Greater time in military service correlated with higher resilience for women but had little correlation for men; might be due to relative reduction in resilience for those goal-oriented women trained at West Point who leave the service

Psychological Resilience in West Point Graduates: Results From a Nationally Representative Study. Melissa M. Thomas et al. Chronic Stress, Nov 5 2021. https://journals.sagepub.com/doi/10.1177/24705470211053850

Abstract

Background: The purpose of this study was to examine factors associated with psychological resilience in a nationally representative sample of West Point graduates.

Aims: The aims of this study were to (a) employ a dimensional approach to operationalizing psychological resilience in a trauma-exposed population that had been highly trained and educated in persisting in the face of stress, was previously unstudied, and in which we could examine correlates of resilience, (b) identify key psychosocial factors, character traits, health variables, military experiences, and coping strategies as potential correlates of psychological resilience; and (c) examine whether reported gender moderated any of these associations in this population.

Methods: A nationally representative sample of 1342 West Point graduates after gender integration from classes 1980 to 2011 were surveyed. Psychological resilience was operationalized using a discrepancy-based approach in which a measure of composite psychological distress (current posttraumatic stress disorder, generalized anxiety and depression symptoms) was regressed on measures of cumulative trauma burden. A multivariable linear regression model was then employed to identify factors that were independently associated with psychological resilience scores.

Results: Purpose in life (29.8% of relative variance explained [RVE]), fewer perceived negative experiences in the military (20.6% RVE), social support (9.6% RVE), and grit (9.5% RVE) were the strongest correlates of psychological resilience scores for both women and men. Time in service was positively associated with resilience in women only.

Conclusion: This study identifies key correlates of psychological resilience in West Point graduates, individuals who are highly trained to persevere in the face of stress and then were trauma-exposed. Most of these factors are modifiable and can be targeted in stress prevention and treatment interventions, especially for high-stress professions such as the military, frontline health care providers, and first responders.

Popular version: What West Point Graduates Can Teach Us About Stress and Resilience. Jan 2 2022. https://medicine.yale.edu/news-article/what-west-point-graduates-can-teach-us-about-stress-and-resilience/

Discussion

To our knowledge, this study is the first to examine factors associated with psychological resilience in a nationally representative sample of West Point graduates. A notable strength of this investigation was access to and study of a sample of individuals extensively trained to be resilient who have high risk of exposure to stressful events. The assessment of psychological resilience used a discrepancy-based approach that computes each participant’s individual level of distress in relation to what is expected at the population level. This approach generates a measure of psychological resilience that spans the full-dimensional spectrum from high vulnerability to high resilience. Given previous criticisms that operationalizations of psychological resilience should not be limited to PTSD symptoms, we chose to employ a more comprehensive assessment of psychological distress that included PTSD, anxiety, and depressive symptoms. In addition, a wide range of psychosocial factors, character traits, health variables, military experiences, as well as coping strategies that could be linked to psychological resilience were measured and assessed.

Results revealed that purpose in life, social support, and grit were most strongly associated with resilience. Report of fewer negative experiences in the military was also associated with resilience and, for women, greater time in service was correlated with resilience. Results of the current study suggest multiple factors contribute to the capacity to weather adversity. Importantly, these factors are modifiable and thus use of multimodal prevention and treatment efforts may be effective in maintaining and building psychological resilience for both men and women.

Purpose in life was most strongly associated with psychological resilience. Potential behavioral mechanisms underlying this association include a positive relationship between purpose in life and physical activity, internal locus of control, better sleep quality, better emotion regulation, and use of preventive health care services.^37–39 Interventions that may help enhance purpose in life for high-risk populations exposed to stress and trauma include using meaning-based therapies, such as logotherapy, and integration of meaning- and purpose-centered activities in other established psychotherapies, such as cognitive-behavioral therapy.^40–43 Development of purpose in life also might lead to an increase in other protective factors, such as motivation to engage in social interactions.³⁷

Military service provides both subjective positive and negative experiences that influence veterans’ mental health later in life.⁴⁴ For example, veterans who report more negative military experiences may be more likely to develop PTSD symptoms later in life and have increased odds of current suicidal ideation and current mental health disorders.^45,46 Results of our study extend this work to suggest that reports of drinking problems, witnessing death and destruction, and worsening physical health may be linked to reduced psychological resilience. Although witnessing death and destruction as a negative consequence of military service may appear to be embedded in our trauma exposure calculation, the trauma exposure measure is based on whether exposure to an event occurred, not whether it is perceived as having a negative consequence in one's life. It is the perception of the event being negative that we found to be related to lower psychological resilience. Given the cross-sectional design of our study, however, we are unable to ascertain whether negative perceptions of reported events are influenced by current mental health difficulties, or if the endorsement of more negative effects drives risk for psychological distress and general maladaptive perceptions of one's life (eg relationships, finances, health).⁴⁶ Nevertheless, this finding underscores the importance of addressing negative mental and physical health consequences of perceived trauma, as well as screening for and treating current risky drinking behaviors and poor health in efforts to help promote resilience.

