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Medina-Martínez J, Aliño M, Vázquez-Martínez A, Villanueva-Blasco VJ, Cano-López I. Risk and Protective Factors Associated with Drug Use in Healthcare Professionals: A Systematic Review. J Psychoactive Drugs 2024; 56:397-411. [PMID: 37341709 DOI: 10.1080/02791072.2023.2227173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
Healthcare professionals are exposed to stressful situations that may favor substance use vulnerability. This systematic review aims to synthesize the risk and protective factors associated with use, abuse, and dependence of alcohol, tobacco, psychoactive drugs, and cannabis in healthcare professionals. Following PRISMA recommendations, a systematic search was performed in PsycINFO, Web of Science, PubMed/MEDLINE, Embase, Scopus, and Cochrane Library. The search yielded 1523 studies, of which 19 were selected. The identified risk factors were demographic factors (i.e. male gender, and single/divorced marital status), psychopathological factors, social factors, positive attitudes toward drugs, unhealthy lifestyle habits, the COVID-19 pandemic, and the coexistence of the use of several substances. The protective factors were demographic factors (i.e. ethnicity and having dependent children), healthy lifestyle habits, and workplace anti-drug policies (i.e. restriction of tobacco use). These findings highlight the need for preventive actions against drug use in healthcare professionals to improve their health and reduce the possible negative impact on their healthcare practice. Knowledge of modifiable risk and protective factors allows their incorporation as components in preventive actions, and non-modifiable factors (e.g. demographic variables) may contribute to the detection of groups of greater vulnerability to propose selective prevention actions in this population.
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Affiliation(s)
| | - Marta Aliño
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group in Psychology and Quality of Life (PsiCal)/VIU-NED Chair of Global Neuroscience and Social Change, Valencian International University, Valencia, Spain
| | - Andrea Vázquez-Martínez
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group in Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, Valencia, Spain
| | - Víctor José Villanueva-Blasco
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group in Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, Valencia, Spain
| | - Irene Cano-López
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Research Group in Psychology and Quality of Life (PsiCal)/VIU-NED Chair of Global Neuroscience and Social Change, Valencian International University, Valencia, Spain
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Bajjani-Gebara J, Wilcox SL, Williams JW, Kosinski AS, Allard RJ, Wilson C, Landoll R. Adjustment Disorders in U.S. Active Duty Military Women: A Scoping Review for the Years 2000 to 2018. Womens Health Issues 2021; 31 Suppl 1:S33-S42. [PMID: 34454702 DOI: 10.1016/j.whi.2020.12.003] [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: 08/30/2019] [Revised: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjustment disorder (AD) is the most common mental health diagnosis in the U.S. military and is more than twice as likely to be diagnosed in active duty servicewomen as compared with male servicemembers. The literature on ADs, particularly in female servicemembers, has not been reviewed yet. We conducted a scoping review of the literature to explore the degree of research activity and summarize current literature gaps. METHODS We created a PRISMA-ScR checklist and prospectively registered it in Open Science Framework. The literature search included articles (including studies and reports) published between 2000 and 2018 in either the grey literature or the following databases: Ovid Medline, CINAHL, Embase, PsycINFO, Web of Science, and Ovid Cochrane. We used DistillerSR to conduct title and abstracts screening, full-text screening, and data charting. The social ecological model for military women's health framework was used to organize the results. RESULTS After screening 1,304 records, 29 were included for data charting. Most frequently, studies were descriptive (cross-sectional) (25%), with no randomized controlled studies. The studies primarily focused on ADs' risk factors in servicewomen (76%), followed by military readiness (38%). Only 14% addressed recommendations for treatments based on expert opinion, although they did not directly test interventions, and 7% focused on health outcomes. CONCLUSIONS ADs affect the health of U.S. military women and military readiness, yet little is known about their successful treatment or health outcomes. Additional research in those areas is warranted.
