Reducing Stress and Burnout in Military Healthcare Professionals Through Mind-Body Medicine: A Pilot Program.

INTRODUCTION: A 6-week mindfulness training course, the Mind-Body Medicine (MBM) pilot program for staff, was implemented at a large military treatment facility to examine the preliminary efficacy of the program in reducing stress and burnout in military healthcare professionals. MATERIALS AND METHODS: A retrospective analysis was conducted of data collected from a single-arm prospective MBM pilot program. The program was designed to help staff members increase their awareness of burnout and its consequences and to learn how to utilize mindfulness-based self-care practices as a means for reducing stress and preventing burnout at work. Participants attended a 2-hour MBM group each week for a total duration of 6 weeks. Assessments of stress, resilience, anxiety, somatic symptoms, functional impairment, sleep quality, quality of life, and burnout were administered at baseline (T1), upon completion of the 6-week program (T2), and at least 3 months after program completion (T3). Multilevel modeling was used as the primary statistical model to assess changes in outcomes. Fifty-nine staff members completed assessments at T1, 31 (52.5%) at T2, and 17 (28.8%) at T3. RESULTS: Participants showed improvements on scores of perceived stress, resilience, anxiety, somatic symptoms, quality of life, and burnout variables from T1 to T2 and from T1 to T3 (P < .05). Additionally, they reported improvements in their knowledge, understanding, and utilization of MBM concepts and practices from T1 to T2 and from T1 to T3 (P < .05). CONCLUSIONS: Results from this pilot suggest that the MBM program has the potential to reduce occupational stress and burnout and improve well-being in military healthcare professionals.

Pre-service factors associated with sexual misconduct among male U.S. Marines.

PURPOSE: Sexual assault is a prevalent and persistent problem in the military, yet few studies have examined predictors of sexual offenses. The study aim was to determine pre-service factors associated with sexual offense conviction among U.S. Marines. METHODS: This retrospective cohort study analyzed data from male active duty U.S. Marines (2003-2018). Pre-service factors were assessed using survey data from the Recruit Assessment Program, obtained prior to recruit training at the Marine Corps Recruit Depot, San Diego, California. These survey data were linked with sexual offense conviction data obtained from the Naval Criminal Investigative Service Consolidated Law Enforcement Operations Center. RESULTS: Of the 146,307 participants, the majority were 18-19 years old (66.7%) and non-Hispanic, White (62.1%) with a high school education or less (76.8%); 107 received convictions for a sexual offense. In unadjusted analyses, race and ethnicity, parental education, type of primary caregiver, parental death, family economic status, childhood emotional trauma, childhood physical abuse, childhood sexual abuse, and unprotected sex were associated with a sexual offense conviction. In the final multivariable model, race and ethnicity (American Indian/Alaskan Native, odds ratio [OR]: 5.28, 95% confidence interval [CI]: 1.86-14.98; Hispanic, OR: 1.83, 95% CI: 1.06-3.18; multiracial/other, OR: 3.28, 95% CI: 1.56-6.89), education (≤ high school, OR: 2.65; 95% CI: 1.21-5.80), parental death (OR: 2.27; 95% CI: 1.16-4.45), unprotected sex (OR: 1.78; 95% CI: 1.03-3.05), and school suspension/expulsion (OR: 1.64; 95% CI: 1.02-2.65) were significant predictors of a subsequent sexual offense conviction. CONCLUSIONS: Results underscore the importance of understanding factors associated with sexual offense and highlight the large discrepancy between self-reported estimates of sexual assault and sexual offense convictions. Findings may inform the development of effective strategies to reduce sexual misconduct, such as technology-facilitated programs that provide private, targeted education; supportive assistance; and prevention materials to individuals who may have elevated sexual misconduct risk.

ORION: A novel solution for tracking service members exposed to trauma and providing targeted outreach.

