Parent Mental Health and Stress Exposure Associated with Behavioral Health Outcomes of Military-Connected Children

Objective. Among military-connected children, there is evidence of elevated adverse outcomes, including depressive symptoms, suicidality, weapon-carrying, and bullying. However, prior work suggests that exposure to deployment and other military stressors may not adequately explain these outcomes. This study employs a family-level stress process framework to explore how the mental health of both military service members and their spouses contribute independently or synergistically to children’s behavioral health. Further, this paper evaluates if early (e.g., maltreatment as a child) and recent (e.g., military deployment) parental stressors have independent effects on child behavior problems over and above parental mental health. Methods. Participants were 3,072 married, opposite-sex, military couples with at least one child aged 3 to 11 years who participated in Millennium Cohort Program surveys. Predictors, including parent stress exposure, PTSD, and depression, were measured at Wave 1. Child problem behaviors were measured via parental reports on the Strength and Difficulties Questionnaire at Wave 2, three years later. Robust modified linear probability models were run for each binary outcome. Results. We considered 10 child problem behaviors which had a prevalence greater than 10% in this sample. Across these behaviors, nontrivial elevations were observed as a function of the comorbidity of PTSD and depression among spouses (average increase = 13% relative to families in which neither parent screened positive for PTSD or depression). Non-comorbid PTSD among spouses was also associated with increases in child problem behaviors (average increase = 7% relative to families in which neither parent screened positive for PTSD or depression). Across all problem behaviors, spouse mental health tended to predict child outcomes while service member mental health did not. Military spouse experiences of maltreatment in their own childhoods also had effects on child behavior problems, independent of spouse mental health. Conclusion. These findings emphasize the importance of considering comorbidity, as the presence of two mental health conditions, particularly among spouses, was associated with meaningful increases in children’s behavioral health problems. Results also highlight the critical role military spouses play in the wellbeing of military families, adding to a body of work which also point to the relationship between spouse mental health and service member wellbeing. These findings underscore the importance of ensuring that spouses who are experiencing mental distress, and particularly comorbidity, have access to and receive mental health care. Properly caring for these spouses is essential not just for their own wellbeing but also for the wellbeing of their partners and their children. Further, the effects of spouses’ exposure to maltreatment in their own childhoods were evident in the association with children’s adverse behavioral health outcomes, even above the effects of spouse mental health. These findings imply that the impact of parent’s exposure to early adversity is multifaceted, complex, and does not operate solely through the mechanism of parent mental health. Family communication and parenting may also be important mechanisms that transmit the adverse effects of exposure to stress and trauma among military parents to their children. Future research is needed to isolate these mechanisms of transmission in military families.