Daily uplifts, daily hassles, and coping in military veterans' post-deployment reintegration.

Our first aim was to explore the relationship between daily uplifts, daily hassles, and coping styles the first year after returning from international military missions and post-deployment work, family, and private reintegration in military veterans. Our second aim was to identify individual patterns regarding daily uplifts, daily hassles, and coping styles and to explore how they relate to the above-mentioned aspects of post-deployment reintegration. Questionnaire responses were received from 446 Swedish military veterans. Regression analyses showed that daily hassles and an escape-avoidance coping style made significant contributions in the predicted, negative direction to the amount of explained variance on reintegration indicator scales. A high level of perceived threat during the last mission also contributed to more negative integration. Using a person-centered approach, three unique profiles of response patterns were identified using a cluster analysis based on the uplift, hassles, and coping style scores. One profile was labeled "resilient and well-functioning"; its members showed favorable reintegration scores. A second profile was called "ambitious and struggling." These individuals scored medium-high on the reintegration scales. The third profile consistently indicated the least favorable reintegration scores and was labeled "worried and avoidant." The results confirm and deepen our existing knowledge.

Association of daily hassles, daily uplifts, coping styles and stress-related symptoms among women exposed to sexual abuse-A cross-sectional study.

BACKGROUND: Women who experience physical or sexual violence report poor self-perceived health. Knowledge of daily hassles, daily uplifts and coping styles, as well as how these factors can affect health and well-being among survivors of sexual abuse, is important for healthcare professionals to understand and target their needs. AIM: The aim of the current study was to explore the association of daily hassles, daily uplifts, coping strategies and stress-related symptoms among female survivors of sexual abuse. METHODS: A group of women (n = 57), exposed to sexual abuse, were recruited from nine support centres in Norway. Participants completed a questionnaire that addressed demographics, socioeconomic conditions, trauma history, daily hassles, daily uplifts, coping styles and stress-related symptoms. Two groups of participants were compared: one group that had above-median scores on uplifts and adaptive coping styles and one group that had above-median scores on daily hassles and maladaptive coping styles. RESULTS: Results indicate that women who experienced more daily hassles and used maladaptive coping styles reported significantly more stress-related symptoms, and particularly emotional symptoms, than women who experienced more daily uplifts and used adaptive coping styles. There were few differences between the two groups related to socioeconomic conditions and trauma history. CONCLUSION: The results indicate that women in both groups struggle with stress-related physical, emotional, cognitive and target group-specific symptoms. However, high incidence of daily hassles and the use of maladaptive coping styles were associated with an increase in stress-related symptoms. Novell's findings indicate that despite severe traumatic experiences, adaptive coping styles and favourable perceptions of stress in everyday life were associated with a lower frequency of stress-related symptoms. It may therefore be helpful to focus on altering maladaptive coping styles to reduce stress-related symptoms among sexual abuse survivors.

Is conduct after capture training sufficiently stressful?

Conduct after capture (CAC) training is for personnel at risk of being captured. To be effective, it needs to be stressful. But how do we know if it is stressful enough? This study uses biomarkers and cognitive measures to evaluate CAC. Soldiers undergoing CAC were measured by the stress hormone cortisol from saliva samples at baseline and during training. The training consisted of being taken capture and put through a number of realistic and threatening scenarios, targeting survival strategies taught in the preceding week. Between scenarios, the trainees were held in a holding cell where they were monitored by a guard. The saliva samples were taken in conjunction with the scenarios. The whole training took place over a period of ~24 h. Cognitive performance was measured at baseline and after training. Three groups took part Group A (n = 20) was taken after 48 h of intense tasks leaving them in a poor resting state. Group B (n = 23) was well rested at CAC onset. Group C (n = 10) was part of a survival, evasion, resistance, and escape (SERE) instructor course. The CAC training was the same for all groups. Group A exhibited a high increase in cortisol during CAC, compared to baseline levels were multiple times as high as "expected" values. Group B exhibited elevated levels slightly lower than those of group A, they also "dropped" to "normal" levels during the latter part of the exercise. Group C displayed the least increase with only slightly elevated levels. CAC training is stressful and cortisol levels were elevated enough to satisfy the prerequisite for effective stress inoculation. No cognitive performance drop could be identified; however, several participants "froze" during the exercise due to intensive stress.

