INTRODUCTION
Though military families have access to numerous resources, including health care and consistent parental employment, military-connected adolescents consistently experience greater behavioural problems and emotional distress compared to their civilian counterparts.
1–7 For example, in California, military-connected students were 43% more likely than civilian peers to report suicidal thoughts, 71% more likely to attempt suicide, 45%−75% more likely to have recently used substances, and 120% more likely to bring a gun to school.
8,9 Though well-established, these findings are grounded in data collected before the global COVID-19 pandemic, an event that dramatically shifted the public education landscape. There is a paucity of investigations exploring the well-being of military-connected adolescents in public schools post-pandemic — a notable gap given the mental distress associated with the pandemic among adolescents
10 and concerns about the impact of remote schooling on adolescent well-being.
11,12Public school students during the COVID-19 pandemic
In response to the rapid spread of the novel coronavirus during February and March 2020, school closures were instituted across the United States, affecting 55 million students.
12 In the 2020–2021 school year, a large portion of students continued to experience either fully remote or hybrid (e.g., partially in person and partially virtual) instruction.
13 In the fall of 2020, 56% of U.S. secondary school students ages 13 to 19 years received fully remote instruction and 24% received hybrid instruction.
14As remote and hybrid instruction continued through the 2020–21 school year and beyond, experts raised concerns about its impact on students’ academic success and well-being,
12 as associations between mode of instruction and students were noted.
11,14,15 Though findings about hybrid instruction are less clear, adolescents receiving only remote instruction (vs. in person) were more likely to report stress, suicidality, and persistent symptoms of depression.
14Moreover, remote schooling is associated with small but meaningful negative effects on mental health, particularly for older children.
11 The mechanisms underlying this relationship are, as yet, not well understood, though possibilities include loss of social connection, stress of online learning, and decreased access to mental health services and other resources offered at school.
11 Further, these associations exist against a backdrop of significant concern about the mental health of young people during the pandemic more generally.
10,16Military-connected students
Of particular concern is whether students exposed to other adversities, such as poverty, housing instability, racism, and/or lack of connection to school, may be especially likely to experience increased psychological distress in the context of pandemic-related school disruptions.
11,14,15 Similar to studies on students experiencing other types of adversity, existing literature on military-connected students indicates they may be at elevated risk for psychological distress in relation to remote or hybrid instruction. A significant and growing body of literature describes unique stressors facing military-connected youth, including 1) exposure to parental or sibling deployment and combat, 2) fear for the well-being of loved ones, 3) increases in parents’ mental health symptomatology, and 4) frequent relocation, leading to school changes on average every 2.9 years.
17–20 Experiencing these unique stressors is associated with elevated rates of adverse mental health outcomes,
17 potentially increasing military-connected students’ susceptibility to pandemic-related stressors.
Frequent moves may also affect military-connected students’ connections to, and experiences within, their schools. Greater mobility is associated with negative perceptions of school climate.
21 Frequent moves increase stress, disrupt social relationships, and may weaken connection to students’ school environments.
22 However, positive perceptions of school climate, including a sense of safety and connectedness to one’s school, appear to be associated with better mental health outcomes among military-connected students.
23 Positive connections to, and experiences within, school may be protective for military-connected youth, potentially buffering the effects of stress experienced in other domains.
24 Disruptions in students’ sense of connection to their schools related to military family mobility may exacerbate effects of pandemic-related school disruptions for this population.
Military families during the COVID-19 pandemic
Very little information exists regarding the well-being of military families during the COVID-19 pandemic. Evidence suggests military families experienced significant disruption, particularly in the initial phase of the pandemic, associated with increased distress and adverse mental health outcomes.
25,26 Military parents expressed concerns for the well-being of their children during this period, describing increases in sadness, anxiety, and acting out, and concerns about isolation from peers.
26 Qualitative research emphasized the critical importance of school connectedness for military-connected adolescents and the challenges families faced in forging connections in the context of remote schooling.
27 Collectively, these findings emphasize the importance of exploring the well-being of military-connected students during the pandemic, as preliminary evidence suggests they may experience adverse outcomes at similar or higher rates than civilian peers.
The current study
Using a large, statewide sample of public secondary school students in California, this investigation examined psychological distress of military-connected and non-military-connected students during the COVID-19 pandemic and its association with primary mode of instruction (e.g., in person, hybrid, or remote). Two hypotheses were explored:
1.
Military-connected students would exhibit greater psychological distress compared to civilian students.
2.
All students engaged in fully remote instruction would exhibit greater psychological distress, compared to hybrid and in-person instruction.
DISCUSSION
Prior literature suggests military-connected students have elevated levels of risk for psychological distress
8,9 compared to civilian peers.
29 This raises questions about the impact of COVID-19-related educational changes for military students. Consequently, the authors assessed whether 1) disparities in psychological distress between military-connected and non-military-connected students would be evident in the context of the pandemic, and 2) whether mode of school instruction would be associated with distress among both groups of students. Findings support both hypotheses. Specifically, military-connected students exhibited greater psychological distress than civilian students, and students engaged in fully remote instruction exhibited greater psychological distress than students in hybrid and in-person instruction.
Findings are consistent with results documented before the pandemic.
3,5,6 Relative to civilian students, military-connected students in this sample were 14% more likely to self-report moderate psychological distress compared to low distress and 23% more likely to self-report high psychological distress compared to low distress. Though these differences were relatively small, this finding has been very robust across time, age groups, geographic regions, and now both before and during the COVID-19 pandemic. Further, these findings are also corroborated using other measures of distress and risky behaviour in schools, including substance use, victimization, weapon-carrying, and gang involvement.
