STRONG STAR Repository

Jan 18, 2022

As the first research consortium to conduct studies on the prevention and treatment of combat-related PTSD with an active-duty military population and recently discharged veterans, STRONG STAR is leading the way in national efforts to prevent the onset of chronic PTSD in a new generation of war fighters.

The Consortium’s assortment of clinical trials have set the stage for immediate payoff, delivering evidence-based treatments to help psychologically wounded warriors recover from PTSD and comorbid conditions now, while its biological and epidemiological studies are designed to help guide the future development of new and improved PTSD prevention and treatment methods.

STRONG STAR investigators know that, as these studies unfold and initial questions are answered, new sets of questions will arise. And the vast array of information and study samples being collected through STRONG STAR’s current investigations could hold the answers to questions not yet even conceived.

With this in mind, the Consortium is developing the STRONG STAR Repository, a comprehensive database of clinical and biological information collected from consenting STRONG STAR study participants. Data such as self-assessments, epidemiological information, treatment outcomes, neuroimages, genetic information, and other valuable measures will be carefully maintained and made available to STRONG STAR investigators to better enable them to address future research questions that arise from the Consortium’s work.

In accordance with federal and Department of Defense guidelines, and in the spirit of the Consortium’s collaborative effort to heal psychological wounds and restore and enhance resilience in our nation’s warriors, STRONG STAR also holds the future aim of making this valuable resource widely available to support future investigations by other researchers exploring questions about combat-related PTSD.

Service-Connected Life Trajectory Comparison of Psychiatric Aeromedical Evacuation and Non-Psychiatric Aeromedical Evacuation Patients From 2001 to 2015

Jan 01, 2022

Numerous epidemiological research studies have been conducted on the military population, but relatively little research has looked at psychiatric aeromedical evacuations from deployed settings. Thus, the long-term impact of these evacuations is not known.

A previous STRONG STAR-affiliated study, OIF/OEF Psychiatric MEDEVACS, examined the career impacts and risk factors for a sample of nearly 10,000 U.S. military personnel who received a psychiatric aeromedical evacuation from Iraq or Afghanistan between 2001 and 2013. That study found that more than half had separated from active duty, were discharged, or were on temporary disability retirement status at the time of the analysis. And it found no relationship between severity of an evacuee’s condition and the reason for separation or discharge. This suggests that psychiatric aeromedical evacuation from the combat zone is often a military career-ending event.

Comparison groups

This new STRONG STAR-affiliated, retrospective study will build on the previous one by adding comparison groups. The research team will analyze the long-term physical and mental health outcomes among active duty service members with and without deployment experience and those with and without history of aeromedical evacuation.

The study team hypothesizes that they will find differences in long-term adverse physical and mental health outcomes between service members aeromedically evacuated from theater for psychiatric reasons, those aeromedically evacuated from theater for non-psychiatric reasons, those never evacuated from combat, and those who never deployed.

The analysis will include data from sample groups of individuals who served in the U.S. military between Jan. 1, 2001, and Dec. 31, 2015. It will be based on data obtained from multiple sources within the U.S. Department of Defense, including the TRANSCOM Regulating and Command & Control Evaluation System, Defense Manpower Data Center, Defense Health Agency, and Air Evacuation Registry.

Clarifying the long-term impact

The investigators believe that the analysis comparing military personnel with a variety of service histories will provide an even clearer picture of the long-term impact of psychiatric aeromedical evacuation. They believe that could influence the military to recommend treatment of some psychiatric patients in theater, which could prevent some evacuations as well as make evacuation flights safer for patients and crews. Results of this study also may help the military to clarify current aeromedical evacuation guidelines, develop improved screening tools and standards of care, and enhance training.

Identifying Suicidal Subtypes and Dynamic Indicators of Increasing and Decreasing Suicide Risk

Sep 01, 2021

The U.S. general population suicide rate has increased steadily over the past 20 years. Those who have served in the U.S. Armed Forces are a high-risk group whose rates have increased more than those who have never served in the military.

Emerging research suggests that there are several subtypes of suicidal states, and that individuals who fall under these subtypes may follow different pathways to becoming high risk for suicide. They also may respond to treatment interventions in different ways. However, no studies have examined these subtypes using integrated data that includes genetic, environmental, medical, and psychological variables to better understand suicide risk and treatment response.

