This study examined the role of cumulative combat experiences with regard to military performance and conduct and mental health among a sample of young soldiers from the Army STARRS dataset (N = 5,283). Higher levels of cumulative combat experiences were directly related to poorer performance and conduct and a greater likelihood of anxiety, depression, and post-traumatic stress disorder (PTSD). Military performance and conduct served as a linking mechanism between combat experiences and mental health. Using moderated mediation structural equation modeling, relationship disruptions were found to exacerbate the adverse effects of combat experiences; conversely, unit cohesion buffered the impact of combat experiences. Implications for military helping professionals include identifying leverage points for intervention, particularly strengthening the social connections of service members within and outside the military.
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The buffering effect of relationships on combat exposure, military performance, and mental health of U.S. military soldiers: A vantage point for CFTs
APA Citation:
Reed‐Fitzke, K., & Lucier‐Greer, M. (2020). The buffering effect of relationships on combat exposure, military performance, and mental health of U.S. Military soldiers: A vantage point for CFTs. Journal of Marital and Family Therapy, 46(2), 321-336. https://doi.org/10.1111/jmft.12402
Focus:
Deployment
Mental health
Other
Branch of Service:
Army
Military Affiliation:
Active Duty
Guard
Reserve
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
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Research & Summary
Reed‐Fitzke, Kayla; Lucier‐Greer, Mallory
2020
Identifying at-risk marines: A person-centered approach to adverse childhood experiences, mental health, and social support
APA Citation:
Reed-Fitzke, K., LeardMann, C. A., Wojciak, A. S., Ferraro, A. J., Hamilton, A., Duncan, J. M., & Rull, R. P. (2023). Identifying at-risk marines: A person-centered approach to adverse childhood experiences, mental health, and social support. Journal of Affective Disorders, 325, 721–731. https://doi.org/10.1016/j.jad.2023.01.020
Focus:
Mental health
Trauma
Branch of Service:
Marine Corps
Military Affiliation:
Active Duty
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research
Reed-Fitzke, Kayla; LeardMann, Cynthia A.; Wojciak, Armeda Stevenson; Ferraro, Anthony J.; Hamilton, Alexus; Duncan, James M.; Rull, Rudolph P.
2023
Background Previous research indicates an association between adverse childhood experiences (ACES) and health outcomes; however, most of these studies rely on variable-centered techniques. This study implemented a person-centered approach to provide a more nuanced understanding of these relations. Methods The sample consisted of 3611 male Marines who completed two surveys, one prior to service and another during or after service. A series of latent class analyses were conducted to identify homogenous subgroups, using ACE categories as indicators. Hierarchical regressions were conducted to examine the relationships between classes, deployment experiences, depression and PTSD, and social support problems. Results Five classes were identified: Low Adversity (48.8 %), Low Adversity – Parental Separation (PS; 33.1 %), Elevated Adversity (7.0 %), Moderate Adversity – Violence/Safety (5.7 %), and Moderate Adversity – Parental Loss (PL; 5.4 %). Several classes were associated with outcomes; in reference to Low Adversity, Moderate Adversity – PL was associated with depression and PTSD, Elevated Adversity was associated with PTSD and social support problems, and Low Adversity – PS was associated with social support problems. Experiencing moderate to high combat appeared to modify the associations between Moderate Adversity – PL and depression and PTSD. Limitations Study sample was limited to U.S. Marines; ACEs indicators were limited to specific categories, not allowing for a full range of potential childhood traumatic experiences. Conclusions Findings suggest a nuanced connection between ACEs and mental health; using specific patterns of ACEs, particularly multifaceted indicators of adversity that are inclusive of parental absence may have more utility than the sheer number of ACEs as an indicator for those who may at a heightened risk for mental health concerns.
A person-centered approach to identifying at-risk U.S. Army soldiers-in-training based on adverse childhood experiences
APA Citation:
Reed-Fitzke, K., Duncan, J. M., Wojciak, A. S., Ferraro, A J., Sánchez, J., & Smith, K. M. (2023). A person-centered approach to identifying at-risk U.S. Army soldiers-in-training based on adverse childhood experiences. Traumatology, 29(4), 481–492. https://doi.org/10.1037/trm0000395
Focus:
Child maltreatment
Mental health
Trauma
Branch of Service:
Army
Military Affiliation:
Active Duty
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
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Research & Summary
Reed-Fitzke, Kayla; Duncan, James M.; Wojciak, Armeda S.; Ferraro, Anthony J.; Sánchez, Jennifer; Smith, Kevin M.
