Job mobility and job performance: beliefs about social and occupational (dis)advantages as mediators.

Background. Modern working conditions require an increased amount of spatial mobility from employed personnel. Research suggests that different types of job mobility might exert negative effects on well-being and health, and additionally have different costs and benefits for the work and the social domains. Methods. Using data from 3191 members of the German Armed Forces, we investigated the effects of four different types of job mobility (long-distance commuters, overnighters, residential mobiles and multi-mobiles) in contrast to non-mobiles on employees' subjective job performance as an occupationally relevant outcome. Moreover, we expected beliefs about social and occupational advantages and disadvantages to mediate the effects of job mobility on subjective job performance. Results. A single concrete event during relocation had fewer negative consequences compared to the effects of circular mobility or multi-mobility. Moreover, beliefs about occupational and social advantages and disadvantages were differently associated with the different types of job mobility and partially mediated the direct effects of job mobility on job performance. Conclusions. Not all types of job mobility are an impairment and extra-organizational stress. Rather, the evaluation and perception of occupational and social (dis)advantages is crucial for the effects of different types of job mobility on organizational relevant outcomes.

Effects of a Workplace-Based Sleep Health Program on Sleep in Members of the German Armed Forces.

STUDY OBJECTIVES: To develop and evaluate a brief manual-based sleep health program within the workplace health promotion of the German Armed Forces. METHODS: The sleep health program comprised four weekly group sessions. Sixty-three members (48 males) were randomly allocated to either a treatment group or a waiting control group matching for age, sex, and baseline Pittsburgh Sleep Quality Index (PSQI). The control group had to wait before participating in the sleep health program until the treatment group finished the intervention. Sleep was assessed by ambulatory polysomnography (PSG) as well as with evening and morning protocols at baseline (t0), directly after the treatment group participated in the sleep health program (t1), and after the control group finished participation (t2). The PSQI, the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS) were applied at the same three time points, and during a 3-month follow-up evaluation (t3). RESULTS: Fifty-seven out of the 63 randomized individuals (42 males, mean age = 40.6 years; complete PSG data: n = 36; complete questionnaire data: n = 39) participated in the sleep health program. Objective wake after sleep onset, sleep efficiency, latency to persistent sleep, self-reported sleep latency, restfulness, PSQI, and ISI scores improved with medium or large effects in both groups. ESS scores decreased with moderate effects in the treatment group only. CONCLUSIONS: The sleep health program had a positive and stable effect on objective and self-reported sleep parameters, and it is suitable as a preventive measure in members of the German Armed Forces. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Title: Development and Evaluation of a Sleep-coaching Program; Identifier: NCT02896062; URL: https://clinicaltrials.gov/ct2/show/record/NCT02896062.

Effect of deployment related experiences on sleep quality of German soldiers after return from an International Security Assistance Force (ISAF) mission to Afghanistan.

The aim of the present study was to investigate the effect of experiencing potentially traumatic events during deployment on post-deployment sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) and the Addendum for Post-Traumatic Stress Disorder (PTSD) of the Pittsburgh Sleep Quality Index (PSQI-A). Deployment related experiences were quantified on a standardised list of the Mental Health Advisory Team of the U.S. armed forces. The original sample consisted of 118 soldiers of the German armed forces who were deployed to Afghanistan for six months. The present analyses focused on data assessed after deployment (n = 70) and in a three-month follow-up (n = 51). Results indicate that immediately after return experiences during deployment had an independent significant effect on sleep quality but not three months later. Immediately after return depressive and stress symptoms significantly affected sleep quality while three months later somatic symptoms were significant. At both time points sleep prior to deployment was a significant predictor of sleep quality following deployment. Given the importance of sleep quality prior to deployment as a known independent risk factor for newly occurring mental disorders after deployment, these results underline the need to improve sleep quality already at an early stage.

Contingent negative variation in acute trauma patients: A prospective exploratory study.

