Abstract
Objectives
To investigate the association between physical and mental health symptoms in adolescents and having a parent in the Canadian Armed Forces and the moderation of these associations by various sources of social support.
Methods
We used data on a nationally representative sample of 18,886 adolescents (11–15 years) in the 2017/18 Canadian Health Behaviour in School-aged Children study (HBSC). Survey assessments included multi-item scales of mental and physical health symptoms and sources of social support (peers, families, classmates, and teachers). Poisson regression was used to estimate incidence rate ratios (IRR) of weekly symptoms in military versus non-military youths. Moderation of differences between these groups were tested using interactions of variables representing support and military families.
Results
Military youth, compared to non-military youth, reported more mental health symptoms (IRR = 1.20; 95% CI 1.08, 1.33) but only marginally more physical symptoms (IRR = 1.15; 95% CI 1.00, 1.33) in the previous week. These associations were stronger in youths who reported lower levels of peer support (IRR = 0.99; 95% CI 0.98, 1.00 [mental health symptoms]; IRR = 0.98; 95% CI 0.97, 1.00 [physical health symptoms]). Support from families, classmates and teachers did not moderate differences in mental or physical symptoms.
Conclusion
Canadian adolescents in military families have increased risk for experiencing poor mental health. Peer support may play a protective role, however further research is needed to guide clinical interventions for this unique population.
Supplementary Information
The online version contains supplementary material available at 10.17269/s41997-023-00758-5.
Keywords: Adolescents, Youth, Mental health, Military health, Peer support
Résumé
Objectifs
Étudier l’association entre les symptômes de santé physique et mentale chez les adolescents et le fait d’avoir un parent dans les forces armées canadiennes et la modération de ces associations par diverses sources de soutien social.
Méthodes
Nous avons utilisé les données d’un échantillon national représentatif d’adolescents (n = 18 886; 11 à 15 ans) dans l’étude 2017–2018 sur les comportements de santé des enfants d’âge scolaire (HBSC) au Canada. Les évaluations de l’enquête comprenaient des échelles multi-items de symptômes de santé mentale et physique et des sources de soutien social (pairs, familles, camarades de classe et enseignants). Un modèle de régression de Poisson a servi à estimer les rapports de taux d’incidence (TRI) des symptômes hebdomadaires chez les jeunes militaires par rapport aux jeunes non militaires. La modération des écarts entre ces groupes a été testée en utilisant les interactions entre le soutien militaire et les variables familiales.
Résultats
Les jeunes militaires, comparativement aux jeunes non militaires, ont signalé plus de symptômes de santé mentale (TRI = 1,20; IC à 95% 1,08, 1,33), mais seulement légèrement plus de symptômes physiques (TRI = 1,15; IC à 95% 1,00, 1,33) au cours de la semaine précédente. Ces associations étaient plus fortes chez les jeunes qui ont déclaré des niveaux inférieurs de soutien par les pairs (IRR = 0,99; IC à 95% 0,98, 1,00 [symptômes de santé mentale]; IRR = 0,98; IC à 95% 0,97, 1,00 [santé physique symptômes]). Le soutien des familles, des camarades de classe et des enseignants n’a pas atténué les différences de symptômes mentaux ou physiques.
Conclusion
Les adolescents canadiens de familles militaires sont exposés à un risque accru de maladie mentale. Le soutien par les pairs peut jouer un rôle de protection, mais il faut effectuer d’autres recherches pour orienter les interventions cliniques auprès de cette population unique.
Mots-clés: Adolescents, jeunes, santé mentale, santé militaire, soutien par les pairs
Introduction
Canada has approximately 66,000 Regular Forces members with 37,000 non-military spouses and 60,000 dependent children (Manser, 2020a). About 4000 members are single parents and half are under the age of 35. Military families are a unique and overlooked group in public health despite evidence of elevated mental health problems, financial pressures, and relationship difficulties (Cramm et al., 2015; Manser, 2020b).
