An Occupational Mental Health Model for the Military

Differences in resilience profiles between military veterans and the general population: An exploratory latent profile analysis using the HUNT-4 survey

Using latent profile analyses, the current work investigated levels of adverse childhood experiences, symptoms of anxiety and depression and 3 dimensions of relational promotive factors) to identify resilience profiles in a large general population sample (N = 161,622, mean age = 53.02; SD = 17.80; 56.1% females). We then used the same method to identify the resilience profiles of military veterans (N = 386, mean age = 43.47; SD = 10.08; 9.8% females), all of whom had served in Afghanistan. A four-profile-solution was the best fitting for the general population (High resilient 30%, Moderate resilient 13%, Low resilient 53%, Work/social-based resilience 4%), while a three-profile-solution had the best fit in the veteran cohort (Family-based resilience 28%, Work/social-based resilience 62%, Hardy loners 10%). To ground the identified profiles in occupational function, we also checked how they predicted reports of sleep difficulties, job demand and job control. Despite both samples inhabiting a geographic region known for high socioeconomic similarity among residents, we found marked differences in profile-solutions between the military veterans and the general population. Our findings suggests that resilience profiles are highly influenced by cohort characteristics and the specific resources needed to manage a given stressor load. Accordingly, the generalisability of specific protective factors may be low across distinct cohorts, and reliable findings need to be obtained in specific populations as defined by stressor context, sample characteristics, and relevant outcomes.

A Retrospective Cohort Analysis of Mental Health-Related Emergency Department Visits Among Veterans and Non-Veterans Residing in Ontario, Canada: Une analyse de cohorte rétrospective des visites au service d'urgence liées à la santé mentale parmi les vétérans et non-vétérans résidant en Ontario, Canada

OBJECTIVES

Emergency departments (EDs) are a vital part of healthcare systems, at times acting as a gateway to community-based mental health (MH) services. This may be particularly true for veterans of the Royal Canadian Mounted Police who were released prior to 2013 and the Canadian Armed Forces, as these individuals transition from federal to provincial healthcare coverage on release and may use EDs because of delays in obtaining a primary care provider. We aimed to estimate the hazard ratio (HR) of MH-related ED visits between veterans and non-veterans residing in Ontario, Canada: (1) overall; and by (2) sex; and (3) length of service.

METHODS

This retrospective cohort study used administrative healthcare data from 18,837 veterans and 75,348 age-, sex-, geography-, and income-matched non-veterans residing in Ontario, Canada between April 1, 2002, and March 31, 2020. Anderson-Gill regression models were used to estimate the HR of recurrent MH-related ED visits during the period of follow-up. Sex and length of service were used as stratification variables in the models.

RESULTS

Veterans had a higher adjusted HR (aHR) of MH-related ED visits than non-veterans (aHR, 1.97, 95% CI, 1.70 to 2.29). A stronger effect was observed among females (aHR, 3.29; 95% CI, 1.96 to 5.53) than males (aHR, 1.78; 95% CI, 1.57 to 2.01). Veterans who served for 5-9 years had a higher rate of use than non-veterans (aHR, 3.76; 95% CI, 2.34 to 6.02) while veterans who served for 30+ years had a lower rate compared to non-veterans (aHR, 0.60; 95% CI, 0.42 à 0.84).

CONCLUSIONS

Rates of MH-related ED visits are higher among veterans overall compared to members of the Ontario general population, but usage is influenced by sex and length of service. These findings indicate that certain subpopulations of veterans, including females and those with fewer years of service, may have greater acute mental healthcare needs and/or reduced access to primary mental healthcare.

National Guard Deployment in Support of COVID-19: Psychological and Behavioral Health

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.

The effect of cadet resilience on self-efficacy and professional achievement: verification of the moderated mediating effect of vocational calling

Background

The primary objective of this study was to empirically examine the influence of cadets' resilience on their professional achievement within the unique context of a Military Academy. In doing so, the study sought to delineate the role of self-efficacy as a key mediator in the intricate relationship between the resilience of cadets and their professional achievements. The main focus of this study was to clarify the causal and effect relationships between the psychology and behavior mechanisms of the cadets. This was achieved through rigorous scrutiny of the moderated mediating effect of vocational calling within the multifaceted relationship involving cadets' resilience, self-efficacy, and professional achievement.

Methods

The study's participant pool consisted of 121 individuals, comprising cadets in their third and fourth years of study, all of whom aspired to attain the rank of officer within the Military Academy. To rigorously investigate the hypotheses presented, a series of causal relationships among the four core variables were evaluated using a robust regression analysis methodology. To facilitate this analysis, the PROCESS macro 3.5v, a Hayes-developed tool, was effectively used.

Results

The findings of this study revealed several critical insights. First, vocational calling emerged as a potent moderating factor in shaping the relationship between cadets' resilience and self-efficacy. Furthermore, it was demonstrated that vocational calling exerted a conditional influence on the impact of cadets' resilience on their professional achievement, with self-efficacy serving as a crucial mediating mechanism in this relationship. In particular, the study affirmed that self-efficacy functioned as a comprehensive mediator, elucidating the pathway through which the resilience of the cadets ultimately influenced their professional achievements.

Conclusion

The results of this research contribute significantly to enhancing our understanding of the intricate connection between the resilience levels exhibited by cadets and their corresponding professional achievements. Furthermore, these findings have valuable implications for the ongoing refinement of military education and training programs. They offer insights that could inform the development of more effective testing and selection protocols for military personnel, ultimately benefiting the armed forces in their pursuit of excellence.

Systematic Improvements to the Army's Deployment Cycle Resilience Training Using a Comprehensive, Iterative Process

INTRODUCTION

To support soldier readiness and mitigate the mental health consequences of deployments, Army regulation mandates soldiers to receive Deployment Cycle Resilience Training (DCRT) throughout their deployment cycle. A recent evaluation revealed several issues with the existing version that threatened the relevancy and usefulness of the training. The present article details the systematic approach taken by the Research Transition Office at the Walter Reed Army Institute of Research to revise the DCRT curriculum and presents the revision updates that are now included in DCRT version 3.

METHOD

Curriculum developers (n = 2) with subject matter expertise relevant to the project followed an iterative process that was critical to the efficacy of the revisions. Developers used the existing DCRT modules as the curriculum framework and utilized several materials to inform the revisions to include Army doctrine, data from the quality improvement evaluation conducted by the Walter Reed Army Institute of Research, and the current research related to the deployment cycle, resilience, and behavior change. Internal and external stakeholders (n = 31) provided iterative feedback to ensure each of the six modules met DCRT revision objectives.

RESULTS

The revised DCRT curriculum was implemented in August 2021. The resulting revisions included an increase in inclusivity, an emphasis on growth opportunities, an integrative approach to the deployment cycle phases, and greater practical application. Additionally, the curriculum incorporates best practices found to enhance the delivery of resilience-based psychoeducational interventions, specifically within high-risk occupational settings like the military.

