Abstract
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 2017–2018 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.
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Data availability
HBSC data can be accessed from https://hbsc.org/data.
Code availability
Code can be made available upon request from the corresponding author.
References
Bruwer, B., Emsley, R., Kidd, M., Lochner, C., & Seedat, S. (2008). Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth. Comprehensive Psychiatry, 49(2), 195–201. https://doi.org/10.1016/j.comppsych.2007.09.002
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 and Adolescent Medicine, 162(11), 1009–1014. https://doi.org/10.1001/archpedi.162.11.1009
Cramm, H., Norris, D., Tam-Seto, L., Eichler, M., & Smith-Evans, K. (2015). Making military families in Canada a research priority. Journal of Military, Veteran and Family Health, 1(2), 8–12. https://doi.org/10.3138/jmvfh.3287.
Cunitz, K., Dölitzsch, C., Kösters, M., Willmund, G.-D., Zimmermann, P., Bühler, A. H., Fegert, J. M., Ziegenhain, U., & Kölch, M. (2019). Parental military deployment as risk factor for children’s mental health: A meta-analytical review. Child and Adolescent Psychiatry and Mental Health, 13, 26–26. https://doi.org/10.1186/s13034-019-0287-y
Currie, C., Molcho, M., Boyce, W., Holstein, B., Torsheim, T., & Richter, M. (2008). Researching health inequalities in adolescents: The development of the Health Behaviour in School-Aged Children (HBSC) family affluence scale. Social Science & Medicine, 66(6), 1429–1436. https://doi.org/10.1016/j.socscimed.2007.11.024
Espinoza, G., Cari, G.-O., Gonzales, N. A., & Fuligni, A. J. (2014). Friend affiliations and school adjustment among Mexican-American adolescents: The moderating role of peer and parent support. Journal of Youth and Adolescence, 43(12), 1969–1981. https://doi.org/10.1007/s10964-013-0023-5
Freeman, J., King, M., & Pickett, W. (2016). Health Behaviour in School-aged Children (HBSC) in Canada: Focus on relationships. Government of Canada. https://healthycanadians.gc.ca/publications/science-research-sciences-recherches/health-behaviour-children-canada-2015-comportements-sante-jeunes/index-eng.php. Accessed 4 March 2023.
Gariepy, G., McKinnon, B., Sentenac, M., & Elgar, F. (2016). Validity and Reliability of a Brief Symptom Checklist to Measure Psychological Health in School-Aged Children. Child Indicators Research, 9, 471–484. https://doi.org/10.1007/s12187-015-9326-2
Gates, M. A., Holowka, D. W., Vasterling, J. J., Keane, T. M., Marx, B. P., & Rosen, R. C. (2012). Posttraumatic stress disorder in veterans and military personnel: Epidemiology, screening, and case recognition. Psychological Services, 9(4), 361–382. https://doi.org/10.1037/a0027649
Goodyear, M., Cuff, R., Maybery, D., & Reupert, A. (2009). CHAMPS: A peer support program for children of parents with a mental illness. Australian e-Journal for the Advancement of Mental Health, 8(3), 296–304. https://doi.org/10.5172/jamh.8.3.296
Gorman, G. H., Eide, M., & Hisle-Gorman, E. (2010). Wartime military deployment and increased pediatric mental and behavioral health complaints. Pediatrics, 126(6), 1058–1066. https://doi.org/10.1542/peds.2009-2856
Haugland, S., & Wold, B. (2001). Subjective health complaints in adolescence: Reliability and validity of survey methods. Journal of Adolescence, 24(5), 611–624. https://doi.org/10.1006/jado.2000.0393
Inchley, J., Currie, D., Young, T., Samdal, O., Torsheim, T., Augustson, L., Mathison, F., Aleman-Diaz, A., Molcho, M., Weber, M., & Barnekow, V. (2016). Growing up unequal: Gender and socioeconomic differences in young people’s health and well-being. In Health Behaviour in School-aged Children (HBSC) study: International report from the 2013/2014 survey. World Health Organization. https://apps.who.int/iris/handle/10665/326320. Accessed 4 March 2023.
Kudinova, A. Y., James, K., & Gibb, B. E. (2018). Cognitive reappraisal and depression in children with a parent history of depression. Journal of Abnormal Child Psychology, 46(4), 849–856. https://doi.org/10.1007/s10802-017-0333-2
Liu, Y., Collins, C., Wang, K., Xie, X., & Bie, R. (2019). The prevalence and trend of depression among veterans in the United States. Journal of Affective Disorders, 245, 724–727. https://doi.org/10.1016/j.jad.2018.11.031
Manser, L. (2020a). Fast facts: Canadian military families. Journal of Military, Veteran and Family Health, 65(1), 13–14. https://doi.org/10.3138/jmvfh-2019-0002
Manser, L. (2020b). The state of military families in Canada: A scoping review. Journal of Military, Veteran and Family Health, 6(2), 120–128. https://doi.org/10.3138/jmvfh-2019-0001
Mahar, A. L., Cramm, H., Carces, I., Aiken, A. B., Chen, S., Ouellette, B., Manswer, L., & Kurdyak, P. (2022). Retrospective cohort study of outpatient mental health visits in children and youth in Canadian military families. Journal of Military, Veteran and Family Health, 8(1), 110–124.
