Running head: Effects of deployment on military-connected children 1

Psychological Effects of Parental Deployment on Military-Connected Children: A

Systematic Review

Wallette Jenerette

University of South Carolina-Columbia

Author Note

Funding for this research was provided by the Ronald E. McNair Post-Baccalaureate

Achievement Program.
Effects of deployment on military-connected children 2

Abstract

Since 2001, Oover 2 million children have had at least one parent deploy to Afghanistan or Iraq.

Research has shown that military-connected children experience psychological distress when

their parents are deployed. This systematic review examined peer-reviewed research from 2000-

2016 to determine identify types of psychological problems military-connected children

experience when theirduring parents parental deployment. Coping mechanisms that help

military-connected children cope with prolonged parental absences were also identified.

Implications for clinical practice and future research with military-connected children will also

be discussed.

Keywords: military, parental deployment, children, mental health, coping

Effects of deployment on military-connected children 3

Psychological Effects of Parental Deployment on Military-Connected Children: A

Systematic Review

The purpose of this systematic review was to examine the psychological effects of

parental military deployment on military-connected children and how they cope when their

parent(s) was deployed. At the completion of this review two questions will be answered, (1)

How does parental deployment affect the mental well-being of military-connected children (ages

0-17) and (2) What types of coping mechanisms military-connected children use to cope with

parental deployment? Many deployed soldiers have children whose lives they are missing out on,

all for the cause of protecting their country. According to a research article entitled, The Home

Front: Operational Stress Injuries and Veteran Perceptions of Their Childrens Functioning,

made reference to the fact that several theories have conclude that the children of military

personnel have an increased rate of emotional and behavioral complications in comparison to

their civilian peers.

Theories hold that children of military veterans have increased emotional and

behavioral difficulties relative to civilian counterparts. The difficulties may be

attributable to poorer parent child relationships precipitated by OSI symptoms or to the

intergenerational transmission of trauma (Duranceau et al., 2015).

When it comes to military-connected children, there are three main areas of concern. The three

main areas for wartime stress in children include, deployment of military parents; injury or

illness of military parents; or parental deaths (Cozza et al., 2005). As it relates military-

connected children, their stress could stem from their parents own anxieties. What parents choose

to share with their children can be the cause of more psychological issues in both the child

parents. Psychological problems among military-connected children can affect their social and
Effects of deployment on military-connected children 4

emotional well-being. Therefore, it is important to better understand psychological distress

experienced when a parent deploys.

Literature

Over 2 million children have had at least one parent deploy to Afghanistan or Iraq.

Research has shown that military-connected children experience psychological distress when

their parents are deployed (U.S. Department of Defense, 2010).

Lester et al. (2013) performed a study, Psychological Health of Military Children:

Longitudinal Evaluation of a Family-Centered Prevention Program to Enhance Family

Resilience, in which they set out to develop an understanding for the relationship of distress

among active duty families with deployment stress that attend Families OverComing Under

Stress Family Resiliency Training (FOCUS), as well as to determine pathways of program

impact on child adjustment. This study used a sample of 280 military families, with a total of 505

military-connected children. Using behavioral and emotional measures, this study came to the

conclusion that military-connected children are more likely to experience stress related to

parental military deployment when their parent, or caretaker, is exhibiting signs of distress.

Lester et al. also came to the conclusion that after going through the FOCUS program the

children with significant levels of distress decreased.

The likelihood of a military-connected child having develop some sort of mental health

disorder is higher than that of a civilian child. Not only does the psychological effects of

deployment effect the child, but also the family as a whole. Upon the return of the deployed

military parent, the family and the recently deployed parent are faced with the challenge of once

again changing their lives to adapt to this new situation.

Effects of deployment on military-connected children 5

Methods

All studies used within this systematic review were found through a search of the

databases PILOTS, PubMed, and PsycInfo. In each database a search was conducted using the

keywords military AND children AND deployment. In order to be considered to be included in

the studies reviewed for this systematic review, each chosen article must have met the following

inclusion criteria. Each study had to be a peer-reviewed study published in English from 2000-

2016. Along with that the study had to examine psychological problems in military-connected

children whose parents deployed while a member of the U.S. Armed Forces. Some of the criteria

that resulted in a study not being included were if the study was not peer-reviewed, published in

a foreign language, or if the article was a dissertations, thesis, or a systematic review.

