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Article ; Online: Cognitive reappraisal moderates the effect of combat or other exposures on negative behavioral health symptoms.

Osgood, Jeffrey M / Yates, Hunter K / Holzinger, Jayne B / Quartana, Phillip J

Military psychology : the official journal of the Division of Military Psychology, American Psychological Association

2023 , Page(s) 1–11

Abstract: Understanding the individual differences that can buffer the impact of combat and other adverse exposures on deleterious behavioral health outcomes could lead to more targeted prevention and intervention efforts. Cognitive reappraisal, an antecedent- ... ...

Abstract	Understanding the individual differences that can buffer the impact of combat and other adverse exposures on deleterious behavioral health outcomes could lead to more targeted prevention and intervention efforts. Cognitive reappraisal, an antecedent-focused emotion regulation strategy, is linked to positive health outcomes such as lower levels of post-traumatic stress disorder, anxiety, and depression. This study examined the moderating effect of individual differences in cognitive reappraisal use on the association between combat exposure and behavioral health outcomes in active-duty U.S. Soldiers (N = 2,290). This study utilized survey data collected approximately 18 months following a combat deployment to Afghanistan in 2014. Results showed that individual differences in cognitive reappraisal use significantly moderated the effect of combat exposure on anxiety and post-traumatic stress symptoms but not depressive symptoms. Specifically, increasing combat exposures predicted a steeper increase in negative behavioral health symptoms for Soldiers reporting lesser (versus greater) cognitive reappraisal use. These findings highlight a role for cognitive reappraisal as a targetable factor that can mitigate the behavioral health consequences of exposure to combat stressors.
Language	English
Publishing date	2023-08-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2021130-2
ISSN	1532-7876 ; 0899-5605
ISSN (online)	1532-7876
ISSN	0899-5605
DOI	10.1080/08995605.2023.2250709
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Article ; Online: Gender differences in aggression: A multiplicative function of outward anger expression.

Kim, Dahyeon / Liu, Qimin / Quartana, Phillip J / Yoon, K Lira

Aggressive behavior

2022 Volume 48, Issue 4, Page(s) 393–401

Abstract: Individuals with a higher (vs. lower) tendency to outwardly express anger (i.e., greater anger-out) generally exhibit greater aggression; men (vs. women) also tend to be more aggressive. Although the general aggression model posits that multiple person ... ...

Abstract	Individuals with a higher (vs. lower) tendency to outwardly express anger (i.e., greater anger-out) generally exhibit greater aggression; men (vs. women) also tend to be more aggressive. Although the general aggression model posits that multiple person variables trigger aggression, the combined effects of multiple person variables are poorly understood. Thus, the aim of this study was to examine the nature of the relation between gender, anger-out, and reactive aggression. In particular, we were interested in whether the effects of anger-out and gender are additive or multiplicative. Specifically, we tested whether men exhibit higher levels of aggression than women at a consistent ratio across all levels of anger-out (i.e., the multiplicative model) or at a fixed amount depending on the level of anger-out (i.e., the additive interaction model). To this end, undergraduate participants (N = 203) completed a task in which they were falsely instructed that their objective was to respond more quickly than a same-sex opponent. They were told that whoever responded more quickly would administer a white noise burst to the opponent and choose its intensity, which served as our measure of aggression. Compared to an additive interaction model, the multiplicative model exhibited a better fit. Specifically, men displayed proportionately more aggression than women with the same level of anger-out. Research on and treatment for aggression should consider the multiplicative effects of factors related to aggression.
MeSH term(s)	Aggression ; Anger ; Female ; Humans ; Male ; Sex Characteristics ; Sex Factors
Language	English
Publishing date	2022-03-22
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	189812-7
ISSN	1098-2337 ; 0096-140X
ISSN (online)	1098-2337
ISSN	0096-140X
DOI	10.1002/ab.22028
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Article ; Online: Management of Acute Stress Reactions in the Military: A Stepped Care Approach.