CONCLUSIONS

The revisions outlined in this article enhance the training quality and potential effectiveness of DCRT, which can positively influence soldier and family readiness and mission success. Furthermore, the deliberate and iterative curriculum revision process can serve as a guide to other curriculum development projects, specifically within the military context. Implementation considerations and potential limitations are provided, and future directions are discussed to include the ongoing evaluation.

Adaptation in Young Military Recruits: Protocol for the Advancing Research on Mechanisms of Resilience (ARMOR) Prospective Longitudinal Study

BACKGROUND

Military services provide a unique opportunity for studying resilience, a dynamic process of successful adaptation (ie, doing well in terms of functioning and symptoms) in response to significant adversity. Despite the tremendous interest in positive adaptation among military service members, little is known about the processes underlying their resilience. Understanding the neurobiological, cognitive, and social mechanisms underlying adaptive functioning following military stressor exposure is essential for enhancing the resilience of military service members.

OBJECTIVE

The primary objective of the Advancing Research on Mechanisms of Resilience (ARMOR) longitudinal study is to characterize the trajectories of positive adaptation among young military recruits in response to basic combat training (BCT), a well-defined, uniform, and 10-week period of intense stress (aim 1), and identify promotive and protective processes contributing to individual variations in resilience (aim 2). The secondary objective is to investigate the pathways by which neurobehavioral markers of self-regulation assessed using electroencephalography and magnetic resonance imaging contribute to adaptive trajectories (aim 3).

METHODS

ARMOR is an ongoing, prospective longitudinal cohort study of young military recruits who recently joined the National Guard but have not yet shipped out for BCT. Participants (N=1201) are assessed at 5 time points over the initial >2 years of military service beginning before BCT (baseline) and followed up at 2 weeks and 6, 12, and 18 months after BCT. Participants complete web-based questionnaires assessing vulnerability and protective factors, mental health, and socioemotional functioning at each time point and a battery of neurocognitive tests at time 0. A subset of participants also complete structured diagnostic interviews and additional self-report measures and perform neurobehavioral tasks before and after BCT during electroencephalography sessions and before BCT only during magnetic resonance imaging sessions.

RESULTS

This UG3/UH3 project was initially funded in August 2017, with the UG3 pilot work completed at the end of 2018. The UH3 phase of the project was funded in March 2019. Study enrollment for the UH3 phase began on April 14, 2019, and ended on October 16, 2021. A total of 1201 participants are enrolled in the study. Follow-up data collection for the UH3 phase is ongoing and projected to continue through February 2024. We will disseminate the findings through conferences, webinars, open access publications, and communications with participants and stakeholders.

CONCLUSIONS

The ARMOR study provides a rich data set to identify the predictors and mechanisms of resilient and nonresilient outcomes in the context of military stressors, which are intended to empirically inform the development of prevention and intervention strategies to enhance the resilience of military trainees and potentially other young people facing significant life challenges.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51235.

Global prevalence of poor sleep quality in military personnel and veterans: A systematic review and meta-analysis of epidemiological studies

Poor sleep quality is prevalent among members of the military but rates of poor sleep quality vary between studies. This study examined the global prevalence of poor sleep quality in military personnel and veterans as well as possible moderators of prevalence differences between studies. PubMed, EMBASE, Web of Science, and PsycINFO were systematically searched from their inception dates to September 1, 2022. Studies were included if they were conducted on military personnel and/or veterans and prevalence estimates of poor sleep quality could be generated from assessments with standardized tools. A random-effects model was used to calculate the pooled prevalence and its 95% confidence intervals (CIs). Fifty-nine studies (N = 28,100) were included for analysis with sample sizes ranging from 14 to 8481. Two studies were rated as "high quality" (3.39%), while 57 were rated as "moderate quality" (96.61%). The overall pooled prevalence of poor sleep quality in military personnel and veterans was 69.00% (95% CI: 62.33-75.30%); pooled rates were 57.79% (95% CI: 49.88-65.50%) and 82.88% (95% CI: 74.08-90.21%) for active duty personnel and veterans, respectively. Subgroup analyses indicated study region, study design, sampling method, Pittsburg Sleep Quality Index cut-off values, and service type moderated prevalence of poor sleep quality. Meta-regression analyses indicated sample size, mean age, depression and posttraumatic stress disorder (PTSD) were associated with prevalence differences between studies. Poor sleep quality was more common in both active duty military personnel and veterans who were older and those who reported PTSD or depression. Regular monitoring of sleep quality and sleep hygiene should be promoted in this population. More relevant studies in middle- and low-income countries should also be conducted.

Advancing Research on Mechanisms of Resilience (ARMOR) Prospective Longitudinal Study of Adaptation in Young Military Recruits: Protocol and rationale for methods and measures

Background

Military service provides a unique opportunity for studying resilience, a dynamic process of successful adaptation (i.e., doing well in terms of functioning and symptoms) in response to significant adversity. Despite tremendous interest in positive adaptation among military service members, little is known about the processes underlying their resilience. Understanding neurobiological, cognitive, and social mechanisms underlying adaptive functioning following military stressor exposure is essential to enhance the resilience of military service members.

Objectives

The primary objective of the Advancing Research on Mechanisms of Resilience (ARMOR) longitudinal study is to characterize trajectories of positive adaptation among young military recruits in response to Basic Combat Training (BCT), a well-defined, uniform, 10-week period of intense stress (Aim 1) and identify promotive and protective processes contributing to individual variations in resilience (Aim 2). The secondary objective is to investigate pathways by which neurobehavioral markers of self-regulation assessed by electroencephalography (EEG) and magnetic resonance imaging (MRI) contribute to adaptive trajectories (Aim 3).

Methods

ARMOR is an ongoing, prospective longitudinal cohort study of young military recruits who recently joined the National Guard but have not yet shipped for BCT. Participants (N=1,201) are assessed at five timepoints over the initial 2+ years of military service beginning before BCT (baseline) and followed up at 2 weeks, 6, 12, and 18 months post-BCT. At each time point, participants complete online questionnaires assessing vulnerability and protective factors, mental health and social-emotional functioning, and, at Time 0 only, a battery of neurocognitive tests. A subset of participants also complete structured diagnostic interviews, additional self-report measures, and perform neurobehavioral tasks before and after BCT during EEG sessions, and, at pre-BCT only, during MRI sessions.

Results

Study enrollment began April 14, 2019 and ended in October 16, 2021. A total of 1,201 participants are enrolled in the study (68.9% male; mean age = 18.9, SD = 3.0). Follow-up data-collection is ongoing and projected to continue through March 2024. We will disseminate findings through conferences, webinars, open access publications, and communications with participants and stakeholders.

Conclusions

Results are expected to elucidate how young military recruits adapt to military stressors during the initial years of military service. Understanding positive adaptation of military recruits in the face of BCT has implications for developing prevention and intervention strategies to enhance resilience of military trainees and potentially other young people facing significant life challenges.