It is still unclear why some individuals completely recover after an acute trauma and others develop a long-lasting post-traumatic stress disorder (PTSD). This study investigates whether the contingent negative variation (CNV) - a slow negative event-related potential - may be associated with the occurrence of PTSD after acute trauma. CNV (auditory 2-stimulus reaction time paradigm) was recorded within one month as well as 6 months after an acute trauma (dangerous or grave physical injuries, witnessing of attempted suicide or murder, robbery, extortion, accidents, heavy illness, death or loss of an important person, hostage-taking) in 39 otherwise healthy adults and compared with CNV recordings in 38 healthy control subjects without potentially traumatizing experience in their history. According to their subsequent clinical course, these subjects were divided into two groups: participants who recovered completely 1 month after the trauma (PTSD- group, n = 31), and those who began to experience PTSD (PTSD+ group, n = 8). Patients from both trauma groups were characterized by a significantly longer reaction time immediately after the trauma. The PTSD+ group demonstrated lower amplitudes of the late CNV component immediately and six months after the trauma compared with the PTSD- and the control group. Whether the lower CNV amplitudes in patients who develop PTSD after the acute trauma, which is already present in the first days after the trauma, may be related to a higher risk for development of PTSD in these subjects, this has to be clarified in further prospective studies.

Assessing Psychological Fitness in the Military - Development of an Effective and Economic Screening Instrument.

Background: There are a high number of soldiers with deployment-related and non-deployment-related mental health problems in the German Armed Forces (Bundeswehr): This has led to an increase in mental disorders and a decrease in quality of life. To tackle these problems and to strengthen resources among the Bundeswehr personnel, this study aims at developing a screening instrument for assessing the psychological fitness of soldiers on the basis of questionnaire scales. In this approach, psychological fitness describes a soldier's ability to integrate and enhance his/her mental and emotional capabilities using resources and trainable skills. Methods: Bundeswehr combat soldiers (N = 361) answered questionnaires about resilience (RS-11), sense of coherence (SOC-L9), quality of life (WHOQOL-BREF), mental disorders (PHQ-D) and post-traumatic growth (PTG). Additionally, they were interviewed by trained troop psychologists both before and after their deployment in Afghanistan from January to June 2014. The screening model is based on self-report data; the psychological fitness in the standardized interview serves as a validation standard. Findings: A linear logistic regression model was performed that includes the social relationship and the psychological scale from WHOQOL-BREF and the somatoform and the stress scale from PHQ. This model allows specialists a first assessment between participants who are psychologically fit before and after deployment and those who are less so. The chosen cutoff for sensitivity is between 70% and 79% and for specificity between 70% and 85%. Discussion: This screening approach is still not applicable to large populations like that of the Bundeswehr, which currently has about 170,000 soldiers but it is limited to deployed combat troops. Classifying psychological fitness allows specialists to differentiate between people in need of special training or additional diagnostic measures and those in need of sustaining their fitness regularly at the earliest possible stage. A follow-up study that is representative of deployed and non-deployed military personnel will examine whether these results can be transferred to the entire Bundeswehr and whether the validity of the interview can be established.

Short-Term-Effectiveness of a Relationship Education Program for Distressed Military Couples, in the Context of Foreign Assignments for the German Armed Forces. Preliminary Findings From a Randomized Controlled Study.

This study examines the short-term effectiveness of a relationship education program designed for military couples. Distressed couples were randomly placed in either a wait-list control group or an intervention group. We conducted training sessions before a 3-month foreign assignment, and refresher courses approximately 6-week post-assignment. We analyzed the dyadic data of 32 couples, using hierarchical linear modeling in a two-level model. Reduction in unresolved conflicts was found in the intervention group, with large pre-post effects for both partners. Relationship satisfaction scores were improved, with moderate-to-large effects only for soldiers, rather than their partners. Post-follow-up effect sizes suggested further improvement in the intervention group. Future research should examine the long-term effectiveness of this treatment.