2023
Military service members are confronted with numerous stressors as they progress through their career. Given the military’s desire to maintain mission readiness, it is imperative to identify areas of early intervention to promote optimal functioning and health. This study used the stress process framework and a person-centered approach to identify subgroups of soldiers-in-training based on adverse childhood experiences (ACEs). Specifically, two questions were addressed: (a) Are there distinct profiles of ACEs among soldiers-in-training, and (b) who are the most at-risk soldiers-in-training? The sample consisted of 30,836 soldiers-in-training from the Army study to Assess Risk and Resilience in Servicemembers. Five subgroups were identified using latent profile analysis: low adversity, moderate emotional adversity, elevated emotional adversity, moderate structural adversity, and high cumulative adversity. Results from a multivariate and univariate analyses of variance indicated significant small main effects of profile membership in anxiety, depression, posttraumatic stress disorder, and resilient mindset. Those with high cumulative adversity and elevated emotional adversity appeared to be the most at-risk regarding mental health, yet those with high cumulative adversity had similar levels of resilient mindset as the lower adversity groups. Those with elevated emotional adversity had the lowest levels of resilient mindset. Findings provide a more holistic understanding of unique combinations of ACEs among individuals’ as they enter military service. ACEs profiles may help providers identify those who may benefit from targeted supports (e.g., trauma-informed mental health providers) prior to or during service for those who may be most vulnerable to poor outcomes.
Military-related stress, self-efficacy, and anxiety: Investigating the role of marital quality in military couples
APA Citation:
Lucier-Greer, M., Frye-Cox, N., Reed-Fitzke, K., Ferraro, A. J., & Mancini, J. A. (2023). Military-related stress, self-efficacy, and anxiety: Investigating the role of marital quality in military couples. Family Process, 62(3), 1253-1271. https://doi.org/10.1111/famp.12833
Focus:
Couples
Mental health
Parents
Branch of Service:
Air Force
Army
Marine Corps
Navy
Multiple branches
Military Affiliation:
Active Duty
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
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Research & Summary
Lucier-Greer, Mallory; Frye-Cox, Nick; Reed-Fitzke, Kayla; Ferraro, Anthony J.; Mancini, Jay A.
2023
This study utilizes a stress process framework in conjunction with a crossover perspective to conceptualize how stress, specifically military-related stress, manifests within individuals and couples. An actor–partner interdependence mediation modeling approach was used in a cross-sectional sample of 243 military couples to examine whether difficulties managing military-related stress may erode one's own self-efficacy and, in turn, contribute to greater anxiety (actor effects) and/or one's partner's self-efficacy and, in turn, anxiety (partner effects). Further, the potential moderating impact of marital quality was explicated in the model to understand if greater marital quality might buffer the impact of military-related stress. There was support for the stress process model primarily regarding actor effects; fewer partner effects emerged. One's own perceptions of military-related stress, specifically higher stress, were related to lower levels of their own self-efficacy, and, consequently, higher anxiety, but military-related stress did not directly affect the partner's self-efficacy or anxiety. Both service members' and civilian spouses' marital quality had ramifications for civilian spouses' self-efficacy, specifically a buffering effect; that was not the case regarding civilian spouse effects on the military member. Findings point to specific ways in which military stressors have implications for personal well-being, the role of a strong couple relationship in buffering stress, especially for civilian spouses, and concomitant leverage points for supporting both individual and couple well-being.
5 Post-high school military enlistment and long-term well-being
Post-high school military enlistment and long-term well-being
APA Citation:
Lucier-Greer, M., O’Neal, C. W., Peterson, C., Reed-Fitzke, K., & Wickrama, K. A. S. (2023). Post-high school military enlistment and long-term well-being. Emerging Adulthood, 11(1), . https://doi.org/10.1177/21676968221131854
Focus:
Mental health
Physical health
Youth
Branch of Service:
Army
Air Force
Navy
Marine Corps
Multiple branches
Military Affiliation:
Active Duty
Population:
Adolescence (13 - 17 yrs)
Childhood (birth - 12 yrs)
Young adulthood (18 - 29 yrs)
Adulthood (18 yrs & older)
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Research & Summary
Lucier-Greer, Mallory; O’Neal, Catherine W.; Peterson, Clairee; Reed-Fitzke, Kayla; Wickrama, K. A. S.