Hair Cortisol, Perceived Stress, and the Effect of Group Dynamics: A Longitudinal Study of Young Men during Compulsory Military Training in Lithuania.

Previous research shows a nonlinear dependency between hair cortisol concentrations and perceived stress levels. This may be due to stress being targeted at the individual level despite it also being a social phenomenon which is often affected by group dynamics. Therefore, the objective of this study was to determine the influence of perceived stress on the hair cortisol level, considering the impact of the variables of group dynamics (interpersonal, task, and norm cohesion). Information was collected on 11 groups of, in total, 112 young men in three phases of time during their compulsory military training (covering nine months in total). The classification and regression tree (C&RT) method was used to predict hair cortisol concentrations in groups. The results show that the variability of the hair cortisol level in young men groups can be explained by perceived stress only when the groups were in formation process (47.7% normalised importance in Model 1) and when the groups were working on their final tasks (37.80% normalised importance in Model 3); meanwhile, the importance of perceived stress in explaining hair cortisol concentrations is low when the group is in a routine period of a group life-span (28.9% normalised importance in Model 2). Interpersonal cohesion (normalised importance 100% in Model 1 and 80.0% in Model 3) and task cohesion (normalised importance 78.6% in Model 2) were the most important predictors in the study area. These results point to the importance of the elements of group dynamics when it comes to explaining the nature of hair cortisol as accumulated stress biomarkers in young men.

Measuring the Impact of Operational Stress: The Relevance of Assessing Stress-related Health Across the Deployment Cycle.

INTRODUCTION: Mental health issues from intense or prolonged stress are a common concern in regard to military deployment. Deployments can objectively vary in stress exposure, but it is the individuals' perception of that stress that affects sustainability, mental health, and combat fitness, which calls for the need of a protocol to evaluate and maintain a current estimation of stress impact. So, how can we assess the impact of stressors during different phases of deployment? MATERIALS AND METHODS: We used three psychological self-rating forms, the PSS14-Perceived Stress Scale, SMBM-Shirom Melamed Burnout Measure, and KSQ-Karolinska Sleep Questionnaire, to measure the impact of stress before (T1), during (T2), and at homecoming (T3). We also wanted to see if T1 or T2 results could predict T3 results to be able to better prepare the homecoming program.The forms were handed out to Swedish soldiers deployed in Mali in 2017. The forms were collected as a way to assess the status of the mental health load at three timepoints based on the personnel function as a way to assess the current "psychological fitness level". RESULTS: The results show that stress measured using PSS14 was high at homecoming. The same result was observed for SMBM. No measures from T1 or T2 could however predict the T3 results. CONCLUSIONS: Taken together, we found that screening of all contingent staff is relatively easy and provides personnel with relevant data on mental health and stress at the current time. We also found that test results correlated between T1 and T2 but not with T3. This indicates that there might be different stressors that affect staff at different timepoints.

Interrelationship of Posttraumatic Stress, Hassles, Uplifts, and Coping in Women With a History of Severe Sexual Abuse: A Cross-Sectional Study.

Experiencing trauma, such as sexual abuse, increases the risk of a negative health outcome. The aim of the present study was to compare two groups of female survivors of sexual abuse, one group with a lower indication of posttraumatic stress disorder (L-PTSD) and one with a higher indication of posttraumatic stress disorder (H-PTSD). We hypothesized that, with a history of sexual abuse, higher levels of PTSD symptoms would be associated with more daily hassles, fewer daily uplifts, and more maladaptive coping strategies, and that there would be more reporting of severe types of sexual victimization, less resourceful socioeconomic conditions and a lower level of emotional stability. A questionnaire, including measures of socioeconomic conditions, trauma experience, emotional stability (the Single-Item Measures of Personality), Posttraumatic Stress Disorder Checklist (PCL), daily hassles and uplifts (the Stress Profile), and coping strategies (the Brief Coping Orientation to Problems Experienced [COPE] questionnaire), was completed by 57 female users at nine support centers for survivors of incest and sexual abuse in Norway. The results show that the H-PTSD group reported significantly more daily hassles, fewer daily uplifts, and more use of maladaptive coping strategies. The L-PTSD group reported more emotional stability, fewer daily hassles, and more uplifts, and used more adaptive coping strategies. However, few differences were found between the H-PTSD and the L-PTSD groups with regard to severity of sexual abuse and socioeconomic conditions. The results on the hassle, uplift, and coping scales are potentially interesting from an interventional point of view. Major life events such as sexual abuse may be out of control for the afflicted victim. Appraisal of and coping with everyday events, however, can be affected and offer interesting possibilities for interventions directed at the survivor, her significant others, and professional helpers.

