Deployment Experiences Research Articles

The association of multi-system conditions on mental health trajectories during naval deployment

ABSTRACT This study seeks to enhance understanding of mental health trajectories across Navy deployments and the predictors of those trajectories by exploring a range of job design and individual-level factors. Personnel from the Royal Australian Navy were surveyed on pre-deployment, mid-deployment, and post-deployment. At pre-deployment, there were 559 (M age = 30.19; male = 75.5%) survey responses, N = 112 survey responses could be linked at all time points (retention rate of 20.04% across all time points), and 314 personnel (56.2%) responded at least twice. Latent class growth analyses and growth mixture models were used to determine the trajectories that best fit the data. Separate models were developed for each of the mental health outcomes studied (i.e. psychological distress, perceived resilience, and perceived stress), plus a latent outcome representing a summary measure of psychological ill-health. This latent outcome, estimated as the most comprehensive assessment approach, was used to evaluate all 33 predictors. Consistent with previous work, we identified between two and four trajectories reflecting resilient/low symptom trajectories and heterogeneous symptom trajectories. There were a greater proportion of personnel in the heterogeneous symptom trajectories than identified in previous research. A key contribution of this work is the thorough comparison and ranking of factors that influence the deployment experience. We emphasize the importance of role demands and resources in determining these trajectories when compared directly to self-regulation strategies. Study findings highlight important implications for job design for military personnel during deployment and underscore the importance of adopting a holistic system approach to well-being.

Factors influencing postdeployment reintegration adjustment for U.S. service members and their spouses by spouse gender

ABSTRACT Research on spouses’ adjustment after military deployment has focused primarily on female spouses of male service members; little is known about how adjustment differs by gender. We used Walsh’s family resilience framework to examine communication, belief system, organizational factors, and other stressors, likely associated with postdeployment adjustment. Using Millennium Cohort Family Study data, logistic regressions assessed risk and protective factors on spouses’ and service members’ time to adjust, exploring whether spouse gender moderated their associations. Findings indicated that the association of (1) spouses’ perceptions of their own mental functioning with spouses’ and service members’ adjustment and (2) spouses’ mental readiness for deployment with service members’ adjustment both differed by spouse gender, with associations attenuated for male spouses and their service member partners. Other factors associated with family adjustment included the spouse’s satisfaction with communication, the extent to which the service member shared deployment experiences, the extent to which the spouse was bothered by deployment experiences, the spouse’s participation in postdeployment transition programs, the spouse’s informal support during deployment, and length of deployment. Results indicated shared and gender-specific risk and protective factors associated with spouse and service member adjustment, demonstrating the importance of tailored military family support programs addressing the needs of different populations of military spouses.

Prevalence and risk factors of post-acute sequelae of SARS-CoV-2 (PASC) among veterans in the airborne hazards and open burn pit registry: a prospective, observational, nested study

BackgroundVeterans have unique military risk factors and exposures during deployment that may augment their risk of post-acute sequelae of SARS-CoV-2 (PASC). The purpose of this study is to identify potential risk factors for PASC among Veterans in the national Airborne Hazards and Open Burn Pit Registry (AHOBPR).MethodsThis prospective observational study consisted of a semi-structured interview conducted via phone or videoconference from November 2021 to December 2022 among a stratified random sample of deployed Veterans nested within the national AHOBPR with laboratory-confirmed SARS-CoV-2 infection. PASC was defined as persistent new-onset symptoms lasting more than 2 months after initial SARS-CoV-2 infection. Deployment history, airborne hazards exposure and symptoms were obtained from the AHOBPR self-assessment questionnaire completed prior to SARS-CoV-2 infection (past). Post-infection symptoms and health behaviors obtained at study interview (present) were used to test the hypothesis that deployment experience and exposure increases the risk for PASC.ResultsFrom a sample of 212 Veterans, 149 (70%) met criteria for PASC with a mean age of 47 ± 8.7 years; 73 (49%) were women and 76 (51%) were men, and 129 (82.6%) continued to experience persistent symptoms of SARS-CoV-2 (596.8 ± 160.4 days since initial infection). Neither exposure to airborne hazards (OR 0.97, CI 0.92–1.03) or to burn pits (OR 1.00, CI 0.99-1.00) augmented risk for PASC.ConclusionsPASC is highly common among Veterans enrolled in the AHOBPR, but we did not observe any unique military risk factors (e.g., airborne hazards exposure) that augmented the risk of PASC. Our findings may provide guidance to clinicians in the VHA network to administer appropriate care for Veterans experiencing PASC.

