US soldiers and the role of leadership: COVID-19, mental health, and adherence to public health guidelines

COVID-19 Concerns, Information Needs, and Adverse Mental Health Outcomes among U.S. Soldiers

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic disrupted U.S. Military operations and potentially compounded the risk for adverse mental health outcomes by layering unique occupational stress on top of general restrictions, fears, and concerns. The objective of the current study was to characterize the prevalence of COVID-19 concerns and information needs, demographic disparities in these outcomes, and the degree to which COVID-19 concerns and information needs were associated with heightened risk for adverse mental health outcomes among U.S. Army soldiers.

MATERIALS AND METHODS

Command-directed anonymous surveys were administered electronically to U.S. soldiers assigned to one of three regional commands in the Northwest United States, Europe, and Asia-Pacific Region. Surveys were administered in May to June 2020 to complete (time 1: n = 21,294) and again in December 2020 to January 2021 (time 2: n = 10,861). Only active duty or active reservists/national guard were eligible to participate. Members from other branches of service were also not eligible.

RESULTS

Highly prevalent COVID-19 concerns included the inability to spend time with friends/family, social activities, and changing rules, regulations, and guidance related to COVID-19. Some information needs were endorsed by one quarter or more soldiers at both time points, including stress management/coping, travel, how to protect oneself, and maintaining mission readiness. COVID-19 concerns and information needs were most prevalent among non-White soldiers. Concerns and information needs did not decline overall between the assessments. Finally, COVID-19 concerns were associated with greater risk of multiple adverse mental health outcomes at both time points.

CONCLUSIONS

COVID-19 concerns and information needs were prevalent and showed little evidence of decrement over the course of the first 6 months of the pandemic. COVID-19 concerns were consistently associated with adverse mental health outcomes. These data highlight two targets and potential demographic subgroups such that local leadership and Army medicine and public health enterprises can be better prepared to monitor and address to maintain force health and readiness in the face of possible future biomedical threats.

National Guard Deployment in Support of COVID-19: Psychological and Behavioral Health

INTRODUCTION

The National Guard (NG) served as a critical component of the USA's response to the Coronavirus Disease 2019 (COVID-19) pandemic, while concurrently managing their personal responses to the pandemic. Determining whether the activation of NG service members in response to the COVID-19 pandemic was associated with a greater psychological strain can identify NG's needs for mental health support.

MATERIALS AND METHODS

We surveyed 3993 NG unit (NGU) service members (75% Army NG, 79% enlisted, 52% 30-49 years old, and 81% males) during the COVID-19 pandemic, with surveys administered between August and November 2020. Almost half (46%) of NGU service members reported being activated in response to COVID-19 (mean activation length = 18.6 weeks). Activated service members completed the survey approximately 2 to 3 months post-activation. Surveys assessed demographics, service-related characteristics, unit cohesion and positive leadership skills (leadership), and COVID-19 activation, and outcomes including probable post-traumatic stress disorder (PTSD), clinically significant anxiety and depression, and anger. Descriptive and logistic regression analyses were conducted. The study was approved by the Institutional Review Board of the Uniformed Services University of the Health Sciences in Bethesda, MD.

RESULTS

In all, 9.7% met the criteria for probable PTSD, 7.6% reported clinically significant anxiety and depression, and 13.2% reported feeling angry/anger outbursts. Multivariate logistic regression analyses, adjusting for demographic and service-related characteristics, indicated that COVID-19 activation was not associated with a greater risk of PTSD, anxiety and depression, or anger. Regardless of activation status, NGU service members with low levels of unit cohesion and leadership were more likely to report PTSD and anger, and low levels of unit cohesion were associated with clinically significant anxiety and depression.

CONCLUSIONS

COVID-19 activation did not increase the risk of mental health difficulties among NGU service members. However, low levels of unit cohesion were associated with the risk of PTSD, anxiety and depression, and anger, and low levels of leadership were associated with the risk of PTSD and anger. The results suggest a resilient psychological response to COVID-19 activation and the potential for strengthening all NG service members through enhancing unit cohesion and leadership support. Future research on specific activation exposures, including the type of work tasks in which service members are engaged, particularly those associated with high-stress work conditions, is needed to help better understand their activation experience and how it may influence post-activation responses.