Political skill in higher military staff: Measurement properties and latent profile analysis.

Social effectiveness, including political skill, reflects individuals' ways of handling interpersonal processes at work. Most research has used a variable-oriented approach to investigate associations between political skill and key organizational factors, including performance, in civil settings. Thus, little is known of whether political skill transfers to a military context and whether there are specific profiles of political skill. Combining variable-oriented and person-oriented approaches, this study used self-reports from two samples of military student officers to: (1) investigate measurement properties of the 18-item political skill inventory; (2) explore whether it is possible to identify different profiles of political skill; and (3) investigate whether such profiles differ in demographics, personality, and job performance. Exploratory (sample 1: n = 185) and confirmatory (sample 2: n = 183) factor analyses supported a four-dimensional representation of political skill including networking ability, apparent sincerity, social astuteness, and interpersonal influence. Latent profile analysis (samples 1 and 2: N = 368) identified four distinct combinations of these dimensions, namely: (1) weak political skill; (2) weak political skill with strong sincerity; (3) moderate political skill; and (4) strong political skill. Importantly, profiles differed consistently in networking ability. Subsequent comparisons suggested potentially important differences in demographics, personality, and job performance. Despite needing additional research of how profiles of political skill develop over time, these findings may have practical implications for recruitment and training in organizational settings where social effectiveness is important.

Perceived stress and hair cortisol levels amongst conscripts during basic military training: A repeated measures study.

The aim was to examine hair cortisol levels and self-reported stress amongst conscripts during their basic military training, and how they are related to four types of theory-derived determinants. The following prediction was made: lower levels of perceived stress and hair cortisol will be associated with: (1) higher levels of emotional stability (the individual nonmilitary aspect); (2) a lower degree of private life problems (the contextual nonmilitary aspect); (3) more positive attitudes toward the military, higher engagement in military service, and higher adaptability to military conditions (the individual-military aspect); and (4) stronger group cohesion and better leadership (the contextual-military aspect). The sample consisted of a total of 107 male Lithuanian conscripts. Assessments were made at the beginning of their basic military training, in the middle, and at the end. Established instruments were used on all self-reported scales. Hair cortisol levels were established through analyses of hair samples. Low to moderate levels of stress were found throughout the basic training period regarding perceived stress levels. Hair cortisol levels were mainly unrelated to the self-rating scales. Regarding perceived stress, the prediction was fully confirmed. The future value of the theoretical model is discussed.

The Association between Endogenous Hair Steroid Hormones and Social Environmental Factors in a Group of Conscripts during Basic Military Training.

This study aimed to analyse the association between endogenous hair steroid hormones as reliable biological indicators of an individual's stress level and the social environmental factors experienced during military training that are manifested at the beginning of compulsory military service. Hair steroid hormone concentrations-cortisol, cortisone, dehydroepiandrosterone (DHEA), and testosterone-in a group of 185 conscripts were measured using the ultra-high performance liquid chromatography-tandem mass spectrometry method. Six subjective social environmental factors in the military-attitude towards the military and military service, adaptation to the military environment, team, task, and norm cohesion, as well as psychological (un)safety in the group-were evaluated using military-specific research questionnaires. Weak but significant negative correlations were identified between cortisol and adaptation (r = -0.176, p < 0.05), attitude (r = -0.147, p < 0.05) as well as between testosterone and task cohesion (r = -0.230, p < 0.01) levels. Additionally, a multiple forward stepwise regression analysis highlighted that cortisone variation might be partially explained by task cohesion; the DHEA-determined by psychological (un)safety in the group, attitude towards the military and military service, and norm cohesion; and the testosterone-determined by task cohesion and adaptation to the new military environment. The results of this study suggest that subjective measures of social factors can be used to predict hair steroid hormone levels as objective measures of the chronic stress perceived by conscripts during their basic military training.

Interrelationship of emotional stability, hassles, uplifts, coping and stress-related symptoms in Swedish female and male military veterans.