Social cognitive aspects of the participation in workplace health promotion as revealed by the theory of planned behavior.

Health-promoting efforts strongly depend on individual cognitions such as attitudes as well as social cognitive aspects of the work environment such as leadership and support. Using the theory of planned behavior (TPB) as a theoretical frame, participation behavior of employees in courses offered by the workplace health promotion (WHP) program of the German Armed Forces was investigated. Social cognitive aspects of the work environment, such as leadership behaviors by setting an example or optimizing organization of work, were included in the TPB components of subjective norm and perceived behavioral control, which allowed for an investigation of the specific effects of leadership on WHP participation. A survey study with N=1385 members of the German Armed Forces was conducted in 2015 in Germany. Results showed that perceived behavioral control and attitudes towards WHP were the strongest predictors for WHP participation. While subjective norm was positively related to attitudes, it had a slightly negative effect on intention to participate in WHP activities. These findings suggest that the most effective way for leadership to increase WHP participation is to enhance perceived behavioral control. Quite contrary, creating a positive subjective norm regarding WHP participation may even result in psychological reactance.

Sleep quality of German soldiers before, during and after deployment in Afghanistan-a prospective study.

In this prospective study, subjective sleep quality and excessive daytime sleepiness prior to, during and after deployment of German soldiers in Afghanistan were examined. Sleep quality (Pittsburgh Sleep Quality Index; PSQI) and daytime sleepiness (Epworth Sleepiness Scale; ESS) were assessed in 118 soldiers of the German army, who were deployed in Afghanistan for 6 months (deployment group: DG) and in 146 soldiers of a non-deployed control group (CG) at baseline. Results of the longitudinal analysis are reported, based on assessments conducted prior to, during the deployment and afterwards in the DG, and in the CG in parallel. Sleep quality and daytime sleepiness in the DG were already impaired during the predeployment training phase and remained at that level during the deployment phase, which clearly indicates the need for more attention on sleep in young soldiers, already at this early stage. The percentage of impaired sleepers decreased significantly after deployment. Programmes to teach techniques to improve sleep and reduce stress should be implemented prior to deployment to reduce sleep difficulties and excessive daytime sleepiness and subsequent psychiatric disorders.

Evaluation of a Technology-Based Adaptive Learning and Prevention Program for Stress Response-A Randomized Controlled Trial.

To prevent deployment-related disorders, Chaos Driven Situations Management Retrieval System (CHARLY), a computer-aided training platform with a biofeedback interface has been developed. It simulates critical situations photorealistic for certain target and occupational groups. CHARLY was evaluated as a 1.5 days predeployment training method comparing it with the routine training. The evaluation was carried out for a matched random sample of N = 67 soldiers deployed in Afghanistan (International Security Assistance Force). Data collection took place before and after the prevention program and 4 to 6 weeks after deployment, which included mental state, post-traumatic stress disorder (PTSD) symptoms, knowledge of and attitude toward PTSD, and deployment-specific stressors. CHARLY has been significantly superior to the control group in terms of psychoeducation and attitude change. As to the mental state, both groups showed a significant increase in stress after deployment with significant lower increase in CHARLY. For PTSD-specific symptoms, CHARLY achieved a significant superiority. The fact that PTSD-specific scales showed significant differences at the end of deployment substantiates the validity of a specifically preventive effect of CHARLY. The study results tentatively indicate that highly standardized, computer-based primary prevention of mental disorders in soldiers on deployment might be superior to other more personal and less standardized forms of prevention.

[Mental disorders in German soldiers after deployment - impact of personal values and resilience]. / Zusammenhänge zwischen Psychischer Symptomatik und Persönlichen Werten bei Bundeswehrsoldaten nach einem Auslandseinsatz.

