Kathleen M. Wright

The impact of a military air disaster on the health of assistance workers. A prospective study

The worst peacetime disaster in United States Army history occurred on December 12, 1985 in Gander, Newfoundland. A charter airline carrying 248 soldiers home from peacekeeping duties in the Sinai Desert crashed after a refueling stop, killing all on board. After the crash, Army family assistance workers were appointed to help the surviving family members of each dead soldier. While substantial attention has been paid to the impact of sudden disasters on survivors and bereaved relatives, little is known about the health risks to those who perform helper roles. This study aimed to: a) identify the major stress areas for disaster family assistance workers; b) examine the relation between degree of exposure to these stressors and health; and c) locate risk factors, or resistance resources that might modulate any ill effects of exposure. A survey instrument assessed duration and intensity of family-helping activities and psychological well-being, psychiatric symptoms, major illness indicators, and social and personality variables at 6 months after the crash and again at the 1-year point for 131 family assistance officers. Results indicate a dose-response effect between exposure measured at time 1 and well-being, symptoms, and illness at time 2. Analysis of covariance findings also show that social supports (work supervisors, family, and friends) modulate the effects of exposure on symptoms and well-being. Social supports and the personality style of hardiness (or dispositional resilience) interact to modulate the effects of exposure on illness. These results demonstrate: a) a delayed negative impact of helper stress on family assistance workers, and b) a protective function of social supports and personality hardiness. Further research in this area should thus consider the potential influence of social/situational variables and personality dispositions in coping with disaster helper stress.

Timing of postcombat mental health assessments.

509 Army Soldiers (who had returned within the previous week from a 12-month deployment to Iraq) participated in a study to examine changes in psychological symptoms between homecoming and 120 days later. Rates of psychological symptoms were significantly higher at 120 days postdeployment than at immediate reintegration largely due to an increase in Soldiers who were initially nonsymptomatic but became symptomatic later.

Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans.

OBJECTIVES The study conducted a longitudinal assessment of insomnia as an antecedent versus consequence of posttraumatic stress disorder (PTSD) and depression symptoms among combat veterans. DESIGN Two postdeployment time points were used in combination with structural equation modeling to examine the relative strength of two possible directions of prediction: insomnia as a predictor of psychological symptoms, and psychological symptoms as a predictor of insomnia. Participants were active duty soldiers (N = 659) in a brigade combat team who were assessed 4 months after their return from a 12-month deployment to Iraq, and then again eight months later. RESULTS Although both insomnia and psychological symptoms were associated at both time periods and across time periods, insomnia at 4 months postdeployment was a significant predictor of change in depression and PTSD symptoms at 12 months postdeployment, whereas depression and PTSD symptoms at 4 months postdeployment were not significant predictors of change in insomnia at 12 months postdeployment. CONCLUSIONS Results support the role of insomnia in the development of additional psychological problems and highlight the clinical implications for combat veterans, to include the importance of longitudinal assessment and monitoring of sleep disturbances, and the need for early intervention.

A2 diagnostic criterion for combat-related posttraumatic stress disorder.

Individuals trained to respond to a potentially traumatic event may not experience the posttraumatic stress disorder (PTSD) A2 diagnostic criterion of fear, helplessness, or horror and yet may still report significant PTSD symptoms. The present study included interviews with 202 soldiers returning from a year in Iraq. Although reporting an A2 response was associated with higher PTSD Checklist scores, there were no significant differences in the percentage of subjects who met cutoff criteria for PTSD. The most common alternative A2 responses were related to military training and anger. The A2 criterion for PTSD should be expanded so as not to underestimate the number of individuals trained for high-risk occupations who might benefit from treatment.

A group randomized trial of critical incident stress debriefing provided to U.S. peacekeepers

In a group randomized trial of critical incident stress debriefing (CISD) with platoons of 952 peacekeepers, CISD was compared with a stress management class (SMC) and survey-only (SO) condition. Multilevel growth curve modeling found that CISD did not differentially hasten recovery compared to the other two conditions. For those soldiers reporting the highest degree of exposure to mission stressors, CISD was minimally associated with lower reports of posttraumatic stress and aggression (vs. SMC), higher perceived organizational support (vs. SO), and more alcohol problems than SMC and SO. Soldiers reported that they liked CISD more than the SMC, and CISD did not cause undue distress.

Leadership as a predictor of stigma and practical barriers toward receiving mental health treatment: a multilevel approach.

