Military Family Literature

The FIG is hard at work on their scoping review of Military Family Literature!

Until that review is complete, we thank Dr. Penny Pierce for sharing this helpful listing of military family literature.

This listing can also be uploaded in PDF format here: USU Center for the Military Family Annotated Resources.

Acion, L., et al. (2013). “Increased risk of alcohol and drug use among children from deployed military families.”

Addiction 108(8): 1418-1425.

Aims to examine the association between military deployment of a parent and use of alcohol and drugs

among children of deployed military personnel. Design Observational and cross-sectional study. Setting

Data from the SA 2010 Iowa Youth Survey, a statewide survey of 6th, 8th and 11th graders, were analyzed

during 2011. Participants Of all 6th-, 8th- and 11th-grade students enrolled in Iowa in 2010, 69% (n = 78

240) completed the survey. Conclusions Children of deployed military personnel should be considered at

higher risk for substance use than children of non-military citizens.

The aim of this research was to ascertain if there is an association between military deployment of a parent

and use of alcohol and drugs among by the children of deployed military personnel. Results were indicative

that children of deployed personnel engage in more risky behaviors and are thus at higher risk than children

of non-military parents.

Allen, E. S., et al. (2011). “On the Home Front: Stress for Recently Deployed Army Couples.” Family Process 50(2):


Military couples who have experienced deployment and reintegration in current U.S. military operations

frequently experience stress regarding the dangers and effects of such experiences. The current study

evaluated a sample of 300 couples with an active duty Army husband and civilian spouse who experienced

a deployment within the year before the survey (conducted in 2007). Wives generally reported greater levels

of emotional stress compared with husbands. Overall, higher levels of stress were found for couples who

reported lower income and greater economic strain, perceive the need for more support and are unsure

about how to get support, have more marital conflict, and are generally less satisfied with the Army and the

current mission. Husband combat exposure was also associated with more stress for husbands and wives.

Additionally, for wives, stress was related to greater child behavior problems and a sense of less Army

concern for families. The results suggest areas of intervention with military couples to help them cope with

the challenges of military life and deployment.

Barnes, V. A., et al. (2007). “Perceived Stress, Heart Rate, and Blood Pressure among Adolescents with Family

Members Deployed in Operation Iraqi Freedom.” Mil Med 172(1): 40-43.

This study compared the impact of the 2003 Operation Iraqi Freedom on heart rate (HR) and blood pressure

(BP) and self reported stress levels among three groups of self-categorized adolescents: 1) miiitary

dependents with family members deployed; 2) military dependents with no family members deployed; 3)

civilian dependents. At the onset and end of the “major hostilities” of Operation Iraqi Freedom. 121

adolescents (mean age = 15.8 ±1.1 years) completed questionnaires evaluating the psychological impact of

the war and were evaluated for HR and BP. The military deployed dependents exhibited significantly higher

HR than other groups at both evaluations (both p < 0.04). Ethnicity by group interactions indicated that

European American-deployed dependents had higher stress scores at both time points (p < 0.02). Military

dependent European Americans exhibited higher systolic BP compared to the other groups on the second

evaluation (p < 0.03).

This study analyzed direct health data such as heart rate, blood pressure, and self-reported stress levels of

adolescents in order to evaluate the impact of the 2003 Operation Iraqi Freedom. Results showed that

adolescent dependents of military personnel have higher levels of stress and higher SBP nad HR than

civilian adolescents.

Beardslee, W., et al. (2011). “Family-centered preventive intervention for military families: implications for

implementation science.” Prev Sci 12(4): 339-348.

In this paper, we report on the development and dissemination of a preventive intervention, Families

OverComing Under Stress (FOCUS), an eight-session family-centered intervention for families facing the

impact of wartime deployments. Specific attention is given to the challenges of rapidly deploying a

prevention program across diverse sites, as well as to key elements of implementation success. FOCUS,

developed by a UCLA-Harvard team, was disseminated through a large-scale demonstration project funded

by the United States Bureau of Navy Medicine and Surgery (BUMED) beginning in 2008 at 7 installations

and expanding to 14 installations by 2010. Data are presented to describe the range of services offered, as

well as initial intervention outcomes. It proved possible to develop the intervention rapidly and to deploy it

consistently and effectively.

Evaluates the efficacy of the FOCUS program implemented public health strategy and family resiliency

training. Discusses the need to separate the FOCUS from other preventative measures in order to

disseminate the information properly.

Beardslee, W. R., et al. (2013). “Dissemination of family-centered prevention for military and veteran families:

Adaptations and adoption within community and military systems of care.” Clinical Child and Family Psychology

Review 16(4): 394-409.

Abstract In response to the needs of military families confronting the challenges of prolonged war, we

developed Families OverComing Under Stress (FOCUS), a multi-session intervention for families facing

multiple deployments and combat stress injuries adapted from existing evidence-based family prevention

interventions (Lester et al. in Mil Med 176(1): 19–25, 2011). In an implementation of this intervention

contracted by the US Navy Bureau of Medicine and Surgery (BUMED),

FOCUS teams were deployed to military bases in the United States and the Pacific Rim to deliver a suite of familycentered

preventive services based on the FOCUS

model (Beardslee et al. in Prev Sci 12(4): 339–348, 2011). Given the number of families affected by wartime service

and the changing circumstances they faced in

active duty and veteran settings, it rapidly became evident that adaptations of this approach for families in other

contexts were needed. We identified the core elements of FOCUS that are essential across all adaptations:

(1) Family Psychological Health Check-in; (2) family-specific psychoeducation; (3) family narrative timeline;

and (4) family-level resilience skills (e.g., problem solving). In

this report, we describe the iterative process of adapting the intervention for different groups of families: wounded, ill,

and injured warriors, families with young children, couples, and parents. We also describe the process of

adopting this intervention for use in different ecological contexts to serve National Guard, Reserve and

veterans, and utilization of technology-enhanced platforms to reach

geographically dispersed families. We highlight the lessons learned when faced with the need to rapidly deploy

interventions, adapt them to the changing, growing needs of families under real-world circumstances, and

conduct rigorous evaluation procedures when long-term, randomized trial designs are not feasible to meet

an emergent public health need.

Bowling, U. B. and M. D. Sherman (2008). “Welcoming Them Home: Supporting Service Members and Their Families

in Navigating the Tasks of Reintegration.” Professional Psychology: Research and Practice 39(4): 451-458.

Burr, J. E., et al. (2013). “Dependent Adolescent Pregnancy Rates and Risk Factors for Pregnancy in the Military

Health Care System.” Mil Med 178(4): 412-415.

Background: We sought to determine the pregnancy rate of U.S. military-dependent adolescents enrolled in

the military healthcare system. Methods: We examined the age and insurance status of dependent

adolescents, ages 12 to 23, and determined the incidence of new pregnancies in the military healthcare

system from 2006 to 2010 in San Antonio, Texas. Adolescents not enrolled or only recently enrolled in

TRICARE Prime at the time of pregnancy were analyzed separately. A Cox-Proportional Hazards model was

used to determine risk factors for pregnancy (relationship to sponsor, age, and contraceptive prescription).

Results: 444 pregnancies were diagnosed among the 12,417 eligible subjects. For adolescents with

continuous enrollment in TRICARE Prime, the pregnancy rate was 9.67/1,000 woman-years at risk, much

lower than the national average. Cox-Proportional Hazards analysis showed age group

(15-19 years), and history of oral contraceptive prescription were associated with a higher pregnancy rate. 59% of

pregnancies occurred in women not enrolled or only briefly enrolled in TRICARE Prime at the time of

pregnancy. Conclusion: Dependent daughters enrolled in TRICARE Prime had a very low pregnancy rate.

The majority of pregnancies occurred in adolescents not enrolled in TRICARE Prime at the time of

pregnancy diagnosis, suggesting many adolescents sought health insurance after pregnancy was


Cederbaum, J. A., et al. (2014). “Well-Being and Suicidal Ideation of Secondary School Students From Military

Families.” 54(6): 672-677.

Chan, C. S. (2014). “Introduction to the special section: Research on psychological issues and interventions for

military personnel, veterans, and their families.” Professional Psychology: Research and Practice 45(6): 395-397.

Chandra, A., et al. (2010). “Children on the Homefront: The Experience of Children From Military Families.” Pediatrics

125(1): 16-25.

