International Review of Psychiatry, April 2011; 23: 210–217
The impact of deployment to Iraq or Afghanistan on military children:
A review of the literature
CLAIRE J. WHITE1, H. THOMAS DE BURGH2, NICOLA T. FEAR3† & AMY C. IVERSEN1†
Centre for Military Health Research (KCMHR), King’s College London, 2Warwick Medical School, Coventry, UK;
Royal Army Medical Corps, British Army and 3Academic Centre for Defence Mental Health (ACDMH), King’s College
London, UK
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1King’s
Abstract
The aim of this review is to evaluate what is known about the impact on children of parental deployment to Iraq or
Afghanistan. We searched for relevant studies with a minimum sample size of 50 which were published between 2003
and 2010 using Google Scholar, MEDLINE, PubMed, PsycINFO and Web of Science. Bibliographies of retrieved articles
were also searched. Nine US-based studies were identified for inclusion in the review, five were cross-sectional, two were
longitudinal and two were analyses of routinely collected data. Researchers found an increase in emotional and behavioral
problems in children when a parent was deployed. Several mediating factors were identified, such as the family demographics
and the number and duration of parental deployments. Parental psychopathology was most consistently identified as a risk
factor for childhood emotional and behavioral disorders in the research. Limitations of the current research and subsequent
recommendations for future research are also outlined.
Introduction
Military children are exposed to a range of stressors
that are rarely experienced by civilian counterparts,
namely the periodic and extended separation from a
parent during deployment to a combat zone. Since
2001, over 700,000 US children have experienced
the deployment of a parent to Iraq or Afghanistan
(APA Presidential Task Force, 2007). A major concern for policy makers is how these deployments
impact on the psychosocial development of military
children (APA Presidential Task Force, 2007; DoD
Mental Health Task Force, 2007; RNRMCF, 2009). A
consensus has not yet been reached because systematic
evidence remains sparse. Research is especially valuable given the characteristics of the current deployments, which are typically longer, more frequent, and
breaks between deployments shorter (Hosek et al., 2006;
Rona et al., 2007).
The cycle of deployment
In the literature, deployment is often described as a
cyclical process rather than a single event, consisting
of stages including pre-deployment, deployment,
post-deployment and re-deployment. Research has
shown that children are likely to face different stressors
at various stages of this cycle (Fitzsimons & KrauseParello, 2009; Pincus et al., 2007). For instance, at
the pre-deployment stage children may anticipate
parental separation and harbour concerns or anxiety
about their parent’s well-being and return (Burrell
et al., 2006; Huebner et al., 2007; Kelley et al., 2001;
McCarroll et al., 2008; Orthner & Rose, 2005).
During deployment children may experience changes
to family roles and routines, including additional
responsibilities for older children (Bowling & Sherman,
2008), which may take place in the context of the
diminished capabilities of the at-home parent who may
also be experiencing stress (Mansfield et al., 2010;
SteelFisher et al., 2008). Post-deployment, the child
must reintegrate their parent back into the family unit;
which can be difficult if some time has passed and
the child has matured (Defense Department Advisory
Committee, 2004). These difficulties may be compounded by the deployed parent’s health on return.
For instance, they may have returned with physical
injuries, readjustment difficulties, post-traumatic
stress disorder (PTSD) or other post-combat mental
health problems (Bowling & Sherman, 2008; Cozza
et al., 2010). The possibility of re-deployments can
†Joint last authors.
Correspondence: Amy C. Iversen, MA, MRCP, MRCPsych, King’s Centre for Military Health Research, Department of Psychological Medicine, Institute
of Psychiatry, Weston Education Centre, Denmark Hill, London SE5 9RJ, UK. Tel: 0044 (0)207 848 5351. Fax: 0044 (0) 20 7848 5397. E-mail: amy.c.iversen@
kcl.ac.uk
(Received 8 December 2010 ; accepted 31 January 2011)
ISSN 0954–0261 print/ISSN 1369–1627 online © 2011 Institute of Psychiatry
DOI: 10.3109/09540261.2011.560143
The impact of deployment to Iraq or Afghanistan on military children
make the re-establishment of bonds even more
challenging for the child. This conceptualization of
deployment as a cycle and the stressors identified are
highly relevant to the current and previous deployments to Iraq or Afghanistan. In this paper, we review
the findings of recent publications to evaluate what
is currently known about the effects of deployments
to Iraq or Afghanistan on military children.
