Retrospective Appraisals of Threat and Benefit Mediate the Effects of Combat Experiences on Mental Health Outcomes in Army Medics

ABSTRACT

A life-threatening traumatic experience can cause physical and psychological distress, but it can also be remembered with pride from having demonstrated one's courage and abilities under severe circumstances. Characteristics of the event, as well as later personal reflection, together determine the individual's response to a traumatic event. This study investigates how traumatic combat experiences and retrospective appraisals of those experiences affect reports of posttraumatic stress and depression symptoms in 324 United States Army medics. Higher levels of combat experiences were associated with both appraisals of threat to life (r = .40) and appraisals of personal benefit of the deployment (r = .15). Threat appraisals were associated with increases in symptoms of posttraumatic stress and depression (r = .33 and .29), whereas benefit appraisals were associated with decreases in those symptoms (r = −.28 and −.30, respectively). These opposing mediation pathways led to weaker or nonsignificant total effects, which concealed the true effects of combat intensity on posttraumatic stress (R² = .28) and depression (R² = .24). Perceiving that combat experiences had beneficial effects on one's life is associated with less intense mental health symptomology and can offset the detrimental effects of traumatic combat experiences.

KEYWORDS:

• Posttraumatic stress
• military
• mental health behavioral symptoms
• veterans
• depression

Acknowledgments

This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans' Hospital. We acknowledge the contribution of LTC David Cabrera, the original principal investigator of the Soldier Medic Mettle Study, who was killed in action in Kabul, Afghanistan on October 29, 2011.

Funding

This study was funded by the United States Army Medical Research and Materiel Command.