Relationships of deployment and combat experiences to postdeployment negative health conditions among Army National Guard soldiers

An interest of researchers and practitioners has been postdeployment adjustment of returned soldiers, though the primary focus has been investigating the prevalence of psychiatric conditions. Less attention has been paid to nonclinical conditions, which still have posed significant adjustment problems for soldiers, in particular, for reserve soldiers who revert back to civilian life, family, and employment. The present study examined the occurrence of postdeployment problems among returned Army National Guard soldiers (N = 4,567 in 50 company-sized units). Survey items reliably indicated 7 problem areas. Highest prevalence of problems was being angry (35.9%) and being unable to sleep (43.3%), followed by alcohol abuse (25.1% reported 5 or more drinks in 1 day). Longer deployment lengths were associated with troubled relationships and aggression toward the significant other adult and children in the household. More deployments were associated with aggression toward household children. Self-reported general combat trauma and having killed or wounded someone were associated with all problem areas. Findings are discussed relative to how combat exposure likely alters soldiers’ perceptions and behaviors, including feelings of loneliness and isolation, and risk-taking behaviors of alcohol abuse and aggression toward others.     

Behavioral Health Adjustment in Reserve Component Soldiers During a Noncombat Deployment to Africa

This study benchmarked rates of mental health problems, adjustment difficulties, and perceptions of unit climate among 505 U.S. soldiers (primarily National Guard) deployed to the Horn of Africa in 2012. In addition, the study examined whether differences across these outcomes exist between combat veterans (n = 239) and noncombat veterans (n = 242). Rates of mental health problems among soldiers on this noncombat deployment were lower than rates typically found among soldiers on combat deployments. Furthermore, soldiers without previous combat experience had lower rates of mental health problems and aggression than combat veterans. Similar differences were evident when adjustment difficulties and unit climate variables were compared. Although combat veterans could be valuable in training new soldiers, the results of this study indicate that combat veterans may need more targeted resources to facilitate their adjustment if they are to be optimally utilized.     

Prior Mental Disorders and Lifetime Suicidal Behaviors Among US Army Soldiers in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We report on associations of retrospectively reported temporally prior mental disorders and Army career characteristics with subsequent first onset of suicidal behaviors in a large, representative sample of US Army soldiers who participated in the Consolidated All‐Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N = 29,982). Results reveal that among men and women, all self‐reported lifetime disorders measured (some assessed with screening scales) are associated with subsequent onset of suicide ideation. Among men, three disorders characterized by agitation and impulsiveness (intermittent explosive disorder, panic disorder, and substance disorders) predict the transition from suicide ideation to attempt. For both men and women, being in the Regular Army (vs. National Guard or Army Reserve) predicts suicide attempts in the total sample. For men, a history of deployment and junior rank are predictors of suicide attempts after adjusting for preenlistment disorders but not accounting for pre‐ and postenlistment disorders, suggesting that postenlistment disorders account for some of the increased suicide risk among these career characteristics. Overall, these results highlight associations between mental disorders and suicidal behaviors, but underscore limitations predicting which people with ideation attempt suicide.     

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.     

Soldier Background and Postinvestigative Events Associated With Timing of Suicide Following Deployment of U.S. Army National Guard Soldiers

The present study examined the timing of suicide and its associated soldier background and postinvestigative events among deployed Army National Guard (ARNG) soldiers from calendar years 2007 through 2014. Suicide deaths were nearly equally distributed between soldiers who had been deployed and those who had not. Among those deployed, however, suicides occurred mostly 1 year or more after having returned from deployment. Soldier background and postsuicide investigative events were associated with the timing of suicide. Having more years of military service, more previous deployments, and being married were associated with in-theater suicides. Soldiers younger in age (17–24 years), single, nonprior service, and lower in rank, in addition to having parent-family conflicts, full-time employment problems, and military transition problems were associated with suicides that had occurred 1–120 days and 120–365 days since return from deployment. Soldiers aged (24–29 years), married, and higher in rank, along with more reported problems including past behavioral health conditions, postdeployment behavior health referrals, criminal behaviors, and military performance were associated with suicides that had occurred 1 year or more after return. Findings likely represent time periods of suicide vulnerability for identifiable groups of soldiers, based on soldier background and events surrounding the suicide. Practical and theoretical implications of the findings are discussed.     

