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Erlewein K, Gossmann E, Fegert JM. 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. Child Adolesc Psychiatry Ment Health 2024; 18:42. [PMID: 38553764 PMCID: PMC10981359 DOI: 10.1186/s13034-024-00732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/13/2024] [Indexed: 04/01/2024] Open
Abstract
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.
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Affiliation(s)
- Katrin Erlewein
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhövelstrasse 5, 89075, Ulm, Germany.
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Ulm, Germany.
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany.
| | - Emily Gossmann
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhövelstrasse 5, 89075, Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Ulm, Germany
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhövelstrasse 5, 89075, Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Ulm, Germany
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany
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MacDermid Wadsworth SM, Topp D, Lester P, Stander V, Christ SL, Whiteman S, Knobloch L. Long-term consequences of mothers' and fathers' wartime deployments: Protocol for a two-wave panel study. PLoS One 2024; 19:e0295007. [PMID: 38498486 PMCID: PMC10947692 DOI: 10.1371/journal.pone.0295007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/13/2023] [Indexed: 03/20/2024] Open
Abstract
Multiple adjustment difficulties have been associated with children's exposure to recent parental wartime military deployments, but long-term consequences have not yet been systematically studied. This investigation will assess direct and indirect relationships between exposures to parental deployments early in life and later youth adjustment. Parents' psychological health and family processes will be examined as mediators, and parents' and children's vulnerability and support will be examined as moderators. Archival data will be combined with new data gathered from two children and up to two parents in families where children will be aged 11 to 16 at the first data collection and will have experienced at least one parental deployment, for at least one child prior to age 6. Data are being gathered via telephone interviews and web-based surveys conducted twice one year apart. Outcomes are indicators of children's social-emotional development, behavior, and academic performance. Notable features of this study include oversampling of female service members, inclusion of siblings, and inclusion of families of both veterans and currently serving members. This study has potentially important implications for schools, community organizations and health care providers serving current and future cohorts of military and veteran families.
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Affiliation(s)
- Shelley M. MacDermid Wadsworth
- Department of Human Development and Family Science, Purdue University, West Lafayette, Indiana, United States of America
| | - Dave Topp
- Department of Human Development and Family Science, Purdue University, West Lafayette, Indiana, United States of America
| | - Patricia Lester
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States of America
| | - Valerie Stander
- Naval Health Research Center, San Diego, California, United States of America
| | - Sharon L. Christ
- Department of Human Development and Family Science, Purdue University, West Lafayette, Indiana, United States of America
| | - Shawn Whiteman
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, United States of America
| | - Leanne Knobloch
- Department of Communication, University of Illinois, Urbana, Illinois, United States of America
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Thompson KA, Bauman V, Sunderland KW, Thornton JA, Schvey NA, Moyer R, Sekyere NA, Funk W, Pav V, Brydum R, Klein DA, Lavender JM, Tanofsky-Kraff M. Incidence and prevalence of eating disorders among active duty US military-dependent youth from 2016 to 2021. Int J Eat Disord 2023; 56:1973-1982. [PMID: 37493029 DOI: 10.1002/eat.24025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/12/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE The offspring of US military service members may be at increased risk for eating disorders. However, no epidemiological studies to date have evaluated eating disorder incidence rates and prevalence estimates among military-dependent youth. METHOD This retrospective cohort study examined eating disorder diagnoses in the military healthcare system (MHS) from 2016 through 2021. Active duty and national guard military-dependent youth, aged 10-17 years, who received care in the MHS via TRICARE Prime insurance, were identified by one or more ICD-10 codes indicative of an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, binge-eating disorder, and other-specified eating disorders). RESULTS During the 6-year surveillance period, 2534 dependents received incident diagnoses of eating disorders, with a crude overall incidence rate of 1.75 cases per 10,000 person-years. The most common diagnosis was other-specified eating disorder, followed by anorexia nervosa, bulimia nervosa, and binge-eating disorder. The crude annual incidence rate of all eating disorder diagnoses increased by nearly 65% from 2016 to 2021. Rates for all diagnoses were highest in 2020 and 2021. Period prevalence estimates were .08% for any eating disorder diagnosis, .01% for anorexia nervosa, .004% for bulimia nervosa, .004% for binge-eating disorder, and .06% for other-specified eating disorders. DISCUSSION The observed increase in eating disorder diagnoses during the surveillance period appeared to be driven by female dependents. More military dependents experienced a new-onset diagnosis during the COVID-19 pandemic compared to previous years. These findings highlight the need for eating disorder screening, identification, and treatment for dependents within the MHS. PUBLIC SIGNIFICANCE STATEMENT Children of US military service members may be at increased risk for eating disorders. Results indicate new-onset eating disorder cases increased 65% from 2016 to 2021, primarily among girls compared to boys. The most diagnosed and fastest growing diagnosis was other-specified eating disorder. Rates of anorexia nervosa increased following the COVID-19 pandemic. Findings highlight the need for eating disorder screening, identification, and treatment within the military healthcare system.
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Affiliation(s)
- Katherine A Thompson
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
| | - Vivian Bauman
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
| | - Kevin W Sunderland
- Clinical Investigation Facility, David Grant Medical Center, Travis Air Force Base, California, USA
- Ripple Effect, Rockville, Maryland, USA
| | - Jennifer A Thornton
- Clinical Investigation Facility, David Grant Medical Center, Travis Air Force Base, California, USA
- Ripple Effect, Rockville, Maryland, USA
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, USU, Bethesda, Maryland, USA
| | - Rachel Moyer
- Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, California, USA
| | - Nana Amma Sekyere
- Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, California, USA
| | - Wendy Funk
- Kennell and Associates Inc., Falls Church, Virginia, United States
| | - Veronika Pav
- Kennell and Associates Inc., Falls Church, Virginia, United States
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rick Brydum
- Kennell and Associates Inc., Falls Church, Virginia, United States
| | - David A Klein
- Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, California, USA
- Department of Family Medicine, USU, Bethesda, Maryland, USA
- Department of Pediatrics, USU, Bethesda, Maryland, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Marian Tanofsky-Kraff
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Department of Medical and Clinical Psychology, USU, Bethesda, Maryland, USA
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Cantor JH, Tong PK. Geographical access to specialized behavioral health treatment programs for U.S. active duty service members and military families from military installations. Prev Med Rep 2023; 34:102267. [PMID: 37273524 PMCID: PMC10236289 DOI: 10.1016/j.pmedr.2023.102267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/24/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023] Open
Abstract
Active duty service members and their families have unique behavioral health care service needs. The purpose of this study is to determine geographical access to specialized behavioral health programs tailored to active duty U.S. service members and military families from military installations. This study generated network distance measures between active duty military installations and licensed substance use disorder (SUD) treatment facilities and mental health treatment facilities for 2015-2018 using data from national surveys administered by the Substance Abuse and Mental Health Services Administration and coordinates for active duty military installations from the Defense Installation Spatial Data Infrastructure Program. Using regression analysis, we calculated the share of installations that are at-risk of being remote from behavioral healthcare services. Separately, we calculated the share of treatment facilities accepting military insurance that offer specialized programs for active duty service members and/or military families within a 30-minute drive to an installation. Three out of 10 installations were at-risk of being remote from a behavioral health treatment facility. About 25 percent of behavioral health treatment facilities accepting military insurance within a 30-minute drive to an installation offered a specialized treatment program for active duty military or military families. Lack of a specialized treatment programs could suggest facilities may not be equipped to manage stressors unique to being in the military, and as a consequence, could adversely impact the health and well-being of this population. Further research is necessary to understand what specialized treatment programs for military populations entail.
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Affiliation(s)
- Jonathan H. Cantor
- Corresponding author at: RAND Corporation, 1776 Main Street, m5159, Santa Monica, CA 90401, USA.
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DuBois D, Richmond R, Stephanie Roberts L, Mahar A, Fear N, Gill K, Samantha Leroux J, Cramm H. A scoping review of military and Veteran families within international suicidality and suicide prevention research. Prev Med Rep 2023; 33:102206. [PMID: 37223562 PMCID: PMC10201831 DOI: 10.1016/j.pmedr.2023.102206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/25/2023] Open
Abstract
The impacts of suicidality on families are well known, which is particularly relevant in at-risk populations, such as active duty military personnel and Veteran communities. This scoping review describes how military and Veteran families have been conceptualized within suicide prevention research. A systematic, multi-database search was conducted, and 4,835 studies were screened. All included studies underwent quality assessment. Bibliographic, participant, methodological, and family-relevant data was extracted and descriptively analyzed into Factors, Actors, and Impacts. In total, 51 studies (2007 - 2021) were included. Most studies focused on suicidality rather than suicide prevention. Factor studies described family constructs as a suicidality risk or protective factor for military personnel or Veterans. Actor studies described families' roles or responsibilities to act in relation to the suicidality of military personnel or Veterans. Impacts studies described the impacts of suicidality on military and Veteran family members. The search was limited to English language studies. There were few studies on suicide prevention interventions for or including military and Veteran family members. Family was typically considered peripheral to the military personnel or Veteran experiencing suicidality. However, there was also emerging evidence of suicidality and its consequences in military-connected family members.
