Fluent Essays

Resilience factors, such as a strong social support system, can contribute to a soldiers ability to cope with traumatic events during deployment and can ultimately facilitate his or her readjustment upon returning home. Similarly, risk factors, such as prior exposure to trauma, can be detrimental to a soldiers ability to cope during deployment and can impair his or her readjustment upon returning home. There are exceptions, of course. For example, even the most resilient soldier can be pushed beyond his or her capacity to cope with a traumatic event. Conversely, a soldier who exhibits risk factors will not necessarily develop a psychological disorder. This is why assessment is critical at all stages of a soldiers exposure to combat and war.In this Assignment, you will analyze risk and resilience factors associated with soldiers in two case studies. Then, based on your analysis, you will determine which soldier might have a greater risk for developing a combat-related psychological disorder.To prepare for this Assignment:Pay particular attention to specific risk and resilience factors related to pre-deployment background, deployment-related experiences and perceptions, and post-deployment events and circumstances.Focus on pre-deployment, war-zone, and post-deployment risk and resilience factors. Consider the relationship between risk and resilience factors and posttraumatic stress symptomology.Review the Week 8 Case Studies. Reflect on each specialists social support system and exposure to trauma before, during, and after deployment. Also, consider the living and working conditions and combat experiences of each specialist during deployment.Identify risk and resilience factors related to pre-deployment, deployment, and post-deployment for both specialists in the case studies.Based on each specialists risk and resilience factors, consider who might have a greater risk for developing a combat-related psychological disorder and why.The Assignment: (1–2 pages)Analyze the risk and resilience factors in each Case Study. Include a brief description of each factor and explain why you think each is a risk or resilience factor.Based on your analysis, explain which of the two combat veterans you think might have a greater risk for developing a combat-related psychological disorder and why. Be specific.Support your Assignment with specific references to all resources used in its preparation week_8__assignment_case_studies.pdf what_is_its_effect_on_stress_in_the_military.pdf combat_and_interpersonal_trauma_on_ptsd_.pdf deployment_risk_and_resilience_inventory.pdf combat_related_posttraumatic_stress_disorder_.pdf Unformatted Attachment Preview Week 8: Assignment Case Studies Case Study #1 Specialist Ramirez—U.S. Army Specialist Ramirez joined the Army a week after he turned 21. Before he left for basic training, his wife, parents, and many of his neighbors celebrated his patriotism at a backyard barbecue. After completing basic training, Ramirez was deployed to Iraq with the 4th Infantry Division and assigned to a combat team. The soldiers on Ramirez’s combat team formed a strong bond and trusted each other with their lives on a daily basis. Although it was rarely stated, they all knew they could depend on each other in the worst of circumstances. Ramirez and his team routinely engaged in combat patrols that were long, hot, and stressful and had endured several firefights with Iraqi insurgents within 3 months of their arrival in Iraq. One day, Ramirez was driving a Humvee in a convoy when an IED (improvised explosive device) detonated, destroying the Humvee ahead of him. The severed arm of one of his comrades flew back, hitting the hood of his vehicle. A few minutes later, he learned that two of his comrades were killed in the explosion. In the days and weeks after the explosion, Ramirez felt he was in constant danger and doubted he would survive his deployment. Also, he worried about how his young wife was coping with living alone off-post back home. Her frequent letters when he was first deployed had dwindled to two or three per month. Ramirez returned to the United States after a 16-month deployment in Iraq. He and his comrades went through a reintegration screening at Fort Hood upon their return. Although his deployment had strained his relationship with his wife, within a month of his homecoming, their relationship was back to normal. Third graders from his old elementary school sent cards and letters showing their appreciation for his service. His father visited, listening quietly while Ramirez described some of his experiences in Iraq. Three months after his return, he reported for rescreening by the Army for medical and psychological problems, which yielded no significant findings except for minor problems concentrating on the day-to-day demands of life at home. Case Study #2 Specialist Johnson—U.S. Army Specialist Johnson joined the Army at age 20, after being displaced from New Orleans to Houston following Hurricane Katrina. He had been living on his own since his parents divorced 2 years earlier. It was raining in Texas the day he left for basic training. After completing basic training, Johnson was deployed to Iraq with the 4th Infantry Division. He was assigned as the driver for a Public Affairs Major who routinely visited various neighborhoods in Baghdad and other Iraqi cities. The Major was often tough on Johnson, and Johnson thought the Major was overly critical. At the end of each day, Johnson was grateful to return to his bunk and relative safety inside the Green Zone, a U.S.