Method
211
deployed parents) according to criteria such as child
demographics or characteristics of the parental deployment (Chandra et al., 2009; Chartrand et al., 2008;
Flake et al., 2009; Lester et al., 2010; Morris & Age,
2009). Two longitudinal studies included comparisons within the group of deployed children at two
time-points between two and twelve months apart
(Barker & Berry, 2009; Barnes et al., 2007), and two
studies analysed routinely collected data of child
maltreatment incidents and paediatric visits (Gibbs
et al., 2007; Gorman et al., 2010).
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Search and screening strategy
Articles were retrieved by one of the authors (C.W.)
on 1 October 2010 by performing a literature
search of Google Scholar, PsycINFO, MEDLINE,
PubMed and Web of Science from 2003 to 2010.
Searches included key words: (‘military’ or ‘armed
forces’ or ‘soldier∗’ or ‘army’ or ‘combat’) and
(‘Iraq’ or ‘Afghanistan’ or ‘Telic’ or ‘Herrick’ or
‘Enduring Freedom’ or ‘Iraqi Freedom’) and ‘deployment*’ and (‘families’ or ‘children’). A hand-search
was then conducted by scanning the bibliographies
of the selected papers for other relevant articles.
A total of 48 articles were retrieved (a list of articles
is available upon request from the corresponding
author). C.W. and H.B. extracted study information
(see Tables I and II).
Inclusion criteria
Studies were included if: 1) they included (or reported
data on) children of deployed military personnel
including deployments to Iraq and Afghanistan, 2)
had at least one measurement of physical, psychological health or well-being, 3) were peer-reviewed,
and 4) were reported in English. Studies with a
sample size of ⬍50 were excluded due to concerns
about the generalizability of results from these small
studies. These exclusion criteria led to the exclusion
of qualitative studies from this review.
Results
Studies identified
When inclusion criteria were applied, nine studies
were identified. All studies were based on US samples and included children whose parent had been
deployed to Iraq or Afghanistan. A summary of the
studies is presented in Table I. Three types of study
design were identified. Five cross-sectional surveys
compared children on a measured outcome (e.g.
questionnaire scores) across different participant
groups (e.g. children of deployed and non-deployed
parents) and within the same group (e.g. children of
Results of reviewed studies
A summary of the study findings and limitations are
presented in Table II. Studies reported higher levels of
stress and more emotional and behavioral difficulties
in military adolescents and their at-home caregivers
compared to national samples and children of nondeployed parents (Barker & Berry, 2009; Barnes et al.,
2007; Chandra et al., 2009; Gorman et al., 2010).
Caregiver mental health and behaviors of the at-home
parent were significantly associated with child wellbeing (Flake et al., 2009; Lester et al., 2010; Morris &
Age, 2009) and children of both civilian mothers and
fathers had a higher rate of maltreatment during their
parent’s deployment than non-deployment. Cumulative length of parental combat-related deployments
during the child’s lifetime predicted increased child
depression and externalizing behaviors (Chartrand
et al., 2008; Lester et al., 2010).
Discussion
Overall, the reviewed research indicates that children
of deployed parents are at higher risk of psychosocial
problems than their civilian counterparts, which may
reflect the multiple stressors that military children
face. Research also suggests that on the whole, children with a deployed parent cope less well than those
of a non-deployed parent. Specifically, some children
with a deployed parent experience moderate to severe
emotional and behavioral problems. An important
question then is why some children cope well with
parental deployment and others not? While some
researchers have looked to differences in the nature
of the parental deployment itself for an answer to this
question, the particular family context within which
deployment operates has also been identified in the
literature as a key explanatory ingredient. These
factors are outlined in more detail below.