OBJECTIVE: Soldiers are at increased risk of developing mental health disorders after military deployment. The impact of personal values on psychological symptomatology based on an empirical working model has not yet been studied in a military environment. METHODS: 117 German Armed Forces soldiers completed the Portrait-Values-Questionnaire (PVQ), the Patient-Health-Questionnaire (PHQ) and the Resilience-Scale (RS-11) after their deployment to Afghanistan. RESULTS: In the regression analyses the values hedonism, benevolence, tradition, self-direction and universalism had a differential significant impact on depression, anxiety and somatoform symptoms of the PHQ. The RS-11 sum scale values were negatively correlated with symptomatology. CONCLUSION: Personal values and resilience seem to be associated with psychological symptomatology in soldiers after military deployment. The results can contribute to the further development of both preventive and therapeutic approaches.

Evaluation of an inpatient preventive treatment program for soldiers returning from deployment.

BACKGROUND: Since 1999, the German Armed Forces (Bundeswehr) have been conducting 3-weeks preventive treatment programs aimed at psychological resource-strengthening in soldiers returning from deployment. METHODS: Five hundred participants of these programs received the Posttraumatic Stress Scale 10 (PTSS-10) before and after treatment and the rehabilitation assessment questionnaire of the German statutory pension insurance body. Sixty control group subjects received the PTSS-10 twice in an interval of 4-5 months without therapeutic interventions. RESULTS: Comparison of pre- and post-treatment PTSS-10 results in the covariance analysis showed an effect of the initial PTSS-10-stress-levels and rank category, not of the intervention. On average, the treatment program received 'very good' to 'excellent' overall ratings in the rehabilitation questionnaire. The acceptance of sports and movement therapy was significantly above average, whereas that of individual and group counselling was below. CONCLUSIONS: The results of this pilot study suggest a high acceptance of the post-deployment preventive program. Effectiveness in terms of psychometric improvement cannot be proven at this point.

Searching for non-genetic molecular and imaging PTSD risk and resilience markers: Systematic review of literature and design of the German Armed Forces PTSD biomarker study.

Biomarkers allowing the identification of individuals with an above average vulnerability or resilience for posttraumatic stress disorder (PTSD) would especially serve populations at high risk for trauma exposure like firefighters, police officers and combat soldiers. Aiming to identify the most promising putative PTSD vulnerability markers, we conducted the first systematic review on potential imaging and non-genetic molecular markers for PTSD risk and resilience. Following the PRISMA guidelines, we systematically screened the PubMed database for prospective longitudinal clinical studies and twin studies reporting on pre-trauma and post-trauma PTSD risk and resilience biomarkers. Using 25 different combinations of search terms, we retrieved 8151 articles of which we finally included and evaluated 9 imaging and 27 molecular studies. In addition, we briefly illustrate the design of the ongoing prospective German Armed Forces (Bundeswehr) PTSD biomarker study (Bw-BioPTSD) which not only aims to validate these previous findings but also to identify novel and clinically applicable molecular, psychological and imaging risk, resilience and disease markers for deployment-related psychopathology in a cohort of German soldiers who served in Afghanistan.

Personal values in soldiers after military deployment: associations with mental health and resilience.

BACKGROUND: After military deployment, soldiers are at an increased risk of developing posttraumatic psychiatric disorders. The correlation of personal values with symptoms, however, has not yet been examined within a military context. METHOD: Schwartz's Portrait Values Questionnaire (PVQ), the Posttraumatic Stress Diagnostic Scale (PDS), and the 11-item version of the Resilience Scale (RS-11) were completed by 117 soldiers of the German Armed Forces who had recently been deployed to Afghanistan (n=40 undergoing initial psychiatric treatment, n=77 untreated). RESULTS: Logistic regression showed that the value types of hedonism (-), power (-), tradition (+), and universalism (+) were significantly correlated with the probability and severity of PTSD and whether the participant was in treatment or not. The effects were partially mediated by the RS-11 scale values. CONCLUSIONS: Value types seem to be associated with psychiatric symptoms in soldiers after deployment. These results could contribute to the further development of therapeutic approaches.

