Moderating Effect of Marital Status on the Association Between Combat Exposure and Post-Deployment Mental Health in Canadian Military Personnel

For military personnel, there are positive and negative aspects of marriage, which may contribute to mental health during times of high stress. The present study investigated the relationship of marital status with three mental health outcomes (general mental health, posttraumatic stress disorder [PTSD], depression) among 14,624 Canadian military personnel recently deployed in support of the mission in Afghanistan. Greater combat exposure was associated with poorer postdeployment mental health, but marital status was, on its own, only slightly associated with PTSD. Marital status significantly moderated the relationship between combat exposure and mental health: For both single and married participants, mental health declined as combat exposure increased, but this association was stronger for married members. This association could be due to the additional familial demands that married personnel may face upon their return from deployment or to the stresses associated with poor marital satisfaction. Overall, results suggest that the relationship between marital status and mental health after deployment is complex and may vary according to other factors.     

The Role of Positive Emotions in Reducing Depressive Symptoms Among Army Wives

The homecoming period following combat deployment can be as stressful to military spouses as the deployment itself. This study used the broaden-and-build theory of positive emotions to examine whether personal resources (adaptive coping, maladaptive coping, and resilience) mediate the relationship between positive emotions and depressive symptoms in Army wives (N = 252) following the homecoming of a deployed active-duty service member. Using path analysis, after controlling for demographic variables and marital satisfaction, positive emotions were related to all 3 personal resources (positively to adaptive coping and resilience, negatively to maladaptive coping). In turn, adaptive coping and resilience were related to fewer depressive symptoms and maladaptive coping to greater depressive symptoms. The direct path between positive emotions and depressive symptoms was nonsignificant, suggesting complete mediation. The final model accounted for 54% of the total variance in depressive symptoms. Results support the important role that positive emotions play in decreasing depressive symptoms in this high-risk population.     

Factors associated with antisocial behavior in combat veterans

The objective of this study was to identify factors associated with antisocial behavior in 1,543 Marines who deployed to combat zones in support of conflicts in Iraq and Afghanistan during 2002–2007. Five factors were associated with antisocial behavior in multivariate analyses: post‐traumatic stress disorder (PTSD) symptoms, deployment‐related stressors, combat exposure, younger age, and being divorced. PTSD symptoms had a stronger association with antisocial behavior than any other variable. A unique and important finding of this study was the association between deployment‐related stressors and a higher incidence of antisocial behavior. Because deployment‐related stressors are potentially modifiable, the military may be able to address them in concrete ways such as by shortening deployments and improving communication with home. Aggr. Behav. 36:330–337, 2010. Published 2010 by Wiley‐Liss, Inc.     

The Role of Natural Support Systems in the Post-deployment Adjustment of Active Duty Military Personnel

This study examined the relations among three different types of naturally occurring social support (from romantic partners, friends and neighbors, and unit leaders) and three indices of service member well‐being (self reports of depressive symptoms, satisfaction with military life, and perceptions of unit readiness) for service members who did and did not report negative experiences associated with military deployment. Data were drawn from the 2011 Community Assessment completed anonymously by more than 63,000 USAF personnel. Regression analyses revealed that higher levels of social support was associated with better outcomes regardless of negative deployment experiences. Evidence of moderation was also noted, with all forms of social support moderating the impact of negative deployment experiences on depressive symptoms and support from unit leaders moderating the impact of negative deployment experience on satisfaction with military life. No moderation was found for perceptions of unit readiness. Subgroup analyses revealed slightly different patterns for male and female service members, with support providing fewer moderation effects for women. These findings may have value for military leaders and mental health professionals working to harness the power of naturally occurring relationships to maximize the positive adjustment of service members and their families. Implications for practices related to re‐integration of post‐deployment military personnel are discussed.     

