Journal of Occupational Health Psychology © 2013 American Psychological Association

2013, Vol. 18, No. 3, 327–337 1076-8998/13/$12.00 DOI: 10.1037/a0033059

Longitudinal Analysis of Psychological Resilience and Mental Health in

Canadian Military Personnel Returning From Overseas Deployment
Jennifer E. C. Lee, Kerry A. Sudom, and Mark A. Zamorski
Department of National Defence, Ottawa, Ontario, Canada

The relationship between exposure to combat stressors and poorer postdeployment health is well
documented. Still, some individuals are more psychologically resilient to such outcomes than others.
Researchers have sought to identify the factors that contribute to resilience in order to inform resilience-
building interventions. The present study assessed the criterion validity of a model of psychological
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resilience composed of various intrapersonal and interpersonal variables for predicting mental health
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among Canadian Forces (CF) members returning from overseas deployment. Participants included 1,584
male CF members who were deployed in support of the mission in Afghanistan between 2008 and 2010.
Data on combat experiences and mental health collected through routine postdeployment screening were
linked with historical data on the intrapersonal and interpersonal variables from the model. The direct and
moderating effects of these variables were assessed using multiple linear regression analyses. Analyses
revealed direct effects of only some intrapersonal and interpersonal resilience variables, and provided
limited support for moderating effects. Specifically, results emphasized the protective nature of consci-
entiousness, emotional stability, and positive social interactions. However, other variables demonstrated
unexpected negative associations with postdeployment mental health (e.g., positive affect and affection-
ate social support). Ultimately, results highlight the complexities of resilience, the limitations of previous
cross-sectional research on resilience, and potential targets for resilience-building interventions. Addi-
tional longitudinal research on the stability of resilience is recommended to build a better understanding
of how resilience processes may change over time and contribute to mental health after adverse
experiences.

Keywords: resilience, personality, military, combat stress, mental health

Exposure to trauma and adversity is an inevitable part of mili- chologically resilient personnel who can withstand the effects of a
tary combat and a potential threat to the health and well-being of wide range of stressors both over the short term (to facilitate
military personnel. Military personnel also face many of the same performance in demanding environments) and long term (to permit
occupational stressors as individuals in other occupations and, in retention of expertise). Examining the factors and processes un-
some cases, perform their jobs under traumatic stress (Castro & derlying psychological resilience is an important step toward iden-
Adler, 2010; Larner & Blow, 2011). In addition to these stressors, tifying individuals at the greatest risk of psychopathology and
other aspects of military service, such as separation from family designing and validating resilience-building interventions.
and friends, frequent moves, and austere living conditions, place a More than a decade of conflict in Southwest Asia has led to
psychosocial burden on personnel and their families and contribute increased interest in psychological resilience in military personnel
to the stresses and strains of everyday life. Although combat stress (Callahan, 2010; Green, Calhoun, Dennis, the Mid-Atlantic Mental
is recognized as a major cause of mental health disorders in service Illness Research Education and Clinical Center Workgroup, &
members (Callahan, 2010), any number of stressors may compro- Beckham, 2010). Although multiple perspectives of this concept
mise mental health and, thereby, impact fitness for duty, opera- exist (Bartone, Hystad, Eid, & Brevik, 2012; Bonanno & Mancini,
tional effectiveness, and force sustainability (Adler, McGurk, 2012; Bonanno et al., 2012; Green et al., 2010; Larner & Blow,
Stetz, & Bliese, 2003). Military organizations therefore need psy- 2011; Masten, Best, & Garmezy, 1990), psychological resilience
has broadly been defined as “the sum total of dynamic psycholog-
ical processes that permit individuals to maintain or return to
Jennifer E. C. Lee, Director General Military Personnel Research and previous levels of well-being and functioning in response to ad-
Analysis & Directorate of Force Health Protection, Department of National versity” (The Technical Cooperation Program, 2012, p. 4). In fact,
Defence, Ottawa, Ontario, Canada; Kerry A. Sudom, Director General a number of intrapersonal characteristics have been found to be
Military Personnel Research and Analysis, Department of National De- associated with better health, well-being, and functioning among
fence; Mark A. Zamorski, Directorate of Mental Health, Department of military personnel, either directly or by moderating the impact of
National Defence.
adverse experiences. By and large, resilient individuals have been
Correspondence concerning this article should be addressed to Jennifer
E. C. Lee, Director General Military Personnel Research and Analysis & noted for their outgoing and open nature, strong sense of control,
Directorate of Force Health Protection, Department of National Defence, as well as their keen ability to maintain a positive outlook and
1745 Alta Vista Drive, Ottawa, Ontario K1A 0K6, Canada. E-mail: reflect on their surroundings (Bartone et al., 2012; Pietrzak &
[email protected] Southwick, 2011). Related attributes such as personal competence,