Results

After searching three separate databases, approximately over 70 studies met the inclusion

criteria, of those 70+ articles 12 were included in this review. All included studies were

published between the years 2000 and 2016. Each study used a sample of military-connected

children, deployed parents, civilian parents, and/or teachers of military-connected children

ranging from roughly 91 to approximately 59,3951. Among the included samples majority were

community samples2, while 2 of the 9 included samples were clinical samples. These samples

were primarily solely military-connected children with ages ranging from birth to 17, however

there was little inclusion on preschool aged (0-4years) children. Though all of the study samples

focused on military-connected children, there was also inclusion on their military, and non-

military parents, as well as their teachers. Each of the studies included had different samples and

1 Of which only 775 had one or more parent currently deployed.

2 Military-connected children community.

Effects of deployment on military-connected children 6

did not specify whether the child(ren) had only one or both parents deployed in the military.

Nevertheless, children involved in each sample had at least one parent deployed in the military.

Mental Health Problems

Numerous studies over the years have been able to conclude that parental military deployment is

correlated with problems of mental health in military-connected children. Some of the most

commonly found mental health issues among military-connected children include depression,

anxiety (can be general or separation anxiety; dependent upon age of the child), and/or conduct

difficulties. Approximately 58% of the studies included in this review discussed the prevalence

of mental health complications in military-connected children as a result of parental deployment.

As aforementioned, the most common types of mental health concerns among military-connected

children are depression, anxiety, and issues with conduct. Though those are the common three

mental health concerns, the most likely mental health condition to be experienced by military-

connected children is anxiety, whether it be general anxiety or separation anxiety. The only

mental health concern that can be dependent upon the age of the child is in the cause of

separation anxiety. Helping Children Cope with Separation During War stated that toddlers,

preschoolers, and in some cases school-aged children can experience separation anxiety when

one or more parent is absent from the home due to military deployment. With school-aged

children at this point in development they should have outgrown the separation anxiety stage.

However, the article states that the extended absence of one or more parent can cause the child to

regress to behaviors that have been previously outgrown. On the other hand, when it comes to

the issue of separation anxiety in toddlers, that is a natural part of their development.

Nonetheless, for a toddler that is experiencing other forms of life stressors, such as deployment

of a parent this stage of development can be a more demanding challenge (Murray, 2002). A
Effects of deployment on military-connected children 7

separate study, Developmental Issues Impacting Military Families with Young Children During

Single and Multiple Deployments, that was included in this review, conducted interviews with

military-connected children, currently deployed parents (CD), the childs at-home civilian

caretaker (AHC), and recently returned (RR) parents. Many of the parents in this survey reported

that the child(ren) were fearful and ad anxiety about the deployed parent going to work and not

coming back. One mother in the study reported that her son asked for daddy during the entire

deployment-seemed angry with me about it. This is an example of where the appearance of

issues with conduct could become noticeable, depending on how far the childs anger went.

Figure 1, a graph from The Long War and Parental Combat Deployment: Effects on Military

Children and At-Home Spouses, shows the percentage of military-connected children, that were

involved in the study, that show signs of depression, internalizing, externalizing, and anxiety

both during parental deployment and after the return of the military parent. This graph illustrates

that not only does the anxiety that the child experiences while a parents is deployed, but it

remains and increases upon the return of the parent. Another study, Impact of the Threat of War

on Children in Military Families, shows more anxieties and fears that military-connected

children may have about their parent(s) being deployed. This article uses direct quotes from

military-connected children of all ages to show how they feel about war and what war means to

them. None of the children involved in this study had anything good to say about the war. When

asked What would happen in your family if there was a war the reaction from an eight-year-

old active military girl was, My family would be killed, shot, stabbed and they might be hurt.

Not only does the extended absence of a parent cause military-connected children anxiety, but

also the lack of knowledge concerning the well-being of their deployed parent. Not only does the

childs own fears of war contribute to their anxieties, but so does the anxieties of the at-home
Effects of deployment on military-connected children 8

caretaker. Cozza et al. article, Military Families and Children During Operation Iraqi Freedom

discusses the fact that the willingness of the parents to tell the child certain aspects of what is

going on plays a major role in the development of anxiety about war in the child. The article

went into detail about the fact that if the parents feel that the child is developmental able to

process everything that is really happening during deployment then they should be told, this

could ease some anxiety about the unknown (Cozza et al., 2005).

