Military deployment health surveillance policy and its application to Special Operations Forces

An evaluation research methodology was used to determine whether deployment health surveillance for Special Operations Forces conformed with Department of Defense policy directives for the specified target population. Data for this methodology were based on pre- and postdeployment health assessments as well as patient encounters recorded during deployments. The data represented 1,094 individual and unique Special Operations Forces members deployed to 12 different countries from October 2000 through December 2001. Results from the study suggested that military deployment health surveillance policy goals for predeployment medical referrals, patient data capture, and documentation during the deployment and postdeployment medical referrals were being poorly met when Department of Defense and Joint Chiefs of Staff mandates were applied to Special Operations Forces in an unconventional operations environment. Preliminary evaluation indicates that deployment health surveillance implementation could be improved with the introduction of policy awareness education, training, and technology.     

Military occupational work capacity as a criterion of health]

The indices of physical, sensor and task performance were used to characterize and estimate the functional state of military specialists and their functional reserves. Application of these criteria gives the possibility for physician-prophylaxist to obtain a truly information about the health status in the military unit making a selective control in it.     

The impact of deployment on the psychological health status, level of alcohol consumption, and use of psychological health resources of postdeployed U.S. Army Reserve soldiers

This study was conducted to investigate the impact of deployment on the psychological health status, level of alcohol consumption, and use of psychological health resources of postdeployed Army Reserve (AR) soldiers. Data were collected from 51,078 postdeployed AR soldiers via DD Form 2900 to detect existing psychological and medical issues. As predicted, findings indicate that AR soldiers screened 7 or more months post redeployment are significantly more likely than those screened 3 to 6 months post redeployment to screen positive for moderate (chi2 (1, N = 44,319) = 15.75, p < 0.001) and severe (chi2 (1, N = 44,319) = 7.82, p < 0.05) functional impairment and PTSD (chi2 (1, N = 51,017) = 14.43, p < 0.001). Present findings are consistent with previous research, suggesting that adverse psychological health issues can be detected during their mild stages and resolved to prevent further degradation when screenings are performed according to military policy.     

Role of hardiness in the psychological well-being of Canadian Forces officer candidates

Previous research has found that hardiness is associated with greater psychological well-being and lower levels of stress. This study examined the role of hardiness in the psychological well-being of military officer candidates undergoing basic training. Although most researchers have conceptualized hardiness as a global psychological construct, it is possible that military-specific hardiness, which pertains specifically to work experiences in the military environment, may be a more relevant measure. The role of both general and military-specific hardiness in life satisfaction, health symptoms, training satisfaction, and training stress was examined. The results of this study were consistent with those of previous research, suggesting that military-specific hardiness is an important predictor of psychological well-being of military personnel. Furthermore, military-specific hardiness served as a better predictor of the psychological well-being of military personnel than general hardiness. The implications of the findings and future research suggestions are discussed.     

不同作业环境舰艇艇员心理健康状况的调查

目的了解艇员心理健康状况及作业环境对舰艇艇员的影响。方法运用自编调查问卷、症状自评量表（SCL-90）对某部362名A型舰、B型舰、C型舰艇员进行调查。结果A型舰艇员的心理健康状况与C型舰艇员相比（除恐怖因子外），B型舰艇员与C型舰艇员相比，各因子及SCL-90总得分差异均有统计学意义（P〈0.05）。3种类型舰艇艇员之间（除强迫症状和恐怖因子外）各因子、SCL-90总得分及他们对环境的适应情况比较差异均有统计学意义（P〈0．01）。结论作业环境对艇员的心理健康有重要影响，应改善艇员的作业环境，以提高艇员的心理健康水平。     

Military women's risk factors for and symptoms of genitourinary infections during deployment

Symptoms of vaginitis and urinary tract infections are miserable, distracting, and significantly affect women's quality of life. Among civilian women, these symptoms account for 10.5 million office visits per year. To examine the scope of the problem for military women during deployment situations, surveys were sent to randomly selected Army and Navy units. Of 841 women who completed the anonymous survey and had been deployed, vaginal infections were experienced by 30.1% and urinary tract infections by 18.4% of them during deployment. Vaginal symptoms were consistent with symptoms associated with the three most common vaginal infections (candida, bacterial, and trichomonas vaginitis). A variety of risk factors, both behavioral and situational, significantly differentiated women with and without infections. Urinary tract infections and vaginal infections are common during deployment situations where resources for self-care and appropriate primary health care for women are scarce or unavailable. One solution is a self-diagnosis and treatment kit for deployed military women.     

