Current directions in military health-care provider resilience

Supporting the Frontlines: A Scoping Review Addressing the Health Challenges of Military Personnel and Veterans

(1) Background: Military personnel and veterans meet unique health challenges that stem from the complex interplay of their service experiences, the nature of warfare, and their interactions with both military and civilian healthcare systems. This study aims to examine the myriad of injuries and medical conditions specific to this population, encompassing physical and psychological traumas. (2) Methods: A scoping review (systematic search and non-systematic review) was performed to evaluate the current landscape of military healthcare. (3) Results: A significant change in the injury profile over time is identified, linked to shifts in combat strategies and the integration of advanced technologies in warfare. Environmental exposures to diverse chemical or natural agents further complicate the health of service members. Additionally, the stressors they face, ranging from routine stress to traumatic experiences, lead to various mental health challenges. A major concern is the gap in healthcare accessibility and quality, worsened by challenges in the civilian healthcare system's capacity to address these unique needs and the military healthcare system's limitations. (4) Conclusions: This review underscores the need for holistic, integrated approaches to care, rigorous research, and targeted interventions to better serve the health needs of military personnel and veterans.

Promoting resilience and psychological wellbeing of military providers: The Navy Medicine Caregiver Occupational Stress Control (CgOSC) program

Military Medicine providers (sometimes referred to as caregivers) not only endure the stress of supporting the medical readiness of operational commands, they take on the continuous demands involved in providing direct care to military beneficiaries. Research shows that occupational stress and burnout impacts the health and wellbeing of providers, increases job turnover, and reduces the quality of patient care. Thus, interventions have aimed to reduce burnout and enhance the wellbeing of military providers. Although these efforts have shown promise, there is much room for improvement. Navy Medicine has implemented the Caregiver Occupational Stress Control (CgOSC) program at its commands, with the objectives to enhance provider wellbeing and resilience, improve retention, and ensure the quality of patient care. This article introduces the Navy Medicine CgOSC program, describes the implementation of the CgOSC program at Navy Medicine commands, and delineates how the program is tracked for program adherence. This tracking method can serve as a model for other healthcare organizations that are establishing programs that aim to promote the wellbeing of their providers.

Reducing Stress and Burnout in Military Healthcare Professionals Through Mind-Body Medicine: A Pilot Program

INTRODUCTION

A 6-week mindfulness training course, the Mind-Body Medicine (MBM) pilot program for staff, was implemented at a large military treatment facility to examine the preliminary efficacy of the program in reducing stress and burnout in military healthcare professionals.

MATERIALS AND METHODS

A retrospective analysis was conducted of data collected from a single-arm prospective MBM pilot program. The program was designed to help staff members increase their awareness of burnout and its consequences and to learn how to utilize mindfulness-based self-care practices as a means for reducing stress and preventing burnout at work. Participants attended a 2-hour MBM group each week for a total duration of 6 weeks. Assessments of stress, resilience, anxiety, somatic symptoms, functional impairment, sleep quality, quality of life, and burnout were administered at baseline (T1), upon completion of the 6-week program (T2), and at least 3 months after program completion (T3). Multilevel modeling was used as the primary statistical model to assess changes in outcomes. Fifty-nine staff members completed assessments at T1, 31 (52.5%) at T2, and 17 (28.8%) at T3.

RESULTS

Participants showed improvements on scores of perceived stress, resilience, anxiety, somatic symptoms, quality of life, and burnout variables from T1 to T2 and from T1 to T3 (P < .05). Additionally, they reported improvements in their knowledge, understanding, and utilization of MBM concepts and practices from T1 to T2 and from T1 to T3 (P < .05).

CONCLUSIONS

Results from this pilot suggest that the MBM program has the potential to reduce occupational stress and burnout and improve well-being in military healthcare professionals.

U.S. Service Member Deployment in Response to the Ebola Crisis: The Psychological Perspective

Introduction

In the fall of 2014, the United States and other nations responded to the worst outbreak of the Ebola virus disease in history. As part of this effort, U.S. service members deployed to West Africa to support a spectrum of activities that did not involve direct patient care. Although previous studies identified the psychological impact of responding to an outbreak, these studies were limited to retrospective data, small sample sizes, and medical personnel. The goals of the present study were to (a) document the mental health and well-being of troops deploying in response to an infectious disease outbreak; (b) identify their stressors, attitudes toward deployment, and health risk concerns; and (c) understand the role of combat experience in adjusting to these types of missions.

Materials and Methods

Study participants at both pre- and during deployment were active duty U.S. soldiers in a combat aviation battalion from a large U.S. military installation. U.S. soldiers were surveyed (n = 251) 3 wk before deploying to Liberia (October 2014) and surveyed again during their deployment (February 2015; n = 173). Participants were primarily male (86.1%), junior ranking (56.0%), and just over half had previous combat deployment experience (51.2%). Surveys were anonymous and not linked to one another over time.

Results

Overall rates of mental health problems were low (2.4% at pre-deployment and 5.8% during deployment), whereas sleep problems were reported by 4.9% at pre-deployment and 12% during deployment. At pre-deployment, top stressors focused on health threats; fewer stressors were reported during deployment. Soldiers were relatively less concerned about contracting Ebola than other more prevalent diseases. Soldiers with combat experience reported more somatic and sleep problems at pre-deployment than those without previous combat experience. There were no significant differences during deployment between those with and without previous combat experience.

Conclusion

Overall, a small proportion of respondents reported significant rates of mental health problems. In contrast, sleep problems were reported by 12% during deployment. In terms of attitudes toward the mission, the vast majority reported that they knew what to do to protect themselves from disease and that they understood the potential risk involved. The study also confirmed previous findings that soldiers with previous combat experience had more somatic symptoms at pre-deployment than those without, although this distinction appeared limited to the pre-deployment phase. Results can be used to address anxiety by personnel during pre-deployment and to inform leadership preparing personnel to deploy in response to future infectious disease outbreaks.

Army Combat Medic Resilience: The Process of Forging Loyalty

This study presents a grounded theory analysis of in-depth interviews of United States Army Combat Medics (CMs) who had served in Iraq and/or Afghanistan. The study explores how 17 CMs nominated by their peers as resilient cope with military stressors in order to identify the factors that enable them to thrive amidst harsh conditions. Four distinct categories of characteristics unique to this group emerged: (1) social bonding, (2) readiness, (3) dual loyalty as performance, and (4) leader by example. Forging loyalty underpins these characteristics and represents the main process used by resilient CMs and comprised three behavior patterns: (1) commitment to the family, (2) commitment to the military mission, and (3) commitment to their guiding religious and spiritual beliefs. Prominent behavioral tendencies of forging loyalty likely developed during childhood and re-enforced by families, friends, and other role models. Based on the findings, new training and education efforts should focus on developing positive emotional, environmental, and social resources to enhance the health and well-being of service members and their families.