Behavioral Health Service Use by Military Children During Afghanistan and Iraq Wars
Medical claims were analyzed from 2810 military children who visited a civilian emergency department (ED) or hospital from 2000 to 2014 with behavioral health as the primary diagnosis and TRICARE as the primary/secondary payer. Visit prevalence was estimated annually and categorized: 2000–2002 (pre-deployment), 2003–2008 (first post-deployment), 2009–2014 (second post-deployment). Age was categorized: preschoolers (0–4 years), school-aged (5–11 years), adolescents (12–17 years). During Afghanistan and Iraq wars, 2562 military children received 4607 behavioral health visits. School-aged children’s mental health visits increased from 61 to 246 from pre-deployment to the second post-deployment period. Adolescents’ substance use disorder (SUD) visits increased almost 5-fold from pre-deployment to the first post-deployment period. Mental disorders had increased odds (OR = 2.93, 95% CI 1.86–4.61) of being treated during hospitalizations than in EDs. Adolescents had increased odds of SUD treatment in EDs (OR = 2.92, 95% CI 1.85–4.60) compared to hospitalizations. Implications for integrated behavioral health and school behavioral health interventions are discussed.
KeywordsMilitary children Behavioral health care Military health system beneficiaries Military medicine Mixed effects model Afghanistan and Iraq wars
Data are from the records of the South Carolina Revenue and Fiscal Affairs Office (SC RFA), Health and Demographics, whose authorization to release these data does not imply endorsement of this study or its findings by either the Division of Research and Statistics or the Data Oversight Council. The authors acknowledge programming assistance from Mr. Chris Finney, SC RFA, Health and Demographics Division, in creating the data extract used in this study and research assistance from Tamara L. Grimm, MSW.
This study was funded by the National Institute on Drug Abuse (NIDA #K01DA037412, PI: Nikki R. Wooten, PhD).
Compliance with Ethical Standards
Conflict of Interest
Dr. Wooten is a lieutenant colonel in the U.S. Army Reserves and Mr. Moore is a lieutenant junior grade in the U.S. Naval Reserves, but neither conducted this study as a part of their official military duties. All other authors report no conflicts of interest. The opinions and assertions herein are those of the authors and do not necessarily reflect the official views of the Department of Defense, SC RFA, NIDA, or the National Institutes of Health.
This study was presented as an oral presentation at the annual meeting of the Society for Social Work and Research, New Orleans, LA, January 14–17, 2017.
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