Substance Abuse

When it comes to substance abuse, children of deployed or recently deployed military

personnel are more likely to have a substance abuse problem than children of parents that are not

in the military (Acion et al., 2013). In a study reported in, Increased Risk of Alcohol and Drug

Use Among Children from Deployed Military Families, information from a statewide Iowa

Youth Survey was used to examine how many military-connected children, in grades 6, 8, and 11

(age range 12-17), have a problem with substance abuse. This study came to the conclusion that

deployment of a parent may be a risk factor for current drinking, binge drinking, use of

marijuana and other illegal drugs, and prescription drug misuse (Acion et al., 2013). Figure 2

shows three graphs that were created from this study. These graphs show that across age

groups/grade level the level of alcohol consumption and marijuana use is consistently higher in

those that have one or more parent deployed in the military. None of the studies included in this

review specified whether the occurrence of substance abuse in military-connected children co-

occurs with any other issues or mental health problems. However, having previous knowledge of

the concepts of depression and anxiety, substance abuse can be a result of the mental health

concerns, leading to the inference that the substance abuse in military-connected children is a

result of their depression and/or anxiety. The most common substance that the military-connected
Effects of deployment on military-connected children 9

children in this study abused would be alcohol. According to the graphs provided in the research

report on this study, more military-connected children binge drink alcohol than non-military

children. The same is true for the comparison of marijuana use in non-military and military-

connected children.

Coping Mechanisms

There is an abundance of studies and research done to determine if the parental military

deployment is detrimental to the mental health of military-connected children. Now that it is

known that parental military deployment has an effect on the mental health of their military-

connected children, what can be done in order to either prevent or decrease the severity of the

mental health issues that occur among military-connected children? Of the articles that were

collected for the purpose of this review 25% discussed the different ways that military-connected

children could cope with parental deployment. Helping Children Cope with Separation During

War groups ways that military-connected children can cope with separation from parental

military deployment by age. Within this article, it was stated that for infants the most strategic

coping method is providing the baby with a calm, unchanging environment. Since infants

would not retain much information this early in their life the best thing that a parent or caretaker

can do is make the child feel comfortable and keep the quality of care and the person that

provides the care consistent. With toddlers and preschool aged children, the article makes a

point that it is essential to give the child attention and not leave them alone more than necessary.

It is also vital to ensure children that the situation of military deployment is not their fault and

explain a number of times the reason for a parents departure and the separation. Unlike

children from birth to preschool age, school-aged children require more external coping

mechanisms. For school-aged children it is important to urge them to be active in extracurricular

Effects of deployment on military-connected children 10

activities, and provide them with opportunities to express their emotions. By having the child

interact with peers and spending extra time outside of the home, this allows for the child to spend

less time worrying and feeling sad and more time using their energy in a positive way. While it is

essential to encourage school-aged military children to focus their energy in other aspects of life,

it is also very important to let them know that it is acceptable to feel sad and cry. This

particular article also makes reference to the fact that it could be comforting for the child to have

something from the deployed/separated parent that they could keep. Adolescent military-

connected children are different from the other age groups. In adolescent children it is considered

a coping mechanism to give the child additional responsibilities within the family to keep them

distracted and give them a sense of control during the duration of separation. Within this article

there is also reference to the fact that military-connected children of all age groups can benefit

from maintaining contact with the deployed parent, the at-home parent or caretaker should allow

the child to talk on the phone when the deployed parent calls, send hand drawn pictures, and/or

write letters (Murray, 2002). While all the coping strategies discussed thus far have been things

that can be done within the home, there are some coping methods that include therapy. Two

studies included in this review by Lester et al., Psychological Health of Military Children:

Longitudinal Evaluation of a Family-Centered Prevention Program to Enhance Family

Resilience and Evaluation of a Family-Centered Prevention Intervention for Military Children

and Families Facing Wartime Deployments discussed and evaluated the benefits of the Families

OverComing Under Stress program. Both studies came to the conclusion that upon termination

of the FOCUS program, the level of distress in military families, including military-connected

children, was significantly lower than it was upon entrance into the program (Lester et al., 2012,

2013). Friedberg and Brelsford also brought up the idea of using cognitive behavioral
Effects of deployment on military-connected children 11

interventions in their research article, Using Cognitive Behavioral Interventions to Help

Children Cope with Parental Military Deployments. They concluded by saying that the use of

cognitive behavior is promising for the purpose of helping military-connected children cope with

the deployment of one or more parent (Friedberg and Brelsford, 2011).

