Impact of deployment on military families with young children: A systematic review

Female-Specific Health Care of Military Female-Designated Service Members and Veterans: A Systematic Overview of Reviews

INTRODUCTION

Since the War in Afghanistan began in 2001, service members have faced significant health effects related to service during war, with female-designated service members facing unique challenges. Numerous high-quality review articles have been published on the health and care of female-designated service members and veterans. Given the increasing volume of literature, we completed an overview of reviews on the health and health care of female-designated military populations. Our objective was to conduct an overview of reviews on the obstetrics and gynecologic health and health care of female-designated military populations since 2000 to understand female-specific health consequences of military service during war and make clinical recommendations.

MATERIALS AND METHODS

On May 10, 2022, a medical librarian performed a comprehensive search across five databases (Ovid Medline, Embase, CINAHL, PsycINFO, Ovid All EBM Reviews, and Web of Science) for all relevant reviews published from 2000 to May 10, 2022. Results were limited to English language. After the removal of duplicates, 2,438 records were reviewed, and 69 studies were included in the final review. The search strategy and methods were registered with PROSPERO and are reported according to the Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. Two independent reviewers conducted title and abstract screening and subsequent full text review using Covidence Systematic Review Software. Reviews addressing female-specific and obstetrics and gynecologic health of female-designated service members or veterans, utilizing a clear and systematic methodology, were eligible for inclusion. Quality assessment was conducted by teams of two reviewers.

RESULTS

A total of 69 studies were included in the final review. Themes included mental health and impact of sexual assault on service members or veterans, veteran health care, issues of menstruation, pregnancy, and urogenital concerns. Areas with few reviews included occupational risks of military service and impact on obstetric outcomes, eating disorders, and menopause. There were insufficient or no reviews on the impact of military service on fertility, access to abortion care, reproductive health outcomes of lesbian, bisexual and transgender service members, surgical treatment of gynecologic conditions, and screening and treatment for breast, gynecologic, and non-pelvic organ cancers.

CONCLUSIONS

Female-designated military populations serving during periods of war face unique health challenges that should be considered in screening practices and the delivery of trauma informed care. Further research and reviews are needed for female-specific oncology, fertility, abortion access, and sexual and non-binary and expansive gender identities to better capture female-designated service member and veteran health during wartime and beyond.

A qualitative examination of the reintegration experiences of Australian Defense Force families

The profound development that occurs during the first five years of a child's life may contribute to military families with young children facing unique challenges during reintegration. Yet, little is known about the reintegration experiences of military families with young children, and less so from the perspectives of non-deployed parents and families outside of the US. In this qualitative study, we explored the reintegration experiences of Australian Defense Force (ADF) families with young children (five years and younger). Through written responses to open-ended prompts, ADF service members (n = 9) and their non-deployed spouses (n = 38) reflected on periods of reintegration and discussed their family's adaption during this time. Using thematic analysis, six themes representing the reintegration experiences of these families were generated from the data. Four themes were generated from the combined experiences of service members and non-deployed parents, while a further two themes were generated from the experiences of non-deployed parents only. Relational and parenting challenges were at the forefront of reintegration experiences. These findings offer meaningful implications for practice and research to improve the quality of parent-child relationships and enhance outcomes for military families with young children during reintegration.

Adverse Childhood Experiences and Positive Childhood Experiences Among United States Military Children

INTRODUCTION

Many facets of military life are contributors to child health including frequent mobility, family separation, and increased risk to parental physical and mental health, as well as strong social networks and military support systems; yet, there has not been an examination of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) among military children.

MATERIALS AND METHODS

This study used the 2020-2021 National Survey of Children's Health, limited to children aged 6 to 17 years of age, to examine the association between a child who has ever had a caregiver on active duty and their exposure to ACEs and PCEs (n = 54,256 children). Bivariate analyses used Pearson's chi-squared tests and were weighted to be nationally representative. Multivariable regression models were used to examine the association between military status and selected ACEs.

