Reciprocal Influences between

Stress Symptoms of Parents of

Combat Soldiers and of Their
Soldier Child as a Result of the
Military Service
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Contents

Abstract 3
Introduction 4
Theoretical Approach to the Parent-Child Relationship 4
The Soldiers Experience in the Israeli Defense Force (IDF) 6
Military Service in the Perspective of Emerging Adulthood 7
Parents Experience of Their Childs Military Service 9
The Potential Effect of Stress and Trauma on Family Members 11
Research Regarding the Spouse and Child Point of View 12
Research from the Parents Point of View 13
Parents' Distress in Other Stressogenic Situations 15
Parent-Child Reciprocal Relationships 16
Purpose of Current Research and Hypothesis 18
Contribution and Importance of Research 20
Research Methods 21
Participants 21
Procedure 22
Tools 23
Statistical Analysis 24
References 27

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3
Abstract

Military service is a significant stage in life for most Israeli adolescents. Alongside

the soldiers experience, the service, especially in combat units, can be a complex and

difficult stage in the life of parents. Supporting this statement are theories and unique

features of the cultural context of the military in Israel. The experience of soldiers

parents, in Israel and around the world, has been mostly ignored in the research of

military families. This is surprising especially in light of the extended literature on

parents response to their childs distress in non-military context. The purpose of this

research is to prospectively examine the emotional needs and distress of combat

soldiers parents before and during the service of their child. Additionally, this research

will examine the reciprocal influences of both the childs and parents distress. 300

family units (parents-child) will take part in the research. The experiment group will

consist of family units of combat soldiers and the control group will consist of family units

of non-combat soldier. Parents and childs distress will be assessed by using measures

of anxiety, depression, perceived stress and well-being. Participants will fill

questionnaires at 2 time points: during the high-school senior year (before recruitment)

and 6-months after recruitment. The research suggests a model for reciprocal

influences, where the childs distress predicts parents distress and parents distress

predicts the childs distress. In addition, parents of combat soldiers are expected to

present higher distress than parents of non-combat soldiers. Finally, we hypothesize

that parents distress will predict lower level of the childs adjustment to military service.

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5
Introduction

The recruitment and adjustment to military service is a highly demanding and

stressful period both for the recruited adolescent and for his parents. While the childs

experience has been well researched, it seems that the parents experience has been

surprisingly neglected. The current studys main goal is to shed light on the experience

and distress of parents and to examine a reciprocal model between childs and parents

distress. Although parent-child relationships are presumed to be trivial, their validity has

been confirmed by many psychological disciplines and theories. The following literature

review will begin with a brief review of the main theories.

Theoretical Approach to the Parent-Child Relationship

The Evolution perspective emphasizes the need of parents to invest resources in

defending and supporting their offspring, in order to reach optimal reproductive success

(e.g. Keller, 2000; Trivers, 1972). Keller (2000) has reviewed parental investment

theories and described 4 systems of parenting that mediate different socialization

experiences. Primary Care System, where the offspring signals of distress elicit primary

nursing care (providing food and shelter) and the parenting main goal is reducing

distress. Body Contact System is defined by the permanent close vicinity of the mother,

which establishes an emotional bond, warmth and affection. The body stimulation

system enhances somatic development and motor control that will help the child to avoid

dangers and prepare for future reproduction. Finally, the last system refers to mutual

eye-contact and use of language.

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 Research on the neurobiology of parenting has defined the coordination of biological

and behavioral responses between parent and child, as a central process underpinning

mammalian bond formation (e.g. Atzil, Hendler, Zagoory-Sharon, Winetraub, &

Feldman, 2012; Abraham et al., 2014). Imaging studies of human parents found

activation in evolutionarily structures implicated in emotional processing, vigilance,

motivation and reward, which are rich in oxytocin and vasopressin hormone receptors

(Atzil , Hendler & Feldman R, 2011). These hormones play a part in the formation of

relationships, sociality, and affiliate behaviors (for review Feldman, 2012).

The Attachment Theory assumes a universal need to form a relationship with an

attachment figure which can protect the child and increase the childs chances of

survival (Ainsworth 1990; Bowlby, 2005). Later on, the child feels distressed or when the

child perceives a threat to the availability of the attachment figure he actively tries to

increase proximity and maintain contact with the attachment figure. As the child is

seeking emotional and psychological closeness, the primary caregiver attachment figure

seeks to ensure the psychological health of this child (ibid). In her research, Ainsworth

(1982) showed that parents who were more sensitive to their child's needs produced

securely attached children. The children of less-sensitive or neglectful parents tended to

develop an anxious-ambivalent or an avoidant style of attachment. Bowlby (1988)

suggested that these patterns will emerge in adolescents and adults when they are

feeling anxious or stressed. Secure people were described as able to balance

relatedness and self-reliance, avoidant people as exhibiting excessive self-reliance,

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whereas ambivalent people were found to exhibit excessive dependency and

ambivalence (ambivalent (Cassidy & Shaver, 1999).