There is good cause for concern for the health of children of military families. The disruption and stress caused by frequent relocations, parental deployment and parental separation are common experiences for military youth (Gorman et al., 2010) and well-established risk factors for youth mental health (Susukida et al., 2016; Woodward et al., 2000). Previous research in the United States found increased child internalizing and externalizing behaviours (Chartrand et al., 2008) and outpatient use of mental health services (Gorman et al., 2010) when a military parent is deployed. Mahar et al. (2022) and Warfield et al. (2018) both found greater health care utilization among children of military as compared with those of non-military personnel for a range of behavioural and physical health conditions, including pervasive developmental disorders, hyperkinetic syndrome, arthritis, asthma, diabetes, head injury and migraine/headaches. Moreover, post-traumatic stress disorder (PTSD) and depression are more prevalent in American active duty and military veterans than in the general population (Gates et al., 2012; Liu et al., 2019) and the children of parents with PTSD (Reid & Berle, 2020) or depression (Kudinova et al., 2018) are at increased risk of experiencing anxiety, depression, and hyperactivity/inattention and other adjustment problems (Cunitz et al., 2019).
It is possible that youth of parents in the Canadian Armed Forces (CAF) also experience poorer mental and physical health than their civilian counterparts. However, there is a general lack of Canadian evidence in this area (Cramm et al., 2015) and knowledge gaps exist with respect to protective social relationships. For instance, healthy social relationships have been found to support adolescent mental health (Viner et al., 2012) and life satisfaction (Walsh et al., 2020), but these topics remain unstudied in Canadian military youth.
In response to calls for more Canadian research on this population (e.g., Cramm et al., 2015), we investigated the association of having a parent in the Canadian military with mental and physical health symptoms in a nationally representative sample of youth. We also examined potential moderators of these associations using youth-reported social support from peers, family members, teachers and schools. We hypothesized there are more health symptoms in military youth than in non-military youth, and these differences would be reduced in better-supported youth.
Methods
Data source
Data were obtained in the 2017/18 Canadian Health Behaviour in School-aged Children study (HBSC) (Freeman et al., 2016). HBSC is a cross-sectional survey conducted every four years in collaboration with the World Health Organization (Inchley et al., 2016). Following an international protocol (Inchley et al., 2016), the Canadian HBSC used anonymous and self-completed questionnaires distributed in classroom settings. Consent (active or passive depending on the practices within individual school boards) was obtained from the participating students, their parents or guardians, and participating schools. The survey was granted ethics approval from the General Research Ethics Board at Queen’s University, and the Health Canada and Public Health Agency of Canada Research Ethics Board.
Sample
The HBSC study used multi-staged sampling. In all Canadian provinces and territories (except Nunavut, which did not participate in the 2017/18 survey cycle), a list of eligible school jurisdictions was created and organized by school language, school board type (Catholic or public), and populations of the schools and surrounding communities (Freeman et al., 2016). Adolescents who were homeschooled, in private schools, living on Indigenous First Nations, or incarcerated were excluded due to the sampling protocol. The mean student response rate from participating classes was 75%, resulting in a sample of 21,750 participants from 287 schools. The data were weighted to make them nationally representative of grade level, school board type, and province/territory.
Measures
Military families
The survey identified youth with a parent in the CAF by asking “Does one of your parents/guardians currently serve, or have they served, in the Canadian Armed Forces military (i.e., Army, Navy, Air Force)?” The response options were “yes,” “no” or “don’t know.” In our analyses, 2864 cases were removed for missing data or indicating “don’t know” to the item on military families.
Psychosomatic health symptoms
The HBSC questionnaire included an 8-item scale that measured the frequency of four mental health symptoms (“feeling low [depressed],” “irritability or bad temper,” “feeling nervous,” and “difficulties getting to sleep”) and four physical health symptoms (“headache,” “stomach-ache,” “backache,” and “feeling dizzy”), each with a 5-point response scale that ranged from 1 (“about every day”) to 5 (“rarely or never”). We used these responses to calculate the rate of weekly mental health symptoms (0 to 4) and the rate of weekly physical health symptoms (0 to 4). The psychosomatic symptom scale was previously verified for construct validity and reliability in Canada (Gariepy et al., 2016) and internationally (Haugland & Wold, 2001; Ravens-Sieberer et al., 2008).