Drawing on previous research, two hypotheses were tested: (1) the higher the frequency of daily uplifts and use of functional coping strategies, and the lower the frequency of daily hassles and use of dysfunctional coping strategies, the lower the prevalence of stress-related symptoms will be, and vice versa; and (2) the direct relationship between the personality dimension emotional stability and stress-related symptoms, will be moderated by daily hassles, daily uplifts and coping processes. A quantitative test of a qualitatively developed model was performed. A questionnaire was sent to all Swedish military veterans who had served in the period 2011-2015 and 1859 individuals (1,614 men and 199 women, 46 individuals did not mark gender) responded (40.5% total response rate). All analyses were made separately for men and women. Comparisons between theoretically favorable and unfavorable profiles across the model variables, daily uplifts, daily hassles, functional coping and dysfunctional coping (based on a cluster analysis), showed considerable differences regarding the prevalence of stress-related symptoms as predicted by the model and supporting the first hypothesis. Regression and moderation analyses yielded limited support for the second hypothesis. As predicted, female veterans reported a higher frequency of physical, emotional and cognitive stress-related symptoms than male veterans. The main conclusion is that the theoretical model stood up well when empirically tested and offers a promising approach to future studies on everyday stress and health. The results contribute with new knowledge of military veterans compared to the main stream PTSD, depression and drug abuse-oriented studies.

How women experience and cope with daily hassles after sexual abuse - a retrospective qualitative study.

The impact of stress on health can depend on factors such as frequency, heightening of stress during a given period or the presence of one or a few repeated hassles of psychological importance. The aim of this study was to gain a deeper understanding of how adult women experience and cope with daily hassles after sexual abuse. Ten interviews were analysed using the grounded theory method. The theoretical model of 'protecting armor in daily life' emerged. The aftermath of sexual abuse related coping with daily stress can be understood as a three-phase process: (1) avoiding and escaping-coping after experiencing sexual abuse; (2) accepting and disclosing-starting a process of recovery; and (3) reconciling and repossessing-living with the experience in the present. The model contributes to a deeper understanding of the everyday life of women who have experienced sexual abuse. Increased knowledge of coping behaviours that can be used to deal with daily hassles may also serve as a tool for health professionals, other helpers and family to help these women rebuild a good life.

Stress reactions following acute situations involving moral challenges among health care professionals.

Many health care professionals have to make morally difficult decisions during acute, stressful situations. The aim was to explore the applicability of an existing qualitatively developed model of individual reactions among professional first responders following such situations using a quantitative approach. According to the model, the interaction of antecedent individual and contextual characteristics affect the immediate emotional reactions to acute, stressful events involving a moral dilemma. Continuous coping efforts and the quality of social support will also affect the long-term positive and negative reactions to the event. The participants (n = 204, about 50% response rate) represented three Swedish health care professions stationed at a university hospital and a regional hospital: Physicians (n = 50), nurses (n = 94) and "others" (n =60, mainly social welfare officers and assistant nurses). Except for the personality dimension emotional stability which was measured using an established instrument, all measurement scales were operationalizations of codes and categories from the qualitative study (ten scales altogether). Four multiple regression analyses were performed with long-term positive and negative reactions in everyday acute and morally extremely taxing situations respectively as dependent variables. The outcome showed that long-term positive reactions covaried with much use of the coping strategies Emotional distancing and Constructive emotional confrontation and a perception of a well-functioning Formal social support. Regarding long-term negative reactions, higher age and little use of Emotional distancing accounted for much of the variance. Immediate emotional reactions also contributed significantly. CONCLUSION: the results largely supported the model concepts and their assumed relationships.

Leadership behavior changes following a theory-based leadership development intervention: A longitudinal study of subordinates' and leaders' evaluations.

The aim was to evaluate effects of leadership courses based on the developmental leadership model at the leadership behavioral level. A longitudinal design was employed with assessments before, one and six months after the leadership courses. The sample consisted of 59 leaders who made self-ratings and were rated by at least three subordinates on each occasion. Leadership behaviors were measured with the Developmental Leadership Questionnaire (DLQ). A limited increase of favorable leadership behaviors and a significant reduction of unfavorable leadership behaviors were found, particularly according to the subordinates' ratings. A cluster analysis yielded three meaningful leader profiles and showed that this pattern was found in all three profiles, irrespective of how favorably they were rated before the onset of the intervention.

