Military Parents Research Articles

Minority Adolescent Mental Health Diagnosis Differences in a National Sample.

Mental health disparities and differences have been identified amongst all age groups, including adolescents. However, there is a lack of research regarding adolescents within the Military Health System (MHS). The MHS is a universal health care system for military personnel and their dependents. Research has indicated that the MHS removes many of the barriers that contribute to health disparities. Additional investigations with this population would greatly contribute to our understanding of disparities and health services delivery without the barrier of access to care. This study analyzed the diagnostic trends of anxiety, depression, and impulse control disorders and differences within a national sample of adolescents of active-duty military parents. The study utilized 2006 to 2014 data in the MHS Data Repository for adolescents ages 13-18. The study identified 183,409 adolescents with at least one diagnosis. Multivariable logistic regressions were conducted to assess the differences and risks for anxiety, depression, and impulse control disorders in the identified sample. When compared to White Americans, minority patients had a higher likelihood of being diagnosed with an impulse control disorder (odds ratio [OR] = 1.43; confidence interval [CI] 1.39-1.48) and a decreased likelihood of being diagnosed with a depressive disorder (OR = 0.98; CI 0.95-1.00) or anxiety disorder (OR = 0.80; CI 0.78-0.83). Further analyses examining the subgroups of minorities revealed that, when compared to White Americans, African American adolescents have a much higher likelihood of receiving a diagnosis of an impulse control disorder (OR = 1.66; CI 1.61-1.72) and a lower likelihood of receiving a diagnosis of a depressive disorder (OR = 0.93; CI 0.90-0.96) and an anxiety disorder (OR = 0.75; CI 0.72-0.77). This study provides strong support for the existence of race-based differences in adolescent mental health diagnoses. Adolescents of military families are a special population with unique experiences and stressors and would benefit from future research focusing on qualitative investigations into additional factors mental health clinicians consider when making diagnoses, as well as further exploration into understanding how best to address this special population's mental health needs.

Resilient Parents… Resilient Communities: A Pilot Study Trialing the Bounce Back and Thrive! Resilience-Training Program With Military Families.

IntroductionThe resilience of Canadian military families (CMFs) – the main support of the Canadian Armed Forces service members (SMs) – is imperative. The Canadian Armed Forces aims to ensure that SMs and their families are resilient and SMs ready to respond when called upon for combat, peacekeeping or pandemic/disaster-response. Family concerns, however, can realistically distract SMs from the mission, potentially compromising themselves, their unit and the mission. Resilience-training programs such as Bounce Back and Thrive! (BBT) can help families manage the realities of military life.ObjectiveThis pilot study aimed to evaluate suitability of BBT implementation by Military Family Resource Centers (MFRCs), including whether BBT: (1) fosters resilience-building among parents, (2) facilitates CMF resilience-building, (3) can be contextualized for CMFs, and (4) supports MFRCs in cultivating a culture of resilience.MethodsAn exploratory qualitative design was used. BBT was offered to parents face-to-face. Participants completed focus groups after the first 6 sessions, final 4 sessions, and one-year post-intervention. Data was thematically analyzed.ResultsNine military parents participated. Four major themes resulted: (1) military parent resilience-building, (2) CMF resilience-building, (3) BBT program feedback and contextualization, and (4) MFRCs as community resilience hubs.DiscussionBBT enabled parents to gain a new perspective on resilience, engage in dialogue and intentionally role model resilience skills. Military-specific BBT contextualization and online-delivery formats would increase suitability and access for CMFs. Access to resilience programs delivered through MFRCs would support CMFs. Further research is warranted.

