ABSTRACT Post 9/11-era veterans and service members are at high risk for posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) exposures. However, symptom overlap between these conditions presents challenges in differential diagnosis and discriminating the relative contributions of each when co-occurring. Neurological soft signs (NSS) represent a potential diagnostic tool given demonstrated associations with PTSD, but to date there is limited research assessing a possible association with mTBI history. The current study sought to identify whether NSS can discriminate between PTSD, mTBI, and their co-occurrence via a neuropsychological test of complex motor functioning, the Behavioral Dyscontrol Scale-II (BDS-II). The study sample included 241 post-9/11 veterans. After adjusting for symptom and performance validity, study results indicated that NSS as measured by the BDS-II did not discriminate between the mTBI, PTSD, and co-occurring mTBI+PTSD groups. Additionally, in contrast to previous research, no association was observed between NSS and PTSD symptoms. Findings do not support NSS insofar as their utility in discrimination between mTBI and PTSD.

ABSTRACT Little is known about what factors contribute to posttraumatic stress disorder among military healthcare personnel during a deployment. Accordingly, the purpose of this study was to explore the association among demographic variables, psychological and occupational stressors, and protective resources with probable PTSD caseness and PTSD symptom severity in a sample of 1161 military healthcare personnel who were deployed to a combat hospital in Balad, Iraq, between 2004 and 2011. In this cross-sectional observational study, participants completed anonymous self-report measures while in theater. Results indicated that a model with reports of depression symptom and negative affect severity, and exposure to combat and futility stressors (i.e. stressors that service members do not feel fully prepared to manage) was associated with probable PTSD caseness (χ2 (17, N = 739) = 236.62, p < .001). The model explained approximately 63.6% of the variance in probable PTSD caseness. A hierarchical linear regression predicted PTSD symptom severity, adding gender and trainable stressors (i.e. stressors that service members feel fully prepared to manage) as independent variables to the variables above (F (17, 839) = 89.76, p < .001; adjusted R 2 = .64). In deployed military healthcare personnel, depression and negative affect (e.g. dysphoria, anhedonia, anger) may be behavioral proxies for PTSD severity and when present with noteworthy exposure to combat and healthcare stressors may provide discernable information that peers and leaders can use to check-in to see what service members may need to recover confidence and competence, if applicable.

ABSTRACT Sleep loss, ubiquitous in the military and especially severe during combat deployments, constitutes a threat to the health and effectiveness of service members (SMs). Mitigating these negative effects depends upon the ability to accurately measure them; however, the utility of current subjective sleep and daytime sleepiness measures, which have been validated in civilian populations, is unclear for SMs. Specifically, established clinical thresholds for poor sleep quality and pathological sleepiness may not accurately reflect the sleep health of previously deployed SMs. The present scoping review was conducted to determine if prior military deployment results in pervasive sleep disturbance as defined by standard subjective measures. The findings suggest that it does, but because objective performance was not included in the reviewed studies, the extent to which these findings actually reflect meaningful impairment is unknown. Future studies using objective measures are needed to determine whether combat deployment results in immediately consequential and long-term deficits in sleep and daytime functioning. Such research will clarify whether currently available subjective measures are appropriate for previously deployed SMs or if new, population-specific measures should be developed, particularly as future large-scale combat operations (LSCO) are expected to involve increasingly severe sleep loss.

ABSTRACT This study describes the wartime experiences of foreign volunteers–Jewish foreign nationals who volunteered for the Israeli military – during the Swords of Iron War. Interviews with 20 participants revealed three themes. 1) Between Two Worlds: Foreign Volunteers’ Relationships with Family Members Back Home During Wartime highlights the emotional strain, communication challenges, and selective disclosure involved in maintaining transnational family ties. 2) From Strangers to Brothers in Arms: The Social Integration Journey of Non-Israeli Soldiers in Israeli Military Units explores their transition from cultural outsiders to integral members of their units, forming a bicultural military identity. 3) Beyond Combat: Personal and Psychological Journeys of Foreign Volunteers Serving Far from Support Systems addresses the emotional challenges of grief, instability, and loss, alongside personal growth and resilience. The findings emphasize the importance of institutional support, social networks, and cultural adaptation, recommending improved family connection tools, enhanced integration programs, and tailored support initiatives for foreign volunteers.

ABSTRACT Military spouses with unmet needs for support are particularly vulnerable to stress during cycles of deployment and reintegration. To complement the literature on perceived support, we investigated actual support as the assistance people actually use to manage stressors. Our study sought to identify who uses actual support, what barriers to actual support exist, and what effects actual support has during reintegration. We examined data from 1,325 military spouses participating in the Millennium Cohort Family Study who had experienced deployment and reunion within the past 6 months. Weighted analyses revealed low levels of both formal and informal support during deployment. Only 16.5% of military spouses reported participating in a formal reintegration program; the biggest barriers were a lack of awareness (45.4%) and having no such program available (40.5%). More support from formal sources during deployment was reported by spouses who were non-Hispanic Black, spouses of officers, and spouses with less household income. More support from informal sources during deployment was reported by spouses who were employed and spouses of officers. Spouses were more likely to participate in a reintegration program if they were employed outside the home, if they were non-Hispanic, if they were affiliated with the Army compared with the Air Force, and if the service member experienced combat during deployment. Informal support during deployment was the strongest predictor of military spouses’ well-being during reintegration. These findings suggest helping military spouses by facilitating more comprehensive support, enriching existing services, and combating disparities.

