Factors Affecting Organizational Commitment in Navy Corpsmen.

BACKGROUND: Organizational commitment is a psychological state that has a strong impact on the likelihood that employees will remain with an organization. Among military personnel, organizational commitment is predictive of a number of important outcomes, including reenlistment intentions, job performance, morale, and perceived readiness. Because of the unique challenges and experiences associated with military service, it may be that organizational commitment is even more critical in the military than in civilian populations. Despite the essential role that they play in protecting the health of other service members, little is known about the factors that influence Navy Corpsmen's organizational commitment. This study investigated demographic and psychosocial factors that may be associated with organizational commitment among Corpsmen. METHODS: Surveys of organizational commitment and possible demographic and psychosocial correlates of organizational commitment were completed by 1,597 male, active duty Navy Corpsmen attending Field Medical Training Battalion-West, Camp Pendleton, California. Bivariate correlations and hierarchical multiple regression analyses were used to determine significant predictors of organizational commitment. FINDINGS: Of the 12 demographic and psychosocial factors examined, 6 factors emerged as significant predictors of organizational commitment in the final model: preservice motivation to be a Corpsman, positive perceptions of Corpsman training, confidence regarding promotions, occupational self-efficacy, social support for a Corpsman career, and lower depression. DISCUSSION/IMPACT/RECOMMENDATIONS: Importantly, a number of the factors that emerged as significant correlates of organizational commitment in this study are potentially modifiable. These factors include confidence regarding promotions, positive perceptions of Corpsman training, and occupational self-efficacy. It is recommended that military leaders and policy-makers take concrete steps to address these factors, thereby strengthening organizational commitment among Corpsmen. Further research is needed to identify ways in which organizational commitment could be strengthened among Corpsmen.

Highly realistic, immersive training for navy corpsmen: preliminary results.

Highly realistic, immersive training has been developed for Navy corpsmen based on the success of the Infantry Immersion Trainer. This new training is built around scenarios that are designed to depict real-life, operational situations. Each scenario used in the training includes sights, sounds, smells, and distractions to simulate realistic and challenging combat situations. The primary objective of this study was to assess corpsmen participants' satisfaction with highly realistic training. The study sample consisted of 434 male Navy service members attending Field Medical Training Battalion-West, Camp Pendleton, California. Corpsmen participants completed surveys after receiving the training. Participants expressed high levels of satisfaction with the training overall and with several specific elements of the training. The element of the training that the corpsmen rated the highest was the use of live actors. The vast majority of the participants reported that the training had increased their overall confidence about being successful corpsmen and had strengthened their confidence in their ability to provide care under pressure. Additional research should extend highly realistic training to other military medical provider populations.

A prospective study of factors affecting recovery from musculoskeletal injuries.

PURPOSE: Research suggests the importance of psychosocial factors in recovery from musculoskeletal injuries. The objective of this study was to identify predictors of recovery among U.S. Marines who had musculoskeletal injuries of the back, knee, or shoulder. METHODS: A sample of 134 participants was assessed at baseline and followed for 1 year to determine outcome information. RESULTS: The strongest predictor of injury recovery at the 1-year follow-up was recovery expectations. In a multivariate logistic model with key demographic and psychosocial factors controlled, individuals who had high recovery expectations at baseline were over five times as likely to be recovered at follow-up as individuals who had low expectations (OR = 5.18, p\.01). CONCLUSIONS: This finding is consistent with a large body of research that has linked recovery expectations with better recovery outcomes in patients with musculoskeletal injuries as well as with research linking recovery expectations with better outcomes across a wide range of medical conditions.Applied to military populations, interventions designed to modify recovery expectations may have the potential to improve rates of return to duty and to reduce rates of disability discharge.

Predictors of psychiatric disorders in combat veterans.

