This article is more than 5 years old. Information may no longer be current.

Child behavioral, mental health visits increased when parent deployed

Davis BE. Pediatrics. 2010;126:1215-1216.
Gorman GH. Pediatrics. 2010;126:1058-1066.

Children of military parents who are deployed had more behavioral and mental health visits than children of military parents who were not deployed, researchers reported in Pediatrics.

In a retrospective cohort study, Cmdr. Gregory H. Gorman, MD, of the department of pediatrics at the Uniformed Services University of the Health Sciences in Bethesda, Md., and colleagues studied the effect of parental deployment on the rate of outpatient visits for mental and behavioral health disorders in children aged 3 to 8 years.

“This issue is relevant to all pediatricians, not just military pediatricians, as more than two-thirds of military children are regularly treated by civilian pediatricians who may not be as attuned to the issue of deployment,” Gorman told Infectious Diseases in Children. “The take-home message is that war and wartime deployment affects the whole family, from the service member, the spouse and the children.”

Previous research has shown that children coped poorly during military deployments, exhibiting more internalizing and externalizing behaviors, maladaptive child behaviors and decreased academic performance, the researchers wrote.

Mental and behavioral health

Gorman and colleagues studied the records of children of active-duty personnel during the fiscal years 2006 and 2007, linking them to their parent’s deployment records. All of the data were obtained from the TRICARE Management Activity, which oversees health care for military personnel and their family members. A total of 642,397 children aged 3 to 8 years and 442,722 military parents were included in the study. Mental and behavioral health visits were identified using the ICD-9 codes.

Of 6,505,771 outpatient visits identified, 611,115 were classified as mental and behavioral health visits. There was an 11% increase of mental and behavioral health visits after a parent was deployed. The most frequent diagnosis was attention-deficit disorder (30.1%). Adjustment disorders (14.6%) and autistic disorders (12.1%) were the next most frequent diagnosed disorders. The incidence rate ratios were as follows: for pediatric anxiety, 1.14; for behavior disorders, 1.19; and for stress disorders, 1.18. Behavioral disorders increased by 19%, and stress disorders increased by 18%.

“The ones we looked at were at the tip of the iceberg, meaning those whose mental health issues were severe enough that the parent thought it was necessary to bring them to a medical provider,” Gorman said. “There are probably a host of other children who have lesser problems but never received clinical attention.”

The researchers observed differences in patterns between children with a male parent being deployed vs. those with a female parent being deployed. Children who had a female parent deployed did not have as much of an increase in behavioral problems compared with children who had a male parent deployed. Also, children with a single parent being deployed did not have as many problems as children with married military parents. The rate of other health care visits decreased when a parent was deployed.

“We suspect that there is no real difference, but rather there is an issue of recognition on behalf of the caregiver,” Gorman said. “In most families, the mother is the primary caregiver and is probably most attuned to the child’s behavior. Thus, they can pick up differences in their children’s behavior. When a single parent deploys, usually the child goes with a family member or friend, and those caregivers probably have an even lesser appreciation of the child’s normal behavior.”

Civilian pediatricians

In an accompanying editorial, retired Col. Beth Ellen Davis, MD, MPH, FAAP, wrote that there is growing evidence that the psychosocial burden of war extends to the family members of the military service member who is deployed. She said one of the most important findings of this study is that 65% of the services provided to children for mental health and behavioral problems are done by civilian pediatricians.

“Along with numerous smaller studies that have sought to understand the effects of parental wartime deployment on children and youth, this article should fortify general pediatricians, both civilian and military, in their primary care role of recognizing and responding to the mental health/behavioral needs of military children,” Davis wrote. “Recognizing childhood stress, anxiety or behavioral problems that are interfering with school or family function has been a responsibility of pediatricians for generations.” – by Emily Shafer

Disclosure: Dr. Gregory H. Gorman has no direct financial interest in any of the products mentioned in this article nor is he a paid consultant for any companies mentioned.

In the lead article of the December 2010 issue of Pediatrics, Gorman et al of the department of pediatrics at The Uniformed Services University of the Health Sciences in Bethesda, Md., presented data confirming what most military parents have always known; that children of deployed military personnel face unique stresses that often result in increased clinic visits for mental and behavioral problems. Only those who generated a record could be studied, but I can tell you from my own experience that those children only represent the “tip of the iceberg,” as Gorman so aptly put it. There are countless others who are affected but not taken in for care. When I was deployed to Iraq in 1990–91, my family experienced similar problems, only no professional services were sought. I am aware of other members of our unit who had a similar experience. Additionally, I can also tell you that spouses of deployed personnel experience similar stress-related problems, whether they seek help or not.

Retired Col. Davis, a developmentalist and recognized expert on this issue, provides some additional perspective in her commentary in the same issue.

—James H. Brien, DO
Infectious Diseases in Children Editorial Board member

Disclosure: Dr. Brien has no direct financial interest in any of the products mentioned in this article nor is he/she a paid consultant for any companies mentioned.