Publication year
2012
Citation Title
Alcohol problems, aggression, and other externalizing behaviors after return from deployment: Understanding the role of combat exposure, internalizing symptoms, and social environment.
Journal Name
Journal of Clinical Psychology
Journal Volume
68
Page Numbers
782-800
DOI
10.1002/jclp.21864
Summary
Researchers examined whether rates of externalizing behavior (e.g., alcohol consumption, aggressive behavior) four and nine months after deployment were related to various internalizing symptoms such as depression, anxiety, posttraumatic stress disorder (PTSD) or elements of the social environment. Both internalizing symptoms and social environment were significantly associated with levels of externalizing behaviors at both four and nine months post-deployment, but only combat exposure significantly predicted increases in externalizing behaviors between four and nine months post-deployment.
Key Findings
Research found a direct correlation between combat exposure and externalizing behaviors after controlling for a range of internalizing symptoms and social environment factors.
Externalizing behaviors were stable between the two assessments. Externalizing behaviors at four months post-deployment were a strong predictor of externalizing behaviors at nine months post-deployment.
Social environment (unit leadership, organizational support, stigma and barriers to care) impacted levels of both internalizing and externalizing behaviors post-deployment.
Implications for Program Leaders
Offer peer support groups for Service members during post-deployment to enhance the Service members' social environment
Provide Service members and their families with information regarding resources available to aid with reintegration
Identify Service members who perceive a poor social environment and provide them with additional support in the form of classes or mentoring
Implications for Policy Makers
Recommend training for professionals who work with military families regarding the links between deployment experiences, post-deployment social environment, and potential risky behaviors
Continue to support additional programs to improve post-deployment social environments for Service members and their families
Encourage collaboration among professionals who work with military families to provide comprehensive continuity of care
Methods
Soldiers were asked to fill out a survey four and nine months after a 15-month deployment to Iraq in 2007-2008.
Measures of combat exposure, work conflict, perceptions of stigma, barriers to care, perceptions of leadership, organizational support, sleep, and physical health were administered.
Depression, anxiety, PTSD symptoms, alcohol problems, aggression, and risky behavior were also assessed.
Data were analyzed to determine the relationships among internalizing and externalizing symptoms and other possible predictive variables.
Participants
Participants included 1,397 Soldiers four months after deployment and 589 Soldiers nine months after deployment.
Of the participants included at four months after deployment, 98% were male, 41% were 20-24 years old, 33% were 25-29 years old, 22% were 30-39 years old, 53% were married, 37% were single, and 61% had no children.
Of the participants included nine months after deployment, 98% were male, 43% were 20-24 years old, 33% were 25-29 years old, 20% were 30-39 years old, 49% were married, 39% were single, and 65% had no children.
Limitations
This study relied on self-report measures; Service members may have felt a need to respond in a socially acceptable manner, which may have influenced results.
The sample was almost entirely male (98%), so results may not generalize to female Soldiers.
There was a large amount of attrition between four and nine months post-deployment, which may limit the strength of comparisons.
Avenues for Future Research
Collect pre-deployment personality and behavioral health data to gain a more nuanced understanding of the relationships between internalizing and externalizing behaviors and combat exposure
Further examine the relationships between combat exposure and a wide range of behavioral outcomes
Utilize a longitudinal design that follows Service members over the course of multiple deployments
Focus
Army
Target Population
Population Focus
Military Branch
Military Component
Abstract
Objectives: The study examined whether elevated rates of externalizing behaviors following deployment could be explained by internalizing symptoms (depression, anxiety, and PTSD symptoms), and health of the social environment (unit leadership, organizational support, and stigma/barriers to care). Design: A model of combat exposure, social environment, internalizing symptoms, and externalizing behaviors was tested in a military unit following a fifteen-month deployment to Iraq. The sample included 1,397 soldiers assessed four month post-deployment; 589 of these soldiers were assessed again nine months post-deployment. Results: Externalizing behaviors were highly stable over the five-month post-deployment period. Both social environment and internalizing symptoms were significantly associated with level of externalizing behaviors at four months and nine months post-deployment, but combat exposure alone significantly predicted change in externalizing behaviors over the follow-up period. Conclusions: Results suggest the need to broaden the scope of interventions targeted to combat veterans and have implications for care providers and military leaders.
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