Buffering Effects of Benefit Finding in a War Environment

Benefit finding (BF) has been extensively examined after exposure to traumatic events. However, less research has examined BF as a buffer against the negative effects of an ongoing stressful event. Data from 1,925 U.S. Army soldiers deployed in support of Operation Iraqi Freedom (OIF) was used to examine whether BF would moderate the relationship between combat exposure and posttraumatic stress disorder (PTSD) and depression. Regression analyses revealed that BF was associated with lower levels of PTSD and depression. However, we found that BF during the combat deployment was found to moderate the combat exposure–PTSD relationship, such that the relationship was stronger when BF was low. Results are discussed in terms of BF being a form of meaning-based coping that may help soldiers adjust to the challenges of war.     

Long-Term Trajectories and Service Needs for Military Families

The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.     

Testing a Military Family Stress Model

The current study examines a military family stress model, evaluating associations between deployment‐related stressors (i.e., deployment length/number, posttraumatic stress disorder [PTSD] symptoms) and parent, child, parenting, and dyadic adjustment among families in which a parent had previously deployed to Iraq or Afghanistan in the recent conflicts. Married families (N = 293) with at least one child between the ages of 4 and 12 were recruited from a Midwestern state. Service members were from the Reserve Component (National Guard or Reserves); fathers (N = 253) and/or mothers had deployed (N = 45) to the recent conflicts in the Middle East. Multiple‐method (observations of parenting and couple interactions; questionnaires) and multiple informant measures were gathered online and in the homes of participants, from parents, children, and teachers. Findings demonstrated associations between mothers’ and fathers’ PTSD symptoms and a latent variable of child adjustment comprising teacher, parent, and child report. Mothers’ but not fathers’ PTSD symptoms were also associated with dyadic adjustment and parenting practices; parenting practices were in turn associated with child adjustment. The results are discussed in terms of their implications for military family stress research and interventions to support and strengthen parents and families after deployment.     

Helping military families through the deployment process: Strategies to support parenting

Recent studies have highlighted the impact of deployment on military families and children and the corresponding need for interventions to support them. Historically, however, little emphasis has been placed on family-based interventions in general, and parenting interventions in particular, with returning service members. This paper provides an overview of research on the associations between combat deployment, parental adjustment of service members and spouses, parenting impairments, and children's adjustment problems, and provides a social interaction learning framework for research and practice to support parenting among military families affected by a parent's deployment. We then describe the Parent Management Training-Oregon model (PMTO(?)), a family of interventions that improves parenting practices and child adjustment in highly stressed families, and briefly present work on an adaptation of PMTO for use in military families (After Deployment: Adaptive Parenting Tools, or ADAPT). The article concludes with PMTO-based recommendations for clinicians providing parenting support to military families.     

Intensive Outpatient Program Using Prolonged Exposure for Combat-Related PTSD: A Case Study

Although prolonged exposure (PE) has been identified as a first-line treatment for posttraumatic stress disorder (PTSD), research has found that military service members and veterans have smaller reductions in symptom severity compared to civilians. The nature of trauma in a deployed combat setting and the unique complexities of military culture have been proposed as explanations for greater rates of PTSD and poorer treatment response to first-line psychotherapies in military and veteran populations. This paper presents a case study to highlight how a novel, intensive outpatient program utilizing prolonged exposure therapy (IOP-PE) may benefit military personnel with combat-related PTSD. The patient is a Caucasian man in his early 40s seeking treatment for PTSD after more than 10 years of enlisted, active duty military service across two branches and three combat deployments. The IOP-PE includes the standard PE components and eight, nonstandard treatment augmentations tailored for military personnel. In contrast to standard PE, which typically is delivered weekly over several months, IOP-PE consists of 15 daily, 90-minute PE sessions conducted over 3 weeks. The patient demonstrated large reductions on the Clinician-Administered PTSD Scale (28 points) and PTSD Checklist (48 points) by the 6-month posttreatment follow-up point. Findings provide support for conducting further research that determines whether IOP-PE is effective and tolerable in military and veteran populations.     

