Advertisement

Parenting in Military Families Faced with Combat-Related Injury, Illness, or Death

  • Stephen J. CozzaEmail author
Chapter
Part of the Risk and Resilience in Military and Veteran Families book series (RRMV)

Abstract

Military children and families possess many strengths and generally enjoy health, wellness, and a capacity for resilience. However, they have also faced unprecedented war-related challenges since 2001, including combat-related parental injury, illness, and death. This chapter describes the distress faced by military children and families due to these experiences and the unique parenting challenges that result. The contribution of parenting to child outcomes is well-established in the literature, although less is known about the potential effects of parenting on child outcomes in such highly stressful or traumatic settings. While several parenting and family programs have been developed to support civilian and military children, none has been designed to specifically address the difficulties faced by these highly impacted families. The author recommends applying positive parenting strategies derived from evidence-based principles to at-risk families, while connecting them to communities capable of supporting their many needs over time. Six evidence-based parenting and family intervention strategies are discussed: (1) maintaining a physically safe and structured environment, (2) engaging required community resources, (3) developing and sharing knowledge within and outside of the family that builds shared understanding, (4) building a positive emotionally safe and warm family environment, (5) mastering and modeling important interpersonal skills, including problem solving and conflict resolution, and (6) maintaining a vision of hope and future optimism for the family. The chapter concludes by highlighting the need for future research to develop and study strategies to meet the needs of these highly impacted families.

Keywords

Positive Parenting Service Member Military Family Complicated Grief Injured Parent 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Brent, D., Melhem, N., Donohoe, M., & Walker, M. (2009). The incidence and course of depression in bereaved youth 21 months after the loss of a parent to suicide, accident or sudden natural death. The American Journal of Psychiatry, 166, 786–794.CrossRefGoogle Scholar
  2. Butera-Prinzi, F., & Perlesz, A. (2004). Through children’s eyes: Children’s experience of living with a parent with an acquired brain injury. Brain Injury, 18(1), 83–101.CrossRefGoogle Scholar
  3. Calhoun, P., Beckham, J., & Bosworth, H. (2002). Caregiver burden and psychological distress in partners of veterans with chronic posttraumatic stress disorder. Journal of Traumatic Stress, 15(3), 2015–2212.CrossRefGoogle Scholar
  4. Cerel, J., Firstad, M., Verducci, J., Weller, R., & Weller, E. (2006). Childhood bereavement: Psychopathology in the 2 years postparental death. Journal of the American Academy of Child and Adolescent Psychiatry, 45(6), 681–690.CrossRefGoogle Scholar
  5. Cerel, J., Fristad, M., Weller, E., & Weller, R. (2000). Suicide-bereaved children and adolescents: II. Parental and family functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 45(6), 437–444.CrossRefGoogle Scholar
  6. Chandra, A., Lara-Cinisomo, S., Jaycox, L., Tanielian, T., Burns, R., Ruder, T., & Han, B. (2010). Children on the homefront: The experience of children from military families. Pediatrics, 125(1), 16–25.Google Scholar
  7. Charles, N., Butera-Prinzi, F., & Perlesz, A. (2007). Families living with acquired brain injury: A multiple family group experience. NeuroRehabilitation, 22(1), 61–76.Google Scholar
  8. Chemtob, C., Nomura, Y., Rajendran, K., Yehuda, R., Schwarz, D., & Abramovitz, R. (2010). Impact of maternal posttraumatic stress disorder and depression following exposure to the September 11 attacks on preschool children’s behavior. Child Development, 81, 1129–1141.CrossRefGoogle Scholar
