Prospective associations of perceived unit cohesion with postdeployment mental health outcomes

Abstract

Background Prior investigations have found negative associations between military unit cohesion and posttraumatic stress disorder (PTSD); however, most relied on cross‐sectional data and few examined relationships of unit cohesion to other mental disorders. This study evaluates prospective associations of perceived unit cohesion with a range of mental health outcomes following combat deployment. Methods U.S. Army soldiers were surveyed approximately 1–2 months before deployment to Afghanistan (T0); and 1 month (T1), 3 months (T2), and 9 months (T3) after return from deployment. Logistic regression was performed to estimate associations of perceived unit cohesion at T0 with risk of PTSD, major depressive episode (MDE), generalized anxiety disorder (GAD), alcohol or substance use disorder (AUD/SUD), and suicidal ideation at T2 or T3 among soldiers who completed all study assessments (N = 4,645). Models were adjusted for sociodemographic and Army service characteristics, predeployment history of the index outcome, and deployment stress exposure. Results Higher perceived unit cohesion at T0 was associated with lower risk of PTSD, MDE, GAD, AUD/SUD, and suicidal ideation at T2 or T3 (AORs = 0.72 to 0.85 per standard score increase in unit cohesion; P‐values < 0.05). Models of incidence of mental disorders and suicidal ideation among soldiers without these problems predeployment yielded similar results, except that perceived unit cohesion was not associated with incident AUD/SUD. Conclusions Soldiers who reported strong unit cohesion before deployment had lower risk of postdeployment mental disorders and suicidal ideation. Awareness of associations of perceived unit cohesion with postdeployment mental health may facilitate targeting of prevention programs.

Military suicide prevention: The importance of leadership behaviors as an upstream suicide prevention target

“…These findings are consistent with previous research demonstrating the protective nature of unit cohesion, leader‐provided purpose, and leader‐provided meaning against depression symptoms and SI/DI in soldiers (Anderson et al, 2019; Sinclair et al, 2016; Trachik et al, 2020). In particular, the findings that unit cohesion concurrently predicted SI/DI and prospectively predicted changes in SI/DI post‐deployment are supported by previous research.…”

“…In particular, the findings that unit cohesion concurrently predicted SI/DI and prospectively predicted changes in SI/DI post‐deployment are supported by previous research. In military populations, unit cohesion has been shown to be protective against adverse mental health outcomes, such as depression, substance use, anxiety, and PTSD, and generally relates to higher levels of positive mental health indicators (Anderson et al, 2019; Bryan & Heron, 2015; Griffith, 2002, 2015; Oliver et al, 1999). This finding is also consistent with previous research demonstrating that unit cohesion can buffer against stressors (Mitchell et al, 2011), especially in a deployment environment when individuals are separated from other types of social support networks (Bierman & Kelty, 2018).…”

“…Strong social bonds within units provide a sense of connection, may help to reduce isolation and loneliness (Capcioppo et al, 2015, 2016), and has been found to attenuate risk for combat‐related post‐traumatic stress disorder (PTSD) symptoms (Brailey et al, 2007). Recently, Anderson et al (2019) found that higher unit cohesion was associated with lower levels of PTSD, major depressive disorder symptoms, and generalized anxiety disorder symptoms, and also associated with less suicidal ideation nine months into a deployment and after deployment as well.…”

The evolution of mental health outcomes across a combat deployment cycle: A longitudinal study of the Guam Army National Guard

“…Organizational support: The degree to which respondents received positive psychological support from their unit overall was assessed with the shortened Perceived Organizational Support measure, which has been widely used in military research [55–56]; respondents indicated their level of agreement with the following items: 1) My unit strongly considers my goals and values; 2) My unit really cares about my well-being; 3) My unit cares about my opinion; and 4) My unit is willing to help me when I need a special favor (0 = strongly disagree to 5 = strongly agree ; α = .95).…”

The Things They Carry: Veterans and the COVID-19 Pandemic

“…Unit cohesion is the bond that unites service members to one another and the mission; 2 it has been prospectively associated with lower risk of adverse mental health outcomes like posttraumatic stress disorder (PTSD), depression, and substance use disorder (SUD). 2 While many have likened our collective experience of COVID-19 to wartime, we must consider what this crisis is like for those who have actually served and how we may best support them during the pandemic. We may also learn from their courage, resilience, and expressions of camaraderie.…”