The Performance of the PHQ-2 and the Examination of Risks Associated With Postdeployment Depression in Air Force Medical Service Personnel

This study assessed the performance of the 2-item Patient Health Questionnaire (PHQ-2) in identifying postdeployment depressive disorders in a cohort of Air Force Medical Services personnel (N = 18,398). The prevalence of depressive disorders in the cohort was 9.00% based on medical record data. The area under the receiver operating characteristic curve was 0.56, indicating very poor classification accuracy. Sensitivity was 15.53%, specificity was 95.57%, positive predictive value was 25.75%, and negative predictive value was 91.97%. The positive and negative likelihood ratios were 3.51 and 0.88, respectively. Several risk factors associated with postdeployment depressive disorders were identified that could potentially improve screening in this population.     

The Performance of the AUDIT-C and the Examination of Risks Associated With Postdeployment Alcohol Misuse in Air Force Medical Service Personnel

This study assessed the performance of the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) in diagnosing a postdeployment alcohol disorder in a cohort of Air Force Medical Services personnel (N = 13,353). The prevalence of alcohol disorders in this population of previously deployed military healthcare personnel was 1.26% based on medical record data. Assessing the AUDIT-C as a screening tool, the following characteristics were found: sensitivity was 23.81%, specificity was 91.48%, positive predictive value was 3.44%, and negative predictive value was 98.95%. The positive and negative likelihood ratios were 2.80 and 0.83, respectively. Classification accuracy of the AUDIT-C was improved by accounting for officer status and female gender. The area under the receiver operating characteristic curve was 0.69 for the multivariable model, indicating poor to fair classification accuracy. However, this model was significantly improved over the univariate model. Thus, taking rank and gender into account when conducting screening may improve the utility of the AUDIT-C.     

Intergenerational occupational inheritance in the military: a reexamination

Recent problems the military services have experienced in retaining sufficient personnel to meet growing manpower requirements are unlikely to diminish in the 1980s. As a consequence, it is vital that military decision makers understand the factors that influence career commitments of service members. Based on a stratified probability sample of Air Force married enlisted personnel and officers, this study reexamines the relationship between the military service patterns of fathers and the career intentions of their sons who enlist in military service. It also expands upon past analysis to include the actual career decisions of military men as a dependent variable. In partial support of past research, the present investigation provides no support for an intergenerational linkage between military service patterns of fathers and the career intentions and decisions of their sons--either enlisted members or officers. Implications for future research are discussed.     

Postdeployment Psychological Health and Interpersonal Problems Among Air Force Mental Health Personnel

This study is one of the first to use validated screening measures to examine the rates of self-reported mental health and interpersonal problems following deployment of military mental health personnel (MMHP). Research has examined the impact of deployment on military personnel finding 10.2% to 29.0% screen positive for at least one mental health problem. However, little is known about impacts of deployment among MMHP. Utilizing health data collected three to twelve months post-deployment from a sample of 759 Air Force MMHP, this study examined rates of positive screens for psychological health or interpersonal problems, subsequent confirmation of positive screens by a medical provider upon examination, and the demographic characteristics associated with psychological health or interpersonal problems. The study found 13.9% screened positive for “possible or probable PTSD,” 4.6% for depressive symptoms, 3.9% for alcohol problems, and 12.6% for interpersonal problems. In total, nearly 26% screened positive for one or more psychological or interpersonal problem. Of those who screened positive, 48.5% of depressive problems, 36.0% of PTSD, 20.0% of alcohol problems and 29.7% of interpersonal problems were confirmed upon subsequent examination by a medical provider. Those who screened positive were more likely to be (a) female, (b) separated, widowed, or divorced, (c) a mental health nurse or psychiatric nurse practitioner, and (d) deployed to Iraq or Afghanistan. The significance, limitations, and implications of the results, along with recommendations for future research are discussed.     