OBJECTIVE: Although studies have begun to explore the impact of the current wars on child well-being,

none have examined how children are doing across social, emotional, and academic domains. In this study,

we describe the health and well-being of children from military families from the perspectives of the child and

nondeployed parent. We also assessed the experience of deployment for children andhowit varies according

to deployment length and military service component.

PARTICIPANTS AND METHODS. Data from a computer-assisted telephone interview with military children, aged 11

to 17 years, and non-deployed caregivers (n 1507) were used to assess child well-being and difficulties

with deployment. Multivariate regression analyses assessed the association between family characteristics,

deployment histories, and child outcomes.

RESULTS: After controlling for family and service-member characteristics, children in this study had more emotional

difficulties compared with national samples. Older youth and girls of all ages reported significantly more

school-, family-, and peer-related difficulties with parental deployment (P .01). Length of parental

deployment and poorer nondeployed caregiver mental health were significantly associated with a greater

number of challenges for children both during deployment and deployed-parent reintegration (P .01).

Family characteristics (eg, living in rented housing) were also associated with difficulties with deployment.

CONCLUSIONS: Families that experienced more total months of parental deployment may benefit from targeted

support to deal with stressors that emerge over time. Also, families in which caregivers experience poorer

mental health may benefit from programs that support the caregiver and child.

Chandra, A., et al. (2010). “The Impact of Parental Deployment on Child Social and Emotional Functioning:

Perspectives of School Staff.” Journal of Adolescent Health 46(3): 218-223.

Purpose: Since 2001, many military families have experienced multiple and extended deployments. Little is

known about the effect of parental deployment on the well-being of children, and few, if any, studies to date

have engaged school staff to understand whether and how parental deployments affect the behavioral,

social, and emotional outcomes of youth in the school setting.

Methods: Focus groups and semi-structured interviews were conducted with teachers, counselors, and

administrative staff at schools serving children from U.S. Army families (N.148 staff). Participants were

queried about the academic, behavioral, and emotional issues faced by children of deployed soldiers. Data

were analyzed for themes in these areas, with attention to differences by service component (Active

Component vs. Army Reserve and National Guard).

Results: Although some children seem to be coping well with deployment, school staff felt that children’s anxiety

related to parental absence, increased responsibilities at home, poor mental health of some nondeployed

parents, and difficulty accessing mental health services affected the ability of other students to function well

in school.

Conclusions: School staff felt that parental deployment negatively affected social and emotional functioning for some

children and youth, although they felt others were coping well. Future research should examine factors

related to youth outcomes during parental deployment (e.g., mental health of the non-deployed parent) and

assess the effects of deployment on other measures of behavior such as

school engagement and academic performance.

Choi, Y. S., et al. (2012). “Prevalence of high body mass index among children and adolescents at a US military

treatment facility, 2008-2009.” 9: E166.

Conclusions were that in order to support RC. there must be a robust public policy in place to support them


Clever, M. and D. R. Segal (2013). “The demographics of military children and families.” 23(2): 13-39.

The military represents a very diverse community that is just as diverse in marriage, parenthood, family life,

and health choice and outcomes. While there are a plethora of commonalities among the U.S. military, it is

important to remember that despite distinguishing trends, military families cannot be neatly grouped and

must instead be stratified for evaluation of needs. Due to these diverse and changing needs, flexibility in

designed health programs for military families should be a hallmark of their design. Knowing who family

members are, what hardships they face, what strengths they bring to the military community, and how these

factors change over time and across an increasingly diverse population is paramount in developing a POA

for health initiatives.

Important issues considered: Moving and child resilience, moving and spousal career/education impairment,

Geographic dispersion of Reserve/Guard, Age of families being significantly younger than compared with the

civilian population, gender (women), more likely to choose marriage over cohab, other significant stressors

Clever, M. and D. R. Segal (2013). “The Demographics of Military Children and Families.” Future of Children 23(2):


Cox, M. J. and B. Paley (1997). “FAMILIES AS SYSTEMS.” Annual Review of Psychology 48(1): 243-267.

Cozza, S., et al. (2013). “Family-Centered Care for Military and Veteran Families Affected by Combat Injury.” Clinical

Child & Family Psychology Review 16(3): 311-321.

The US military community includes a population of mostly young families that reside in every state and the

District of Columbia. Many reside on or near military installations, while other National Guard, Reserve, and

Veteran families live in civilian communities and receive care from clinicians with limited experience in the

treatment of military families. Though all military families may have vulnerabilities based upon their exposure

to deployment-related experiences, those affected by combat injury have unique additional risks that must

be understood and effectively managed by military, Veterans Affairs, and civilian practitioners. Combat injury

can weaken interpersonal relationships, disrupt day-to-day schedules and activities, undermine the parental

and interpersonal functions that support children’s health and well-being, and disconnect families from

military resources. Treatment of combat-injured service members must therefore include a family-centered

strategy that lessens risk by promoting positive family adaptation to ongoing stressors. This article reviews

the nature and epidemiology of combat injury, the known impact of injury and illness on military and civilian

families, and effective strategies for maintaining family health while dealing with illness and injury.

Cozza, S. J., et al. (2010). “Combat-injured service members and their families: The relationship of child distress and

spouse-perceived family distress and disruption.” Journal of Traumatic Stress 23(1): 112-115.

Combat injury in military service members affects both child and family functioning. This preliminary study

examined the relationship of child distress postinjury to preinjury deployment-related family distress, injury

severity, and family disruption postinjury. Child distress postinjury was assessed by reports from 41 spouses

of combat-injured service members who had been hospitalized at two military tertiary care treatment

centers. Families with high preinjury deployment-related family distress and high family disruption postinjury

were more likely to report high child distress postinjury. Spouse-reported injury severity was unrelated to

child distress. Findings suggest that early identification and intervention with combat-injured families

experiencing distress and disruption may be warranted to support family and child health, regardless of

injury severity. [ABSTRACT FROM AUTHOR]

This empirical study examines the impact of combat injuries on children and families. It compares predepolyment

injury child distress with post-deployment injured soldiers’ child and family distress. Data

Statistics – 48% of spouses reported high family disruption. and injury alone (not severity) was a determining

factor Note: Data regarding child distress was obtained from spouses of servicemembers and not children

directly and sample size is moderate (>30 but <45).

Creech, S. K., et al. (2014). “The impact of military deployment and reintegration on children and parenting: A

systematic review.” Professional Psychology: Research and Practice 45(6): 452-464.

Hundreds of thousands of children have had at least 1 parent deploy as part of military operations in Iraq

(Operation Iraqi Freedom; OIF; Operation New Dawn; OND) and Afghanistan (Operation Enduring Freedom;

OEF). However, there is little knowledge of the impact of deployment on the relationship of parents and their

children. This systematic review examines findings from 3 areas of relevant research: the impact of

deployment separation on parenting, and children’s emotional, behavioral, and health outcomes; the impact

of parental mental health symptoms during and after reintegration; and current treatment approaches in

veteran and military families. Several trends emerged. First, across all age groups, deployment of a parent

may be related to increased emotional and behavioral difficulties for

children, including higher rates of health-care visits for psychological problems during deployment. Second,

symptoms of PTSD and depression may be related to increased symptomatology in children and problems

with parenting during and well after reintegration. Third, although several treatments have been developed

to address the needs of military families, most are untested or in the early stages of implementation and

evaluation. This body of research suggests several promising avenues for future research.

Crum-Cianflone, N. F., et al. (2014). “The Millennium Cohort Family Study: a prospective evaluation of the health and

well-being of military service members and their families.” International Journal of Methods in Psychiatric Research

23(3): 320-330.

The need to understand the impact of war on military families has never been greater than during the past

decade, with more than three million military spouses and children affected by deployments to Operations

Iraqi Freedom and Enduring Freedom. Understanding the impact of the recent conflicts on families is a

national priority, however, most studies have examined spouses and children individually, rather than

concurrently as families. The Department of Defense (DoD) has recently initiated the largest study of military

families in US military history (the Millennium Cohort Family Study), which includes dyads of military service

members and their spouses (n > 10,000). This study includes US military families across the globe with

planned follow-up for 21+ years to evaluate the impact of military experiences on families, including both

during and after military service time. This review provides a comprehensive description of this landmark

study including details on the research objectives, methodology, survey instrument, ancillary data sets, and

analytic plans. The Millennium Cohort Family Study offers a unique opportunity to define the challenges that

military families experience, and to advance the understanding of protective and vulnerability factors for

designing training and treatment programs that will benefit military families today and into the future.

