Child maltreatment in enlisted soldiers' families during combat-related deployments

Context Parental stress is believed to play a critical role in child maltreatment, and deployment is often stressful for military families.

Objective To examine the association between combat-related deployment and rates of child maltreatment in families of enlisted soldiers in the US Army who had 1 or more substantiated reports of child maltreatment.

Design and Setting Descriptive case series of substantiated incidents of parental child maltreatment in 1771 families of enlisted US Army soldiers who experienced at least 1 combat deployment between September 2001 and December 2004.

Main Outcome Measures Conditional Poisson regression models were used to estimate rate ratios (RRs) that compare rates of substantiated child maltreatment incidents during periods of deployment and nondeployment.

Results A total of 1858 parents in 1771 different families maltreated their children. In these families, the overall rate of child maltreatment was higher during the times when the soldier-parents were deployed compared with the times when they were not deployed (942 incidents and 713 626 days at risk during deployments vs 2392 incidents and 2.6 million days at risk during nondeployment; RR, 1.42 [95% confidence interval {CI}, 1.31-1.54]). During deployment, the rates of moderate or severe maltreatment also were elevated (638 incidents and 447 647 days at risk during deployments vs 1421 incidents and 1.6 million days at risk during nondeployment; RR, 1.61 [95% CI, 1.45-1.77]). The rates of child neglect were nearly twice as great during deployment (761 incidents and 470 657 days at risk during deployments vs 1407 incidents and 1.6 million days at risk during nondeployment; RR, 1.95 [95% CI, 1.77-2.14]); however, the rate of physical abuse was less during deployments (97 incidents and 80 033 days at risk during deployments vs 451 incidents and 318 326 days at risk during nondeployment; RR, 0.76 [95% CI, 0.58-0.93]). Among female civilian spouses, the rate of maltreatment during deployment was more than 3 times greater (783 incidents and 382 480 days at risk during deployments vs 832 incidents and 1.2 million days at risk during nondeployment; RR, 3.33 [95% CI, 2.98-3.67]), the rate of child neglect was almost 4 times greater (666 incidents and 303 555 days at risk during deployments vs 605 incidents and 967 362 days at risk during nondeployment; RR, 3.88 [95% CI, 3.43-4.34]), and the rate of physical abuse was nearly twice as great (73 incidents and 18 316 days at risk during deployments vs 141 incidents and 61 105 days at risk during nondeployment; RR, 1.91 [95% CI, 1.33-2.49]).

Conclusions Among families of enlisted soldiers in the US Army with substantiated reports of child maltreatment, rates of maltreatment are greater when the soldiers are on combat-related deployments. Enhanced support services may be needed for military families during periods of increased stress.

Child maltreatment includes neglect, physical abuse, emotional abuse, and sexual abuse. Children who are maltreated are at increased risk for negative health behaviors, depression, and chronic health conditions, with negative sequelae extending into adulthood.1 - 3 Few studies have examined child maltreatment within military families,4 - 10 of which there were more than 1.1 million with children younger than 18 years in 2004.11 Limited knowledge regarding these families is of concern because of the possible impact of combat-related deployments on child maltreatment.

Military families have been found to demonstrate high levels of resilience12 - 13 ; nonetheless, deployments pose unique challenges. These deployments may affect the family's children, the soldier-parent preparing for (or returning from) deployment, and the parent remaining at home during deployment. Deployments have been associated with stress14 - 18 and behavioral problems14 ,19 among children in military families, situations that can exacerbate parental stress.

Deployment also has been associated with increased stress17 ,20 - 21 among nondeployed parents, which may hamper their ability to appropriately care for their children. Parental stress (as mediated by their appraisals of the situation, available resources, and coping strategies) is believed to play a critical role in child maltreatment,22 - 23 particularly child neglect.24 Hillson and Kuiper's stress and coping model of child maltreatment22 suggests that parents respond to stress either with positive adaptive behaviors or with dysfunctional behaviors that may result in child maltreatment.

The findings of 2 studies25 - 26 suggest a relationship between large-scale military deployments and increases in child maltreatment; however, the study designs did not permit the investigators to compare rates of child maltreatment events within abusive families during periods of deployment and nondeployment.

.