2,4,6,30 The consistency of these results suggests this is a meaningful finding that warrants greater attention for the well-being of military-connected youth in schools.
With respect to the second hypothesis, students engaged in hybrid or in-person instruction were less likely to report psychological distress compared to students receiving only remote instruction. This finding held for all respondents and military-connected students, specifically. Among all students, relative to those receiving remote instruction, students attending school in person were 23% less likely to report moderate compared to low distress and 18% less likely to report high compared to low distress. Thus, there appears to be some benefit to hybrid instruction compared to fully remote learning. Students experiencing hybrid instruction were 12% less likely to report moderate, compared to low, distress and 9% less likely to report high compared to low distress. Among the military sub-group, a similar pattern emerged, though not all findings were statistically significant, as the sample was considerably smaller for these analyses. Across these results, findings clearly emphasize students present in school, at least some of the time, were less likely to be distressed. Though the authors cannot speak to mechanisms accounting for these differences, in-person instruction may support development of social connections and access to critical resources, like mental health services.
11Beyond results related to the primary hypotheses, additional findings emerged. Male students in both the full sample and the military-connected sub-sample were considerably less likely to report both moderate and high psychological distress relative to low distress. In addition, differences in psychological distress among sexual minority and transgender students, compared to their heterosexual and cisgender peers, were quite large. For example, compared to heterosexual students, lesbian/gay students were nearly six times as likely to report high psychological distress compared to low psychological distress. Again, a similar pattern emerged for sexual- and gender-minority students within the military-connected only sample, though odds ratios were slightly attenuated in this group. Limited research on LGBTQIA2S+ youth in military-connected families suggests these youth may be at elevated risk of adverse outcomes,
31 but more research is needed to understand the potential confluence of risk conferred from sexual- and/or gender-minority status and military connectedness. Differences were also noted by race/ethnicity, such that students who identified as Black or other race/ethnicity reported less distress compared to Latine students, while other racial/ethnic groups reported more distress. Ultimately, with respect to the objectives of this study, it is important to note military connectedness adds meaningful risk of psychological distress over and above these other factors.
Strengths and limitations
This sample included over 400,000 secondary school students, offering a representative picture of public school students across California. Further, CHKS data include extensive demographic information that was used to control for a number of important alternative explanations for observed outcomes. Among these, CHKS includes information on parental education, which is a proxy for socio-economic status (SES). Though this variable is not included in presented models because of missing data, preliminary models included this variable in the spirit of a sensitivity analysis, and the direction and strength of the relationships reported here were replicated in these models. These supplemental findings suggest differences in SES between military and non-military-connected students is not likely to be a reasonable explanation for the disparities in distress observed in these results. This conclusion is strengthened by the fact analyses controlled for school clustering, functionally matching military-connected and non-military-connected students by school.
Several limitations should be noted. First, the CHKS core survey employed here does not include contextual variables related to military service, which may be important in explaining psychological distress of military-connected students. Deployment of a parent or sibling, in particular, has been associated with adverse outcomes for military-connected youth but was not available in this dataset. Relatedly, the survey did not measure contextual factors related to the COVID-19 pandemic that could influence mental health outcomes, including exposure to illness, death, and (for military-connected students) exposure to high-risk deployment of parents. Second, though the CHKS is a biennial survey, it is not possible to link data for individual students across time. Thus, the data presented here are cross-sectional, which limits the ability to consider, for example, how the transition to remote instruction may have impacted students’ psychological distress. While the sample included over 10,000 military-connected youth, the proportion of these youth who were sexual and gender minorities was quite limited. Thus, this study does not have adequate power to stratify within military-connected youth by these important socio-demographic characteristics. The limits due to sparseness and sample size restrictions are evidenced by the wide confidence intervals for some of the associations examined.
Implications and conclusions
These findings have important public health implications, given that most (55%) U.S. students ages 13 to 19 received fully remote education in fall 2020, compared to only 24% receiving hybrid instruction.
14 Among this sample, 7 out of every 10 respondents indicated being in fully remote instruction for the 90 days before survey implementation. Echoing findings, reviews on the impact of COVID-19 school closures on adolescent health contend remote learning was associated with “increased anxiety and loneliness in young people and child stress, sadness, frustration, indiscipline, and hyperactivity.”
32(p. 415) Though not measured in this study, the risk of growing educational disparities among more and less advantaged students is also a frequent concern raised with respect to remote instruction.
32These concerns about remote instruction may be particularly problematic for military-connected students. Compared to their civilian peers, military-connected students were significantly more likely to be classified as experiencing moderate or high distress. Military-connected youth learning in person reported less distress than their military-connected peers in fully remote instruction. Thus, removing military-connected youth, a group who already report greater exposure to unique stressors and frequent relocations associated with adverse mental health outcomes, from an in-person classroom is likely to further exacerbate distress. These results highlight the need for targeted efforts to enhance school and social connectedness among military-connected students.
These findings also suggest several important future directions for research. First, longitudinal data that offer the opportunity to estimate change at both the population and the sub-group levels are needed, particularly considering that military-connected students were likely already experiencing elevated distress, on average, before the pandemic. These data would also be useful for identifying mechanisms that may account for the cross-sectional relationships observed here. Second, the risk evident among sub-groups in this dataset, including sexual- and gender-minority and military-connected youth, speaks to the need to explore interactions between these experiences and identities to better estimate the impact of overlapping risk categories. Finally, this study does not explore factors that could promote recovery or resilience among military- or non-military-connected youth. Though elevated distress was observed among both groups, particularly among those receiving remote instruction, approximately 70% of students in both groups nevertheless reported relatively low distress. Future research should consider protective factors that may account for this finding.