During early childhood the primary attachment figures are usually the parents,

whereas during adolescence peers are expected to be added as attachment figures and

may also come to replace parents as primary attachment figures (Smollar & Youniss,

1989). However, parents remain major attachment figures and close relationships with

parents continue to be a major component of young adulthood (e.g. Allen & Land, 1999;

Trinke & Bartholomew, 1997).

The Family System perspective (e.g. Minuchin, 1985; Cox & Paley, 1997) assumes

that the family is a whole greater than the sum of its parts. Family members have an

ongoing mutual impact on one another therefore influences on the individuals must be

examined in the context of the family. Any time a family member is affected by certain

stressors, it is likely that other family members will also be affected. Furthermore, a

person's individual life development tasks intersect with those of the other family

members' individual development and with the development of the family as a unit

(Carter and McGoldrick, 2005). Duvall & Hill (in Carter and McGoldrick, 2005) have

used the term Family Life Cycle to describe the developmental stages of the family as

a whole unit, considering major transitional events such as marriage, birth of child, child

leaving home, retirement and death.

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The Soldiers Experience in the Israeli Defense Force (IDF)

To better understand the young soldiers experience in the IDF, it is important to first

understand the cultural context of the military service in Israel. The Israeli society formed

and developed under the ongoing existential threat and questionable legitimacy of its

existence (Sela, 1989). The hostility with Arab neighboring countries effectuated through

the years in the form of declared wars and long periods of terror threats and attacks

between those wars (ibid). As a result security issues and considerations have become

a significant part in Israeli society and receive outstanding attention by exposure to

ongoing security events, military service (active duty and reserves), radio and television

broadcasting (Mayseless, 2002; Sela, 1989). In this context military service is

considered a necessary condition for the existence of the Israeli society and the people

living in it (Mayseless, 2002). As a central part of Israeli culture, since its origination, the

military service has been considered a universal initiation stage in the process of

forming an adult Israeli identity, and as such a major component of that identity (ibid).

Furthermore, in Israeli society there is an emphasis of communal ethos that pushes

toward conformity to society and family norms (ibid).

One of the profound stages in the life of an Israeli adolescent is the army service

between the ages 18-21 (Mayseless, 2002). The army service in the IDF is mandatory.

As of 2014 about 73% of male 18-years-olds were recruited for a 3-year service and

about 57% of female 18-years-olds where recruited for service of 2-year (Pesso, 2014).

Of the recruited men about 45% served in combat units at 2013 (David, 2013).

9
 The military service is considered a turbulent period for adolescent soldiers, which

includes challenges and dangers that can trigger stress and distress (Dar & Kimhi, 2001;

Mayseless & Scharf, 2003). The military system, especially in combat units, is highly

demanding and requires obedience and control of the soldiers activity during most of

the day. In addition, recruits are exposed to substantial physical and psychological

demands that push them to the limit of their capacities (Mayseless, 2004). In combat

units soldiers are assigned duties and ranks are required to take responsibilities for the

lives of others, making decisions and completing missions that can involve life threat

scenarios, uncertainty and danger for themselves and others (Mayseless, 2002). In

addition, the army employs punishment and indoctrination as the primary motivational

paradigms (Wintre & Ben-Knaz, 2000). Compared to combat soldiers, soldiers in

non-combat units commonly serve in the rear lines under relatively comfortable

conditions and are much less exposed to the dangers faced by combat units (Wintre &

Ben-Knaz, 2000).

Basic training (the beginning of army service) has been identified as the critical

period in terms of soldier adaptation and coping (Rabinowitz, 1982). The soldier must

suddenly adjust to a threatening environment that disrupts previous adjustment

mechanisms by the deprecation of self-esteem, lack of immediate availability of parental

support, and the acceptance of psychological control and support based on performance

(ibid).

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 Although the military environment in the IDF is challenging, the great majority of

young recruits successfully complete their military service, adjust to and cope well with

its hardships, and find these experiences valuable (Dar & Kimhi, 2001).

Military Service in the Perspective of Emerging Adulthood

In the past, the transition from adolescence to adulthood was defined by

developmental tasks such as separation from parents, marriage, parenthood, finding a

career and developing moral and professional identity (Arnett, 2000, 2006). Sociological

and demographic changes in western culture in the last decades led to phenomena of a

continuous and delayed transition from adolescence to adulthood referred to as

Emerging Adulthood (ibid). Emerging adulthood has become a distinct period

characterized by change and exploration for most young people (ages 18-25) as they

examine the life possibilities open to them and gradually arrive at more enduring choices

in love, work, and worldviews, thus avoiding immediate long-term adult commitments

(e.g. marriage, career) (ibid). During this period many young people remain dependent

emotionally and economically on their parents (Arnett, 2004).

Erikson (1968) was the first to speak of the institutionalized moratorium. In his

writing he especially emphasizes the moratorium of the identity stage (ages 12-18),

arguing that most cultures provide their new members with some sort of social structural

guidance t them from childhood to adulthood (the institutionalized part of the concept),

as well as a time-out from certain social responsibilities that constitutes a delay in the

transition (the moratorium part).

