Longitudinal predictors of children's self-blame appraisals among military families reported for family violence.

BACKGROUND: Although children's self-blame appraisals are recognized as important sequelae of child victimization that contribute to subsequent adjustment problems, little is known about the factors that predict their development and longitudinal course. OBJECTIVE: The current study examines the stability and longitudinal predictors of children's self-blame appraisals among a sample of children reported for family violence. PARTICIPANTS AND SETTING: Children (N = 195; 63 % female) aged 7 to 17 years (Mage = 12.17) were recruited as part of a longitudinal assessment of families referred to the United States Navy's Family Advocacy Program due to allegations of child physical abuse, sexual abuse, or intimate partner violence. METHODS: Children completed assessments on self-blame at 3 time points (baseline, 9-12 months, and 18-24 months) and baseline measures of their victimization experience, caregiver-child conflict, and depression. RESULTS: In univariate analyses, victimization that involved injury (r = 0.29, p < .001), the number of perpetrators (r = 0.23, p = .001), the number of victimization types (r = 0.32, p < .001), caregiver-child conflict (r = 0.36, p < .001), and depression (r = 0.39, p < .001) were each positively associated with baseline self-blame. When examined in a single longitudinal multilevel model, results indicated only caregiver-child conflict (b = 0.08, p = .007) and baseline depression (b = 0.06, p = .013) predicted increases in self-blame. CONCLUSION: Findings suggest clinicians and researchers may consider assessment of victimization characteristics, caregiver-child relationships, and depression symptoms to identify children most at risk for developing self-blame appraisals.

Parental efficacy after a military parenting program: A dyadic latent growth model.

Parental efficacy is an important aspect of parenting and a key outcome in many parenting programs. However, most studies focus on mothers, and less is known about the relationship between coparents' parental efficacy over time following intervention, and how parental distress can impact parental efficacy. The current study (N = 271 heterosexual couples; 162 intervention and 109 control) used a dyadic latent growth model to explore the dependence structure of parental efficacy between couples 2 years after assignment to a military parenting program, After Deployment, Adaptive Parenting Tools or a control condition. Results revealed a significant intervention effect, with both mothers and fathers in the intervention group exhibiting quadratic changes over 2 years, while the control group remained relatively stable. Notably, mothers' baseline emotional distress and fathers' deployment length emerged as predictors in understanding parental efficacy improvement over time. This research underscores the importance of adopting a family systems perspective and considering emotional distress and environmental stressors in designing targeted interventions to support military families and enhance overall well-being.

Parental perceptions of social and emotional well-being of young children from Australian military families.

INTRODUCTION: Many Australian Defence Force (ADF) and Veteran families are affected by the stressors of Defence family life, including frequent and prolonged parental deployments, and frequent relocations. OBJECTIVE: To address a gap in information about Defence and Veteran (hereafter Defence) parents' knowledge, confidence and resources to support their young children's well-being and build their resilience. DESIGN: This study used a mixed methods design to explore Defence parent's perceptions of their young children's (aged 2-8 years) social and emotional well-being and understanding of their children's responses to unique stressors as well as their confidence in providing support. Data from 41 parents were available. FINDINGS: Overall, parents reported positive well-being evaluation of their children. However, just over a third of parents also reported that their children rarely cope well on two indicators combined (adapting to new situations and sharing negative emotions with others). Significantly, more than half of the parents (61%) were only partially confident in their ability to assist their children to cope with unique stressors in military families. Qualitative data provided further insights into children's struggle with relocations and parental absence and the challenges parents face in supporting them. Parents reported having limited access to effective age- and culturally appropriate resources to support their young children. DISCUSSION: In a first-of-its kind study, we found that Australian Defence parents reported their young children were coping on most of the key well-being indicators. However, awareness of currently available supports for children remains a barrier as well as access to contextualised, age- and culturally appropriate resources are lacking. CONCLUSION: There is a need for access to free, quality, online, research-based Australian resources to support young children from Defence families, especially for those living in regional and rural locations and are less likely to have access to mental health and other specialist supports.

Use of food distribution resources among military families with young children since the COVID-19 pandemic.