不同特训方式男兵身心健康与人格的对比研究

目的探讨不同特殊训练后，男兵在个性和身心健康方面的差异。方法运用卡特尔16种人格特质量表、症状自评量表、疲劳量表和自编的意志品质量表对50名男兵（男兵1组）和40名男兵（男兵2组）经不同特训后进行心理测量与调查，然后进行统计学处理。结果较长期高强度、高难度和高要求的军事训练磨练了男兵的意志品质，也使他们容易产生疲劳感。训练专业不同，要求不一样，产生的身心疲劳感受也不一样。结论要特别关注特训男兵1组的心理健康，帮助他们学习有效调节情绪的方法，注意解除他们的疲劳，引导他们培养良好的人格，从而较好地维护身心健康。     

对于深入开展心理健康和神经认知研究的若干建议

军人心理健康已成为我军重点关注的问题,与之相应的神经认知能力的提升对于最大程度地发挥战斗力至关重要。结合全军军事认知与心理卫生研究中心的成立,对其任务方向进行分析并提出建议,包括建立心理科学研究与认知神经科学紧密结合的研究体系,发展定量心理学等相关学科,发展定量行为学以及分子行为学,并适时将其与心理科学研究对接,发展并完善利用模式动物研究神经行为和心理活动的研究,结合神经精神相关研究促进心理和认知行为研究的发展,加强心理正常和心理异常的外在表现及其物质基础研究,以及个体心理与群体心理的相关性研究,研究并发展系列新型有效的心理干预技术等,旨在为提高我军军人心理健康水平和军事作业能力提供参考。     

心理干预对新兵心理健康状况的影响研究

 目的 探讨心理干预对新兵心理健康状况的影响.方法 采用症状自评量表,对1 113名新训队新兵进行心理测量,并根据统计学的聚类分析随机在症状组抽出47人,亚健康组抽出45人,健康组抽出38人进行心理干预.同时,分别对三组进行组内差异比较以及平均数差异比较.结果 在各组干预前后的比较中:症状组的恐怖因子没有差异,焦虑因子差异显著(P＜0.05),其余各因子差异十分显著(P＜0.01);亚健康组的敌对和恐怖因子没有差异,人际和抑郁因子差异显著(P＜0.05),其余各因子差异十分显著(P＜0.01);健康组的强迫和焦虑因子有十分显著的差异(P＜0.01),其余各因子则没有差异.在各组干预后平均数差异比较中,症状组的新兵心理健康水平改变的最高.结论 心理干预后新兵的心理健康水平有显著提高,是提高部队新征兵员心理健康水平的有效方法.     

Soldier attitudes toward mental health screening and seeking care upon return from combat

OBJECTIVE: This study examined soldier attitudes about postdeployment mental health screening, treatment, barriers to care, strategies for overcoming barriers, and settings, personnel and timing for conducting postdeployment mental health screening. METHODS: Deploying soldiers participated in a voluntary anonymous survey. RESULTS: Of 3,294 soldiers, 2,678 (81.3%) responded to the survey. When the three most endorsed perceived barriers to mental health care (negative perception by unit members, negative perception by leaders, and being viewed as weak) were examined, approximately 15% fewer soldiers endorsed the perceptions, compared with a previous study conducted at the beginning of the war. Receipt of training focused on managing psychological problems associated with increased agreement to seek treatment. Participants endorsed surveys, interviews, and unit providers as preferred instruments and providers for postdeployment screening. Soldiers endorsed encouragement from family members and friends as the preferred approach to reducing barriers to mental health care. CONCLUSION: Extensive educational programs seemed to have reduced the stigma related to receiving mental health care. Programs that focus on friend and family member encouragement of soldiers to seek mental health assistance should continue. Postdeployment screening should be conducted under conditions in which soldiers are most likely to report problems honestly.     

水面舰艇长远航期间舰员心理状况研究

目的 研究水面舰艇长远航期间舰员的心理状况变化情况,为制定合理的心理卫生保健措施提供依据.方法 采用症状自评量表(SCL-90),分别于出航前7 d和出航第77、142、204天时,对执行远航任务的某水面舰艇官兵进行"重复性横断面"团体问卷抽样调查分析,并与中国军人常模作比较.结果 出航前舰员的群体心理状况良好,SCL-90总均分和多项因子分值均明显低于军人常模值(P＜0.05);出航第77天舰员的SCL-90总均分、躯体化、敌对性、偏执、其他因子均分都高于出航前水平(P＜0.05),其中敌对性和偏执因子分明显高于军人常模值(P＜0.01).出航第142天和204天,舰员SCL-90总均分和各因子分值明显回落,仅"其他"因子项均分仍显著高于出航前(P＜0.01).SCL-90筛查阳性率比较显示,出航第77天(15.1%)和出航第204天(20.0%)均明显高于出航前(2.4%)(P＜0.01),而出航第142天(7.7%)与出航前相比差异无统计学意义(P＞0.05).结论 舰员的群体心理状态在长远航早期明显低落,而在中后期经调整适应后趋于常态化;但舰员的个体心理状态在后期出现了明显的分化趋势.