Psychological Model of Military Aggressive Behavior: Findings From Population-Based Surveys

The U.S. military has expressed concern about the influence of deployment and combat exposure on the criminal behavior of personnel returning from Iraq and Afghanistan. This study examines the role of behavioral health risk and protective factors associated with combat exposure and criminal and aggressive behavior in active duty Army and Naval personnel. Data from this cross-sectional study are based on two large anonymous, population-based health-related behavior surveys. Findings show that the proportion of all active duty Army and Naval service personnel who reported encounters with law enforcement or committed one or more aggressive acts in the past year increased from 19.41% in 2005 to 22.58% in 2008. Substance use, especially illicit drug use, and mental health problems were significant correlates of criminal and aggressive behavior, as were younger age, male sex, high impulsivity, and work/family stress. Path modeling suggested that several variables, notably combat exposure and history of childhood abuse, appeared to manifest their influence on criminal or aggressive behavior through increases in substance use and mental health problems. The potential mediating influence of substance use and mental health on combat and other trauma experiences has significant implications for preventing criminal and aggressive behavior among U.S. active duty military personnel.     

Interaction of Combat Exposure and Unit Cohesion in Predicting Suicide‐Related Ideation Among Post‐Deployment Soldiers

Suicide is one of the leading causes of death among U.S. Army soldiers. Suicide‐related ideation, which is associated with suicide attempts and suicide, can cause considerable distress. In a sample of 1,663 recently redeployed soldiers, we used factor analysis and structural equation modeling to test the associations between combat exposure, unit cohesion, and their interaction in predicting suicide‐related ideation. We found that combat exposure was a significant risk factor for suicide‐related ideation, while unit cohesion was a significant protective factor. The significant interaction between the two factors indicated that soldiers who experienced greater combat exposure but also had higher levels of unit cohesion had relatively lower levels of suicide‐related ideation. In addition, those who had higher levels of combat exposure and lower unit cohesion were most at risk for suicide‐related ideation. Our findings indicate the importance of unit cohesion in protecting soldiers from suicide‐related ideation and suggest a higher risk group of soldiers who should be targeted for interventions.     

Gender Differences in Predicting Antisocial Behaviors: Developmental Consequences of Physical and Relational Aggression

This study investigated gender differences in the relationship of early physical and relational aggression to later peer rejection and overt and covert antisocial behaviors. Significant gender differences were found indicating physically aggressive boys were more likely than girls to experience later peer rejection. Early physical aggression was related to later overt antisocial behavior for boys and girls, and more strongly for girls than for boys. Early relational aggression was not associated with later forms of antisocial behavior. In the context of early physical aggression, for boys and girls peer rejection generally served to increment risk for later overt and covert antisocial behavior in an additive fashion. The data suggest some gender specificity in the social risk processes associated with the development of early overt and covert antisocial behaviors.     

The Army National Guard in OIF/OEF: Relationships among combat exposure,postdeployment stressors,social support,and risk behaviors

With the continued operations in Iraq and Afghanistan, studies of the prevalence of posttraumatic stress disorder and related symptoms are now common. However, lacking is how these symptoms relate to precipitating conditions and the mitigating effects of social support on these symptoms. This is particularly relevant for reserve military personnel, who have been shown to be greater at-risk for postdeployment problems. The present study examined questionnaire data obtained from Army National Guard (ARNG) units immediately after their return from deployment to Iraq and Afghanistan during 2010 (N = 4329 soldiers in 50 units). Findings showed few soldiers displayed risk behaviors (i.e., daily alcohol use, use of illicit drugs, suicide thoughts, and physically threatening others) during and after deployment. Those most likely to have more postdeployment risk behaviors were also those who showed more risk behaviors during deployment. A substantial percentage of soldiers reported combat exposure, postdeployment negative emotions, and postdeployment loss of a personal relationship. These reported outcomes were all related to increased risk behaviors after deployment. The buffering effect of social support on postdeployment risk behaviors was equally evident when data were examined individually and when grouped by unit memberships. Implications of findings for future research, practice, and policies are discussed.     

