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Veterans’ perceptions of benefits and important program components of a therapeutic fly-fishing program.

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Abstract

While evidence is emerging for therapeutic recreation programs for veterans with combat-related disabilities, minimal research has been done to understand participants’ perceptions of these programs. The intent of this study was to examine the perceptions of veterans with combat-related disabilities and their significant others following participation in a therapeutic fly-fishing program. Six focus group discussions were conducted and the constant comparison method of analysis was used to discover the two primary themes of Perceived Benefits and Important Program Components. Based on these findings, implications for therapeutic recreation practice are included.

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... • 269 and OIF deployment. Further, we designed this study to allow us to gain insight into combat veteran's perceptions of their regular, ongoing leisure, rather than focusing speci cally on responses to a particular intervention, such as sports programs and camps (e.g., Hawkins et al., 2011;Lundberg et al., 2011) or recreation activities such as y-shing (e.g., Bennett et al., 2014b;Mowatt & Bennett, 2011;Price et al., 2015) and river running (Dustin et al., 2011). To some, outdoor recreation and physical activity is leisure; to others, leisure encompasses other pursuits that can occur each day, such as having a cup of a favorite hot drink with one's spouse at a local co ee shop. is research study allows us to explore and increase our understanding of combat veterans' perceptions relative to leisure and the complex interpersonal dynamics in uenced by military life and combat deployment. ...
... Although writers have identi ed the restorative bene ts of nature (e.g., Kaplan, 1995;Kaplan & Kaplan, 1989;Mayer, McPherson Frantz, Bruehlman-Senecal, & Dolliver, 2009), only recently have studies been conducted examining e ects of outdoor recreation programs on veterans, especially with those identi ed as having PTSD. Positive results have been reported associated with such activities as y-shing (Bennett et al., 2014b;Mowatt & Bennett, 2011;Vella, Milligan, & Bennett, 2013) and river running (Dustin et al., 2011). Findings from this study regarding the theme e outdoors gets me o the grid are consistent with the perspective presented in Price et al. (2015) as they state, " ere I stood in the middle of nature... Gone were the images of the dead and dying… I was completely in the moment surrounded by a gentle breeze with the boat rocking beneath my feet… I felt peace" (p. ...
... Researchers have identi ed bene ts associated with speci c therapeutic programs for veterans; however, there is a dearth of research examining outcomes associated with their leisure experiences. One exception is a study conducted by Bennett et al. (2014b) who used focus group discussions with veterans and found support for the value of being in nature; the study identi ed the importance of the physical setting of the natural environment as a valued program component. One veteran participating in the Bennett et al. (2014b) study described the e ect of being in nature in the following way: "I think for some of us this is kinda like our element, you know. ...
Article
Framed within the Theory of Planned Behavior, researchers examined the relationship between military life, deployment, and leisure engagement. Following a constant comparative analytic framework, we transcribed and coded semi-structured, in-depth individual interviews with 10 combat veterans of Operations Enduring Freedom and Iraqi Freedom and member check inter-views. Twenty-five themes emerged from the interviews, 10 of which were unique to the combat veterans. Military life both facilitated leisure by creating opportunities and providing resources, as well as constrained it by creating impermanence and imposing structure. Themes emerged about negative influences of deployment on veterans, and about a general sense of appreciation during reintegration post-deployment. There appears to be dialectical tension between constraints and facilitators of leisure. Researchers found the theory of planned behavior to be useful in interpreting results and exploring strategies to improve the well-being of combat veterans.
... The relationship between spending time in nature and well-being has been demonstrated throughout the literature (Annerstedt & Währborg, 2011;Capaldi et al., 2014;Hartig et al., 2014). Additionally, in previous adventure-based therapy studies, data have indicated that spending time with individuals from a similar background can promote open communication, which may help to establish social recognition (van der Velden et al., 2019) through validation, acceptance, or acknowledgement of experiences by peers (Bird, 2015;Bennett et al., 2014b;Burke & Utley, 2013). Through utilising peer-facilitation and a group format, social support and social recognition are key components of the Trojan's Trek program, and this may help contribute to improved mental health outcomes. ...
