Positive and negative family communication and mental distress: Married service members during a non-combat deployment

This study examines whether married service member perceptions of positive or negative communication moderate the relationship between how frequently they communicate home during a deployment and their mental distress. Participants included 382 married service members who completed surveys regarding their marital relationships, communication, and mental health while on a non-combat deployment. Though marital satisfaction was not significantly associated with service member reports of their mental distress, perceptions of negative (β = 4.32, SE = 0.59, p < 0.001) and positive communication (β = -1.32, SE = 0.57, p < 0.05) were. Further, significant interactions between frequency of communication and the perception of negative (β = 0.54, SE = 0.13, p < 0.001) and positive (β = 0.17, SE = 0.07, p < 0.01) communication suggest positive communication may be protective for service members while frequent, negative communication can exacerbate distress. Findings highlight the importance of engaging families in planning and skill building to support healthy communication across the deployment cycle.

Image of a Junior Officer in Military Personnel Participating in Combat Operations with Symptoms of Post-traumatic Stress Disorder

"According to the results of the conducted study there were distinguished the peculiarities of perception of the image of a junior officer by servicemen who participated in hostilities and had various PTSD symptoms. The study included 233 male servicemen with combat experience. The age of the participants varied from 20 to 55 years. It was determined that the image perception of the direct commander by the servicemen who did not have any PTSD symptoms had been influenced by both the key features of the modern way of fighting and the way a protective mechanism of consciousness acted, which gave the possibility to maintain mental health under combat conditions. These servicemen considered the awareness, kindness, and physical strength of their commander to be not important. The first stage was occupied by his/her ability to adequately fulfill his/her leadership function and the power of his/her spirit – the courage and love of the Motherland, which formed his/her reliability. Servicemen who had PTSD symptoms were less satisfied with the role of a junior officer and considered him/her to be less capable of meeting their expectations. They were less interested in commanders who could involve them in situations that required quick, brave action and complete responsibility for the entrusted part of common affairs. The most important factors in the structure of the direct commander image in both studied groups were the power of personality (the ability of self-regulation); however, the servicemen with PTSD symptoms had a specific orientation of these factors – to help their subordinates. They were quite selfishly aimed at using their direct commanders as a way of getting help. "

Toward a dual process model of moral injury and traumatic illness

Moral injury has emerged as a topic of significant research and clinical interest over the last decade. However, much work remains to be done to comprehensively define the moral injury construct, with implications for understanding the etiology and maintenance of moral injury, its symptoms, associations with and distinctions from traumatic illness, and treatment approaches. We provide a brief overview of the existing moral injury literature and introduce a novel dual process model (DPM) of moral injury and traumatic illness. The DPM posits an event exposure which may satisfy DSM-5 posttraumatic stress disorder (PTSD) criterion A, potential morally injurious event (PMIE) criteria, or both, followed by individual role appraisal as a perpetrator through action or inaction, a witness, a victim, or a combination of the these. Role appraisal influences symptoms and processes across biological, psychological, behavioral, social, spiritual/religious, as well as values, character, and identity domains to support a label of traumatic illness, moral injury, or both. The DPM provides a flexible analytical framework for evaluating symptoms associated with moral injury and traumatic stress and has important implications for treatment. The most thoroughly reviewed evidence-based interventions for traumatic stress hinge on exposure and habituation mechanisms to manage dysregulation of fear and memory systems, but these mechanisms often do not address core domains of moral injury identified in the DPM, including spiritual, religious, values, character, and identity domains as these exist largely outside of the putative fear network. We provide brief vignettes to illustrate the practical application of the DPM and argue that adjunct and stand-alone approaches which address values and character domains, leveraging principles of Stoicism, non-judgment of experience, acceptance, and values-oriented action, are more likely than traditional trauma treatment approaches to positively affect moral injury symptoms.

Do morally injurious experiences and index events negatively impact intensive PTSD treatment outcomes among combat veterans?

Background: It has been suggested that current frontline posttraumatic stress disorder (PTSD) treatments are not effective for the treatment of moral injury and that individuals who have experienced morally injurious events may respond differently to treatment than those who have not. However, these claims have yet to be empirically tested. Objective: This study evaluated the rates of morally injurious event exposure and morally injurious index trauma and their impact on PTSD (PCL-5) and depression symptom (PHQ-9) reductions during intensive PTSD treatment. Method: Data from 161 USA military combat service members and veterans (91.3% male; mean age = 39.94 years) who participated in a 3-week Cognitive Processing Therapy (CPT)-based intensive PTSD treatment programme (ITP) was utilized. Morally injurious event exposure was established via the Moral Injury Event Scale (MIES). Index traumas were also coded by the treating clinician. Linear mixed effects regression analyses were conducted to examine if differences in average effects or trends over the course of treatment existed between veterans with morally injurious event exposure or index trauma and those without. Results: Rates of morally injurious event exposure in this treatment sample were high (59.0%-75.2%). Morally injurious event exposure and the type of index trauma did not predict changes in symptom outcomes from the ITP and veterans reported large reductions in PTSD (d = 1.35-1.96) and depression symptoms (d = 0.95-1.24) from pre- to post-treatment. Non-inferiority analyses also demonstrated equivalence across those with and without morally injurious event exposure and index events. There were no significant gender differences. Conclusions: The present study suggests that PTSD and depression in military veterans with morally injurious event exposure histories may be successfully treated via a 3-week CPT-based ITP.

Expanded Roles and Recommendations for Stakeholders to Successfully Reintegrate Modern Warriors and Mitigate Suicide Risk

This article draws upon the legends of warriors from ancient Greece and other traditions to illuminate the journey of Modern Warriors (MWs) who have served in the United States military over the last century. It then turns to stakeholders that can assist current MWs in their reintegration to civilian life and mitigate suicide risk. Until this point, without an existing and coordinated local, federal, non-profit, and private system, rates of suicide for post-9/11 MWs after leaving the military have greatly increased, especially for young and women MWs. This is due in part to the military satisfying many of MWs’ needs by providing units, leaders, and a mission during the Departure and Initiation stages of the MW journey. However, as MWs exit the military and face the difficult task of reintegration, the absence of units, leaders, and mission leads to deteriorating psychological health and increasing suicide risk. Written primarily by post-9/11 MWs, this article proposes recommendations for stakeholders to better reintegrate MWs and mitigate suicide risk. The authors strive to develop a system that satisfies MWs’ reintegration needs and enables MWs to be well positioned to continue their next ‘mission’ – to serve and improve society.

