well-being, controlling for relevant contextual factors. Participant were from military families with children and included deployed husbands from multiple service branches and their at-home wives (N = 106 couples). They provided data on military contextual factors (perceived barriers to communication, months deployed), family contextual factors (military rank, family size), quantity of communication (frequency of synchronous communication, total hours of communication), quality of communication (positive and negative emotions immediately after communicating), and contemporaneous well-being (marital satisfaction, perceived stress, health/mental health down days, and self-rated health). Wives reported more negative emotions after communicating and more stress and down days than husbands, and partners’ reports of their experiences were only moderately correlated. Wives’ well-being was most closely associated with a short separation and a high quality of communication as indicated by high positive and/or low negative emotions after communicating. Quality of communication was the only significant predictors of deployed husbands’ well-being. Implications for military family support are discussed.
Article
Maisonneuve fractures are relatively well known in the sports medicine, and orthopedic communities, however, can be commonly missed among primary care providers. The following case outlines an active duty 35-yr-old female patient who presented with acute pain on the left ankle and lower leg after she misjudged a step. The injury is a combination of high fibular and medial malleolar fractures with a disruption of the tibiofibular syndesmosis ligaments. This is a result of extreme external rotation and pronation of a fixed foot. The proper diagnosis is reliant on ankle and tibiofibular films, to include orthogonal views. This case serves as a reminder to always examine joints above and below the injury site, obtain orthogonal views of a fracture, as well as the unstable nature of syndesmosis injuries. This fracture is commonly a sports-related injury; thus, it is particularly important for military providers to be aware of Maisonneuve fractures and the common pitfalls in diagnosis and treatment.
Article
Les familles des militaires font face à de nombreux facteurs de stress, tels que les réinstallations fréquentes, les longues pério des de séparation familiale, l’isolement géographique du réseau de soutien de la famille élargie et le déploiement en zones très dangereuses. Les enfants et les adolescents des familles des militaires vivent les mêmes trajectoires développementales et motivationnelles que leurs homologues civils, mais ils sont également aux prises avec des pressions et des facteurs de stress liés à leur développement qui sont inhabituels et qui leur sont imposés par les exigences de la vie militaire. Les effets de la vie militaire sur les familles et les enfants commencent à être admis et mieux caractérisés. Il est essentiel de comprendre les préoccupations propres aux enfants et aux adolescents des familles des militaires et de mobiliser les ressources nécessaires pour les soutenir afin de répondre à leurs besoins en matière de santé.
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Book Chapter: Abstract: This paper on children in Army families is the first to examine objective, non-self-report, measures of all health care utilization inclusive of prescription medications among children experiencing the deployment of a parent. It employs a quasi-experimental, pre–post, non-equivalent group design to compare changes in pediatric health care utilization. Multivariate difference-in-differences regression models isolate the effect of deployment on change in service usage comparing a period prior to deployment to a period starting with the parent’s deployment. The proportion of children using any specialist office visits showed a net increase, while the proportion with any generalist office visits showed a net decline. Post-hoc analysis revealed that these pediatric specialist visits were predominantly, not exclusively, for psychiatric-type services. There also was, in users of antidepressants prescriptions, a 28 % relative increase in children under age 12 and 18 % relative increase in children age 12 years and older. Policy and procedures to support the increased care coordination required of both primary care providers and parents of children who make use of psychiatric specialty services is important, especially since pediatric providers are often in the civilian, and not military, sector. Chapter 6. In S. M. Wadsworth & D. Riggs (Eds.), Risk and resilience in U.S. military families (Vol. 2), Chapter 6 (pp 87-110). New York, NY: Springer. ISBN: 9781461487111 Hardcover 336-Pages . Authors Larson MJ, Mohr BA, Lorenz LS, Grayton C, and Williams TV. (2014) Publication Date: 2013 http://link.springer.com/chapter/10.1007/978-1-4614-8712-8_6?no-access=true
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Many US military families have faced separations of at least 1 family member for extended periods of time. This article shows how changes in military culture have increased the repercussions for military families, and especially for military-connected children. This article provides an introduction to aspects of military culture that are most applicable to children, an overview of important aspects of childhood development, a discussion of the impact of deployment on the emotional development and behavior of children left at home and their caregivers, and a review of some interventions and resources available to help these families navigate these challenges.
