Protecting the home front: The 10-year global war on terror and our military families

Understanding ways we can improve the overall well-being of our military families and children affected is vital

Authors: Candice A. Alfano, PhD, Jessica Balderas, Simon Lau, Brian E. Bunnell and Deborah C. Beidel, PhD, ABPP

The number of U.S. military service members deployed during the more than 10 years since the Global War on Terror (GWOT) began now exceeds two million (Department of Defense, 2011). The risks faced by these brave men and women are perhaps best understood through data and statistics provided by the Department of Defense (DoD) and Veterans Health Administration (VHA) indicating that more than 4,500 service members have lost their lives and more than 30,000 have been wounded in action during Operation Iraqi Freedom and/or Operation Enduring Freedom (OIF/OEF) (Department of Defense, Defense Casualty Analysis System, as of June 29, 2012). Recent advances in body armor and medical care on the battle field mean that while OIF/OEF has been a war of fewer deaths as compared to other conflicts, survivable injuries, many of which involve the head, neck and upper extremities, have increased considerably (Wallace, 2009). Similarly, rates of mental health problems and psychiatric disorders also have increased (Kang & Hyman, 2005; Seal, Metzler, et al., 2009). Post-traumatic stress disorder (PTSD), depression, and alcohol/substance abuse alone are each estimated to affect more than 20 percent of OIF/OEF veterans (Cohen et al., 2010; Ramchand et al., 2010; Schnurr et al., 2010; Seal, Metzler, et al., 2009; Seal, Maguen, et al., 2010).

Our service members do not suffer these injuries and illnesses alone. More than half of the almost four million military U.S. personnel are married and over 75 percent have dependent children (Deputy under the Secretary of Defense, 2009). The proportion of children with both parents serving continues to increase (Segal & Segal, 2004). During the past decade these families have endured lengthy and multiple deployments, frequent relocations, upheaval in family routines, and the very real threat of harm befalling their loved one. Hardships and stress do not necessarily remit when service members return home. Coping with and managing a service member’s physical and/or psychological disability, occupational and financial challenges, and altered family roles represent common and sometimes permanent stressors. Indeed, many of the children in these families have never known life without the difficult realities of war.

The GWOT and Children of Service Members

Remarkably, most families show great adaptability and resilience in the face of such events. Others, however, fare less well. DoD data suggest that the number of outpatient mental health visits for children of active-duty parents doubled between 2003 and 2008 (Department of Defense Reaches Out to Children of Soldiers, 2009). Numerous factors influence service seeking behavior among families, yet a vast majority of research examining child mental health has focused on the role of parental deployment specifically. Several studies report increased anxiety, depression and behavioral problems among children during these periods of separation (Flake, Davis, Johnson & Middleton, 2009; Lincoln, Swift & Shorteno-Fraser, 2008; Mansfield et al., 2010). For example, using parent and teacher reports, one study found preschool-aged children with a deployed parent exhibited more internalizing and externalizing problems then preschoolers from (military) families without a deployed parent (Chartrand, Frank, White, & Shope, 2008). Among school-aged children, (non-deployed) parental distress and cumulative length of deployment have been shown to correlate with greater child externalizing and depressive symptoms (Lester et al., 2010). Mansfield and colleagues (2010) found deployments lasting greater than 11 months to increase risk for child emotional and behavioral problems. Other reported negative sequelae of deployment include decrements in academic performance, diminished opportunities/resources for social activities, and increased risk-taking behaviors (Chandra, Martin, Hawkins & Richardson, 2010; Engel, Gallagher & Lyle, 2010; Huebner et al., 2007).

Findings from a recent meta-analysis of 16 separate studies of the associations between military deployment and emotional, behavioral and academic adjustment in children nonetheless caution against drawing any firm conclusions at this time (Card et al., 2011). In general, results are characterized by considerable between-study variability, discrepancies between parent and child reports, and an overall lack of methodological rigor. The authors underscore the fact that, on average, children of deployed military service members do not appear to experience greater rates of maladjustment than their civilian counterparts (Card et al., 2011). Of importance, however, is the fact that several of the studies examined were based on pre-GWOT and non-combat related deployments. This distinction appears critical since most pre-GWOT/non-combat deployment studies did not report significant relationships between deployment and child adjustment whereas a majority of studies based on GWOT-related deployments have. These findings point toward a clear need for more controlled and systematic research focused on a broader range of individual and contextual factors that serve to influence the mental health of children from military families affected by the GWOT.