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.     

The Protective Role of Teacher Preference for At‐Risk Children's Social Status

Aggressive behaviors have been associated with social costs (e.g., rejection) and benefits (e.g., popularity) in previous studies. The current study sought to examine the moderating effect of teacher preference on the association between distinct forms of aggressive behavior (i.e., physical aggression and relational aggression) and social status (i.e., rejection and popularity), and to explore whether these associations differed for boys and girls. Fourth and fifth grade students (N = 193) completed peer nomination procedures to assess rejection and aggressive behavior and teachers provided self‐reports of their preferences for their students. Findings indicated that relationally aggressive girls were more likely to be popular with their peers when their teachers also liked them. In addition, both relationally and physically aggressive girls were less likely to be rejected by their peers when their teachers liked them. Although physical aggression was most strongly associated with rejection among boys whose teachers liked them, relational aggression predicted popularity among boys whose teachers disliked them. Results suggest that teacher preferences may be a particularly important factor contributing to both physically and relationally aggressive children's social status (e.g., rejection and popularity), especially for girls. Aggr. Behav. 38:481‐493, 2012. © 2012 Wiley Periodicals, Inc.     

Prior Health Care Utilization Patterns and Suicide Among U.S. Army Soldiers

Suicides among U.S. Army soldiers are increasing and, in January 2009, outpaced deaths due to combat. For this study, 1,873 army suicides identified through death, inpatient, and emergency room records were matched with 5,619 controls. In multivariate models, older, male, White, single, and enlisted soldiers with a prior injury (OR = 2.04, 95% CI = 1.64‐2.54), alcohol (OR = 3.41, 95% CI = 2.32‐4.99), or mental health hospitalization (OR = 6.62, 95% CI = 4.77‐9.20) were at increased risk for suicide. Risk was greatest immediately following diagnoses, but remained elevated even after 5 or more years of follow‐up. Most injury hospitalizations were unintentional but, nonetheless, significantly associated with suicide. Interactions indicate soldiers with both mental health and injury history are particularly vulnerable.     

Mental Disorders,Comorbidity, and Pre‐enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; N = 38,507). Most new soldiers with a pre‐enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs = 2.6–8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention‐deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre‐enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.     

Perpetration of Aggressive Behaviors Against Peers and Teachers as Predicted by Student and Contextual Factors

This study uses an ecological/contextual theory to explore how students’ perpetration of violence and other aggressive behaviors is associated with individual factors such as gender, age, and perception of school climate, and contextual factors such as cultural affiliation, school climate, and teacher characteristics among 4th‐ through 6th‐grade Jewish and Arab students in Israel. A questionnaire testing the use of aggressive behavior in school was completed by 120 homeroom teachers and 3,375 students. The results of the study show that levels of perpetration of violence and other aggressive behaviors vary between classes (15.20% directed against students and 7.33% directed against teachers). At the teacher–classroom level, higher levels of perpetration were found in classes with a lower percentage of girls and in classes with fewer or less clear and consistent policies to deal with aggressive behaviors. At the individual level, gender and perception of school climate were found to be associated with levels of perpetration of aggression. The “Discussion” section highlights the importance of improving school climate in order to deal more effectively with violence and aggressive behaviors in schools. Aggr. Behav. 38:253‐262, 2012. © 2012 Wiley Periodicals, Inc.     

The Relationship Between Violent Fantasy and Alcohol Misuse in Aggressive Behaviours

Alcohol misuse and cognitions supportive of violent behaviour have been linked with higher likelihood of engaging in aggressive actions. The present study investigated the interactive effects of alcohol abuse and violent fantasy on aggressive behaviour. A community sample of 279 adults recruited from South East Queensland completed the Aggression Questionnaire, Alcohol Use Disorder Identification Test, Scheduled of Imagined Violence, and the Marlowe‐Crowne Social Desirability Scale. Controlling for age, gender, and social desirability response, participants who acknowledged fantasies about violence and higher levels of alcohol consumption reported higher levels of aggression. Importantly, the interactive effects of alcohol and fantasy indicated that the contribution of violent fantasies was greatest among individuals with high levels of alcohol use compared with individuals with low alcohol use. The current findings, in conjunction with recent experimental evidence, highlight potential concerns regarding the additive effects of alcohol and violent fantasy.     