OBJECTIVE: The present study examined military families' use of food distribution resources and military (e.g. rank) and non-military (e.g. race/ethnicity) characteristics associated with using food distribution resources. DESIGN: Secondary data analyses from a cross-sectional survey in the first 6 months of 2021. SETTING: A national sample of eligible families completed an online survey. PARTICIPANTS: 8326 enlisted military families with an active duty service member in the United States Army or Air Force who applied for supplemental childcare funding distributed by National Military Family Association. RESULTS: 13·2 % of the families reported utilising a food distribution resource in the past 12 months. Those with lower financial well-being were more likely to utilise such resources. Older (OR = 1·04, 95 % CI = 1·02, 1·05, P < 0·001), single-earner (OR = 0·73, 95 % CI = 0·61, 0·89, P = 0·001) families with a lower rank (OR = 0·69, 95 % CI = 0·64, 0·75, P < 0·001) and Army affiliation (compared with Air Force) (OR = 2·31, 95 % CI = 2·01, 2·67, P < 0·001) were more likely to utilise food distribution resources. Members of certain racial/ethnic minority groups were more likely to utilise food distribution resources than White respondents (OR from 1·47 for multi-racial to 1·69 for Asians), as were families with more dependent children (OR = 1·35, 95 % CI = 1·25, 1·47, P < 0·001). CONCLUSIONS: These results identify the extent of food distribution resource utilisation in military families with young children approximately 1 year into the COVID-19 pandemic. The results also identify characteristics associated with their use of food distribution resources. Findings are discussed with an emphasis on prevention and intervention implications for military families.

Exploring the Lived Experiences of Pain in Military Families: A Qualitative Examination.

Chronic pain in Canadian Veterans is twice that of the general population and the prevalence of their related mental health concerns is alarmingly high. This likely puts their children at an increased risk of developing pain and mental health problems that can pervasively impact daily life and persist into adulthood. Pain care and military culture of (acute and chronic) pain have been identified as a top priority of Canadian Veterans. This study aimed to gain an in-depth understanding of the pain experiences of Canadian Armed Forces families. Thirty-five semi-structured qualitative interviews were conducted. Demographic information was collected; age, gender, and ethnicity were reported. Twelve Canadian Armed Forces members/Veterans, 17 youth, and 6 spouses were interviewed. Ninety-two percent of Veteran participants reported chronic pain. Reflexive thematic analyses generated four themes: 1) Military mindset: herd culture and solider identity, 2) The culture of pain within military families, 3) Inseparability of mental health and pain, and 4) Breaking the cycle and shifting the military mindset. Military culture and identity create a unique context within which pain expression and experience is integrally shaped within these families. This study sheds light on how pain is experienced and perceived within military families and can inform research on and efforts to foster resilience in these families. PERSPECTIVE: This is the first qualitative study to explore the lived experiences of pain in Canadian military families. Findings underscore the key role that military culture and identity plays in how pain is experienced and perceived in all family members.

A cross-sectional study of mental health and well-being among youth in military-connected families. / Étude transversale sur la santé mentale et le bien-être de jeunes de familles liées au milieu militaire.

INTRODUCTION: The study objective was to compare the mental health and risk-taking behaviour of Canadian youth in military-connected families to those not in military-connected families in a contemporary sample. We hypothesized that youth in military-connected families have worse mental health, lower life satisfaction and greater engagement in risk-taking behaviours than those not in military-connected families. METHODS: This cross-sectional study used 2017/18 Health Behaviour in School-aged Children in Canada survey data, a representative sample of youth attending Grades 6 to 10. Questionnaires collected information on parental service and six indicators of mental health, life satisfaction and risk-taking behaviour. Multivariable Poisson regression models with robust error variance were implemented, applying survey weights and accounting for clustering by school. RESULTS: This sample included 16 737 students; 9.5% reported that a parent and/or guardian served in the Canadian military. After adjusting for grade, sex and family affluence, youth with a family connection to the military were 28% more likely to report low well-being (95% CI: 1.17-1.40), 32% more likely to report persistent feelings of hopelessness (1.22-1.43), 22% more likely to report emotional problems (1.13-1.32), 42% more likely to report low life satisfaction (1.27-1.59) and 37% more likely to report frequent engagement in overt risk-taking (1.21-1.55). CONCLUSION: Youth in military-connected families reported worse mental health and more risk-taking behaviours than youth not in military-connected families. The results suggest a need for additional mental health and well-being supports for youth in Canadian military-connected families and longitudinal research to understand underlying determinants that contribute to these differences.

