Parental Combat Injury and Early Child Development: A Conceptual Model for Differentiating Effects of Visible and Invisible Injuries

Abstract

The injuries (physical and emotional) sustained by service members during combat influence all members of a family system. This review used a systemic framework to conceptualize the direct and indirect effects of a service member's injury on family functioning, with a specific focus on young children. Using a meta-ethnographic approach to synthesize the health research literature from a variety of disciplines, this review makes relevant linkages to health care professionals working with injured veterans. Studies were included that examined how family functioning (psychological and physical) is impacted by parental illness; parental injury; and posttraumatic stress disorder. The synthesis of literature led to the development of a heuristic model that illustrates both direct and indirect effects of parental injury on family functioning and the development of young children. It further illustrates the contextual factors or moderating variables that buffer detrimental effects and promote family resilience. This model can be a foundation for future research, intervention, and policy.

The Impact of Parental Operational Stress Injury on Child Mental Health and Well-Being: A Scoping Review

“…Renegotiating parenting roles and responsibilities When parents live with OSIs they can experience a range of invisible issues, such as irritability, emotional unavailability, hostility, and hypervigilance, that are disruptive to family relationships (Arata-Maiers & Stafford, 2010;Cozza, Holmes, & Van Ost, 2013;Cozza & Lieberman, 2007;Danish & Antonides, 2013;Dekel & Goldblatt, 2008;Gewirtz, Pinna, Hanson, & Brockberg, 2014;Gorman, Fitzgerald, & Blow, 2010;Harrison, Albanese, & Berman, 2014;Janke-Stedronsky et al, 2016;Lester & Flake, 2013;Lieberman & Horn, 2013;Palmer, 2008;Reed, Bell, & Edwards, 2011;Sammons & Batten, 2008;Seamone, 2012;Ternus, 2010). These issues can impact a parent's ability to consistently negotiate and meet role expectations and household routines, which typically creates friction among family members as the distress an individual living with an OSI feels reverberates throughout the family (Boricevic Mar sanic, Aukst Margetic, Jukic, Matko, & Grgic, 2014;Campbell, Brown, & Okwara, 2011;Cozza, Holmes, et al, 2013;Lester & Flake, 2013;Lester et al, 2010;Lieberman & Horn, 2013), leaving the family with a lower threshold for everyday stressors .…”

“…A study that examined the impact of warm and caring maternal relationships on the children of PTSD veterans indicated that, as adults, children of PTSD veterans experienced less emotional distress and had a greater capacity for intimacy (Dinshtein et al, 2011). This closeness with the children may lead to friction in the spousal relationship and, in some cases, potential exposure to intimate partner violence (Campbell et al, 2011;Dekel & Goldblatt, 2008;Gorman et al, 2010;McFarlane, 2009;Palmer, 2008;Pearrow & Cosgrove, 2009) and negative impacts on the caregiver's psychological well-being and capacity to meet household maintenance demands (Ahmadi, Azampoor-Afshar, Karami, & Mokhtari, 2011;Cozza, Holmes, et al, 2013;Lester, 2012). …”

“…There appears to be a spillover effect of OSI onto the spouse, as it has been shown that spouses demonstrate moderate to severe levels of secondary trauma and mental health issues (Ahmadi et al, 2011;Campbell et al, 2011;Davis, Blaschke, & Stafford, 2012;Gorman et al, 2010;Lester & Flake, 2013;Lester, 2012;Lincoln & Sweeten, 2011;Seamone, 2012). Strain within and disintegration of the marital relationship are not uncommon (Gorman et al, 2010;Holmes, Rauch, & Cozza, 2013), and the "increased burden and responsibility on the wife may reach a point where problems develop in her parental functioning" (Boricevic Mar sanic, Aukst Margetic, Jukic, et al, 2014, p. 301) such that it drains the parent of the capacity to attend to the needs of the children (Gorman et al, 2010).…”

“…Strain within and disintegration of the marital relationship are not uncommon (Gorman et al, 2010;Holmes, Rauch, & Cozza, 2013), and the "increased burden and responsibility on the wife may reach a point where problems develop in her parental functioning" (Boricevic Mar sanic, Aukst Margetic, Jukic, et al, 2014, p. 301) such that it drains the parent of the capacity to attend to the needs of the children (Gorman et al, 2010).…”

Parental Injury and Psychological Health of Children

“…13 Injuries sustained by parents in combat can have a variety of psychological effects on their children. 14 Injuries to 1 child in the family increase the risk of injuries to siblings, especially in the first 3 months after the index child' s trauma. 15 However, there has been little research on the effect of parental injury on children in the civilian setting.…”