Social support was also strongly associated with psychological resilience. Greater perceptions of social support may help increase psychological resilience by promoting self-esteem, active coping strategies, a sense of control, evaluation of potentially stressful events as less threatening, and motivation to adopt healthfully and reduce risky behaviors.¹ Encouraging involvement in one's community, as well as community policies and programs that support and enhance connection by promoting safe neighborhoods, affordable housing, and public spaces for assembly and exercise are all methods of promoting and improving social support.⁴⁷ Of note, positive social support has been shown to activate the parasympathetic nervous system and brain regions implicated in the processing of safety cues and stimulate the release of oxytocin, which is known to have anxiolytic effects.^48,49

Grit has 2 main components, perseverance of efforts and consistency of interest.^21,50–52 The first component, perseverance of efforts is thought to overlap with the construct of resilience since it refers to maintaining goals even when obstacles are encountered. Some studies show grit is associated with a reduced tendency for suicide ideation and decreased burnout in doctors and surgical residents.^53–55 In studying West Point cadets, Duckworth and colleagues found that those who had higher grit at the entry to the academy were less likely to drop out of the first basic training summer than less gritty peers, even after controlling for SAT scores, high school class rank, and conscientiousness.⁵² Recently, Duckworth et al.⁵⁶ also found that grit and physical ability in a cohort of West Point cadets were better predictors of 4-year graduation from the Academy than cognitive ability. Additionally, grit has been associated with resilience itself but, to our knowledge, this is only based on self-reported resilience scales, such as the Connor–Davidson Resilience Scale©.^57,58 Our study adds to this literature by identifying a relationship between grit and psychological resilience using a resilience score measured on a continuum. This is an important identified relationship since grit is also a modifiable factor. Therapeutic interventions to promote a growth mindset and work on goal-setting and discovering one's passions may help increase grit.^59,60

Results did not indicate gender differences in factors associated with resilience except for the greater time in service, which was associated with greater resilience in women only.^61-63 This is perhaps a result of women who stay in the military longer being those who have accommodated to the military environment and learned to cope and survive in a male-dominated hierarchical environment.⁶⁴ It is also possible that there are psychological vulnerabilities from leaving military service that are inherent to women only. One reason women are more likely to leave the service than men are due to family obligations, such as having children. Driven, gritty women who obtain training and education by attending West Point then no longer work or fill the role of a military officer may become more vulnerable to mental health issues later in life. This is perhaps due to a loss of purpose in life or career goals, whereas men who leave the military are more often pursuing a different career. For those who opt to leave the military and pursue a different career, female veterans often seek careers in similarly male-dominated fields and have reported difficulty integrating into the civilian workforce due to differences in dress, behavior (posture, assertiveness), identity issues, and disconnection from their civilian female counterparts.^64,65 Efforts to support a smooth transition for women into civilian careers may alleviate these experiences, particularly regarding the unique challenges they may face.

Limitations of this study include the use of self-report measures, which may be subject to recall bias, although this is a similar possibility with clinician-administered scales. The response rate of the survey was also a limitation. However, with our sampling strategy of overrepresenting women, we achieved statistically significant results for gender comparisons; and, through age, class year, racial, and branch demographics for the population, we were able to achieve a representative sample of the targeted population. Although social support and grit appear to play a role in psychological resilience, the amount of variance explained by each was relatively low. Finally, given the cross-sectional design, we cannot establish temporal or causal associations. Consequently, it is unclear if the greater purpose in life, social support, and grit give rise to greater resilience or vice versa, or if these associations are bidirectionally linked over time. To date, all of the known studies that have employed a discrepancy based psychological resilience approach to operationalizing resilience have done so using cross-sectional data.^9,10 Longitudinal studies employing prospective designs are needed to evaluate the application of a discrepancy-based approach and evaluate the role of flexible self-regulation and other time-varying factors in contributing to resilience.⁶⁶