Mental health of Canadian children growing up in military families: The parent perspective.

A recent scoping review found that stressors involved in the military lifestyle (i.e., frequent relocation, parental absence, and risk of parental injury) may be associated with mental health issues among military-children. However, most of the included studies were conducted in the United States with little Canadian representation. To examine the degree to which the scoping review findings are relevant to the Canadian context, we conducted a qualitative study and interviewed 37 parents in Canadian military families. Through the use of a qualitative description approach and content analysis, three themes were identified: 1. Military lifestyle factors have an impact on child mental health; 2. Military life can promote both resilience and vulnerability; and 3. Military lifestyle impacts on parental mental health had an impact on children. These themes align with the scoping review findings asserting that military lifestyle factors can influence child mental health and have significant implications for health care providers working with military-connected children.

Identifying Mental Health Profiles Among Adolescents Who Experienced a Recent Parental Deployment or Military-Related Family Separation.

Accessing two independent samples of adolescents in military families in the United States who recently experienced parental separation (N = 573; N = 186), this study sought to identify adolescent mental health profiles indexed on multiple indicators. In other words, we asked how military adolescents fare after parental separation in terms of mental health indicators. Proximal family processes (family cohesion, conflict, and marital adjustment) were also examined in relation to mental health profiles as well as core adolescent outcomes, self-rated health, and school enjoyment. In both samples, three profiles emerged identifying similar structures of mental health profiles. Two-thirds of adolescents were in the lowest risk mental health group. Poor family cohesion and greater conflict were associated with the moderate and highest risk groups. The lowest risk group reported better health and greater school enjoyment. Family nurses and other health care professionals are encouraged to inquire about military connectedness, structural changes occurring within the family system, and family processes in relation to adolescent well-being.

Examining food parenting practices in military families.

Food parenting practices impact child eating and weight outcomes. While there are currently no data examining food parenting practices among military families, research on general parenting has shown that military families are more likely to engage in authoritarian parenting practices. In addition, psychological well-being affects food parenting, and the military lifestyle is defined by how frequently they experience stressful demands such as deployment and relocation. The study objectives were to describe food parenting practices among military families by: (1) comparing food parenting practices between military families and civilian families; and (2) exploring associations between military (total military years, deployments, relocation) and psychological (stress, anxiety, depression) factors and food parenting practices. Participants includes 358 parents (103 military, 255 civilian) of children between the ages of five and 13 years. There were no significant differences in food parenting practices between military and civilian families. However, within military families, both total number of military parent and having more than one military parent were associated with increased structure-based food parenting practices. Having more than one military relocation was associated with more frequent pressure to eat and coercive control. While stress was associated with more frequent restriction, there were no associations between anxiety or depression and food parenting practices. These findings suggest that although food parenting practices of military families are similar to those of their civilian counterparts, there are specific psychological and military life factors that impact food parenting practices in this population.

Adolescent mental health in military families: Evidence from the Canadian Health Behaviour in School-aged Children study.

OBJECTIVES: To investigate the association between physical and mental health symptoms in adolescents and having a parent in the Canadian Armed Forces and the moderation of these associations by various sources of social support. METHODS: We used data on a nationally representative sample of 18,886 adolescents (11-15 years) in the 2017/18 Canadian Health Behaviour in School-aged Children study (HBSC). Survey assessments included multi-item scales of mental and physical health symptoms and sources of social support (peers, families, classmates, and teachers). Poisson regression was used to estimate incidence rate ratios (IRR) of weekly symptoms in military versus non-military youths. Moderation of differences between these groups were tested using interactions of variables representing support and military families. RESULTS: Military youth, compared to non-military youth, reported more mental health symptoms (IRR = 1.20; 95% CI 1.08, 1.33) but only marginally more physical symptoms (IRR = 1.15; 95% CI 1.00, 1.33) in the previous week. These associations were stronger in youths who reported lower levels of peer support (IRR = 0.99; 95% CI 0.98, 1.00 [mental health symptoms]; IRR = 0.98; 95% CI 0.97, 1.00 [physical health symptoms]). Support from families, classmates and teachers did not moderate differences in mental or physical symptoms. CONCLUSION: Canadian adolescents in military families have increased risk for experiencing poor mental health. Peer support may play a protective role, however further research is needed to guide clinical interventions for this unique population.

