National Guard Members Research Articles

Military Helps Civilian Psychiatrists Respond to Soldiers, Families

Back to table of contents Previous article Next article Professional NewsFull AccessMilitary Helps Civilian Psychiatrists Respond to Soldiers, FamiliesChristine LehmannChristine LehmannSearch for more papers by this authorPublished Online:21 Jan 2005https://doi.org/10.1176/pn.40.2.00400012A new electronic series of fact sheets on deployment-related concerns of soldiers and their families is being distributed to civilian psychiatrists and military physicians as well as other health care professionals.The Courage to Care health-promotion campaign is produced by an interdisciplinary team at the Uniformed Services University (USU) Center for the Study of Traumatic Stress (CSTS), which is directed by Col. Robert Ursano, MC, USAF (Ret.).Ursano, who chairs the department of psychiatry at USU, told Psychiatric News, “As the nation's federal medical school, we have a special relationship with our Department of Defense (DoD) community that is unique and worldwide. The health of our soldiers, airmen, and marines—men and women—and their families is our concern.”Ursano and his team of experts at CSTS identify topics for the fact sheets after consulting with military and hospital commanders, primary care physicians, and public affairs officers, according to Ursano, who was the first chair of APA's Committee on Psychiatric Dimensions of Disasters and is now a corresponding member.“One of the unique aspects of the health-promotion campaign is its relevance. Topics are chosen for no other reason than to answer the questions being asked by service members and their families,” Ursano said.Each fact sheet presents an outline of particular issues that health care and social service professionals need to understand when dealing with families with a deployed spouse/parent. A companion fact sheet on the same topic is attached for professionals to give to soldiers or family members to take home.For example, the first fact sheet addressed issues that arise when deployed soldiers reunite with their spouse and other family members after being apart for months. “This particular topic was prompted by a request for information from a spouse of a soldier deployed to Iraq. She wanted to prepare her family for her husband's return for the holidays in 2003,” commented Ursano.“When I responded to her concerns, I realized that the military community as a whole needed more information on what to expect when soldiers returned home from Iraq, particularly around the holidays,” he said.He proposed that the center, with its expertise in disaster mental health and trauma research in terrorism and bioterrorism, produce a series of electronic fact sheets to educate the military community.In June 2003, Ursano created the Office of Public Education and Preparedness at CSTS and hired health-promotion and public-education specialist Nancy Vineburgh to be its director and an assistant professor of psychiatry.Ursano enlisted Vineburgh to develop the theme for the new health-promotion campaign and individual fact sheets, edit the content, and design the format and look.She gave the campaign its name, Courage to Care, which complemented the USU slogan “caring for those in harm's way,” said Ursano.He also enlisted the expertise of Col. Molly Hall, MC, USAF, associate professor and assistant chair of psychiatry at USU, to oversee the development of the educational content of the campaign (Psychiatric News, June 18, 2004).Capt. Derrick Hamaoka, MC, USAF, also a psychiatrist, joined the campaign's interdisciplinary team about a year ago during his third-year clerkship in the psychiatry department. His primary roles are to coordinate the campaign and oversee the distribution of the fact sheets to military and civilian health care and social-service professionals, Hamaoka told Psychiatric News.“The concept of producing attractive, ready-to-use fact sheets that could be disseminated electronically to health care professionals and customized if they wished appealed to me,” Hamaoka said.He observed that the military community's response to the reintegration fact sheet was overwhelming and positive. He has since expanded the distribution list in response to numerous requests.For example, one military commander wrote a note to the team saying,“ I can't thank you enough. Your Courage to Care series is the just the product we were looking for to provide to the Air Force/National Guard. It has direct, immediate impact on our troops and the current urgent combat mental health care crisis.”The second fact sheet, which was released last month, addressed a national concern—the flu. “It guides health care professionals in educating patients and their communities about good health habits to decrease the risk of infections,” said Ursano.The third fact sheet will address issues that National Guard and Reserve members may face when they re-enter the workplace, according to Vineburgh.“ These families are not necessarily located near an active military base so they require special outreach by the DoD, their home communities, and employers.”Additional fact sheets will address the impact of deployment on children and families, women's health during deployment, and talking about injuries with spouses and families, according to Ursano.The Courage to Care fact sheets are posted online at<www.usuhs.mil/psy/courage.html>.▪ ISSUES NewArchived

Assessment of urinary metals following exposure to a large vegetative fire, New Mexico, 2000.

