Acute Stress Reaction in Combat: Emerging Evidence and Peer-Based Interventions

Social Determinants of Suicide and Suicidality in Serving Military Personnel: A Global Scoping Review

ISSUE ADDRESSED

Nearly a million people die by suicide annually, with military personnel being at heightened risk. For every suicide, about 20 cases of suicidality, including ideation and attempts, are reported. Social determinants of health may influence suicide risk factors, but research within military contexts, particularly in Australia, is scarce. This review aimed to scope global literature and synthesise current knowledge on the social determinants of suicide and suicidality among serving military members, focusing on the Australian military.

METHODS

A systematic review was conducted using the social determinants of health framework to analyse contemporary peer-reviewed articles and grey literature on military suicide and suicidality. Thematic analyses and critical appraisals were performed to identify key themes and assess the quality of the literature. The review included grey literature specific to the Australian military population.

RESULTS

Fifteen peer-reviewed articles were included, predominantly from the United States, with one each from South Korea and Israel. Five Australian military grey literature studies were also reviewed. The findings suggest a link between social support, addiction, socioeconomic status, education and occupational factors with suicide and suicidality.

CONCLUSIONS

This review provides an update on the evidence regarding the social determinants of suicide and suicidality in military personnel. While some evidence links social support with suicidality, the research outside the United States remains limited. SO WHAT?: The review highlights the need for further research to identify effective health-promotion strategies and interventions addressing social determinants in military contexts.

The effects of acute operational stress and passive heat stress on physiological and subjective stress responses in military personnel

Military personnel often encounter situations that can trigger acute stress, which may affect operational performance. Therefore, it is important to examine stress responses in controlled environments to obtain more insights in performance-influencing effects of acute stress. This study investigated the impact of passive heat exposure combined with virtual combat scenarios on cardiovascular and psychophysiological parameters in a controlled setting. Sixty-eight healthy servicemembers were randomized into a low-stress or high-stress condition. Both groups engaged in two virtual combat scenarios. The low-stress group, however, underwent testing under thermoneutral conditions (MTemp = 22.4°C, MRelativeHumidity = 41.4%) whereas the high-stress group was exposed to passive heat exposure (MTemp = 35.9°C, MRelativeHumidity = 66.4%) using a portable environmental facility. While virtual combat scenarios alone led to a decrease in heart rate variability (HRV) without affecting heart rate (HR), the addition of passive heat exposure elicited a more pronounced physiological stress response, characterized by significantly higher HR and lower HRV in the high-stress condition. However, no significant changes were observed in respiratory rate, salivary cortisol, or alpha-amylase levels across the conditions, suggesting that there was no activation of either the hypothalamic-pituitary-adrenal or the sympathetic-adrenal-medullary axis. Furthermore, subjective stress and anxiety scores did not differ between conditions, underscoring the physiological nature of the observed changes. Resultantly, the physiological response was likely a thermal reaction rather than an acute stress response. These findings highlight the importance of incorporating environmental stressors into military training protocols to enhance realism and prepare personnel for operational stressors. However, the mild response observed suggests that higher ambient temperatures and longer exposure times may be necessary to evoke a more robust stress response for effective stress inoculation training.

Peer-based intervention for acute stress reaction: adaptations by five militaries

Military service members need to be able to operate under conditions of extreme stress to ensure the success of their team's mission; however, an acute stress reaction (ASR) can compromise team safety and effectiveness by rendering an individual unable to function. Building on an intervention originally developed by the Israel Defense Forces, several countries have developed, tested, and disseminated a peer-based intervention to help service members manage acute stress in others. This paper reviews how five countries (Canada, Germany, Norway, the UK and the USA) adjusted the protocol to fit their organisational culture while retaining essential elements of the original procedure, suggesting there can be interoperability and mutual intelligibility in the management of ASR by military allies. Future research should examine the parameters of effectiveness for this intervention, the impact of intervention on long-term trajectories, and individual differences in managing ASR.

