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Petrofsky LA, Heffernan CM, Gregg BT, Smith-Forbes EV, Sturdivant RX. Sleep and Military Leaders: Examining the Values, Beliefs, and Quality of Sleep and the Impact on Occupational Performance. Mil Med 2024; 189:1023-1031. [PMID: 36919969 DOI: 10.1093/milmed/usad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/06/2022] [Accepted: 02/03/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION Sleep deprivation is rampant within the military population, and insufficient sleep can lead to physical and mental health problems impacting soldier's readiness and deployability. Past research has shown the importance of leadership's role in subordinates' sleep health. Understanding the values, beliefs, and quality of military leader sleep is essential to the development of effective interventions to optimize occupational performance and overall sleep health. Therefore, the purpose of this study was to examine the military leaders' values, beliefs, and sleep quality and the impact on occupational performance. The authors aimed to (1) identify military leaders' sleep quality and beliefs; (2) explore the relationship between military leaders' sleep quality, beliefs and attitudes about sleep, and impact on occupational performance; and (3) examine the value leaders place on sleep for themselves and subordinates in relation to occupational performance. MATERIALS AND METHODS This observational, mixed-methods study design recruited a convenience sample of 109 Army active duty medical service members currently serving in a leadership role. Participants completed an electronic survey to include general demographic information and three self-report measures: the Pittsburgh Quality of Sleep Index, the Dysfunctional Beliefs about Sleep, and the Functional Outcomes of Sleep Questionnaire. Eleven participants completed the semi-structured qualitative interview focusing on sleep values and the impacts on performance. Univariate and multivariate regressions were performed for statistical analysis of the quantitative survey data, whereas thematic analysis was used to analyze the qualitative interview data. This study was approved by the U.S. Army Medical Center of Excellence Institutional Review Board. RESULTS Multivariate regression analysis demonstrated small-to-medium effect sizes (R2 = 0.355-0.559) for relationships between sleep quality, sleep beliefs, functional performance, and demographic variables. More specifically, military grade, position, use of alcohol, time in service, and gender were all found to contribute significantly to scores on the Pittsburgh Sleep Quality Index, the Dysfunctional Beliefs About Sleep Scale-16, and the Functional Outcomes of Sleep Questionnaire-10 (P < .05). Qualitative data resulted in three primary themes: (1) Poor sleep degrades performance, (2) sleep is a top priority, and (3) leaders have a responsibility for subordinates' sleep health. CONCLUSIONS This sample of military leaders was found to perceive themselves as poor-quality sleepers despite demonstrating more functional attitudes and beliefs about sleep and reporting normal-to-mild impairments in daily functioning as a result of daytime sleepiness. Furthermore, findings suggest that leaders' sleep quality and beliefs stand to be further improved, whereas their sleep values need to be consistently demonstrated to subordinates. With a clearer understanding of military leaders' values, beliefs, and sleep quality, future research could focus on implementing and developing holistically based and individualized sleep interventions intended to optimize performance and sleep health.
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Affiliation(s)
- Lyddia A Petrofsky
- U.S. Army Medical Center of Excellence, San Antonio, TX 78234, USA
- U.S. Army-Baylor University, San Antonio, TX 78234, USA
| | - Corinne M Heffernan
- U.S. Army Medical Center of Excellence, San Antonio, TX 78234, USA
- U.S. Army-Baylor University, San Antonio, TX 78234, USA
| | - Brian T Gregg
- U.S. Army-Baylor University, San Antonio, TX 78234, USA
| | - Enrique V Smith-Forbes
- U.S. Army Medical Center of Excellence, San Antonio, TX 78234, USA
- U.S. Army-Baylor University, San Antonio, TX 78234, USA
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Alger SE, Bennett C, Bennett N, Huebner MG, Lee JEC, Edge HJM, Simms A, Adler AB. Insufficient Sleep and Behavioral Health in the Military: A 5-Country Perspective. Curr Psychiatry Rep 2024; 26:229-239. [PMID: 38700836 PMCID: PMC11081997 DOI: 10.1007/s11920-024-01497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE OF REVIEW The goal of this paper was to highlight the degree to which sleep, behavioral health, and leader involvement were interrelated using data from militaries in five English-speaking countries: Australia, Canada, New Zealand, the UK, and the United States. RECENT FINDINGS Many service members reported sleeping fewer than the recommended 7 h/night: 34.9%, 67.2%, and 77.2% of respondents from New Zealand, Canada, and the United States, respectively. Countries reporting shorter sleep duration also reported fewer insomnia-related difficulties, likely reflecting higher sleep pressure from chronic sleep loss. Across all countries, sleep problems were positively correlated with behavioral health symptoms. Importantly, leader promotion of healthy sleep was positively correlated with more sleep and negatively correlated with sleep problems and behavioral health symptoms. Insufficient sleep in the military is ubiquitous, with serious implications for the behavioral health and functioning of service members. Leaders should attend to these risks and examine ways to promote healthy sleep in service members.
