Military occupation as a moderator between combat exposure and posttraumatic stress disorder symptoms in US Army personnel

ABSTRACT

Military occupational designations are standardized classifications that help define and convey a service member’s expected duties and responsibilities. The present study examined how occupational designation was related to adverse combat-reactions, specifically posttraumatic stress disorder (PTSD). It was hypothesized that at comparable levels of combat, non-combat units would display greater symptomology than combat units. The study sample consisted of 785 combat-deployed, active-duty enlisted US Army personnel. Participants were administered self-report questionnaires, including the Combat Experiences Scale and PTSD Checklist for DSM-5. Occupation was coded using the three-branch system (i.e., Operations, Support, & Force Sustainment). Hierarchical multiple linear regression (MLR) was run to examine the effect of occupation, combat, and unit cohesion on PTSD symptoms. Operations units reported the highest frequency of combat exposure; however, Force Sustainment units displayed the highest PTSD symptoms. In MLR analysis, there was a significant interaction between Force Sustainment units and combat exposure (β = 0.10, p = .019), that was not observed in Operations or Support units. These findings demonstrate that PTSD symptom intensity is not solely a function of combat exposure, and that non-combat units may react differently when exposed to elevated levels of combat.     

Marital intimacy,family support,and secondary traumatization: A study of wives of veterans with combat stress reaction

Abstract

The main aim of the study was to assess the role of family variables in the process of secondary traumatization among wives of post-traumatic veterans. We compared a sample of 49 wives of Israeli veterans with combat stress reaction (CSR) from the 1982 Lebanon War with a sample of 31 wives of Israeli veterans who fought in the war without developing CSR. We assessed their psychological reactions to the war, their health status six years later, and their reported levels of marital intimacy and family support after the war. When compared with controls, wives of veterans with CSR reported more negative emotions and lower perceived intimacy after the war, and greater severity of psychiatric and somatic symptoms six years later. Results also indicate that the greater the perceived marital intimacy, the less the negative emotions wives of veterans with CSR felt after the war and the better their health status six years later. In addition, wives of veterans with CSR who reported having received more support from their families after the war reported more anxiety and hostility than wives who received less support. The roles of marital intimacy and family support in the process of secondary traumatization were discussed.     

Personal Growth of Mothers of Preterms: Objective Severity of the Event,Subjective Stress,Personal Resources,and Maternal Emotional Support

This prospective study investigated the personal growth of Israeli mothers of premature babies at two medically defined risk levels (infants at low risk, n = 42; infants at moderate-high risk, n = 52), examining the contribution to the five dimensions of personal growth of objective event characteristics (baby’s risk level), perceived levels of mother’s stress (linear and curvilinear associations), and mother’s personal resources (self-esteem, attachment styles, perceived emotional support from her own mother). In addition, the role of the event severity as a moderator of the association between perceived maternal emotional support and personal growth was explored. Findings indicate that mothers in the two risk groups did not differ in level of perceived stress. Mothers of infants at moderate-high risk, however, experienced more spiritual change. In addition, consistent curvilinear associations emerged between perceived levels of stress and personal growth for three dimensions of growth: new possibilities, personal strength, and relations with others (with a similar trend for appreciation of life). Thus, mothers reporting moderate stress levels experienced the highest personal growth. Finally, risk group played a moderating role in the association between perceived maternal emotional support and personal growth on the dimensions of new possibilities, personal strength, and relations with others. On these dimensions, only among mothers of low-risk babies were higher levels of maternal emotional support associated with greater personal growth. The results highlight the importance of the subjective experience and the value of maternal emotional support for the personal growth of mothers of preterms. These findings may help in designing measures to identify populations at risk and developing appropriate interventions, as well as impact on the working procedures and support currently offered in most neonatal intensive care units.     

Combat Stressors Predicting Perceived Stress Among Previously Deployed Soldiers

While combat exposures are considered principle stressors in developing mental health problems, research suggests social support can reduce this risk. Using data from 1,592 previously deployed soldiers, we found five classes of soldiers based on their patterns of responses to items measuring perceived stress. In subsequent analyses, we found increased combat exposure predicted membership in classes with greater combat-related stress, while greater unit cohesion predicted membership in classes with lower perceived stress. Also, greater willingness to report misconduct predicted greater unit cohesion. Results suggest that unit cohesion plays a vital role in the reduction of perceived stress among soldiers.     