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Affiliation(s)
- Jouhayna Bajjani-Gebara
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland.
| | - Sherrie L Wilcox
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Department of Preventive Medicine and Biostatistics, Bethesda, Maryland
| | - John W Williams
- Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina
| | - Andrzej S Kosinski
- Duke University School of Medicine, Department of Biostatistics and Bioinformatics, Durham, North Carolina
| | - Rhonda J Allard
- Uniformed Services University of the Health Sciences, James A. Zimble Learning Resource Center, Bethesda, Maryland
| | - Candy Wilson
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland
| | - Ryan Landoll
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland
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Blais RK, Tirone V, Orlowska D, Lofgreen A, Klassen B, Held P, Stevens N, Zalta AK. Self-reported PTSD symptoms and social support in U.S. military service members and veterans: a meta-analysis. Eur J Psychotraumatol 2021; 12:1851078. [PMID: 34992740 PMCID: PMC8725779 DOI: 10.1080/20008198.2020.1851078] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: The mental health burden of posttraumatic stress disorder (PTSD) is high in U.S. military samples. Social support is one of the most robust protective factors against PTSD and a recent meta-analysis indicates that this relationship is even stronger in military samples compared to civilian samples. Yet no meta-analyses have explored factors impacting this association in veterans and military service members (VSMs). Objective: The current meta-analysis examined demographic, social support, and military characteristics that may moderate the relationship of PTSD severity and social support among U.S. VSMs. Method: A search identified 37 cross-sectional studies, representing 38 unique samples with a total of 18,766 individuals. Results: The overall random effects estimate was -.33 (95% CI: -.38, -.27, Z = -10.19, p <.001), indicating that lower levels of social support were associated with more severe PTSD symptoms. PTSD measures based on the Diagnostic and Statistical Manual (DSM)-III had a larger effect size than measures based on DSM-IV or DSM-5. The social support source was a significant moderator such that support perceived from non-military sources was associated with a larger effect size than support perceived from military sources. This finding held after accounting for covariates. Deployment-era, timing of social support, and age were also significant moderators, but were no longer significantly associated with effect size after adjusting for covariates. Although previous meta-analyses have shown social negativity to be more impactful than positive forms of social support, there were too few studies conducted to evaluate social negativity in moderator analyses. Conclusion: Results suggest that social support received from civilians and in the home environment may play a greater protective role than social support received from military sources on long-term PTSD symptom severity. The literature on social support and PTSD in U.S. VSMs would be strengthened by studies examining the association of social negativity and PTSD symptoms.
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Affiliation(s)
- Rebecca K Blais
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Vanessa Tirone
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Daria Orlowska
- University Libraries, Western Michigan University, Kalamazoo, MI, USA
| | - Ashton Lofgreen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Brian Klassen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Natalie Stevens
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Alyson K Zalta
- Department of Psychological Science, University of California Irvine, Irvine, CA, USA
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Sex and Gender in Research on Healthcare Workers in Conflict Settings: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124331. [PMID: 32560496 PMCID: PMC7346087 DOI: 10.3390/ijerph17124331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 01/04/2023]
Abstract
The occupational health literature has established that sex and gender are associated with all dimensions of the workplace. Sex and/or gender (sex/gender) factors play an important role in shaping the experiences, exposures, and health outcomes of male and female healthcare providers working in war and conflict settings. This study aims to (1) assess how sex/gender is considered in the occupational health literature on healthcare workers in conflict settings, and (2) identify the gaps in incorporating sex/gender concepts in this literature. A scoping review was carried out and nine electronic databases were searched using a comprehensive search strategy. Two reviewers screened the titles/abstracts and full-texts of the studies using specific inclusion and exclusion criteria. Key information was extracted from the studies and four themes were identified. Of 7679 identified records, 47 were included for final review. The findings underlined the harsh working conditions of healthcare workers practicing in conflict zones and showed sex/gender similarities and differences in experiences, exposures and health outcomes. This review revealed a dearth of articles with adequate consideration of sex/gender in the study design. Sex/gender-sensitive research in occupational health is necessary to develop effective occupational health and safety policies to protect men and women healthcare workers in conflict settings.
