Potential mental health risk and protective factors assessed included demographic factors (age, gender, race, marital status, education, and employment status), warzone deployments, combat exposure, self-esteem, use of drugs/ alcohol to cope postdeployment, exposure to adverse childhood events, and psychological resilience, all derived from the survey instrument. As suggested, our study was guided by a psychosocial-stress approach used in previous studies, which is focused on the availability of psychosocial resources in the pre- and posttrauma periods and the impact of environmental factors in the onset and course of mental disorders and treatment seeking (Adams et al., 2006 (link); Adams & Boscarino, 2011 (link); Rosen et al., 2012 (link); Yamashita, 2012 (link)). Warzone exposure was based on self-report and included the Korean war, Vietnam war, Persian Gulf war, Afghanistan/Iraq war, and “other” warzone deployments as currently defined by the VA (http://www.va.gov ). Combat exposure was based on a version of the Combat Experience Scale, a widely used and validated measure of combat exposure (Hoge et al., 2004 (link); Janes, Goldberg, Eisen, & True, 1991 (link)). Versions of this scale have been used in military health studies since the Vietnam war period (Boscarino, 1995 (link)). Cronbach’s alpha for this exposure scale in the current study was 0.806.
Self-esteem was measured by a 5-item version of the Rosenberg Scale (e.g., feel like a person of worth, certainly feel useless at times), a scale widely used in previous trauma studies (Boscarino & Adams, 2009 (link); Boscarino, Hoffman, et al., 2014 (link)). The reliability and validity of this scale is reported to be good (Robinson, Shaver, & Wrightsman, 1991 ; Sinclair et al., 2010 (link)). Cronbach’s alpha for this scale in the current study was 0.721.
For use of alcohol/drugs to cope postdeployment, we used the drug and alcohol items from the brief coping scale (BCS) (e.g., “Since your warzone service, have you been doing the following: using alcohol or other drugs to make you feel better?”). The BCS is a widely used, validated measure of coping used in previous research (Carver, 1997 (link)). Cronbach’s alpha for this sub-scale in the current study was 0.909. For adverse childhood events, we included a valid and reliable 12-item scale used in past studies: the Adverse Childhood Events (ACE) scale (Binder et al., 2008 (link); Dong et al., 2004 (link)). Items in this scale asked respondents to report how often as a child did a parent hit them, how often they went hungry, and the like. Cronbach’s alpha for this scale in the current study was 0.842.
Finally, for psychological resilience we used the 5-item version of the Connor-Davidson Resilience Scale (CD-RISC) (Campbell-Sills & Stein, 2007 (link)). Items in this measure included reports related to being able to adapt to change, having a strong sense of purpose, and so on. CD-RISC has been extensively used in clinical research and is reported to be a valid and reliable measure of psychological resilience (Connor & Davidson, 2003 (link)). Cronbach’s alpha for the CD-RISC scale in the current study was 0.796.
Self-esteem was measured by a 5-item version of the Rosenberg Scale (e.g., feel like a person of worth, certainly feel useless at times), a scale widely used in previous trauma studies (Boscarino & Adams, 2009 (link); Boscarino, Hoffman, et al., 2014 (link)). The reliability and validity of this scale is reported to be good (Robinson, Shaver, & Wrightsman, 1991 ; Sinclair et al., 2010 (link)). Cronbach’s alpha for this scale in the current study was 0.721.
For use of alcohol/drugs to cope postdeployment, we used the drug and alcohol items from the brief coping scale (BCS) (e.g., “Since your warzone service, have you been doing the following: using alcohol or other drugs to make you feel better?”). The BCS is a widely used, validated measure of coping used in previous research (Carver, 1997 (link)). Cronbach’s alpha for this sub-scale in the current study was 0.909. For adverse childhood events, we included a valid and reliable 12-item scale used in past studies: the Adverse Childhood Events (ACE) scale (Binder et al., 2008 (link); Dong et al., 2004 (link)). Items in this scale asked respondents to report how often as a child did a parent hit them, how often they went hungry, and the like. Cronbach’s alpha for this scale in the current study was 0.842.
Finally, for psychological resilience we used the 5-item version of the Connor-Davidson Resilience Scale (CD-RISC) (Campbell-Sills & Stein, 2007 (link)). Items in this measure included reports related to being able to adapt to change, having a strong sense of purpose, and so on. CD-RISC has been extensively used in clinical research and is reported to be a valid and reliable measure of psychological resilience (Connor & Davidson, 2003 (link)). Cronbach’s alpha for the CD-RISC scale in the current study was 0.796.