Parental deployment
Some researchers have considered the characteristics
of parental deployments at different stages of the
14–16
Not reported
Health
screening
Not reported
Family readiness
group
N/A
N/a
N/a
Psychological
Behavioral
Active duty and
reserves
Iraq &
Afghanistan
M&F
Engagement
type
Deployment
Deployed
parent’s sex
Physical
Army
N/a
1. Heart rate
2. Blood
pressure
1. PRS
2. PTSDC
M&F
Iraq
Active duty
Army
Longitudinal
121
81%
1. Child
57
Not reported
1. At-home
parent
2. Previously
deployed
parent
0–4
Longitudinal
2007
2003
Barnes
2009
Not reported
Barker
Service arm
Design
Study design
Child age
(years)
Multiple
children
Sample
Publication
Data collection
period
Population
N
Response rate
Data collected
from
First author
Table I. Summary of study design.
1.PBFS
1. SCARED
2. SDQ
N/A
M (95%) & F
Active and
reserves
Not reported
Tri-service
Cross-sectional
survey
Summer camp
Random
11–17
1507
89%
1. At-home
parent
2. Child
2009
2008
Chandra
N/a
N/a
N/A
Iraq &
Afghanistan
M (92%) & F
Active duty
Marines
Cross-sectional
survey
Marine base
camp
Oldest
1.5–5
169
73%
1. At-home
parent
2. Child-care
provider
2008
2007
Chartrand
N/a
n/a
N/A
Iraq &
Afghanistan
M (86%) & F
Not reported
Army
Cross-sectional
survey
deployment
meetings
Not reported
5–12
101
98%
1. At-home
parent
2009
Not reported
Flake
N/a
1. Abuse
(emotional)
1. Neglect and
abuse
Iraq &
Afghanistan
M&F
Active duty
Army
Analysis of
records
Electronic data
systems
Multiple
0–18
1858
n/a
1. Data
records
2010
2001-2004
Gibbs
1. Anxiety
disorders
2. Stress
disorders
1. Behavioral
disorders
N/A
M (90%) & F
Not reported
Active duty
Tri-service
Analysis of
records
Health care
reports
Multiple
3–8
642,397
n/a
1. Data records
2010
2006-2007
Gorman
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1.CBC
1. CDI
2.MASC
N/A
M&F
Iraq & Afghanistan
Army
Marines
Active duty
Cross-sectional
survey
Marine base camp
Multiple
6–12
272
92%
1. At-home parent
2. Previously or
currently
deployed parent
2010
2008
Lester
N/a
1. SSAS
2. CCSC-R.
3. SDQ
N/A
Iraq &
Afghanistan
M&F
Active duty
Crosssectional
survey
Airforce
Naval base
camp
Not reported
9–15
65
30%
1. Child
2009
2006
Morris
212
C. J. White et al.
Notes: Multiple children: where children had siblings, who was included in the analyses and how. PRS, Psychosocial Resources Scale; PTSDC, Post-Traumatic Stress Disorder Checklist; SCARED,
Screen for Child Anxiety Related Emotional Difficulties; SDQ, Strengths and Difficulties Questionnaire; CDI, Children’s Depression Inventory; MASC, Multi-dimensional Anxiety Scale for
Children; SSAS, Social Support Appraisal Scale; CCSC-R Children’s Coping Strategies Checklist-Revision; PBFS, Problem Behavior Frequency Scale; CBC, Child Behavior Checklist; PSI-Short,
Parenting Stress Index short form; CES-DS, Centre for Epidemiological Studies-Depression Screener; PPSF, Perceived Parenting Stress Form; BSI, Brief Symptom Inventory; PTS, Posttraumatic
Diagnostic Scale; PQLI, Pediatrics Quality of Life Inventory.