Jewish Physicians’ Beliefs and Practices Regarding Religion/Spirituality in the Clinical Encounter

We used data from a 2003 survey of US physicians to examine differences between Jewish and other religiously affiliated physicians on 4-D of physicians’ beliefs and practices regarding religion and spirituality (R/S) in the clinical encounter. On each dimension, Jewish physicians ascribed less importance to the effect of R/S on health and a lesser role for physicians in addressing R/S issues. These effects were partially mediated by lower levels of religiosity among Jewish physicians and by differences in demographic and practice-level characteristics. The study provides a salient example of how religious affiliation can be an important independent predictor of physicians’ clinically-relevant beliefs and practices.     

Factors Associated With Physical Aggression Among US Army Soldiers

There are a growing number of studies that have approximated levels of aggression and associated outcomes among combat veterans returning from Iraq and Afghanistan using brief screening assessments. However, further research to evaluate the relative role of combat exposures and overt physical behaviors is required to further elucidate potential associations between military service, combat deployment, and overt physical aggression. The purpose of the current study was to assess the prevalence of self‐reported physical aggression in a sample of US Army soldiers using an adaptation of the Revised Conflict Tactics Scale (CTS2), and examine factors associated with higher levels of aggression. A population‐based cross‐sectional study was conducted at a single US Army Installation within a sample of active duty US Army soldiers (n = 6,128) from two large units. Anonymous surveys were collected 6 months following deployment to measure overt aggressive behaviors, posttraumatic stress disorder, anxiety, depression, traumatic brain injury, and misuse of alcohol. There were a relatively higher number of minor and severe physical overt aggressive actions reported among soldiers who previously deployed, notably highest among deployed soldiers reporting the highest levels of combat intensity. Soldiers screening positive for the misuse of alcohol were also significantly more likely to report relatively higher levels of physical aggression. This study quantified overt aggressive behaviors and associated factors, showing increasing combat exposures may result in increased physical aggression. Clinicians treating service members returning from combat may consider assessing relative levels of combat. Aggr. Behav. 38:357‐367, 2012. Published 2012 Wiley Periodicals, Inc.?     

Military Influence Tactics: Lessons Learned in Iraq and Afghanistan

When deployed U.S. soldiers attempt to influence the attitudes, beliefs, or behaviors of civilians, success can save lives and failure can be deadly. Survey data from 228 military personnel with deployment experience to Iraq and Afghanistan revealed that in a challenging wartime environment, empathy, respect, prior relationships, and familiarity with influence targets predicted success in cross-cultural influence attempts. Influence techniques involving resources and positive feelings were used more commonly in relatively successful influence attempts; negative tactics were used more commonly in unsuccessful attempts.     

The Army's New Unit Personnel Replacement and Its Relationship to Unit Cohesion and Social Support

A recent concern of the U.S. Army's top leadership has been the deterioration of morale and cohesion in combat arms units. High personnel turnover in U.S. Army units has been viewed as a primary factor contributing to decreased unit cohesiveness. The current and traditional U.S. Army Indi- vidual Replacement (IR) System trained, assigned, and deployed soldiers to units as individuals. As a result, IR units have had as much as 45% personnel turnover annually. The new Unit Replacement (UR) System trained, assigned, and deployed soldiers as intact groups for the entire first-term soldier's enlistment. The objective of the study was to examine the effects of unit replacement on cohesion and to elaborate on the function of cohesion by examining the relationship between cohesion and social support in a sample of 3,245 soldiers in 43 line companies matched by type of replacement, type of combat arms, and stateside/overseas deployment. Soldiers in UR units in which soldiers had previously undergone Basic and Advanced Individual Training together or had their personnel stabilized reported a significantly higher level of cohesion than did soldiers in IR units. This difference persisted even when personal and unit characteristics were held constant in compari- sons. In terms of social support, UR soldiers cited more support providers in their units than did IR soldiers. Perceived satisfaction with social support and perceived helpfulness of social support provided by unit members were significantly and positively correlated with the cohesion measures, irrespective of the type of replacement. Whereas reciprocity was significantly and positively related to cohesion in commonly trained UR and IR units, it was nonsignificantly related to cohesion in personnel-stabilized UR units. Impli- cations of results for the expected effects of cohesion on the quality of interpersonal relations among unit members are discussed.     