A novel intervention for acute stress reaction: exploring the feasibility of ReSTART among Norwegian soldiers

Background: Soldiers in combat may experience acute stress reactions (ASRs) in response to trauma. This can disrupt function, increasing both immediate physical danger and the risk for post-trauma mental health sequelae. There are few reported strategies for managing ASRs; however, recent studies suggest a novel peer-based intervention as a promising approach.Objectives: This study assesses the feasibility of ReSTART training, a peer-based course designed to prepare soldiers to manage ASRs. ReSTART builds on programmes established by US and Israeli militaries. The current study evaluates the ReSTART programme in a Norwegian setting, across distinct groups of soldiers, professionals and conscripts.Methods: Participants included professional soldiers deploying to Mali and conscripts with 6 months of service, who completed the ReSTART training course and surveys administered pre- and post-training. These surveys assessed attitudes and programme acceptability. Analyses included 74 soldiers who provided complete survey responses.Results: ReSTART training received high ratings in terms of usefulness, relevance, and importance in managing ASRs. From pre- to post-training, respondents had significant increases in positive attitudes towards ASR management and confidence in handling ASRs personally, and at the unit level; decreases in stigma-related attitudes associated with ASRs; and increased perception of leadership emphasizing ASR management.Conclusions: ReSTART training shows potential as an effective tool when preparing soldiers to manage ASRs in high-risk environments, enhancing military units' capacity to support each other and effectively respond to stress-induced functional disruptions. This study adds evidence supporting the utility of peer-based ASR management in operational settings and highlights the need for broader implementation and systematic evaluation.

Exploring metabolomic dynamics in acute stress disorder: amino acids, lipids, and carbohydrates

Acute Stress Disorder (ASD) is a psychiatric condition that can develop shortly after trauma exposure. Although molecular studies of ASD are only beginning, groups of metabolites have been found to be significantly altered with acute stress phenotypes in various pre-clinical and clinical studies. ASD implicated metabolites include amino acids (β-hydroxybutyrate, glutamate, 5-aminovalerate, kynurenine and aspartate), ketone bodies (β-hydroxybutyrate), lipids (cortisol, palmitoylethanomide, and N-palmitoyl taurine) and carbohydrates (glucose and mannose). Network and pathway analysis with the most prominent metabolites shows that Extracellular signal-regulated kinases and c-AMP response element binding (CREB) protein can be crucial players. After highlighting main recent findings on the role of metabolites in ASD, we will discuss potential future directions and challenges that need to be tackled. Overall, we aim to showcase that metabolomics present a promising opportunity to advance our understanding of ASD pathophysiology as well as the development of novel biomarkers and therapeutic targets.

The Nature of Combat Stress Development During Military Operations and Psychotherapy in Extreme Situations

The purpose of the research work is the theoretical and empirical analysis of the study of the nature of combat stress in military personnel and the assessment of psychotherapeutic methods of providing psychological assistance in extreme situations. The authors used the following methods to achieve this goal: method of analysis and synthesis, hermeneutic method, testing method, comparative method, and generalization method. The results of the research work have revealed the meaning of traumatic stress, psychological trauma, and combat mental trauma, and explained the concept of combat stress and the dynamics of its growth. The findings identified the factors of posttraumatic stress syndrome and its prevalence, tracked down the dynamics of psychoemotional disorders, and revealed the importance of military psychological selection and determination of combat readiness. The authors established the main tasks of a staff psychologist in working with military personnel, conducted an empirical study of the nature of combat stress in the military, observed main psychotherapeutic tools for the prevention of negative mental states in combat conditions, and investigated self-regulation techniques of emotional, physical, and mental health. The practical significance of the scientific work lies in the modern coverage of the phenomenon of combat stress and the classification of effective psychotherapeutic methods that will ensure the sustainable psychological preparation of the soldiers for extreme situations.

