Deployment Linked to Child Psychiatric Hospitalizations

Deborah Brauser

May 16, 2011

May 16, 2011 (Honolulu, Hawaii) — Parental combat deployment may be associated with increased child psychiatric hospitalizations, new research presented here at the American Psychiatric Association (APA) 2011 Annual Meeting suggests.

In a retrospective cohort study of more than 375,000 children, investigators found that those with parents deployed for Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) in the previous year had a 10% greater risk of being hospitalized for any psychiatric condition compared with those who had nondeployed parents.

In addition, there was a "dose-response relationship," meaning the risk further increased as the time of deployment lengthened.

"The number one takeaway is that deployment does have effects on families," lead author Jeffrey Millegan, MD, MPH, lieutenant commander in the Navy and a Disaster and Preventive Psychiatry Fellow at the Uniformed Services University of the Health Sciences at Bethesda, Maryland, told Medscape Medical News.

Dr. Jeffrey Millegan

Noting that this is "the only large population-based study on this topic to date," Dr. Millegan said this has become "a more appreciated issue" over the last several years.

"My research looked specifically at a marker for more severe issues and is another contributing study showing that deployments in general have an adverse effect on children. This, along with length of deployment, should be taken into account when making plans during the predeployment stage."

Growing Evidence of Distress

According to the study, over 2 million military personnel have deployed in support of OIF and OEF.

"Since 43% of the active duty military have children, the potential costs and implications of deployment on these children are enormous," report the researchers.

Subsequent hospitalization, which signifies particularly severe problems related to mental health, accounts for a tremendous amount of these costs, said Dr. Millegan.

He cited a 2010 article on increased outpatient visits by military wives (N Engl J Med. 2010;362:101-109) and another 2010 article (Pediatrics. 2010;126:1058-1066) that showed an increase in outpatient visits among children between the ages of 3 and 8.

"There's a growing body of evidence about the psychological effects from deployment to combat zones on service members; and recent research has reported on distress in families. But they haven't looked at inpatient hospitalization of children," said Dr. Millegan.

"We wanted to look specifically at that as an outcome and at the most severe effects that can happen from the family dynamic disruption that can occur from deployment."

The investigators evaluated administrative records from between October 2006 and September 2009 of 377,576 children between the ages of 9 and 17 years (mean age, 12.3 years; 50.8% male) of active duty personnel.

Information from the Medical Data Repository, which included healthcare usage, was linked with that from the Defense Manpower Data Center, which included details on parental deployment.

A total of 10.8% of these children had a psychiatric history, and 23.3% had experienced a recent move. Of the active duty parents, 89.8% were married, 93% were male, 61.5% were white, and 22.8% were black; the mean age was 37.8 years.

Increased Hospitalizations

Results showed that 32.1% of the active duty parents deployed in fiscal year 2008, with a median cumulative length of 332 days. A total of 76.8% had a deployment of more than 180 days.

Hospitalizations were recorded for 2533 of the children (0.7%), with a median stay of 8 days.

After adjustment for the child's sex, age, past psychiatric history, and change of residence and for both the active duty and civilian parent's psychiatric history, the odds ratio (OR) for hospitalization was 1.10 (95% confidence interval, 1.01 - 1.19) for the children of deployed parents vs those with nondeployed parents.

Plus, the adjusted OR for risk for hospitalization was greater as the length of parental deployment increased, with a "positive test of trend" (P < .05).

For parents with a deployment of 180 days or more, the OR for hospitalization of their child was 1.12, compared with an OR of 1.03 when deployment was 180 days or less.

Hospitalization length of stay did not significantly differ between the kids with vs those without deployed parents (median stay, 9 vs 8 days).

"This was somewhat of a surprise, but we felt that that could probably be explained by factors that go into insurance, which can sometimes play a role in inpatient hospitalization lengths. Still, I expected that to be longer for children of deployers," said Dr. Millegan.

"Hospitalization for children is still a pretty rare event. Looking at the specific diagnostic clusters or groupings, we also didn't find a significant difference in the reasons why they were hospitalized. There's no specific diagnosis that's necessarily more of an issue during deployment as opposed to not being deployed when it comes to hospitalization," he added.

Dr. Millegan said he now hopes follow-up research will examine the cumulative effect of deployment.

"There is literature out there to suggest that the more a parent is deployed, the more of an effect there is on kids. And I think that's a very important issue in these particular wars because parents are deploying sometimes 3 or 4 or 5 times. A limitation of our study was that it looked at deployment as a 1-time event."

He would also like to look at the specific risks associated with children of National Guard reserves.

"There are many reasons to believe that this is a very different population because they come from areas that don't necessarily have a robust military community or support-group setting. They also have different levels of health benefits and coverage and the age is very different," explained Dr. Millegan.

"Good First Step"

"It's very important to understand the impact of deployment on families. So this is a very good first step in doing that," APA Scientific Program Committee co-chair Don Hilty, MD, told Medscape Medical News.

"We know how hard it is for veterans when they go and when they come back. And there are a lot of innovations in treatments. But this is a good first step in figuring out what the issues are for families. Then, after more studies, some interventions may be possible for them," added Dr. Hilty, who is a professor of psychiatry and behavioral sciences at the University of California, Davis, in Sacramento.

"I think that clinicians who work with patients or spouses or significant others or extended family or kids of those deployed might think about doing a little more screening in terms of regular medical visits in primary care or in mental health settings."

He noted that examining the different reasons for hospitalization would be interesting in the future, "whether it's change in behavior or depression or trouble at school."

"Still, I think it's a fine study and I think this will really be helpful eventually for the families," concluded Dr. Hilty.

The study authors and Dr. Hilty have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2011 Annual Meeting: Poster NR07-15. Presented May 16, 2011.

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