In response to the USS Fitzgerald (FTZ) and USS John S. McCain (JSM) collisions in 2017, Navy Medicine developed the Organizational Incident Operational Nexus (ORION) to track Service members and conduct targeted outreach (Caring Contacts) to those at elevated risk for psychological injury after unit-level, non-combat trauma exposure. A 1-year pilot was conducted to test the feasibility of implementing ORION. During the pilot, crews from the FTZ and JSM received Caring Contacts twice, once in winter/spring of 2018 and once in the summer/fall of 2018. Caring Contacts included reaching out to Service members over email, checking in with Service members over the phone, and connecting them to mental health resources, if desired. Sixty-two percent of the crews of the FTZ and JSM completed Caring Contacts. The Caring Contacts were well received and one in five Service members requested assistance connecting to mental healthcare through ORION. Additionally, all paygrades from enlisted to officers and 66% of Service members who separated from Service requested assistance connecting to mental healthcare through ORION. Findings from the Caring Contacts also demonstrated that 50% of the crews needed mental health support after the collision, with 30% of Sailors reporting accessing care since the collision and an additional 20% requesting care during the Caring Contacts. Overall, results suggest Service members greatly benefited from ORION's proactive approach to confidential outreach. Navy Medicine is now working toward implementing ORION throughout the enterprise and collecting more data to refine the program. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A mind-body program for pain and stress management in active duty service members and veterans.

The Mind-Body Medicine (MBM) program at the Naval Medical Center San Diego, created in collaboration with the Benson-Henry Institute for Mind Body Medicine and the Home Base Program at Massachusetts General Hospital, is a 7-week program designed to facilitate stress management habits into patient treatment plans. The aim of this study is to test the feasibility and acceptability of a mind-body program for service members and veterans. Participants (N = 239) were primarily active duty service members of the U.S. Navy and Marine Corps reporting significant perceived stress (Stress Resiliency (SR) group; n = 124), or meeting criteria for chronic pain (Pain Management (PM) group; n = 115). Participants completed measures at preprogram and post-program assessing for perceived stress, pain, functional impairment, quality of life, and psychological and somatic symptoms. Changes in self-reported psychological symptoms and knowledge and practice of mind-body principles were examined. Participants across groups had significant improvement in most outcomes (perceived stress, response to stressful experience, functional impairment, sleep disturbance, depression, PTSD, and anxiety symptoms; and each quality of life domain aside from social relationships), with p values < .0017 (Bonferroni corrected level of significance). The SR group demonstrated significant improvements in primary outcomes of perceived stress and response to stressful experience, and the PM group demonstrated significant improvement in pain severity, but not perceived stress. Significant change was observed in knowledge and practice of mind-body medicine principles, and high satisfaction was reported. Results suggest that a mind-body program may improve physical and psychological functioning for service members, including those facing significant perceived stress and chronic pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Workforce Planning for Embedded Mental Health Care in the U.S. Navy.

INTRODUCTION: Embedding mental health providers directly into operational units provides opportunities for holistic individual and population focused mental health support. To effectively provide clinical mental health care to a large number of Sailors and Marines while supporting the larger command, it is crucial to arrive at an optimal number of mental health (MH) care staff. In response to an increasing demand for MH care by operational units distributed globally, the U.S. Navy (USN) critically analyzed the current MH staffing levels, estimated future demand for MH care providers, and evaluated several staffing options. The following article illustrates a case study of workforce planning for the USN's embedded MH delivery model. MATERIALS AND METHODS: Several existing data sources were used to calculate current number of MH care staff across all USN platforms and to estimate demand for MH care. An open source Linear Programming application was used to estimate staffing solutions that meet business requirements in the most efficient manner possible. RESULTS: Results suggested different conclusions for embedded mental health staffing across USN communities. Depending on existing staffing levels and the number of Sailors or Marines anticipated to require care, the Linear Programming algorithm estimated needed staffing levels to address demand. CONCLUSION: The current project represents the first systematic workforce planning initiative designed to help staff the USN's global demand for community focused MH care. The results of this project have identified areas where additional embedded mental health resources should be made available. By systematically documenting all services and capabilities and carefully examining the operational demands of each community, the current solution was able to identify precisely what type of MH resources should be allocated to a given community.

Factors associated with persistent posttraumatic stress disorder among U.S. military service members and veterans.

