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The Long War Comes Home

The Long War Comes Home

VeteransA key role of mental health providers is to educate communities about the impact of combat deployments on service members, veterans, and their families. Through increased awareness about multiple systems of care, a national public health response can increase awareness and education, screening and early identification, mitigation of risk and promotion of resiliency factors, and access to treat-ment for veterans and their families.

Most military families successfully adapt to a service member’s deployments for military duties.1 Nevertheless, almost a decade of wartime stress associated with the current wars in Iraq and Afghanistan has presented unprecedented challenges for military families.2 These families have negotiated a cycle of recurrent and prolonged deployments; faced parental absences and caregiving changes; and endured parental combat stress, safety worries, and disrupted routines.

The majority of military children appear to be functioning well despite these demands; however, increased child anxiety and behavioral changes have been identified across developmental ages.3-5 Factors that increase children’s vulnerability to these stressors include preexisting psychological disorders, past trauma, parental mental health symptoms, and cumulative deployment separation.5,6 Factors that enhance resilience include family support and positive communication.7

When wartime service members come home

In addition to deployment stressors, some service members return home with combat-related mental health problems, traumatic brain injury, or serious physical injuries. The risk of combat-related mental health problems increases during the year following return from combat and for those who have had multiple deployments. Parents—particularly younger parents with young children—who experience repeated or pro-longed deployments are at higher risk for increased marital conflict, domestic violence, and/or child maltreatment or neglect.8-10 Reunions and reintegrations are marked by an array of emotional and logistical challenges, particularly for military families facing physical or psychological injuries in a parent.

Numerous studies have described the impact of posttraumatic stress disorder (PTSD) on families, including parenting impairment and the potential for “secondary traumatization” of spouses and children.11 Traumatized parents may have difficulty in reconnecting with family members, be overly concerned about family safety, and/or be excessively emotionally reactive. Parents with blunted emotions and reduced ability to connect emotionally with loved ones are at higher risk for marital distress and problematic parent-child relationships.12,13

Trauma reminders that trigger abrupt changes in the mood and behavior of the parent may confuse or frighten his or her children and spouse. Hypervigilance and hyperreactivity to perceived threat can lead to irritability, a rigid authoritarian parenting style, and an inability to tolerate normal family interactions (eg, children arguing or engaging in physical play).14 Families of service members with PTSD tend to be less cohesive, adaptive, and supportive.15,16 Sadly, some military families have to cope with the loss of a loved one due to combat, accidental death, or suicide.

What is already known about mitigating risk and promoting resilience in children and families of military service members?

? Studies have shown that many military families successfully adapt to a service member’s deployment, and the majority of military children appear to be functioning well despite the challenges of parental absence, caregiver changes, parental worries, and disrupted routines. Despite this, new research is emerging that indicates increasing risk of emotional and behavioral symptoms in children and spouses affected by wartime deployment. New studies suggest that risk factors for child distress include parental distress and cumulative months of deployment, and protective factors include social support and family communication.

What new information does this article provide?

? This article examines factors related to recent study findings of increases in military children’s vulnerability as well as factors that promote resilience to the stressors associated with deployment. Children face new challenges at every stage of deployment and at every developmental age; this article provides strategies for recognizing and mediating children’s signs of stress as well as for enhancing resilience in military children and families.

What are the implications for psychiatric practice?

? It is widely recognized that military children and families are resilient; however, recent studies have shown that military children are at increased risk for anxiety and behavioral changes. Findings indicate that the resilience of these children can be enhanced and the risks mediated when families receive greater education regarding deployment stress, combat-related stress, and developmental stress reactions in children as well as resiliency skills training related to emotional regulation (including traumatic stress reminder management techniques), goal setting, problem solving, and family communication.

Challenges for children during wartime

More than 1 million US children have experienced a parental combat deployment. The majority of these children are younger than 10 years; 40% are younger than 5 years. Parental deployments present an array of developmental and psychological challenges to children. Younger children may have spent their entire lives anticipating or experiencing a parent’s deployment. Feelings of loss are normal for both parent and child when a parent misses important moments in the child’s life, such as when the child learns a new skill, participates in an exciting event (eg, a school play, a prom, or a sporting event), or specific milestones (eg, graduations, birthdays).

Chronic worry about the safety of the deployed parent and the stress level of the remaining parent can take a toll. Cell phone and Internet communication with a deployed parent may assist parents and children in maintaining their relationship at a distance. Yet these same technologies may make the experience of war more immediate for the children, including an increased awareness of risk.

There are many available resources to strengthen and support children of military service members and their families. High-quality social and health care services are available to military families, particularly those living near a military base. The military community also provides a network of advocacy, information, resources, and social support. Military families often report a positive sense of mission and values that are central to their family’s identity and that provide meaning and strength. Finally, some children and parents convey that the challenge of moves and separations provides opportunities for developing new skills as children assume and master new responsibilities and contribute to the well-being of the family in meaningful ways.

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