N/a
N/a
At-home parent
1. Psychosocial
functioning
Behavioral
At-home parent:
1. Invalidated
survey of child
behavior
responses and
intense
attachment
behaviors
N/a
At-home
parent:
1. PQLI
At-home
parent or
child-care
provider:
1. CBC
2. Teacher
report form
N/a
N/a
N/a
At-home parent:
1. PSI-Short
2. PPSF
At-home
parent:
1. PSI-Short
2. CES-DS
At-home
parent:
1. SDQ
N/a
N/a
Adults
Psychological
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At-home parent:
1. BSI
2. PTDS
Active duty or
currently
deployed parent:
1. PTSDC
(Military)
N/a
N/a
The impact of deployment to Iraq or Afghanistan on military children
213
deployment cycle. For example, Barnes et al. (2007)
considered the effect of parental deployment on children at two different time-points, two months apart,
but found no significant differences between these
two times. However, adolescents with a deployed
parent had higher blood pressure and significantly
higher perceived stress levels and heart rates (HR)
than military children at both time-points than children without a deployed parent. The authors interpreted this as evidence that some children of deployed
parents have anxiety from the stress of the parental
deployment. The results from Barker and Berry’s
(2009) study support this interpretation; they found
that children showed increased behavioral problems
from pre-deployment to deployment.
Relevant risk factors determining children’s health
outcomes include the number and length of parental deployments. For instance, in Barker and Berry’s
(2009) study, both the number of deployments
and deployment length were associated with more
behavioral problems, though not significantly so.
Lester et al. (2010) found that cumulative length of
parental combat-related deployments during the
child’s lifetime predicted increased child depression
and externalizing behaviors. Similarly, Chandra et al.
(2009) reported that the total months deployed in
the previous three years were significantly associated with a greater number of child difficulties
during deployment and reintegration. Other research
outside the scope of this review has suggested
that the risk of psychosocial problems in military
parents was associated with the physical and emotional abuse of children (Marshall et al., 2005;
Taft et al., 2007).
Family demographics
Although there is agreement in the research reviewed
here and the wider literature that some children are
vulnerable to the effects of deployment, findings have
been mixed. The finding that girls may be particularly vulnerable (Cozza et al., 2005; Lester et al.,
2010; McCarroll et al., 2008) seems to contradict
research suggesting that attachment behaviors are
most likely to be displayed by young boys of deployed
parents (Barker & Berry, 2009; Blount et al., 1992;
Jensen et al., 1996; Paris et al., 2010).
Research on the impact of the child’s age is also
inconclusive. The reviewed research suggests that
young pre-school children express separation anxiety through externalizing behaviors, whereas older
children, who are more aware of the reasons and
danger involved in deployment, may become anxious
or depressed (Chartrand et al., 2008, Gorman et al.,
2010). This finding is not consistent across all
reviewed articles, as two papers suggest that older
214
C. J. White et al.
Table II. Summary of key results and limitations.
Reference
Barker et al.
(2009)
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Barnes et. al.
(2007)
Chandra et al.
(2009)
Chartrand et al.
(2008)
Flake et al.
(2009)
Key results
1. No significant effect of number of deployments on children’s
behavior.
2. Children showed increased behavior problems from
pre-deployment to deployment compared to community
sample norms.
3. Association (weak correlation) between deployment length
and behavioral problems.
4. Older children had more behavioral problems than infants.
5. Family stress associated with increased behavioral problems.
1. Adolescents with a deployed parent had higher heart rates and
perceived stress than civilian children and military children
without a deployed parent.
1. Children had more emotional difficulties compared with
national samples.
2. Length of parental deployment and poorer non-employed
caregiver mental health was significantly associated with a
greater number of challenges for children.
3. Academic engagement and problem behaviors got worse with
increasing age but peer functioning got better.
1. No significant association between deployment and
internalising, externalising behaviors or total scores on CBCL
or TRF.
2. Independent of parents’ stress/depression, they reported
significantly higher behavioral (externalizing) symptoms in
children aged 3–5 with a deployed parent than parents of
children without. Childcare providers also reported similarly
on another questionnaire.
1. Parental report identified one in every three children to be at
risk for psychosocial morbidity during a wartime deployment.
2. Parents reporting high levels of stress were likely to perceive
their children as having increased psychosocial morbidity.
Gibbs et al.
(2010)
1. Rates of maltreatment are greater when soldiers are on
combat-related deployments.
Gorman et al.
(2010)
1. Children of male military parents had increased rates of
outpatient visits during periods of deployment compared with
female military parents.
2. Behavioral and stress disorders increased by ⬎ 10% during
deployment.
