Factors That Influence Health care-Seeking Behavior and Health Information Disclosure Among U.S. Air Force Pilots.

INTRODUCTION: The reality of pilot health care avoidance behavior is often common knowledge to both pilots and aeromedical physicians, but the underlying factors leading to this behavior are less understood. In the current study, we conducted a qualitative assessment of a sample of U.S. Air Force (USAF) pilots to gather firsthand perceptions of the factors that encourage and discourage disclosure during aeromedical screening and use of mental and physical health care services, as well as recommendations to improve the USAF aeromedical health care system. MATERIALS AND METHODS: We conducted interviews with 21 USAF pilots on their perceptions of seeking medical care to identify factors that uniquely discourage or encourage disclosure and health care utilization to understand factors that aid the aeromedical provider/aviator relationship and to elicit interventions that could be prospectively researched. This work was reviewed by the Air Force Research Laboratory Institutional Review Board at Wright-Patterson Air Force Base and designated as exempt research, FWR20220103E. RESULTS: The most reported factors that discourage military pilot health care disclosure and health care utilization overall were medical revocation, stigma, and lack of trust in providers. Unit-embedded services, ease of access, and severity of condition were the most reported factors encouraging disclosure and utilization. Factor descriptions and exemplary quotes from pilots and pilot recommendations to encourage health care utilization and disclosure are provided. CONCLUSIONS: Results from firsthand interviews with pilots provide valuable information for flight surgeons to focus on building trust with their pilots to reduce health care avoidance.

The self-reported impacts of the COVID-19 pandemic on psychological health of U.S. Air Force cyber personnel.

U.S. Air Force cyber personnel were faced with changes in their workplace, fitness routines, and personal lives during the COVID19 pandemic. Adjusting to COVID-19-related requirements likely increased the stress of already stressful jobs for military members and their families, which could have resounding impacts on emotional, social, and physical well-being. Therefore, it is important to evaluate psychological health outcomes and self-perceived impacts of the changes presented to cyber personnel because of the COVID-19 pandemic. An online occupational health assessment that included demographics, standardized measures of burnout, psychological distress, and work role strain; health behaviors; and perceived impacts of the COVID-19 pandemic was administered to 1488 cyber personnel. Thirty-two negative themes and 13 positive themes were created from qualitative coding for "How has the COVID-19 pandemic impacted you as an individual?" Of the themes created, 966 (68.5%) reported at least one negative impact and 440 (31.2%) reported at least one positive impact. Top-reported negative impacts were limited face-to-face interactions and loss of personal activities. Negative impacts were associated with negative psychological health outcomes (e.g., psychological distress, exhaustion, cynicism) and work role strain. Action-oriented recommendations are given in the event of another pandemic.

Assessing work role strain, burnout, and job satisfaction among remotely piloted aircraft operators: the moderating role of unit social support.

Utilizing the Job Demands-Resources (JD-R) theory as a guiding framework, the current study examined the relationships between job demands (work role strain) and occupational outcomes (burnout and job satisfaction) and assessed how job resources (team member social support and leader social support) mitigated the impact of high job demands for U.S. Air Force remotely piloted aircraft (RPA) operators. A total of 905 active duty U.S. Air Force RPA operators participated in a web-based occupational health assessment. Study findings confirmed that work role strain proved to be strongly related to negative occupational outcomes - increased burnout and reduced job satisfaction. Compelling evidence emerged suggesting that boosting job resources (i.e., team member and leader social support) may be a promising point of intervention to mitigate negative occupational outcomes. By investigating ongoing job demands that result in a higher incidence of burnout and job dissatisfaction, as well as job resources that protect against burnout and job dissatisfaction, researchers and practitioners can continue to introduce supportive resources at crucial points to alleviate the adverse consequences of occupational stress and burnout. Applying the JD-R theory to these findings highlights the importance of job resources for RPA operators and other employees working in high-risk, high-demand career fields. Implications and future directions are discussed.

Emotional reactions of distributed common ground system imagery analysts exposed to remote combat operations.

