BACKGROUND/RATIONALE:
Combat exposure and other traumatic experiences are significant, known risk factors for post-traumatic stress disorder (PTSD), depression, and other psychiatric and substance abuse conditions. Consequently, soldiers returning from deployment in Iraq and Afghanistan are likely to be vulnerable to these conditions, and recent research indicates that OEF/OIF veterans have higher rates of mental health concerns than veterans from other wars. However, some individuals are particularly resilient following traumatic exposure and do not develop mental health or substance abuse problems. Thus, both risk and resilience factors interact to determine whether an individual will develop a psychiatric or substance abuse disorder. Resilience factors identified in the literature include social support, self-efficacy, hardiness and positive coping strategies.

OBJECTIVE(S):
The goal of this study was to understand risk and resilience factors that predict development of a psychiatric or substance abuse disorder and associated mental health and/or substance abuse service use. Specific objectives were to: 1) examine the association between pre-deployment risk and resilience factors, deployment experiences and post-deployment factors in a national sample of OEF and OIF veterans up to one year post-deployment; 2) examine change in post-deployment life events, social support, mental health and substance abuse status, functioning and service use over a 6-9 month period following baseline assessment; and 3) identify risk and resilience factors that predict mental health status, functioning, and service use six months after baseline assessment. In addition to examining these research questions, we explored the impact of gender, which has previously been found to show differential effects of pre-war factors on PTSD. Inclusion of risk and resilience factors expands on existing models of mental health status and service use that are limited to data available from administrative databases (primarily demographic and diagnostic information), allowing for better prediction of mental health status, substance abuse and service use, and for identification of risk and resilience factors that may be amenable to improvement through clinical intervention.

METHODS:
This study used an observational research design in which a national sample of returning OIF/OEF military personnel stratified by gender (50%) and service component, (50% Active Duty, 25% National Guard, 25% other Reserve) were surveyed first within 12 months of returning from deployment to obtain descriptive characteristics, measures of risk, resilience, mental health including PTSD, substance abuse, stigma and health service use within and outside the VA. Surveys were repeated six months later to assess factors that predict future mental health and substance abuse symptoms, functioning and service use. The survey included demographic and descriptive characteristics including age, gender, education, self-reports of medical conditions, the PTSD Checklist, Veterans SF-12 (VR-12), Behavior and Symptom Identification Scale (BASIS-24), Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST), Deployment Risk and Resilience Inventory (DRRI), Bartone Hardiness Scale, and General Self-Efficacy Scale. 597 individuals returned completed Time 1 surveys and 512 of them (86%) completed Time 2 surveys. Structural equation models and regression analyses with weights for sampling design and non-response probabilities, using mental health/substance abuse status and service use as outcomes, and risk and resilience measures as independent variables were conducted to address the research questions.

FINDINGS/RESULTS:
We received completed T1 surveys from 597 individuals. 58% were female; average age was 33.9 years; 66% were white, 15% African-American and 12% Latino. Length of last deployment varied widely from less than one month to more than two years with a mean of 245 days. Eighty percent of the sample reported at least some combat experience. Since returning from deployment 14.5% reported that they had been told they had depression, 13.7%, PTSD, and 1.5% another psychiatric condition. 13.9% of the sample met the threshold score of 50 on the PTSD checklist. The mean Mental Component Summary score (VR-12) was 40.56 (sd=7.91), a full standard deviation below the general population mean (50). The mean Physical Component Score was 49.51 (sd=9.63), near the general population mean. Service branch was consistently associated with risk, resilience, mental health and alcohol/drug use. Army and Marine personnel reported worse mental health, PTSD, alcohol and/or drug use. Air force personnel reported best mental health (including least PTSD, alcohol or drug use). Army and/or Marines also reported more risk factors (including combat exposure) and less resilience (including social support and hardiness) than Air Force or Navy personnel. Men reported more combat exposure and alcohol use, but less hardiness than women; gender was not associated with mental health or PTSD. Regarding resilience factors, after controlling for respondent characteristics and DRRI risk factors, higher levels of hardiness, and self-efficacy each contributed significantly to the prediction of better overall mental health and less PTSD symptomatology (p's<.01), but were not significantly associated with lower levels of alcohol use. Higher post-deployment social support was associated with increased alcohol use.

IMPACT:
The research reported here identified Army and Marine personnel as subject to higher levels of risk and worse mental health in a number of areas than Air Force or Navy personnel, suggesting that these branches of service might consider implementing interventions to increase resilience. The findings that greater resilience (hardiness and self-efficacy) were associated with better mental health further support the need to bolster resilience in OEF/OIF veterans.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Delman J, Clark JA, Eisen SV, Parker VA. Facilitators and barriers to the active participation of clients with serious mental illnesses in medication decision making: the perceptions of young adult clients. The journal of behavioral health services & research. 2015 Apr 1; 42(2):238-53. [view]
2. Eisen SV, Schultz MR, Vogt D, Glickman ME, Elwy AR, Drainoni ML, Osei-Bonsu PE, Martin J. Mental and physical health status and alcohol and drug use following return from deployment to Iraq or Afghanistan. American journal of public health. 2012 Mar 1; 102 Suppl 1:S66-73. [view]
3. Vogt D, Smith B, Elwy R, Martin J, Schultz M, Drainoni ML, Eisen S. Predeployment, deployment, and postdeployment risk factors for posttraumatic stress symptomatology in female and male OEF/OIF veterans. Journal of abnormal psychology. 2011 Nov 1; 120(4):819-31. [view]
4. Schultz M, Glickman ME, Eisen SV. Predictors of decline in overall mental health, PTSD and alcohol use in OEF/OIF veterans. Comprehensive psychiatry. 2014 Oct 1; 55(7):1654-64. [view]

Conference Presentations

1. Eisen SV, Elwy AR, Glickman ME, Vogt D, Schultz MR, Martin JA, Drainoni M, Howard A, DelVecchio N. Combat Experience, Mental Health, Alcohol and Drug Use in Post-Deployed Afghanistan (OEF) and Iraq (OIF) Veterans. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 16; National Harbor, MD. [view]
2. Eisen SV, Vogt D, Glickman ME, Elwy AR, Martin JA, Schultz MR, Drainoni M, DelVecchio N, Howard A. Does Resilience Predict Mental Health, Alcohol or Drug Abuse in Afghanistan (OEF) and Iraq (OIF) Veterans? Poster session presented at: VA HSR&D National Meeting; 2011 Feb 16; National Harbor, MD. [view]
3. Vogt D, Smith B, Elwy AR, Martin J, Schultz MR, Glickman ME, Drainoni M, Eisen SV. Examination of a model of risk factors for postdeployment stress symptomatology in female OEF/OIF Veterans. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2010 Nov 4; Montréal, Canada. [view]
4. Drainoni M, Schultz MR, Glickman ME, DelVecchio N, Elwy AR, Howard A, Martin J, Vogt DS, Eisen SV. Health Conditions and Health Service Use among Post-Deployed OEF/OIF Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2010 Jun 27; Boston, MA. [view]
5. Elwy AR, Schultz M, Drainoni M, Vogt DS, Glickman ME, Martin JA, Eisen SV. Perceived Stigma Among OIF/OEF Personnel Who Seek Outpatient Mental Health and Medical Services. Paper presented at: AcademyHealth Annual Research Meeting; 2010 Jun 28; Boston, MA. [view]

DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Prevention
Keywords: Deployment Related, PTSD
MeSH Terms: none