Predicting Adverse Child Outcomes
A consistent finding across developmental literature is that children’s levels of distress are linked to parental distress. About one third of the AHC parents and almost 40% of the smaller subset of AD parents assessed showed elevations in either anxiety, depression or global severity scores, comparable to or higher than other retuning service members from OIF/OEF and their spouses.44,45
This study’s rates of AD service members screening positive for PTSD following combat deployments are comparable to previously reported studies on Iraq war veterans.44
The level of distress among service members and their partners clearly underscores the family level risk for operational wear and tear.
Past studies of the impact of parental deployment on children generally index adverse child outcomes at a single point in time and often assume that the most difficult time for the child is during the parent’s absence. The current study suggests that children can have complex reactions to multiple phases of the deployment cycle as evidenced by high levels of child anxiety even after the active duty parent has returned. As the number of deployments increase along with the total amount of time a parent is absent, there is a greater likelihood for AD combat operational stress, changes in parenting styles, emotional estrangement, or even heightened fear between family members.31
The relative timing of parental departure and return represents variable challenges for children and families, as described in a deployment cycle model.46
Further studies are needed to assess child adjustment and develop interventions across phases of this cycle.
Results indicate that school-aged boys and girls have different behavioral reactions during and after a deployment. Girls, and not boys, showed increased externalizing symptoms when a parent was deployed compared to when the parent was returned. In contrast, boys may have more difficulties adjusting to reduced autonomy and increased structure when the deployed parent returns. Findings here differed as a function of gender, age, and symptom reporter (age effects on CBCL parent report vs. MASC child report). Longitudinal studies are sparse, but such factors are all likely to influence the long-term impact of wartime deployments on child outcomes and warrant further investigation.
Whereas child distress was not lower in the RR relative to the CD group, AHC parent distress was lower in those with a RR spouse than those with a CD spouse. Anecdotal reports suggest the deployed spouse’s return generally heralds a net decrease in the non-deployed spouses stress burden and a net increase in support. Civilian parents with a deployed spouse manage multiple increased duties, including financial, child care, and household responsibilities with an often limited support system, which may contribute to increased distress during deployment separations. Nevertheless, the fact that AHC parent distress increased as their spouses’ total number of months deployed rose, mirroring the pattern seen in children, suggests cumulative stress builds across wartime deployments for children and civilian parents.
AD officers reported few PTSD symptoms, and none met criteria for PTSD, while 23% of enlisted AD parents screened positive for PTSD. All participants were aware of the confidential nature of study participation, so this rank discrepancy may represent a reporting bias, with AD officers less likely to endorse psychological symptoms due to potential career impact. A similar non-significant pattern was seen among the at-home caretaker spouses of officers compared to enlisted service members. Future studies will need to examine the specific military and socio-economic components of rank that contribute to differential prevalence rates at the parent level as well as the potential for child level influences.
A consistent finding across developmental literature is that child distress is linked to parental distress. Multiple pathways are theorized by which parental psychological distress levels can impact children: through impairments in primary caretaking behaviors such as maintaining emotional availability and consistent care routines. The current analyses of parental predictors of adverse child outcomes support this relationship in military families, with parental psychological symptoms linked to a range of child emotional and behavioral symptoms. Because the study design was cross-sectional, we are not able to determine whether there is a reciprocal influence of child distress on parental distress for this sample. Longitudinal evaluation of child and family adjustment across the cycles of deployment are needed to determine the directionality of these influences. Nevertheless, this study contributes a unique observation in the current literature in trying to isolate the relationships between specific adverse child outcomes and specific symptom presentations in AD and AHC parents. Such pathways provide guidance to targeting interventions that will best support family resiliency and address family distress in the context of wartime deployments.
Traditional methods of teaching emotional regulation skills, using family level anxiety management approaches and enhancing family communication require adaptation to address the specific worries of children of combat-deployed parents. Whereas the implications of heightened separation anxiety symptoms in a population affected by parental wartime deployments may be distinct from similar symptoms in a general child population47
, the presence of persistent anxiety symptoms may interfere with important child developmental tasks and family life (such as independent sleeping, school attendance, etc.). Clinical experience with these children suggests heightened anxiety about another potential deployment even after a parent has returned. Families often report that children are reactive to reminders of separation, and especially to cues that may indicate a service member’s potential departure, such as donning a uniform or coming home late from work. In addition, parents often report children’s worries about parental safety and possible loss of the military and
civilian parents, with a persistent sense of uncertainty about life threatening danger. Reintegration may also be marked by a child’s fears over changes in their parent, whether behavioral or physical.31
Developing skills that enable both parents and children to reduce psychological distress, as well as to negotiate the ambiguity of a parent’s presence and absence may assist families with adjustment across the deployment cycle.48
There are two primary limitations to the present study. First, this is a convenience sample recruited from families living on or near large military installations. The generalizability of any data set is dependent upon how it is collected; there may be biases introduced by the recruitment process. For example, participating families may have been more pro-social or had greater financial need for the assessment incentive than those who refused. However, the demographics of the recruited sample at both sites was comprised almost entirely of married families, with a mean parental age in their early 30’s, and consisting of more officers at both sites than officer-to-enlisted ratios reported for the Army or the Marines. Given that officers and their spouses reported less psychological distress than the enlisted and their spouses, this study sample may reflect lower risk than the overall population of deployed service member parents, and actually underestimate
overall risk for emotional distress in these families. Conversely, this volunteer sample of families interested in participating in this study may have been more likely to report symptoms and seek services. Several of the key findings are similar to a much larger sample of adolescent children and their parents,20
suggesting findings here may be consistent across other military families.
Secondly, this is a cross-sectional analysis of families currently deployed and those recently returned. Whereas it is logically plausible that the emotional distress or problem behaviors of a child can increase parental distress and that distress may be reciprocal across family relationships, we believe the directionality of the hypothesized “predictors” is more reasonable; the duration of parental combat deployments during the child’s lifetime and current reports of parental distress symptoms increase child symptoms. In any case, these data indicate increased risk for emotional distress across the family system. Future studies should be designed to provide longitudinal information regarding family adjustment across the deployment cycle, and to clarify the timing of adjustment across the phases of deployment and reintegration.
The military demographic in the United States has changed in the past several decades to include a much larger proportion of service members having families. Planning for extended military operations needs to take into account the impact on family members. Programs that potentially mitigate the impact as described here need to be examined for benefit in an effort to offset these consequences. By demonstrating the impact of wartime deployments across the family system, as well as providing information about the relationships among family member’s stress, these findings provide support for a family centered targeted preventive approach for children and families facing ongoing combat-related deployments, and especially interventions that target reduction of parental anxiety, depression and post traumatic stress symptoms, as well as child anxiety symptoms.