OBJECTIVE: Imagery analysts of the United States Air Force distributed common ground system (DCGS) provide real-time intelligence informing battlefield decision-making processes worldwide. The number of DCGS combat operations personnel has grown along with the demand for their products, but little is known about the emotional impacts of remote warfighting. The current study is a mixed methods analysis of emotional reactions to remote fatality-inducing combat events and of potential demographic, occupational, and mission-specific correlates of negative emotional reactions to these combat operations in DCGS personnel. METHOD: One-hundred ninety-six active duty analysts with direct exposure to weapon strike operations volunteered to participate in semistructured interviews. RESULTS: Participants were largely enlisted (93.9%), male (75%), and between 18 and 30 years of age (73.0%). Eighty-nine percent reported at least one positive emotion and 71% reported both positive and negative emotions in response to weapon strike events. An underlying current of positive emotions (e.g., pride, camaraderie, patriotism) combined with mission-specific negative emotions (e.g., sadness related to witnessing pain, suffering, and/or loss of life; anxiety and stress related to uncertainty and unforeseeable events) were commonly reported. Twenty-one percent endorsed negative emotions that disrupted their daily functioning, and witnessing a civilian casualty increased risk by 217%. CONCLUSION: DCGS analysts reported emotional responses similar to other remote warfighters but with proportional distributions that reflect their unique wartime roles and responsibilities. The heightened sense of responsibility associated with their wartime roles may elevate risk for negative emotional outcomes when adverse events, such as the death of a civilian, occur. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Personality Traits That Distinguish Special Operations Female Aircrew.

INTRODUCTION: U.S. Air Force Special Operations Command (AFSOC) female aircrew represent a small group of military personnel in challenging high-risk, high-demand professions. Personality characteristics may play a key role in distinguishing those women who pursue a career as a special operations aircrew member and succeed in this pursuit. Having access to normative personality data can potentially support psychologists in assessing AFSOC female aircrew and subsequently making informed recommendations to leadership.METHODS: A total of 586 AFSOC aircrew trainees58 (9.9%) women and 528 (90.1%) mencompleted a series of computer-based psychological tests to assess cognitive ability and personality traits.RESULTS: Results indicated significant differences between female AFSOC aircrew and female civilians on four of the five NEO Personality Inventory domains: Neuroticism (M 74.9 vs. M 87.1), Extraversion (M 123.7 vs. M 112.8), Openness to Experience (M 122.6 vs. M 111.0), and Conscientiousness (M 136.0 vs. M 120.6), respectively. The comparison between female AFSOC aircrew and male AFSOC aircrew revealed significant differences across three of the five domains: Neuroticism (M 74.9 vs. M 65.1), Openness to Experience (M 122.6 vs. M 115.0), and Agreeableness (M 119.6 vs. M 112.7), respectively.DISCUSSION: Implications for assessment and interpretation of psychological testing are discussed. This paper provides a unique perspective and insight into those who pursue and excel in this career field. Identifying specific personality traits in our AFSOC female aircrew allows for tailored care and support when evaluating readiness in special operations aircrew for optimizing performance.Chappelle W, Shadle AH, Martinez RN, Reardon LE, Goodman T, Spencer H, Thompson W. Personality traits that distinguish special operations female aircrew. Aerosp Med Hum Perform. 2021; 92(4):240247.

Sources of Stress and Psychological Health Outcomes for Remotely Piloted Aircraft Operators: A Comparison Across Career Fields and Major Commands.

INTRODUCTION: U.S. Air Force remotely piloted aircraft (RPA) operators perform a variety of around-the-clock global intelligence, surveillance, and reconnaissance (ISR) missions that are considered critical to operational effectiveness. The growing need for ISR operations has led to significant increases in operational tempo and workload, resulting in elevated operational stress, burnout, and psychological distress. These negative outcomes are linked to conditions such as long hours, low manning, lack of sleep, and communication issues. Through regular assessments and the implementation of additional resources (i.e., embedded health care providers), Air Force leadership is working to alleviate the stressors and maintain psychological well-being. Thus, the purpose of this study is to compare the levels of stress, and prevalence of burnout and psychological distress across RPA career fields within two major commands. MATERIALS AND METHODS: Assessments were completed by 571 RPA operators from 2 major commands: Air Force Special Operations Command (n = 158) and Air Combat Command (n = 413). RPA career fields included pilots (n = 331), sensor operators (n = 137), and intelligence operators (n = 103). RESULTS: Results revealed that high stress levels from an array of sources continue to result in increased risk of burnout and psychological distress for RPA operators. Several significant differences in sources of high stress across career fields and major commands are identified and discussed. CONCLUSIONS: Overall, the results of this study highlight specific problem areas unique to certain subsets of the RPA community in need of targeted intervention and clarify several avenues for future research.

