Wartime military deployment and increased pediatric mental and behavioral health complaints.
BACKGROUND
Children of military personnel face stress when a parent deploys.


OBJECTIVE
Our goal was to determine the effect of parental military deployment on the relative rate of outpatient visits for mental and behavioral health disorders in children aged 3 to 8 years.


METHODS
This was a retrospective cohort study. Records of children of active-duty personnel during fiscal years 2006 and 2007 were linked with their parent's deployment records. Mental and behavioral health visits were identified by using International Classification of Diseases, Ninth Revision, codes. The incidence rate ratio (IRR) of visits per year according to parental deployment status was determined with random-effects negative binomial regression modeling with longitudinal data analysis.


RESULTS
A total of 642,397 children aged 3 to 8 years and 442,722 military parents were included. Mean child age was 5.0 years (SD: 1.9 years); 50.6% were male, and 68.0% were white. Ninety percent of the parents were male, and 90.5% were married; 32.0% of the parents were deployed during the study. There were 1,049,081 person-years with 611,115 mental and behavioral health visits (0.6 visit per year). The IRR of mental and behavioral health visits for children with a deployed parent compared with when a parent was home was 1.11 (95% confidence interval [CI]: 1.07-1.14; P < .001). IRRs of pediatric anxiety, behavioral, and stress disorders when a parent deployed were 1.14 (95% CI: 0.98-1.32; P = .095), 1.19 (95% CI: 1.07-1.32; P < .001), and 1.18 (95% CI: 1.10-1.26; P < .001), respectively. Older children and children with military fathers and married parents had larger increases in rates of mental and behavioral health visits during parental deployments. In contrast, the overall outpatient rate and rates of visits for other diagnoses decreased when a parent was deployed.


CONCLUSIONS
Mental and behavioral health visits increased by 11% in these children when a military parent deployed; behavioral disorders increased 19% and stress disorders increased 18%. Rates especially increased in older children and children of married and male military parents.
Department of Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA. ggorman@usuhs.mil
Gregory H
GH
Gorman
Matilda
M
Eide
Elizabeth
E
Hisle-Gorman
D001008:Anxiety Disorders / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology* / Q000209:etiology; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D008889:Military Personnel; D010290:Parents; D012189:Retrospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology; D014481:United States / Q000453:epidemiology; D014857:Warfare