3. Older children and children of married parents had larger
increases in rates of mental and behavioral health visits when
their parent was deployed.
1. Children did not show higher depression, or externalizing/
internalizing compared to normative data.-Girls with deployed
parent had higher externalizing symptoms relative to norms.
2. Parental distress (at home and Active Duty) and cumulative
length of parental combat-related deployments during the
child’s lifetime predicted increased child depression and
externalizing behaviors.
3. Cumulative length of deployment was associated with
increased risk of child depression and externalizing behaviors.
1. No differences between children/adolescents of recently
deployed versus non-deployed parents.
2. Military children/adolescents had higher levels of conduct
problems and overall symptomatology.
3. Coping style did not have as great an effect on outcome as
parental support.
Lester et al.
(2010)
Morris et al.
(2009)
Limitations
1. Convenience sample.
2. Small sample size.
3. Difficulty in obtaining follow-up data for
participants.
4. Based on parental report.
1. Convenience sample.
2. Lack of mediating variables: cannot infer
causality.
1. Convenience sample.
2. Cross-sectional design.
3. Biased sample: program to help children cope
with deployment.
1. Convenience sample.
2. Biased sample: children had high quality
child-care in a single military base.
3. Cross-sectional design.
4. Lengths of deployment were not representative
of US deployments (3.9 months).
1. Convenience sample.
2. Cross-sectional design.
3. Reliance exclusively on at-home caregiver
report of children’s coping.
4. Demographics of study sample not
representative of US military population.
1. Diagnostic criteria based on the army, which is
different from civilian child protection agencies.
2. Reliance on diagnoses and provider coding.
3. Discrepancies between the date of
maltreatment and reporting may have
compromised the classification of some
incidents as during deployment.
1. Reporting bias: reliance on parents: child
distress is linked to parental distress.
2. Reliance on clinical diagnoses and provider
coding.
3. Potential confounders were not included in the
analysis (e.g., parent’s mental health).
4. Multiple interpretations of the results that were
not ruled out because of the study design.
1. Convenience sample.
2. Cross-sectional design.
1. Convenience sample.
2. Cross-sectional design.
3. Low validity for some scales.
4. Small sample.
5. Low response rate.
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The impact of deployment to Iraq or Afghanistan on military children
children may have more behavioral problems (Barker
& Berry, 2009; Gorman et al., 2010) but researchers
do not include an age gap of more than six years.
Children’s temperament pre-deployment may also
affect their response to the separation of the parent.
For instance, a child who is described as anxious is
more likely to show behavioral problems during
deployment (Barker & Berry, 2009).
Gorman et al. (2010) considered differences in
caregiver behavior during periods of deployment and
non-deployment. They found increases in outpatient
visits during deployment, especially for children of
male military parents, highlighting the potential
interaction between military parents’ gender and
deployment.
At-home parent/child-parent relationship
A consistent finding in the reviewed research is that
children’s response to the absence of the deployed
parent is mediated by the relationship and capability of the at-home civilian parent in both younger
and older children. Chandra et al. (2009) found
that parents with poorer mental health reported
more child difficulties during deployment. They
also found a positive association between parental
report of general child emotional difficulties and
parental and child report of deployment challenges.
Likewise, (Flake et al. 2009) found that parental
stress was the most significant predictor of children’s psychosocial functioning during wartime
deployment; parents who reported high levels of
stress on the Parenting Stress Index were seven
times as likely as those who did not to report symptoms in their children. Interestingly, Morris and
Age (2009) found that children’s coping style did
not have as great an effect on their psychological
outcome as parental support. They also found that
military support and community support were
associated with lower levels of children’s psychosocial symptoms and parental stress. There appears
to be an important relationship between community support, parental support and coping and the
child’s coping, and this has also been suggested
elsewhere (de Burgh et al., 2011).
