Laurel L. Hourani

Longitudinal study of resilience and mental health in marines leaving military service

BACKGROUNDnDespite a growing emphasis on psychological outcomes following military combat, few longitudinal studies have examined the combined role of risk and protective factors in the mental health of combat-exposed military personnel. This study characterizes the impact of resilience scale scores and combat exposure on mental health outcomes among Marines after separating from military service, along with intra-individual changes in mental health status.nnnMETHODSnData were collected from longitudinal surveys of 475 active duty Marines attending a random sample of mandatory Transition Assistance Program workshops before leaving the military and responding to follow-up mail or web surveys an average of 6 months after returning to civilian life.nnnRESULTSnResults revealed distinct risk and protective factors for those meeting screening criteria for mental health problems (depression, anxiety, and PTSD) and functional impairment at follow-up. Primary risk factors included experiencing higher levels of pre-separation combat exposure; post-separation stress across multiple life domains; and experiencing multiple areas of pain post-separation. Protective factors include having higher scores on pre-separation resilience and perceived social support at follow-up indices. We also identified a number of factors associated with change in mental health status from baseline to follow-up.nnnLIMITATIONSnGenerality is limited by a lower than expected follow-up response rate and an exclusively Marine sample.nnnCONCLUSIONnThe role of resilience appeared to have a greater impact on functional impairment than on mental health symptoms per se. Findings provide important input for enhancing training programs and services intended to promote adjustment from military to civilian life. Additional emphasis on social support and coping with stress-related issues are needed in support of combat veterans.

Influence of Spirituality on Depression, Posttraumatic Stress Disorder, and Suicidality in Active Duty Military Personnel

Understanding the role of spirituality as a potential coping mechanism for military personnel is important given growing concern about the mental health issues of personnel returning from war. This study seeks to determine the extent to which spirituality is associated with selected mental health problems among active duty military personnel and whether it moderates the relationship between combat exposure/deployment and (a) depression, (b) posttraumatic stress disorder (PTSD), and (c) suicidality in active duty military personnel. Data were drawn from the 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. Over 24,000 randomly selected active duty personnel worldwide completed an anonymous self-report questionnaire. High spirituality had a significant protective effect only for depression symptoms. Medium, as opposed to high or low, levels of spirituality buffered each of the mental health outcomes to some degree. Medium and low spirituality levels predicted depression symptoms but only among those with moderate combat exposure. Medium spirituality levels also predicted PTSD symptoms among those with moderate levels of combat exposure and predicted self-reported suicidal ideation/attempt among those never deployed. These results point to the complex relationship between spirituality and mental health, particularly among military personnel and the need for further research.

Suicidal or Self-Harming Ideation in Military Personnel Transitioning to Civilian Life

Suicides have markedly increased among military personnel in recent years. We used path analysis to examine factors associated with suicidal/self-harming ideation among male Navy and Marine Corps personnel transitioning to civilian life. Roughly 7% of men (Sailors = 5.3%, Marines = 9.0%) reported ideation during the previous 30 days. Results suggest that combat exposure, substance abuse, and resilience are associated with suicidal ideation/self-harming thoughts through the mediation of posttraumatic stress disorder symptoms and/or depression symptoms. Substance abuse plays a moderating role. Resilience had a direct effect only among the Marines. Implications for improving the transition to civilian life are discussed.

Gender differences in the expression of PTSD symptoms among active duty military personnel

This study examined gender differences in posttraumatic stress disorder (PTSD) symptoms and symptom factors in the total U.S. active duty force. Data were drawn from the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel including 17,939 men and 6751 women from all services. The results indicated that women expressed more distress than men across almost all the symptoms on the PTSD Checklist except for hypervigilance. Women also scored significantly higher on all four factors examined: Re-experiencing, Avoidance, Emotionally Numb, Hyperarousal. More women than men were distressed by combat experiences that involved some type of violence, such as being wounded, witnessing or engaging in acts of cruelty, engaging in hand-to-hand combat, and, to a lesser extent, handling dead bodies. Men who had been sexually abused had a greater number of symptoms and were consistently more distressed than women on individual symptoms and symptom factors.

