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Enabling the Global Response Force : access strategies for the 82nd Airborne Division
\"The Global Response Force (GRF) is built for rapid response to unforeseen or, more specifically, unplanned operations. Selected Army airborne forces provide a large portion of the GRF and are dependent on joint concepts for deployment and access. This study illustrates a method for determining the best access strategies given constraints in aircraft, intermediate staging bases, operational capabilities, and other factors. The study applies this method to each geographic combatant command and develops specific, tailored strategies for each. The access strategies are built from multiple analytic techniques: historical aircraft data and platform specifications to determine capabilities and limitations of the air fleet; several airfield databases, site reports, and expert judgments to determine probable intermediate staging base locations and their likely capabilities; multiple deployment concepts for access to minimize operational risks; and detailed geographic and operational analysis to determine global coverage and reach. In the end, we were able to deduce a preferred strategy for each of the combatant commands. Global access for the GRF is provided partially through the use of well-established staging bases but will necessarily rely on austere basing and complex deployment concepts for particular locations in multiple combatant commands. The study concludes with several recommendations to close those risks, which span the services, combatant commands, and joint staff\"--Back cover.
BOOK
Holding and rupture: Describing post-traumatic stress among former UK Army and Royal Marine personnel deployed to Iraq and Afghanistan
Former UK military personnel who were previously deployed to Iraq and Afghanistan in combat roles have exhibited elevated levels of Post-Traumatic Stress Disorder (PTSD) compared to other groups. The present qualitative analyses used semi-structured interviews and a framework analysis to compare the experiences of symptomatic (N=10) and asymptomatic (N=7) former Army and Royal Marine personnel who were exposed to combat. Participants were drawn from a large UK military health and wellbeing cohort study and were sampled based upon probable PTSD status using scores from the PTSD Checklist-Civilian Version (PCL-C). All symptomatic participants attributed the development of post-traumatic stress to deployment events, with one additionally ascribing symptoms to childhood events. Among the participants, post-traumatic stress was temporarily buffered, and held at bay, by the holding function of various military structures, including the military collective; cultural and ethical frameworks that helped to organise traumatic experiences; an operational necessity for psychological compartmentalisation and even the distraction of deployment itself. Leaving the military appeared to elicit a global rupture of these supports. As a result, the military-to-civilian transition led to an intensification of post-traumatic stress, including deployment-related memories, among the symptomatic participants. In contrast, asymptomatic participants tended to report continuity of their holding structures across the lifespan, especially across the military-to-civilian transition. The onset and maintenance of post-traumatic stress may thus be explained by an interplay between the capacity of holding structures and the magnitude of lifetime rupture . Overall, findings might provide an explanation for the widening discrepancies between those with enduring post-traumatic stress and those without and further research is required to determine the fit of our findings for other groups and contexts. This approach further illustrates the need to situate individual experiences of post-traumatic stress in wider structural, ecological, cultural and ethical contexts.
Journal Article
Attachment Style During a Partner’s Deployment with the United States Navy: Associations with Relational Satisfaction, Stress, and Changes over Time
Separation from a loved one can trigger the attachment system and cause stress, especially for those with insecure attachment styles. The present study investigates how attachment style relates to the degree of stress and relational satisfaction individuals experience during one such situation—that of being separated from a partner who is on military deployment. Findings from a questionnaire distributed while participants’ partners were deployed show that secure attachment is positively related to relational satisfaction, whereas preoccupied and fearful attachment are negatively related to satisfaction. In addition, having a preoccupied or fearful attachment style is positively associated with experiencing deployment stress, whereas having a secure or dismissive style is negatively related to experiencing deployment stress. This study also addressed whether attachment style might change over the course of deployment and if affectionate writing would lead people to report becoming less insecure. Results from a quasi-experiment using a pre-test–post-test design showed that those who engaged in affectionate writing (versus innocuous writing or no writing) reported less preoccupied attachment over time. Both affectionate and innocuous writing led to less fearful attachment over time in comparison to a no-writing condition. Thus, communicating via writing may be an important tool for reducing attachment insecurity during military deployments.