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Affiliation(s)
- Denise DuBois
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Rachel Richmond
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Lauren Stephanie Roberts
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Alyson Mahar
- Max Rady College of Medicine, Community Health Sciences, University of Manitoba, Winnipeg, Ontario R3E 3P5, Canada
| | - Nicola Fear
- Department of Military Mental Health, Institute of Psychiatry, King’s College London, London WC2R 2LS, England, United Kingdom
| | - Kamaldeep Gill
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Janette Samantha Leroux
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Heidi Cramm
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
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Surabhi, Yadav AK, Prakash J, Mukherjee R. Do children separated from fathers have higher anxiety levels? A comparative analysis. Med J Armed Forces India 2023; 79:316-320. [PMID: 37193532 PMCID: PMC10182266 DOI: 10.1016/j.mjafi.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/04/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Surabhi
- Resident, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Arun Kumar Yadav
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Jyoti Prakash
- Professor, Department of Psychiatry, Armed Forces Medical College, Pune, India
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Gilreath TD, Montiel Ishino FA, Sullivan KS, Okoror TA. Maladaptive coping among military-connected adolescents: Examining combined risk using QCA. Front Psychol 2022; 13:948474. [PMID: 36600698 PMCID: PMC9806339 DOI: 10.3389/fpsyg.2022.948474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Military-connected students in public schools face a unique set of stressors that may impact their wellbeing and academic functioning. Methods Twenty-four youth in the 7th to 12th grades who had an active-duty parent (mother or father) serving in the U.S. Armed Forces were interviewed. Participants completed a qualitative interview while actively completing a Life History Calendar (LHC) to mark deployment and family military service milestones and discuss how they impacted the youth respondent. This study used Qualitative Comparative Analysis (QCA) to explore the interplay and combination of specific stressors related to relocation and deployment experiences among adolescents, and to determine key factors associated with maladaptive outcomes. Results The results of the QCA analysis identified bullying experiences and negative experiences with other military-connected youth as conditions that are associated with maladaptive coping. Discussion Chronic and acute stressors in adolescence are established risk factors for mental, emotional, and behavioral problems in the short and long-term including suicidality, substance use and abuse, and substance use disorders. Through qualitative inquiry we were able to identify specific contextual details related to maladaptive coping that can be used to further refine areas of focus for research, prevention, and interventions for military-connected adolescents.
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Affiliation(s)
- Tamika D. Gilreath
- Transdisciplinary Center for Health Equity Research, Texas A&M University, College Station, TX, United States,*Correspondence: Tamika D. Gilreath,
| | | | | | - Titilayo A. Okoror
- Department of Africana Studies, Binghamton University, Binghamton, NY, United States
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Solomon S, Shank LM, Lavender JM, Higgins Neyland MK, Gallager-Teske J, Markos B, Haynes H, Repke H, Rice AJ, Sbrocco T, Wilfley DE, Schvey NA, Jorgensen S, Ford B, Ford CB, Haigney M, Klein DA, Quinlan J, Tanofsky‐Kraff M. The Relationship Between Anxiety, Coping, and Disordered-Eating Attitudes in Adolescent Military-Dependents at High-Risk for Excess Weight Gain. MILITARY PSYCHOLOGY 2022; 35:95-106. [PMID: 36968637 PMCID: PMC10012895 DOI: 10.1080/08995605.2022.2083448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
Adolescent military-dependents are an understudied population who face unique stressors due to their parents' careers. Research suggests that adolescent military-dependents report more anxiety and disordered-eating than their civilian counterparts. While anxiety symptoms predict the onset and worsening of disordered-eating attitudes, the mechanisms underlying this relationship remain unclear. One factor that may underlie this relationship, and be particularly relevant for military-dependent youth, is coping. Therefore, we examined adolescent military-dependents (N=136; 14.5±1.5 years; 59.6% female; BMI-z: 1.9±0.4) who were at-risk for adult obesity and binge-eating disorder due to an age- and sex-adjusted BMI ≥ 85th percentile and loss-of-control eating and/or elevated anxiety. Participants completed an interview assessing disordered-eating attitudes and questionnaires on anxiety symptoms and coping strategies at a single time point. Bootstrapping models were conducted to examine the indirect paths between anxiety symptoms and disordered-eating attitudes through five coping subscales (aggression, distraction, endurance, self-distraction, and stress-recognition). Adjusting for relevant covariates, no significant indirect paths through the coping subscales (ps > .05) were found in any models. General coping, non-specific to eating, may not be a pathway between anxiety symptoms and disordered-eating attitudes among adolescents. Future research should examine other potential mediators of this relationship.
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Affiliation(s)
- Senait Solomon
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, USA
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
| | - Lisa M. Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, USA
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland, USA
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - M. K. Higgins Neyland
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Julia Gallager-Teske
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Bethelhem Markos
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Hannah Haynes
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Hannah Repke
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Alexander J. Rice
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Natasha A. Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland, USA
| | - Sarah Jorgensen
- Department of Family Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Brian Ford
- Department of Family Medicine, USU, Bethesda, Maryland, USA
| | - Caitlin B. Ford
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Mark Haigney
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
| | - David A. Klein
- Department of Family Medicine, USU, Bethesda, Maryland, USA
- Department of Pediatrics, USU, Bethesda, Maryland, USA
| | - Jeffrey Quinlan
- Department of Family Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Marian Tanofsky‐Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, USA
- Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, Maryland, USA
- Department of Medicine, USU, Bethesda, Maryland, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland, USA
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Pine AE, Schvey NA, Shank LM, Burke NL, Neyland MKH, Hennigan K, Young JF, Wilfley DE, Klein DA, Jorgensen S, Seehusen D, Hutchinson J, Quinlan J, Yanovski JA, Stephens M, Sbrocco T, Tanofsky-Kraff M. A Pilot Feasibility Study of Interpersonal Psychotherapy for the Prevention of Excess Weight Gain Among Adolescent Military-dependent Girls. Mil Med 2021; 186:344-350. [PMID: 33241297 PMCID: PMC7909453 DOI: 10.1093/milmed/usaa514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Adolescent military-dependents face unique psychosocial stressors due to their parents' careers, suggesting they may be particularly vulnerable to excess weight gain and symptoms of depression and anxiety. Despite these risk factors, there is a lack of tested preventative interventions for these youths. Given the transient nature of military family deployments, research may be hindered due to difficulty in collecting long-term prospective outcome data, particularly measured height and weight. The primary aim of this study was to examine the feasibility and acceptability of collecting body mass index (BMI, kg/m2) outcome data up to 2 years following a randomized controlled pilot trial of an adapted interpersonal psychotherapy (IPT) program aimed at preventing excess weight gain and improving psychological functioning for adolescent military-dependents. In exploratory analyses, patterns in body composition over time were examined. MATERIALS AND METHODS Twenty-seven adolescent military-dependent girls (baseline: Mage: 14.4 ± 1.6 years; MBMI: 30.7 ± 4.9 kg/m2; MBMI-z: 1.9 ± 0.4) participated in this study. After a baseline assessment, utilizing a computerized program to create a randomization string, girls were assigned to either an IPT or a health education (HE) program. Participants completed three follow-up visits (posttreatment, 1-year follow-up, and 2-year follow-up). Girls completed a Treatment Acceptability Questionnaire at posttreatment; at all time points, height and fasting weight were collected. For the primary aim, Fisher's exact tests examined the rate of obtained follow-up data and lost to follow-up status between the two groups, Mann-Whitney U tests examined the session attendance between groups, and treatment acceptability ratings were compared between the two groups at posttreatment using an independent samples t-test. For the exploratory aim, one-way analyses of covariance (ANCOVAs) examined the group differences in BMI at each time point, adjusting for baseline values, and paired samples t-tests examined the within-group differences at each time point relative to baseline. Using imputed data in the full intent-to-treat sample, mixed model ANCOVAs were conducted to examine the group differences over time. RESULTS Across both groups, girls attended an average of 72.0% of sessions. At least partial data were collected at posttreatment, 1-year follow-up, and 2-year follow-up for 96.3%, 85.2%, and 74.1% of the participants, respectively. There were no significant group differences in follow-up data collection rates, follow-up status, number of sessions attended, or treatment acceptability. BMI-z stabilized across groups, and there were no group differences in BMI-z. In adjusted ANCOVA models with imputed data, no significant group-by-time effects emerged. CONCLUSIONS For this randomized controlled prevention trial, long-term outcome data collection of measured BMI was possible in adolescent military-dependents and IPT was an acceptable and feasible intervention. An adequately powered trial is required to assess the efficacy of this intervention among military-dependents for obesity prevention and improvements in BMI.
