WASHINGTON (Army News Service, Oct. 16, 2008) - Studies show that most military children are just as healthy and resilient as civilian children, but psychiatrists are concerned about their stress levels, said a mental health expert during the Association of the United States Army annual meeting last week.

Retired Col. Stephen J. Cozza, M.D., the associate director of the Center for the Study of Traumatic Stress and a professor at the Uniformed Services University School of Medicine's psychiatry department, told the audience at the third and final Family Forum that experts need to know more about how multiple deployments and changes like combat injuries, death and post-traumatic stress disorder affect military children.

He pointed out that although several studies are currently being conducted, most of the existing research and data comes from Operation Desert Storm or earlier and civilian studies.

"Military deployments are changing and military deployments are different," said Cozza. "First deployments can be different than second deployments and third deployments, so as we're moving into increasing optempo...how do we better understand it'"

With each deployment comes increased stress, which he said can eventually become distracting and difficult to manage, both for children and their caregivers. He pointed out that child maltreatment and neglect rates rise during deployments, so it's important that communities, leaders and support programs remain strong as well.

And then there is the stress families and children undergo when servicemembers return from deployment, which is also of particular concern, especially if the deployed parent suffered from injuries, or is experiencing PTSD or depression.

"We know that the health of military families and Soldiers are interconnected, Cozza said. "So if one is not doing well, it's likely that the other is going to be powerfully impacted by that. There isn't a whole lot of data in our military literature about the impact of psychiatric illnesses in parents, but we do know from the civilian literature that it can profoundly impact and impair children.

"It can disrupt parental roles. It can lead to child confusion and distortion about how they understand the changed behaviors they notice in parents, and it can also lead to increased risk behaviors, whether that has to do with domestic violence or substance misuse. PTSD itself is likely to be a significant and powerful impactor on relationships within families," he continued.

According to Cozza, the existing literature on military PTSD comes from Vietnam and shows that it had huge impacts on patients' spouses and children. In addition, civilian literature on serious injuries and traumatic brain injury also indicate behavioral changes and unique childhood experiences.

In one of the few recent studies, experts interviewed spouses of wounded Soldiers at Walter Reed and Brooke Army Medical Centers to examine the effect of combat injuries on families. It found families faced huge changes and challenges in separation, living arrangements, schedules, discipline, time devoted to children and parental concerns about the emotional impact on their children.

"Those experiences were profound ... We've coined this term: injury communication. The question a lot of parents want to know is, 'What do we tell our kids' We don't really know how to talk to them about this. So how do we help find and give them the words that they need in order to better talk about it''" Cozza said.

"Trauma is not an event," he added. "It's a process. It puts in place a whole confounding group of events," including Soldiers separating from the military and the resulting moves and school changes. And because families might move to civilian communities with little understanding of military trauma, Cozza said it should be a national concern.

He also mentioned that because many of the Soldiers with catastrophic injuries are young fathers with young children, they're often used to rough housing and playing sports with their children. Their injuries may even mean finding new ways to think about parenting and playing with their children.

And if a parent is killed in action, children experience even more profound changes and loss, he said. They may also face additional upheavals in their lives such as moving, and are not only extremely vulnerable, but at increased risk for developing PTSD themselves.

"There are certain instances in which children are powerfully impacted or there are images that they have that are hard for them to get out of their head. It's difficult for them to move past the normal grieving process. They continue to be pathologically attached to that person who's died and have difficulties thinking about them, talking about them, without becoming tremendously distressed. We need to be thinking about whether that occurs in our community. We don't know whether it does or not. Certainly if children are demonstrating those symptoms, we want to make sure we get them help," Cozza said.