Expectant Casualty Care Training Needs for Future Conflicts.

The demands of future large-scale combat operations may require medics and corpsmen to increasingly perform expectant casualty care (ECC). However, no detailed guidelines currently exist for providing ECC within military medicine. To guide the development of education and training guidelines and advance team training of both medics and non-medics, an in-depth understanding is first needed regarding caregivers' experiences providing ECC in recent conflicts as well as perceived training gaps. Therefore, this study explored the experiences of medics and physicians providing ECC and investigated their perceptions of training needs in this area for future conflicts characterized by large-scale combat operations and prolonged casualty care operational settings. We conducted an engaged qualitative phenomenological study to explore ECC training needs for future conflicts. We interviewed 9 senior health care professionals (medics and physicians) who had extensive combat and deployment experiences and served primarily in the Role 1 environment. The interviews averaged 45 min each and were conducted via phone. To analyze this interview data, we reviewed the interview transcripts and then noted terms, phrases, and concepts within the interview transcripts that we found to be salient to answering the research question. Our team then met to review these codes and grouped them into categories. These categories served as the themes of this study that illustrated the participants' perceptions and experiences. Five themes emerged from our data: (1) There is a current gap in ECC training for enlisted Role 1 caregivers throughout the military; (2) ECC training is needed to shift organizational culture; (3) ECC training should be comprehensive; (4) ECC training should be deliberate; and (5) Time is the greatest challenge to implementing ECC training. Our participants noted that developing guidelines and filling training gaps is not only critical for preparing Role 1 providers for effective and ethical military medical decision-making but also for addressing death and dying on the battlefield and building moral resilience across the medical corps. Our results provide direction for development of ECC clinical guidance and collective team training recommendations. Following these guidelines may increase life-saving capabilities on the far-forward battlefield and equip medical directors and medics to provide ethical and compassionate care to those who cannot be saved in the setting of limited resources and evacuation opportunities.

Transforming Veteran Rehabilitation Care: Learnings from a Remote Digital Approach for Musculoskeletal Pain.

While musculoskeletal pain (MSP) stands as the most prevalent health condition among Veterans, timely and high-quality care is often hindered due to access barriers. Team Red, White & Blue (Team RWB), a nonprofit organization dedicated to promoting a healthier lifestyle among Veterans, aimed to assess innovative approaches to veteran care. This is a single-arm pilot study investigating the feasibility, clinical outcomes, engagement, and satisfaction of a remote multimodal digital care program among Veterans with MSP. The impact of deployment experience on outcomes was explored as a secondary aim. From 75 eligible Veterans, 61 started the program, reporting baseline pain frequently comorbid with mental distress. Program acceptance was suggested by the high completion rate (82%) and engagement levels, alongside high satisfaction (9.5/10, SD 1.0). Significant improvements were reported in all clinical outcomes: pain (1.98 points, 95%CI 0.13; 3.84, p = 0.036); mental distress, with those reporting at least moderate baseline depression ending the program with mild symptoms (8.50 points, 95%CI: 6.49; 10.51, p = 0.012); daily activity impairment (13.33 points, 95%CI 1.31; 25.34, p = 0.030). Deployed Veterans recovered similarly to their counterparts. Overall, the above results underscore the potential of a remote digital intervention to expand Veterans' access to timely MSP care.

Carbon capture and storage at Malaysia power plants: Evaluation of its feasibility and requisite enablers

Rapidly growing GHG emissions are significantly altering the world climate, necessitating a global decarbonization efforts to avert irreversible catastrophic failure of the world ecosystem. Malaysia is pledging to achieve carbon neutrality by 2050 and has subsequently identified Carbon Capture and Storage (CCS) as one of the solutions for carbon removal from its energy sector by 2050. However, the implementation of CCS presents formidable challenges, encompassing both technical and commercial complexities, especially for a nation like Malaysia, which has limited experience in large-scale CCS deployment. This study evaluates the feasibility of CCS implementation in Malaysia's fossil fuel power plants by conducting a comprehensive techno-economic assessment, taking into considerations the prevailing energy landscape of the country. This assessment is very crucial to demonstrate the feasibility of this plan within the timeframe, considering the limited research have been done to assess a national-scale implementation, as well as to provide the important insights for future policy implication to promote CCS adoption. The CCS scenarios are assessed through an analytical approach, and comparative analyses are conducted between alternative paths. The result shows that a large-scale implementation of CCS at Malaysia's fossil fuel power plant to achieve net-zero emission by 2050 are feasible given a strong enforcement on emission policy and establishment of CCS legal framework. CCS can potentially reduce 60% of Malaysia's energy sector total emissions, and a solar-supported CCS helps to reduce it further. Levelized Cost of Electricity analysis reveals that the implementation of CCS leads to only a minimal increase between pre- and post-CCS LCOE when carbon price is considered. A SWOT-PESTLE analysis was also conducted to identify gaps in regulatory framework, financial and social aspects. It can be concluded that CCS is a techno-economically viable solution, however Malaysia's readiness for CCS implementation is still at a very novice stage, and aggressive actions are needed to enable a successful full-scale implementation.