Social Support and Mental Health Outcomes Among U.S. Army Special Operations Personnel

Mental health disorders continue to plague service members and veterans; thus, new approaches are required to help address such outcomes. The identification of risk and resilience factors for these disorders in specific populations can better inform both treatment and prevention strategies. This study focuses on a unique population of U.S. Army Special Operations personnel to assess how specific avenues of social support and personal morale are related to mental health outcomes. The results indicate that, whereas personal morale and friend support reduce the relationship between combat experiences and posttraumatic stress disorder (PTSD), strong unit support exacerbates the negative effects of combat experiences in relation to PTSD. The study thus shows that although informal social support can lessen postdeployment mental health concerns, military populations with strong internal bonds may be at greater risk of PTSD because the support that they receive from fellow service members may heighten the traumatic impact of combat experiences.     

Sleep deprivation in Air National Guard medical personnel responding to simulated disaster-training exercises

National Guard personnel remain largely unstudied within the sleep research community, despite their unique and important role. In response, the purpose of this study was to investigate the extent of sleep deprivation in National Guard medical personnel from two separate Air Force Bases (AFBs) responding to simulated disaster-training exercises. National Guard medical personnel (N = 77) were fitted with wrist activity monitors (actigraphy) to objectively measure their sleep for 4 days of their civilian time (baseline), followed by a 4-day transition period from civilian to military duty, and a 3–5-day disaster-training exercise. Differences in sleep quantity, quality, and “cognitive effectiveness” were analyzed using generalized linear mixed models. Participants’ sleep quantity was significantly reduced from civilian to disaster-training periods, and their cognitive effectiveness also dropped significantly. National Guard medical personnel were sleep-deprived during a simulated disaster-training exercise, which, although a valid proxy for real-world disasters, is likely to be a conservative approximation of the stress and fatigue National Guard personnel experience during crisis response. As such, the need for targeted fatigue-related interventions to safeguard our service members during these critical times is clear.     

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.     

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.     

Patterns of Posttraumatic Stress Symptoms Among United States Air Force Combat Search and Rescue Personnel

U.S. Air Force (USAF) combat search and rescue (CSAR) aircrew and special duty rescue personnel are specially trained airmen with high levels of direct exposure to combat-related medical trauma. The purpose of this study was to explore the prevalence rate of CSAR military personnel meeting the Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM–5) posttraumatic stress disorder (PTSD) symptom criteria. USAF CSAR aircrew (n = 128) and rescue personnel (n = 300) across multiple units participated in the study by completing a demographics survey and the PTSD checklist based on DSM–5. Fourteen participants endorsed a pattern of symptoms of moderate to extreme level of severity meeting PTSD diagnostic criteria. Recommendations are provided for line and medical leadership to optimize health and performance among CSAR personnel.     

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.     

Subtypes of severe psychological distress among US Air Force remote warriors: A latent class analysis

US Air Force remote warrior personnel include a range of military personnel composed of remotely piloted aircraft aircrew, intelligence operators, and cyber warfare operators. Job duties in these professions entail long work hours, rotating shifts, and regular engagement in combat operations. Although research has identified a number of factors correlated with elevated burnout and emotional distress in this population, little is known about the unique needs of discrete subgroups of distressed personnel. In a sample of 7,550 US Air Force remote warriors, results of latent class analysis yielded four distinct classes. Three of the four reported moderately elevated burnout and job dissatisfaction but differed with respect to demographics and development career stage. The fourth group reported significantly higher levels of emotional distress, burnout, job dissatisfaction, and problems in living. This latter group was comparable to the mid-career group with respect to demographics, although this group had much lower levels of responsibility and indicators of career advancement. Results suggest that, among remote warrior personnel, there are several subtypes of elevated emotional distress. Prevention and intervention strategies that are matched to each subtype may yield better occupational and mental health outcomes than universal, “one size fits all” strategies.     