Daily hassles, their antecedents and outcomes among professional first responders: A systematic literature review.

Occupational groups such as firefighters, military officers, paramedics and police officers are exposed to a combination of acute, severe and accumulated everyday stress. Drawing on the daily hassles perspective on stress, the aim was to synthesize existing research on daily hassles in professional first responder settings into a theoretical model. A systematic mixed studies review with an integrated design was undertaken. The selection process resulted in 40 articles meeting the inclusion criteria. The selected papers represented two literature reviews, one qualitative study, eight longitudinal studies and 29 cross-sectional studies. Five superior categories emerged in the analysis: Individual antecedent and continuously framing factors, Environmental antecedent and continuously framing factors, Appraisal and coping processes, Daily hassles and Outcome. Suggestions for future research are presented.

Implementation of patient-focused care: before-after effects.

PURPOSE: The purpose of this paper is to evaluate an organizationally oriented, patient-focused care (PFC) model's effects on care quality and work climate. DESIGN/METHODOLOGY/APPROACH: The study has a before-after (PFC implementation) design. The sample included 1,474 patients and 458 healthcare providers in six participating wards before and after PFC implementation, plus five additional randomly chosen wards, which only featured in the post-assessment. FINDINGS: No pre-post differences were found regarding care perceptions or provider work climate evaluations. Statistically significant improvements were noted among provider care evaluations. Using aggregate-level ward data, multiple regression analyses showed that high adherence to PFC principles and a positive work climate contributed significantly to variance among care quality ratings. RESEARCH LIMITATIONS/IMPLICATIONS: Among healthcare providers, questions related to specific PFC aspects during evenings, nights and weekends had to be dropped owing to a low response rate. PRACTICAL IMPLICATIONS: An important requirement for both practice and research is to tailor PFC to various health and social care contexts. ORIGINALITY/VALUE: The study is large-scale before-after PFC model review, where patient and provider data were collected using well-established measurements.

Terrorism as a process: a critical review of Moghaddam's "Staircase to Terrorism".

This study reviews empirical evidence for Moghaddam's model "Staircase to Terrorism," which portrays terrorism as a process of six consecutive steps culminating in terrorism. An extensive literature search, where 2,564 publications on terrorism were screened, resulted in 38 articles which were subject to further analysis. The results showed that while most of the theories and processes linked to Moghaddam's model are supported by empirical evidence, the proposed transitions between the different steps are not. These results may question the validity of a linear stepwise model and may suggest that a combination of mechanisms/factors could combine in different ways to produce terrorism.

Birthgiving women's feelings and perceptions of quality of intrapartal care: a nationwide Swedish cross-sectional study.

AIM: The aim was to explore the relationships between the feelings of women who give birth and several birth-related care conditions, the womens' socio-demographic background, personality and perceptions of the quality of intrapartum care. BACKGROUND: Childbirth is a highly significant emotional event for women and it is an explicit goal that each woman should have a positive childbirth experience. DESIGN: The nationwide study is cross-sectional and was conducted at Swedish maternity units over two months in 2007. METHODS: The study group consisted of 739 women (63% response rate). A dimensionality analysis of six emotion items was performed using structural equation modelling (SEM). Non-parametric tests and generalised linear mixed effects model analyses were used to study relationships and to make subgroup comparisons. RESULTS: In the SEM analysis, a positive and a negative feeling factor were identified. Strong associations between the feeling factors and the womens' perceptions of the quality of care were found, particularly in regard to the so-called identity-oriented approach of the midwives and other health professionals. In addition, a higher intensity of negative feelings was associated with a personality pattern characterised by extraversion, emotional instability and lower degree of conscientiousness, a lower level of education and having had delivery through Caesarean section. CONCLUSIONS: The positive and negative feelings of women who give birth strongly covary with the women's perception of the quality of their intrapartum care. This pertains in particular to information issues, the midwives showing commitment, empathy and respect, being present during labour and allowing the women to actively participate as much as they want to. RELEVANCE TO CLINICAL PRACTICE: Subgroup differences indicate that midwives should pay increased attention to childbearing women who have primary school education only, a lower emotional stability and/or deliver through Caesarean section.