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Study Objectives Despite the prevalence of sleep problems among service members, few prior studies have examined the rate of sleep problems among military spouses, who also face the stresses of deployment and military life. This is the first study of spouses of US service members to examine the prevalence of sleep disturbances, effect of service member deployment, and associated physical and psychosocial outcomes. Design Cross-sectional analysis of RAND Deployment Life Study data. Setting Self-report measures administered via telephone and web-based surveys in Fall 2012. Participants Female military spouses (n = 1805) aged 19 to 65 years (M = 33.5 [8.3]), married to service members across branches and components (73% previously, 10% currently, and 16% never deployed). Measurements Spouses self-reported sleep duration, sleep quality, daytime fatigue, and daytime impairment. Outcomes included self-rated health, marital satisfaction, and depressive symptoms. Results Eighteen percent of spouses reported extreme short sleep duration, which is higher than rates reported in the general population. Spouses indicated worse sleep when the service member was currently or previously deployed, although deployment status was not associated with sleep duration or daytime impairment. Greater sleep disturbances were significantly associated with all three outcomes, with the strongest association observed with greater depressive symptoms. Conclusions This is the first report to document high rates of short sleep duration and poor sleep quality among spouses of service members. Furthermore, sleep problems were independent correlates of poor mental and physical health. Findings highlight the importance of addressing sleep issues in military families as well as in service members.
Chapter
Military deployments often introduce a variety of family-related stressors for both service members and their family members. The purpose of this chapter is to summarize what is known about the effects of deployment, and associated family-related experiences during deployment, on service members and their families. Following a review of the existing literature, preliminary study findings are presented regarding the nature and consequences of deployment family experiences for the postdeployment health and adjustment of service members deployed in support of the recent wars in Afghanistan (Operation Enduring Freedom; OEF) and Iraq (Operation Iraqi Freedom; OIF). These findings, based on a nationally representative sample of 1,046 OEF/OIF veterans, revealed that contemporary war veterans experience a variety of both objective and subjective family stressors during deployment. In turn, these experiences, as well as deployment social support from loved ones, demonstrate unique relationships with a variety of postdeployment mental health and adjustment outcomes. The chapter concludes with a discussion of future directions for research in this area, underscoring the need for additional prospective studies and more attention to the nature of family stressors experienced by family members.
Article
Spouse predisposing, enabling, and need factors and service member need variables were examined to explain number of supportive services used by spouses. Service use was analyzed with stagewise regression for 227 spouses. Spouses who used supportive services reported worse depression, anxiety, resilience, and general health, and more service member care difficulties. By themselves, spouse predisposing, enabling, and need variables did not significantly explain spouse service use. Service member need variables significantly explained 16.2% of spouse variance and 36.7% of service member variance. Spouses who were caregivers were more distressed, and they and their service members used more services. Targeted help with caregiving may be a needed addition to reintegration assistance.
Article
The US Army has developed an innovative School Behavioral Health (SBH) program, part of the Child and Family Behavioral Health System, a collaborative, consultative behavioral health care model that includes SBH, standardized training of primary care providers in treatment of common behavioral health problems, use of tele-consultation/tele-behavioral health, optimizing community outreach services, and integration with other related behavioral health services. In this article, the needs of military children, adolescents, and families are reviewed, a history of this initiative is presented, key themes are discussed, and next steps in advancing this evolving, innovative system of health care featuring SBH are described. Published by Elsevier Inc.
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The life of a military child has several challenges that can provide opportunities for resilience or risk for vulnerability. Nurses in emergent/urgent care may encounter military children when they are in a stressful transition such as during a move or deployment. Understanding the unique lifestyle of military children and implementing some key suggestions for practice can improve outcomes for this population. This article highlights the exceptional context of military children, military transitions, and opportunities to recognize families who are at risk and strategies to reach out using the I CARE (identify, correlate, ask, ready resources, and encourage) framework.