  9. Chesnut, R., Carney, N., Maynard, H., Patterson, P., Mann, N., & Helfand, M. (1999). Rehabilitation for traumatic brain injury. Rockville, MD: Agency for Health Care Policy and Research.Google Scholar
  10. Cohen, J., & Mannarino, A. (2002). Childhood traumatic grief: Concepts and controversies. Trauma, Violence and Abuse, 3, 307–327.CrossRefGoogle Scholar
  11. Cohen, J., & Mannarino, A. (2004). Treatment of childhood traumatic grief. Journal of Clinical Child and Adolescent Psychology, 33(4), 819–831.CrossRefGoogle Scholar
  12. Cozza, S., Chun, R., & Miller, C. (2011). The children and families of combat-injured service members. In E. Ritchie (Ed.), Combat and operational behavioral health (pp. 503–534). Falls Church, VA: Office of the Surgeon General, United States Army.Google Scholar
  13. Cozza, S., Chun, R., & Polo, J. (2005). Military families and children during operation Iraqi freedom. Psychiatric Quarterly, 76(4), 371–378.CrossRefGoogle Scholar
  14. Cozza, S., & Feerick, M. (2011). The impact of parental combat injury on young military children. In J. Osofsky (Ed.), Clinical work with traumatized young children (pp. 139–154). New York, NY: Guilford Press.Google Scholar
  15. Cozza, S., Fisher, J., La Flair, L., Zhou, J., LaMorie, J., Grein, K., … Ursano, R. (manuscript in review). Bereaved military dependent spouses and children: Those left behind in a decade of war (2001–2011).Google Scholar
  16. Cozza, S., & Guimond, J. (2011). Working with combat-injured families through the recovery trajectory. In S. MacDermid Wadsworth & D. Riggs (Eds.), Risk and resilience in U.S. military families (pp. 259–277). New York, NY: Springer.CrossRefGoogle Scholar
  17. Cozza, S., Guimond, J., McKibben, J., Chun, R., Arata-Maiers, T., & Schneider, B. (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(1), 112–115.Google Scholar
  18. Dausch, B., & Saliman, S. (2009). Use of family focused therapy in rehabilitation for veterans with traumatic brain injury. Rehabilitation Psychology, 54(3), 279–287.CrossRefGoogle Scholar
  19. Dowdney, L. (2000). Annotation: Childhood bereavement following parental death. Journal of Child Psychology and Psychiatry, 41(7), 819–830.CrossRefGoogle Scholar
  20. Easterbrooks, M., Ginsburg, K., & Lerner, R. (2013). Resilience among military youth. The Future of Children, 23(2), 99–120.CrossRefGoogle Scholar
  21. Flake, E., Davis, B., Johnson, P., & Middleton, L. (2009). The psychosocial effects of deployment on military children. Journal of Developmental and Behavioral Pediatrics, 30(4), 271–278.CrossRefGoogle Scholar
  22. Galovski, T., & Lyons, J. (2004). Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran’s family and possible interventions. Aggression and Violent Behavior, 9, 477–501.CrossRefGoogle Scholar
  23. Gawande, A. (2004). Casualties of war-military care for the wounded from Iraq and Afghanistan. New England Journal of Medicine, 351, 2471–2475.CrossRefGoogle Scholar
  24. Gewirtz, A., Forgatch, M., & Wieling, E. (2008). Parenting practices as potential mechanisms for child adjustment following mass trauma. Journal of Marital and Family Therapy, 34(2), 177–192.CrossRefGoogle Scholar
  25. Gewirtz, A., Pinna, K., Hanson, S., & Brockberg, D. (2014). Promoting parenting to support reintegrating military families: After deployment, adaptive parenting tools. Psychological Services, 11(1), 31–40.CrossRefGoogle Scholar
  26. Gewirtz, A., Polusny, M., DeGarmo, D., Khaylis, A., & Erbes, C. (2010). Posttraumatic stress symptoms among National Guard soldiers deployed to Iraq: Associations with parenting behaviors and couple adjustment. Journal of Consulting and Clinical Psychology, 78(5), 599–610.CrossRefGoogle Scholar
  27. Gibbs, D., Martin, S., Kupper, L., & Johnson, R. (2007). Child maltreatment in enlisted soldiers’ families during combat-related deployments. Journal of the American Medical Association, 298(5), 528–535.CrossRefGoogle Scholar
