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Journal of Mental Health
ISSN: 0963-8237 (Print) 1360-0567 (Online) Journal homepage: http://www.tandfonline.com/loi/ijmh20
Non-deployment factors affecting psychologicalwellbeing in military personnel: literature review
Samantha K. Brooks & Neil Greenberg
To cite this article: Samantha K. Brooks & Neil Greenberg (2017): Non-deployment factorsaffecting psychological wellbeing in military personnel: literature review, Journal of MentalHealth, DOI: 10.1080/09638237.2016.1276536
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http://tandfonline.com/ijmhISSN: 0963-8237 (print), 1360-0567 (electronic)
J Ment Health, Early Online: 1–11! 2017 Informa UK Limited, trading as Taylor & Francis Group. DOI: 10.1080/09638237.2016.1276536
REVIEW ARTICLE
Non-deployment factors affecting psychological wellbeing in militarypersonnel: literature review
Samantha K. Brooks and Neil Greenberg
King’s College London, King’s Centre for Military Health Research, Weston Education Centre, London, UK
Abstract
Background: Most military mental health research focuses on the impact of deployment-relatedstress; less is known about how everyday work-related factors affect wellbeing.Aims: This systematic narrative literature review aimed to identify non-deployment-relatedfactors contributing to the wellbeing of military personnel.Method: Electronic literature databases were searched and the findings of relevant studies wereused to explore non-deployment-related risk and resilience factors.Results: Fifty publications met the inclusion criteria. Determinants of non-deployment stresswere identified as: relationships with others (including leadership/supervisory support; socialsupport/cohesion; harassment/discrimination) and role-related stressors (role conflict; commit-ment and effort-reward imbalance; work overload/job demands; family-related issues/work-lifebalance; and other factors including control/autonomy, physical work environment andfinancial strain). Factors positively impacting wellbeing (such as exercise) were also identified.Conclusions: The literature suggests that non-deployment stressors present a significantoccupational health hazard in routine military environments and interpersonal relationships atwork are of fundamental importance. Findings suggest that in order to protect the wellbeing ofpersonnel and improve performance, military organisations should prioritise strengtheningrelationships between employees and their supervisors/colleagues. Recommendations foraddressing these stressors in British military personnel were developed.
Keywords
Military, leadership, management,organisational culture, social support
History
Received 13 June 2016Revised 23 August 2016Accepted 16 October 2016Published online 25 January 2017
Introduction
Within any workplace there are certain stressors which can
affect psychological wellbeing, job satisfaction and job
performance. (Bryson et al., 2014)
There has been much research on stress in the military,
though generally this tends to focus on stressors relating to
combat operations, such as traumatic exposure to death and
injuries, exhaustion and deprivation, and being exposed to
extreme climates. An international review of occupational
stressors in the military (Campbell & Nobel, 2009) identified
several categories of stressors. Though much of the review
focused on deployment-related stress, results also yielded
several categories of stressors applying to non-deployed
personnel, including work stressors (e.g. workload, role
ambiguity, poor leadership); social-interpersonal stressors
(e.g. acceptance, conflict, friendship); and family-related
stressors (e.g. separation).
It thus appears that non-deployment stress may be
substantial and important to consider. In light of the
completion of the withdrawal of forces from Afghanistan in
2014/15, there is a need to identify factors of stress beyond
those associated with being in a combat zone. Though non-
deployment stressors have received greater attention within
military research in recent years, there has to date been no
systematic review synthesising the various results.
Throughout this review, we use the term non-deployment
stress due to the intent to explore workplace stressors outside
of the operational environment. Our definition of non-
deployment stress is based on the Health and Safety
Executive (HSE, 2007) definition of workplace stress as the
adverse reaction which employees experience following
excessive pressures or demands at work. The HSE describes
six primary sources of work stress: demands (whether
employees can cope with the demands of their job), control
(the extent to which employees have a say in their work),
support (whether adequate support is received from col-
leagues), relationships (whether employees are subject to
negative behaviours e.g. bullying), role (the extent to which
employees understand their responsibilities) and change
(whether employees feel involved in organisational changes).