... Other components of the Trojan's Trek program including a focus on skills building and participation in adventurous activities, may have also contributed to positive psychosocial outcomes. For example, learning new psychological and physical skills has previously been reported to increase confidence and provide an outlet for coping with various difficulties (Bennett et al., 2014b). Correspondingly, this study demonstrated increased self-efficacy at posttrek and follow-up compared to pre-trek which may be associated with positive health outcomes (Cusack et al., 2019). ...
... The Angling Trust resource hub proposes that fishing is an inclusive activity which can be used to relieve long term health and wellbeing conditions as part of social prescribing initiatives [19]. Previous research has found fishing can be a form of stress relief [20][21][22], improve social relations [23,24] and is an accessible form of physical activity for older adults and people recovering from illness [15]. However, it is important to examine if there are significant differences in fishing participation patterns (i.e., frequency, duration, type of fishing, and fishing match engagement), between people with disabilities and people without disabilities. ...
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Green social prescribing, which includes the referral of patients to nature-based activities, could exacerbate inequalities between people with disabilities and people without. Research suggests fishing could be more inclusive relative to other outdoor sports. To understand if fishing is an inclusive sport, and the potential benefits and barriers to prescribing fishing, the present study compared participation, motivators and barriers to fishing, between anglers with and without disabilities. UK adults were invited to participate in an online survey. Chi-square tests examined differences between anglers with and without disabilities regarding the type of fishing anglers engaged in, the frequency of fishing, the length of time spent fishing, motivators for fishing and barriers to fishing. Among 1799 anglers (97.5% male), 292 (16.2%) anglers reported having a disability. Most anglers with disabilities were over 55 years old (56.5%). There was no difference in fishing participation, or motivators for fishing, between anglers with and without disabilities; however, anglers with disabilities were more likely to report ‘costs’, ‘lack of transport’ and ‘having no one to go with them’ as barriers. Overall, there appeared to be no differences in fishing participation between anglers with versus without disabilities, although additional barriers to participation may exist.
... A small number of published articles highlight fly-fishing as a form of recreation therapy that appears to aid in alleviating symptoms, assist with stress management and instil a positive future focus among combat veterans diagnosed with PTSD. 7,8,9 Despite being discussed as a therapy for PTSD, a complex mental disorder, no researched form of therapeutic fly-fishing appears to be facilitated by licensed mental health professionals. Likewise, there seems to be no research that integrates evidencebased treatment for PTSD with therapeutic flyfishing. ...
Article
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Therapeutic fly-fishing is a nature-based intervention that is experiencing increased use to adjunct mental health treatment with current and former uniformed service professionals. While promising, literature suggesting the use of therapeutic fly-fishing with evidenced-based psychotherapy for posttraumatic stress disorder (PTSD), or any other mode of psychotherapy, does not appear to exist. This raises several questions regarding the ethics and fidelity of current uses of fly-fishing during a person's mental health care. Because of these concerns, the author explores literature surrounding the use of therapeutic fly-fishing for combat-related PTSD and offers a way to integrate fly-fishing directly within a well-researched and widely used PTSD treatment modality: Eye Movement Desensitization and Reprocessing (EMDR) therapy. The distinct phases of EMDR are demonstrated through a treatment protocol, followed by implementation suggestions for interested mental health professionals, organisations and other treatment providers worldwide. The author hopes that clinicians and treatment programs will better understand the importance of using trained psychotherapists to facilitate trauma treatment-with the model presented as one way to integrate the worlds of nature-based treatment and evidence-based practice easily. Finally, this paper serves as a call for research into the concept of Therapeutic Fly-Fishing with EMDR (TF-EMDR) and other such integrations of nature-and evidence-based PTSD treatment approaches.
... There are numerous efficacious programs for veterans that utilize nature-based interventions already. These programs include horticulture therapy (Detweiler et al., 2015;Lehmann et al., 2018), fishing (Bennett et al., 2017;Bennett et al., 2014), and sailing interventions (Gelkopf et al., 2013;Marchand et al., 2018). In one study, veterans participating in horticulture therapy showed lower cortisol levels and depressive symptoms compared with veterans participating in other occupational therapy activities such as ceramic painting, flower arranging, or leather belt construction (Detweiler et al., 2015). ...