Effects of social support and battle intensity on loneliness and breakdown during combat

A sample of 382 Israeli soldiers who developed combat stress reactions (CSR) during the 1982 Israel-Lebanon War were compared with groups of carefully matched controls who did not develop CSR. Lack of social support from officers was found to be related to greater feelings of loneliness and greater likelihood of CSR in soldiers. Lack of social support from buddies was found to be related to greater loneliness. Intensity of battle was also found to be related to greater feelings of loneliness and increased likelihood of CSR. A path model was tested and supported. The model suggests that battle intensity and officer support lead to CSR directly and indirectly by causing increased feelings of loneliness. Possible cognitive and psychodynamic explanations for the findings are offered. The limitations of making causal statements from retrospective perceptions is discussed.     

Moral Dilemmas in Military Situations: Proportionality Principle,Religiosity, Political Attitudes,and Authoritarian Personality

The current study focuses on a moral dilemma in military situations: the amount of force to be used in order to neutralize a “most wanted” terrorist. This study examines the association between this moral dilemma with 4 independent variables: agreement with the proportionality principle (mediating variable), level of religiosity, authoritarian personality, and political attitudes. Three equal groups of participants (together, N = 357) were included: Israeli regular army combat soldiers, Israeli reserve combat soldiers, and Israeli students. In accordance with the study hypotheses, the 4 independent variables significantly correlated with each other and with moral decisions. Structural equation modeling indicated that agreement with the proportionality principle is the best predictor of moral decision, and mediated the association between level of religiosity and political attitudes and moral decisions.     

Neighborhood Context and Perceptions of Stress Over Time: An Ecological Model of Neighborhood Stressors and Intrapersonal and Interpersonal Resources

We examine the association between neighborhood socio-economic disadvantage and perceived stress during middle and late adolescence among African American youth (N = 665; 51 % female; M = 15.9 years at baseline). In addition, we explored the ways through which neighborhood stressors interacted with an individual’s intra- and interpersonal resources (e.g., coping, social support and substance use), to affect their perceived stress trajectories during adolescence. First, we tested a neighborhood stressors model and found that youth who lived in neighborhoods with greater socioeconomic disadvantage had higher baseline stress and a steeper increase in stress over time. When we included individual-level risk and promotive factors in the model, however, the effect of neighborhood disadvantage on perceived stress was no longer significant, and the stress trajectory was explained by adolescent substance use, social support and perceptions of the neighborhood. Our results support theories of stress and coping, and the importance of proximal intra- and interpersonal factors in either amplifying or mitigating perceptions of stress. We discuss implications of the neighborhood context and how our findings may inform future prevention and intervention related to adolescent stress and development.     

Sexual well-being and perceived stress in couples transitioning to parenthood: A dyadic analysis

Background/ObjectiveThe transition to parenthood encompasses several psychological and relational changes that might contribute to couples’ high levels of stress postpartum. Although common across the postpartum, couples’ sexual changes are frequently overlooked.MethodWe surveyed 255 mixed-sex new parent couples to examine the associations between sexual well-being—sexual satisfaction, desire, and postpartum sexual concerns—and perceived stress postpartum. Couples completed self-report questionnaires assessing perceived stress and sexual well-being.ResultsFor both mothers and fathers, greater sexual satisfaction was associated with their partners’ lower perceived stress and, for fathers, this was also associated with their own lower perceived stress. For mothers, greater partner-focused sexual desire was associated with their own lower perceived stress whereas, for fathers, greater partner-focused sexual desire was associated with their partners’ higher perceived stress. In addition, greater solitary sexual desire and postpartum sexual concerns were associated with both parents’ own higher perceived stress.ConclusionsThis study highlights the association between sexual well-being and couples’ postpartum stress, suggesting that more positive sexual experiences are linked to lower perceptions of stress across this vulnerable period. Couples’ sexual well-being may be an important target for interventions aimed at helping postpartum couples cope with stress.     

Positive impact of prior military combat exposure on Terrorism Prevention work: Inoculation to stress

Forty-four Israeli security agents employed by the Israeli Government Terrorism Prevention Agency providing security services for the national Israeli airlines and the Israeli Consulate in Los Angeles were administered the Subjective Stress Experience Scale (SSES). This scale measures stress at terrorism-prevention work, past stress during combat exposure, and subjects’ most stressful life events. Results support the hypothesis that terrorism prevention personnel who are also combat veterans appraise their work as less stressful than their noncombat exposed counterparts. Combat veterans also rated their combat experience as significantly more stressful than prevention team member’s other stressful life events. Subjects presented a uniform stress- inoculation effect but, combat veterans of the prevention team were more stress-inoculated than their noncombat exposed counterparts.     