Discussion

The purpose of this systematic review has been to shine a light on the current

psychological effects that parental military deployment has on military-connected children, as

well as share knowledge on the different ways that the at-home caretaker and the child could aid

in coping with the extended absence of one or more parent. Though there were many findings

previously discussed within this review, there are some key points to be taken away from this

and used to aid future research and the decrease of these mental health concerns. To begin with,

the challenge of having one or more parent absent from the home due to military deployment is

very distressing on a childs development causing regression and mental health conditions such

as anxiety and depression. Not only do military-connected children run the risk of developmental

regression and developing problems in mental health, but they can also develop a substance

abuse problem; The rates of alcohol use, binge drinking, marijuana use, other illegal drug use,

and prescription drug misuse are greater for children of currently or recently deployed parents

than for children of parents who are not in the military (Acion et al., 2013). While it is

commonly known that military-connected children have a higher risk of developing mental

health and substance abuse issues, there is little known about the different strategies there are to

coping with extended absence of a parent. From things that can done at home by the family, to

actual therapy.
Effects of deployment on military-connected children 12

Through this systematic review there has been an adequate amount of research to support

the fact that there are numerous psychological effects of parental deployment on military-

connected children, and there are several forms of coping that can be utilized to help children

manage the challenge of living with one or more parent for an extended period of time. For each

mental health condition that can be experienced by military-connected children, and substance

abuse their prevalence is significantly higher than those that are civilian children.

Conclusion

The military community is consistently growing, which means that the number of

military-connected children is also a growing part of the military community. Numerous articles

have been collected for the purpose of this systematic review to show that there is a proven

connection between the mental health issues, and the mental stability of military-connected

children, and parental military deployment. This review has also provided evidence that there are

ways to assist in the steady decrease of the prevalence of such mental health conditions in the

military community.

Significance

With the population of the military and military-connected people constantly expanding it

is vital that there is development as to how to treat the various mental health conditions that can

be developed in both military personnel and their families when military soldiers deploy to war

for an extended period of time. Currently the likelihood of a military-connected child having

develop some sort of mental health disorder is higher than that of a civilian child. Until the

necessary changes are made to convey the urgency of this issue, little will be done to change it.

Some of the same military-connected children that are developing mental health disorders could

one day make up the military that protects this country.

Effects of deployment on military-connected children 13

Limitations

Limitations of this review include the exclusion of research articles that studied the

effects of military deployment on the overall family as a whole, rather than just military-

connected children. Though the military-connected children would still be included if this review

focused on the effects military deployment had on family life, it is essential to think about how

each member of the family of effected by the extended absence of a family member, and being

concerned for their safety. While providing ideas as to where future research in this area of study

could potential head, this systematic review also serves the purpose of being able to aid in the

treatment of mental health conditions such as depression and anxiety in military-connected

children.

Clinical Practice Implications

All the information that has been reported through this systematic review can be used in

clinical practice. The information that has been collected beforehand can aid in the treatment

and prevention of mental health complications through both the fields of counseling psychology

and mental health counseling. Through the knowledge that has been shared in this review a

practicing clinical mental health counselor would have an abundance of information that can be

used at their disposal to produce the best outcome in mental health patients, specifically those

whose struggle with mental health that are associated with the military.

Future Research

Though there has been an emergence in the research field of studies being done to

examine the well-being of military-connected children, there is still a plethora of information and

research that needs to be done as it relates to the subject. One of the areas of which more

research needs to done, is which coping mechanisms are best when applied to which mental
Effects of deployment on military-connected children 14

health issues. In other words, what types of coping mechanisms work best with military-

connected children with anxiety and which work best for those with depression or issues of

conduct. The topic of the development of mental health concerns among military-connected

children is one that will always be relevant until there is more research done to implement

practices that aid in the decrease of the prevalence of mental health conditions in military-

connected children and the rest of their military family.

Effects of deployment on military-connected children 15

Figures

Figure 1

Prevalence of clinically significant child symptoms as a function of parent deployment

(Lester et al., 2010).

Note: Prevalence of signs of mental distress in military-connected children with either currently

deployed (CD) or recently returned (RR) parents.

Effects of deployment on military-connected children 16

Figure 2

Predicted percentages of 30-day alcohol use, binge drinking, and marijuana use

(Acion et al., 2013).

Note: These graphs show that there is a correlation between parental deployment and a military-

connected childs level of alcohol consumption and marijuana use.

Acknowledgements

I would like to extend my greatest appreciation to the Ronald E. McNair Post-

Baccalaureate Achievement Program for funding this research, as well as Dr. Sharon White at the

University of South Carolina for allowing me the opportunity to be a part of such a great

program. Also I would like to thank Dr. Nikki Wooten, also at the University of South Carolina,
Effects of deployment on military-connected children 17

for providing me with any help I needed throughout the duration of this project. Also, I would

like to thank my family, and the 2016 McNair Cohort for always showing their support. Lastly,

of course I would like to thank the brave men and women that serve in the U.S. Armed Forces

and their families.

Effects of deployment on military-connected children 18

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