The Comprehensive Soldier and Family Fitness Program Evaluation. Report #4: Evaluation of Resilience Training and Mental and Behavioral Health Outcomes

Authors

Peter D. Harms, University of Nebraska - LincolnFollow
Mitchel Herian, University of Nebraska - LincolnFollow
Dina V. Krasikova, University of Texas at San AntonioFollow
Adam J. Vanhove, University of Nebraska-LincolnFollow
Paul B. Lester, Office of the Deputy Undersecretary of the ArmyFollow

Date of this Version

4-2013

Document Type

Article

Comments

U.S. government work, not subject to copyright

Abstract

The purpose of this evaluation is to examine the effectiveness of Master Resilience Training, which is a pillar of the Comprehensive Soldier and Family Fitness (CSF2) program. The report evaluates the relationship between resilience training and diagnoses for mental health or substance abuse problems and whether this relationship was mediated by Soldiers’ self-reported resilience/ psychological health (R/PH). In other words, we tested whether Soldiers with MRT trainers in their units experienced increases in self-reported R/PH, and whether increases in self-reported R/PH were associated with reduced odds of Soldiers receiving diagnoses for mental health or substance abuse problems.

The results revealed that exposure to resilience training increased various aspects of Soldier R/PH, which, in turn, appeared to be associated with a reduced likelihood of receiving a diagnosis for a mental health problem (i.e., anxiety, depression, or posttraumatic stress disorder [PTSD]). Thus, this finding suggested that the reduced odds of receiving a diagnosis for a mental health problem was partly due to increases in indicators of R/PH that were likely associated with exposure to resilience training. Moreover, the findings provided evidence that Soldiers exposed to the training were diagnosed with substance abuse problems at a significantly lower rate than Soldiers who were not exposed to the training.

Importantly, the results of this evaluation bolster findings from previous evaluations by employing more sophisticated and stringent statistical techniques to demonstrate that resilience training can improve the R/PH of Soldiers. Additionally, the analyses included in this evaluation accounted for the potential effects of Soldier deployment; these considerations were not made in previous evaluations of the program. Therefore, the current evaluation provides further evidence that resilience training may improve the self-reported R/PH of Soldiers, even when controlling for a wider range of factors that might be expected to impact the R/PH of Soldiers.

The findings of this evaluation have a number of implications. First, this evaluation provides some evidence that resilience training may be related to improvements on objective measures of mental and behavioral outcomes (i.e., diagnoses for mental health and substance abuse problems). Second, when considered at the organizational level, the effects of resilience training may reach beyond improving the health of individual Soldiers by improving the aggregate health and effectiveness of the Army as an organization. Given that diagnoses for mental health disorders are a leading cause for hospitalization in the Armed Forces (Armed Forces Health Surveillance Center, 2012b), the findings provide evidence that interventions such as those offered by CSF2 may help relieve the stress that is currently being placed on medical services in the Army. In sum, it appears that the improvement of R/PH through resilience training efforts can protect against problems that undermine the effectiveness and efficiency of the Army.

As with any large-scale evaluation of this type, there are a number of limitations to be acknowledged. First, the timing of deployment cycles of Soldiers in the eight Brigade Combat Teams (BCTs) that were examined introduced potential confounds with regard to the timing of resilience training and data collection efforts for use in this report. Specifically, it appeared that the timing of deployments was such that Soldiers with MRTs in their units were more likely to have been deployed to combat than were those who had no MRT trainers in their units. This means that Soldiers who received resilience training were also more likely to have experienced combat which likely increased the probability of subsequently experiencing the adverse outcomes examined in this study. While this fact posed a potential confound, statistical controls were put in place that allowed for a meaningful test of the resilience training program’s effect on R/PH and diagnoses for mental health and substance abuse problems. Other limitations of this evaluation effort have been described elsewhere (Lester, Harms, Herian, Krasikova & Beal, 2011c) and are expanded upon later in this report.

In light of these limitations, it is important that readers recognize two points when reviewing this report. First, this report builds on previous evaluations of the CSF2 program. Specifically, the analyses used here were more stringent given the nature of the data. It is important to note that, given the more rigorous testing methods, the results of this and previous evaluations are fairly consistent. Second, it is critical to recognize that the findings presented in this report represent the latest effort in an ongoing evaluation of the resilience training program. Future analyses may also be conducted that empirically explore the relationship between resilience training and other objective outcomes. If such analyses are undertaken, it is possible that the results may differ from those presented here and in previous evaluations due to the amount of time that has passed since implementation of the training program. In the end, however, the effectiveness of CSF2 cannot be judged solely on the results of any single evaluation, but instead must be considered in light of the entire body of work done to date.