Special Concerns in Military Families.

purpose of reviewMilitary cultural competence has been recognized as an important factor to delivering effective care to service members, who are a distinct population with unique exposures, and thus with different clinical implications-though only recently has the military service been recognized as a cultural identity that can impact treatment (Meyer et al. Curr Psychiatry Rep. 18:26:1-8, 2016). Competencies within this field do not share a universal definition but have been recognized by the Center for Deployment Psychology (CDP) to include four key components: (1) military ethos, (2) organization and roles, (3) military stressors and resources, and (4) treatment, resources, and tools (Atuel & Castro Clin Soc Work J. 46:74-82, 2018). This article summarizes research literature published in the last 6 years addressing common features and health needs of military families with the goal of improving military cultural competence. This includes recognizing that (a) The military carries its own culture as evidenced by its particular traditions, beliefs, language, and set of guiding principles (Sanghera Optom Educ J Assoc Sch Coll Optom. 42:8-16, 2017) and (b) military families-defined in this paper as active duty service members, their spouses, their children, and civilian warfighters in the form of National Guard and Reservists (NG/R)-face unique stressors as they access health care either in military treatment facilities (MTFs) or in civilian settings. Given the broad and unshared definition of military cultural competence, the CDP's framework for understanding military culture helped shape the focus of our review into literature addressing military stressors and resources, with a particular interest on the impact of deployment, reintegration after deployment, interfamily relationships strained by military service, mental health concerns related to military families, and the vulnerabilities of civilian warfighters. RECENT

findingsA 2018 demographics profile revealed there were 1.3 million active duty service members, with 605,677 spouses and 981,871 children (Department of Defense, Office of the Deputy Assistant Secretary of Defense for Military Community Family Policy (ODASD (MC&FP)). 2018). Concerningly, military families exhibit above-average mental health issues-defined in this review to include increased susceptibility to mental health diagnoses and hospitalizations, worse academic achievement in their children, and higher rates of child maltreatment-and challenges related to military service such as frequent relocations and deployments, geographic isolation from social/support network, financial stressors, worries about infidelity, sexual trauma, and child maltreatment. The military has been described as the most engrossing and demanding institution in American society. Our review shows that military families exhibit above-average mental health issues, thought to be related, at least in part, to the challenges of frequent relocations and deployments. The implications for this are broad, given that 8% of the USA has served in the military, and a third is directly related to a service member (Meyer et al. Curr Psychiatry Rep. 18:26:1-8, 2016) This article describes unique challenges military families face and their impact on the service member, their spouse, and their children.