U.S. Army National Guard and Army Reserve (ANG/USAR) soldiers are at risk for substance use, and research in other populations suggests risk-related behaviors and traits affect the propensity for use. Less is known about how deployment might amplify these effects. Our research explored the relations between risk-related behaviors and substance use among ANG/USAR soldiers and investigated differences by deployment (previously vs. never deployed). We drew a subset of data from Operation: SAFETY, an ongoing study of ANG/USAR soldiers and their partners (married/living together as if married). Cross-sectional regression models examined domains of risk (i.e., risk perception, risk-taking/impulsivity, sensation-seeking) and substance use (any current drug use, current non-medical use of prescription drugs, current illicit drug use, alcohol problems, and frequent heavy drinking [FHD]). Final models controlled for age, sex, anger, and PTSD. Interaction terms between risk behaviors and deployment status on substance use were also noted. Results revealed that greater risk perception was significantly associated with a lower likelihood of and protective against FHD. Greater risk-taking/impulsivity was associated with a higher likelihood of any current drug use and alcohol problems. Additionally, interaction models suggest that non-deployed soldiers at every level of risk-taking/impulsivity had a consistently high likelihood of illicit drug use overall. Sensation-seeking was not associated with any outcome. Findings demonstrate that greater risk-taking/impulsivity was associated with substance use, and never deployed/non-deployed ANG/USAR soldiers might be more vulnerable. Our work can help inform substance use interventions in the military by highlighting the role and impact of risk-related behaviors and non-deployment.
Combat-related physical injuries not only affect the individual but also close family members. Emerging evidence indicates that injuries that change appearance, such as limb loss and physical scarring, may create additional psychosocial challenges for the injured person and their family. However, to date the impact of appearance-altering combat injuries have not been explored among the partners of those who were injured. Using a qualitative individual interview design, this study aimed to gain experiential insights into the appearance-specific impact on the partners of military personnel who sustained appearance-altering injuries during deployments or training. Reflexive Thematic Analysis of interviews with 11 female partners identified two main themes "The challenges of looking different" and "How our life continues." The themes reflect challenges experienced by the partners in relation to their injured partner looking "different" from societally accepted appearance ideals, and the impact this could have on their children. Yet, they had found ways for life to continue such as drawing on positive emotions, having gratitude, pride in their partner's service, and normalizing difference for their children. While the partners found ways to adapt, this study draws attention to unmet needs for appearance-specific support.
Resilience training offered to military personnel often fails to reinforce training practices into routine military activities. We describe the implementation of a supervisor-led after action review designed to provide personnel with frequent opportunities for the supervisor reinforced application of resilience training skills at work. This paper provides a roadmap for engaging supervisors to support this program and details strategies used across its design and their contribution to implementation fidelity. Strategies included iterative stakeholder engagement in co-design and the use of mixed-methods data collection, including field observational ratings, open ended survey questions, and focus group interviews. The design and implementation process are reported in two phases: initial and re-implementation phases. Chi-square analyses and t-tests of initial phase data indicated that the after action review designed to guide the application of resilience training skills was distinct from preexisting after action reviews of tactical skills and drills. Reflexive interpretations of instructor feedback guided refinement to the extension and subsequent re-implementation phase data indicated implementation fidelity. When engaging leaders and resilience non-specialists in activities that support military resilience training, we recommend involving stakeholders in the design and implementation process, responding flexibly to their concerns, and balancing their experienced work change demands with appropriate resources.
A self-report four-item Brief Resilient Coping Scale (BRCS) measures tendencies to cope with stress in a highly adaptive manner. We investigated the level of resilient coping and the psychometric properties of the BRCS among young men participating military call-up. The study sample consisted of a one-year military call-up sample (N = 2184) in the Northern Finland. Most of the participants were at the age of 17–18 years. They completed a study questionnaire including the BRCS and other psychosocial scales during the military call-up. The construct validity of the BRCS was assessed with exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Convergent and discriminant validity were assessed by relating resilient coping with self-reports of dispositional optimism (LOT-R), sense of coherence (SOC-13), perceived stress (PSS-10), general anxiety (GAD-7), and depression (R-BDI). The mean BRCS total score of the participants indicated good resilient coping and was related to specific sociodemographic factors, such as education, relationship status and family structure. The internal consistency of the BRCS was good. EFA and CFA showed that one-factor solution fitted to the data best. BRCS correlated positively with dispositional optimism and sense of coherence, and negatively with perceived stress, general anxiety, and depression. BRCS appears to be psychometrically adequate tool in assessing healthy young men's resilient coping before commencing their compulsory conscript service. The evaluation of resilient coping prior to military service is important to military forces.
