Positive and negative family communication and mental distress: Married service members during a non-combat deployment.

This study examines whether married service member perceptions of positive or negative communication moderate the relationship between how frequently they communicate home during a deployment and their mental distress. Participants included 382 married service members who completed surveys regarding their marital relationships, communication, and mental health while on a non-combat deployment. Though marital satisfaction was not significantly associated with service member reports of their mental distress, perceptions of negative (ß = 4.32, SE = 0.59, p < 0.001) and positive communication (ß = -1.32, SE = 0.57, p < 0.05) were. Further, significant interactions between frequency of communication and the perception of negative (ß = 0.54, SE = 0.13, p < 0.001) and positive (ß = 0.17, SE = 0.07, p < 0.01) communication suggest positive communication may be protective for service members while frequent, negative communication can exacerbate distress. Findings highlight the importance of engaging families in planning and skill building to support healthy communication across the deployment cycle.

Conjugates of human serum butyrylcholinesterase and nerve agents are behaviorally safe in rhesus macaques.

Exogenously administered human serum butyrylcholinesterase (Hu BChE) affords protection by binding to organophosphorus (OP) nerve agents and pesticides in circulation. The resulting Hu BChE-OP conjugate undergoes 'aging' and the conjugate circulates until cleared from the body. Thus, we evaluated the effects of Hu BChE-OP conjugates on the general health and operant behavior of macaques. Rhesus macaques trained to perform a six-item serial probe recognition (SPR) task were administered 30 mg/kg of Hu BChE-soman conjugate (n = 4) or Hu BChE-VX conjugate (n = 4) by intramuscular injection. Performance on the SPR task was evaluated at 60-90 min after conjugate administration and daily thereafter for the next 4 weeks. Diazepam (3.2 mg/kg), a positive control, was administered 5 weeks after conjugate administration and performance on the SPR task was evaluated as before. Blood collected throughout the study was analyzed for acetylcholinesterase (AChE) and BChE activities. Residual BChE activity of conjugates displayed a similar pharmacokinetic profile as free Hu BChE. Neither of the Hu BChE-OP conjugates produced clear or pronounced degradations in performance on the SPR task. In contrast, diazepam clearly impaired performance on the SPR task on the day of administration in 7 of 8 macaques (and sometimes longer). Taken together, these results suggest that Hu BChE-OP conjugates are safe and provide further support for the development of Hu BChE as a bioscavenger for use in humans.

Mental Health Service Utilization and Perceived Barriers to Receiving Care in Deployed Soldiers.

INTRODUCTION: Scant research has examined mental health treatment utilization and barriers to care in deployed U.S. soldiers. This study aims to assess mental health treatment utilization in deployed soldiers, including providers used and barriers to care. MATERIALS AND METHODS: U.S. Army soldiers (n = 2,412) in a combat environment were surveyed on psychiatric symptoms, mental health help received, sources of care, and perceived barriers to care by Mental Health Advisory teams from 2009 to 2013. RESULTS: Of the 25% of soldiers at mental health risk, 37% received mental health help, with 18% receiving help from a provider. Nonprovider sources of care were utilized significantly more frequently than providers. Soldiers at mental health risk reported significantly greater anticipated career-related stigma, organizational barriers to care, self-reliance views, and negative attitudes toward care, yet these constructs did not differ between who did or did not receive help. Soldiers who received help from providers exclusively reported significantly more anticipated career-related stigma and fewer organizational barriers to care than those that received no help. Soldiers who spent no time living outside the forward operating base and soldiers with six or more types of combat exposures were more likely to receive help. CONCLUSIONS: Prevalence of common psychopathology and receipt of care in a combat environment was similar to previous reports from postdeployment settings. Nonprovider sources of care were more frequently utilized as compared to an in-Garrison report. Findings suggest important differences exist in sources of help and barriers to care in deployed vs. postdeployment environments. The hypothesized barriers to care did not preclude receiving any help, however, less than one-half of soldiers at mental health risk received help. Thus, future research should identify factors that have the greatest influence on help seeking behavior in both deployed and Garrison settings.

Determinants of mental and physical health treatment-seeking among military personnel.

