Can Strong Communities Build Resilience in Military Children?

Whenever a new study about the mental health woes of military families is released to the public, Bethanne Patrick reads it with interest. This mother of two believes that the family’s military life profoundly affected her children over the course of her now-retired Army officer husband’s career.

“We never went through a deployment during my husband’s career—and we’re so fortunate that way. But military life, even without a deployment, is hard on kids, with the moves and the uncertainties and all of that,” she says. “It was particularly hard on my older daughter: She couldn’t cope with the moves very well. They shook her up mentally and emotionally. It wasn’t quite as tough on my younger daughter, but it still wasn’t always easy on her either.” Patrick believes her older daughter may have had a tougher time because she experienced more moves at a younger age, but she concedes she doesn’t know “how much of the issue is about nature and how much is about nurture—or the military’s lack thereof in terms of services and help.”

A new study presented at the Pediatric Academic Societies meeting in May confirms Patrick’s observations about military life being hard on children. The researchers, led by Elizabeth Lisle-Gorman at the Uniformed Services University of the Health Sciences, found that the percentage of military children diagnosed with anxiety, attention deficit hyperactivity disorder (ADHD), or other mental health conditions had significantly increased over the past 15 years.

Increased diagnoses

Several studies have shown that military life has short-term effects on the mental health of families. But she wanted to learn more about the possible long-term effects, Lisle-Gorman says. “We wanted to understand if this is a trend that is increasing over time, and [if so] is it a result of all the combat that kids’ parents had been going through or something else? When going through the literature, I found, much to my dismay, that there are not a lot of good national studies, in large part because we don’t have a good way to look at everyone equally because the healthcare that people are getting is so different from family to family.”

Lisle-Gorman and colleagues reviewed the records of every military child who had contact with the healthcare system, in a military or civilian practice, whose family was reimbursed through Tricare, the military’s insurance plan, over the past 15 years. This gave the scientists a “snapshot” of care across millions of children. Among that group, the researchers found an increase in mental health diagnoses among military children, as well as an increase in mental health treatment.

Lisle-Gorman says that the results leave her with more questions than answers. “Our studies of this population are remarkably insufficient,” she says. “We need to do more research to understand what’s behind these increased mental health care needs and if these kids are really that different than civilian populations. They may actually be more resilient and just trending up with the general population. We don’t really know the answers to those questions yet and there’s a lot left to learn.”

Born resilient, or grown?

A variety of studies have demonstrated that children who experience adverse childhood experiences (ACEs) such as physical abuse, emotional abuse, the death of a loved one, or economic hardship are much more likely to have mental health issues later in life. Certainly, military life, especially during times of war, can expose children to some of those ACEs. But why do some kids fall prey to depression, anxiety and substance abuse problems while others seem to do just fine? It might come down to better executive functioning in the brain.

Keith Burt, a resilience researcher at the University of Vermont, recently found that having larger grey volume areas in the frontal gyri were associated with resilience in the face of adverse experiences in adolescents. The results were published in the Journal of Child Psychology and Psychiatry in April 2016.

“It’s was a nice finding that is in line with a lot of the psychological work on resilience. We see this combination of emotion regulation and executive function in children that better cope with adverse events,” he says. “There’s a cognitive control piece here. And it appears that maybe resilient kids are, for whatever reason, able to do this kind of control more easily than others, although it’s something that is also developing over time.”

New work by Iman Sharif, a pediatrician at Thomas Jefferson University, also suggests it is possible to build infrastructure in communities, military and beyond, to help foster resilience in all kids, not just likely-to-be-resilient kids.

“We know that kids can grow up healthy despite the adversity they’ve been exposed to. So we wanted to see what might be there to help those kids do better,” she says. “When we looked at data from the 2011-2012 National Survey of Children’s Health, we found some really nice surprises. We saw good outcomes where these kids were flourishing when families were part of patient-centered medical homes [a model of healthcare where patients have one physician who integrates and coordinates care across the family], where families had social and community support, and where Mom’s mental health was in good shape.”

Sharif and colleagues also saw a positive correlation between resilience and parents who had completed at least some college, as well as safer neighborhoods where children had access to libraries, parks, and recreation centers. These findings, Sharif says, should help us direct investments in our neighborhoods to help build up reserves of resilience in kids—in both civilian and military communities.

“It comes down to linking kids who are at risk to these kinds of support that we’ve identified as protective. We can help families find community supports and social networks to more coordinated healthcare,” she says. “And if we can understand how some families are accessing these supports successfully, we have the opportunity to help other families who aren’t linked to these supports to find a way to get there, too.”

Patrick’s daughters, now 23 and 18, are doing well. Patrick says she is not surprised by Sharif’s findings and agrees that community is an important component of resilience and long term success for military kids. She strongly advocates for military families to stay in one place long enough to put down strong community roots.

“It really was such a marked difference between one child who experience a lot of the moves—and those stresses that go along with the moves—and the child who got to go through school with all the same friends, the same teachers, and same community. I think it makes a huge difference for mental health when you can put down roots,” she says. “And this is important whether or not the service member is in the theatre of war. Kids, spouses, service members—everyone can benefit from more stability and community, mentally and emotionally.”