Post Traumatic Stress Disorder (PTSD) symptoms among service members appear to have a stronger impact on functioning in military families compared to civilian families. To better understand this relationship, this study applied the concepts explained by Social Identity Theory to explore how a Veteran's social identity interacts with PTSD symptoms to affect family functioning. The sample included Veteran parents (N = 291) from San Francisco, CA and Chicago, IL who completed a cross-sectional survey about their well-being and transition out of service, including measures of PTSD, military identity, and family functioning. Linear regression showed a Veteran's social identification with the military had significant main effects on adverse family functioning (β = 1.5, p = .001) and significantly moderated the relationship between PTSD and adverse family functioning (β = −0.02, p = .03). The interaction shows that higher perceptions of the military as family appeared to attenuate the relationship between PTSD symptoms and adverse family functioning up to a certain point. Our findings suggest that a Veteran's greater desire to go back to the military or stronger feelings that the military was their family protected the functioning of their family from their PTSD symptoms. However, when a Veteran had the highest possible desire to go back to the military or the strongest feeling like the military was their family, there was no effect on the relationship between PTSD symptoms and family functioning. Findings suggest the need to better understand how dimensions and strength of military identity can affect the relationship between PTSD symptoms and family functioning.
Enhancing well-being amongst partners of current serving military personnel is a growing area of interest and concern. Partners of Australian Defence Force (ADF) personnel experience unique challenges because of their military connection above those faced by the broader civilian community. This paper sought to understand undertake an investigation of the most important risk and protective factors which influence well-being in this cohort. This cross-sectional study gathered responses from 444 participants (partners of current serving military members) through an online survey. Bivariate and multivariate regression models found higher well-being scores were associated with younger partners, higher military member rank brackets, existing social support in their location, and partners who were in their desired employment status. Additionally, higher COVID-19 impacts were associated with lower well-being scores. Moving forward, interventions which target social support, desired employment, and periods of national crisis requiring a military response should be the focus. The findings of this study impact policy and programs which aim to provide support to military-connected families.
Emerging evidence indicates that combat injuries that change appearance, such as limb loss and physical scarring, can impact psychosocial wellbeing of injured military veterans. Parents of young children with a visibly different appearance may experience emotional distress and consequently have their own support needs, but less is known about the experiences of the parents of veterans with appearance-altering combat injuries. Using a qualitative individual interview design, this study aimed to understand the experiences and support needs of parents of military veterans who sustained appearance-altering combat injuries. Reflexive Thematic Analysis of interviews with six mothers identified two main themes "The distress of my son's appearance-altering injury" and "I can't express my distress". The themes represent the emotional distress, guilt, and social difficulties experienced by the mothers following their sons' appearance-altering injury, their experience of feeling they should supress their feelings of distress, the limited available support, and barriers to accessing support. This study highlights how the mothers of combat-injured veterans are often overlooked and provides emerging evidence that adjusting to a son's changed appearance following combat-injury can create additional challenges for mothers, who could benefit from specific support.
The Canadian Armed Forces (CAF) is currently struggling with a retention crisis. Within the CAF, The Canadian Army (CA) experiences the greatest attrition rates. Staffing shortages lead to an increase in job demands subsequently leading to greater stress, burnout, and turnover intentions. Psychological resilience has been found to buffer the negative effects of workplace stressors. There is a need to understand resilience within specific occupations to better inform resilience building interventions. This study aims to enhance knowledge of how infantry soldiers in the CA define resilience and what challenges they experience within the workplace that contribute to stress and how they cope with such stressors. A qualitative approach was used, with 14 semi-structured interviews conducted with CA personnel employed as infantry soldiers. Data were analyzed using a deductive content-analysis. Four themes emerged from the interviews: the nature of resilience, challenges of the profession, resilience strategies (attitudes), and resilience strategies (protective practices). The study provides unique insights into the experiences of infantry soldier’s and the mechanisms they employ to facilitate and maintain resilience.