BACKGROUND: Although research has documented factors influencing whether military personnel seek treatment for mental health problems, less research has focused on determinants of treatment-seeking for physical health problems. AIMS: To explicitly compare the barriers and facilitators of treatment-seeking for mental and physical health problems. METHOD: US soldiers (n = 2048) completed a survey with measures of barriers and facilitators of treatment-seeking for mental and physical health problems as well as measures of somatic symptoms and mental health. RESULTS: The top barrier for both mental and physical health treatment-seeking was a preference for handling problems oneself. The top facilitators for both symptom types were related to treatment improving quality of life. Differential endorsement of barriers occurred for treatment of mental versus physical health symptoms. In contrast, facilitators were endorsed more for physical than for mental health treatment. While there were few gender differences, officers reported more barriers and facilitators than did enlisted personnel. Screening positive for mental or physical health problems was associated with greater endorsement of both barriers and facilitators for physical and mental health treatment, respectively. CONCLUSIONS: The leading barriers and facilitators for seeking treatment for mental health and physical problems are relatively similar, suggesting that health education should consider decision-making in seeking both mental and physical healthcare. Interventions should be tailored to reduce barriers for officers and improve facilitators for junior enlisted personnel, and address barriers and facilitators for service members screening positive for a mental or physical health problem.

U.S. Soldiers and Foreign Language School: Stressors and Health.

INTRODUCTION: While previous studies have examined the stress of the military training environment, studies have not systematically examined the stress associated with attending the Defense Language Institute Foreign Language Center (DLIFLC). Service members assigned to DLIFLC endure intense academic pressure to succeed while meeting military requirements. Thus, not only are traditional academic stressors likely to be of concern but there are other academic and military-related stressors that have to managed by students. The goal of the present study was to characterize the stressors facing military students, document their mental health status and well-being, and identify mitigating factors such as coping, social support, time management, and the classroom environment. MATERIALS AND METHODS: Data were obtained from a cross-sectional survey administered in March of 2016. Study participants were 759 active-duty U.S. soldiers enrolled in DLIFLC, with a consent rate of 87.7%. Surveys were administered in classroom settings. Survey topics included demographics, student experience (e.g., classroom hours, stressors), mental health (e.g., depression, anxiety, hazardous alcohol use) and burnout, and mitigating factors (e.g., coping, social support, time management, classroom environment). Multiple logistic regressions were used to identify which variables in the predictor set were significantly associated with each of the five outcomes while controlling for the presence of all other variables. RESULTS: In terms of behavioral health, 7.2% met screening criteria for depression, 9.4% for anxiety, and 17.1% for hazardous alcohol use; 43.4% reported high/very high levels of burnout. About one-third of the sample who had taken a test failed at least one (32.2%). In terms of common stressors more than half reported high or very high-stress levels from meeting academic expectations, not getting enough sleep, and pressure to succeed from civilian language instructors. For depression and anxiety, regression results found that denial coping was a risk factor whereas positive social interaction and classroom climate were protective factors. For hazardous alcohol use, denial coping and higher rank were risk factors and acceptance and time management were protective factors. In terms of academic burnout, in-class and military work hours were risk factors, whereas time management and classroom climate were protective. Finally, lower educational attainment, time spent in the classroom and times spent on military duties predicted exam failure. CONCLUSION: Individual coping, social connection, and classroom climate are each associated with better DLIFLC student adjustment. Denial coping appears to impede individuals from assembling the personal resources needed to study a foreign language. In contrast, acceptance appears to support healthier adjustment, perhaps freeing individuals to focus on the task at hand rather than expend valuable energy resisting the demands being placed on them. Positive social interaction also appears to provide an important resource for students, and positive classroom climate is also associated with better mental health. These findings suggest that there are measures that individuals and the school can take to improve the DLIFLC experience and support students as they manage a myriad of stressors given the significance of their success to individual students and to the larger organization.

Testing the effects of using a behavioral health provider to deliver a routine post-deployment assessment for soldiers returning from combat.

Studies indicate that changes in postdeployment behavioral health care delivery are necessary to improve symptom-reporting and treatment-seeking. The present study compared two behavioral health strategies implemented during the Post-Deployment Health Assessment (PDHA) with soldiers within the first months of returning from a combat deployment. A quasi-experimental, longitudinal study compared soldiers (N = 1,612) interviewed by a behavioral health (BH) provider and soldiers (N = 1,326) interviewed by a primary care provider using the standard PDHA procedure. Surveys pre- and post-PDHA and four months later assessed treatment-seeking attitudes; PDHA data and BH clinic use were compiled and compared by each interview strategy. Soldiers interviewed by a BH provider rated interview usefulness, quality, and comfort reporting BH concerns more positively than soldiers interviewed by a primary care provider using the standard procedure. However, there were no differences in treatment-seeking attitudes, provider referral rates, or use of BH services in the 4 months after the PDHA. Although there were initial positive reports of the interview with the BH Provider, there was no evidence BH provider interviews resulted in any lasting improvements in treatment-seeking or long-term treatment attitudes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

U.S. Service Member Deployment in Response to the Ebola Crisis: The Psychological Perspective.