Matson, Liana M / Adler, Amy B / Quartana, Phillip J / Thomas, Connie L / Lowery-Gionta, Emily G

Current psychiatry reports

2022 Volume 24, Issue 12, Page(s) 799–808

Abstract: Purpose of the review: This review highlights knowledge gaps surrounding the development and use of interventions for Acute Stress Reactions (ASRs). First, we propose that a stepped care approach to intervention for ASR be developed and utilized in ... ...

Abstract	Purpose of the review: This review highlights knowledge gaps surrounding the development and use of interventions for Acute Stress Reactions (ASRs). First, we propose that a stepped care approach to intervention for ASR be developed and utilized in military operational environments. A stepped care approach would include detection and assessment, followed by behavioral intervention, and then medication intervention for ASRs. Second, we discuss potential strategies that can be taken for the development of safe and effective ASR medications. Recent findings: ASRs commonly occur in operational environments, particularly in military populations. ASRs impact the safety and performance of individual service members and teams, but there are currently limited options for intervention. Efforts to improve ASR detection and assessment, and development and delivery of ASR interventions for implementation in operational environments, will be critical to maintaining the safety and performance of service members.
MeSH term(s)	Humans ; Military Personnel
Language	English
Publishing date	2022-12-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2055376-6
ISSN	1535-1645 ; 1523-3812
ISSN (online)	1535-1645
ISSN	1523-3812
DOI	10.1007/s11920-022-01388-3
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Zs.A 5520: Show issues

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Article ; Online: COVID-19 Vaccination Attitudes and Intentions Among U.S. Soldiers: Results from the U.S. Army Behavioral Health Advisory Team (BHAT).

Beymer, Matthew R / Gomez, Stephanie A Q / Santo, Theresa Jackson / Bell, Amy Millikan / Quartana, Phillip J

Journal of community health

2022 Volume 48, Issue 2, Page(s) 228–237

Abstract: Introduction: The objective of this study is to characterize the associations between demographic, attitudinal, and leadership factors with COVID-19 vaccination rates, vaccination intentions among those not vaccinated, and attitudes about vaccination ... ...

Abstract	Introduction: The objective of this study is to characterize the associations between demographic, attitudinal, and leadership factors with COVID-19 vaccination rates, vaccination intentions among those not vaccinated, and attitudes about vaccination safety, effectiveness, and importance. Methods: A serial cross-sectional anonymous online survey was administered to soldiers at two large U.S. Army Divisions located in the Southwestern region of the U.S. at two different time points (April-May 2021 [Time 1; T1] N = 24,629; July-August 2021 [Time 2; T2] N = 21,116). Binary logistic regressions were used to assess demographic and attitudinal predictors of vaccination receipt and vaccination intent. Multinomial logistic regressions were used to assess demographic and leadership predictors of endorsement of three vaccination attitudes concerning effectiveness, safety, and importance. Results: Approximately 43% of soldiers reported that they received a COVID-19 vaccine at T1, increasing to 67% at T2. Soldiers who agreed with three separate statements on vaccination effectiveness, safety, or importance were more likely to indicate that they intended to get the vaccination at both time points. Soldiers who reported that their immediate supervisor encouraged soldiers to get a COVID-19 vaccine were more likely to indicate that the vaccination was effective, safe, or important at both time points. Discussion: Negative attitudes about COVID-19 vaccines were prevalent and correlated with less intention to get a vaccination. However, prioritizing leadership engagement around the importance of vaccinations may be a simple but widely effective intervention point to increase future vaccine uptake following the development of novel vaccines to future COVID-19 variants.
MeSH term(s)	Humans ; Military Personnel ; Intention ; COVID-19 Vaccines/therapeutic use ; Cross-Sectional Studies ; COVID-19/prevention & control ; SARS-CoV-2 ; Vaccination
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-11-12
Publishing country	Netherlands
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	426631-6
ISSN	1573-3610 ; 0094-5145
ISSN (online)	1573-3610
ISSN	0094-5145
DOI	10.1007/s10900-022-01149-6
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Article ; Online: US Soldiers' Individual and Unit-level Factors Associated with Perceptions of Disinformation in the Military Context.