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This report presents the primary results of the 2005 Department of Defense (DoD) Survey of Health-Related Behaviors among Active Duty Military Personnel. This study is the 9th in a series of surveys of active-duty military personnel conducted in 1980, 1982, 1985, 1988, 1992, 1995, 1998, 2002, and 2005 under the direction of the Office of the Assistant Secretary of Defense (Health Affairs). All of the surveys investigated the prevalence of alcohol use, illicit drug use, and tobacco use, as well as negative consequences associated with substance use. The 1985 through 1992 surveys also covered an expanded set of health behaviors and related issues. In 1995 and 1998, health behavior questions were revised and items were added to assess selected "Healthy People 2000" objectives. In addition, questions were added to examine the mental health of the active force, specific health concerns of military women and military men, oral health, and gambling behaviors. The 2002 and 2005 surveys continued the general focus of the 1998 survey and expanded it to include "Healthy People 2010" objectives. They also augmented the items on exercise, nutrition, and mental health and added new items on dietary supplement use, risk taking and impulsive behavior, job satisfaction, deployment, and religiosity/spirituality. The final sample consisted of 16,146 military personnel (3,639 Army, 4,627 Navy, 3,356 Marine Corps, and 4,524 Air Force) who completed self-administered questionnaires anonymously. Following an introductory chapter, chapters are as follows: (2) Methodology of the 2005 DoD Active Duty Survey; (3) Overview of Trends in Substance Use and "Healthy People 2010" Objectives; (4) Alcohol Use; (5) Illicit Drug Use; (6) Tobacco Use; (7) Healthy Lifestyles and Disease Prevention; (8) Health Behavior and Health Promotion; (9) Stress and Mental Health; and (10) Other Health-Related Issues in the Military. The report includes 137 tables.
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The Department of Defense (DoD) is exploring the holistic construct of total force fitness for individual service members. This exploration provides an opportunity to understand fitness concepts in the context of military families. Currently, there are no developed operational definitions or integrated models for the concept of “total family fitness.” This article used the U.S. Navy experience with family programs to begin the discourse of family fitness and identify potential family fitness-related metrics. A proposed definition of family fitness was developed from the conservation of resources theory and a model of family resilience. This article identifies eight dimensions of family functioning: problem solving, communications, family roles, affective responsiveness, affective involvement, behavior control, global health, and spiritual support. Four potential instruments are identified that could provide metrics for these family dimensions.
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A survey of military wives (N = 77) identifies their most stressful experiences, self-appraised control over these stressors, and coping strategies used. The authors examine two competing hypotheses: the goodness-of-fit hypothesis that the effects of problem-focused coping (PFC) and emotion-focused coping (EFC) strategies on distress are moderated by the appraised controllability of the stressor, and the main-effects hypothesis that PFC strategies are more effective than EFC strategies in reducing distress regardless of appraisal of controllability. Wives identified deployment of soldiers as their most stressful experience, and reported using PFC strategies more frequently than EFC strategies. EFC strategies were predictive of greater physical symptoms of illness, while PFC strategies were related to reduced physical symptoms of illness only when military wives’ perceived control of the situation was low. PFC strategies and controllability were significantly related to decreased depressive symptoms; EFC was marginally related to increased depressive symptoms, lending greater support to the main-effects hypothesis.
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To characterize the risk of mental health diagnoses among children of US military personnel associated with parental deployment in support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Nonrandomized, retrospective cohort study (2003-2006). Electronic medical record data for outpatient care. Children (N = 307 520) aged 5 to 17 years with at least 1 active-duty US Army parent. Number of months of parental deployment for OIF and OEF. A mental health diagnosis was defined as having at least 1 mental health-related International Classification of Diseases, Ninth Revision, code out of 4 possible codes for a given outpatient medical visit. Diagnoses were further classified into 1 of 17 disorder categories. Overall, children with parental deployment represented an excess of 6579 mental health diagnoses during the 4-year period compared with children whose parents did not deploy. After the children's age, sex, and mental health history were adjusted for, excess mental health diagnoses associated with parental deployment were greatest for acute stress reaction/adjustment, depressive, and pediatric behavioral disorders and increased with total months of parental deployment. Boys and girls showed similar patterns within these same categories, with more diagnoses observed in older children within sex groups and in boys relative to girls within age groups. A dose-response pattern between deployment of a parent for OIF and OEF and increased mental health diagnoses was observed in military children of all ages. Findings may be used to inform policy, prevention, and treatment efforts for military families facing substantial troop deployments.
