Wartime Military Deployment and Increased Pediatric Mental and Behavioral Health Complaints

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Military deployment of a parent influences children's behavior in a variety of settings. The clinical significance of these deployment-associated behavior changes has not been determined. WHAT THIS STUDY ADDS:Children experiencing separation from a parent due to wartime military deployment have an 11% increase in outpatient visits for mental and behavioral health complaints, which contrasts with a general deploymentassociated decrease in health care visits in all other diagnostic categories.abstract BACKGROUND: Children of military personnel face stress when a parent deploys. OBJECTIVE: Our goal was to determine the effect of parental military deployment on the relative rate of outpatient visits for mental and behavioral health disorders in children aged 3 to 8 years. METHODS:This was a retrospective cohort study. Records of children of active-duty personnel during fiscal years 2006 and 2007 were linked with their parent's deployment records. Mental and behavioral health visits were identified by using International Classification of Diseases, Ninth Revision, codes. The incidence rate ratio (IRR) of visits per year according to parental deployment status was determined with random-effects negative binomial regression modeling with longitudinal data analysis. RESULTS: A total of 642 397 children aged 3 to 8 years and 442 722 military parents were included. Mean child age was 5.0 years (SD: 1.9 years); 50.6% were male, and 68.0% were white. Ninety percent of the parents were male, and 90.5% were married; 32.0% of the parents were deployed during the study. There were 1 049 081 person-years with 611 115 mental and behavioral health visits (0.6 visit per year). The IRR of mental and behavioral health visits for children with a deployed parent compared with when a parent was home was 1.11 (95% confidence interval [CI]: 1.07-1.14; P Ͻ .001). IRRs of pediatric anxiety, behavioral, and stress disorders when a parent deployed were 1.14 (95% CI: 0.98 -1.32; P ϭ .095), 1.19 (95% CI: 1.07-1.32; P Ͻ .001), and 1.18 (95% CI: 1.10 -1.26; P Ͻ .001), respectively. Older children and children with military fathers and married parents had larger increases in rates of mental and behavioral health visits during parental deployments. In contrast, the overall outpatient rate and rates of visits for other diagnoses decreased when a parent was deployed. CONCLUSIONS: Mental and behavioral health visits increased by 11% in these children when a military parent deployed; behavioral disorders increased 19% and stress disorders increased 18%. Rates especially increased in older children and children of married and male military parents.

Long-Term Trajectories and Service Needs for Military Families

“…These reports of increased child distress during deployment were confirmed by the evaluations of medical claims data and school data. Parent deployment and deployment length were associated with increased rates of mental health care visits and diagnoses and reduced academic performance among military children (De Pedro et al 2011;Gorman et al 2010;Mansfield et al 2011). Barnes et al (2007) found a history of parent deployment was associated with elevated cardiovascular measures, like heart rate (Barnes et al 2007).…”

Health and Mental Health Needs of Children in US Military Families

“…Changes in behavior, both externalizing and internalizing, and changes in school performance are reported. [7][8][9]11,[36][37][38] High levels of sadness and worry are reported in most age groups. [7][8][9]39 Depressive symptoms are reported in approximately 1 in 4 children experiencing deployment of a parent.…”

“…39 In addition, a recent population-based study reported increased use of mental-behavioral health services in children whose parents were deployed. 11 Finally, a large population study of 307 520 children of parents in the nonretired active duty military, children 5 to 17 years of age (2003)(2004)(2005)(2006)) noted a greater number of mental health diagnoses and more diagnoses correlating with the total time of deployment. 40 Children of All Ages Are Affected by Wartime Deployments…”

“…More than 50% of military children receive their health and mental health care from nonmilitary providers, outside the gates of military installations, especially children of activated service members in the National Guard and Reserve. 11 One civilian group practice outside a large military treatment facility has 12% of their pediatric patient population enrolled in Tricare Prime, constituting care for more than 22 000 children from military families (Stuart A. Cohen, personal communication, November 21, 2012). Pediatricians need to be aware of common issues during wartime deployments, assess family coping skills, provide anticipatory guidance for the typical cycle of deployment, know where to find appropriate resources, and know when to refer for specialized services or care.…”

Parental Wartime Deployment and the Use of Mental Health Services Among Young Military Children

“…In this issue of Pediatrics, Commander Gorman et al 6 address parental wartime deployment and the use of MH services among military children aged 3 to 8 years. It is one of the first studies to capture data from a large number of military children representing multiple active-duty (AD) services during a period of high-intensity parental deployments.…”