Page 137 - JSOM Fall 2022

Posttraumatic Stress experiencing subjective well­being or its components (positive
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SOF career stage (χ [1] = 5.06, p = .02; H1d supported), resil­ affect, satisfaction with life, perceived mastery) as well as a
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ience (χ [1] = 8.23, p < .01), and their interaction (χ [1] = 6.03, lack of mental illness symptoms after experiencing a stressor.
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p = .01), significantly accounted for the variance in posttrau­ With the continual operational load and the likelihood that
matic stress symptoms while controlling for mTBI history and the load does not lessen, it is possible resilient outcomes may
total military service. Resilience’s effect on posttraumatic stress only include immediate stress adaptation or sustained perfor­
symptoms was a function of career stage with career start SOF mance in this population. Perhaps mental health outcomes
Servicemembers tending to report lower posttraumatic stress come later in the resilience process and SOF combat Service­
symptoms with higher resilience. With no mTBI history and members must continually adapt to psychological and physical
average total military service, SOF careers start Servicemem­ military stressors to experience more complete mental health.
bers with median resilience (estimate = 51.77 [1,92­245.51]) Evaluating operationally relevant performance in SOF combat
was higher than those with high resilience (estimate = 1.35 Servicemembers could support or reject this hypothesis.
[0.23­7.88]), whereas this effect was not seen in mid­career
SOF Servicemembers as demonstrated by nearly equivalent In the present study, there was an overall lack of mTBI his­
posttraumatic stress at low (estimate = 22.34 [3.85–129.80]), tory main effects. It is possible that the other study constructs
median (estimate = 23.10 [3.53–151.29]), and high (estimate (SOF career stage, resilience, and total military service) have a
= 21.82 [3.12–152.66]) resilience. This effect followed a simi­ greater influence on the variance in mental health symptoms
lar pattern to that of anxiety symptoms (H2c not supported). in SOF combat Servicemembers. Interestingly, mTBI history
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History of mTBI had a significant main effect (χ [1] = 8.92, did associate with posttraumatic stress symptoms, but in the
p < .01) but in the opposite direction as hypothesized with opposite direction than previous literature in the area. 28,29
a higher mTBI history being associated with lower posttrau­ We found that SOF combat Servicemembers with more past
matic stress symptoms. mTBIs tended to report fewer posttraumatic stress symptoms.
It is currently unclear conceptually why we may have observed
this inverse relationship. If replicated in future studies, the re­
Discussion
lationship between mTBI and posttraumatic stress will need
This present study aimed to gain preliminary evidence for to be reconsidered, specifically for the SOF population. Self­
future longitudinal studies into SOF combat Servicemember reported clinician­confirmed injuries from any time was used
mental health. We hypothesized that SOF mid­career combat to quantify mTBI history. Though self­reporting mTBI history
Servicemembers would report lower subjective well­being as may have been a limitation, it has been noted that self­reported
well as higher depression, anxiety, and posttraumatic stress recall of mTBI is reliable and particularly useful when medical
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symptoms than SOF career start combat Servicemembers due records cannot be accessed. Instead, our lack of findings may
to greater operational exposure. Our first hypothesis was sup­ be due to the limited range of past injuries reported in our
ported for all mental health outcomes, though some findings sample (i.e., range = 0–6, median = 0). Future research should
were dependent on resilience levels. employ more objective head injury quantifications, such as us­
ing medical records. Additionally, previous work has also in­
We hypothesized that resilience would buffer against lower vestigated neurocognitive symptoms following mTBI, which
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mental health symptoms scores in SOF mid­carer combat Ser­ is an important consideration for clinical injury management
vicemembers while still accounting for mTBI history and total and informing return­to­duty. 29
military service. Study results failed to support this hypothesis,
though an interaction between resilience and SOF career stage Resilience, per its definition, is inherently selected in the mil­
was supported. The SOF career start Servicemembers showed a itary, and therefore self­reporting measurements may fall to
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positive association between resilience and subjective well­be­ social desirability bias. This is evidenced by previous military
ing as well as a negative association with anxiety and post­ resilience research demonstrating ceiling effects when using
traumatic stress symptoms similar to the relationships found established psychometrics. 32,33 The resilience metric employed
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in previous healthy adult studies. The interactions between in the present study, the ER89, has relatively low face valid­
resilience and SOF career stage showed that mid­ career com­ ity (in which a scale’s items look like the construct they mea­
bat Servicemembers did not endorse adaptive mental health sure). The ER89 has not demonstrated ceiling effects in recent
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benefits of resilience. These findings indicate that years of SOF SOF research. With all self­reported measures, there can be
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combat service may have detrimental effects on mental health recall bias. One study found that US infantry Soldiers did
above and beyond that of other military service or mTBI his­ not underreport negative mental health symptoms when they
tory. This indicates that additional work to enhance mental were able to respond anonymously, as they were in the present
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health symptoms using constructs other than resilience follow­ study. We attempted to mitigate the influence of social desir­
ing years of SOF service may be pivotal. With the blunted ef­ ability bias on negative mental health symptoms via a quiet
fect of resilience observed in the present study’s SOF mid­career testing environment and ensured patient responses were anon­
combat Servicemembers, resilience growth may not occur until ymous, but our SOF combat Servicemembers may have still
stress­recovery balance is near or achieved. In all, we do not responded in a socially desirable manner. It should be noted
provide evidence to include resilience in mental health training that approximately 17% of our sample reported no posttrau­
for those years into specialized military service. matic stress symptoms, indicating that these individuals either
truly lack these mental illness symptoms or they did not wish to
It has been proposed that resilience has three factors involved report their symptoms despite anonymity. Assuming that par­
in its adaptation process: 1) trait­based resilient tendencies, 2) ticipants did report honestly, the wide dispersion of mental ill­
dynamic alterations in adaptation based on the environment ness symptoms in active SOF combat Servicemembers requires
and available resources, and 3) resilient outcomes from the further investigation. Another main limitation of this study was
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stressor. This third factor has been conceptualized in part as the use of cross­sectional data to compare SOF career stages,
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