Neurostat Publications

U.S. Air Force Distributed Common Ground Station (DCGS) intelligence (Intel) operators sustain 24/7 battlefield situational awareness and facilitate precision-strike operations. DCGS operations are global, synergistic, Total Force (TF) endeavors by active duty, Air National Guard (ANG) and Reserve units, providing combatant commanders with critical real-time intelligence and shaping operational and tactical decisions. Continual surveillance of this community’s psychological health is important to its military leaders. This study re-examines the most frequently reported occupational stressors, as well as the prevalence of occupational burnout (i.e., high-emotional exhaustion and cynicism, and low professional efficacy), and psychological distress within this population. Active duty (n = 1717), ANG (n = 139), and Reserve (n = 173) Intel operators participated in a comprehensive, online, occupational health assessment. Results reveal that occupational stressors contributing to elevated rates of distress, regardless of TF status (i.e., low manning, long work hours, excessive workload, and organizational communication concerns) are consistent with previous research. The prevalence of high-emotional exhaustion (AD: 29%/ANG: 25%/RES: 14%) and psychological distress (AD: 19%/ANG: 17%/RES: 5%) are above estimates for other military communities. These findings combined with demographic and occupational risk factors lay the foundation for improving psychological health within this Total Force community.

Despite the broad literature base on factor analysis best practices, research seeking to evaluate a measure’s psychometric properties frequently fails to consider or follow these recommendations. This leads to incorrect factor structures, numerous and often overly complex competing factor models and, perhaps most harmful, biased model results. Our goal is to demonstrate a practical and actionable process for factor analysis through (a) an overview of six statistical and psychometric issues and approaches to be aware of, investigate, and report when engaging in factor structure validation, along with a flowchart for recommended procedures to understand latent factor structures; (b) demonstrating these issues to provide a summary of the updated Posttraumatic Stress Disorder Checklist (PCL–5) factor models and a rationale for validation; and (c) conducting a comprehensive statistical and psychometric validation of the PCL–5 factor structure to demonstrate all the issues we described earlier. Considering previous research, the PCL–5 was evaluated using a sample of 1,403 U.S. Air Force remotely piloted aircraft operators with high levels of battlefield exposure. Previously proposed PCL–5 factor structures were not supported by the data, but instead a bifactor model is arguably more statistically appropriate.

The 70th Intelligence, Surveillance, and Reconnaissance Wing (70 ISRW) engages in intelligence operations to provide accurate and timely intelligence products to military and national-level decision-makers. Understanding 70 ISRW health patterns is critical to developing relevant and appropriate medical and mental health strategies to foster optimal health across the entire community. The objective of this study was to identify and discuss between-group differences among the intelligence operators and support personnel on the following items: (a) the frequency of health behaviors related to sleep obtained before work and physical exercise throughout the week; (b) the frequency and increase of poor health habits related to alcohol, tobacco, and caffeine use and the reasons for these increases; (c) self-reported medical conditions believe to have been caused or worsened by occupational stress; (d) availability or access to medical care and the increases in healthcare utilization and the reasons for these increases; and (e) self-reported increases in medication usage and the reasons for these increases. A total of 1223 intelligence operators and 599 support personnel participated in the study. The participants were asked to electronically complete a survey assessing demographics; sleep and physical exercise health behaviors; alcohol, tobacco, and caffeinated beverage use; medical conditions believed to have been created or made worse by current unit assignment; medical, mental health support, and alternative healthcare utilization; and medication utilization. Quantitative and qualitative analyses were calculated. Although the overarching findings of this study indicate substantial similarity between 70 ISRW intelligence operators and support personnel, when differences occurred, intelligence operators tended to present the more notable health concerns, such as poor access to medical health resources, increased use of mental health services due to work stress and personal issues, and self-medication through over-the-counter drugs for stress and sleep difficulties. Both groups attributed their increase in alcohol and tobacco use, as well as alternative health services and prescription medication use, to stress. Additionally, shift work and exhaustion emerged as common attributions for increased caffeine use among all 70 ISRW personnel. Based on these results, it is recommended that line leadership strive to facilitate ready access to medical and mental healthcare, identify areas that will optimize work/rest cycles, and consider supplying sufficient manning to allow for adjustments in shift length, shift work rotations, and break frequency and decreased work hours.