BACKGROUND: Most previous research that has examined mental health among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combatants has relied on self-report measures to assess mental health outcomes; few studies have examined predictors of actual mental health diagnoses. The objective of this longitudinal investigation was to identify predictors of psychiatric disorders among Marines who deployed to combat in Iraq and Afghanistan. METHODS: The study sample consisted of 1113 Marines who had deployed to Iraq or Afghanistan. Demographic and psychosocial predictor variables from a survey that all Marines in the sample had completed were studied in relation to subsequent psychiatric diagnoses. Univariate and multivariate logistic regression were used to determine the influence of the predictors on the occurrence of psychiatric disorders. RESULTS: In a sample of Marines with no previous psychiatric disorder diagnoses, 18% were diagnosed with a new-onset psychiatric disorder. Adjusting for other variables, the strongest predictors of overall psychiatric disorders were female gender, mild traumatic brain injury symptoms, and satisfaction with leadership. Service members who expressed greater satisfaction with leadership were about half as likely to develop a mental disorder as those who were not satisfied. Unique predictors of specific types of mental disorders were also identified. CONCLUSIONS: Overall, the study's most relevant result was that two potentially modifiable factors, low satisfaction with leadership and low organizational commitment, predicted mental disorder diagnoses in a military sample. Additional research should aim to clarify the nature and impact of these factors on combatant mental health.

Anxiety and depression in Marines sent to war in Iraq and Afghanistan.

Although the effects of combat deployment on posttraumatic stress disorder have been extensively studied, little is known about the effects of combat deployment on depression and anxiety. This study examined the factors associated with anxiety and depression in a sample of 1560 US Marines who were deployed to Iraq and Afghanistan. Eleven demographic and psychosocial factors were studied in relation to depression and anxiety. Five factors emerged as significant in relation to depression: deployment-related stressors, combat exposure, attitudes toward leadership, mild traumatic brain injury symptoms, and marital status. The same factors, with the exception of marital status, emerged as significant in relation to anxiety. Deployment-related stressors had a stronger association with both depression and anxiety than any other variable, including combat exposure. This finding is important because deployment-related stressors are potentially modifiable by the military.

Psychiatric diagnoses and punishment for misconduct: the effects of PTSD in combat-deployed Marines.

BACKGROUND: Research on Vietnam veterans suggests an association between psychological problems, including posttraumatic stress disorder (PTSD), and misconduct; however, this has rarely been studied in veterans of Operation Iraqi Freedom or Operation Enduring Freedom. The objective of this study was to investigate whether psychological problems were associated with three types of misconduct outcomes (demotions, drug-related discharges, and punitive discharges.) METHODS: A population-based study was conducted on all U.S. Marines who entered the military between October 1, 2001, and September 30, 2006, and deployed outside of the United States before the end of the study period, September 30, 2007. Demographic, psychiatric, deployment, and personnel information was collected from military records. Cox proportional hazards regression analysis was conducted to investigate associations between the independent variables and the three types of misconduct in war-deployed (n = 77,998) and non-war-deployed (n = 13,944) Marines. RESULTS: Marines in both the war-deployed and non-war-deployed cohorts with a non-PTSD psychiatric diagnosis had an elevated risk for all three misconduct outcomes (hazard ratios ranged from 3.93 to 5.65). PTSD was a significant predictor of drug-related discharges in both the war-deployed and non-war-deployed cohorts. In the war-deployed cohort only, a specific diagnosis of PTSD was associated with an increased risk for both demotions (hazard ratio, 8.60; 95% confidence interval, 6.95 to 10.64) and punitive discharges (HR, 11.06; 95% CI, 8.06 to 15.16). CONCLUSIONS: These results provide evidence of an association between PTSD and behavior problems in Marines deployed to war. Moreover, because misconduct can lead to disqualification for some Veterans Administration benefits, personnel with the most serious manifestations of PTSD may face additional barriers to care.

Factors associated with antisocial behavior in combat veterans.

The objective of this study was to identify factors associated with antisocial behavior in 1,543 Marines who deployed to combat zones in support of conflicts in Iraq and Afghanistan during 2002-2007. Five factors were associated with antisocial behavior in multivariate analyses: post-traumatic stress disorder (PTSD) symptoms, deployment-related stressors, combat exposure, younger age, and being divorced. PTSD symptoms had a stronger association with antisocial behavior than any other variable. A unique and important finding of this study was the association between deployment-related stressors and a higher incidence of antisocial behavior. Because deployment-related stressors are potentially modifiable, the military may be able to address them in concrete ways such as by shortening deployments and improving communication with home.

Psychosocial predictors of military misconduct.

