By the end of 2008, 1.7 million American Service Members had served in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF).(1) Military personnel serving in Iraq and Afghanistan run the risk of developing problems such as depression, PTSD, anxiety, and traumatic brain injury due to their deployment. Studies of these returning service members and Veterans have found rates of 4% to 14% for depression, 12% to 25% for PTSD, 11% to 19% for traumatic brain injury, and 18% to 35% for any mental health risk or concern. (2,3,4)
Forty-three percent of active duty service members have children. (5) These children face the challenges inherent in having a parent deployed. Many of them must also cope with living with a parent who returns profoundly changed by war. Most families will be able to overcome these adversities through the support of family, friends, and community. Others, however, will need additional help from service providers to strengthen their resilience, access needed services, and readjust to life post-deployment. Veterans themselves recognize the need for such services. In a recent study of Veterans receiving treatment for PTSD, nearly 80% were interested in greater family involvement in their care. (6)
While frequent moves, absence of the military parent, and other stresses are common for military families, the deployment of a parent to a combat zone represents a challenge of a different magnitude. (7) For the parent who stays behind (usually the mother) increased family responsibilities, financial issues, isolation, and fear for their spouse's safety can cause anxiety, loneliness, sadness, and a feeling of being overwhelmed. (8)
Children's reactions to a parent's deployment vary by child, and more broadly, by a child's developmental stage, age, and presence of any preexisting psychological or behavioral problems. Very young children may exhibit separation anxiety, temper tantrums, and changes in eating habits. School-age children may experience a decline in academic performance, and have mood changes or physical complaints. Adolescents may become angry and act out, or withdraw and show signs of apathy. (9)
Especially for young children (10), the mental health of the at-home parent is often a key factor affecting the child's distress level. Parents reporting clinically significant stress are more likely to have children identified as "high risk" for psychological and behavioral problems. (11,12)
Older studies of Vietnam Veterans demonstrate the negative impact on families of war-related PTSD. These Veterans have higher levels of marital problems, family violence, and partner distress. Their children present more behavioral problems than do those of Veterans without PTSD. Veterans with the highest levels of symptomology had families with the worst functioning. (13) The numbing and avoidance experienced by Veterans with PTSD is associated with lower parenting satisfaction. (14) The difficulty these Veterans have experiencing emotions and their sense of detachment may make it difficult for them in their personal relationships, and may even lead to behavioral problems on the part of their children.
More recent studies of personnel deployed to Afghanistan and Iraq have looked at family functioning in the near-term post-deployment period. In one study, soldiers' dissociative symptoms, sexual problems, and sleep disturbances had the greatest impact on relationships. The total number of traumatic events experienced, either during the war or in other contexts, did not significantly affect relationship satisfaction. (15) In a sample referred for mental health evaluation, 75% of Veterans with partners reported at least one family adjustment issue. Fifty-four percent of these Veterans reported shouting with, shoving, or pushing current or former partners. Symptoms of depression were associated with family problems generally and domestic abuse in particular. Among Veterans with children, those with more severe PTSD and depression were more likely to report that their children were afraid of them or lacked warmth towards them. (16)
Resources for providers can be found on the Children and Adolescents Web Links page in the "Professional" section of our website.
Links to educational materials for patients can be found on our website:
Information from previous conflicts and from the ongoing conflicts in Iraq and Afghanistan indicates that the effects of war go far beyond the deployed service member. Children and families struggle both with changes resulting from an absent parent or spouse as well as changes when the absent service member returns.
The mental health of the at-home parent plays a crucial role in children's adjustment during deployment. The mental health of the returning service member also affects the children as well as family functioning and relationship satisfaction. Therefore, it is important that the needs of the entire family are considered. Pilot programs both within and outside VA are currently underway to address this important issue.