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Zungu D, Visagie N. All eyes on Sudan: The journey of female psychologists in the theatre of operation. SA JOURNAL OF INDUSTRIAL PSYCHOLOGY 2020. [DOI: 10.4102/sajip.v46i0.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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The role of childhood trauma and stress reactivity for increased alcohol craving after induced psychological trauma: an experimental analogue study. Psychopharmacology (Berl) 2018; 235:2883-2895. [PMID: 30203300 DOI: 10.1007/s00213-018-4979-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/17/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Traumatic events are associated with alcohol use problems with increased alcohol craving as a potential mediator. There is still a lack of knowledge regarding the causal nature of this association and its underlying mechanisms. This study investigated the effects of acute trauma exposure on alcohol craving in healthy individuals considering the role of stress reactivity and childhood trauma (CT) using a laboratory randomized controlled design. METHODS Ninety-five healthy participants were randomly exposed to a trauma or a neutral film. History of CT, and pre- to post-film changes in craving (craving reactivity, CR), anxiety, skin conductance, heart rate, and saliva cortisol levels were assessed. Moreover, associations between trauma film exposure and CR, the moderating role of CT, and associations between CT, stress reactivity, and trauma-induced CR were analyzed. RESULTS Relative to the neutral film, the trauma film elicited an increase in CR in females but not in males. In males but not in females, the association between trauma film exposure and CR was moderated by CT, with trauma-induced CR increasing with the number of CT. In males, CT was related to decreased cortisol reactivity and increased heart rate and skin conductance response of which skin conductance was also associated with CR. DISCUSSION These findings provide further evidence for a causal link between traumatic experiences and CR. While this association seems to be stronger in females, males might still be at risk in case of other vulnerability factors such as CT, with altered sympathetic stress reactivity as a potential contributing mechanism.
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Kelley ML, Braitman AL, White TD, Ehlke SJ. Sex differences in mental health symptoms and substance use and their association with moral injury in veterans. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2018; 11:337-344. [PMID: 30234322 DOI: 10.1037/tra0000407] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examines potential sex differences in 3 types of experiences (i.e., atrocities of war, cognitive and emotional changes from combat, and leadership failure or betrayal) that may result in moral injury (i.e., guilt, shame, inability to forgive one's self, inability to forgive others, and withdrawn behavior associated with these three types of experiences). In addition, we examine whether moral injury results in different associations with mental health and substance use outcomes for female versus male veterans. We expected more symptoms of depression and anxiety for women and more symptoms of hazardous alcohol use and drug abuse for men. Also, we examined sex as a moderator between moral injury and outcomes, expecting stronger relationships between moral injury and symptoms of depression and anxiety among women and stronger associations between moral injury and alcohol use and drug abuse symptoms for men. METHOD Participants (n = 256; 60.9% [n = 156] males) were a community sample of recent-era military personnel who completed a measure of morally injurious experiences (MIEs) and associated moral injury. RESULTS After correcting for Type I error rate, sex was not associated with mental health or substance use. Further, no Sex × Moral Injury interactions were present; however, moral injury significantly positively predicted all negative mental health symptoms (depression, anxiety, suicidality, and posttraumatic stress disorder [PTSD]) and hazardous alcohol use, but not drug abuse symptoms. CONCLUSIONS Results reveal the need for improved screening and treatment of moral injury and integrated treatments that may assess moral injury and associated disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - Tyler D White
- Department of Psychology, University of North Carolina at Wilmington
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Maupin GM, Tvaryanas AP, White ED, Mahaney HJ. Assessment of Deployment-Related Exposures on Risk of Incident Mental Health Diagnoses Among Air Force Medical Service Personnel: Nested Case-Control Study. Mil Med 2018. [PMID: 29514347 DOI: 10.1093/milmed/usx056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Recent military conflicts in Iraq (Operation Iraqi Freedom), Afghanistan (Operation Enduring Freedom), and elsewhere have been associated with psychological impacts among military personnel. However, relatively little is known about the relationship between those conflicts and psychological health of military health care professionals. Previous work has shown certain demographic factors associated with diagnosed mental health conditions after deployment. However, unique exposures in the deployed environment may be present that are also associated. Understanding the relationship between the demographic factors, exposures, and post-deployment mental health (PDMH) conditions has not been investigated. The purpose of this study was to determine the association between occupational and/or environmental exposures and incident PDMH conditions in a defined population of United States Air Force health care personnel returning from the deployed environment (i.e., deployment-related exposures). Methods A nested case-control study compared cohort members with (N = 4,114) and without (N = 14,073) a PDMH condition in terms of deployment-related occupational and/or environmental exposures. PDMH conditions were identified using the electronic health record and exposures were determined using post-deployment health assessments. Demographic-adjusted multivariable logistic regression models were used to compute odds ratios (ORs). Results The final regression model comprised five exposure and 12 demographic variables. Reported exposures were not strongly associated with incident PDMH conditions (OR ranged from 1.22 to 1.38) and were lower than some demographic factors. Demographic characteristics with relatively large effect sizes (ORs less than 0.5 or greater than 1.5) included the protective factors of Air Force Guardsman (OR: 0.45), reservists (OR: 0.34), and surgeons (OR: 0.32), as well as the risk factor of nurses (OR: 1.51). All model parameters had a p-value less than 0.0001 and the area under the receiver operating characteristic curve was 0.668. Conclusions Given the low area under the receiver operating characteristic, the final statistical model had only marginal performance in its ability to correctly identify cases. Thus, other factors should be studied to identify additional predictors for PDMH conditions.
