Military service has transgenerational impact, study shows

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) reports that while children of veterans' families possess several socioeconomic advantages, including higher familial income, health insurance, and married caregivers, they also have higher rates of clinically recognized externalizing behavioral disorders, including ADHD and conduct problems, and adverse childhood experiences.

"As the US concludes nearly two decades of military involvement in Iraq and Afghanistan, the persisting effects of war on veterans and their children are of renewed concern," said lead author Tanner Bommersbach, MD, MPH, a child and adolescent psychiatry fellow at Mayo Clinic, Rochester, Minnesota.

Bommersbach conducted the study with co-authors Robert Rosenheck, MD, and Greg Rhee, Ph.D., of UConn Health and UConn School of Medicine and the Yale Department of Psychiatry.

"Much of the research on military children has been focused on children of active-duty service members, but less is known about the potential transgenerational effects of military service on children after service has ended," said Bommersbach.

"Children from veteran families are more likely to experience clinically-recognized externalizing mental health problems than those from non-veteran families," shared Rhee of UConn School of Medicine's Department of Public Health Sciences. "Future research on moderating roles of parenting and family functioning on mitigating such mental health conditions is needed. Also, future research is needed of long-term trajectories of their educational performance as well as mental health well-being."

These findings are based on a secondary analysis of data from the 2018-2019 National Survey of Children's Health (NSCH). The NSCH is a parent-reported nationally representative survey of non-institutionalized children in the US.

The authors compared school-age children of veterans' families (n = 4,028) to those of non-veterans' families (n=38,228) across a large number of parent-reported sociodemographic, physical and mental health, access to care, and school performance factors. Parents were asked whether their children had ever been diagnosed with anxiety, depression, ADD/ADHD, or conduct problems. The authors used multivariate analyses to adjust for socioeconomic factors that could potentially confound the analysis.

The study found that aside from increased rates of clinically recognized ADHD and conduct problems, there were few other substantial differences between children of veterans' and non-veterans' families in other clinical conditions, including chronic medical problems, anxiety, depression, and school performance measures. The study did find that children of veterans' families were reported to experience greater adverse childhood experiences, especially living with someone who is mentally ill.

"While future studies are needed to better understand the specific factors that may be associated with higher rates of clinically recognized child mental health problems in veterans' families, the findings point to the potential benefit of developing more targeted services for veterans' children," explains Bommersbach. "Service systems working with veterans may consider integrating screening for child mental health problems and parenting challenges. Such programs may aid in early detection of child behavioral problems and support children of veterans and their families."