Suicide and War: The Mediating Effects of Negative Mood, Posttraumatic Stress Disorder Symptoms, and Social Support among Army National Guard Soldiers

The mediating effects of posttraumatic stress disorder (PTSD) symptoms, negative mood, and social support on the relationship of war experiences to suicidality were examined. The research literature suggested a sequence among study scales representing these constructs, which was then tested on survey data obtained from a sample of National Guard soldiers (N = 4,546). Results from structural equation modeling suggested that war experiences may precipitate a sequence of psychological consequences leading to suicidality. However, suicidality may be an enduring behavioral health condition. War experiences showed no direct effects on postdeployment suicidality, rather its effect was indirect through PTSD symptoms and negative mood. War experiences were, however, predictive of PTSD symptoms, as would be expected. PSTD symptoms showed no direct effect on postdeployment suicidality, but showed indirect effects through negative mood. Results also suggested that suicidality is relatively persistent, at least during deployment and postdeployment. The percentage of those at risk for suicide was low both during and after deployment, with little association between suicidality and time since returning from deployment. Additionally, few soldiers were initially nonsuicidal and then reported such symptoms at postdeployment. Implications of relationships of both negative mood and combat trauma to suicidality are discussed, as well as possible mediating effects of both personal dispositions and social support on relationships of war experiences to PTSD, negative mood, and suicidality.     

Moderators of Skill Retention Interval/Performance Decrement Relationships in Eight U.S. Air Force Enlisted Specialties

A robust finding in the literature on skill maintenance is that extended skill-retention intervals (SRIs) lead to decreased task performance. We investigated three potential moderators of the SRVtask performance decrement relationship: (a) degree of initial skill learning, (b) performer aptitude, and (c) degree of task difficulty. Results in eight samples of enlisted U.S. Air Force personnel (N = 1,544) generally supported a negative SRIItask performance relationship, but support for moderator effects was mixed. Implications for skill maintenance in actual work settings are discussed.     

抗震救灾官兵心理健康状况及相关因素分析

了解参加抗震救援官兵的心理健康状况及相关因素,为进行心理危机干预提供科学依据。方法 采用症状自评量表（SCL-90）、简易应对方式问卷（SCSQ）、艾森克人格问卷简式量表中国版（EPQ-RSC）及军事应激症状核查表（PCL-M）,对空军某部抗震救援官兵进行心理测评。结果 消极应对和PCL-M总分与SCL-90总分及各因子分呈正相关（p＜0.01）;积极应对方式与PCL-M总分、SCL-90总分及4项因子分呈低相关（p＜0.01）;不同气质类型PCL-M总分及SCL-90各项统计指标之间均有显著性差异（p＜0.01）。结论 气质类型与应对方式对心理健康状况有很大影响,个别官兵应及时给予心理疏导     

Type D personality and the development of PTSD symptoms: a prospective study

Psychological trauma and prolonged stress may cause mental disorders such as posttraumatic stress disorder (PTSD). Pretrauma personality is an important determinant of posttraumatic adjustment. Specifically, trait neuroticism has been identified as a risk factor for PTSD. Additionally, the combination of high negative affectivity or neuroticism with marked social inhibition or introversion, also called Type D personality (Denollet, 2000), may compose a risk factor for PTSD. There is no research available that examined pretrauma Type D personality in relation to PTSD. The present study examined the predictive validity of the Type D personality construct in a sample of Dutch soldiers. Data were collected prior to and 6 months after military deployment to Afghanistan. Separate multiple regression analyses were performed to examine the predictive validity of Type D personality. First, Type D personality was defined as the interaction between negative affect and social inhibition (Na × Si). In a second analysis, Type D was defined following cutoff criteria recommended by Denollet (2000). Results showed that negative affectivity was a significant predictor of PTSD symptoms. Social inhibition and the interaction Na × Si did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, negative affectivity, and prior psychological symptoms. A second analysis showed that Type D personality (dichotomous) did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, and prior psychological symptoms. Therefore, Type D personality appears to be of limited value to explain development of combat-related PTSD symptoms.     

