PsychiatricTimes Members: Login | Register

|     

PsychiatricTimes SearchMedica Medline Drugs

Powered by SearchMedica

 
Risk Assessment
News
Current Issues
Blogs
Special Reports
CME
Conferences
Resources
Careers
Multimedia
About Us
 

Home » Major Depressive Disorder

Psychiatric Times.
COMMENTARY 

Military Mental Health: An Army of Children

By Michael Miovic, MD | October 28, 2011
Dr Miovic is a psychiatrist at the Cambridge Health Alliance, Department of Psychiatry, in Cambridge, Mass.

I am a civilian psychiatrist who recently finished 20 months working as a contractor for the United States Army. Going into the job, I expected the degree of combat-related stress I saw in our troops. However, I was not prepared for the scope of impact our 2 long wars have had on military children.

Like most civilians with no military background, I didn’t realize how many children there are in the Army. During the Vietnam War, the United States used the draft to maintain a large fighting force of single soldiers, most of whom did only one tour of duty. Today, we have an all-volunteer force full of families. About 55% of the military is married, 1.9 million children have a parent in the military, and up to 1 million children have had a parent deploy.1,2 In fact, in 2010 the active-duty sector of the Army actually had more children (570,000) than soldiers (562,000).3

(MORE: The Epidemic of Military Suicide)

The consequences of this shift in military structure are major. As the wars in Iraq and Afghanistan dragged on, the Army has had to recycle soldiers through multiple deployments, because our total force is relatively small. Some military families are resilient and cope well with the stress of deployments, but some do not—and for most it gets harder with each cycle. I met too many young parents in the infantry who were justifiably overwhelmed with the competing demands of going to war and raising kids, two pursuits that do not fit naturally together. Fights over finances, video game addiction, and infidelity were common, and too often this escalated into substance abuse, domestic violence, child maltreatment, and/or divorce. And, of course, some parents return with devastating injuries, or die in battle, both of which are hard on children.

What do we know about the impact of our current military structure on children? Recent reviews of the research find that “most” military families are resilient, but that a significant number of children—about one third—show anxiety symptoms and behavioral disorders during and following a parent’s deployment. Multiple deployments and parents returning with PTSD are risk factors for increased distress.1-6 Also, a new Pew study of post-9/11 veterans7 found that almost 50% feel that deployment negatively affected their relationships with spouses and children.

Based on my experience with enlisted soldiers, I would say the veterans’ perceptions are right, and the other research underestimates the rates of adverse impact on children (perhaps because it misses the real but more subtle dimensions of children’s emotional experience, such as the grim atmosphere and restriction of joy one feels on military bases). So, do the math: 50% of 1 million makes 500,000 military children who have suffered negative mental health effects of parental deployment—and combat isn’t over yet. That’s a lot of children. As a nation, what should we do about this?

We have three broad options: increase mental health services to military children, decrease their exposure to parental deployment, or look the other way. Most people’s first reaction is to say increase services and research into effective interventions. That is good. I was impressed with the Army’s clinical programs and have only praise for our armed forces’ huge investment in mental health services in the last decade. No fighting force in the history of the world has tried harder to support its soldiers and families than this one, and we can all be proud of that accomplishment.

However, research and services cost money, and the American public is growing increasingly disengaged in the war(s). Thus, it seems unlikely that services will grow now as the budget shrinks. Also, there are natural limits to what services and research can achieve. Soldiers at war will be stressed no matter how much therapy or resiliency training they get, and stressed parents make for stressed children. Developmental psychology has already shown that young adults cannot master the tasks of intimacy, career, and parenting simultaneously in their 20s. And if people cannot do this during peacetime, how are they supposed to do it during war?

This leads us to the second option. For both practical and moral reasons, I think it’s time for the United States to decrease children’s exposure to the emotional wounds of war. Our current military structure is a social experiment, and there is evidence the experiment is in trouble. Whatever later generations decide is the ultimate political effect of our wars in Iraq and Afghanistan, I think one of the lessons learned at home will be the negative impact that long ground wars have on military children.