327
 328 LEE, SUDOM, AND ZAMORSKI

stress tolerance, acceptance of change, personal control, and spir- Although the model of resilience received empirical support
itual orientation to the future have been directly associated with a (Lee et al., 2011), the involvement of its constituent variables in
number of indicators of psychological well-being, including lesser the process of resilience following an adverse experience was
suicide ideation, lower alcohol consumption, lower depressive not fully explored. Cross-sectional analyses revealed that all of
symptom severity, lower prevalence of posttraumatic stress disor- them were significantly associated with better health (Lee et al.,
der (PTSD), and fewer health complaints among U.S. military 2011). However, these intrapersonal and interpersonal variables
combat veterans (Green et al., 2010; Pietrzak, Johnson, Goldstein, could also moderate the negative impact of adverse experiences
Malley, & Southwick, 2009b; Pietrzak, Russo, Ling, & Southwick, on health and well-being in line with previous studies (Pietrzak
2011; Pietrzak & Southwick, 2011). Green et al. (2010) also found & Southwick, 2011), ultimately influencing psychological re-
that such factors moderated the relationship between combat ex- silience. In light of growing interest in the use of training
periences and PTSD diagnosis, such that high levels of resilience programs to enhance psychological resilience by military orga-
were most protective under high levels of combat exposure (Green nizations (e.g., Comprehensive Soldier Fitness, as discussed in
et al., 2010). Cornum, Matthews, & Seligman, 2011), understanding the role
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Beyond intrapersonal characteristics, interpersonal variables, of these variables as moderators of the negative impacts of
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such as social support or other aspects of the social environment, adverse experiences, such as combat experiences, on health and
have been thought to play a role in promoting and sustaining well-being would be of value. Specifically, determining which
resilience in the face of adversity (Rutter, 1999). The quality of variables are stronger, independent predictors of health and
one’s social environment, both before and after an overseas mili- well-being among military personnel having been deployed
tary deployment, has been found to be associated with mental over time would help to develop a more efficient means of
health upon return from deployment (Brewin, Andrews, & Valen- assessing resilience and to identify key targets for intervention.
tine, 2000; Fritch, Mishkind, Reger, & Gahm, 2010). In their study To date, the vast majority of studies on psychological resil-
of reserve and National Guard Operation Enduring Freedom/Op- ience in military personnel have been cross-sectional (Bartone
eration Iraqi Freedom (OEF/OIF) veterans, for example, Pietrzak et al., 2012; Goldmann et al., 2012; Green et al., 2010; Pietrzak
et al. (2009b) found that postdeployment social support was neg- et al., 2009b, 2011; Pietrzak & Southwick, 2011). This has
resulted in difficulties with the interpretation of findings, as
atively associated with traumatic stress and depressive symptoms,
observed relationships may reflect the influence of resilience-
even after adjusting for combat experiences. Additional analyses
related variables on health and well-being, the influence of
examining the characteristics of veterans who demonstrated a
health and well-being on resilience-related variables, or the
“resilient” mental health trajectory (i.e., they experienced high
sharing of a common substrate between the two. In addition,
combat exposure and reported low PTSD symptoms) revealed that
most studies have focused on psychopathology (e.g., the pres-
these individuals experienced fewer psychosocial stressors and
ence of PTSD or its symptoms) as opposed to general mental
greater family support and understanding (Pietrzak & Southwick,
health. The latter encompasses several aspects of mental health
2011). Hence, these findings reveal that interpersonal variables
in addition to symptoms of psychopathology, including vitality,
related to the social environment may also contribute to health and
social and role-related functional impairment, and subjective
well-being, both directly and by moderating the impact of adverse
well-being (Ware & Sherborne, 1992). In an effort to address
experiences. Conversely, a poor social environment may be detri- these research gaps, the aim of this study was to prospectively
mental to health or may exacerbate the impact of adverse experi- assess the criterion validity of intrapersonal and interpersonal
ences on health (Mavandadi, Rook, Newsom, & Oslin, 2013; variables from the model of resilience (Lee et al., 2011) for
Mulligan, et al., 2012). predicting mental health among Canadian Forces (CF) members
With so many intrapersonal and interpersonal variables having upon their return from deployment. A conceptual framework of
been linked with resilience, there is a clear need to better under- hypothesized relationships among variables is presented in Fig-
stand the relationships among these variables and identify which ure 2. Based on previous research (Green et al., 2010; Pietrzak
ones contribute most to better outcomes following adverse expe- et al., 2009b, 2011; Pietrzak & Southwick, 2011), it was ex-
riences. Recently, a conceptual and empirical analysis of several pected that intrapersonal and interpersonal variables would
variables previously believed to contribute to resilience (Wald, have sizable direct effects on postdeployment mental health and
Taylor, Asmundson, Jang, & Stapleton, 2006) was conducted to would moderate the impact of combat experiences on mental
identify a more parsimonious set of relevant factors (Lee, Sudom, health.
& McCreary, 2011). The resulting set included the Big Five
personality dimensions (i.e., agreeableness, conscientiousness, ex-
troversion, emotional stability,1 and openness), positive affect, Method
mastery, and social support. Based on further analysis, it was
found that these distinct variables could be represented as latent Procedure
factors representing both intrapersonal (i.e., the Big Five, positive
affect, and mastery) and interpersonal (i.e., social support) aspects Baseline health data collected using the CF Recruit Health
of resilience, as illustrated in Figure 1. In particular, intrapersonal Questionnaire (RHQ) were linked with data collected, on average,
resilience reflected a higher order latent factor consisting of an 4 years later during the Enhanced Post-Deployment Screening
array of interrelated, yet conceptually distinct, individual traits,
whereas interpersonal resilience was a latent factor defined by 1
Emotional stability was operationalized as the reverse of neuroticism—
various forms of social support. one of the Big Five personality dimensions (John & Srivastava, 1999).
 RESILIENCE AND POSTDEPLOYMENT MENTAL HEALTH 329

Emotional Stability
Extroversion Openness

Conscientiousness Positive Affect

Agreeableness Mastery

Intrapersonal
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Resilience

Interpersonal
Resilience
(Affectionate,
Emotional/Informational,
Positive Social Interaction
and Tangible Social Support)

Figure 1. Model of psychological resilience. Adapted from “Higher-Order Model of Resilience in the
Canadian Forces,” by J. E. C. Lee, K. A. Sudom, and D. R. McCreary, 2011, Canadian Journal of Behavioural
Science/Revue canadienne des sciences du comportement, 43, p. 228.