Identifying risk types, patterns, and expressions to improve detection and prevention

To address that knowledge gap, a STRONG STAR-affiliated research team will analyze data stored in the STRONG STAR Repository, an unparalleled resource that contains data from the consortium’s array of studies with military service members and veterans. That includes genetic, environmental, medical, and psychological variables from over 4,000 military personnel who were assessed before and after deployment.

Using that repository data, the team will conduct analyses (a) to identify subgroups of suicidal military personnel and (b) to identify different patterns of increasing, decreasing, and static suicide risk. Through these analyses, researchers expect to identify genetic and physiological expressions of suicide risk. Importantly, they also hope to provide ways to identify multiple risk models that can be used to improve risk detection and refine suicide prevention interventions.

Understanding risk fluctuations over time and developing “warning systems”

Emerging research also suggests that suicide risk can wax and wane indiscriminately without a clear progression of symptoms. To better understand the process of suicide risk over time and the way that risk typically fluctuates between higher and lower states, the team also will analyze STRONG STAR Repository data from more than 800 individuals who participated in six clinical trials. Those archived datasets each include repeated assessments of depression, posttraumatic stress disorder, and suicide ideation.

The investigators believe that analysis of the clinical trial data will make it possible to estimate the likelihood of a given patient transitioning to a high-risk state at a given point in time. They also hope to develop “warning systems” that identify who will experience increased risk over time, and when.

They expect these data analyses to yield significant advances in detection and monitoring of suicide risk and methods for intervening to prevent suicide in military-affiliated individuals as well as civilians.

Development and Validation of a Theory Based Screening Process for Suicide Risk

Jan 09, 2018

Population-level screening for suicide risk is a difficult task. It has long been known that military service members are reluctant to admit suicide-related behaviors due to stigma and concerns about career ramifications. Is it possible to improve risk detection by asking targeted questions addressing direct and indirect risk factors? This is a key question posed by Steven Vannoy, PhD, of the University of Massachusetts at Boston, whose research is supported by the Department of Defense.

Suicide prevention is a priority health care concern for the Army. Identifying service members who may be at risk for suicide is a critical task for Army suicide prevention efforts. Recent reports suggest that the routine screening instruments currently used to assess suicidal thoughts are underdetecting the rates of suicide ideation in active-duty service members.

The U.S. Army Medical Research and Materiel Command’s Military Operational Medicine Research Program (MOMRP) brought together a panel of mental health experts to assess and recommend improvements to the Army’s ability to identify personnel at elevated risk for suicide through routine, universal screening. The panel produced a recommended protocol based on best practices and integration of the current literature base in suicide research. The protocol included direct assessment of imminent risk, current and past suicide related behavior, identification of acute indicators of risk, and common stressors considered to increase vulnerability.

What’s the process?

In order to evaluate the impact of the proposed protocol, Steven Vannoy, PhD, designed a research study involving the survey of 4,000 U.S. Army Soldiers who have recently returned from deployment. At the time they complete the Army’s Post-Deployment Health Reassessment (PDHRA), the Soldiers are invited to volunteer for the study survey.

Those who choose to participate complete a confidential questionnaire that includes the expert-panel-recommended items; some additional items that might provide validation for the Interpersonal Theory of Suicide; and a two-question anonymous survey dealing specifically with suicide ideation and willingness to seek support. The purpose of the anonymous survey is to generate estimated rates of service members who report suicide ideation when there is no risk of stigma or penalty.

The Interpersonal Theory of Suicide hypothesizes which individuals are most likely to follow through with action once suicidal ideation develops. This theory, developed by Thomas Joiner, maintains that three factors are necessary: feelings of being a burden to friends, family and/or society; feelings of being an outsider or not being understood; and a learned insensitivity to harm through exposure to violent or high-risk experiences.

At the conclusion of the data collection phase of the study, subjects’ study data will be associated with key medical/experiential information from their PDHRA medical record. Using descriptive statistics, Dr. Vannoy will compare and contrast the two data sources to accurately identify suicide risk, to evaluate the proposed decision support algorithm for clinical risk management, and to advance clinically relevant knowledge related to the relationship between the Interpersonal Psychological Theory of Suicide and common risk factors for military personnel and their corresponding general population peers.

The benefits of success

If the results show that the inclusion of the study questionnaire and strategy in the screening process improve the accuracy of detecting soldiers in need of additional mental health support, there is the potential to save lives and improve the stability of the military work force.