  28. Gilreath, T., Wrabel, S., Sullivan, K., Capp, G., Roziner, I., Benbenishty, R., & Astor, R. (2016). Suicidality among military-connected adolescents in California schools. European Child and Adolescent Psychiatry, 25(1), 61–66.Google Scholar
  29. Goldberg, M. (2007). Statement of Matthew S. Goldberg, Deputy Assistant Director for National Security: Projecting the costs to care for veterans of U.S. military operations in Iraq and Afghanistan. Washington, DC: Congressional Budget Office Testimony.Google Scholar
  30. Green, B., Krupnick, J., Stockton, P., Goodman, L., Corcoran, C., & Petty, R. (2001). Psychological outcomes associated with traumatic loss in a sample of young women. American Behavioral Scientist, 44(5), 817–837.CrossRefGoogle Scholar
  31. Grieger, T., Cozza, S., Ursano, R., Hoge, C., Martinez, P., Engel, C., & Wain, H. (2006). Posttraumatic stress disorder and depression in battle-injured soldiers. The American Journal of Psychiatry, 163, 1777–1783.Google Scholar
  32. Hagan, M., Tein, J., Sandler, I., Wolchik, S., Ayers, T., & Luecken, L. (2012). Strengthening effective parenting practices over the long term: Effects of a preventive intervention for parentally bereaved families. Journal of Clinical Child and Adolescent Psychology, 41(2), 177–188.CrossRefGoogle Scholar
  33. Halcomb, E., & Davidson, P. (2005). Using the illness trajectory framework to describe recovery from traumatic injury. Contemporary Nurse, 19, 232–241.CrossRefGoogle Scholar
  34. Harrington-Lamorie, J., Cohen, J., & Cozza, S. (2014). Caring for bereaved military family members. In S. Cozza, M. Goldenberg, & R. Ursano (Eds.), Care of military service members, veterans and their families (pp. 257–276). Washington, DC: American Psychiatric Publishing.Google Scholar
  35. Herzog, J., Everson, R., & Whitworth, J. (2011). Do secondary trauma symptoms in spouses of combat-exposed national guard soldiers mediate impacts of soldiers’ trauma exposure on their children? Child and Adolescent Social Work Journal, 28(6), 459–473.CrossRefGoogle Scholar
  36. Hidalgo, R., & Davidson, J. (2000). Posttraumatic stress disorder: Epidemiology and health-related considerations. Journal of Clinical Psychiatry, 61(Suppl. 7), 5–13.Google Scholar
  37. Hisle-Gorman, E., Harrington, D., Nylund, C., Tercyak, K., Anthony, B., & Gorman, G. (2015). Impact of parents’ wartime military deployment and injury on young children’s safety and mental health. Journal of the American Academy of Child Adolescent Psychiatry, 54(4), 294–301.CrossRefGoogle Scholar
  38. Hoge, C., Auchterlonie, J., & Milliken, C. (2006). Mental health problems, use of mental health service, and attrition from military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association, 295(9), 1023–1032.CrossRefGoogle Scholar
  39. Hoge, C., Castro, C., Messer, S., McGurk, D., Cotting, D., & Koffman, R. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13–22.CrossRefGoogle Scholar
  40. Holmes, A., Cozza, S., Anderson, A., Sullivan, J., Fullerton, C., & Ursano, R. (2013). Child functioning in combat-injured military families: The moderating effects of injured service member parenting and PTSD symptoms. Seattle, WA: Society for Research in Child Development.Google Scholar
  41. Holmes, A., Rauch, P., & Cozza, S. (2013). When a parent is injured or killed in combat. The Future of Children, 23(2), 143–162.CrossRefGoogle Scholar
  42. Kaltman, S., & Bonanno, G. (2003). Trauma and bereavement: Examining the impact of sudden and violent deaths. Journal of Anxiety Disorders, 17(2), 131–147.CrossRefGoogle Scholar
  43. Kelley, S., & Sikka, A. (1997). A review of research on parental disability: Implications for research and counseling practice. Rehabilitation Counseling Bulletin, 41, 105–121.Google Scholar