RESULTS

There were no statistically significant differences in PCEs between military and civilian children. Compared to children with a civilian caregiver, children who had a caregiver who had ever served on active duty had a higher odds of experiencing domestic violence (adjusted Odds Ratio (aOR), 1.61; 95% CI 1.23-2.11), mental health issues or depression in the household (aOR 1.28; 95% CI 1.07-1.52), and substance use (aOR 1.28; 95% CI 1.06-1.55).

CONCLUSIONS

This study complements and extends previous research that has taken a deficit approach and focused exclusively on the hardships faced by children in military families. The findings from this study may be instructive for child welfare advocates and policymakers as they intervene in communities with programming that promotes PCEs among children and adolescents.

Parental conscription and cumulative adverse experiences in war-affected children and adolescents and their impact on mental health: a comment following Russia's invasion of Ukraine in 2022

BACKGROUND

With Russia's invasion of the Ukraine on February 2022, Ukrainian children and adolescents have been exposed to several stressful life events. In addition to the confrontation with war, flight and parent-child separation due to flight and forced displacement, the majority underwent another challenge at the initial phase of the war: the fatherly separation due to conscription.

MAIN BODY

In the literature, the negative effects of exposure to war and flight/refuge, parent-child separation due to flight or forced displacement and parental deployment are well established. In the context of self-experienced war, the effects of parent-child separation caused by compulsory military service have not yet been sufficiently taken into account. However, the findings of the literature on the impact of these events on the mental health of children and adolescents show that they are at high risk for developing numerous psychological and behavioral problems.

CONCLUSION

As children's and adolescents' mental health might be severely affected by war and its consequences, interventional programs that address the special needs of those children and adolescents are crucial.

Evaluation of Racial Disparities in Suspected Child Abuse among Insured Children with Head Injury

Previous studies demonstrate racial disparities in child abuse evaluations even after controlling for health insurance coverage. We conducted a cross-sectional study using the Military Health System Data Repository (MDR) of Military Health System (MHS) beneficiaries born between fiscal years 2016 and 2018 to evaluate racial disparities and other factors in the suspicion of child abuse. We observed beneficiaries for 2.5 years after birth and assessed the incidence of head injury using diagnostic codes. Among children with head injury codes, we performed a multivariable logistic regression analysis to measure the association between race and the concurrent use of the diagnostic code for suspected child abuse (SCA) or for the performance of a skeletal survey. There were 195,893 infants included and 45,269 (23.1%) underwent evaluations for head injury. Less than one percent (n = 424) concurrently had the diagnostic code for SCA or a skeletal survey performed within 2 weeks of the head injury evaluation. When controlling for other factors, race was not associated with SCA. Higher military rank was independently associated with decreased odds of SCA. Racial disparities in SCA may be mitigated in the MHS, and further evaluation is needed. Military rank could be a factor in SCA disparities and warrants further study.

Military families: the impacts of having a first child during service on military mothers

INTRODUCTION

The rights, roles and responsibilities of servicewomen in the UK Armed Forces has changed dramatically over time. Previously, service personnel were automatically discharged from the military if they became pregnant. As the percentage of servicewomen in the UK Armed Forces increases, having children during service is becoming more common and maternity policies are now in place. Having children during military service can impact on the health and well-being of servicewomen, including a greater risk of illness when returning to work.

METHODS

A cross-sectional, self-report survey was used for data collection. The response rate was approximately 45%. Female Army veterans were recruited via a female military association. The survey collected data on parental status, the timing of their first child (during or after service), and several current mental and physical health and well-being outcomes.

RESULTS

Of the 750 female Army veterans who completed the survey, 406 reported having children. Of those with children, 14.5% had their first child during service compared with 85.5% after service. The most frequently endorsed health outcomes were low social support, loneliness and common mental health difficulties. Participants who had their first child during military service were more likely to have left the service non-voluntarily.