Duffy, Farifteh Firoozmand / McDonnell, Gerald P / Auslander, Margeaux V / Bricault, Stephanie A / Kim, Paul Y / Rachlin, Nicholas W / Quartana, Phillip J

Military medicine

2023 Volume 188, Issue Suppl 6, Page(s) 698–708

Abstract: Introduction: Although the US Government considers threats of misinformation, disinformation, and mal-information to rise to the level of terrorism, little is known about service members' experiences with disinformation in the military context. We ... ...

Abstract	Introduction: Although the US Government considers threats of misinformation, disinformation, and mal-information to rise to the level of terrorism, little is known about service members' experiences with disinformation in the military context. We examined soldiers' perceptions of disinformation impact on the Army and their units. We also investigated associations between disinformation perceptions and soldiers' sociodemographic characteristics, reported use of fact-checking, and perceptions of unit cohesion and readiness. Methods: Active-duty soldiers (N = 19,465) across two large installations in the Southwest US completed an anonymous online survey. Results: Sixty-six percent of soldiers agreed that disinformation has a negative impact on the Army. Thirty-three percent of soldiers perceived disinformation as a problem in their unit. Females were more likely to agree that disinformation has a negative impact on the Army and is a problem in their unit. Higher military rank was associated with lower odds of agreeing that disinformation is a problem in units. Most soldiers were confident about their ability to recognize disinformation (62%) and reported using fact-checking resources (53%), and these factors were most often endorsed by soldiers who agreed that disinformation is a problem for the Army and their unit. Soldiers' perceptions of unit cohesion and readiness were negatively associated with the perception that disinformation is a problem in their unit. Conclusion: While the majority of soldiers viewed disinformation as a problem across the Army, fewer perceived it as problematic within their units. Higher levels of reported fact-checking were most evident among those who perceived disinformation as a problem, suggesting that enhancing awareness of the problem of disinformation alone could help mitigate its deleterious impact. Perceptions of disinformation problems within units were associated with soldiers' perceptions of lower unit cohesion and readiness, highlighting misinformation, disinformation, and mal-information's impact on force readiness. Limitations and future directions are discussed.
MeSH term(s)	Female ; Humans ; Military Personnel ; Disinformation ; Terrorism
Language	English
Publishing date	2023-11-10
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usad322
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Article ; Online: A Preliminary Examination of the Effects and Mechanisms of Cognitive Behavioral Therapy for Insomnia on Systemic Inflammation Among Patients with Knee Osteoarthritis.

Mun, Chung Jung / Speed, Traci J / Finan, Patrick H / Wideman, Timothy H / Quartana, Phillip J / Smith, Michael T

International journal of behavioral medicine

2023 Volume 31, Issue 2, Page(s) 305–314

Abstract: Background: Systemic inflammation, particularly the elevation of interleukin-6 (IL-6), plays an important role in the maintenance and progression of knee osteoarthritis. Insomnia, being highly prevalent in knee osteoarthritis, is understood to be a risk ...

