Children of military parents who were deployed overseas had significantly fewer overall visits to health care providers than did children whose parents were stationed at home, but children of deployed parents had more mental health visits, according to a new study published online November 8 in Pediatrics.

The children of deployed parents recorded 11 percent fewer outpatient visits for physical health issues during the parent's deployment, but 11 percent more visits for mental or behavioral health, wrote Gregory Gorman, M.D., M.H.S., an assistant professor of pediatrics at the Uniformed Services University of the Health Sciences in Bethesda, Md., and colleagues.

Those percentages may seem modest but have significant implications, given the large absolute numbers involved, said Gorman in an interview with Psychiatric News.

"That's an extra 60,000 visits for which providers—mostly in primary care—need to be ready to recognize and manage mental health symptoms at a time when pediatric mental health resources are already in great demand," he said.

"Visits" covered outpatient office visits to any type of provider, whether primary care or mental health specialists.

The retrospective cohort study linked medical records from October 2005 through September 2007 for 642,397 children of military personnel with the deployment records of 442,722 parents.

The children were aged 3 to 8, with an average age of 5. The deployed parents' average age was 34, and about 90 percent were male.

Over two-thirds of the visits in the study were made to civilian providers under the authority of Tricare, the Department of Defense's health insurance management contractor.

The study covered more than 6.5 million patient visits, including 611,115 mental health visits. The most common mental health diagnosis was attention-deficit/hyperactivity disorder, accounting for 30.1 percent of all mental health diagnoses.

Among the mental health visits, the relative rate of mental disorders was 1.19, and of stress disorders was 1.18. The relative rate of anxiety disorders was 1.14, but was not statistically significant.

"The overall outcomes are not only statistically significant, they are also meaningful in the real world; I'm just relieved that they are not greater," said Shelley MacDermid Wadsworth, Ph.D., M.B.A., a professor of child development and family studies and director of the Center for Families and the Military Family Research Institute at Purdue University.

The pattern of mental health visits diverged sharply depending on whether the father or mother was deployed. When the mother deployed and the father was home taking care of the children, the incidence rate ratio for mental health visits was 0.70. When the father deployed and the mother was at home, the rate rose to 1.19.

The difference may arise because mothers, generally the primary caregivers, are more attuned to their children's emotional status and were thus more likely to take them to the doctor when they saw behavior that concerned them, said Gorman.

Men's attitudes toward symptoms might plausibly account for some of the gender differences, Wadsworth, who was not involved in the study, told Psychiatric News.

"Men and women behave differently toward the health care system," she said. "Women may respond to symptoms when a child complains, while men take more of a ‘shake-it-off’ attitude."

The researchers also found that fewer mental health visits were recorded during deployment for children of single parents than for children of married parents. That may occur because many of those children are cared for during the parent's deployment by adults outside the immediate family who may be less aware of the child's changing emotional states, said Gorman. Those caregivers may also be taking the children in their charge to outside civilian practitioners, and thus the visits were not recorded in the military database.

In any case, the data emphasize the need to continue extra support to children and families of deployed troops and collaboration between providers of primary care services to children and child mental health specialists, Gorman emphasized.

"We have to educate these pediatric providers to be more comfortable in managing these issues and these patients," he said.

The researchers did not have access to parental medical records and so could not know if the parents had been diagnosed with any mental conditions that might have contributed to the symptoms or behaviors that led to the child's mental health visit. Without further research that includes such data, they caution against assigning direct causation between parents' deployment and their children's visits for mental and behavioral health issues.

"The good thing about the study is that the numbers are large, so there's good population data, but it's hard to know why something has happened," said Wadsworth.

Gorman and his colleagues are addressing that issue as they continue research into specific diagnostic subgroups of children.

"Wartime Military Deployment and Increased Pediatric Mental and Behavioral Health Complaints" is posted at <http://pediatrics.aappublications.org/cgi/reprint/peds.2009-2856v1>.