Ship management attitudes and their relation to behavior and performance.

OBJECTIVE: The aim of this study was to adapt the Crew Resource Management (CRM) Attitudes Questionnaire (CMAQ) to the maritime domain, to assess the ship management attitudes of junior naval officers, and to determine the extent to which these attitudes correlate with behavior and performance in a naval exercise. BACKGROUND: CRM attitudes have been shown to be associated with performance in aviation, but it is unclear whether this construct is applicable and relevant to the maritime domain. METHOD: Participants were 121 active seafarers and 101 junior officers of the German Navy who completed the Ship Management Attitudes Questionnaire-German Navy (SMAQ-GN). Ratings of nontechnical skills and ratings of mission success of the junior officers were collected during a real-world naval exercise. RESULTS: Internal consistencies of SMAQ-GN were similar to those of the original CMAQ and retest reliability was rather high. Attitudes of junior officers toward communication and coordination were positive. Regarding command responsibility and the recognition of stressor effects, positive as well as neutral and negative attitudes were found. Overall, attitudes did not correlate with behavior and performance. Separate analysis of those participants reporting negative to neutral ship management attitudes showed substantial positive correlations of attitudes with behavior and performance. CONCLUSION: Ship management attitudes play a significant role in commanding ships. The attitude-performance linkage is not linear. Behavior and performance are less effective in officers with negative attitudes and equally effective in officers with slightly positive and very positive attitudes. APPLICATION: Ship management attitudes can be used to assess training needs for nautical teams.

Treatment of avoidant personality traits in a German armed forces inpatient psychiatric setting.

Military duty places high demands on the soldiers' social adaptability and competences. Avoidant personality traits can lead to interpersonal conflicts and at least to mental disorders. 192 German Armed Forces soldiers were treated in a multimodal inpatient psychiatric treatment setting at a Bundeswehr hospital between 2007 and 2010. 129 of these patients received a social skills group training (group training of social competence [GSC]) as part of this setting. A comparison group (n=63) did not participate but got unspecific treatment elements instead. The Symptom Checklist 90-Revised (SCL-90-R) and the Inventory on Competence and Control Beliefs (Fragebogen zu Kompetenz- und Kontrollüberzeugungen [FKK]) were applied. Symptom severity in the SCL-Global Severity Index, sum scale of the SCL-90-R and the four primary scales of the FKK showed significant improvements both immediately after treatment and at follow-up. No significant influence of the form of treatment (with/without GSC), age, gender, diagnosis, and deployments on the treatment result was established in the analysis of covariance. The data suggest that an inpatient psychiatric treatment setting focused on avoidant personality traits has a favorable effect on psychiatric symptom severity in military personnel. Social skills group training as a treatment component does not seem to be significantly superior to the standard setting.

Deployment-related stress disorder in german soldiers: utilization of psychiatric and psychotherapeutic treatment.

INTRODUCTION: Military missions abroad carry a high risk of psychological traumatization. In this study, we examined the reasons for increased utilization of the treatments offered to soldiers by the German armed forces' psychiatric services. METHOD: We analyzed trends in initial contacts with psychiatrists and psychotherapists among German soldiers participating in missions to Afghanistan and the Balkans. To this end, we evaluated existing data from the psychiatric services of all German Armed Forces Military Hospitals with respect to sociodemographic factors (sex, area of mission) and the underlying psychiatric disorders over an 18-month period (January 2010 to June 2011). RESULTS: 615 soldiers made an initial contact with the psychiatric and psychotherapeutic services during the study period. The total number of first contacts did not change significantly (p = 0.195), but there was a notable rise in the number of first contacts by female soldiers with deployment-related stress (p = 0.003). Mission-specific statistics revealed a significant increase in the number of first contacts only for soldiers deployed to the Balkans (p = 0.017). 91% of soldiers making a first contact were given the diagnosis of a stress reaction (ICD-10: F 43); the second most common diagnosis (8.9%) was an affective disorder (ICD-10: F 32.0, F 32.1). CONCLUSION: Despite psychological prevention efforts, military missions abroad often lead to mental disorders. Our findings indicate that the mild observed increase in incidence is both sex-specific and deployment-area-specific.