Danish, S. J., et al. (2013). “The challenges of reintegration for service members and their families.” 83(4): 550-558.

The ongoing wars in Afghanistan and Iraq have posed a number of reintegration challenges to service

members. Much of the research focuses on those service members experiencing

psychological problems and being treated at the VA. In this article, we contend that much of the distress service

members experience occurs following deployment and is a consequence of the difficulties encountered

during their efforts to successfully reintegrate into their families and communities. We propose a new

conceptual framework for intervening in this reintegration distress that is psycho-educational in nature as

well as a new delivery model for providing such services. An example of this new intervention framework is


Dausch, B. M. and S. Saliman (2009). “Use of family focused therapy in rehabilitation for veterans with traumatic

brain injury.” Rehabilitation Psychology 54(3): 279-287.

Objective: Military personnel returning from Iraq and Afghanistan with traumatic brain injury (TBI) present

with a complex array of stressors encountered during combat as well as upon re-entry, often with additional

physical and mental health comorbidities. This requires an intensive approach to treatment that includes

family intervention as a part of rehabilitation. There is a small but growing literature addressing the needs of

families when a family member has sustained a TBI. An established treatment intervention for individuals

with serious mental illness, such as family focused therapy (FFT), is uniquely suited to

address the complexity of issues presented by returning military personnel, and may be adapted for moderate to

severe TBI populations. In this article, we discuss the rationale for adapting this family intervention for this

population and present a case vignette illustrating adaptations for TBI. Conclusions: The adaptation of an

existing family intervention for a chronic condition that focuses on enhancing both individual and family

functioning is a useful starting point. With further research to modify FFT for this unique population and

establish feasibility, this approach may supplement existing models of family intervention.

De Pedro, K. M. T., et al. (2011). “The Children of Military Service Members: Challenges, Supports, and Future

Educational Research.” Review of Educational Research 81(4): 566-618.

The wars in Afghanistan and Iraq have led to concerning psychological, behavioral, and academic outcomes

for children in military families. Of the 1.2 million school-aged children of military service members, only

86,000 actually attend schools administered by the Department of Defense on military installations

throughout the world. The remaining military children attend schools administered by civilian public schools,

private schools, and other civilian-run educational agencies. At present, there is a knowledge gap in

educational research regarding military-connected schools and students. Given the lack of educational

research on military children, the primary objective of this review is to outline findings from noneducational

disciplinary empirical literatures that are of direct relevance to schooling for educational researchers who

want to conduct studies on military-connected schools and students. The authors reviewed studies on

military children and their families that examined links between special circumstances and stressors as well

as outcomes that are known to impact students’ school experiences. A synthesis of literature generated six

themes: mental health in military families, child maltreatment, the impact of deployment on military children

and families, the reintegration experience, war-related trauma of the returning veteran parent, and the

experience of Reservist and Guard families in civilian contexts. The article concludes with a heuristic model

for future educational research, including linkages to school reform.

Defense, O. o. t. S. o. (2014). “DEFENSE MANPOWER REQUIREMENTS REPORT.” Total Force Planning &

Requirements Directorate.


Official Statistics.

Drummet, A. R., et al. (2003). “Military Families Under Stress: Implications for Family Life Education.” Family

Relations 52(3): 279-287.

Esposito-Smythers, C., et al. (2011). “Military youth and the deployment cycle: Emotional health consequences and

recommendations for intervention.” Journal of Family Psychology 25(4): 497-507.

The United States military force includes over 2.2 million volunteer service members. Three out of five

service members who are deployed or are preparing for deployment have spouses and/or children.

Stressors associated with the deployment cycle can lead to depression, anxiety, and behavior problems in

children, as well as psychological distress in the military spouse. Further, the emotional and behavioral

health of family members can affect the psychological functioning of the military service member during the deployment and reintegration periods. Despite

widespread acknowledgment of the need for emotional and behavioral health services for youth from military

families, many professionals in a position to serve them struggle with how to best respond and select

appropriate interventions. The purpose of this paper is to provide an empirically based and theoretically

informed review to guide service provision and the development of evidence based treatments for military

youth in particular. This review includes an overview of stressors associated with the deployment cycle,

emotional and behavioral health consequences of deployment on youth and their

caretaking parent, and existing preventative and treatment services for youth from military families. It concludes with

treatment recommendations for older children and adolescents experiencing emotional and behavioral

health symptoms associated with the deployment cycle.

Faber, A. J., et al. (2008). “Ambiguous absence, ambiguous presence: a qualitative study of military reserve families

in wartime.” Journal of family psychology : JFP : journal of the Division of Family Psychology of the American

Psychological Association (Division 43) 22(2): 222-230.

Flake, E. M., et al. (2009). “The psychosocial effects of deployment on military children.” 30(4): 271-278.

Objective: The impact of the Global War on Terror on two million U.S. military children remains unknown.

The purpose of this study was to describe the psychosocial profile of school age children during parental

deployment utilizing standardized psychosocial health and stress measures, and to identify predictors of

children at “high risk” for psychosocial morbidity during wartime deployment.

Methods: Army spouses with a deployed service member and a child aged 5–12 years completed a deployment

packet consisting of demographic and psychosocial questions. The psychosocial health measures included

the Pediatric Symptom Checklist (PSC), the Parenting Stress Index-Short Form and the Perceived Stress


Results: Overall, 32% of respondents exceeded the PSC cut off score for their child, indicating “high risk” for

psychosocial morbidity and 42% reported “high risk” stress on the Parenting Stress Index-Short Form.

Parenting stress significantly predicted an increase in child psychosocial morbidity (odds ratio 7.41,

confidence interval 2.9–19.0, p < 0.01). Parents utilizing military support reported less child psychosocial

morbidity (odds ratio 0.32, confidence interval 0.13–0.77, p < 0.01) and parental college education was

related to a decrease in child psychosocial morbidity (odds ratio 0.33, confidence interval 0.13–0.81, p <

0.02). The effects of military rank, child gender, child age, and race or ethnic background did not reach

statistical significance.

Conclusion: Families in this study experiencing deployment identified one-third of military children at “high risk” for

psychosocial morbidity. The most significant predictor of child psychosocial functioning during wartime

deployment was parenting stress. Military, family and community supports help mitigate family stress during

periods of deployment.

Foran, H. M., et al. (2012). “Hazardous alcohol use and intimate partner violence in the military: Understanding

protective factors.” Psychology of Addictive Behaviors 26(3): 471-483.

Hazardous alcohol use is a well-established risk factor for men’s intimate partner violence (IPV), with dozens

of studies demonstrating the association. The current study extends understanding of the hazardous alcohol

use-IPV link by examining what factors moderate this association in a more systematic and broader way that

has been done in past studies. Individual, family, workplace, community, and developmental factors were

tested as moderators of the hazardous alcohol use and IPV link in a large, representative sample of active

duty service members (the 2006 Community Assessment), and the results were tested for replicability in a

hold-out sample. Two family variables (relationship satisfaction and parent–child satisfaction), 1 community

variable (community safety), and 3 developmental variables (years in the military, marital length, and family

income/pay grade) cross-validated as significant moderators of the association between men’s hazardous

alcohol use and IPV. Across the significant moderators, the association between hazardous alcohol use and

men’s IPV was weakened by maturation/development, improved community safety, and better relationship

functioning. No individual or workplace variables were significant moderators for men, and there were no

significant moderators found for women. The results support the importance of a developmental and

relational perspective to understanding the hazardous alcohol use-IPV link, rather than solely an individual

coping perspective. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)

Ford, C. A. (2004). “Living in a time of terrorism: What about older adolescents and young adults?” Families,

Systems, & Health 22(1): 52-53.