-occupied and heavily guarded area of Baghdad. Other than small arms fire in the distance, Johnson never faced any direct combat. One day, he and the Major went into Baghdad to visit a family who had reported the death of their daughter. When they arrived at the family home, what they presumed to be the body of the missing daughter lay in the street in front of the house. Her burned body was almost © 2014 Laureate Education, Inc. Page 1 of 2 unrecognizable as human. Following this incident, Johnson met with a combat stress counselor in the Green Zone to discuss the experience. Johnson returned to the United States after a 16-month deployment. He went through a reintegration screening at Fort Hood with no significant findings. Once on leave, he visited his old neighborhood in New Orleans. Some of his neighbors had rebuilt their homes, and some were still living in FEMA trailers. Many others had never returned after the hurricane. Three months after his return to the United States, Johnson reported for rescreening by the Army for medical and psychological problems. While he denied stressors related to his deployment in Iraq, he did report feeling uneasy after his leave in New Orleans. © 2014 Laureate Education, Inc. Page 2 of 2 MILITARY MEDICINE. 172, 9;931. 2007 Culture: What Is Its Effect on Stress in the Military? Guarantor: Surgeon Commander Neil Greenberg Contributors: Victoria Langston, BSc (Hons)*; Matthew Gould, DClin Psychf; Surgeon Commander Neil GreenbergI Culture provides the unwritten rules that inform and shape expected behaviors. To date, little research has been conducted into the attitudes or opinions that service personnel hold toward mental health issues. This article examines current literature and research into the recognition of mental health problems in the military and potential organizational barriers to care including stigma and the specific characteristics of a military culture such as the significant reliance on buddy support. We conclude that the barriers to care which operate in both military and civilian populations are not insignificant. Westem militaries in fact currently face an uphill struggle to combat the substantial barriers to care that exist. sors. such as length of deployment or exposure to adverse living condition, may exacerbate the effects of traumatic stress. In this section, relevant research on the two different types of stressors will be discussed. Studies have shown that the degree of psychological trauma from operational duties is proportionally related to the type of warfare fought.^ One of the adverse outcomes of wartime trauma is PTSD. Rates of PTSD in combat veterans have been measured on numerous occasions and vary from 15 to 31\%.* These rates are in excess of the 2 to 3\% prevalence of PTSD symptoms recorded in the U.K. general population.^ However, focusing on PTSD alone may not give the full picture of operationally induced psychological distress. For instance, it has been reported that up to 50\% of Falkland War veterans have symptoms of PTSD even though they may not have sufficient or intense enough symptoms to warrant a formal diagnosis of PTSD. ^ Introduction ilitary personnel are at a high risk of exposure to potenM tially traumatic events. As such, this makes them an atrisk group who are vulnerable to suffering from psychological distress and mental health problems including depression, family violence, substance abuse, and post-traumatic stress disorder [PTSD). all of which are problems for the militaiy services and a threat to occupational functionality. The impact of mental health on decision making is especially of significance given the high technology, fast-paced warfare of the 21 st century, the battlefield which leaves little margin for error. Furthermore, many military forces have to cope with increasingly complicated conflicts with an ever decreasing number of soldiers available to fulfill these duties.^ Troops therefore need to function at peak efficiency and inefficiencies imposed by work stress and mental health problems may have very serious consequences.-^ Recent claims from soldiers and commanders inside the theaters of Iraq and Afghanistan have raised questions about the state of mental health in the U.K. military.^ This article attempts to explore the issue of militaiy culture in relation to stress (traumatic or otherwise) and examines how the military environment may exacerbate psychological problems because of barriers to care including stigma. The Different Types of Stressors within a Military Environment The potential of being exposed to traumatic stressors is an ever present issue for individuals who choose the military as their occupation. Furthermore, additional work-related stres•Research Worker. Kings Centre for Miiitary Health Researcii. Kings Coiiege London. Weston Education Centre. iO Cutcombe Road. London. SE5 9f41, U.K. tTralnee Ciinicai Psychoiogist. Royal Holloway. University of London. Eghatn. Surrey TW20 OEX. U.K. tSenior Lecturer, Military Psychiatiy, Kings Centre for Militaiy Health Research. Kings Coiiege London, Weston Education Centre, iO Cutcomi)e Road, ix)ndon. SE5 9RJ U.K, This manuscript was received for review In June 2006. The revised manuscript was accepted for pubilcation in Aprii 2007. Reprint & Copyright © by Association of Militaiy Surgeons of U.S,. 2007. Some of Uie variation in rates of PTSD and prevalence of traumatic stress symptoms may be accounted for by differences in study design. For instance, there are many types of instruments used to measure PTSD and many different ways of classifying military missions. Furthermore, questionnaires usually overestimate the prevalence of psychiatric conditions.