RéSUMé: OBJECTIFS: Étudier l'association entre les symptômes de santé physique et mentale chez les adolescents et le fait d'avoir un parent dans les forces armées canadiennes et la modération de ces associations par diverses sources de soutien social. MéTHODES: Nous avons utilisé les données d'un échantillon national représentatif d'adolescents (n = 18 886; 11 à 15 ans) dans l'étude 2017­2018 sur les comportements de santé des enfants d'âge scolaire (HBSC) au Canada. Les évaluations de l'enquête comprenaient des échelles multi-items de symptômes de santé mentale et physique et des sources de soutien social (pairs, familles, camarades de classe et enseignants). Un modèle de régression de Poisson a servi à estimer les rapports de taux d'incidence (TRI) des symptômes hebdomadaires chez les jeunes militaires par rapport aux jeunes non militaires. La modération des écarts entre ces groupes a été testée en utilisant les interactions entre le soutien militaire et les variables familiales. RéSULTATS: Les jeunes militaires, comparativement aux jeunes non militaires, ont signalé plus de symptômes de santé mentale (TRI = 1,20; IC à 95% 1,08, 1,33), mais seulement légèrement plus de symptômes physiques (TRI = 1,15; IC à 95% 1,00, 1,33) au cours de la semaine précédente. Ces associations étaient plus fortes chez les jeunes qui ont déclaré des niveaux inférieurs de soutien par les pairs (IRR = 0,99; IC à 95% 0,98, 1,00 [symptômes de santé mentale]; IRR = 0,98; IC à 95% 0,97, 1,00 [santé physique symptômes]). Le soutien des familles, des camarades de classe et des enseignants n'a pas atténué les différences de symptômes mentaux ou physiques. CONCLUSION: Les adolescents canadiens de familles militaires sont exposés à un risque accru de maladie mentale. Le soutien par les pairs peut jouer un rôle de protection, mais il faut effectuer d'autres recherches pour orienter les interventions cliniques auprès de cette population unique.

The Relationship Between Anxiety, Coping, and Disordered-Eating Attitudes in Adolescent Military-Dependents at High-Risk for Excess Weight Gain.

Adolescent military-dependents are an understudied population who face unique stressors due to their parents' careers. Research suggests that adolescent military-dependents report more anxiety and disordered-eating than their civilian counterparts. While anxiety symptoms predict the onset and worsening of disordered-eating attitudes, the mechanisms underlying this relationship remain unclear. One factor that may underlie this relationship, and be particularly relevant for military-dependent youth, is coping. Therefore, we examined adolescent military-dependents (N=136; 14.5±1.5 years; 59.6% female; BMI-z: 1.9±0.4) who were at-risk for adult obesity and binge-eating disorder due to an age- and sex-adjusted BMI ≥ 85th percentile and loss-of-control eating and/or elevated anxiety. Participants completed an interview assessing disordered-eating attitudes and questionnaires on anxiety symptoms and coping strategies at a single time point. Bootstrapping models were conducted to examine the indirect paths between anxiety symptoms and disordered-eating attitudes through five coping subscales (aggression, distraction, endurance, self-distraction, and stress-recognition). Adjusting for relevant covariates, no significant indirect paths through the coping subscales (ps > .05) were found in any models. General coping, non-specific to eating, may not be a pathway between anxiety symptoms and disordered-eating attitudes among adolescents. Future research should examine other potential mediators of this relationship.

Epidemiology of obesity and high blood pressure among school-age children from military families: the largest report from our region.