Initial job analysis of military embedded behavioral health services: Tasks and essential competencies

Utilization of mental health personnel assigned to operational military units is an area of growth for the US military. What activities they perform, how requirements may differ from working in clinical settings, and how to select and train for these types of positions is still poorly understood. A job analysis was conducted of Air Force mental health providers and enlisted technicians embedded in special operations, intelligence, and high-risk training units. Participants rated 27 tasks on frequency, importance, difficulty, and risks, as well as the importance of 37 knowledge, skills, and abilities (KSAs), with differentiation between KSAs that may be trained versus those that must be present to be assigned to the embedded position. Tasks reflected 4 areas of activity: unit embedding/engagement, behavioral health consultation and support, performance optimization activities, and operational mission tasks. Tasks varied by professional training (psychologist, social worker, enlisted technician) and unit type. The KSAs rated as most important were ethical judgment and ability to manage complex relationships and boundaries while working outside of a clinic, strong interpersonal skills with appropriate assertiveness to advocate for safe, effective courses of action, and understanding of unit missions and organizational dynamics. Results have implications for job design, selection criteria, professional disciplines with KSAs necessary to unit-specific tasks, and training of personnel for integrated operational support positions.     

Predicting Pay Grade in the U.S. Military by Gender and Ethnic Minority Status1

This study examined predictors of pay grade for ethnic minorities and women in the U.S. military using hierarchical regression analyses. In the analysis including all personnel, being a woman and ethnic minority status were negative predictors of pay grade after controlling for education and years of service. In the analysis using enlisted personnel, the interaction between years of service and minority status showed that more years of service was associated with higher pay grade among ethnic majority enlisted personnel after controlling for education and years of service. In the model using officers, being a woman was a negative predictor of pay grade after controlling for education and years of service. Future studies, implications, limitations, and strengths are discussed.     

Rumination,Resilience, and Posttraumatic Stress Disorder Symptom Severity Among Veterans of Iraq and Afghanistan

This study investigated the relationships among combat exposure, intrusive, and deliberate rumination, resilience, and posttraumatic stress disorder (PTSD) among service members who deployed to Iraq or Afghanistan (N = 191). Participants completed an online survey and hierarchical linear regression results indicated that enlisted rank, higher combat exposure, lower resilience, and higher intrusive rumination predicted higher levels of PTSD symptom severity. Resilience moderated the relationship between combat exposure and PTSD symptom severity, such that participants who had higher levels of resilience had lower levels of PTSD symptom severity at all levels of combat exposure. These findings suggest the importance of increasing resilience in combat veterans, specifically those of enlisted rank and veterans exposed to higher levels of combat. Findings also suggest that teaching veterans how to control or minimize intrusive rumination might help lower PTSD severity.     

Good News: Work Sample Administrators' Global Performance Judgments are (About) as Valid as We've Suspected

Data obtained on over 1,500 first-term U.S. Air Force enlisted personnel indicated that work sample administrators' global ratings of work sample performance substantially reflect actual ratee behavior in the work sample, and not potentially biasing factors (e.g., race, gender, amount of recent experience), supporting the "folk wisdom" that these global performance judgments are, in fact, valid and unbiased measures of performance. Good news!     

Posttraumatic Stress,Depression, and Insomnia Among U.S. Air Force Pararescuemen

Few studies have examined rates of mental health problems among special duty military personnel, who often have frequent deployments and high exposure to operational stressors and trauma. The current study examined the severity and rates of positive screening for posttraumatic stress, depression, and insomnia among 194 U.S. Air Force pararescuemen (PJs) in the active duty (AD) and National Guard/Reserve (NG/R) components. Overall estimated rates were 11.6% for probable posttraumatic stress disorder (PTSD), 1.6% for probable depression, and 16.1% for clinical insomnia. PJs in the NG/R reported significantly more severe posttraumatic stress symptoms (F(1, 162) = 10.031, p = .002, partial η² = .058) and were approximately twice as likely to screen positive for probable PTSD (8.5% vs. 19.1%; χ²[1] = 3.679, p = .055). No differences in the rate or severity of depression or insomnia symptoms were found. Rates of positive screens are comparable to or lower than previously published rates among military personnel.