“I Rationed Food, Water, and my iPod Battery”: Canadian Army Veterans on Music “In Theatre”

Background: While a small number of scholars explore how contemporary American soldiers consume music “in theatre” (in a war zone) to motivate themselves and protect their mental health, little research addresses how music functions for Canadian combatants. Analysis: Case studies of two Canadian veterans illuminate the varied ways they used music to protect their mental health during their deployments in Afghanistan. Conclusion and implications: This article demonstrates that Canadian soldiers listened to a wide range of music to cope while on tour and argues for music as a unique portal through which to understand soldiers’ deployment experiences.

Putting the ready in readiness: A post hoc analysis of surgeon performance during a military mass casualty situation in Afghanistan.

All military surgeons must maintain trauma capabilities for expeditionary care contexts, yet most are not trauma specialists. Maintaining clinical readiness for trauma and mass casualty care is a significant challenge for military and civilian surgeons. We examined the effect of a prescribed clinical readiness program for expeditionary trauma care on the surgical performance of 12 surgeons during a 60-patient mass-casualty situation (MASCAL). The sample included orthopedic (four) and general surgeons (eight) who cared for MASCAL victims at Hamad Karzai International Airport, Kabul, Afghanistan, on August 26, 2021. One orthopedic and two general surgeons had prior deployment experience. The prescribed program included three primary measures of clinical readiness: 1, expeditionary knowledge (examination score); 2, procedural skills competencies (performance assessment score); and 3, clinical activity (operative practice profile metric). Data were attained from program records for each surgeon in the sample. Each of the 60 patient cases was reviewed and rated (performance score) by the Joint Trauma System's Performance Improvement Branch, a military-wide performance improvement organization. All scores were normalized to facilitate direct comparisons using effect size calculations between each predeployment measure and MASCAL surgical care. Predeployment knowledge and clinical activity measures met program benchmarks. Baseline predeployment procedural skills competency scores did not meet program benchmarks; however, those gaps were closed through retraining, ensuring all surgeons met or exceeded the program benchmarks predeployment. There were very large effect sizes (Cohen's d ) between all program measures and surgical care score, confirming the relationship between the program measures and MASCAL trauma care provided by the 12 surgeons. The prescribed program measures ensured that all surgeons achieved predeployment performance benchmarks and provided high-quality trauma care to our nation's service members. Prognostic and Epidemiological; Level IV.

Distancing through peacekeeping: global peacekeeping assemblages and the Gambian armed forces

Abstract This article contributes to the understanding of incentives for peacekeeping contribution from non-democratic countries through the largely unexplored case of peacekeeping under authoritarian rule in The Gambia. It argues that President Yahya Jammeh (1994–2017) aimed to use peacekeeping to help keep himself in power, fitting a broader global pattern of peacekeeping for regime maintenance. However, the research also demonstrates that leadership's aims for peacekeeping can be misaligned with the experiences of soldiers. Rather than draw soldiers closer to the regime, the peacekeeping experience involved a distancing from the forces for Gambian soldiers when they returned home. The findings draw on interviews with returned peacekeepers and military decision makers in The Gambia, as well as publications from the armed forces and new public sources of information made available after the 2017 political transition. The article proposes that viewing the deployment experience as a global peacekeeping assemblage helps to understand the more subtle, yet significant, ways in which soldiers' views can shift following peacekeeping deployments.

Impact of Rank, Provider Specialty, and Unit Sustainment Training Frequency on Military Critical Care Air Transport Team Readiness.

