Virological and Serological Assessment of US Army Trainees Isolated for Coronavirus Disease 2019.

BACKGROUND: Laboratory screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a key mitigation measure to avoid the spread of infection among recruits starting basic combat training in a congregate setting. Because viral nucleic acid can be detected persistently after recovery, we evaluated other laboratory markers to distinguish recruits who could proceed with training from those who were infected. METHODS: Recruits isolated for coronavirus disease 2019 (COVID-19) were serially tested for SARS-CoV-2 subgenomic ribonucleic acid (sgRNA), and viral load (VL) by reverse-transcriptase polymerase chain reaction (RT-PCR), and for anti- SARS-CoV-2. Cluster and quadratic discriminant analyses of results were performed. RESULTS: Among 229 recruits isolated for COVID-19, those with a RT-PCR cycle threshold >30.49 (sensitivity 95%, specificity 96%) or having sgRNA log10 RNA copies/mL <3.09 (sensitivity and specificity 96%) at entry into isolation were likely SARS-CoV-2 uninfected. Viral load >4.58 log10 RNA copies/mL or anti-SARS-CoV-2 signal-to-cutoff ratio <1.38 (VL: sensitivity and specificity 93%; anti-SARS-CoV-2: sensitivity 83%, specificity 79%) had comparatively lower sensitivity and specificity when used alone for discrimination of infected from uninfected. CONCLUSIONS: Orthogonal laboratory assays used in combination with RT-PCR may have utility in determining SARS-CoV-2 infection status for decisions regarding isolation.

Distinguishing the Effects of Life Threat, Killing Enemy Combatants, and Unjust War Events in U.S. Service Members.

Although previous studies have identified behavioral health risks associated with combat exposure, it is unclear which types of combat events are associated with these risks, particularly regarding contrasts among the risks associated with life-threatening experiences, killing combatants, and exposure to unjust war events, such as killing a noncombatant or being unable to help civilian women and children. In the present study, we examined surveys from 402 soldiers following deployment (i.e., baseline) and again 13 months later (i.e., Year 1). Regression analyses were conducted across a range of behavioral health (e.g., posttraumatic stress disorder, depression, suicide ideation, anxiety, somatic, insomnia, aggression) and benefit-finding measures, each controlling for two combat event categories while assessing the predictive utility of a third. The results suggested that life-threatening events were associated with poor behavioral health at baseline, relative risk (RR) = 10.00, but not at Year 1, RR = 2.67. At both baseline and Year 1, killing enemy combatants was not associated with behavioral health, RRs = 1.67-3.33, but was positively associated with benefit-finding, RRs = 26.67-40.00. Exposure to unjust war events was associated with a transdiagnostic pattern of behavioral health symptoms at baseline, RR = 40.00, and Year 1, RR = 23.33. Overall, the results suggest unjust war event exposure is particularly injurious, above and beyond exposure to other combat-related events. Future research can build on these findings to develop clearer descriptions of the combat events that might place service members at risk for moral injury and inform the development of assessment and treatment options.

An End-User Evaluation of Blast Overpressure and Accelerative Impact Body-Worn Sensors.