Suicide risk detection and suicide prevention is a national health care priority. Although the prevention of suicide in this study is aimed primarily at working age adults, the knowledge gained may inform efforts across the age and gender spectrums.

OIF/OEF Psychiatric MEDEVACs

Apr 10, 2015

Aeromedical evacuations of military personnel from combat areas for psychiatric reasons often have negative consequences for the patients as well as for the military. Unstable or misclassified psychiatric patients may be the single greatest threat to aircrew and aircraft safety during an aeromedical evacuation because of an increased likelihood that they will become combative or disorderly. In addition, many of those evacuated do not return to deployed locations and end up leaving the military, ending their careers and eroding the size of deployed forces.

Although 10 percent of the U.S. military aeromedical evacuations out of combat theater in Iraq and Afghanistan since 2001 were for psychiatric reasons, few studies have provided demographic and other descriptive information about those evacuations. And little is known about the short- and long-term military career impact of psychiatric aeromedical evacuations in terms of Medical Evaluation Boards, discharges from active duty, involuntary discharges and other consequences.

The most comprehensive study to date of patients evacuated for psychiatric reasons to Landstuhl Army Medical Center, Germany, found that they were more likely to be younger, enlisted, members of the Reserve or National Guard, and ethnic minorities. Fewer than 5% returned to duty in Iraq/Afghanistan, representing a significant degree of force reduction in theater.

In an effort to learn more about psychiatric medical evacuations from theater and their long-term consequences, investigators have launched a STRONG STAR-affiliated study examining the outcomes of service members evacuated from Iraq and Afghanistan since January 2001.

Leading the investigation are Lt Col Monty Baker, PhD, with Wilford Hall Ambulatory Surgical Center at Joint Base San Antonio-Lackland; Lt Col Alan Peterson, PhD (USAF, Retired) of The University of Texas Health Science Center at San Antonio; and Lt Col Jeffrey Cigrang, PhD (USAF, Retired) of Wright State University. All active duty or retired Air Force psychologists, Drs. Baker, Peterson, and Cigrang and their colleagues are analyzing clinical data of those evacuated for psychiatric reasons to determine their demographic characteristics, their combat experiences, and the incidence of acute stress disorder and posttraumatic stress disorder. They hypothesize that the majority of those evacuated for psychiatric reasons end up being medically discharged or involuntarily separated from active duty.

Expected benefits

Investigators believe that study findings will influence recommendations for patient treatment. For instance, if results indicate that the majority of psychiatric patients aeromedically evacuated from the combat theater are medically discharged from active duty, this may highlight the value of treating some patients prior to evacuation. It may also demonstrate a need for increased availability of treatment for combat-related PTSD in deployed locations with evidence-based therapies such as Prolonged Exposure and Cognitive Processing Therapy. Successful treatment of more individuals in-theater would mean fewer career-ending psychiatric evacuations, reduced levels of combat zone force reductions, and fewer psychiatric patients aboard aeromedical evacuation flights.

The Impact of the Treatment of PTSD on Comorbid Insomnia and Pain

Apr 08, 2015

Insomnia and pain are two of the symptoms most commonly reported by military personnel who have returned from deployment to Operation Iraqi Freedom and Operation Enduring Freedom. They also are common comorbidities of posttraumatic stress disorder (PTSD). Doctors have numerous issues to consider when treating each problem individually, but when physical and psychological disorders such as these present themselves as a group, diagnosis and treatment become even more complicated as one condition aggravates another.

For example, the nightmares of PTSD and the pain of a physical trauma can keep one from sleeping; a lack of sleep can slow down the body’s physical and mental healing process; and strong medications used to treat severe pain and even sleeping pills can further alter one’s mental state. Many of these medications also carry the risk of causing drug dependence, which can cause even further complications in treating PTSD. In these situations, it can quickly become difficult for health care professionals to discern what ailment – or therapy – is causing a particular problem and how best to tailor their patients’ treatment.

STRONG STAR Consortium Coordinator COL Stacey Young-McCaughan, PhD, RN (U.S. Army, Retired), is trying to provide valuable insight on the interrelation of PTSD comorbidities to help unravel this tangled web and guide improved treatment.