(EPDS) process. The RHQ is a paper-and-pencil tool that is riences during their deployment. However, those who reported no
administered to CF recruits during basic training over 45- to combat experiences (n ⫽ 215) were excluded from the analysis to
60-min group sessions. Participation is voluntary, although the ensure a minimum level of adversity among subjects, and because
response rate has been high (i.e., close to 70%; Lee & Hachey, they were believed to reflect a separate group of individuals with
2011). The study protocol was approved by the Defence Research largely distinct roles and responsibilities in the operation. In ad-
and Development Canada (DRDC) Human Research Ethics Com- dition, the small number of females (n ⫽ 169) was excluded, as the
mittee. mechanisms of resilience might differ between men and women.
The EPDS process is mandatory for all members having gone The analysis thus included 1,584 male CF members who reported
on deployment overseas lasting 60 days or longer and takes at least one combat experience. Over this period, the mission was
place between 90 and 180 days after CF members return to a combat and peace support operation in Kandahar Province in
Canada. It is carried out in order to identify those with Southern Afghanistan. Most personnel were stationed there, al-
deployment-related health problems so that they can be engaged though some supported the operation from elsewhere in the region.
in treatment as early as possible. The EPDS process consists of
As well, mental health and resilience training practices evolved
completion of a confidential (though not anonymous) health
substantially in the CF over this timeframe. As a result, partici-
questionnaire, followed by an in-depth interview with a mental
pants may differ in terms of their exposure to mental health and
health clinician.
resiliency training: All would have received at least some basic
mental health literacy training on PTSD and other service-related
Participants mental health problems. However, some may have had as much as
Using service numbers, it was possible to match RHQ and 30 hr of training over the course of their basic training, pre- and
EPDS records for 1,926 CF members who were deployed in postdeployment training, and career development training. As a
support of the mission in Afghanistan between 2008 and 2010. rule, earlier cohorts received significantly less training than later
Participants reported between 0 and 29 (out of 30) combat expe- cohorts.
 330 LEE, SUDOM, AND ZAMORSKI

INTRAPERSONAL:
Agreeableness (+)
Conscientiousness (+)
Extroversion (+)
Emotional Stability (+)
Positive Affect (+)
Mastery (+)
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Combat Experiences (-) Mental health

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INTERPERSONAL:
Affectionate Support (+)
Emotional/Informational Support (+)
Positive Social Interaction (+)
Tangible Support (+)

(+)
Variable hypothesized to be positively associated with post-deployment mental health.
(-)
Variable hypothesized to be negatively associated with post-deployment mental health.

Figure 2. Conceptual framework of the direct and moderator effects of intrapersonal and interpersonal
resilience variables and combat experience on postdeployment mental health.

At the time of postdeployment screening, participants were 26.2 Measures

years of age (SD ⫽ 4.8), on average, and had achieved a high
school education or less (57.3%). The majority were in the Army RHQ measures. Intrapersonal resilience variables were mea-
(93.8% Army, 1.5% Navy, 4.7% Air Force) and were junior rank sured in the RHQ using validated scales that were found in a
noncommissioned members (NCMs; 28.6% privates or the equiv- previous analysis to reflect unique dimensions of this higher order
alent and 62.8% other NCMs). Participants had been in the CF for latent factor (Lee et al., 2011). Dimensions included mastery,
an average of 4.2 years (SD ⫽ 1.7) and a median of 3.8 years.2 which was assessed using a 7-item measure drawn from the
They reported a median of 12 combat experiences (out of 30) Canadian Community Health Survey (CCHS; Statistics Canada,
during their last deployment. 2001). Items in this measure are presented in the form of state-
Overall, participants demonstrated a low level of psychopathol- ments to be rated in terms of level of agreement (e.g., “You can do
ogy at the time of postdeployment screening. Based on results of just about anything you really set your mind to”). Additional
the Patient Health Questionnaire (PHQ) 9-item depression screen- intrapersonal dimensions were the Big Five personality traits (i.e.,
ing tool (Kroenke, Spitzer, & Williams, 2001), 2.8% of partici- agreeableness, conscientiousness, extroversion, neuroticism
pants had symptoms strongly suggestive of major depressive syn- [reverse-scored to reflect emotional stability], and openness),
drome. Similarly, 2.8% of participants had symptoms strongly which were assessed using a 41-item measure adapted from the
suggestive of PTSD (i.e., a PTSD Checklist for Civilians score of Big Five Inventory (John & Srivastava, 1999; Thompson & Smith,
50 or greater; Blanchard, Jones-Alexander, Buckley, & Forneris, 2002), and positive affect, which was assessed with the 10-item
1996). Finally, 13.7% of participants were identified as high-risk
drinkers according to the Alcohol Use Disorders Identification 2
Because the RHQ is administered early during basic training, the
Test (score of 8 or higher; Babor, Higgins-Biddle, Saunders, & number of years in the military should approximate the number of years
Monteiro, 2001). between the completion of the RHQ and the EPDS.
 RESILIENCE AND POSTDEPLOYMENT MENTAL HEALTH 331