BACKGROUND: For the first time, we aimed to determine the epidemiology and associated factors of obesity and hypertension among children of military families in our region. METHODS: In this multi-centered study, children between the ages of 5 to 12 years old, entered the study. Data on baseline and clinical characteristics, history of disease and anthropometric measurements, were collected. RESULTS: Among 504 children, 44.2% were males. Mean (SD) age of participants was 7.9 ± 1.9 years. Overall, 5% were obese and 9.9% were overweight. In total, 16.3% had elevated BP, 12.5% had stage one and 0.2% had stage two hypertension. Age (beta = 0.306, OR = 1.35, 95% CI:1.14-1.61), obesity/overweight (OR = 5.58, 95% CI:2.59-12.0), history of hypertension in mother (OR = 43.24, 95% CI:5.99-312.11), low birth weight (OR = 7.96, 95% CI:2.59-12.0), physical activity (OR = 0.27, 95% CI:0.10-0.72), and consumption of fast food more than once a week (OR = 3.36, 95% CI:1.82-6.19), were associated with risk of hypertension. Furthermore, age (beta = 0.346, OR = 1.41, 95% CI:1.21-1.64), history of childhood obesity in the father (OR = 3.78, 95% CI: 1.77-8.06) and mother (OR = 2.44, 95% CI:1.07-5.56), and physical activity (OR = 0.27, 95% CI:0.11-0.66), were associated with obesity. CONCLUSION: Age, obesity/overweight, history of hypertension in the mother, birth weight, physical activity, and consumption of fast food, were associated with risk of hypertension. Moreover, age, history of childhood obesity in parents, and physical activity, were associated with obesity. Furthermore, we found that school-age children in military families have higher rates of hypertension and overweight compared to other reports from our region.

Should we give military families a break? A call for research on military family holidays.

While the well-being of the family unit is increasingly acknowledged (eg, in academic research, policy debate and podcast media) as central to the fitness and resilience of the Armed Forces, initiatives to support family well-being have been slow to emerge. One proposed means of support is the provision of holidays (whether abroad or 'staycations') to families who may be struggling to cope with stressors related to military life. Building on evidence from leisure and tourism studies, holidays are understood as providing benefits to family well-being, including rest and recuperation, respite from the stressors of everyday life, and building resilience and social capital. With a view to developing policy and practice, we suggest that research could meaningfully examine the use of holidays as a means of supporting military families. This article aims to stimulate debate regarding how families are supported within the UK Armed Forces.

Pre- and Perinatal Risk Factors for Child Maltreatment in Military Families Across the First Two Years of Life.

Military families are exposed to a unique constellation of risk factors, which may impact maltreatment outcomes. The present study examined prospective relationships between demographic, health, birth-related, and military-specific risk factors identified prior to a child's birth on their risk for maltreatment in the first two years of life. Data from the Millennium Cohort Study, Department of Defense (DoD) operational records and Family Advocacy Program data on met-criteria maltreatment, and Birth and Infant Health Research program data on suspected maltreatment were linked for 9076 service member parents. Discrete time survival analysis showed that preterm birth increased risk of maltreatment while parents' older age, physical health, and service in the Navy or Air Force decreased risk. Building on DoD's New Parent Support Program, findings suggest the need for universal and targeted prevention efforts, beginning during pregnancy, which limit or eliminate risk factors for maltreatment in military families.

An Education Intervention to Improve Knowledge of Post-Traumatic Stress Disorder Symptoms and Treatments Among U.S. Women Service Members and Veterans.

INTRODUCTION: Due to decades of prolonged combat operations, post-traumatic stress disorder (PTSD) is widely discussed and generally well conceptualized. The objective of this study was to determine if an educational program on the signs and symptoms of PTSD and an explanation of the current treatments utilized by the Veterans Administration is effective in increasing the knowledge levels of women service members and veterans, leading to seeking treatment. MATERIALS AND METHODS: The design of this study was a quantitative pretest/posttest interventional study. The educational program was conducted at a Senior Citizen Center. The population was a purposive sample of 44 women service members and veterans from a military base in New Jersey. A 25-item PTSD Knowledge Questionnaire developed for the earlier Web-Based Post-traumatic Stress Disorder Education for Military Family Members (2012) study was used as the pretest and posttest. RESULTS: The knowledge level of PTSD among women service members and veterans who participated in this study was significantly higher after completing the educational program with 43% indicating that they would seek mental health care. CONCLUSIONS: Women service members and veterans were ill-informed on the signs, symptoms, and treatment options of PTSD. If the results of this survey are an indicator of the knowledge level of women service members in broader populations, there is a need to restructure how those who are at risk of developing PTSD are educated. Through better educational programs, women and men could seek care with increasingly favorable long-term outcomes.