The primary caregiver’s behavior may have
detrimental effects on the health and well-being of
children during deployment. Although rates of
maltreatment have not been found to be significantly
higher than the civilian population (CIARMP,
2010), Gibbs et al.’s (2007) analysis revealed that
the maltreatment of children increases during periods of deployment, a finding consistent with other
recent reports (McCarroll et al., 2008; Rentz et al.,
2008). However, this trend reached significance
for female spouses only. The authors suggest that
female civilian spouses may suffer more stress
215
during their spouse’s deployment, may cope with
stress less well than their male counterparts, or are
not as good at mobilizing resources such as assistance with child care.
Limitations of current research and recommendations
for future research
There are four main limitations to research in this
area. First, accounts of the factors influencing
children’s health and well-being may be unreliable.
Data on children’s coping are based on retrospective
reports of one or two informant groups, often exclusively mothers, who may be biased by their own
coping levels (Cozza et al., 2010). Reports from
multi-informants, including the deployed and nondeployed parent, multiple children and additional
objective informant, such as a professional caregiver
(e.g. teacher) are rare.
Second, studies typically focus on only one or two
risks or protective factors and overlook confounding
variables, such as prior family relationships and
existing child behavioral issues, which results in
under-specified models with a high risk of bias.
Reports on the mental health of military fathers
returning from combat deployments are also notably lacking yet this is likely to be an important influence on the psychosocial development of children
(de Burgh et al., 2010). Inclusion of multiple participant groups and family history would offer a more
holistic understanding of the role of parental deployments in child well-being.
Third, the reliance on cross-sectional designs
limits the ability to support causal inference and to
elucidate the course of childhood disorders: it is
not clear from the research reviewed whether the
reported effects of deployment on children are
transient or if they will affect the child’s long-term
adjustment. Although scholars have depicted
deployment as a cyclical process, most researchers
have not yet analysed children’s response throughout the process of deployment. Furthermore, the
developmental stage of the child is likely to be a
critical determinant of the effects of their parents’
deployment (Fitzsimons & Krause-Parello, 2009;
Kelley, 1994), yet researchers have not addressed
an age gap of more than six years in the reviewed
studies. Longitudinal research would provide useful information about the effects of different stages
of the deployment cycle, children of different ages
and the impact of certain confounding variables
(e.g. prior family relationships, existing child behavioral issues). Longitudinal research may also give
greater insight into protective factors, such as the
role of resilience in some military families, which
other work has identified as an important but
understudied area of research (Palmer, 2008).
216
C. J. White et al.
Finally, the external generalizability of the findings
is limited due to the use of small convenience
samples in US populations. Research with large samples based on UK military populations would
enhance the generalizability of some findings and
may also enable scholars to consider the influence of
different cultures (both military and societal) on children’s health outcomes.
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Conclusion
The most robust finding across these studies is that
children’s outcomes during the deployment cycle relate
to the level of concurrent family stressors, particularly
maternal psychopathology, which accords with findings from previous conflicts and the clinical literature
on civilian populations (Bowlby, 1969; Cozza et al.,
2005; Fergus & Zimmerman, 2005). Due to the limitations of the research, drawing conclusions about the
relative importance of maternal psychopathology to
other variables (e.g. paternal psychopathology, child
demographics) would be premature, and future
research that adjusted for the differential rates of
maternal and paternal psychopathology would be
more revealing. Despite these limitations we are
optimistic that future research will address methodological gaps in the research. Contributions to
this area of research would inform the development
of interventions to facilitate the psychosocial adjustment of military families, such as those highlighted
by McFarlane (2009).
Declaration of interest: H. Thomas de Burgh is
employed by the UK Armed Forces and based in
Warwick Medical School. Claire White and Amy
Iversen are employees of the King’s Centre for Military Health Research and Nicola Fear is an employee
of the Academic Centre for Defence Mental Health.
The authors alone are responsible for the content
and writing of the paper.
References
APA (2007). American Psychological AssociationPresidential Task
Force on Military Deployment Services for Youth, Families and Service Members: A preliminary report. Washington, DC: American
Psychological Association.
Barker, L.H. & Berry, K.D. (2009). Developmental issues impacting military families with young children during single and
multiple deployments. Military Medicine, 174, 1033–1040.
Barnes, V.A., Davis, H. & Treiber, F.A. (2007). Perceived stress,
heart rate, and blood pressure among adolescents with family
members deployed in Operation Iraqi Freedom. Military
Medicine, 172, 40–43.