Relational coping during deployment: Managing communication and connection in relationships

Wartime deployment involves prolonged separation and creates uncertainty, fear, and disorganization in families (M. J. Peebles‐Kleiger & J. H. Kleiger, 1994). This study examined how military wives/fiancées reported coping with the demands they associated with spousal deployment. Twenty‐six in‐depth interviews were conducted with wives and fiancées whose partners were currently deployed. Through qualitative analysis, 2 main coping themes emerged: (a) maintaining a mediated interpersonal connection and (b) choosing open versus restricted communication. Further analyses revealed that the former theme promoted 2 relationship functions (e.g., intimacy and positivity, confronting realities and fears) and the latter 4 functions (e.g., closeness, smooth reunion, outlet, and protection). On the basis of these coping strategies and functions, a conceptual framework for understanding relational coping communication patterns is proposed. Themes, practical applications, and theoretical implications are discussed.     

A Nonrandomized Trial of Prolonged Exposure and Cognitive Processing Therapy for Combat-Related Posttraumatic Stress Disorder in a Deployed Setting

For many decades, the U.S. military’s general operational guideline has been to limit the use of trauma-focused treatments for combat and operational stress reactions in military service members until they have returned from deployment. Recently, published clinical trials have documented that active-duty military personnel with combat-related posttraumatic stress disorder (PTSD) can be treated effectively in garrison. However, there are limited data on the treatment of combat and operational stress reactions or combat-related PTSD during military deployments. This prospective, nonrandomized trial evaluated the treatment of active-duty service members (N = 12) with combat and operational stress reactions or combat-related PTSD while deployed to Afghanistan or Iraq. Service members were treated by deployed military behavioral health providers using modified Prolonged Exposure (PE; n = 6) or modified Cognitive Processing Therapy (CPT; n = 6), with protocol modifications tailored to individual mission requirements. The PTSD Checklist–Military Version (PCL-M) total score was the primary outcome measure. Results indicated that both groups demonstrated clinically significant change in PTSD symptoms as indicated by a reduction of 10 points or greater on the PCL-M. Participants treated with modified PE had significant reductions in PTSD symptoms, t = -3.83, p = .01; g = -1.32, with a mean reduction of 18.17 points on the PCL-M. Participants treated with modified CPT had a mean PCL-M reduction of 10.00 points, but these reductions were not statistically significant, t = -1.49, p = .12; g = -0.51. These findings provide preliminary evidence that modified forms of PE and CPT can be implemented in deployed settings for the treatment of combat and operational stress reactions and combat-related PTSD.     

The impact of posttraumatic growth,transformational leadership,and self-efficacy on PTSD and depression symptom severity among combat Veterans

Previous research has established self-efficacy as essential to postdeployment adjustment among Veterans, and perceived transformational leadership is well known for its positive effects on follower outcomes across contexts. However, little is known regarding how transformational leadership may relate to posttraumatic growth and self-efficacy in fostering psychological wellbeing among combat Veterans. The purpose of this study was to examine the role of transformational leadership in predicting posttraumatic stress disorder (PTSD) and depression symptoms among combat Veterans, as well as how posttraumatic growth and postdeployment coping self-efficacy may influence these relations. The study sample consisted of 130 combat Veterans recruited from a university, Veterans Affairs medical center, and the greater community. Path analysis based on bootstrapped resampling revealed postdeployment coping self-efficacy and perceived transformational leadership as predictors of lower PTSD and depression symptom severity. In addition, mediation modeling revealed that postdeployment coping self-efficacy mediated the relation between transformational leadership and both PTSD and depression, while posttraumatic growth did not predict PTSD symptoms. These findings may aid in the prediction of PTSD and depression symptoms among Veterans, which may then influence pre-deployment leadership training among military personnel as well as clinical treatment protocols for Veterans.     