Behavioral health of US military veterinary personnel deployed to Afghanistan

OBJECTIVE To compare symptoms of compromised behavioral health (BH symptoms) and factors protecting against those symptoms (protective factors) in military veterinary and nonveterinary health-care personnel deployed to Afghanistan. DESIGN Cross-sectional survey. SAMPLE 237 deployed military health-care personnel (21 veterinary and 216 nonveterinary). PROCEDURES Surveys were administered to participants during combat deployment in Afghanistan in 2013 to collect information on BH symptoms and protective factors. Data were compared between veterinary and nonveterinary health-care personnel by use of regression models controlling for demographic characteristics and deployment experiences. Partial correlations were computed to assess relationships between protective factors and BH symptoms, controlling for personnel type. RESULTS Less than 15% of veterinary and nonveterinary health-care personnel were at risk for suicidal ideation, major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder. After adjusting for covariates, both personnel types had similar levels of depression, posttraumatic stress disorder, and anxiety symptoms; however, veterinary personnel reported more distressing secondary traumatic stress symptoms and a greater number of anger reactions. Self-care, team support, and perceived supportive leadership were inversely associated with BH symptoms regardless of personnel type. Veterinary personnel engaged in less self-care, provided less team care, and rated leadership behaviors less positively than nonveterinary health-care personnel. CONCLUSIONS AND CLINICAL RELEVANCE Compared with nonveterinary health-care personnel, deployed veterinary personnel were at greater risk of generalized anxiety disorder and reported more secondary traumatic stress and anger reactions, but were less likely to be engaged in and exposed to protective factors. Interventions designed to promote self-care and team support for veterinary personnel and their leaders may reduce the occupational risk of BH symptoms in deployment and perhaps other settings.

Deployed Military Medical Personnel: Impact of Combat and Healthcare Trauma Exposure

Introduction

Limited research has been conducted on the impact of deployment-related trauma exposure on post-traumatic stress symptoms in military medical personnel. This study evaluated the association between exposure to both combat experiences and medical duty stressors and post-traumatic stress symptoms in deployed military medical personnel.

Materials and Methods

U.S. military medical personnel (N = 1,138; 51% male) deployed to Iraq between 2004 and 2011 were surveyed about their exposure to combat stressors, healthcare stressors, and symptoms of post-traumatic stress disorder (PTSD). All participants were volunteers, and the surveys were completed anonymously approximately halfway into their deployment. The Combat Experiences Scale was used as a measure of exposure to and impact of various combat-related stressors such as being attacked or ambushed, being shot at, and knowing someone seriously injured or killed. The Military Healthcare Stressor Scale (MHSS) was modeled after the Combat Experiences Scale and developed for this study to assess the impact of combat-related healthcare stressors such as exposure to patients with traumatic amputations, gaping wounds, and severe burns. The Post-traumatic Stress Disorder Checklist-Military Version (PCL-M) was used to measure the symptoms of PTSD.

Results

Eighteen percent of the military medical personnel reported exposure to combat experiences that had a significant impact on them. In contrast, more than three times as many medical personnel (67%) reported exposure to medical-specific stressors that had a significant impact on them. Statistically significant differences were found in self-reported exposure to healthcare stressors based on military grade, education level, and gender. Approximately 10% of the deployed medical personnel screened positive for PTSD. Approximately 5% of the sample were positive for PTSD according to a stringent definition of caseness (at least moderate scores on requisite Diagnostic and Statistical Manual for Mental Disorders criteria and a total PCL-M score ≥ 50). Both the MHSS scores (r(1,127) = 0.49, p < 0.0001) and the Combat Experiences Scale scores (r(1,127) = 0.34, p < 0.0001) were significantly associated with PCL-M scores. However, the MHSS scores had statistically larger associations with PCL-M scores than the Combat Experiences Scale scores (z = 5.57, p < 0.0001). The same was true for both the minimum criteria for scoring positive for PTSD (z = 3.83, p < 0.0001) and the strict criteria PTSD (z = 1.95, p = 0.05).

Conclusions

The U.S. military has provided significant investments for the funding of research on the prevention and treatment of combat-related PTSD, and military medical personnel may benefit from many of these treatment programs. Although exposure to combat stressors places all service members at risk of developing PTSD, military medical personnel are also exposed to many significant, high-magnitude medical stressors. The present study shows that medical stressors appear to be more impactful on military medical personnel than combat stressors, with approximately 5-10% of deployed medical personnel appearing to be at risk for clinically significant levels of PTSD.

Deployment of personnel to military operations: impact on mental health and social functioning

This Campbell systematic review examines the effects of deployment on mental health. The review summarizes evidence from 185 studies. All studies used observational data to quantify the effect of deployment. This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment). Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive.

Plain language summary

Deployment to military operations negatively affects the mental health functioning of deployed military personnel: While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel.What is this review about?: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health.The primary condition under consideration is deployment to an international military operation. Deployment to a military operation is not a uniform condition; rather, it covers a range of scenarios. Military deployment is defined as performing military service in an operation at a location outside the home country for a limited time period, pursuant to orders.The review included studies that reported outcomes for individuals who had been deployed. This review looked at the effect of deployment on mental health outcomes. The mental health outcomes are: post-traumatic stress disorder (PTSD), major depressive disorder (MDD), common mental disorders (depression, anxiety and somatisation disorders) and substance-related disorders.By identifying the major effects of deployment on mental health and quantifying these effects, the review can inform policy development on deployment and military activity as well as post-deployment support for veterans. In this way the review enables decision-makers to prioritise key areas.What are the main findings of this review?: What studies are included?: This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment).Does deployment have an effect on mental health?: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive.What do the findings of this review mean?: The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long-lasting.Overall the risk of bias in the majority of included studies was high. While it is difficult to imagine a randomised study design to understand how deployment affects mental health, other matters such as changes to personnel policy, or unanticipated shocks to the demand for military personnel, could potentially be a rich source of quasi-experimental variation.How up-to-date is this review?: The review authors searched for studies up to 2017. This Campbell systematic review was published in March 2018.