Blount, B.W., Curry, A., Jr & Lubin, G.I. (1992). Family separations in the military. Military Medicine, 157, 76–80.
Bowlby, J. (1969). Attachment and Loss. New York: Basic Books.
Bowling, U.B. & Sherman, M. (2008). Welcoming them home:
Supporting service members and their families in navigating
the tasks of reintegration. Professional Psychology: Research &
Practice, 39, 451–458.
Burrell, L.M., Adams, G.A., Durand, D.B. & Castro, C.A.
(2006). The impact of military lifestyle demands on well-being,
army, and Family outcomes. Armed Forces & Society, 33,
43–58.
Chandra, A, Lara-Cinisomo, S., Jaycox, L. H., Tanielian, T., Burns,
R. M., Ruder, T. & Han, B. (2009). Children on the homefront:
The experience of children from military families. Paediatrics,
125, 16–25.
Chartrand, M.M, Frank, D.A, White, L.F. & Shope, T.R. (2008).
Effect of parents’ wartime deployment on the behavior of young
children in military families. Archives of Pediatrics & Adolescent
Medicine, 162, 1009–1014.
CIARMP (Committee on the Initial Assessment of Readjustment
needs of Military Personnel, Veterans and their Families)
(2010). Board on the Health of Selected Populations. Institute
of Medicine. Available from http://www.iom.edu/Reports/2010/
Returning-Home-from-Iraq-and-Afghanistan-PreliminaryAssessment.aspx (accessed 3 Oct 2010).
Cozza, S.J., Chun, R.S. & Polo, J.A. (2005). Military families and
children during Operation Iraqi Freedom. Psychiatric Quarterly,
76, 371–378.
Cozza, S.J., Guimond, J.M., McKibben, J.B., Chun, R.S.,
Arata-Maiers, T.L., Schneider, B... Ursano, R.J. (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, 112–115.
De Burgh, H.T., White, C.J., Fear, N.T. & Iversen, A.C. (2011).
The impact of deployment to Iraq or Afghanistan on partners
and wives of service personnel. International Review of
Psychiatry, April, 23, 192–200.
Defense Department Advisory Committee (2004). Women in the
Services Report. Available from www.dtic.mil/dacowits/annual_
reports (accessed 1 Oct 2010).
DoD Task Force on Mental Health (2007). An achievable vision:
Report of the Department of Defense Task Force on Mental
Health. Available from http://www.apa.org/releases/Military
DeploymentTaskForceReport.pdf (accessed 3 Oct 2010).
Fergus, S. & Zimmerman, M.A. (2005). Adolescent resilience:
A framework for understanding healthy development in the
face of risk. Annual Review of Public Health, 26, 399–419.
Fitzsimons, V.M. & Krause-Parello, C.A. (2009). Military children:
When parents are deployed overseas. Journal of School Nursing,
25, 40–47.
Flake, E.M., Davis, B.E., Johnson, P.L. & Middleton, L.S. (2009).
The psychosocial effects of deployment on military children.
Journal of Developmental & Behavioral Paediatrics. 30, 271–278.
Gibbs, D.A., Martin, S.L., Kupper, L.L. & Johnson, R.E. (2007).
Child maltreatment in enlisted soldiers’ families during combatrelated deployments. Journal of the American Medical Association,
298, 528–535.
Gorman, H.G., Eide, M. & Hisle-Gorman, E. (2010). Wartime
military deployment and increased pediatric mental and
behavioral health complaints. Pediatrics, 126, 1058–1066.
Hosek, J., Kavanagh, J. & Miller, L. (2006). How Deployments
Affect Service Members. Santa Monica, CA: RAND.
Huebner, A.J.., Mancini, J.A., Wilcox, R.M., Grass, S.R. & Grass,
G.A. (2007). Parental deployment and youth in military
families: Exploring uncertainty and ambiguous loss. Family
Relations, 56, 112–122.
Jensen, P.S., Martin, D. & Watanabe, H. (1996). Children’s
response to parental separation during Operation Desert Storm.