Fullerton, C. S., et al. (2011). “Child Neglect in Army Families: A Public Health Perspective.” Mil Med 176(12):


ABSTRACT Military families include 2.9 million people, with approximately 40% of all service members

having at least one child. Rates of child neglect in this population have increased in recent years, but little is

known about the characteristics of the neglect. To better identify targets for intervention, it is necessary that

we refine our understanding of child neglect in the military. In this review, we examine definitions of child

neglect and the specific definitions used by

the U.S. Army. We identify domains of neglect and caregiver behaviors and affiliated. We suggest that this approach

can inform prevention efforts within the Institute of Medicine’s framework for preventive interventions.

Understanding risk

and protective factors in the military family are important to interventions for child neglect in military families.

Gilreath, T. D., et al. (2013). “Substance use among military-connected youth: the California Healthy Kids Survey.”

44(2): 150-153.

Gorman, L., et al. (2010). “Parental Combat Injury and Early Child Development: A Conceptual Model for

Differentiating Effects of Visible and Invisible Injuries.” Psychiatric Quarterly 81(1): 1-21.

The injuries (physical and emotional) sustained by service members during combat influence all members of

a family system. This review used a systemic framework to conceptualize the direct and indirect effects of a

service member’s injury on family functioning, with a specific focus on young children. Using a metaethnographic

approach to synthesize the health research literature from a variety of disciplines, this review

makes relevant linkages to health care professionals working with injured veterans. Studies were included

that examined how family functioning (psychological and physical) is impacted by parental illness; parental

injury; and posttraumatic stress disorder. The synthesis of literature led to the development of a heuristic

model that illustrates both direct and indirect effects of parental injury on family functioning and the

development of young children. It further illustrates the contextual factors or moderating variables that buffer

detrimental effects and promote family resilience. This model can be a foundation for future research,

intervention, and policy.

Gorman, L., et al. (2010). “Parental Combat Injury and Early Child Development: A Conceptual Model for

Differentiating Effects of Visible and Invisible Injuries.” Psychiatric Quarterly 81(1): 1-21.

Hildreth, C. J. (2009). “Effect of Parents’ Wartime Deployment on the Behavior of Young Children in Military Families.”

JAMA 301(1): 21.

Objective: To describe the effect of wartime military deployments on the behavior of young children in

military families.

Design: Cross-sectional study.

Setting: Childcare centers on a large Marine base

Conclusions: This study is the first to show that children aged 3 years or older with a deployed parent exhibit

increased behavioral symptoms compared with peers

without a deployed parent after controlling for caregiver’s stress and depressive symptoms.

Hill, R. (1949). Families under stress; adjustment to the crises of war separation and reunion. New York, Harper.

Hinojosa, R., et al. (2012). “Problems With Veteran-Family Communication During Operation Enduring Freedom/

Operation Iraqi Freedom Military Deployment.” Mil Med 177(2).

Hisle-Gorman, E., et al. (2015). “Impact of Parents’ Wartime Military Deployment and Injury on Their Young Children’s

Safety and Mental Health.” American Academy of Child and Adolescent Psychiatry(Article in Press: Accepted


Objective: Children are at risk of adverse outcomes during parental military deployments. We aim to

determine the impact of parental deployment and combat injury on young children’s post-deployment mental

health, injuries, and maltreatment.

Method: This is a population-based, retrospective cohort study of young children of active duty military parents

during fiscal years (FY) 2006-2007, a high deployment period. 487,460 children, aged 3 to 8 years old, who

received Military Health System care, were included. The relative rates of mental health, injury, and child

maltreatment visits of 1) children whose parents deployed and 2) children of combat-injured parents were

compared to children unexposed to parental deployment.

Results: Of included children, 58,479 (12%) had a parent deploy, and 5,405 (1%) had a parent injured during

deployment. Relative to children whose parents did not deploy, children of deployed and combat-injured

parents, respectively, had additional visits for mental health diagnoses (incidence rate ratio [IRR] 1.17 [95%

CI 1.09-1.24], IRR 1.66 [95% CI 1.43-1.93]), injuries (IRR 1.08 [95% CI 1.05-1.11] , IRR 1.26 [95% CI

1.16-1.37]), and child maltreatment (IRR 1.21 [95% CI 1.09-1.35], IRR 2.41 [95% CI 1.99-2.92]) post


Conclusion: Young children of deployed and combat-injured military parents have more post-deployment visits for

mental health, injuries, and child maltreatment. Mental health problems, injuries, and maltreatment following

a parent’s return from deployment are amplified in children of combat-injured parents. Increased preventive

and intervention services are needed for young children as parents return from deployments. Child health

and mental health providers are crucial to effective identification of these at-risk children to ensure effective

care provision.

Holmes, A. K., et al. (2013). When a parent is injured or killed in combat. 23: 143+.

When a service member is injured or dies in a combat zone, the consequences for his or her family can be

profound and long-lasting. Visible, physical battlefield injuries often require families to adapt to long and

stressful rounds of treatment and rehabilitation, and they can leave the service member with permanent

disabilities that mean new roles for everyone in the family. Invisible injuries, both physical and psychological,

including traumatic brain injury and combat-related stress disorders, are often not diagnosed until many

months after a service member returns from war (if they are diagnosed at all–many sufferers never seek

treatment). They can alter a service member’s behavior and personality in ways that make parenting difficult

and reverberate throughout the family. And a parent’s death in combat not only brings immediate grief but

can also mean that survivors lose their very identity as a military family when they must move away from

their supportive military community.

Sifting through the evidence on both military and civilian families, Allison Holmes, Paula Rauch, and Stephen Cozza

analyze, in turn, how visible injuries, traumatic brain injuries, stress disorders, and death affect parents’

mental health, parenting capacity, and family organization; they also discuss the community resources that

can help families in each situation. They note that most current services focus on the needs of injured

service members rather than those of their families. Through seven concrete recommendations, they call for

a greater emphasis on family-focused care that supports resilience and positive adaptation for all members

of military families who are struggling with a service member’s injury or death.

Notes that most resources available focus on the health and well-being of the inuured servicemember and

lack emphasis on family members.

Horton, J. L., et al. (2014). “Trends in New U.S. Marine Corps Accessions During the Recent Conflicts in Iraq and

Afghanistan.” 179(1): 62-70.

The objective of this study was to analyze trends in preservice characteristics among Marine Corps recruits

during the recent operations in Iraq and Afghanistan. Recruits completed a confidential survey during their

first week of training at the Marine Coips Recruit Depot in San Diego, California. Demographics, behaviors,

and health

information were analyzed for trends from 2001 to 2010 using the Cochran-Armitage trend test and F statistic. Data

from 131,961 male recruits with a mean age of 19.8 years were atialyzed. Overall, entty characteristics

remained stable

exhibiting only modest changes over the study period. Favorable trends included recent (2009-2010) improvernents

in body mass index and physical activity levels. Unfavorable trends included increases in smokeless tobacco

and caffeine

use, and angry outbursts. Although many recruit characteristics remained similar over the past decade, both

favorable and unfavorable trends in sociobehavioral characteristics were noted. The ongoing assessment of

preservice characteristics

is important for detecting emerging trends over time. Findings may guide leadership’s understanding of changes to

help develop early-service trainings promoting a healthier force and potentially reducing f’uture adverse


Jedrzejczak, M. (2005). “Family and Environmental Factors of Drug Addiction among

Young Recruits.” Mil Med 170.

Drug addiction in a family results from three factors: (1) effect of pathological families on young people’s

behavior, (2) easy access to drugs, and (3) influence of groups of people of the same age. In the present

study, it was investigated to what

extent individual factors related to family and environment affect the extent of drug addiction among recruits. The

study included 559 subjects. The results proved direct interdependence between the family condition and

the extent of narcomania.

Drug addicts came mostly from incomplete and pathological families. The main family factors of drug addiction,

according to the results obtained, are family atmosphere, strength of family ties, sense of family happiness,

structure of authority in the family, and alcoholism. In families where there is warmth and love, children do

not or rarely take drugs. Drug addicts come from families where there is ill will and hostility (p < 0.05). Drug

addicts have weaker family ties than do those who do not take drugs [w^ = 0.26, p < 0.05). In families where

there was contact with drugs, authority belonged to the mother to a greater degree (54.4%) than to the

father (23.6%). In 46.3% of the studied drug addicts’ families, alcohol was drunk. The results of the

investigations approximate results of other studies conducted among young people in Poland and elsewhere

in the world.