CONCLUSIONS

This study provided insight into the impacts of having a first child during military service on servicewomen. Overall, female Army veterans who had their first child during service had poorer outcomes, including leaving service non-voluntarily. However, none of the health or well-being outcomes remained significant after adjusting the results. This study explored a widely under researched population and field of research. Future research should seek to expand on our findings and continue to explore the impacts of having a first child during military service for military mothers.

Do children separated from fathers have higher anxiety levels? A comparative analysis

Background

There is limited literature from India on effect of fathers' deployment on the mental health of children. This cross-sectional analytical study investigates the difference in anxiety levels of children whose fathers are deployed in a field location and compares it with children currently located with their fathers.

Method

Data were collected in an army school from 200 children aged 10-17 years with fathers deployed in field locations (n = 99) and fathers currently residing with the children (n = 105) via interviewer administered and self-completed Screen for Child Anxiety-Related Disorders (SCARED) questionnaire.

Results

Anxiety scores were on an average, minimally raised above the cut-off level for children who had fathers deployed. In addition, panic disorder scores were also above the cut-off levels for these children. While scores were normal in all other domain, they were higher than that for children residing with their fathers, although the difference was not significant. Girls with fathers deployed had scores higher than cut-off scores for domains such as panic, separation anxiety and school avoidance, while boys had scores higher than cut-off scores only for panic disorders. However, the girls had significantly higher scores than boys in all domains. Girls in both groups (with and without father deployed) had higher scores than cut-off scores for panic disorders.

Conclusion

Anxiety levels in children were not found to be unduly affected by the deployment of fathers. But girls were found to have clinically relevant panic disorder, school avoidance and separation anxiety scores as compared with boys in the similar situation of parental separation.

Parenting Pre-teens During COVID-19 in a Rural Midwestern Community: An Interpretive Phenomenological Study

To uncover the experiences of parenting Generation Z pre-teen children in rural communities impacted by the Stay Home Missouri order from April through May 2020. Researchers have focused on urban parents, leading to gaps in understanding the impact of the COVID-19 quarantine on rural parents and children. A qualitative study employing interpretive phenomenology. 14 white cis-male-sexed fathers and cis-female-sexed mothers living in midwestern rural communities participated in this study. Semi-structured interviews with 14 participants parenting pre-teen children were conducted. The interviews were analyzed using interpretive phenomenology. The COREQ checklist was followed. One theme that emerged from the narratives was the study participants' understandings of parenting, discovered when their routines were disrupted by the Stay Home Missouri order. This theme involved three sub-themes: 1) responding to the challenges of protecting pre-teen children; 2) coping with disrupted social relationships; and 3) renegotiating responsibilities. Professionals who work with families need to find ways to assist parents during and after a health emergency that requires quarantine. COVID-19 is not the first pandemic to endanger humanity, and the next pandemic-or a future variant of SARS-could require an additional period of local, regional, or national quarantine. Implications for professionals supporting parents during periods of severe disruption-such as future public health crises as well as large scale quarantines-are offered to assist with preparation for and coping with severe disruptions to parenting.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-022-00507-9.

The Effect of COVID-19 on the Mental Health of Military Connected Children and Adolescents

With a growing body of literature describing the coronavirus disease 2019 (COVID-19) pandemic's effect on children and adolescents, there remain few official reports regarding mental health in military connected youth. With sparse literature available specifically in youth associated with the Armed Forces, published studies on global child and adolescent mental health during the COVID-19 pandemic are first reviewed. Military connected youth have unique needs and experiences. Implications of pandemic-related stressors on their mental health are suggested based on analysis of disaster and deployment literature. Military members have continued to move and deploy throughout the pandemic. Uniformed families have high risk factors for mental health concerns. Managing the mental health of military connected youth will fall heavily on civilian providers, both in primary and subspecialty practices. As such, vigilance for psychological health concerns and familiarity with military resources are vital for the mental wellness of our military pediatric patients. [Pediatr Ann. 2022;51(4):e138-e143.].