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Affiliation(s)
- Genny M Maupin
- 711th Human Performance Wing, U.S. Air Force School of Aerospace Medicine, Aeromedical Research Department, 2510 5th Street, Building 840, Wright-Patterson AFB, OH 45433-7913
| | - Anthony P Tvaryanas
- 711th Human Performance Wing, Human Systems Integration Directorate, 2698 G Street, Building 190, Wright-Patterson AFB, OH 45433
| | - Edward D White
- Air Force Institute of Technology, Department of Mathematics and Statistics, 2950 Hobson Way, Wright-Patterson AFB, OH 45433
| | - Heather J Mahaney
- 711th Human Performance Wing, U.S. Air Force School of Aerospace Medicine, Aeromedical Research Department, 2510 5th Street, Building 840, Wright-Patterson AFB, OH 45433-7913
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Bergman HE, Przeworski A, Feeny NC. Rates of Subthreshold PTSD Among U.S. Military Veterans and Service Members: A Literature Review. MILITARY PSYCHOLOGY 2017; 29:117-127. [PMID: 28630531 PMCID: PMC5473625 DOI: 10.1037/mil0000154] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Hannah E Bergman
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Amy Przeworski
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Norah C Feeny
- Case Western Reserve University, Department of Psychological Sciences, 10900 Euclid Avenue, Cleveland, OH 44106, USA
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10
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MacGregor AJ, Clouser MC, Mayo JA, Galarneau MR. Gender Differences in Posttraumatic Stress Disorder Among U.S. Navy Healthcare Personnel. J Womens Health (Larchmt) 2017; 26:338-344. [PMID: 28410014 DOI: 10.1089/jwh.2014.5130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The role of women in the U.S. military has changed markedly over the course of 20th- and 21st-century conflicts. Although women frequently occupy healthcare positions in the military, little is known about gender differences in posttraumatic stress disorder (PTSD) within this occupational subgroup. MATERIALS AND METHODS A total of 4275 (667 women and 3608 men) U.S. Navy healthcare personnel supporting military operations in Iraq and Afghanistan were identified from electronic deployment records. Data from Post-Deployment Health Assessments were abstracted to identify PTSD screen positives, and to adjust for self-reported combat exposure and other deployment experiences. RESULTS The prevalence of PTSD screen positive in the sample was 8.2% (n = 351/4275). After adjusting for combat exposure, previous psychiatric history, and demographics, women had significantly higher odds of screening positive for PTSD than did men (odds ratio = 1.99, 95% confidence interval 1.34-2.96). Interactions between gender and combat exposure, and between gender and previous psychiatric history were not statistically significant. CONCLUSIONS This is one of the first studies to examine gender differences in PTSD among military healthcare personnel. Future research should account for additional stressors, such as long work hours, disrupted sleep patterns, and number of casualties treated. As women are further integrated into military occupations that may lead to different exposures, knowledge of gender differences in the manifestation of PTSD is paramount for prevention and treatment purposes.