Joseph, A. L. and T. D. Afifi (2010). “Military wives’ stressful disclosures to their deployed husbands: The role of

protective buffering.” Journal of Applied Communication Research 38(4): 412-434.

Kelty, R., et al. (2010). “The Military and the Transition to Adulthood.” Future of Children 20(1): 181-207.

Ryan Kelty, Meredith Kleykamp, and David Segal examine the effect of military service on the transition to adulthood.

They highlight changes since World War II in the role of the military in the lives of young adults, focusing

especially on how the move from a conscription to an all-volunteer military has changed the way military

service affects youths’ approach to adult responsibilities. The authors note that today’s all-volunteer military

is both career-oriented and family-oriented, and they show how the material and social support the military

provides to young servicemen and women promotes responsible membership in family relationships and the

wider community. As a result, they argue, the transition to adulthood, including economic independence from

parents, is more stable and orderly for military personnel than for their civilian peers. At the same time, they

stress that serving in the military in a time of war holds dangers for young adults. The authors examine four

broad areas of military service, focusing in each on how men and women in uniform today make the

transition to adulthood. They begin by looking at the social characteristics of those who serve, especially at

differences in access to the military and its benefits by socio-demographic characteristics, such as age,

gender, race and ethnicity, social class, and sexual orientation. Military service also has important effects on

family formation, including the timing of marriage and parenthood, family structure, and the influence of

military culture on families. Family formation among servicemen and women, the authors observe, is earlier

and more stable than among civilians of the same age. The authors then consider the educational and

employment consequences of service. Finally, they scrutinize the dangers of military service during times of

war and examine the physical and psychological effects of wartime military service. They also note the

sexual trauma endured both by male and female military personnel and the physical and symbolic violence

women can experience in a male-dominated institution. Kelty, Kleykamp, and Segal conclude by seeking

policy lessons from the military’s success in facilitating the transition to adulthood for young men and women

in uniform.

Lester, P. and E. Flake (2013). How wartime military service affects children and families. 23: 121+.

Lester, P., et al. (2013). “Military service, war, and families: Considerations for child development, prevention and

intervention, and public health policy.” Clinical Child and Family Psychology Review 16(3): 229-232.

Lester, P., et al. (2010). “The Long War and Parental Combat Deployment: Effects on Military Children and At-Home

Spouses.” Journal of the American Academy of Child and Adolescent Psychiatry 49(4): 310-320.

Objective: Given the growing number of military service members with families and the multiple combat

deployments characterizing current war time duties, the impact of deployments on military children requires

clarification. Behavioral and emotional adjustment problems were examined in children (aged 6 through 12)

of an active duty Army or Marine Corps parent currently deployed (CD) or recently returned (RR) from

Afghanistan or Iraq.

Address psychological aspect and affect on children/families in addition to other various aspects.

Lester, P., et al. (2012). “Evaluation of a Family-Centered Prevention Intervention for Military Children and Families

Facing Wartime Deployments.” American Journal of Public Health 102(S1): S48-S54.

Objectives. We evaluated the Families OverComing Under Stress program, which provides resiliency

training designed to enhance family psychological health in US military families affected by combat- and

deployment-related stress. Methods. We performed a secondary analysis of Families OverComing Under

Stress program evaluation data that was collected between July 2008 and February 2010 at 11 military

installations in the United States and Japan. We present data at baseline for 488 unique families (742

parents and 873 children) and pre-post outcomes for 331 families. Results. Family members reported high

levels of satisfaction with the program and positive impact on parent-child indicators. Psychological distress

levels were elevated for service members, civilian parents, and children at program entry compared with

community norms. Change scores showed significant improvements across all measures for service

member and civilian parents and their children (P<.001). Conclusions. Evaluation data provided preliminary

support for a strength-based, trauma-informed military family prevention program to promote resiliency and

mitigate the impact of wartime deployment stress.

This study evaluated the FOCUS program’s effectiveness in postive outcomes regarding military family

health. Current research suggests that child distress and child adjustment is directly correlated with the

psychologicla symtptoms of both the military parent and souse at home. The results of study found that the

FOCUS program perceive the program to be relevant to problems families are facing both duuring

deployment and during reintegration.

Lester, P., et al. (2013). “Psychological health of military children: Longitudinal evaluation of a family-centered

prevention program to enhance family resilience.” Mil Med 178(8): 838-845.

Family-centered preventive interventions have been proposed as relevant to mitigating psychological health

risk and promoting resilience in military families facing wartime deployment and réintégration. This study

evaluates the impact of a family-centered prevention program. Families Overcoming Under Stress Family

Resilience Training (FOCUS), on the psychological adjustment of military children. Two primary goals

include (1) understanding the relationships of distress among family members using a longitudinal path

model to assess relations at the child and family level and (2) determining pathways of program impact on

child adjustment. Multilevel data analysis using structural equation modeling was conducted with

deidentified .service delivery data from 280 families (505 children aged 3-17) in two follow-up assessments.

Standardized measures included .service member and civilian parental distress (Brief Symptom Inventory,

PTSD Checklist—Military), child adjustment (Strengths and Difficulties Questionnaire), and family

functioning (McMa.ster Family As.sessment Device). Distress was significantly related among the service

member parent, civilian parent, and children. FOCUS improved family functioning, which in turn significantly reduced

child distress at follow-up. Salient components of improved family functioning in reducing child distress

mirrored resilience processes targeted by FOCUS. These findings underscore the public health potential of

family-centered prevention for military families and suggest areas for future research.

Lieberman, A. and P. Van Horn (2013). “Infants and Young Children in Military Families: A Conceptual Model for

Intervention.” Clinical Child and Family Psychology Review 16(3): 282-293.

Infants and young children of parents in the military deserve special attention because the first years of life

are pivotal in establishing trusting attachment relationships, which are based on the developmental

expectation that parents will be reliably available and protective both physically and emotionally. For young

children in military families, the stresses of extended absences of mothers and/or fathers as the result of

deployment abroad, recurrent separations and reunions resulting from repeated deployments, or parents

struggling with the emotional sequelae of their war experiences, and the traumatic impact of parental injury

and death can strain and derail the normative expectation of parental availability and protectiveness. This

article describes the key features of mental health in infancy and early childhood, the developmentally

expectable early anxieties that all children experience in the first years of life across cultures and

circumstances, and the ways in which these normative anxieties are exacerbated by the specific

circumstances of military families. The article also describes interventions that may be helpful in supporting

military families and their children with the specific challenges they face.

Useful information – however, it is a literature review – not empirical data/study

Link, P. E. and L. A. Palinkas (2013). “Long-Term Trajectories and Service Needs for Military Families.” Clinical Child

& Family Psychology Review 16(4): 376-393.

The deployment of US military personnel to recent conflicts has been a significant stressor for their families;

yet, we know relatively little about the long-term family effects of these deployments. Using data from prior

military service eras, we review our current understanding of the long-term functioning and needs of military

families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in

violence during war deployment, service member injury or disability, and combat-related post-traumatic

stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several

recommendations to address these impacts such as the provision of family-centered, trauma-informed

resources to families of veterans with

PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of

caregivers of veterans should be evaluated and expanded, as necessary. We should also help military

families plan for predictable life events likely to challenge their resilience and coping capacities. Future

research should focus on the

following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family

dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed

population; and system-level innovations necessary to ensure adequate access to these interventions.

These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence

during war deployment, service member injury or disability, and

combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military

families.These impacts include an increased likelihood of divorce and domestic violence; decreased

satisfaction in relationships; increased physical and mental health problems experienced by spouses,

children, and family of origin; and increased caregiver burden.

Lucier-Greer, M., et al. (2014). “Adolescent Mental Health and Academic Functioning: Empirical Support for

Contrasting Models of Risk and Vulnerability.” Mil Med 179(11): 1279-1287.