In May 2000, a vegetative fire burned 47,000 acres in northern New Mexico, including 7500 acres of land administered by the Los Alamos National Laboratory. We evaluated potential human exposures from the fire. We surveyed two populations (firefighters and the general population) in four cities for urine heavy metal concentrations. Reference concentrations were based on the Third National Health and Nutrition Examination Survey (NHANES III). Multivariate linear regression assessed the association of urinary metal concentrations with smoke exposure. We also performed isotopic analysis of uranium and cesium on a subset of specimens. A total of 92 firefighters and 135 nonfirefighters participated. In both populations, urinary nickel, cesium, chromium, and uranium concentrations were greater than expected compared with NHANES III reference values. No values required immediate medical follow-up. Regression analysis demonstrated that for National Guard members, arsenic and cadmium levels were significantly related to smoke exposure, and for firefighters, cesium and arsenic levels were significantly related to exposure; however, only for cesium in National Guard members was this association in the positive direction. Isotopic analysis demonstrated that the cesium and uranium were naturally occurring. Some people had spot urine metal concentrations above nationally derived reference values, and values for some metals were associated with smoke exposure. These associations had little public health or clinical importance. Studies of exposures resulting from vegetative fires are difficult, and careful consideration should be given to the technical and communication processes at the outset of a fire exposure investigation. Recommendations for future investigations include testing as soon as possible during or after a fire, and early clinical consultation with a medical toxicologist.

Fine Needle Aspiration in the Management of Thyroid Nodules: Experience at King Khalid National Guard Hospital, Jeddah

Fine Needle Aspiration in the Management of Thyroid Nodules: Experience at King Khalid National Guard Hospital, Jeddah

Abusive supervision and subordinates' organizational citizenship behavior.

The relationship between subordinates' perceptions of abusive supervision and supervisors' evaluations of subordinates' organizational citizenship behavior (OCB) was explored among a sample of 373 Air National Guard members and their military supervisors. As predicted, the relationship between abusive supervision and subordinates' OCB was stronger among subordinates who defined OCB as extra-role behavior (compared with those defining OCB as in-role behavior), and this effect was fully mediated by the interactive effect of procedural justice and OCB role definitions. The study's implications for theory and research are discussed, its limitations are identified, and directions for future research are suggested.

Understanding mail survey response rates among male reserve component Gulf War era veterans.

In this study of current and former male Reserve and National Guard members from the State of Ohio, it was expected that veterans who were older, had more years of military service, who had participated in the Persian Gulf War, who were Euro-Americans, who were higher in rank, who had higher residential stability in Ohio, who belonged to the Air Force, who had higher formal education, and who belonged to the National Guard would have a greater investment in U.S. society as defined by 11 demographic variables. It was assumed that those with greater investment in society would more often have valid addresses and would be more likely to respond to a survey on military issues, thereby biasing sample outcomes in those directions. Results for male veterans were consistent with the hypothesis that investment in the society system would predict validity of addresses and response rates. In other words, results supported the idea that those veterans who might be expected to have a greater investment in U.S. society were more likely to be located and to respond (once located) to a survey concerning Desert Storm-era military service and its aftermath. Implications for future Desert Storm research are discussed.

Understanding Mail Survey Response Rates among Female Reserve Component Veterans Serving during the Persian Gulf War

In this study of current and former female reservists and National Guard members from the state of Ohio, veterans who were older, who had more years of military service, who had participated in the Gulf War, who were Euro-Americans, who were or had been married, and who were higher in rank tended to have more valid addresses and higher response rates, thus biasing sample outcomes in those directions. Educational attainment, branch of service, component of service, and residential stability appeared to be less important, although some significant findings were noted. Implications for further research on Desert Storm are discussed. In general, those veterans who might have been expected to have a greater investment in U.S. society were more likely to respond to a survey concerning Desert Storm era military service and its aftermath.

