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Background Infectious disease outbreaks are uniquely stressful for non-medical essential employees. Promoting the health of these workers is vital to minimize their distress and to ensure they are able to continue in their professional capacity. One way to support worker health is for supervisors to engage in behaviors that promote their employees’ behavioral health, wellbeing, and attitudes towards preventive medicine practices. Methods The present study examined if health-promoting leadership contributes to these outcomes in employees operating in an epidemic. Active-duty soldiers (N = 173) deployed to provide non-medical support in Liberia during the 2014 Ebola crisis completed surveys assessing posttraumatic stress disorder (PTSD), depression, anxiety, sleep problems, burnout, morale and attitudes, and rating their leaders on health-promoting behaviors. An exploratory factor analysis identified two leadership factors, one focused on psychological health and one on preventive medicine behaviors. Results Using mixed effects logistic regression, after adjusting for general leadership and soldier rank, health-promoting leadership focused on psychological health was associated with decreased odds of PTSD, depression, anxiety, and burnout, and increased odds of high morale and avoiding unnecessary risk. Health-promoting leadership behaviors focused on preventive medicine were associated with decreased odds of depression and anxiety, and increased odds of high morale, understanding the level of risk from disease, positive attitudes towards the deployment and preventive practices, and avoiding unnecessary risk. Conclusions Findings suggest health-promoting leadership behaviors could be valuable for employees responding to infectious disease outbreaks. Future research should examine whether training leaders in these skills can improve outcomes for non-medical employees in both military and civilian settings.

BackgroundInfectious disease outbreaks are uniquely stressful for non-medical essential employees. Promoting the health of these workers is vital to minimize their distress and to ensure they are able to continue in their professional capacity. One way to support worker health is for supervisors to engage in behaviors that promote their employees' behavioral health, wellbeing, and attitudes towards preventive medicine practices. MethodsThe present study examined if health-promoting leadership contributes to these outcomes in employees operating in an epidemic. Active-duty soldiers (N = 173) deployed to provide non-medical support in Liberia during the 2014 Ebola crisis completed surveys assessing posttraumatic stress disorder (PTSD), depression, anxiety, sleep problems, burnout, morale and attitudes, and rating their leaders on healthpromoting behaviors. An exploratory factor analysis identi ed two leadership factors, one focused on psychological health and one on preventive medicine behaviors. ResultsUsing mixed effects logistic regression, after adjusting for general leadership and soldier rank, healthpromoting leadership focused on psychological health was associated with decreased odds of PTSD, depression, anxiety, and burnout, and increased odds of high morale and avoiding unnecessary risk.Health-promoting leadership behaviors focused on preventive medicine were associated with decreased odds of depression and anxiety, and increased odds of high morale, understanding the level of risk from disease, positive attitudes towards the deployment and preventive practices, and avoiding unnecessary risk. ConclusionsFindings suggest health-promoting leadership behaviors could be valuable for employees responding to infectious disease outbreaks. Future research should examine whether training leaders in these skills can improve outcomes for non-medical employees in both military and civilian settings.

Introduction The role of the drill sergeant is one of the most challenging within the US Army, involving unusually long hours and little time off, for a minimum of 2 years. The current study sought to examine the behavioral health of this population and identify risk factors that might be addressed by policy changes. Materials and Methods In total, 856 drill sergeants across all Army basic training sites completed surveys from September to November of 2018. Drill sergeants identified factors that had caused stress or worry during their assignment. Rates were measured for behavioral health outcomes including depression, insomnia, anxiety, burnout, functional impairment, alcohol misuse, aggression, and low morale. Potential risk and resilience factors included time as a drill sergeant, sleep, route of assignment, general leadership, health-promoting leadership, and drill sergeant camaraderie. The study was approved by the Walter Reed Army Institute of Research Institutional Review Board. Results The most commonly experienced stressors were finding time to exercise, lack of sleep, and long work hours. Percentages of drill sergeants meeting behavioral health screening criteria were 19% for depression, 27% for moderate-to-severe insomnia, 14% for generalized anxiety disorder, 48% for high burnout, 32% for functional impairment, 35% for moderate alcohol misuse, 32% for off-duty aggression, and 25% for low morale. Rates for most outcomes were associated with time spent as a drill sergeant, with behavioral health issues peaking during 13-18 months. Poorer outcomes were also associated with fewer hours of sleep and initial unhappiness regarding involuntary assignment to the role of drill sergeant, while better outcomes were associated with higher ratings of general leadership, health-promoting leadership, and drill sergeant camaraderie. Conclusions This study is the first to examine behavioral health and morale of drill sergeants and to identify risk and resilience factors. Suggestions for policy changes include increasing the number of drill sergeants to decrease workload and allow sufficient time for recovery and sleep.

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