The association of resilience on psychiatric, substance use, and physical health outcomes in combat trauma-exposed military service members and veterans

Figures & data

Table 1. Descriptive characteristics of the sample (N = 1046) and main predictor and outcome variables.

Demographic Variables	N/Mean	%/SD
Age	36.2	9.86
Gender
Male	920	88.0
Female	126	12.0
Ethnicity
White/Caucasian	580	55.4
African American	460	44.0
Marital Status
Married/Partnered	572	54.7
Divorced/Separated	244	23.3
Never Married	226	21.6
Widowed	3	.3
Education
GED	53	5.4
High School	431	41.2
Technical/Trade School	101	9.7
Associate’s Degree	174	16.6
Bachelor Degree	167	16.0
Master Degree	50	4.8
Doctorate Degree	7	.7
Other	63	6.0
Military Related Variables
Active Duty	87	8.3
Rank
E-1 to E-4	338	32.5
E-5 to E-7	569	54.7
E-8 to E-9	59	5.7
W-1 to W-5	17	1.6
O-1 to O-9	58	5.6
Tours Served	1.63	1.13
Study Predictor Variables
Combat Exposure	18.68	9.02
Social Support	70.42	26.74
Resilience*	590	56.4
GSI items
GSI raw score**	1.16	.88
GSI t-score	50.0	10.0
Above cut-off threshold ≥ 63	133	12.7
TLEQ events endorsed	7.31	3.57
TLEQ items (top 5)
Natural disaster	703	67.3
Sudden death of loved one	835	79.9
Life threat to loved one	426	40.8
Threatened with death or harm	400	38.3
Other life threatening/distressing event	578	55.3
Study Outcome Variables
Current Psychiatric Diagnosis	721	68.9
Count of Psychiatric Diagnoses	1.05	0.91
Primary diagnostic categories
Posttraumatic stress disorder	623	59.6
Major depressive disorder	300	28.7
Alcohol abuse/dependence	89	8.5
Panic disorder	33	3.2
Social anxiety disorder	36	3.4
Illicit drug abuse/dependence	28	2.7
AUDIT total	5.91	6.67
Above cut-off threshold ≥ 8	122	11.7
DAST total	1.58	2.85
Above cut-off threshold ≤ 6	84	8.0
Physical Health Complaints	4.93	4.28

*As resilience represents the standardized residuals from a regression, the mean is 0. A dichotomous yes/no resilience status is presented here only for descriptive purposes, wherein a positive residual (after multiplying by −1) was deemed resilient. The continuous measure is used in the study analyses, with a range of is −3.17–2. Measures comprising the resilience variable are included as well. ** the GSI T score, not the raw score, was used in creation of the resilience variable, which has a mean of 50 and SD of 10.

Abbreviations: TLEQ = Traumatic Life Events Questionnaire, using the event sum of endorsed traumatic events resulting in intense fear, helplessness, or hopelessness; SLC GSI = General severity index of the Symptom Check List-90; AUDIT = Alcohol Use Disorders Identification Test; DAST = Drug Abuse Screening Test.

Table 2. Correlations of study variables of interest (N = 1046).

Variable	1	2	3	4	5	6	7	8	9	10	11	12
1. Age at visit	–
2. Gender^a	−.02	–
3. Race^b	.22**	.12**	–
4. Education^c	.23**	.15**	−.001	–
5. Marital Status^d	−.28**	.19**	.06	−.08*	–
6. CES	−.20**	−.16**	−.20**	−.10**	.04	–
7. MOS	−.01	.001	−.09*	.07*	−.27**	−.09**	–
8. DBPR	.09**	−.05	−.04	.15**	.01	−.17**	.31**	–
9. Psychiatric Dx^e	−.03	.10**	.05	−.14**	.06	.20**	−.29**	−.55**	–
10. AUDIT	−.22**	−.14**	−.08*	−.11**	.12**	.18**	−.13**	−.21**	.15**	–
11. DAST	−.18**	−.04*	.02	−.16**	.14**	.10**	−.12**	−.17**	.19**	.38**	–
12. NVVRS Health	.02	.11**	−.08*	.01	−.07*	.18**	−.18**	−.46**	.41**	.08**	.12**	–