Impact of Parental Illness and Injury on Pediatric Disorders of Gut–Brain Interaction

To evaluate the relationship between parental injury and illness and disorders of gut-brain interaction (DGBI) in children. A self-controlled case series using data from the Military Health System Data Repository compared International Classification of Diseases, Ninth Revision-identified DGBI-related outpatient visits and prescriptions in 442 651 children aged 3-16years in the 2years before and the 2years after the injury and/or illness of their military parent. Negative binomial regression was used to compare visit rates for constipation, fecal incontinence, abdominal pain, irritable bowel syndrome, and a composite of these before and after parental injury and/or illness. Logistic regression, clustered by child, compared the odds of stooling agent and antispasmodic prescription before and after parental injury and/or illness. In the 2years following parental injury and/or illness, children had increased visits for DGBIs (adjusted incidence rate ratio [aIRR] 1.09; 95% CI 1.07-1.10), constipation (aIRR 1.07; 95% CI 1.04-1.10), abdominal pain (aIRR 1.09; 95% CI 1.07-1.12), and irritable bowel syndrome (aIRR 1.37; 95% CI 1.19-1.58). Following parental injury and/or illness, the odds of stooling agent prescription decreased (aOR 0.95; 95% CI 0.93-0.97) and the odds of antispasmodic prescription increased (aOR 1.26; 95% CI 1.18-1.36). Parental injury and/or illness is associated with increased healthcare use for DGBIs. Parental health should be considered by clinicians when assessing DGBIs, counseling patients, and formulating treatment plans.

A different kind of battle: the effects of NICU admission on military parent mental health.

To determine the incidence of mental health symptoms in military families after prolonged NICU admission. Prospective cohort study of military-affiliated NICU parents participating in serial electronic surveys, which included validated screening tools for acute stress (ASD), post-traumatic stress (PTSD), and depression disorders. Among 106 military parents surveyed after NICU admission, 24.5% screened positive for ASD and 28.3% for depression. 77 (72.6%) parents continued participation beyond discharge, with 7.8% screening positive for PTSD and 15.6% for late depression. Positive ASD correlated with later symptoms of PTSD (OR 8.4 [2.4-30]) and early depression with both PTSD symptoms (OR 5.7 [1.7-18.8]) and late depression (OR 8.4 [2.4-30]) after discharge. Secondary analysis determined these findings were independent of deployment and other military related factors. This study highlights the potential mental health burden experienced by military-affiliated NICU parents. Early ASD and depression screening may identify parents at risk for mental health symptoms after discharge.

Screening for adult attention deficit and hyperactivity disorder among military parents: A pilot study

IntroductionThe prevalence of adult Attention Deficit and Hyperactivity Disorder (ADHD) has been investigated in the general population by multiple studies. However, few studies have focused on identifying its prevalence in the military population, particularly among military parents of children with ADHD.ObjectivesThe aim of our study was to screen for adult ADHD among military parents of ADHD children followed-up at the child and adolescent psychiatry department in the Military Hospital of Instruction of Tunis, Tunisia.MethodsThis prospective study was carried among military parents (one or both parents belonging to the national army) of ADHD children. Children were diagnosed with ADHD based on the 5th Diagnostic and Statistical Manual ADHD criteria and the Conners Comprehensive Behavior Rating Scale. Whereas adult ADHD was screened for using the Adult ADHD Self-Report Scale-V1.1.ResultsFifteen children and twenty-nine parents were included in the study: sixteen of the parents were military members and thirteen were civilian spouses. Eight (50%) of the sixteen military parents, and four (30,7%) of the civilian spouses were screened positive for ADHD. Whereas 73% of these children had at least one parent screened positive for ADHD, and 53% had at least one military parent screened positive for ADHD. These results suggest a high prevalence of adult ADHD among this population.ConclusionsADHD occurs in childhood and may persist into adulthood. The findings of this study indicate that ADHD symptoms are not limited to the youth and are common in military population. Implications on screening, management, preventive measures and research should be discussed.

Family and occupational functioning following military trauma exposure and moral injury

IntroductionEvidence is growing regarding the impact of potentially morally injurious events (PMIEs) on mental health; yet how moral injury may affect an individual’s occupational and familial functioning remains poorly understood.MethodThirty...

Military parents' perceptions of separation for their younger children.