Moral Dilemma in the War against Terror: Political Attitudes and Regular Versus Reserve Military Service

The current study examines moral dilemmas related to the war against terror: the amounts of force used to arrest or harm a “most wanted” terrorist: the greater the use of force, the higher the risk for harming civilians and the lower the risk to the soldiers and vice versa. The study focuses on the association between moral decisions, confidence, and level of difficulty in making the decisions and political attitudes among Israeli Defense Forces soldiers. In addition, the study examines the differences between regular (202) and reserve (144) combat infantry soldiers regarding these variables. According to study hypotheses results indicate (a) more right-wing political attitudes predicted greater use of force and fewer difficulties in making moral decisions, and (b) reserve soldiers reported higher use of fire, higher confidence, and lower level of difficulty in making moral decisions compared with regular soldiers.     

大学生特质焦虑与网络成瘾的关系:一个有调节的中介模型

通过对530名大学生的问卷调查,考察特质焦虑、压力知觉、未来时间洞察力和网络成瘾之间的关系。结果发现：（1）压力知觉在特质焦虑和网络成瘾之间起部分中介作用,特质焦虑既对网络成瘾产生直接影响,也通过压力知觉产生间接影响;（2）未来时间洞察力对压力知觉的中介作用起调节作用,压力知觉对网络成瘾的影响随着个体未来时间洞察力的增加而减少。大学生特质焦虑、压力知觉、未来时间洞察力和网络成瘾共同构成一个有调节的中介模型。     

Trust and Influence in Combat: An Interdependence Model

Two studies tested an interdependence model of trust development and the links between trust and influence in the in extremis environment of combat, and a non-combat replication. Structural equation modeling was used to test the model. Results from both studies suggested that a modified interdependence model provided a plausible explanation for how leaders may earn subordinate trust, through fostering the establishment of cooperative interdependence and being perceived as credible. Credibility was demonstrated through both competence and good character, and organizational structures that were in place contributed to trust by encouraging leaders to behave cooperatively toward group members. Most importantly, the level of trust subordinates had in their leaders determined the amount of leader influence subordinates accepted.     

Work addiction is associated with increased stress and reduced quality of life: Validation of the Bergen Work Addiction Scale in Danish

Addiction to work is defined as a compulsion or an uncontrollable need to work incessantly. Only few measures exist to identify work addiction and the health consequences are sparsely explored. The Bergen Workaholic Scale (BWAS) measures seven core elements of work addiction and has been used in Norway, Hungary, Brazil, Italy, USA and Poland. The aim of this study was to validate the BWAS in a Danish sample and to investigate if high risk of work addiction was associated with stress and reduced quality of life. We conducted an online screening survey with 671 participants aged 16–68 years with the Danish translation of the BWAS. We added the perceived stress scale (PSS) and the quality of life scale EQ‐5D‐5L. Those with high risk of work addiction reported significantly higher mean PSS scores (20.0 points) compared to those with low risk of addiction (12.5 points) and poorer quality of life (61.9) compared to the low risk group (81.3). Furthermore, work addiction was associated with more weekly working hours (44.0 vs. 35.6 hours/week) and having more leadership responsibility. A preliminary estimate of work addiction prevalence was 6.6%. The BWAS demonstrated good reliability (α = 0.83), and factor analyses pointed at a single factor structure. Work addiction seems to be associated with health problems in terms of stress and poorer quality of life. The BWAS is recommended as a reliable and valid tool to identify work addiction in Danish.     

Pavlovian eyeblink conditioning in combat veterans with and without post-traumatic stress disorder

Several recent studies have investigated relationships between post-traumatic stress disorder (PTSD) and learning and memory problems. These reports have found in general that not only does PTSD affect trauma-related memories, but when patients with PTSD are compared with similar trauma patients without PTSD, general memory impairments have been found. The present paper reports a study in which associative learning, using Pavlovian eyeblink conditioning, was investigated in combat veterans with and without chronic PTSD, using interstimulus intervals of 500 and 1000 msec in two separate experiments. Although several recent reports suggest that larger-magnitude autonomic conditioned responses occur in patients with PTSD during Pavlovian conditoning, the present study found evidence of impaired Pavlovian eyeblink conditioning in combat veterans with and without PTSD, compared to non-combat veterans. Although these data suggest that combat leads to an impaired associative learning process regardless of whether PTSD is apparent, a group of community-dwelling combat veterans not under medical treatment showed normal conditioning, suggesting that variables other than prior combat must also be involved.     