  44. Kessler, R. (2000). Posttraumatic stress disorder: The burden to the individual and to society. Journal of Clinical Psychiatry, 61(Suppl. 5), 4–12.Google Scholar
  45. Kreutzer, J., Stejskal, T., Godwin, E., Powell, V., & Arango-Lasprilla, J. (2010). A mixed methods evaluation of the Brain Injury Family Intervention. NeuroRehabilitation, 27, 19–29.Google Scholar
  46. Kreutzer, J., Stejskal, T., Ketchum, J., Marwitz, J., Taylor, L., & Menzel, J. (2009). A preliminary investigation of the brain injury family intervention: Impact on family members. Brain Injury, 23(6), 535–547.CrossRefGoogle Scholar
  47. Kwok, O., Haine, R., Sandler, I., Ayers, T., Wolchik, S., & Tein, J. (2005). Positive parenting as a mediator of the relations between parental psychological distress and mental health problems of parentally bereaved children. Journal of Clinical Child and Adolescent Psychology, 34, 260–271.CrossRefGoogle Scholar
  48. LeClere, F., & Kowalewski, B. (1994). Disability in the family: The effects on children’s wellbeing. Journal of Marriage and Family, 56, 457–468.CrossRefGoogle Scholar
  49. Lester, P., Peterson, K., Reeves, J., Knauss, L., Glover, D., & Mogil, C. (2010). The long war and parental combat deployment: Effects on military children and at-home spouses. Journal of the American Academy of Child and Adolescent Psychiatry, 49(4), 310–320.Google Scholar
  50. Lester, P., Stein, J., Saltzman, W., Woodward, K., MacDermid, S., & Milburn, N. (2013). Psychological health of military children: Longitudinal evaluation of a family-centered prevention program to enhance family resilience. Military Medicine, 178(8), 838–845.CrossRefGoogle Scholar
  51. Lin, K., Sandler, I., Ayers, T., Wolchik, S., & Luecken, L. (2004). Resilience in parentally bereaved children and adolescents seeking preventive services. Journal of Clinical Child and Adolescent Psychology, 33, 673–683.CrossRefGoogle Scholar
  52. Manguno-Mire, G., Sautter, F., Lyons, J., Myers, L., Perry, D., & Sherman, M. (2007). Psychological distress and burden among female partners of combat veterans with PTSD. Journal of Nervous and Mental Disease, 195(2), 144–151.CrossRefGoogle Scholar
  53. Mansfield, A., Kaufman, J., Engel, C., & Gaynes, B. (2011). Deployment and mental health diagnoses among children of US Army personnel. Archives of Pediatric and Adolescent Medicine, 165(11), 999–1005.CrossRefGoogle Scholar
  54. Mansfield, A., Kaufman, J., Marshall, S., Gaynes, B., Morrissey, J., & Engel, C. (2010). Deployment and the use of mental health services among US Army wives. New England Journal of Medicine, 362(2), 101–109.CrossRefGoogle Scholar
  55. McCarroll, J., Fan, Z., Newby, J., & Ursano, R. (2008). Trends in US Army child maltreatment reports: 1990–2004. Child Abuse Review, 17, 108–118.CrossRefGoogle Scholar
  56. Melhem, N., Porta, G., Shamseddeen, W., Payne, M., & Brent, D. A. (2011). Grief in children and adolescents bereaved by sudden death. Archives of General Psychiatry, 68(9), 911–919.CrossRefGoogle Scholar
  57. Miklowitz, D., & Goldstein, M. (1997). Bipolar disorder: A family focused approach. New York, NY: Guildford Press.Google Scholar
  58. Milliken, C., Auchterlonie, J., & Hoge, C. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. Journal of the American Medical Association, 298(18), 2141–2148.CrossRefGoogle Scholar
  59. Owens, B., Kragh, J., Wenkos, J., Macaitis, J., Wade, C., & Holcomb, J. (2008). Combat wounds in operation Iraqi freedom and operation enduring freedom. Journal of Trauma-Injury Infection and Critical Care, 64, 295–299.CrossRefGoogle Scholar
  60. Pessar, L., Coad, M., Linn, R., & Willer, B. (1993). The effects of parental traumatic brain injury on the behaviour of parents and children. Brain Injury, 7(3), 231–240.CrossRefGoogle Scholar
  61. President’s Commission on Care for America's Returning Wounded Warriors. (2007). Serve, support, simplify: Report of the President's Commission on Care for America's Returning Wounded Warriors. Washington, DC.Google Scholar
