Page 36 - Journal of Special Operations Medicine - Summer 2014

Warzone Stressor Exposure, Unit Support,
and Emotional Distress Among U.S. Air Force Pararescuemen

Erica L. Armstrong; Craig J. Bryan, PsyD, ABPP; James A. Stephenson, PsyD, ABPP;
AnnaBelle O. Bryan, BSPH; Chad E. Morrow, PsyD, ABPP

ABSTRACT
Objectives: Combat exposure is associated with increased outcomes among military personnel, including occupa-
mental health symptom severity among military person- tional and marital dissatisfaction, violence, alcohol and
nel, whereas unit support is associated with decreased se- substance abuse, and suicide. 1,3,6–15 Of the many contribu-
verity. However, to date no studies have examined these tors to mental health problems among military personnel
relationships among U.S. Air Force pararescuemen (PJs), and veterans, combat exposure has received considerable
who have a unique and specialized career field that serves attention, with studies confirming that increased symp-
in both medical and combatant capacities. Design: Cross- toms of PTSD severity and/or the development of PTSD
sectional self-report survey. Methods: Self-reported sur- is associated with greater exposure to combat. 16–18
vey data regarding depression symptoms, posttraumatic
stress disorder (PTSD) symptoms, perceived unit support,
and exposure to traditional combat experiences (e.g., Review of the Literature
firefights) and medical consequences of combat (e.g., in- In a study of veterans of the Vietnam conflict, more than
juries and human remains) were collected from 194 PJs in 27% with high to very high combat exposure, opera-
seven rescue squadrons. Results: Levels of combat expo- tionalized as the overall rate of unit members who were
sure were compared with previously published findings killed in action, met criteria for current PTSD compared
from combat units, and levels of medical exposure were with 14% with moderate exposure and 0.3% with low
compared with previously published findings among mil- exposure. Among Iraq and Afghanistan veterans who
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itary medical professionals. Medical exposure intensity screened negative for PTSD before deployment, rates of
showed a stronger relationship with PTSD severity (β = postdeployment PTSD were 7.6% for those with combat
.365, p = .018) than with combat exposure intensity (β exposure compared with 1.4% for those without com-
= .136, p = .373), but neither combat nor medical expo- bat exposure. In this study, it was also found that mili-
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sure was associated with depression severity (βs < .296, tary personnel with PTSD before their deployment had a
ps > .164). Unit support was associated with less severe higher rate of postdeployment PTSD if they experienced
PTSD (β = –.402, p < .001) and depression (β = –.259, p = combat again (43.5%) compared with those who did not
.062) symptoms and did not moderate the effects of com- (26.2%). Increased incidence and severity of anxiety and
bat or medical exposure. Conclusions: Medical stressors depression have also been observed among U.S. military
contribute more to PTSD among PJs than do traditional personnel with more intense combat exposure, suggest-
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combat stressors. Unit support is associated with reduced ing that these trends are not limited to PTSD.
PTSD and depression severity regardless of intensity of
warzone exposure among PJs. Considerably fewer studies have been conducted to ex-
amine protective factors for mental health (i.e., variables
Keywords: unit support, military, trauma, combat exposure, that may guard against PTSD and other disorders) among
pararescue, aftermath military personnel, although several studies have linked
unit support with positive outcomes. For example, mili-
tary personnel who score higher on measures of unit sup-
port also score higher on measures of job satisfaction and
Introduction
well-being. Unit support is also positively associated
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Mental health conditions continue to be a source of strug- with morale and better military performance, fewer
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gle for many military personnel and veterans, with studies sleep problems, greater psychological resilience, or hardi-
suggesting that up to 25% have at least one psychological ness, combat preparedness, and less chance that the indi-
disorder and that 5% to 17% have PTSD, the most fre- vidual will leave his or her unit. 24–28 The protective effect
quently diagnosed mental health condition among mili- of unit support on PTSD symptoms was further suggested
tary personnel and veterans. Depression and PTSD are in a recent study of UK military personnel in which re-
1–5
associated with a host of functional problems and negative duction of PTSD symptoms was significantly more likely

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