The Critical Care Air Transport (CCAT) Advanced Course utilizes fully immersive high-fidelity simulations to assess personnel readiness for deployment. This study aims to determine whether simple well-defined demographic identifiers can be used to predict CCAT students' performance at CCAT Advanced. CCAT Advanced student survey data and course status (pass/fail) between March 2006 and April 2020 were analyzed. The data included students' Air Force Specialty Code (AFSC), military status (active duty and reserve/guard), CCAT deployment experience (yes/no), prior CCAT Advanced training (yes/no), medical specialty, rank, and unit sustainment training frequency (never, frequency less often than monthly, and frequency at least monthly). Following descriptive analysis and comparative tests, multivariable regression was used to identify the predictors of passing the CCAT Advanced course for each provider type. A total of 2,576 student surveys were analyzed: 694 (27%) physicians (MDs), 1,051 (40%) registered nurses (RNs), and 842 (33%) respiratory therapists (RTs). The overall passing rates were 92.2%, 90.3%, and 85.4% for the MDs, RNs, and RTs, respectively. The students were composed of 579 (22.5%) reserve/guard personnel, 636 (24.7%) with CCAT deployment experience, and 616 (23.9%) with prior CCAT Advanced training. Regression analysis identified groups with lower odds of passing; these included (1) RNs who promoted from Captain to Major (post-hoc analysis, P = .03), (2) RTs with rank Senior Airman, as compared to Master Sergeants (post-hoc analysis, P = .04), and (3) MDs with a nontraditional AFSC (P = .0004). Predictors of passing included MDs and RNs with CCAT deployment experience, odds ratio 2.97 (P = .02) and 2.65 (P = .002), respectively; and RTs who engaged in unit CCAT sustainment at least monthly (P = .02). The identifiers prior CCAT Advanced training or reserve/guard military status did not confer a passing advantage. Our main result is that simple readily available metrics available to unit commanders can identify those members at risk for poor performance at CCAT Advanced readiness training; these include RNs with rank Major or above, RTs with rank Senior Airman, and RTs who engage in unit sustainment training less often than monthly. Finally, MD specialties which are nontraditional for CCAT have significantly lower CCAT Advanced passing rates, reserve/guard students did not outperform active duty students, there was no difference in the performance between different RN specialties, and for MD and RN students' previous deployment experience was a strong predictor of passing.

Deployment and combat experiences and their impact on partner substance use

Despite burgeoning evidence of the negative effects of service experiences on service members’ spouses/partners, limited research has examined these effects in the context of substance use. Additionally, a strong literature demonstrates the protective role relationship satisfaction can play for health-related outcomes. The goal of the present research is to examine relations between service experiences (e.g., deployment, combat exposure) and partner substance use, as well as how relationship satisfaction may buffer these effects. Data from 275 civilian partners were drawn from Operation: SAFETY (Soldiers And Families Excelling Through the Years), a longitudinal study examining health among U.S. Army Reserve/National Guard (USAR/NG) soldiers and partners. Analyses examined relations between soldier service history (baseline) and civilian partner alcohol/drug use (2-year follow-up), as well as interactions with relationship satisfaction. Models controlled for civilian partner sex and age and soldiers’ self-reported posttraumatic stress disorder symptoms and substance use. Results revealed interactions between service experiences and partner satisfaction for models predicting alcohol consumption and heavy drinking. Greater relationship satisfaction mitigated overall alcohol consumption and heavy drinking frequency among partners of soldiers with two or more deployments and among partners of soldiers with greater combat exposure. Soldier service experiences were unrelated to civilian partner drug use. The effects of deployment and combat exposure extend beyond the service member to negatively influence civilian partner alcohol consumption and heavy drinking, with relationship satisfaction buffering these risks. Interventions that assist USAR/NG soldiers and spouses in strengthening their relationships may also help protect against spouse substance use related to soldier service experiences.