ABSTRACT This study examined the effects of the Thank You-Sorry-Love (TSL) program on depression, anger, marital satisfaction, and cortisol levels among military spouses. A total of 18 military spouses were matched and randomly assigned to either an experimental group (n = 9), which participated in the TSL program, or a control group (n = 9), which did not receive the intervention. Depression, anger, marital satisfaction, and cortisol levels (an oxidative stress biomarker) were measured at two time points: pretest and posttest. The results demonstrated significant reductions in depression and anger, as well as improved marital satisfaction in the experimental group compared to the control group. Additionally, the program was effective in reducing cortisol levels, further supporting its utility as a stress-reduction intervention. These findings highlight the potential of the TSL program as an effective strategy for enhancing psychological and physiological well-being among military spouses.

ABSTRACT Drug and alcohol misuse, sexual misconduct, and suicidal behaviors can negatively affect the well-being of personnel in high-risk occupations and compromise organizational effectiveness. While the U.S. Army has established policies, programs, and a professional prevention workforce to reduce the occurrence of these behaviors, soldiers who are in the presence of their at-risk peers are best positioned to intervene. Thus, to leverage the impact of peer-based bystander intervention, the Army developed a two-hour training entitled “Engage.” Engage provides soldiers with instruction on fostering awareness of risky behaviors, taking responsibility in situations where such behaviors may occur, and having a plan of action for intervening on behalf of those at risk. A longitudinal quasi-randomized evaluation of Engage was conducted with active-duty soldiers over a nine-month period. Eight companies were assigned to receive Engage, and eight companies were assigned to a control condition. Surveys assessed training acceptability, knowledge related to bystander behaviors, confidence in intervening, and perceptions of unit engagement. Soldiers found the training to be acceptable, evidenced improved knowledge of bystander intervention concepts following training, and perceived their units to be more engaged in bystander practices over time. Longitudinal assessment of soldiers’ confidence in intervening was moderate to high at baseline; while confidence remained stable over multiple follow-up assessments, no significant changes were observed due to training. These findings highlight the potential value of tailoring bystander intervention training for service members. Results also provide direction for improving such training for the military and other high-risk occupations.

ABSTRACT Unlike in efficacy trials, there can be notable variability in session frequency when PTSD treatment protocols, such a Prolonged Exposure (PE), are disseminated in clinical practice. The current study aimed to examine the impact of PE session frequency on treatment outcomes in a clinical Veteran sample. This study utilized retrospective data drawn from the Veterans Health Administration’s Corporate Data Warehouse, a national data repository which includes Electronic Health Records. The extracted cohort of 648 Veterans was majority White-non-Hispanic and male [(M age = 55.66 (14.08)]. All Veterans had a diagnosis of PTSD and completed in-person PE in outpatient Veterans Affairs behavioral health clinics between 2017 and 2018. The treatment outcome measure was the PTSD Checklist for DSM-5 (PCL-5). Linear multiple regression analyses did not find that session frequency predicted treatment outcome. Likewise, t-test results did not find differences in PCL-5 change scores based on session frequency. Effect sizes for pre- to post-treatment PCL-5 change scores ranged from d = 1.25 to 1.40. Overall, the current study suggests that PE may still be a useful intervention even when the treatment manual recommendation of weekly or twice weekly sessions cannot feasibly be conducted in clinical practice. Cross-validation is needed.

ABSTRACT As the Army continues to adapt to evolving mission demands and global threats, those who execute the mission – both soldiers and Department of the Army (DA) civilians – must also adapt to changing occupational demands and requirements. Occupational stress within the military community is a threat to health and wellbeing that impacts not only individual soldiers and civilian personnel, but also units, families, and the broader military community. Hardiness is an operational requirement for military success, spirituality might be a means to positively impact soldier and DA Civilian hardiness. This study sought to understand the relationship between spirituality and hardiness within the Army, which included data collected from U.S. Army soldiers (N = 313) and DA Civilians (N = 276). We hypothesized that increased individual spirituality have a direct relationship with the positive aspects of hardiness and an inverse relationship with the negative aspects of hardiness as defined by the dual process model of hardiness. Employing regression analysis, empirical support was found to support our hypotheses for relationships between spirituality and hardiness variables, with increased spirituality relating to increased positive hardiness and decreased negative hardiness traits. Military leaders can use that knowledge to develop and test targeted interventions that may help to increase positive hardiness and decrease negative hardiness in the Army. Further, Holistic Health and Fitness programming may benefit from improved psychological function by incorporating training that integrates hardiness and spirituality concepts.

ABSTRACT Building on emerging literature, a new self-report inventory was developed to assess multiple psychological attributes relevant to adaptability in remote warriors. Literature search backed by surveys of military and psychological experts identified 32 attributes for self-report scale development. Items were sorted reliably into targeted dimensions (67.5% vs. 1.6% random) in support of content validity. Item analysis of responses from 255 U.S. Air Force remote operations Airmen (74.5% sensor operators) narrowed the set to 25 empirically distinct scales demonstrating overall strong internal consistency reliability (Mdn alpha = .83), unidimensionality per scale, convergent and discriminant validity in relations with the NEO Personality Inventory-3 (e.g. Stress Tolerance r = −.50 with NEO Neuroticism and r = .00 with NEO Openness), and criterion validity in relations with burnout (e.g., Coping Flexibility r = −.43 with Exhaustion) and psychological distress (e.g., Hardiness r = −.62). Results support the continued development of the measure for advancing understanding of the psychology of remote warfare and engagement in similarly demanding occupations.