Stress and Mental Health

Concern over large numbers of psychological casualties among military personnel returning from Afghanistan and Iraq during Operation Enduring Freedom and Operation Iraqi Freedom has led to renewed impetus to identify those at risk for serious mental health problems. The Department of Defense Surveys of Health Related Behaviors Among Active Duty Military Personnel (HRB surveys) provide the first population-based mental health data on active duty military personnel in all service branches worldwide. Since 1988, the HRB survey series has contained a set of questions related to the stress and mental health of active duty personnel. This chapter presents findings related to the issues of mental health, exposure to challenges eliciting stress, coping strategies, and help-seeking. Trends, prevalence rates, and a wide range of risk and protective factors are examined for multiple screening measures, including work and family stress, depression, generalized anxiety disorder, posttraumatic stress disorder (PTSD), suicidal ideation, and receipt of mental health counseling.

Posttraumatic Stress Disorder, Substance Abuse, and Other Behavioral Health Indicators among Active Duty Military Men and Women

Posttraumatic Stress Disorder, Substance Abuse, and Other Behavioral Health Indicators among Active Duty Military Men and Women nDespite civilian studies showing that women exhibit higher rates of PTSD, but men have greater exposure to traumatic events, few studies have examined this apparent contradiction among active duty personnel. The current study examined gender differences in PTSD and the influence of a wide range of risk factors and comorbid conditions in the United States military.

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.

Graphic Novels: A New Stress Mitigation Tool for Military Training: Developing Content for Hard-to-Reach Audiences

ABSTRACT This article describes the development of two graphic novels as a new approach to mental health communication and coping strategies for the Navy and Marine Corps. The novels are intended to capture the attention of the younger target audience and provide vital teaching messages to better prepare personnel for deployment to combat zones. The novels were developed based on embedding the principles of combat and operational stress control (COSC) into realistic and relatable characters, stories, and images. Approaches used for development included (a) basing storylines on real-life service members and the situations they face in combat and their personal lives; (b) partnering with COSC experts to embed teaching points; (c) ensuring technical accuracy through research and target audience reviews of the storyboard and artwork; (d) developing characters that are representative of the target audience, with varied jobs, ages, backgrounds, and professional concerns; and (e) designing artwork in a manner sensitive to training objectives and the psychological effects on readers. Because technical accuracy, realism, and sensitivity were noted as essential components of an effective graphic novel tool, focus-group research and review of author drafts by the target audience and technical experts are strongly recommended.

Summary and Implications of Findings

This chapter summarizes key findings and implications emerging from analyses presented in earlier chapters of this book that draw from the 1980 to 2008 Department of Defense (DoD) Surveys of Health Related Behaviors Among Active Duty Military Personnel (HRB surveys). Following a brief background discussion, the chapter reviews analyses from the 2008 HRB survey of the correlates and predictors of substance abuse, physical health problems, and mental health problems among active duty military service members. This is followed by a discussion of how the health and behavioral health of our active duty service members jointly impact their productivity and readiness as shown by our model of productivity loss. It then considers study limitations, examines programmatic approaches of the military to address challenges of service members, and describes significant issues requiring further research.

Health and Behavioral Health in the Military

Sizable numbers of dedicated U.S. military personnel experience physical health problems, mental health problems, and substance abuse problems during their military service. Although these problems are known, there are many gaps in understanding the overlap and intersections of these complex issues and their effects on the military. This book is the first effort to provide a broad-based integrative look at the nature and extent of substance abuse, physical health status and health behaviors, and mental health problems in the active military and their impact on the productivity and readiness of the active duty armed forces. This chapter provides background and context about the military, describes key factors that reduce military productivity and readiness, and introduces our conceptual framework that guides the analyses presented in this book. Findings are based on the analyses of 10 comprehensive Department of Defense Surveys of Health Related Behaviors Among Active Duty Military Personnel conducted from 1980 to 2008.