Children's Affective Reactions and Coping Under Threat of Missile Attack: A Semiprojective Assessment Procedure

This study reports on 170 Israeli school children at risk for missile attack during the Persian Gulf War, The Bar-Ilan Picture Test for Children (Itskowitz & Strauss, 1982, 1986) was specially adapted to the war situation specifically to measure children's affective reactions and coping strategies. Children with a greater sense of control and social support, and more complex defenses, tended to demonstrate better coping strategies. Children who were less defensive showed higher levels of anxiety under stress. Children scoring higher in social support showed greater perceived control over their immediate environment and more verbal expressivity with respect to the crisis situation. Girls scored higher than boys on emotional and verbal expressiveness. These data, elicited through semiprojective procedures, are consistent with much of the prior research based mainly on objective scales or self-report questionnaires. Overall, the results lend additional validity to the nexus of relations (largely established through conventional objective scales) between resources, coping, and outcomes in a naturalistic stressor situation.     

Israelis' attitudes toward the disengagement plan, perceived risk, and knowledge of Biblical events

A sample of 73 Israeli students perceived current risks related to the disengagement plan but showed low awareness of Biblical civil wars and political assassinations. Attitude toward disengagement did not correlate with current perceived risks or awareness of Biblical violence. Left-leaning subjects were more supportive of disengagement and perceived greater risk of political assassination in its wake.     

Pavlovian Eyeblink Conditioning in Combat Veterans With and Without Post-Traumatic Stress Disorder

Several recent studies have investigated relationships between post-traumatic stress disorder (PTSD) and learning and memory problems. These reports have found in general that not only does PTSD affect trauma-related memories, but when patients with PTSD are compared with similar trauma patients without PTSD, general memory impairments have been found. The present paper reports a study in which associative learning, using Pavlovian eyeblink conditioning, was investigated in combat veterans with and without chronic PTSD, using interstimulus intervals of 500 and 1000 msec in two separate experiments. Although several recent reports suggest that larger-magnitude autonomic conditioned responses occur in patients with PTSD during Pavlovian conditioning, the present study found evidence of impaired Pavlovian eyeblink conditioning in combat veterans with and without PTSD, compared to non-combat veterans. Although these data suggest that combat leads to an impaired associative learning process regardless of whether PTSD is apparent, a group of community-dwelling combat veterans not under medical treatment showed normal conditioning, suggesting that variables other than prior combat must also be involved.     

压力知觉对大学生手机成瘾的影响：自我控制和学习倦怠的序列中介效应

为考察自我控制、学习倦怠在压力知觉与手机成瘾之间的序列中介效应,运用压力知觉量表、自我控制量表、学习倦怠量表和手机成瘾量表对946名大学生进行调查,结果表明：(1) 压力知觉与手机成瘾呈显著正相关;(2) 自我控制在压力知觉与大学生手机成瘾倾向之间起中介作用;(3)学习倦怠在压力知觉与大学生手机成瘾倾向之间起中介作用;(4) 压力知觉通过自我控制和学习倦怠的序列中介作用对大学生手机成瘾倾向产生影响。     

Chronic pain, meaning, and spirituality: A qualitative study of the healing process in relation to the role of meaning and spirituality

This qualitative study explores experiences of individuals with chronic pain in their attempt to find meaning in the presence of continual pain. Fifteen participants at Loma Linda University Behavioral Medicine Center were interviewed. Emerging themes from this study show that (1) meaning is initially defined as the ability to engage in productive activities and positive relationships; (2) chronic pain is perceived as the factor that removes meaning from the lives of sufferers; (3) medication is used to cope with pain, leading to addiction; (4) addiction results in greater loss of meaning; and (5) rediscovery of meaning takes place through a more complex understanding of the self that embraces suffering and thus is able to explain the interrelation of pain, emotions, and addiction. A change in self-understanding makes the reintegration of meaning possible.