Long-term trajectories of depressive symptoms in deployed military personnel: A 10-year prospective study

BackgroundMilitary missions, especially those involving combat exposure, are associated with an increased risk of depression. Understanding the long-term course of depressive symptoms post-deployment is important to improve decision-making regarding deployment and mental health policies in the military. This study investigates trajectories of depressive symptoms in the Dutch army, exploring the influence of factors such as demographics, early-life trauma, posttraumatic stress disorder (PTSD) symptoms, and deployment stressors. MethodsA cohort of 1032 military men and women deployed to Afghanistan (2005–2008) was studied from pre- to 10 years post-deployment. Depressive and PTSD symptoms were assessed using the Symptom CheckList-90 and the Self-Rating Inventory for PTSD. Demographics, early trauma, and deployment experiences were collected at baseline and after deployment, respectively. Latent Class Growth Analysis was used to explore heterogeneity in trajectories of depressive symptoms over time. ResultsFour trajectories were found: resilient (65%), intermediate-stable (20%), symptomatic-chronic (9%), and late-onset-increasing (6%). The resilient group experienced fewer deployment stressors, while the symptomatic-chronic group reported more early life traumas. Trajectories with elevated depressive symptoms consistently demonstrated higher PTSD symptoms. LimitationsPotential nonresponse bias and missing information due to the longitudinal design and extensive follow-up times. ConclusionsThis study identified multiple trajectories of depressive symptoms in military personnel up to 10 years post-deployment, associated with early trauma, deployment stressors, adverse life events and PTSD symptoms. The prevalence of the resilient trajectory suggests a substantial level of resilience among deployed military personnel. These findings provide valuable insights and a foundation for further research.

Large Single-Center Experience with Short-Term Follow-up of Neqstent-Assisted Coiling.

Endovascular treatment of wide-neck bifurcation aneurysms has historically proved difficult with variable outcomes. Different endovascular techniques such as balloon-assisted coiling, stent-assisted coiling, or intrasaccular devices provide a varied range of efficacy and safety. Neqstent-assisted coiling is a new device and technique that aim to provide a maximum of both. We analyzed the early clinical and radiologic outcomes after the use of this new technique and device in our practice. This study was a retrospective analysis of ruptured and unruptured intracranial aneurysms treated with the Neqstent. The primary radiologic outcomes were quantified on DSA, CTA, or MRA using the modified Raymond-Roy criteria. The outcomes were defined as immediate complete occlusion (modified Raymond-Roy criteria 1) and complete (modified Raymond-Roy criteria 1) and adequate occlusion (modified Raymond-Roy criteria 1 and modified Raymond-Roy criteria 2) at 6 months posttreatment. The primary safety outcome was the rate of device-related adverse events. Secondary safety outcomes included time to discharge and change in the mRS score at 6-month follow-up. Twenty patients were treated with the Neqstent from November 2020 to January 2023. Nine had unruptured aneurysms, and 11 were patients with subarachnoid haemorrhage due to ruptured aneurysms. Eighteen of 20 aneurysms (90%) treated demonstrated complete occlusion (modified Raymond-Roy criteria 1) on immediate postembolization angiograms. Sixteen of 17 aneurysms treated (94.1%) remained adequately occluded on 6-month follow-up (modified Raymond-Roy criteria 1 and modified Raymond-Roy criteria 2). Immediate postoperative complications occurred in 2 patients; only 1 patient had residual neurologic deficits at 6 months (mRS = 2). Management of large, wide-neck aneurysms remains difficult, with high rates of recurrence and complications. The use of the Neqstent shows promising short-term results for the treatment of complex wide-neck aneurysms. Initial complication rates for our cohort were relatively high. However, this result is likely related to the initial learning experience of device deployment and the use of antiplatelets.

Considerations for Clinician-Educators Developing Online Educational Content: A Narrative Review.

In modern medical education, clinician-educators are increasingly called upon to develop online education to complement or replace in-person instruction. Despite a growing need for online curricula, many medical professionals lack training and experience in digital content development, deployment, assessment, and maintenance. Previous studies offer guidance on some aspects of online education development but often overlook key components, such as accessibility, legal considerations, financial implications, and sustainability challenges. This review offers medical professionals a broad overview of these important issues. We discuss various pedagogical considerations, including aligning educational goals and objectives with the digital content, choosing the appropriate online interface, and employing strategies to mitigate cognitive load while maximizing accessibility to create an inclusive online learning environment. We offer practical tips for creating effective, high-quality, and enduring audio-visual content and reflect on initial content deployment, testing, assessment, and revision. We discuss the intricacies of obtaining continuing medical education credits when the target audience includes faculty members. We address several legal issues online educators must consider, such as copyright laws, intellectual property rights, and medical liability. The review concludes with a discussion of sustainability mechanisms and financial considerations to ensure the long-term success of the educational program. Our recommendations aim to equip medical professionals embarking on a digital education journey with practical tools to produce effective, inclusive, and sustainable online content while considering legal implications.

