Gerald E. Larson

Social desirability effects on computerized and paper-and-pencil questionnaires

Abstract The objectives of the present study were to determine the impact of computer administration of questionnaires on impression management (IM) and self-deceptive enhancement (SDE) and on the disclosure of sensitive information such as alcohol use and risky sex. College students ( N xa0=xa0301) completed several questionnaires in either a computer-administered or paper-and-pencil condition. Respondents who completed the survey on the computer scored significantly higher on SDE than those completing the survey on paper. No differences were found for IM. Respondents in the computer condition also reported a higher level of alcohol consumption and riskier sexual behaviors than those in the paper-and-pencil condition. It is possible that computer administration of surveys creates a social situation that produces a sense of disinhibition in respondents, and this sense of disinhibition may lead to greater reports of risky behaviors.

Psychiatric Diagnoses in Historic and Contemporary Military Cohorts: Combat Deployment and the Healthy Warrior Effect

Research studies have identified heightened psychiatric problems among veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). However, these studies have not compared incidence rates of psychiatric disorders across robust cohorts, nor have they documented psychiatric problems prior to combat exposure. The authors objectives in this study were to determine incidence rates of diagnosed mental disorders in a cohort of Marines deployed to combat during OIF or OEF in 2001-2005 and to compare these with mental disorder rates in two historical and two contemporary military control groups. After exclusion of persons who had been deployed to a combat zone with a preexisting psychiatric diagnosis, the cumulative rate of post-OIF/-OEF mental disorders was 6.4%. All psychiatric conditions except post-traumatic stress disorder occurred at a lower rate in combat-deployed personnel than in personnel who were not deployed to a combat zone. The findings suggest that psychiatric disorders in Marines are diagnosed most frequently during the initial months of recruit training rather than after combat deployment. The disproportionate loss of psychologically unfit personnel early in training creates a healthy warrior effect, because only those persons who have proven their resilience during training remain eligible for combat.

Predeployment and In-Theater Diagnoses of American Military Personnel Serving in Iraq

OBJECTIVEnThis purpose of this study was to determine the incidence and types of preexisting mental disorders among military personnel who received mental health services in an Iraqi war zone.nnnMETHODSnThe study examined psychiatric histories of 1,078 American military personnel (Marines, 65%; Army, 23%; Navy, 11%; and Air Force, <1%) deployed to Iraq and seen by in-theater mental health providers between January 2006 and February 2007.nnnRESULTSnAmong the 1,078 patients, the most frequent in-theater diagnoses were anxiety (24%), adjustment (23%), and mood (19%) disorders. Twenty-nine percent of the sample (N=308) had a psychiatric diagnosis in their medical records before their first encounter with mental health services in Iraq (Navy patients, 42%; Army patients, 39%; and Marine Corps patients, 23%). The mean time between last predeployment diagnosis and first in-theater mental health encounter was 21 months. For patients with a prior diagnosis, the highest rate of relapse (receipt of the same diagnosis in theater) was for attention-deficit hyperactivity disorder (57%), followed by anxiety disorders (44%)--especially posttraumatic stress disorder (PTSD) (55%)--mood disorders (38%), and adjustment disorders (32%).nnnCONCLUSIONSnA significant proportion of military personnel who experienced mental health problems in a combat zone had preexisting psychiatric conditions. Because more than half of predeployment diagnoses were received in the nine months before the in-theater mental health encounter, further study may be advisable to determine whether a time-based algorithm for deployability is needed, particularly for PTSD, for which a high rate of repeat diagnosis in theater was found.

Behavioral Predictors of Acute Stress Symptoms During Intense Military Training

A better understanding of factors influencing human responses to acute stress is needed to enhance prevention and treatment of stress-related disorders. In the current study, the authors examined predictors of acute stress symptoms during intense military training in 35 men. In univariate and multivariate models, perceived stress, passive coping, and emotion-focused coping during daily living predicted acute stress symptoms in response to realistic survival training, whereas active coping and problem-focused coping did not. Baseline stress levels and coping styles, both of which may be modifiable, appear to play a fundamental role in the human response to acute uncontrollable stress. Additional research is needed to better elucidate the relative and interactive contributions of behavioral predictors of acute stress.

Psychiatric Diagnoses and Treatment of U.S. Military Personnel While Deployed to Iraq

Military personnel deployed in support of combat operations are at significantly higher risk for mental health problems. However, much of what we know about combat-related mental health comes from postdeployment assessments. This study describes the mental health of 1,336 treatment-seeking deployed U.S. military personnel and interventions recommended by military mental health providers in Iraq from January 2006 to January 2007. Cases were primarily young enlisted men, most of whom were on their first combat deployment. Marines made up the majority of the cases (60%), but there were also large numbers of Army and Navy personnel. The most common psychiatric diagnoses were anxiety disorders (31%, including 11% with posttraumatic stress disorder), followed by adjustment (27%) and mood disorders (25%, including 22% with depression). Medication was the most commonly prescribed treatment for patients with psychiatric diagnoses but was often combined with recommendations for psychotherapy/counseling and/or behavioral modifications. The findings illustrate the distribution of mental health conditions seen among treatment-seeking troops while actively serving in a combat environment and the interventions recommended for them. Further examination of postdeployment health outcomes may help to facilitate the development of more effective acute intervention strategies in theater.

Prospective prediction of functional difficulties among recently separated veterans.

