Abstract
The mental health impact of the initial years of military service is an under-researched area. This study is the first to explore mental health trajectories and associated predictors in military members across the first 3-4 years of their career to provide evidence to inform early interventions. This prospective cohort study surveyed Australian Defence personnel (n = 5329) at four time-points across their early military career. Core outcomes were psychological distress (K10+) and posttraumatic stress symptoms [four-item PTSD Checklist (PCL-4)] with intra-individual, organizational and event-related trajectory predictors. Latent class growth analyses (LCGAs) identified subgroups within the sample that followed similar longitudinal trajectories for these outcomes, while conditional LCGAs examined the variables that influenced patterns of mental health. Three clear trajectories emerged for psychological distress: resilient (84.0%), worsening (9.6%) and recovery (6.5%). Four trajectories emerged for post-traumatic stress, including resilient (82.5%), recovery (9.6%), worsening (5.8%) and chronic subthreshold (2.3%) trajectories. Across both outcomes, prior trauma exposure alongside modifiable factors, such as maladaptive coping styles, and increased anger and sleep difficulties were associated with the worsening and chronic subthreshold trajectories, whilst members in the resilient trajectories were more likely to be male, report increased social support from family/friends and Australian Defence Force (ADF) sources, and use adaptive coping styles. The emergence of symptoms of mental health problems occurs early in the military lifecycle for a significant proportion of individuals. Modifiable factors associated with wellbeing identified in this study are ideal targets for intervention, and should be embedded and consolidated throughout the military career.
Highlights
Military life can be extremely rewarding but, for some, challenging
This study is the first to explore the mental health impact of the early years in the military on its members. It offers a first look into the potentially modifiable factors that can influence the trajectories of mental health and potential mitigation of psychiatric disorder
The trajectories of mental health that emerged in this study and the approximate proportion of members in each were similar to those found in personnel who had deployed or were transitioning out of the military (Andersen et al, 2014; Berntsen et al, 2012; Boasso et al, 2015; Bonanno et al, 2012; Dickstein et al, 2010; Eekhout et al, 2016; Karsten et al, 2013; Nash et al, 2015; Orcutt et al, 2004), indicating that the emergence of mental health symptoms is occurring very early in the lifecycle of a military member, and in the absence of events such as deployment
Summary
Military life can be extremely rewarding but, for some, challenging. A significant body of literature exists informing the impact of military experiences during/after deployment and transition out of the military (Cheok, Ang, Chew, & Tan, 2000; Mobbs & Bonanno, 2018); there is a critical gap in understanding the health and wellbeing impacts of initial enculturation into the military. This study is the first to identify these key factors and provides an early look at mental health trajectories across the initial years of a military career, offering an important opportunity to pinpoint how and when to build resilience and mitigate the development of psychiatric disorder in Defence forces. This study is the first to explore mental health trajectories and associated predictors in military members across the first 3–4 years of their career to provide evidence to inform early interventions. Four trajectories emerged for post-traumatic stress, including resilient (82.5%), recovery (9.6%), worsening (5.8%) and chronic subthreshold (2.3%) trajectories Across both outcomes, prior trauma exposure alongside modifiable factors, such as maladaptive coping styles, and increased anger and sleep difficulties were associated with the worsening and chronic subthreshold trajectories, whilst members in the resilient trajectories were more likely to be male, report increased social support from family/friends and Australian Defence Force (ADF) sources, and use adaptive coping styles. Modifiable factors associated with wellbeing identified in this study are ideal targets for intervention, and should be embedded and consolidated throughout the military career
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