This review was exploratory in nature, and therefore
although there are several models of job stress we did not aim
to test any specific hypothesis, and instead aimed to simply
explore any and all non-deployment factors affecting the
psychological wellbeing or related organisational outcomes
Correspondence: Samantha K. Brooks, King’s College London, King’sCentre for Military Health Research, Weston Education Centre,Cutcombe Road, London SE5 9RJ, UK. Tel: 020 7848 0267. E-mail:[email protected]
(e.g. job satisfaction) of military personnel, with the goal of
developing recommendations for reducing non-deployment
stress. This paper is the first to our knowledge to systematically
review all of the literature in the area of non-deployment stress.
By presenting all of the current literature together, we aimed to
(1) identify any gaps in the literature or any limitations to the
current research and (2) use our identification of non-deploy-
ment stressors to make suggestions for how stress can be
reduced in routine military environments.
Method
Type of review
This systematic narrative review involved systematic search-
ing of literature followed by narrative analysis. This method
was chosen as the review was exploratory in nature (i.e.
aiming to explore the number of different factors associated
with military stress rather than testing any specific hypoth-
esis). The narrative format of analysis allows us to provide a
summarised overview of the broad range of topics covered.
Narrative reviews have become increasingly ‘systematic’ in
nature and are frequently used to review quantitative data
when studies are not similar enough to undergo meta-analysis
(Snilstveit et al., 2012). Narrative reviews can be strengthened
by incorporating elements of a systematic literature review
(Murphy, 2012), which we have done in this study i.e. the
search strategy, use of multiple databases, and standardised
data extraction process.
Selection of studies
Inclusion criteria were:
� Peer-reviewed primary studies;
� Reporting on non-deployment-related factors associated
with any aspect of psychological wellbeing or job
satisfaction in military personnel;
� English language;
� Published 2003–2013 (a time period of ten years was
chosen due to the volume of studies in this area);
� Quantitative studies (to allow us to identify factors which
showed statistically significant associations with out-
comes, or report whether there were inconsistencies in
the literature if some studies reported significant associ-
ations and others showed no associations);
� Scoring at least 75% on all sections of our quality
appraisal.
Conducting the review
This review forms part of a wider study on workplace stress in
high-risk occupational settings. Though this paper focuses
entirely on military literature, one search was undertaken to
cover both military and comparable high-risk occupations.
Therefore, search terms were separated into three compo-
nents: military terms (e.g. Army, Navy), other high-risk
occupation terms (e.g. police, fire fighter) and wellbeing-
related terms (e.g. stress, depression). One search using
military ‘‘AND’’ wellbeing-related terms was conducted, and
one search using civilian ‘‘AND’’ wellbeing-related terms.
Full search terms can be seen in Appendix I. Multiple
electronic databases were searched: the British Nursing Index;
Cochrane; EMBASE; Health Management Information
Consortium; MEDLINE; PsycINFO; Science Direct; and
Web of Science. Resulting citations were downloaded to
EndNote� software version X7 (Thomson Reuters, New
York, NY).
Article screening
Duplicate citations were removed. Titles of citations were
assessed and any clearly irrelevant to the study were removed.
The abstracts of those remaining were read, evaluated and full
texts of papers identified as potentially eligible for inclusion
were obtained. The reviewer read these papers in their
entirety and assessed eligibility according to inclusion
criteria. Reference lists of all included studies were also
hand-searched.
Data extraction and quality assessment
Details from relevant studies were extracted into spreadsheets
designed specifically for this review, with headings such as
‘‘country of study’’, ‘‘participant demographics’’, ‘‘measures
used’’ and ‘‘outcomes’’ (full data extraction table available
on request). Studies were assessed for quality in three
different areas: study design; data collection and method-
ology; and analysis and interpretation of results. Quality
assessment forms were designed for the study, informed by
existing tools such as the Effective Public Health Practice
Project’s Quality Assessment Tool for Quantitative studies
(EPHPP, 2009) and the British Medical Journal’s criteria
originally designed for assessing economic studies
(Drummond & Jefferson, 1996). This combination of assess-
ment tools was used to ensure a comprehensive quality
appraisal; the final appraisal tool can be seen in Appendix II.