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Affiliation(s)
- Sara E Alger
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 29010, US.
| | - Clare Bennett
- Defence Health Directorate, New Zealand Defence Force, Wellington, New Zealand
| | - Neanne Bennett
- Australian Defence Force, Joint Health Command, Canberra, Australia
| | - Matthew G Huebner
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Canada
| | - Jennifer E C Lee
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Canada
| | - Heather J McCuaig Edge
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Canada
| | - Amos Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 29010, US
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Mash HBH, Fullerton CS, Adler AB, Morganstein JC, Biggs QM, Ursano RJ. National Guard Deployment in Support of COVID-19: Psychological and Behavioral Health. Mil Med 2024; 189:e127-e135. [PMID: 37209168 DOI: 10.1093/milmed/usad177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/11/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023] Open
Abstract
INTRODUCTION The National Guard (NG) served as a critical component of the USA's response to the Coronavirus Disease 2019 (COVID-19) pandemic, while concurrently managing their personal responses to the pandemic. Determining whether the activation of NG service members in response to the COVID-19 pandemic was associated with a greater psychological strain can identify NG's needs for mental health support. MATERIALS AND METHODS We surveyed 3993 NG unit (NGU) service members (75% Army NG, 79% enlisted, 52% 30-49 years old, and 81% males) during the COVID-19 pandemic, with surveys administered between August and November 2020. Almost half (46%) of NGU service members reported being activated in response to COVID-19 (mean activation length = 18.6 weeks). Activated service members completed the survey approximately 2 to 3 months post-activation. Surveys assessed demographics, service-related characteristics, unit cohesion and positive leadership skills (leadership), and COVID-19 activation, and outcomes including probable post-traumatic stress disorder (PTSD), clinically significant anxiety and depression, and anger. Descriptive and logistic regression analyses were conducted. The study was approved by the Institutional Review Board of the Uniformed Services University of the Health Sciences in Bethesda, MD. RESULTS In all, 9.7% met the criteria for probable PTSD, 7.6% reported clinically significant anxiety and depression, and 13.2% reported feeling angry/anger outbursts. Multivariate logistic regression analyses, adjusting for demographic and service-related characteristics, indicated that COVID-19 activation was not associated with a greater risk of PTSD, anxiety and depression, or anger. Regardless of activation status, NGU service members with low levels of unit cohesion and leadership were more likely to report PTSD and anger, and low levels of unit cohesion were associated with clinically significant anxiety and depression. CONCLUSIONS COVID-19 activation did not increase the risk of mental health difficulties among NGU service members. However, low levels of unit cohesion were associated with the risk of PTSD, anxiety and depression, and anger, and low levels of leadership were associated with the risk of PTSD and anger. The results suggest a resilient psychological response to COVID-19 activation and the potential for strengthening all NG service members through enhancing unit cohesion and leadership support. Future research on specific activation exposures, including the type of work tasks in which service members are engaged, particularly those associated with high-stress work conditions, is needed to help better understand their activation experience and how it may influence post-activation responses.
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Affiliation(s)
- Holly B Herberman Mash
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Carol S Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Joshua C Morganstein
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Quinn M Biggs
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Mash HBH, Morganstein JC, Fullerton CS, Ursano RJ. COVID-19 Pandemic Responses among National Guard Service Members: Stressors, Coping Strategies, Sleep Difficultiesand Substance Use. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095731. [PMID: 37174249 PMCID: PMC10178564 DOI: 10.3390/ijerph20095731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
The National Guard (NG) served as a critical component of the US COVID-19 response while concurrently managing personal COVID-19 responses. Understanding pandemic-related concerns, sleep difficulties, increased substance use, and stress management strategies can promote readiness for subsequent disasters. We surveyed 3221 NG service members (75% Army; 79% enlisted; 52% 30-49 years; 81% male) during COVID-19 (August-November 2020). Almost half were activated in response to COVID-19 (mean = 18.6 weeks) and completed the survey 2-3 months post-activation. Service members indicated great concern about family health (39%), the indefinite nature of the pandemic (35%), and their financial situation (23%). Over one-third reported changes in usual sleep amount, 33% described poor sleep quality, and 21% had trouble falling/staying asleep. Increased substance use was reported by 30%, including increased alcohol (13.5%), tobacco (9%), and caffeine/energy drinks (20.1%) consumption. Chi-square analyses and analyses of variance found those who activated reported more increased tobacco and caffeine/energy drink use versus non-activated, with no sleep difficulties nor alcohol use differences. Helpful stress management strategies included spending time outdoors (53%), exercising (48%), talking to family/friends (38%), and having a daily routine (38%). Specific health-, financial-, and job-related stressors were associated with COVID-19. Incorporating stress management in planning/preventive efforts promotes resilience during disasters.
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Affiliation(s)
- Holly B Herberman Mash
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Joshua C Morganstein
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Carol S Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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Sørengaard TA, Langvik E, Olsen A, Saksvik-Lehouillier I. Predictors of insomnia symptoms in police employees: a longitudinal investigation and comparison of personality and psychosocial work factors. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2137246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
| | - Eva Langvik
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olav’s Hospital, Trondheim University Hospital, Norway
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Bessey AF, Black KJ, Britt TW. A bidirectional examination of mental health symptoms and perceptions of leader support: Which comes first? MILITARY PSYCHOLOGY 2022; 35:119-131. [PMID: 37133493 DOI: 10.1080/08995605.2022.2085957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Leader support for psychological health (LSPH) has been identified as an important factor in the prediction of mental health symptoms among warfighters. Although research has examined the relationship between LSPH and mental health symptoms, the extent to which this relationship is bidirectional has been underexplored. Consequently, the present study examined the longitudinal relationships between perceived LSPH and mental health symptoms (depression and PTSD) among military personnel over a 5-month period. We found that perceived LSPH at Time 1 (T1) was associated with fewer mental health symptoms at Time 2 (T2); however, mental health symptoms at T1 were also associated with lower perceptions of LSPH at T2. The results differed slightly based on the type of symptoms experienced, but the relationships between perceived LSPH and symptoms did not vary based on whether soldiers had been exposed to combat. However, it is important to note that the overall sample had low combat experience. Despite this, these findings may suggest that the assumption that leader support can enhance soldier mental health may fail to consider that the symptoms themselves may also affect how leaders are perceived. Therefore, organizations such as the military should consider both directions to optimally understand the relationship between leaders and subordinate mental health.