Executive summary

BACKGROUND: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health. Research suggests that the increased risk to mental health is mainly due to the hazards of war, combat exposure: firing weapons, road side bombs, seeing fellow soldiers, friends, civilians, and enemies being injured, maimed or killed. These experiences may lead to severe mental stress. The adverse impact on mental health is the psychological cost of war, and it is of interest to policymakers to learn the magnitude of these effects. This review sets out to synthesise available evidence about the consequences of deployment for deployed military personnel in the mental health and social functioning domains.OBJECTIVES: The objective of this review isto synthesise the consequences of deployment to military operation on the mental health and social functioning of deployed military personnel.SEARCH METHODS: We searched electronic databases, grey literature, and references from primary studies and related reviews. No language or date restrictions were applied to the searches. We searched the following electronic databases: Academic Search Elite, Cochrane Library, EMBASE, ERIC, MEDLINE, PsycINFO, Science Citation Index, Social Science Citation Index, SocINDEX, as well as the Nordic platforms: bibliotek.dk, BIBSYS, and LIBRIS. The conclusions of this review are based on the most recent searches performed. The last search was performed in April 2017.SELECTION CRITERIA: Primary studies had to meet the following inclusion criteria: Participants: The participants should be military personnel.Intervention: The condition should be deployment to a military operation.Comparison: The relevant comparisons were either comparing a) deployed military personnel to non-deployed military personnel, b) deployed military personnel to military personnel deployed elsewhere, for example personnel deployed to non-combat operations, c) military personnel deployed to the same operation but stratified by combat exposure.Outcomes: The study should report on one or more mental health outcomes, and/or social functioning for the deployed participants. In particular studies should report on one or more of the following mental health outcomes: PTSD, major depression, substance abuse or dependence (including alcohol), and common mental disorders (depression and anxiety disorders). The following social functioning outcomes were relevant: employment, and homelessness.Study Designs: Both experimental and quasi-experimental designs with a comparison group were eligible for inclusion in the review. Studies were excluded if they: Reported on deployments taking place before 1989.Used a within group pre-post study design.Did not report on at least one of the mental health or social functioning outcomes. DATA COLLECTION AND ANALYSIS: The total number of potentially relevant studies constituted31,049records. A total of 185 studies met the inclusion criteria and were critically appraised by the review authors. The final selection of 185 studies was from 13 different countries.Forty eight of the 185 studies did not report effect estimates or provide data that would allow the calculation of an effect size and standard error. Fifty four studies were excluded because of overlapping samples. The majority of those studies were from USA but the main reason for not using studies from USA in the synthesis was lack of information to calculate an effect size. Nearly half the studies from the UK could not be used in the synthesis due to overlap of data samples. Forty three studies were judged to have a very high risk of bias (5 on the scale) and, in accordance with the protocol, we excluded these from the data synthesis on the basis that they would be more likely to mislead than inform., Thus a total of 40 studies, from five different countries, were included in the data synthesis.Random effects models were used to pool data across the studies. We used the odds ratio. Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were calculated. The meta-analyses were carried out by time since exposure (short, medium, long, and other time since exposure) and by type of comparison (deployed versus non-deployed, all deployed but stratified by either combat operations versus non-combat operations, or stratified by combat exposure). We performed single factor subgroup analysis. The assessment of any difference between subgroups was based on 95% confidence intervals. Funnel plots were used to assess the possibility of publication bias. Sensitivity analysis was used to evaluate whether the pooled effect sizes were robust across components of methodological quality.MAIN RESULTS: The findings were mixed, depending on the outcome, the time since exposure and the approach (deployed versus non-deployed termed absolute or stratified by extent of combat termed relative) used to investigate the effect. It was not possible to analyse the outcomes homelessness and employment. All studies that could be used in the data synthesis reported on the impact of deployment on mental health; PTSD, depression, substance use or common mental disorder.For assessments taken less than 24 months since exposure the evidence was inconclusive either because too few studies reported results in the short and medium term and/or the degree of heterogeneity between studies was large.For assessments taken at other time points (a variable number of months since exposure) the evidence was inconclusive for the relative comparisons due to either too few studies or a substantial degree of heterogeneity between studies. For the absolute comparison the analysis of common mental disorder was inconclusive, whereas the average effects of PTSD and depression were positive and statistically significant (PTSD odds ratio (OR) was 1.91 (95% confidence interval (CI): 1.28 to 2.85) and OR=1.98 (95% CI: 1.05 to 3.70) for depression). The analysis concerning substance use indicated that deployed participants did not have higher odds of screening positive for substance use compared to non-deployed participants (OR=1.15 (95% CI: 0.98 to 1.36)).For assessments taken more than 24 months post exposure, meta-analyses indicated that the odds of screening positive for PTSD, depression, substance use and common mental disorder were higher for participants in the deployed group compared to participants in the group that were not deployed (PTSD OR=3.31 (95% CI: 2.69 to 4.07), OR=2.19 (95% CI: 1.58 to 3.03) for depression, OR=1.27 (95% CI: 1.15 to 1.39) for substance use, and OR=1.64 (95% CI: 1.38 to 1.96) for common mental disorder). Likewise, participants reporting high combat exposure had higher odds of screening positive for PTSD and depression than participants reporting lower exposure for long term assessments (PTSD OR=3.05 (95% CI: 1.94 to 4.80) and OR=1.81 (95% CI: 1.28 to 2.56) for depression). The analyses of substance use and common mental disorder were inconclusive due to too few studies.On the basis of the prevalence of mental health problems in pre-deployed or non-deployed population based comparison sampleswe would therefore expect the long term prevalence of PTSD in post-deployed samples to be in the range 6.1 - 14.9%, the long term prevalence of depression to be in the range from 7.6% to 18%, the long term prevalence of substance use to be in the range from 2.4% to 17.5% and the prevalence of common mental disorder to be in the range from 10% to 23%.Sensitivity analyses resulted in no appreciable change in effect size, suggesting that the results are robust.It was only possible to assess the impact of two types of personnel characteristics (branch of service and duty/enlistment status) on the mental health outcomes. We found no evidence to suggest that the effect of deployment on any outcomes differ between these two types of personnel characteristics.AUTHORS' CONCLUSIONS: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. We focused on the effect of deployment on PTSD (post-traumatic stress disorder), depression, substance abuse/dependence, and common mental disorders (depression and anxiety disorders). For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all domains, particularly on PTSD. There is increased political awareness of the need to address post deployment mental health problems. The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long lasting. Mental illness is of particular concern in the military for operational reasons, but they may be hard to detect in the military setting because a military career is intimately linked with mental and physical strength.It was not possible to examine a number of factors which we had reason to expect would impact on the magnitude of the effect. This would have been particularly relevant from a policy perspective because these are direct parameters that one could use to optimally "organize" deployment in order to minimize impacts on mental health functioning.While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel. The next step is to begin to examine preventive measures and policies for organizing deployment, in order to minimize the effects on mental health.