Effects of Resilience Training on Resilient Functioning in Chronic Stress Situations among Cadets of the Swiss Armed Forces

Research on resilient functioning has gained increasing interest, and some recent studies interpreted resilience in the sense of resilient functioning to stress. In the present study, we investigated the associations between resilient functioning and coping strategies, stress reactivity, self-efficacy, and well-being, and we examined whether resilient functioning could be improved through a training intervention. The participants were 110 male cadets from two infantry officers' schools of the Swiss Armed Forces. The schools were divided into an intervention and control group. The participants in the intervention group took part in the resilience training intervention, whereas the participants in the control group performed military training as usual. Data were assessed before and after the intervention period. Results showed that resilient functioning was positively associated with task-oriented coping and well-being and negatively associated with emotion-oriented coping and stress reactivity. Furthermore, resilient functioning significantly improved in the intervention group from pre- to post-intervention. The results suggested that specific interventions have the power to increase resilient functioning.

Transformational leadership and flourishing in Portuguese professional firefighters: The moderating role of the frequency of intervention in rural fires

Introduction

The main objective of this study is to analyze the effect of transformational leadership on firefighters' well-being and understand the moderating role of the frequency of intervention in rural fires in this relationship.

Methods

A total of 90 responses of Portuguese professional firefighters were analyzed in two waves (T1 and T2) separated by a period of 3 weeks during which the frequency of intervention in rural fires were also recorded on a daily basis.

Results

There is a direct and positive effect, albeit small, of the transformational leadership dimensions on flourishing. Moreover, the frequency of intervention in rural fires amplified the effect of individual consideration on this wellbeing indicator, and it was observed that the more frequent the firefighters intervene in rural fires, the stronger the effect of this leadership dimension on their flourishing.

Discussion

These results contribute to the literature to the extent that they highlight the role of transformational leadership in promoting well-being in high-risk professions, thus supporting the assumptions of the Conservation of Resources Theory (COR). Some practical implications are presented, as well as limitations and suggestions for future studies.

Helping Others Results in Helping Yourself: How Well-Being Is Shaped by Agreeableness and Perceived Team Cohesion

This longitudinal research explores team cohesion as a potential mediator explaining the associations between agreeableness as a personality trait and well-being. Additionally, the study examines whether the leader offering support moderates the mediating role of perceived group cohesion. The sample consists of male military personnel (N = 648) from six different units. The longitudinal design examined two time points, T1 and T2, during the soldiers' training period. The PROCESS macro for SPSS was utilized to determine the significance of the moderator and the mediation effect. The results indicate that an agreeable personality and team cohesion at T1 predicted increased well-being at T2 (two months later). In addition, the moderated mediation hypothesis was significant, indicating that when leaders offered more support, the indirect link between an agreeable personality and well-being via team cohesion was stronger than when they offered less. The findings suggest that an agreeable personality and leader support are important in the organizational domain, and these variables promote well-being. By understanding the contribution of both external and internal sources of support to soldiers' well-being, intervention plans can be developed to lessen the stressors of their mental well-being and help them reach their maximum potential.

Examining bidirectional associations between perceived social support and psychological symptoms in the context of stressful event exposure: a prospective, longitudinal study

BACKGROUND

After stressful event exposure, higher perceived social support is a well-established correlate of decreased risk for psychological symptoms, including depressive, anxiety and posttraumatic stress (PTS) symptoms. However, longitudinal data on the direction of this association and the stability of perceived social support are scarce and have yielded mixed results, with a particular lack of prospective studies. We aimed to investigate changes in perceived social support and bidirectional associations between perceived social support and psychological symptoms in a prospective, longitudinal study.

METHODS

A sample of German soldiers was assessed before and after deployment to Afghanistan. Group-based trajectory modelling was used to investigate the stability of perceived social support and to identify possible distinguishable trajectories of perceived social support. Bidirectional associations between perceived social support (general and workplace) and psychological symptoms (depressive, anxiety and PTS) were examined using gamma regressions.

RESULTS

Average levels of perceived general social support did not change, while perceived workplace social support increased slightly (t(344) = 5.51, p < .001). There were no distinguishable trajectories of perceived social support. Higher perceived general (Mean ratio (MR) = 0.84, 95% CI = [0.74, 0.95]) and workplace social support (MR = 0.82, 95% CI = [0.72, 0.92]) predicted lower depressive symptoms, but not anxiety or PTS symptoms. Only higher PTS (MR = 0.95, 95% CI = [0.91, 0.99]) and higher depressive symptoms (MR = 0.96, 95% CI = [0.93, 0.99]) predicted lower perceived general social support.

CONCLUSIONS

Perceived social support can remain relatively stable under exposure to environmental stressors such as military deployment. Higher perceived social support could protect against depressive symptoms via a stress-buffering mechanism, while support may need to be more tailored to individual needs for a protection against PTS symptoms. Individuals with elevated depressive and PTS symptoms might have impaired abilities or opportunities to access social support after stressful event exposure. Future studies could investigate distressing social emotions and associated maladaptive social cognitions as possible mechanisms in the association between symptoms and lower perceived social support. Especially with respect to PTS symptoms, future studies could focus on conditions that enable individuals to benefit from social support.

Combat exposure and behavioral health in U.S. Army Special Forces

Although combat has been found to be associated with adverse health outcomes, little is known about the impact of specific combat exposures, particularly among specialized personnel. This study examined the association of different types of combat exposures with behavioral health outcomes, and whether these associations differed by Army occupational specialization: General Purpose Forces infantrymen (n = 5,361), Ranger Qualified infantrymen (n = 308), and Special Forces personnel (n = 593). Multivariable regression models estimated the association of combat severity, type of combat event (fighting, killing, threat to oneself, death/injury of others), and type of killing with mental health disorders, trouble sleeping, and problem drinking. Combat severity, each type of combat event, and killing noncombatants were associated with adverse health outcomes after adjusting for covariates and other combat exposures. Except for trouble sleeping, these associations did not differ by occupational specialization, though the prevalence and odds of outcomes were generally lower for Special Forces personnel.

Does Training Motivation Influence Resilience Training Outcome on Chronic Stress? Results from an Interventional Study

Resilience is understood as an acquired skill which aids in coping with acute and chronic stress. Accordingly, the present study aimed to determine the effect of resilience training on mental health problems during chronic stress. To this end, we conducted a quasi-experimental study with 127 male cadets (mean age: 21 years) of the Swiss Armed Forces officers' school. Whereas the intervention group (IG) received resilience training in addition to the standard officer's education program, the control group (CG) completed the officers' school as usual. Data assessment included pre- and post- measurement of chronic stress, symptoms of depression, and vital exhaustion in both groups. Motivation for training was collected before the first training session. Those who received the resilience training reported no change in chronic stress, whereas participants in the CG showed a significant increase in chronic stress over time (η_p² = 0.025). Furthermore, significant differences between IG and CG were only found for symptoms of depression: Participants in the IG reported significantly decreased symptoms of depression, while this was not the case for participants in the CG. Within the IG, participants' training motivation strongly influenced the effectiveness of the resilience training. More specifically, motivated individuals were more likely to benefit from the resilience training than unmotivated ones. Outcome data suggest that resilience training appeared to favorably affect chronic stress and related mental health symptoms; however, the motivation for the training seemed to be an essential prerequisite.

