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Resilience in the face of adversity is vital for military service members to survive potential threats to their own lives and safety and to accomplish assigned missions, often for the sake of others’ survival and welfare. The ability of service members to bounce back from operational stress may also determine how successfully they reintegrate with their families and communities after returning from deployment, whether they can continue to work in military professions, and whether they develop potentially disabling mental disorders or other serious behavioral problems. Military organizations have long traditions of selecting, training, and sustaining service members to endure intense and persistent operational stress without losing their abilities to function on the battlefield, but other indices of resilience have only recently attracted the sustained interest of the military. As military organizations develop programs to promote a broader spectrum of desired stress outcomes, they are faced with a choice between expecting traditional resilience-building methods to meet untraditional objectives and creating entirely novel approaches to resilience.
Academic interest in the psychological, biological, social, and personality-trait differences associated with successful adaptation to combat and operational experiences has increased rapidly since the late 1990s. Underlying recent studies in this area has been the assumption that the incidence of various mental health and functional problems associated with combat and operational experiences might be reduced if modifiable risk and resilience factors could be identified and then targeted in military prevention programs. Unfortunately, research and translational programs to enhance resilience in members of the armed services have, so far, been limited by the lack of a unified or paradigmatic approach to conceptualizing the military and extra-military processes and functions that may lead to resilient outcomes, and even by the lack of a consensus definition of resilience. Uniform methods of measuring resilience processes or outcomes also do not yet exist. The little empirical research that has been conducted in the military has significant internal and external validity problems, greatly limiting their power to inform prevention or intervention practices, which is the basic goal of resilience research.
This chapter explores both major depressive disorder (MDD) and prolonged grief disorder (PGD) as responses to disasters and terrorist events. MDD should be diagnosed in individuals for whom intense dysphoria and feelings of sadness persist and who experience related depressive symptoms. PGD is more severe and unremitting than normal grief. PGD is associated with considerable functional impairment, physical and mental health morbidity, lost productivity, suicide, and fewer quality adjusted life years. Studies have shown that PGD symptoms form a coherent cluster distinct from bereavement-related depressive and anxiety symptom clusters. Postdisaster prevalence of depression varies considerably across disasters and estimates can be misleading without additional information. Risk and resilience factors can be temporally categorized into three categories: preevent predictors, perievent predictors, and postevent predictors. Grief and depression-focused treatments are rarely implemented systematically in the wake of disasters.