BACKGROUND: Posttraumatic stress disorder (PTSD) can have long-term and far-reaching impacts on health and social and occupational functioning. This study examined factors associated with persistent PTSD among U.S. service members and veterans. METHODS: Using baseline and follow-up (2001-2013) questionnaire data collected approximately every 3 years from the Millennium Cohort Study, multivariable logistic regression was conducted to determine factors associated with persistent PTSD. Participants included those who screened positive for PTSD using the PTSD Checklist-Civilian Version at baseline (N = 2409). Participants were classified as having remitted or persistent PTSD based on screening negative or positive, respectively, at follow-up. RESULTS: Almost half of participants (N = 1132; 47%) met criteria for persistent PTSD at the first follow-up; of those, 804 (71%) also screened positive for PTSD at the second follow-up. Multiple factors were independently associated with persistent PTSD in an adjusted model at the first follow-up, including older age, deployment with high combat exposure, enlisted rank, initial PTSD severity, depression, history of physical assault, disabling injury/illness, and somatic symptoms. Among those with persistent PTSD at the first follow-up, additional factors of less sleep, separation from the military, and lack of social support were associated with persistent PTSD at the second follow-up. CONCLUSIONS: Combat experiences and PTSD severity were the most salient risk factors for persistent PTSD. Comorbid conditions, including injury/illness, somatic symptoms, and sleep problems, also played a significant role and should be addressed during treatment. The high percentage of participants with persistent PTSD supports the need for more comprehensive and accessible treatment, especially after separation from the military.

Responding to Trauma at Sea: A Case Study in Psychological First Aid, Unique Occupational Stressors, and Resiliency Self-Care.

The U.S. Navy deploys Special Psychiatric Rapid Intervention Teams (SPRINT) to sites of military disasters to assist survivors and the command. SPRINT functions primarily as a consultant to help commands effectively respond to the mental health needs of their service members following a traumatic event. Utilizing the principles of psychological first aid, the overall goal of SPRINT is to mitigate long-term mental health dysfunction and facilitate recovery at both the individual and unit level. We present a case study of a SPRINT mission to a deployed U.S. Navy ship in response to a cluster of suicides and subsequent concerns about the well-being of the remaining crew. Throughout this mission, important themes emerged, such as the impact of accumulated operational stressors and the subsequent development of mental health stigma. Also, this case study demonstrates the potential effectiveness of introducing resiliency self-care meditation training to remote environments that lack ready access to mental health resources. From here, SPRINT can provide a model for immediate disaster mental health response that has potential relevancy beyond the military.

Sexual Trauma and Adverse Health and Occupational Outcomes Among Men Serving in the U.S. Military.

Although absolute counts of U.S. service men who experience sexual trauma are comparable to service women, little is known about the impact of sexual trauma on men. The association of recent sexual trauma (last 3 years) with health and occupational outcomes was investigated using longitudinal data (2004-2013) from the Millennium Cohort Study. Of 37,711 service men, 391 (1.0%) reported recent sexual harassment and 76 (0.2%) sexual assault. In multivariable models, sexual harassment or assault, respectively, was associated with poorer mental health: AOR = 1.60, 95% CI [1.22, 2.12], AOR = 4.39, 95% CI [2.40, 8.05]; posttraumatic stress disorder: AOR = 2.50, 95% CI [1.87, 3.33], AOR = 6.63, 95% CI [3.65, 12.06]; depression: AOR = 2.37, 95% CI [1.69, 3.33], AOR = 5.60, 95% CI [2.83, 11.09]; and multiple physical symptoms: AOR = 2.22, 95% CI [1.69, 2.92]; AOR = 3.57, 95% CI [1.98, 6.42], after adjustment for relevant covariates. Sexual harassment was also associated with poorer physical health: AOR = 1.68, 95% CI [1.27, 2.22]. Men who reported sexual trauma were more likely to have left military service: AOR = 1.60, 95% CI [1.14, 2.24], and be disabled/unemployed postservice: AOR = 1.76, 95% CI [1.02, 3.02]. Results suggest that sexual trauma was significantly associated with adverse health and functionality extending to postmilitary life. Findings support the need for developing better prevention strategies and services to reduce the burden of sexual trauma on service men.