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 Considering the theoretical basis of the emerging adulthood concept, three of the

major developmental tasks the adolescent has to successfully cope with are: (a)

home-leaving transition, (b) developing the capacity for mature intimacy in friendships

and in romantic relationships while maintaining close and autonomous relationships with

parents, and (c) developing a sense of self-efficacy and individuation (Arnett, 2000).

A significant body of research has focused on the transition of young adults in the

United States to college, where the separation usually involves only a semi-autonomous

living arrangement, namely experiences of residential separation from the parents, while

not establishing an independent household (Goldscheider & Davanzo, 1986). This

physical separation was found to be associated with positive changes in the

parent-adolescent relationship, including both a heightened sense of autonomy and

independence along with warmer affection and better communication (e.g. Thornton,

Orbuch, & Axinn, 1995; Sullivan & Sullivan, 1980). Supporting these findings, it was

found that mothers described a better and closer relationship with their sons who lived

away at college rather than at home (Anderson, 1990). Furthermore, studies have

shown that positive current family relations are linked to better adjustment to college,

higher college grade point averages, and better peer relationships (e.g. Richardson,

Abraham & Bond 2012; Wintre & Yaffe, 2000). Although, not like college, the military

service in Israel is mandatory and doesnt take into consideration the adolescent

readiness to leave home. It encourages the adolescent to develop autonomy and

independence from his parents, while at the same time there is still a strong economic,

emotional and instrumental dependency between them (Mayseless, 2002). Lieblich

12
(1989) described a regression process, where while the teenager before recruitment

was striving for independence and separation from his parents and suddenly becomes

dependent on their support.

Research on the military service experience in IDF has focused on the point of view

of the adolescent soldier, while adopting the developmental perspective of emerging

adulthood. Army service was found to contribute to the self-perceived maturation of

Israeli youth, specifically an increase in independence, self-confidence, control, efficacy,

awareness, social sensitivity, and ability to have intimate relationships (Dar & Kimhi,

2001). In longitudinal studies, which measured before and after recruitment,

relationships with both parents were reported to improve (Mayseless & Hai, 1998;

Mayseless, 2002). On the one hand the adolescent feels more affection and closeness

to his parents and quarrels less with them, and on the other the adolescent feels more

autonomous and less supervised (ibid). Zohar et al. (2004) has found that

homesickness contributed to the perceived stress as reported by adolescents during

their military service and family support as a significant part of their perceived support.

Furthermore, the way in which the sons perceived their relationship with their

parents was documented as being important in the context of their adjustment to military

service (Mayseless & Hai, 1998). It was found that relationships with parents before

recruitment and improved relationship during the service, contributed significantly to

reported coping and adjustment of the soldier in the Israeli military service.

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Parents Experience of Their Childs Military Service

Alongside the well-researched soldiers experiences, the childs military service may

serve as a challenging and stressful phase in the parents life as well. Parents, most of

whom probably served in the army as well, send their children to the army, while

understanding the danger and threat for their childs lives. The parents own military

experiences influence how they in turn experience their childs military service

(Man-Shalvi, 2006). The parent understands the importance of military service in their

child's life and for the existence of the Israeli country but at the same time is completely

aware of the obvious danger (ibid).

In a qualitative research by Man-Shalvi (2006) 12 sets of Israeli parents of boys

were interviewed about their thoughts and feelings regarding raising children. The

sample included parents that were expecting a son (before birth), parents of sons before

first grade (age 6), before Bar-Mitsva (age 13) and before recruitment (age 18). All

parents, regardless of their son age, spontaneously raised the issue of their sons future

recruitment and expressed anxiety for the life of their son (i.e. anticipatory anxiety).

In addition to the cultural context and their own experience, several specific unique

features of military service might affect the parents experience (Zohar, 1989): (a) The

recruitment is mandatory and forced upon the family, with no consideration to the will

and readiness of the child or parents, (b) Leaving-home transition is only partial, as most

soldiers come back to their parents home during the weekends (usually once every 2-3

weeks in combat units); meaning that parents experience recurring separations from

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their child. (c) the army service in combat units includes by definition involvement in life

threatening experiences (d) Only a part of parental functions are taken on by the Army.

This can result in a negotiation with the parents regarding rearing authority. Parents

often push to be more involved and the army is challenged to define limits to their

involvement (e.g. visiting hours, involvement in commanders decisions).

Segal (1986) described the military and the family as greedy institutions that

compete for commitment, loyalty and the time of their members. In the past three

decades, parents are increasingly and openly more involved in the affairs of the army

(Gon-Gross, 2003; Levy, 2009). Parents have almost unlimited access to their childs

commanders and routinely bargain over their preferences with regard to their children's

assignments and conditions of service (Gon-Gross, 2003).

The Potential Effect of Stress and Trauma on Family Members

As described, the military service system, especially in combat units, might be highly

demanding and stressful. Not infrequently soldiers are exposed to traumatic events as

part of their duties and military activities.