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.

Leadership and post-traumatic stress disorder: are soldiers' perceptions of organizational justice during deployment protective?

Background: Soldiers' perception of leadership during military deployment has gained research attention as a potentially modifiable factor to buffer against the development of postdeployment post-traumatic stress disorder (PTSD). Within nonmilitary research, the organizational justice (OJ) framework, i.e. distributive justice, procedural justice (PJ) and interactional justice (IJ), has been found to relate to mental health outcomes. Aspects of OJ may, therefore, be protective against PTSD. Objectives: We examined the prospective relationship between aspects of OJ, namely the perceptions of PJ and IJ by subordinate soldiers without leadership obligations in relationship to immediate superiors and PTSD. Method: Participants were soldiers (n = 245) deployed to Helmand Province in Afghanistan in 2009. Logistic regression procedures were used. The primary analysis measured PTSD cases using the Structured Clinical Interview for DSM-IV-TR Axis-I Disorder (SCID) 2½ years after homecoming. PJ/IJ was measured during deployment with a 6-item composite measure ranging from 0 to 12. Supplementary primary analyses were performed with PJ/IJ measured before and immediately after deployment. A secondary PJ/IJ analysis also tested against four postdeployment measures with the Post-Traumatic Stress Disorder Checklist Civilian (PCL-C) dichotomized at screening symptom levels. Results: Higher levels of perceived PJ/IJ for soldiers without leadership obligations during deployment had a prospective relation (OR = 0.86, 95% CI = 0.75-0.98) with PTSD on the SCID 2½ years after homecoming after adjustment for factors including predeployment PTSD symptoms, trauma and combat exposure, and state affectivity. Similar results were found by measuring PJ/IJ before (OR = 0.83, 95% CI = 0.71-0.95) but not immediately after homecoming (OR = 0.97, 95% CI = 0.85-1.11). A relationship with PTSD symptoms at the screening level at the four measurements of PCL-C was found, but only when predeployment PTSD symptoms were not controlled for. Conclusions: These results suggest that PJ/IJ exercised by superiors in relation to military deployments may protect subordinate soldiers against the development of postdeployment PTSD.

Distress Levels among Parents of Active Duty Soldiers during Wartime

Objective: Military service is a highly stressful period both for the soldiers serving and for their parents. Surprisingly, parents’ experience has been mostly ignored in the research. This study’s goal is to shed light on the experience and distress levels of parents of active duty combat soldiers during Operation Protective Edge, a military operation carried out by the Israel Defense Forces during July and August of 2014.

Methods: During the advanced stages of the operation, 69 parents of Israeli male combat soldiers (55 mothers and 14 fathers) completed an online survey measuring symptoms of Posttraumatic Stress Disorder (PTSD-Checklist-5) and distress (Brief Symptom Inventory-18). Participants were recruited using a convenience sample, by posting ads on the public Facebook pages of the researchers and of the groups dedicated to parents of Israeli soldiers.

Results: Parents’ depression and anxiety symptom levels were higher than depression and anxiety symptom levels of the adult community norms in Israel. General distress rates of parents were similar to those presented by adults in southern Israel who were exposed for 7 years to the ongoing threat of daily rocket fire from Gaza, and higher than rates of a non-threatened Israeli population. Finally, 20.2% of the parents presented PTSD-like symptoms, a higher percentage than the probable PTSD diagnosis rates that were found in the general population in Israel during previous terror waves.

Conclusion: This study provides preliminary evidence of soldiers’ parents’ distress and indicates the need for a better understanding of the impact of military service on soldiers’ parents.

Deployment characteristics and long-term PTSD symptoms

OBJECTIVE

The impact of number, length, and time between (i.e., "dwell time") deployments on long-term Diagnostic and Statistical Manual of Mental Disorders Fourth Edition posttraumatic stress disorder (PTSD) symptoms was examined in post-9/11 U.S. veterans.

METHOD

This cross-sectional design includes data from 278 veterans participating in a larger longitudinal research program of postdeployment recovery. Measures included self-report questionnaires and the Clinician Administered PTSD Scale.

RESULTS

Hierarchical regression was used to evaluate the independent contributions of deployment characteristics on long-term PTSD symptoms after controlling for demographics and combat exposure. As expected, dwell time was a significant predictor of long-term PTSD symptoms (β = - 0.17, p = .042; F_5,108  = 8.21, ∆R²  = 0.03, p < .001). Follow-up analyses indicated that dwell time of less than 12 months was associated with significantly greater long-term PTSD symptoms than those deployed once or with dwell time greater than 12 months.

CONCLUSION

In addition to combat exposure, time between deployments warrants clinical attention as an important deployment characteristic for predicting long-term PTSD symptoms.