Each study was given an overall score.
Synthesis of results
Thematic analysis was used to group predictors of wellbeing
(both positive and negative) into a typology, and the
‘‘themes’’ which emerged from the literature are presented
in this review. To be accepted as a theme, topics needed to be
identified by at least two studies. One reviewer (SKB) went
through the results of each paper, noting which stressors were
explored in each one, and these stressors were then coded into
appropriate ‘‘themes’’. Any uncertainties regarding the def-
inition of themes were discussed with another researcher
(NG) until consensus was reached. The coding of results into
themes was guided purely by the data itself and not by any of
the various categories of workplace stressors already
proposed by workplace stress models.
As we were interested in factors affecting both risk and
resilience, we included any studies reporting on stressors, risk
factors, mediators or moderators of stress, or protective
factors. As these terms clearly cannot be used inter-change-
ably, we report on them using the terminology used in the
original papers.
Results
As stated earlier, this report forms part of a wider review on
workplace stress in high-risk occupations thus the search
2 S. K. Brooks & N. Greenberg J Ment Health, Early Online: 1–11
strategy encompassed non-military literature also. 11,834
studies were initially found, of which 8295 related to the
military. After the various screening processes, 50 papers
were retained for data extraction (see Appendix III for details
of the full screening process). We note that this is a small
retention rate: however, this is a reflection of the very broad
search strategy that was used to avoid missing any potentially
relevant papers. A summary of the literature reviewed in
this study (including year of publication, country, design,
number of participants and military service) can be seen
in Table 1.
An overview of stressors identified is presented in Table 2.
Relationships with others
Leadership and supervisory support
Effective leadership was found to be important for wellbeing
in military organisations, likely due to the highly structured
environment. Aspects of leadership identified as particularly
beneficial included trustworthiness (Redman et al., 2011);
skills, knowledge and concern for morale and success
(Pflanz & Ogle, 2006); being ‘‘involved’’ rather than distant
and providing motivation, stimulation, clear expectations and
recognition (Bass et al., 2003); and providing regular
feedback (Mohd Bokti & Abu Talib, 2009). Perceived
supervisory support predicted occupational and psycho-
logical outcomes in the US military (Dupre & Day, 2007),
and stress and strain in the Royal Navy (UK) (Brasher et al.,
2010; Bridger et al., 2007, 2009), with better perceptions of
support associated with better outcomes. Leaders with
attachment-related anxiety were associated with subordin-
ates’ poor instrumental functioning, socio-emotional func-
tioning and mental health in the Israeli military (Davidovitz
et al., 2007).
Social support and cohesion
Social support, particularly from colleagues, was found to be
important. Unit cohesion (the unity or bonds between
employees in a team) was positively associated with overall
health in the US military (Mitchell et al., 2011) and job
satisfaction and stress in the US Army (Walsh et al., 2010).
Several US studies suggested unit cohesion and a strong sense
of ‘‘belongingness’’ were significant protective factors
against suicidal ideation (Bryan et al., 2013;
Langhinrichsen-Rohling et al., 2011; Mitchell et al., 2012).
Increased conflict with co-workers predicted stress and
depression in the US Air Force (Pflanz & Ogle, 2006) and
stress in Royal Navy submariners (Brasher et al., 2010). Low
peer support was associated with strain in the UK Navy
(Bridger et al., 2007); depression and post-traumatic stress
disorder (PTSD) in US Army personnel (Carter-Visscher
et al., 2010); PTSD, depression, stress and suicidal ideation in
the Canadian military (Mota et al., 2012; Nelson et al., 2011);
psychological distress (Rona et al., 2009) and PTSD, common
mental disorders and alcohol misuse (Harvey et al., 2011) in
UK personnel; and suicidal ideation in the Canadian military
(Nelson et al., 2011) and US Air Force (Langhinrichsen-
Rohling et al., 2011). Hatch et al. (2013), comparing UK
service personnel and those who left the service, found
service leavers reported less social participation outside work
and a general disengagement with military social contacts in
comparison to serving personnel, and were more likely to
report common mental disorders and PTSD. Conversely, high
support within the organisation was associated with better job
satisfaction and turnover intentions in the Canadian military
(Dupre & Day, 2007) and better self-rated health in the
Slovenian military (Selic et al., 2012). Social support was a
protective factor for psychological distress in US Air Force
personnel (Lemaire & Graham, 2011) and Marines (Hourani
et al., 2012).
