Publication year
2012
Citation Title
Longitudinal study of resilience and mental health in marines leaving military service.
Journal Name
Journal of Affective Disorders
Journal Volume
139
Issue Number
2
Page Numbers
154-165
DOI
10.1016/j.jad.2012.01.008
Summary
Marines with combat exposure who took part in mandatory, pre-separation Transition Assistance Programs (TAP) participated in a longitudinal study of the impacts of risk and protective factors on their mental health following separation from the military. Risk factors for increased mental health problems and functional impairment include higher levels of combat exposure, post-separation civilian life stress, and experiencing multiple areas of physical pain post-separation. Protective factors include higher scores on pre-separation resilience measures and perceived social support.
Key Findings
Combat exposure was related to increased posttraumatic stress disorder (PTSD) symptoms, continued mental health problems, and functional impairment after separation.
Resilience was associated with mental health problems only when measures of functional impairment were included, indicating that the effect of resilience may be in its ability to maintain an individual’s functioning despite mental health problems.
Pre-separation resilience increased the likelihood of improvements for those with mental health problems and functional impairment; higher self-reported resilience was associated with increased age, increased social support, and decreased stress.
Stress occurring after separation was a strong predictor of new and chronic mental health problems.
Implications for Program Leaders
Offer workshops for Service members pre-separation regarding stress management that include resilience building activities and strategy development sessions
Offer transition support services to Service members who are anticipating discharge from the military
Distribute information to Service members and their families regarding common mental health issues associated with combat exposure and ways to cope with these issues
Implications for Policy Makers
Support programs that provide services prior to separation, particularly those that focus on increasing resilience among Service personnel, potentially alleviating the demand for post-separation services
Continue to support post-deployment reintegration workshops to address combat exposure and mental health issues following deployment
Recommend training for service providers working with military families regarding the impact of deployment, combat exposure, and military separation on mental health outcomes
Methods
Baseline data were collected from a group of active duty Marines at six randomly selected Marine Corps installations who attended mandatory TAP pre-separation briefings.
Follow-up web or mail surveys occurred post-separation, on average six months after completion of military service.
Data were collected between January and April 2010.
Participants
Four hundred seventy-four Marines who completed both the baseline and follow-up surveys were included.
Age, gender, and ethnicity data for the whole sample were not provided; rather, these data were presented separately for each outcome variable.
The prevalence of depression at baseline was 50% and 43% at follow-up and PTSD was 28% at baseline and 23% at follow-up.
Limitations
Marines who provided follow-up data were significantly more likely to meet criteria for mental health problems, report more life event stress at baseline, were younger, less resilient, and reported fewer combat deployments; therefore, follow-up data may be biased.
Only Marines were sampled for study, other branches were not represented.
Low follow-up response rate (19%) limits the generalizability of these findings.
Avenues for Future Research
Explore resilience models that work specifically with military populations that have been exposed to combat
Examine the impact on mental health outcomes of varying length of time in civilian life with larger and more representative samples of various military branches
Investigate possible mechanisms to improve the functioning of impacted Service members with combat exposure
Focus
Marines
Target Population
Population Focus
Military Branch
Military Component
Abstract
Background: Despite a growing emphasis on psychological outcomes following military combat, few longitudinal studies have examined the combined role of risk and protective factors in the mental health of combat-exposed military personnel. This study characterizes the impact of resilience scale scores and combat exposure on mental health outcomes among Marines after separating from military service, along with intra-individual changes in mental health status. Methods: Data were collected from longitudinal surveys of 475 active duty Marines attending a random sample of mandatory Transition Assistance Program workshops before leaving the military and responding to follow-up mail or web surveys an average of 6 months after returning to civilian life. Results: Results revealed distinct risk and protective factors for those meeting screening criteria for mental health problems (depression, anxiety, and PTSD) and functional impairment at follow-up. Primary risk factors included experiencing higher levels of pre-separation combat exposure; post-separation stress across multiple life domains; and experiencing multiple areas of pain post-separation. Protective factors include having higher scores on pre-separation resilience and perceived social support at follow-up indices. We also identified a number of factors associated with change in mental health status from baseline to follow-up. Limitations: Generality is limited by a lower than expected follow-up response rate and an exclusively Marine sample. Conclusion: The role of resilience appeared to have a greater impact on functional impairment than on mental health symptoms per se. Findings provide important input for enhancing training programs and services intended to promote adjustment from military to civilian life. Additional emphasis on social support and coping with stress-related issues are needed in support of combat veterans.
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