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Young children (birth through 5 years of age) are disproportionately represented in U.S. military families with a deployed parent. Because of their developmental capacity to deal with prolonged separation, young children can be especially vulnerable to stressors of parental deployment. Despite the resiliency of many military families, this type of separation can constitute a developmental crisis for a young child. Thus, the experience may compromise optimal child growth and development. This article reviews what is known about the effects of the military deployment cycle on young children, including attachment patterns, intense emotions, and behavioral changes and suggests an ecological approach for supporting military families with infants, toddlers, and preschoolers. Specifically, home-based family focused interventions seem to warrant the most serious consideration.
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Military operations in Iraq and Afghanistan have involved the frequent and extended deployment of military personnel, many of whom are married. The effect of deployment on mental health in military spouses is largely unstudied. We examined electronic medical-record data for outpatient care received between 2003 and 2006 by 250,626 wives of active-duty U.S. Army soldiers. After adjustment for the sociodemographic characteristics and the mental health history of the wives, as well as the number of deployments of the personnel, we compared mental health diagnoses according to the number of months of deployment in Operation Iraqi Freedom in the Iraq-Kuwait region and Operation Enduring Freedom in Afghanistan during the same period. The deployment of spouses and the length of deployment were associated with mental health diagnoses. In adjusted analyses, as compared with wives of personnel who were not deployed, women whose husbands were deployed for 1 to 11 months received more diagnoses of depressive disorders (27.4 excess cases per 1000 women; 95% confidence interval [CI], 22.4 to 32.3), sleep disorders (11.6 excess cases per 1000; 95% CI, 8.3 to 14.8), anxiety (15.7 excess cases per 1000; 95% CI, 11.8 to 19.6), and acute stress reaction and adjustment disorders (12.0 excess cases per 1000; 95% CI, 8.6 to 15.4). Deployment for more than 11 months was associated with 39.3 excess cases of depressive disorders (95% CI, 33.2 to 45.4), 23.5 excess cases of sleep disorders (95% CI, 19.4 to 27.6), 18.7 excess cases of anxiety (95% CI, 13.9 to 23.5), and 16.4 excess cases of acute stress reaction and adjustment disorders (95% CI, 12.2 to 20.6). Prolonged deployment was associated with more mental health diagnoses among U.S. Army wives, and these findings may have relevance for prevention and treatment efforts.
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Although studies have begun to explore the impact of the current wars on child well-being, none have examined how children are doing across social, emotional, and academic domains. In this study, we describe the health and well-being of children from military families from the perspectives of the child and nondeployed parent. We also assessed the experience of deployment for children and how it varies according to deployment length and military service component. PARTICIPANTS AND METHODS. Data from a computer-assisted telephone interview with military children, aged 11 to 17 years, and nondeployed caregivers (n = 1507) were used to assess child well-being and difficulties with deployment. Multivariate regression analyses assessed the association between family characteristics, deployment histories, and child outcomes. After controlling for family and service-member characteristics, children in this study had more emotional difficulties compared with national samples. Older youth and girls of all ages reported significantly more school-, family-, and peer-related difficulties with parental deployment (P < .01). Length of parental deployment and poorer nondeployed caregiver mental health were significantly associated with a greater number of challenges for children both during deployment and deployed-parent reintegration (P < .01). Family characteristics (eg, living in rented housing) were also associated with difficulties with deployment. Families that experienced more total months of parental deployment may benefit from targeted support to deal with stressors that emerge over time. Also, families in which caregivers experience poorer mental health may benefit from programs that support the caregiver and child.
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We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans. We determined the prevalence and predictors of mental health diagnoses among 289,328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data. Of 289,328 Iraq and Afghanistan veterans, 106,726 (36.9%) received mental health diagnoses; 62,929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated with higher risk for PTSD. Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness.