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Affiliation(s)
- Abigail E Pine
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD 20892, USA
| | - Lisa M Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD 20892, USA
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD 20814, USA
| | - Natasha L Burke
- Department of Psychology, Fordham University, Bronx, NY 10458, USA
| | - M K Higgins Neyland
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD 20814, USA
- Metis Foundation, San Antonio, TX 78205, USA
| | - Kathrin Hennigan
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD 20814, USA
- Metis Foundation, San Antonio, TX 78205, USA
| | - Jami F Young
- Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Denise E Wilfley
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - David A Klein
- Departments of Family Medicine and Pediatrics, USU, Bethesda, MD 20814, USA
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
| | - Sarah Jorgensen
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Dean Seehusen
- Department of Family Medicine, Medical College of Georgia, Augusta, GA 30912, USA
| | | | - Jeffrey Quinlan
- Departments of Family Medicine and Pediatrics, USU, Bethesda, MD 20814, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD 20892, USA
| | - Mark Stephens
- Departments of Family and Community Medicine and Humanities, Pennsylvania State University, Old Main, State College, PA 16801, USA
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, MD 20814, USA
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD 20892, USA
- Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR) Program, USU, Bethesda, MD 20814, USA
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10
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Whiteman SD, Hamwey MK, Topp D, MacDermid Wadsworth S. Youth's Sibling Relationships Across the Course of a Parent's Military Deployment: Trajectories and Implications. Child Dev 2020; 91:1988-2000. [PMID: 32208522 DOI: 10.1111/cdev.13367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The present exploratory study explored the trajectories and implications of at-home (military unaffiliated) parents' perceptions of youth's sibling relationships across the course of a parent's military deployment. Participants included 109 families with at least two siblings (older sibling and younger siblings age: M = 10.85, SD = 3.92 and M = 7.89, SD = 3.58, respectively) and one parent serving in the National Guard. Data were collected via in-home interviews, at six time points across the deployment cycle. A series of multilevel models revealed increases in sibling disharmony during the months a deployed parent was away, but showed signs of recovery in the year after they returned. Increases in sibling disharmony were positively associated with increases in youth's externalizing behaviors above and beyond the effects of parenting.
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Affiliation(s)
| | - Meghan K Hamwey
- Henry M. Jackson Foundation.,Uniformed Services University of Health Services
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11
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Briggs EC, Fairbank JA, Tunno AM, Lee RC, Corry NH, Pflieger JC, Stander VA, Murphy RA. Military Life Stressors, Family Communication and Satisfaction: Associations with Children's Psychosocial Outcomes. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:75-87. [PMID: 32318230 PMCID: PMC7163866 DOI: 10.1007/s40653-019-00259-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Families experience multiple stressors as a result of military service. The purpose of this study was to examine facets of military life and family factors that may impact child psychosocial and mental health functioning. Using baseline data from the Millennium Cohort Family Study, this study examined family demographics and composition (age, number of children), military life stressors (injury, family, and deployment stressors), family communication and satisfaction as assessed by the Family Adaptability and Cohesion Evaluation Scale-IV, parental social functioning assessed via the Short Form Health Survey-36, and child mental health and behavioral functioning (parental reports of clinician-diagnosed mental health conditions such as depression) and an adapted version of the Strengths and Difficulties Questionnaire. Injury- and family-related military stressors were significant indicators of heightened risk for child mental health conditions, whereas greater levels of parental social functioning and family satisfaction were associated with lower risk of child mental health conditions. Differential associations were found in child functioning when military-related variables (e.g., service component), sociodemographic, and family composition factors (number and age of the children in the home) were examined. These findings underscore the importance of examining the "whole child" within the broader ecological and military family context to understand factors associated with children's mental and behavioral health. The results from the present study highlight the complex relationships that may be at play, which, in turn, have considerable implications for the development of policies to support children and families encountering multiple stressors related to a parent's military service.
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Affiliation(s)
- Ernestine C. Briggs
- UCLA-Duke University National Center for Child Traumatic Stress, Duke University School of Medicine, 1121 West Chapel Hill Street, Suite 201, Durham, NC 27701 USA
- Department of Psychiatry and the Behavioral Sciences, Duke University Medical Center, Durham, NC USA
- Center for Child and Family Health, Durham, NC USA
| | - John A. Fairbank
- UCLA-Duke University National Center for Child Traumatic Stress, Duke University School of Medicine, 1121 West Chapel Hill Street, Suite 201, Durham, NC 27701 USA
- Department of Psychiatry and the Behavioral Sciences, Duke University Medical Center, Durham, NC USA
- Mid-Atlantic Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham VA Health Care System, Durham, NC USA
| | - Angela M. Tunno
- UCLA-Duke University National Center for Child Traumatic Stress, Duke University School of Medicine, 1121 West Chapel Hill Street, Suite 201, Durham, NC 27701 USA
- Department of Psychiatry and the Behavioral Sciences, Duke University Medical Center, Durham, NC USA
- Center for Child and Family Health, Durham, NC USA
| | - Robert C. Lee
- UCLA-Duke University National Center for Child Traumatic Stress, Duke University School of Medicine, 1121 West Chapel Hill Street, Suite 201, Durham, NC 27701 USA
- Department of Psychiatry and the Behavioral Sciences, Duke University Medical Center, Durham, NC USA
| | - Nida H. Corry
- Abt Associates, Research Triangle Park, Durham, NC USA
| | | | | | - Robert A. Murphy
- Department of Psychiatry and the Behavioral Sciences, Duke University Medical Center, Durham, NC USA
- Center for Child and Family Health, Durham, NC USA
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12
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Van Donge N, Schvey NA, Roberts TA, Klein DA. Transgender Dependent Adolescents in the U.S. Military Health Care System: Demographics, Treatments Sought, and Health Care Service Utilization. Mil Med 2020; 184:e447-e454. [PMID: 30325452 DOI: 10.1093/milmed/usy264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Transgender and gender-diverse (TGD) youth are at greater risk for mental health and medical conditions than their cisgender peers; however, poor health outcomes and identity-based discrimination can be minimized in the context of optimal support. Approximately 1.7 million youth may be eligible for care covered by the Military Health System, which includes mental health and gender-affirming medications. The purpose of the current study is to identify sociodemographic characteristics, the psychosocial and behavioral risk profile, and health care utilization patterns of TGD dependent youth cared for in the U.S. military system to inform provider training and resource allocation. MATERIALS AND METHODS We performed a retrospective chart review by searching all medical records between July 1, 2014 and July 1, 2017 for diagnoses suggesting visits for TGD-services at a regional referral-based adolescent medicine clinic which cares for dependent children of active duty, activated selected reserve, and retired military service members between the ages of 9 and 24 years for a wide range of health care needs. RESULTS Fifty-three participants were included in this study. Sixty-four percent reported a transmasculine identity, 21% a transfeminine identity, and 15% a non-binary or undecided identity. The mean age at first gender-related visit was 14.5 years (SD 3.2). The mean number of primary care physicians and specialists seen by a given individual in a military treatment facility for any visit type since the implementation of the medical record system in 2005 was 12 (SD 6.8) and 10.2 (SD 7.8), respectively. Thirty-three percent of all patients assigned as female at birth were on testosterone therapy and 23% of all patients assigned as male at birth were on estrogen therapy at their most recent clinic visit. Twelve patients were undergoing pubertal suppression with an injectable or implantable gonadotropin-releasing hormone agonist. Seventy percent reported a history of suicidal ideation, 42% self-harm, 21% at least one suicide attempt, and 33% psychiatric hospitalization. Having strongly supportive parents was significantly associated with recognizing, disclosing and seeking treatment for gender nonconformity at an earlier age (ps ≤ 0.03) and marginally associated with less likelihood of current suicidal ideation (p = 0.06) compared to those with less supportive parents. CONCLUSIONS This study elucidated the sociodemographic and behavioral risk profile of a sample of TGD youth in the MHS. Military and non-military health care providers across a broad spectrum of specialties should be knowledgeable about the unique psychosocial and medical needs, requisite sensitivity, and available referral options in the care of TGD youth. Assumptions about one's gender identity, sexual orientation, gender expression, or behaviors cannot be made based on birth-assigned sex. Further research is needed to investigate the health and wellbeing of TGD military-affiliated youth over time and to determine quality transgender-related services in support of this vulnerable and underserved population.
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Affiliation(s)
- Nela Van Donge
- Department of Pediatrics, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD
| | - Timothy A Roberts
- Department of Adolescent Medicine, Children's Mercy Hospital, 3101 Broadway Blvd, 10th Floor, Kansas City, MO
| | - David A Klein
- Departments of Family Medicine and Pediatrics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD.,Department of Family Medicine, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA
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13
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Higgins Neyland MK, Shank LM, Burke NL, Schvey NA, Pine A, Quattlebaum M, Leu W, Gillmore D, Morettini A, Wilfley DE, Stephens M, Sbrocco T, Yanovski JA, Jorgensen S, Klein DA, Olsen CH, Quinlan J, Tanofsky-Kraff M. Parental deployment and distress, and adolescent disordered eating in prevention-seeking military dependents. Int J Eat Disord 2020; 53:201-209. [PMID: 31593352 PMCID: PMC7028444 DOI: 10.1002/eat.23180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Parental military deployment can lead to stress in the family system due to concerns about the deployed service-member's safety and increased responsibilities for those not deployed. Parent-related stress can impact adolescent disordered eating. Given the important role that stress plays in disordered eating and obesity, it is crucial to understand the impacts of unique stressors to which vulnerable populations are exposed. METHOD We studied 126 adolescent (14.3 ± 1.6 years; 59.5% girls; 44.4% non-Hispanic White; BMI-z, 1.91 ± .39) military dependents prior to entering an obesity and binge-eating disorder prevention trial. The Eating Disorder Examination was used to assess adolescent disordered eating. Parents self-reported their own distress and family deployment history that occurred during the adolescent's lifetime. RESULTS Parental distress interacted with frequency of parental deployments such that for those with high parental distress, more frequent deployment was associated with greater adolescent shape and weight concerns (β = .21, p = .012) and global eating pathology (β = .18, p = .024). DISCUSSION In this hypothesis-generating study, the combination of number of deployments and parental distress may be associated with disordered eating among adolescent military dependents seeking prevention of binge-eating disorder and adult obesity. If these preliminary findings are supported longitudinally, interventions to reduce parental stress related to deployment may be warranted to reduce disordered eating in adolescent dependents.