During four decades of research in the field of trauma, the influence of traumatic

events on those who are emotionally connected or those supporting people who suffer

from trauma or ongoing stress, especially in a military context, has been well researched

(e.g. Bride & Figley, 2009; Figley, 1995; Klari, Kvesi, Mandi, Petrov& Franikovi,

2013). Psychological and emotional difficulties were documented in those in close

contact with the victim, even when they were not directly exposed to the trauma event.

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This phenomenon is most commonly referred to as secondary traumatization, but over

time different terms (such as vicarious trauma or compassion fatigue) have been

used in research and theories (for review see Klari et al., 2013). The latest version of

the Diagnostic and Statistical Manual (DSM-5), the standard criteria for the classification

of mental disorders, has acknowledged secondary traumatization and included indirect

exposure to traumatic event as one of the possible criteria for Post-Traumatic-Stress

disorder (PTSD) (American Psychiatric Association, 2013).

Two main approaches in secondary traumatization research can be identified. The

first approach focuses on PTSD symptoms (e.g., intrusive thoughts, flashbacks and

avoidance behaviors), while the second approach adapts a broader perspective,

referring to more generalized distress in people who have a close relationship with a

person who suffers from trauma (Galovski & Lyons, 2004). The current study will focus

on the ongoing stress that characterizes the military service and not necessarily a

specific traumatic event and therefore better fits the second approach of broader

distress examination.

Considering the danger, life-threat, reduced sense of control and uncertainty that

characterize the military service, it is reasonable to expect a certain level of anxiety and

worry among people that are emotionally attached to the soldier. Anxiety response is

described by the DSM-5 as anticipation of future threat (American Psychiatric

Association, 2013). Symptoms of anxiety include apprehensive expectation,

restlessness, difficulty concentrating, irritability, muscle tension, and disturbed sleep

(ibid). In a preliminary research Fisak, Holderfield, Douglas-Osborn, & Cartwright-Hatton

16
(2012) defined the construct of parental worry as a sub category of anxiety which is

based on the parents concerns with respect to future events that involve an anticipation

of potential negative outcomes for their child.

Ambiguous loss refers to uncertainty or a lack of information about the whereabouts

or status of a loved one as absent or present, as dead or alive (Boss, 2004). Without

information to clarify their loss, family members have no choice but to live with the

paradox of absence and presence (Boss, 2002) Psychologically, ambiguous loss can be

a problem, in that it can create feelings of hopelessness, uncertainty, and confusion that

can lead to depression, guilt, anxiety, and immobilization (Boss, 2004).

Since the early 90s, after the first gulf war (also known as operation Desert

Storm), there has been significant interest in research regarding the experience and

coping of military personal families after deployment to warzone, mostly focusing on the

soldiers spouse and or children (Crow & Myers-Bowman, 2011). The experiences and

needs of parents of deployed soldiers have been for the most part absent from research

done on military families (Crow & Myers-Bowman, 2011).

Research Regarding the Spouse and Child Point of View

The interactive nature of the spouses intense emotional relationship, cultural norms,

expectations, and feelings of obligation all contribute to the susceptibility of the spouse

to the stress of the other (Klari et al. 2013). The non-military spouse must cope with

the fear of losing their spouse in combat (Rosen & Durand, 2000) or apprehension over

the possibility that the deployed member will return with combat related stress

17
(Binneveld, 1997). Dealing with such stress can be exhausting and lead to long periods

of loneliness and depression (Burrell, Adams, Durand & Castro, 2006). If not managed

effectively, stressors related to deployment have the potential to create problems for

military spouses that may affect their overall health and general well-being (Bell &

Schumm, 1999; Padden, Connors & Agazio, 2011a).

The stress of separation may manifest by psychosocial, behavioral, or physical

symptoms (Padden & Posey, 2013). Burrell et al. (2006) reported a negative correlation

between physical well-being and spouses fear for their service members safety, impact

of separation, and their own psychological well- being. Negative correlation was found

between perceived stress and physical well-being during deployment (Padden et al.,

2011b). Spouses of deployed soldiers exhibited more global psychological distress,

manifested by depression and anxiety, compared to community norms (Lester et al.,

2010).

There are inconsistent results regarding the effect of deployment on the childs

adjustment. Card et al. (2011) performed a meta-analytic review of internalizing,

externalizing, and academic adjustment among children of deployed parent and found a

small and negligible association between deployment and poorer adjustment. In a recent

research communication between the deployed soldier, spouse and child at different

stages of deployment, was found to be directly related to the family members ability to

cope with the deployment experience (Houston, Pfefferbaum, Sherman, Melson, &

Brand, 2013).

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 The importance of supporting the families of service members is highlighted by

research that shows that a secure relationship with a spouse can improve the Soldier's

performance and lessen their likelihood of experiencing trauma symptoms

(Basham, 2008). At the same time, an insecure relationship can increase likelihood of

later development of trauma-related symptoms and decrease the soldiers performance

(ibid).