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Military spouses must contend with unique issues such as a mobile lifestyle, rules and regulations of military life, and frequent family separations including peacekeeping and combat deployments. These issues may have an adverse effect on the health of military spouses. This study examined the mental health status, rates of care utilization, source of care, as well as barriers and stigma of mental health care utilization among military spouses who were seeking care in military primary care clinics. The data show spouses have similar rates of mental health problems compared to soldiers. Spouses were more likely to seek care for their mental health problems and were less concerned with the stigma of mental health care than were soldiers. Services were most often received from primary care physicians, rather than specialty mental health professionals, which may relate to the lack of availability of mental health services for spouses on military installations.
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The objective of this study was to determine whether a military deployment of 6 months predicted domestic violence against the wives of deployed and nondeployed soldiers during the postdeployment period. The method involved the completion of an anonymous questionnaire by a sample of the spouses of soldiers deployed from a large U.S. Army post. The Conflict Tactics Scale identified incidents of domestic violence by the soldier husbands, and a logistic regression model predicted domestic violence during the postdeployment period. The results indicate that deployment was not a significant predictor of domestic violence during the first 10 months of the postdeployment period. Younger wives and those who were victims of predeployment domestic violence were more likely to report postdeployment domestic violence. The conclusion was that interventions for domestic violence in the U.S. Army should address risks among younger couples and those with a previous incident of domestic violence.
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The general public has become increasingly interested in the health and well being of the children and families of military service members as the war in Iraq continues. Observers recognize the potential stresses or traumas that this population might undergo as a result of the military deployment or the possible injury or death of military family members. While such concern is welcomed, it is sometimes misplaced. Not infrequently, conclusions that are drawn are fraught with misunderstanding and bias based upon lack of understanding of the military community or a preconceived notion of the vulnerabilities of the population. This problem is compounded by the paucity of scientific study. In this article the authors review the strengths of military families as well as the unique challenges that they face. The authors also highlight parental deployment, parental injury and parental death as unique stresses to military children and families. Available and pertinent scientific information is reviewed. Clinical observations of children and families during the ongoing war in Iraq are presented.
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Ten years after the 1991 Persian Gulf War (GW I), a comprehensive evaluation of a national cohort of deployed veterans (DV) demonstrated a higher prevalence of several medical conditions, in comparison to a similarly identified cohort of nondeployed veterans (NDV). The present study determined the prevalence of medical conditions among nonveteran spouses of these GW I DV and NDV. A cohort of 490 spouses of GW I DV and 537 spouses of GW I NDV underwent comprehensive face-to-face examinations. No significant differences in health were detected except that spouses of DV were less likely to have one or more of a group of six common skin conditions. We conclude that, 10 years after GW I, the general physical health of spouses of GW I DV is similar to that of spouses of NDV.
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War has a profound emotional impact on military personnel and their families, but little is known about how deployment-related stress impacts the occurrence of child maltreatment in military families. This time-series analysis of Texas child maltreatment data from 2000 to 2003 examined changes in the occurrence of child maltreatment in military and nonmilitary families over time and the impact of recent deployment increases. The rate of occurrence of substantiated maltreatment in military families was twice as high in the period after October 2002 (the 1-year anniversary of the September 11th attacks) compared with the period prior to that date (rate ratio = 2.15, 95% confidence interval: 1.85, 2.50). Among military personnel with at least one dependent, the rate of child maltreatment in military families increased by approximately 30% for each 1% increase in the percentage of active duty personnel departing to (rate ratio = 1.28, 95% confidence interval: 1.20, 1.37) or returning from (rate ratio = 1.31, 95% confidence interval: 1.16, 1.48) operation-related deployment. These findings indicate that both departures to and returns from operational deployment impose stresses on military families and likely increase the rate of child maltreatment. Intervention programs should be implemented to mitigate family dysfunction in times of potential stress.
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This study examined problems pertaining to the health and well-being of Army spouses during deployment, comparing those whose experienced extensions of their partners' deployments with those whose partners returned home on time or early. It used data from a 2004 survey of 798 spouses of active duty personnel. Controlling for demographic and deployment characteristics, spouses who experienced extensions fared worse on an array of measures, including mental well-being (e.g., feelings of depression), household strains (e.g., problems with household and car maintenance), and some areas of their jobs (having to stop work or to work fewer hours). There were no statistically significant differences regarding problems pertaining to their overall health, marriage, other work issues, finances, relationships with Army families, or safety. However, spouses who experienced extensions were more likely to perceive the Army negatively during deployment. These findings suggest that deployment extensions may exacerbate certain problems and frustrations for Army spouses.
