At a press conference, lead author Jeffrey Millegan, MD, MPH, a Naval lieutenant commander and a Disaster and Preventive Psychiatry Fellow at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, said that the effects of the war efforts in Iraq and Afghanistan on families have received increasing attention. He believes the study on the relationship of parental military deployment to child psychiatric hospitalizations in the US Armed Forces that he co-authored with Charles Engel, MD, MPH, Michael Dinesen, MD, PhD, and Xian Liu, PhD, “is the first comparative population-based study on this topic.”
“The risk of psychiatric hospitalization is about 10% greater among those children aged 9 to 17 years when the parent is deployed in support of Operation Iraqi Freedom [OIF] or Operation Enduring Freedom [OEF],” he said. “Also, a dose response association was present between deployment and psychiatric hospitalization, meaning that the greater the length of deployment, the greater chance of hospitalization in the child. The predominant excess in risk is in those children whose parent is deployed for longer than 6 months.”
In speculating about the increased risk, Millegan said, “it is probably related to the obvious family disruption that occurs when a major caregiver leaves for a period of time, along with concern about the health of that particular member. And we know from other studies that deployment does cause increased mental health issues in both the civilian parent and the person being deployed. It’s quite clear that it may have some influence on the child.”
In the retrospective cohort study, the investigators evaluated administrative records from Oct. 1, 2006 to Sept. 30, 2009 for 377,565 children aged 9 to 17 years, along with data on both their active-duty and civilian parent. Information from the Medical Data Repository, which included healthcare usage, was linked with that from the Defense Manpower Data Center, which included details on parental deployment. The mean age of the children was 12.53 years and 51% were male. The mean age of the active-duty parent was 37.8 years; 93% were male, 90% were married, and 62% were white.
Psychiatric hospitalizations were identified using ICD-10 codes. The data revealed that 2,533 children were hospitalized for a mental or behavioral health disorder, with a median length of hospital stay of 8 days. Nearly one-third (32%) of the children had a parent deployed in support of OIF or OEF during the study period.
After adjusting for multiple covariates, such as the child’s sex, age, past psychiatric history, and parents’ psychiatric history, the investigators found that the odds ratio of hospitalization for children with a deployed parent was 1.10. Although not statistically significant, the odds ratio of hospitalization among children with parents who were deployed less than 180 days was 1.028. But the odds ratio of hospitalization among children with parents who were deployed longer than 180 days was 1.12, with a test of trend that was statistically significant.
The investigators recommend that a greater focus be placed on the mental health of children of active-duty personnel during the deployment cycle. One suggestion is alerting physicians and other healthcare professionals who interact with children to explore their possible psychiatric and behavioral problems when a parent is deployed for a long time.
Millegan said he also wants to study the specific risks associated with children of National Guard members and the Reserves. Even though the National Guard and Reserves are highly used in the conflicts, he said, those groups have opportunities for other forms of health care and health insurance. Consequently, their children were excluded from the current study, he said.
