Development of character strengths across the deployment cycle among U.S. Army soldiers.

OBJECTIVE: Despite a narrative of post-traumatic growth and resilience, research reliably demonstrating positive character development following adversity has proved elusive. In the current study, we examined changes in character strengths in Army soldiers deploying for the first time. METHOD: The sample was comprised of 212,386 Army soldiers (Mage  = 26.5 years old, SD = 7.13; 70.8% White) who were deploying for the first time. Character strengths were assessed once before and up to three times following soldiers' return from deployment. RESULTS: We found evidence for two classes of change-a resilient class ("stable high") and a declining class ("persistent low"). Most soldiers were resilient-they had high levels of character strengths prior to deployment and changed very little across the deployment cycle. Approximately 40% of soldiers started with lower character and experienced initial declines post-deployment, from which they experienced no more than small gains over time. CONCLUSIONS: Character strengths were highly stable across the deployment transition but some soldiers experienced initial declines from which they never fully rebounded. The findings are discussed in the context of the mechanisms that drive character development.

Optimism and risk of incident hypertension: a target for primordial prevention.

AIMS: Optimism is associated with reduced cardiovascular disease risk; however, few prospective studies have considered optimism in relation to hypertension risk specifically. We investigated whether optimism was associated with a lower risk of developing hypertension in U.S. service members, who are more likely to develop high blood pressure early in life. We also evaluated race/ethnicity, sex and age as potential effect modifiers of these associations. METHODS: Participants were 103 486 hypertension-free U.S. Army active-duty soldiers (mean age 28.96 years, 61.76% White, 20.04% Black, 11.01% Hispanic, 4.09% Asian, and 3.10% others). We assessed optimism, sociodemographic characteristics, health conditions, health behaviours and depression status at baseline (2009-2010) via self-report and administrative records, and ascertained incident hypertension over follow-up (2010-2014) from electronic health records and health assessments. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and adjusted models for a broad range of relevant covariates. RESULTS: Over a mean follow-up of 3.51 years, 15 052 incident hypertension cases occurred. The highest v. lowest optimism levels were associated with a 22% reduced risk of developing hypertension, after adjusting for all covariates including baseline blood pressure (HR = 0.78; 95% CI = 0.74-0.83). The difference in hypertension risk between the highest v. lowest optimism was also maintained when we excluded soldiers with hypertension in the first two years of follow-up and, separately, when we excluded soldiers with prehypertension at baseline. A dose-response relationship was evident with higher optimism associated with a lower relative risk (p < 0.001). Higher optimism was consistently associated with a lower risk of developing hypertension across sex, age and most race/ethnicity categories. CONCLUSIONS: In a diverse cohort of initially healthy male and female service members particularly vulnerable to developing hypertension, higher optimism levels were associated with reduced hypertension risk independently of sociodemographic and health factors, a particularly notable finding given the young and healthy population. Results suggest optimism is a health asset and a potential target for public health interventions.

Comparison of Cardiovascular Health Between US Army and Civilians.

Background Cardiovascular conditions are common in US Army and civilian populations. The recently developed concept of ideal cardiovascular health provides a new approach to evaluating population cardiovascular status. Methods and Results We defined a cohort of 263 430 active duty Army personnel, aged 17 to 64 years, who completed a 2012 physical examination and a corresponding subset of the noninstitutionalized, civilian US population, who participated in the National Health and Nutrition Examination Survey ( NHANES ) 2011 to 2012 cycle. We compared 4 cardiovascular health metrics (current smoking, body mass index, blood pressure, and diabetic status) between Army and civilian groups overall, and separately by sex, race/ethnicity, and age. The Army population was younger, was less often women or Hispanic, and had less post-high school education than the NHANES population. Smoking rates were ≈20% in the Army and NHANES groups, but <15% among Army women and Hispanics. Overall, one third of the Army and NHANES groups and NHANES women, but nearly half of Army women, demonstrated ideal body mass index. Ideal blood pressure was strikingly less prevalent in the Army than NHANES participants (30% versus 55%). Diabetes mellitus was rare in both groups. Conclusions Ideal cardiovascular health was less prevalent in the Army than NHANES group, despite exclusion of the least healthy recruits. Prevalence of ideal body mass index and blood pressure was low in both the Army and NHANES groups, even at early adult ages. This finding reveals the need for policy changes to promote, preserve, and improve ideal cardiovascular health in both the Army and the US population as a whole.