Harassment and discrimination
Sexual harassment was associated with higher risk of turnover
in the US military personnel (Nye et al., 2010) and lower co-
worker satisfaction and more reported role limitations in the
US military (Settles et al., 2012). Perceived tokenism (e.g.
isolation, stereotyping) was associated with lower levels of
organisational commitment in US Army Captains (Karrasch,
2003).
Role-related stressors
Role conflict
Role conflict and lack of job clarity – i.e. lack of
understanding of what is expected of one in their workplace
or not understanding one’s responsibilities – also appeared to
be predictive of psychological and work-related outcomes.
Role conflict predicted strain in the Royal Navy (Bridger
et al., 2007); occupational stress in the Indian Navy (Pawar &
Rathod, 2007); physical and psychological health symptoms
in the Canadian military (Dupre & Day, 2007), and psycho-
logical distress in Australian Navy personnel (McDougall &
Drummond, 2010).
Commitment, over-commitment and effort-reward imbalance
Brasher et al. (2012) found that over-commitment and
difficulty disengaging from work predicted stress in Royal
Navy submariners. Bridger et al. (2011) found that the biggest
stressor for UK Naval personnel was inability to disengage
from work, implying over-commitment. Royal Navy person-
nel with chronic strain were more likely to perceive that
reward for high effort was lacking than those without chronic
strain, and more likely to be over-committed to their specific
work role but lack commitment to the service as a whole
(Bridger et al., 2009). Submariners with the highest stress
levels tended to be those who were over-committed to their
work roles, but lacked commitment to the Royal Navy as a
whole (Brasher et al., 2010). There were also positive findings
relating to commitment; for example, Meyer et al. (2013)
found that commitment mediated the relationship between
stress and both psychological and work-related outcomes in
the Canadian military.
Effort-reward imbalance was strongly associated with
mental disorders in Brazilian Army personnel (Martins &
Lopes, 2012, 2013). Conversely, appreciation at work was
positively associated with job satisfaction and negatively
associated with feelings of resentment in the Swiss military
(Stocker et al., 2010).
DOI: 10.1080/09638237.2016.1276536 Non-deployment predictors of wellbeing 3
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DOI: 10.1080/09638237.2016.1276536 Non-deployment predictors of wellbeing 5
Work (over) load and job demands
In one US study, 33% and 30% of Air Force personnel listed
‘‘work overload’’ and ‘‘long work hours’’ as their primary
sources of job stress, respectively (Pflanz & Ogle, 2006).
High role strain predicted decreased mental health in US Air
Force women (Hopkins-Chadwick & Ryan-Wenger, 2009).
Qualitative overload (that is, pressures of the job related to
responsibility and complexity of work rather than amount of
work) predicted poor work ability in the Netherlands Army
(Goedhard & Goedhard, 2005). Having too heavy a workload
and a quantity of work which could interfere with quality
predicted occupational stress in the Malaysian Navy (Mohd
Bokti & Abu Talib, 2009). The higher the workload, the
greater the strain in the UK Navy (Bridger et al., 2009) and
psychological distress in Australian Navy personnel
(McDougall & Drummond, 2010). However, in one study
workload was found to correlate positively with performance
in the US Army, whereas role overload (the perception of
individuals that their resources are overwhelmed) was not
correlated with performance (Thomas et al., 2005). Sanchez
et al. (2004) found the strongest predictors of job satisfaction
in US military personnel were perception of job pressure and
belief that the biggest problem in one’s life was the result of
job-related, rather than non-job-related, issues.