Health Care Provider Burnout in a United States Military Medical Center During a Period of War.

OBJECTIVE: Provider burnout can impact efficiency, empathy, and medical errors. Our study examines burnout in a military medical center during a period of war. METHODS: A survey including the Maslach Burnout Inventory (MBI), deployment history, and work variables was distributed to health care providers. MBI subscale means were calculated and associations between variables were analyzed. RESULTS: Approximately 60% of 523 respondents were active duty and 34% had deployed. MBI subscale means were 19.99 emotional exhaustion, 4.84 depersonalization, and 40.56 personal accomplishment. Frustration over administrative support was associated with high emotional exhaustion and depersonalization; frustration over life/work balance was associated with high emotional exhaustion. CONCLUSIONS: Levels of burnout in our sample were similar to civilian medical centers. Sources of frustration were related to administrative support and life/work balance. Deployment had no effect on burnout levels.

Leveraging iPads to introduce meditation and reduce distress among cancer patients undergoing chemotherapy: a promising approach.

PURPOSE: Distress is common among cancer patients. Regular meditation practice has the potential to mitigate this distress and improve quality of life for this population. Introducing meditation to cancer patients can be particularly challenging given the demands on patients' time from treatment and normal life events. This internal process improvement study examined the potential benefit of utilizing iPads during chemotherapy sessions to introduce meditation and reduce distress. METHODS: Patients undergoing chemotherapy infusion were offered iPads with various meditation videos and audio files during the session. Levels of distress were measured using the distress thermometer at the beginning of chemotherapy and at the conclusion of chemotherapy. RESULTS: Seventy-three patients accepted the meditation iPads during the chemotherapy session. Among those who accepted the iPads, average distress dropped 46% by the end of the session (p < 0.0001). CONCLUSIONS: The use of iPads during chemotherapy is a potentially effective way to introduce meditation as a stress management tool for people with cancer.

Recent Sexual Trauma and Adverse Health and Occupational Outcomes Among U.S. Service Women.

Sexual trauma is prevalent among military women, but data on potential effects are needed. The association of sexual trauma with health and occupational outcomes was investigated using longitudinal data from the Millennium Cohort Study. Of 13,001 U.S. service women, 1,364 (10.5%) reported recent sexual harassment and 374 (2.9%) recent sexual assault. Women reporting recent sexual harassment or assault were more likely to report poorer mental health: OR = 1.96, 95% CI [1.71, 2.25], and OR = 3.45, 95% CI [2.67, 4.44], respectively. They reported poorer physical health: OR = 1.39, 95% CI [1.20, 1.62], and OR = 1.39, 95% CI [1.04, 1.85], respectively. They reported difficulties in work/activities due to emotional health: OR = 1.80, 95% CI [1.59, 2.04], and OR = 2.70, 95% CI [2.12, 3.44], respectively. They also reported difficulties with physical health: OR = 1.55, 95% CI [1.37, 1.75], and OR = 1.52 95% CI [1.20, 1.91], respectively, after adjustment for demographic, military, health, and prior sexual trauma characteristics. Recent sexual harassment was associated with demotion, OR = 1.47, 95% CI [1.12, 1.93]. Findings demonstrated that sexual trauma represents a potential threat to military operational readiness and draws attention to the importance of prevention strategies and services to reduce the burden of sexual trauma on military victims.

Mind body medicine in the care of a U.S. Marine with chronic pain: a case report.

Many service members suffer from chronic pain that can be difficult to adequately treat. Frustration has led to more openness among service members to complementary and alternative medicine modalities. This report follows JK, a Marine with chronic pain related to an injury while on combat deployment through participation in a 6-week self-care-based Mind Body Medicine program and for 7 months after completion of the program. JK developed and sustained a regular meditation practice throughout the follow-up period. JK showed a noticeable reduction in perceived disability and improvements in psychological health, sleep latency/duration and quality of life. This report supports further study into the efficacy and feasibility of self-care-based mind body medicine in the treatment of chronic pain in the military medical setting.

