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Prior research has identified behavioural health outcomes as key sequelae to combat deployment. However, relatively little is known about differential patterns of change in depression or generalised anxiety linked to deployment to a combat zone. In this paper, we add to the existing trajectory literature and examine key predictive factors of behavioural health risk.
The primary aim is to leverage growth mixture modelling to ascertain trajectories of psychological distress, operationalised as a coherent construct combining depression and generalised anxiety, and to identify factors that differentiate adaptive and maladaptive patterns of change.
Data were collected from a brigade combat team prior to a combat deployment to Afghanistan, during deployment, at immediate re-integration and approximately 2–3 months thereafter. The main outcome was measured using the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS).
Three latent trajectories were identified: a low–stable trajectory, a declining trajectory and a rising trajectory. Most individuals aligned with the low–stable trajectory. A conditional model using covariates measured during deployment showed that the low–stable trajectory differed consistently from the remaining trajectories on self-reported loneliness and non-combat deployment stressors.
The examination of differential patterns of adaptation, to identify individuals at higher risk, is critical for the efficient targeting of resources. Our findings further indicate that loneliness may be a useful leverage point for clinical and organisational intervention.
Occupational groups operating in dangerous environments may witness the development of acute stress reaction (ASR) in team members. Witnessing ASR in team members may increase the risk of developing subsequent post-traumatic stress disorder (PTSD) symptoms.
To describe ASR symptoms that individuals witness, assess the relationship between witnessing a team member exhibiting ASR symptoms and an individual's own PTSD symptoms, and describe common intervention responses by peers.
Cross-sectional, anonymous surveys were conducted with US soldiers who were previously deployed (sample 1; n = 176) and currently deployed sample 2; n = 497). Surveys assessed combat experiences, PTSD (PTSD Checklist-5), ASR exposure and intervention responses. Analyses included frequencies and binary logistic regression.
Witnessing at least one ASR symptom during a combat-related event was reported by 51.7% in sample 1 and 42.4% in sample 2; the most commonly observed symptoms were being unable to function or being detached. Controlling for combat experiences, high levels of witnessing a team member exhibit ASR symptoms was associated with increased risk of subthreshold PTSD or PTSD in sample 1 (odds ratio (OR) = 8.69, 95% CI 2.29–42.60) and approached significance in sample 2 (OR = 1.67, 95% CI 0.98–2.81). Common intervention responses included providing a directive or yelling; many also reported being unsure how to respond.
Witnessing team members who exhibit ASR symptoms appears to be associated with screening positive for subthreshold PTSD or PTSD. Results suggest the need for further research into how to prepare individuals to manage ASR in team members and to examine ASR in other high-risk occupations.
Although research has documented factors influencing whether military personnel seek treatment for mental health problems, less research has focused on determinants of treatment-seeking for physical health problems.
To explicitly compare the barriers and facilitators of treatment-seeking for mental and physical health problems.
US soldiers (n = 2048) completed a survey with measures of barriers and facilitators of treatment-seeking for mental and physical health problems as well as measures of somatic symptoms and mental health.
The top barrier for both mental and physical health treatment-seeking was a preference for handling problems oneself. The top facilitators for both symptom types were related to treatment improving quality of life. Differential endorsement of barriers occurred for treatment of mental versus physical health symptoms. In contrast, facilitators were endorsed more for physical than for mental health treatment. While there were few gender differences, officers reported more barriers and facilitators than did enlisted personnel. Screening positive for mental or physical health problems was associated with greater endorsement of both barriers and facilitators for physical and mental health treatment, respectively.
The leading barriers and facilitators for seeking treatment for mental health and physical problems are relatively similar, suggesting that health education should consider decision-making in seeking both mental and physical healthcare. Interventions should be tailored to reduce barriers for officers and improve facilitators for junior enlisted personnel, and address barriers and facilitators for service members screening positive for a mental or physical health problem.
Studies with members of the armed forces have found a gap between reports
of mental health symptoms and treatment-seeking.
To assess the impact of attitudes on treatment-seeking behaviours in
soldiers returning from a combat deployment.
A sample of 529 US soldiers were surveyed 4 months (time 1) and 12 months
(time 2) post-deployment. Mental health symptoms and treatment-seeking
attitudes were assessed at time 1; reported mental healthcare visits were
assessed at time 2.
Factor analysis of the total time 1 sample revealed four attitude
factors: professional concerns, practical barriers, preference for
self-management and positive attitudes about treatment. For the subset of
160 soldiers reporting a mental health problem at time 1, and controlling
for mental health symptom severity, self-management inversely predicted
treatment-seeking; positive attitudes were positively related.
Results demonstrate the importance of broadening the conceptualisation of
barriers and facilitators of mental healthcare beyond stigma. Techniques
and delivery models emphasising self-care may help increase soldiers'
interest in using mental health services.
Research of military personnel who deployed to the conflicts in Iraq or
Afghanistan has suggested that there are differences in mental health
outcomes between UK and US military personnel.
To compare the prevalence of post-traumatic stress disorder (PTSD),
hazardous alcohol consumption, aggressive behaviour and multiple physical
symptoms in US and UK military personnel deployed to Iraq.
Data were from one US (n = 1560) and one UK
(n = 313) study of post-deployment military health of
army personnel who had deployed to Iraq during 2007–2008. Analyses were
stratified by high- and low-combat exposure.
Significant differences in combat exposure and sociodemographics were
observed between US and UK personnel; controlling for these variables
accounted for the difference in prevalence of PTSD, but not in the total
symptom level scores. Levels of hazardous alcohol consumption (low-combat
exposure: odds ratio (OR) = 0.13, 95% CI 0.07–0.21; high-combat exposure:
OR = 0.23, 95% CI 0.14–0.39) and aggression (low-combat exposure: OR =
0.36, 95% CI 0.19–0.68) were significantly lower in US compared with UK
personnel. There was no difference in multiple physical symptoms.
Differences in self-reported combat exposures explain most of the
differences in reported prevalence of PTSD. Adjusting for self-reported
combat exposures and sociodemographics did not explain differences in
hazardous alcohol consumption or aggression.
For learning to take place with any kind of efficiency students must be motivated. To be motivated, they must become interested. And they become interested when they are actively working on projects which they can relate to their values and goals in life.
Gus Tuberville, President, Penn College
There is no debate that combat places tremendous psychological and physical demands on those involved. And as we learn more about how combat affects the psychological well-being of those involved, a set of central questions emerge. What can we do to prepare service members for the psychological demands of combat? What can we do to sustain the mental health and well-being of those deployed in a combat environment? What can we do to facilitate the return of these service members from the combat environment to home? In short, what do service members need to know about how combat can affect them?
In response to these questions, the US Army developed the Battlemind Training System, a mental health resilience building program (US Army Medical Command, 2007). This system established several fundamental principles of mental health training, identified key implementation principles, and defined several important terms. Throughout this chapter, the Battlemind Training System will be used as an exemplar to highlight how a military mental health training program can be created that employs theses principles of mental health training and implementation.
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