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Affiliation(s)
- Alexxa F. Bessey
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
| | - Kristen Jennings Black
- Department of Psychology, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | - Thomas W. Britt
- Department of Psychology, Clemson University, Clemson, South Carolina, USA
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I can't get no Sleep: The Role of Leaders' Health and Leadership Behavior on Employees' Sleep Quality. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2022. [DOI: 10.1080/1359432x.2022.2077198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The Development, Implementation, and Feasibility of a Circadian, Light, and Sleep Skills Program for Shipboard Military Personnel (CLASS-SM). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053093. [PMID: 35270786 PMCID: PMC8910671 DOI: 10.3390/ijerph19053093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022]
Abstract
Service members face unique barriers to sufficient and high quality sleep. In the present study, a circadian, light, and sleep skills program for shipboard military personnel (CLASS-SM) was designed to encourage and inform strategies that support optimal sleep and circadian health in the context of those barriers. Phase 1 included program development and refinement via an iterative formative evaluation, including structured interviews with service members and feedback from veterans and experts, resulting in further tailoring to the population. In Phase 2, the highly tailored program was administered to shipboard personnel (n = 55), and acceptability indicators were measured. Sleep- and circadian-related knowledge (pre- and post-program) and the perceived relevance of, and satisfaction with, program content (post-program) were assessed. Before the intervention, most individuals were unaware that 7−9 h of sleep is recommended (72%) and had little understanding of the physiological effects of light; however, knowledge scores increased significantly post-program, from 51% to 88% correct (p < 0.0001). Reception was positive, with high reported satisfaction and relevance. Most individuals reported that they learned something new (89%), planned to use one or more learned strategies (100%), and intended to share learned information with others (85%); the physiological effects of light and circadian rhythms were the content areas most frequently reported as new and useful. The results demonstrate the need for, and feasibility of, the delivery of this program in operational environments.
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Teyhen DS, Capaldi VF, Drummond SPA, Rhon DI, Barrett AS, Silvernail JL, Boland DM. How sleep can help maximize human potential: The role of leaders. J Sci Med Sport 2021; 24:988-994. [PMID: 34481741 DOI: 10.1016/j.jsams.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 03/23/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE During multi-domain operations (MDO), soldiers need the physical supremacy, cognitive dominance, and emotional resilience to help defend and win our nation's wars. Optimal sleep has been shown to boost physical performance and cognitive processing. This manuscript will discuss how recent advances in sleep science strongly argue for the integration of sleep planning into military operations. DESIGN Review article. METHODS We reviewed the current understanding of how sleep affects Soldier readiness, how sleep and pain are interrelated, and unique challenges to obtaining adequate sleep in military training environments. We then address solutions that can be implemented by leaders and individuals to manage warfighter fatigue and optimize unit performance. RESULTS Since sleep is foundational to soldier health and readiness, improving warfighter fatigue management is a priority for leaders. CONCLUSION To succeed in MDO, military personnel require physical supremacy, cognitive dominance, and emotional resilience to fight and win. Sleep science is a rapidly emerging field, and the clear implications for maximizing human performance argue strongly for more deliberate integration into military training and operations. Leaders that incorporate sleep and fatigue management into the planning and execution phases of operations will help facilitate mission priorities and prove a powerful force multiplier.
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Affiliation(s)
| | | | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | | | - Amelia S Barrett
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, USA
| | | | - David M Boland
- Army-Baylor University Doctoral Program in Physical Therapy, USA
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Booth LC, Schwalb ME, Kim PY, Adler AB. Health-Promoting Leadership During an Infectious Disease Outbreak: A Cross-Sectional Study of US Soldiers Deployed to Liberia. J Nerv Ment Dis 2021; 209:362-369. [PMID: 33835954 DOI: 10.1097/nmd.0000000000001305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Infectious disease outbreaks are uniquely stressful for essential employees. One way to support workers is for supervisors to engage in behaviors promoting employees' well-being and attitudes toward preventive medicine practices. We examined whether health-promoting leadership contributes to these outcomes in a population of active-duty soldiers (N = 173) deployed to provide nonmedical support in Liberia during the 2014 Ebola epidemic using data reported in Sipos, Kim, Thomas, and Adler (Mil Med 183[3-4]:e171-e178, 2018). Soldiers completed surveys assessing posttraumatic stress disorder (PTSD), depression, anxiety, sleep problems, burnout, morale, and attitudes and rated their leaders on health-promoting behaviors. Using mixed-effects logistic regression, health-promoting leadership focused on psychological health was associated with decreased odds of PTSD, depression, anxiety, and burnout, and increased odds of high morale and avoiding unnecessary risk. Health-promoting leadership focused on preventive medicine was associated with decreased odds of depression and anxiety, and increased odds of high morale, positive attitudes, and avoiding unnecessary risk. Findings suggest health-promoting leadership could be valuable for workers responding to epidemics.
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Affiliation(s)
- Laurel C Booth
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Trachik B, Oakey-Frost N, Ganulin ML, Adler AB, Dretsch MN, Cabrera OA, Tucker RP. Military suicide prevention: The importance of leadership behaviors as an upstream suicide prevention target. Suicide Life Threat Behav 2021; 51:316-324. [PMID: 33876487 DOI: 10.1111/sltb.12707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the longitudinal relationships between unit cohesion, Army leader behaviors, and subordinate suicidal/death ideation. Recent cross-sectional research indicates that subordinates who perceive that their leaders instill a sense of purpose regarding military service demonstrate less frequent suicidal ideation. METHOD Five hundred fifty-nine soldiers completed self-report measures of perceptions of leadership behaviors, unit cohesion, and suicidal/death ideation during deployment as well as one and three months following deployment. Latent change score modeling was conducted to evaluate the course and direction of study variables as well as the relationship between them. RESULTS Although lower levels of suicidal/death ideation were related to leader-provided purpose, leader-provided meaning, and unit cohesion at baseline, only leader-provided purpose and unit cohesion prospectively predicted changes in suicidal/death ideation. CONCLUSIONS Consistent with the goal of military leadership to augment effective clinical interventions that reduce suicide risk, prevention programs that reach a broader population of personnel should be considered. Enhanced leadership training may be an important primary prevention tool to reduce suicide risk that warrants further research.