INTRODUCTION: Blast overpressure and accelerative impact can produce concussive-like symptoms in service members serving both garrison and deployed environments. In an effort to measure, document, and improve the response to these overpressure and impact events, the U.S. Army Medical Material Development Activity is evaluating body-worn sensors for use by the Joint Conventional Force. In support, the WRAIR completed a qualitative end-user evaluation with service members from high-risk mission occupational specialties to determine the potential needs, benefits, and challenges associated with adopting body-worn sensors into their job duties. MATERIALS AND METHODS: WRAIR staff led hour-long semi-structured focus groups with 156 Army, Navy, and Marine Corps participants, primarily representing infantry, combat engineer, explosive ordnance disposal, artillery, mortar, and armor job specialties. Topics included their sensor needs, concepts of operations, and recommended design features for implementing sensors into the force. Dialogue from each focus group was audio recorded and resulting transcripts were coded for thematic qualitative analysis using NVivo software. RESULTS: Users recommended a single, unobtrusive, rugged, multi-directional sensor that could be securely mounted to the helmet and powered by a battery type (such as rechargeable lithium or disposable alkaline batteries) that was best suited for their garrison and field/deployed environments. The sensors should accurately measure low-level (∼1.0 pounds per square inch) blasts and maintain a record of cumulative exposures for each service member. Discussions supported the need for immediate, actionable feedback from the sensor with the option to view detailed blast or impact data on a computer. There were, however, divergent opinions on security issues regarding wireless versus wired data transfer methods. Participants also expressed a need for the exposure data to integrate with their medical records and were also willing to have their data shared with leadership, although opinions differed on the level of echelon and if the data should be identifiable. Regarding accountability, users did not want to be held fiscally liable for the sensors and recommended having the unit be responsible for maintenance and distribution. Concerns about being held fiscally liable, being overly burdened, and having one's career negatively impacted were listed as factors that could decrease usage. Finally, participants highlighted the importance of understanding the purpose and function of the sensors and supported a corresponding training module. CONCLUSIONS: Participating service members were generally willing to adopt body-worn sensors into their garrison and deployed activities. To maximize adoption of the devices, they should be convenient to use and should not interfere with service members' job tasks. Providing a clear understanding of the benefits (such as incorporating exposure data into medical records) and the function of sensors will be critical for encouraging buy-in among users and leaders. Incorporating end-user requirements and considering the benefits and challenges highlighted by end users are important for the design and implementation of body-worn sensors to mitigate the risks of blast overpressure and accelerative impact on service members' health.

Leadership in moral awareness: Initial evidence from U.S. Army soldiers returning from deployment.

OBJECTIVE: To determine whether moral awareness leadership moderated the relationship between combat experiences and soldier mental health symptoms following deployment. METHOD: The Leadership in Moral Awareness Scale (LIMAS) was evaluated using anonymous surveys completed by 177 U.S. Army National Guardsmen. The survey also assessed general leadership, combat experiences, and posttraumatic stress disorder (PTSD), anxiety, and depression symptoms. Following factor analyses of the LIMAS, moderated regression models examined interactions between the LIMAS and combat experiences on mental health symptoms. RESULTS: Six items were selected to comprise the LIMAS. No main effect of the LIMAS was found for mental health variables after adjusting for general leadership. There were significant interaction effects between the LIMAS and combat experiences for depression and anxiety symptoms. Soldiers with higher levels of combat experiences reported fewer mental health symptoms if their leaders were rated highly on the LIMAS. CONCLUSIONS: The LIMAS may offer a useful tool for assessing leader behaviors that can counteract negative mental health outcomes associated with combat. Findings provide support for encouraging leaders to focus on moral awareness during deployment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Impact of Just and Unjust War Events on Mental Health Need and Utilization within U.S. Service Members.

Background: Soldiers are resilient to just war events, such as killing enemy combatants and life-threatening experiences, but these same soldiers appear to struggle with unjust war events, such as killing a noncombatant or being unable to help civilian women and children in need. This study is the first to examine how just and unjust war experiences are associated with clinical health service outcomes. Methods: Two samples of soldiers in different stages of readjustment from deployment were drawn from a longitudinal, survey-based study of a US Army brigade. Measures included items related to combat events, mental health utilization, perceived mental health need, PTSD, depression, and functional impairment. Results: After controlling for other kinds of combat events, just war events (i.e., life-threatening events and killing enemy combatants) predicted outcomes in soldiers who are less than three months post-deployment, but only predicted 2 of 26 outcomes in soldiers one year post deployment. In contrast, unjust war events were found to be robust predictors of short-term and long-term outcomes related to mental health need and utilization, even after controlling for exposure to other combat events. Conclusions: The results extend previous longitudinal research that suggests that exposure to unjust war events carry a heavier long-term mental health burden than other types of events. Additionally, Soldiers exposed to unjust war events had an unmet need for care one year post deployment that was not directly tied to PTSD or depression. The results question the emphasis on life-threat within mental health pathogenesis models.