Social support
Family and peer social support were measured by using two of the three subscales of the Multi-dimensional Scale of Perceived Social Support (MSPSS; Zimet et al., 1988). The third scale of the MSPSS, which measures support from a significant other, was not included in the HBSC questionnaire. Four items measured family support (degree of help from family, availability of emotional help and support, ability to talk about problems, and willingness to help make decisions; α = 0.94). Four items measured friend support (degree of help from friends, ability to count on them when things go wrong, ability to share both happy and sad feelings, and ability to talk about problems; α = 0.92). Response options for these items ranged from 1 (“very strongly disagree”) to 7 (“very strongly agree”). We calculated the total score (range 0 to 28) for each subscale to represent family support and peer support. The scales were previously validated in adolescents (e.g., Bruwer et al., 2008).
The HBSC questionnaire included an additional 3-item measure of classmate support (e.g., “Most of the students in my class are kind and helpful,” α = 0.90) and an 8-item measure of teacher support (e.g., “When I need extra help, I can get it,” α = 0.90) with response options ranging from 1 = “strongly agree” to 5 = “strongly disagree.” These items were reverse-scored and summed to represent classmate support (range 0 to 12) and teacher support (range 0 to 32). This scale was also validated in international samples of adolescents (Torsheim et al., 2000).
Covariates
Regression analyses of mental health symptoms controlled for age, gender (male, female, or neither), family structure, community size and socioeconomic position (SEP) in quintile groups (Ormel et al., 2015; Reiss, 2013; Van Droogenbroeck et al., 2018). Family structure was dichotomized to distinguish two-parent families (married or common-law) from families with one parent. SEP was measured using a 6-item index of material assets in the home and family activities (e.g., number of cars, having own bedroom, family vacations; Currie et al., 2008). Community size was estimated using the postal code of the sampled school and categorized as either rural (below 1000 population), small town (1000 to 29,999 population), medium town (30,000 to 99,999 population) or urban (more than 100,000 population).
Statistical analysis
Data analyses were weighted and adjusted for sampling stratification using the svy command in Stata 16.1 (StataCorp, College Station, TX). Poisson regression was used to estimate incidence rate ratios (IRR) of mental and physical health symptoms during the previous week. These associations were tested without the covariates and then with the covariates in a fully adjusted model. Military families were identified by a dummy variable. The reference categories for the covariates were: male (gender), single-parent (family structure), lowest quintile (SEP), and small town (community size). Moderation of differences between military and non-military youths were tested using interactions of support variables and military families. Where significant, we graphically show the direction of these interactions in the form of adjusted incidence rates of health symptoms across levels of social support in military and non-military youth.
Results
Our analytic sample included 18,886 youth (2864 cases were removed due to having missing data or reporting “don’t know” to the question on military families). Youth in military families made up 9.7% of the sample. This group was slightly younger than non-military youth and included more males (51.6% vs. 48.4%; χ2 = 16.46, p = 0.005) and fewer females (46.8% vs. 52.3%; χ2 = 19.70, p = 0.003; Table 1). Small differences were found in the distribution of SEP groups, with fewer military youth in the first SEP quintile (15.0% vs. 18.7%, χ2 = 12.68, p = 0.018) and more in the second SEP quintile (26.6% vs. 21.9%; χ2 = 17.94, p = 0.011). Table 1 also shows unadjusted mean differences in social support, with military youth reporting less family, peer, classmate, and teacher support compared to non-military youth (p < 0.01).
Table 1.