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Using research designs patterned after randomized experiments, many recent economic studies examine outcome measures for treatment groups and comparison groups that are not randomly assigned. By using variation in explanatory variables generated by changes in state laws, government draft mechanisms, or other means, these studies obtain variation that is readily examined and is plausibly exogenous. This article describes the advantages of these studies and suggests how they can be improved. It also provides aids in judging the validity of inferences that they draw. Design complications such as multiple treatment and comparison groups and multiple preintervention or postintervention observations are advocated.
Book
Nearly 1.9 million U.S. troops have been deployed to Afghanistan and Iraq since October 2001. Many service members and veterans face serious challenges in readjusting to normal life after returning home. This initial book presents findings on the most critical challenges, and lays out the blueprint for the second phase of the study to determine how best to meet the needs of returning troops and their families. © 2010 by the National Academy of Sciences. All rights reserved.
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Using research designs patterned after randomized experiments, many recent economic studies examine outcome measures for treatment groups and comparison groups that are not randomly assigned. By using variation in explanatory variables generated by changes in state laws, government draft mechanisms, or other means, these studies obtain variation that is readily examined and is plausibly exogenous. This article describes the advantages of these studies and suggests how they can be improved. It also provides aids in judging the validity of inferences that they draw. Design complications such as multiple treatment and comparison groups and multiple preintervention or postintervention observations are advocated.
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The context of military service has changed greatly since the events of 9/11. The forward deployment of service members to active war zones, which involves the issues of separation, time away from home, and eventual reunion, increases the vulnerability of their families to multiple, negative short-term and long-term effects. This article explores these issues and suggests a new approach to building support systems to support these military families. To this end, a capacity-building framework is introduced, and 4 diverse and innovative social action programs consistent with this approach are highlighted. Implications for implementing the community capacity-building model are presented. The worst time is when the phone rings because you don't know who is calling. They could be call-ing, telling you that he got shot or something. (Global War on Terrorism, 13-year-old son of Army Soldier; Huebner, Mancini, Wilcox, Grass, & Grass, 2007) The forward deployment of service members to active war zones, which involves the issues of separation, time away from home, and eventual reunion, increases the vulnerability of their families to multiple, negative short-term and long-term effects. Although it is difficult to place a positive spin on family issues associated with war and its aftermath, the U.S. military has an impressive human service delivery system in place that is designed to support families and thus lower their chances of experiencing problems and dysfunction. In recent years, the military services have discovered the broad power of community—as both encompassing and distinct from the formal human service delivery system—as a resource for supporting military families and helping them cope effectively with adversity and positive challenges (Bowen, Mancini, Martin, Ware, & Nelson, 2003; Hoshmand & Hoshmand, 2007).
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The aim of this review is to evaluate what is known about the impact on children of parental deployment to Iraq or Afghanistan. We searched for relevant studies with a minimum sample size of 50 which were published between 2003 and 2010 using Google Scholar, MEDLINE, PubMed, PsycINFO and Web of Science. Bibliographies of retrieved articles were also searched. Nine US-based studies were identified for inclusion in the review, five were cross-sectional, two were longitudinal and two were analyses of routinely collected data. Researchers found an increase in emotional and behavioral problems in children when a parent was deployed. Several mediating factors were identified, such as the family demographics and the number and duration of parental deployments. Parental psychopathology was most consistently identified as a risk factor for childhood emotional and behavioral disorders in the research. Limitations of the current research and subsequent recommendations for future research are also outlined.
