This study showed an association between parental war involvement and negative psychosocial outcomes, particularly in boys. It did not corroborate the previous findings that parental war participation was associated with lower socioeconomic status, lower employment rate, and homelessness (35
). Our study showed that children of war veterans were more likely to have unemployed fathers, but were also more likely to come from families with home ownership. This might seem confounding, but can be explained by the Croatian government’s provision of generous benefits to war veterans, especially if they had been wounded, have disabling depression, or suffer from PTSD. Such benefits often include early retirement, financial compensation, and free housing.
Sons of war veterans were significantly more likely to unintentionally injure themselves than sons of non-veterans. According to the literature, unintentional injuries were associated with externalizing disorders such as conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder, as well as internalizing disorders like depression (39
). Still, this study did not find any connection between parental war participation and depression in male adolescents. Unintentional injuries in this case might be a marker of externalizing behavior, or even some form of parasuicidal behavior as result of an increased propensity towards risk-taking behavior (40
A major finding of this study is the association between parental war involvement and male suicidality across the entire suicidal spectrum (thoughts about death, thoughts about suicide, suicide attempts). Although many adolescents with suicidal ideation and suicide attempts grow up without apparent signs of psychological disturbances, such behaviors are suggested to be indicators and/or predictors of future psychosocial distress. Besides being strong predictors of suicide completion (43
), suicidal phenomena are indicators of long-term difficulties (45
) or concurrent psychiatric disorders like depression (46
) and conduct/oppositional disorder (49
). Also, suicidal ideation has been linked to poorer health outcomes and psychosocial distress (50
). Longitudinal studies have shown its significant predictive value for a lower level of psychological and social functioning across the lifespan (52
). Thus, observed suicidal behaviors in early adolescence could be a marker of significant negative outcomes later on in life. This association could be direct and specific, since numerous reports indicate a relationship between suicidality and depression (57
) and externalizing behaviors or disorder (49
). We found no evidence that supports such hypothesis, except for unintentional injuries.
Beside possible indications of internalizing and/or externalizing behavior, it is possible that the increased prevalence of suicidal behaviors in sons of veterans might be a consequence of direct identification, imitation, or social learning because suicidality was also prevalent in veterans (61
We proposed the hypothesis that the association between suicidality and parental war involvement was not so direct and specifically mediated by any distinct psychopathological condition in male adolescents. The presence of suicidality in children of veterans might be linked to the war-induced psychosocial distress of their parents. Active war participation could precipitate a wide range of psychological and psychosocial difficulties in veterans, with indirect effects on their children. Parents, especially fathers who participated in the war, may have incurred psychological distress, which is then transferred onto male children and expressed as suicidality. The mechanism of transfer could be through some form of identification, emotional withdrawal of traumatized fathers, or secondary trauma experienced by the children (9
). Our finding that male children are more affected by parental war involvement supports the “identification hypothesis,” since the majority of parent veterans were men.
Surprisingly, there was no association between parental war involvement and subjective sleep-related problems. We expected to find this relationship, since suicidality and sleep-related problems might be seen as nonspecific, overlapping indicators of distress. Sleep problems and suicidal ideation are associated with many common psychopathological entities in adolescence (54
), and available reports indicate a link between suicidality and sleep problems in this developmental cohort (64
Our findings should be considered preliminary in the light of several limitations. A major weakness of this investigation is participant assessment and the definition of parental war involvement. Unfortunately, a great proportion (128/803) of participants did not report parental war participation. This could be a source of considerable bias, since it is possible that this subgroup represents those individuals whose families were most severely influenced by the war. However, we do not believe this to be the case. The participation in the war was perceived as an act of defense and patriotism. Therefore, we postulate that children of parents who did not participate in the war were more likely to comprise the group of children who did not report parental war involvement.
As already mentioned, this study used a cross-sectional convenience sample and did not determine causal relationships, which could be assessed only with an appropriately designed prospective follow-up study. The data were based only on adolescent self-reports and were not proofed by using other sources. This could affect the reliability of the results. However, as already mentioned, Lie scores were low, and self report investigations showed that 30-60% of adolescents did not reveal suicidal attempts to anyone, and up to 90% of such cases were unknown to parents (68
). Because of this, self-reported data might even be seen as a strength of the study in the sense of better disclosure of internalizing problems. Also, this investigation did not include possible parental psychopathology, so it remains unknown whether mental disorders, particularly depression and PTSD, might have influenced the results. Certainly, there are many more factors that could act as the mediators of transference of war-influenced psychosocial distress, such as the involvement of grandparents or other relatives. However, we believe that this influence is more distal than that from parents.
To conclude, this study found associations between parental war involvement and several observed psychosocial domains of their children. These associations seem to have sex-specific patterns, such as that male adolescents more often reported unintentional injuries and suicidal ideation. At the same time, female adolescents were more resilient and less likely to respond to parental war involvement in the psychosocial domains examined by this study, except for anhedonia which in the absence of raised overall CDI scores is not clinically significant.
Adolescent sons of war veterans constitute a target group for selective prevention. We suggest a development of group and sex-specific, individually tailored preventive interventions for children of war veterans. Possible interventions might focus not only on children but also on war veterans teaching them the importance of parenting skills. This could be done through the National Program of Psychosocial Help for War Veterans (69
), which has a broad network of professionals who are mainly helping to resolve veterans’ psychosocial problems and legal status. We propose the inclusion of psychoeducation and consulting about parenting in the routine agenda of these institutions.