How Much Distress Is Too Much on Deployed Operations? Validation of the Kessler Psychological Distress Scale (K10) for Application in Military Operational Settings

The aim of this study was threefold: (a) to assess the factor structure of the Kessler Psychological Distress Scale (K10) to determine whether interpreting the scale as a single dimensional measure of psychological distress is justified in military operational setting; (b) to validate the K10 for mental health surveillance in operational settings against self-reported occupational impairment; (c) to evaluate whether the K10 has better discriminatory power than de facto standards for mental health surveillance on deployment, namely the Patient Health Questionnaire and the Posttraumatic Stress Disorder Checklist, Civilian version. A convenience sample of Canadian Armed Forces personnel serving in Afghanistan (N = 1,264) completed self-report measures of psychological distress and occupational impairment. On examination of 6 competing models, the authors determined that interpreting the K10 as a measure of unspecified psychological distress is justified. Using receiver operating characteristic (ROC) curve analysis, they identified new cutoff values for dichotomous and polychotomous scoring methods. After comparing the area beneath the ROC curves for each of the 3 mental health surveillance questionnaires, the authors determined that all measures perform well as predictors of self-rated occupational impairment, with values ranging from .86 to .90. These results highlight the importance of cross-setting validation and demonstrate that validating psychological screening questionnaires against self-report measures of occupational impairment can be a useful strategy for understanding the manifestation of psychological distress on deployed military operations.     

“Drive On”: The Relationship Between Psychological Variables and Effective Squad Leadership

The U.S. Reserve Officer Training Program (ROTC) conducts systematic assessments of cadets’ leadership abilities during field training exercises (FTX) to assess their leadership abilities. While cadets in ROTC programs learn specific tactical operation procedures to augment FTX performances, much less is known about the relationship between psychological variables and squad leadership performance. To this end, 220 cadets completed self-efficacy, psychological flexibility, and grit questionnaires, which were then compared to FTX performance scores. Results underscored that only self-efficacy was significantly related to cadets’ squad leadership ability. Furthermore, prior service in the U.S. Army had no effect on the performance score one attained, highlighting an interesting paradox. Therefore, while self-efficacy can be cultivated through prior experiences, it seems more prudent to educate ROTC cadets on how to apply psychological skills to bolster self-efficacy in preparation for upcoming challenging leadership experiences.     

Maternally administered interventions for preterm infants in the NICU: Effects on maternal psychological distress and mother–infant relationship

Although studies have examined the effects of interventions focused on preterm infants, few studies have examined the effects on maternal distress (anxiety, depressive symptoms, post-traumatic stress symptoms, parenting stress) or parenting. This study examined the effects of the auditory–tactile–visual–vestibular (ATVV) intervention and kangaroo care (KC) on maternal distress and the mother–infant relationship compared to an attention control group.240 mothers from four hospitals were randomly assigned to the three groups. Maternal characteristics in the three groups were similar: 64.1% of ATVV mothers, 64.2% of KC mothers, and 76.5% of control mothers were African American; maternal age averaged 26.3 years for ATVV mothers, 28.1 for KC mothers, and 26.6 for control mothers; and years of education averaged 13.6 for ATVV and KC mothers, and 13.1 for control mothers. Mothers only differed on parity: 68.4% of ATVV and 54.7% of KC mothers were first-time mothers as compared to 43.6% of control mothers. Their infants had a similar mean gestational ages (27.0 weeks for ATVV, 27.2 for KC, and 27.4 for control) and mean birthweights (993 g for ATVV, 1022 for KC, and 1023 for control).Mothers completed questionnaires during hospitalization, and at 2, 6 and 12 months corrected age on demographic characteristics, depressive symptoms, state anxiety, post-traumatic stress symptoms, parenting stress, worry about child health, and child vulnerability (only at 12 months). At 2 and 6 months, 45-min videotapes of mother–infant interactions were made, and the HOME Inventory was scored. Behaviors coded from the videotapes and a HOME subscale were combined into five interactive dimensions: maternal positive involvement and developmental stimulation and child social behaviors, developmental maturity, and irritability.Intervention effects were examined using general linear mixed models controlling for parity and recruitment site. The groups did not differ on any maternal distress variable. Kangaroo care mothers showed a more rapid decline in worry than the other mothers. The only interactive dimensions that differed between the groups were child social behaviors and developmental maturity, which were both higher for kangaroo care infants. Change over time in several individual infant behaviors was affected by the interventions. When mothers reported on the interventions they performed, regardless of group assignment, massage (any form including ATVV) was associated with a more rapid decline in depressive symptoms and higher HOME scores. Performing either intervention was associated with lower parenting stress. These findings suggest that as short-term interventions, KC and ATVV have important effects on mothers and their preterm infants, especially in the first half of the first year.