A New Military Hierarchy of Needs Model

The aim of our research was to create an up-to-date model of the hierarchy of needs of regular soldiers serving in the Hungarian Defense Forces. Our starting point was the theory of motivation, which states that people’s actions are motivated by a system of needs. As qualitative systematic data analysis offers an opportunity to create a relevant (decisive) theory to answer the main research question, we based our analysis on the grounded theory method. The results showed that the needs identified in our model often resembled those identified in other theories, including military models, although on different levels. The hierarchy of needs pyramid that we constructed contains terms such as resources, power, team spirit, development, quest for challenges, and fulfillment and, by way of general background, appreciation. Our research broadened our knowledge regarding individuals’ motivation to choose a military career.

Health Service Interventions for Intimate Partner Violence among Military Personnel and Veterans: A Framework and Scoping Review

IPV is a significant concern among active duty (AD) military personnel or veterans, and there is a need for initiatives to address violence perpetrated by such personnel, and IPV victimisation in military and veteran-specific contexts. The aim of this paper was to provide an overview of major IPV intervention approaches and evidence in military and veteran-specific health services. A scoping review was conducted involving a systematic search of all available published studies describing IPV interventions in military and veteran-specific health services. Findings were synthesised narratively, and in relation to a conceptual framework that distinguishes across prevention, response, and recovery-oriented strategies. The search identified 19 studies, all from the U.S., and only three comprised randomised trials. Initiatives addressed both IPV perpetration and victimisation, with varied interventions targeting the latter, including training programs, case identification and risk assessment strategies, and psychosocial interventions. Most initiatives were classified as responses to IPV, with one example of indicated prevention. The findings highlight an important role for specific health services in addressing IPV among AD personnel and veterans, and signal intervention components that should be considered. The limited amount of empirical evidence indicates that benefits of interventions remain unclear, and highlights the need for targeted research.

Measuring the Impact of Operational Stress: The Relevance of Assessing Stress-related Health Across the Deployment Cycle

INTRODUCTION

Mental health issues from intense or prolonged stress are a common concern in regard to military deployment. Deployments can objectively vary in stress exposure, but it is the individuals' perception of that stress that affects sustainability, mental health, and combat fitness, which calls for the need of a protocol to evaluate and maintain a current estimation of stress impact. So, how can we assess the impact of stressors during different phases of deployment?

MATERIALS AND METHODS

We used three psychological self-rating forms, the PSS14-Perceived Stress Scale, SMBM-Shirom Melamed Burnout Measure, and KSQ-Karolinska Sleep Questionnaire, to measure the impact of stress before (T1), during (T2), and at homecoming (T3). We also wanted to see if T1 or T2 results could predict T3 results to be able to better prepare the homecoming program.The forms were handed out to Swedish soldiers deployed in Mali in 2017. The forms were collected as a way to assess the status of the mental health load at three timepoints based on the personnel function as a way to assess the current "psychological fitness level".

RESULTS

The results show that stress measured using PSS14 was high at homecoming. The same result was observed for SMBM. No measures from T1 or T2 could however predict the T3 results.

CONCLUSIONS

Taken together, we found that screening of all contingent staff is relatively easy and provides personnel with relevant data on mental health and stress at the current time. We also found that test results correlated between T1 and T2 but not with T3. This indicates that there might be different stressors that affect staff at different timepoints.

Stress exposure status and associated factors among Chinese People's Armed Police personnel: A cross-sectional study

BACKGROUND

MG (Mass gathering) deployment is one of the primary duties of Chinese People's Armed Police (PAP) personnel. Due to prolonged and repeated deployments in difficult conditions and harsh climates, military personnel are exposed to multiple stressors.

OBJECTIVES

This study aims to understand the stress exposure status of armed police personnel during MG deployment and to explore its influencing factors.

METHODS

A cross-sectional study was conducted among PAP in 2021. We used a cluster random sampling to select 960 PAP personnel. Binary logistic regression was used to examine whether the stress exposure status was associated with factors such as demographics, health service utilization, and MG deployment.

RESULTS

Among 960 PAP personnel,83% of PAP personnel participated in MG in the past month, and 23.1% of PAP personnel suffered stress. The chi-square test showed that there were significant differences in MG'cycle time (p < 0.05). The binary logistic regression results showed that satisfaction with medical skills (p = 0.008), satisfaction with health environment (p = 0.031), satisfaction with medicine (OR = 0.640, 95%CI:0.436,0.938), and seeking health services (OR = 5.36, 95%CI:2.316,12.402) were associated with stress exposure status. However, age, and length of military service did not have any association with the stress exposure status of PAP personnel in this study.

CONCLUSION

This study demonstrated that stress exposure status among PAP personnel was associated with MG deployment, and health service utilization. These findings can help policy-makers and clinicians to relieve the stress of the armed police personnel, as well as provide a basis for developing military health service security plans.

Resilience to Suicidal Ideation Among U.S. Military Veterans with Posttraumatic Stress: Results from the National Health and Resilience in Veterans Study

Veterans with combat exposure experience high rates of posttraumatic stress symptoms (PTSS) and associated suicidal ideation. The current study examined whether social support (i.e., social connectedness and social engagement) and protective psychological factors (i.e., resilience and altruism) moderated the relation between PTSS and suicidal ideation severity in a sample of 149 U.S. military combat veterans who served in the Vietnam War or Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). Consistent with expectations, initial PTSS were positively associated with concurrent and three-year follow-up severity of suicidal ideation. Moderation analyses revealed the relation between initial PTSS and concurrent suicidal ideation severity was no longer significant at above average levels of social connectedness, social engagement, and psychological resilience. Further, the relation between initial PTSS and suicidal ideation severity three years later continued to be buffered by above average levels of social engagement. Results suggest social connectedness, psychological resilience, and social engagement help moderate initial severe thoughts of suicide linked to PTSS, while social engagement might be the strongest protective factor against severe suicidal ideation over time. Empirically-supported prevention and treatment efforts enhancing social engagement may help promote resilience to severe PTSS-related suicidal ideation among veterans from Vietnam and OEF/OIF/OND combat eras.

Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective

Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the past six years to update and broaden the discussion on pathways to mental healthcare in military populations. We find that at a broad population level, there is improvement in several indicators of mental health care access, with greater gains in initial engagement, time to first treatment contact, and subjective satisfaction with care, and smaller gains in objective indicators of adequacy of care. Among individual-level barriers to care-seeking, there is progress in improving recognition of need for care and reducing stigma concerns. Among organizational-level barriers, there are advances in availability of services and cultural acceptance of care-seeking. Other barriers, such as concerns around confidentiality, career impact, and deployability persist, however, and may account for some remaining unmet need. To address these barriers, new initiatives that are more evidence-based, theoretically-driven, and culturally-sensitive, are therefore needed, and must be rigorously evaluated to ensure they bring about additional improvements in pathways to care.

Health-Promoting Leadership During an Infectious Disease Outbreak: A Cross-Sectional Study of US Soldiers Deployed to Liberia

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.

Military suicide prevention: The importance of leadership behaviors as an upstream suicide prevention target

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.

Symptoms of depression, anxiety, and post-traumatic stress disorder and their relationship to health-related behaviors in over 12,000 US military personnel: Bi-directional associations

Background Military personnel are at greater risk of psychological disorders and related symptoms than civilians. Limited participation in health-promoting behaviors may increase presence of these disorders. Alternatively, these symptoms may limit engagement in health-promoting behaviors. Methods Self-reported data from the 2015 Department of Defense Health Related Behaviors Survey were used to assess bi-directional relationships between health-related behaviors (obesity, physical activity [PA], alcohol, smoking, sleep) and self-reported psychological disorders (generalized anxiety disorder [GAD], depression, post-traumatic disorder [PTSD]) in U.S. military personnel. Outcomes Among 12 708 respondents (14.7% female; 28.2% 17-24 y; 13.7% obese), self-reported depression was reported by 9.2%, GAD by 13.9%, and PTSD by 8.2%. Obesity and short sleep were associated with self-reported depression, GAD, and PTSD; current smoking was associated with higher odds of GAD; higher levels of vigorous PA were associated with lower odds of GAD; higher levels of moderate PA associated with lower odds of PTSD; and higher alcohol intake associated with higher odds of depression and PTSD. Self-reported depression, GAD, and PTSD were associated with higher odds of short sleep, obesity, and low levels of PA. Interpretation Obesity, short sleep, and limited engagement in health-promoting behaviors are associated with higher likelihood of self-reported psychological disorders, and vice-versa. Encouraging and improving health-promoting behaviors may contribute to positive mental health in military personnel.

PTSD networks of veterans with combat versus non-combat types of index trauma

BACKGROUND

Network analysis has become popular among PTSD researchers for studying causal structure or interrelationships among symptoms. However, some have noted that results do not seem to be consistent across studies. Preliminary evidence suggests that trauma type may be one source of variability.

METHODS

The current study sought to examine the PTSD networks of veterans with combat versus non-combat index trauma. Participants included 944 veterans who completed the PTSD Checklist for DSM-5 at intake at two VA PTSD clinics.

RESULTS

There were many similarities between the combat and non-combat trauma networks, including strong edges between symptoms that were theoretically related or similar (e.g., avoidance) and negative emotion being a highly central symptom. However, correlations of edge weights (0.509) and node centrality (0.418) across networks suggested moderate correspondence, and there appeared to be some differences associated with certain symptoms. Detachment was relatively more central and the connections of negative emotion with blame and lack of positive emotion with reckless behavior were stronger for veterans with combat-related index trauma.

LIMITATIONS

The data were cross-sectional, which limits the ability to infer directional relationships between symptoms. In addition, the sample was likely not large enough to directly test for differences between networks via network comparison tests.

CONCLUSIONS

Although there were many similarities, results also suggested some variability in PTSD networks associated with combat versus non-combat index trauma that could have implications for conceptualizing and treating PTSD among veterans.

Relationship Between Depression and Disease Activity in United States Veterans With Early Rheumatoid Arthritis Receiving Methotrexate

OBJECTIVE

Depression is common in patients with rheumatoid arthritis (RA), exacerbates disease activity, and may decrease response to first-line disease-modifying antirheumatic drugs. This study aimed to determine if depression affects disease activity among veterans with early RA prescribed methotrexate (MTX).

METHODS

Participants included veterans enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry with early RA (onset < 2 yrs) prescribed MTX. Depression was assessed at enrollment using the International Classification of Diseases, 9th revision codes (296.2-296.39, 300.4, 311). Disease activity was measured using the Disease Activity Score in 28 joints (DAS28) and other core measures of RA disease activity. Propensity score weights were used to adjust depressed (n = 48) and nondepressed (n = 220) patients on baseline confounders within imputed datasets. Weighted estimating equations were used to assess standardized mean differences in disease activity between depressed and nondepressed patients at 6-month, 1-year, and 2-year follow-ups.

RESULTS

The analytic sample was composed of 268 veterans with early RA prescribed MTX who were predominantly male (n = 239, 89.2%) and older (62.7 yrs, SD 10.6) than patients with RA in the general population. Adjusted estimates indicated that depression was associated with significantly higher DAS28 at 6 months (β 0.35, 95% CI 0.01-0.68) but not at the 1- or 2-year follow-up. Also, depression was associated with significantly worse pain at 6 months (β 0.39, 95% CI 0.04-0.73) and 1 year (β 0.40, 95% CI 0.04-0.75).

CONCLUSION

In early RA, depression is associated with greater short-term disease activity during MTX treatment, as well as more persistent and severe pain.

Occupational Violence and PTSD-Symptoms: A Prospective Study on the Indirect Effects of Violence Through Time Pressure and Nontraumatic Strains in the Occupational Context

OBJECTIVE

The aim of this study was to assess whether frequency of occupational violence (OV) affects posttraumatic stress disorder (PTSD) symptoms through nontraumatic strains in the occupational context.

METHODS

Twelve-month prospective survey data on 1763 Social educators were used. Path-analysis measured direct and indirect pathways of frequency of OV on PTSD through change in time pressure, change in burnout, change in sense of safety at work, and change in coping with regret in patient work.

RESULTS

Forty-two pct. of the variance in PTSD symptoms was predicted; F (20, 1541) = 36.8, P < 0.001, R = 0.42. Frequency of OV indirectly affected level of PTSD through all the mediators; estimated indirect effects = 0.14, 95% confidence interval 0.07 to 0.22.

CONCLUSION

PTSD resulting from OV is not only a result of the violent acts themselves but is also caused by nontraumatic strains. It is essential to include the broader context of work environment factors in prevention of work-related PTSD.

