Post-traumatic stress disorder risk and witnessing team members in acute psychological stress during combat

Abstract

Background Occupational groups operating in dangerous environments may witness the development of acute stress reaction (ASR) in team members. Witnessing ASR in team members may increase the risk of developing subsequent post-traumatic stress disorder (PTSD) symptoms. Aims To describe ASR symptoms that individuals witness, assess the relationship between witnessing a team member exhibiting ASR symptoms and an individual's own PTSD symptoms, and describe common intervention responses by peers. Method Cross-sectional, anonymous surveys were conducted with US soldiers who were previously deployed (sample 1; n = 176) and currently deployed sample 2; n = 497). Surveys assessed combat experiences, PTSD (PTSD Checklist-5), ASR exposure and intervention responses. Analyses included frequencies and binary logistic regression. Results Witnessing at least one ASR symptom during a combat-related event was reported by 51.7% in sample 1 and 42.4% in sample 2; the most commonly observed symptoms were being unable to function or being detached. Controlling for combat experiences, high levels of witnessing a team member exhibit ASR symptoms was associated with increased risk of subthreshold PTSD or PTSD in sample 1 (odds ratio (OR) = 8.69, 95% CI 2.29–42.60) and approached significance in sample 2 (OR = 1.67, 95% CI 0.98–2.81). Common intervention responses included providing a directive or yelling; many also reported being unsure how to respond. Conclusions Witnessing team members who exhibit ASR symptoms appears to be associated with screening positive for subthreshold PTSD or PTSD. Results suggest the need for further research into how to prepare individuals to manage ASR in team members and to examine ASR in other high-risk occupations.

Immediate management of acute psychological trauma in conflict zones

“…Post-traumatic stress disorder can also develop in individuals who witness, or provide immediate care for, someone with an acute stress reaction. A quantitative study of 673 previously deployed US soldiers found that witnessing a fellow soldier having an acute stress reaction made it more than eight times more likely that they would subsequently develop post-traumatic stress disorder themselves 8…”

Acute Stress Reaction in Combat: Emerging Evidence and Peer-Based Interventions

“…We surveyed two samples of soldiers who reported having deployed to combat and having experienced at least one combat-related event (176 soldiers in study 1 and 497 soldiers in study 2) and found that 51.7% and 42.4% of soldiers, respectively, reported witnessing unit members experience a possible ASR [ 13 ••]. The most common description endorsed was being unable to function and potentially increasing the risk to the team, with each of the descriptions endorsed by at least 19% of the sample that had observed a possible ASR in a teammate.…”

Peer-based intervention for acute stress reaction: adaptations by five militaries

“…By their nature, ASRs typically render individuals experiencing them unable to accelerate their own recovery; that is why it is important to consider how teammates can intervene. Research in Israel, [6][7][8] the USA 9 and Canada 5 suggests that approximately 29%-56% of service members who have been in high-stress contexts have witnessed a teammate experience an ASR. The fact that service members can identify the signs of an ASR in their teammates provides the foundation for focusing on developing a peer-based intervention.…”