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Affiliation(s)
- Benjamin Trachik
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | | | - Michelle L Ganulin
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Amy B Adler
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Michael N Dretsch
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Oscar A Cabrera
- U.S. Army Medical Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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Sleep and social relationships in healthy populations: A systematic review. Sleep Med Rev 2021; 57:101428. [PMID: 33596514 DOI: 10.1016/j.smrv.2021.101428] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022]
Abstract
Over the past decade, research linking sleep and social relationships has burgeoned. Researchers across the globe are trying to understand whether the quality and quantity of our social relationships matter for sleep, and vice versa. We conducted a systematic review of the literature, identifying over 200 relevant articles examining sleep and social relationships in healthy populations. Here, we summarize our findings by reviewing 1) links between sleep and broad social ties across the lifespan, and 2) links between sleep and specific social relationships identified in the literature search, including romantic relationships, family relationships, and work relationships. Taken together, the literature provides evidence that the quality and presence of social relationships, especially our closest relationships, play a role in how we sleep. Likewise, sleep appears to influence our social bonds. However, the majority of work is correlational, limiting conclusions about the directionality of these effects. We conclude by synthesizing the findings, considering the limitations of the present literature, and identifying key future directions for this emerging area of research.
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Brossoit RM, Crain TL, Hammer LB, Lee S, Bodner TE, Buxton OM. Associations among patient care workers’ schedule control, sleep, job satisfaction and turnover intentions. Stress Health 2020; 36:442-456. [PMID: 32181575 PMCID: PMC8919502 DOI: 10.1002/smi.2941] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/27/2020] [Accepted: 03/06/2020] [Indexed: 12/25/2022]
Abstract
Healthcare is the fastest growing occupational sector in America, yet patient care workers experience low job satisfaction, high turnover, and susceptibility to poor sleep compared to workers in other jobs and industries. Increasing schedule control may be one way to help mitigate these issues. Drawing from conservation of resources theory, we evaluate associations among schedule control (i.e. a contextual resource), employee sleep duration and quality (i.e. personal resources), job satisfaction, and turnover intentions. Patient care workers who reported having more schedule control at baseline reported greater sleep duration and sleep quality 6 months later, as well as higher job satisfaction and lower turnover intentions 12 months later. Workers who experienced greater sleep sufficiency (i.e. feeling well-rested) reported higher job satisfaction 6 months later, and workers who experienced fewer insomnia symptoms (i.e. trouble falling and staying asleep) reported lower turnover intentions 6 months later. The association between schedule control and job satisfaction was partially mediated by greater sleep sufficiency, though this effect was small. Providing patient care workers with greater control over their work schedules and opportunities for improved sleep may improve their job attitudes. Results were not replicated when different analytical approaches were performed, so findings should be interpreted provisionally.
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Affiliation(s)
| | - Tori L. Crain
- Department of Psychology, Colorado State University, Fort Collins, Colorado
| | - Leslie B. Hammer
- Oregon Institute for Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon,Department of Psychology, Portland State University, Portland, Oregon
| | - Soomi Lee
- School of Aging Studies, University of South Florida, Tampa, Florida
| | - Todd E. Bodner
- Department of Psychology, Portland State University, Portland, Oregon
| | - Orfeu M. Buxton
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania,Department of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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Adler AB, Bliese PD, LoPresti ML, McDonald JL, Merrill JC. Sleep leadership in the army: A group randomized trial. Sleep Health 2020; 7:24-30. [PMID: 32651093 DOI: 10.1016/j.sleh.2020.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Examine impact of training military leaders in sleep health on leaders and unit members. DESIGN Following a baseline survey, two-person platoon leadership teams were randomly assigned by company to a training or waitlist control condition. After training, leadership teams completed a post-training survey. Six weeks later, leaders and unit members completed a final survey. SETTING Classroom-style areas on a US military base. PARTICIPANTS US soldiers (76 leaders and 448 unit members) from 39 platoons across 14 companies in a brigade combat team. INTERVENTION One-hour training in sleep leadership. MEASUREMENTS Leaders were surveyed about sleep knowledge, sleep attitudes, sleep training, sleep quantity, sleep quality and sleep problems. Unit members were surveyed about sleep leadership behaviors, sleep hours, sleep quality and sleep problems. RESULTS Leaders rated the training highly and most knowledge and some attitudes about sleep improved from the baseline to post-training survey. Fewer leaders in the training condition reported sleep problems at follow-up than those in the waitlist control condition; there were no differences in sleep hours or sleep quality. More unit members with leaders in the training condition reported that their leaders engaged in sleep leadership behaviors at least sometimes and reported sleeping at least 7 hours/24 hours period than did unit members in the waitlist control condition; sleep quality and sleep problems did not differ by condition. CONCLUSIONS Results suggest a simple training intervention targeting leaders may be able to shift sleep health and the cultural perspective on sleep across an organization.