New study provides in-depth analysis, could help health care providers tailor therapy

In a new exploratory study for STRONG STAR, Dr. Young-McCaughan will extend preliminary results from a study she previously conducted as she evaluates the interrelation of comorbid insomnia, pain and PTSD as seen in participants of other STRONG STAR randomized clinical trials. She will do an in-depth analysis to determine if the successful treatment of PTSD will in turn reduce comorbid insomnia and pain, or whether additional therapies are needed to treat these conditions. Conversely, she will analyze whether comorbid insomnia and pain have a negative effect on participants’ response to PTSD therapy. This would potentially indicate that these comorbidities need to be targeted specifically as part of a comprehensive plan to treat PTSD effectively.

Additional insights gained from this investigation could improve the ability of mental health professionals to tailor patients’ treatment to achieve the best possible outcomes.

Project BLAST Balad/Bagram Longitudinal Assessment of the Symptoms of TBI/PTSD/ASD

Apr 26, 2011

Disentangling a service member’s physical and psychological wounds following a blast injury – the most common cause of injury for U.S. military personnel deployed in support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) – can be a particularly challenging task. However, an accurate assessment and diagnosis is necessary if the injured service member is to receive the proper care.

That is why, with Defense Department funding through the Military Operational Medicine Research Program, Project BLAST has brought together a multidisciplinary team of military and civilian experts to develop and evaluate a clinical assessment battery that can be used with blast-injury patients in theater – a task that begins with a retrospective review of data collected following previous blast injuries.

That team is led by co-principal investigators Lt Col Monty Baker, PhD, of Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, and Lt Col (Ret) Alan Peterson, PhD, of the University of Texas Health Science Center at San Antonio. Dr. Peterson also serves as director of the STRONG STAR PTSD Research Consortium and has pulled in other STRONG STAR experts and resources to advance this vital effort.

Where it all started

Lt Col Baker, an active-duty Air Force psychologist, knows from first-hand clinical experience that blast injuries can result in physical trauma, such as traumatic brain injury (TBI), as well as psychological trauma, such as posttraumatic stress disorder (PTSD) and its predecessor, acute stress disorder (ASD). Moreover, accurate diagnosis of these conditions can be difficult because, although some of their symptoms are distinct, many overlap. Further complicating the issue is the fact that when an individual’s TBI is mild, resulting neurological impairment may not be readily apparent through routine medical evaluations and brain scans.

These were issues Lt Col Baker faced during his own deployment to Iraq, when he was charged with evaluating more than 750 military blast-injury patients who were sent to the combat theater hospital at which he served. To help with his diagnoses, he compiled a battery of assessments to measure TBI as well as related psychological problems, particularly ASD and PTSD. In the processes, he collected what is believed to be the largest clinical data set that exists on TBI and ASD/PTSD assessed during a military deployment after a blast injury.

Experts on a mission

Now that data will be used by Project BLAST’s panel of experts on TBI, PTSD, ASD, psychometrics, and biostatistics, who will try to “make sense of the data” and use it to develop a standardized assessment battery to recommend to the military. Such a development will make things easier for people who have Lt Col Baker’s former job in the future – ultimately, for the benefit of our combat-injured men and women in uniform.

A three-phase approach

Phase I of Project BLAST entails a retrospective data analysis: Together, investigators will look at the data and ask such questions as, “How do these conditions overlap? What do they have in common? What’s different about them? Can we disentangle them and determine the accurate diagnosis for an individual patient?” Once that work is done, they will ask another set of questions: “Did the battery we examined include the best measures, or all the measures necessary, for this type of assessment? What else is there that might helpful? What set of measures would we recommend that others use?” Answers to these questions will lead to the development of what Project BLAST investigators believe should be the military’s standard assessment battery for TBI, ASD, and PTSD.

When Phase I is complete, it’s on to Phase II: conducting a prospective evaluation of this assessment battery in theater, at military medical treatment facilities in Afghanistan. Military personnel who have suffered a blast injury in Afghanistan and are referred to the study will be assessed with Project BLAST’s recommended measures. An entire new set of complete, standardized data will be collected, from these evaluations, and that data will be used to help evaluate the assessment battery’s efficacy.

Finally, in Phase III, investigators will follow up with volunteer study participants and conduct a reassessment of their physical and psychological health six months later. If they had ASD, did they get better, or did it develop into PTSD? Did those who had a TBI develop post-concussive syndrome, or did they improve?

