The impact of military deployment on children: Placing developmental risk in context
Introduction
A common saying in the military is that when one person joins, the whole family serves. Thus, families play a critical role in ensuring the success of military operations (Gewirtz et al., 2011, Park, 2011). More than one-half (51.4%) of the 3.5 million U.S. military personnel are married and more than 42% have dependent children (Deputy Assistant Secretary of Defense, 2015), meaning that the number of military dependents, including spouses/partners and children, far outnumber service members. More than a decade of conflict in the Middle East has presented a range of challenges for these families including lengthy and repeated separations, frequent relocations, upheaval of family routines, role changes within the family, and the very real threat of harm or death befalling a loved one (Park, 2011). As part of active missions Operation Inherent Resolve (OIR; Iraq and Syria) and Operation Freedom's Sentinel (OFS; Afghanistan), as well as recently-ended missions Operation Enduring Freedom (OEF, Afghanistan), Operation New Dawn (OND; Iraq) and Operation Iraqi Freedom (OIF; Iraq), more than 6853 service members have lost their lives and more than 52,379 have been wounded in action (Department of Defense, Defense Casualty Analysis System, as of November 6, 2015). Remarkably, many military families show great adaptability and resilience under the pressures of war (MacDermid et al., 2008, The White House, 2011). Others fare less well however, as evidenced by a growing body of research demonstrating high rates of mental health problems, work/academic struggles, family conflict, and maltreatment in relation to deployment (Department of Defense, 2010).
There is agreement that the emotional health and well-being of children from military families should be a national priority (The White House, 2011) yet existing gaps and limitations in research render it difficult to know how to best respond to these needs. For example, a majority of investigations to date have utilized broad measures of psychopathology, failed to include relevant comparison control groups, and focused exclusively on problem behaviors (as opposed to strengths) during periods of deployment. Further, even though child outcomes cannot be adequately understood outside of the broader family environment, few studies have systematically assessed the influence of contextual factors (e.g., living arrangements during deployment, levels of stress in the at-home parent, frequency of contact with the deployed parent) as contributors toward risk. Together, these limitations raise concern as to whether the myriad of well-intended interventions developed for military families in recent years (e.g., Beardslee et al., 2011, Gewirtz et al., 2011, Lester et al., 2011, Wilson et al., 2011) track specifically onto the actual needs of children and families.
Perhaps an even more salient point with regard to children relates to developmental stage. Although it is well-recognized that stressful events, such as parental deployment, can play a significant role in the etiology and maintenance of early mental health problems, the ways in which children understand and respond to such events are heavily influenced by development (Compas et al., 2001, Evans et al., 2013, Garmezy et al., 1984). That is, the impact of any stressor is largely conditional upon when it occurs in the course of a child's life. For example, whereas young children cannot fully appreciate the meaning of a parent's absence, school-aged children and adolescents are better able to comprehend the nature and range of potential risks associated with deployment. In this way, younger children may be somewhat shielded from the realities of war. On the other hand, the sudden, inexplicable absence of a parent and unclear time frame for their return may be highly stressful for young children. Developmental differences in the ways children in military families respond to and cope with periods of parental separation have nonetheless received inadequate attention.
Section snippets
The current review
In the current review we examine and consider available research findings on the mental health and functioning of children in U.S. military families in relation to deployment during OIR/OFS/OEF/OND/OIF combat operations (hereafter referred to as recent conflicts). We begin with a brief description of each phase of the deployment cycle, including pre-deployment, deployment, and reintegration (post-deployment) periods to provide the reader with necessary background and context. We then examine
Methods
In compiling our review, electronic databases including MEDLINE, PubMed, PsycInfo, and Google Scholar were searched for relevant, empirical papers and official reports published between 2001 and 2015. The search terms ‘deployment, reintegration, military, youth, toddlers, preschoolers, children, and adolescents’ were cross-referenced with the terms ‘adjustment, mental health, stress, coping, school, academic, risk, and maltreatment’. We also examined the reference lists of identified papers to
Phases of the deployment cycle
The deployment cycle, sometimes referred to by different names within individual service branches, includes three phases: pre-deployment, deployment, and reintegration. The pre-deployment phase begins when a unit receives a deployment alert and preparation for deployment begins (Military One Source, 2012).1 Service members receive additional training, attend required briefings, undergo medical and dental
Mental health in children during deployment
Several reports document an alarming increase in the number of children from active-duty military families receiving mental health services during the past decade. For example, between 2003 and 2008 alone, the Department of Defense (DoD) reported a 50% increase in the number of children of active-duty service members seen in both outpatient mental health clinics and inpatient units (U.S. Medicine, 2009). Several studies point toward parental deployment specifically as a causal factor for these
School and academic functioning in children during deployment
Research based on focus groups and interviews among school personnel suggests that at least some military children experience a decline in their academic performance during periods of parental deployment (Aronson and Perkins, 2013, Chandra et al., 2010a). Empirical data, while limited, also are indicative of such a relationship. Engel, Gallagher, and Lyle (2010) examined the academic functioning of nearly 56,000 children in grades 3 and 11 enrolled in DoD schools. Test scores were compared
Post-deployment mental health and functioning in children
Although less commonly the focus of research, periods of reintegration can be as stressful (if not more so) for families than periods of separation (Nelson Goff, Crow, Reisbig, & Hamilton, 2007). Available findings are somewhat mixed, however. Among a broad age range of children (3 to 17 years) from National Guard families, significantly greater behavioral difficulties were reported both during and after deployment as compared with community norms (Wilson et al., 2011). Among 6 to 18 year olds
Child maltreatment
A growing number of studies have reported increases in the incidence of child maltreatment, including neglect, physical, emotional and sexual abuse in association with parental deployment. Increased rates of maltreatment have been found during each phase of the deployment cycle (i.e., pre-deployment, deployment and reintegration periods) (Gibbs et al., 2007, McCarthy et al., 2015, Rentz et al., 2007, Thomsen et al., 2014). A similar pattern was notably found in relation to parental deployment
Parental and contextual influences of child-based outcomes
In addition to the threat or reality of a parent deploying for long periods of time, military children and families face additional stressors in relation to the deployment cycle such as frequent moves and relocations, distance from family and friends, financial strains, and increased responsibilities at home. Well-established connections also exist between child coping, parent mental health, parenting behaviors, social support, and deployment duration (Drummet et al., 2003, Flake et al., 2009).
Pivotal directions for future research based on previous study limitations
Our review summarizes findings from the growing number of qualitative and quantitative studies examining how more than a decade of war has impacted the psychological health and functioning of children in military families. Although several notable limitations characterize much of this research, available studies provide needed insight into the experiences of an entire generation of children that have endured lengthy and frequent separation from one or both parents. While it is encouraging to
Conclusions
The recent conflicts have forced many U.S. military families to navigate lengthy separations, relocations, and other persistent stressors due to multiple deployments. However, challenges for families are not limited to periods of separation, with some of the most significant stressors potentially occurring either before a service member deploys or after he/she returns home. Far less is known about children's functioning and coping during stages of the deployment cycle other than the deployment
Role of funding sources
No funding sources.
Contributors
All authors contributed to literature searches and writing of this paper. All authors approved the final manuscript.
Conflict of interest
The authors have no disclosures or conflicts of interest to report.
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