Research from the Parents Point of View

Only recently, few studies focusing on the parents experience were published. In a

study done on partners and parents of Dutch non-combat soldiers, parents symptoms of

sleeplessness or anxiety were measured against the service member's level of PTSD. In

general, it was found that parents' symptoms did not increase proportionately to their

son's service related PTSD symptoms, although mothers did report more PTSD

symptoms, more sleep disturbance and more somatic problems than did fathers

(Dirkzwager, Bramsen, Adr & van der Ploeg, 2005).

In a qualitative research Crow and Myers-Bowman (2011) explored the experiences

of American parents while their adult children were deployed to Iraq and revealed

important themes within the parents portrayals expressing strong reactions of fear,

worry/anxiety and concern for their childrens safety and well-being throughout their

experiences. Parents also described frustration communicating with their deployed

children and feelings of helplessness. Support from formal and informal sources was

important to their coping, as was assistance from religious and military organizations.

19
Finally, parents reported varied impacts of the adult childrens deployment on their

marriages.

Slaven-Lee, Padden, Andrews & Fitzpatrick (2011) compared self-reported levels of

emotional distress and health-risk behaviors among mothers of deployed US marines

with mothers of non-deployed marines. Mothers of deployed sons reported significantly

higher levels of emotional distress and more health risk behaviors (such as smoking,

over-weight and physical inactivity) compared with mothers of sons not deployed. Many

of the mothers in both groups reported high levels of emotional distress.

Trying to understand the reason behind the lack of research on parents experience,

it should be considered that most research on military families was done in the US.

There are many differences between the US army service and the Israeli service, but

some demographic differences might offer an explanation. Unlike the Israeli army, the

US army is a professional non-mandatory service. Updated demographic statistics show

that the average age of US soldiers in active duty is 28.6, about 55% are married and

about 43% are parents (U.S. Department of Defense, 2013). The fact that most soldiers

formed independence from their parents, while some of them even have families have

their own, it might explain why the influence on the soldiers parents wasnt the focus of

research. Furthermore, the previously discussed concept of emerging adulthood (Arnett,

2000 & 2006) is still a rather new framework and it seems research focusing on

sociological development of delayed transfer to adulthood pertaining to military families

is still lagging

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Parents' Distress in Other Stressogenic Situations

The lack of research on parents experiences during and after their childs emerging

adulthood is not limited only to the military context. No body of research focusing on the

parents experience as a result of their adult childs life event has been found. The lack

of research on parental experience is surprising especially when we consider the

extended literature and research findings regarding parents distress reactions in

response to their young childs (from childhood to adolescence) distress or trauma.

The vast literature in this area focused on parents traumatic stress in association

with pediatric medical events of their young children, including cancer (e.g. Kazak et al.,

1998 & 2004), burns (Hall et al., 2006) , intensive care admission (Balluffi et al., 2004;

Bronner, Knoester, Bos, Last, & Grootenhuis, 2008), organ transplantation (Young et al.,

2003), asthma (Kean, Kelsay, Wamboldt, & Wamboldt, 2006), and diabetes (Landolt,

Vollrath, Laimbacher, Gnehm, & Sennhauser, 2005).

Feelings of uncertainty, anxiety, depressive symptoms, and post-traumatic stress

symptoms are most prevalent shortly after the parents are confronted with the diagnosis

of childhood cancer (for review Jantien Vrijmoet-Wiersma et al., 2008). These emotional

manifestations of strain decrease to near normal levels over time in the majority of the

parents, but have been found to persist in a substantial proportion of the parents, even

many years post-treatment (ibid).

Parents early experiences of loss of control and anxiety were found to predict

post-traumatic stress symptoms during and after their childrens cancer treatment

21
(Kazak et al., 1998; Norberg & Boman, 2013). Predictors of parental PTSD have

included preexisting family and individual factors such as parent pre-trauma,

psychological adjustment, parent appraisal of life threat or medical severity and social

support (e.g., Balluffi et al., 2004; Kazak et al. 2004).

Several studies have asked to investigate the occurrence of the previously

presented trauma-related phenomena of burnout (Maslach, 1982) among parents of

chronically ill children. The findings indicated burnout symptoms among parents,

consisting of emotional exhaustion, physical fatigue and cognitive difficulties were found

among parents of brain tumor survivors (e.g. Norberg, 2007; Lindstrm, man, &

Norberg, 2010; Weiss, 2002). Strain does not have to be traumatic or severe to have a

high psychological effect, even low-intensity stressors may create a severe effect, if they

are long-lasting or recurrent (Norberg, 2007).

Another area of research directed at major and daily stressful life events and

psychological symptoms of both parents and children. Findings showed that parents

reports of their child internalizing problems were associated with the parents daily

stressors and symptoms (e.g. Banez & Compas, 1990; Compas, Howell, Phares,

Williams & Ledoux, 1989). In addition, children self-report revealed a similar association,

when influence patterns were found to be gender specific (both of parent and child)

(ibid).