Many studies are available in the literature considering effects of deployment on older school age and adolescent children, but less is known about the effects on younger children. The purpose of this study was to describe the experience of deployment/separation for military children aged 4-10 years from both the deployed parent and stay-at-home parent's experiences. Parents completed demographics followed by an interview to describe the child's reaction to separation. Thematic analysis was used to identify children's reactions and intervention strategies. Thirty-eight families, encompassing 57 children aged 4-10 who experienced a separation or deployment within the past 2 years participated. Interviews included 24 military members and 34 spouses (most frequently the mothers) completed the interview and research instruments. Interview data revealed a turbulent experience for families resulting from frequent and repeated separations. Parents actively employed strategies garnered from military-provided materials and informal interaction with other military parents. The different perspectives provided new insights as to the strategies military families find successful during separations and will be useful in providing anticipatory guidance.

Web-Based Training for School-Based Mentors of Military-Connected Youth: A Multi-Phase Development Study.

This paper describes a multi-phase effort to develop a web-based training for adults serving as mentors in school-based programs for youth with a parent in the military. In Phase 1, we conducted focus groups with military parents to: gauge their receptivity to this type of supportive intervention, identify program features that would make the option of mentoring for their children more or less appealing, and identify specific training needs for adult volunteers preparing for the role of mentor to youth in this population. In Phase 2, we used an iterative process to develop the training protocol, including cycling through multiple drafts, creating a web-based platform, reviewing and incorporating feedback from various stakeholders, and then pilot testing the training with two groups of mentor volunteers as part of a school-based mentoring program for military-connected students. We report on what we learned from the military parent focus groups, including parent skepticism about the need for such a program, concerns about potential stigma, and the need for mentors to have some understanding of military culture. We describe how we used that information to develop a practical and accessible training module for volunteer mentors, especially those without a military background, who could be matched with military-connected youth.

Examining Implementation Feasibility of a Multicomponent Parenting and Health Promotion Program for Military Families

Promoting military child well-being is imperative for enhancing resiliency and public health within military families and the United States. Providing military families with parent-focused interventions (PFIs) is one, potentially beneficial technique for fostering favorable health outcomes in military children. This study presents implementation feasibility, fidelity, and initial post-program findings from a pilot study of Grow, a PFI that enhances positive parenting, stress management, and physical health promotion skills in military parents of children 5- to 10-year-old. Results indicate that Grow is highly acceptable, feasible to implement with fidelity, and shows promising post-program health outcomes. Study limitations and future directions are discussed.

School Food and Beverage Availability and Children's Diet, Purchasing, and Obesity: Evidence From a Natural Experiment

PurposeExisting evidence on relationships between school food environments and children's in-school purchases, dietary behaviors, and body composition is based on observational studies that are vulnerable to residential selection bias. MethodsThis study leveraged exogenous variation in school environments generated by the natural experiment due to military parents' assignment to installations. We analyzed 1,010 child-wave observations from the Military Teenagers Environments, Exercise, and Nutrition Study collected during 2013–2015. Using multiple linear and logistic regression, we examined whether the number of competitive food and beverage (CF&B) items available for purchase in school, overall and by type (unhealthy, healthy, neutral), was associated with in-school food purchases, dietary behaviors, and body mass index (BMI) outcomes. Covariates included child and family characteristics and the healthiness of the home food environment. ResultsUnhealthy item availability was positively associated with purchasing any sweets (adjusted odds ratio [AOR], 1.30; p < .01), snacks (AOR, 1.23; p < .01), and sugar-sweetened beverages (AOR, 1.19; p = .01). However, there were no significant associations with overall food and beverage intake (e.g., sweets, soda) nor BMI outcomes. The home food environment was significantly associated with all outcomes. ConclusionsAccess to unhealthy CF&B items may influence in-school purchases but does not appear to influence overall dietary behaviors and BMI outcomes. Substitution of caloric intake across locations within versus outside of school may play a role in explaining why purchases were associated with unhealthy CF&B availability but overall diet and downstream BMI were not.

The Physiological Regulation of Emotion During Social Interactions: Vagal Flexibility Moderates the Effects of a Military Parenting Intervention on Father Involvement in a Randomized Trial.