Positive Affect subscale of the Positive and Negative Affect yielded by a factor analysis of items that were designed to assess
Schedule (PANAS; Watson, Clark, & Tellegen, 1988). The Big various facets of psychological health and well-being, including
Five Inventory includes a list of characteristics that reflect each of vitality (e.g., feeling energetic and peppy), health-related social
the personality traits (e.g., agreeableness: “is helpful and unselfish functioning impairment (e.g., extent and frequency of feeling like
with others”; conscientiousness: “does a thorough job”; extrover- emotional problems have interfered with normal social activities),
sion: “is outgoing, sociable”; neuroticism: “worries a lot”; open- mental health-related role impairment (e.g., feeling like emotional
ness: “is curious about many different things”). Respondents are problems have interfered with time, accomplishments or being
asked to indicate whether each of these items is characteristic of careful at work), symptoms of anxiety and depression (e.g., feeling
them. Similarly, the Positive Affect subscale of the PANAS in- nervous or downhearted), and general health (e.g., self-evaluations
cludes a list of adjectives reflecting pleasant emotional states (e.g., regarding one’s level of health). A detailed description of this
“enthusiastic”), and respondents are asked to indicate whether they widely used measure and its psychometric properties is available
agree that they experience each emotional state, on average. A online (Ware, n.d.). In brief, its reliability estimates have been
5-point rating scale was used for every scale (1 ⫽ strongly agree, found to be excellent in a variety of contexts (Ware, n.d.).
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2 ⫽ agree, 3 ⫽ neither agree nor disagree, 4 ⫽ disagree, 5 ⫽

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strongly disagree). Some items were reverse-scored, as required, Statistical Analyses

and total scores were computed so that higher values reflect one’s
Sequential multiple linear regression was used to explore the
greater propensity to act and think in accordance with the dimen-
association of intrapersonal and interpersonal resilience variables
sion in question. All scales used as indicators of intrapersonal
and combat exposure with postdeployment mental health, control-
resilience demonstrated adequate internal reliability (Cronbach’s
ling for age, rank, years of service, and baseline self-rated health
alphas of .69 to .83).
in the first step.3 The role of intrapersonal and interpersonal
The 19-item Social Support Scale (SSS) was used to assess
variables as moderators in the relationship between combat expe-
affectionate support (e.g., behavioral manifestations of love), emo-
riences and postdeployment mental health was tested using the
tional/informational support (e.g., intimate and supportive commu-
PROCESS macro for SPSS. This macro facilitates the analysis of
nication), positive social interaction (e.g., social companionship
moderation, mediation, and conditional process modeling among
and integration), and tangible support (e.g., reliable help or mate-
variables (Hayes, 2012). A separate sequential multiple linear
rial support) dimensions of interpersonal resilience (Sherbourne &
regression was performed for each potential moderator to optimize
Stewart, 1991). Respondents used a 5-point scale to indicate the
power and simplify interpretation. Moderator effects that yielded a
extent that different types of social support provided in the list of
significant improvement in prediction over and above the direct
items (e.g., affectionate support: “someone who shows you love
effects of control variables, intrapersonal and interpersonal resil-
and affection”; emotional/informational support: “someone to con-
ience variables, and combat experiences were further explored by
fide in or talk about your problems”; positive social interaction:
examining the conditional effect of combat experiences on post-
“someone to do something enjoyable with”; tangible support:
deployment mental health at different values of the moderator(s)
“someone to take you to the doctor if you needed it”) would be
(this output is generated using PROCESS).
available to them, if needed (1 ⫽ none of the time, 2 ⫽ a little of
the time, 3 ⫽ some of the time, 4 ⫽ most of the time, 5 ⫽ all of the
time). Subscales demonstrated adequate internal reliability, with Results
Cronbach’s alphas ranging from .86 to .95. Variables were screened for missing values and violations of
Self-rated health was assessed with one item from the Canadian assumptions inherent to the analyses. Missing values were consis-
Community Health Survey (Statistics Canada, 2001): “In general, tent with data being missing completely at random. Therefore,
would you say your health is . . .,” which was rated on a 5-point listwise deletion was used, resulting in a final sample of 1,315.4
scale (1 ⫽ excellent, 2 ⫽ very good, 3 ⫽ good, 4 ⫽ fair, 5 ⫽ poor) Binary correlations between each model variable are presented in
and subsequently reverse-scored. Table 1, along with means and standard deviations. The regression
Enhanced postdeployment screening measures. A modified model included the control variables, intrapersonal variables (e.g.,
version of a 34-item scale developed by Walter Reed Army Insti- Big Five, positive affect, mastery), interpersonal variables (e.g.,
tute for Research was used to assess the extent of combat exposure the various forms of social support), and combat experiences as
during the EPDS. Providing an assessment of combat events that direct predictors (Table 2).
were experienced during the deployment (e.g., being attacked or Of the intrapersonal variables, only conscientiousness, emo-
ambushed, having hostile reactions from civilians, shooting or tional stability, and mastery were correlated with postdeployment
directing fire at the enemy), this scale has been found to be a strong mental health, with emotional stability demonstrating the largest
predictor of postdeployment mental health (Killgore et al., 2008). correlation (r ⫽ .17). Of the interpersonal variables, positive social
Four items of the original scale were removed due to concerns that interaction had a small correlation with postdeployment mental
they might require investigation into potential misconduct (e.g., health (r ⫽ .08). Combat exposure was negatively correlated with
witnessing mistreatment of noncombatants). Each item was a postdeployment mental health (r ⫽ ⫺.18).
yes/no question, and the scale score was simply the sum of positive
responses (range 0 to 30). The internal reliability of this scale was
3
excellent (Kuder–Richardson Coefficient 20 of .89). Data on age and years of service were collected at the time of the
EPDS, while data on rank (NCM or Officer) was collected in the RHQ.
Mental health status was determined using the Mental Health 4
Analyses were also carried out using mean substitution and multiple
Component Summary (MCS) score derived from the SF-36 (Ware imputation, with both approaches yielding results similar to the analysis
& Sherborne, 1992). This score is computed using the factor scores with listwise deletion.
 332 LEE, SUDOM, AND ZAMORSKI