Few early studies have focused on parents experience during their childs

adolescence. It was suggested that adolescents provide a major source of stress to their

22
parents (e.g. Small, Eastman & Cornelius, 1988; Pearlin & Lieberman, 1979). Small et

al. (1988) reviewed the aspects of adolescent autonomy that may affect parental stress

during this period, among them: transformations in emotional attachments, growth of

peer influences, self-reliance, and experimentation with deviant behavior (e.g. substance

use, criminal behavior).

Parent-Child Reciprocal Relationships

Most of the research and studies presented here so far have been largely restricted

to the unidirectional effect, correlations and influences in the parent-child relationship.

There are several developmental theories that attempt to account for an interactive

relationship, including a transactional theory (Sameroff, 1975) or coercion theory

(Patterson, 1982). The common basis of each of these theories is that the behaviors of

parents and children influence each other, causing changes in both over time.

Theoretical models of reciprocity in parent-child relations are gaining empirical

interest from a growing body of research, particularly in regard to parenting practices

and child behavior problems. So far results are varied. Reciprocal relationships were

found between parenting practices (such as involvement, communication, and

punishment) and child conduct problems (Burke, Pardini & Loeber, 2008), harsh

parenting and a childs ability to self-regulate (Brody and Ge, 2001) as well as parental

attachment and adolescents delinquency (Gault-Sherman, 2012). In contrast, some

studies found only a unidirectional effect, whether a child-effect (e.g. Stice & Barrera,

23
1995; Huh, Tristan, Wade & Stice, 2006) or a parental-effect (e.g. Coley, Votruba-Drzal

& Schindler, 2008; Lifford, Harold & Thaper, 2008).

From an ecological perspective, one would also expect parent and child

psychological distress to be reciprocally interrelated (e.g. Bronfenbrenner, 1986;

Compas & Wagner, 1991). There is a very limited body of research that that has

investigated the effect of child internalizing problems on parent internalizing problems

(Hughes & Gullone, 2010). A research by Ge, Conger, Lorenz, Shanahan, & Elder

(1995) found that symptoms among parents (depression, anxiety and hostility) not only

predicted compatible adolescent symptoms one to two years later, but that adolescent

symptoms also predicted later parent symptoms. In a more recent study, findings

supported reciprocity between maternal and adolescent internalizing symptoms

(depression and anxiety) but not between paternal and adolescent internalizing

symptoms (Hughes & Gullone, 2010). More specifically, maternal symptoms

prospectively predicted adolescent symptoms and adolescent symptoms prospectively

predicted maternal (ibid). Scheeringa and Zeanah (2001) introduced the concept of

relational PTSD that suggests that parent and child symptoms mutually influence each

other concurrently and sustain each other over time. Consequently, not only do parents

responses to a traumatic event contribute to the childs distress but also the childs

responses contribute to the parents distress (ibid).

The lack of research of reciprocal parent-child relationship and investigating

measures related to distress and trauma emphasizes the importance of the current

study. Given the scarce research of reciprocal parent-child relationship and parents

24
experience and in general, the current research will not focus on the differences

between fathers and mothers relationship with son.

Purpose of Current Research and Hypothesis

As presented above, little is known about the experience, needs and possible

distress of parents of children in military service around the world, especially those in

combat units. Specifically in Israel, where military service is mandatory and there is high

percentage of soldiers in combat units, this lack of research focus is surprising. The

main purpose of this study is to contribute to the knowledge base pertaining to families

of military personel, by prospectively examining the emotional needs and coping abilities

of combat soldiers parents and their dynamics before and during the actual active duty

service of their child in IDF. This research will consider the parents emotional

experience as part of reciprocal parent-child relationship and will attempt to examine the

reciprocal influences of the childs and parents distress before and during military

service.

Review of earlier research suggests that an adequate explanatory and prospective

model linking parent and soldier distress must incorporate considerable complexity and

specificity to predict parent-soldier influences across time. As far as we know no studies

have systematically reviewed mutual emotional concurrent or prospective influences of

parent-child dyads during the military service. On the basis of the limited empirical and

25
theoretical work available we propose to examine the following prospective effect model

(Figure 1):

26
 Given the lack of previous research on parents experience during the soldiers

military service only the following specific hypothesis are offered:

1) Parents of soldiers serving in combat units will suffer from higher rates of

distress in comparison to parents of soldiers serving in non-combat units.

(1a) Parents of soldiers serving in combat units will show higher rates of

anxiety, depression and perceived stress in comparison to parents of

soldiers serving in non-combat units.

(1b) Parents of soldiers serving in combat units will show lower rates of

well-being in comparison to parents of soldiers serving in non-combat

units.

2) Parents distress will predict a lower level of the childs adjustment to military

service.

Furthermore, in case that the geo-political environment in Israel escalates, the

parents experiences near and during a military long-term operation or regional war will

be compared to what they experience during everyday routine. We can assume that the

level of distress during wartime will be higher both for parents and child, but as no prior

research or theoretical consideration was found for the mutual influence, no prior

hypothesis will be made for such mutual influences.