^ Studies which use semistructured instruments such as the Clinician-Administered PTSD Scale are likely to give a better estimate of the true prevalence figure. Studies also vary in their use of terminology and it is important to remember that suffering with PTSD symptoms does not always prevent individuals from working or having fulfilling social bves. Symptoms are not the same as disorder, although it would be foolish to merely dismiss subdiagnostic symptoms as being irrelevant: they may well affect quality of life. Aside from operationally related traumatic stress, there are numerous other work-related stressors which significantly affeet the lives of service personnel. Pflanz et al. investigated sources of stress and their prevalence in the U.S. military. Significant work stress was reported by 26\% of troops and another 15\% described significant emotional distress related to work stressors. The study revealed that being in combat, exposure to heavy casualties, and unexpected deployments all correlated with increased levels of psychological distress.* Mental disorders, whether they are the result of traumatic or work stressors, appear to have had a significant impact on manpower and retention rates. Hoge et al. conducted a population-based analysis of hospitalizations occurring at U.S. military medical facilities between 1990 and 1999 among active duty personnel. Results showed that mental disorders were the leading cause of medical discharge among men and the second leading category among women, accounting for 13\% of all hospitalizations. Overall, 23\% of all inpatient bed days were attributed to mental disorders. The significant costs involved in recruiting, training, and retaining military personnel make it important to identify robust 931 Military Medicine. Vol. 172, September 2007 Culture and Its Effect on Stress in the Military 932 psychological support systems to avoid the loss of valuable personnel to the effects of psychological trauma.^ From an organizational perspective therefore, the military have a moral and legal duty to consider the psychological welfare of their workforce.^ However, significant organizational obstacles and barriers to care must be overcome in order for such systems to be worthwhile.^ Not only must any support given be effective, but it is also important to ensure that those in need of help feel able to come forward and ask for it or at the very least receive it, even if they feel too ashamed or embarrassed to ask for help themselves. These barriers to care will be further examined later. The Importance of Morale and Homecoming Experience Interestingly, it appears that the level of stress felt by personnel is reflected by the nations attitudes toward the military as well as unit morale. It has been suggested that one of the reasons for the poor psychological condition of many of American Vietnam veterans was the hostile attitude that many of their fellow countrymen took toward the war in the late 1960s and 1970s.^^ The converse also appears to be true in that lower levels of distress were reported by U.S. peacekeepers following a positive homecoming experience. ^ Labuc* highlighted how morale in the army correlates with the incidence of combat stress reactions: after analyzing a number of campaigns by Israeli and British soldiers, he comments: It can be seen that when morale is high stress casualties are Iow, and \1ce versa.^ He argues that unit cohesion and suppori are important factors which determine morale and can therefore influence the psychological state of those personnel who serve within a unit. Thus, when a military force can foster high morale among troops, the likelihood of that force suffering substantial numbers of stress casualties is lower. An example of this was the Falklands War, where morale was high and the stress casualty rate was in the region of 4\%. However, the Malta campaign of 1942 was associated with low morale in the British troops and as a result, the number of stress casualties was substantial, estimated as at least 25\% of the deployed force. ^ This may have been as a result of varying factors including poor leadership, extensive physical hardship, and physical casualties. Culture and Stigma: What Significance Do These Factors Hold in a Military Context? In this section, the significance of stigma toward help-seeking behaviors will be discussed within the context of military culture. Culture itself provides the unwritten rules that inform and shape expected behaviors and can be defined as a way of liie that is leamed and shared by human beings and is taught by one generation to the next. Stigma is one of several reasons that might help to explain the behavioral choices people make toward mental health care; one defmition of stigma is a sign of disgrace or discredit which sets a person apart from others.^ The consequences of stigma associated with mental illness are well cited. Stigma may occur at all stages of mental illness from help-seeking to treatment and discharge and has been commented as being more devastating, life-limiting and long-lasting than the primary illness, Miiitary Medicine. Vol. 172. September 2007 meaning that the effects of stigma can often be felt long after the original problems have disappeared.^ According to the World Health Organization: The single most important barrier to overcome in the community is the stigma and associated discrimination toward persons suffering from mental and behavioral disorders.