A National Priority

Understanding ways we can improve the overall well-being of our military families and children is vital not only from a service provision standpoint but from a national one. In 2010, President Obama directed the National Security Staff (NSS) to develop a coordinated government-wide approach to supporting our military families. In response to this directive, the Interagency Policy Committee (IPC) has identified four priority areas:

  1. Ehance the well-being and psychological health of the military family.

  2. Ensure excellence in military children’s education and their development.

  3. To develop career and educational opportunities for military spouses.

  4. Increase child care availability and quality for the Armed Forces.

In 2011, First Lady Michelle Obama and Dr. Jill Biden launched Joining Forces, a nationwide initiative to raise awareness of the service, sacrifice, and needs of our nation's service members and their families. This initiative has already made impressive strides in expanding employment and opportunities for veterans and military spouses as well as access to wellness programs and resources for military families. 

Much work remains to be done however and the degree of disconnect between U.S. military and civilian populations remains large. According to results from a recent survey conducted among more than 4,000 military families, 95 percent agreed with the statement, “The general public does not truly understand or appreciate the sacrifices made by service members and their families” (Blue Star Families, 2012). This disconnect may well relate to the fact that only 0.5 percent of all American adults have served on active duty at any given time during the GWOT; the smallest percentage since the peace-time era between World Wars I and II (Pew Research Center, 2011). Nonetheless, a significant proportion of today’s military families live off of and away from military installations (Department of Defense, 2011) where a shared understanding of military life exists. During periods of deployment in particular, families often relocate to be closer to extended family members who are able to provide familial support and assistance. In light of previous research indicating involvement in military-related support activities serves as potential buffer against child mental problems during periods of deployment (Flake et al., 2009), the provision and availability of community-based, culturally sensitive support services for these families should indeed be a matter of national concern.

A military-civilian divide is equally apparent in the small number of empirical studies focused on the mental health of military family members, children especially. The current state of this research stands in stark contrast to the nearly two million children of service members in the U.S. today (Department of Defense, 2007). Notably, most studies have been carried out by researchers who are current or former service members. These seminal data have set the stage for civilian scientists and professionals to now play a more central role in expanding this knowledge base through systematic research focused on both individual and contextual influences of family adjustment. In addition, much of the prior research has been conducted by professionals from disciplines other than psychology. Given the findings of the research to date, the expertise of psychologists and overall commitment of psychology as a field is particularly needed. Our ability as professionals and as a discipline to respond effectively to the needs of these children and families necessitates a more comprehensive and integrated approach for understanding specific risk factors as well as potential protective mechanisms that exist within this unique population. With this goal in mind, several broad areas of investigation are highlighted for future inquiry.

Directions for Future Research

First, there is great need for prospective studies of child and family functioning during and throughout discrete phases of the deployment cycle. Although deployment is commonly assumed to represent the period of greatest distress, pre-deployment and reintegration phases also coincide with considerable changes and adjustment (Laser & Stephens 2011). To date, few studies have investigated the well-being and adjustment of family members during these (often extended) periods. Second, the percentage of nontraditional military families is increasing while understanding of unique factors that constitute risk and resilience are relatively unknown. For example, families with female service members, dual-career military parents, and single-parent service members often need to make additional preparations and provisions for children during periods of deployment. Lastly, longitudinal investigations focused on effective coping strategies and resilient outcomes rather than just maladjustment and psychopathology are needed to address questions regarding long-term adjustment. 

References

Blue Star Families, Department of Research and Policy (May, 2012). Military Family Lifestyle Survey: Findings and analysis. Washington, D.C.

Card, N. A., Bosch, L., Casper, D. M., Wiggs, C., Hawkins, S., Schlomer, G. L., & Borden, L. M. (2011). A meta-analytic review of internalizing, externalizing, and academic adjustment among children of deployed military service members. Journal Of Family Psychology, 25(4), 508-520. doi:10.1037/a0024395

Chandra, A., Martin, L. T., Hawkins, S., & Richardson, A. (2010). The impact of parental deployment on child social and emotional functioning: Perspectives of school staff. Journal Of Adolescent Health, 46(3), 218-223. doi:10.1016/j.jadohealth.2009.10.009

Chartrand, M. M., Frank, D. A., White, L. F., & Shope, T. R. (2008). Effect of parents’ wartime deployment on the behavior of young children in military families. Archives of Pediatrics & Adolescent Medicine, 162, 1009–114.

Cohen, B. E., Gima, K., Bertenthal, D., Kim, S., Marmar, C. R., & Seal, K. H. (2010). Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. Journal of General Internal Medicine, 25, 18-24.

Department of Defense (2011). Strengthening our military families: Meeting America’s commitment (PDF, 4.47MB).

Department of Defense Defense Casualty Analysis System (DCAS).

Department of Defense Reaches Out to Children of Soldiers (2009). U.S. Medicine.

Department of Defense Task Force on Mental Health (2007). An achievable vision: Report of the Department of Defense Task Force on Mental Health. Falls Church, Va.: Defense Health Board.

Deputy Under the Secretary of Defense (2009). Demographics profile of the military community. Washington, D.C.: Office of the Deputy Under Secretary of Defense.