There is a pressing need to prepare health professions students to work effectively with veterans and military families (VMFs). Instruction that includes elements of military/veteran cultural competence (MVCC), such as military culture and values and the range of issues that VMFs may confront during reintegration, seems essential to achieving this aim. In the present study, we examined the effects of teaching these topics on reported VMF knowledge, comfort, self-efficacy, and behavioral intentions concerning future VMF-focused practice among five cohorts of graduate students (N = 65). About three quarters of the students were civilians, and most had a personal military connection (past/current military service or family relationship) that motivated them to take the class. Results indicated significant course-related increases in VMF knowledge and anticipated comfort and self-efficacy in working with this population, and that increased knowledge was associated with increased comfort. Behavioral intention changes did not reach significance, which may be due to the high baseline level of motivation that students reported. This study demonstrates that knowledge-based elements of MVCC may be successfully taught even to those familiar with the military. Future research should examine whether this knowledge translates into the practice skills/attitudes needed for effective and culturally competent practice with VMFs.
The U.S. Department of Defense continues to have a significant interest in the development and evaluation of evidence-based programs for enhancing resilience in military personnel. However, few studies have documented evidence-based interventions to maintain or boost performance and enhance resilience among service members. A robust body of literature describes the positive association between psychological flexibility and resilience as well as outcomes including performance, mental health, and social functioning in both healthy and clinical populations. Acceptance and Commitment Therapy (ACT) is an evidence-based intervention that directly targets the enhancement of psychological flexibility. In the current paper, we first describe the association between psychological flexibility and resilience. Then we briefly note the limitations of existing military resilience training programs and outline the relevant evidence in support of an ACT-based resilience training program. Finally, we describe the six psychological flexibility processes that comprise ACT interventions along with the relevance of each process for resilience enhancement in military personnel. We conclude with information about an in-progress study of a novel ACT-based training program targeting resilience enhancement and readiness optimization in active duty service members.Keywords: Resilience enhancementmilitary personnelpsychological flexibilityacceptance and commitment therapy Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationFundingThis research was supported by the Department of Defense’s Psychological Health and TBI Research Program (W81XWH-19-1-0628; PI: Alan Peterson).
Warzone deployment increases risk for posttraumatic stress disorder symptoms (PTSS), including among service members who have children. Parental PTSS are associated with child depression, anxiety, hyperactivity, and conduct problems, yet few studies of child behavioral health outcomes in military populations have accounted for PTSS in both warzone veterans and their partners. Fewer still incorporate non-clinically-recruited samples of nationally dispersed warzone veterans and their families. The current research examines whether children whose parent(s) have higher levels of PTSS exhibit more behavioral health symptoms. One hundred and thirty-three Iraq and Afghanistan War veterans and their cohabitating partners completed clinical interviews and self-report questionnaires. Higher intimate partner PTSS, more extensive child exposure to stressful life events, and being an adolescent were significantly associated with child depression after adjusting for warzone veteran PTSS, demographics, and recent warzone veteran absence from the household. Greater child exposure to stressful life events was also associated with child conduct problems. Treatment of PTSD symptoms experienced by warzone veterans' intimate partners, and preventative interventions aimed at helping the children of warzone veterans cope with stress, may ultimately yield positive benefits for the behavioral health of children in military families.
Inappropriate sexual behaviors represent a serious individual and collective health issue for organizations, including military ones. In addition to the direct negative impact on its victims, they create an unhealthy work environment, having important consequences on performance and readiness. The purpose of this study is to evaluate different aspects which may contribute to lowering the level of acceptability of such behaviors. Are there any cultural biases, including gender biases that relate to the level of acceptance of inappropriate sexual behaviors? Could certain aspects of opened-minded thinking or a certain level of morality in relation to certain behaviors of a sexual nature moderate this possible relationship?
Army personnel operate in volatile and stressful environments where self-regulation is critical to maintain performance, health, and well-being. Though self-regulation is a malleable construct, the complex nature of both self-regulation and the Army context in which it is enacted makes a tailored application for individual development challenging. In this paper, we explore salient issues in the potential application of self-regulation concepts and techniques to the Army context. In doing so, we review leading conceptualizations and major theoretical models of self-regulation, discuss aspects of military professions in which self-regulation may be particularly relevant, and identify challenges associated with applying existing approaches to self-regulation in the Army context. Finally, we discuss promising self-regulation interventions for competency development that may be beneficial for the Army and highlight where future efforts should be directed.Keywords: self-regulationArmymilitaryskillswell-being Disclosure statementThe authors have no conflicts of interest to report.Additional informationFundingAspects of this work were funded through the Consortium Research Fellows Program in support of the U.S. Army Research Institute for the Behavioral and Social Sciences (ARI) at Fort Benning, Georgia.
