文章基本信息

标题：Adolescent Well-Being in Washington State Military Families
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作者：Sarah C. Reed ; Janice F. Bell ; Todd C. Edwards 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2011
卷号：101
期号：9
页码：1676-1682
DOI：10.2105/AJPH.2011.300165
语种：English
出版社：American Public Health Association
摘要：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 = 10 606). 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. In 2007, 1.88 million US children had at least 1 parent serving in the military.¹ Deployments of US soldiers to Iraq and Afghanistan have increased in frequency and duration, leaving many military families, spouses, and children alone to navigate the consequences of war.^{2 , 3} Adolescents are uniquely vulnerable to adverse health effects from parental military deployment. Healthy development, including identifying a sense of self and separation from family, can be interrupted during parents’ active military service.^{4 , 5} Media exposure coupled with the developmental ability to understand the violent consequences of war and additional responsibilities at home after a parent's deployment may further disrupt adolescents’ adjustment and coping.^{6 – 8} Furthermore, adolescence is a developmental period characterized by an increased predisposition to health risk behaviors (e.g., alcohol and other drug use, risky sexual behaviors) that may be exacerbated with parental absence.^{9 – 14} Several qualitative studies have offered descriptive accounts of the influence of parental combat deployment on young people.^{6 – 8 , 15 , 16} In these studies, adolescents have reported fear, worry, and anxiety about the deployed parent.^{6 , 7 , 15} Faber et al. explored themes of “ambiguous absence and ambiguous presence” in interviews conducted with military reserve families.¹⁶ Adjusting and readjusting to new responsibilities and roles is a significant source of stress for young people, particularly when the deployed parent returns home.^{6 , 7 , 15} Problems with school behavior and performance have also been noted.^{7 , 8} Most recently Chandra et al., in qualitative interviews with school personnel, reported that resiliency in military families and adolescents has been “used up.”⁸ Most of the extant quantitative research addressing the mental health of young people with a military parent has focused on children younger than 13 years. The findings of these studies are inconsistent and limited by small sample sizes. A higher prevalence of psychological stress^{17 – 20} and increases in behavioral problems during parental deployment^{18 – 20} have been reported most consistently. In some studies, however, military families have been highlighted as “robust” and “healthy,” with few differences noted between civilian and military populations.^{21 – 23} Parental combat exposure in the Vietnam War has been associated with behavioral disturbances at home and school and with negative effects on parent–child relationships.^{24 , 25} One study showed that, with family income controlled, children of National Guard troops deployed in the Persian Gulf War had overall poorer health, had significantly more health-related problems, and engaged in more high-risk behaviors than did civilian children.²⁶ Two recent studies revealed that adolescents with a deployed parent had significantly higher heart rates and systolic blood pressure and higher rates of self-perceived stress and disordered eating (female adolescents only) than did their counterparts with civilian parents.^{27 , 28} Multiple studies have indicated that the caretaking parent's ability to cope and the level of stress associated with the service member's deployment significantly influence the ability of children to adjust and be resilient.^{7 , 8 , 17 , 20 , 29 – 32} Mental health problems, including posttraumatic stress disorder, are well documented among US service members returning from war.^{3 , 33 – 35} These psychiatric conditions have tremendous consequences for adolescents during all phases of the deployment cycle.^{2 , 5 , 15 , 36 , 37} Studies of wars prior to Operation Enduring Freedom and Operation Iraqi Freedom have evaluated the negative impact of combat-related trauma on family functioning. Taft et al.³⁸ reported that combat exposure alone leads to poorer family functioning, and Jordan et al.³⁹ suggested that regardless of individual or family history (e.g., substance use, child abuse, other psychiatric disorders) combat-related trauma is more strongly related to poor family functioning than are individual or family factors. Emerging evidence from the current wars has shown deleterious effects of deployment on various components of family functioning, including marital intimacy concerns, caregiver burden, secondary traumatization, violence, parenting concerns, and child maltreatment.^{40 – 42} These aspects of family functioning may have spillover effects on adolescents’ health and well-being.⁴³ We found no population-based quantitative studies evaluating the impact of military service in Operation Enduring Freedom and Operation Iraqi Freedom on adolescent quality of life. Only 1 quantitative study to our knowledge has examined well-being among young people with a deployed parent; that investigation, which involved adolescents aged 11 to 17 years, showed that older adolescents and adolescent girls were more likely than were their counterparts to face school-, family-, and peer-related challenges.³² However, the results of the study, which was conducted among a sample of military children enrolled in Operation Purple (a camp offered through the National Military Family Association), were limited by the small sample size, low response rate, and sample selection bias.³² We examined the association of parental military service with adolescent well-being in a population-based sample in Washington State. With a high prevalence of military families and bases, Washington State offers a unique opportunity to study these issues.⁴⁴ Our results will be useful to military, school-based, and public health professionals interested in promoting healthy adolescent adjustment and development and may suggest target populations and interventions to better serve young people at risk.