The mental health of sons and daughters of Australian Vietnam veterans

Associations of Warzone Veteran and Intimate Partner PTSD Symptoms with Child Depression, Anxiety, Hyperactivity, and Conduct Problems

Warzone deployment increases risk for posttraumatic stress disorder symptoms (PTSS), including among service members who have children. Parental PTSS are associated with child depression, anxiety, hyperactivity, and conduct problems, yet few studies of child behavioral health outcomes in military populations have accounted for PTSS in both warzone veterans and their partners. Fewer still incorporate non-clinically-recruited samples of nationally dispersed warzone veterans and their families. The current research examines whether children whose parent(s) have higher levels of PTSS exhibit more behavioral health symptoms. One hundred and thirty-three Iraq and Afghanistan War veterans and their cohabitating partners completed clinical interviews and self-report questionnaires. Higher intimate partner PTSS, more extensive child exposure to stressful life events, and being an adolescent were significantly associated with child depression after adjusting for warzone veteran PTSS, demographics, and recent warzone veteran absence from the household. Greater child exposure to stressful life events was also associated with child conduct problems. Treatment of PTSD symptoms experienced by warzone veterans' intimate partners, and preventative interventions aimed at helping the children of warzone veterans cope with stress, may ultimately yield positive benefits for the behavioral health of children in military families.

Use of home care services by older Veterans and dependants in Melbourne, Australia, 2007-2016

LAY SUMMARY

Military service has an impact on health and well-being across the life course. However, there is little research on older Veterans and dependants who use home care to enable them to remain living in the community. The authors analysed data from a Melbourne, Australia, home care organization’s electronic care records to explore the differences between clients supported by the Department of Veterans’ Affairs and clients in the general home nursing population. Results showed the greater needs of and complexity of care utilized by Veterans and dependants. Funding structures and support services need to account for these needs in older age.

Transgenerational Factors Associated With Military Service: Comparison of Children of Veterans and Nonveterans in a Nationally Representative Sample

OBJECTIVE

While the psychological effects of military service on the children of active-duty personnel have been studied extensively, little is known about the potential effects of military service for children of veterans after service has ended.

METHOD

Using nationally representative data from the 2018-2019 National Survey of Children's Health, school-age children of veteran families (n = 4,028) were compared with children of nonveteran families (n = 38,228). Owing to large sample sizes, effect sizes (relative risk and Cohen's d), rather than p values, were used to identify substantial differences in caregiver-reported sociodemographic, clinical, and school performance factors between children and caregivers in families with and without a veteran caregiver. Multivariate analyses were used to adjust for socioeconomic factors that could increase health service use.

RESULTS

Children of veteran families were more likely to have higher family incomes, health insurance, and married caregivers, but were also reported to have higher rates of clinically recognized externalizing behavioral conditions (attention-deficit disorder/attention-deficit/hyperactivity disorder or conduct disorder) (17.6% vs 12.7%; relative risk 1.42; 95% CI 1.21-1.66) and adverse childhood experiences; no substantial differences were reported in clinically recognized anxiety or depression. After adjustment for potentially confounding factors, children in veteran families were still more likely to be reported to have externalizing problems (odds ratio 1.34; 95% CI 1.02-1.77).

CONCLUSION

After adjustment for socioeconomic advantages that may increase health service use, children of veteran families demonstrate substantially higher rates of clinically recognized externalizing problems. While explanations for this require further study, service systems working with veterans may consider integrating child-focused screening/services.

Intergenerational Transmission of Posttraumatic Stress Disorder in Australian Vietnam Veterans' Daughters and Sons: The Effect of Family Emotional Climate While Growing Up

Posttraumatic stress disorder (PTSD) in military veterans increases the risk of PTSD in their offspring, a concept known as "intergenerational transmission;" however, the mechanism by which this transmission may occur is, as yet, undetermined. The present study included a nonclinical sample of 197 Australian Army veterans of the Vietnam War who were interviewed 17 years before in-person interviews of their adult daughters (n = 163) and sons (n = 120) were conducted. Veterans' PTSD symptoms were assessed using the Mississippi Scale for Combat-Related PTSD. Approximately 17 years later, offspring PTSD symptoms were assessed using the Clinician-Administered PTSD Scale for DSM-IV. In addition, offspring described the family emotional climate during their youth; responses were coded using the Family Affective Attitude Rating Scale (FAARS) to produce scale scores of veterans' negative, positive, and family relationship styles. A path analysis was conducted via structural equation modeling to test for significant path coefficients between veteran PTSD, family emotional climate, and offspring PTSD symptoms. For daughters, significant path coefficients were observed between veteran PTSD scores and FAARS scores, path coefficient = -.268; FAARS scores and offspring CAPS severity scores, path coefficient = -.223; and veteran PTSD scores and daughters' CAPS severity scores, path coefficient = .186. No satisfactory model could be found for sons. The results suggest that a positive emotional climate while growing up may be a significant protective factor against the development of PTSD in veterans' daughters, but other factors remain significant in veteran-to-offspring intergenerational transmission.

Family emotional climate in childhood and risk of PTSD in adult children of Australian Vietnam veterans

The mechanisms of intergenerational transmission of posttraumatic stress disorder (PTSD) from parent to child are not yet known. We hypothesised that the mechanisms involved in trauma transmission may be dependent upon sex specific caregiver-child dyads and these dyads may have a differential impact on post-traumatic stress disorder (PTSD). A non-clinical sample of adult offspring (N = 306) of Australian Vietnam veterans was interviewed in-person to assess the relationship between family emotional climate and caregiver attachment with the offspring's adult experience of post-traumatic stress disorder (PTSD). Attachment to the veteran father was not associated with sons' PTSD, but was for daughters. Attachment to mother was associated with PTSD and depression for both sons and daughters, with positive and warm attachment related to reduced PTSD diagnosis and its symptom clusters. A less positive family emotional environment was related to increased PTSD symptoms in daughters, while for sons a negative relationship style with their mother was related to increased frequency and severity of numbing/avoidance behaviours and hyperarousal symptoms. The findings suggest that sex-related differences in caregiver-child dyads do have a differential impact on PTSD symptom domains and may be one environmental mechanism by which trauma is transmitted across generations.