27
Contribution and Importance of Research

Despite more than 4 decades of vast research in the field of stress and trauma, the

parents point of view when dealing with their child military service has been almost

entirely overlooked. The current research serves as a pioneer research of the parents

experience in the unique cultural conditions of Israeli culture and IDF service, while

following a few recently published studies suggesting that a parents experience might

involve significant and unique distress. Considering the universality and significance of

the military service in the Israeli culture and the involvement of other countries in

warzones around the world, there is a need for a better understanding of the parents

needs and distress that will allow the development of more focused social and/or

professional clinical support than what is currently offered for such a common distress.

Furthermore, understanding the family dynamics and reciprocal influences, will allow the

development of a theoretical framework that can in turn be the base of family

intervention designed to reduce the distress of family members as they approach and

during military service, as well as and improving the childs adjustment to the military

service.

Research Methods

The current research will be a prospective longitudinal research that will examine the

mutual influences in parent and child distress reported independently in 2 time points:

before recruitment (during the childs high-school senior year), and 6 months after

recruitment.

28
Participants

Considering the longitudinal and dyadic design of the research (for more details see

statistical analysis chapter) a high rate of dropout is expected (about 30%). In addition,

at the point of measurement point (before recruitment) we might not be able to know in

advance if the child will be recruited to a combat unit or non-combat unit. In order to be

able to apply the required statistical analysis of the suggested model, a large sample is

required and a minimum size of experiment and control groups. For the needs of this

research the goal will be to reach 300 family units (consisted of child, father and

mother). The experiment group will consist of 150 family units where the child is serving

in a combat unit and 150 family units where the child is serving in a non-combat unit will

serve as a control group.

Convenience sampling will be used that will allow to maximize recruitment potential.

Families will be recruited by reaching out to children and parents using a variety of

platforms such as online social media (e.g. Facebook, social blogs or forums), youth

organizations, pre-military training and support groups. In addition, a request to the

ministry of education will be submitted to allow access to children in senior-year

high-school classes.

As this research serves as a preliminary investigation of suggested reciprocal

model, in order to avoid additional complexity, only families with male children will be

recruited. Families where either the child or parents were diagnosed with PTSD in the

past will be filtered from the research.

29
Procedure

In a case in which the research receives financial support and funds become

available, a modest payment will be offered for participation to the students. Ongoing

professional support from the researches will be offered to the parents participating in

the study. Advertisements in different platforms will include an invite to participate in the

research and contact information of the researchers.

In case the initial contact will be via the child, initial research details will be given in

the first conversation and the contact information of one of the parents will be required.

The researchers will contact the parents to briefly present the research and to schedule

a personal meeting with the family members (both parents and child).

Upon receiving approval from The Ministry of Education, the researchers will present

the study to senior-year students in different high-schools. After presentation of the

goals and procedure of the current study, students wanting to participate will leave their

contact information and will receive a letter addressed to their parents. The parents

letter will present the study and request their approval as well

During the meeting with family members a preliminary interview will take place and

family members will fill in questionnaires of first stage of the study. The family members

will then receive the contact information of the researches for needed support before

and during their child service. In addition to availability of researchers for participants

30
during the study, researchers will periodically contact participants personally, as a

measure to limit dropout.

Family members will be again contacted before the second stage of the research

and will be asked to complete questionnaires online using QUALTRICS online survey

platform (www.qualtrics.com). QUALTRICS software allows distributing surveys via

online platforms or smartphones by repeatedly delivering a link of the questionnaire to

the participants e-mail account at a designated time. This will make it easy and

accessible to fill out the questionnaires and help reduce additional dropout. QUALTRICS

servers are protected by high-end firewall systems (for more information:

http://www.qualtrics.com/security-statement) and the data stored is restricted by access

authorization (only granted by the study researchers). Moreover, sensitive data, such as

personal information (participants name, phone number, and e-mail account) will be

encoded and retained separately from research data. In outstanding cases, researchers

will administrate the questionnaires via phone or in person.

Tools

Distress measures

The following measures will be reported by both parents and soldiers at each time point:

State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch & Lushene, 1970).

using the validated Hebrew version (Teichman & Malineck, 1978). For the purpose of

this study only state anxiety will be estimated. The tool includes 20 statements

31
describing emotional conditions, and the subjects are asked to rate their feelings about

each statement on a four-point scale.

Beck Depression Inventory-II (BDI-II; Beck, Steer, Ball, & Ranieri, 1996). This

well-established questionnaire consists of 21 items scored from 03, and assesses the

presence and severity of cognitive, motivational, emotional, and somatic symptoms of

depression. The reliability and validity of the BDI-II have been extensively documented

in the literature (Beck et al., 1996). The Hebrew version of the BDI-II has been validated

in clinical as well as nonclinical populations and has been used in multiple

Hebrew-speaking samples (e.g., Ophir & Mor, 2014).