Engel, R. C., Gallagher, L. B., & Lyle, D. S. (2010). Military deployments and children’s academic achievement: Evidence from Department of Defense education activity schools. Economics of Education Review, 29, 73–82.

Flake, E. M., Davis, B., Johnson, P. L., & Middleton, L. S. (2009). The psychosocial effects of deployment on military children. Journal of Developmental And Behavioral Pediatrics, 30, 271-278.

Huebner, A. J., Mancini, J. A., Wilcox, R. M., Grass, S. R., & Grass, G. A. (2007). Parental deployment and youth in military families: exploring uncertainty and ambiguous loss. Family Relations, 56, 112–122.

Kang, H. K., & Hyams, K. C. (2005). Mental health care needs among recent war veterans. New England Journal of Medicine, 352, 1289.

Laser, J. & Stephens, P. (2011). Working with Military Families through Deployment and Beyond. Clinical Social Work Journal 39, 28-38.

Lester, P., Peterson, K., Reeves, J., Knauss, L., Glover, D., Mogil, C., Beardslee, W. (2010). The long war and parental combat deployment: Effects on military children and at-home spouses. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 310–320.

Lincoln, A., Swift, E., & Shorteno-Fraser, M. (2008). Psychological adjustment and treatment of children and families with parents deployed in military combat. Journal of Clinical Psychology, 64(8), 984-992.

Mansfield, A. J., Kaufman, J. S., Marshall, S. W., Gaynes, B. N., Morrissey, J. P., & Engel, C. C. (2010). Deployment and the use of mental health services among U. S. Army wives. The New England Journal of Medicine, 362(2), 101-109.

Pew Research Center. (2011). The Military-Civilian Gap: Fewer Family Connections.

Ramchand, R., Schell, T. L., Karney, B. R., Osilla, K. C., Burns, R. M., & Caldarone, L. B. (2010). Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: Possible explanations. Journal of Traumatic Stress, 23, 59-68.

Schnurr, P. P., Kaloupek, D., Sayer, N., Weiss, D. S., Cohen, J., Galea, S., et al. (2010). Understanding the impact of the wars in Iraq and Afghanistan. Journal of Traumatic Stress, 23, 3-4.

Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. American Journal of Public Health, 99, 1651-1658.

Seal, K. H., Maguen, S., Cohen, B., Gima, K. S., Metzler, T. J., Ren, L., et al. (2010). VA mental health  services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. Journal of Traumatic Stress, 23, 5-16.

Segal, D. R., & Segal, M. W. (2004). America’s military population. Population Bulletin, 59, 1–40.

Wallace, D. (2009). Improvised explosive devices and traumatic brain injury: The military experience in Iraq and Afghanistan. Australasian Psychiatry, 17, 218-224.

Authors Bios 

Candice A. Alfano, PhDCandice A. Alfano, PhD, is associate professor of psychology and director of the Sleep and Anxiety Center for Kids (SACK) at the University of Houston. Dr. Alfano's research and clinical interests include the etiology, development and treatment of anxiety and sleep disorders in children and adolescents, including children from military families. Her research is funded by grants from the National Institutes of Health and the Department of Defense. She is the author of more than 40 books, scientific papers, articles and chapters, and serves as Associate Editor of the Journal of Anxiety Disorders.

 

Jessica Balderas, BSJessica Balderas, BS, is a project coordinator at the Sleep & Anxiety Center for Kids (SACK) at the University of Houston for research study examining sleep and adjustment in military families following OIF/OEF deployment. She plans to pursue a PhD in clinical psychology.

 

Simon LauSimon Lau
is a research assistant at Sleep and Anxiety Center for Kids (SACK) at the University of Houston (UH). After a successful military career, earning the Bronze Star Medal, multiple Army Commendation Medals, multiple Army Achievement Medals and multiple honors for leadership, Simon is pursuing an undergraduate degree in psychology at UH and eventually plans to pursue a PhD clinical psychology.

 

Brian E. Bunnell, BABrian E. Bunnell, BA, is a doctoral student in clinical psychology at the University of Central Florida (UCF). His clinical research interests are in developmental psychopathology with an emphasis on mechanisms associated with the development, maintenance, and treatment outcome of anxiety disorders.


Deborah C. Beidel, PhD, ABPPDeborah C. Beidel, PhD, ABPP
, is professor of psychology and director of the doctoral program in clinical psychology at the University of Central Florida. She holds American Board of Professional Psychology Diplomates in clinical psychology and behavioral psychology and is a fellow of the American Psychological Association and the Association for Psychological Science. She is the author of over 200 scientific publications including journal articles, book chapters and books on the treatment of anxiety disorders and post-traumatic stress disorder. She is the recipient of numerous grants from the National Institute of Mental Health and the Department of Defense.