Benefit to the military

Once all three phases are complete, Project BLAST investigators will be able to recommend to the military a standardized, comprehensive assessment battery for TBI, ASD, and PTSD. This valuable tool should increase the accuracy of complicated diagnoses and lead to the best course of treatment and the improved physical and psychological health of injured warfighters.

Assessing the Prevalence of Fibromyalgia in PTSD Patients and Family Members

Aug 18, 2010

Research published by H. Cohen and colleagues in 2002 shows a significant overlap between posttraumatic stress disorder (PTSD) and fibromyalgia, a painful rheumatic disorder that causes muscle tenderness and stiffness. This finding has led some to suggest that optimal care for fibromyalgia patients should include investigation for a component of PTSD.

But in an exploratory STRONG STAR study, Col Jay B. Higgs, MD, (USAF, Ret.) of San Antonio Military Medical Center will take the opposite approach. He and his research team seek to determine whether it is important to assess for fibromyalgia in active-duty members of the military suffering from PTSD.

As part of this novel research effort, patients with PTSD who are enrolled in STRONG STAR clinical trials at Fort Hood will be asked to consent to an additional study in which they will be screened for fibromyalgia. Investigators will then calculate the prevalence of fibromyalgia among PTSD patients and observe its influence on their prognosis by comparing treatment-outcome data between groups that do and do not meet criteria for fibromyalgia. The prevalence of fibromyalgia among patients’ spouses who are willing to consent to screening will also be investigated, as researchers look for secondary familial consequences of PTSD.

Research findings could shed light on yet another painful effect of PTSD and reveal additional complications for health care professionals to consider when treating PTSD or fibromyalgia.

Who gets better and why? Predicting Outcome Trajectories in STRONG STAR Trials

Aug 18, 2010

The military culture requires, builds, and nurtures cohesive bonds among its members. Cohesion, coupled with good leadership, is critical to successful military efforts, and these factors help service members heal and recover from the stress and trauma of combat. However, no matter how effective, the quality of leadership and group cohesion can vary across deployment cycles, and unique factors in each person’s life can still have a strong effect on individual coping styles and stress responses.

Individual service members adapt differently to combat and operational stress and trauma by virtue of a complex web of biological, social, and service-related risk and resilience factors. Over time, deployed service members follow multiple courses of adjustment. Most are impacted by what they see and do but still recover fully; some grow and become stronger; some have chronic postdeployment mental health problems; and still others experience delayed or maladjustment. Likewise, service members have diverse care needs, and each will respond differently to treatment interventions for mental health problems related to combat and operational stress.

The various causes of these different “trajectories of response” are unknown, leaving commanders and decision-makers with a lack of useful information about how to prevent problems in those most at risk for posttraumatic stress disorder and other mental health problems across the deployment cycle and beyond. It also hampers the efforts of mental health professionals who, ideally, would want to tailor treatment interventions to achieve the best possible outcome for service members.

Identification of response trajectories could propel PTSD research

As the director of the STRONG STAR Assessment Core, Brett Litz, PhD, with the Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Health Care System, and professor at Boston University School of Medicine, has designed a study utilizing the comprehensive dataset from all STRONG STAR clinical trials to perform a variety of analyses with three key aims. One is to identify risk and resilience variables that predict the trajectory, or path, service members follow over time as they adapt to war-zone trauma. The second objective is to examine variables that influence the outcome of treatment interventions or that reveal subgroups of individuals who might be adversely impacted or uniquely changed by various intervention strategies. The third is to conduct a meta-analysis of all the treatment trials to examine how well treatments that have primarily been developed and tested on civilians and veterans with very chronic problems are able to help service members.

Researchers hypothesize that they will see four trajectories of response to combat exposure and operational trauma, as well as to treatment for PTSD:

  • a recovery/positive outcome course, characterized by an initial worsening of symptoms as the individual focuses on the trauma, followed by steady improvement over time;
  • a resilience course, characterized by relatively low symptoms and impairment over time;
  • a relapse course, characterized by apparent treatment gains lost at follow-up intervals; and
  • a chronic worsening course, in which symptoms worsen and then remain high over time.

Dr. Litz and his research team will collapse information across the entire STRONG STAR dataset to evaluate the prevalence of these trajectories of response, as well as the particular biological, psychological, social, and service-related risk and resilience variables that correspond with each trajectory and appear to influence treatment outcomes. For example, individual vulnerabilities, environmental demands of the job, personal appraisals, socio-cultural resources, and certain predisposing behavioral and biological response capacities, including personal coping style, might all be factors in whether someone develops PTSD following trauma, how severe the symptoms are, what outcome path they follow in response to treatment, or even what type of treatment is most or least beneficial for them.