Table 1
Descriptive Statistics and Correlations Among Model Variables

Bivariate correlations
M SD 1 2 3 4 5 6 7 8 9 10 11 12 13

1. Agreeableness 34.0 4.2 —

2. Conscientiousness 33.5 4.7 .32ⴱⴱ —
3. Extroversion 27.4 5.2 .14ⴱⴱ .26ⴱⴱ —
4. Emotional stability 28.3 4.9 .29ⴱⴱ .39ⴱⴱ .33ⴱⴱ —
5. Openness 23.7 2.9 .15ⴱⴱ .27ⴱⴱ .37ⴱⴱ .23ⴱⴱ —
6. Mastery 20.4 4.4 .21ⴱⴱ .43ⴱⴱ .35ⴱⴱ .45ⴱⴱ .24ⴱⴱ —
7. Positive affect 39.8 4.9 .23ⴱⴱ .41ⴱⴱ .45ⴱⴱ .34ⴱⴱ .42ⴱⴱ .37ⴱⴱ —
8. Tangible support 15.5 4.3 .15ⴱⴱ .10ⴱⴱ .15ⴱⴱ .15ⴱⴱ .09ⴱⴱ .16ⴱⴱ .16ⴱⴱ —
9. Emotional/Informational support 32.4 7.9 .19ⴱⴱ .14ⴱⴱ .26ⴱⴱ .16ⴱⴱ .10ⴱⴱ .22ⴱⴱ .24ⴱⴱ .75ⴱⴱ —
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10. Positive social interaction 12.9 2.7 .14ⴱⴱ .15ⴱⴱ .28ⴱⴱ .21ⴱⴱ .13ⴱⴱ .24ⴱⴱ .24ⴱⴱ .62ⴱⴱ .75ⴱⴱ —
.19ⴱⴱ .13ⴱⴱ .24ⴱⴱ .14ⴱⴱ .07ⴱⴱ .18ⴱⴱ .19ⴱⴱ .67ⴱⴱ .76ⴱⴱ .75ⴱⴱ —
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11. Affectionate support 12.2 3.4

12. Combat experiences 11.2 6.1 ⫺.03 .05 .07ⴱ .06ⴱ .04 .03 .12ⴱⴱ .02 .01 .04 .02 —
13. Mental health 50.5 9.5 .05 .10ⴱⴱ .02 .17ⴱⴱ ⫺.01 .11ⴱⴱ ⫺.02 .03 .04 .08ⴱⴱ .01 ⫺.18ⴱⴱ —
ⴱ ⴱⴱ
p ⬍ .05. p ⬍ .01.

Controlling for age, rank, years of service and baseline health in higher conscientiousness, higher emotional stability, lower posi-
Step 1, the model with intrapersonal and interpersonal resilience tive affect, lower affectionate social support, higher positive social
variables and combat exposure, added in Step 2, was found to interaction, and fewer combat experiences each uniquely predicted
significantly predict postdeployment mental health, R2 ⫽ .09, better postdeployment mental health. The magnitude of the main
F(16, 1298) ⫽ 7.93, p ⬍ .001. These variables contributed to a effects of intrapersonal and interpersonal variables was small
significant improvement in prediction above control variables, (standardized regression coefficients of ␤ ⬍ ⫽ .15). Combat
⌬R2 ⫽ .08, F(12, 1298) ⫽ 9.80, p ⬍ .001. With higher scores exposure had a larger main effect (␤ ⫽ ⫺.20).
representing better mental health, it was found that younger age, To identify significant moderators of the relationship between
combat exposure and postdeployment mental health, interaction
terms between combat experiences and each of the intrapersonal
Table 2 and interpersonal resilience variables were entered separately after
Results of Sequential Multiple Linear Regression Analysis control variables, intrapersonal and interpersonal resilience vari-
Predicting Postdeployment Mental Health ables, and combat experiences (Step 3). A significant interaction
between agreeableness and combat experiences was observed,
Mental health although it only marginally improved prediction, ⌬R2 ⫽ .003, F(1,
⌬R 2
␤ t 1297) ⫽ 3.94, p ⫽ .05. Further analysis revealed a tendency for
combat experiences to be more strongly associated with postde-
Step 1 .01
Age ⫺.03 ⫺0.88 ployment mental health at higher levels of agreeableness. None of
Rank .04 1.35 the other hypothesized interactions with combat exposure signifi-
Years of service ⫺.02 ⫺0.51 cantly improved model prediction. Thus, the effects of combat
Baseline self-rated health .07 2.33ⴱ exposure were only moderated by agreeableness, albeit not exten-
Step 2 .08ⴱⴱ
Age ⫺.07 ⫺2.43ⴱ
sively and not in the expected manner. Because this interaction
Rank .03 1.06 only marginally improved prediction, and estimates for other ef-
Years of service ⫺.05 ⫺1.72 fects were similar than those observed in the preceding step, only
Baseline self-rated health ⫺.03 ⫺1.12 results of the analysis after Step 2 are presented in Table 2.
Intrapersonal resilience variables
Agreeableness ⬍.01 ⫺0.14
Conscientiousness .08 2.55ⴱ
Extroversion ⫺.02 ⫺0.47
Discussion
Emotional stability .15 4.67ⴱⴱⴱ The present study prospectively assessed the criterion validity of
Openness ⫺.03 ⫺1.00
Mastery .04 1.24 a model of psychological resilience (Lee et al., 2011) for predict-
Positive affect ⫺.10 ⫺3.05ⴱⴱ ing the mental health of CF members returning from overseas
Interpersonal resilience variables deployment. As expected, several of the intrapersonal and inter-
Emotional/Informational support ⬍.01 ⫺0.06 personal variables believed to underlie psychological resilience in
Positive social interaction .14 3.12ⴱⴱ
Affectionate support ⫺.12 ⫺2.52ⴱ
this model demonstrated significant bivariate correlations with
Tangible support .02 0.40 postdeployment mental health (i.e., conscientiousness, emotional
Combat experiences ⫺.20 ⫺7.14ⴱⴱⴱ stability, mastery, positive social interaction). However, only a few
Note. The final model significantly predicted postdeployment mental
of these significantly predicted this outcome in the hypothesized
health, R2 ⫽ .09, F(16, 1298) ⫽ 7.93, p ⬍ .001. manner in the adjusted multiple linear regression model, and the
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001. magnitude of these effects was small. Postdeployment mental
 RESILIENCE AND POSTDEPLOYMENT MENTAL HEALTH 333