Health screening surveys play a key role in understanding military personnel’s perceived climate of their organization. These screenings provide participants with the opportunity to self-report on many aspects of their job and their personal well-being. Nonparticipation in these health screenings is of concern. The continuum of resistance model is one way to measure non-participation bias. Participants who answer a survey without additional reminders are thought to have little resistance to responding to the survey, and participants who need additional reminders, especially a final reminder email, are thought to have a higher resistance to responding to the survey. This study examines early, intermediate, and late responders on resistance behaviors, substantive survey results, and nonresponse bias for two samples. Online occupational health screenings were available to two U.S. Air Force wings for a 9-week period. Late responders showed higher rates of resistance behaviors and similar rates for quality of responses, burnout, and psychological distress. Reminder emails throughout the data collection effort were important to elicit a greater number of responses. However, responses recorded after the final reminder email resulted in similar outcomes, and the extra week of data collection did not change results for either sample.

The U.S. Air Force remote warrior community is largely composed of distributed common ground system intelligence operators, cyber operators, and remotely piloted aircraft (RPA) operators. The demand for these remotely conducted capabilities has increased exponentially over the past decade, and remote warrior skills are considered essential to maintaining situational awareness and operational effectiveness in the field of conflict. Sustaining an intellectually strong and psychologically resilient workforce is crucial to ensuring the continued effectiveness of this operationally critical mission area. A total of 3513 remote warriors (60.46% intel and cyber from the 25th Air Force, 32.71% RPA, and 6.83% intel and cyber from the 24th Air Force) participated in the current study, a reassessment including distributed common ground system, cyber, and RPA operator samples from units that had also been surveyed in the earlier study. All three datasets include active duty, Reserve, and Air National Guard participants. An anonymous survey was completed that assessed demographics, occupational demands, psychological distress, burnout, and suicide ideation. Outcomes of the current reassessment reveal increased suicide ideation rates of 6-11%, with 2-4.5% reporting suicidal thoughts more often than “rarely.” Results of multinomial logistic regression indicate risk factors similar to those identified in the initial assessment: being unmarried, experiencing relational crises, engaging in chronic, long work hours, being an Air National Guard member, and endorsing elevated rates in certain facets of burnout. These risk factors were associated with increased risk for suicide ideation even when psychological distress was included as a covariate. Validation of the previous risk factors, along with other findings discussed in this report, offers insights into how mental health providers may better screen for suicide risk within the remote warrior populations.

As part of United States Air Force remotely piloted aircraft (RPA) weapon-strike operations, Predator/ Reaper crewmembers participate in the targeting and destruction of enemy combatants and witness the aftermath via live video feed. Although the demand for weapon-strike operations has increased dramatically, the emotional impact of engaging in remote warfare remains unclear. The purpose of this study is to gather both quantitative and qualitative data on the emotional reactions of remote warriors and examine potential occupational (e.g., number of years as an RPA crewmember, prior military experience, prior combat deployments, and total number of weaponstrike missions), demographic (i.e., age, marital status, gender, and dependents living at home), and mission-specific (i.e., target familiarity, mission outcome, and high-definition vs. standard-definition video feed) correlates of negative reactions. Seventy-four RPA crewmembers participated in semistructured interviews. Relative risk (RR) analyses indicated only witnessing civilian casualties and witnessing nonhuman collateral damage were associated with elevated risk for negative reactions (RR D 1.91, p < .05, 95% confidence interval [CI]: 1.11–3.26, and RR D 1.94, p < .05, 95% CI: 1.14– 3.29). Limitations of the study, directions for future research, and potential implications of these findings for selection, training, and post-mission support are discussed.

The prevalence and expression of post-traumatic stress disorder (PTSD) symptoms among United States Air Force remotely piloted aircraft (RPA; commonly referred to as “drones”) warfighters exposed to battlefield trauma via remote, electronic warfare is relevant and critical to the effective delivery of mental health care for this population. RPA warfighters (n = 715) with real-time exposure to at least one traumatic event participated in an online survey. Measures included the PTSD Checklist for DSM-5 (PCL-5) and survey of exposure to traumatic events during the course of operational combat missions. A total of 6.15% met PTSD symptom criteria; those in the age ranges of 31–35 and 36–40 and those working 51 or more hours per week had greater odds of meeting symptom criteria. For combat-related events, the number of events in which RPA warfighters witnessed civilian bystanders being killed by enemy forces or felt shared responsibility for the injury or death of bystanders were also significant predictors, regardless of whether the risk was anticipated or unanticipated. The results of this study suggest that specific types of exposure and participation in missions with specific outcomes, albeit via electronic, remote means, are associated with an increased risk for meeting PTSD symptom criteria.