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Affiliation(s)
- Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.
| | - Paul D Bliese
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA; University of South Carolina, Darla Moore School of Business, Columbia, South Carolina, USA
| | | | - Jennifer L McDonald
- United States Army Medical Research Directorate-West, Joint Base Lewis McChord, Washington, USA
| | - Julie C Merrill
- United States Army Medical Research Directorate-West, Joint Base Lewis McChord, Washington, USA
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Barnes CM, Awtrey E, Lucianetti L, Spreitzer G. Leader sleep devaluation, employee sleep, and unethical behavior. Sleep Health 2020; 6:411-417.e5. [DOI: 10.1016/j.sleh.2019.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/18/2019] [Accepted: 12/01/2019] [Indexed: 11/15/2022]
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Osgood JM, Finan PH, Hinman SJ, So CJ, Quartana PJ. Combat exposure, post-traumatic stress symptoms, and health-related behaviors: the role of sleep continuity and duration. Sleep 2020; 42:5250906. [PMID: 30561746 DOI: 10.1093/sleep/zsy257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/29/2018] [Accepted: 12/14/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Aggression, substance misuse, and other health risk behaviors are common among combat veterans. We examined whether sleep quality and quantity predict the association between combat exposure, post-traumatic stress symptoms, and adverse health-related behaviors. METHODS Soldiers (N = 2420) from a brigade combat team completed surveys assessing combat experiences, and psychological and behavioral health factors, approximately 3 months following deployment to Afghanistan in 2011. RESULTS Respondents were 93.5% male; 73% were age 18-29 years old. The response rate was 80% (3076/3832); 94% (2876/3076) of the soldiers who attended the recruitment briefings consented to participate in this research. Complete data were available across the variables used in this study for up to 2420 soldiers. Sleep continuity disturbance accounted for the association of combat exposure with post-traumatic stress symptoms and aggression, alcohol use, and risky behavior. Moreover, for soldiers who reported sleep duration of <6 hr per day, the indirect association of combat exposure and post-traumatic stress on aggression, alcohol use, risky behavior, and opioid use was strongest. CONCLUSIONS This study is the first to model sleep problems as a predictor of the association between combat exposure and post-traumatic stress symptoms and frequently reported health-related behavior problems. Sleep disturbance is highly prevalent among Warfighters. While not fully preventable in operational contexts, these problems can be effectively mitigated postdeployment with appropriate policy and intervention resources. Improving the sleep characteristics of combat-exposed soldiers following deployment should reduce subsequent post-traumatic stress and related health compromising behavior, thereby enhancing force readiness.
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Affiliation(s)
- Jeffrey M Osgood
- Walter Reed Army Institute of Research, Center for Military Psychiatry and Neuroscience, Silver Spring, MD
| | | | - Sarah J Hinman
- Walter Reed Army Institute of Research, Center for Military Psychiatry and Neuroscience, Silver Spring, MD
| | - Christine J So
- Walter Reed Army Institute of Research, Center for Military Psychiatry and Neuroscience, Silver Spring, MD
| | - Phillip J Quartana
- Walter Reed Army Institute of Research, Center for Military Psychiatry and Neuroscience, Silver Spring, MD
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Wood MD, Walker T, Adler AB, Crouch CL. Post-Traumatic Growth Leadership: Mitigating Stress in a High-Risk Occupation. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s41542-019-00052-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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18
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It's been a hard day's night: A diary study on hardiness and reduced sleep quality among naval sailors. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2019.109635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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19
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Hammer LB, Brady JM, Perry ML. Training supervisors to support veterans at work: Effects on supervisor attitudes and employee sleep and stress. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2019. [DOI: 10.1111/joop.12299] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Leslie B. Hammer
- Oregon Institute of Occupational Health Sciences Oregon Health & Science University Portland Oregon USA
- Department of Psychology Portland State University Oregon USA
| | - Jacquelyn M. Brady
- Oregon Institute of Occupational Health Sciences Oregon Health & Science University Portland Oregon USA
- Department of Psychology Portland State University Oregon USA
| | - MacKenna L. Perry
- Oregon Institute of Occupational Health Sciences Oregon Health & Science University Portland Oregon USA
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20
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Adrian AL, Skeiky L, Burke TM, Gutierrez IA, Adler AB. Sleep problems and functioning during initial training for a high-risk occupation. Sleep Health 2019; 5:651-657. [PMID: 31377248 DOI: 10.1016/j.sleh.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/06/2019] [Accepted: 06/18/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The current study sought to characterize the sleep problems of soldiers entering Basic Combat Training and to identify the link between sleep problems and subsequent performance, psychological distress, anger reactions, and attention. DESIGN Soldiers were surveyed at 4 time points throughout the standard 10 weeks of Basic Combat Training. Surveys were administered at weeks 1, 3, 6, and 9. Sleep problems were identified as either present or absent at each time point using a sleep problem screening questionnaire. Four sleep patterns were identified and then used to evaluate outcomes throughout training (n = 1577). RESULTS When compared to those who never had a sleep problem ("healthy "; 60.6%), those who recovered from their initial sleep problem ("recovered"; 12.8%) started training with higher psychological distress and anger reactions and lower attention but steadily improved throughout training. Those who developed a sleep problem during training ("new onset"; 20.0%) and those who had a sleep problem throughout training ("chronic"; 6.6%) also started off significantly worse than the healthy group. The new-onset and chronic groups saw slower psychological distress improvement and a decline in attention throughout the course compared to the healthy group. The chronic group also significantly increased their anger reactions throughout training compared to the healthy group. CONCLUSION Sleep problems during Basic Combat Training may be an indicator for difficulties managing entry into the military. These findings highlight the importance of improving sleep health for soldiers throughout Basic Combat Training and for others with similar training in high-risk occupations.