European military surgical teams in combat theater: A survey study on deployment preparation and experience

IntroductionAdequate (predeployment) training of the nowadays highly specialized Western military surgical teams is vital to ensure a broad range of surgical skills to treat combat casualties. This survey study aimed to assess the self-perceived preparedness, training needs, deployment experience, and post-deployment impact of surgical teams deployed with the Danish, Dutch, or Finnish Armed Forces. Study findings may facilitate a customized predeployment training. MethodsA questionnaire was distributed among Danish, Dutch, and Finnish military surgical teams deployed between January 2013 and December 2020 (N = 142). The primary endpoint of self-perceived preparedness ratings, and data on the training needs, deployment experiences, and post-deployment impacts were compared between professions and nations. ResultsThe respondents comprised 35 surgeons, 25 anesthesiologists, and 39 supporting staff members, with a response rate of 69.7 % (99/142). Self-perceived deployment preparedness was rated with a median of 4.0 (IQR 4.0–4.0; scale: 1 [very unprepared]–5 [more than sufficient]). No differences were found among professions and nations. Skills that surgeons rated below average (median <6.0; scale: 1 [low]–10 [high]) included tropical disease management and maxillofacial, neurological, gynecological, ophthalmic, and nerve repair surgery. The deployment caseload was most often reported as <1 case per week (41/99, 41.4 %). The need for professional psychological help was rated at a median of 1.0 (IQR 1.0–1.0; scale: 1 [not at all]–5 [very much]). ConclusionsMilitary surgical teams report overall adequate preparedness for deployment. Challenges remain for establishing broadly skilled teams because of a low deployment caseload and ongoing primary specializations. Additional training and exposure were indicated for several specialism-specific skill areas. The need for specific training should be addressed through customized predeployment programs.

Effect of project-based learning method for improving students problem-solving ability in the experiment of power electronics course

Abstract— This paper examines the integration of the CDIO (Conceive, Design, Implement, Operate) framework in Mechatronics curriculum. CDIO revolutionizes technical education by emphasizing project-based learning (PBL) and practical experiences, fostering skills, attitudes, and problemsolving abilities for real-world challenges. The Power Electronics course for fourth-semester students, aligned with CDIO, covers semiconductor devices, converters, rectifiers, choppers, inverters, and specialized machine switching circuits. Being an outcomebased education (OBE) curriculum, two of its outcomes focuses on applying gained knowledge. PBL was implemented to achieve the outcome of the course among students. During the process of implementation, students demonstrated diverse outcomes. In the proposed case study, Set A effectively accomplished problem identification, simulation, and hardware implementation. In contrast, Set B had difficulties pertaining to the integration of hardware components. This study highlights the varied dynamics observed in student involvement and academic achievement within the context of project-based learning. By doing a comparative analysis of the outcomes between Set A and Set B, valuable insights may be gained to enhance instructional techniques. This statement highlights the significance of utilizing the CDIO framework's principles to improve project-based learning and better the overall educational experience in future deployments. Keywords— Power Electronics, CDIO, Project Based Assignment, T-test.

Nasty wars and needy veterans? How cognitive polyphasia may explain conceptualizations of the U.S. Iraq and Afghanistan veterans as victims and heroes.

Representative opinion polls indicate that members of the U.S. public may hold dichotomous perceptions of their veterans. While the majority of the U.S. public appreciates and honors their veterans, they are also considered to suffer from war-induced trauma and physical disabilities. Victimizing attitudes toward the veteran population may result in stigmatization and a more difficult transition into civilian society. This may be particularly problematic for U.S. veterans who were deployed to Iraq and Afghanistan as this younger veteran population needs to reintegrate not only into civilian society but also into civilian workplace settings. The present study aims to uncover and unravel underlying rationalities that justify heroizing and victimizing sentiments in relation to Iraq and Afghanistan veterans. In order to delve beyond socially desirable reporting and cultural norms, in-depth semi-structured interviews with 29 individuals (20 non-veterans and 9 veterans) were conducted. Three themes were identified by thematic analysis: Theme 1 "Individual Understandings of the Deployments to Iraq and Afghanistan" represents an underlying framework that tainted perceptions of Theme 2 "Conceptualizations of war, deployment, and violence" and Theme 3 "Evaluations of the veteran's personality." If the deployments were considered justified, then veterans were heroized, characterized with supreme altruistic traits when compared with civilians. Negative effects on health that were arbitrarily related to deployment experience were classified as short-lived. If the deployments were scrutinized, then veterans were considered as naïve victims of a deceitful government, suffering from long-term health problems. Importantly, as discussions surrounding the legitimacy of the deployments were context-dependent, the participants were able to hold perceptions of veterans as victims and as heroes side by side. In conclusion, the heroization and victimization of veterans may be the result of considering different viewpoints, elucidating diversity and access to equivocal information in an increasingly complex social world. Although the present findings may require further validation, they suggest that changing negative, stereotyping perceptions of veterans may require a coherent rationale for deployments and uniform mission objectives.