* = p < .05; ** = p < .01; correlations created specifying dichotomous and continuous variables; a = Reference, males (= 0, females = 1); b = Reference, Caucasian (= 0, African American and Other = 1); c = Education was treated as an ordinal variable with 1 = G.E.D., 2 = High School Diploma, 3 = Technical/Trade school, 4 = Associate degree, 5 = Bachelor degree, 6 = Master degree, 7 = Doctoral degree, the ‘other’ option was considered missing in analyses as level/nature of education is unknown; d = Marital status, reference is married vs. divorced/separated/widowed or never married; e = Psychiatric Dx; sum count of current diagnosis of internalizing Axis 1 conditions by DSM-IV.

Abbreviations: CES = Combat Exposure Scale; MOS = Social Support Scale; Resilience = discrepancy-based resilience determination; AUDIT = Alcohol Use Disorders Identification Test; DAST = Drug Abuse Screening Test; NVVRS Health = National Vietnam Veteran Readjustment Study Self-Reported Medical Questionnaire.

Table 3. Model predicting sum of psychiatric diagnoses, alcohol abuse symptoms, drug abuse symptoms, and physical health complaints from several predictors without resilience and model predicting these outcomes with resilience included (N = 1046).

	Psychiatric Diagnosis		AUDIT total		DAST total		Physical Health Complaints
Predictors	β	SE B	β	SE B	β	SE B	β	SE B
Model 1: Initial Model, all variables
Age	0.01	0.02	−0.18***	0.10	−0.17***	0.03	0.04	0.08
Gender	0.15***	0.09	−0.13***	0.54	−0.08*	0.16	0.18***	0.46
Race	0.05	0.06	−0.01	0.42	0.04	0.11	−0.09**	0.28
Education	−0.14***	0.02	−0.02	0.14	−0.08*	0.04	−0.01	0.10
Marital Status	−0.06	0.06	0.06	0.44	0.02	0.11	−0.14***	0.29
Combat Exposure	0.20***	0.02	0.11***	0.12	0.08*	0.03	0.19***	0.08
Social Support	−0.28***	0.02	−0.12**	0.13	−0.13***	0.03	−0.20***	0.09
Model 2: Trimmed, without resilience
Age	–		−0.20***	0.09	−0.18***	0.03	–
Gender	0.14***	0.09	−0.12***	0.52	−0.07*	0.15	0.18***	0.46
Race	–		–		–		−0.10**	0.25
Education	−0.13***	0.02	–		−0.08*	0.03	–
Marital Status	–		–		–		−0.13***	0.26
Combat Exposure	0.19***	0.02	0.11***	0.12	0.07* 0.03		0.18***	0.08
Social Support	−0.27***	0.02	−0.14***	0.13	−0.14***	0.03	−0.20***	0.09
Model 3: Trimmed, with resilience
Age	–		−0.19***	0.09	−0.18***	0.03	–
Gender	0.10***	0.07	−0.13***	0.51	−0.08**	0.15	0.15***	0.43
Race	–		–		–		−0.11**	0.24
Education	−0.08**	0.16	–		−0.07*	0.03	–
Marital Status	–		–		–		−0.11***	0.25
Combat Exposure	0.12***	0.01	0.09**	0.11	0.05 0.03		0.12***	0.07
Social Support	−0.14***	0.02	−0.09*	0.14	−0.11**	0.03	−0.07^+	0.09
Resilience	−0.47***	0.03	−0.16***	0.23	−0.13***	0.06	−0.42***	0.15

*** = p < .001, ** = p < .01, * = p < .05; ⁺ = p = .054; Psychiatric diagnosis = count of presence of any current Axis I disorder excluding substance use disorders; Alcohol Use = AUDIT; Drug Use = DAST, log transformed; Physical Health Complaints = NVVRS Medical Questionnaire, Part 1, section 2 (current, general health complaints); Gender (male = 0, female = 1); Race (Caucasian = 0, African American and Other = 1); Education was treated as an ordinal variable with 1 = G.E.D., 2 = High School Diploma, 3 = Technical/Trade school, 4 = Associate degree, 5 = Bachelor degree, 6 = Master degree, 7 = Doctoral degree; Marital status (married = 0, divorced/separated/widowed/never married = 1).