Introduction: In the fall of 2014, the United States and other nations responded to the worst outbreak of the Ebola virus disease in history. As part of this effort, U.S. service members deployed to West Africa to support a spectrum of activities that did not involve direct patient care. Although previous studies identified the psychological impact of responding to an outbreak, these studies were limited to retrospective data, small sample sizes, and medical personnel. The goals of the present study were to (a) document the mental health and well-being of troops deploying in response to an infectious disease outbreak; (b) identify their stressors, attitudes toward deployment, and health risk concerns; and (c) understand the role of combat experience in adjusting to these types of missions. Materials and Methods: Study participants at both pre- and during deployment were active duty U.S. soldiers in a combat aviation battalion from a large U.S. military installation. U.S. soldiers were surveyed (n = 251) 3 wk before deploying to Liberia (October 2014) and surveyed again during their deployment (February 2015; n = 173). Participants were primarily male (86.1%), junior ranking (56.0%), and just over half had previous combat deployment experience (51.2%). Surveys were anonymous and not linked to one another over time. Results: Overall rates of mental health problems were low (2.4% at pre-deployment and 5.8% during deployment), whereas sleep problems were reported by 4.9% at pre-deployment and 12% during deployment. At pre-deployment, top stressors focused on health threats; fewer stressors were reported during deployment. Soldiers were relatively less concerned about contracting Ebola than other more prevalent diseases. Soldiers with combat experience reported more somatic and sleep problems at pre-deployment than those without previous combat experience. There were no significant differences during deployment between those with and without previous combat experience. Conclusion: Overall, a small proportion of respondents reported significant rates of mental health problems. In contrast, sleep problems were reported by 12% during deployment. In terms of attitudes toward the mission, the vast majority reported that they knew what to do to protect themselves from disease and that they understood the potential risk involved. The study also confirmed previous findings that soldiers with previous combat experience had more somatic symptoms at pre-deployment than those without, although this distinction appeared limited to the pre-deployment phase. Results can be used to address anxiety by personnel during pre-deployment and to inform leadership preparing personnel to deploy in response to future infectious disease outbreaks.

Professional Stress and Burnout in U.S. Military Medical Personnel Deployed to Afghanistan.

BACKGROUND: Studies of medical staff members have consistently documented high levels of burnout compared to those in other professions. Although there are studies of burnout in military medical staff, there are gaps in understanding the experience of medical staff while they are deployed and few occupationally-related factors associated with decreased burnout have been identified in this population. PURPOSE: To assess work-related variables accounting for burnout over and above rank, post-traumatic stress disorder (PTSD) symptoms, and professional stressors in the deployed environment. METHODS: U.S. military medical staff members were surveyed in Afghanistan. The survey assessed burnout (emotional exhaustion and depersonalization), PTSD symptoms, perception of professional stressors, self-care behaviors, taking care of team members (team care), general leadership, and health-promoting leadership. Participants provided informed consent under a protocol approved by the institutional review board at Walter Reed Army Institute of Research, and coordinated through the Washington Headquarters Service and the Joint Casualty Care Research Team located in Afghanistan. A total of 344 individuals provided their consent (83.3%) and completed the survey. RESULTS: Correlations found significant positive relationships between perception of professional stressors and levels of burnout. Significant negative correlations were found between burnout and self-care, team care, general leadership, and health-promoting leadership. Regression analyses found self-care and team care accounted for less burnout even after controlling for rank, PTSD symptoms, and professional stressors. Health-promoting leadership accounted for less burnout even after controlling for these same covariates and general leadership as well. CONCLUSION: Although a cross-sectional survey, results provide three specific directions for reducing burnout in deployed medical staff. By emphasizing self-care, team care, and health-promoting leadership, policy makers, researchers, and leaders can address factors that influence burnout in this, and other occupational contexts. In addition, the constructs of team care and leadership offer novel contributions to the study of burnout in medical personnel.

Attention and interpretation processes and trait anger experience, expression, and control.

This study explored attention and interpretation biases in processing facial expressions as correlates of theoretically distinct self-reported anger experience, expression, and control. Non-selected undergraduate students (N = 101) completed cognitive tasks measuring attention bias, interpretation bias, and Spielberger's State-Trait Anger Expression Inventory (STAXI-2). Attention bias toward angry faces was associated with higher trait anger and anger expression and with lower anger control-in and anger control-out. The propensity to quickly interpret ambiguous faces as angry was associated with greater anger expression and its subcomponent of anger expression-out and with lower anger control-out. Interactions between attention and interpretation biases did not contribute to the prediction of any anger component suggesting that attention and interpretation biases may function as distinct mechanisms. Theoretical and possible clinical implications are discussed.