The objective of this longitudinal study was to determine psychosocial predictors of military misconduct in a cohort of Marine Corps war veterans. The study included data from 20,746 male Marines who completed a life history questionnaire during initial basic training and were subsequently deployed to a combat zone. Associations between psychosocial variables, psychiatric diagnoses, and subsequent misconduct outcomes were analyzed using Cox proportional hazards regression. The strongest predictors of misconduct outcomes (bad conduct discharges and military demotions) were psychiatric diagnoses and young age at first combat deployment. The results indicate that combat-related psychological disorders may manifest in numerous harmful ways, including impulsive, disruptive, and antisocial behavior. We recommend that the association between misconduct and psychiatric disorders be more explicitly acknowledged in research and treatment efforts involving military war veterans and other trauma victims.

Correlates of posttraumatic stress disorder symptoms in Marines back from war.

The effect of combat and operational stress on the mental health of military personnel is a major concern. The objective of this study was to identify factors associated with possible posttraumatic stress disorder (PTSD). A questionnaire was completed by 1,569 Marines who deployed in support of conflicts in Iraq and Afghanistan (2002-2007). Using the PTSD Checklist with a cutoff score of 44, 17.1% of the sample screened positive for possible PTSD. Of 9 demographic and psychosocial factors examined in relation to PTSD, 4 were significant in a multivariate analysis: deployment-related stressors, combat exposure, marital status, and education. Deployment-related stressors had a stronger association with PTSD than any other variable. This is an important finding because deployment-related stressors are potentially modifiable.

Prospective analysis of psychiatric risk factors in marines sent to war.

The objective of this longitudinal study was to identify risk factors for combat-related psychiatric disorders. The sample consisted of 6442 enlisted U.S. Marines who completed a questionnaire during basic training, deployed to a combat zone with no prior psychiatric diagnoses, and completed a postdeployment assessment form. Cox proportional hazards regression was used to determine associations between predeployment and postdeployment self-reports and subsequent mental health outcomes. During the observation period, 6.8% of the sample were diagnosed with a psychiatric disorder. The strongest predictors of postdeployment psychiatric disorders were, in order of importance, low paygrade, hospitalization during deployment, low education, preservice smoking, and post-traumatic stress disorder symptoms at deployment's end. The impact of war zone variables was smaller than expected. It was recommended that the combat experience section of the military's postdeployment assessment form be expanded to enhance the military's ability to identify and refer personnel who may be at risk for psychiatric disorders.

Psychosocial predictors of return to duty among marine recruits with musculoskeletal injuries.

Psychosocial factors may have an important impact on injury recovery and return to work. To explore the influence of psychosocial factors in a cohort of injured military personnel, data were collected from 166 Marine Corps basic training recruits with musculoskeletal injuries. This sample was followed prospectively to determine whether they graduated from basic training or were discharged from the Marines. Demographic, injury-related, and psychosocial factors were analyzed to determine predictors of failure to graduate from basic training. The strongest risk factors for failing to graduate were not expecting to graduate, low or uncertain career intentions, lack of determination, psychological distress, and low organizational commitment. In the final multivariate logistics model, two predictors of failure to graduate emerged: not expecting to graduate and low or uncertain career intentions. The results suggest that interventions to reduce attrition in injured military populations should be designed to counter pessimistic expectations and emphasize career opportunities.

Psychiatric diagnoses in historic and contemporary military cohorts: combat deployment and the healthy warrior effect.

Research studies have identified heightened psychiatric problems among veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). However, these studies have not compared incidence rates of psychiatric disorders across robust cohorts, nor have they documented psychiatric problems prior to combat exposure. The authors' objectives in this study were to determine incidence rates of diagnosed mental disorders in a cohort of Marines deployed to combat during OIF or OEF in 2001-2005 and to compare these with mental disorder rates in two historical and two contemporary military control groups. After exclusion of persons who had been deployed to a combat zone with a preexisting psychiatric diagnosis, the cumulative rate of post-OIF/-OEF mental disorders was 6.4%. All psychiatric conditions except post-traumatic stress disorder occurred at a lower rate in combat-deployed personnel than in personnel who were not deployed to a combat zone. The findings suggest that psychiatric disorders in Marines are diagnosed most frequently during the initial months of recruit training rather than after combat deployment. The disproportionate loss of psychologically unfit personnel early in training creates a "healthy warrior effect," because only those persons who have proven their resilience during training remain eligible for combat.

Predictors of psychiatric hospitalization in the Navy.