Reports of functional problems are common among Veterans who served post-9/11 (more than 25% report functional difficulties in at least one domain). However, little prospective work has examined the risk and protective factors for functional difficulties among Veterans. In a sample of recently separated Marines, we used stepwise logistic and multiple regressions to identify predictors of functional impairment, including work-related problems, financial problems, unlawful behavior, activity limitations due to mental health symptoms, and perceived difficulty reintegrating into civilian life. Posttraumatic stress disorder symptoms assessed both before and after military separation significantly predicted functional difficulties across all domains except unlawful behavior. Certain outcomes, such as unlawful behavior and activity limitations due to mental health symptoms, were predicted by other or additional predictors. Although several forms of functioning were examined, the list was not exhaustive. The results highlight a number of areas where targeted interventions may facilitate the reintegration of military servicemembers into civilian life.

Comparative analysis of mandated versus voluntary administrations of post-deployment health assessments among Marines.

Little empirical data exist regarding candidness of service members responses on the mandated Post-Deployment Health Reassessment (PDHRA) administered 3 to 6 months postdeployment. This study reports on the agreement between responses from U.S. Marines on a subset of the military-administered mandatory PDHRA items and answers to the same subset of items embedded in confidential research surveys. Results show that personnel are clearly underreporting certain symptoms and conditions on the mandatory PDHRA. The most dramatic increases in reporting on the research studys PDHRA items, as indicated by the percentage ratio, were for self-harming ideation and concern about harming others, each of which has about 14 times the endorsement percentage on the survey as on the official PDHRA. Lack of agreement for some items may be the result of resolution or onset of more acute conditions, but disagreement on sensitive behavioral concerns suggests that mandated PDHRAs are not effective screens for those domains.

Risk Factors for Misconduct in a Navy Sample

Understanding antisocial behavior and organizational misconduct is an important objective, because these maladaptive behaviors are disruptive and costly to organizations and to society as a whole. The objective of this study was to identify psychosocial risk factors for misconduct and antisocial behavior in a sample of Navy personnel. A group of sailors (n = 158) who had engaged in significant misconduct were compared with a demographically similar group of sailors (n = 288) who had not engaged in misconduct and who were in good standing with the Navy. The psychosocial variables that emerged as the most important risk factors for antisocial behavior were alcohol use (odds ratio [OR] = 2.42), high impulsivity (OR = 2.20), high trait hostility (OR = 1.79), and antisocial behavior of friends (OR = 1.65). The implications of these results for the military and for research on antisocial behavior are discussed.

Sex differences in cardiovascular and subjective stress reactions: prospective evidence in a realistic military setting

Abstract Evidence points to heightened physiological arousal in response to acute stress exposure as both a prospective indicator and a core characteristic of posttraumatic stress disorder (PTSD). Because females may be at higher risk for PTSD development, it is important to evaluate sex differences in acute stress reactions. This study characterized sex differences in cardiovascular and subjective stress reactions among military survival trainees. One hundred and eighty-five military members (78% males) were studied before, during, and 24 h after stressful mock captivity. Cardiovascular (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP]) and dissociative states were measured at all three time points. Psychological impact of mock captivity was assessed during recovery. General linear modeling with repeated measures evaluated sex differences for each cardiovascular endpoint, and causal steps modeling was used to explore interrelationships among sex, cardiovascular reactions and psychological impact of mock captivity. Although females had lower SBP than males at all three time points, the difference was most pronounced at baseline and during stress. Accordingly, females showed greater residual elevation in SBP during recovery. Females had lower DBP at all three time points. In addition, females reported greater psychological impact of mock captivity than males. Exploratory causal steps modeling suggested that stress-induced HR may partially mediate the effect of sex on psychological impact of mock captivity. In conclusion, this study demonstrated sex-specific cardiovascular stress reactions in military personnel, along with greater psychological impact of stress exposure in females. This research may elucidate sex differences in PTSD development.

Genetic variants in serotonin and corticosteroid systems modulate neuroendocrine and cardiovascular responses to intense stress.

Common variants in serotonin and corticosteroid receptor genes influence human stress in laboratory settings. Little is known of their combined effects, especially in high stress environments. This study evaluated distinct and combined effects of polymorphisms in the serotonin transporter (5HTTLPRL/S), glucocorticoid receptor (Bcl1C/G), and mineralocorticoid (-2C/G) receptor genes on adrenocortical and cardiovascular responses to intense, realistic stress. One hundred and forty four healthy, active-duty military men were studied before, during, and 24h after a stressful 12-day survival course. Dependent variables were cortisol, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP). 5HTTLPR SS carriers revealed higher overall cortisol concentrations than L carriers (p=.022). 5HTTLPR L carriers demonstrated higher stress-induced HR than non-carriers (SS) yet rebounded to a lower recovery value (p=.026), while Bcl1 G carriers showed higher mean stress-induced HR than non-carriers (CC) (p=.047). For DBP, 5HTTLPR S carriers showed higher overall values than non-carriers (LL) (p=.043), Bcl1 GG were higher than C carriers (p=.039), and -2C/G G carriers exceeded non-carriers (CC) (p=.028). A high composite genotype group revealed substantially higher overall cortisol concentrations than a low composite genotype group (p<.001), as was the case for DBP (p=.037). This study revealed a synergistic effect of common polymorphisms on the acute stress response in healthy men. Pending additional study, these findings may have implications for drug discovery, gene therapy, and stress inoculation strategies.