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					      Stress, hardiness & symptoms in Bosnia deployed soldiers


                                      Paul T. Bartone, Ph.D.*

                       Department of Behavioral Sciences and Leadership
                               United States Military Academy
                                  West Point, NY 10996




                                           ABSTRACT

      Utilizing survey methods, this study examines sources of stress for American forces
deployed to Bosnia, the relation of stress to psychiatric symptoms and PTSD, and the influence
of personality hardiness as a stress moderator or buffer. Common sources of stress during the
deployment include boredom, family separation, and powerlessness. Less common, more severe
stressors are physical injury or assault, exposure to mines, and exposure to dead and severely
injured people. Approximately 6-months into the year-long deployment, up to 30% of soldiers
report Post Traumatic Stress Disorder (PTSD) symptoms. PTSD scores are related to both more
and less severe stressors. Personality hardiness interacts with severe or traumatic stress to predict
lower PTSD scores. In a more rigorous prospective analysis, personality hardiness served to
moderate the effects of pre-deployment stress on later general psychiatric symptoms, lending
further support to a stress- buffering role for hardiness.




Paper presented at the American Psychological Association convention, August 1998,
San Francisco.

* LP7894@exmail.usma.edu
      Stress, hardiness & symptoms in Bosnia deployed soldiers


                                      Paul T. Bartone, Ph.D.


        As the United States deploys an increasing number of soldiers to operations other than war,
such as in Bosnia, it is important to understand the sources of stress on such missions, their health
effects, and the factors that may contribute to continued good health of soldiers under stressful
circumstances. To address these issues, survey data were collected on over 1,000 soldiers 6-
months after they deployed for what was to be a year-long mission of peacekeeping in the former
Yugoslavia. This “mid-deployment” survey listed 65 potential daily stressors. Total stress
exposure scores were created by summing responses to these stressor items. In addition, a list of
16 more extreme (traumatic) events was included. A traumatic stress exposure index was likewise
created by summing responses to these items. Two separate regression models were tested,
examining the influence of these two types of stressors on reported Post-Traumatic Stress Disorder
(PTSD). PTSD was assessed by means of a 17-item checklist based directly on DSM-IV criteria
(Bartone, Vaitkus & Adler, 1993). Personality hardiness was entered into both regression models,
both as an independent predictor and as an interaction term with stress. Hardiness was measured
with a short, 15-item scale that includes positively- and negatively-keyed items covering three
hardiness facets of commitment, control and challenge (Bartone, 1995). This scale has an overall
Cronbach’s alpha of .83 (for the facets, commitment .77; control .71; challenge .70).

        Personality hardiness has been identified as a significant moderator of stress in a variety of
occupational groups (e.g., Bartone, 1989; Contrada, 1989; Kobasa, Maddi & Kahn, 1982; Roth et.
al, 1989; Wiebe, 1991). Conceptually, “hardiness” is an individual differences variable that
develops early in life and is reasonably stable over time, though amenable to change under certain
conditions (Maddi & Kobasa, 1984). Hardy persons have a high sense of life and work
commitment, greater sense of control, and are more open to change and challenges in life. In
military groups, hardiness has been identified as a significant moderator of combat exposure stress
in US Gulf War soldiers (Bartone, 1993).

       When responses on the PTSD scale are scored according to diagnostic criteria of DSM-IV,
8% to 30% of the samples show a pattern of symptoms consistent with a PTSD diagnosis (8% if
more extreme cut-off is used, i.e., symptom is counted as “present”only if respondent reports
experiencing it “often” during the past month; 30% if less exteme cut-off is used, i.e., symptom is
counted as present if experienced “sometimes” during the past month). Regression analysis found
a main effect for daily stressors on total PTSD scores, but no effects for hardiness (R2 = .27, p <
.0001). A second regression (Table 1) examining more extreme or traumatic stressors found a
main effect for stress on PTSD scores, and also a significant stress X hardiness interaction effect.
The interaction effect shows that high hardy soldiers show less PTSD under high stress conditions
than do low hardiness soldiers. Stressors correlating most highly with PTSD include family
concerns and problems, problems with coworkers, isolation and boredom. Major stressors
correlating with PTSD include being assaulted, witnessing an explosion, and witnessing serious
injury or death.



       Table 1: Traumatic Event Exposure (mid-deploy) Predicts PTSD Symptoms

         ________________________________________________________

         Predictor                       Beta               T         p<

         Tot. Trauma                     .45             3.1          .002

         Hardy X Trauma                -.45             -1.9          .05

        ________________________________________________________
       Multiple Regression (direct entry method)
       Model: F(3,1007) = 53.9, p<.0001
       Multiple R       .37
       R Square =       .14
       N=1,010 U.S. Army personnel deployed to Bosnia-Croatia (June, 1996)


        Data on pre-deployment stressors were also available for a sub-group (N=103) of soldiers
in the mid-deployment sample. This made it possible to examine the effects of earlier stress on
later reported symptoms (Bartone et. al., 1989), and the possible moderating role of hardiness.
Using (direct entry) regression, results showed that stress exposure in the pre-deployment period
predicts later symptoms (using a 20-item psychiatric symptoms scale; Bartone et. al, 1989). Also,
hardiness again interacts with exposure to predict (fewer) symptoms (Table 2). Other analyses
found that pre-deployment stress predicts later depression as well, but not as strongly as it does
symptoms.


