Post on 02-Jan-2016
Operational Stress in Detainee Operations at Joint Task Force
Guantanamo Bay Cuba
Scott Johnston, PhD, ABPPCDR MSC USN
Stephanie Raducha, BAGali Goldwaser, PhD
Elizabeth J. Abou, BA Douglas C. Johnson, PhD
Naval Center for Combat & Operational Stress Control
Introduction• NCCOSC collaboration• Combat tours vs. GTMO
deployment• Questions
– Stress / PTSD– Working outside of rate– Beliefs of mental health
Life as a Guard at GTMO• History
– Camp X-Ray
• Safe, humane, legal and transparent care• Spotlight of the world• Tropical paradise
Sample
• N = 498• Guards and medical
personnel• Mid-deployment• Self report surveys• August 2009 –
November 2009
GTMO Guard DemographicsSex
84%
16%
MaleFemale
Age
42.8%
29.5%
22.9%
4.8%
0 10 20 30 40 50
18-24
25-29
30-39
40 plus
Ag
e G
rou
p
Percent
Rank (Pay Grade)
65%
0%
27.7%
5.6%
1.6%
0% 20% 40% 60% 80%
E1-3
E4-6
E7-9
O1-3
O4-8
Ran
k
Percent
Military Branch
68%
32%
NavyArmy
Measures• PTSD Checklist – military (PCL-M)• Patient Health Questionnaire (PHQ-9)• Perceived Stress Scale (PSS)• Response to Stressful Experiences Scale (RSES)• Beliefs about Psychotherapy• Neurocognitive Survey – Alcohol Section• NEO-N
PTSD Symptoms for GTMO Population vs. Combat Population
*Operation Iraqi Freedom National Guard Soldiers with moderate combat exposure who served from 2005 to 2006. (Renshaw et al., 2009).
0
5
10
15
20
25
30
35
40
45
50
GTMO Guards OIF Soldiers*Servicemember Group
Mea
n P
CL
-M S
core
0
2
4
6
8
10
12
14
16
18
20
GTMO Guards Marines &Soldiers in OIF*
Before Deplomentto Iraq
Service Member Groups
Pe
rce
nt
Me
eti
ng
Cri
teri
a f
or
PT
SD
Hoge data
GTMO data
*Marines and Soldiers exposed to combat while deployed to Operation Iraqi Freedom, Hoge et al., 2004. Based on PCL-M symptoms endorsed.
GTMO PTSD Rates Compared to Combat Vets and Pre-Deployment Rates
0%
5%
10%
15%
20%
25%
GTMOGuards
Not deployed DeployedwithoutCombat
Deployed withCombat
Service Member Group
Pe
rce
nt
Me
eti
ng
De
pre
ss
ion
Cri
teri
a
GTMO Population
Millennium Cohort Population
*Millennium Cohort data from: Wells et al., 2010. Depression criteria based on PHQ-9 score of 10 or greater.
Depression in GTMO Guards vs. Other Service Members
Increased risk for Depression• Hypotheses
– Psychological vs. kinetic warfare– Constriction vs. small unit autonomy
Working outside of your rate
• Rate = job• 52% work outside
their regular job• Training as
resilience factor
*All reported results are statistically significant (p<.05). Depression – Patient Health Questionnaire (PHQ-9); PTSD - PTSD Checklist – Military (PCL-M); Alcohol - CAGE Alcohol – primary care alcohol screener; Self refer - based on question: If you believed you had a mental health problem, would you ask for professional help?
Working Within vs. Outside Rate
Within Rate
Outside Rate
0
5
10
15
20
25
30
35
Depression PTSD Alcohol Self Refer
Measure
Me
an
Sc
ore
Beliefs in Mental Health• Stigma
– 50% don’t seek care
• If you believed you had a mental health problem, would you ask for professional help?
• If you believed you had a trooper under your leadership that had a mental health problem, would you refer them for professional help?
66%
28%
1%
5%
Refer Self & Refer Trooper
Not Refer Self & Refer Trooper
Refer Self & Not Refer Trooper
Not Refer Self & Not Refer Trooper
* Based on questions: 1) If you believed you had a mental health problem, would you ask for professional help? 2) If you believed you had a trooper under your leadership that had a mental health problem, would you refer them for professional help?
Willingness to Refer to Mental Health Treatment
Willingness to Refer with or without PTSD
*Will Refer Self, Won’t Refer Trooper; Won’t Refer Self, Won’t Refer Trooper are not reported.
0
10
20
30
40
50
60
70
80
PTSD No PTSD
Pe
rce
nta
ge
(%
)
Refer Self & Refer Trooper
Not Refer Self & Refer Trooper
Willingness to Refer with and without Depression
Refer Self & Refer Trooper
Not Refer Self & Refer Trooper
0
10
20
30
40
50
60
70
80
90
Depression No Depression
Per
cen
tag
e (%
)
*Will Refer Self, Won’t Refer Trooper; Won’t Refer Self, Won’t Refer Trooper are not reported.
Conclusions• Detainee operations are stressful
– Higher risk for depression
• Protective quality of working outside rate• Stigma is present
– More likely to refer other then self– Those at risk are less likely to seek mental health
Questions
CDR Scott Johnstonscott.johnston@med.navy.mil