Page 60 - JSOM Summer 2019

populations, specifically within populations with the highest
• We argue here that Servicemembers cannot overcome operations tempo, elevated PTSD-symptom reporting, and
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even indirect indicators of PTSD and suicidality (e.g., sustained fatalities: in other words, SOF.
relationship dysfunction, anger, depression, addiction)
by embodying tenets of positive psychology such as Individual Servicemembers’ personal histories and/or behav-
positive thinking and virtuousness. Moreover, we are ioral health patterns are part of the calculus involving suicidal
unaware of Servicemembers whose suicides or PTSD behaviors. Some military occupational specialties may increase
were caused by ingratitude, optional pessimism, being risk of suicidal behaviors because of those occupations’ in-
less than a model citizen, or for not living one’s best creased exposure to trauma. High-risk careers (e.g., SOF),
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life.
• Resilience is certainly an element contributing to over- by nature, may attract people attracted to risk: propensities
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all wellness and ability to withstand adversity. How- toward suicide and propensities toward risk are connected.
ever, presenting resilience as something that can be Furthermore, some Servicemembers may exhibit higher suicide
built to reduce PTSD and suicide implies that those risk because of suicidal behaviors demonstrated before join-
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suffering from combat stress reactions, chronic trau- ing the military. Yet, no large-scale studies of resilience nor
matic stress, or those who have considered or commit- its connection to adverse mental health outcomes, suicide in-
ted suicide are at fault for being low in resilience. cluded, specifically involved active units of SOF Servicemem-
• Physical injuries, skyrocketing suicide rates, and un- bers beyond civilian-driven academic estimates, retrospective
derexplored PTSD in SOF can be neither fully ex- reviews of Department of Defense (DoD) medical records, 4–6
plained nor mitigated by Servicemembers’ resilience. and reports of print and television media. 7–9,12
• Current resilience and suicide prevention programs
in the military are influenced heavily by positive psy- Resilience: Definitions and Origins
chology paradigms in which pain and suffering are For SOF, resilience-building initiatives are part of a multi-
variables to be avoided, despite negative experiences million-dollar program called Preservation of the Force and
being known essentials in overcoming trauma and for Family, offered through SOCOM. Regarding building re-
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posttraumatic growth. silience, Gauvin-Lepage et al. 26,27 determined resilience is an
• Resilience in SOF must be studied by independent in- ability developed to cope with stress and catastrophe, though
vestigators researching it with SOF personnel. Rice and Liu suggest resilience-type coping behaviors are not
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born of specific inherent traits enabling resilience. Whether re-
silient abilities are inborn or learned traits is often presented
Consistent assertions that SOF Servicemembers are highest in without concrete support thoroughly justifying either perspec-
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resilience throughout the armed forces are undermined by tive. Mangham et al. and Stewart et al. held that resilience
4–6
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SOF’s escalating rates of suicide, qualitatively described by the evolves on the basis of available resources. Investigators also
Special Operations Command (SOCOM) commander in 2017 use resilience as a preemptive factor in deflecting stress and
7
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as “morbid . . . [SOF] is suffering.” Active-duty military and its effects. When posited as a dispositional personality trait,
veteran deaths by suicide eclipsed combat fatalities in recent similar to neuroticism or extraversion, resilience is referred
8,9
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years. One estimate concluded 22 veterans commit suicide to and used synonymously with hardiness. As amalgamated
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daily. Overall, active military and veteran suicides surpassed elements of commitment, control, and challenge, hardiness
combat deaths and civilian suicide rates in the past several as an operationalized concept launched several iterations of
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years. In 2018, SOF suicide rates tripled from years prior. an instrument of measurement used to quantify its presence in
8,9
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SOF sustained almost 85% of combat fatalities after 9/11, military Servicemembers and military candidates aiming to
and SOF posttraumatic stress disorder (PTSD) symptom inci- be selected for elite units, such as US Army SF trainees. 35
dence is nearly double estimates compared with conventional
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forces. Perpetual deployments in SOF, in addition to intense Purpose
training while home, leads to a lack of decompressing dwell
time needed to reset resilience, mitigate stress, and enable re- Given varying views of resilience and disagreement on how
integration. Military populations obviously are at increased resilience develops and/or is evident in humans, the purpose of
risk for developing PTSD and associated mental health out- this integrative review was to examine and synthesize evidence
comes (e.g., anxiety, mood disorders, substance abuse, sui- on resilience studied in military populations. The research
cidal behaviors) because of occupational exposure to trauma, question was: What is known about resilience in Special Op-
deployment-related separation from support networks, and erations Forces?
substantial physiological and emotional stress. As such, re-
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silience is a timely and important concept in studying health Methods
of military (active, reserve, and veteran) Servicemembers. 15–17
Design and Sample
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Suicide risk in adult civilian populations is believed to decrease Whittemore and Knafl’s seminal work on conducting rigor-
as elements of resilience increase, such as social connectedness ous integrative reviews served as our framework. Electronic
and strong interpersonal relationships. Similarly, Rossetti et research databases were searched separately, though it is
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al. found that protective elements of resilience, such as so- now accepted that commercial search programs are a com-
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cial resources and cohesion, modulate suicide risk in civilian bination of individual repositories and thus our searched
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populations. Resilience studied within communities at risk databases totaled more than two dozen. Search terms used
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and in vulnerable groups after natural disasters found sim- were “resilience, hardiness” and then combined separately
ilar protective factors instrumental in resilience exhibited in with “special operations” (which returned zero results) and
both contexts. This begs the question whether those same pro- then “military,” which expanded our question to resilience
tective factors could apply in sustaining resilience in military in conventional-forces military versus SOF alone. Inclusion
58 | JSOM Volume 19, Edition 2 / Summer 2019