The Impact of Unit Membership on Smoking Among Soldiers.

Cultural, organizational, and dyadic influences have been found to be associated with smoking in the military while group-level influences have been identified in the general population. However, there are few studies examining group-level influences in the military and none using group-level analyses. Such studies are essential for understanding how to optimally forestall or cease smoking. This study, using mixed effects modelling, examined whether unit membership influenced smoking behavior in soldiers from brigade combat teams. Unit membership was assessed in 2008 to 2009 at the company level (n = 2204) and in 2012 at the platoon level (n = 452). Smoking was assessed by the number of daily cigarettes smoked (range: 0-99) with smoking status (nonsmoker vs. smoker) and smoking level (none, smoker, and heavy [20 + cigarettes/day]) as the outcomes. For both samples, unit membership was not significantly associated with a soldier's propensity to smoke when comparing either all smokers to nonsmokers or heavy smokers to smokers. These results suggest typical military unit-level training programs are unlikely to be the most effective mode of intervention for smoking prevention or cessation. Smoking rates in the military may be influenced instead by small group or individual relationships or by overall military culture.

Threat-Related Attention Bias Variability and Posttraumatic Stress.

OBJECTIVE: Threat monitoring facilitates survival by allowing one to efficiently and accurately detect potential threats. Traumatic events can disrupt healthy threat monitoring, inducing biased and unstable threat-related attention deployment. Recent research suggests that greater attention bias variability, that is, attention fluctuations alternating toward and away from threat, occurs in participants with PTSD relative to healthy comparison subjects who were either exposed or not exposed to traumatic events. The current study extends findings on attention bias variability in PTSD. METHOD: Previous measurement of attention bias variability was refined by employing a moving average technique. Analyses were conducted across seven independent data sets; in each, data on attention bias variability were collected by using variants of the dot-probe task. Trauma-related and anxiety symptoms were evaluated across samples by using structured psychiatric interviews and widely used self-report questionnaires, as specified for each sample. RESULTS: Analyses revealed consistent evidence of greater attention bias variability in patients with PTSD following various types of traumatic events than in healthy participants, participants with social anxiety disorder, and participants with acute stress disorder. Moreover, threat-related, and not positive, attention bias variability was correlated with PTSD severity. CONCLUSIONS: These findings carry possibilities for using attention bias variability as a specific cognitive marker of PTSD and for tailoring protocols for attention bias modification for this disorder.

Behavioral health leadership: new directions in occupational mental health.

The impact of stress on mental health in high-risk occupations may be mitigated by organizational factors such as leadership. Studies have documented the impact of general leadership skills on employee performance and mental health. Other researchers have begun examining specific leadership domains that address relevant organizational outcomes, such as safety climate leadership. One emerging approach focuses on domain-specific leadership behaviors that may moderate the impact of combat deployment on mental health. In a recent study, US soldiers deployed to Afghanistan rated leaders on behaviors promoting management of combat operational stress. When soldiers rated their leaders high on these behaviors, soldiers also reported better mental health and feeling more comfortable with the idea of seeking mental health treatment. These associations held even after controlling for overall leadership ratings. Operational stress leader behaviors also moderated the relationship between combat exposure and soldier health. Domain-specific leadership offers an important step in identifying measures to moderate the impact of high-risk occupations on employee health.

Postdeployment threat-related attention bias interacts with combat exposure to account for PTSD and anxiety symptoms in soldiers.

BACKGROUND: Recent studies suggest that assessment of threat-related attention bias may be useful in identifying soldiers at risk for clinical symptoms. The present study assessed the degree to which soldiers experienced combat events and showed attentional threat avoidance affected their reported levels of post-traumatic stress disorder (PTSD) and anxiety symptoms. METHODS: Four months after a combat deployment to Iraq, 63 US soldiers completed a survey assessing combat exposures and clinical symptoms as well as a dot-probe task assessing threat-related attention bias. RESULTS: Significant three-way interactions regressing threat reaction times (RTs), neutral RTs, and combat exposure on PTSD and anxiety symptoms were observed. Specifically, soldiers with high levels of combat exposure, who were more likely to demonstrate attentional bias away from threat, were also more symptomatic. CONCLUSION: These results demonstrate the potential of threat-related attention bias as a behavioral marker of PTSD and anxiety symptoms in a high-risk military occupational context.