Deployment-related quarantining-a risk or resilience factor for German military service members? A prospective analysis during the third-fifth waves of COVID-19

Background

Mandatory deployment-related quarantining added further constraints on soldiers during the pandemic. Contrary to overwhelming research documenting an adverse impact of quarantining on mental health, no adverse short-term mental health effects of pre-deployment quarantining for German soldiers were identified. Therefore, we are interested in a potentially delayed onset, the impact of an additional post-deployment quarantine, and quarantine-associated risk and resilience factors predicting mental health post-deployment.

Methods

In a prospective research design, 928 German soldiers enrolled in the study at the in-processing of pre-deployment quarantine between February 2021 and March 2022. Every German military service member undergoing pre-deployment quarantine could participate. The soldiers were between 18 and 64 years old; 87.5% identified as male and 12.5% as female. Self-reported mental health (Mini-SCL), perceived social support (FSozU-K22), and perceived unit cohesion were assessed three to five times: at the beginning and the end of pre-deployment quarantine (Nt1 = 928, Nt2 = 907), if still mandatory-at the beginning and the end of post-deployment quarantine (Nt3 = 143 and Nt4 = 132), and 3 months post-deployment, on average 7 to 8 months later than pre-deployment quarantine (Nt5 = 308). The analyzed quarantine-associated risk and resilience factors were informedness about COVID-19, infection risk, quarantine benefit, clarity of quarantine protocol, need for intimacy/bonding, norms, stigma, practicality, financial disadvantages, boredom, and health-promoting leadership.

Results

Despite four different mental health trajectories identified, repeated measures ANOVAs revealed a significant improvement in mental health post-deployment (F[2,265] = 21.54, p < 0.001), a small decrease in social support (F[2,266] = 16.85, p < 0.001), and no significant changes in unit cohesion (F[2,264] = 0.482, p = 0.618) 3 months post-deployment. Using stepwise regression, 24% of variance in mental health symptomatology post-deployment is predicted pre-deployment by a clear quarantine protocol, unit cohesion, intimacy/bonding, and social support (F[4,263] = 22.23, p < 0.001). In total, 30% of mental health at the end of post-deployment quarantine is predicted by stigma and a clear quarantine protocol (F[2,99] = 22.22, p < 0.001).

Conclusion

Although no overall adverse impact of quarantining on mental health was found, it is recommended to address perceived stigma and clearly communicate the quarantine protocol, and to further follow up on the perceived decrease in social support.

US Soldiers' Individual and Unit-level Factors Associated with Perceptions of Disinformation in the Military Context

INTRODUCTION

Although the US Government considers threats of misinformation, disinformation, and mal-information to rise to the level of terrorism, little is known about service members' experiences with disinformation in the military context. We examined soldiers' perceptions of disinformation impact on the Army and their units. We also investigated associations between disinformation perceptions and soldiers' sociodemographic characteristics, reported use of fact-checking, and perceptions of unit cohesion and readiness.

METHODS

Active-duty soldiers (N = 19,465) across two large installations in the Southwest US completed an anonymous online survey.

RESULTS

Sixty-six percent of soldiers agreed that disinformation has a negative impact on the Army. Thirty-three percent of soldiers perceived disinformation as a problem in their unit. Females were more likely to agree that disinformation has a negative impact on the Army and is a problem in their unit. Higher military rank was associated with lower odds of agreeing that disinformation is a problem in units. Most soldiers were confident about their ability to recognize disinformation (62%) and reported using fact-checking resources (53%), and these factors were most often endorsed by soldiers who agreed that disinformation is a problem for the Army and their unit. Soldiers' perceptions of unit cohesion and readiness were negatively associated with the perception that disinformation is a problem in their unit.

CONCLUSION

While the majority of soldiers viewed disinformation as a problem across the Army, fewer perceived it as problematic within their units. Higher levels of reported fact-checking were most evident among those who perceived disinformation as a problem, suggesting that enhancing awareness of the problem of disinformation alone could help mitigate its deleterious impact. Perceptions of disinformation problems within units were associated with soldiers' perceptions of lower unit cohesion and readiness, highlighting misinformation, disinformation, and mal-information's impact on force readiness. Limitations and future directions are discussed.

Mental Health Outcomes Among American Indian and Alaska Native U.S. Army Soldiers: A Serial Cross-Sectional Analysis

INTRODUCTION

American Indian and Alaska Native (AI/AN) individuals in the USA experience higher rates of mental illness and preventable death than the general population. Published research demonstrates that AI/AN veterans experience similar disparities to other minorities compared to non-minority veterans; few studies, however, have assessed mental health outcomes in AI/AN active duty military members. The objective of this study was to determine differences in depression, anxiety, hazardous alcohol consumption, and suicidal ideation among AI/AN soldiers compared to soldiers of other races during the Coronavirus Disease 2019 (COVID-19) pandemic.