^ Stigma based on Goffmans^^ notion of spoiled identity refers to a discrediting social attitude toward mental illness. For example, Britt^ investigated the stigma of psychological problems among active service personnel returning from the U.S. peacekeeping mission in Bosnia. He found that admitting to a psychological problem was much more stigmatizing than admitting to a medical problem and personnel were much less likely to follow through with a psychological referral than with a medical referral.^ More than one-half of the participants believed that their career would be affected if they disclosed a psychological problem and almost half felt that admitting to a psychological problem would cause a coworker to maintain a distance from the service member.^- In 2002. a number of ex-service personnel brought a court case against the Ministry of Defence for the failure to identify PTSD issues at an early stage and to provide support and effective treatment.^ Stigma was a continual theme throughout the proceedings: the case was both lengthy and costly. The judgment was found in favor of the Ministry of Defence, although in coming to his ruling. Justice Owen stated: There can be no doubt that .. . there was a stigma attached to psychiatric/ psychological disorder. It was seen to be a sign of weakness which, if revealed, would expose an individual to ridicule, and would be the kiss of death to a military career.^^ Discrimination in comparison refers to unfair treatment of people with mental health problems which results in the denial of the justified rights and responsibilities of a particular organization on an interpersonal or institutional level.^* For example, recently, a staff sergeant in the U.S. forces was initially charged with cowardice after he attempted to seek help for a comb^at stress reaction, although these charges were later dropped and resulted in the individual voluntarily leaving the army. Westem culture has become more accepting and less stigmatizing of mental health problems in recent years.^ However, many aspects of military life remain potentially prostigmatic. For instance, military culture encourages mutual support between personnel, known as the buddy system which encourages individuals to learn to closely rely on each other, both for physical and potentially psychological needs, when deployed or otherwise.^^ In a study surveying U.K. peacekeepers, 98\% of personnel felt able to talk to military friends or peers in the same deployment and only 8\% had used formal suppori networks (such as the use of medical or welfare services). Furthennore, only 15\% had spoken to the chain of command about their experiences.^^ Notably for most participants, there was a significant association between talking about their experiences and having lower psychological distress scores.^^ However, the buddy system can be a hindrance when ones close community cannot provide the necessary support. A distressed indi\idual may feel that they have let themselves and their buddies down if they ask for help outside of their peer group tthose who challenge any culture are often ostracized by those who strongly identify with it^). In Greenberg et al.s^^ Culture and Its Effect on Stress in the Military 933 study, older peacekeepers were significantly less favorable to the by their peers. Although the majority considered it acceptable to concept of formal debriefing for all. probably representing an sufter from stress, they did not trust that others would have the old school approach of not talking about distress, often de- same view and therefore said that they did not and would not scribed as the stiff upper lip. Greenberg further suggests that disclose their difficulties.^ It is noteworthy that the response the results also show that older peacekeepers are more likely to rate in this study was approximately 50\% and it is possible that make use of social networks and the chain of command and the views reported may be heavily subject to response bias. thus may not feel that any formal sources of support are required.^^ This is especially important, as experienced and senior The Management of Stress and Stigma personnel are likely to influence the attitudes and help-seeking behavior of others in their command. The close community. The management of both traumatic and work stress has reliant on mutual support, therefore, may act as a hindrance proved a difficult and controversial topic within both civilian and acting as an organizational barrier that prevents personnel from military settings. In particular, the military is a challenging using appropriate support and mental health care to fit in with environment in which to provide any medical and psychological the existing military culture ethos. treatment. Numerous physical barriers to care exist on operaHoge et al. investigated help-seeking and barriers to care tions such as logistical constraints, difficult terrain, a wide disamong U.S. soldiere and Marines after deployments to Iraq and persal of personnel, limited practitioners, and hostility to outAfghanistan. Personnel completed a questionnaire which in- siders. This section does not aim to be exhaustive, but aims cluded an expanded version of a stigma rating scale developed rather to outline some of the key features in the treatment of earlier by Britt^^ along with a range of medical and psychological stress including front-line treatment, single session psychologscreening measures. Findings indicated that of those who ical debriefmg, and intervention programs. The most widely accepted treatment for battlefield combat seored above the cutoff on screening for outcomes, including major depression, generalized anxiety, and PTSD, only 38 to stress reactions is front-li ... Purchase answer to see full attachment