Journal of the American Academy of Child & Adolescent Psychiatry,
35, 433–441.
Kelley, M.L., Hock, E., Smith, B.S., Jarvis, M.S., Bonney, J.F. &
Gaffney, M.A. (2001). Internalizing and externalizing behavior
of children with enlisted navy mothers experiencing military
Int Rev Psychiatry Downloaded from informahealthcare.com by Kings College London on 05/25/11
For personal use only.
The impact of deployment to Iraq or Afghanistan on military children
induced separation. Journal of the American Academy of Child &
Adolescent Psychiatry, 40, 464–471.
Kelley, M.L. (1994). The effects of military-induced separation
on family factors and child’s behavior. American Journal of
Orthopsychiatry, 64, 103–111.
Lester, P., Peterson, K., Reeves, J., Knauss, L., Glover, D.,
Mogil, C., …Beardslee, W. (2010). The long war and parental
combat deployment: Effects on military children and at-home
spouses. Journal of the American Academy of Child & Adolescent
Psychiatry, 49, 310–320.
McFarlane, A.C. (2009). Military deployment: The impact on
children and family adjustment and the need for care. Current
Opinion in Psychiatry, 22, 369–373.
Mansfield, A.J., Kaufman, J.S., Marshall, S.W., Gaynes, B.N.,
Morrissey, J.P. & Engel, C.C. (2010). Deployment and the use
of mental health services among US army wives. New England
Journal of Medicine, 362, 101–109.
Marshall, A.D., Panuzio, J. & Taft, C.T. (2005). Intimate partner
violence among military veterans and active duty duty servicemen. Clinical Psychology Review, 25, 862–876.
McCarroll, J.E., Fan, Z., Newby, J.H. & Ursano, R.J. (2008).
Trends in US Army child maltreatment reports 1990–2004.
Child Abuse Review, 17, 108–118.
Morris, A.S. & Age, T.R. (2009). Adjustment among youth
in military families: The protective roles of effortful control
and maternal social support. Journal of Applied Developmental
Psychology, 30, 695–707.
Orthner, D.K. & Rose, R. (2005). Adjustment Among Army
Children to Deployment Separations. Washington, DC: Army
Research Institute for the Behavioral and Social Sciences.
217
Palmer, C. (2008). A theory of risk and resilience factors in military
families. Military Psychology, 20, 205–217.
Paris, R., DeVoe, E.R., Ross, A.M. & Acker, M. (2010). When a
parent goes to war: Effects of parental deployment on very
young children and implications for intervention. American
Journal of Orthopsychiatry, 80, 610–618.
Pincus, S., House, R., Christenson, J. & Adler, L. (2007). The
emotional cycle of deployment: a military family perspective.
Available from http://www.hooah4health.com/deployment/
familymatters/emotionalcycle.htm# (accessed 4 October 2010).
Rentz, E.D., Marshall, S.W., Martin, S.L., Gibbs, D.A., Casteel,
C. & Loomis, D. (2008). Occurrence of maltreatment in active
duty military and non-military families in the state of Texas.
Military Medicine, 173, 515–522.
RNRMCF (Royal Naval & Royal Marines Children’s Fund) (2009).
The overlooked casualties of conflict: Understanding the challenges faced by the children of the armed forces personnel. Available from http://rnrmchildrensfund.org.uk/uploads/overlooked_
casualties_of_conflict_report.pdf (accessed 1 October 2010).
Rona, R.J., Fear, N.T., Hull, L., Greenberg, N., Earnshaw, M.,
Hotopf, M. & Wessely, S. (2007). Mental health consequences
of overstretch in the UK armed forces: First phase of a cohort
study. British Medical Journal, 335, 603–610.
SteelFisher, G.K., Zaslavsky, A.M. & Blendon, R.J. (2008).
Health-related impact of deployment extensions on spouses of
active duty army personnel. Military Medicine, 173, 221–229.
Taft, C.T., Street, A.E., Marshall, A.D., Dowdall, D.J. & Riggs,
D.S. (2007). Posttraumatic stress disorder, anger, and partner
abuse among Vietnam combat veterans. Journal of Family
Psychology, 21, 270–277.