ABSTRACT Adolescents in military families contend with normative stressors that are universal and exist

across social contexts (minority status, family disruptions, and social isolation) as well as stressors reflective

of their military life context (e.g., parental deployment, school transitions, and living outside the United

States). This study utilizes a social ecological perspective and a stress process lens to examine the

relationship between multiple risk factors and relevant indicators of youth well-being, namely depressive

symptoms and academic performance, as well as the mediating role of self-efficacy (N = 1,036). Three risk

models were tested: an additive effects model (each risk factor uniquely influences outcomes), a full

cumulative effects model (the collection of risk factors influences outcomes), a comparative model (a

cumulative effects model exploring the differential effects of normative and military-related risks). This design

allowed for the simultaneous examination of multiple risk factors and a comparison of alternative

perspectives on

measuring risk. Each model was predictive of depressive symptoms and academic performance through persistence;

however, each model provides unique findings about the relationship between risk factors and youth

outcomes. Discussion is provided pertinent to service providers and researchers on how risk is

conceptualized and suggestions for identifying at-risk youth.

Examines adolescents in a military family context and evaluates the stressors that exists and their impact on

youth well-being. The results are are indicative that previous research, findings indicate that adolescent

well-being, specifically psychological health and academic performance, is adversely impacted by the

presence of various, socioecological risk factors. Interpret results and generalize results to larger population

with caution due to methods and procedure.

Lynch, J. P., et al. (2004). “Health-related behaviors in young military smokers.” 169(3): 230-235.

This cross-sectional study examined the association between smoking and other health-related risk

behaviors, individually as well as in clusters, across branches of military service in the higher risk ages of 18

to 25 years old within the 1998

Department of Defense Survey of Health-Related Behaviors among Military personnel. Examination of the

demographic variables revealed that, in general, smokers tended to be single, white, enlisted men in the 18-

to 20-year age group with less education and serving in the Army or Marine Corps. Our findings support that

there is an increased likelihood of co-occurrence of substance use along with other negative health-related

risk behaviors found in military members. It may be practical and necessary to develop a focused survey

given to those attending smoking cessation interventions, or perhaps to smokers in general, which attempts

to identify associated risk behaviors and channel clients accordingly

Marek, L. and C. D’Aniello (2014). “Reintegration Stress and Family Mental Health: Implications for Therapists

Working with Reintegrating Military Families.” Contemporary Family Therapy 36(4): 443-451.

Abstract Military families respond and adjust differently to reintegration stressors with some families coping

well with these changes while other families do not. It is important to understand factors that contribute to

reintegration stress since reintegration stress can affect their own and their family’s emotional health and

well-being for months if not years into the future. This study addresses the factors that contribute to more

positive outcomes and reduced reintegration stress, for reintegrating military families. Service members and

partners who report the presence of PTSD related symptoms and report their own and their partner’s mental

health as low, are more likely to experience more reintegration stress. The results indicate that this model is

able to significantly predict variance (32 and 37 %, respectively) in reintegration stress levels. It is important

for mental health providers to understand the variation in reintegrating families’ stress levels and coping

skills. Employing a systemic approach uniquely positions therapists to more effectively address these issues

to help military families develop healthy cohesive family systems

Melvin, K. C., et al. (2015). “Strong Army Couples: A Case Study of Rekindling Marriage After Combat Deployment.”

Research in Nursing & Health 38(1): 7-18.

Post-traumatic stress symptoms (PTSS), occurring in 15% of combatexposed military personnel, are

associated with a decrease in couples’ relationship quality. The purpose of this analysis was to describe

reintegration in Army couples with high couple functioning, despite PTSS in one or both partners.

Reintegration refers to readjustment after deployment; returning to previous role(s). In a mixedmethods case

study of Army couples with a history of combat deployment, we used existing quantitative data to define

sampling boundaries, select cases, and guide interviews. Couples scoring high on couple functioning,

resilience, and couple satisfaction were interviewed (N.5 couples, 10 participants). “Rekindling marriage”

required strategies to overcome challenges during couple reintegration. For participants as individuals, those

strategies were allowing negative emotions, giving each other time and space to do the work of rediscovery

and accepting a changed reality, and recognizing and addressing individual needs of the other. As couples,

strategies were to go with the flow, open your heart, become best friends, maintain trust, and communicate

effectively. As families, strategies were to normalize schedules and protect family time. Findings offer a

preliminary basis for interventions to promote strong relationships for military couples with PTSS. _

Merolla, A. J. (2010). “Relational Maintenance during Military Deployment: Perspectives of Wives of Deployed US

Soldiers.” Journal of Applied Communication Research 38(1): 4-26.

Miller, K. E., et al. (2014). “Are communities ready? Assessing providers’ practices, attitudes, and knowledge about

military personnel.” Professional Psychology: Research and Practice 45(6): 398-404.

One potential barrier to helping returning military personnel and their families is a lack of community

providers skilled to help these groups. Although capacity and competence have expanded within the

Department of Defense (DoD) and the Veterans Health Administration (VHA), it is unknown if community

agencies have the interest, capacity, and competence to help service members, veterans, and

their families postdeployment. This study used an online survey to examine the knowledge, common practices,

attitudes, and training needs of community mental health providers, in order to determine if needs are

adequately addressed. Assessment and treatment practices with veterans and service members varied

greatly in community practices. Additional training opportunities are needed, particularly for helping military

personnel with traumatic brain injuries and providing evidence-based practice. Furthermore, clinicians in the

community need to systematically assess new clients for military service.

The overall goal of the study was to ascertain community mental health professionals’ knowledge, practices,

and attitudes about military service members and veterans, in order to further enhance care outside the DoD

and VA health care systems. TBI was consistently identified as an area requiring more training and

education. Although many professionals considered TBI important to the case vignette, they rated TBIs as

less relevant to their clinical work and felt less competent in working with such problems.

Mmari, K. N., et al. (2010). “Exploring the Role of Social Connectedness Among Military Youth: Perceptions from

Youth, Parents, and School Personnel.” Child & Youth Care Forum 39(5): 351-366.

Abstract The increased stress on military families during wartime can be particularly

difficult for adolescents. The current study employed 11 focus groups with military youth, parents, and school

personnel working with military youth to better understand how youth and their families cope with stressors

faced as result of living in a military family. An inductive approach was used for data analysis, where two

coders and the lead author coded the transcripts until saturation was achieved. Matrices and data display

models were developed to make comparisons across participant groups. Findings revealed that military

youth are most worried about making frequent moves and having a parent deployed. However, youth and

their parents who had better social connections to each other, their peers, and their neighborhoods

appeared to make better adjustments to these challenges.

School personnel reported that more military families needed to become aware of the services offered to help families

cope effectively. Implications for future research and intervention programs for military youth and their

families are discussed.

The increased stress on military families during wartime can be particularly difficult for adolescents.

Adolescents feel particular anxiety regarding moves and settling into new locations – especially for sports

players. Evaluation involved theoretical models of stress and coping, as well as research on social

connectedness in order better understand the potential impact of having a parent in the military on youths’

adjustment. School personnel at a Navy base concurred and added that a large part in deciding whether a

not a military youth is going to cope well with a parental deployment is dependent on how well the remaining

parent is coping.

Murphy, R. A. and J. A. Fairbank (2013). “Implementation and Dissemination of Military Informed and Evidence-

Based Interventions for Community Dwelling Military Families.” Clinical Child & Family Psychology Review 16(4):


Community dwelling military families from the National Guard and Reserve contend with deploymentrelated

stressors in relative isolation, living in communities where mental health providers may have little knowledge

of military culture. When they are community residents, active duty service members and families tend to

live in close proximity to their military installations. This article will focus primarily on the challenges to quality

mental health care for reserve component (RC) families. Where studies of RC families are absent, those of

active component (AC) families will be highlighted as relevant. Upon completion of a deployment,

reintegration for RC families is complicated by high rates of symptomatology, low service utilization, and

greater barriers to care relative to AC families. A paucity of providers skilled in evidence-based treatments

(EBTs) limits community mental health capacity to serve RC military families. Several emergent programs

illustrate the potential for better serving community dwelling military families. Approaches include behavioral

health homes, EBTs and treatment components, structured resiliency and parent training, military informed

schools, outreach methods, and technology-based coping, and psychoeducation. Methods from

implementation science to improve clinical skill acquisition and spread and sustainability of EBTs may

advance access to and quality of mental health treatment and are reviewed herein. Recommendations

related to research methods, military knowledge and treatment competencies, and transition to a public

health model of service delivery are discussed. Reserve and Guard members are isolated from healthcare

providers in a military context and who are fmailiar with conditions that may affect the military culture. There

must be a robust polic policy in place to support these reservee components.