Description of the survey population
| Military families (n = 1815) | Non-military families (n = 17,071) | p value | |||
|---|---|---|---|---|---|
| % (95% CI) | M (SD) | % (95% CI) | M (SD) | ||
| Age | 13.7 (1.5) | 13.9 (1.4) | 0.007 | ||
| Gender | |||||
| Male | 51.6 (47.9, 55.3) | 46.6 (44.9, 48.3) | 0.005 | ||
| Female | 46.8 (43.1, 50.6) | 52.3 (50.5, 54.0) | 0.003 | ||
| Neither | 1.6 (0.9, 2.7) | 1.1 (0.9, 1.4) | 0.213 | ||
| Community size | |||||
| Rural | 0.9 (0.2, 3.2) | 1.3 (0.3, 6.2) | 0.121 | ||
| Small town | 44.2 (34.2, 54.6) | 47.3 (35.9, 58.9) | 0.510 | ||
| Medium town | 17.6 (11.4, 26.3) | 22.4 (13.4, 34.9) | 0.248 | ||
| Urban | 37.2 (28.0, 47.5) | 29.0 (20.1, 40.0) | 0.058 | ||
| Family structure | |||||
| Single-parent | 21.5 (18.7, 24.6) | 19.3 (17.7, 21.0) | 0.150 | ||
| Two-parent | 78.5 (75.4, 81.3) | 80.7 (79.0, 82.3) | 0.150 | ||
| SEP quintile | |||||
| 1 (lowest) | 15.0 (12.4, 18.0) | 18.7 (17.1, 20.5) | 0.018 | ||
| 2 | 26.6 (23.0, 30.6) | 21.9 (20.0, 23.9) | 0.011 | ||
| 3 | 15.1 (12.6, 18.0) | 15.6 (14.0, 17.3) | 0.750 | ||
| 4 | 21.9 (19.1, 24.9) | 25.2 (23.2, 27.3) | 0.053 | ||
| 5 (highest) | 21.4 (18.2, 25.1) | 18.6 (17.1, 20.2) | 0.102 | ||
| Family support | 15.2 (7.5) | 15.9 (7.2) | < 0.001 | ||
| Peer support | 14.8 (7.4) | 15.3 (7.1) | 0.002 | ||
| Classmate support | 7.5 (2.7) | 7.8 (2.5) | < 0.001 | ||
| Teacher support | 21.9 (6.5) | 22.7 (6.0) | < 0.001 | ||
| Weekly mental health symptoms | |||||
| 0 | 52.3 (48.4, 56.1) | 55.7 (54.1, 57.4) | 0.08 | ||
| 1 | 19.8 (17.1, 22.9) | 19.6 (18.5, 20.7) | 0.88 | ||
| 2 | 12.0 (9.7, 14.8) | 12.0 (11.3, 12.8) | 0.99 | ||
| 3 | 9.4 (7.4, 11.9) | 7.3 (6.6, 8.0) | 0.04 | ||
| 4 | 6.5 (4.8, 8.6) | 5.4 (4.8, 6.1) | 0.23 | ||
| Weekly physical health symptoms | |||||
| 0 | 70.8 (66.5, 74.7) | 71.2 (69.6, 72.9) | 0.17 | ||
| 1 | 15.6 (12.8, 18.9) | 16.6 (15.7, 17.5) | 0.52 | ||
| 2 | 6.6 (5.2, 8.4) | 6.8 (6.2, 7.4) | 0.83 | ||
| 3 | 4.7 (3.4, 6.6) | 3.3 (2.8, 3.9) | 0.05 | ||
| 4 | 2.3 (1.5, 3.5) | 2.1 (1.8, 2.5) | 0.69 | ||
Note: Shown are weighted estimated means and standard deviations (SD) or percent and 95% confidence intervals (CI). P-values are for pairwise comparisons (chi-square or t-test) of youth in military and non-military families
Table 2 shows the results of our regression analysis of mental health symptoms. Military youth experienced a higher rate of mental health symptoms than non-military youth. The association was found in both unadjusted (IRR = 1.13, p = 0.034) and adjusted regression models (IRR = 1.20; p < 0.001). However, as shown in Table 3, the difference between military and non-military youth in physical health symptoms was not statistically significant in an unadjusted regression model and only approached significance once the covariates were entered in the model (IRR = 1.15, p = 0.06).
Table 2.
