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This chapter examines the role of stress and emotional well-being as critical antecedents of important outcomes in the military context. In it, we provide a framework for understanding the sources of stress among military personnel. Using this model, we review the risk factors associated with combat and deployment cycles in addition to protective factors, such as personality characteristics and social support, which mitigate the effects of stress on emotional well-being and performance. Finally, we evaluate efforts by military organizations to enhance the emotional well-being of service members through training programs designed to build resiliency.

In recent years, a wide range of psychosocial health interventions have been implemented among military service members and their families. However, there are questions over the evaluative rigor of these interventions. We conducted a systematic review of this literature, rating each relevant study (k = 111) on five evaluative rigor scales (type of control group, approach to participant assignment, outcome quality, number of measurement time points, and follow-up distality). The most frequently coded values on three of the five scales (control group type, participant assignment, and follow-up distality) were those indicating the lowest level of operationally defined rigor. Logistic regression results indicate that the evaluative rigor of intervention studies has largely remained consistent over time, with exceptions indicating that rigor has decreased. Analyses among seven military sub-populations indicate that interventions conducted among soldiers completing basic training, soldiers returning from combat deployment, and combat veterans have had, on average, the greatest evaluative rigor. However, variability in mean scores across evaluative rigor scales within sub-populations highlights the unique methodological hurdles common to different military settings. Recommendations for better standardizing the intervention evaluation process are discussed.

Harriet Martineau analyzed the structural characteristics associated with health, sickness, medicine, occupations, and the bureaucratic administration of health care in her later writings. I concentrate here on two major examples of this type of work: England and Her Soldiers (1859a) and Health, Husbandry, and Handicraft (London: Bradbury and Evans, 1861). In this type of study, in contrast to her early non-fiction, her own illnesses and bodily difficulties are invisible. Her sympathy with the sick and ill, nonetheless, helped her maintain her interest in the topic and her sense of mission to document and discuss it.

Martineau was aided in this work through a close alliance with Florence Nightingale and together they created a public sociology with a major social impact on health, war, and occupations delivering health care. Their intellectual and personal alliance is one of the first examples of female sociologists successfully co-ordinating their work for the common good, a model also applicable to their female successors at Hull-House and the University of Chicago.

Army and Joint Transformation initiatives in U.S. national defense (Shinseki, 2000) underscore the need to plan and meet mission requirements for individual soldier and small unit deployment in “close fight” scenarios (e.g. close combat, direct fire, complex terrain). This has focused interest and attention on the need for improved individual human performance research data, models, and high-fidelity simulations that can accurately represent human behavior in individual and small unit settings. New strategies are now needed to bridge the gap between performance outcome assessment and prediction (see also Pew & Mavor, 1998). The purpose of this chapter is to address epistemological and methodological issues that are fundamentally relevant to this goal.

In 2012, Headquarters 17 Combat Service Support Brigade (HQ 17 CSS Bde) implemented a clinical governance framework. The framework is intended as a quality improvement tool through which excellence in deployed healthcare is achieved. The purpose of this paper is to describe the implementation of this clinical governance framework to 17 CSS Bde and present feedback provided by users on their application of the clinical governance framework.

An electronic survey was disseminated to the four 17 CSS Bde deployable health battalions (n=1,061). Qualitative data were analysed using descriptive statistics and qualitative data using thematic analysis.

In total, there were 105 responses providing valid data for analysis. The data identified mixed understanding and awareness of clinical governance amongst participants, and pinpointed aspects of the framework that needed refinement.

The results highlight important challenges implementing a clinical governance framework for deployable health units. The authors propose embedding clinical governance education in all army soldier and officer health courses to remedy deficits in knowledge and understanding. Recommendations for further development of the clinical governance framework are also made with particular emphasis on education, clinical risk and clinical evaluation.

This paper offers unique insight into the implementation of a clinical governance framework to the 17 CSS Bde, Australian Army. The results suggest that levels of understanding and awareness of clinical governance are stalling its translation through the military hierarchy. The data identify that implementation of a clinical governance framework is not easy, even within a military environment where the culture is to follow orders and obey the chain of command.

Job performance in the US Army is a complex construct, in part because of the stressors that soldiers face, both day-to-day and during deployment. This chapter critically reviews job performance, and the connections between performance and stress and health, discussing how findings may also be relevant within the specific context of the Army. We review established conceptualizations and metrics of job performance within the Army as well as the civilian sector. Then, we discuss the existing research on the associations between performance and stress, physical health, health behaviors, and mental health. Considering these findings, we discuss lessons learned for Army performance metrics, recommending that stress- and health-related issues be incorporated into unit and leader performance metrics, with two critical caveats: (1) data are aggregated at a company level and (2) non-reactive measures are used. Finally, we discuss how existing data repositories can facilitate future research and note potential constraints of using secondary data.

