Experiences of children growing up with a parent who has military-related post-traumatic stress disorder: a qualitative systematic review
Authors: Cramm Heidi , Godfrey Christina M. , Murphy Susanne , McKeown Sandra , Dekel Rachel 
Published: October 2021

ABSTRACT

Objective:
The objective of this review is to describe the experiences of children growing up in military families with a parent who has military-related post-traumatic stress disorder.

Introduction:
Whether serving as a peacekeeper or warrior, military service is both physically and psychologically demanding, increasing exposures to potentially traumatic and morally injurious events and threats to personal safety. Those who have served in the military are at increased risk of developing post-traumatic stress disorder, which includes symptoms such as emotional numbing, withdrawal, and hyperarousal. Research has focused on the experiences of, and impacts on, spouses and partners of military veterans with post-traumatic stress disorder, with quantitative and synthesis studies reporting on measurable impacts on children growing up in military families where a parent is diagnosed with post-traumatic stress disorder.

Inclusion criteria:
This review included children who are currently living in, or have grown up in, military families in domestically peaceful nations that deploy their armed forces to global locations of political instability, armed civil conflict, or natural disasters for the purposes of peacekeeping, humanitarian aid, or war. This review also included parents living with post-traumatic stress disorder who speak specifically about the experience of their children. Situations of homeland conflict were excluded. The military families of interest are those with one or more parent with a diagnosis of post-traumatic stress disorder associated with military service. Traumatic experiences leading to post-traumatic stress disorder can be acquired prior to military service or through unrelated experiences, so it cannot be presumed that military service or even combat deployment, in and of itself, causes post-traumatic stress disorder. This review includes the experiences of children currently in childhood as well as adult children of a parent with current or previous military service.

Methods:
The following databases were first searched in August 2016 and updated in January 9, 2020: MEDLINE, Embase, Web of Science Core Collection, CINAHL, PsycINFO, AMED, ERIC, and ProQuest Dissertations and Theses Global. This review was conducted in accordance with JBI methodology for systematic reviews of qualitative evidence and with an a priori protocol.

Results:
Twelve studies were included. The majority of the studies were published after 2006. Elicited through data from adult (n = 65) and adolescent (n = 43) children and/or their parents (n = 65), the review represents the experiences of participants from military families in the United States, Canada, and Australia. There were four synthesized findings: i) Parental post-traumatic stress disorder creates a volatile and distressing climate within the family, eliciting a range of responses from children (87 findings across three categories); ii) Parental post-traumatic stress disorder ripples through the family system, disrupting interpersonal communication and relationships during childhood (57 findings across four categories); iii) Children can experience emotional and psychological difficulties well into adulthood (80 findings across five categories); and iv) Making sense of it all and moving beyond parental post-traumatic stress disorder can take significant time, energy, and support (74 findings across four categories).

Conclusions:
The quality of the included studies proved to be high, giving strength to this review. Effective ways of communicating with children about the nature of both the traumatic exposure and the post-traumatic stress disorder itself must be developed. While individuals with post-traumatic stress disorder deserve appropriate interventions to alleviate symptoms and improve functioning, it is not sufficient for recovery from post-traumatic stress disorder either for the individual or for the family who has been deeply affected themselves. Prospective and longitudinal research is needed, ensuring that both the voice of the child and of multiple perspectives within family systems are included and compared.