Psychophysiological Responses in Soldiers during Close Combat: Implications for Occupational Health and Fitness in Tactical Populations

This study explores the psychophysiological responses and subjective exertion experiences of soldiers in simulated hand-to-hand combat, aligning these findings with established physiological benchmarks. Active military personnel were monitored for heart rate, blood lactate levels, subjective exertion, cortical arousal, and muscle strength during combat scenarios. The results showed significant increases in heart rate and blood lactate, indicating intense cardiovascular demands and a reliance on anaerobic energy systems. Contrary to these physiological changes, soldiers reported lower levels of exertion, suggesting a possible underestimation of physical effort or individual differences in perception and mental resilience to stress. Notably, a decrease in cortical arousal post-combat was observed, potentially signaling cognitive function deficits in decision-making and information processing in high-stress environments. This decline was more pronounced than typically seen in other high-stress situations, highlighting the unique cognitive demands of hand-to-hand combat. Additionally, an increase in muscle strength was noted, underscoring the physiological adaptations arising from intensive combat training. These findings provide valuable insights into the psychophysiological effects of hand-to-hand combat, emphasizing the complex interplay between physical exertion, cognitive function, and stress response in military contexts. The study underscores the need for comprehensive training strategies that address both physical and psychological aspects to enhance combat readiness and decision-making under stress.

Network analysis of acute stress reaction in a sample of Chinese male military college students

Background

Acute stress reaction (ASR) following a stressful event is associated with stress-related mental disorders. However, no studies have investigated the relationships between ASR symptom clusters. The present study aimed to provide a fine-grained understanding of the complex relationships among symptom clusters and identify the central symptom clusters of ASR using network analysis.

Methods

The Acute Stress Reaction Scale (ASRS) was used to investigate the network structure of ASR in 1792 Chinese male military college students who were about to participate in an important physical fitness test. We calculated the weights of the edges connecting different symptom clusters and the central indices of 25 symptom clusters in the final network.

Results

There were five strongest edges with significantly higher weights than most other edge weights, including the edges between "Less communication" and "Isolated from others." The symptom clusters of "Somatic symptoms," "Hypoprosexia," and "Anxiety" were found to be the central nodes with the highest expected influences (primary centrality index).

Conclusion

The present study explored the network structure of ASR, revealed complex connections between symptom clusters, and identified central clusters. These findings have important clinical implications, and it is suggested that the three central symptom clusters may be potential targets for effective interventions for ASR.

PECULIARITIES OF FORMATION OF CADETS' PSYCHOLOGICAL RESILIENCE AND PHYSICAL READINESS FOR COMBAT STRESS

OBJECTIVE

The aim: To investigate the impact of special physical training sessions on the formation of cadets' psychological resilience and physical readiness for the stress factors of future professional and combat activities.

PATIENTS AND METHODS

Materials and methods: The research involved 96 cadets (men) in the 2nd training year of S. P. Koroliov Zhytomyr Military Institute (Ukraine) aged 18-20 years, who were divided into two groups: the experimental (E, n = 47) and the control (C, n = 49). The cadets of the E group studied according to the authors' program, and the C group cadets - according to the existing program. Cadets' psychological resilience was studied using psycho-diagnostic methods aimed at assessing their volitional qualities. Cadets' physical fitness was assessed by the tests of general and special physical training.

RESULTS

Results: It was found that the level of general physical training of the E and the C group cadets was significantly the same (p > 0.05) at the end of the research but in terms of special physical training and psychological readiness, the E group cadets had all indicators significantly (p < 0.05-0.001) better than those of the C group.

CONCLUSION

Conclusions: It has been proved that the special physical training sessions conducted according to the authors' program were more effective than the existing program in forming cadets' physical readiness and psychological resilience for stress factors of future professional and combat activities.

Management of Acute Stress Reactions in the Military: A Stepped Care Approach

PURPOSE OF THE REVIEW

This review highlights knowledge gaps surrounding the development and use of interventions for Acute Stress Reactions (ASRs). First, we propose that a stepped care approach to intervention for ASR be developed and utilized in military operational environments. A stepped care approach would include detection and assessment, followed by behavioral intervention, and then medication intervention for ASRs. Second, we discuss potential strategies that can be taken for the development of safe and effective ASR medications.

RECENT FINDINGS

ASRs commonly occur in operational environments, particularly in military populations. ASRs impact the safety and performance of individual service members and teams, but there are currently limited options for intervention. Efforts to improve ASR detection and assessment, and development and delivery of ASR interventions for implementation in operational environments, will be critical to maintaining the safety and performance of service members.