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Affiliation(s)
- M K Higgins Neyland
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
| | - Lisa M Shank
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland
- Metis Foundation, San Antonio, Texas
- Department of Medicine, Military Outcomes Cardiovascular Research (MiCOR), USU, Bethesda, Maryland
| | - Natasha L Burke
- Department of Psychology, Fordham University, Bronx, New York
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland
| | - Abigail Pine
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
| | - Mary Quattlebaum
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
| | - William Leu
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
| | - Dakota Gillmore
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
| | - Alexandria Morettini
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Mark Stephens
- Department of Family and Community Medicine, Pennsylvania State University, University Park, Pennsylvania
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
| | - Jack A Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland
| | - Sarah Jorgensen
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - David A Klein
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
- Department of Family Medicine, USU, Bethesda, Maryland
| | - Cara H Olsen
- Preventative Medicine and Biometrics Department, USU, Bethesda, Maryland
| | | | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland
- Department of Medicine, Military Outcomes Cardiovascular Research (MiCOR), USU, Bethesda, Maryland
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14
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Cunitz K, Dölitzsch C, Kösters M, Willmund GD, Zimmermann P, Bühler AH, Fegert JM, Ziegenhain U, Kölch M. Parental military deployment as risk factor for children's mental health: a meta-analytical review. Child Adolesc Psychiatry Ment Health 2019; 13:26. [PMID: 31249614 PMCID: PMC6587296 DOI: 10.1186/s13034-019-0287-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 06/13/2019] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Katrin Cunitz
- grid.410712.1Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany ,0000 0001 0482 5331grid.411984.1Institute for Medical Psychology and Medical Sociology, University Hospital of Goettingen, Waldweg 37A, 37073 Goettingen, Germany
| | - Claudia Dölitzsch
- grid.410712.1Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
| | - Markus Kösters
- 0000 0004 1936 9748grid.6582.9Department of Psychiatry II, Bezirkskrankenhaus Günzburg, Ulm University, Ludwig-Heilmeyer-Str. 2, 89312 Günzburg, Germany
| | - Gerd-Dieter Willmund
- Bundeswehr Hospital Berlin, Center for Psychiatry and Psychotraumatology, German Armed Forces Centre of Military Mental Health, Scharnhorststraße 13, 10115 Berlin, Germany
| | - Peter Zimmermann
- Bundeswehr Hospital Berlin, Center for Psychiatry and Psychotraumatology, German Armed Forces Centre of Military Mental Health, Scharnhorststraße 13, 10115 Berlin, Germany
| | - Antje Heike Bühler
- Bundeswehr Hospital Berlin, Center for Psychiatry and Psychotraumatology, German Armed Forces Centre of Military Mental Health, Scharnhorststraße 13, 10115 Berlin, Germany
| | - Jörg M. Fegert
- grid.410712.1Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
| | - Ute Ziegenhain
- grid.410712.1Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
| | - Michael Kölch
- grid.410712.1Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany ,0000 0000 9737 0454grid.413108.fDepartment of Child and Adolescent Psychiatry, Rostock University Medical Center, Gehlsheimer Straße 20, 18147 Neuruppin, Germany
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15
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Military Teen App: Engagement, Safety, Commercialization, and Marketing. Comput Inform Nurs 2019; 37:285-288. [PMID: 33055492 DOI: 10.1097/cin.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Quattlebaum M, Burke NL, Neyland MKH, Leu W, Schvey NA, Pine A, Morettini A, LeMay-Russell S, Wilfley DE, Stephens M, Sbrocco T, Yanovski JA, Jorgensen S, Olsen C, Klein D, Quinlan J, Tanofsky-Kraff M. Sex differences in eating related behaviors and psychopathology among adolescent military dependents at risk for adult obesity and eating disorders. Eat Behav 2019; 33:73-77. [PMID: 31005683 PMCID: PMC6535360 DOI: 10.1016/j.eatbeh.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 01/14/2023]
Abstract
Stressors unique to military families may place dependents of military service members of both sexes at high-risk for disordered-eating. Yet, there are no data examining sex-related differences in eating pathology and distress among this population. Therefore, we examined disordered-eating attitudes and associated psychosocial characteristics in adolescent military dependents at high-risk for both eating disorders and adult obesity (i.e., BMI ≥ 85th percentile and elevated anxiety symptoms and/or loss-of-control eating). One-hundred-twenty-five (55.2% female) adolescent (12-17 y) military dependents were studied prior to entry in an eating disorder and obesity prevention trial. Youth were administered the Eating Disorder Examination interview to determine disordered-eating attitudes, and completed questionnaires to assess self-esteem, social functioning, and depression. Girls and boys did not differ in BMIz (p = .66) or race/ethnicity (p = .997/p = .55). Adjusting for relevant covariates, girls and boys did not differ significantly with regard to disordered-eating global scores (p = .38), self-esteem (p = .23), or social functioning (p = .19). By contrast, girls reported significantly more symptoms of depression (p = .001). Adolescent male and female dependents at high-risk for eating disorders and adult obesity reported comparable levels of eating-related and psychosocial stress. Data are needed to elucidate how adolescent military dependents respond to intervention and whether sex moderates outcome.
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Affiliation(s)
- Mary Quattlebaum
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Natasha L. Burke
- Psychology Department, Fordham University, 441 E. Fordham Road, Bronx, NY 10458, USA
| | - M. K. Higgins Neyland
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - William Leu
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Natasha A. Schvey
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
| | - Abigail Pine
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Alexandria Morettini
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Sarah LeMay-Russell
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
| | - Denise E. Wilfley
- Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Mark Stephens
- Pennsylvania State University, Old Main, State College, PA 16801, USA
| | - Tracy Sbrocco
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA
| | - Sarah Jorgensen
- Fort Belvoir Community Hospital (FBCH), 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA
| | - Cara Olsen
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - David Klein
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA,Fort Belvoir Community Hospital (FBCH), 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA
| | - Jeffrey Quinlan
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Marian Tanofsky-Kraff
- Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, Bethesda, MD 20814, USA.
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17
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Reinhardt J, Clements-Nolle K, Yang W. Physical Fighting Among Male and Female Adolescents of Military Families: Results From a Representative Sample of High School Students. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:115-134. [PMID: 27030017 DOI: 10.1177/0886260516640546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The impact of family military involvement on adolescent mental health and substance abuse is well established, but little is known about other behavioral health outcomes such as physical fighting. We assessed the relationship between family military involvement and physical fighting in a representative sample of 3,928 high school students. Weighted logistic regression was used to determine whether adolescents from military families had higher odds of fighting and fighting on school property compared with adolescents of non-military families after controlling for demographics, substance use, depressive symptoms, and bullying victimization. We also assessed the cumulative impact of multiple risk factors on fighting outcomes. Overall, 23.5% of high school students reported physical fighting and 7.0% reported physical fighting at school. Youth from military families had higher odds of physical fighting (adjusted odds ratios [AOR] = 1.69; 95% confidence interval [CI] = [1.27, 2.25]) and physical fighting on school property (AOR = 1.98; 95% CI = [1.16, 3.39]). In models stratified by gender, family military involvement remained independently associated with physical fighting and physical fighting at school for males (AOR = 1.74; 95% CI = [1.15, 2.65] and AOR = 2.21; 95% CI = [1.03, 4.74]) and females (AOR = 1.65; 95% CI = [1.11, 2.45] and AOR = 1.88; 95% CI = [1.01, 3.50]). The odds of engaging in each physical fighting outcome increased as the cumulative number of risk factors increased. School-based interventions aimed at addressing fighting should be tailored to fit the unique needs of adolescents in military families, particularly those with additional risk factors.
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Affiliation(s)
| | | | - Wei Yang
- 1 University of Nevada, Reno, NV, USA
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18
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Williamson V, Stevelink SAM, Da Silva E, Fear NT. A systematic review of wellbeing in children: a comparison of military and civilian families. Child Adolesc Psychiatry Ment Health 2018; 12:46. [PMID: 30443263 PMCID: PMC6220523 DOI: 10.1186/s13034-018-0252-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/12/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Children in military families have uniquely different childhood experiences compared to their civilian peers, including a parent in employment and a stable familial income, frequent relocations, indirect exposure to and awareness of conflict, and extended separation from parents or siblings due to deployment. However, whether children from military families have poorer wellbeing than non-military connected children is not well understood. METHOD We conducted a systematic review to explore the relationship between military family membership (e.g. parent or sibling in the military) and child wellbeing compared to non-military connected controls. Searches for this review were conducted in September 2016 and then updated in February 2018. RESULTS Nine studies were identified, eight were cross-sectional. All studies utilised self-report measures administered in US school settings. On the whole, military connected youth were not found to have poorer wellbeing than civilian children, although those with deployed parents and older military connected children were at greater risk of some adjustment difficulties (e.g. substance use, externalising behaviour). Although only assessed in two studies, having a sibling in the military and experiencing sibling deployment was statistically significantly associated with substance use and depressive symptoms. CONCLUSIONS This study is unique in its direct comparison of military and non-military connected youth. Our results highlight the need to examine the impact of military service in siblings and other close relatives on child wellbeing. Given the adverse impact of poor mental health on child functioning, additional research is needed ensure appropriate, evidence-based interventions are available for youth in military families.