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Affiliation(s)
- Amanda L Adrian
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | - Lillian Skeiky
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Tina M Burke
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Ian A Gutierrez
- Research Transition Office, Center for Enhancing Capabilities, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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21
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McDonald JL, Ganulin ML, LoPresti ML, Adler AB. Sleep knowledge, goals, and habits in soldiers. Sleep Health 2019; 5:426-428. [DOI: 10.1016/j.sleh.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 11/24/2022]
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22
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Galliker S, Nicoletti C, Feer S, Irene Etzer-Hofer, Brunner B, Grosse Holtforth M, Melloh M, Dratva J, Elfering A. Quality of leadership and presenteeism in health professions education and research: a test of a recovery-based process model with cognitive irritation and impaired sleep as mediators. PSYCHOL HEALTH MED 2019; 25:239-251. [PMID: 31244323 DOI: 10.1080/13548506.2019.1634823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Presenteeism (PRES) includes working while feeling ill and constrained in performance. Compared with absence from work, PRES generates significantly higher cost estimates. Health problems and PRES are related to leadership quality. Hence, research on corporate health management needs to explore why leadership problems (LP) correspond to more frequent PRES.This study tests recovery after work as an underlying process with cognitive irritation (COGIRR) and sleep problems (SP) as simultaneous mediators and explores three mediation pathways (path one: LP→COGIRR→PRES; path two: LP→SP→PRES; and path three: LP→COGIRR→SP→PRES). Out of 293 employees of a university's school of health professions in German-speaking Switzerland, 211 completed a questionnaire. LP and PRES were found to be positively related (r(211) = .22, p < .01). The tests of mediation yielded no significant results for path one and two, but the third mediation path LP→COGIRR→SP→PRES was positive and differed significantly from zero (B = 0.83, CI95 = 0.33 to 1.69). According to our results, a recovery-based mediation model fits the empirical self-report data best. These results suggest that occupational health interventions should improve leadership quality to promote recovery after work in order to increase health and productivity by reduced PRES.
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Affiliation(s)
- Sibylle Galliker
- Department of Work and Organizational Psychology, University of Bern, Institute of Psychology, Bern, Switzerland
| | - Corinne Nicoletti
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Sonja Feer
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Irene Etzer-Hofer
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Beatrice Brunner
- School of Management and Law, Zurich University of Applied Sciences, Winterthur Institute of Health Economics, Winterthur, Switzerland
| | - Martin Grosse Holtforth
- Department of Clinical Psychology and Psychotherapy, University of Bern, Institute of Psychology, Bern, Switzerland.,Division of Psychosomatic Medicine, Bern University Hospital, Bern, Switzerland
| | - Markus Melloh
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland.,Curtin Medical School, Curtin University, Bentley, Australia.,UWA Medical School, The University of Western Australia, Perth, Australia
| | - Julia Dratva
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Achim Elfering
- Department of Work and Organizational Psychology, University of Bern, Institute of Psychology, Bern, Switzerland
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Bell ST, Brown SG, Mitchell T. What We Know About Team Dynamics for Long-Distance Space Missions: A Systematic Review of Analog Research. Front Psychol 2019; 10:811. [PMID: 31156490 PMCID: PMC6530432 DOI: 10.3389/fpsyg.2019.00811] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background: To anticipate the dynamics of future long-distance space exploration mission (LDSEM) teams, research is conducted in analog environments (e.g., Antarctic expeditions, space chamber simulations), or environments that share key contextual features of LDSEM such as isolation and confinement. We conducted a systematic review of research conducted on teams in LDSEM-analog environments to identify which factors have been examined with quantitative research, and to summarize what the studies reveal about team dynamics in LDSEM-analog environments. Methods: We used a comprehensive search strategy to identify research on teams that lived and worked together. Data on team dynamics were extracted where possible, and sources were coded for key contextual features. The data did not lend themselves to traditional meta-analysis. We used two approaches to summarize the data: a weighted averages approach when the study reported enough data to calculate an effect size, and descriptive figures when data across studies were directly comparable. Results: Seventy-two sources met our inclusion criteria, yielding 253 effect sizes and 1,150 data points. Results from our weighted averages approach suggested that the team cohesion and performance relationship may be operating differently in isolated and confined environments than other teams that lived and worked together (e.g., military teams), and that, given the available data, we can say very little about the magnitude and direction of the relationship. Our descriptive figures revealed important trends: (a) team members in longer missions generally spent less social time together than shorter missions; (b) consistent team efficiency over time was typical, whereas decreased team efficiency over time was atypical; (c) by 40% of mission completion or 90 days, all teams reported at least one conflict, (d) commanders' written communication with mission control decreased in length over time, and (e) team mood dynamics did not consistently support the third-quarter phenomenon. Conclusions: There are inherent limitations to our study, given the nature of the analog research (e.g., correlational studies, small sample size). Even so, our systematic review provides key insights into team dynamics in LDSEM-analog environments. We discuss the implications of our research for managing future space crews. Importantly, we also provide guidance for future research.
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Affiliation(s)
- Suzanne T. Bell
- Department of Psychology, DePaul University, Chicago, IL, United States
| | - Shanique G. Brown
- Department of Psychology, Wayne State University, Detroit, MI, United States
| | - Tyree Mitchell
- School of Leadership & Human Resource Development, Louisiana State University, Baton Rouge, LA, United States
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24
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Woodruff SI, Hurtado SL, Simon-Arndt CM. U.S. Marines' Perceptions of Environmental Factors Associated With Alcohol Binge Drinking. Mil Med 2019; 183:e240-e245. [PMID: 29425366 DOI: 10.1093/milmed/usx121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/21/2017] [Indexed: 11/12/2022] Open
Abstract
Introduction Alcohol misuse, in particular binge drinking, is a serious concern among military personnel because it is strongly associated with adverse consequences and has a deleterious effect on readiness. Although most alcohol misuse studies have focused on individual risk factors, studies are increasingly examining environmental influences and strategies for reducing alcohol risks. The purpose of this study is to address gaps in what is known about how service members' perceptions of environmental factors are related to binge drinking in the U.S. Marine Corps. Materials and Methods The relationship between Marines' self-reports of environmental factors and alcohol binge drinking was assessed in this correlational study using data from three large Marine Corps installations drawn from the Department of Defense 2011 Health Related Behaviors Survey of Active Duty Military Personnel (N = 2,933). We proposed several directional hypotheses based on existing civilian and military studies of alcohol use and misuse, as well as health behavior theory. Results Agreement with the statements that alcoholic beverages cost too much, that drinking might negatively affect one's military career, and that one's immediate supervisor and installation discourage alcohol use were independently associated with decreased odds of binge drinking (i.e., protective factors). Perceptions that alcoholic beverages are difficult to get was particularly protective; the odds of having binged were lower for participants who endorsed this belief than for those who did not. Perceptions that drinking is part of being in one's unit was a risk factor for binge drinking (odds ratio = 1.29). Conclusion Even after accounting for strong sociodemographic correlates, binge drinking was independently associated with a number of environmentally oriented perceptions. Beliefs that alcohol is affordable and easy to access were the strongest environmental correlates of increased risk of binge drinking. Addressing the threat alcohol misuse poses to both Marines and mission readiness will likely require multiple strategies, including both policy and environmental changes.