Serological and RT-PCR Surveillance for COVID-19 in an Asymptomatic US Army Trainee Population.

BACKGROUND: Significant variability exists in the application of infection control policy throughout the US Army initial entry training environment. To generate actionable information for the prevention of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease 2019 (COVID-19) transmission among new recruits, active enhanced surveillance was conducted for evidence of and exposure to SARS-CoV-2/COVID-19. METHODS: We serially tested recruits with a reverse transcriptase polymerase chain reaction (RT-PCR) COVID-19 and/or total antibody to SARS-CoV-2 tests at days 0, 14, and week 10 upon arrival for basic combat training at a location in the Southern United States. RESULTS: Among 1403 recruits who were enrolled over a 6-week period from August 25 through October 11, 2020, 84 recruits tested positive by RT-PCR, with more than half (55%, 46/84) testing positive at arrival and almost two-thirds (63%, 53/84) also testing seropositive at arrival. Similarly, among an overall 146 recruits who tested seropositive for SARS-CoV-2 during the period of observation, a majority (86%) tested seropositive at arrival; no hospitalizations were observed among seropositive recruits, and antibody response increased at week 10. CONCLUSIONS: These findings that suggest serological testing may complement current test-based measures and provide another tool to incorporate in COVID-19 mitigation measures among trainees in the US Army.

Relationship of perceived stress with depression: complete mediation by perceived control and anxiety in Iran and the United States.

This study sought to clarify the importance and cross-cultural relevance of associations between generalized perceived stress and depression. Also tested was the hypothesis that perceived stress would correlate more strongly with anxiety than with depression, whereas control would be more predictive of depression than of anxiety. Relationships between perceived stress, anxiety, depression, and perceived control were examined in samples of Iranian (n = 191) and American (n = 197) undergraduates. Correlations among these variables were generally similar across the two societies. Perceived stress did predict anxiety better than depression, but perceptions of control predicted depression significantly better than anxiety only in the United States. Best fitting structural equation models revealed that anxiety and perceived control completely accounted for the linkage between perceived stress and depression in both societies. An equally acceptable and more parsimonious model described perceived stress as a consequence rather than as an antecedent of anxiety and perceived control. Structural equation models were essentially identical across the two cultures except that internal control displayed a significant negative relationship with anxiety only in Iran. This result seemed to disconfirm any possible suggestion that a supposedly individualistic process like internal control could have no noteworthy role within a presumably more collectivistic Muslim society like Iran. Overall, these data documented the importance of anxiety and perceived control in explaining the perceived stress-depression relationship cross-culturally and therefore questioned the usefulness of perceived stress in predicting depression. Whether this understanding of the stress-depression relationship deserves general acceptance will require additional studies that measure the frequency of stressful life events and that utilize a longitudinal design.

Private self-consciousness factors: relationships with need for cognition, locus of control, and obsessive thinking in Iran and the United States.

The authors measured Internal State Awareness (ISA) and Self-Reflectiveness (SR) factors from the Private Self-Consciousness Scale in Iranian (N = 325) and U.S. (N = 401) university students. In both societies, positive correlations with Need for Cognition and Internal Control and negative correlations with external control and obsessive thinking confirmed ISA as an adaptive form of self-consciousness. In partial correlations in which the authors controlled for ISA, SR was associated cross-culturally with greater Obsessive Thinking. This outcome conformed with the authors' expectations that SR would have negative mental health implications, but other data revealed complexities in the SR association with adjustment. Differences between samples failed to yield any simple support for F. Fukuyama's (1992) suggestion that Iranians might be more "alienated" (pp. 236-237) in their psychological functioning. The present study most importantly offered cross-cultural evidence in favor of the claim that better measures of an introspective self-awareness need to be developed.