Abstract：

Objective To investigate changes in the nental health status of the ship crew onboard surface naval vessels during a prolonged deployment, so as to provide scientific basis for the development of sound psychological health service measures for the ship crew. Methods Reproducibility and cross - sectional survey were conducted to investigate the emotional status of the ship crew aboard a certain naval surface vessel with symptom check list (SCL-90), 7 days before deployment, and on the 77th, 142nd, and 204th days after deployment during a prolonged ocean - going voyage. The obtained data were compared with the norms of the Chinese servicemen. Results The mental health status of the ship crew was on the whole in good mode before deployment. Total average score and various SCL-90 patterns were obviously lower than the norms of the Chinese servicemen(P＜0. 05 ). On the 77th day after deployment, the psychological state of the ship crew degraded markedly, manifested by the elevation of the SCL-90 total mean score and other scores, such as somatizaion, hostility, crankiness and other factors, when compared with those after deployment( P ＜0. 05 ).Of all the scores, the scores of hostility and crankiness were significantly higher than the norms of the Chinese servicemen( P ＜0. 01 ). Total SCL-90 average score and various factor scores on the 142nd and 204th days after deployment dropped sharply, except that one other factor score of SCL-90 was higher than that before deployment(P ＜0. 01 ). Screening positive rate of SCL-90 indicated that positive rates on the 77th( 15. 1% )and 204th days ( 20% ) were all obviously higher than that of pre - deployment( 2. 4% ) ( P ＜ 0. 01 ). However,no statistical differences could be seen in the scores on 142nd day(7.7% ), when compared with that of predeployment(2. 4% ) ( P ＞ 0. 05 ). Conclusions The psychological status of the ship crew, on the whole,degraded markedly during the initial stage of a prolonged deployment, then, would gradually come to normal with adaptation thereafter. Nevertheless, individual psychological status showed a tendency of obvious differentiation in the late stage of deployment.     

The psychological health and stress of pilots in a labor dispute

This study investigated the psychological stress and psychiatric symptomatology in a representative sample of pilots involved in a labor dispute with management. Standardized epidemiological psychometric instruments revealed that one quarter of the pilots could be labelled "psychologically at risk" showing elevated symptoms of anger-hostility, paranoia, and obsessive-compulsiveness. A certain combination of personality scores with stress reactions was found to correctly classify pilots who were healthy vs. "at risk" with 92% accuracy. Interviews with pilots revealed both general causes of stress associated with a labor dispute as well as specific and unique sources of disturbances threatening safety in the air.     

Post-traumatic stress disorder and depression in health care providers returning from deployment to Iraq and Afghanistan

OBJECTIVE: This study examines risk factors for post-traumatic stress disorder (PTSD), depression, and mental health care use among health care workers deployed to combat settings. METHODS: Anonymous surveys were administered to previously deployed workers at a military hospital. PTSD and depression were assessed by using the PTSD Checklist and the Patient Health Questionnaire depression scale, respectively. Deployment exposures and perceived threats during deployment were also assessed. RESULTS: There were 102 respondents (36% response rate). Nine percent (n=9) met the criteria for PTSD and 5% (n=5) met the criteria for depression. Direct and perceived threats of personal harm were risk factors for PTSD; exposure to wounded or dead patients did not increase risk. Those who met the criteria for PTSD were more likely to seek mental health care after but not before their deployment. CONCLUSIONS: For health care workers returning from a warfare environment, threat of personal harm may be the most predictive factor in determining those with subsequent PTSD.     

