Elsevier

Journal of Psychiatric Research

Volume 84, January 2017, Pages 301-309
Journal of Psychiatric Research

Psychological resilience in U.S. military veterans: A 2-year, nationally representative prospective cohort study

https://doi.org/10.1016/j.jpsychires.2016.10.017Get rights and content

Highlights

  • The current study suggests that most military veterans (67.7%) are resilient.

  • Emotional stability and extraversion were longitudinal predictors of resilience.

  • Gratitude, altruism, and endorsement of purpose in life predicted resilient status.

  • Novel interventions for trauma-exposed veterans may target such modifiable factors.

Abstract

Although many cross-sectional studies have examined the correlates of psychological resilience in U.S. military veterans, few longitudinal studies have identified long-term predictors of resilience in this population. The current prospective cohort study utilized data from a nationally representative sample of 2157 U.S. military veterans who completed web-based surveys in two waves (2011 and 2013) as part of the National Health and Resilience in Veterans Study (NHRVS). Cluster analysis of cumulative lifetime exposure to potentially traumatic events and Wave 2 measures of current symptoms of posttraumatic stress, major depressive, and generalized anxiety disorders was performed to characterize different profiles of current trauma-related psychological symptoms. Different profiles were compared with respect to sociodemographic, clinical, and psychosocial characteristics. A three-group cluster analysis revealed a Control group with low lifetime trauma exposure and low current psychological distress (59.5%), a Resilient group with high lifetime trauma and low current distress (27.4%), and a Distressed group with both high trauma exposure and current distress symptoms (13.1%). These results suggest that the majority of trauma-exposed veterans (67.7%) are psychologically resilient. Compared with the Distressed group, the Resilient group was younger, more likely to be Caucasian, and scored lower on measures of physical health difficulties, past psychiatric history, and substance abuse. Higher levels of emotional stability, extraversion, dispositional gratitude, purpose in life, and altruism, and lower levels of openness to experiences predicted resilient status. Prevention and treatment efforts designed to enhance modifiable factors such as gratitude, sense of purpose, and altruism may help promote resilience in highly trauma-exposed veterans.

Introduction

Although most studies on trauma focus on psychopathology and other negative sequelae, a burgeoning literature has begun to characterize the prevalence and correlates of psychological resilience in both military and civilian populations (Elliott et al., 2015, Nievergelt et al., 2015, Rutter, 1985, Yehuda and Flory, 2007). Psychological resilience is defined as the ability to adapt in the aftermath of trauma or extreme stress and preserve a high level of psychological functioning (American Psychological Association, 2016; Southwick et al., 2011). Studying resilient trauma survivors is important, as resilience is the most common reaction to psychological trauma, including in high-risk populations, such as military veterans, who often have a greater level of cumulative trauma burden, including combat exposure, compared to the general adult population (Bonanno et al., 2011, Mancini and Bonanno, 2006). While several cross-sectional studies have provided an initial characterization of factors associated with psychological resilience (Alegria et al., 2013, Bonanno et al., 2007; Bonanno et al., 2011; Brewin et al., 2000, Feder et al., 2013, Fredrickson et al., 2003, Friborg et al., 2005, Peng et al., 2012, Pietrzak and Cook, 2013, Segovia et al., 2012, Southwick et al., 2011, Southwick et al., 2005), prospective data in nationally representative samples of trauma survivors are lacking. Such data are important in that they can inform population-based prevention and treatment initiatives geared toward the promotion of psychological resilience in trauma-exposed individuals.

