Parental Combat Deployment Tied to Mental Problems in Kids

Fran Lowry

July 07, 2011

July 6, 2011 — Children with a parent — usually a father — who was deployed in military combat for long periods in Iraq or Afghanistan have more mental health problems than children whose parents were not deployed, new research shows.

"Children fear a parent’s death above any other event and, in military families, view war as a threat to their caretakers’ security and stability," write lead author Alyssa J. Mansfield, PhD, MPH, of the Department of Veterans Affairs National Center for Post-traumatic Stress Disorder, Honolulu, Hawaii, and her colleagues.

Dr. Alyssa J. Mansfield

"Even the possibility of war and a parent’s potential harm has been shown to be sufficient to induce psychological distress among children with military parents, as has actual parental separation during military deployment."

The study was published online July 4 in the Archives of Pediatrics and Adolescent Medicine.

First-Hand Experience

Research into the mental health of children of military personnel during Operation Enduring Freedom and Operation Iraqi Freedom is sparse, and what research there is indicates increased stress and behavior problems associated with parental deployment.

Dr. Mansfield and her group sought to shed more light on the subject by characterizing the risk for mental health diagnoses among these children.

"I worked as an epidemiologist for the Army from 2000 to 2003, and during that time September 11 occurred, as well as the start of the operations in Iraq and Afghanistan," Dr. Mansfield told Medscape Medical News.

"I was really able to see first-hand the effects of these operations and I wanted to focus my research on them when I was completing my doctorate work at UNC [University of North Carolina] Chapel Hill," she added.

Recent previous research presented at the American Psychiatric Association 2011 meeting and reported by Medscape Medical News shows that children whose parents were deployed for Operation Iraqi Freedom or Operation Enduring Freedom had a 10% greater risk of being hospitalized for any psychiatric condition compared with children who had nondeployed parents.

More Mental Illness in Older Children

In the present study, Dr. Mansfield and her team examined electronic medical record data for outpatient care received at military facilities or through military health insurance between 2003 and 2006.

The study included 307,520 children, aged 5 through 17 years, who had at least 1 parent serving on active duty in the US Army. They used the International Classification of Disease, Ninth Revision, to identify mental health diagnoses.

They found that 16.7% of the children had at least 1 mental health diagnosis. The most common diagnoses were disorders of stress (5.9%), depression (5.6%), behavior problems (4.8%), anxiety (2.7%), and sleep disorders (2.4%).

Overall, there were an excess of 6579 mental health diagnoses during the 4-year period among the children with a deployed parent compared with children whose parents did not deploy.

The study also showed that older children (aged 13 to 17 years) had more mental health diagnoses than children aged 5 to 8 years and those aged 9 to 12 years. Boys had more diagnoses than girls.

The researchers also found that the longer a child’s parent was deployed during the study period, the more likely the child was to experience a mental health problem.

Clear Clinical Implications

"Anyone who is involved in caring for children in a medical setting, such as a physician, nurse, psychologist, social worker, or in a nonmedical setting, such as teachers or other individuals in a child’s life, should take time to find out whether their parents are deployed, recently deployed, or have spent a significant amount of time in deployment and then ask if they are doing okay," Dr. Mansfield said.

She also pointed out that most of the children were actually doing well and had no mental health problems recorded in their medical records.

"There are children and families who are doing well. We have a lot to learn from them to find out what they are doing that could help the families that are struggling more and having a tougher time coping," she said.

In an accompanying editorial, Stephen J. Cozza, MD, from the Uniformed Services University School of Medicine, Bethesda, Maryland, writes that this research provides valuable information about the association between the mental health of a child and parental combat deployment "that has clear implications for clinical practice."

He agrees that military children need to be identified by healthcare providers because they have unique needs.

"There is a tendency to see the military as stagnant and unchanging in composition, suggesting that military families live elsewhere rather than ‘where I live and practice medicine,’" Dr. Cozza writes.

"Brief screening for anxiety, depression, behavioral problems, academic difficulties, peer relational problems, or high risk behaviors (such as substance misuse or unsafe sexual practices) is warranted and will help identify treatment needs," he concludes.

Dr. Mansfield and Dr. Cozza have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. Published online July 4, 2011.

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