       Table 2: Pre-deployment Stress & Hardiness Predict Later General Symptoms

       ________________________________________________________

          Predictor                      Beta           T               p<

          Stress                          .84            3.8        .0002

          Stress X Hardy                 -.64          -2.9         .004

       ________________________________________________________
       Multiple Regression (direct entry method)
       Model: F(2, 99) = 8.2, p<.0005
       Multiple R       .38
       R Square =       .14
       N=103 US Army personnel deployed to Bosnia-Croatia (1996)
       These results on American soldiers 6-months into a year-long Bosnia deployment show
clear and strong effects of stress exposure on PTSD symptomatology, for less severe and more
extreme stressors. Hardiness interacts significantly with traumatic stress to predict PTSD. The
prospective analyses show that stress exposure in the pre-deployment phase predicts depression
and general symptoms later in time, at the mid-deployment phase, for U.S. Army soldiers
deployed to Bosnia. Stress exposure at pre-deployment is more strongly related to later
symptoms than to depression. Also, personality hardiness interacts with stress exposure to
further predict symptoms, but not depression. These findings lend support to a stress buffering
role for hardiness, where soldiers who are high in hardiness are more resilient and healthy under
high stress conditions. Results also suggest soldiers tend to express psychological stress in terms
of somatic complaints and symptoms, moreso than depression symptoms. This accords with
recent studies showing long-term physical health effects of war stress (Elder et. al., 1997), and
supports the view that psychological stress plays an important role in the emergence of symptoms
in soldiers following military operations.



                                             References


Bartone, P.T. (I 989). Predictors of stress-related illness in city bus drivers. J. of Occupational
     Medicine, 3 1. 657-663.

Bartone, P.T. (June, 1993). Psychosocial predictors of soldier adjustment to combat stress.
     Paper presented at the Third European Conference on Traumatic Stress, Bergen, Norway.

Bartone, P.T. (July, 1995). A short hardiness scale. Paper presented at the Annual Convention
     of the American Psychological Society, New York.

Bartone, P.T., Ursano, R.J., Wright. K.W. & Ingraham, L.H. (1989). The impact of a military
     air
     disaster on the health of assistance workers: A prospective study. J- of Nervous and
     Mental Disease, 177, 317-328.

Bartone, P.T., Vaitkus, M.A. & Adler, A.B. (June, 1994). Assessing Post Traumatic Stress
     Disorder and PTSD symptomatology in U.S. Army personnel. Presented at the 30th
     international Congress on Military Medicine, Augsburg, Germany.

Contrada, R.J. (1989). Type A behavior, personality hardiness, and cardiovascular responses to
     stress. J. of Personality and Social Psychology, 57, 895-903.
Elder, G.H., Shanahan, M.J. & Clipp, E.C. (1997). Linking combat and physical health: the
      legacy of World War II in men's lives. American Journal of Psychiatry, 154, 330-336.

Kobasa, S.C. (1979). Stressful life events, personality, and health: An inquiry into hardiness. J.
     of Personality and Social Psychology. 37, 1 -1 1.

Kobasa, S.C. & Maddi, S.R. (1977). Existential personality theory. In R. Corsini (Ed.),
     Existential Personality Theories, Itasca, IL: Peacock.

Kobasa, S.C., Maddi, S.R., & Kahn, S. (1982) Hardiness and health: A prospective study. J. of
     Personality & Social Psychology, 42, 168-177.

Maddi, S.R. & Kobasa, S.C. (1984). The Hardy Executiye. Homewood, IL: Dow Jones-Irwin.

Roth, D.L., Wiebe, D.J., Fillingim, R.B. & Shay, K.A. (1989). Life events, fitness, hardiness,
      and health: A simultaneous analysis of proposed stress-resistance effects. J. of Personalily
      and Social Psychology, 57, 136-142.

Wiebe, D.J. (1991). Hardiness and stress moderation: A test of proposed mechanisms. J. of
     Personalily and Social Psychology, 60, 89-99.
Table 1: Traumatic Event Exposure (mid-deploy) Predicts PTSD Symptoms
 ________________________________________________________
 Predictor                Beta       T            p<
Tot. Trauma           .45      3.1      .002
Hardy X Trauma       -.45     -1.9      .05
________________________________________________________

Multiple Regression (direct entry method)
Model: F(3,1007) = 53.9, p<.0001
Multiple R= .37
R Square = .14
N=1,010 U.S. Army personnel deployed to Bosnia-Croatia (June, 1996)
Table 2: Pre-deployment Stress & Hardiness Predict Later General Symptoms
    ________________________________________________________
      Predictor               Beta          T             p<

     Stress               .84          3.8     .0002
     Stress X Hardy      -.64         -2.9      .004
    ________________________________________________________

    Multiple Regression (direct entry method)
    Model: F(2, 99) = 8.2, p<.0005
    Multiple R= .38
    R Square = .14
    N=103 US Army personnel deployed to Bosnia-Croatia (1996)

				
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