Casualties on the Homefront

There's a paper in today's edition of the Journal of the American Medical Association that examines the impact of combat deployments on child abuse and neglect. The authors, lead by Deborah Gibbs of RTI International, found that the overall rate of abuse and neglect increased by more than 40% when a parent was deployed in support of combat operations in Iraq and Afghanistan. That result might not be very surprising, but it is alarming.

Once you get beyond the general finding, there are a lot of very interesting results in this paper. The increase in the rate of mistreatment is not even across all army families. Some groups of people are at a substantially higher risk for abuse/neglect than others, while some factors (such as the number of deployments) turn out to be much less important than you might expect.

Here's the bullet point breakdown of the findings:

• The only form of maltreatment to show a significant increase is neglect. The rate of neglect almost doubles during deployment, while the rates for physical and emotional abuse decrease and the rates for sexual abuse and cases with multiple forms of abuse remain unchanged.
• The group most at risk for increased neglect is civilian white females. The rates of abuse/neglect do not increase in other ethnic groups, and the increase seen in men is much smaller (RR men 1.36; RR women 3.33) and is not statistically significant. (The lack of significance may be due to the small sample size for this group.)
• This is not a problem that mainly involves the 18- and 19-year-old junior enlisted families who are dealing with major responsibilities for the first time. Neither age nor rank was a significant factor.
• Repeat deployments did not significantly change the relative risk - those who had deployed more than once did not differ from those on the first deployment.

The authors of the paper have some good ideas about the reasons for some of those findings. Since I'm a man who's a member of an Army Family that's dealt with deployment a couple of times now, I thought I'd add a couple of less-informed thoughts of my own.

One of the more surprising findings (at least for some; personally, I knew it all along. Really.) is probably the gender difference. Although the sample size for the men is quite small and the confidence intervals fairly large, it's very clear that women are at a substantially higher risk of abusing or neglecting their children while their husband is deployed than men are when their wife is away. Here's what the authors think:

...rates of child maltreatment were greater during soldier deployment for female civilian parents but not for male civilian parents, suggesting that these 2 groups may be different in terms of the stress they experience during their spouses' deployment, how they cope with such stress, or how they mobilize resources such as assistance with child care.

Of those three, I would guess that the most likely culprit is a difference in coping mechanisms. Speaking for myself, I was stressed out enough during my wife's last deployment that I would hate to think that the women were getting even more stressed.

The child care issue is more complex. There are support mechanisms, such as the Family Readiness Groups, that are easier for women to access than for most men. That's not a criticism of those groups - in my experience, FRG leaders have gone out of their way to encourage male spouses to participate - it's simply a fact of life. Being the only, or one of a handful, of men in a large group of women can easily create an awkward situation under the best of circumstances, and a group composed of people who's spouses work with each other and are away for a long period of time is not the best of circumstances. There's so much potential for gossip that everyone has to be very careful of appearances, and that gets uncomfortable fast. On the other hand, it would not surprise me to learn that male spouses are much more likely to be working outside the house, and that women who work outside the house have a risk level that's similar to the men. (The authors do point out that outside the house employment is one possible explanation for the ethnic difference.)

The lack of any significant change between the 1 deployment group and the 2+ deployment group is a bit harder to explain, but the authors have a few ideas:

...the civilian parent's evaluation of the situation might change after the experience of the initial deployment, moderating the experience of stress during subsequent deployments. In addition, the civilian parent may develop coping strategies during the soldier's initial deployment that help to alleviate the experience of stress during subsequent deployments. ...

After looking at the pool of data the authors used, I think there are a couple of other possible explanations. The data available covered a period that began on 9/11 and ended in December of 2004. The number of soldiers who did two combat tours during that period was relatively small compared to today, extended tours were less common, and during much of the period the mortality risk to the troops was much lower than today. There was also much more hope that the current tour would be the last one. It would not surprise me at all if a difference between single- and multiple-deployment groups shows up when (if) these analyses are repeated with data from more recent years.

The remaining factors indicate, at least to me, that increasing the mental health services available to spouses during deployment might be a really good idea. I'm no psychiatrist, and the plural of anecdote isn't data, but I know a lot of army spouses who've started on antidepressants during a deployment. Between that, the increase in neglect but not abuse, and the lack of any significant age factor, I'm starting to wonder how much of a factor clinical depression might be in this situation. It's worth noting, I think, that while soldiers receive at least nominal mental health screening during the pre- and post-deployment process, mental health screening for spouses has been purely voluntary, and takes place through self-referral. It might not be a bad idea if the military made more

of an effort to try and get spouses screened during deployments.

In closing, I should probably add that there is some good news - or at least not-so-bad news. During the study period, 1,771 families of enlisted United States Army soldiers were involved in a substantiated case of abuse and/or neglect. That's too many, but it's less than 1% of the total number of families. The study itself was funded by the Army, which indicates that this is a problem that they are taking seriously. Seriously enough, in fact, that they're hiring more family readiness support assistants (people who are paid to help coordinate support for families during deployments) and spending more money to provide respite childcare during deployments. That's good, and I hope it works.