Resilience in Army STARRS: Evaluating psychometrics of a multi-dimensional resilience measure.

As policymakers and the U.S. military continue to place an emphasis on the resilience of servicemembers, it is critical to utilize psychometrically sound and valid scales to measure resilience. Using two independent samples of Army soldiers-in-training, this study explored the measurement of resilience in the Army Study to Assess Risk and Resilience among Servicemembers (Army STARRS) New Soldier Study Component (NSS). Exploratory factor analysis (EFA) was used to identify the factor structure of a measure of resilience within the Army STARRS NSS. Confirmatory factor analysis (CFA) was then used to confirm the factor structure, then internal reliability was assessed. Convergent validity of the identified resilience factors was examined using two-tailed bivariate correlations. The EFA identified a three-factor structure of a measure of resilience. The CFA confirm the first-order three-factor structure of stress tolerance, positive orientation, and social resources. Each factor was uniquely distinct from measures of the likelihood of generalized anxiety disorder and major depressive disorder, lifetime stressful events, and social network. Findings highlights the utility of a three-factor aggregate measure of resilience in the Army STARRS NSS and provide practitioners with a more nuanced picture of the role of resilience among soldiers-in-training.

Identifying at-risk marines: A person-centered approach to adverse childhood experiences, mental health, and social support.

BACKGROUND: Previous research indicates an association between adverse childhood experiences (ACES) and health outcomes; however, most of these studies rely on variable-centered techniques. This study implemented a person-centered approach to provide a more nuanced understanding of these relations. METHODS: The sample consisted of 3611 male Marines who completed two surveys, one prior to service and another during or after service. A series of latent class analyses were conducted to identify homogenous subgroups, using ACE categories as indicators. Hierarchical regressions were conducted to examine the relationships between classes, deployment experiences, depression and PTSD, and social support problems. RESULTS: Five classes were identified: Low Adversity (48.8 %), Low Adversity - Parental Separation (PS; 33.1 %), Elevated Adversity (7.0 %), Moderate Adversity - Violence/Safety (5.7 %), and Moderate Adversity - Parental Loss (PL; 5.4 %). Several classes were associated with outcomes; in reference to Low Adversity, Moderate Adversity - PL was associated with depression and PTSD, Elevated Adversity was associated with PTSD and social support problems, and Low Adversity - PS was associated with social support problems. Experiencing moderate to high combat appeared to modify the associations between Moderate Adversity - PL and depression and PTSD. LIMITATIONS: Study sample was limited to U.S. Marines; ACEs indicators were limited to specific categories, not allowing for a full range of potential childhood traumatic experiences. CONCLUSIONS: Findings suggest a nuanced connection between ACEs and mental health; using specific patterns of ACEs, particularly multifaceted indicators of adversity that are inclusive of parental absence may have more utility than the sheer number of ACEs as an indicator for those who may at a heightened risk for mental health concerns.

An exploration of factors related to service utilization in emerging adults: Loneliness and psychosocial supports.

Objective: To examine the relationships between loneliness and psychosocial supports, emerging adult service utilization, and barriers to utilization. Participants: 18 to 29-year-old students enrolled in a large Midwestern University (n = 292). Methods: Online surveys were administered to all participants involving information on loneliness, social supports, basic need satisfactions, community/university service utilization, and barriers to service use. Logistic and linear regressions, analysis of variance were conducted. Results: Emerging adults were found to have a greater likelihood of service utilization when higher in social support from friends and less likely to utilize services when high in relatedness and competence need satisfaction, specifically in regard to community services. Group differences in greater barriers to service utilization were found among the highest levels of loneliness and the lowest levels of need satisfaction. Conclusion: Overall, this study indicates psychosocial supports and loneliness are related to service utilization in a nuanced manner.

Military-related stress, self-efficacy, and anxiety: Investigating the role of marital quality in military couples.