This article introduces the use of an art therapy assessment, the Bridge with Path Drawing, for service members experiencing effects of Traumatic Brain Injury (TBI) and/or Post-Traumatic Stress Disorder (PTSD) during treatment at an outpatient clinic. Brief clinical vignettes describe the processes and outcomes of Bridge with Path Drawing Assessment for two service members. Bridge to Path Drawing aided service members with TBI/PTSD in discovering and disclosing thoughts and feelings through symbolic and metaphorical associations to their drawings. Service members shared meanings related to their senses of identity, their futures, the transitions to civilian lives, strategies to overcome obstacles, and purposes and meanings in their lives. Providers working with service members experiencing effects of TBI/PTSD and military-to-civilian transition found an art therapy assessment, the Bridge with Path Drawing, useful to explore patients’ meaning in life at an outpatient medical clinic on a military base.
AbstractWorkplace productivity can be impaired by many different environmental and occupational factors. These disruptive influences are problematic but also represent opportunities for tailored mitigation strategies that could enhance performance. In the naval context, sleep quality is an especially pervasive impairment. Naval personnel also represent a unique and understudied population as they both live and work within the same austere, industrial-like operational environment. As such, the relationship between occupational environment, responsibilities, and sleep warrants investigation. To assess these relationships, this study used survey data from a large sample of active-duty military personnel (N > 11,000) with three dependent sleep variables in sleep obtained, sleep disturbances, and work-related sleep impairments. Possible occupational-related sleep factors included different ship-classes, different departmental assignments (e.g., administrative, engineering), and paygrade (e.g., officer or enlisted). Statistically significant differences were observed for all multivariate analyses and interactions, indicating pervasive sleep disruption as no occupational category approached the daily recommended 7 h of sleep. However, occupational factors accounted only for exceptionally small effect sizes. The findings suggest that sleep disruptions are a pervasive problem for all naval personnel, regardless of ship-class or occupational assignment, but that chronic sleep disruption better explains sleep-related performance deficits than daily occupational disturbances.Keywords: Sleepfunctional impairmentoccupational factorsnavalship-class
The goal of this study was to develop a gender-sensitive resilience scale for screening combat-support officers. This was achieved by investigating the factor structure of resilience in both male and female personnel. Participants were 1467 combat-support personnel who underwent psychological evaluation at the Israel Defense Force (IDF) Officer Selection Center (OSC) and attended Officer Training School (OTS). Exploratory Factor Analysis (EFA) was used to analyze multiple resilience scales. EFA bore two factors: Self-efficacy (SE) and social support (SS). Construct validity for SE and SS was demonstrated against IDF's Officer Personality Inventory (OPI) of Big Five dimensions, Anticipated Military Stress Scale (AMS-S) and Psychological Evaluation Scores (PES). Analysis of gender differences indicated higher SS scores for women than for men while no differences were found in SE scores. Discussion of these findings focuses on gender-related socialization. In men, PES were more strongly associated with SS than SE; in women, PES were more strongly associated with SE than SS. Discussion of these findings focuses on how psychologist evaluators may view resilience needs differently in male vs. female officers. This study furthers understanding of gender-related differences in the military setting. The new resilience scale enables more inclusive military personnel selection.
Abstract Recognizing the stressors that military families may face, the military offers educational programs to support families, including deployment/reintegration programs and financial programs. However, little research examines these commonly offered programs. Grounded in the Contextual Model of Family Stress (CMFS), this study addresses this gap, conceptualizing program use as a resource that may be impacted by families’ external contexts (i.e., demographic and military contextual characteristics) and associated with various indicators of well-being. This study was a secondary data analysis of cross-sectional data from 266 military families at one Army installation. A logistic regression path model was used to examine if the likelihood of program use varied by demographic and military contextual characteristics (e.g., number of deployments, PCS moves), and independent samples t-tests were conducted to assess mean differences in elements of military families’ well-being (e.g., financial well-being, anxiety). Demographic and military contextual characteristics (e.g., number of deployments and PCS moves) were associated with program use. Families that used financial programs had SMs with lower financial well-being and civilian spouses with marginally higher anxiety. The results indicate that programs providing standardized yet personalized content may be helpful for families, as well as suggest important directions for future research.
