Combat-related stress, cohesion, coping, and perceived threat: Predictors and moderators of posttraumatic symptomatology among deployed U.S. Army soldiers

This study examined the roles cohesion, coping, and perceived threat have in buffering the effect of war-zone stress on mental health symptoms. Specifically, six factors were tested as potential moderators of the relationship between combat-related stressors and posttraumatic stress symptomatology (PTSS), including horizontal (peer) cohesion, vertical (NCO) cohesion, vertical (officer) cohesion, problem-focused coping, emotion-focused coping, and perceived threat. In addition, direct effects and curvilinear interaction effects were examined. This study was a secondary analysis of Mental Health Advisory Team (MHAT) VI data collected by military researchers as part of an ongoing effort to assess soldiers' behavioral health. This study analyzed data from a total of 1,824 male and female U.S. Army soldiers from 15 active-duty brigades who anonymously completed the Walter Reed Army Institute of Research (WRAIR) Deployment Well-Being Survey during their deployment to Iraq in support of Operation Iraqi Freedom (OIF). PTSS, combat-related stressors, horizontal (peer) cohesion, vertical (NCO) cohesion, vertical (officer) cohesion, problem-focused coping, emotion-focused coping, and perceived threat were measured. Hierarchical multiple regression analysis was used to identify both risk factors and protective factors for PTSS. The analysis revealed three risk factors and four protective factors. During a war-zone deployment, higher levels of combat-related stressors, problem-focused coping, and perceived threat (i.e., risk factors) were independently associated with greater report of PTSS. Higher levels of horizontal (peer) cohesion, vertical (NCO) cohesion, vertical (officer) cohesion, and emotion-focused coping (i.e., protective factors) were independently associated with decreased levels of PTSS. Hierarchical moderated multiple regression analysis indicated that vertical (NCO) cohesion, vertical (officer) cohesion, and emotion-focused coping buffered the effect of combat-related stressors on PTSS; soldiers higher in vertical (NCO) cohesion, vertical (officer) cohesion, and emotion-focused coping showed weaker relationships between combat-related stressors and PTSS. No support for curvilinear interaction effects were found, suggesting that for this population of soldiers deployed to Iraq, the moderating effect of vertical cohesion and emotion-focused coping on the relationship between combat-related stressors and PTSS is linear in nature.