Abstract	Background: Systemic inflammation, particularly the elevation of interleukin-6 (IL-6), plays an important role in the maintenance and progression of knee osteoarthritis. Insomnia, being highly prevalent in knee osteoarthritis, is understood to be a risk factor for systemic inflammation. The present study examined if cognitive behavioral therapy for insomnia (CBT-I) would reduce circulating IL-6 levels to a larger extent than the active control condition via greater improvement in sleep maintenance disturbance at mid-treatment, among individuals with knee osteoarthritis and insomnia disorder. Methods: This is an ancillary study (N = 64) from a larger double-blind, randomized, active controlled clinical trial. Serum IL-6 was measured at baseline, post-treatment, and 3- and 6-month follow-ups. Sleep was measured by daily sleep diaries. Results: Overall, there was no significant IL-6 trajectory differences between CBT-I and the active control (p = .64). Compared to the active control, CBT-I demonstrated greater improvement in sleep maintenance disturbance at mid-treatment (p = .01), which, in turn, was significantly associated with lower levels of IL-6 at 3-month follow-up (p < .05). Sleep maintenance disturbance at mid-treatment did not significantly predict changes in IL-6 levels at post-treatment (p = .43) and 6-month follow-up (p = .90). Conclusions: Our study demonstrates that CBT-I can be efficacious in improving sleep maintenance disturbance among individuals with knee osteoarthritis and insomnia disorder. However, no convincing evidence was found that CBT-I can substantially reduce IL-6 levels via improvement in sleep. CBT-I alone may not be effective in reducing systematic inflammation in this clinical population. Trial registration: NCT00592449.
MeSH term(s)	Humans ; Sleep Initiation and Maintenance Disorders/complications ; Sleep Initiation and Maintenance Disorders/therapy ; Osteoarthritis, Knee/complications ; Osteoarthritis, Knee/therapy ; Interleukin-6 ; Treatment Outcome ; Inflammation/complications ; Cognitive Behavioral Therapy
Chemical Substances	Interleukin-6
Language	English
Publishing date	2023-05-25
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	1187972-5
ISSN	1532-7558 ; 1070-5503
ISSN (online)	1532-7558
ISSN	1070-5503
DOI	10.1007/s12529-023-10184-z
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Article ; Online: COVID-19 Concerns, Information Needs, and Adverse Mental Health Outcomes among U.S. Soldiers.

Quartana, Phillip J / Beymer, Matthew R / Gomez, Stephanie A Q / Adler, Amy B / Santo, Theresa Jackson / Thomas, Jeffrey L / Bell, Amy Millikan

Military medicine

2023 Volume 189, Issue 3-4, Page(s) e878–e887

Abstract: Introduction: The coronavirus disease 2019 (COVID-19) pandemic disrupted U.S. Military operations and potentially compounded the risk for adverse mental health outcomes by layering unique occupational stress on top of general restrictions, fears, and ... ...

Abstract	Introduction: The coronavirus disease 2019 (COVID-19) pandemic disrupted U.S. Military operations and potentially compounded the risk for adverse mental health outcomes by layering unique occupational stress on top of general restrictions, fears, and concerns. The objective of the current study was to characterize the prevalence of COVID-19 concerns and information needs, demographic disparities in these outcomes, and the degree to which COVID-19 concerns and information needs were associated with heightened risk for adverse mental health outcomes among U.S. Army soldiers. Materials and methods: Command-directed anonymous surveys were administered electronically to U.S. soldiers assigned to one of three regional commands in the Northwest United States, Europe, and Asia-Pacific Region. Surveys were administered in May to June 2020 to complete (time 1: n = 21,294) and again in December 2020 to January 2021 (time 2: n = 10,861). Only active duty or active reservists/national guard were eligible to participate. Members from other branches of service were also not eligible. Results: Highly prevalent COVID-19 concerns included the inability to spend time with friends/family, social activities, and changing rules, regulations, and guidance related to COVID-19. Some information needs were endorsed by one quarter or more soldiers at both time points, including stress management/coping, travel, how to protect oneself, and maintaining mission readiness. COVID-19 concerns and information needs were most prevalent among non-White soldiers. Concerns and information needs did not decline overall between the assessments. Finally, COVID-19 concerns were associated with greater risk of multiple adverse mental health outcomes at both time points. Conclusions: COVID-19 concerns and information needs were prevalent and showed little evidence of decrement over the course of the first 6 months of the pandemic. COVID-19 concerns were consistently associated with adverse mental health outcomes. These data highlight two targets and potential demographic subgroups such that local leadership and Army medicine and public health enterprises can be better prepared to monitor and address to maintain force health and readiness in the face of possible future biomedical threats.
MeSH term(s)	Humans ; United States/epidemiology ; Military Personnel ; COVID-19/epidemiology ; Outcome Assessment, Health Care ; Europe
Language	English
Publishing date	2023-09-15
Publishing country	England
Document type	Journal Article
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usad350
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Article ; Online: Tired and angry: Sleep, mental health, and workplace relational aggression.