A Comparison ofUniformed Services University andHealth Professions Scholarship Program Graduates' First Deployment Readiness.

Military physicians must be prepared to lead health care teams across complex landscapes of war during future small- and large-scale combat operations. This preparation optimally begins in medical school so that early career physicians are fully ready for their first deployment. Past qualitative research has suggested that military physicians who attended civilian medical school are not as well prepared for the operational environment as physicians who attended the Uniformed Services University (USU), our nation's military medical school. However, there is a lack of larger-scale quantitative research comparing the readiness differences between the two medical school pathways. The purpose of this study, therefore, was to quantify any differences in first deployment preparation between students attending USU and civilian medical schools through the Health Professions Scholarship Program (HPSP). We compared USU and HPSP graduates' first deployment experiences by distributing a 14-item Likert survey to active duty military physicians in the U.S. Army, U.S. Navy, and U.S. Air Force who graduated within the past 10 years from medical school (USU or civilian). The USU graduates rated themselves significantly higher than the HPSP graduates on their readiness for deployment (3.83 vs. 3.24; P < .001); ability to navigate the operational environment (3.59 vs. 2.99; P < .001); confidence in communicating with their commanding officer (3.59 vs. 2.99; P = .002); navigating the combined role as physician and officer (3.33 vs. 2.84; P = .004); leading a health care team (3.94 vs. 3.43; P = .001); preparation by a medical school (3.78 vs. 2.52; P < .001); and overall readiness compared to peers (4.20 vs. 3.49; P < .001). There was no significant difference between the two pathways regarding their stress level at the beginning of deployment (2.74 vs. 2.68; P = .683); clinical preparation (3.94 vs. 3.76; P = .202); and success of first deployment (3.87 vs. 3.91; P = .792). The largest effect size of the difference between the two pathways was noted on the question "How well did medical school prepare you for your first deployment" (Cohen's d = 1.02). While both groups believed that they were prepared for their first deployment, USU graduates consistently reported being more prepared by medical school for their first deployment than HPSP graduates. To close this readiness gap, supplemental military unique curricula may help to optimize HPSP students' readiness.

Identifying factors related to stigma toward psychiatric illness and mental health services and attitudes of help-seeking among Japan Ground Self-Defense Force members

The stigma that military personnel feel toward mental illness and mental healthcare hinders their access to mental health services. Stigma is influenced by culture—specifically, that held by military personnel is closely related to military culture. To our knowledge, this is the first large-scale investigation aimed at identifying the factors, including demographic factors and elements of military culture, related to stigma among members of the Japan Ground Self-Defense Force. An anonymous questionnaire was administered to 4754 members. The questionnaire included items regarding demographic factors, history of psychiatric visits, military rank, overseas deployment experience, disaster relief experience, supervisor leadership, unit cohesion, general psychological distress, stigma toward perceived mental illness, and attitudes toward help-seeking. Multiple regression analysis was used to identify the various factors related to stigma. Responses were obtained from 4305 (90.5%) participants, among which 3723 (78.3%) were valid. Multiple regression analyses revealed that a variety of factors including age, psychiatric consultation, leadership, and cohesiveness were markedly associated with stigma and attitudes toward help-seeking. This study revealed that various factors including demographic factors and military culture factors such as supervisor leadership and unit cohesion are related to stigma and attitudes toward mental health services among Japan Ground Self-Defense Force personnel. Further studies are needed to examine the results in depth.

Feasibility of Virtual Reality-Delivered Transcending Self Therapy in Veterans Undergoing Residential Substance Use Treatment

Substance Use Disorder (SUD) is common among military veterans, where post-traumatic stress disorder and other comorbidities stemming from deployment or other military experiences increase the severity of SUD and incidence of relapse. It is thus critical to discover and evaluate potential advances in SUD treatment, such as methods for enhanced patient engagement in treatment.