Study samples, having responded to similar survey content, allowed examination of suicide risk factors for deployed soldiers relative to nondeployed or home station soldiers. Specific research questions addressed by this study are: First, what is the prevalence of suicidal behaviors among Army National Guard (ARNG) soldiers – deployed or not, and how do these rates compare with known US national and international rates? Second, what are stressful life events associated with suicidal risk? How do these compare between deployed and nondeployed soldiers? Third, what specifically about combat exposure makes soldiers at risk for suicide? And fourth, is there any evidence of stress-buffering effect between risk factors and suicidal behaviors? The paper aims to discuss these issues.

Three data sources were used. First, the responding sample for the Unit Risk Inventory consisted of 180 company-sized units with a total of 12,567 responding soldiers. Second, the responding sample for the Unit Risk Inventory-Reintegration consisted of 50 company-sized units with a total of 4,567 soldiers. The third data source was all ARNG suicides for calendar years 2007 through 2012. For each calendar year, a random sample of 1,000 ARNG soldiers was drawn to represent nonsuicides. This resulted in a study sample size of 6,523, including the 523 suicides for the years 2007 through 2012 plus 1,000 nonsuicide cases for each calendar year.

Prevalence of suicidal behaviors among soldiers was higher (for thoughts, plans, and attempts, respectively, 4-6, 1.3-2.2, and 0.7-0.08 percent) than among civilian populations (respectively, 2.6, 0.7, and 0.4 percent). Risk was highest among home station than deployed soldiers. Stressful life events associated with suicide risk included personal feelings of loneliness, anger, and frustration, followed by interpersonal behavioral problems, such as aggressive behavior toward a significant other and having committed a crime. Also evident are the beneficial effects (as a main effect and buffering effect) of feelings of cohesiveness, quality leaderships, and job satisfaction on suicidal behaviors.

Findings here were consistent with the stressor-strain hypothesis. Stressful life events were associated with suicide risk, especially, personal feelings of loneliness, anger, and frustration, followed by interpersonal behavioral problems, such as aggressive behavior toward a significant other and having committed a crime. Evident, too, were the beneficial effects of feelings of cohesiveness, quality leaderships, and job satisfaction on suicidal behaviors. Soldiers reporting these events were less likely to report suicidal behaviors and social support lessened the cumulative effect of risk factors on suicidal behaviors. Given these findings, it seems that suicide risk in the military is not uniquely different from that observed in civilian populations. The higher prevalence of suicides in the military likely has to do with proportionally more individuals who have historically shown to be at risk for suicide, namely, young males.

Strong association of individual-level attributes with suicidal behaviors, such as age, gender, and race, suggest individual-level vulnerability to suicidal behaviors. This expectation is consistent with the stress/suicide vulnerability theory (Bryan, 2014; Nock et al., 2013). Such vulnerabilities may include negative affectivity (one of the Big Five personality dimensions) and early childhood trauma to suicidal behaviors (Griffith, 2012a, 2014).

Suicide, related constructs, and their underlying processes need to be further examined in future research. Their understanding would be useful in screening individuals most at risk for suicidal behaviors, with referral and treatment, if needed. Practically, such vulnerabilities in relation to what specific experiences could be determined, potentially describing which individuals are suited best to adapt to which environments.

There has been much research on the increased suicides in the military, and to date, studies have focussed primarily on traumatic events, such as, deployments and combat exposure associated with suicidal behaviors. Yet, studies have almost exclusively examined the combat-suicide connection without reference to suicide risk factors among nondeployed or home station soldiers. This study fills this gap by examining survey responses to standardized questionnaires administered to ARNG soldiers during calendar year 2010 – one sample of deployed units either to Iraq or to Afghanistan and another sample of nondeployed or home station units.

This chapter uses Goffman’s concept of total institutions in a comparative case study approach to explore the role of psychotropic drugs in the process of transinstitutionalization.

This chapter interprets psychotropic drug use across four institutionalized contexts in the United States: the active-duty U.S. military, nursing homes and long-term care facilities, state and federal prisons, and the child welfare system.

This chapter documents a major unintended consequence of transinstitutionalization – the questionable distribution of psychotropics among vulnerable populations. The patterns of psychotropic use we synthesize suggest that total institutions are engaging in ethically and medically questionable practices and that psychotropics are being used to serve the bureaucratic imperatives for social control in the era of transinstitutionalization.

Psychotropic prescribing practices require close surveillance and increased scrutiny in institutional settings in the United States. The flows of mentally ill people through a vast network of total institutions raises questions about the wisdom and unintended consequences of psychotropic distribution to vulnerable populations, despite health policy makers’ efforts regulating their distribution. Medical sociologists must examine trans-institutional power arrangements that converge around the mental health of vulnerable groups.

This is the first synthesis and interpretive review of psychotropic use patterns across institutional systems in the United States. This chapter will be of value to medical sociologists, mental health professionals and administrators, pharmacologists, health system pharmacists, and sociological theorists.