A key demand faced by military personnel is the number of
hours worked: military organisations require service to be
provided 24 hours per day, so days are divided into ‘‘shifts’’,
with different employees taking up posts throughout the day,
often involving working throughout the night. Shift work
increased stress in military police officers in Brazil (Franca
et al., 2011), while rotating shifts were related to poorer
turnover intentions (i.e. intention to leave the service), higher
levels of burnout, lower levels of job satisfaction and
commitment, and greater absenteeism in Dutch military
police (Demerouti et al., 2004). Greater number of weekly
hours worked was a predictor of suicide ideation in the US Air
Force (Langhinrichsen-Rohling et al., 2011).
Family issues/work-life balance
Due to the nature of the role, military personnel are often
away from their families for long periods, and the long hours
involved may lead to disruption at home. Several US studies
found that being away from family was a stressor (Bray et al.,
2010; Pflanz & Ogle, 2006) and predicted both turnover
intentions (Behnke et al., 2010) and psychological symptoms
(Carter-Visscher et al., 2010). Poor work-life balance signifi-
cantly predicted health symptoms and turnover intentions in
the Canadian military (Dupre & Day, 2007); stress in the US
military (Allen et al., 2011; Bray et al., 2010); turnover
intentions in US military law enforcement (Sachau et al.,
2012); and strain in the Royal Navy (Bridger et al., 2009).
Odle-Dusseau et al. (2013) found that poorer perception of the
work environment as family-supportive was associated with
psychological strain.
Other role-related factors
There were several other stressors identified which have been
categorised together as ‘‘other’’ work-related factors due to
the small number of studies that discussed their impact, and
the fact that they were not the primary focus of any study.
These stressors are: control/autonomy; physical work envir-
onment; and financial strain.
There was a small amount of literature relating to control;
lack of autonomy and control predicted strain in UK Navy
personnel (Bridger et al., 2011) and post-traumatic stress and
common mental disorders in the UK military (Fear et al.,
2009).
The physical work environment could also affect stress:
dissatisfaction with the physical conditions they had to work
under predicted stress and strain in both UK and US Navy
personnel (Bridger et al., 2011; Wilcove et al., 2009).
Finally, Allen et al. (2011) found a negative correlation
between stress and income in US Army families, though the
psychological sense of financial strain (i.e. worrying about
financial situation) was a stronger predictor of stress than
actual salary. A study of US Air Force personnel
(Langhinrichsen-Rohling et al., 2011) found that financial
stress predicted suicidal ideation in female personnel only.
Positive impact on wellbeing
Several factors were identified which were consistently
associated with a positive effect on wellbeing or job
performance. There was a small amount of literature
concerning fitness and exercise: the impact of stressors on
psychological wellbeing was mediated by physical fitness in
the US military (Dolan et al., 2005) and amount of time spent
on leisure-time physical activity in Brazilian Army personnel
(Martins & Lopes, 2013). Involvement in recreational
Table 2. Overview: factors affecting wellbeing.
Category Examples
Relationships with others: Leadership and Supervisory Support Support, feedback, leadership styleRelationships with others: Social Support and Cohesion Sense of belonging/camaraderie at work, relationships with colleagues/
family/friendsRelationships with others: Harassment and Discrimination Sexual harassment, perceived tokenismRole-related Stressors: Role Conflict Role clarity, role conflictRole-related Stressors: Commitment, Over-commitment and Effort-
Reward ImbalanceOver-commitment, effort-reward imbalance, feeling valued
Role-related Stressors: Work (Over)load and Job Demands Demands, resources, control, workload, long hours, shift workRole-related Stressors: Family Issues/Work-Life Balance Separation, concerns about family, demands at work/homeRole-related Stressors: Other Role-related Factors Control/autonomy, ability to participate in decision-making; physical work
environment; financial strainPositive Impact on Wellbeing Fitness, exercise, role identification, trust in the organisation
6 S. K. Brooks & N. Greenberg J Ment Health, Early Online: 1–11
activities mediated the relationship between work stress and
psychological distress in Australian Navy personnel
(McDougall & Drummond, 2010).
