What Did We Miss? Analysis of Military Personnel Responses to an Open-Ended Question in a Post-Deployment Health Survey.

INTRODUCTION: Post-deployment health surveys completed by military personnel ask about a range of deployment experiences. These surveys are conducted to determine if there are links between experiences and poor health. Responses to open-ended questions in these surveys can identify experiences that might otherwise go unreported. These responses may increase knowledge about a particular deployment and inform future surveys. This study documented deployment experiences described by Australian Defence Force personnel who were deployed to the Middle East. MATERIALS AND METHODS: A survey completed by 14,032 personnel examined health outcomes and over 100 experiences relating to their Middle East deployment. Responses to two open-ended questions captured additional experiences. Descriptive statistics reveal the characteristics of those who did and did not describe additional experiences, and a content analysis details the nature and frequency of the experiences reported. The study was approved by an Institutional Review Board. RESULTS: Five percentage (n = 692) of personnel who completed the survey described additional deployment experiences. The most frequently reported experiences were specific Navy experiences; experiences of poor leadership; administrative or organizational issues; the anthrax vaccine; and traumatic events/potentially morally injurious experiences. CONCLUSIONS: The findings suggest that post-deployment health surveys should have questions about certain deployment experiences tailored by military service (i.e., Air Force, Army, and Navy). Researchers could consider including questions about personnel experiences of leadership for its impact on health and about potentially morally injurious experiences that may help explain adverse mental health. Clear wording of open-ended questions and participant instructions may improve response rates and reduce response biases.

Implementation of evidence-based, non-pharmacological interventions addressing behavior and psychological symptoms of dementia: a systematic review focused on implementation strategies.

OBJECTIVE: This study aimed to identify the nature and effects of implementation strategies to increase the use of evidence-based, non-pharmacological interventions designed to reduce the frequency and/or severity of behavioral and psychological symptoms associated with dementia, for people living in the community. DESIGN: This was a systematic review of implementation studies. We searched six databases (in January 2019) and hand-searched reference lists of reports. Studies were included if they used quantitative methods evaluating the use of implementation strategies to increase the use of non-pharmacological interventions. These interventions had to have been tested in a randomized controlled trial (RCT) and found to reduce behavioral and psychological symptoms of dementia, for those living in the community. Studies needed to report the effect of the implementation on clinical practice, for example, a change in practice or the adoption of the intervention in community settings. RESULTS: Twelve studies were included: 11 one-group pre-post design studies and 1 cluster RCT. All studies reported practice change - the majority implementing a new intervention, with six different types of interventions implemented. All studies reported including using partnerships, new funding, educational strategies, and ongoing support and consultation. Seven implementation studies reported positive outcomes for clients on some aspect of behavior or depression for the person with dementia. CONCLUSIONS: Implementation studies using multiple implementation strategies to increase the use of non-pharmacological interventions have demonstrated improvements in behavioral and psychological symptoms common in people with dementia, when provided by clinicians as part of their everyday work routines.

Military Personnel Ratings of a Deployment and Their Positive and Negative Deployment Experiences.

INTRODUCTION: There is limited investigation of how military personnel evaluate their deployment experiences. An understanding of their perceptions would help unit psychologists to advise commanders on ways to improve the deployment experience (and therefore mental well-being) of personnel. This study examined the interplay between deployment overall ratings, personnel characteristics and positive and negative deployment experiences in aid of such understanding. MATERIALS AND METHODS: The participants were 1,226 Australian Defence Force personnel who deployed to East Timor and (through a survey) provided an overall rating of their deployment and comments on major positive and negative deployment experiences. Descriptive statistics detail ratings by personnel characteristics, and a hybrid content/thematic analysis details the positive and negative experiences. The study was approved by an Institutional Review Board. RESULTS: Over 80% of the participants rated their overall East Timor deployment experience as positive, with 13% rating it as neutral and 7% as negative. Intrinsic rewards (eg, ability to use skills) were the most commonly expressed major positive experiences of the deployment, with deployment administration and military leadership the most common negatives. Most intrinsic rewards were reported more often in participants with a positive deployment rating, while poor leadership was most frequent in those with a negative rating. CONCLUSIONS: Military leadership is corroborated as a negative experience of military deployment, while a new finding indicates that intrinsic rewards are a common feature in positive evaluations of deployment. Leadership is a factor that Defence Forces can address to improve the deployment experience. The study strength is the range and size of the sample, with a limitation the potential for recall bias (the data were collected, on average, 5 years postdeployment). Future research should replicate this type of analysis to build a picture of the experiences and evaluations of personnel from a range of different deployments.

Effect of Multiple Deployments on Military Families: A Cross-Sectional Study of Health and Well-Being of Partners and Children.

This study explored the impact of multiple deployments on the health and well-being of the partners (married or de facto) and children of Australian military personnel who have deployed frequently. Permission to contact military partners was sought from a sample of Australian Defence Force (ADF) members. Partners provided data on deployment history, physical health, mental health, and their children's emotions, and behaviors. Associations between multiple deployments and health and well-being of partners and children were assessed using logistic regression. Data were collected from 1,332 Australian Defence Force partners (response rate 36%) with 1,095 children aged between 4 and 17 years. Almost half (47%) of partners had experienced more than one deployment, mainly to Timor-Leste, Iraq, and Afghanistan. There was little evidence of associations between numbers of deployments and the health of the partner. In contrast, more behavioral problems were reported for children who experienced two or more deployments with odds ratios generally greater than 2 and significant trends with increasing numbers of deployment. Although military families who experience multiple deployments may, by selection, be more resilient than those who have fewer deployments, these results suggest that adverse impacts on the children may accrue with increasing parental absences because of deployment.

Spouses of military members' experiences and insights: qualitative analysis of responses to an open-ended question in a survey of health and wellbeing.

INTRODUCTION: There are few studies on the experiences of spouses of military members, with most focused on adverse impacts of deployment. Responses to an open-ended question in a survey of spouses' health and wellbeing enabled access to perceptions and insights on a broad range of topics. The objective of this investigation was to examine how respondents used the open-ended question and what they discussed, in aim of informing support service agencies and spouses of military members. METHODS: Thematic analysis was conducted on responses to the open-ended question. Descriptive analysis was performed on the demographics, military member characteristics and self-reported health of respondents and non-respondents to the open-ended question. FINDINGS: Over a quarter (28.5%) of the 1,332 survey participants answered the open-ended question, with respondents having a significantly higher level of education than non-respondents. Respondents expressed negative and positive experiences and insights on military life, provided personal information, commented on the survey, and qualified their responses to closed-ended questions. Topics included 'inadequate support', 'deployment impacts', 'suggestions for supporting agencies', 'appraisal of experiences' and 'coping strategies'. CONCLUSIONS: This investigation uncovered issues of importance to spouses of military members that were not included or identified in a quantitative study. The findings provide a platform from which to explore these issues further, particularly the impact of military life on the non-serving spouse's career. The findings also provide support agencies with evidence to strengthen their services and they give spouses an opportunity to reflect on their own and others' feelings and evaluations of military life.