Individual and experiential predictors of character development across the deployment cycle

How soldiers adapt to and change in response to the deployment experience has received a great deal of attention. What predicts which soldiers are resilient and which soldiers decline in character strengths across the deployment transition? We examined this question in two analyses drawing from the same data source of soldiers deploying for the first time (Analysis 1: N = 179,026; Analysis 2: N = 85,285; Mage = 24.6–24.7 years old, SD = 4.87; 66.5–66.9% White). Specifically, we examined how individual (e.g. sociodemographic, military) and deployment (e.g. stressful experiences) characteristics predict character development across the deployment cycle. Character strengths were assessed once before and up to three times after soldiers’ return from deployment. Reproducing previous work, we found evidence for two classes of change—a resilient class (“stable high”) and a recovery class (“persistent low”). The strongest predictor of high, resilient character strength levels was better self-rated health at baseline. The findings are discussed in the context of the mechanisms that drive character development, evidence for post-traumatic growth, and practical implications for the U.S. Army.

Development of character strengths across the deployment cycle among U.S. Army soldiers

OBJECTIVE

Despite a narrative of post-traumatic growth and resilience, research reliably demonstrating positive character development following adversity has proved elusive. In the current study, we examined changes in character strengths in Army soldiers deploying for the first time.

METHOD

The sample was comprised of 212,386 Army soldiers (M_age  = 26.5 years old, SD = 7.13; 70.8% White) who were deploying for the first time. Character strengths were assessed once before and up to three times following soldiers' return from deployment.

RESULTS

We found evidence for two classes of change-a resilient class ("stable high") and a declining class ("persistent low"). Most soldiers were resilient-they had high levels of character strengths prior to deployment and changed very little across the deployment cycle. Approximately 40% of soldiers started with lower character and experienced initial declines post-deployment, from which they experienced no more than small gains over time.

CONCLUSIONS

Character strengths were highly stable across the deployment transition but some soldiers experienced initial declines from which they never fully rebounded. The findings are discussed in the context of the mechanisms that drive character development.

Comparison of Cardiovascular Health Between US Army and Civilians

Background

Cardiovascular conditions are common in US Army and civilian populations. The recently developed concept of ideal cardiovascular health provides a new approach to evaluating population cardiovascular status.

Methods and Results

We defined a cohort of 263 430 active duty Army personnel, aged 17 to 64 years, who completed a 2012 physical examination and a corresponding subset of the noninstitutionalized, civilian US population, who participated in the National Health and Nutrition Examination Survey (NHANES) 2011 to 2012 cycle. We compared 4 cardiovascular health metrics (current smoking, body mass index, blood pressure, and diabetic status) between Army and civilian groups overall, and separately by sex, race/ethnicity, and age. The Army population was younger, was less often women or Hispanic, and had less post–high school education than the NHANES population. Smoking rates were ≈20% in the Army and NHANES groups, but <15% among Army women and Hispanics. Overall, one third of the Army and NHANES groups and NHANES women, but nearly half of Army women, demonstrated ideal body mass index. Ideal blood pressure was strikingly less prevalent in the Army than NHANES participants (30% versus 55%). Diabetes mellitus was rare in both groups.

Conclusions

Ideal cardiovascular health was less prevalent in the Army than NHANES group, despite exclusion of the least healthy recruits. Prevalence of ideal body mass index and blood pressure was low in both the Army and NHANES groups, even at early adult ages. This finding reveals the need for policy changes to promote, preserve, and improve ideal cardiovascular health in both the Army and the US population as a whole.

Association Between Predeployment Optimism and Onset of Postdeployment Pain in US Army Soldiers

IMPORTANCE

Pain after deployment is a major health care concern. While risk factors have been previously studied, few studies have explored protective factors.

OBJECTIVE

To examine the prospective association between predeployment optimism and the onset of new pain after deployment in US Army soldiers.

DESIGN, SETTING, AND PARTICIPANTS

This prospective longitudinal cohort study examined US Army soldiers (active duty, Reserve, and National Guard) who deployed to Afghanistan or Iraq between February 12, 2010, and August 29, 2014, and completed the necessary psychological and health assessments before and after deployment. Analyses were performed in the Person-Event Data Environment between July 2016 and November 2018. This study relied exclusively on existing, secondary Army data. Of the 413 763 Army soldiers who met the specified deployment criteria, 385 925 soldiers were missing 1 or more of the required assessment forms. Of the remaining 27 838 soldiers who were examined for eligibility, 7104 soldiers were excluded because of preexisting back pain, joint pain, or frequent headaches. These exclusions resulted in a final analytic sample of 20 734 eligible soldiers.

MAIN OUTCOMES AND MEASURES

This study examined new reports of pain after deployment, including new back pain, joint pain, and frequent headaches.

RESULTS

Among 20 734 US Army soldiers (87.8% male; mean [SD] age, 29.06 [8.42] years), 37.3% reported pain in at least 1 new area of the body after deployment: 25.3% reported new back pain, 23.1% reported new joint pain, and 12.1% reported new frequent headaches. As a continuous measure, each 1-U increase in optimism was associated with 11% lower odds of reporting any new pain after deployment, even while adjusting for demographic, military, and combat factors (odds ratio, 0.89; 95% CI, 0.86-0.93). Tertile analyses revealed that compared with soldiers with high optimism (lowest odds of new pain) soldiers with low optimism had 35% greater odds of reporting new pain in any of the 3 sites evaluated (odds ratio, 1.35; 95% CI, 1.21-1.50). In addition, a larger increase in risk of new pain was observed when comparing the moderate-optimism and low-optimism groups rather than the high-optimism and moderate-optimism groups.

