Psychological distress across the deployment cycle: exploratory growth mixture model

Abstract

Background Prior research has identified behavioural health outcomes as key sequelae to combat deployment. However, relatively little is known about differential patterns of change in depression or generalised anxiety linked to deployment to a combat zone. In this paper, we add to the existing trajectory literature and examine key predictive factors of behavioural health risk. Aims The primary aim is to leverage growth mixture modelling to ascertain trajectories of psychological distress, operationalised as a coherent construct combining depression and generalised anxiety, and to identify factors that differentiate adaptive and maladaptive patterns of change. Method Data were collected from a brigade combat team prior to a combat deployment to Afghanistan, during deployment, at immediate re-integration and approximately 2–3 months thereafter. The main outcome was measured using the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Results Three latent trajectories were identified: a low–stable trajectory, a declining trajectory and a rising trajectory. Most individuals aligned with the low–stable trajectory. A conditional model using covariates measured during deployment showed that the low–stable trajectory differed consistently from the remaining trajectories on self-reported loneliness and non-combat deployment stressors. Conclusions The examination of differential patterns of adaptation, to identify individuals at higher risk, is critical for the efficient targeting of resources. Our findings further indicate that loneliness may be a useful leverage point for clinical and organisational intervention.

Deployment-related quarantining—a risk or resilience factor for German military service members? A prospective analysis during the third–fifth waves of COVID-19

“…In a descriptive exploratory analysis of mental health trajectories across the deployment cycle, we identified four trajectories based on clinical criteria (changes of at least one standard deviation, respectively, exceeding a T-value of 60): 66.6% with a stable resilient trajectory, 16.2% with decreasing mental health symptomatology, 4.6% with increasing mental health symptoms (delayed onset), and 12.6% with a stable chronic trajectory (above a T-value of 60). These four resilience trajectories are in line with pre-and peri-pandemic research based on large civilian samples (25, 26), while the only study on mental health trajectories across the deployment cycle suggests one more trajectory, a "chronic-stable" trajectory (21). While we cannot attribute any of the resilience trajectories to the impact of quarantining, the different mental health trajectories across the deployment cycle indicate that approximately 12.6% of deployed soldiers are at risk, and 4.6% of soldiers showed a delayed onset of mental health symptoms only 3 months post-deployment.…”

“…Question 1a: Which resilience trajectories can be identified for military deployment shaped by quarantining? Question 1b: Do they resemble the three resilience trajectories identified for deployed US soldiers (21) or the more common four trajectories as a response to the pandemic (26)?…”

“…Growing research, also for German soldiers, indicates that it is not deployment per se but combat with a heightened threat to life and physical integrity that is linked to elevated prevalence rates for anxiety disorders and PTSD ( 19 , 20 ). As for differential trajectories of mental health across the deployment cycle, three trajectories were identified, namely, a resilient-stable trajectory (83.8%), an increase in mental distress (9%), and a decrease in mental health symptoms (7.1%), so far only analyzed for US military personnel ( 21 ).…”

“…Question 1b: Do they resemble the three resilience trajectories identified for deployed US soldiers ( 21 ) or the more common four trajectories as a response to the pandemic ( 26 )?…”

Mental health across the early years in the military

“…Additional classes for moderate or subthreshold symptom levels have been identified, including a temporary-benefit and pre-existing symptom class of high symptoms that initially decrease, but remain fluctuating in the subthreshold zone over time (Andersen et al, 2014 ; Berntsen et al, 2012 ; Nash et al, 2015 ; Orcutt et al, 2004 ). Although comparatively far less literature has examined symptom trajectory heterogeneity for general psychological distress in military populations, the same core trajectory classes appear to be relevant, with evidence supporting the existence of resilient , recovery and worsening classes (Cabrera & Adler, 2021 ; Palmer et al, 2019 ).…”