Predictors and protective factors for suicide ideation across remotely piloted aircraft career fields.

The US Air Force remote warrior community comprises several career fields including remotely piloted aircraft pilots and intelligence, cyber, and sensor operators. The crews are responsible for working seamlessly together to provide 24/7 real-time intelligence, surveillance, and reconnaissance and precision-strike weapons capabilities for a wide range of global combat operations. Due to the rapid increase in global demands and operational tempo, there is growing concern from military leadership about the impact of operational stress on the health and psychological well-being of remote warriors. Previous assessments from 2011 and 2015 have demonstrated a significant increase in the reported rates of operators experiencing suicide ideation. The current study examined two protective factors expected to reduce the risk of suicide ideation - team member social support and leader social support. A total of 905 active duty remote warriors participated in occupational health assessments conducted in 2018. Risk factors for suicide ideation included being unmarried, worsening relationship problems, occupational burnout, and increased operational stress. Results indicated that team member and leader social support were significant protective factors for shift workers and those who reported being less likely to seek mental healthcare. Implications of the findings, intervention recommendations, and directions for future research are discussed.

Sources of Stress and Psychological Health Outcomes Among U.S. Air Force Total Force Distributed Common Ground System Operators.

U.S. Air Force Distributed Common Ground Station (DCGS) intelligence (Intel) operators sustain 24/7 battlefield situational awareness and facilitate precision-strike operations. DCGS operations are global, synergistic, Total Force (TF) endeavors by active duty, Air National Guard (ANG) and Reserve units, providing combatant commanders with critical real-time intelligence and shaping operational and tactical decisions. Continual surveillance of this community's psychological health is important to its military leaders. This study re-examines the most frequently reported occupational stressors, as well as the prevalence of occupational burnout (i.e., high-emotional exhaustion and cynicism, and low professional efficacy), and psychological distress within this population. Active duty (n = 1717), ANG (n = 139), and Reserve (n = 173) Intel operators participated in a comprehensive, online, occupational health assessment. Results reveal that occupational stressors contributing to elevated rates of distress, regardless of TF status (i.e., low manning, long work hours, excessive workload, and organizational communication concerns) are consistent with previous research. The prevalence of high-emotional exhaustion (AD: 29%/ANG: 25%/RES: 14%) and psychological distress (AD: 19%/ANG: 17%/RES: 5%) are above estimates for other military communities. These findings combined with demographic and occupational risk factors lay the foundation for improving psychological health within this Total Force community.

Combat and operational risk factors for post-traumatic stress disorder symptom criteria among United States air force remotely piloted aircraft "Drone" warfighters.

The prevalence and expression of post-traumatic stress disorder (PTSD) symptoms among United States Air Force remotely piloted aircraft (RPA; commonly referred to as "drones") warfighters exposed to battlefield trauma via remote, electronic warfare is relevant and critical to the effective delivery of mental health care for this population. RPA warfighters (n = 715) with real-time exposure to at least one traumatic event participated in an online survey. Measures included the PTSD Checklist for DSM-5 (PCL-5) and survey of exposure to traumatic events during the course of operational combat missions. A total of 6.15% met PTSD symptom criteria; those in the age ranges of 31-35 and 36-40 and those working 51 or more hours per week had greater odds of meeting symptom criteria. For combat-related events, the number of events in which RPA warfighters witnessed civilian bystanders being killed by enemy forces or felt shared responsibility for the injury or death of bystanders were also significant predictors, regardless of whether the risk was anticipated or unanticipated. The results of this study suggest that specific types of exposure and participation in missions with specific outcomes, albeit via electronic, remote means, are associated with an increased risk for meeting PTSD symptom criteria.

Post-Traumatic Stress Symptoms in United States Air Force Aeromedical Evacuation Nurses and Technicians.