CONCLUSIONS AND RELEVANCE

Higher levels of optimism were associated with lower odds of reporting new pain after deployment, over and above other common determinants of pain, including demographic and military characteristics and combat experiences. Soldiers with low levels of optimism before deployment could benefit from programs geared toward enhancing optimism.

Protective Effects of Psychological Strengths Against Psychiatric Disorders Among Soldiers

This study prospectively examined psychological strengths targeted in U.S. Army training programs as predictors of psychiatric diagnosis in active duty soldiers. At baseline, the cohort (140,584 soldiers) was without psychiatric disorder. Soldiers were then followed for 2 yr and classified as healthy, or acquiring a psychiatric diagnosis (adjustment disorder, anxiety disorder, depression, or post-traumatic stress disorder), or being prescribed psychotropic medication without a psychiatric diagnosis. Soldiers who remained healthy reported significantly higher strengths scores at baseline, compared with soldiers who were diagnosed with a psychiatric disorder. In addition, soldiers in the worst strengths decile were twice as likely to develop a psychiatric disorder, compared with soldiers in the top 50% on baseline strengths. Strengths afforded the greatest protection against depression. Offering tailored resilience training programs could help the Army steel vulnerable soldiers against the challenges of life, military training, and combat.

The U.S. Army Person-Event Data Environment: A Military-Civilian Big Data Enterprise

This report describes a groundbreaking military-civilian collaboration that benefits from an Army and Department of Defense (DoD) big data business intelligence platform called the Person-Event Data Environment (PDE). The PDE is a consolidated data repository that contains unclassified but sensitive manpower, training, financial, health, and medical records covering U.S. Army personnel (Active Duty, Reserve, and National Guard), civilian contractors, and military dependents. These unique data assets provide a veridical timeline capturing each soldier's military experience from entry to separation from the armed forces. The PDE was designed to afford unprecedented cost-efficiencies by bringing researchers and military scientists to a single computerized repository rather than porting vast data resources to individual laboratories. With funding from the Robert Wood Johnson Foundation, researchers from the University of Pennsylvania Positive Psychology Center joined forces with the U.S. Army Research Facilitation Laboratory, forming the scientific backbone of the military-civilian collaboration. This unparalleled opportunity was necessitated by a growing need to learn more about relations between psychological and health assets and health outcomes, including healthcare utilization and costs-issues of major importance for both military and civilian population health. The PDE represents more than 100 times the population size and many times the number of linked variables covered by the nation's leading sources of population health data (e.g., the National Health and Nutrition Examination Survey). Following extensive Army vetting procedures, civilian researchers can mine the PDE's trove of information using a suite of statistical packages made available in a Citrix Virtual Desktop. A SharePoint collaboration and governance management environment ensures user compliance with federal and DoD regulations concerning human subjects' protections and also provides a secure portal for multisite collaborations. Taking similarities and differences between military and civilian populations into account, PDE studies can provide much more detailed insight into health-related questions of broad societal concern. Finding ways to make the rich repository of digitized information in the PDE available through military-civilian collaboration can help solve critical medical and behavioral issues affecting the health and well-being of our nations' military and civilian populations.

The Person-Event Data Environment: leveraging big data for studies of psychological strengths in soldiers

The Department of Defense (DoD) strives to efficiently manage the large volumes of administrative data collected and repurpose this information for research and analyses with policy implications. This need is especially present in the United States Army, which maintains numerous electronic databases with information on more than one million Active-Duty, Reserve, and National Guard soldiers, their family members, and Army civilian employees. The accumulation of vast amounts of digitized health, military service, and demographic data thus approaches, and may even exceed, traditional benchmarks for Big Data. Given the challenges of disseminating sensitive personal and health information, the Person-Event Data Environment (PDE) was created to unify disparate Army and DoD databases in a secure cloud-based enclave. This electronic repository serves the ultimate goal of achieving cost efficiencies in psychological and healthcare studies and provides a platform for collaboration among diverse scientists. This paper provides an overview of the uses of the PDE to perform command surveillance and policy analysis for Army leadership. The paper highlights the confluence of both economic and behavioral science perspectives elucidating empirically-based studies examining relations between psychological assets, health, and healthcare utilization. Specific examples explore the role of psychological assets in major cost drivers such as medical expenditures both during deployment and stateside, drug use, attrition from basic training, and low reenlistment rates. Through creation of the PDE, the Army and scientific community can now capitalize on the vast amounts of personnel, financial, medical, training and education, deployment, and security systems that influence Army-wide policies and procedures.

Changes in isometric strength and range of motion of the isolated cervical spine after eight weeks of clinical rehabilitation

There have been no reports in the literature objectively measuring changes in strength and range of motion in patients with non-spinal-cord injuries of the cervical spine. Ninety patients participated in an 8-week training study. Diagnostic groups included patients with the following: degenerative disc (n = 6), herniated disc (n = 14), and cervical strain (n = 70). Full-range isometric strength tests were performed at eight equidistant positions in a device that constrained all motion with the exception of cervical flexion and extension. Post tests were performed following training. Significant gains were seen in strength as well as range of motion. Perceived pain was significantly reduced. This kind of testing can potentially provide the clinician with objective findings to direct patient management more adequately.