This study utilizes a stress process framework in conjunction with a crossover perspective to conceptualize how stress, specifically military-related stress, manifests within individuals and couples. An actor-partner interdependence mediation modeling approach was used in a cross-sectional sample of 243 military couples to examine whether difficulties managing military-related stress may erode one's own self-efficacy and, in turn, contribute to greater anxiety (actor effects) and/or one's partner's self-efficacy and, in turn, anxiety (partner effects). Further, the potential moderating impact of marital quality was explicated in the model to understand if greater marital quality might buffer the impact of military-related stress. There was support for the stress process model primarily regarding actor effects; fewer partner effects emerged. One's own perceptions of military-related stress, specifically higher stress, were related to lower levels of their own self-efficacy, and, consequently, higher anxiety, but military-related stress did not directly affect the partner's self-efficacy or anxiety. Both service members' and civilian spouses' marital quality had ramifications for civilian spouses' self-efficacy, specifically a buffering effect; that was not the case regarding civilian spouse effects on the military member. Findings point to specific ways in which military stressors have implications for personal well-being, the role of a strong couple relationship in buffering stress, especially for civilian spouses, and concomitant leverage points for supporting both individual and couple well-being.

Identifying Risk and Resilience Factors Associated With the Likelihood of Seeking Mental Health Care Among U.S. Army Soldiers-in-Training.

INTRODUCTION: The Department of Defense aims to maintain mission readiness of its service members. Therefore, it is important to understand factors associated with treatment seeking in order to identify areas of prevention and intervention early in a soldier's career that can promote positive functioning and increase their likelihood of seeking mental health care when necessary. METHOD: Using a theory of planned behavior lens, this study identified potential barriers (risk) and facilitators (resilience) to treatment seeking among 24,717 soldiers-in-training who participated in the New Soldiers Study component of the "Army Study to Assess Risk and Resilience in Servicemembers" (Army STARRS). Approval for this study was granted by the University of Iowa IRB # 201706739. Hierarchal linear regression modeling and independent samples t-tests were used to examine associations between demographics and study variables, intersections of risk and resilience, and to explore differences in the likelihood of seeking help based on mental health diagnoses. RESULTS: A four-stage hierarchical linear regression was conducted, using likelihood of help-seeking as the dependent variable, to identify the most salient factors related to help-seeking. "Step one" of the analysis revealed soldiers-in-training who identified as female, Hispanic or Other ethnicity, and married, divorced, or separated reported a greater likelihood of seeking help. "Step two" of the analysis indicated soldiers-in-training with a history of sexual trauma, experience of impaired parenting, and clinical levels of mental health symptomatology (anxiety, depression, PTSD) reported a greater likelihood of seeking help. Inversely, soldiers-in-training with a history of emotional trauma and parental absence/separation reported a lower likelihood of seeking help. "Step three" of the analysis demonstrated soldiers-in-training with a prior history of seeking help and larger social networks had a greater likelihood of seeking help. "Step four" of the analysis revealed several interactive effects between risk and resilience factors. Specifically, soldiers-in-training who reported greater depressive symptomatology in combination with prior history of treatment seeking reported a greater likelihood of help seeking, whereas soldiers-in-training who reported prior sexual trauma and PTSD in combination with large social networks reported a lower likelihood of seeking help. Finally, a greater percentage of soldiers-in-training with clinical levels of anxiety, depression, and PTSD indicated they would likely seek help in comparison to soldiers-in-training without clinical symptoms. CONCLUSION: Findings suggest few soldiers-in-training are likely to seek help when experiencing a problem. General efforts to encourage help-seeking when needed are warranted with particular focus on subsets of soldiers-in-training (eg, men, those with a history of some adverse childhood experiences). Strengths of this study include the examination of a large sample of soldiers-in-training to identify possible leverage points for early intervention or prevention prior to entering stressful military operating environments. Limitations of this study include the examination of only one military branch and exclusion of soldiers not "in-training." Future studies could consider replicating the current study using a sample of military personnel longitudinally to track behavioral trends as well as looking at military populations outside of basic combat training.

The Buffering Effect of Relationships on Combat Exposure, Military Performance, and Mental Health of U.S. Military Soldiers: A Vantage Point for CFTs.

This study examined the role of cumulative combat experiences with regard to military performance and conduct and mental health among a sample of young soldiers from the Army STARRS dataset (N = 5,283). Higher levels of cumulative combat experiences were directly related to poorer performance and conduct and a greater likelihood of anxiety, depression, and post-traumatic stress disorder (PTSD). Military performance and conduct served as a linking mechanism between combat experiences and mental health. Using moderated mediation structural equation modeling, relationship disruptions were found to exacerbate the adverse effects of combat experiences; conversely, unit cohesion buffered the impact of combat experiences. Implications for military helping professionals include identifying leverage points for intervention, particularly strengthening the social connections of service members within and outside the military.