Pre-deployment Year Mental Health Diagnoses and Treatment in Deployed Army Women

We estimated the prevalence of select mental health diagnoses (MHDX) and mental health treatment (MHT), and identified characteristics associated with MHT during the pre-deployment year (365 days before deployment) in active duty Army women (N = 14,633) who returned from Iraq or Afghanistan deployments in FY2010. Pre-deployment year prevalence estimates were: 26.2 % for any select MHDX and 18.1 % for any MHT. Army women who had physical injuries since FY2002 or any behavioral health treatment between FY2002 and the pre-deployment year had increased odds of pre-deployment year MHT. During the pre-deployment year, a substantial percentage of Army women had MHDX and at least one MHT encounter or stay. Future research should determine if pre-deployment MHDX among Army women reflect vulnerability to future MHDX, or if pre-deployment MHT results in protection from chronic symptoms.

Prospective post-traumatic stress disorder symptom trajectories in active duty and separated military personnel

Post-traumatic stress disorder (PTSD) is a serious mental illness that affects current and former military service members at a disproportionately higher rate than the civilian population. Prior studies have shown that PTSD symptoms follow multiple trajectories in civilians and military personnel. The current study examines whether the trajectories of PTSD symptoms of veterans separated from the military are similar to continuously serving military personnel. The Millennium Cohort Study is a population-based study of military service members that commenced in 2001 with follow-up assessments occurring approximately every 3 years thereafter. PTSD symptoms were assessed at each time point using the PTSD Checklist. Latent growth mixture modeling was used to compare PTSD symptom trajectories between personnel who separated (veterans; n = 5292) and personnel who remained in military service (active duty; n = 16,788). Four distinct classes (resilient, delayed-onset, improving, and elevated-recovering) described PTSD symptoms trajectories in both veterans and active duty personnel. Trajectory shapes were qualitatively similar between active duty and veterans. However, within the resilient, improving, and elevated recovering classes, the shapes were statistically different. Although the low-symptom class was the most common in both groups (veterans: 82%; active duty: 87%), veterans were more likely to be classified in the other three classes (in all cases, p < 0.01). The shape of each trajectory was highly similar between the two groups despite differences in military and civilian life.

Resilience, Stress, Stigma, and Barriers to Mental Healthcare in U.S. Air Force Nursing Personnel

Background

Stigma may deter military service members from seeking mental health (MH) services. Previously, substantial proportions of U.S. Air Force (USAF) registered nurses and medical technicians reported concerns about stigma with accessing MH services; in particular, that unit members might lose confidence in them or perceive them as weak, unit leadership might treat them differently, or accessing care might affect career advancement.

Objective

This study assessed the extent to which stigma and barriers to accessing MH services as perceived by USAF nursing personnel are associated with resilience, stress, previous deployment, or demographic characteristics.

Methods

An anonymous, online survey was administered to active-duty USAF registered nurses and medical technicians at three locations (N = 250). The survey included demographic items, the Stigma and Barriers to Care scales, Conner–Davidson Resilience Scale, and Perceived Stress Questionnaire.

Results

Mean resilience was high, and perceived stress was moderate. About half of participants agreed that unit members might have less confidence in me (54%) or unit leadership might treat me differently (58%). Many also had concerns that it would harm my career (47%), I would be seen as weak (47%), or there would be difficulty getting time off work for treatment (45%). Stigma was positively correlated with perceived stress (r = .40, p < .01) and negatively correlated with resilience (r = −.24, p < .01). Officers had significantly higher stigma and resilience scores and lower stress scores compared with enlisted personnel, but those differences were small.

Discussion

This study validated previous findings that substantial percentages of USAF nursing personnel have concerns that accessing MH services may adversely affect their careers and how they are viewed by unit leaders and peers. In addition, higher levels of concern about stigma were associated with higher levels of stress and lower levels of resilience. Limitations included a low response rate (18%) and self-selection biases.

The Relationship Between US Military Officer Leadership Behaviors and Risk of Sexual Assault of Reserve, National Guard, and Active Component Servicewomen in Nondeployed Locations

OBJECTIVES

To determine if military leader behaviors are associated with active component and Reserve-National Guard servicewomen's risk of sexual assault in the military (SAIM) for nondeployed locations.

METHODS

A community sample of 1337 Operation Enduring Freedom and Operation Iraqi Freedom-era Army and Air Force servicewomen completed telephone interviews (March 2010-December 2011) querying sociodemographic and military characteristics, sexual assault histories, and leader behaviors. We created 2 factor scores (commissioned and noncommissioned) to summarize behaviors by officer rank.

RESULTS

A total of 177 servicewomen (13%) experienced SAIM in nondeployed locations. Negative leader behaviors were associated with increased assault risk, at least doubling servicewomen's odds of SAIM (e.g., noncommissioned officers allowed others in unit to make sexually demeaning comments; odds ratio = 2.7; 95% confidence interval = 1.8, 4.1). Leader behavior frequencies were similar, regardless of service type. Negative leadership behavior risk factors remained significantly associated with SAIM risk even after adjustment for competing risk. Noncommissioned and commissioned officer factor scores were highly correlated (r = 0.849).

CONCLUSIONS

The association between leader behaviors and SAIM indicates that US military leaders have a critical role in influencing servicewomen's risk of and safety from SAIM.

Lesbian, Gay, Bisexual, and Transgender (LGBT) Service Members: Life After Don't Ask, Don't Tell

Lesbian, gay, and bisexual service members can serve openly in the military with the repeal of the Don't Ask, Don't Tell policy. The fate of transgender service members remains uncertain as the policy preventing them from serving in the military remains under review. The health care needs of these populations remain for the most part unknown, with total acceptance and integration in the military yet to be achieved. In this paper, we review the literature on the health care needs of lesbian, gay, bisexual, and transgender (LGBT) service members, relying heavily on what is known about LGBT civilian and veteran populations. Significant research gaps about the health care needs of LGBT service members are identified, along with recommendations for closing those gaps. In addition, recommendations for improving LGBT acceptance and integration within the military are provided.

Occupational outcomes following mild traumatic brain injury in Canadian military personnel deployed in support of the mission in Afghanistan: a retrospective cohort study

OBJECTIVE

Deployment-related mild traumatic brain injury (MTBI) occurs in a significant number of military personnel but its long-term impacts are unclear. This study explores the impact of deployment-related MTBI on continued fitness-for-duty, with the ultimate intent of identifying potential targets for intervention to attenuate its effects.