Poisson regression of weekly mental health symptoms in military and non-military youth in Canada
| Unadjusted associations | Adjusted associations | |||
|---|---|---|---|---|
| IRR | 95% CI | IRR | 95% CI | |
| Gender | ||||
| Male | 1.00 (ref.) | 1.00 (ref.) | ||
| Female | 1.87*** | (1.74, 2.00) | 1.80*** | (1.69, 1.93) |
| Neither | 2.97*** | (2.51, 3.51) | 2.78*** | (2.33, 3.31) |
| Age (years) | 1.15*** | (1.12, 1.18) | 1.13*** | (1.10, 1.15) |
| SEP quintile | ||||
| 1 (lowest) | 1.00 (ref.) | 1.00 (ref.) | ||
| 2 | 0.90* | (0.82, 0.98) | 0.94 | (0.86, 1.03) |
| 3 | 0.80*** | (0.73, 0.88) | 0.85** | (0.78, 0.93) |
| 4 | 0.73*** | (0.67, 0.80) | 0.79*** | (0.73, 0.87) |
| 5 (highest) | 0.74*** | (0.67, 0.81) | 0.81*** | (0.74, 0.88) |
| Community size | ||||
| Rural | 1.22 | (0.92, 1.63) | 1.31 | (0.97, 1.78) |
| Small | 1.00 (ref.) | 1.00 (ref.) | ||
| Medium | 0.99 | (0.86, 1.13) | 1.01 | (0.92, 1.11) |
| Urban | 0.95 | (0.85, 1.05) | 0.97 | (0.89, 1.04) |
| Family structure | ||||
| Single-parent | 1.00 (ref.) | 1.00 (ref.) | ||
| Two-parent | 0.78*** | (0.72, 0.84) | 0.83*** | (0.77, 0.89) |
| Military family | 1.13* | (1.01, 1.26) | 1.20** | (1.08, 1.33) |
Shown are incidence rate ratios (IRR) of weekly mental health symptoms and 95% confidence interval (CI). Reference categories were male (gender), single-parent (family structure), lowest quintile (SEP), and small town (community size)
*p < 0.05 **p < 0.01 ***p < 0.001
Table 3.
Poisson regression of weekly physical health symptoms in military and non-military youth in Canada
| Unadjusted associations | Adjusted associations | |||
|---|---|---|---|---|
| IRR | 95% CI | IRR | 95% CI | |
| Gender | ||||
| Male | 1.00 (ref.) | 1.00 (ref.) | ||
| Female | 2.16*** | (1.99, 2.36) | 2.14*** | (1.97, 2.32) |
| Neither | 3.55*** | (2.80, 4.49) | 3.38*** | (2.62, 4.36) |
| Age (years) | 1.18*** | (1.13, 1.23) | 1.16*** | (1.12, 1.20) |
| SEP quintile | ||||
| 1 (lowest) | 1.00 (ref.) | 1.00 (ref.) | ||
| 2 | 0.83** | (0.73, 0.95) | 0.90 | (0.79, 1.02) |
| 3 | 0.73*** | (0.63, 0.85) | 0.79** | (0.69, 0.91) |
| 4 | 0.73** | (0.63, 0.84) | 0.82** | (0.72, 0.93) |
| 5 (highest) | 0.81*** | (0.71, 0.92) | 0.93 | (0.82, 1.06) |
| Community size | ||||
| Rural | 1.27 | (0.87, 1.84) | 1.41 | (0.95, 2.07) |
| Small | 1.00 (ref.) | 1.00 (ref.) | ||
| Medium | 0.99 | (0.82, 1.21) | 1.03 | (0.89, 1.18) |
| Urban | 0.83* | (0.72, 0.96) | 0.84** | (0.74, 0.95) |
| Family structure | ||||
| Single-parent | 1.00 (ref.) | 1.00 (ref.) | ||
| Two-parent | 0.70*** | (0.64, 0.77) | 0.75*** | (0.68, 0.83) |
| Military family | 1.08 | (0.92, 1.26) | 1.15 | (1.00, 1.33) |
Shown are incidence rate ratios (IRR) of weekly physical health symptoms and 95% confidence interval (CI). Reference categories were male (gender), single-parent (family structure), lowest quintile (SEP), and small town (community size)
*p < 0.05 **p < 0.01 ***p < 0.001
Regarding other sociodemographic variables, mental and physical health symptoms were more prevalent in female and gender-minority youths than in males and were more prevalent in older youths (Tables 2 and 3). Mental health symptoms were progressively less prevalent in higher SEP quintiles (Table 2). Physical health symptoms showed a less pronounced gradient across SEP; their prevalence was lower only in 3rd and 4th quintile groups than in the lowest quintile. Rates of weekly physical health symptoms were also more prevalent in urban settings than in small communities (Table 3).