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Affiliation(s)
- Andrew J MacGregor
- Department of Medical Modeling, Simulation and Mission Support, Naval Health Research Center , San Diego, California
| | - Mary C Clouser
- Department of Medical Modeling, Simulation and Mission Support, Naval Health Research Center , San Diego, California
| | - Jonathan A Mayo
- Department of Medical Modeling, Simulation and Mission Support, Naval Health Research Center , San Diego, California
| | - Michael R Galarneau
- Department of Medical Modeling, Simulation and Mission Support, Naval Health Research Center , San Diego, California
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11
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Kanesarajah J, Waller M, Zheng WY, Dobson AJ. Factors associated with low unit cohesion in Australian Defence Force members who deployed to the Middle East (2001-2009). J ROY ARMY MED CORPS 2015; 162:366-372. [PMID: 26567321 PMCID: PMC5099321 DOI: 10.1136/jramc-2015-000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 10/10/2015] [Indexed: 11/29/2022]
Abstract
Introduction Unit cohesion has been shown to bolster the mental health of military personnel; hence, it is important to identify the characteristics that are associated with low unit cohesion, so that interventions to improve unit cohesion can be targeted and implemented. Little is known about the factors associated with low unit cohesion. This research aims to identify demographic, military service and deployment factors associated with low unit cohesion. Methods Data from a self-reported cross-sectional study of 11 411 current or ex-serving Australian military personnel deployed to Iraq or Afghanistan between 2001 and 2009 were used. Multivariable logistic regression was used to investigate the research aims. Results Being female (adjusted OR (aOR) (95% CI) 1.35 (1.21 to 1.51)), non-commissioned officer (aOR (95% CI) 1.50 (1.39 to 1.62)), lower ranked (aOR (95% CI) 1.74 (1.51 to 2.01)) or having left military service (aOR (95% CI) 1.71 (1.46 to 2.02)) was associated with reporting low unit cohesion. Potentially modifiable factors such as performing logistic roles on deployment (aOR (95% CI) 1.13 (1.01 to 1.27)), dissatisfaction with work experience on deployment such as working with colleagues who did not do what was expected of them (aOR (95% CI) 4.09 (3.61 to 4.64)), and major problems at home while deployed (aOR (95% CI) 1.50 (1.38 to 1.63)) were also associated with reporting low unit cohesion. Conclusions This is the first study to identify demographic, military service and deployment factors associated with low unit cohesion. The modifiable nature of unit cohesion means that military leaders could use this information to identify subgroups for targeted resilience interventions that may reduce vulnerabilities to mental health problems and improve the job satisfaction, preparedness and deployment experiences of serving members.
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Affiliation(s)
- Jeeva Kanesarajah
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - M Waller
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - W Y Zheng
- School of Aviation, University of New South Wales, Sydney, Australia
| | - A J Dobson
- School of Public Health, The University of Queensland, Brisbane, Australia
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12
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Abstract
After more than a decade of war, the US military continues to place significant emphasis on psychological health and resilience. While research and programs that focus on the broader military community's resilience continue to emerge, less is known about and until recently little focus has been placed on military medical provider resilience. In this article, we review the literature on military medical provider resilience, provide an overview of the programmatic and technological advances designed to sustain and develop military medical provider resilience, and finally offer recommendations for future research.
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Affiliation(s)
- Paul B Lester
- Research Facilitation Laboratory, Army Analytics Group, Monterey, CA, USA,
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13
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Kelley ML, Runnals J, Pearson MR, Miller M, Fairbank JA, Brancu M, Brancu M. Alcohol use and trauma exposure among male and female veterans before, during, and after military service. Drug Alcohol Depend 2013; 133:615-24. [PMID: 24054989 PMCID: PMC5287364 DOI: 10.1016/j.drugalcdep.2013.08.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 07/30/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The present study examined lifespan and combat-related trauma exposure as predictors of alcohol use among male and female veterans. Posttraumatic stress and depressive symptoms were examined as mediators of the effects of trauma exposure on alcohol use. METHODS Data were examined from 1825 (1450 male, 375 female) veterans and active duty service members who took part in a multi-site research study conducted through the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC). RESULTS For both men and women, depressive symptoms significantly mediated the effects of non-combat trauma exposure experienced before, during and after the military, as well as combat-exposure, on alcohol use. With posttraumatic stress symptoms, the models for men and women differed. For men, the effects of non-combat trauma exposure during and after military service, and combat exposure, on alcohol use were mediated by PTSD symptoms; however, for women, PTSD symptoms did not mediate these relationships. CONCLUSION Findings are discussed in the context of potential gender differences in response to trauma such as use of alcohol to cope with traumatic events.