PARTICIPANTS

Consisted of 16 193 Canadian Armed Forces (CAF) personnel who deployed in support of the mission in Afghanistan and completed an enhanced postdeployment screening (EPDS) questionnaire over the period January 2009-July 2012.

PRIMARY OUTCOME

The primary outcome was development of permanent medical unfitness defined as a 'career-limiting medical condition' (CL-MC). The secondary outcome was the diagnostic categories recorded for each individual at the time a CL-MC was established.

DESIGN

This study used a retrospective cohort design. Linked administrative and health data provided the primary outcome and the diagnoses responsible for it. Survival analysis was used to estimate the risk of a CL-MC and Cox regression provided adjusted HRs (aHRs) for the association between a CL-MC and MTBI, accounting for key covariates and confounders. Diagnostic categories associated with CL-MCs were identified.

RESULTS

Over a median follow-up period of 3.42 years, 6.57% of the study population developed a CL-MC. MTBI was independently associated with CL-MCs (aHR=1.65, 95% CI 1.35 to 2.03). Mental disorders and musculoskeletal conditions were the primary diagnoses associated with CL-MCs (identified as the primary diagnosis in 55.4% and 25.9%, respectively), and a neurological condition was only documented in 5.8% of those with MTBI who developed a CL-MC CONCLUSIONS: Deployment-related MTBI was associated with adverse occupational outcome but mental disorders and musculoskeletal conditions primarily drove subsequent medical unfitness. These findings support a diagnostic and treatment approach focusing on these comorbidities as the most promising strategy to minimise the burden of disability in MTBI-exposed military personnel.

Retrospective Appraisals Mediate the Effects of Combat Experiences on PTS and Depression Symptoms in U.S. Army Medics

A life-threatening traumatic experience can cause physical and psychological distress, but it can also be remembered with pride from having demonstrated one's courage and abilities under severe circumstances. Characteristics of the event, early response, as well as later personal reflection, together determine the individual's response to a traumatic event. We investigated how traumatic combat experiences and retrospective appraisals of those experiences affected reports of symptoms of posttraumatic stress and depression in 324 U.S. Army medics. Higher levels of combat experiences were associated with both appraisals of threat to life (r = .40) and appraisals of personal benefit of the deployment (r = .15). Threat appraisals were associated with increases (r = .33 and .29), whereas benefit appraisals were associated with decreases (r = -.28 and -.30, respectfully), in symptoms of posttraumatic stress and depression. These opposing mediation pathways led to weak or nonsignificant total effects, which concealed the effects of combat intensity on posttraumatic stress (R(2) = .28) and depression (R(2) = .24). Acknowledging the beneficial effects that a combat experience had on one's life was associated with less intense behavioral health symptoms and offset the detrimental effects of traumatic combat experiences.

How Do Aftermath of Battle Experiences Affect Returning OEF/OIF Veterans?

Aftermath of battle experiences (ABE) may contribute to adverse mental and physical health outcomes. This study examined ABE and their effect on health functioning and posttraumatic stress disorder (PTSD) in 66 OEF/OIF/OND Veterans. Bivariate correlations were conducted to investigate the contribution of ABE to PTSD and health functioning, after controlling for combat experiences. Additionally, a mediation analyses was conducted on Role Limitations due to Emotional Problems. Results suggested that the association between ABE and Role Limitations due to Emotional Problems was mediated by PTSD. These initials findings suggest the need for more research on differences in deployment experiences.

Veteran exposure to suicide: Prevalence and correlates

BACKGROUND

The aim of this study was to determine rates and consequences of suicide exposure in a veteran population and variables related to psychiatric morbidity.

METHODS

931 veterans from a random digit dial survey conducted July 2012-June 2013 in the Commonwealth of Kentucky was utilized to examine associations between suicide exposure and depression and anxiety. For those with lifetime suicide exposure, perceptions of closeness to the decedent and additional traumatic death exposure were also examined.

RESULTS

Almost half of veterans (47.1%, n=434) reported lifetime exposure to suicide. Suicide-exposed individuals were almost twice as likely to have diagnosable depression (OR=1.92, CI=1.31-2.8) and more than twice as likely to have diagnosable anxiety (OR=2.37, CI=1.55-3.61). Suicide-exposed were also more likely than non-exposed to report suicide ideation (9.9% vs. 4.3%). Perceived closeness to decedent increased the odds of depression (OR=1.38, CI=1.12-1.69), anxiety (OR=1.51, CI=1.21-1.89) and PTSD (OR=1.65, CI=1.27-2.16) and more than doubled the odds of Prolonged Grief (OR=2.47, CI=1.60-3.83). A model examined time sequence of suicide and traumatic death exposure. Experiencing a suicide exposure first and subsequent traumatic death exposure in their military career almost quadrupled the odds of suicide ideation (OR=3.56, p=.01, CI=1.34-9.46).

LIMITATIONS

Major study limitations include use of only one US state and random digit dial response rate.

CONCLUSIONS

Suicide exposure confers psychiatric risks in veterans. Perceptions of closeness to decedents, which may extend beyond familial lines, may heighten these risks in the suicide exposed. Multiple exposures to suicide and traumatic death may lead to significant suicide risk.

Role of morality in the experience of guilt and shame within the armed forces

OBJECTIVE

Despite advances in our understanding of mental health issues among military forces, a large proportion of military personnel continue to exhibit deployment-related psychological issues. Recent work has identified symptoms of guilt and shame related to moral injury as contributing significantly to combat-related mental health issues. This systematic scoping review explores the association between morality and symptoms of guilt and shame within military forces.

METHOD

A search of the literature pertaining to guilt, shame and morality within military samples was conducted.

RESULTS

Nineteen articles were selected for review. There is strong evidence linking exposure to and the perceived perpetration of moral transgressions with experiences of guilt and shame. Critically, symptoms of guilt and shame were related to adverse mental health outcomes, particularly the onset of post-traumatic stress disorder (PTSD). No studies have explored moral judgment in conjunction with assessments of guilt or moral injury.

