Stephen J. Cozza

The desire to explore the unknown is a recurring motif throughout human history that has led to the discovery of life-saving treatments for illnesses—but also to wars and the colonization of commun...

Importance: Information regarding risk factors among service member families for different child maltreatment types is needed to improve prevention efforts. Objective: To identify factors associated with first occurrences of 4 child maltreatment types and examine child age–related changes in risk for each type among active duty service member families. Design, Setting, and Participants: This population-based retrospective cohort study used data from the Child Maltreatment in Military Families Life Course Study on active duty service member families with a first occurrence of child maltreatment in fiscal years 2009 through 2018 and a representative sample of active duty families without child maltreatment incidents. Data were analyzed from August 2023 to February 2026. Exposure: One or more parents serving as an active duty service member. Main Outcomes and Measures: First documented occurrences of neglect, physical abuse, emotional abuse, and sexual abuse, identified using Family Advocacy Program data. Associations between sociodemographic, family, and military-related characteristics and first occurrences of maltreatment types were examined in univariable and multivariable logistic regressions. Results: The study included 618 101 active duty service member families (28 684 [4.64%] with a first occurrence of child maltreatment and 589 417 [95.36%] without child maltreatment incidents), consisting of 1 070 510 family-months (FM); the total weighted sample was 65 142 809 FM (59 031 293 male service member FM [90.62%]; mean [SD] age, 32.74 [6.97] years). Crude rates of child maltreatment were highest for child neglect (22.16 per 100 000 FM) followed by physical abuse (10.97 per 100 000 FM), emotional abuse (4.23 per 100 000 FM), and sexual abuse (2.66 per 100 000 FM). Factors associated with higher odds of all child maltreatment types in multivariable models were female service member families (eg, sexual abuse: odds ratio [OR], 1.39 [95% CI, 1.18-1.64]; physical abuse: OR, 1.82 [95% CI, 1.70-1.95]), early parenting (age <21 years) (eg, neglect: OR, 1.32 [95% CI, 1.22-1.41]; sexual abuse: OR, 2.12 [95% CI, 1.75-2.56]), larger number of dependent children (≥3) (eg, emotional abuse: OR, 1.63 [95% CI, 1.48-1.79]; sexual abuse: OR, 2.32 [95% CI, 2.06-2.61]), and never-deployed status (eg, sexual abuse: OR, 1.90 [95% CI, 1.55-2.32]; emotional abuse: OR, 3.76 [95% CI, 3.09-4.57]). Risk rates peaked at 3 months of age for neglect (48.61 per 100 000 FM) and physical abuse (25.49 per 100 000 FM). Risk of emotional and sexual abuse peaked in middle childhood (age 5-12 years) and adolescence but was generally lower (<6 per 100 000 FM) than risk of other child maltreatment types across all ages. Conclusions and Relevance: In this cohort study, families with female service members, never-deployed service members, 3 or more children, and young parents had higher risk of child maltreatment. Dynamic prevention approaches appear to be needed to address evolving risk factors across the family life course.

Large-scale combat operations (LSCO) represent sustained, high-intensity warfare with near-peer adversaries involving massive casualty volumes. Military projections suggest 3000 casualties per day, approaching World War II intensity levels. LSCO will expose military personnel to continuous confrontation with death, producing psychological effects that threaten force preservation and mission continuity. Traditional centralized behavioral-health systems will be unable to sustain operations effectively under conditions of continuous exposure, contested evacuation, and specialist unavailability. Leadership emerges as the primary mechanism for force preservation, with influence increasing precisely when followers face the greatest threat. This narrative review examines three areas: (1) psychological consequences (stress reactions, grief, moral injury); (2) vulnerable populations (infantry, junior leaders, medics); and (3) leadership interventions including transformational leadership and grief-informed command practices. In contrast to centralized models, we propose a three-level operational framework: immediate unit-level peer support, embedded resource utilization through medics, chaplains, and behavioral health officers, and delayed professional intervention when feasible. This model positions leadership as the central mechanism for sustaining the fighting force amid continuous death exposure.

Digital social technologies, such as social media and online multiplayer video games (MVGs), have ushered in an era of peer relationships that evolve online, in addition to in person. This report reviews existing research about the dual role of social media and MVGs in shaping youth social connectedness, recognizing both their potential benefits and their associated risks on youth mental health. By providing evidence-based insights, it aims to inform strategies that optimize these technologies' advantages while safeguarding youth mental health and well-being. This report reviews peer-reviewed literature, clinical recommendations, reports, and surveys that assess youth usage of social media and MVGs and their associated psychological and physical health outcomes. Social media provides many opportunities for peer connection, including self-expression and social support, fostering positive social development and well-being. MVGs combine entertainment with collaboration, further strengthening social bonds. However, the use of these technologies has also been linked to negative outcomes, including social isolation, depression, anxiety, and sleep disorders. Publically-available, evidence-based resources can provide caregivers and professionals with guidance and clinical recommendations regarding youth social media and MVG use. Digital social technologies have become increasingly user-specific and immersive as the internet evolves and social media algorithms become more powerful. Additional research is required to understand how current youth usage of these technologies impacts physical and psychological outcomes. Future research should also investigate the differences in usage, outcomes, and the efficacy of treatments across youth sex and age.

Objective: Between 2005 and 2022, more than 315,000 grave violations were verified against children in wartime, including killing, physical maiming, exploitation, and forced displacement. While the resulting harm to children is widely recognized, the profound toll on professionals who witness and respond to these tragedies remains under examined. This article explores the psychological and occupational impacts of exposure to child casualties during wartime on healthcare providers, military personnel, journalists, and mortuary affairs workers. Method: Google Scholar, PsycINFO, PsychNET, and PubMed were searched for literature examining the impact of pediatric death and injury on healthcare professionals, service members, journalists, and mortuary affairs workers in wartime settings. Supplementary searches were conducted to identify supportive evidence from literature addressing impacts in non-conflict contexts. Results: Evidence varied across professions, but impacts examined included moral injury, secondary traumatic stress, heightened emotions, including guilt, anger, helplessness, and grief, as well as professional challenges such as self-questioning, and burnout. Potential mechanisms exacerbating distress include loss of trust in the goodness of the world, cynicism, and hopelessness, personal identification with children, and perceived lack of adequate skills or a sense of professional failure. Conclusions: Findings underscore the urgent need for tailored strategies to sustain the well-being and effectiveness of professionals confronted with child casualties in war. In response, the article highlights promising individual-level and organization-level strategies for building resilience and growth, and promising interventions for professionals requiring clinical care.