心理素质训练对新兵心理健康状况的影响

目的 探讨心理素质训练对新兵心理健康状况的影响.方法 200名新兵随机分为两组:干预组(n＝100)在新兵集训期内全程参加心理素质训练,对照组(n＝100)在新兵集训期内未参加心理素质训练.采用SCL-90及应对方式量表对两组新兵在集训前后进行团体测量,并在集训结束后1个月时对干预组新兵心理素质训练效果进行主观评价.结果 干预组在集训后除恐怖和精神病性无显著降低外,其他各SCL-90因子分均显著下降;对照组在集训前后除躯体化外各SCL-90因子分均无显著差异.两组比较除躯体化、恐怖及精神病性外,其他各因子集训前后差值干预组均显著大于对照组(P＜0.05).干预组集训前后应对方式中退避和合理化无显著改变,但更多地运用解决问题、求助等应对方式,自责、幻想则显著减少;对照组集训前后应对方式无显著变化.两组比较,除退避和合理化外各应对方式差值干预组均显著大于对照组(P＜0.05).结论 心理素质训练有助于改善新兵心理健康状况和应对方式,可降低军事心理应激水平.     

Military medicine: establishing a more comprehensive strategy for improved worker health

In an era of decreased resources, optimizing worker safety and health has become increasingly challenging. Data obtained from the Army and Navy Safety Centers suggest that current strategies for managing worker safety and health can be improved. In the past, work safety management practices placed sole responsibility for safety upon the worker. More recently, safety and health practices have recognized that organizational climate and structure influence worker safety and health. Furthermore, although worker safety and health, work site health promotion, and risk management efforts have been managed autonomously, all three components are interrelated and dependent on one another to achieve greater worker safety and health. The intent of this article is to increase awareness and marketing among military medicine staff members of the crucial components of an improved health and safety program. This article explains common organizational barriers to achieving worker safety and health, provides an understanding of the interconnectedness of occupational safety and health, health promotion, and risk management, and suggests strategies for optimizing worker safety and health.     

Seeking psychological treatment as a cure for a medical problem.

Today health care providers are more likely to experience legal, moral and ethical dilemmas regarding their treatment principles given the climate of health care. Clinical practice in the United States is being affected by many external forces which can affect patient care. Government and insurance companies are attempting to legislate treatment as evidenced by DRG's and reimbursement patterns. Hospital and clinic administrators are pressuring faculty and staff to increase revenue by participating in more income generating activities. Within this milieu of dwindling resources, consumers continue to demand a variety of health care services. A case example of a woman who asked for a psychological intervention to treat a medical condition is presented. This case focuses on the important issue of offering efficacious treatments to informed patients with carefully diagnosed disorders. Whether scientific, ethically-based treatments are being rendered when any of the criteria, efficacious, informed and diagnosed are altered or missing, is open to doubt. This case is presented, not as a model of clinical management, but rather to stimulate discussion and generate ideas on how to better address future situations: (a) Where the patient requests an available treatment for a problem which would not be directly helped by such treatment; (b) how far must a clinician go to insure that informed consent has been reached?; (c) what is the physician's responsibility in providing what a patient wants in the way of treatment?; and (d) conversely, should clinicians provide medical interventions (at the patient's insistence) for psychological problems, for example, provide a penile prosthetic implant to a man whose disorder is clearly psychogenic impotence?     

137名护士学生心理健康状况调查分析

采用精神卫生自评量表(SCI-90)调查了137名护生心理健康状况,其中17人存在轻度以上的心理障碍,发生率达12.4％,以人际关系敏感、焦虑、偏执较多,说明护生的心理问题是不容忽视的。并从生理、心理、社会因素三方面,分析了影响护生心理健康的因素,提出了改善护生心理健康状况的对策。     

空军某部飞行事故后飞行员心理健康状况调查

目的：调查飞行员在飞行事故后的心理健康状况,为开展有针对性的心理干预提供依据。方法采用症状自评量表,在事故后1周内进行测评,与飞行员平时症状自评量表（symptoms check list-90,SCL-90）心理健康测评结果进行比较,并比较分析不同年龄（30岁为界）、不同婚姻状况的飞行员各因子分值。结果与飞行员平时SCL-90结果比较,事故后总分虽有升高但差异无统计学意义（P＞0.05）;敌对因子分值显著高于平时（P＜0.01）,其他因子分值差异无统计学意义（P＞0.05）;30岁以下飞行员其恐怖因子分值升高,与平时比较差异有统计学意义（P＜0.01）,其他因子分值差异无统计学意义（P＞0.05）。30岁以上飞行员其敌对因子分值显著高于平时（P＜0.01）,其他因子分值差异无统计学意义（P＞0.05）。未婚、已婚飞行员其各项因子分值事故前后虽有变化但差异无统计学意义（P＞0.05）。结论飞行事故后,飞行员敌对因子分值有所增高,提示飞行事故后飞行员心理健康水平有所降低,年龄对飞行员的心理健康状况有不同程度的影响,婚姻状况则影响不明显。