CONCLUSION

These findings have important implications for the prevention and treatment of PTSD-related symptoms in military samples. By measuring moral judgment prior to deployment, it may be possible to predict the likelihood of incurring moral injuries and the development of associated symptoms. Early intervention programmes aimed at ameliorating guilt and shame are required to prevent the long-term development of deployment-related psychological distress.

An examination of the broader effects of warzone experiences on returning Iraq/Afghanistan veterans' psychiatric health

The objective of the present research was to test the hypotheses that: (1) Iraq/Afghanistan war veterans experience a wide range of psychiatric symptomatology (e.g., obsessive-compulsive symptoms, hypochondriasis, somatization); and (2) general psychiatric symptomatology among Iraq/Afghanistan war veterans is associated with their warzone experiences. To achieve this objective, Iraq/Afghanistan war veterans (N=155) completed a screening questionnaire that assessed a wide range of psychiatric symptoms along with a measure of warzone experiences. As expected, returning veterans reported significant elevations across a wide range of clinical scales. Approximately three-fourths screened positive on at least one clinical subscale, and a one-third screened positive on five or more. In addition, nearly all of these conditions were associated with veterans' warzone experiences (average r=0.36); however, this association was much stronger among veterans with posttraumatic stress disorder (PTSD) (average r=0.33) than among veterans without PTSD (average r=0.15). We also observed that approximately 18% of the variance in total psychiatric symptomatology was attributable to warzone experiences above and beyond the effects of childhood trauma and demographic factors. Taken together, these findings suggest that returning veterans experience a broad array of psychiatric symptoms that are strongly associated with their warzone experiences.

Behavioral health leadership: new directions in occupational mental health

The impact of stress on mental health in high-risk occupations may be mitigated by organizational factors such as leadership. Studies have documented the impact of general leadership skills on employee performance and mental health. Other researchers have begun examining specific leadership domains that address relevant organizational outcomes, such as safety climate leadership. One emerging approach focuses on domain-specific leadership behaviors that may moderate the impact of combat deployment on mental health. In a recent study, US soldiers deployed to Afghanistan rated leaders on behaviors promoting management of combat operational stress. When soldiers rated their leaders high on these behaviors, soldiers also reported better mental health and feeling more comfortable with the idea of seeking mental health treatment. These associations held even after controlling for overall leadership ratings. Operational stress leader behaviors also moderated the relationship between combat exposure and soldier health. Domain-specific leadership offers an important step in identifying measures to moderate the impact of high-risk occupations on employee health.

Posttraumatic stress disorder post Iraq and Afghanistan: prevalence among military subgroups

A large body of research has been produced in recent years investigating posttraumatic stress disorder (PTSD) among military personnel following deployment to Iraq and Afghanistan, resulting in apparent differences in PTSD prevalence. We compare prevalence estimates for current PTSD between military subgroups, providing insight into how groups may be differentially affected by deployment. Systematic literature searches using the terms PTSD, stress disorder, and acute stress, combined with terms relating to military personnel, identified 49 relevant papers. Studies with a sample size of less than 100 and studies based on data for treatment seeking or injured populations were excluded. Studies were categorized according to theatre of deployment (Iraq or Afghanistan), combat and noncombat deployed samples, sex, enlistment type (regular or reserve and [or] National Guard), and service branch (for example, army, navy, and air force). Meta-analysis was used to assess PTSD prevalence across subgroups. There was large variability in PTSD prevalence between studies, but, regardless of heterogeneity, prevalence rates of PTSD were higher among studies of Iraq-deployed personnel (12.9%; 95% CI 11.3% to 14.4%), compared with personnel deployed to Afghanistan (7.1%; 95% CI 4.6% to 9.6%), combat deployed personnel, and personnel serving in the Canadian, US, or UK army or the navy or marines (12.4%; 95% CI 10.9% to 13.4%), compared with the other services (4.9%; 95% CI 1.4% to 8.4%). Contrary to findings from within-study comparisons, we did not find a difference in PTSD prevalence for regular active-duty and reserve or National Guard personnel. Categorizing studies according to deployment location and branch of service identified differences among subgroups that provide further support for factors underlying the development of PTSD.

The US framework for understanding, preventing, and caring for the mental health needs of service members who served in combat in Afghanistan and Iraq: a brief review of the issues and the research

This paper reviews the psychological health research conducted in the United States in support of combat veterans from Iraq and Afghanistan, using the Military Psychological Health Research Continuum, which includes foundational science, epidemiology, etiology, prevention and screening, treatment, follow-up care, and services research. The review is limited to those studies involving combat veterans and military families. This review discusses perplexing issues regarding the impact of combat on the mental health of service members such as risk and resilience factors of mental health, biomarkers of posttraumatic stress syndrome (PTSD), mental health training, psychological screening, psychological debriefing, third location decompression, combat and suicide, the usefulness of psychotherapy and drug therapy for treating PTSD, role of advanced technology, telemedicine and virtual reality, methods to reduce stigma and barriers to care, and best approaches to the dissemination of evidence-based interventions. The mental health research of special populations such as women, National Guardsmen and reservists, and military families is also presented. The review concludes by identifying future areas of research.

Suicides in the military: the post-modern combat veteran and the Hemingway effect

Suicides in the military have increased over the last ten years. Much effort has been focused on suicide prevention and treatment, as well as understanding the reasons for the sharp increase in military suicides. Despite this effort, the definitive causes of military suicides remain elusive. Further, highly effective suicide prevention and treatment approaches have not yet been developed. The purpose of this article is to present a short review of the current state of suicide prevention interventions within the context of the military. The root causes of suicidal behavior and the role of combat in the military are each discussed. Interpersonal-psychological theory of suicide and the military transition theory are introduced as guiding frameworks for understanding suicides and suicidal behavior amongst active military personnel and military veterans. The article concludes with a set of recommendations for moving forward in understanding and addressing suicides in the military.