So what can we do? A lot—but all options involve change. We can keep our current military structure, but end combat in Afghanistan and limit future conflicts to shorter or less dangerous interventions (as in Bosnia and the first Gulf War). Or we can modify military structure in a number of ways: shorten deployments, lengthen rest periods between deployments, limit combat roles for parents, or change recruitment and retention standards to reduce the number of children in the military. And finally, if we really believe in long wars, we can bring back the draft.

Which brings us to the last choice: look away. Because all of the options above could be either expensive and/or politically unpopular, there will be a strong temptation to look away. This is where mental healthcare professionals, as part of our mandate to protect children, must speak out. We have to put a spotlight on the issue of military children, and remind the public that war is a national commitment, not a lifestyle choice for a small percent of American families. Where children are involved, silence and looking away are not acceptable responses. The military has done its part to fight for the country—now American civilians have to do their part to take care of the military. The first step is to admit our military children are hurting, the second is to start a serious discussion about how best to help them.

[Editor's Note: For further information, see Psychiatric Times' Resources for Veterans.]

 

 

Join the Conversation

Want to join the conversation? If you're a healthcare professional, we'd like to hear your comments. Just sign in or register today to become part of our growing, online community.

New Article Series Display Name

The Military Can Do More To Prevent Suicides

The Epidemic of Military Suicide

Military Mental Health: An Army of Children





References
1. U.S. Department of Defense. Strengthening Our Military Families: Meeting America’s Commitment. http://www.defense.gov/home/features/2011/0111_initiative/. Accessed October 25, 2011.
2. Lester P, Bursch B. The long war comes home: mitigating risk and promoting resilience in military children and families. Psychiatr Times. 2011;28(7):1-3.
3. US Army Demographics. http://www.armyg1.army.mil/hr/demographics.asp. Accessed October 25, 2011.
4. White CJ, de Burgh HT, Fear NT, Iversen AC. The impact of deployment to Iraq or Afghanistan on military children: a review of the literature. Int Rev Psychiatry. 2011;23:210-207
5. de Burgh HT, White CJ, Fear NT, Iversen AC. The impact of deployment to Iraq or Afghanistan on partners and wives of military personnel. Int Rev Psychiatry. 2011;23:192-200.
6. Park N. Military children and families: strengths and challenges during peace and war. Am Psychol. 2011;66:65-72.
7. Pew Research Center. War and sacrifice in the post-9/11 era: the military-civilian gap. October 5, 2011. http://pewresearch.org/pubs/2111/veterans-post-911-wars-iraq-afghanistan-civilian-military-veterans. Accessed October 25, 2011.


 
RELATED TOPICS

Bipolar disorder
Depressive disorders
Dysthymia
Mood disorders
Psychotic affective disorders
Major depressive disorder
Suicide prevention and assessment

 
TOPIC INDEX

Addiction Medicine
Alzheimer Disease
Anxiety Disorders
ADHD
Bipolar Disorder
Child & Adolescent Psychiatry
Dementia
Depression
DSM-5
Geriatric Psychiatry

 

Health Care Reform
Major Depressive
Disorder
OCD
Personality Disorders
Schizoaffective Disorder
Schizophrenia
Sleep Disorders
Somatoform Disorders
All Topics

 


 
FROM PHYSICIANS PRACTICE
Primary Care Can't Thrive Without Nurse Practitioners
Courtney H. Lyder, ND,  May 17, 2013
With a projected shortfall of primary-care physicians, it's time for alternate solutions to patient care. Nurse practitioners are one logical remedy.
VWhat Physicians Can Learn from the Allscripts EHR Lawsuit
Marisa Torrieri,  May 16, 2013
Lawsuit prompts question: What should physicians do to ensure they end up with a great EHR instead of buyer’s remorse?
Eight Ways ICD-9 Will Still Matter to Medical Practices
Brenda Edwards, CPC,  May 15, 2013
What should your medical practice do with your ICD-9-CM book after October 1, 2014? Keep it.
Seven Ways Technology Can Speed Up Patient Collections
Cheyenne Brinson,  May 15, 2013
Failing to adopt widely available billing and collections technology can cost medical practices big. Here's how to do it right.
Four Reasons Private Medical Practice is Becoming Extinct
Carol Stryker,  May 15, 2013
It’s becoming increasingly difficult for private medical practices to thrive. Here’s what’s driving the trend toward consolidation.
 