Osgood, Jeffrey M / Yates, Hunter K / Adler, Amy B / Dyches, Karmon D / Quartana, Phillip J

Military psychology : the official journal of the Division of Military Psychology, American Psychological Association

2021 Volume 33, Issue 2, Page(s) 80–91

Abstract: Workplace relational aggression incurs substantial costs to organizations in the form of reduced employee effectiveness and can exact a personal toll on the targets of the aggression. The extant literature contains limited studies related to ... ...

Abstract	Workplace relational aggression incurs substantial costs to organizations in the form of reduced employee effectiveness and can exact a personal toll on the targets of the aggression. The extant literature contains limited studies related to physiological variables in predicting the perpetration of workplace relational aggression. Using survey data from a large US military sample (N = 2290), this research tested a hypothesized indirect effects model of sleep and relational aggression against unit members. Results suggest that subjective sleep duration and discontinuity are associated indirectly with perpetrating relational aggression against unit members through higher levels of poor mental health symptoms. Moreover, this association was more robust at higher versus lower levels of trait anger. This research is among the first to examine sleep disturbance or mental health as potential upstream factors associated with instigating relational aggression in the workplace. This is also among the first scientific studies on perpetrating relational aggression against unit members in the US military.
Language	English
Publishing date	2021-03-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2021130-2
ISSN	1532-7876 ; 0899-5605
ISSN (online)	1532-7876
ISSN	0899-5605
DOI	10.1080/08995605.2021.1897490
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Article ; Online: Prototyping Apps for the Management of Sleep, Fatigue, and Behavioral Health in Austere Far-Forward Environments: Development Study.

Germain, Anne / Wolfson, Megan / Pulantara, I Wayan / Wallace, Meredith L / Nugent, Katie / Mesias, George / Clarke-Walper, Kristina / Quartana, Phillip J / Wilk, Joshua

Journal of medical Internet research

2023 Volume 25, Page(s) e40640

Abstract: Background: Military service inherently includes frequent periods of high-stress training, operational tempo, and sustained deployments to austere far-forward environments. These occupational requirements can contribute to acute and chronic sleep ... ...

Abstract	Background: Military service inherently includes frequent periods of high-stress training, operational tempo, and sustained deployments to austere far-forward environments. These occupational requirements can contribute to acute and chronic sleep disruption, fatigue, and behavioral health challenges related to acute and chronic stress and disruption of team dynamics. To date, there is no centralized mobile health platform that supports self- and supervised detection, monitoring, and management of sleep and behavioral health issues in garrison and during and after deployments. Objective: The objective of this study was to adapt a clinical decision support platform for use outside clinical settings, in garrison, and during field exercises by medics and soldiers to monitor and manage sleep and behavioral health in operational settings. Methods: To adapt an existing clinical decision support digital health platform, we first gathered system, content, and context-related requirements for a sleep and behavioral health management system from experts. Sleep and behavioral health assessments were then adapted for prospective digital data capture. Evidence-based and operationally relevant educational and interventional modules were formatted for digital delivery. These modules addressed the management and mitigation of sleep, circadian challenges, fatigue, stress responses, and team communication. Connectivity protocols were adapted to accommodate the absence of cellular or Wi-Fi access in deployed settings. The resulting apps were then tested in garrison and during 2 separate field exercises. Results: Based on identified requirements, 2 Android smartphone apps were adapted for self-monitoring and management for soldiers (Soldier app) and team supervision and intervention by medics (Medic app). A total of 246 soldiers, including 28 medics, received training on how to use the apps. Both apps function as expected under conditions of limited connectivity during field exercises. Areas for future technology enhancement were also identified. Conclusions: We demonstrated the feasibility of adapting a clinical decision support platform into Android smartphone-based apps to collect, save, and synthesize sleep and behavioral health data, as well as share data using adaptive data transfer protocols when Wi-Fi or cellular data are unavailable. The AIRE (Autonomous Connectivity Independent System for Remote Environments) prototype offers a novel self-management and supervised tool to augment capabilities for prospective monitoring, detection, and intervention for emerging sleep, fatigue, and behavioral health issues that are common in military and nonmilitary high-tempo occupations (eg, submarines, long-haul flights, space stations, and oil rigs) where medical expertise is limited.
MeSH term(s)	Humans ; Prospective Studies ; Psychiatry ; Fatigue ; Educational Status ; Military Personnel
Language	English
Publishing date	2023-08-28
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1438-8871
ISSN (online)	1438-8871
ISSN	1438-8871
DOI	10.2196/40640
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Article ; Online: Mental Health Outcomes Among American Indian and Alaska Native U.S. Army Soldiers: A Serial Cross-Sectional Analysis.