Mustillo, S., et al. (2014). “Traumatic combat exposure and parenting among national guard fathers: an application of

the ecological model.” Fathering 12: 303+.

This study investigates how traumatic combat exposure affects fathers’ perceptions of parenting difficulties

following military deployment with data from 206 Indiana National Guard members. Based on Belsky’s

ecological model, findings from structural equation modeling indicate that combat exposure is indirectly

associated with parental difficulties through major depression, but not Post-Traumatic Stress Disorder.

Further, unit support experienced while deployed is associated with lower perceptions of parenting

difficulties among fathers during reintegration. Detecting and treating depression upon redeployment and

encouraging support within the unit during deployment and after may enhance well-being among National

Guard families.

Nash, W. and B. Litz (2013). “Moral Injury: A Mechanism for War-Related Psychological Trauma in Military Family

Members.” Clinical Child and Family Psychology Review 16(4): 365-375.

Recent research has provided compelling evidence of mental health problems in military spouses and

children, including post-traumatic stress disorder (PTSD), related to the war-zone deployments, combat

exposures, and post-deployment mental health symptoms experienced by military service members in the

family. One obstacle to further research and federal programs targeting the psychological health of military

family members has been the lack of a clear, compelling, and testable model to explain how war-zone

events can result in psychological trauma in military spouses and children. In this article, we propose a

possible mechanism for deployment-related psychological trauma in military spouses and children based on

the concept of moral injury, a model that has been developed to better understand how service members

and veterans may develop PTSD and other serious mental and behavioral problems in the wake of warzone

events that inflict damage to moral belief systems rather by threatening personal life and safety. After

describing means of adapting the moral injury model to family systems, we discuss the clinical implications

of moral injury, and describe a model for its psychological treatment.

O’Donnell, L., et al. (2011). “Trauma Spectrum Disorders: Emerging Perspectives on the Impact on Military and

Veteran Families.” 16(3): 284-290.

This article summarizes the findings from the Second Annual Trauma Spectrum Disorders Conference,

which was held in December 2009 and was sponsored by the Defense Centers of Excellence for

Psychological Health and Traumatic Brain Injury in conjunction with the Department of Veterans Affairs and

the National Institutes of Health. The conference covered recent research on the impact of trauma spectrum

disorders on military and veteran families and caregivers during deployment, homecoming, and

reintegration. Attendees highlighted the need for research studies that examine the needs of warriors with

trauma spectrum disorders on

a deeper level. Current interventions for trauma spectrum disorders were discussed, as well as recommendations for

advancing the quality of care for warriors and their families in the future.

Acknowledges the definition of “family” has changed. i.e. and the differences of issues in modern families

can be vast. The problems of a single mother with limited job skills returning home to her two teenage sons

are vastly different from a middle-aged man with TBI who is responsible for his aging mother. Couples in

same-sex relationships and those living with friends or extended family members have to be considered in

the mix.

Provides a background of programs offered by the VA for families and children of soldiers with TBI and also


Pfeiffer, P. N., et al. (2012). “Peers and peer-based interventions in supporting reintegration and mental health among

National Guard soldiers: a qualitative study.” 177(12): 1471-1476.

National Guard soldiers experience high levels of mental health symptoms following deployment to Iraq and

Afghanistan, yet many do not seek treatment. We interviewed 30 National Guard soldiers with prior

deployments to Iraq or Afghanistan to assess mental health treatment barriers and the role of peers in

treatment engagement. Interview transcripts were analyzed by a multidisciplinary research team using

techniques drawn from grounded theory. The following themes were identified: (1) personal acceptance of

having a mental health problem rather than treatment access is the major barrier to treatment entry; (2)

tightly connected, supportive peer networks can decrease stigma related to mental health problems and

encourage treatment; however, soldiers in impoverished or conflicted peer networks are less likely to receive

these benefits; and (3) soldiers are generally positive about the idea of peer-based programs to improve

treatment engagement, although they note the importance of leadership support, peer assignment, and unit

specialty in implementing these programs. We conclude that some, but not all, naturally occurring peer

networks serve to overcome stigma and encourage mental health treatment seeking by soldiers. Formal

peer-based programs may assist soldiers not sufficiently benefitting from natural peer networks, although

there are barriers to implementation.

Reed, S. C., et al. (2011). “Adolescent Well-Being in Washington State Military Families.” American Journal of Public

Health 101(9): 1676-1682.

Objectives. We examined associations between parental military service and adolescent well-being.

Methods. We used cross-sectional data from the 2008 Washington State Healthy Youth Survey collected in

public school grades 8, 10, and 12 (n=10606). We conducted multivariable logistic regression analyses to

test associations between parental military service and adolescent well-being (quality of life, depressed

mood, thoughts of suicide). Results. In 8th grade, parental deployment was associated with higher odds of

reporting thoughts of suicide among adolescent girls (odds ratio [OR]=1.66; 95% confidence interval

[CI]=1.19, 2.32) and higher odds of low quality of life (OR=2.10; 95% CI=1.43, 3.10) and thoughts of suicide

(OR=1.75; 95% CI=1.15, 2.67) among adolescent boys. In 10th and 12th grades, parental deployment was

associated with higher odds of reporting low quality of life (OR=2.74; 95% CI=1.79, 4.20), depressed mood

(OR=1.50; 95% CI=1.02, 2.20), and thoughts of suicide (OR=1.64; 95% CI=1.13, 2.38) among adolescent

boys. Conclusions. Parental military deployment is associated with increased odds of impaired well-being

among adolescents, especially adolescent boys. Military, school-based, and public health professionals

have a unique opportunity to develop school- and community-based interventions to improve the well-being

of adolescents in military families. ABSTRACT FROM AUTHOR

This study examined the association between parental military service and adolescent well-being. Results

were statistically different between genders. The results showed military parents were more likely to engage

in binge drinking or drug use than were those with civilian parents and parental deployment was associated

with higher odds of reporting thoughts of suicide among adolescent girls and boys.

Riggs, S. A. (2011). “Risk and resilience in military families experiencing deployment: The role of the family

attachment network.” 25(5): 675-687.

Rodriguez, A. J. and G. Margolin (2011). “Siblings of Military Servicemembers: A Qualitative Exploration of Individual

and Family Systems Reactions.” Prof Psychol Res Pr 42(4): 316-323.

How does having a sibling in the military affect young adults? Despite increasing attention to the challenges

faced by spouses and children of servicemembers, the siblings of servicemembers have been largely

ignored. This qualitative investigation uses unstructured narratives to explore siblings’ perceptions of

changes in their lives and changes in the family of origin associated with having a family member enlist in

the United States military. Thematic analyses revealed an acute period of conflict followed by reorganization,

awareness of the parents’ distress, changes in the emotional climate of the family, shifts in family roles,

admiration for the military sibling, and increased meaning and purpose for the family following the

servicemember’s enlistment. Computer-assisted text analyses revealed both positive and negative

emotional content associated with the siblings’ military service. For professional psychologists who come

into contact with siblings of servicemembers, it is important to recognize that military enlistment can have

ripple effects and complicate other common individual and family stresses. More generally, it is important to

provide siblings and the family of origin with information about what to expect during and after the

servicemember’s enlistment, especially since these families may lack support and contact from others going

through similar transitions.

Most current literature does not evaluate the affect of a young adult enlisting in the military on younger

siblings in their family and the change in family dynamic. This study provides a qualitative look at this affect

via self-reported analyses of the: acute period of conflict followed by reorganization, awareness of the

parents’ distress, changes in the emotional climate of the family, shifts in family roles, admiration for the

military sibling, and increased meaning and purpose for the family following the servicemember’s enlistment.

Study reveled both positive and negative emotional expressions associated with the siblings’ military service.

Ross, A. M. and E. R. DeVoe (2014). “Engaging military parents in a home-based reintegration program: a

consideration of strategies.” 39(1): 47-54.