Article
Objectives: Duration, frequency, and intensity of nature exposure link to different physical and psychological benefits. The present study aimed to determine how time outdoors affected military veterans' posttraumatic stress disorder (PTSD) symptomology during PTSD treatment. Method: Hypotheses regarding time outdoors and the effect of program duration on PTSD symptoms were examined using multilevel models. The authors hypothesized that hours outdoors, both within- and between-persons, would predict reduced PTSD symptomology, program duration would predict reduced PTSD symptomology, and that hours outdoors and program duration would be significant when accounting for the other. Results: The present study found that time outdoors correlated with participants' decreased PTSD symptomology: the more time participants spent outdoors, the greater the reduction in their PTSD symptoms. Conclusion: The effect of time outdoors was significant within-person, not between persons, suggesting that nature exposure may be used as an adjunct to traditional mental health treatment where exposure or dosage should be person-specific.
... Still utilized today as an intervention in many veteran's affairs treatment groups, the calmness and serene atmosphere of fly-fishing paired with the pride in catching a fish has been found to provide benefits to those who participate. Through distraction, focus, relaxation, and overcoming challenges and fears, veterans identified fly fishing as a potential coping mechanism for their PTSD (Bennett, Van Puymbroeck, Piatt & Rydell, 2014). Narrative accounts of participation in a therapeutic fly-fishing program revealed themes of camaraderie, reflection, and coping with regret as outcomes of involvement (Mowatt & Bennet, 2011;Price, Lundberg, Zabriskie & Barney, 2015). ...
Thesis
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Developing research, anecdotal evidence and a growing focus on non-pharmacological interventions for veterans with post-traumatic stress support the use equine-therapy as a therapeutic outlet; however, programmatic factors that contribute to veteran's desire to attend such programs are under-investigated. Furthermore, evaluative processes in equine therapy for this particular population are scare and vary greatly from program to program. The use of the Importance-Performance Analysis (IPA) tool when applied to social services yields direct, applicable feedback of program success and relevancy. In this study, interviews with the selected population informed the evaluation tool used to assess the importance, and subsequent performance, of various program factors in a national military-specific equine therapy program. Results of this study provided insight into key factors being sought after in similar equine therapy programs to inform the development and maintenance of programs serving the veteran population.
... Hignett et al. [(Hignett et al., 2017), p. 12] found that 'Surprisingly, there was no direct improvement in connectedness to nature or the beach as a result of the study overall'. Bennett et al. (Bennett et al., 2014) referred to the importance of the physical setting for restoration, including the sound of the river but did not provide any details on the quality or characteristics of the natural setting. Hayhurst et al. (Hayhurst et al., 2015) did not consider nature connectedness, but included a weather rating scale as part of a mix of measures assessing the effect of sail training on the resilience of young people. ...
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There is increasing interest in the potential use of outdoor water environments, or blue space, in the promotion of human health and wellbeing. However, therapeutic nature-based practices are currently outpacing policy and the evidence base for health or wellbeing benefits of therapeutic interventions within blue space has not been systematically assessed. This systematic review aims to address the gap in understanding the impacts of blue space within existing interventions for targeted individuals. A systematic review was carried out, searching Google Scholar, SCOPUS, PubMed, etc. through to August 2017. Only blue space interventions were included that were specifically designed and structured with a therapeutic purpose for individuals with a defined need and did not include nature-based promotion projects or casual recreation in the outdoors. Thirty-three studies met the inclusion criteria and were assessed. Overall, the studies suggest that blue care can have direct benefit for health, especially mental health and psycho-social wellbeing. The majority of papers found a positive or weak association between blue care and health and wellbeing indicators. There was also some evidence for greater social connectedness during and after interventions, but results were inconsistent and mixed across studies with very few findings for physical health. This is the first systematic review of the literature on blue care. In summary, it has been shown that mental health, especially psycho-social wellbeing, can be improved with investment in blue spaces. Key areas for future research include improving understanding of the mechanisms through which blue care can improve public health promotion.
