Page 134 - JSOM Fall 2022

operations have wide ranging domestic and international Methods
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ramifications. With the inherent taxation of SOF combat
service, those further in their SOF careers could be experienc­ Participants
ing worse psychological health outcomes due to prolonged SOF combat Servicemembers (age = 33.1 ± 4.5 years) are
exposure. Additionally, total military service should be con­ assigned to an organization within the United States Special
trolled for as some Servicemembers may join SOF later in Operations Command (USSOCOM). We recruited combat
their military careers, which may confound SOF service ef­ Servicemembers affiliated with either the United Stated Army
fects. It was an aim of the present study to gather preliminary Special Operations Command (USASOC; n=37, 63.8%) or
evidence to address whether continued SOF exposure was the Air Force Special Operations Command (AFSOC; n=21,
detrimental to combat Servicemembers’ positive and negative 36.2%). Fifty­eight SOF combat Servicemembers either enter­
mental health symptoms. To investigate years within SOF ser­ ing SOF (career start; n=38) or multiple years with their SOF
vice in the absence of extensive longitudinal data, career stage organization (mid­career; n=20) completed the psychometric
differences could be investigated, while accounting for total battery. Most SOF combat Servicemembers self­reported no
years in the military. Specifically, do Servicemembers years lifetime clinician­confirmed mTBI history (n=33; 56.9%);
into SOF service report worse mental health symptoms com- those with mTBI history reported 1–6 mTBIs.
pared to their peer combat Servicemembers just starting their
SOF service? Procedures
This study was approved by the Office of Human Research
Ethics and by the Office of Human Research Ethics at the Uni­
Military Servicemembers also have a relatively high prevalence
of traumatic brain injury (TBI) as compared to the civilian versity of North Carolina at Chapel Hill and by the Human
2
population. These injuries range over a spectrum of severities Research Protection Office at the US Army Medical Research
from mild TBI (mTBI, or concussion) to severe TBI. With the and Development Command (USAMRDC). Participants were
extant research conducted on head impact exposure in the mil­ assigned a confidential study ID. Participants completed all
itary, it appears that this population is at increased mTBI risk. measures in­person. After obtaining verbal consent, demo­
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In a prospective study following a Brigade Combat Team, Ser­ graphic information (including month and year of birth, service
vicemembers who sustained a deployment­acquired TBI had years, and total number of clinician­diagnosed concussive inju­
elevated adjusted odds of clinical posttraumatic stress disorder ries [mTBI history]) was self­reported through an online ques­
(PTSD) and generalized anxiety disorder 3­ and 9­months fol­ tionnaire. Using the same online platform, all psychometric
lowing deployment to Afghanistan and major depressive dis­ assessments including measures of resilience as well as positive
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order at 3­months post­deployment. History of mTBI is an (subjective well­being) and negative (depression, posttraumatic
important consideration in this active duty population. stress, and anxiety) mental health symptoms were employed.
Measures
As not all SOF combat Servicemembers report poor mental
health, there are other factors relating to symptom variability. All study metrics demonstrated acceptable internal consistency
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One factor related to adaptive outcomes following stress or (see Table 1).
injury is resilience. Resilience can be defined as one’s capacity
to equilibrate or adapt affective and behavioral responses to Independent Variables
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adverse physical or emotional experiences. Resilience related Study personnel recorded SOF career stage (career start or
to adaptative mental health outcomes from both continua: mid­career) for each participant. Psychological resilience
fewer depressive symptoms, lower trait anxiety, and greater was measured via the valid and reliable Ego Resiliency Scale
16
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well­being in a sample of civilian adults. Resilience may also (ER89). The ER89 is a 14­item scale that assessed a person’s
be a constructive intrapersonal characteristic in recovering general ability to bounce back from adversity. Questions so­
from mTBI. Reported relationships between higher resilience licited responses on a scale ranging from 1 (does not apply
and lower mTBI symptom severity, including negative mental at all) to 4 (applies very strongly) for statements such as “I
health symptoms, support this notion. 18,19 Yet, there is limited quickly get over and recover from being startled” or “I like to
research on combat Servicemembers’ sustained mental health, take different paths to familiar places.” Item responses were
especially in relation to resilience, in a single study. aggregated into a resilience score, with a higher score indicat­
ing higher resilience. The ER89 exhibited acceptable internal
consistency in this study (α = 0.77) and has been related to the­
The present study’s purpose was 1) to differentiate mental
health symptoms between SOF career stages while accounting oretically­relevant mental health and physiological stress resil­
9,20,21
for total military service and mTBI history and 2) determine ience outcomes in SOF Servicemembers in recent research.
whether resilience was associated with mental health symp­
tom differences between SOF career stages. First, it was hy­ Covariates
pothesized that SOF combat Servicemember years into SOF Participants self­reported whether they have ever had a
service would report less adaptive mental health (lower sub­ clinician­confirmed mTBI at any point in their lifetime (yes ver­
jective well­being [H1a] as well as higher depressive [H1b], sus no), their lifetime mTBI incidence (ranging from 0–10+),
anxiety [H1c], and posttraumatic stress symptoms [H1d]) and the recency of the last injury (past week, past month, past
than combat Servicemembers just beginning their SOF careers. year, year+). Only lifetime mTBI incidence was employed for
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Second, it was hypothesized that higher resilience would pro­ the current project as has been done in previous SOF research.
tect against less adaptive mental health symptoms in SOF com­ Study personnel also recorded USSOCOM branch (Army or
bat Servicemembers further into their SOF careers. That is, Air Force) for each participant. The SOF combat Servicemem­
mid­career SOF combat Servicemembers with high resilience bers self­ reported their age and date of enlistment or date of
were expected to have similar mental health as low resilient commission. Total military service (in years) was calculated
SOF career start combat Servicemembers [H2]. as the difference between the enlistment/commission date and
testing date.

130 | JSOM Volume 22, Edition 3 / Fall 2022