Military occupation as a moderator between combat exposure and posttraumatic stress disorder symptoms in US Army personnel

Military occupational designations are standardized classifications that help define and convey a service member's expected duties and responsibilities. The present study examined how occupational designation was related to adverse combat-reactions, specifically posttraumatic stress disorder (PTSD). It was hypothesized that at comparable levels of combat, non-combat units would display greater symptomology than combat units. The study sample consisted of 785 combat-deployed, active-duty enlisted US Army personnel. Participants were administered self-report questionnaires, including the Combat Experiences Scale and PTSD Checklist for DSM-5. Occupation was coded using the three-branch system (i.e., Operations, Support, & Force Sustainment). Hierarchical multiple linear regression (MLR) was run to examine the effect of occupation, combat, and unit cohesion on PTSD symptoms. Operations units reported the highest frequency of combat exposure; however, Force Sustainment units displayed the highest PTSD symptoms. In MLR analysis, there was a significant interaction between Force Sustainment units and combat exposure (β = 0.10, p = .019), that was not observed in Operations or Support units. These findings demonstrate that PTSD symptom intensity is not solely a function of combat exposure, and that non-combat units may react differently when exposed to elevated levels of combat.

Behavioral correlates of self-reported health status in US active duty military

Trends and relationships between health behaviors and conditions in US active duty military and Coast Guard personnel are understudied. Self-reported data from the 2011 and 2015 Department of Defense Health Related Behaviors Surveys were analyzed to estimate associations between seven behaviors (reasons for not exercising; moderate, vigorous, and strength training exercise; alcohol intake; sleep; and smoking) and five health conditions (high blood pressure [BP], blood sugar [BG], cholesterol [CH]; overweight/obesity [OW]; or obesity [OB]). In 33,531 respondents, 14.8%, 1.7%, 13.6%, 65.5%, and 12.1% had high BP, BG, CH, OW, or OB, respectively. Respondents in 2015, versus 2011, had higher odds of BP, BG, OW, and OB. Compared to exercising as much as desired, citing a disability or injury, or work commitments as reasons for not exercising associated with higher odds of each condition. Longer sleep associated with lower odds of each condition except BG. Current and former smoking associated with higher odds of BP; former smoking also associated with higher odds of high CH and OW. Three behaviors contributing to the best predictive models of each condition resulted in associations of reasons for not exercising with all conditions; strength training for OW and OB; alcohol intake for BP and BG; sleep for BP and CH; and moderate exercise for BG. Disability and injury and time constraints limiting exercise were consistent markers of self-reported health conditions. Military-specific initiatives to promote strategies for overcoming barriers to exercising, continued emphasis on adequate sleep, and reduction of alcohol intake and smoking are warranted.

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.

Social and Psychological Risk and Protective Factors for Veteran Well-Being: The Role of Veteran Identity and Its Implications for Intervention

Social psychological theory hypothesizes that one’s identity, self-definitions, and meanings used for a particular social role fosters individual purpose in life and affects behavior in specific social situations. As such, it can be protective against the onset of psychological disorders. We examined this hypothesis with data collected from 1,730 military veterans recruited to study the health effects of warzone deployments. The sample was primarily male, older, and White. Our key independent variable was a Likert scale rating the prominence of a respondent’s veteran identity: how important it is to the person. Outcome variables included posttraumatic stress disorder (PTSD), suicide ideation, depression, alcohol misuse, and use of VA services. Bivariate analysis suggested that veterans with a prominent veteran identity are older, noncollege graduates, have less income, and had their first deployment to Vietnam. In multivariate analyses, study participants with a prominent veteran identity were less likely to exhibit suicide ideation, but more likely to misuse alcohol and use VA services. We found no differences for PTSD, self-rated health, or depression by veteran identity. Veterans who scored higher on the veteran identity scale appeared to be protected from suicidal thoughts, although they had an elevated risk for alcohol misuse.

Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward

Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health.

Depression among military spouses: Demographic, military, and service member psychological health risk factors

BACKGROUND

More than a decade of war has strained service members and their families and the psychological health of military spouses is a concern. This study uses data from the largest study of military families in the United States to examine the demographic, military-specific, and service member mental health correlates of probable diagnosis of major depressive disorder (MDD) among military spouses.

METHODS

Data were from service member-spouse dyads from all branches of the U.S. military. Demographic and military-specific factors were assessed using administrative personnel records and survey data.

RESULTS

Of the 9,038 spouses, 4.9% had a probable diagnosis of MDD. In unadjusted models, spouses of service members who deployed and experiencecd combat-related events, were enlisted, had a probable posttraumatic stress disorder (PTSD) diagnosis, or screened positive for alcohol misuse were more likely to screen positive for MDD. In adjusted models, only spouses married to enlisted service members or those with PTSD had increased risk for MDD. Other demographic and military-related factors associated with MDD in spouses included less educational attainment, unemployment, having four or more children, and having prior military service (although not currently serving in the military) in the adjusted models.

CONCLUSIONS

Findings characterize demographic, military, and service member psychological health factors that are associated with depression among military spouses. These findings imply that deployment alone may not negatively affect military spouses, but rather it may be the mental health impact on the service member, especially PTSD that increases the odds for MDD among military spouses.

Mental Health Impact of Homecoming Experience Among 1730 Formerly Deployed Veterans From the Vietnam War to Current Conflicts: Results From the Veterans' Health Study

We examined the effects of homecoming support on current mental health among 1730 deployed veterans from Vietnam, Iraq/Afghanistan, Persian Gulf, and other conflicts. The prevalence of current posttraumatic stress disorder (PTSD) was 5.4%, current depression was 8.3%, and 5.4% had suicidal thoughts in the past month. Overall, 26% of veterans had low homecoming support, which was more prevalent among Vietnam veterans (44.3%, p < 0.001). In multivariable logistic regressions, controlling for demographics, combat exposure, number of deployments, trauma history, and operational theater, low postdeployment support was associated with PTSD (odds ratio, 2.13; p = 0.032) and suicidality (odds ratio, 1.91; p < 0.030), but not depression. For suicidality, an interaction was detected for homecoming by theater status, whereby Iraq/Afghanistan veterans with lower homecoming support had a higher probability of suicidal thoughts (p = 0.002). Thus, years after deployment, lower homecoming support was associated with current PTSD and suicidality, regardless of theater and warzone exposures. For suicidality, lower support had a greater impact on Iraq/Afghanistan veterans.

Challenges for Research into Military Investigations

In cases of suspected violations of rules, regulations or the law by armed forces personnel, investigations are invariably mandatory. Military investigations differ from well-researched civilian criminal investigations. Differing from civilian police detectives, most military investigators - as disciplinary supervisors and military police personnel - have a number of tasks to accomplish, which include leading in combat and ensuring military readiness. Military investigations can lead to substantive negative or positive consequences for military readiness, including mental health, unit cohesion and subjective legal certainty. This impact on unit cohesion and mental health is influenced by any prior history of distress or trauma; military investigations are often preceded by contravention of internal disciplinary acts, complaints and traumatic events. This study explores factors in the differing military and legal systems of Germany and the United Kingdom (UK) that might help military personnel to successfully conduct investigations while ensuring deployment readiness and maintaining human rights.