... The impact of specific types of leisure on posttraumatic growth has also been explored. Research on adapted sports (Bennett, Townsend, Van Puymbroeck, & Gillette, 2014;Crawford, Gayman, & Tracey, 2014;Lundberg, Bennett, & Smith, 2011;Tasiemski, Kennedy, Gardner, & Taylor, 2005) and nature-based outdoor recreation activities such as fly fishing, hunting, river running, surfing, and other adventure activities (Bennett, Van Puymbroeck, Piatt, & Rydell, 2014;Caddick, Smith, & Phoenix, 2015;Dustin, Bricker, Arave, Wall, & Wendth, 2011;Hawkins, Townsend, & Garth, 2016;Rogers, Loy, & Brown-Bochicchio, 2016;Vella, Milligan, & Bennett, 2013) showed that these leisure activities played a significant role in posttraumatic growth. Caddick and Smith (2014) conducted a meta-analysis of several studies on posttraumatic growth through sport and outdoor recreation and found, across all studies, participation in these activities had a positive and lasting impact on subjective and psychological well-being, motivation, and posttraumatic growth. ...
... fly-fishing, river running, kayaking) has been associated with various beneficial outcomes for injured service members. These benefits include, but are not limited to, improved mood states (Lundberg, Bennett, & Smith, 2011), decreases in PTS, depression, and anxiety symptoms (Bennett, Piatt, & Van Puymbroeck, 2017;Caddick & Smith, 2014;Dustin, Bricker, Arave, Wall, & Wendt, 2011;Scherer, Gade, & Yancosek, 2014), increases in motivation, social support and camaraderie (Bennett, Van Puymbroeck, Piatt, & Rydell, 2014;Caddick & Smith, 2014;Duvall & Kaplan, 2013;Hawkins, Cory, & Crowe, 2011;Mowatt & Bennett, 2011;Rogers, Loy, & Brown-Bochicchio, 2016;Sporner et al., 2009), improved perceived health and perception of disability (Hawkins et al., 2011), increased marital satisfaction (Bennett, Lundberg, Zabriskie, & Eggett, 2014), improved psychosocial well-being (Vella, Milligan, & Bennett, 2013), and community reintegration (Hawkins et al., 2015). ...
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Recreation-based health and wellness programs for military service members are currently a topic of significant interest in the recreation and health industries. This study examined the health outcomes associated with participation in Project Sanctuary, a week-long recreation-based health and wellness family retreat for injured military service members. Linear mixed modeling was used to examine changes in health outcomes over four time points, and considered multiple covariates. One-hundred twenty-seven service members participated. Statistically significant reductions in total scores for Post-Traumatic Stress Disorder Checklist (PCL) measures were found, as well as notable improvements in Depression, Anxiety, and Stress Scale (DASS) and mental health functioning immediately following the intervention. No changes were found in physical health functioning. Trends demonstrated that participants maintained the positive psychological health changes over the three and six month time points. Veteran's Administration (VA) disability rate was the only significant covariate associated with health outcome change across time points. Implications for future practice and research are discussed in the article.
... Who were my participants? The Discussion Themes Four discussion (research) themes from the thematic analysis The 'disabled' individual, their motivations and their enjoyment The 'disabled' individual, their motivations and their enjoyment (Aitchison, 2000Aitchison, , 2003Aitchison, , 2009 Blackshaw, 2010; Carr, 2002; Crouch, 1999 Crouch, , 2000 Dickinson and Robbins, 2009; Eichhorn et al, 2013; Hannam and Knox, 2010; Hibbert et al, 2013; McCabe, 2005; Obrador Pons, 2003; Ryan, 2003) The disabled should be seen as individuals (Aitchison, 2001; Bennett et al, 2014; Fullagar, , 2012 Kovic and Schultz-Krohn, 2013; Kunstler and Daly, 2010; Mayer and Anderson, 2014 Kovic and Schultz-Krohn, 2013; Robertson and Long, 2008) Leisure, the 'self' and the therapeutic benefits Conclusion  Disability is not one thing. This brings major implications to how we look at disability within the leisure spectrum (leisure, sport, tourism, events, hospitality …. ...