To make prevention programs more effective and understand "what works for whom," evidence regarding what individual characteristics predict intervention responsiveness is needed. Previous studies have evaluated a military parent training program known as After Deployment Adaptive Parenting Tools/ADAPT, yet less is understood about the program's varying effects for fathers. We tested the physiological regulation of emotion during social interactions as a moderator predicting fathers' responsiveness in a randomized trial of ADAPT, in which emotion regulation was operationally measured through vagal flexibility (VF; dynamic changes in cardiac vagal tone). Families with a child aged between 4 and 13years for whom physiological data were gathered (n = 145) were randomly assigned to ADAPT (14-week face-to-face group intervention) or a control group (services as usual). Fathers in these families were National Guard/Reserve members who had been deployed to war in Iraq and/or Afghanistan and recently returned. Prior to the intervention, cardiac data was collected in-home throughout a set of family interaction tasks and VF was operationalized as the changes in high frequency (HF) power of heart rate variability (HRV) from a reading task to a problem-solving task. Parenting behaviors were observed and coded based on theory-driven indicators pre-intervention and at 1-year follow-up. Results of structural equation modeling showed that VF significantly moderated fathers' intervention responsiveness, such that fathers with higher vs. lower VF exhibited more effective parenting at 1-year follow-up if they were randomized into ADAPT vs. the control group. This study is the first to demonstrate that parasympathetic vagal functioning may be a biomarker to predict response to a military parenting intervention to enhance parenting in combat deployed fathers. The implications for precision-based prevention are discussed.

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

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

Tell Me A Story: Promoting resiliency in military children with a bibliotherapy intervention.

Research demonstrates the complex effect of the military lifestyle on children of military members. Problem behaviors can manifest in military children as young as 6 years old (eg, physical violence). Some military children have better outcomes (ie, resiliency). These differences in outcomes are not fully understood; literature agrees that parent's interaction with their children predicts resiliency. Nurses can utilize resiliency interventions to improve the health and wellbeing of families. Tell Me A Story (TMAS), a bibliotherapy intervention, role models for parents reading with their children, using story as a platform to deal with issues in a safe way. The purpose of this pilot study was to determine if child resiliency increased and problem behavior decreased with TMAS participation. A community-based study examined the impact of TMAS intervention on parent's perceptions of their school-aged children's behavior. Participants were active-duty military parents, recruited on or near seven military installations in the continental United States. Child problem behavior showed a change from baseline, with sex and parental deployment factoring for improved or worsening behavior among children. Total and internalizing problem behavior scores increased after intervention if a parent was deployed. Girls experienced increased resiliency scores after TMAS intervention while boys experienced decreased scores. Overall, TMAS intervention is beneficial for behavior and resiliency for some children and provides research for future programming offered by nurses for military families.

Extension Military Parent–Teen Camp Experiences: Family Resilience Building in Action

The purpose of the study addressed in this article was to gather information from military service members and their teenage children attending Extension camping programs together. We used a pretest and a posttest to examine resilience of both groups and compared other postprogram youth outcome measures to a normative sample. We found statistically significant increases in resilience scores for both service member participants and teenage participants as well as elevated youth outcomes in the areas of problem solving and connecting with others. Our results constitute useful information on the value of Extension outdoor and recreational programming for family systems.

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

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

Examining Impacts of Cumulative Risk on Military-Connected Youth and the Role of Family in Coping

Youth in military families are confronted with stressors that are normative (e.g., racial or ethnic minority status, non-married family structure, social isolation) and context-specific in relation to a parent’s military career (e.g., parental deployment, school transitions, parent rank, dual military parents, living outside of the continental United States, living 30+ min from a military base). This study applied a stress process and cumulative risk lens to examine the impact of cumulative risk on military-connected youth outcomes accounting for contextual factors such as gender, age, and family. First, this study examined the relationship between cumulative risk and two outcomes, self-efficacy and depressive symptomology. Then, gender differences, developmental considerations, and the role of family were examined to determine whether any of these factors buffered or exacerbated the relationship between risk and adverse outcomes. Data were collected from military-connected youth (N = 1036) between the ages of 11 and 18. Multiple regression and moderation analyses were conducted. Higher levels of cumulative risk were associated with lower levels of self-efficacy and higher levels of depressive symptomology. Few differences were found based on gender or age; however, a trend in which older youth reported higher levels of depressive symptomology than younger youth in the context of risk emerged. Turning to family as a coping resource buffered the effects of risk on self-efficacy, but this finding did not exist for depressive symptomology. Youth who are able to turn to their family when they are overwhelmed by stressors are more likely to experience a protective or buffering effect, especially with regard to self-efficacy.