For more than a decade, the long wars in Afghanistan and Iraq have

placed tremendous and cumulative strain on U.S. military personnel and their families. The high operational tempo,

length, and number of deployments—and greater in-theater exposure to threat—have resulted in well-documented

pychological health concerns among service members and veterans. In addition, there is increasing and

compelling evidence describing the significant deleterious impact of the deployment cycle on family

members, including children, in military-connected families. However, rates of engagement and service

utilization in prevention and intervention services continue to lag far belowapparent need among service

members and their families, because of both practical and psychological barriers. The authors describe the

dynamic and ultimately successful process of engaging military families with young children in a homebased

reintegration program designed to support parenting and strengthen parent–child relationships as

service member parents move back into family life. In addition to the integration of existing evidence-based

engagement strategies, the authors applied a strengths-based approach to working with military families and

worked from a community-based participatory foundation to enhance family engagement and program

completion. Implications for engagement of military personnel and their loved ones are discussed.

Rossetto, K. R. and K. R. Rossetto (2013). “Relational coping during deployment: Managing communication and

connection in relationships.” 20(3): 568-586.

Sahlstein, E., et al. (2009). “Contradictions and Praxis Contextualized by Wartime Deployment: Wives’ Perspectives

Revealed through Relational Dialectics.” Communication Monographs 76(4): 421-442.

Schaaf, K. P. W., et al. (2013). “Evaluating the needs of military and veterans’ families in a polytrauma setting.”

Rehabilitation Psychology 58(1): 106-110.

Objective – To examine the perceived importance of needs and the extent to which they are met among a

sample of family members in an inpatient polytrauma setting. Method: The Family Needs Questionnaire was

administered to 44 family members of patients at the Polytrauma Rehabilitation Center at McGuire Veterans

Affairs Medical Center over a 30-month period. Results: Families rated health information needs as most

important and most frequently met. conversely, family members rated emotional support and instrumental

support needs as least important and most frequently unmet. Conclusion: Preliminary data suggest that the similarity

between family needs in military and civilian settings is noteworthy, and provide direction for development of

empirically based family intervention models for polytrauma settings.

Study is very limited – To date, there is little or no systematically derived empirical information about the

unique needs of families in polytrauma settings and what interventions may be effective in supporting their


Settersten, R. A., Jr. and B. Ray (2010). “What’s going on with young people today? The long and twisting path to

adulthood.” The Future of Children 20(1): 19-41.

Richard Settersten and Barbara Ray examine the lengthening transition to adulthood over the past several

decades, as well as the challenges the new schedule poses for young people, families, and society.

Lack of relelevant information

Shalv, I., et al. (2012). Childhood Trauma and Telomere Maintenance. European Journal of Psychotraumatology:

Effects of Traumatic Stress Molecular and Hormonal Mechanism. M. Olff, Co-Action Publishing. 3: 1-2.

Rationale/ statement of the problem: Stress in early life is known to have a powerful direct effect on poor

health in later life. This direct effect requires one or more underlying mechanisms that can maintain it across

the life-course. It is therefore essential to characterize the biological mechanisms through which children

may acquire such lasting

vulnerability to disease, namely, the mechanisms of biological embedding. One plausible mechanism may lie in

changes to DNA. New research suggests that stress exposures can accelerate the erosion of DNA

segments called telomeres. In the past 2 years, six studies provided support for an association between

telomere length (TL) and childhood stress.

Although these studies advance understanding of the link between childhood stress and TL, almost all studies have

relied on adult measures of TL and retrospective recall of stress years after the stress was experienced

raising important questions about the true nature of these findings. Interpretation of findings from cross-sectional

studies of TL is ambiguous in light of recent longitudinal analyses of repeated TL measurements.

These recent findings

indicate that the temporal process of telomere erosion is more complex than initially assumed, and that repeated

measures (not just length at one time point) are needed to measure true telomere erosion in individuals who

are experiencing stress. Moreover, given the elapsed time between the putative stress exposure and the

measurement of

TL, it has not been clear whether telomeres began eroding during stress exposure or whether erosion occurred years

later, possibly promoted by the sequelae of childhood stress or other intervening variables. In our study, we

used a longitudinal design to test the effects of violence exposure during childhood on telomere erosion in a

cohort of young children. We tested the hypothesis that cumulative violence exposure would accelerate

telomere erosion in children while they experienced stress.

Conclusion: This finding provides the first evidence that stress-related accelerated telomere erosion in buccal cells

can be observed already at young age while children are experiencing stress. Children who experienced two

or more types of violence exposure between age-5 baseline and age-10 follow-up measurements showed

significantly more telomere erosion, even after adjusting for confounding factors. The results of the present

study add weight to the hypothesis that exposure to stress in childhood can alter biological processes in

relation to telomere erosion. Methodological strengths of this study include a longitudinal design with reliable

and valid prospective assessments of multiple violence exposures during childhood and repeated

measurements of TL during this same developmental period.

Research and statistics show there is significant impact on health outcomes as a result of prolonged

deployment and trauma-related stress on military families, particularly spouses and children. This research

demonstrates the biological impact of stress on children via telomere erosion attributable to traumatic stress.

Shonkoff, J. P. (2011). “Protecting Brains, Not Simply Stimulating Minds.” Science 333(6045): 982-983.

Curricular enhancements in early childhood education that are guided by the science of learning must be

augmented by protective interventions informed by the biology of adversity. The same neuroplasticity that

leaves emotional regulation, behavioral adaptation, and executive functioning skills vulnerable to early

disruption by stressful environments also enables their successful development through focused

interventions during sensitive periods in their maturation. The early childhood field should therefore combine

cognitive-linguistic enrichment with greater attention to preventing, reducing, or mitigating the consequences

of significant adversity on the developing brain. Guided by this enhanced theory of change, scientists,

practitioners, and policy-makers must work together to design, implement, and evaluate innovative

strategies to produce substantially greater impacts than those achieved by existing programs.

Shonkoff, J. P., et al. (2012). “The Lifelong Effects of Early Childhood Adversity and Toxic Stress.” Pediatrics 129(1):


Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental

psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding

of health and disease across the lifespan. This converging, multidisciplinary science of human development has

profound implications for our ability to enhance the life prospects of children and to strengthen the social and

economic fabric of society. Drawing on these multiple streams of investigation, this report presents an

ecobiodevelopmental framework that illustrates how early experiences and environmental influences can

leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term

health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering

intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior,

and both physical and mental well-being. The implications of this framework for the practice of medicine, in

general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases

should be viewed as developmental disorders that begin early in life and that persistent health disparities

associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in

childhood. An ecobiodevelopmental framework also underscores the need for new thinking about the focus

and boundaries of pediatric practice. It calls for pediatricians to serve as both front-line guardians of healthy

child development and strategically positioned, community leaders to inform new science-based strategies

that build strong foundations for educational achievement, economic productivity, responsible citizenship,

and lifelong health.

Slomski, A. (2014). “Iom: Military psychological interventions lack evidence.” JAMA 311(15): 1487-1488.

During 11 years of war, there were 936 283 diagnoses of psychological disorders among current or former

service members, with adjustment disorders the most prevalent (26%), followed by depression (17%),

substance abuse and dependence (17%), anxiety (10%), and posttraumatic stress disorders (PTSDs, 6%).

Suicide rates in the Army also began to substantially increase at the beginning of the Iraq and Afghanistan

wars, including among soldiers never deployed.

The take away – Fallout Extends to Military Families Deployment to combat zones also takes a heavy toll on

spouses and children. “About a third of military children have clinically significant levels of anxiety, and

adolescents have higher levels of risk-taking behavior and behavioral problems,” said IOM committee

member Patricia Lester,MD, of the University of California, Los Angeles. “When parents have PTSD,

theymay pull themselvesaway from the family to avoid scaring their kids, which causes a negative impact on

marriage and family life.

Smith, C. K. (2011). “2011 presidential initiative: strengthening our military families.” Professional case management

– Journal Article 16(4): 214.

Source, M. O. (2013). “Demographics Profile of the Military Community – 2013.” Office of the Deputy Assistant

Secretary of Defense.

Thompson, R. A. (2014). Stress and child development. 24: 41+.

Willerton, E. (2011). “Military fathers’ perspectives on involvement.” 25(4): 521-530.

Zatzick, D., et al. (2015). “Parental injury and psychological health of children.” Pediatrics (Evanston) 134(1): e88.

Results – There were bidirectional effects of parental and child injury on the outcomes of each other. Injuries

to the parent negatively affected the health-related quality of life of the injured children, over and above the

effect of the injury itself on the child. Of great concern is the effect of parental injury on risk of stress and

PTSD among uninjured children in the home.