 

 
MOST POPULAR
  • Most Popular
  • Most Emailed
  • Most Recent
  • Developmental Psychopathology Comes of Age
  • The Moral Struggles of Practicing Psychiatrists
  • Grief and Depression: The Sages Knew the Difference
  • Update on Mental Health Benefits and Substance Use Disorder Services Under the Affordable Care Act
  • Synthetic Cathinones: Signs, Symptoms, and Treatment
  • Grief and Depression: The Sages Knew the Difference
  • Successful Aging: Strategies to Help Maintain and Nurture a Healthy Brain
  • Synthetic Cathinones: Signs, Symptoms, and Treatment
  • Developmental Psychopathology Comes of Age
  • Psychiatry and the Myth of “Medicalization”
  • Successful Aging: Strategies to Help Maintain and Nurture a Healthy Brain
  • Ethical and Legal Issues in Geriatric Psychiatry
  • Eco-Psychiatry: Why We Need to Keep the Environment in Mind
  • DSM-5: Where Do We Go From Here?
  • Suicidal Behavior: A Separate Diagnosis
Click here to subscribe to our newsletter
 
COMMENTS
  • Most Commented
  • Most Recent
  • Psychiatry and the Myth of “Medicalization”
  • Grief and Depression: The Sages Knew the Difference
  • Is it Time for a Treatment Manual to Complement DSM-5?
  • Diagnosis and its Discontents: The DSM Debate Continues
  • Lamotrigine for Major Depressive Disorder Is Inappropriate
  • Psychiatry and the Myth of “Medicalization”
  • Parity Laws: Powerful Weapon—or Pipe Dream?
  • The Moral Struggles of Practicing Psychiatrists
  • DSM-5 Won’t Solve the Overdiagnosis Problem—But Clinicians Can
  • NIMH vs DSM 5: No One Wins, Patients Lose
Click here to subscribe to our newsletter
 
CAREER CENTER

  •   Featured Jobs  
  •    Resources   
  • Psychiatry and Nurse Practitioner Opportunities
  • Associate Medical Director - Psychiatrist Delray Beach, Florida
  • Retiring Child Psychiatrist Seeks Replacement August 2010 or Before
  • Chairperson, Dept of Psychiatry Needed
  • FT Staff Psychiatrist - Excellent Benefits
  • BC Adult and Child Psychiatrits - PT and FT Positions Available
  • Managing Risks When Practicing in Three-Party Care Settings
  • 12 Tips for Making Your Practice Greener
  • Keys to Avoiding Malpractice: Standard of Care in Psychiatric Practice
  • Take This Job and Shove It
  • Merging Administrative and Academic Careers in Psychiatry
 
CME
Get CME for reading Psychiatric Times articles
Mood Disorders
Anxiety Disorders
Sleep Disorders
Psychopharmacology
Schizophrenia-Psychotic disorders
Cognitive Disorders
Substance Abuse
Medical Comorbidities
More Psychiatry CME


 
SearchMedica Search Result

Find peer-reviewed literature and websites for practicing medical professionals

CME on Mdd
Evidence on Mdd
Guidelines on Mdd
Patient Education on Mdd
Clinical Trials on Mdd
Practical Articles on Mdd
Research and Reviews on Mdd
All "Mdd" results


CancerNetwork | ConsultantLive | Diagnostic Imaging | Musculoskeletal Network | OBGYN.net | PediatricsConsultantLive |
Physicians Practice | Psychiatric Times | SearchMedica | Medical Resources

© 1996 - 2013 UBM Medica LLC, a UBM company
Privacy Statement - Terms of Service - Advertising Information - Editorial Policy Statement - UBM Medica Network Privacy Policy