Date of Award

January 2020

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Carolyn M. Mazure

Second Advisor

Robert H. Pietrzak

Abstract

We examined what defines psychological resilience in graduates of the United States Military Academy at West Point, a special population that was selected and trained to adapt and excel in the face of risk factors that can adversely affect mental and physical health. We also assessed self-reported mental and physical health in this population and compared these data to other veteran and civilian populations to lay the groundwork for further investigations into the relationship of resilience to health outcomes. The aims of this study were to: 1) employ a novel approach to operationalizing psychological resilience, defined as adapting well and functioning despite adversity, trauma, and significant stress; 2) identify how a broad range of sociodemographic variables, military experiences, and psychosocial factors are associated with resilience in these graduates and if these differ by gender; and 3) determine the long-term prevalence of physical and mental health conditions in West Point graduates of the post-Vietnam era, and compare these data (a) by gender and (b) to nationally-representative veteran and civilian populations.

A nationally representative sample of 1,344 West Point graduates from the classes 1980-2011 completed a web-based survey using validated questionnaires. We summarized variables using descriptive statistics; and conducted independent-sample t tests and chi-square tests of association to compare variables by gender, and multivariable regression analyses to evaluate rates of health conditions in male vs. female graduates, while adjusting for characteristics that differed by gender. We operationalized resilience using a novel ‘discrepancy-based’ measure that reflects the difference between actual and predicted psychological distress (i.e., posttraumatic stress, depressive, and anxiety symptoms). We then examined sociodemographic, military, and psychosocial correlates of greater resilience.

Results revealed that increased purpose in life, social connectedness, grit, fewer negative military experiences, increased time in service, increased activity level compared to peers, and use of acceptance coping were associated with greater resilience. Gender did not moderate these relationships, except that increased time in service was associated with greater resilience in female graduates.

Comparative data on self-reported mental and physical health indicated that West Point graduates were healthier than the general veteran and civilian populations except for higher rates of anxiety, PTSD and arthritis, for which West Point graduates are similar to other veteran populations and had greater rates than the general population. Female graduates were more likely than male graduates to have depression, anxiety, stress and inflammatory conditions (arthritis and migraines), while male graduates were more likely to have cardiovascular and sleep disorders, alcohol use problems, and to use nicotine; they also reported greater physical activity but were more likely to be overweight or obese.

This study provides the first known characterization of factors associated with psychological resilience, as well as the mental and physical health status of West Point graduates. We anticipate that this work will inform targeted prevention and treatment interventions designed to address the unique health needs of this special population. This study also provides the groundwork for studying resilience in other populations and understanding the gender-specific contribution of resilience to health outcomes.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 09/10/2021

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