Perceived Stress Scale (PSS; Cohen, Kamarck & Mermelstein, 1983). adjusted

and translated into Hebrew by Drori (1989). The questionnaire examined perceived

stress in the present, and has been used in various studies dealing with stressful

life-events. The questionnaire includes 14 items which measured the participant's

emotional state over the past month. Items include questions such as: During the past

month, to what extent did you successfully handle matters that bothered you? The scale

of responses ranged from 1 ('to a very limited extent') to 5 ('to a very great extent').

Cronbach's reliability coefficient was .83. One score was derived by computing the mean

for all 14 items. The higher the score, the higher the level of perceived stress

WHO-5 Well Being Index (WHO-5; Bech, 1998). A well validated brief

assessment of emotional well-being over a 14-day period. Reflecting the positive tone of

the World Health Organization (WHO) definition of health, the 5 items cover positive

32
mood (feeling in good spirits, feeling relaxed), vitality (being active and waking up fresh

and rested), and being interested in things. Several studies have reported internal

consistency, with alpha Cronbach coefficients ranging from 0.82 to 0.95.

Soldiers adjustment to military service

Adjustment to the Military Questionnaire (Catz & Orbach, 1990) is a 5-item scale

frequently used in the IDF to study subjective sense of coping. It includes reference to

(a) whether the respondent views his military service as a positive or negative

experience, (b) his motivation to work hard in military service, (c) his evaluation of his

capacity as a soldier, (d) his evaluation of his social adjustment, and (e) his evaluation of

his general adjustment. Soldiers are asked to respond to each of these questions on a

5-point scale, with higher scores denoting better adjustment. Reported Cronbachs alpha

for the scale was .79.

Statistical Analysis

A two time-point longitudinal analysis is proposed that will be built on interviews with

pre-recruitment and post-recruitment youth. This research analysis will also integrate the

fact that emotional and behavioral measurements are measured for both these young

soldiers and their parents such that a cross effect between parents on soldiers and

soldiers on parents can be tested in a dyadic model (Kashy and Kenny 2000). Latent

variables for anxiety, depression, stress, and well-being will be constructed first in a

confirmatory factor analysis (CFA) that tests the associations between specific items and

the latent factor with respect to theoretical expectation and empirical constraints by

33
means of goodness of fit (Byrne 2012). This analysis will then be run in a multi-group

comparison where combat recruiters will be compared to non-combat recruiters in a

measurement invariance test (Wang and Wang 2012). Finally, a structural equation

model (SEM) will be developed to test hypotheses simultaneously. This SEM will be

shaped as an actor partner dyadic analysis, however, the two parents' emotional and

behavioral measurements will be combined into one latent factor to reduce the

complexity of the model and to minimize the effect of missing response from one parent.

This means that the first step to control the source of variability across respondents is a

2X2 ANOVA table that tests whether changes occurred at time point one in comparison

to time point two, or changes are the result of the dyadic structure of the data or the

interactions between these two factors. This stage can be expanded to more complex

analysis of variance of repeatedly measured research measurements (Rutherford 2011).

A correlation matrix is also a preliminary requirement that enables to evaluate

associations between parents and young soldiers on key measurements.

The multi-group measurement model and measurement invariance test: A

multi-group measurement model is a model in which constraints are imposed gradually

in such a way that factor loading and regression weights are set equal. This means that

in the case of equal factor loadings across the combat soldiers' group and the

non-combat soldiers' group, the structure of the latent factors is similar in case in which

the reduction in the goodness of fit from the free model to the constrained model is

insignificant. In other words, these two groups of soldiers and their parents respond

similarly to the questionnaire. If the regression weights are found to be equal across the

34
two groups, it means that similar behavior is also observed. For a detailed procedure for

measurement invariance test see for example Meade et al. 2006, or Scmitt and Goran

2008 among others.

The actor partner interdependence model (APIM): The main purpose of a dyadic

model is to examine potential correlations not only between measurements within the

same survey participant, but also across two participants who are associated to each

other as a dyad (Campbell and Kashy 2002). In this proposed research, these

interdependences are at the core of the hypotheses which argue that parents may be

affected and develop psychopathological symptoms in response to the stress their

children soldiers expressed. To determine this type of relationship, the APIM is the

better solution to that estimation process. As SEM allows for multiple equations

simultaneously, the adjustment to military service can be added as the final outcome

which responds not only to the way the new recruiter feels and behaves, but also to the

way the parents react and the cross effects in between the two different survey

participants. Finally, a power analysis will be performed by using the Monte Carlo

simulation technique (Bandalos 2006). This final step complements the research report

by evaluating the power of the sampling and the parameters estimated.

Limitation of the sampling procedure: One critical problem in collecting longitudinal

data is the level of dropouts, also known as the attrition problem (Newsom et al.

2012, Diggle and Kenward 1994). In the case of following recruiters this problem

may exceed and cause severe estimation constraint. To simplify the empirical

complexity of the longitudinal analysis, we propose to measure two time points for

35
each dyad. Although more waves along time will probably improve the analysis,

the proposed dyadic model can rely on two time points only while reducing the

risk of attritions. Note the power analysis suggested above which is supposed to

evaluate the sample power under this limit.

36
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