health was better among military personnel who reported higher though these analyses focused on older Canadians, the consistency
conscientiousness and emotional stability, but lower among those with results reported here is encouraging. Still, additional research
who reported higher positive affect after controlling for other is warranted to further investigate the mechanisms that may ac-
variables. Postdeployment mental health was also better among count for the negative associations of affectionate social support,
military personnel who reported a high level of positive social as well as positive affect, with mental health.
interaction, but lower among those who reported a high level of In addition to revealing some surprising findings, some of the
affectionate social support at baseline. Also, contrary to expecta- hypothesized relationships did not achieve significance, despite the
tions, only agreeableness was found to moderate the relationship generous sample size, precise and valid measurement of con-
between combat experiences and postdeployment mental health, structs, and adequate variability in predictors and outcomes. In
albeit not in the hypothesized manner. contrast to other work (Klein et al., 2011), there was no indepen-
The significant associations of mental health with conscien- dent association of mental health with the other Big Five person-
tiousness, emotional stability, and positive social interaction re- ality traits or mastery. As well, the effect sizes of intrapersonal and
ported in this study are in line with results reported in other work. interpersonal resilience variables that did achieve significance
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The positive effect of emotional stability and of social support on were smaller than those reported in cross-sectional military studies
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mental health is well documented in both civilians coping with (Green et al., 2010; Peng, Riolli, Schaubroeck, & Spain, 2012;
adversity and military personnel returning from deployment Pietrzak et al., 2009b, 2011; Pietrzak & Southwick, 2011; Polusny
(Ibarra-Rovillard & Kuiper, 2011; Klein, Kotov, & Bufferd, 2011; et al., 2011). Peng and her colleagues, for example, found stan-
Kotov, Gamez, Schmidt, & Watson, 2010; Paykel, 1994; Pietrzak dardized regression coefficients of between .39 and .49 for the
et al., 2009b, 2011; Pietrzak & Southwick, 2011; Polusny et al., association of emotional stability and physical and mental health
2011). However, the observed relationships of positive affect and outcomes (Peng et al., 2012). Meanwhile, social support has been
affectionate social support with mental health in the final adjusted found to predict PTSD severity among OEF/OIF veterans, with a
model were not in line with expectations. In addition to having standardized regression coefficient of .31 (Green et al., 2010;
been associated with better health outcomes based on a variety of Pietrzak et al., 2009b).
indicators in community samples (Cohen & Pressman, 2006), Last, converse to findings reported elsewhere (Green et al.,
positive affect has been found to be associated with lower scores 2010; Pietrzak & Southwick, 2011), there was limited support for
on a measure of PTSD symptoms in U.S. military personnel the moderating role of intrapersonal and interpersonal resilience
(Maguen et al., 2008). The benefits of social support on postde- variables in the relationship between combat experiences and
ployment health outcomes have also been documented (Brewin et postdeployment mental health. Other than a marginally significant
al., 2000; Fritch et al., 2010; Pietrzak et al., 2009b; Pietrzak & interaction between agreeableness and combat experiences, none
Southwick, 2011). of the interactions significantly improved the prediction of mental
Given that positive affect and affectionate social support were health. In addition, combat experiences were more strongly asso-
not significantly associated with mental health in the binary cor-
ciated with mental health in military personnel with high rather
relations, the present findings could reflect spurious relationships
than low levels of agreeableness. Of note is the fact that similar
or the presence of a suppressor variable in the model. More
results were obtained in a cross-sectional analysis on the role of
importantly, the nature of the relationship between these variables
these intrapersonal and interpersonal variables in resilience to
and mental health could be more complex than originally antici-
stressful life events among military recruits (Watkins, Lee, &
pated. Although they recognize the general role of positive emo-
Sudom, 2012). Possibly, highly agreeable individuals, who have
tions in mental health, Fredrickson and Losada (2005) found, in
positive expectations of others and the world around them, react
their research on flourishing, that an excessively high degree of
more strongly to adverse experiences because these more promi-
positive affect in the absence of negative affect may actually be
nently challenge their worldviews. A similar argument was made
problematic. These researchers also noted the importance of the
regarding the role of secure attachment in individuals’ responses to
situational appropriateness of the positivity, arguing that feigned
psychological trauma (Kanninen, Punamaki, & Quota, 2003).
positivity may do more harm than good (Fredrickson & Losada,
2005). If this were in fact the case, any social desirability that may
have biased the assessment of positive affect may have had a Limitations
particularly pronounced impact on results.
Similarly, there is recognition that specific types of social sup- Several factors may have contributed to the modesty of findings
port may, in some instances, contribute to increased distress (Robi- relative to previous studies. Because the tools used for data col-
taille, Orpana, & McIntosh, 2012). However, a reliance on cross- lection were not anonymous, participants may have underreported
sectional analyses and failure to make the distinction between mental health symptoms. Nonanonymous reporting of postdeploy-
different types of support has made it difficult to understand the ment mental health problems, in particular, is subject to substantial
specific pathways and processes involved in this relationship underreporting (Warner et al., 2011). However, the use of a di-
(Robitaille et al., 2012). In their longitudinal analysis, which mensional and less transparent measure of mental health as an
examined reciprocal relationships between social support and dis- outcome may have limited the effects of underreporting. As well,
tress across multiple time points, Robitaille et al. found that no information on exposure to mental health and resilience training
affectionate social support predicted later increases in distress. was collected such that it was not possible to control for variation
They also found that positive social interaction predicted decreases across participants. If such training were effective, this could
in later distress at one time point, whereas neither tangible nor contribute to the modest effects of intrapersonal and interpersonal
emotional/informational social support predicted later distress. Al- resilience variables on mental health.
 334 LEE, SUDOM, AND ZAMORSKI