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The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
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The wars in Iraq and Afghanistan-Operation Iraqi Freedom and Operation Enduring Freedom, or OEF/OIF-have created unique conditions for promoting the development of psychological difficulties such as posttraumatic stress disorder (PTSD). PTSD is an important outcome because it can affect quality of life, impairing psychosocial and occupational functioning and overall well-being. The literature on PTSD and quality of life in OEF/OIF Veterans is at an early stage, but the consistency of the evidence is striking. Our review indicates that the findings on PTSD and quality of life in OEF/OIF veterans are comparable to findings obtained from other war cohorts and from nonveterans as well. Even though the duration of PTSD in OEF/OIF Veterans is much shorter than in Vietnam Veterans, for example, those with PTSD in both cohorts are likely to experience poorer functioning and lower objective living conditions and satisfaction. The review ends with discussion of the implications of the evidence for research and clinical practice.
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Exposure to reminders of trauma underlies the theory and practice of most treatments for post-traumatic stress disorder (PTSD), yet exposure may not be the sole important treatment mechanism. Interpersonal features of PTSD influence its onset, chronicity, and possibly its treatment. The authors review interpersonal factors in PTSD, including the critical but underrecognized role of social support as both protective posttrauma and as a mechanism of recovery. They discuss interpersonal psychotherapy (IPT) as an alternative treatment for PTSD and present encouraging findings from two initial studies. Highlighting the potential importance of attachment and interpersonal relationships, the authors propose a mechanism to explain why improving relationships may ameliorate PTSD symptoms.
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At a single U.S. Army installation from 1997 to 2005, domestic violence volunteer victim advocates assisted 1,417 clients in 1,380 physical and 301 verbal abuse incidents. The average soldier and spouse population during this time was slightly less than 10,000. Advocates went to the scene of the incident to talk to the victim to ensure that her/his rights were observed, to determine whether the victim was safe, was referred to the hospital social work service for assessment, and had the information necessary to negotiate the complex military and community systems. The advocate inquired of the victim the characteristics of the incident and risk factors in the history of the relationship. In many incidents, risk factors indicated a history of serious violence by the offender including an increasing level of violence, stalking, and assaults. Frequently reported precipitants of incidents were relationship problems, jealously, and infidelity. Spouses often reported previous attempts to leave and to get help. Advocates play an important role in gathering information uniquely available at the scene that can be useful in planning education and intervention programs to reduce domestic violence in the Army, the military services, and civilian society.
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The present study examined the temporal relationship between posttraumatic stress disorder (PTSD) and social support among 128 male veterans treated for chronic PTSD. Level of perceived interpersonal support and stressors were assessed at two time points (6 months apart) for four different potential sources of support: spouse, relatives, nonveteran friends, and veteran peers. Veteran peers provided relatively high perceived support and little interpersonal stress. Spouses were seen as both interpersonal resources and sources of interpersonal stress. More severe PTSD symptoms at Time 1 predicted greater erosion in perceived support from nonveteran friends, but not from relatives. Contrary to expectations, initial levels of perceived support and stressors did not predict the course of chronic PTSD symptoms.
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Psychological tests were administered to 24 participants of an inpatient posttraumatic stress disorder (PTSD) treatment program both immediately before and following completion of treatment. Responses were compared to a treatment/wait list comparison group composed of 24 subjects awaiting entry into the program. All treatment/wait list comparison group subjects received weekly PTSD outpatient group therapy. Significant improvements were found in the inpatient treatment group in areas of hopelessness, feelings of guilt and shame, loneliness, and emotional expressiveness. Other indices of psychological functional, including interpersonal skills, gender role stress, anxiety, anger, and PTSD symptomatology did not change significantly in response to treatment. No positive changes in any area of psychological function occurred in the treatment/wait list comparison group. Implications for PTSD and areas of future research are discussed.
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There is a paucity of studies on Outward Bound Experiences (OBE) with adult psychiatric populations and, more notably, with trauma victims. This study evaluates the efficacy of OBE as an adjunct to specialized inpatient PTSD treatment with survivors of chronic combat-related PTSD (N = 219) at two Veterans Administration Medical Centers. On several measures of PTSD and general adaptation, results showed that the five-day OBE did not differ from standard treatment of PTSD survivors. Two other issues were addressed: identification of successful and non-successful subjects as a result of OBE, and exploration of objective versus subjective measures among this chronic group. Finally, as a post-study analysis, inferred curative components of the OBE were discussed as each appeared to impact on the participants.