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Affiliation(s)
- Victoria Williamson
- Kings Centre for Military Health Research, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
| | - Sharon A. M. Stevelink
- Kings Centre for Military Health Research, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
| | - Eve Da Silva
- Kings Centre for Military Health Research, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
| | - Nicola T. Fear
- Kings Centre for Military Health Research, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
- Academic Department for Military Mental Health, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
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19
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Panton J. Caring for Military Children: Implications for Nurse Practitioners. J Pediatr Health Care 2018; 32:435-444. [PMID: 29661617 DOI: 10.1016/j.pedhc.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/28/2018] [Indexed: 11/28/2022]
Abstract
Nearly two million American children belong to a military family. Armed Forces families are located in almost every state and around the globe. Military children are a unique and at times vulnerable population. Military children and adolescents may face significant stressors throughout their lives compared to their civilian counterparts. Military families encounter frequent moves and over half of these children have encountered at least one parental deployment since September 11th, 2001. Civilian health care providers often care for military children and adolescents. The purpose of this article is to provide pediatric providers with an understanding of the deployment cycle and how it relates to childhood development, to discuss common military stressors and their impact on the family, and to describe strategies and resources pediatric providers can utilize to care for this unique population.
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Hernandez BF, Peskin MF, Markham CM, Burr J, Roberts T, Emery ST. The Context of Sexual Decisions and Intrapersonal and Interpersonal Factors Related to Sexual Initiation Among Female Military-Dependent Youth. JOURNAL OF SEX RESEARCH 2018; 55:73-83. [PMID: 28339293 DOI: 10.1080/00224499.2017.1298715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite the sizable population of military-dependent youth (MDY) in the United States and the military stressors they experience (e.g., relocations, parental deployment), little is known about MDY's sexual behavior, especially about the perceived role that military stressors play in their sexual decisions, such as the decision to initiate sex. We conducted 25 semistructured, in-depth interviews with sexually experienced female MDY aged 15 to 19 years to (a) describe MDY's general perceptions of military life and (b) identify intrapersonal and interpersonal characteristics related to MDY's sexual initiation, including the perceived impact of military stressors. We analyzed life history grids and transcripts to identify common and unique themes across participants' experiences. Most participants reported having positive experiences related to military life, and most did not believe that military stressors influenced their decision to initiate sex. Common intrapersonal and interpersonal characteristics related to sexual initiation were having an older first sexual partner, being in a dating relationship, receiving sexual health education prior to their first sexual experience, and discussing sex with a parent prior to their first sexual experience. These intrapersonal and interpersonal characteristics should be considered when developing sexual health programs for MDY, which should focus on building supportive peer and parental relationships.
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Affiliation(s)
- Belinda F Hernandez
- a School of Public Health, University of Texas Health Science Center at Houston
| | - Melissa F Peskin
- a School of Public Health, University of Texas Health Science Center at Houston
| | - Christine M Markham
- a School of Public Health, University of Texas Health Science Center at Houston
| | - Jean Burr
- b San Antonio Military Medical Center
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21
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Lester P, Rauch P, Loucks L, Sornborger J, Ohye B, Karnik NS. Posttraumatic Stress Disorder and Military-Connected Families: The Relevance of a Family-Centered Approach. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2017; 15:420-428. [PMID: 31975873 PMCID: PMC6519530 DOI: 10.1176/appi.focus.20170027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since the September 11, 2001, terrorist attacks, military service in the United States has been linked to a range of behavioral health and physical injuries in a significant number of the almost three million service members who have returned from wartime deployment. These injuries have occurred in the larger context of wartime military service, which is characterized by an array of stressors that have been associated with increased risk for behavioral health problems not only for service members but also for their family members. For the past 15 years, military-connected (defined as active-duty, reserve component, and veteran) family members have shared their own experiences of military service, including multiple deployments in the context of danger, high operational stress within their communities, and living with the physical and behavioral health injuries and ongoing care needs of a loved one. This article provides an overview of the evolving research on the specific impact of posttraumatic stress disorder (PTSD) and other war zone-related behavioral health problems among families in the context of contemporary warfare, as well as research on the impact of family adjustment on veteran recovery and care. We propose an empirically supported, family-centered framework to inform a continuum of prevention and care for veterans with PTSD and their families. Gaps in the current continuum of behavioral health services for veterans with PTSD are identified, as well as efforts underway to develop trauma-informed, family-centered screening, prevention, and treatment approaches. Future research recommendations are provided.
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Affiliation(s)
- Patricia Lester
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Paula Rauch
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Laura Loucks
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Jo Sornborger
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Bonnie Ohye
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
| | - Niranjin S Karnik
- Dr. Lester is with the Nathanson Family Resilience Center, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Rauch is with the Department of Psychiatry, Massachusetts General Hospital, Boston. Dr. Loucks is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Sornborger is with Operation Mend, UCLA Health. Dr. Ohye is with the Massachusetts General Hospital Program, Harvard Medical School, Boston. Dr. Karnik is with the Department of Psychiatry, Rush University Medical Center, Chicago
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22
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Nicosia N, Wong E, Shier V, Massachi S, Datar A. Parental Deployment, Adolescent Academic and Social-Behavioral Maladjustment, and Parental Psychological Well-being in Military Families. Public Health Rep 2016; 132:93-105. [PMID: 28005475 DOI: 10.1177/0033354916679995] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Increases in the frequency and length of military deployments have raised concerns about the well-being of military families. We examined the relationship between a military parent's deployment and (1) adolescent academic and social-behavioral maladjustment and (2) parental psychological well-being. METHODS We collected data from April 2013 through January 2014 from 1021 families of enlisted US Army personnel with children aged 12 or 13 during the Military Teenagers' Environments, Exercise, and Nutrition Study. Through online parent surveys, we collected data on deployment, adolescent academic and social-behavioral maladjustment, and parental psychological well-being. We estimated adjusted logistic and linear regression models for adolescents (all, boys, girls), military parents (all, fathers, mothers), and civilian parents. RESULTS Compared with no or short deployments, long deployments (>180 days in the past 3 years) were associated with significantly higher odds of decreases in adolescent academic performance (adjusted odds ratio [AOR] = 1.54), independence (AOR = 2.04), and being responsible (AOR = 1.95). These associations were also significant for boys but not for girls. Among parents, long deployments were associated with significantly higher odds of being depressed (AOR = 2.58), even when controlling for adolescent maladjustment (AOR = 2.54). These associations did not differ significantly between military and civilian parents and were significant for military fathers but not military mothers. Recent deployment (in the past 12 months) was not associated with either adolescent or parent outcomes. CONCLUSION Long deployments are associated with adolescents' academic and social-behavioral maladjustments and diminished parental well-being, especially among boys and military fathers.
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Affiliation(s)
| | - Elizabeth Wong
- 2 Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | | | - Samira Massachi
- 2 Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Ashlesha Datar
- 2 Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
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23
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MacDermid Wadsworth S, Bailey KM, Coppola EC. U.S. Military Children and the Wartime Deployments of Family Members. CHILD DEVELOPMENT PERSPECTIVES 2016. [DOI: 10.1111/cdep.12210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Nelson SC, Baker MJ, Weston CG. Impact of Military Deployment on the Development and Behavior of Children. Pediatr Clin North Am 2016; 63:795-811. [PMID: 27565359 DOI: 10.1016/j.pcl.2016.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Suzie C Nelson
- Department of Psychiatry, Wright State University Boonshoft School of Medicine, 627 South Edwin C. Moses Boulevard, Dayton, OH 45417-1461, USA.
| | - Matthew J Baker
- Department of Psychiatry, Wright State University Boonshoft School of Medicine, 627 South Edwin C. Moses Boulevard, Dayton, OH 45417-1461, USA
| | - Christina G Weston
- Department of Psychiatry, Wright State University Boonshoft School of Medicine, 627 South Edwin C. Moses Boulevard, Dayton, OH 45417-1461, USA
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25
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Gyura AN, McCauley SO. The Whole Family Serves: Supporting Sexual Minority Youth in Military Families. J Pediatr Health Care 2016; 30:414-23. [PMID: 26597449 DOI: 10.1016/j.pedhc.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/08/2015] [Accepted: 10/23/2015] [Indexed: 11/18/2022]
Abstract
Sexual minority youth in military families have a unique set of stressors that affect their mental, emotional, and physical health. There is a pronounced gap in data addressing the specific stressors of this population and how they interact to impact the health of the adolescent. The culture of the United States military has historically been heterosexist and homophobic, propelled primarily by policies that restricted the recruitment and service of lesbian, gay, bisexual, or transgender individuals, leading to a continued secrecy around sexual orientation that may affect how sexual minority youth within the community view themselves. Homophobia, social stigma, and victimization lead to significant health disparities among sexual minority youth, and youth connected to the military have additional stressors as a result of frequent moves, parental deployment, and general military culture. Primary care providers must be aware of these stressors to provide a safe environment, thorough screening, and competent care for these adolescents.