‘‘Army identification’’ was negatively associated with
depression and positively associated with job satisfaction
(Sani et al., 2012). Other personal or work-related values
which may moderate or mediate the effects of stressors
included possessing a strong ‘‘achievement’’ value (Britt
et al., 2004) and having trust in the organisation as a whole
(Redman et al., 2011).
It should also be noted that many of the factors identified
as stressors can also have a positive impact depending how
they are perceived. For example, while perceived poor or
lacking social support at work increased stress, perception of
support as good may increase job satisfaction and reduce
stress.
Discussion
This review highlights the importance of considering non-
deployment stressors in military personnel. Military organ-
isations should be able to improve the wellbeing of personnel
through addressing exposure to, and mediating the impact of,
non-deployment stressors.
Implications
Areas highlighted as worthy of attention are discussed below.
As many of the reviewed studies reported correlational
findings some caution must be taken before translating these
into practical implications. However, this review’s findings
provide useful insights into potential levers for intervention
which could be tested in future studies.
Relationships with others, particularly supervisors, were
particularly important to the psychological wellbeing and
occupational functioning of military personnel (Bridger et al.,
2007; Dupre & Day, 2007). This is interesting given that such
a profession is considered to be characterised more by
physical than socially-related risks. We suggest that super-
visors should be aware of the need to be supportive and give
directions and feedback clearly. Whilst military leadership
training for operational duties is well-developed, supervisors
may benefit from improved understanding about how best to
facilitate teams working on non-deployment tasks. Ensuring
that supervisors are trained in management as well as
leadership skills should be useful; for example, training to
encourage assigning well-defined roles for team members and
dealing with problems in a non-confrontational way. Evidence
suggests that employees thrive with clear, constructive
feedback from leaders (Mohd Bokti & Abu Talib, 2009),
and it should be investigated how to best provide this. For the
UK military, it may be that the current practice of twice-
yearly formal feedback from line managers is insufficient to
effectively inform employees of their performance and, if
necessary, how they can improve. Current appraisal methods
use a traditional top-down approach, where the manager is the
only evaluator. Assuming the manager is impartial and fair,
this can be useful in evaluating performance and setting goals;
however, the singular perspective means that bias from
managers could limit the potential for development. It may be
helpful to consider a more contemporary 360-degree
approach to appraisals, where employees are evaluated from
people in all areas within the organisation, providing a more
complete picture of how performance is being perceived. This
type of appraisal has been explored within civilian organisa-
tions with positive findings; employees reported that it
promoted reflection on what was going well and what could
be improved, and found it a positive learning experience
overall (Drew, 2009). Although 360 degree appraisals have
not been well-studied in military organisations, this is starting
to attract attention (Charbonneau & MacIntyre, 2011). Future
research may consider trialling both top-down and 360-degree
approaches to ascertain which method is most effective.
Cohesive units, good team functioning and peer support
were important (Mitchell et al., 2011, 2012). Future studies
should investigate how to build and maintain cohesion in units
even when not preparing for deployment. Group goals are
important in developing and maintaining cohesive units, and
leaders could influence this by establishing joint goals and
encouraging employees to work together. Many military
training courses aim to improve unit cohesion as a primary or
secondary objective (e.g. adventurous training), but few
training opportunities foster interpersonal skills. One excep-
tion to this is Trauma Risk Management (TRiM) training
(Greenberg et al., 2008), an intervention delivered by line
managers and aimed at improving the way personnel support
their colleagues following traumatic events. Although this
focuses on traumatic/operational stressors, TRiM may well be
useful at improving team relationships outside of the conflict
zone, and has been shown to effectively improve cohesion and
attitudes towards mental health in others in other organisa-
tions such as the police and railway employees (Sage et al.,
2016; Whybrow et al., 2015). Studies focusing on workplace
discrimination and harassment suggest that strategies to
reduce bullying and promote an equal opportunities climate
would be beneficial in terms of the wellbeing of employees.