Parental Wartime Deployment and Socioemotional Adjustment in Early Childhood: The Critical Role of Military Parents' Perceived Threat During Deployment

Infants, toddlers, and preschool-aged children have unique developmental needs that render them vulnerable to challenges associated with parental military service. We used a sample of military-connected families with 3-6-year-old children (N = 104) to examine associations among children's socioemotional development and fathers' trauma-related deployment experiences, including perceived threat during deployment and exposure to combat and the aftermath of battle. Of these potential stressors, only paternal perceived threat during deployment was significantly associated with measures of mother-reported child adjustment. Fathers' perceived threat during deployment was associated with child behavior problems even after accounting for demographic variables and current paternal symptoms of posttraumatic stress, depression, and anxiety, β = .36, p = .007. The association between fathers' perceived threat during deployment and child behavior problems was mediated by several family processes related to emotion socialization, including father-reported sensitive parenting, indirect effect (IE) B = 0.106, 95% CI [0.009, 0.236]; parent-child dysfunctional interaction, IE B = 0.119, 95% CI [0.014, 0.252]; and mother-reported family emotional responsiveness, IE B = 0.119, 95% CI [0.011, 0.258]. Implications for future research on the intergenerational transmission of traumatic stress as well as prevention and intervention efforts for military-connected families with young children are discussed.

The contributions of child-mother attachment, maternal parenting stress, and military status to the prediction of child behavior problems

Studies show that children with a military parent are at heightened risk of the development of behavior problems. However, there is limited work examining how other factors experienced by military families may also influence behavior problems. In the current study, we recruited three types of Canadian families with a preschooler: families with a deployed military member, families with a nondeployed military member, and nonmilitary families. We examined whether the nonmilitary parent's (in all cases the mother) parenting stress and attachment relationship with the child are associated with behavior problems, and whether deployment status further contributes to the prediction. Child-mother dyads participated in an observed attachment assessment, and mothers reported on their stress levels and their child's behavior. Results showed that both child attachment insecurity and parenting stress were associated with elevated levels of internalizing problems; however, only parenting stress was associated with conduct problems. Military deployment predicted higher levels of internalizing and conduct problems beyond the contributions of attachment and stress. Furthermore, having a father in the military (whether deployed or not) also contributed to internalizing problems. These findings shed light on how the military lifestyle impacts early childhood mental health through the complex interplay between various parts of their environment.

[Intervention programs for psychological stress in children of military personnel in the USA - Results of a systematic literature review with regard to transferability to Germany]

Intervention programs for psychological stress in children of military personnel in the USA - Results of a systematic literature review with regard to transferability to Germany Abstract. Military personnel who have been deployed in war zones or other unstable regions are at an increased risk to develop mental health disorders, including posttraumatic stress disorder. Likewise, their children are at high risk to develop mental health problems as well as emotional and behavioral difficulties. Most research on prevalence of mental health problems as well as on interventions within this group was conducted in the USA. In Germany, no systematic intervention for children of military members focusing on their experiences of deployment exist. The systematic literature review aimed to analyze existing intervention programs in the USA, in particular for children of military members regarding evidence, type and addressed target group (parents, children, both). Compared to the social welfare and health care systems in the USA, the German systems are different. Hence, a second aim was to examine the transferability of these programs to the specific needs of children of German military members (Bundeswehr). 27 intervention programs could be included in the review. Programs, directly or indirectly, are addressing the needs of children of a deployed parent. They are usually focusing on the "emotional cycle of deployment" (phase of preparation of deployment, separation phase of deployment and the return of the deployed parent). The programs mainly focused on parenting skills, family reactions to stress, coping strategies of families, and the feeling of coherence within the family. Only 20 % of the interventions could be assigned to the type of indicated prevention. Nine interventions have shown positive effects (either in RCT or non-experimental designs). Several elements of the programs are transferable to the German situation of children of military members. In particular, contents which address the specific situation of families with a military member are desperately needed in Germany. Transferability is limited by the non-comparability of health care and social welfare systems in the USA and in Germany.