Results may also have been impacted by the timing at which addressing both intrapersonal and interpersonal aspects of resil-
measures were taken. For instance, because social support was ience (Cornum et al., 2011). With conscientiousness and emotional
assessed during the very early phases of basic military training, it stability emerging as the only intrapersonal variables that were
likely inaccurately reflected the degree of social support that independently associated with better postdeployment mental
participants were receiving upon their return from deployment. On health, results suggest that emotion regulation is of central impor-
the other hand, the early assessment of social support ensured that tance in intrapersonal resilience. It may therefore be appealing for
observed relationships more purely reflect the influence of social resilience-building interventions to target emotion regulation pro-
support on mental health rather than being confounded by the cesses, possibly by enhancing mental health literacy and emotional
influence of mental health on social support seeking. fitness or by encouraging proactive approaches for sustaining and
Last, the extent that findings may be generalized to all CF improving well-being (Algoe & Fredrickson, 2011; Kelly, Jorm, &
personnel who were deployed overseas remains unclear, as it was Wright, 2007; Pietrzak, Johnson, Goldstein, Malley, & Southwick,
only possible to include individuals for whom data were available 2009a). Given the beneficial influence of positive social interac-
in the present analyses. Due to the nature of the data, it was not tion on mental health, it may also be of value to focus on facili-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

possible to obtain an accurate comparison of participants and tating this form of social support over and above, perhaps, other
This document is copyrighted by the American Psychological Association or one of its allied publishers.