The Coping Self-Efficacy Scale: Psychometric properties in an outpatient sample of active duty military personnel

ABSTRACT

Active duty military service members endure a unique constellation of stressors while deployed or at home. Yet, assessment of protective factors against these stressors among active duty service members represents an under studied area. The present study advances the assessment of protective factors through the psychometric evaluation of the Coping Self-Efficacy Scale (CSES) in a clinical sample of military service members in mental health or substance abuse treatment (n = 200). Cross-sectional data were drawn from military medical records and a supplemental self-report questionnaire. Data extracted included demographic (e.g., sex, age), military characteristics (e.g., rank, years in service), physical health and mental health (e.g., anxiety, depression), and coping self-efficacy. Findings suggest a 3-factor (i.e., problem-focused coping, thought-stopping, and getting social support) CSES structure with acceptable internal consistency. Further, there were small-to-moderate associations with physical and mental health outcomes, providing evidence of construct validity. There were few significant associations with military-related characteristics. Finally, controlling for covariates, thought-stopping beliefs explained unique variance in suicide-related behaviors. Together, findings support the use of the CSES to measure coping-related beliefs in military service members. Recommendations are offered for future research and practice with active duty service members.     

Deployment‐Related Benefit Finding and Postdeployment Marital Satisfaction in Military Couples

Extensive research has evaluated potential negative effects of military deployments on romantic relationships. Comparatively few studies have examined potential positive effects of such deployments. In stressful situations, benefit finding (BF) has been found to be linked with better functioning on both individual and interpersonal levels. This study reports on deployment‐related BF in a sample of 67 male service members (SMs) who deployed at least once since 9/11/2001 and their wives. Couples completed measures of marital satisfaction at baseline (an average of 1 year postdeployment) and follow‐up 4–6 months later. At follow‐up, SMs also provided data on symptoms of posttraumatic stress, and both partners provided reports of deployment‐related BF. Multivariate path analysis controlling for SMs' PTSD symptom severity revealed that wives' BF was positively associated with increases in SMs' relationship satisfaction. These findings suggest that wives' responses to deployment may be more influential than SMs' responses to deployment on military couples' relationships. This pattern indicates that support for spouses during deployments is essential; furthermore, such support should include an emphasis on trying to facilitate personal growth in spouses.     

Experiences in the War Zone,Shared Narratives,and Shifting Identities: Systematic Review of Qualitative Research

This systematic review examines qualitative research into the mental health issues encountered by military veteran personnel deployed to a combat zone. A small number of researchers have examined the often information-rich and complex experiences of returning personnel using a qualitative approach to data collection and analysis. However, qualitative studies have not often been appraised or synthesized. Using a qualitative method for conducting systematic review, the objectives of this article are twofold: (a) to review select research literature on veteran military populations, and (b) to describe veteran's experiences using a synthesis of themes across original qualitative research. Findings are discussed with considerations for applying qualitative research methods to future research of military service populations and implications for the provision of care.     

Deployment Stress and Well-Being Among Military Spouses: The Role of Social Support

The demands of military service, including the intensity and frequency of military operations, can have numerous effects on military families. Evidence suggests that spousal support may play an important role in the resiliency of military families. The present study examined the roles of deployment stress and social support in the psychological well-being of spouses of deployed military personnel (N = 639). The results showed that deployment stress and perceived social support from family, nonmilitary friends, and military partner played independent roles in the psychological wellbeing of military spouses. This evidence suggests the importance of taking perceived social support into account when explaining the variance in the psychological wellbeing of military spouses. Results are discussed in light of some methodological constraints, and the potential implications related to heightening families’ perceptions of interpersonal relationships are emphasized.