Coercive Parenting Mediates the Relationship between Military Fathers’ Emotion Regulation and children’s Adjustment

Military parents' combat-related posttraumatic stress disorder (PTSD) symptoms have been linked to poor parenting and child maladjustment. Emotion regulation (ER) difficulties are thought to underlie PTSD symptoms, and research has begun to link parental ER to parenting behaviors. Little empirical evidence exists regarding whether fathers' ER is associated with child adjustment and what may be the underlying mechanism for this association. This study investigated whether deployed fathers' ER was associated with child emotional and behavioral problems, and whether the associations were mediated by coercive parenting behaviors. The sample consisted of 181 deployed fathers with non-deployed female partners and their 4- to 13-year-old children. Families were assessed at three time points over 2years. ER was measured using a latent construct of fathers' self-reports of their experiential avoidance, trait mindfulness, and difficulties in emotion regulation. Coercive parenting was observed via a series of home-based family interaction tasks. Child behaviors were assessed through parent- and child-report. Structural equation modeling revealed that fathers with poorer ER at baseline exhibited higher coercive parenting at 1-year follow-up, which was associated with more emotional and behavioral problems in children at 2-year follow-up. The indirect effect of coercive parenting was statistically significant. These findings suggest that fathers' difficulties in ER may impede their effective parenting behaviors, and children's adjustment problems might be amplified as a result of coercive interactions. Implications for the role of paternal ER on parenting interventions are discussed.

Effectiveness of Tailored Educational Resources for American Military Parents of a Child with a Disability: A Preliminary Study

Effectiveness of Tailored Educational Resources for American Military Parents of a Child with a Disability: A Preliminary Study

The lasting effects of growing up in a military-connected home: a qualitative study of college-aged American military kids

ABSTRACT Being reared as a military kid is a unique experience shared by millions of children all over the world. This study seeks to understand the experiences shared by military kids and how those experiences change their perspectives, behaviours, and relationships. In the present phenomenological study, we conducted 21 in-depth, semi-structured qualitative interviews of college students who were reared as United States military kids (MKs). Using criterion sampling, the participants all met specific criteria, including experiencing deployment of their military parent as well as a minimum of 10 years of parental service during the MK’s lifetime. Interviews were tape-recorded, transcribed, and coded for analysis. Researchers reviewed the transcriptions to find common themes and meta-themes present in a majority of the interviews. Common themes centred around relationships with family, changes during childhood, and military presence in everyday life. Particular findings reported in the present article include demonstrated respect, military pride, military community commonality, anticipation of change, childhood instability, family dynamics, military terminology, adaptability, and an overall positive experience. These common themes are relevant for all involved in the care of military kids and their families, as they underline the unique perspective that MKs have about their childhood and their future.

The Impact Of Military Parents' Injuries On The Health And Well-Being Of Their Children.

Parental injuries and illnesses affect child and family life. We hypothesized that military parental injury would adversely affect children's preventive care, injuries, maltreatment, mental health care, and psychiatric medication prescriptions. Visit and prescription data of 485,002 military-connected children ages2-16 were tracked for two years before and two years after the injury of a parent in the period 2004-14. Adjusted negative binomial regression compared pre- and post-injury visit and prescription rates. Children with injured parents had decreased rates of preventive care visits and increased rates of visits for injuries, maltreatment, and mental health care, as well as increased psychiatric medication use, following their parent's injury. Across all categories of care, children of parents with posttraumatic stress disorder (PTSD), both alone and with traumatic brain injury, appeared to have more pronounced changes in care patterns. Parental injury and illness are associated with changes in children's health care use, and PTSD in a parent increases the effect.