In both military veteran and civilian populations, several demographic characteristics, including older age, male gender, Caucasian race, and higher educational levels have been weakly associated with psychological resilience (Alegria et al., 2013; Bonnano et al., 2007; Bonanno et al., 2011; Brewin et al., 2000; Southwick et al., 2011), while worse physical health has been negatively associated with this outcome (Bonanno and Galea, 2007; Pietrzak and Cook, 2013; Southwick et al., 2005). Protective psychosocial characteristics, which are potentially modifiable and include emotional stability, dispositional optimism, and a strong social support network, have also been linked to greater resilience (Feder et al., 2013; Fredrickson et al., 2003; Friborg et al., 2005; Peng et al., 2012; Segovia et al., 2012; Southwick et al., 2005). For example, using cross-sectional data from Wave 1 the National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative sample of more than 2000 older U.S. veterans, psychological resilience, which was operationalized as having high lifetime trauma but low current psychological distress, was associated with a having a college or higher education, being married/partnered, and report of higher levels of emotional stability, social connectedness (e.g., secure attachment style), and protective psychosocial characteristics (e.g., purpose in life) (Pietrzak and Cook, 2013). However, because this study was cross-sectional, it is unclear whether these factors are prospectively linked to psychological resilience. Further, this study focused on veterans aged 60 and older, so additional studies of veterans from the full age spectrum are needed to evaluate the generalizability of these results.

We had two aims in the current study. First, we sought to extend our prior cross-sectional results (Pietrzak and Cook, 2013) to conduct a prospective evaluation of Wave 1 sociodemographic, military, and psychosocial determinants of psychological resilience over a 2-year period in the full NHRVS sample. We hypothesized that we would observe a group with both low lifetime trauma burden and low psychological distress at Wave 2, a group with high lifetime trauma burden and high psychological distress at Wave 2, and a group with high lifetime trauma burden and low psychological distress at Wave 2 (i.e., Resilient Group). Second, we sought to examine Wave 1 sociodemographic, military, and psychosocial determinants of these subgroups at the Wave 2 assessment.

Section snippets

Participants

Participants included 2157 individuals who completed both waves of the National Health and Resilience in Veterans Study (NHRVS). The NHRVS is a prospective cohort study of a nationally representative sample of U.S. military veterans. The NHRVS sample was drawn from KnowledgePanel®, a probability-based, online non-volunteer access survey panel maintained by GfK Knowledge Networks, Inc. (Menlo Park, California), which includes over 50,000 households representing approximately 98% of the U.S.

Results

Veterans reported exposure to an average of 3.9 (SD = 3.1; range = 0–21) potentially traumatic events in their lifetimes; the average number of lifetime events at Wave 1 was 3.2 (SD = 2.6; range = 0–15) and average number of events between Wave 1 and 2 was 0.9 (SD = 1.3; range = 0–13). A total of 224 veterans (weighted prevalence = 12.0%) screened positive for PTSD, MDD, and/or GAD. With regard to specific disorders, 148 (weighted prevalence = 7.8%) screened positive for MDD, 141 (weighted

Discussion

This prospective cohort study of a nationally representative sample of U.S. military veterans revealed that of veterans who endured a high number of traumas over the course of their lifetimes, nearly 70% (67.7%) reported minimal-to-no current psychological distress. This finding, which is consistent with prior literature (Bonanno and Galea, 2007; Bonanno et al., 2012, deRoon-Cassini et al., 2010, Norris et al., 2009, Orcutt et al., 2014, Pietrzak et al., 2014, Pietrzak et al., 2012, Pietrzak

Contributors

Drs. Pietrzak and Southwick acquired the data. Dr. Mota and Ms. Isaacs conducted the statistical analyses. Ms. Isaacs and Drs. Pietrzak and Mota drafted the manuscript. Drs. Tsai, Harpaz-Rotem, Cook, Kirwin, Krystal, Southwick, Mota, and Pietrzak contributed to conceptualizing the study, interpreting the findings, and revising the manuscript. All authors have approved the final version of this manuscript.

Role of the funding source

The National Health and Resilience in Veterans Study was funded by the U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder. This funding source did not play any role in the conduct or publication of the current study.

Acknowledgement

We would like to thank the START@Yale program and the Office of Student Research at the Yale School of Medicine.

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