“Toughness” in association with mental health symptoms among Iraq and Afghanistan war veterans seeking Veterans Affairs health care.

Abstract

The association between endorsement of emotional "toughness" (i.e., extreme self-reliance and the suppression of outward displays of emotional distress) and likelihood for screening positive for mental health conditions was examined in a male sample of 198 Iraq and Afghanistan veterans presenting for postdeployment Veteran Affairs health care. After accounting for relevant covariates, veterans endorsing higher levels of emotional toughness were more likely to screen positive for posttraumatic stress disorder and depression. There was also a nonsignificant trend {p = .08) associated with a positive relationship between toughness and likelihood of self-reported alcohol abuse. Results are discussed in terms of identifying and addressing toughness norms among returning veterans to promote effective use of mental health services.

Lifetime Suicidal Behaviors and Career Characteristics Among U.S. Army Soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

“…There are at least two explanations why these occupations would be associated with suicide death but not non-lethal suicidal behaviors. First, those in combat-related positions could be more likely to conceal prior suicidal behaviors because of cultural norms that include avoiding negative emotions or stimuli that produce them (Bryan, Stephenson, Morrow, Staal, & Haskell, 2014), withholding expressions of negative or difficult emotions (Jakupcak, Blais, Grossbard, Garcia, & Okiishi, 2014), and stigma associated with reporting mental health problems or using mental health services (Hoge, Auchterlonie, & Milliken, 2006; Zinzow et al, 2013). Second, combat arms soldiers may truly have similar rates of suicidal behaviors as other occupations but be more likely to act on suicidal thoughts with more lethal means, such as firearms (Shenassa, Catlin, & Buka, 2003), resulting in death.…”

Posttraumatic Stress and Stigma in Active‐Duty Service Members Relate to Lower Likelihood of Seeking Support

“…Higher AES was associated with lower likelihood of support seeking. AES may be related to military culture or male gender norms that equate vulnerability or support seeking with weakness (Jakupcak, Blais, Grossbard Garcia, & Okiishi, ). These findings highlight the importance of addressing service members’ perceptions that people will react negatively to them if they seek help.…”

“…The DSM‐5 description of PTSD closely mirrors the numbing model, but confirmatory factor analyses indicate the dysphoria model has superior fit and stability in samples of Iraq veterans (Meis, Erbes, Kaler, Arbisi, & Polusny, ). Higher dysphoria is associated with greater interpersonal difficulties (Pietrzak, Goldstein, Malley, Rivers, & Southwick, ), and higher avoidance is associated with fewer psychotherapy visits (Blais, Hoerster, Malte, Hunt, & Jakupcak, ). These same features of PTSD may also affect support seeking, but this has not been examined.…”

From Service Member to Student: Predictors of Psychological Help-Seeking Attitudes in Student Servicemembers and Veterans

“…While toughness may be an adaptive coping mechanism in combat settings, this construct may be maladaptive in nonmilitary environments like higher education. Among a sample of Iraq and Afghanistan veterans, for example, higher levels of emotional toughness were positively associated with the likelihood for self-reported PTSD and depression (Jakupcak et al, 2014). That said, males, or females who highly ascribe to emotional toughness, may not seek necessary help due to traditional gender norms relevant to toughness and self-reliance.…”

“…Toughness (i.e., suppression of outward expression of emotion) is central to masculine norms in most Western societies (Jakupcak, Blais, Grossbard, Garcia, & Okiishi, 2014).…”