Do Investments in Mental Health Systems Result in Greater Use of Mental Health Services? National Trends in Mental Health Service Use (MHSU) in the Canadian Military and Comparable Canadian Civilians, 2002-2013

BACKGROUND

Mental disorders constitute a significant public health problem worldwide. Ensuring that those who need mental health services access them in an appropriate and timely manner is thus an important public health priority. We used data from 4 cross-sectional, nationally representative population health surveys that employed nearly identical methods to compare MHSU trends in the Canadian military versus comparable civilians.

METHOD

The surveys were all conducted by Statistics Canada, approximately a decade apart (Military-2002, Military-2013, Civilian-2002, and Civilian-2012). The sample size for the pooled data across the surveys was 35,984. Comparisons across the 4 surveys were adjusted for differences in need in the 2 populations at the 2 time points.

RESULTS

Our findings suggested that first, in the Canadian military, there was a clear and consistent pattern of improvement (i.e., increase) in MHSU over the past decade across a variety of provider types. The magnitudes of the changes were large, representing an absolute increase of 7.15% in those seeking any professional care, corresponding to an 84% relative increase. Second, in comparable Canadian civilians, MHSU remained either unchanged or increased only slightly. Third, the increases in MHSU over time were consistently greater in the military than in the comparable civilian sample.

CONCLUSIONS

Our findings point to advantages with respect to MHSU of the military mental health system over the civilian system in Canada; these advantages have widened substantially over time. These findings speak strongly to the potential impact of analogous changes in other health systems, both military and civilian.

Self-reported health behaviors, including sleep, correlate with doctor-informed medical conditions: data from the 2011 Health Related Behaviors Survey of U.S. Active Duty Military Personnel

BACKGROUND

Health behaviors and cardiometabolic disease risk factors may differ between military and civilian populations; therefore, in U.S. active duty military personnel, we assessed relationships between demographic characteristics, self-reported health behaviors, and doctor-informed medical conditions.

METHODS

Data were self-reported by 27,034 active duty military and Coast Guard personnel who responded to the 2011 Department of Defense Health Related Behaviors Survey. Multivariate linear and logistic regressions were used to estimate cross-sectional associations between (1) demographic characteristics (age, sex, service branch, marital status, children, race/ethnicity, pay grade) and self-reported behaviors (exercise, diet, smoking, alcohol, sleep); (2) demographic characteristics and doctor-informed medical conditions (hypertension, hypercholesterolemia, low high density lipoprotein (HDL) cholesterol, hyperglycemia) and overweight/obesity; and (3) behaviors and doctor-informed medical conditions.

RESULTS

Among respondents (age 29.9 ± 0.1 years, 14.7% female), females reported higher intake than men of fruit, vegetables, and dairy; those with higher education reported higher intakes of whole grains; those currently married and/or residing with children reported higher intake of starches. Older age and female sex were associated with higher odds (ORs 1.25 to 12.54 versus the youngest age group) of overweight/obesity. Older age and female sex were also associated with lower odds (ORs 0.29 to 0.65 versus male sex) of doctor-informed medical conditions, except for blood glucose, for which females had higher odds. Those currently married had higher odds of high cholesterol and overweight/obesity, and separated/divorced/widowed respondents had higher odds of high blood pressure and high cholesterol. Short sleep duration (< 5 versus 7-8 h/night) was associated with higher odds (ORs 1.36to 2.22) of any given doctor-informed medical condition. Strength training was associated with lower probability of high cholesterol, high triglycerides, and low HDL, and higher probability of overweight/obesity. Dietary factors were variably associated with doctor-informed medical conditions and overweight/obesity.

CONCLUSIONS

This study observed pronounced associations between health behaviors-especially sleep-and medical conditions, thus adding to evidence that sleep is a critical, potentially modifiable behavior within this population. When possible, adequate sleep should continue to be promoted as an important part of overall health and wellness throughout the military community.

Measuring Aggregated and Specific Combat Exposures: Associations Between Combat Exposure Measures and Posttraumatic Stress Disorder, Depression, and Alcohol-Related Problems

Research has shown combat exposure to be associated with negative mental health outcomes. Different combat exposure measures are not composed of the same combat experiences, and few combat exposure measures have been directly compared to another measure. Furthermore, research about the unique associations between specific combat experiences and mental health is lacking. We investigated associations between new-onset posttraumatic stress disorder (PTSD), new-onset depression, and alcohol-related problems and two commonly used measures of combat among a sample of 20,719 recently deployed U.S. military personnel. A 13-item measure assessed both direct and indirect combat exposures, and a 5-item measure assessed only indirect exposures. Both combat measures were associated with all outcomes in the same direction (e.g., PTSD, odds ratio [OR] = 2.97 vs. 4.01; depression, OR = 2.03 vs. 2.42; alcohol-related problems, OR = 1.41 vs. 1.62, respectively, for the 5- and 13-item measures). The 13-item measure had a stronger association with some outcomes, particularly PTSD. Each specific item had significant bivariate associations with all outcomes, ORs = 1.43-4.92. After adjusting for other combat exposures, items assessing witnessing abuse, feeling in danger, and knowing someone injured or killed remained associated with all outcomes, ORs = 1.18-2.72. After this adjustment, several items had unexpected protective associations with some mental health outcomes. Results indicated these two combat exposure measures were approximately equally effective for determining risk for negative mental health outcomes in a deployed population, despite having different content. Additional research is needed to replicate and understand how specific combat exposures affect health.

Distinct Trauma Types in Military Service Members Seeking Treatment for Posttraumatic Stress Disorder

We examined the frequency of trauma types reported in a cohort of service members seeking treatment for posttraumatic stress disorder (PTSD) and compared symptom profiles between types. In this observational study, 999 service members (9.2% women; M_age = 32.91 years; 55.6% White) were evaluated using a standardized assessment procedure to determine eligibility for clinical trials. Participants were evaluated for DSM-IV-TR-defined PTSD using the PTSD Symptom Scale-Interview; all participants reported a Criterion A event. Independent evaluators rated descriptions of Criterion A events as belonging to trauma types at a high degree of reliability, κ = 0.80. Aggregated non-life-threat primary trauma types were more frequently endorsed than aggregated life-threat types, 95% CI [17.10%, 29.20%]. Participants who endorsed moral injury-self traumas had a higher level of reexperiencing (d = 0.39), guilt (hindsight bias, d = 1.06; wrongdoing, d = 0.93), and self-blame (d = 0.58) symptoms, relative to those who reported life threat-self. Participants who experienced traumatic loss had greater reexperiencing (d = 0.39), avoidance (d = 0.22), guilt (responsibility, d = 0.39), and greater peri- and posttraumatic sadness (d = 0.84 and d = 0.70, respectively) symptoms, relative to those who endorsed life threat-self. Relative to life threat-self, moral injury-others was associated with greater peri- (d = 0.36) and posttraumatic (d = 0.33) betrayal/humiliation symptoms, and endorsement of aftermath of violence was associated with greater peri- (d = 0.84) and posttraumatic sadness (d = 0.57) symptoms. War zone traumas were heterogeneous, and non-life-threat traumas were associated with distinct symptoms and problems.