Journal Article
Problematic anger among military personnel after combat deployment: prevalence and risk factors
Background
Problematic anger, characterized by excessive frequency, intensity, and duration of anger which causes substantial emotional distress and functional interference, poses a marked challenge in military populations. Despite its importance, research on this topic is limited. This study contributes to the literature by exploring problematic anger in a large sample of Norwegian military personnel who served in NATO missions in Afghanistan.
Methods
All Norwegian military personnel who deployed to Afghanistan between 2001 and 2020 were sent a link to a cross-sectional web-based survey by the Joint Medical Services of the Norwegian Armed Forces in 2020. A total of 6205 individuals (response rate: 67.7%) participated. The cross-sectional survey assessed problematic anger, mental and physical health, war zone stressor exposure, and quality of life.
Results
Overall, 8.4% of participants reported problematic anger. Mental health disorders, deployment-related shame and guilt, chronic pain, and challenges with the military-to-civilian transition were independently associated with problematic anger. Both staying in service and maintaining a part-time connection with the military as a reservist mitigated the risk of problematic anger after deployment, compared to complete separation from military service.
Conclusion
Findings demonstrate a sizeable prevalence of problematic anger among veterans of combat deployments. Given the associations between problematic anger and mental health disorders, chronic pain, and transition challenges, interventions designed to mitigate problematic anger need to be multi-faceted, including the possibility of maintaining an ongoing connection to military service. By reducing the risk of problematic anger, occupational, interpersonal and health outcomes may be improved for service members. Future research should examine the impact of problematic anger on adjustment over time, prevention strategies, and problematic anger in other high-risk occupations.
Journal Article
Anesthesia during deployment of a military forward surgical unit in low income countries: A register study of 1547 anesthesia cases
Military anesthesia meets unique logistical, technical, tactical, and human constraints, but to date limited data have been published on anesthesia management during military operations.
This study aimed to describe and analyze French anesthetic activity in a deployed military setting.
Between October 2015 and February 2018, all patients managed by Sainte-Anne Military Hospital anesthesiologists deployed in mission were included. Anesthesia management was described and compared with the same surgical procedures in France performed by the same anesthesia team (hernia repair, lower and upper limb surgeries). Demographics, type of surgical procedure, and surgical activity were also described. The primary endpoint was to describe anesthesia management during the deployment of forward surgical teams (FST). The secondary endpoint was to compare anesthesia modalities during FST deployment with those usually used in a military teaching hospital.
During the study period, 1547 instances of anesthesia were performed by 11 anesthesiologists during 20 missions, totaling 1237 days of deployment in nine different theaters. The majority consisted of regional anesthesia, alone (43.5%) or associated with general anesthesia (21%). Compared with France, there was a statistically significant increase in the use of regional anesthesia in hernia repair, lower and upper limb surgeries during deployment. The majority of patients were civilians as part of medical support to populations.
In the context of an austere environment, the use of regional anesthesia techniques predominated when possible. These results show that the training of military anesthetists must be complete, including anesthesia, intensive care, pediatrics, and regional anesthesia.
Journal Article
Marriage and divorce after military deployment to Afghanistan: A matched cohort study from Sweden
To investigate the probability of marriage and divorce among Swedish military veterans deployed to Afghanistan relative to non-deployed matched comparators.
Matched cohort study in Sweden.
Military veterans were identified through Swedish military personnel registers regarding foreign deployments, and comparators from the Military Service Conscription Register (1969-2013). Of 1,882,411 eligible conscripts, 7041 had served in Afghanistan at some point in time between 2002 and 2013. To each military veteran, up to 5 non-deployed comparators who underwent conscription were matched by age, sex, psychological assessment, cognitive ability, psychiatric history and social characteristics. After matching there were 4896 (82%) unmarried and 1069 (18%) married deployed military veterans. The main outcome was marriage or divorce after deployment to Afghanistan. Data on marital status were retrieved from Statistics Sweden until December 31, 2014.