Time-dependent post-imperative negative variation indicates adaptation and problem solving in migraine patients.

According to the Seligman theory of learned helplessness, depression is caused by a repetitive experience of loss of control resulting in internal, stable and global attributional styles for negative events. In depressed patients and healthy controls experiencing such events, an increased amplitude of the post-imperative negative variation (PINV) has been described. The aim of the study was to investigate a possible correlation between migraine, depression, learned helplessness and PINV. 24 patients suffering from migraine without aura and 24 healthy controls were exposed to a situation of loss of control whilst the contingent negative variation (CNV) from C3, C4 and Cz were recorded. Before conducting the experiment, the subjects were asked to answer the Beck Depression Inventory (BDI) and the German attributional style questionnaire (GASQ). Amplitudes of total CNV, early and late component and PINV were calculated in eight blocks of four recordings each. The results confirm findings of a pronounced PINV in situations of loss of control, though high amplitudes were not correlated with low values in the GASQ and therefore with learned helplessness. High PINV in migraine patients correlated with high scores in the BDI and the list of the complaints questionnaire. However, this was not the case in healthy controls. In this experimental situation, PINV in migraine patients can be interpreted as an expectancy potential in order to avoid failure and helplessness.

Does inert gas narcosis have an influence on perception of pain?

The effect of an increased nitrogen partial pressure under hyperbaric conditions is known as nitrogen narcosis (NN). At an ambient pressure of about 4 bar, reduced cognitive performance as well as euphoric effects are reported. We examined the effect of NN on pain perception. 22 subjects completed an experimental (50 meters = 6 bar) and a simulated control dive (0 m = 1 bar) in a hyperbaric chamber. Before and during each dive a standardized cold pressure test was performed. The intensity of pain perceived was assessed with the help of a visual analogue scale; additionally, subjects assessed the subjective effect of NN. The study showed that the perceived pain intensity is significantly reduced under nitrogen narcosis conditions (F1.21 = 5.167, p < 0.034) when compared to the perceived pain intensity under the control dive conditions (F1.21 = 0.836, p = 0.371). A connection between perceived pain intensity and subjects experience of the NN was not found under the experimental dive condition (r = 0.287, p = 0.195). We could show that even relatively moderate hyperbaric conditions may have an influence on the perception of pain. The results are highly relevant since nitrogen narcosis occurs in divers as well as in medical personnel or construction workers, working under hyperbaric conditions.

The impact of a multimodal Summer Camp Training on neuropsychological functioning in children and adolescents with ADHD: an exploratory study.

This study examined the combined effects of methylphenidate (MPD) and response cost and token strategy (RCT), administered in an intensive ADHD Summer Camp Training (ASCT) format, on neuropsychological functions. Forty children with ADHD were randomly assigned to either the ASCT treatment (MPD plus RCT) or a control group (MPD plus a 1-hour session of standardized parental education/counselling [SPC]). This latter group was structured to be similar to the more typical current treatment. The ASCT treatment was administered for 2½ weeks and included RCT, consisting of elements of social skill training, attention training, and sports participation. RCT was systematically applied in all daily situations and activities. Executive functions and state of regulation using the Test for Attention Performance (TAP) and the Trail-Making Test (TMT) were assessed before training and at a 6-month follow-up. Participants receiving the ASCT improved specific neuropsychological functions in attention regulation and inhibitory control tasks at the 6-month follow-up. No changes occurred for participants assigned to the control condition. The data suggest that an intensive multimodal summer camp treatment program including strategies of instrumental learning can lead to substantial and enduring improvements in neuropsychological functioning of children and adolescents with ADHD.