Finally, while family, peer, classmate, and teacher support variables showed robust inverse associations with mental and physical health symptoms, only peer support moderated their associations with military families. As summarized in Table 4 and shown in more detail in supplementary Tables S1 and S2, the interaction of being in a military family and peer support was negatively associated with mental health symptoms (IRR = 0.99, p = 0.043) and physical health symptoms (IRR = 0.98, p = 0.047). In both instances, the negative associations of peer support with symptoms were stronger in military youths (IRR = 0.86, p < 0.001 [mental health symptoms]; IRR = 0.96; p < 0.001 [physical health symptoms]) than in non-military youths (IRR = 0.97, p < 0.001 [mental health symptoms]; IRR = 0.97; p < 0.001 [physical health symptoms]). The direction of these interactions is displayed in the regression-based predicted incidence of mental and physical health symptoms in Fig. 1. The figure indicates that differences in health symptoms between military and non-military youth were narrower when peer support was greater.
Table 4.
Unmoderated and moderated associations of military families with mental and physical health symptoms by social support
| Mental health symptoms | Physical health symptoms | |||
|---|---|---|---|---|
| IRR | 95% CI | IRR | 95% CI | |
| Family support | ||||
| Unmoderated | 0.96*** | (0.95, 0.96) | 0.96*** | (0.96, 0.97) |
| Moderated | 1.00 | (0.99, 1.01) | 1.00 | (0.98, 1.01) |
| Peer support | ||||
| Unmoderated | 0.97*** | (0.97, 0.98) | 0.97*** | (0.97, 0.98) |
| Moderated | 0.99* | (0.98, 1.00) | 0.98* | (0.97, 1.00) |
| Classmate support | ||||
| Unmoderated | 0.88*** | (0.87, 0.89) | 0.89*** | (0.87, 0.90) |
| Moderated | 0.98 | (0.95, 1.01) | 0.99 | (0.95, 1.04) |
| Teacher support | ||||
| Unmoderated | 0.95*** | (0.94, 0.95) | 0.95*** | (0.94, 0.96) |
| Moderated | 1.00 | (0.98, 1.01) | 1.01 | (0.99, 1.03) |
Shown are incidence rate ratios (IRR) of weekly mental or physical health symptoms and 95% confidence intervals (CI) that correspond to unmoderated associations with social support variables and with moderated associations (interactions) of military family and support variables, controlled for the covariates shown in Tables 2 and 3. The complete regression results are shown in supplementary Tables S1 and S2
*p < 0.05 **p < 0.01 ***p < 0.001
Fig. 1.
Predicted incidence of weekly mental health symptoms (left panel) and weekly physical health symptoms (right panel) by peer support in military youth (n = 1815) and non-military youth (n = 17,071). Shaded areas represent 95% confidence intervals
Discussion
This study shows that having a parent in the Canadian Armed Forces is associated with mental health symptoms in adolescents. The results are in line with previous studies carried out mostly in the USA (Manser, 2020b) and with data from Ontario on outpatient visits by military youth (Mahar et al., 2022), and extends this literature by finding the association in a nationally representative school survey of Canadian adolescents. This finding is significant given there are roughly 60,000 dependent children of active members in the CAF, and potentially many more of parents who retired from service (Manser, 2020a). Prior research has established that children in military families are at risk for experiencing poor mental health (Manser, 2020b). The good news, as Manser (2020a) notes, is that most military families do cope effectively. Our results are consistent with that conclusion. While statistically significant, the excess risk of mental health symptoms associated with having a parent in the military was small after other differences were controlled and the difference in physical health symptoms only approached statistical significance (p = 0.06).