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Children of military personnel face stress when a parent deploys. Our goal was to determine the effect of parental military deployment on the relative rate of outpatient visits for mental and behavioral health disorders in children aged 3 to 8 years. This was a retrospective cohort study. Records of children of active-duty personnel during fiscal years 2006 and 2007 were linked with their parent's deployment records. Mental and behavioral health visits were identified by using International Classification of Diseases, Ninth Revision, codes. The incidence rate ratio (IRR) of visits per year according to parental deployment status was determined with random-effects negative binomial regression modeling with longitudinal data analysis. A total of 642,397 children aged 3 to 8 years and 442,722 military parents were included. Mean child age was 5.0 years (SD: 1.9 years); 50.6% were male, and 68.0% were white. Ninety percent of the parents were male, and 90.5% were married; 32.0% of the parents were deployed during the study. There were 1,049,081 person-years with 611,115 mental and behavioral health visits (0.6 visit per year). The IRR of mental and behavioral health visits for children with a deployed parent compared with when a parent was home was 1.11 (95% confidence interval [CI]: 1.07-1.14; P < .001). IRRs of pediatric anxiety, behavioral, and stress disorders when a parent deployed were 1.14 (95% CI: 0.98-1.32; P = .095), 1.19 (95% CI: 1.07-1.32; P < .001), and 1.18 (95% CI: 1.10-1.26; P < .001), respectively. Older children and children with military fathers and married parents had larger increases in rates of mental and behavioral health visits during parental deployments. In contrast, the overall outpatient rate and rates of visits for other diagnoses decreased when a parent was deployed. Mental and behavioral health visits increased by 11% in these children when a military parent deployed; behavioral disorders increased 19% and stress disorders increased 18%. Rates especially increased in older children and children of married and male military parents.
Article
Over a million children and their families have now experienced the stress of the deployment of a family member during the recent wars in Iraq and Afghanistan. Whereas there is an extensive clinical literature about the developmental challenges facing children and issues of family adjustment, there is a lack of systematic research. This review summarizes the findings of recent publications. Some veterans develop posttraumatic stress disorder as a consequence of their experiences. This condition drives many of the adverse changes in the families of returning veterans through the effects on intimacy and nurturance in their families of withdrawal, numbing and irritability that are components of posttraumatic stress disorder. There is the more general challenge that all families and children face when a partner/parent deploys of role ambiguity consequent on anxiety that is provoked by the threat that deployed family members experience. A study of Kuwaiti military showed that mothers' anxiety had the greatest impact on the children of deployed fathers, although absence of posttraumatic stress disorder in mothers could mitigate the effects of their fathers' posttraumatic stress disorder. Intervention programs are described, but there is a poverty of their evaluation. A substantial advantage of focusing on family adjustment is that it can facilitate access to mental healthcare for veterans while assisting families' positive adaptation.
Article
The authors report on a cohort-controlled study designed to examine the effect of paternal absence on medical visits made by families. The total number of visits made by study wives was significantly increased in the period immediately after their husband's return (p < 0.01). When only stress-related visits were considered, study wives were seen more often, both during the spouse's absence and after his return (p < 0.01). No significant differences were noted between groups of study and control children in any period measured. Separation from the husband causes a significant increase in health care utilization by the mothers of young children but does not appear to affect the number or type of pediatric visits made.
Article
Longitudinal designs typically involve repeated time-ordered observations for each individual (or unit). Such designs are uniquely suited to studying changes over time within individuals, and relating these to individual characteristics to identify processes and causes of intra- individual changes and interindividual differences in physiologic and psychological development. The purpose of this paper is to compare and contrast univariate and multivariate ANOVA with repeated measures to hierarchical linear modeling as approaches to analyzing such longitudinal data. This will enable researchers to choose the approach that best meets their research needs, and it will enable them to compare research results that are reported using one analytical approach with results that are reported using the other approach.