Association Between Predeployment Optimism and Onset of Postdeployment Pain in US Army Soldiers.

Importance: Pain after deployment is a major health care concern. While risk factors have been previously studied, few studies have explored protective factors. Objective: To examine the prospective association between predeployment optimism and the onset of new pain after deployment in US Army soldiers. Design, Setting, and Participants: This prospective longitudinal cohort study examined US Army soldiers (active duty, Reserve, and National Guard) who deployed to Afghanistan or Iraq between February 12, 2010, and August 29, 2014, and completed the necessary psychological and health assessments before and after deployment. Analyses were performed in the Person-Event Data Environment between July 2016 and November 2018. This study relied exclusively on existing, secondary Army data. Of the 413 763 Army soldiers who met the specified deployment criteria, 385 925 soldiers were missing 1 or more of the required assessment forms. Of the remaining 27 838 soldiers who were examined for eligibility, 7104 soldiers were excluded because of preexisting back pain, joint pain, or frequent headaches. These exclusions resulted in a final analytic sample of 20 734 eligible soldiers. Main Outcomes and Measures: This study examined new reports of pain after deployment, including new back pain, joint pain, and frequent headaches. Results: Among 20 734 US Army soldiers (87.8% male; mean [SD] age, 29.06 [8.42] years), 37.3% reported pain in at least 1 new area of the body after deployment: 25.3% reported new back pain, 23.1% reported new joint pain, and 12.1% reported new frequent headaches. As a continuous measure, each 1-U increase in optimism was associated with 11% lower odds of reporting any new pain after deployment, even while adjusting for demographic, military, and combat factors (odds ratio, 0.89; 95% CI, 0.86-0.93). Tertile analyses revealed that compared with soldiers with high optimism (lowest odds of new pain) soldiers with low optimism had 35% greater odds of reporting new pain in any of the 3 sites evaluated (odds ratio, 1.35; 95% CI, 1.21-1.50). In addition, a larger increase in risk of new pain was observed when comparing the moderate-optimism and low-optimism groups rather than the high-optimism and moderate-optimism groups. Conclusions and Relevance: Higher levels of optimism were associated with lower odds of reporting new pain after deployment, over and above other common determinants of pain, including demographic and military characteristics and combat experiences. Soldiers with low levels of optimism before deployment could benefit from programs geared toward enhancing optimism.

Protective Effects of Psychological Strengths Against Psychiatric Disorders Among Soldiers.

This study prospectively examined psychological strengths targeted in U.S. Army training programs as predictors of psychiatric diagnosis in active duty soldiers. At baseline, the cohort (140,584 soldiers) was without psychiatric disorder. Soldiers were then followed for 2 yr and classified as healthy, or acquiring a psychiatric diagnosis (adjustment disorder, anxiety disorder, depression, or post-traumatic stress disorder), or being prescribed psychotropic medication without a psychiatric diagnosis. Soldiers who remained healthy reported significantly higher strengths scores at baseline, compared with soldiers who were diagnosed with a psychiatric disorder. In addition, soldiers in the worst strengths decile were twice as likely to develop a psychiatric disorder, compared with soldiers in the top 50% on baseline strengths. Strengths afforded the greatest protection against depression. Offering tailored resilience training programs could help the Army steel vulnerable soldiers against the challenges of life, military training, and combat.

Is Optimism Associated With Healthier Cardiovascular-Related Behavior? Meta-Analyses of 3 Health Behaviors.