  62. RAND Center for Military Health Policy Research. (2008). Invisible wounds: Mental health and cognitive needs of America’s returning veterans. Arlington, VA: RAND.Google Scholar
  63. Reiber, G., McFarland, L., Hubbard, S., Maynard, C., Blough, D., Gambel, J., & Smith, D. (2010). Service members and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: Survey methods, participants, and summary findings. Journal of Rehabilitation Research and Development, 47(4), 275–298.Google Scholar
  64. Rentz, E., Marshall, S., Loomis, D., Casteel, C., Martin, S., & Gibbs, D. (2007). Effect of deployment on the occurrence of child maltreatment in military and nonmilitary families. American Journal of Epidemiology, 165(10), 1199–1206.CrossRefGoogle Scholar
  65. Resnik, L., & Allen, S. (2007). Using international classification of functioning, disability and health to understand challenges in community reintegration of injured veterans. Journal of Rehabilitation and Research Development, 44(7), 991–1006.CrossRefGoogle Scholar
  66. Rosenheck, R., & Nathan, P. (1985). Secondary traumatization in children of Vietnam veterans. Hospital and Community Psychiatry, 36, 538–539.Google Scholar
  67. Saltzman, W., Lester, P., Beardslee, W., Layne, C., Woodward, K., & Nash, W. (2011). Mechanisms of risk and resilience in military families: Theoretical and empirical basis of a family-focused resilience enhancement program. Clinical Child and Family Psychological Review, 14, 213–230.CrossRefGoogle Scholar
  68. Sandler, I., Ayers, T., Wolchik, S., Tein, J., Kwok, O., & Haine, R. (2003). The Family Bereavement Program: Efficacy evaluation of a theory-based prevention program for parentally bereaved children and adolescent. Journal of Consulting and Clinical Psychology, 71(3), 587–600.CrossRefGoogle Scholar
  69. Sanders, M., Kirby, J., Tellegen, C., & Day, J. (2014). The triple P-positive parenting program: A systematic review and meta-analysis of a multi-level system of parenting support. Clinical Psychology Review, 34, 337–357.CrossRefGoogle Scholar
  70. Tanielian, T., & Jaycox, L. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Arlington, VA: RAND Corporation.Google Scholar
  71. Urbach, J., & Culbert, J. (1991). Head-injured parents and their children: Psychosocial consequences of a traumatic syndrome. Psychosomatics, 32, 24–33.CrossRefGoogle Scholar
  72. Verhaeghe, S., Defloor, T., & Grypdonck, M. (2005). Stress and coping among families of patients with traumatic brain injury: A review of the literature. Journal of Clinical Nursing, 14(8), 1004–1012.CrossRefGoogle Scholar
  73. Wain, H., & Gabriel, G. (2007). Psychodynamic concepts inherent in a biopsychosocial model of care of traumatic injuries. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 35(4), 555–573.CrossRefGoogle Scholar
  74. Walsh, F. (2006). Strengthening family resilience (2nd ed.). New York, NY: Guilford Press.Google Scholar
  75. Weaver, F., Burns, S., Evans, E., Rapacki, L., Goldstein, B., & Hammond, M. (2009). Provider perspectives on soldiers with new spinal cord injuries from Iraq and Afghanistan. Archives of Physical Medicine and Rehabilitation, 90, 517–521.CrossRefGoogle Scholar
  76. Weinstein, E., Salazar, A., & Franklin, D. (1995). Behavioral consequences of traumatic brain injury. In F. Jones, L. Sparacino, V. Wilcox, J. Rothberg, & J. Stokes (Eds.), War psychiatry (pp. 319–351). Falls Church, VA: Office of the Surgeon General, United States Army.Google Scholar
  77. Wickrama, K., & Kaspar, V. (2008). Family context of mental health risk in tsunami-exposed adolescents: Findings from a pilot study in Sri Lanka. Social Science & Medicine, 64, 713–723.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of PsychiatryUniformed Services University of the Health SciencesBethesdaUSA

Personalised recommendations