Mental disorders represent an important source of morbidity among U.S. military personnel and are a common reason for early separation from the military. The objective of this study was to identify factors predictive of hospitalization for mental health disorders in a large sample of enlisted Navy personnel. Demographic variables and a variety of psychosocial variables assessed on the Sailors' Health Inventory Program questionnaire were studied as predictors of psychiatric hospitalization. Three psychiatric categories were examined: adjustment reaction, personality disorder, and all other mental health disorders. Several variables were significantly predictive of all three categories of psychiatric hospitalization: female gender, low education level, history of abuse (physical, emotional, or sexual), and tobacco smoking. The results of this study support efforts to develop better psychological screening methods and potential interventions aimed at helping recruits adapt to military life.

Predictors of Navy attrition. I. Analysis of 1-year attrition.

First-term attrition, defined as failing to complete the contracted first enlistment term, is one of the most serious and costly problems faced by the U.S. Navy. This study was an investigation of 1-year Navy attrition in relation to demographic factors and variables assessed by the Sailors' Health Inventory Program (SHIP) questionnaire, a medical and psychosocial history questionnaire completed by all Navy recruits. Overall attrition, as well as specific categories of attrition (e.g., medical, behavioral, and administrative), were studied. The sample consisted of 66,690 Navy recruits whose status (retention vs. attrition) could be tracked to the 1-year mark. The strongest predictors of overall attrition were educational level, self-reported history of shortness of breath, ever being suspended or expelled from school, history of depression/excessive worry, fainting or dizziness, and recurrent back pain. Many other medical and psychosocial items from SHIP were also predictive of attrition. Similar factors were associated with different categories of attrition (e.g., medical, behavioral). The implications of these findings for attrition reduction strategies are discussed.

Predictors of Navy attrition. II. A demonstration of potential usefulness for screening.

The Sailors Health Inventory Program (SHIP) questionnaire is a medical and psychosocial history questionnaire completed by all Navy recruits. This study was an investigation of the potential usefulness of the SHIP questionnaire for screening to reduce basic training attrition. The sample consisted of 66,690 Navy recruits. Although the most valid individual SHIP items for predicting attrition tended to be psychological or behavioral in nature, a composite of 40 diverse SHIP questions (including medical questions) was found to be the best overall attrition predictor. Further analyses revealed that the 40-item composite is a considerably more powerful attrition predictor than is either educational credential or mental ability score, which together are currently the U.S. military's primary attrition management tools. Finally, the consequences of using different cutoff scores on the 40-item composite were simulated so that various hypothetical screening strategies could be considered.

Effectiveness of two versions of a sexually transmitted diseases/human immunodeficiency virus prevention program.

Little is known about the comparative effectiveness of human immunodeficiency virus prevention interventions that differ in duration but contain similar content. The objective of this study was to evaluate and compare the effectiveness of two versions (6 hours vs. 3 hours) of a behavioral intervention called the STD/HIV Intervention Program (SHIP) in a sample of Marines. Marines were exposed to either a 6-hour or a 3-hour version of SHIP. Comparisons of pre-test and post-test knowledge, attitude, and behavioral intention scores revealed similar results for both versions. For both versions of the intervention, scores on sexually transmitted diseases/human immunodeficiency virus knowledge were significantly higher after the intervention. Both the 6-hour and the 3-hour versions of SHIP also led to significant increases on scales measuring social norms and behavioral intentions. The two versions of SHIP appeared to be of comparable effectiveness for producing short-term changes in knowledge, attitudes, and behavioral intentions.

A behavioral intervention to prevent sexually transmitted diseases/human immunodeficiency virus in a Marine Corps sample.

Research evaluating human immunodeficiency virus (HIV) behavioral interventions among U.S. military personnel has been lacking. In this study, a behavioral intervention to prevent HIV and sexually transmitted diseases (STDs) was implemented in a sample of Marine security guards. Participants were assessed before and after a three-session intervention on a measure of STDs/HIV knowledge and a number of psychosocial scales. The results indicated that STDs/HIV knowledge was significantly greater after the intervention. Significant pre-test vs. post-test differences were also found on the Social Norms, Behavioral Intentions, Attitudes toward Condoms, and Self-Efficacy/Impulse Control scales. On Social Norms and Behavioral Intentions, the differences were as expected: subjects perceived greater social norms supporting condom use and had stronger intentions to practice safe sex after the intervention than they had before. On Attitudes toward Condoms and Self-Efficacy/Impulse Control, the differences were not in the expected direction. Psychosocial factors associated with self-reported condom use were also identified.