The present research examined positive and negative leadership behaviors as predictors of stigma and practical barriers to mental health treatment. Soldiers completed measures of noncommissioned officer (NCO) and officer leadership, stigma, and practical barriers to getting mental health treatment at 2, 3, and 4 months following a 15-month deployment to Afghanistan. The results revealed that positive and negative NCO and officer leader behaviors were predictive of overall stigma and barriers to care (collapsed across the three time periods), with only NCO positive and negative behaviors being uniquely predictive of stigma when included in the same model with officer behaviors. In addition, negative and positive NCO leader behaviors were predictive of stigma within participants over the course of the three month time period, and positive NCO leader behaviors were inversely related to practical barriers to mental health treatment within participants across the same time period. The results are discussed in terms of how different leader behaviors may be linked to different factors influencing a soldiers decision to seek mental health treatment.

Alcohol Problems, Aggression, and Other Externalizing Behaviors After Return From Deployment: Understanding the Role of Combat Exposure, Internalizing Symptoms, and Social Environment

OBJECTIVES The study examined whether elevated rates of externalizing behaviors following deployment could be explained by internalizing symptoms (depression, anxiety, and PTSD symptoms), and health of the social environment (unit leadership, organizational support, and stigma/barriers to care). DESIGN A model of combat exposure, social environment, internalizing symptoms, and externalizing behaviors was tested in a military unit following a fifteen-month deployment to Iraq. The sample included 1,397 soldiers assessed four month post-deployment; 589 of these soldiers were assessed again nine months post-deployment. RESULTS Externalizing behaviors were highly stable over the five-month post-deployment period. Both social environment and internalizing symptoms were significantly associated with level of externalizing behaviors at four months and nine months post-deployment, but combat exposure alone significantly predicted change in externalizing behaviors over the follow-up period. CONCLUSIONS Results suggest the need to broaden the scope of interventions targeted to combat veterans and have implications for care providers and military leaders.

Individual and Community Responses to Trauma and Disaster: Community responses to disaster: the Gander plane crash

Several theoretical approaches or models are available to those interested in studying community responses to disaster and trauma. Unfortunately, recent experience with disasters proves that these models are overly restrictive. This chapter draws on observations following a major military air disaster to develop a new, expanded model of the impact on communities from such events. This model avoids the key restrictions of earlier models. One critical restriction of community disaster models is the principal level of analysis that is adopted. Some models focus on individuals within the community, and aggregate individual reactions to form a picture of community response. Others view the community as a social unit that must be considered as a separate entity. These different views are usually assumed to be mutually exclusive, leading to a debate over which is more correct (Melick, 1985; Quarantelli, 1985; Powell & Penick, 1983; Tierney, 1986). Tierney (1986) summarizes the controversy about theoretical orientation. Each orientation focuses either on a group or an individual level of analysis to the exclusion of the other. Those researchers who assume a community perspective conclude that psychological effects following disaster are minimal and short term, and that poor outcomes arise from inadequate disaster planning and resources on the part of community organizations (Quarantelli, 1985). The alternative orientation is a ‘psychological trauma’ perspective. It concludes that the catastrophic nature of the event and the subsequent trauma of dealing with the experience and its aftermath result in significant, adverse, and typically long-term psychological effects (Erikson, 1976; Lifton & Olson, 1976).

Gruesomeness, emotional attachment, and personal threat: dimensions of the anticipated stress of body recovery.

Previous research has shown that exposure to grotesque death has been associated with posttraumatic stress disorder and higher levels of stress have been associated with mortuary workers who anticipated handling remains than those who did not. Additional research is presented here to further clarify the nature of the anticipated stress of handling the dead. Anticipated stress of handling human remains was rated for 13 different situations by 479 persons (384 men and 95 women) without such experience, but whose job was likely to require it. Factor analysis of their ratings revealed three psychological dimensions: the gruesomeness of the remains, an emotional link between the viewer and the remains, and personal threats to the remains handler. Suggestions for preventive measures, training, and interventions for those who may handle remains are made.

Psychological screening procedures for deploying U.S. Forces.

This study examined the validity of psychological measures used in screening for the U.S. Army with 885 soldiers before a 6-month peacekeeping rotation in Kosovo. Content validity and construct validity were assessed by evaluating the clinical domains, comparing clinician assessments of functioning, and assessing risk factors for screening positive. Construct validity and content validity were demonstrated. Risks, benefits, and future directions of the Armys psychological screening research program are discussed.