Page 21 - JSOM Spring 2023

from the rescue community, which suggests exposure to se- Measures
vere injuries (especially injured children) and dead bodies to
be among the most troubling deployment stressors for rescue Posttraumatic Stress Symptoms
personnel. Posttraumatic stress symptoms were measured using the
Posttraumatic Stress Disorder Checklist, Military Version
(PCL-M), a 17-item self-report checklist that directs respon-
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Given the specific contextual demands of their mission, ad-
ditional research with rescue personnel is warranted to fur- dents to rate the severity of each DSM-IV-defined symptom of
ther clarify and tease apart different deployment-related PTSD during the past month on a scale ranging from 1 (not
factors that may influence postdeployment stress disorders. at all) to 5 (extremely). Item scores are summed to provide an
Results of such research may provide clues for developing overall metric of PTSD symptom severity, with higher scores
and implementing targeted and focused prevention strategies indicating more severe symptoms. Internal consistency of the
and interventions for the promotion of mental health in this scale in the current sample was 0.93.
population and potentially the military more generally. In the
present study, we sought to examine the relative strength of Threat Appraisal
associations among specific deployment-related stressors, sub- Subjective threat appraisal was assessed using the Perceived
jective threat appraisal, and PTSD symptom severity among Threat Scale of the Deployment Risk and Resilience Inventory
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rescue personnel. We first hypothesized that the association (DRRI), a 17-item self-report checklist that directs respon-
of aftermath exposure with PTSD symptom severity would be dents to rate the extent to which they worried or feared for
statistically accounted for by threat appraisal. Consistent with their safety or well-being on a scale ranging from 1 (strongly
previous research, we additionally hypothesized that the asso- disagree) to 5 (strongly agree). Item scores are summed to pro-
ciation of combat exposure with PTSD symptoms would be vide an overall metric of perceived threat, with higher scores
statistically accounted for by threat appraisal. indicating more severe symptoms. Internal consistency of the
scale in the current sample was 0.90.
Method Deployment Stressor Exposure
Participants and Procedures Combat exposure was assessed using the Combat Experiences
Participants included 207 rescue personnel (75.4% active Scale (CES) of the DRRI, a 21-item checklist of common events
duty, 24.6% National Guard or Reserve) with 1 to 26 years of associated with combat-related operations (e.g., going on com-
service (M=8.90, SD=5.95) and ranging from 23 to 50 years bat patrols, being attacked or fired upon, firing at the enemy),
of age (M=32.06, SD=5.86). Rank distribution was 23.7% whereas postcombat exposure was assessed using the After-
E3-E4, 31.9% E5-E6, 12.0% E7-E9, 14.9% O1-O3, and 5.3% math of Battle Scale (ABS) of the DDRI, a 15-item checklist of
O4-O5. Self-reported race was 78.7% Caucasian, 1.9% Afri- common events associated with the consequences of combat
can American, 1.9% Asian, 1.4% Hawaiian or Pacific Island, operations (e.g., taking care of injured or dying people, seeing
1.0% Native American, 2.4% other, and 12.6% unknown or dead bodies). Items are rated on a scale ranging from 1 (never)
unreported. In addition, 5.3% of the sample endorsed His- to 5 (daily or almost daily). Because the purpose of the present
panic or Latino ethnicity. Participants had deployed a total of study was to examine the associations among individual scale
one to seven times (M=2.82, SD=1.70). The most commonly items with other constructs, items were not summed to obtain
reported deployed locations were Afghanistan (69.6%) and full-scale scores.
Iraq (34.8%); only 12.6% had never deployed to either of
these locations. Data Analytic Approach
To test the associations of individual deployment stressors
Squadron commanders agreed to participate as research sites with PTSD symptoms and subjective threat appraisal, zero-
prior to the initiation of data collection. Upon study approval, order correlation coefficients were calculated. In order to de-
data were collected from participants at each installation. termine if deployment stressors accounted for unique variance
Pararescue jumpers (PJs) were gathered as a group while the in PTSD symptoms beyond the effects of threat appraisal, par-
investigators explained the study’s purpose and procedures. tial correlation coefficients were also calculated. The relative
The informed consent document was reviewed, and questions strength of associations among PTSD symptoms and deploy-
were addressed by the investigators. To minimize possible ment stressors was determined via consideration of effect sizes,
coercion, PJs were informed that they could choose to leave with cutoffs for large, medium, and small effects being set at
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their survey packets blank if they did not want to participate r>0.50, 0.30, and 0.10, respectively.
but did not feel comfortable leaving the room in front of their
teammates. Survey packets were distributed to PJs and were Results
subsequently returned to the investigators upon completion.
Responses were manually entered by research staff at the Na- Response frequencies for each of the Aftermath of Battle
tional Center for Veterans Studies at the University of Utah Scale (ABS) and Combat Experiences Scale (CES) items are
and double-checked for validation and quality assurance. Ap- summarized in Tables 1 and 2, respectively. To determine how
proval for the current study was obtained by the Wilford Hall common each deployment-related stressor was experienced,
Ambulatory Surgical Center’s Institutional Review Board. At we first calculated the proportion of personnel who reported
the time of data collection, there were a total of 462 rescue experiencing each stressor. The most commonly endorsed
personnel in the US Air Force, of which 216 were invited to stressors were taking care of injured or dying people (76.5%),
participate. Of these 216, a total of 207 consented and com- going on combat patrols or missions (69.3%), seeing Ameri-
pleted the survey packet (response rate: 95.8%). The current cans or allies after they had been severely wounded or disfig-
sample therefore represents just under half of the career field ured (63.7%), and seeing civilians after they had been severely
at that time. wounded or disfigured (61.8%). Next, we examined how

Threats, Recovery, and PTSD in Air Force Rescue Personnel | 19