non-participants. Participants nevertheless appeared to demon- forms of social support in such interventions.
strate a similar level of mental health as all CF personnel who were One implication of the fact that the intrapersonal and interper-
deployed overseas. sonal variables exerted a broader influence on postdeployment
mental health (rather than simply moderating the impact of combat
experiences) is that it might be possible to build resilience in ways
Implications
that are not directly related to specific adverse events, for example,
These limitations aside, the findings have important implica- through positive psychology interventions (Seligman, 2011). The
tions for the development of resilience-building interventions. At limited evidence for the moderating role of intrapersonal and
first glance, the small and conflicting effects of intrapersonal and interpersonal resilience variables in the relationship between com-
interpersonal resilience variables on postdeployment mental health bat experiences and mental health also suggests the need to look
would appear to provide limited support for resilience-building beyond such factors to enhance and maintain the well-being of
interventions targeting these variables. Effect sizes observed in military personnel. In particular, these findings contrast starkly
previous cross-sectional studies have been more encouraging, but with the powerful moderating effect of perceptions of leadership in
their intrinsic biases (e.g., failure to control for baseline health military settings (Greenberg & Jones, 2010): In the best-led units,
status, common method variance, and conflation of predictors and rates of psychological problems in heavily combat-exposed per-
outcomes) likely resulted in overestimated effect sizes. Still, the sonnel are the same as in those with little or no combat exposure
present findings also point to the possibility that intrapersonal and (Mental Health Advisory Team [MHAT] IV, 2006). This finding
interpersonal resilience variables can change over time. Indeed, points to the greater potential value to well-being of interventions
there is evidence that many of the characteristics underlying dis- that improve leadership (and perhaps cohesion and support among
positional resilience are in fact more akin to a state than a trait peers) over interventions that promote intrapersonal psychological
(Hourani, et al., 2012; Luthar, Chicehtti, & Becker, 2000; Watson, variables.
Ritchie, Demer, Bartone, & Pfefferbaum, 2006).
Genetic predispositions (Caspi, Roberts, & Shiner, 2005) and
Future Research
processes, such as seeking out environments that reinforce person-
ality tendencies (Caspi, Bem, & Elder, 1989), may maintain indi- In order to determine the extent to which resilience changes over
vidual differences, but individual characteristics may also be ame- time and in response to stressors, additional longitudinal research
nable to change under certain conditions. Longitudinal research on the stability of resilience variables is needed, particularly those
has shown that changes in personality are particularly pronounced of an intrapersonal nature. Specifically, research in this area could
during early adulthood (Ardelt, 2000; Vaidya, Gray, Haig, Mroc- help to guide training and intervention efforts by helping to iden-
zek, & Watson, 2008), under conditions of significant stress (Al- tify which characteristics, if any, are most amenable to change.
dwin, Sutton, Chiara, & Spiro, 1996), and during periods of Given that military personnel are receiving more and more routine
transition (Park, Cohen, & Murch, 1996). Such observations have resilience training, and that such training may influence intraper-
obvious relevance for military members in the early years of their sonal resilience, exposure to such training should be considered. If
career (Jackson, Thoemmes, Jonkmann, Ludtke, & Trautwein, intrapersonal resilience is then found to be stable or not strongly
2012). Indeed, decreases in neuroticism and increases in consci- linked to mental health outcomes, intervention efforts can be
entiousness have been found in military recruits across the very focused elsewhere. In addition, longitudinal research involving
brief basic training period (Vickers, Hervig, Paxton, Kanfer, & more phases of data collection would shed light on possible
Ackerman, 1993), as have decreases in hardiness as a result of nonlinear relationships among variables, and would be useful to
higher stress reactions in military recruits (Vogt, Rizvi, Shipherd, disentangle and quantify the dynamic and complex relationships
& Resick, 2008). Deployment-related stressors, such as exposure between mental health and social support. While limited support
to combat, may also increase the likelihood of changes in intrap- was found for the moderating role of the variables considered in
ersonal aspects of resilience. this study, other mechanisms, such as mediation, may be involved.
Taken together, the research suggests that the ideal time to It would also be helpful if additional variables (e.g., appraisals,
implement resilience-building interventions is at recruitment or coping) were examined in future longitudinal research in order to
early in a military career. Existing interventions have focused on thoroughly investigate such mechanisms. Ultimately, the design of
 RESILIENCE AND POSTDEPLOYMENT MENTAL HEALTH 335

interventions will depend upon a deeper understanding of these Ardelt, M. (2000). Still stable after all these years? Personality stability
psychological processes. theory revisited. Social Psychology Quarterly, 63, 392– 405. doi:
Finally, these findings pertain to a very specific population 10.2307/2695848
under very specific circumstances (male CF members who have Babor, T. F., Higgins-Biddle, J., Saunders, U., & Monteiro, M. (2001). The
been deployed in support of a combat and peace support mission). Alcohol Use Disorders Identification Test: Guidelines for use in primary
health care (No. WHO/ MSD/MSBO1.6a). Geneva, Switzerland: World
It remains to be determined whether similar variables predict
Health Organization.
mental health among female CF members upon their return from Bartone, P. T., Hystad, S. W., Eid, J., & Brevik, J. I. (2012). Psychological
deployment. Because data were available for only a small number hardiness and coping style as risk/resilience factors for alcohol abuse.
of women, it was not feasible to carry out the same analysis and Military Medicine, 177, 517–524.
compare results with that of men. However, future work focusing Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A.
on a smaller set of variables and a simpler model is planned to (1996). Psychometric properties of the PTSD Checklist (PCL). Behav-
explore resilience and postdeployment mental health among fe- iour Research and Therapy, 34, 669 – 673. doi:10.1016/0005-
male CF personnel. With regard to other occupations, the greatest 7967(96)00033-2
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

applicability would be to other military organizations or to recruits Bonanno, G. A., & Mancini, A. D. (2012). Beyond resilience and PTSD:
This document is copyrighted by the American Psychological Association or one of its allied publishers.

in other cohesive occupational groups that experience traumatic Mapping the heterogeneity of responses to potential trauma. Psycholog-
stress as part of their job (e.g., police, firefighters, first respond- ical Trauma: Theory, Research, Practice, and Policy, 4, 74 – 83. doi:
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Bonanno, G. A., Mancini, A. D., Horton, J. L., Powell, T. M., Leardmann,
and work environments may be of value to determine which
C. A., Boyko, E. J., . . . Millennium Cohort Study Team. (2012).
aspects of the resilience process are unique and shared across Trajectories of trauma symptoms and resilience in deployed US military
occupations. service members: Prospective cohort study. The British Journal of
Psychiatry, 200, 317–323. doi:10.1192/bjp.bp.111.096552
Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of
Conclusions
risk factors for posttraumatic stress disorder in trauma-exposed adults.
The present study helped address several gaps in previous work Journal of Consulting and Clinical Psychology, 68, 748 –766. doi:
in this area, given its longitudinal nature, generous sample size, 10.1037/0022-006X.68.5.748
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complexities of resilience, the limitations of previous cross- ment: Stability and change. Annual Review of Psychology, 56, 453– 484.
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