Parental military deployment as risk factor for children's mental health: a meta-analytical review

There is evidence that military service increases the risk of psychosocial burden for not only service members but also their spouses and children. This meta-analysis aimed to systematically assess the association between military deployment of (at least one) parent and impact on children's mental health. For this meta-analytic review, publications were systematically searched and assessed for eligibility based on predefined inclusion criteria (studies between 2001 until 2017 involving children with at least one parent working in military services). Measurements were determined by total problem scores of the children as well as symptoms of anxiety/depression, hyperactivity/inattention, and aggressive behavior. Meta-analyses aggregated the effect sizes in random-effect models and were calculated separately for the relation between parental deployment and civilian/normative data and for the relation between parental deployment and non-deployment. Age of the children was used as moderator variable to explore any potential source of heterogeneity between studies. Parental military deployment was associated with problems in children and adolescents compared to civilian/normative samples. Significant effect sizes reached from small to moderate values; the largest effect sizes were found for overall problems and specifically for anxious/depressive symptoms and aggressive behavior. Within the military group, children of deployed parents showed more problem behavior than children of non-deployed parents, but effect sizes were small. Age of the children had no moderating effect. The results emphasize that children of military members, especially with a deployed parent, should be assessed for emotional and behavioral problems.

Health and Mental Health Needs of Children in US Military Families

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.

Improving Child Peer Adjustment in Military Families through Parent Training: The Mediational Role of Parental Locus of Control

The current study investigated the mechanisms through which a parenting intervention for military families fosters positive peer adjustment in children. A sample of 336 families with a history of parental deployment enrolled in a randomized controlled trial of the After Deployment Adaptive Parenting Tools (ADAPT) preventive intervention. ADAPT is a 14-week preventive intervention designed to strengthen parenting in military families. The intervention was associated with improvements in mother's and father's parental locus of control (i.e., a more internal locus of control) at a 6-month follow-up assessment while controlling for baseline levels. Mothers' parental locus of control was positively associated with improvements in children's peer adjustment 12 months following the intervention while controlling for baseline peer adjustment. A significant indirect effect revealed that participation in ADAPT resulted in improved 12-month peer adjustment by improving mothers' parental locus of control. Implications for supporting youth resilience to stressors associated with deployment are discussed.

Parenting Needs Among Mothers of Young Children During Military Deployment

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.

Pathways of Risk and Resilience: Impact of a Family Resilience Program on Active-Duty Military Parents

Over the past decade, studies into the impact of wartime deployment and related adversities on service members and their families have offered empirical support for systemic models of family functioning and a more nuanced understanding of the mechanisms by which stress and trauma reverberate across family and partner relationships. They have also advanced our understanding of the ways in which families may contribute to the resilience of children and parents contending with the stressors of serial deployments and parental physical and psychological injuries. This study is the latest in a series designed to further clarify the systemic functioning of military families and to explicate the role of resilient family processes in reducing symptoms of distress and poor adaptation among family members. Drawing upon the implementation of the Families Overcoming Under Stress (FOCUS) Family Resilience Program at 14 active-duty military installations across the United States, structural equation modeling was conducted with data from 434 marine and navy active-duty families who participated in the FOCUS program. The goal was to better understand the ways in which parental distress reverberates across military family systems and, through longitudinal path analytic modeling, determine the pathways of program impact on parental distress. The findings indicated significant cross-influence of distress between the military and civilian parents within families, families with more distressed military parents were more likely to sustain participation in the program, and reductions in distress among both military and civilian parents were significantly mediated by improvements in resilient family processes. These results are consistent with family systemic and resilient models that support preventive interventions designed to enhance family resilient processes as an important part of comprehensive services for distressed military families.

Impact of Military Deployment on the Development and Behavior of Children

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.