The study also found evidence for a protective influence of peer support. While all four sources of support showed robust associations with mental health symptoms, peer support helped close the mental health gap between military and non-military youth. This result is consistent with previous studies that found peers to be a key protective factor for children and youth, particularly those exposed to stressors in the family (Espinoza et al., 2014). Prior research has called for examination of these protective factors in military families (Cunitz et al., 2019). If future research elucidates the circumstances in which peer support acts as a moderator, this could potentially be enhanced as a way of intervening in those military children who are affected by their parent’s profession.
Strengths of this study include the large sample size and multidimensional assessment of health and social supports. Epidemiological investigations of this kind require data on large samples given that youth in military families is a relatively small segment of the population. Some weaknesses in the study design should also be noted. HBSC sampling excluded youths in Nunavut and First Nations and in private schools, as well as home-schooled youth. Therefore, caution is warranted when generalizing these findings to the general population. The sample excluded youths who were absent from school or declined to participate in the survey due to emotional or behavioural health problems. The HBSC study relies on brief, self-report assessments of mental and physical health symptoms, and their low prevalence—in physical health symptoms in particular (see Table 1)—may explain why observed differences between military and non-military youth were small despite previous evidence of more psychiatric and physical chronic conditions and disabilities in this population (Warfield et al., 2018). Also, there was no way to verify self-designations of being in a military family, nor the history of the parent’s involvement in military service.
Future studies should address these issues and aim to measure known risk factors for military families (e.g., recent family moves resulting from military service, role of the military parent within the Armed Forces, whether this role involves time away from home, and especially whether the parent was recently deployed and if this was to a combat zone). Controlling for these factors will allow researchers to identify the most toxic stressors. Further analysis of social support in this unique population will also support prevention and clinical interventions. Moreover, following military children and youth longitudinally will generate more robust evidence of key risk and resilience factors.
Conclusion
Peer support is a potential moderator of the association of having a parent in the Canadian military and mental and physical health symptoms in youth. While further research is needed, our results support focusing on peers to promote mental health in military youth. Peer support interventions are beneficial for children whose parents suffer from mental health issues (Goodyear et al., 2009) and could be adapted to military populations. Helping young people form lasting, supportive relationships with peers can improve mental health outcomes and help them adapt with their unique set of stressors. Finally, while the data show that youth of military families are at higher risk for mental health issues, it is important to not overstate these differences. The effect sizes were small and other research has shown that most military dependants and families cope effectively (Manser, 2020a).
Contributions to knowledge
What does this study add to existing knowledge?
This study finds an association between having a parent in the Canadian Armed Forces and experiencing more mental health symptoms in a large, nationally representative, Canadian study.
This study also finds a potential moderator for this association, peer support.
What are the key implications for public health interventions, practice or policy?
Public health bodies should make resources available to the families of servicepeople.
More investigation should be done into the protective nature of peer support as a moderator of the association as interventions aimed at improving peer support are currently available.
Supplementary Information
Below is the link to the electronic supplementary material.
Author contributions
Kinley and Elgar conceived and designed the study. The first draft of the manuscript was written by Kinley. Kinley and Samira led the statistical analysis. All the authors commented on previous versions of the manuscript and have read and approved the final manuscript.
Funding
This study was supported by an award from the Canada Research Chairs program awarded to Elgar.
Data availability
HBSC data can be accessed from https://hbsc.org/data.
Code availability
Code can be made available upon request from the corresponding author.
Declarations
Ethics approval
The HBSC Canadian survey was granted ethics approval from the General Research Ethics Board at Queen’s University, and the Health Canada and Public Health Agency of Canada Research Ethics Board.
Consent to participate
Following the HBSC international protocol, the Canadian HBSC used anonymous and self-completed questionnaires distributed in classroom settings. Consent (active or passive depending on the practices within individual school boards) was obtained from the participating students, their parents or guardians, and participating schools.
Conflict of interest
None to declare.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
HBSC data can be accessed from https://hbsc.org/data.
Code can be made available upon request from the corresponding author.