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26
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Friedman SL, Sigelman CK, Rohrbeck CA, del Rio-Gonzalez AM. Quantity and quality of communication during parental deployment: Links to adolescents’ functioning. APPLIED DEVELOPMENTAL SCIENCE 2016. [DOI: 10.1080/10888691.2016.1207536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Gewirtz AH, DeGarmo DS, Zamir O. Effects of a Military Parenting Program on Parental Distress and Suicidal Ideation: After Deployment Adaptive Parenting Tools. Suicide Life Threat Behav 2016; 46 Suppl 1:S23-31. [PMID: 27094107 PMCID: PMC5113712 DOI: 10.1111/sltb.12255] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Few studies have examined whether parenting prevention programs might mitigate risk for suicidality in parents, yet parent suicidality is a strong risk factor for offspring suicidality. We report results from a randomized controlled trial of a parenting program for deployed National Guard and Reserve families with a school-aged child. Intent-to-treat analyses showed that random assignment to the parenting program (ADAPT) was associated with improved parenting locus of control (LOC). Improved parenting LOC was concurrently associated with strengthened emotion regulation which predicted reductions in psychological distress and suicidal ideation at 12 months postbaseline. Results are discussed in the context of ongoing efforts to reduce suicide rates in military populations.
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Affiliation(s)
- Abigail H. Gewirtz
- Department of Family Social Science & Institute of Child Development, & Institute for Translational Research in Children’s Mental Health, University of Minnesota
| | - David S. DeGarmo
- Prevention Science Institute, Department of Educational Methodology, Policy, and Leadership, University of Oregon
| | - Osnat Zamir
- Institute for Translational Research in Children’s Mental Health, University of Minnesota
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28
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Gilreath TD, Wrabel SL, Sullivan KS, Capp GP, Roziner I, Benbenishty R, Astor RA. Suicidality among military-connected adolescents in California schools. Eur Child Adolesc Psychiatry 2016; 25:61-6. [PMID: 25791079 DOI: 10.1007/s00787-015-0696-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
Abstract
Previous research indicates that suicidal ideation is higher among military-connected youth than non military-connected youth. This study extends prior work by examining suicidal ideation, plans, and attempts in military-connected and non military-connected adolescents. Data were gathered from 390,028 9th and 11th grade students who completed the 2012-2013 California Healthy Kids Survey. Bivariate comparisons and multivariate logistic analyses were conducted to examine differences in suicidal ideation, plans, attempts, and attempts requiring medical attention between military and not military-connected youth. In multivariate logistic analyses, military-connected youth were at increased risk for suicidal ideation (OR = 1.43, 95 % CI = 1.37-1.49), making a plan to harm themselves (OR = 1.19, CI = 1.06-1.34), attempting suicide (OR = 1.67, CI = 1.43-1.95), and an attempted suicide which required medical treatment (OR = 1.71, CI = 1.34-2.16). These results indicate that military-connected youth statewide are at a higher risk for suicidal ideation, plans, attempts, and attempts requiring medical care because of suicidal behaviors. It is suggested that policies be implemented to increase awareness and screening among primary care providers, school personnel, and military organizations that serve military-connected youth.
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Affiliation(s)
- Tamika D Gilreath
- School of Social Work, University of Southern California, 669 W 34th Street, Los Angeles, CA, 90089-0411, USA.
| | - Stephani L Wrabel
- Rossier School of Education, University of Southern California, 3470 Trousdale Parkway, Los Angeles, CA, 90089-4038, USA
| | - Kathrine S Sullivan
- School of Social Work, University of Southern California, 669 W 34th Street, Los Angeles, CA, 90089-0411, USA
| | - Gordon P Capp
- School of Social Work, University of Southern California, 669 W 34th Street, Los Angeles, CA, 90089-0411, USA
| | - Ilan Roziner
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, 5290002, Ramat Gan, Israel
| | - Rami Benbenishty
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, 5290002, Ramat Gan, Israel
| | - Ron A Astor
- School of Social Work, University of Southern California, 669 W 34th Street, Los Angeles, CA, 90089-0411, USA
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29
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The impact of military deployment on children: Placing developmental risk in context. Clin Psychol Rev 2015; 43:17-29. [PMID: 26655960 DOI: 10.1016/j.cpr.2015.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 11/20/2015] [Accepted: 11/21/2015] [Indexed: 11/20/2022]
Abstract
During recent conflicts in the Middle East, U.S. military families have endured multiple separations, relocations, and alterations in family structure/routines, combined with other significant stressors. This review examines what is known about children's mental health and functioning in relation to parental military deployment during conflicts spanning the last 14years. Findings are organized and considered by age group (i.e., toddlers and preschoolers, school age children, and adolescents) in an effort to highlight unique challenges and strengths present at different stages of development. Across all age groups, numerous studies document an increase in the number of military-connected children receiving mental health services in relation to parental deployment, though specific types of problems and long-term outcomes are not well understood. Evidence for a concerning increase in rates of child maltreatment related to parental deployment has also emerged. However, findings are largely based on aggregate data and the specific perpetrator is often unclear. Overall, we emphasize several critical next steps for research in this area including investigations characterized by greater methodological rigor, consideration of broader parental and contextual influences on child mental health, objective indicators of stress and coping, and longitudinal designs to examine persistence of child emotional/behavioral problems. A focus on adaptive/resilient outcomes is equally essential for understanding long-term outcomes and developing effective intervention programs.
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30
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Reed SC, Bell JF, Edwards TC. Weapon carrying, physical fighting and gang membership among youth in Washington state military families. Matern Child Health J 2015; 18:1863-72. [PMID: 24463984 DOI: 10.1007/s10995-014-1430-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To examine associations between parental military service and school-based weapon carrying, school-based physical fighting and gang membership among youth. We used cross-sectional data from the 2008 Washington State Healthy Youth Survey collected in 8th, 10th, and 12th grades of public schools (n = 9,987). Parental military service was categorized as none (reference group), without combat zone deployment, or deployed to a combat zone. Multivariable logistic regression was used to test associations between parental military service and three outcomes: school-based weapon carrying, school-based physical fighting and gang membership. Standard errors were adjusted for the complex survey design. In 8th grade, parental deployment was associated with higher odds of reporting gang membership (OR = 1.8) among girls, and higher odds of physical fighting (OR = 1.6), and gang membership (OR = 1.9) among boys. In 10th/12th grade, parental deployment was associated with higher odds of reporting physical fighting (OR = 2.0) and gang membership (OR = 2.2) among girls, and physical fighting (OR = 2.0), carrying a weapon (OR = 2.3) among boys. Parental military deployment is associated with increased odds of reporting engagement in school-based physical fighting, school-based weapon carrying, and gang membership, particularly among older youth. Military, school, and public health professionals have a unique, collaborative opportunity to develop school- and community-based interventions to prevent violence-related behaviors among youth and, ultimately, improve the health and safety of youth in military families. Ideally, such programs would target families and youth before they enter eighth grade.
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Affiliation(s)
- Sarah C Reed
- Betty Irene Moore School of Nursing, University of California, Davis, Education Building, 4610 X Street, Sacramento, CA, 95817, USA,
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31
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Klein DA, Adelman WP, Thompson AM, Shoemaker RG, Shen-Gunther J. All Military Adolescents Are Not the Same: Sexuality and Substance Use among Adolescents in the U.S. Military Healthcare System. PLoS One 2015; 10:e0141430. [PMID: 26512892 PMCID: PMC4626116 DOI: 10.1371/journal.pone.0141430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/07/2015] [Indexed: 11/30/2022] Open
Abstract
Data examining sexuality and substance use among active duty and military-dependent youth is limited; however, these psychosocial factors have military implications. Adolescents and young adults aged 12-23 were recruited from an active-duty trainee clinic (n = 225) and a military pediatric clinic (n = 223). Active duty participants were more likely to be older, male, White, previous tobacco users, and report a history of sexual activity and less contraception use at their most recent intercourse, compared to the dependent group. Over 10% of all participants indicated attraction to members of the same gender or both genders. In logistic regression analysis, non-White participants were less likely to use contraception compared to White participants. Adolescents and young adults seen in military clinics frequently engage in high-risk behavior. Clinicians who care for military youth should assess their patient's psychosocial history. Further study of this population is warranted to identify factors that may influence risk and resilience.