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Affiliation(s)
- Susan I Woodruff
- School of Social Work, San Diego State University, 5500 Campanile Drive, HH 203, San Diego, CA
| | - Suzanne L Hurtado
- Health and Behavioral Sciences Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA
| | - Cynthia M Simon-Arndt
- Health and Behavioral Sciences Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA.,Leidos, Inc., 140 Sylvester Road, San Diego, CA
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25
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Layman PG, Sanford K, Myers DR, Dolan S, Ellor JW, Morissette SB, Whitacre J, Crow J. Intimate partner cohesion and military unit cohesion: Different types of interpersonal relationships each uniquely predict soldier well-being. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1579606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Keith Sanford
- Department of Psychology, Baylor University, Waco, Texas
| | | | - Sara Dolan
- Department of Psychology, Baylor University, Waco, Texas
| | | | - Sandra B. Morissette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas
| | - Janice Whitacre
- Warrior Combat Stress Reset Program, Carl. R. Darnall Army Medical Center, Fort Hood, Texas
| | - Janet Crow
- Diana R. Garland School of Social Work, Baylor University, Waco, Texas
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26
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Mantua J, Bessey A, Sowden WJ, Chabuz R, Brager AJ, Capaldi VF, Simonelli G. A Review of Environmental Barriers to Obtaining Adequate Sleep in the Military Operational Context. Mil Med 2019; 184:e259-e266. [DOI: 10.1093/milmed/usz029] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractIntroductionSleep loss is ubiquitous in military settings, and it can be deleterious to cognitive, physiological, and operational functioning. This is especially true in the military operational context (e.g., training, garrison, combat) where continuous operations prevent adequate time for rest and recuperation. Furthermore, even when servicemembers do have opportunities for sleep, environmental disruptors in the military operational context make it difficult to obtain restorative sleep. Such environmental disruptors are potentially preventable or reversible, yet there is little public awareness of how to minimize or eliminate these sleep disruptors. Therefore, the goal of this review was to outline prominent environmental sleep disruptors, describe how they occur in the military operational context, and also discuss feasible strategies to mitigate these disruptors.Materials and MethodsWe discuss four factors – light, noise, temperature, and air pollution – that have previously been identified as prominent sleep disruptors in non-military settings. Additionally, we extracted publicly-available yearly temperature and pollution data, from the National Oceanic and Atmospheric Association and the Environmental Protection Agency, respectively, for major prominent military installations in the continental US in order to identify the sites at which servicemembers are at the greatest risk for environmental sleep disruptions.ResultsBased on previous literature, we concluded light and noise are the most easily mitigatable sleep-disrupting environmental factors. Air pollution and temperature, on the other hand, are more difficult to mitigate. We also propose that harsh/uncomfortable sleeping surface is a fifth critical, previously unexplored sleep disruptor in the military operational context. Furthermore, we identified several problematic military sites for air pollution for temperature. Specifically, each branch has major installations located in regions with extreme heat (especially the Army), and each branch has at least one major installation in a high air pollution region. These findings show that even when in training or garrison in the US, military servicemembers are at risk for having sleep disruption due to environmental factors.ConclusionsEnvironmental disruptors, such as light, noise, temperature, and air pollution, can negatively impact sleep in the military operational context. Simple, feasible steps can be taken to reduce sleep disruptions that are caused by light and noise. Yet there is a need for research and development on tools to mitigate air pollution, extreme temperatures, and inhospitable sleeping surfaces. Leadership at the discussed military bases and training facilities should focus on improving the sleep environment for individuals under their command. Such interventions could ultimately improve warfighter health, wellness, and operational performance, leading to greater warfighter readiness and lethality.