Military families: the impacts of having a first child during service on military mothers.

INTRODUCTION: The rights, roles and responsibilities of servicewomen in the UK Armed Forces has changed dramatically over time. Previously, service personnel were automatically discharged from the military if they became pregnant. As the percentage of servicewomen in the UK Armed Forces increases, having children during service is becoming more common and maternity policies are now in place. Having children during military service can impact on the health and well-being of servicewomen, including a greater risk of illness when returning to work. METHODS: A cross-sectional, self-report survey was used for data collection. The response rate was approximately 45%. Female Army veterans were recruited via a female military association. The survey collected data on parental status, the timing of their first child (during or after service), and several current mental and physical health and well-being outcomes. RESULTS: Of the 750 female Army veterans who completed the survey, 406 reported having children. Of those with children, 14.5% had their first child during service compared with 85.5% after service. The most frequently endorsed health outcomes were low social support, loneliness and common mental health difficulties. Participants who had their first child during military service were more likely to have left the service non-voluntarily. CONCLUSIONS: This study provided insight into the impacts of having a first child during military service on servicewomen. Overall, female Army veterans who had their first child during service had poorer outcomes, including leaving service non-voluntarily. However, none of the health or well-being outcomes remained significant after adjusting the results. This study explored a widely under researched population and field of research. Future research should seek to expand on our findings and continue to explore the impacts of having a first child during military service for military mothers.

Evaluating the KidCOPE for Children in Active Duty Military Families.

The KidCOPE is a widely used measure designed to examine how children cope in the face of stressful events. The current study aimed to replicate the factor structure of the KidCOPE found in four prior studies. KidCOPE responses from children of military families (2256 children, ages 7-12 years, 47.9% female, Age M = 8.90, SD = 1.62) enrolled in the Families OverComing Under Stress (FOCUS) at baseline were used. No prior factor structure could be replicated. The sample was then split, and exploratory and confirmatory factor analyses were conducted. A 2-factor model including factors for generally positive and negative coping was identified; but not confirmed. Overall, this study supports prior research suggesting limitations of the KidCOPE as a valid measure of coping style.

Bereaved UK military families: A mixed methods study on the provision of practical and emotional support.

Traumatic deaths of military personnel can have tragic consequences for the lives and health of bereaved significant others. To mitigate the effects, the UK Armed Forces enhanced the support for bereaved military families. However, little is known about whether the support has been satisfactory. The present research applied mixed methods to explore the experiences of bereaved UK military families (N = 264) with different types of support and how it historically changed over time. The findings suggest that although support has improved, further improvements are required in the provision of financial information, administrative support, and access to psychological support for all bereaved family members.

Predictors of missed school days among military connected families: A feasibility study.

BACKGROUND: There is a paucity of research specific to military children's health, especially those with special needs. This may be partly attributed to the difficulty in accessing military connected families as a population. Yet, given the recognized importance of military connected families to the national security agenda, a need exists for studies to explore factors underlying child and family health. PURPOSE: We sought to identify factors among a sample of military children with special health care needs (CSHCN) predictive of missed school days, a commonly used measure of health and one used by NPs to monitor chronic conditions management success. METHODOLOGY: We used a secondary data analysis design and multivariable logistic regression with a subsample of military connected families from the National Survey of CSHCN identified by their reported insurance type. RESULTS: We identified 1,656 military CSHCN. According to the adjusted model, hours of care per week, family work hours change, and activity limitations for the child were positive predictors of ≥4 missed school days per year. CONCLUSION/IMPLICATIONS: Our models identified important predictors of missed school days among military children that may inform assessments, interventions, and referrals by nurse practitioners caring for them. We identified a robust sample of military CSHCN from the National Survey of CSHCN by using self-reported insurance, a novel and simple approach to conducting a focused study of this population. Although feasible, this sampling approach was not without limitations. We advocate for including military connected families within sampling frameworks of national surveys to ensure that studies with this critical and unique population continue.