Recent reports show U.S. sailors have the highest rates of self-reported psychological health symptoms of any service, perhaps in part due to the unique challenges of serving in a shipboard environment. Resources are available to maximize the psychological health of sailors while at sea, though no empirical research is available regarding sailors’ perspectives on what strategies, services, and programs they find most helpful and accessible. To address this knowledge gap, thirteen focus groups were conducted with sailors from two different ships (n = 86) to determine how they manage stress and maximize psychological health while underway. Content analysis of focus group transcripts conducted by two independent reviewers identified themes within three content areas: strategies and resources to manage stress and maximize psychological health; challenges to accessing supportive services and resources; and opportunities to improve psychological health. Five themes emerged for managing stress underway, the most common of which was engaging in physical fitness. Others included participating in organized social events, general comradery and social support, seeking help from medical, and communicating with Chaplains. Social and logistical barriers to seeking psychological healthcare were identified, including stigma, fear of adverse career repercussions, and too few providers/long wait times. Suggestions for improving psychological health at sea included improving sleep health, changes to workload and scheduling, increased shipboard providers trained in psychological healthcare, and increased social support. Specific interventions that may benefit shipboard sailors are sleep health education, improvements to berthing areas, adoption of circadian watchbills, telemedicine, and an increased number of social events aboard ships.
Military healthcare providers experience a unique combination of occupational stressors, which put them at risk for adverse mental health outcomes. However, little attention has been devoted to organizational and incident stressors. The current study used a mixed-methods approach to examine organizational and incident stressors and their associations with mental health symptoms in a sample of Navy corpsmen. Participants completed qualitative interviews assessing workplace stressors, followed by a quantitative questionnaire that assessed organizational stressors, incident stressors, and mental health symptoms (i.e., depression, posttraumatic stress, and anxiety). Qualitative analyses revealed that corpsmen most commonly discussed themes associated with heavy workload, high level of responsibility, long work hours, lack of leadership support, and feelings of burden associated with the responsibility for saving the lives of others. Quantitative analyses revealed that organizational stressors were associated with depression symptoms and incident stressors were associated with posttraumatic stress symptoms. The results indicated that different types of stressors are associated with distinct mental health outcomes and highlighted modifiable contextual factors that could reduce distress among Navy corpsmen. Interventions that address organizational and incident stressors and enhance resilience would ensure that corpsmen are well-prepared to withstand stressors and provide quality care to their patients.
Many currently published studies examining elements of self- and team-efficacy in military personnel have not utilized military-specific assessments, thereby limiting the generalizability of their findings to the broader military population. The present study evaluates the factor structure and performance correlates of the Trainee Self-Efficacy Scale (TSES) and the Team-Efficacy and Training Climate Inventory (TETCI) in two samples of military trainees. Exploratory factor analysis was conducted in sample 1 (N = 481). Confirmatory factor analysis, measure validity, and structure validation were conducted in sample 2 (N = 442). Factor analysis results revealed the TSES was best represented by a three-factor correlated traits model including constructs related to performance confidence, performance uncertainty, and performance optimism. The TETCI was best represented by a two-factor correlated traits model including constructs related to team member efficacy and leadership climate. TSES subscales exhibited small or moderate correlations with assessments of soldier performance (e.g., physical fitness, land navigation, and confidence in rifle marksmanship) in the expected directions. The TETCI subscales exhibited small positive correlations with an assessment of team performance. Findings indicate that the TSES and TETCI are parsimonious measures (10 and 7-items, respectively) that have the potential to be useful tools for the continued assessment of military trainees.Keywords: Performancetrainee self-efficacyfactor analysismilitary psychologyinitial entry trainingpsychometric sciencesmall unit climateteam-efficacy AcknowledgmentsWe thank the Soldiers and leaders who gave their time to contribute to the completion of this project. Additionally, we thank the Directorate of Training and Doctrine Program Evaluation Office for substantial contributions to the development of the scale items and subsequent data collections.Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationFundingThe research described herein was performed by a team of Department of Army scientists and sponsored researchers. The work of the first author (BAM) was funded by the Consortium Research Fellows Program in support of the U.S. Army Research Institute for the Behavioral and Social Sciences (ARI).