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Affiliation(s)
- Janna Mantua
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, USA
| | - Alexxa Bessey
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, USA
| | - Walter J Sowden
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, USA
| | - Richard Chabuz
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, USA
| | - Allison J Brager
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, USA
| | - Vincent F Capaldi
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, USA
| | - Guido Simonelli
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, USA
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27
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Affiliation(s)
- Alexa A. Lopez
- United States Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Tacoma, Washington
| | - Amy B. Adler
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Oscar A. Cabrera
- United States Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Tacoma, Washington
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28
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Pallesen S, Olsen OK, Eide EM, Nortvedt B, Grønli J, Larøi F, Nordmo M, Glomlien FE. Sleep deprivation and hallucinations. A qualitative study of military personnel. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1478561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Olav K. Olsen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Royal Norwegian Naval Academy, Norway
| | - Elisabeth M. Eide
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Benedicte Nortvedt
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Janne Grønli
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT – Norwegian Centre of Excellence for Mental Disorders Research, University of Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Morten Nordmo
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Fride E. Glomlien
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
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Klingaman EA, Brownlow JA, Boland EM, Mosti C, Gehrman PR. Prevalence, predictors and correlates of insomnia in US army soldiers. J Sleep Res 2018; 27:e12612. [PMID: 29024363 PMCID: PMC5895531 DOI: 10.1111/jsr.12612] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/22/2017] [Indexed: 12/31/2022]
Abstract
The objective of this study was to investigate the rates, predictors and correlates of insomnia in a national sample of US Army soldiers. Data were gathered from the cross-sectional survey responses of the All-Army Study, of the Army Study to Assess Risk and Resilience in Service members. Participants were a representative sample of 21 499 US Army soldiers who responded to the All-Army Study self-administered questionnaire between 2011 and 2013. Insomnia was defined by selected DSM-5 criteria using the Brief Insomnia Questionnaire. The results highlight significant functional difficulties associated with insomnia among US soldiers, as well as insights into predictors of insomnia specific to this population. Insomnia was present in 22.76% of the sample. Predictors of insomnia status in logistic regression included greater number of current mental health disorders, less perceived open lines of communication with leadership, less unit member support and less education. Insomnia had global, negative associations with health, social functioning, support, morale, work performance and Army career intentions. The results provide the strongest evidence to-date that insomnia is common in a military population, and is associated with a wide array of negative factors in the domains of health, military readiness and intentions to remain in military careers.
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Affiliation(s)
- Elizabeth A Klingaman
- US Department of Veterans Affairs Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC) and Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Janeese A Brownlow
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Cpl. Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Elaine M Boland
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Cpl. Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Caterina Mosti
- Department of Psychology, Drexel University, Philadelphia, PA, USA
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip R Gehrman
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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30
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Adrian AL, Adler AB, Thomas JL, Britt TW. Integrating new soldiers: The role of leaders and unit members. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1425064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Amanda L. Adrian
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Amy B. Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jeffrey L. Thomas
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Thomas W. Britt
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Department of Psychology, Clemson University, Clemson, South Carolina
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31
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Hammer LB, Wan WH, Brockwood KJ, Mohr CD, Carlson KF. Military, Work, and Health Characteristics of Separated and Active Service Members From the Study for Employment Retention of Veterans (SERVe). MILITARY PSYCHOLOGY 2018. [DOI: 10.1037/mil0000196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Leslie B. Hammer
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University
| | - Wylie H. Wan
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University
| | - Krista J. Brockwood
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University
| | | | - Kathleen F. Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System (R&D 66), Portland, Oregon, and School of Public Health, Oregon Health & Science University
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32
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Adler AB, Gunia BC, Bliese PD, Kim PY, LoPresti ML. Using actigraphy feedback to improve sleep in soldiers: an exploratory trial. Sleep Health 2017; 3:126-131. [DOI: 10.1016/j.sleh.2017.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 12/24/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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Wickwire EM, Geiger-Brown J, Scharf SM, Drake CL. Shift Work and Shift Work Sleep Disorder: Clinical and Organizational Perspectives. Chest 2016; 151:1156-1172. [PMID: 28012806 DOI: 10.1016/j.chest.2016.12.007] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/20/2016] [Accepted: 12/12/2016] [Indexed: 01/31/2023] Open
Abstract
Throughout the industrialized world, nearly one in five employees works some form of nontraditional shift. Such shift work is associated with numerous negative health consequences, ranging from cognitive complaints to cancer, as well as diminished quality of life. Furthermore, a substantial percentage of shift workers develop shift work disorder, a circadian rhythm sleep disorder characterized by excessive sleepiness, insomnia, or both as a result of shift work. In addition to adverse health consequences and diminished quality of life at the individual level, shift work disorder incurs significant costs to employers through diminished workplace performance and increased accidents and errors. Nonetheless, shift work will remain a vital component of the modern economy. This article reviews seminal and recent literature regarding shift work, with an eye toward real-world application in clinical and organizational settings.
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Affiliation(s)
- Emerson M Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD; Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.
| | | | - Steven M Scharf
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Christopher L Drake
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI; Department of Psychiatry, University of Michigan, Ann Arbor, MI
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Olsen OK, Pallesen S, Torsheim T, Espevik R. The effect of sleep deprivation on leadership behaviour in military officers: an experimental study. J Sleep Res 2016; 25:683-689. [DOI: 10.1111/jsr.12431] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ståle Pallesen
- Department of Psychosocial Science; University of Bergen; Bergen Norway
| | - Torbjørn Torsheim
- Department of Psychosocial Science; University of Bergen; Bergen Norway
| | - Roar Espevik
- Royal Norwegian Naval Academy; Lillehammer Norway
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Adler AB, Saboe KN, Anderson J, Sipos ML, Thomas JL. Behavioral health leadership: new directions in occupational mental health. Curr Psychiatry Rep 2014; 16:484. [PMID: 25160794 DOI: 10.1007/s11920-014-0484-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The impact of stress on mental health in high-risk occupations may be mitigated by organizational factors such as leadership. Studies have documented the impact of general leadership skills on employee performance and mental health. Other researchers have begun examining specific leadership domains that address relevant organizational outcomes, such as safety climate leadership. One emerging approach focuses on domain-specific leadership behaviors that may moderate the impact of combat deployment on mental health. In a recent study, US soldiers deployed to Afghanistan rated leaders on behaviors promoting management of combat operational stress. When soldiers rated their leaders high on these behaviors, soldiers also reported better mental health and feeling more comfortable with the idea of seeking mental health treatment. These associations held even after controlling for overall leadership ratings. Operational stress leader behaviors also moderated the relationship between combat exposure and soldier health. Domain-specific leadership offers an important step in identifying measures to moderate the impact of high-risk occupations on employee health.
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Affiliation(s)
- Amy B Adler
- US Army Medical Research Unit-Europe, Walter Reed Army Institute of Research, Sembach, Germany,
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