The effect of geographic moves on mental healthcare utilization in children.

PURPOSE: Geographic moves have been reported to have a negative impact on the mental health of children, but it is often difficult to separate the effect of the move from the circumstances that impelled it. Military populations may offer a way to examine this issue. Moves are common in military families, but parental employment and healthcare coverage remain constant. METHODS: Children of military parents with geographic moves in 2008 were compared with those without geographic moves with regard to the odds of mental health service use in 2009. RESULTS: This study included 548,336 children aged 6-17 years, and 179,486 (25%) children moved in 2008. Children aged 6-11 years with a geographic move had higher odds of mental health and outpatient visits (odds ratio [OR] 1.03; 95% confidence interval [CI] 1.01-1.06). Children aged 12-17 years with a geographic move had higher odds of mental outpatient visits (OR 1.04; 95% CI 1.01-1.07), psychiatric hospitalizations (OR 1.19; 95% CI 1.07-1.32), and emergency psychiatric visits (OR 1.20; 95% CI 1.07-1.32). CONCLUSION: Children with a geographic move in the previous year have increased odds of mental health encounters. Among adolescents, this increase extends to psychiatric hospitalizations and emergency visits.

Parental Iraq/Afghanistan deployment and child psychiatric hospitalization in the U.S. military.

OBJECTIVE: Members of the US armed forces have been heavily deployed in support of wars in Afghanistan and Iraq. This study examined the affect of a parent's deployment to war on the rate of psychiatric hospitalization among their children. METHODS: This was a retrospective cohort study. Records of children of active duty personnel during fiscal years 2007 through 2009 were linked with their parent's deployment records. Psychiatric hospitalizations were identified using International Classification of Diseases, Ninth Revision codes on admission. Odds ratios (OR) of hospitalization were determined using both univariate and multivariate logistic regression. Lengths of hospital stay were also compared by linear regression using Duan's smearing estimate method. RESULTS: A total of 377,565 children aged 9-17 years were included along with data on both their active duty and civilian parent. Mean child age was 12.53 years (S.D.: 2.5 years); 51% were male. Mean age of active duty parent was 37.8 years (S.D.: 5.2 years); 93% were male, 90% were married and 62% were white. In the study, 2533 children were hospitalized for a mental or behavioral health disorder in fiscal year 2009 with a median length of stay of 8 days. After adjusting for demographic data and past psychiatric history of the child, active duty parent and civilian parent, the OR of hospitalization for children with a recently deployed parent was 1.10 (95% confidence interval: 1.01-1.19). The OR of hospitalization increased with increasing length of deployment with a positive test of trend. There was no statistically significant difference in distribution of admission diagnoses or length of hospital stay based on deployment by the active duty parent. CONCLUSIONS: Psychiatric hospitalization increased by 10% among children aged 9-17 years when a military parent was recently deployed. The odds of hospitalization increased with increasing length of a parent's deployment.

Spousal military deployment as a risk factor for postpartum depression.

OBJECTIVE: To compare the Edinburgh Postnatal Depression Scale (EPDS) results in women whose spouses had deployed during or after pregnancy vs. those whose spouses had not. STUDY DESIGN: A chart review of 6-week postpartum visits of women with active-duty spouses was conducted over 10 months. Associations between military deployments and EPDS score were examined by Student's t test, and rates of positive screens (with a cutoff of 12) between groups were compared by odds ratio (OR). Linear regression was used to calculate predictors of EPDS score. RESULTS: A total of 415 charts were analyzed. The average EPDS score of women whose partner did deploy during the pregnancy was 7.36 compared to 4.81 for those whose partners did not (p < 0.001). The percentage of positive screens for women whose partner deployed during the pregnancy was 25.27% compared with 10.94% for an OR of 2.75 (p < 0.001). Linear regression showed partner's deployment during pregnancy to be an independent predictor of EPDS score (p < 0.005). CONCLUSION: Deployment of a spouse during pregnancy may be a risk factor for depression. Aggressive screening of this at-risk population is recommended.