What's Changed? A Comparison of Army Suicide Surveillance Data to Cases from 1975 to 1982

US Army suicide rates increased significantly in the last decade and have remained high. To inform future research hypotheses, Army suicide surveillance data (2012–2014) were compared to similar Army data for suicides from 1975 to 1982. Preliminary data suggest that suicide rates increased across most demographic groups, but may have decreased among divorced soldiers. Mental health utilization increased over time. Legal problems and physical health problems were identified in a higher percentage of cases in the recent data relative to the 1975–1982 era. Potential implications for suicide prevention are discussed.     

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.     

Hostile Attributional Bias,Negative Emotional Responding,and Aggression in Adults: Moderating Effects of Gender and Impulsivity

The current study examined the main effects of hostile attributional bias (HAB) and negative emotional responding on a variety of aggressive behaviors in adults, including general aggression, physical aggression, relational aggression, and verbal aggression. Effects of both externalizing (anger) and internalizing (embarrassment/upset) negative emotions were considered. In addition, the moderating roles of gender and impulsivity on the effects of HAB and negative emotional responding were explored. Multilevel models were fitted to data from 2,749 adult twins aged 20–55 from the PennTwins cohort. HAB was positively associated with all four forms of aggression. There was also a significant interaction between impulsivity and HAB for general aggression. Specifically, the relationship between HAB and general aggression was only significant for individuals with average or above‐average levels of impulsivity. Negative emotional responding was also found to predict all measures of aggression, although in different ways. Anger was positively associated with all forms of aggression, whereas embarrassment/upset predicted decreased levels of general, physical, and verbal aggression but increased levels of relational aggression. The associations between negative emotional responding and aggression were generally stronger for males than females. The current study provides evidence for the utility of HAB and negative emotional responding as predictors of adult aggression and further suggests that gender and impulsivity may moderate their links with aggression. Aggr. Behav. 38:47‐63, 2012. © 2011 Wiley Periodicals, Inc.     

Predicting Suicide Ideation in the Military: The Independent Role of Aggression

The purpose of this study was to examine the longitudinal relationship between aggression and suicide ideation when controlling for other externalizing (i.e., alcohol misuse and risk‐taking) and internalizing (i.e., depression and sleep problems) risk factors in an active duty, military sample. Preexisting data from a longitudinal study were analyzed to assess the wellness of service members across the deployment cycle. Participants were 944 active duty service members (95% male, 48% between 18 and 24 years old) who completed surveys upon initial return from deployment and approximately 3 months later. After controlling for other externalizing (alcohol misuse, risk‐taking) and internalizing (depression, sleep problems) risk factors, service members reporting aggression were significantly more likely to report suicide ideation than those reporting no aggression (OR = 3.19; OR 95% CI: 1.16–8.80). The independent nature of the relationship between anger and suicidality suggests aggression may be an important indicator of suicidality for service members. Understanding the role of aggression in suicidality may improve the ability to identify at‐risk service members and to develop effective interventions to reduce suicide risk.     

Alcohol‐aggression expectancies and dispositional aggression moderate the relationship between alcohol consumption and alcohol‐related violence

Alcohol consumption increases aggression, but only in some drinkers. This study examines how expectancies for alcohol‐induced aggression and dispositional aggression moderate the link between alcohol consumption and alcohol‐related violence, building on previous studies that have employed limited measures of alcohol‐related violence and included few women. A sample of 212 men and women reported their alcohol consumption, alcohol‐aggression expectancies, dispositional aggression, and incidents of alcohol‐related aggressive acts. Alcohol‐aggression expectancies and quantity of alcohol consumed interacted to predict alcohol‐related aggression. Alcohol‐aggression expectancies covaried with alcohol‐related aggressive acts, particularly in heavier drinkers. Dispositional aggression also correlated with alcohol‐related aggression among heavier drinkers. These results help identify that alcohol might increase aggression only among heavy drinkers who expect alcohol to increase aggression or who are dispositionally aggressive. Aggr. Behav. 32:517–527, 2006. © 2006 Wiley‐Liss, Inc.