2023
Longitudinal data from the National Longitudinal Study of Adolescent to Adult Health were used to evaluate the impact of post-high school military enlistment during emerging adulthood. Comparisons were made between matched samples of emerging adults who enlisted in the military (n = 576) and their civilian counterparts (n = 576) on well-being over a decade later. Well-being was broadly conceptualized to reflect socioeconomic well-being, physical health, mental health, and risky lifestyle behaviors. Matching maximizes confidence that findings reflect differences due to enlistment, rather than pre-existing characteristics that contribute to both enlistment rates and well-being. No consistent differences emerged between the matched samples. Service members reported some indicators of better mental health (perceived stress, anxiety), yet higher rates of post-traumatic stress disorder diagnosis, and civilians reported some indicators of better physical health. Strengths-based perspectives and models that account for the concurrent possibility that military service may positively and negatively impact well-being are needed in future research.
Identifying risk and resilience factors associated with the likelihood of seeking mental health care among U.S. Army Soldiers-in-training
APA Citation:
Duncan, J. M., Reed-Fitzke, K., Ferraro, A. J., Wojciak, A. S., Smith, K. M., & Sánchez, J. (2020). Identifying risk and resilience factors associated with the likelihood of seeking mental health care among US Army soldiers-in-training. Military Medicine, 185(7-8), e1247-e1254. https://doi.org/10.1093/milmed/usz483.
Focus:
Mental health
Trauma
Branch of Service:
Army
Military Affiliation:
Active Duty
Guard
Reserve
Population:
Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
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Research & Summary
Duncan, James M.; Reed-Fitzke, Kayla; Ferraro, Anthony J.; Wojciak, Armeda S.; Smith, Kevin M.; Sánchez, Jennifer
2020
INTRODUCTION: The Department of Defense aims to maintain mission readiness of its service members. Therefore, it is important to understand factors associated with treatment seeking in order to identify areas of prevention and intervention early in a soldier's career that can promote positive functioning and increase their likelihood of seeking mental health care when necessary. METHOD: Using a theory of planned behavior lens, this study identified potential barriers (risk) and facilitators (resilience) to treatment seeking among 24,717 soldiers-in-training who participated in the New Soldiers Study component of the "Army Study to Assess Risk and Resilience in Servicemembers" (Army STARRS). Approval for this study was granted by the University of Iowa IRB # 201706739. Hierarchal linear regression modeling and independent samples t-tests were used to examine associations between demographics and study variables, intersections of risk and resilience, and to explore differences in the likelihood of seeking help based on mental health diagnoses. RESULTS: A four-stage hierarchical linear regression was conducted, using likelihood of help-seeking as the dependent variable, to identify the most salient factors related to help-seeking. "Step one" of the analysis revealed soldiers-in-training who identified as female, Hispanic or Other ethnicity, and married, divorced, or separated reported a greater likelihood of seeking help. "Step two" of the analysis indicated soldiers-in-training with a history of sexual trauma, experience of impaired parenting, and clinical levels of mental health symptomatology (anxiety, depression, PTSD) reported a greater likelihood of seeking help. Inversely, soldiers-in-training with a history of emotional trauma and parental absence/separation reported a lower likelihood of seeking help. "Step three" of the analysis demonstrated soldiers-in-training with a prior history of seeking help and larger social networks had a greater likelihood of seeking help. "Step four" of the analysis revealed several interactive effects between risk and resilience factors. Specifically, soldiers-in-training who reported greater depressive symptomatology in combination with prior history of treatment seeking reported a greater likelihood of help seeking, whereas soldiers-in-training who reported prior sexual trauma and PTSD in combination with large social networks reported a lower likelihood of seeking help. Finally, a greater percentage of soldiers-in-training with clinical levels of anxiety, depression, and PTSD indicated they would likely seek help in comparison to soldiers-in-training without clinical symptoms. CONCLUSION: Findings suggest few soldiers-in-training are likely to seek help when experiencing a problem. General efforts to encourage help-seeking when needed are warranted with particular focus on subsets of soldiers-in-training (eg, men, those with a history of some adverse childhood experiences). Strengths of this study include the examination of a large sample of soldiers-in-training to identify possible leverage points for early intervention or prevention prior to entering stressful military operating environments. Limitations of this study include the examination of only one military branch and exclusion of soldiers not "in-training." Future studies could consider replicating the current study using a sample of military personnel longitudinally to track behavioral trends as well as looking at military populations outside of basic combat training.
1 WHAT ARE ADVERSE CHILDHOOD EXPERIENCES (ACES)?
Posted by Reed-Fitzke, Kayla