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Affiliation(s)
- David A. Klein
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - William P. Adelman
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Amy M. Thompson
- Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX, United States of America
| | - Richard G. Shoemaker
- Clinical Investigations, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States of America
| | - Jane Shen-Gunther
- Department of Clinical Investigation and Department of Obstetrics and Gynecology, San Antonio Military Medical Center, San Antonio, TX, United States of America
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32
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Hernandez BF, Peskin MF, Markham CM, Burr J, Roberts T, Tortolero S. Associations between parental deployment, relocation, and risky sexual behaviors among a clinic-based sample of military-dependent youth. J Prim Prev 2015; 36:351-9. [PMID: 26324389 DOI: 10.1007/s10935-015-0399-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although sexual behaviors have been extensively studied among youth in general, they have been relatively understudied among military-dependent youth (MDY). Furthermore, the impact of unique military stressors, such as parental deployment and multiple relocations, on the sexual behaviors of MDY has not been assessed. In this pilot study, we estimated the prevalence of sexual behaviors among MDY, and examined the association between these behaviors and parental deployment and multiple relocations. Between June and September 2011, we recruited youth (N = 208; aged 15-19 years) who attended a military treatment facility in the southern United States, to complete a short, paper-based survey. We computed prevalence estimates and conducted Chi-square analyses, as well as logistic regression analyses, while adjusting for age, gender, and race/ethnicity. More than half (53.7 %) of the youth reported being sexually experienced, and many of these youth reported engaging in risky sexual behaviors. Parental deployment and multiple relocations were significantly associated only with having had sex in the past 3 months. Although with most sexual behaviors there was no significant association between parental deployment and multiple relocations, many MDY are sexually experienced and engage in risky sexual behaviors. MDY should thus be exposed to evidence-based strategies for sexually transmitted infection and pregnancy prevention, as well as provided with teen-friendly health care services and comprehensive sexual/reproductive health counseling.
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Affiliation(s)
- Belinda F Hernandez
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA.
| | - Melissa F Peskin
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
| | - Christine M Markham
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
| | - Jean Burr
- Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Timothy Roberts
- Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Susan Tortolero
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA
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33
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Schvey NA, Sbrocco T, Stephens M, Bryant EJ, Ress R, Spieker EA, Conforte A, Bakalar JL, Pickworth CK, Barmine M, Klein D, Brady SM, Yanovski JA, Tanofsky-Kraff M. Comparison of overweight and obese military-dependent and civilian adolescent girls with loss-of-control eating. Int J Eat Disord 2015; 48:790-4. [PMID: 25955761 PMCID: PMC4543400 DOI: 10.1002/eat.22424] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Limited data suggest that the children of U.S. service members may be at increased risk for disordered-eating. To date, no study has directly compared adolescent military-dependents to their civilian peers along measures of eating pathology and associated correlates. We, therefore, compared overweight and obese adolescent female military-dependents to their civilian counterparts along measures of eating-related pathology and psychosocial functioning. METHOD Adolescent females with a BMI between the 85th and 97th percentiles and who reported loss-of-control eating completed interview and questionnaire assessments of eating-related and general psychopathology. RESULTS Twenty-three military-dependents and 105 civilians participated. Controlling for age, race, and BMI-z, military-dependents reported significantly more binge episodes per month (p < 0.01), as well as greater eating-concern, shape-concern, and weight-concern (p's < 0.01) than civilians. Military-dependents also reported more severe depression (p < 0.05). DISCUSSION Adolescent female military-dependents may be particularly vulnerable to disordered-eating compared with civilian peers. This potential vulnerability should be considered when assessing military-dependents.
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Affiliation(s)
- Natasha A. Schvey
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Tracy Sbrocco
- Uniformed Services University of the Health Sciences (USUHS)
| | - Mark Stephens
- Uniformed Services University of the Health Sciences (USUHS)
| | - Edny J. Bryant
- Uniformed Services University of the Health Sciences (USUHS)
| | - Rachel Ress
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | | | | | | | - Courtney K. Pickworth
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Marissa Barmine
- Uniformed Services University of the Health Sciences (USUHS)
| | | | - Sheila M. Brady
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Jack A. Yanovski
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
| | - Marian Tanofsky-Kraff
- Uniformed Services University of the Health Sciences (USUHS),Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS
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Weston CG, Dougherty JG, Nelson SC, Baker MJ, Chow JC. US Military Child and Adolescent Psychiatry Training Programs and Careers of Military Child Psychiatrists. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:365-371. [PMID: 25804354 DOI: 10.1007/s40596-015-0302-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 01/27/2015] [Indexed: 06/04/2023]
Abstract
Military child and adolescent psychiatry (CAP) fellowship programs offer educational experiences universal to all civilian training programs in the USA. They also offer unique training opportunities not found in civilian CAP fellowships in order to prepare graduates to serve the needs of military families. Military-specific curricula and exposures prepare trainees to address various issues faced by military families, in contending with frequent military moves, parental deployments, and disrupted social ties. Curricula are also designed to provide the psychiatrist with a greater understanding of the rigors of military service. CAP training and subsequent assignments prepare military psychiatrists for diverse career paths in the military environment. CAP military careers often include duties in addition to treating patients. Administrative roles, academic teaching positions, as well as school consultation positions are all career options available to military CAP.
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Addressing the Needs of Military Children Through Family-Based Play Therapy. CONTEMPORARY FAMILY THERAPY 2015. [DOI: 10.1007/s10591-015-9342-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Faran ME, Johnson PL, Ban P, Shue T, Weist MD. The evolution of a school behavioral health model in the US Army. Child Adolesc Psychiatr Clin N Am 2015; 24:415-28. [PMID: 25773333 DOI: 10.1016/j.chc.2014.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The US Army has developed an innovative School Behavioral Health (SBH) program, part of the Child and Family Behavioral Health System, a collaborative, consultative behavioral health care model that includes SBH, standardized training of primary care providers in treatment of common behavioral health problems, use of tele-consultation/tele-behavioral health, optimizing community outreach services, and integration with other related behavioral health services. In this article, the needs of military children, adolescents, and families are reviewed, a history of this initiative is presented, key themes are discussed, and next steps in advancing this evolving, innovative system of health care featuring SBH are described.
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Affiliation(s)
- Michael E Faran
- Child and Family Behavioral Health Office, United States Army Medical Command, 9913-A Madigan Annex, Tacoma, WA 98431, USA.
| | - Patti L Johnson
- Child and Family Behavioral Health Office, United States Army Medical Command, 9913-A Madigan Annex, Tacoma, WA 98431, USA
| | - Paul Ban
- Child and Family Behavioral Health Office, United States Army Medical Command, 9913-A Madigan Annex, Tacoma, WA 98431, USA
| | - Tracy Shue
- Child and Family Behavioral Health Office, United States Army Medical Command, 9913-A Madigan Annex, Tacoma, WA 98431, USA
| | - Mark D Weist
- Department of Psychology, University of South Carolina, 1512 Pendleton Street, Barnwell 237D, Columbia, SC 29208, USA
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Creech SK, Hadley W, Borsari B. The Impact of Military Deployment and Reintegration on Children and Parenting: A Systematic Review. ACTA ACUST UNITED AC 2014; 45:452-464. [PMID: 25844014 DOI: 10.1037/a0035055] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hundreds of thousands of children have had at least 1 parent deploy as part of military operations in Iraq (Operation Iraqi Freedom; OIF; Operation New Dawn; OND) and Afghanistan (Operation Enduring Freedom; OEF). However, there is little knowledge of the impact of deployment on the relationship of parents and their children. This systematic review examines findings from 3 areas of relevant research: the impact of deployment separation on parenting, and children's emotional, behavioral, and health outcomes; the impact of parental mental health symptoms during and after reintegration; and current treatment approaches in veteran and military families. Several trends emerged. First, across all age groups, deployment of a parent may be related to increased emotional and behavioral difficulties for children, including higher rates of health-care visits for psychological problems during deployment. Second, symptoms of PTSD and depression may be related to increased symptomatology in children and problems with parenting during and well after reintegration. Third, although several treatments have been developed to address the needs of military families, most are untested or in the early stages of implementation and evaluation. This body of research suggests several promising avenues for future research.
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Affiliation(s)
- Suzannah K Creech
- Providence VA Medical Center, Providence, Rhode Island and Brown University
| | - Wendy Hadley
- Bradley/Hasbro Children's Research Center, Providence, Rhode Island and Brown University
| | - Brian Borsari
- Providence VA Medical Center, Providence Rhode Island and Brown University
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Rodriguez AJ, Margolin G. Parental incarceration, transnational migration, and military deployment: family process mechanisms of youth adjustment to temporary parent absence. Clin Child Fam Psychol Rev 2014; 18:24-49. [PMID: 25304163 DOI: 10.1007/s10567-014-0176-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The temporary absence of a parent (e.g., due to incarceration, migration, or military deployment) is experienced by many youth and can have profound effects. Available research within these disparate literatures primarily has catalogued contextual and individual variables that influence youth adaptation, which are integrated and summarized here. In addition, we present a systematic review of proximal family process mechanisms by which youth and their family members adapt to periods of temporary parent absence. This systematic review across the different types of parent absence produced four themes: communication among family members, parenting characteristics during absence, negotiation of decision-making power and authority, and shifts in family roles. By juxtaposing the three types of temporary parent absence, we aim to bridge the separate research silos of parent absence due to incarceration, deployment, and migration, and to bring wide-ranging characteristics and processes of temporary parent-absent families into sharper focus. The review highlights possibilities for fuller integration of these literatures, and emphasizes the clinical value of considering these types of experiences from a family and relational perspective, rather than an individual coping perspective.