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This study examines the association between posttraumatic stress disorder (PTSD), in terms of the three main symptom clusters (intrusion, avoidance and arousal), and the self-report of family functioning of Vietnam veterans and the self-report of family functioning of their partners. A second objective was to determine if depression, anger and alcohol abuse mediated between PTSD symptoms and family functioning. Vietnam veterans and their partners completed a series of questionnaires as part of their participation in the inpatient and outpatient PTSD treatment program, in the Veterans Psychiatry Unit, at the Austin and Repatriation Hospital. Data from 270 veterans and partners were used in the final analyses. The PTSD subscales were initially correlated with family functioning for veterans and family functioning for partners. Then two path diagrams were constructed and analyzed using the statistical program AMOS to test for mediating effects between PTSD symptoms and family functioning. For veterans there were significant initial correlations with all three subscales of the PTSD measure. In the path analysis when the mediating variables were included only the avoidance subscale of the PTSD measure remained directly associated with family functioning. The arousal PTSD subscale was mediated by anger. The measures of depression and anger were significantly associated with poor family functioning and the anger and the avoidance subscales were significantly associated with depression. In the second set of analyses conducted on data from partners, the PTSD symptoms of avoidance and arousal were initially correlated with family functioning. When the test for mediation was conducted none of the PTSD subscales remained associated with partners' self-report of family functioning. Posttraumatic stress disorder arousal and alcohol abuse were mediated by anger for partners' self-report of family functioning. Posttraumatic stress disorder symptoms of avoidance for veterans, and comorbid symptoms of anger and depression for veterans, and anger on its own for partners appear to be important in the self-report of family functioning. These findings suggest that veterans and their partners have similar difficulties as couples with distressed relationships in the community.
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As of November 9, 2004, a total of 10,153 service members had suffered war injuries. Dr. Atul Gawande writes about a military medical system that has made fundamental and effective changes in the strategies and systems of battle care.
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Traumatic brain injury (TBI) is an important source of morbidity in the Iraq and Afghanistan wars. Although penetrating brain injuries are more readily identified, closed brain injuries occur more commonly. Explosion or blast injury is the most common cause of war injuries. The contribution of the primary blast wave (primary blast injury) in brain injury is an area of active research. Lessons learned from the sports concussion and civilian mild TBI literature are useful. Individuals with TBI and posttraumatic stress disorder require treatment of both conditions. Families and communities need to be cognizant of the needs of these returning veterans.
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Combat exposure is associated with increased rates of mental health problems such as post-traumatic stress disorder, depression, and anxiety when Soldiers return home. Another important health consequence of combat exposure involves the potential for increased risk-taking propensity and unsafe behavior among returning service members. Survey responses regarding 37 different combat experiences were collected from 1252 US Army Soldiers immediately upon return home from combat deployment during Operation Iraqi Freedom. A second survey that included the Evaluation of Risks Scale (EVAR) and questions about recent risky behavior was administered to these same Soldiers 3 months after the initial post-deployment survey. Combat experiences were reduced to seven factors using principal components analysis and used to predict post-deployment risk-propensity scores. Although effect sizes were small, specific combat experiences, including greater exposure to violent combat, killing another person, and contact with high levels of human trauma, were predictive of greater risk-taking propensity after homecoming. Greater exposure to these combat experiences was also predictive of actual risk-related behaviors in the preceding month, including more frequent and greater quantities of alcohol use and increased verbal and physical aggression toward others. Exposure to violent combat, human trauma, and having direct responsibility for taking the life of another person may alter an individual's perceived threshold of invincibility and slightly increase the propensity to engage in risky behavior upon returning home after wartime deployment. Findings highlight the importance of education and counseling for returning service members to mitigate the public health consequences of elevated risk-propensity associated with combat exposure.
Returning wars' wounded, injured, and ill: A reference handbook
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