Posttraumatic stress symptoms and work-related accomplishment as predictors of general health and medical utilization among Special Operations Forces personnel

Research has established clear links among posttraumatic stress disorder (PTSD), somatic symptoms, and general health among conventional force military personnel. It is possible that the same relationships exist among Special Operations Force (SOF) personnel, but there are very few, if any, studies that examine these relationships. This study investigated correlates of general health and medical visits among SOF personnel and found that the interaction of somatic and PTSD symptoms was associated with worse health and more frequent medical visits. Follow-up analyses indicated that the interaction of avoidance symptoms with somatic symptoms was significantly associated with worse health, whereas the interaction of emotional numbing with somatic symptoms significantly contributed to increased medical visits. In addition, the results suggest that a sense of accomplishment among SOF personnel may serve as a protective factor against poor health. The results suggest developing interactions among SOF personnel that promote a sense of achievement to ultimately improve the health of the force.

Predictors of psychiatric disorders in combat veterans

BACKGROUND

Most previous research that has examined mental health among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combatants has relied on self-report measures to assess mental health outcomes; few studies have examined predictors of actual mental health diagnoses. The objective of this longitudinal investigation was to identify predictors of psychiatric disorders among Marines who deployed to combat in Iraq and Afghanistan.

METHODS

The study sample consisted of 1113 Marines who had deployed to Iraq or Afghanistan. Demographic and psychosocial predictor variables from a survey that all Marines in the sample had completed were studied in relation to subsequent psychiatric diagnoses. Univariate and multivariate logistic regression were used to determine the influence of the predictors on the occurrence of psychiatric disorders.

RESULTS

In a sample of Marines with no previous psychiatric disorder diagnoses, 18% were diagnosed with a new-onset psychiatric disorder. Adjusting for other variables, the strongest predictors of overall psychiatric disorders were female gender, mild traumatic brain injury symptoms, and satisfaction with leadership. Service members who expressed greater satisfaction with leadership were about half as likely to develop a mental disorder as those who were not satisfied. Unique predictors of specific types of mental disorders were also identified.

CONCLUSIONS

Overall, the study's most relevant result was that two potentially modifiable factors, low satisfaction with leadership and low organizational commitment, predicted mental disorder diagnoses in a military sample. Additional research should aim to clarify the nature and impact of these factors on combatant mental health.

Guilt, shame, and suicidal ideation in a military outpatient clinical sample

BACKGROUND

Increased suicide risk among US military personnel is a growing concern. Research has linked trauma exposure, including exposure to combat-related injuries, death, and atrocities to suicidal ideation among combat veterans. Guilt (feeling bad about what you did to another) and shame (feeling bad about who you are) have been proposed as potential contributors to suicidal ideation among military personnel, but have not yet received much empirical attention.

METHODS

Sixty-nine active duty military personnel receiving outpatient mental health treatment at a military clinic completed self-report symptom measures of guilt, shame, depression, posttraumatic stress disorder, and suicidal ideation while engaged in treatment. Generalized linear regression modeling was utilized to test the association of guilt and shame with suicidal ideation.

RESULTS

Mean levels of guilt and shame were significantly higher among military personnel with a history of suicidal ideation. Guilt (B = 0.203, SE = .046, P < .001) and shame (B = 0.111, SE = .037, P = .002) were independently associated with severity of current suicidal ideation above and beyond the effects of depression, PTSD symptoms, and the depression-by-PTSD interaction, and fully mediated the relationships of depression and PTSD symptom severity with suicidal ideation. When considered simultaneously, only guilt (B = 0.167, SE = .053, P = .001) was significantly associated with increased suicidal ideation.

CONCLUSIONS

Guilt and shame are associated with increased severity of suicidal ideation in military mental health outpatients. Guilt has a particularly strong relationship with suicidal ideation.

Anxiety and depression in Marines sent to war in Iraq and Afghanistan

Although the effects of combat deployment on posttraumatic stress disorder have been extensively studied, little is known about the effects of combat deployment on depression and anxiety. This study examined the factors associated with anxiety and depression in a sample of 1560 US Marines who were deployed to Iraq and Afghanistan. Eleven demographic and psychosocial factors were studied in relation to depression and anxiety. Five factors emerged as significant in relation to depression: deployment-related stressors, combat exposure, attitudes toward leadership, mild traumatic brain injury symptoms, and marital status. The same factors, with the exception of marital status, emerged as significant in relation to anxiety. Deployment-related stressors had a stronger association with both depression and anxiety than any other variable, including combat exposure. This finding is important because deployment-related stressors are potentially modifiable by the military.

Deployment cycle stressors and post-traumatic stress symptoms in Army National Guard women: the mediating effect of resilience

This study examined the associations between deployment cycle stressors, post-traumatic stress symptoms (PTSS), and resilience in Army National Guard (ARNG) women deployed to Operations Enduring Freedom and Iraqi Freedom. Resilience was also tested as a mediator. Hierarchical linear regression indicated that deployment and post-deployment stressors were positively associated, and resilience was negatively associated with PTSS. Resilience fully mediated the association between post-deployment stressors and PTSS. Findings suggest assessing deployment and post-deployment stressors in ARNG women may be helpful in identifying those at risk for severe PTSS; and highlight the potential of individual-level resilient characteristics in mitigating the adverse impact of post-deployment stressors.

Postcombat outcomes among Marines with preexisting mental diagnoses

Preexisting mental disorders are not always considered in mental health studies with military populations, even though prior diagnoses may be a risk factor for additional psychiatric harm stemming from combat exposure, as well as postdeployment behavioral problems. The objectives of this study were to investigate postcombat psychiatric and career outcomes among Marines with preexisting mental disorder diagnoses who deployed to combat in Iraq, Afghanistan, or Kuwait from 2002 to 2008. Marines with a preexisting diagnosis were 3.6 times (p < .001) more likely to have at least 1 postdeployment mental health disorder within 6 months postdeployment compared with Marines with no prior psychiatric diagnoses. Marines with a preexisting diagnosis were also 1.8 (p < .001) times more likely to receive a new-onset psychiatric diagnosis within 6 months postdeployment, indicating that postdeployment mental health concerns in this cohort extend beyond continuation of earlier disorders. Additionally, demotions and separation were significantly associated with having any preexisting mental health diagnoses (yielding odds ratios of 2.34 and 2.00, p < .001, respectively. Based on the current findings, it may be advisable to mandate a full medical and psychiatric record review during deployment health screening as part of new initiatives to address whether combat exposure has worsened preexisting conditions or compounded them with new-onset concerns.