Optimistic people have reduced risk for cardiovascular disease and cardiovascular-related mortality compared with their less optimistic peers. One explanation for this is that optimistic people may be more likely to engage in healthy behavior like exercising frequently, eating fruits and vegetables, and avoiding cigarette smoking. However, researchers have not formally determined the extent or direction of optimism's association with health behaviors. Moreover, it is unclear whether optimism temporally precedes health behaviors or whether the relationship is because of shared common causes. We conducted random effects meta-analyses examining optimism's association with 3 health behaviors relevant for the prevention of cardiovascular disease. PubMed and PsycINFO databases were searched for studies published through November 2017 reporting on optimism's relationship with physical activity, diet, and cigarette smoking. We identified 34 effect sizes for physical activity (n=90 845), 15 effect sizes for diet (n=47 931), and 15 effect sizes for cigarette smoking (n=15 052). Findings suggested that more optimistic individuals tended to engage in healthier behaviors compared with less optimistic individuals, but effect sizes were modest (ractivity=0.07, P<0.0001; rdiet=0.12, P<0.0001; and rsmoking=0.07, P=0.001). Most evidence was cross-sectional (≥53% of effect sizes) and did not consider sociodemographic characteristics (<53% of effect sizes) or psychological distress (<27% of effect sizes) as potential confounders. Optimism is associated with healthier behaviors that protect against cardiovascular disease, although most evidence was relatively low quality. Additional longitudinal and experimental research is required to determine whether optimism causally contributes to healthy behaviors and whether optimism could be an effective target for preventing cardiovascular disease.

The U.S. Army Person-Event Data Environment: A Military-Civilian Big Data Enterprise.

This report describes a groundbreaking military-civilian collaboration that benefits from an Army and Department of Defense (DoD) big data business intelligence platform called the Person-Event Data Environment (PDE). The PDE is a consolidated data repository that contains unclassified but sensitive manpower, training, financial, health, and medical records covering U.S. Army personnel (Active Duty, Reserve, and National Guard), civilian contractors, and military dependents. These unique data assets provide a veridical timeline capturing each soldier's military experience from entry to separation from the armed forces. The PDE was designed to afford unprecedented cost-efficiencies by bringing researchers and military scientists to a single computerized repository rather than porting vast data resources to individual laboratories. With funding from the Robert Wood Johnson Foundation, researchers from the University of Pennsylvania Positive Psychology Center joined forces with the U.S. Army Research Facilitation Laboratory, forming the scientific backbone of the military-civilian collaboration. This unparalleled opportunity was necessitated by a growing need to learn more about relations between psychological and health assets and health outcomes, including healthcare utilization and costs-issues of major importance for both military and civilian population health. The PDE represents more than 100 times the population size and many times the number of linked variables covered by the nation's leading sources of population health data (e.g., the National Health and Nutrition Examination Survey). Following extensive Army vetting procedures, civilian researchers can mine the PDE's trove of information using a suite of statistical packages made available in a Citrix Virtual Desktop. A SharePoint collaboration and governance management environment ensures user compliance with federal and DoD regulations concerning human subjects' protections and also provides a secure portal for multisite collaborations. Taking similarities and differences between military and civilian populations into account, PDE studies can provide much more detailed insight into health-related questions of broad societal concern. Finding ways to make the rich repository of digitized information in the PDE available through military-civilian collaboration can help solve critical medical and behavioral issues affecting the health and well-being of our nations' military and civilian populations.

The Person-Event Data Environment: leveraging big data for studies of psychological strengths in soldiers.

The Department of Defense (DoD) strives to efficiently manage the large volumes of administrative data collected and repurpose this information for research and analyses with policy implications. This need is especially present in the United States Army, which maintains numerous electronic databases with information on more than one million Active-Duty, Reserve, and National Guard soldiers, their family members, and Army civilian employees. The accumulation of vast amounts of digitized health, military service, and demographic data thus approaches, and may even exceed, traditional benchmarks for Big Data. Given the challenges of disseminating sensitive personal and health information, the Person-Event Data Environment (PDE) was created to unify disparate Army and DoD databases in a secure cloud-based enclave. This electronic repository serves the ultimate goal of achieving cost efficiencies in psychological and healthcare studies and provides a platform for collaboration among diverse scientists. This paper provides an overview of the uses of the PDE to perform command surveillance and policy analysis for Army leadership. The paper highlights the confluence of both economic and behavioral science perspectives elucidating empirically-based studies examining relations between psychological assets, health, and healthcare utilization. Specific examples explore the role of psychological assets in major cost drivers such as medical expenditures both during deployment and stateside, drug use, attrition from basic training, and low reenlistment rates. Through creation of the PDE, the Army and scientific community can now capitalize on the vast amounts of personnel, financial, medical, training and education, deployment, and security systems that influence Army-wide policies and procedures.