MATERIALS AND METHODS

We conducted repeated cross-sectional electronic surveys to assess the mental health of active duty and activated reserve U.S. Army soldiers within three commands in the Northwestern Continental United States , Republic of Korea, and Germany during May-June 2020 (T1) and December 2020-January 2021 (T2). The primary exposure of interest in the present analysis was race and ethnicity, and the primary outcomes were probable depression with functional impairment (subsequently "depression"), probable anxiety with functional impairment (subsequently "anxiety"), hazardous alcohol use, and suicidal ideation. Multivariable logistic regression models were used to determine the association between demographics and COVID-19 concerns on mental health outcomes for each time point.

RESULTS

A total of 21,293 participants responded to the survey at T1 (participation rate = 28.0%), and 10,861 participants responded to the survey at T2 (participation rate = 14.7%). In the multivariable model, AI/AN participants had 1.36 higher adjusted odds of suicidal ideation (95% CI: 1.02-1.82) at T1 and 1.50 greater adjusted odds of suicidal ideation at T2 (95% CI: 1.00-2.24), when compared to non-Hispanic White participants. During T1, there was no significant difference detected between AI/AN and non-Hispanic White participants for anxiety (adjusted odds ratio: 1.21; 95% CI: 0.91-1.60) (Table IV). However, AI/AN participants had 1.82 greater adjusted odds of anxiety when compared to non-Hispanic White participants at T2 (adjusted odds ratio: 1.82; 95% CI: 1.29-2.57). There were no significant differences detected between AI/AN participants and non-Hispanic White participants in multivariable models for either depression or hazardous alcohol use at both time points.

CONCLUSIONS

Although we hypothesized that all adverse mental health outcomes would be higher for AI/AN service members at both time points, there were no significant differences at each of the time points analyzed for most of the outcomes analyzed. However, differences in suicidal ideation were found at both time points. Analyses and proposed interventions should account for diversity and heterogeneity of AI/AN populations.

Depression and anxiety in peruvian military personnel during the pandemic context: a cross-sectional study

BACKGROUND

During the COVID-19 pandemic, increased workload and stress could have increased mental health problems (anxiety and depression) in military personnel. However, the number of studies in military members is scarce, especially in regard to mental health. The objective of this study was determine the prevalence and factors associated with depression and anxiety in Peruvian military personnel.

METHODS

We undertook an analytical cross-sectional study. The survey was distributed face to face between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic among the military personnel. We used some instruments to measure depression (Patient Health Questionnaire, PHQ-9), anxiety (Generalized Anxiety Disorder, GAD-7), insomnia (Insomnia Severity Index, ISI), food insecurity (Household Food Insecurity Access Scale, HFIAS), physical activity (International Physical Activity Questionnaires, IPAQ-S), resilience (abbreviated CD-RISC), and fear of COVID-19 scale. The exclusion criteria included those who did not completely fill out the evaluation instruments.

RESULTS

We analyzed the data of 615 military personnel that participated in the survey. Of them, 93.7% were male and the median age was 22 years old. There was a prevalence of 29.9% and 22.0% in regard to depression and anxiety symptoms, respectively. In addition, it was found that being married (PR: 0.63; 95% IC: 0.42-0.94), having a relative with mental health problems (PR: 2.16), having experienced food insecurity (PR: 1.48), insomnia (PR: 2.71), fear of COVID-19 (PR: 1.48), and a high level of resilience (PR: 0.65) were factors associated with depression. In regard to anxiety, the factors associated were working for more than 18 months since the beginning of the COVID-19 pandemic (PR: 0.52), a high level of resilience (PR: 0.50; 95% IC: 0.33-0.77), insomnia (PR: 3.32), fear of COVID-19 (PR: 2.43).

CONCLUSION

We found a prevalence of symptoms of depression and anxiety of 29.9% and 22.0%, respectively. In regard to the factors that attenuate depression, we can mention being married and having resilience; and among the aggravating factors, having a relative with mental health problems, food insecurity, insomnia, and fear of COVID-19. Finally, anxiety increased through working time, insomnia, and fear of COVID-19.