Health effects on leaders and co-workers of an art-based leadership development program.

BACKGROUND: There are very few evaluations of the effectiveness of leadership development programs. The purpose of the study was to examine whether an art-based leadership program may have a more beneficial effect than a conventional one on leaders' and their corresponding subordinates' mental and biological stress. METHODS: Participating leaders were randomized to 2 year-long leadership programs, 1 art-based and 1 conventional, with follow-up of the leaders and their subordinates at 12 and 18 months. The art-based program built on an experimental theatre form, a collage of literary text and music, followed by writing and discussions focused on existential and ethical problems. RESULTS: After 18 months a pattern was clearly visible with advantage for the art-based group. In the art group (leaders and their subordinates together as well as for subordinates only) compared to the conventional group, there was a significant improvement of mental health, covert coping and performance-based self-esteem as well as significantly less winter/fall deterioration in the serum concentration of the regenerative/anabolic hormone dehydroepiandrosterone-sulfate. CONCLUSIONS: Our findings indicate a more beneficial long-term health effect of the art-based intervention compared to a conventional approach. Positive results for both standardized questionnaires and biological parameters strengthened the findings. The study provides a rationale for further evaluation of the effectiveness of this alternative educational approach.

Womens' opinions on intrapartal care: development of a theory-based questionnaire.

AIM: To develop a patient questionnaire specific to intrapartal care, based on the theoretical foundation of the general instrument Quality from the Patient's Perspective (QPP). BACKGROUND: Existing general patient questionnaires do not take intrapartal care aspects fully into account, and available intrapartal-specific patient questionnaires tend to have a weak theoretical foundation. DESIGN: A cross-sectional, nationwide study carried out during a two-week period in 2007 at Swedish maternity units. METHOD: An intrapartal-specific QPP-questionnaire (QPP-I) was developed by combining a selection of 22 items from the short and long versions of the QPP with 10 newly constructed items. Responses were obtained from 739 women (63% response rate). The dimensionality of the QPP-I was assessed using structural equation modelling (a nested factor model). Non-parametric statistics were used for subgroup comparisons. RESULTS: A nested model with a general factor including all 32 items and 10 subordinate factors was developed. Most scales had acceptable reliability coefficients (0.73-0.93), and a meaningful pattern of subgroup differences was obtained. CONCLUSIONS: The QPP-I is theory based and has its roots in a patient perspective. It was developed using a nationwide sample of Swedish women receiving intrapartal care, and an advanced statistical method was used. The outcome of this initial empirical trial was promising but needs to be tested in different countries and cultures. RELEVANCE TO CLINICAL PRACTICE: By combining womens' responses on perceived reality and subjective importance ascribed to the various aspects of care measured, the QPP-I offers the care provider better guidelines on which elements to focus quality improvement work on, than would be the case if only a rank order of perceived reality ratings was available.

Quality of care and patient satisfaction: a new theoretical and methodological approach.

PURPOSE: The paper's purpose is to develop a care-context adapted version of the emotional stress reaction questionnaire (ESRQ), which is based on the cognitive-phenomenological writings of Lazarus, and, using this instrument, to explore the relationship between quality of care from a patient perspective and patient satisfaction while taking key antecedent conditions into account. DESIGN/METHODOLOGY/APPROACH: Data were collected from 624 patients at 16 Swedish out-patient clinics (75 per cent response rate). Patients responded to the ERSQ, the quality from the patient's perspective questionnaire (QPP), the single-item measures of personality (SIMP), and questions related to the outcome of the visit. Dimensionality of the ESRQ was analysed using exploratory factor analysis and structural equation modelling. The relationship between the theoretical concepts was explored with logistic regression analysis. FINDINGS: A care-context adapted version of the ESRQ was developed with meaningful factors and satisfactory psychometric properties. Care-episode specific appraisal and coping processes covaried as predicted with emotional responses. The theoretical model was partly confirmed when assessed against two outcome criteria: intention to follow the doctor's advice and hesitation to visit the same out-patient clinic again. PRACTICAL IMPLICATIONS: The scales used are easy to administer and interpret. ORIGINALITY/VALUE: The suggested theoretical model of the relationship between quality of care from a patient perspective and patient satisfaction is new, as is the emotion-oriented approach to assessing patient satisfaction.