An investigation into the possibility of transmission of tick-borne pathogens via blood transfusion. Transfusion-Associated Tick-Borne Illness Task Force.

Tick-borne illnesses were diagnosed in a group of National Guard members, including some who had donated blood a few days before the onset of symptoms. A voluntary recall of those blood components was issued and a multistate investigation was conducted to determine if transfusion-transmitted illness had occurred. Donors and recipients were asked to complete questionnaires regarding symptoms and risk factors for infection and to provide blood samples for laboratory analysis. Among National Guard personnel who donated blood, 12 individuals were found to have a confirmed or probable case of Rocky Mountain spotted fever or ehrlichiosis. A total of 320 units (platelets or packed red cells) from 377 donors were transfused into 129 recipients. Although 10 recipients received units from National Guard personnel with confirmed or probable infection, none became ill. Transfusion-transmitted illness did not occur. Despite the awareness of the risk for tick-borne diseases and the use of tick-preventive measures, many National Guard personnel reported exposure to ticks. In addition to augmenting current tick-preventive measures, scheduling blood drives before rather than after field exercises could further reduce the potential for transmission of tick-borne pathogens.

Guard and Reserve Spouse Separation during the Persian Gulf War: Coming to Terms with Uncertainty

During the Persian Gulf War (1990-1991), more than 228,000 National Guard and reserve members were recalled to active duty. Little information exists about the effect of wartime military separation among the civilian spouses of guard and reserve personnel. This grounded theory study describes the effect of the Persian Gulf War separation on 14 guard and reserve spouses. Data were generated from in-depth interviews and were analyzed using the constant comparative method. Three patterns of coming to terms with the separation emerged from analysis of the intensive interviews: (a) settling in immediately, (b) struggling followed by settling in, and (c) struggling without relief. Each pattern is associated with different patterns of social support that affect the relationship between uncertainty and adjustment. These findings provide important information for nurses who work with spouses who can anticipate this type of separation.

Side Effects from Influenza Vaccination: Differences between Returned and Random Surveys

Annually vaccinated Air National Guard members were surveyed by return of questionnaire in 1991 (20.5%) and in 1992 by random phone survey (23.5%). By returned questionnaire the sample reported any side effects at the rate of 48.1%; by randomly telephoned sample a significantly lower rate, 37.7% (p < 0.02), was reported. An inverse relationship existed between age and return of the questionnaire, present only in males, despite an increased rate of reporting of side effects in the younger ages. Females reported a significantly higher rate of side effects than males by return of questionnaire in all age groups and for the sample as a whole (p < 0.03). In the randomized survey the age effect disappeared, except for the tendency for the oldest group to report fewer side effects than the other age groups in their aggregate (p < 0.07). The higher reporting rate for females was less apparent by random survey but remained as a trend (p = 0.08; odds ratio 1.398; 95% confidence interval = 0.776-4.049).

Victims of Groupthink

An important theory in the study of small group decision making is groupthink, developed by Irving Janis. Groupthink refers to a process by which a small group of decision makers subjected to intense stress may become more concerned with achieving concurrence among their members than in arriving at carefully considered decisions. In this study, Janis's theory is applied to the 1977 gymnasium controversy at Kent State University where trustees decided to build an addition to the school's gymnasium on part of the area where students and Ohio National Guard members confronted each other just before the tragic shootings of May 4, 1970. Despite opposition from the student body and faculty, large-scale protest activities, massive arrests, and numerous third party efforts to resolve the conflict, the trustees not only refused to alter their decision but also refused even to reconsider their decision. A detailed analysis of Janis's theory reveals that each major condition of the theory was present in the conflict and that the trustees were indeed victims of groupthink.