Critical Care Air Transport Teams (CCATT) are specialized military medical personnel who provide high-acuity care in an aeromedical environment. The rate of post-traumatic stress disorder (PTSD) symptoms was assessed in CCATT personnel and their rates were compared to general aeromedical evacuation (AE) personnel. As part of a computer-based occupational stress survey, 188 crew members (138 AE nurses and technicians, 50 CCATT nurses and respiratory therapists) completed the PTSD Checklist - Military Version. A categorical MEET/DOES NOT MEET CRITERIA variable was created, and a Fisher's exact test was computed to identify differences between groups. Contingency table analyses were used to assess associations between demographic and occupational variables with meeting criteria. χ2 or Fisher's exact test results, relative risks, and 95% confidence intervals were obtained, with 4.35% of AE and 14.00% of CCATT crew members meeting PTSD symptom criteria. The CCATT crew members were 3.22 times (95% confidence interval = 1.14-9.12) more likely to meet symptom criteria than AE, and for CCATT meeting criteria, the most commonly endorsed symptoms were arousal and avoidance. The demographic and occupational factors assessed in this study were not associated with meeting PTSD symptom criteria. Current findings are discussed in relation to current research on post-traumatic stress in ground-based critical care personnel.

Prevalence of posttraumatic stress symptoms in United States Air Force intelligence, surveillance, and reconnaissance agency imagery analysts.

Imagery analysts are critical to the intelligence capabilities of the United States Air Force (USAF) and are known as the "eyes" of the USAF. The purpose of this study was to assess for posttraumatic disorder (PTSD) symptoms among this cohort. Of the 498 imagery analysts who participated, a total of 4.22% met provisional diagnostic criteria for PTSD as outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 2000) which was lower than established rates of PTSD (up to 18%) among military personnel returning from deployment. Implications of subclinical PTSD symptoms on occupational functioning and overall diagnostic picture are discussed.

Reassessment of psychological distress and post-traumatic stress disorder in United States Air Force Distributed Common Ground System operators.

The goal of this study was to assess for the main sources of occupational stress, as well as self-reported symptoms of distress and post-traumatic stress disorder among U.S. Air Force (USAF) Distributed Common Ground System (DCGS) intelligence exploitation and support personnel. DCGS intelligence operators (n=1091) and nonintelligence personnel (n = 447) assigned to a USAF Intelligence, Surveillance, and Reconnaissance Wing responded to the web-based survey. The overall survey response rate was 31%. Study results revealed the most problematic stressors among DCGS intelligence personnel included high workload, low manning, as well as organizational leadership and shift work issues. Results also revealed 14.35% of DCGS intelligence operators' self-reported high levels of psychological distress (twice the rate of DCGS nonintelligence support personnel). Furthermore, 2.0% to 2.5% self-reported high levels of post-traumatic stress disorder symptoms, with no significant difference between groups. The implications of these findings are discussed along with recommendations for USAF medical and mental health providers, as well as operational leadership.

Symptoms of psychological distress and post-traumatic stress disorder in United States Air Force "drone" operators.

The goal of this study is to repeat a survey administered in 2010 to assess for changes in mental health among United States Air Force aircrew operating Predator/Reaper remotely piloted aircraft, also commonly referred to as "drones." Participants were assessed for self-reported sources of occupational stress, levels of clinical distress using the Outcome Questionnaire-45.2, and symptoms of post-traumatic stress disorder (PTSD) using the PTSD Checklist-Military Version. A total of 1,094 aircrew responded to the web-based survey composed of the commercially available standardized instruments mentioned above. The survey also contained nonstandardized items asking participants to report the main sources of their occupational stress, as well as questions addressing demographics and work-related characteristics. The estimated response rate to the survey was 49%. Study results reveal the most problematic self-reported stressors are operational: low manning, extra duties/administrative tasks, rotating shift work, and long hours. The results also reveal 10.72% of operators self-reported experiencing high levels of distress and 1.57% reported high levels of PTSD symptomology. The results are lower than findings from the 2010 survey and from soldiers returning from Iraq and Afghanistan. Implications of the study and recommendations for United States Air Force line leadership and mental health providers are discussed.

An analysis of post-traumatic stress symptoms in United States Air Force drone operators.

Remotely piloted aircraft (RPA), commonly referred to as "drones," have emerged over the past decade as an innovative warfighting tool. Given there is a paucity of empirical research assessing drone operators, the purpose of this study was to assess for the prevalence of PTSD symptoms among this cohort. Of the 1084 United States Air Force (USAF) drone operators that participated, a total of 4.3% endorsed a pattern of symptoms of moderate to extreme level of severity meeting criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders-4th edition. The incidence of PTSD among USAF drone operators in this study was lower than rates of PTSD (10-18%) among military personnel returning from deployment but higher than incidence rates (less than 1%) of USAF drone operators reported in electronic medical records. Although low PTSD rates may be promising, limitations to this study are discussed.