Expected outcomes

As STRONG STAR investigators perform their analyses, they expect to find causal models, or sets of variables, that can be used to predict individuals’ responses to trauma and combat stress and various PTSD treatments. This will provide useful information to support evidence-based decisions about primary and secondary prevention strategies for chronic deployment-related mental health problems, especially PTSD, and to help generate more tailored treatment strategies for maximum impact.

Medical Deployment Resilience Study

Apr 20, 2009

Why do medical personnel respond differently after exposure to traumatically injured medical patients? What conditions influence why one person remains resilient through the experience, one seems psychologically “wounded” at first but then grows even stronger after a natural recovery period, and one develops posttraumatic stress disorder?

Particularly for our military medical personnel, what kinds of contributing or protective factors are somewhat within the military’s control? The military has no influence over a person’s genetic make-up or past life experiences, but are there things it can do proactively-such as team-building to strengthen unit cohesion, types of pre-deployment training, or other internal processes, programs, and procedures-that can enhance service members’ resilience and help prevent psychological problems such as PTSD?

The study’s purpose

These are all questions being asked in a STRONG STAR-affiliated study led by Lt Col (Ret) Alan Peterson, PhD, of The University of Texas Health Science Center at San Antonio, who serves as the principal investigator for the Air Force-funded “Medical Deployment Resilience Study.” Dr. Peterson actually initiated the study without funding in 2004 when he was still active duty with the U.S. Air Force. With his collaborators within the Air Force, at Harvard University, and at the VA’s National Center for PTSD in Boston, he greatly enhanced study efforts with a grant in 2007 from the U. S. Air Force Operational Medicine Research Program.

The purpose of the study is to conduct a prospective evaluation of risk, resilience, natural recovery, and posttraumatic growth in medical personnel deployed to work at a combat-theater hospital in Iraq. Medical personnel at this location are often exposed to patients with severe traumatic injuries, mass casualties, human remains, and risk of personal injury from attacks by rockets, missiles, and snipers.

Currently, little is known about the effects of this type of high-stress/high-risk environment on military medical personnel, although previous, retrospective studies of military nurses who worked in combat hospitals in Vietnam found rates of PTSD at levels similar to those of Vietnam combat veterans.

How it works

This study is the first large-scale, prospective evaluation of the impact of deployment on Air Force medical personnel. It involves all active- duty Air Force medical personnel since 2004 who have deployed from Wilford Hall Ambulatory Surgical Center, Lackland AFB, to serve as part of the 332 Expeditionary Medical Group (EMDG), as well as Air Force medical personnel from other bases who process through Lackland’s Deployment Processing Center to serve in Iraq with the 332 EMDG.

All personnel who volunteer for the study-more than 1,000 to date-are surveyed on five separate occasions: pre-deployment, mid-deployment, one month post-deployment, six months post-deployment, and 12 months post-deployment.

These anonymous surveys contain questions about previous exposure to traumatic life events; PTSD symptoms; health care stressors unique to deployed military settings; general military attitudes and experiences; attitudes and beliefs about working with Iraqi patients; anxiety; depression; resilience; and posttraumatic growth. Some participants also are being recruited when they return to Lackland to voluntarily participate in focus groups. These groups discuss their deployment with investigators and provide direct feedback on both positive and negative experiences during deployment, as well as suggestions for improving the deployment experience.


Together, the surveys and focus groups are allowing investigators to do the following:

  • Identify factors that are related to increased risk for the development of PTSD, such as exposure to specific types of medical trauma patients and injuries;
  • Evaluate protective factors that are related to resilience, which can be the focus of future studies targeting programs to increase resilience prior to deployment;
  • Evaluate the course of natural recovery in individuals who initially show symptoms of PTSD or its precursor, acute stress disorder, but recover without any formal intervention;
  • Evaluate the impact of work with Iraqi patients in order to allow for improved training programs for military medical personnel.

Study findings have already resulted in over 20 scientific presentations and publications and are expected to help the military enhance resilience and reduce psychological distress among military medical personnel. These findings also have implications for the deployment of civilian medical personnel who are sent to provide health care after terrorist attacks or natural disasters.