Assessment of an alternative postdeployment reintegration strategy with soldiers returning from Iraq.

The present study examined behavioral health outcomes, risk behaviors, aggression, alcohol misuse, marital satisfaction, and attitudes toward reintegration associated with an alternative, front-loaded reintegration strategy compared with a more standardized reintegration process in soldiers returning from combat deployments. The type of reintegration strategy used did not predict differences in posttraumatic stress disorder (PTSD) symptoms, alcohol misuse, aggression, and marital satisfaction, although slightly higher reports of risk behaviors were found in the unit using the standard reintegration approach even after controlling for demographic covariates and combat exposure. These findings may help guide leadership when making decisions regarding reintegration approaches in the future.

Postdeployment behavioral health screening: face-to-face versus virtual behavioral health interviews.

Virtual behavioral health (VBH) services are used frequently to address the high demand for behavioral health (BH) services in the military. Few studies have investigated the relationship between the use of VBH services and BH outcomes or preferences for the use of VBH technologies. In this article, we evaluated BH interviews conducted via video teleconferencing (VTC) or face-to-face in terms of BH symptoms, satisfaction rates, stigma, barriers to care, and preferences for future use of BH care. Soldiers (n = 307) from the headquarters element of an operational unit were surveyed 4 months following a 12-month deployment to Iraq. There were no significant differences in satisfaction rates based on interview modality, but significantly more soldiers preferred face-to-face interviews over VTC interviews in the future. Soldiers who preferred face-to-face interviews also reported higher levels of anxiety and depression symptoms than those who preferred VTC interviews. No significant age differences were found in terms of interview modality satisfaction or preference. Soldiers with greater deployment experience were more likely to report that they would not like using VTC if seeking BH care in the future than soldiers with less deployment experience. These findings highlight the importance of promoting choice in type of BH interview modality.

Behavioral data management using Visual Basics for Applications to automate data capture and analysis.

Many researchers are familiar with the spreadsheet capabilities of Microsoft Excel, but have never explored using customized VISUAL BASIC FOR APPLICATIONS (VBA) macros embedded in the program. At the United States Army Medical Research Institute of Chemical Defense (USAMRICD), the implementation of VBA program code to carry out repetitive operations has resulted in a tremendous savings in both the time and manpower required to reliably capture, analyze, and plot data from research protocols. A set of "template" workbooks was developed and is used to organize data from different types of studies. At the heart of the concept is a "setup information" worksheet onto which the user enters information about the study (i.e. the number of subjects, groups, graphs). Clicking a control button on this worksheet launches the VBA code that creates worksheets for each subject, group and chart specified. A "pairmatch" function allows the user to create groups either randomly or by pair matching based on user-specified variables. Controls are provided that run VBA program code to parse subject data files into the proper worksheets and perform group averages. Charts are updated automatically whenever group averages change so that the researcher always has an up-to-date plot available. The ability to reformat the captured data onto a "statistical output" worksheet allows data to be imported easily to statistical software packages. The concept is being used for several different types of studies at USAMRICD and has significantly reduced not only amount of time spent on data management, but also the number of data entry errors. Readers interested in acquiring an electronic copy of the startle workbook example, which contains the complete VBA code, should send the request to the authors at reseco@erols.com or maurice.sipos@us.army.mil.

Effects of anticholinergics on serial-probe recognition accuracy of rhesus macaques (Macaca mulatta).

Potential deleterious behavioral effects of the anticholinergics biperiden and scopolamine were examined via the performance of rhesus monkeys on a serial-probe recognition (SPR) procedure. On each trial, six unique stimuli (list items) were presented sequentially followed by a choice phase. In the choice phase, two stimuli were presented, a standard or 'default' stimulus (a white rectangle) and a 'probe' stimulus that differed with each choice trial. Choosing the probe stimulus was considered correct if the probe matched one of the list items; otherwise, choosing the default stimulus was considered correct. Behavior was examined under a range of doses of biperiden (0.001-1.0 mg/kg) and scopolamine (0.0056-0.03 mg/kg). Scopolamine (0.01-0.03 mg/kg) and biperiden (0.3-1.0 mg/kg) reduced overall accuracy. At the highest dose, scopolamine, but not biperiden, reduced the number of trials completed per session. The results suggest that doses of scopolamine and biperiden necessary to prevent or eliminate organophosphate induced seizures may affect performance adversely. However, because the degree of impairment from biperiden was modest, further examination of this anticonvulsant may be warranted.