Ormel, J., Raven, D., van Oort, F., Hartman, C., Reijneveld, S., Veenstra, R., Vollebergh, W., Buitelaar, J., Verhulst, F., & Oldehinkel, A. (2015). Mental health in Dutch adolescents: A TRAILS report on prevalence, severity, age of onset, continuity and co-morbidity of DSM disorders. Psychological Medicine, 45(2), 345–360. https://doi.org/10.1017/S0033291714001469
Ravens-Sieberer, U., Erhart, M., Torsheim, T., Hetland, J., Freeman, J., Danielson, M., & Thomas, C. (2008). An international scoring system for self-reported health complaints in adolescents. European Journal of Public Health, 18(3), 294–299. https://doi.org/10.1093/eurpub/ckn001
Reid, K., & Berle, D. (2020). Parental trajectories of PTSD and child adjustment: Findings from the Building a New Life in Australia study. American Journal of Orthopsychiatry, 90(2), 288–295. https://doi.org/10.1037/ort0000434
Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science & Medicine, 90, 24–31. https://doi.org/10.1016/j.socscimed.2013.04.026
Susukida, R., Mojtabai, R., Murcia, G., & Mendelson, T. (2016). Residential mobility and risk of major depressive episode among adolescents in the National Survey on Drug Use and Health. Journal of Public Health, 38(3), 432–440. https://doi.org/10.1093/pubmed/fdv100
Torsheim, T., Wold, B., & Samdal, O. (2000). The teacher and classmate support scale factor structure, test-retest reliability and validity in samples of 13-and 15-year-old adolescents. School Psychology International, 21, 195–212. https://doi.org/10.1177/0143034300212006
Van Droogenbroeck, F., Spruyt, B., & Keppens, G. (2018). Gender differences in mental health problems among adolescents and the role of social support: Results from the Belgian health interview surveys 2008 and 2013. BMC Psychiatry, 18(1), 1–9. https://doi.org/10.1186/s12888-018-1591-4
Viner, R. M., Ozer, E. M., Denny, S., Marmot, M., Resnick, M., Fatusi, A., & Currie, C. (2012). Adolescence and the social determinants of health. Lancet (London, England), 379(9826), 1641–1652. https://doi.org/10.1016/S0140-6736(12)60149-4
Walsh, S. D., Sela, T., De Looze, M., Craig, W., Cosma, A., Harel-Fisch, Y., Boniel-Nissim, M., Malinowska-Cieslik, M., Molcho, M., Vieno, A., Ng, K., & Pickett, W. (2020). Clusters of contemporary risk and their relationship to mental well-being among 15-year-old adolescents across 37 countries. Journal of Adolescent Health, 66(6), S40–S49. https://doi.org/10.1016/j.jadohealth.2020.02.012
Warfield, M. E., Adams, R. S., Ritter, G. A., Valentine, A., Williams, T. V., & Larson, M. J. (2018). Health care utilization among children with chronic conditions in military families. Disability and Health Journal, 11(4), 624–631. https://doi.org/10.1016/j.dhjo.2018.06.002
Woodward, L., Fergusson, D. M., & Belsky, J. (2000). Timing of parental separation and attachment to parents in adolescence: Results of a prospective study from birth to age 16. Journal of Marriage and Family, 62(1), 162–174. https://doi.org/10.1111/j.1741-3737.2000.00162.x
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2
Funding
This study was supported by an award from the Canada Research Chairs program awarded to Elgar.
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Kinley and Elgar conceived and designed the study. The first draft of the manuscript was written by Kinley. Kinley and Samira led the statistical analysis. All the authors commented on previous versions of the manuscript and have read and approved the final manuscript.
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The HBSC Canadian survey was granted ethics approval from the General Research Ethics Board at Queen’s University, and the Health Canada and Public Health Agency of Canada Research Ethics Board.
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Following the HBSC international protocol, the Canadian HBSC used anonymous and self-completed questionnaires distributed in classroom settings. Consent (active or passive depending on the practices within individual school boards) was obtained from the participating students, their parents or guardians, and participating schools.
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Kinley, J., Feizi, S. & Elgar, F.J. Adolescent mental health in military families: Evidence from the Canadian Health Behaviour in School-aged Children study. Can J Public Health 114, 651–658 (2023). https://doi.org/10.17269/s41997-023-00758-5
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DOI: https://doi.org/10.17269/s41997-023-00758-5