Page 24 - JSOM Spring 2023

Conclusions Author Contributions
SR, MJ, and CB conceived the study concept. CB, CM, and JS
From a prevention standpoint, these results suggest that strat- obtained funding. CB, AB, CM, JH, and JS coordinated and
egies focused on how military personnel appraise danger and collected the data. CB analyzed the data. CB and DF wrote the
threat while deployed may be key for understanding the sub- first draft. All authors read and approved the final manuscript.
sequent emergence and/or worsening of PTSD symptoms.
Predeployment training scenarios in which military personnel References
are exposed to warzone stressors that are most likely to be 1. Castro CA, McGurk D. The intensity of combat and behavioral
associated with perceived danger and threat may therefore health status. Traumatology. 2007;13(4):6–23.
reduce the risk for developing stress disorders. Specific to res- 2. Osório C, Greenberg N, Jones N, Goodwin L, Fertout M, Maia
cue personnel, exposure to injury, atrocity, and death under Â. Combat exposure and posttraumatic stress disorder among
simulated conditions of combat may be more useful for psy- Portuguese special operation forces deployed in Afghanistan. Mil
chological health promotion than training scenarios that focus Psychol. 2013;25(1):70–81.
on only one of these two conditions in isolation (i.e., expo- 3. Peterson AL, Wong V, Haynes MF, Bush AC, Schillerstrom JE.
Documented combat-related mental health problems in military
sure to injury and death without simulated threat or simu- noncombatants. J Trauma Stress. 2010;23(6):674–681.
lated threat without exposure to injury and death). This aligns 4. Armstrong EL, Bryan CJ, Stephenson JA, Bryan AO, Morrow CE.
with previous research suggesting that perceptions of readi- Warzone stressor exposure, unit support, and emotional distress
ness or preparedness reduce the risk for subsequent stress dis- among U.S. Air Force Pararescuemen. J Spec Oper Med. 2014;
orders. 8,16 Clinically, these findings suggest that addressing a 14(2):26–34.
Servicemember’s assumptions and appraisals about his or her 5. King DW, King LA, Gudanowski DM, Vreven DL. Alternative
representations of war zone stressors: Relationships to posttrau-
deployment, notably with respect to safety, trust, and power matic stress disorder in male and female Vietnam veterans. J Ab-
and control, may be useful for reducing PTSD symptoms. This norm Psychol. 1995;104(1):184.
approach is central to cognitive processing therapy, one of 6. Hendin H, Haas AP. Combat adaptations of Vietnam veterans
17
the only treatments with demonstrated efficacy for PTSD. without posttraumatic stress disorder. Am J Psychiatry. 1984;141
(8):956–959.
Conclusions based on the present results should be considered 7. King LA, King DW, Bolton EE, Knight JA, Vogt DS. Risk factors
in light of several limitations, however. First, data were limited for mental, physical, and functional health in Gulf War veterans.
J Rehabil Res Dev. 2008;45(3):395–407.
to self-report methods that could be vulnerable to response 8. Iversen AC, Fear NT, Ehlers A, et al. Risk factors for post-
bias. This is especially true for measures of PTSD symptom- traumatic stress disorder among UK Armed Forces personnel.
atology, for which there may have been motivation to mini- Psychol Med. 2008;38(04):511–522.
mize or underreport due to non-anonymous data collection 9. Mott JM, Graham DP, Teng EJ. Perceived threat during deploy-
procedures. Future studies that use anonymous data collection ment: Risk factors and relation to axis I disorders. Psychological
Trauma: Theory, Research, Practice, and Policy. 2012;4(6):587.
procedures and/or structured diagnostic interview methods 10. Renshaw KD. An integrated model of risk and protective factors
(e.g., the Clinician-Administered PTSD Scale) are needed to for post-deployment PTSD symptoms in OEF/OIF era combat
confirm the present results. Conclusions are further limited veterans. J Affect Disord. 2011;128(3):321–326.
by the cross-sectional design, which restricts our ability to 11. Vogt DS, Tanner LR. Risk and resilience factors for posttraumatic
establish temporal and/or causal relationships. Longitudinal stress symptomatology in Gulf War I veterans. J Trauma Stress.
designs are needed to further tease apart the emergence of 2007;20(1):27–38.
PTSD symptoms among rescue personnel across the deploy- 12. Weathers F, Litz B, Herman D, Huska J, Keane T. The PTSD
Checklist (PCL): reliability, validity, and diagnostic utility. Paper
ment cycle relative to stressor exposure and threat appraisal. presented at: International Society for Traumatic Stress Studies;
Despite these limitations, the present study provides additional 1993; San Antonio, TX.
information about the associations among warzone stressors, 13. Vogt DS, Proctor SP, King DW, King LA, Vasterling JJ. Validation
threat appraisal, and postdeployment stress disorders in a sub- of scales from the Deployment Risk and Resilience Inventory in a
population of military personnel. Because of the unique com- sample of Operation Iraqi Freedom veterans. Assessment. 2008;
bination of deployment-related stressors experienced by the 15(4):391–403.
rescue community, these results provide further support for the 14. Cohen J. A power primer. Psychol Bull. 1992;112(1):155–159.
15. Renshaw KD, Rodrigues CS, Jones DH. Psychological symptoms
importance of threat appraisal in PTSD. and marital satisfaction in spouses of Operation Iraqi Freedom
veterans: Relationships with spouses’ perceptions of veterans’ ex-
Funding periences and symptoms. J Fam Psychol. 2008;22(4):586.
This study was supported by a grant from the Air Force 16. Franz MR, Wolf EJ, MacDonald HZ, Marx BP, Proctor SP, Vast-
Medical Support Agency (#FA8650-12-2-6277). The views erling JJ. Relationships among predeployment risk factors, war-
expressed in this paper are those of the authors and do not zone-threat appraisal, and postdeployment PTSD symptoms. J
Trauma Stress. 2013;26(4):498–506.
necessarily represent the official position or policy of the U.S. 17. Resick PA, Wachen JS, Mintz J, et al. A randomized clinical trial
Government, the Department of Defense, or the Department of group cognitive processing therapy compared to group present
of the Air Force. centered therapy for PTSD among active duty military personnel.
J Consult Clin Psychol. In press.
Disclosures
CB, AB, CM, and JS have received grant funding from the De-
partment of Defense. The remaining authors report no finan-
cial relationships relevant to this article.

22 | JSOM Volume 23, Edition 1 / Spring 2023