Women Veterans' Experiences of Intimate Partner Violence and Non-Partner Sexual Assault in the Context of Military Service: Implications for Supporting Women's Health and Well-Being

Women who have served in the military in the United States experience high rates of intimate partner violence (IPV) and non-partner sexual assault (SA). The military setting presents challenges and opportunities not experienced in other employment contexts that may compound the negative impacts of IPV/SA on women's lives. The purpose of this study was to explore the intersection of women's experiences of IPV/SA and military service through analysis of women veterans' narrative accounts. We conducted in-depth face-to-face qualitative interviews with 25 women veterans receiving primary care at a U.S. Veterans Affairs Medical Center. We draw upon Adler and Castro's (2013) Military Occupational Mental Health Model to frame our understanding of the impact of IPV/SA as a stressor in the military cultural context and to inform efforts to prevent, and support women service members who have experienced, these forms of violence. Our findings highlight the impact of IPV/SA on women's military careers, including options for entering and leaving military service, job performance, and opportunities for advancement. Women's narratives also reveal ways in which the military context constrains their options for responding to and coping with experiences of IPV/SA. These findings have implications for prevention of, and response to, intimate partner or sexual violence experienced by women serving in the military and underscore the need for both military and civilian communities to recognize and address the negative impact of such violence on women service members before, during, and after military service.

Beyond Pathologizing Harm: Understanding PTSD in the Context of War Experience

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder (PTSD) grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic models of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members.

Soldiers and Leaders With Combat Experience: Unit Health and Climate

Objective: The present study investigated the association between previous deployment experience and somatic symptoms, mental health, unit climate perceptions, anger, and risk taking among junior-enlisted soldiers who were preparing to deploy or who were in garrison, or home duty station. The study also investigated potential differences in these variables based on unit leader deployment history. Method: Soldiers in a combat unit were surveyed either in a predeployment (n = 1,554; one week before deployment) or garrison setting (n = 1,326). Surveys addressed deployment history, health, unit climate, and leader deployment history. Results: Those in the predeployment sample with deployment history had significantly more somatic symptoms, posttraumatic stress disorder (PTSD), sleep problems, and anger reactions, and significantly less favorable unit climate perceptions, compared to those without deployment history. Higher rates of sleep problems, anger reactions, and endorsement of a risk-taking item, along with less favorable unit climate perceptions, were also reported by experienced soldiers in the garrison sample. In both samples, soldiers with experienced leaders endorsed more risk-taking behaviors than those with inexperienced leaders. Predeployment soldiers with experienced leaders also reported higher unit cohesion than those with inexperienced leaders. Conclusions: Previous deployments appear to increase the risk for a range of outcomes reported by soldiers at predeployment and in garrison. Findings suggest the impact of deployment should be considered well beyond the traditional deployment phases. Future research should examine what experienced leaders bring to units, in terms of boosting cohesion and potentially increasing the willingness of unit members to engage in risk-taking behaviors.

Social Support, Help-Seeking, and Mental Health Outcomes Among Veterans in Non-VA Facilities: Results from the Veterans' Health Study

Using a stress process model, the authors examined social and psychological resources to better understand mental health outcomes among veterans. For this study, we surveyed 700 U.S. veterans who were outpatients in the Geisinger Health System. Independent variables included demographic factors, stressful and traumatic events, social support measures, and psychosocial factors. Using logistic regression, the authors examined 4 types of social connections: social support, help-seeking support, social capital, and other mental health support to predict mental health outcomes, including posttraumatic stress disorder, depression, suicide ideation, alcohol misuse, mental health service use, and Veterans Affairs service use. Results suggested that help-seeking support since deployment was a risk factor for 5 adverse outcomes, whereas social support was protective for 1 outcome. We concluded that high levels of help-seeking support since deployment among veterans was associated with a higher prevalence of mental health problems. These findings were unexpected and suggest the need for additional social support-related research among veterans.

Understanding deployment from the perspective of those who have served

BACKGROUND

The term deployment is used by the military to describe sending troops to carry out a combat, peacekeeping, or humanitarian mission.

PURPOSE

The purpose of this analysis was to illustrate the variations around combat deployment experiences.

METHODS

Qualitative descriptive methodology was used to examine data from 17 members of the U.S. military who deployed at least once to a combat zone after the September 11, 2001 attacks.

FINDINGS

No two deployments were the same between individuals or within individuals if they deployed more than once. Variations were discovered in deployment experiences related to deployment demands, deployment resources, and coming back changed as individuals.

CONCLUSIONS

Regarding deployment as a singular concept does not take into account the variations in the deployment experience. Individuals caring for those who have served in war would benefit from understanding that each deployment is unique and a life-altering experience.

A Survey of Military Counseling Content and Curriculum Among Council on Rehabilitation Education- and Council for Accreditation of Counseling and Related Educational Programs-Accredited Programs

Purpose:To determine the amount, frequency, and type of course content related to military counseling issues in Council on Rehabilitation Education (CORE)- and Council for Accreditation of Counseling and Related Educational Programs (CACREP)-accredited master’s-level counselor education programs.

Methods:A questionnaire was sent to all CORE- and CACREP-accredited program directors/coordinators (N= 383) via Microsoft Outlook e-mail system. The authors used the 6-item questionnaire to ask participants to report data in the following areas: (a) if their program offered a certificate program, specialty track, concentration, or degree program in military counseling; (b) if not, do they intend to add a stand-alone military counseling course, certificate program, specialty track, or degree program in military counseling; (c) if they currently have plans, how do they intend to deliver such topics within the structure of their curriculum or counselor education program; (d) if coursework already exists, how is it currently structured within their curriculum and counselor education program; and (e) 3 open-end questions requesting course titles; semester hours related to course content, curriculum, and/or concentration, and comments regarding student assignments and/or projects that are military related.

Results:Overall, out of 362 programs surveyed, 85 (23.4%) responded. All 85 of survey respondents indicated that they did not have a (a) certificate program, (b) specialty track, or (c) degree program that related to military counseling. Of the 85 programs, 34 schools (4.7%) had developed stand-alone courses that offered military counseling content. More than two-thirds of the 85 programs reported covering military counseling content in various courses across the curriculum.

Conclusion:None of the program directors/coordinators in this study indicated they had a specialty track, concentration, or certificate program. Some of the participants indicated they were considering adding additional seminars, courses, and other student experiences that would integrate assessment, diagnosis, and treatment for persons that are active-duty personnel and veterans. Overall, the data suggest that there is greater attention and a willingness among counselor educators to infuse military counseling–related coursework. This is promising because it is critical that preprofessionals and professionals alike be introduced to the emerging population of providing rehabilitation counseling services to military personnel, veterans, and their family members.