During a median follow-up of 4.1 years after deployment of married individuals, 124 divorces were observed among deployed military veterans and 399 in the matched non-deployed comparator cohort (277 vs. 178 per 10,000 person-years; adjusted hazard ratio 1.61, 95%CI 1.31-1.97). During a median follow-up of 4.7 years after deployment in the unmarried cohort, 827 new marriages were observed among deployed military veterans and 4363 in the matched non-deployed comparators cohort (399 vs. 444 per 10,000 person-years; adjusted hazard ratio 0.89, 95%CI 0.83-0.96).
Military veterans were more likely to divorce and less likely to marry after deployment compared with matched non-deployed comparators.
Journal Article
Effect of spousal military deployment during pregnancy on neonatal birth outcomes: a systematic review
IntroductionStress experienced during pregnancy is associated with adverse birth outcomes including preterm delivery (PTD) and low birth weight (LBW). Pregnant spouses and partners of deployed military personnel can experience heightened stress due to several factors associated with the military lifestyle. This systematic review aims to ascertain whether deployment at the time of delivery increases the risk of PTD and/or LBW in babies born to pregnant spouses or partners of deployed service persons.MethodsA systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method by searching EMBASE, Medline, PubMed and Global Health databases from inception to March 2021. Keyword searches were used to identify primary research, English language journal articles, that included any military branch and reported a measure of PTD and/or LBW of babies born to spouses/partners of deployed service persons. Risk of bias was assessed with validated tools appropriate for study type and a narrative synthesis was performed.ResultsThree cohort or cross-sectional studies fulfilled the eligibility criteria. All three studies were conducted in the US military, were published between 2005 and 2016 and included a cumulative total of 11 028 participants. Evidence suggests that spousal deployment may be a risk factor for PTD, although strength of evidence is weak. No association between spousal deployment and LBW was found.ConclusionPregnant spouses and partners of deployed military personnel may be at increased risk of PTD. The strength of evidence is limited by a paucity of rigorous research in this area. No studies were identified that included service women in the UK Armed Forces. Further research is required to understand the perinatal needs of pregnant spouses/partners of deployed service persons and to understand if there are unmet clinical or social needs in this population.
Journal Article
Low neuroticism as an indicator of resilience: a longitudinal study of Danish soldiers before, during and after deployment
: Posttraumatic stress disorder (PTSD) is a serious and debilitating condition among military veterans. Exposure to potentially traumatic events (PTEs) may lead to PTSD and PTE sensitivity may be influenced by the personality trait neuroticism.
: The current investigation aims to test whether exposure to PTEs during deployment is associated with changes in PTSD symptoms, and whether individual levels of neuroticism are related to resilience or sensitivity to such exposures.
: The study sample included 701 Danish soldiers deployed to Afghanistan in 2009. PTSD symptoms were measured pre-, peri- and post-deployment (T1-T3) with the PTSD Checklist-Civilian Version. PTSD symptom load was modelled in a mixed linear model along with an extensive list of covariates. Interactions between time, exposure, and neuroticism were tested in order to assess whether neuroticism moderated the effect of PTEs upon PTSD symptoms.
: On average, PTSD symptoms decreased from T1 through T3. Factors associated with higher PTSD symptom levels included number of past trauma, neuroticism, and low age at deployment. Interaction analyses showed that individuals with low and medium neuroticism levels displayed no significant change in PTSD symptoms, and individuals with high neuroticism displayed a significant decrease in PTSD symptoms. These changes were consistent across levels of perceived exposure to danger and combat and witnessing the consequences of war.
: Results indicate that low levels of neuroticism appear to be related to resilience. Individuals with high levels of neuroticism displayed elevated PTSD symptoms across all time points, but contrary to expectations, they reported a significant decrease in PTSD symptoms from pre- to post-deployment.
Journal Article