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Affiliation(s)
- Aubrey J Rodriguez
- Department of Psychology, University of Southern California, 3620 S McClintock Ave, SGM 501, Los Angeles, CA, 90089-1061, USA,
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Abstract
The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.
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Well-being and suicidal ideation of secondary school students from military families. J Adolesc Health 2014; 54:672-7. [PMID: 24257031 DOI: 10.1016/j.jadohealth.2013.09.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 09/13/2013] [Accepted: 09/13/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND The mental health of children is a primary public health concern; adolescents of military personnel may be at increased risk of experiencing poorer well-being overall and depressive symptoms specifically. These adolescents experience individual and intrafamilial stressors of parental deployment and reintegration, which are directly and indirectly associated with internalizing behaviors. PURPOSE The present study sought to better understand the influence of parental military connectedness and parental deployment on adolescent mental health. METHODS Data from the 2011 California Healthy Kids Survey examined feeling sad or hopeless, suicidal ideation, well-being, and depressive symptoms by military connectedness in a subsample (n = 14,299) of seventh-, ninth-, and 11th-grade California adolescents. Cross-classification tables and multiple logistic regression analyses were used. RESULTS More than 13% of the sample had a parent or sibling in the military. Those with military connections were more likely to report depressive symptoms and suicidal ideation. Controlling for grade, gender, and race/ethnicity, reporting any familial deployment compared with no deployments was associated with increasing odds of experiencing sadness or hopelessness, depressive symptoms, and suicidal ideation. CONCLUSIONS Findings emphasize the increased risk of mental health issues among youth with parents (and siblings) in the military. Although deployment-related mental health stressors are less likely during peace, during times of war there is a need for increased screening in primary care and school settings. Systematic referral systems and collaboration with community-based mental health centers will bolster screening and services.
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Milburn NG, Lightfoot M. Adolescents in wartime US military families: a developmental perspective on challenges and resources. Clin Child Fam Psychol Rev 2014; 16:266-77. [PMID: 23780722 DOI: 10.1007/s10567-013-0144-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Adolescents in wartime US military families are a unique group of young people who are experiencing the usual milestones of adolescent development, including establishing their identities and becoming autonomous, while they face the challenges of military life such as multiple frequent moves, relocation, and parent deployment to combat settings. This paper reviews research on adolescents in wartime US military families, within the context of adolescent development, to identify their behavioral, emotional and academic risk status, and challenges and resources. Recommendations for future research and interventions to foster the healthy development of these adolescents are also provided.
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Affiliation(s)
- Norweeta G Milburn
- Department of Psychiatry and Biobehavioral Sciences, Nathanson Family Resilience Center, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, A8-159A, Los Angeles, CA 90024, USA.
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Gilreath TD, Astor RA, Cederbaum JA, Atuel H, Benbenishty R. Prevalence and correlates of victimization and weapon carrying among military- and nonmilitary-connected youth in Southern California. Prev Med 2014; 60:21-6. [PMID: 24333605 DOI: 10.1016/j.ypmed.2013.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 11/21/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The present analysis sought to explore the normative rates and correlates of school victimization and weapon carrying among military-connected and nonmilitary-connected youth in public schools in Southern California. METHODS Data are from a sub-sample of the 2011 California Healthy Kids Survey (N=14,512). Items to assess victimization and weapon carrying were separated into three categories: physical acts (e.g., being pushed or shoved), nonphysical acts (e.g., having rumors spread about them) and weapon carrying. RESULTS The bivariate results indicate that youth with a military-connected parent had higher rates of physical victimization (56.8%), nonphysical victimization (68.1%), and weapon carrying (14.4%) compared to those with siblings serving (55.2%, 65.2%, and 11.4%, respectively) and nonmilitary-connected (50.3%, 61.6%, and 8.9%, respectively) youth. Having a parent in the military increased the odds of weapon carrying by 29% (Odds Ratio=1.29, 95% confidence interval=1.02-1.65). Changing schools and a larger number of family member deployments in the past 10years were associated with significant increases in the likelihood of victimization and weapon carrying. CONCLUSIONS The results of this analysis warrant a focus on school supports for youth experiencing parental military service, multiple relocations and deployments of a family member.
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Affiliation(s)
- Tamika D Gilreath
- University of Southern California, School of Social Work, 669 W 34th Street, Los Angeles, CA 90089-0411, USA.
| | - Ron A Astor
- University of Southern California, School of Social Work, 669 W 34th Street, Los Angeles, CA 90089-0411, USA
| | - Julie A Cederbaum
- University of Southern California, School of Social Work, 669 W 34th Street, Los Angeles, CA 90089-0411, USA
| | - Hazel Atuel
- University of Southern California, School of Social Work, 669 W 34th Street, Los Angeles, CA 90089-0411, USA
| | - Rami Benbenishty
- Bar Ilan University, Louis and Gabi Weisfeld School of Social Work, Ramat Gan 5290002, Israel
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Gewirtz AH, Zamir O. The impact of parental deployment to war on children: the crucial role of parenting. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2014; 46:89-112. [PMID: 24851347 DOI: 10.1016/b978-0-12-800285-8.00004-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
It is estimated that approximately 2 million children have been affected by military deployment, yet much of what is known about the adjustment of children experiencing a parent's combat deployment has emerged only within the past 5-10 years. The extant literature on associations of parental deployment and children's adjustment is briefly reviewed by child's developmental stage. Applying a family stress model to the literature, we propose that the impact of parental deployment and reintegration on children's adjustment is largely mediated by parenting practices. Extensive developmental literature has demonstrated the importance of parenting for children's resilience in adverse contexts more generally, but not specifically in deployment contexts. We review the sparse literature on parenting in deployed families as well as emerging data on empirically supported parenting interventions for military families. An agenda for future research in this area is proffered.
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Pullmann LD, Johnson PL, Faran ME. Implementing an evidence-based practices training curriculum to U.S. Army child and family behavioral health providers. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2013; 43:158-68. [PMID: 24063249 DOI: 10.1080/15374416.2013.833096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Military Children who have experienced multiple deployments of one or both parents are more likely to have emotional and behavioral difficulties compared with their civilian peers (e.g., Chandra et al., 2010 ). The U.S. Army Medical Command has tasked the Child, Adolescent and Family Behavioral Health Office (CAF-BHO) to develop programs to address the behavioral health (BH) needs of Army Children and Families. This article will describe the efforts of the CAF-BHO Training Section to disseminate and implement an evidence based practice training curriculum for Army Child and Family Behavioral Health Providers. Specifically, this article will detail: (a) the decision making strategy used to identify the training protocol for dissemination, (b) adaptations to the training program and treatment protocol to fit a Military context, and (c) efforts to implement, maximize and sustain utilization of evidence-based practices by Military BH providers over a large geographical area with limited resources.
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Acion L, Ramirez MR, Jorge RE, Arndt S. Increased risk of alcohol and drug use among children from deployed military families. Addiction 2013; 108:1418-25. [PMID: 23441867 DOI: 10.1111/add.12161] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/04/2012] [Accepted: 02/13/2013] [Indexed: 12/01/2022]
Abstract
AIMS To examine the association between military deployment of a parent and use of alcohol and drugs among children of deployed military personnel. DESIGN Observational and cross-sectional study. SETTING Data from the USA 2010 Iowa Youth Survey, a statewide survey of 6th, 8th and 11th graders, were analyzed during 2011. PARTICIPANTS Of all 6th-, 8th- and 11th-grade students enrolled in Iowa in 2010, 69% (n = 78 240) completed the survey. MEASUREMENTS Ever drink more than a few sips of alcohol and past 30-day: binge drinking, marijuana consumption, other illegal drug use and prescription drug misuse. FINDINGS The rates of alcohol use [risk difference (RD) = 7.85, 99.91% confidence interval (CI) = 4.44-11.26], binge drinking (RD = 8.02, 99.91% CI = 4.91-11.13), marijuana use (RD = 5.30, 99.91% CI = 2.83-7.77), other illegal drug use (RD = 7.10, 99.91% CI = 4.63-9.56) and prescription drug misuse (RD = 8.58, 99.91% CI = 5.64-11.51) are greater for children of currently or recently deployed parents than for children of parents who are not in the military. The magnitude of the effects is consistent across 6th, 8th and 11th grades. Disrupted living arrangements further accentuate increased substance use, with the largest effect seen in children with a deployed parent who was not living with a parent or relative. CONCLUSIONS Children of deployed military personnel should be considered at higher risk for substance use than children of non-military citizens.
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Affiliation(s)
- Laura Acion
- Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, Iowa City, IA 52242, USA.
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Moral Injury: A Mechanism for War-Related Psychological Trauma in Military Family Members. Clin Child Fam Psychol Rev 2013; 16:365-75. [DOI: 10.1007/s10567-013-0146-y] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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47
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The Promotional Role of School and Community Contexts for Military Students. Clin Child Fam Psychol Rev 2013; 16:233-44. [DOI: 10.1007/s10567-013-0139-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Maholmes V. Adjustment of Children and Youth in Military Families: Toward Developmental Understandings. CHILD DEVELOPMENT PERSPECTIVES 2012. [DOI: 10.1111/j.1750-8606.2012.00256.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Valerie Maholmes
- Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health
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