Article
Parental stress is believed to play a critical role in child maltreatment, and deployment is often stressful for military families. To examine the association between combat-related deployment and rates of child maltreatment in families of enlisted soldiers in the US Army who had 1 or more substantiated reports of child maltreatment. Descriptive case series of substantiated incidents of parental child maltreatment in 1771 families of enlisted US Army soldiers who experienced at least 1 combat deployment between September 2001 and December 2004. Conditional Poisson regression models were used to estimate rate ratios (RRs) that compare rates of substantiated child maltreatment incidents during periods of deployment and nondeployment. A total of 1858 parents in 1771 different families maltreated their children. In these families, the overall rate of child maltreatment was higher during the times when the soldier-parents were deployed compared with the times when they were not deployed (942 incidents and 713 626 days at risk during deployments vs 2392 incidents and 2.6 million days at risk during nondeployment; RR, 1.42 [95% confidence interval {CI}, 1.31-1.54]). During deployment, the rates of moderate or severe maltreatment also were elevated (638 incidents and 447 647 days at risk during deployments vs 1421 incidents and 1.6 million days at risk during nondeployment; RR, 1.61 [95% CI, 1.45-1.77]). The rates of child neglect were nearly twice as great during deployment (761 incidents and 470 657 days at risk during deployments vs 1407 incidents and 1.6 million days at risk during nondeployment; RR, 1.95 [95% CI, 1.77-2.14]); however, the rate of physical abuse was less during deployments (97 incidents and 80 033 days at risk during deployments vs 451 incidents and 318 326 days at risk during nondeployment; RR, 0.76 [95% CI, 0.58-0.93]). Among female civilian spouses, the rate of maltreatment during deployment was more than 3 times greater (783 incidents and 382 480 days at risk during deployments vs 832 incidents and 1.2 million days at risk during nondeployment; RR, 3.33 [95% CI, 2.98-3.67]), the rate of child neglect was almost 4 times greater (666 incidents and 303 555 days at risk during deployments vs 605 incidents and 967 362 days at risk during nondeployment; RR, 3.88 [95% CI, 3.43-4.34]), and the rate of physical abuse was nearly twice as great (73 incidents and 18 316 days at risk during deployments vs 141 incidents and 61 105 days at risk during nondeployment; RR, 1.91 [95% CI, 1.33-2.49]). Among families of enlisted soldiers in the US Army with substantiated reports of child maltreatment, rates of maltreatment are greater when the soldiers are on combat-related deployments. Enhanced support services may be needed for military families during periods of increased stress.
Article
To promote early identification of mental health problems among combat veterans, the Department of Defense initiated population-wide screening at 2 time points, immediately on return from deployment and 3 to 6 months later. A previous article focusing only on the initial screening is likely to have underestimated the mental health burden. To measure the mental health needs among soldiers returning from Iraq and the association of screening with mental health care utilization. Population-based, longitudinal descriptive study of the initial large cohort of 88 235 US soldiers returning from Iraq who completed both a Post-Deployment Health Assessment (PDHA) and a Post-Deployment Health Re-Assessment (PDHRA) with a median of 6 months between the 2 assessments. Screening positive for posttraumatic stress disorder (PTSD), major depression, alcohol misuse, or other mental health problems; referral and use of mental health services. Soldiers reported more mental health concerns and were referred at significantly higher rates from the PDHRA than from the PDHA. Based on the combined screening, clinicians identified 20.3% of active and 42.4% of reserve component soldiers as requiring mental health treatment. Concerns about interpersonal conflict increased 4-fold. Soldiers frequently reported alcohol concerns, yet very few were referred to alcohol treatment. Most soldiers who used mental health services had not been referred, even though the majority accessed care within 30 days following the screening. Although soldiers were much more likely to report PTSD symptoms on the PDHRA than on the PDHA, 49% to 59% of those who had PTSD symptoms identified on the PDHA improved by the time they took the PDHRA. There was no direct relationship of referral or treatment with symptom improvement. Rescreening soldiers several months after their return from Iraq identified a large cohort missed on initial screening. The large clinical burden recently reported among veterans presenting to Veterans Affairs facilities seems to exist within months of returning home, highlighting the need to enhance military mental health care during this period. Increased relationship problems underscore shortcomings in services for family members. Reserve component soldiers who had returned to civilian status were referred at higher rates on the PDHRA, which could reflect their concerns about their ongoing health coverage. Lack of confidentiality may deter soldiers with alcohol problems from accessing treatment. In the context of an overburdened system of care, the effectiveness of population mental health screening was difficult to ascertain.
Article
The effects of the military deployment of parent-soldiers on children and families need to be understood in the context of military culture as well as from developmental risk for maladjustment. Although research addressing such effects is limited in both scope and certainty, we can identify several key factors that relate to psychological risk, adjustment, and outcome. Most children are resilient to the effects of deployment of at least one of their parents, but children with preexisting psychological conditions, such as anxiety and depression, may be particularly vulnerable, as well as children with specific risk factors, such as child abuse, family violence, or parental substance abuse. A series of case vignettes illustrate the psychological adjustment and treatment implications for children with parents deployed in support of military combat operations.
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