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Consensus Recommendations for Common Data Elements for Operational Stress Research and Surveillance: Report of a Federal Interagency Working Group

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Abstract

Nash WP, Vasterling J, Ewing-Cobbs L, Horn S, Gaskin T, Golden J, Riley WT, Bowles SV, Favret J, Lester P, Koffman R, Farnsworth LC, Baker DG. Consensus recommendations for common data elements for operational stress research and surveillance: report of a federal interagency working group.

Empirical studies and surveillance projects increasingly assess and address potentially adverse psychological health outcomes from the stress of military operations, but no standards yet exist for common concept definitions, variable categories, and measures. This article reports the consensus recommendations of the federal interagency Operational Stress Working Group for common data elements to be used in future operational stress research and surveillance with the goal of improving comparability across studies. Operational stress encompasses more than just combat; it occurs everywhere service members and their families live and work. Posttraumatic stress is not the only adverse mental or behavioral health outcome of importance. The Operational Stress Working Group contends that a primary goal of operational stress research and surveillance is to promote prevention of adverse mental and behavioral outcomes, especially by recognizing the preclinical and subclinical states of distress and dysfunction that portend a risk for failure of role performance or future mental disorders. Recommendations for data elements are divided into 3 tiers: core, supplemental, and emerging, including variable domains and specific measures for assessing operational stressor exposures, stress outcomes, moderating factors, and mediating processes. Attention is drawn to the emerging construct of stress injury as a generic term for subclinical operational stress, and to emerging data elements addressing biological, psychological, and spiritual mediators of risk. Methodologies are needed for identifying preclinical and subclinical states of distress or dysfunction that are markers of risk for failure of role performance and future clinical mental disorders, so that targeted prevention interventions can be developed and evaluated.

Section snippets

Working Group Composition and Process

Participants in the OSWG were recruited from the Department of Defense and its service branches, the Department of Veterans Affairs, the National Institute of Mental Health, the Uniformed Services University of the Health Sciences, and a number of civilian academic institutions. OSWG members were selected for their expertise in operational stress research, military psychological health promotion, research and surveillance in various operational stress target populations, and the many conceptual

Constructs

Appendix 1 contains the conceptual constructs recommended by the OSWG for use in future operational stress research and surveillance. Most of the concepts and definitions listed are well represented in the literature in at least a similar form.

One notable exception is the concept of moral injury, which is defined here as changes in biological, psychological, social, or spiritual functioning resulting from witnessing or perpetrating acts or failures to act that transgress deeply held, communally

Core Data Elements

The following specific core variables and measures deserve explanation. Military-specific demographic information may be crucial to understanding not only the stressors to which service members may be routinely exposed, but also the cultural ecologies within which they are mastered. Rank can be conveniently divided into 5 natural groupings: junior enlisted (E1–E3), noncommissioned officer (E4–E9), warrant officer (W1–W5), junior commissioned officer (O1–O4), and senior commissioned officer

Conclusions

With the goal of increasing comparability and facilitating analyses across studies, we presented conceptual constructs and 3 tiers of empirical data elements (core, supplemental, and emerging). The terms, variables, and measures we recommended were those we believed to possess both the strongest evidence base and most direct applicability to future operational stress research and surveillance in the U.S. military. Key issues that emerged during the process of assembling these recommendations

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