Beymer, Matthew R / Apostolou, Andria / Smith, Colin M / Paschane, David M / Gomez, Stephanie A Q / James, Tamara D / Bell, Amy Millikan / Santo, Theresa / Quartana, Phillip J

Military medicine

2023

Abstract: Introduction: American Indian and Alaska Native (AI/AN) individuals in the USA experience higher rates of mental illness and preventable death than the general population. Published research demonstrates that AI/AN veterans experience similar ... ...

Abstract	Introduction: American Indian and Alaska Native (AI/AN) individuals in the USA experience higher rates of mental illness and preventable death than the general population. Published research demonstrates that AI/AN veterans experience similar disparities to other minorities compared to non-minority veterans; few studies, however, have assessed mental health outcomes in AI/AN active duty military members. The objective of this study was to determine differences in depression, anxiety, hazardous alcohol consumption, and suicidal ideation among AI/AN soldiers compared to soldiers of other races during the Coronavirus Disease 2019 (COVID-19) pandemic. Materials and methods: We conducted repeated cross-sectional electronic surveys to assess the mental health of active duty and activated reserve U.S. Army soldiers within three commands in the Northwestern Continental United States , Republic of Korea, and Germany during May-June 2020 (T1) and December 2020-January 2021 (T2). The primary exposure of interest in the present analysis was race and ethnicity, and the primary outcomes were probable depression with functional impairment (subsequently "depression"), probable anxiety with functional impairment (subsequently "anxiety"), hazardous alcohol use, and suicidal ideation. Multivariable logistic regression models were used to determine the association between demographics and COVID-19 concerns on mental health outcomes for each time point. Results: A total of 21,293 participants responded to the survey at T1 (participation rate = 28.0%), and 10,861 participants responded to the survey at T2 (participation rate = 14.7%). In the multivariable model, AI/AN participants had 1.36 higher adjusted odds of suicidal ideation (95% CI: 1.02-1.82) at T1 and 1.50 greater adjusted odds of suicidal ideation at T2 (95% CI: 1.00-2.24), when compared to non-Hispanic White participants. During T1, there was no significant difference detected between AI/AN and non-Hispanic White participants for anxiety (adjusted odds ratio: 1.21; 95% CI: 0.91-1.60) (Table IV). However, AI/AN participants had 1.82 greater adjusted odds of anxiety when compared to non-Hispanic White participants at T2 (adjusted odds ratio: 1.82; 95% CI: 1.29-2.57). There were no significant differences detected between AI/AN participants and non-Hispanic White participants in multivariable models for either depression or hazardous alcohol use at both time points. Conclusions: Although we hypothesized that all adverse mental health outcomes would be higher for AI/AN service members at both time points, there were no significant differences at each of the time points analyzed for most of the outcomes analyzed. However, differences in suicidal ideation were found at both time points. Analyses and proposed interventions should account for diversity and heterogeneity of AI/AN populations.
Language	English
Publishing date	2023-02-27
Publishing country	England
Document type	Journal Article
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usad049
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