COMMENTARY

Increased Rates of Child Maltreatment in Military Families During Deployments?

William T. Basco, Jr, MD, FAAP

Disclosures

December 17, 2007

Child Maltreatment in Enlisted Soldiers' Families During Combat-Related Deployments

Gibbs DA, Martin SL, Kupper LL, Johnson RE
JAMA. 2007;298:528-535.

These investigators sought to determine whether there was an increased rate of child maltreatment in military families when one of the parents was on a combat deployment. This study linked data from 2 US Army data systems, looking at a 3.5-year period from 2001-2004.

The primary outcome was overall rates of maltreatment, but the authors also conducted subanalyses of the different types of maltreatment: neglect, physical abuse, emotional abuse, and sexual abuse. From the databases, they could identify cases and descriptions of the incidents, as well as collect data on demographics, deployment status, rank, etc. These analyses are confined to the 1771 incidents among the families of enlisted soldiers.

There were 49 cases involving officers' families, but the authors felt that the number was too small for purposes of analysis. Of the 1771 cases, 90% involved child maltreatment on 1 day, with 9% involving maltreatment on 2 days and 1% (22 parents) involving maltreatment on 3 days or more. The mean parental age was 29 years, and 54% of the offenders were non-Hispanic whites. There was no difference in maltreatment by child gender, and the mean age of the children involved was 6 years.

Twenty-eight percent of the maltreatment events occurred during a combat deployment (this could be during a deployment furlough, when both parents might be present or when 1 parent was actually out of the area), but only 22% of the total children's days occurred during a parent's deployment. Utilizing Poisson regression, the authors calculated an unadjusted relative risk of 1.42, meaning a 42% increase in risk of maltreatment during a combat deployment.

In addition, the severity of maltreatment was worse during deployment times, with the maltreatment episodes being more likely to be classified as "moderate" to "severe." The relative risk of neglect was 1.95 during combat deployments, and this increase accounted for a large proportion of the overall increased rate of maltreatment.

There were no differences in rates of sexual abuse during deployment times. As one might expect, the rates of child maltreatment by soldiers (both male and female) were lower when on deployment. However, female spouses (nonmilitary) had a significantly greater relative risk of 3.33 during deployments.

There was not a significant increase in maltreatment by male spouses when a female soldier was deployed. There was an increase in maltreatment during deployment among white soldiers' families, but not among families that were black or Hispanic. Gender of the children was not associated with rates of maltreatment.

The authors conclude that among cases of maltreatment, there was a relative increase in maltreatment episodes during combat deployments.

As I read this article, I had to keep reminding myself that it was not a population-based survey, so one can't infer rates in any way (all were "cases" included in an analysis to determine whether rates were higher during deployment vs nondeployment times). The authors note this limitation. The best take-home message is that deployments are times of stress for military families, and spouses remaining behind need a lot of support. Pediatric providers can help in part by monitoring the children of soldier families even more carefully during deployments, paying particular attention to issues of potential neglect.

Abstract

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