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Affiliation(s)
- Michelle L. Kelley
- Department of Psychology, Old Dominion University, Norfolk, VA 23529, USA
| | - Jennifer Runnals
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham, NC 27705, USA,Durham VA Medical Center, Durham, NC 27705, USA,Duke University Medical Center, Durham, NC 27705, USA
| | - Matthew R. Pearson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, 87106, USA
| | - Marinell Miller
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham, NC 27705, USA,Hampton VA Medical Center, Hampton, VA 23667, USA
| | - John A. Fairbank
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham, NC 27705, USA,Durham VA Medical Center, Durham, NC 27705, USA,Duke University Medical Center, Durham, NC 27705, USA
| | | | - Mira Brancu
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham, NC 27705, USA,Durham VA Medical Center, Durham, NC 27705, USA,Duke University Medical Center, Durham, NC 27705, USA
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Abstract
Military deployment, especially in combat or dangerous areas, can have a strong influence on subsequent mental health. This effect may be intensified as a result of the potential stigma that admission of mental health problems indicates weakness. Additional mental health issues exist for female soldiers from the National Guard who are pulled from non-military environments to work under dangerous conditions far from home and traditional social support. Minimal documentation is available about the day-to-day, gendered experiences of deployment for this group of female soldiers. To provide background for appropriate training and support, the aim of this study was to understand better the experiences of military deployment for women in the National Guard. We used content analysis to analyze individual, semi-structured interviews with a sample of 42 women from 7 U.S. National Guard units who were deployed in combat areas. Four general themes emerged about deployment experience: the general environment of stress, heterogeneous job responsibilities, home comes with you, and gendered stress. Military efforts are needed to address gender-specific issues associated with deployment and to develop resilience training that will optimize the mental health of female soldiers.
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Affiliation(s)
- Patricia J Kelly
- a School of Nursing and Health Studies, University of Missouri-Kansas City , Kansas City , Missouri , USA
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15
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Gibbons SW, Barnett SD, Hickling EJ, Herbig-Wall PL, Watts DD. Stress, coping, and mental health-seeking behaviors: gender differences in OEF/OIF health care providers. J Trauma Stress 2012; 25:115-9. [PMID: 22354515 DOI: 10.1002/jts.21661] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Health care providers (HCPs) are often placed in positions of heightened stress when serving in military operations. As military HCPs have a large number of female providers, there is a concern that gender may influence both risk and resiliency within the health care provider subgroup. The purpose of this secondary analysis of the 2005 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel (data collected April through August 2005) is to describe stress, coping, and health-seeking behaviors of Operation Enduring Freedom and Operation Iraqi Freedom deployed military health care providers and the role gender may have for both health care officers and specialists. Female HCP responses indicate the lives of these women are significantly impacted by their family responsibilities. Reluctance of females to seek mental health care is concerning with perhaps more concern over career than personal well-being. Findings included (a) concern about performance, odds ratio (OR) = 1.86, 95% confidence interval (CI) [0.43, 8.12] for enlisted females, OR = 2.83, 95% CI [0.31, 25.66] for female officers; (b) problems with money, OR = 1.6 CI [0.69, 3.7] for enlisted females; (c) having a drink to cope, OR = 3.26, 95% CI [0.22, 48.68] for enlisted females; and (d) damage military career to seek mental health care, OR = 1.78, 95% CI [0.59, 5.39] for female officers. Results indicate needed provider awareness concerning mental health-seeking behavior and sensitivity toward gender differences that contribute to unique manifestations of operational stress outcomes.
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Affiliation(s)
- Susanne W Gibbons
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
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