Role clarity should also be considered as a possible target
for intervention as this impacted on wellbeing (Bridger et al.,
2007). Whilst it may not be practical to actually modify work
roles, it may be useful to provide personnel with information
focusing on role clarity such as ‘‘refresher’’ skills training
courses, and include providing role clarity as part of
leadership/management training. Role clarification interven-
tions have been used in the nursing sector with positive results
(Smith & Larew, 2013); these could be trialled in military
contexts to assess their impact. While it is appreciated that
organisations cannot necessarily reduce workloads, it may be
useful for personnel in particularly high-pressured roles to be
provided with ‘‘workload management’’ training focusing on
prioritising work, knowing when to delegate, and coping
strategies to mitigate the effects of a heavy workload.
Enabling employees to be involved in decision-making
processes, where possible, would also be helpful in terms of
giving them a sense of autonomy which appeared to be
associated with greater wellbeing. Weston (2010) outlines
strategies for enhancing autonomy in the nursing sector, such
as encouraging nurses to incorporate their knowledge and
expertise into clinical practice, encouraging continuous
reflection on the degree of autonomy involved in their
tasks, and coaching nurses in decision-making. Interventions
have provided mixed results in terms of actually enhancing
DOI: 10.1080/09638237.2016.1276536 Non-deployment predictors of wellbeing 7
autonomy (Schalk et al., 2010); further research is needed to
establish successful ways of improving autonomy. We do note
that as an authoritarian organisation, the ability of the military
to allow junior staff to be fully involved with decision making
may be limited.
Organisations may be regarded as having some duty of
care to the families of personnel; the review showed that
family concerns impact upon personnel’s wellbeing (Odle-
Dusseau et al., 2013). It might be possible to reduce work–
home interference by family-friendly working, e.g. flexible
working, where possible outside of deployment periods. For
example, it may be helpful to consider how personnel can
book annual leave when they want rather than as directed.
Leisure-time physical activity may mitigate the effects of
stress (Martins & Lopes, 2013). Agility and physical readi-
ness are obviously fundamental aspects of being in the
military or comparable occupations; nevertheless, our review
suggests that for some personnel additional physical fitness
training could be useful, especially if incorporated into their
everyday lives. Since unit cohesion and good relationships
with colleagues appeared to be protective while poor relations
with co-workers increased stress, we suggest it is important to
ensure that cutbacks in expenditure do not remove opportu-
nities for service sports teams and friendly matches or group
exercise routines. We further suggest that since military and
civilian personnel work together on joint projects within the
Ministry of Defence, there should be scope for whole teams,
not just uniformed teams, to recreate together to foster
cohesion.
These implications are particularly pertinent for those in
supervisory roles, who are in a position to improve many of
the aspects contributing to stress. These individuals should
actively build and maintain good relationships with subor-
dinates and use team-building activities to improve unit
cohesion; they can improve engagement by providing
encouragement and ensuring that their employees feel
pride in their work; and they can reward their personnel –
even if only in terms of positive feedback – to reduce any
imbalance between effort and reward and to ensure that
employees feel valued. Regular work-focused appraisals and
provision of feedback (formally and/or informally) with
employees may also improve role clarity. During these
discussions leaders should also enquire whether employees
have the necessary resources for the job; they could ask
personnel whether they felt supported by other unit members
and also about support networks outside of work to identify
those with poor support who might therefore benefit from
extra colleague support.
It is perhaps reassuring to note that many of the suggested
interventions are similar to those that the British military has
been using to develop and support operational capability for
many years. However, we suggest that there may be a need for
alteration of training styles and processes for use in support of
reducing the impact of non-deployment stressors.
Strengths
The main strengths of the review are the extensive list of
search terms, the searches of multiple databases, the rigorous
screening and data extraction processes and the use of a
quality appraisal tool allowing us to assess the quality of each
individual paper which was included.
A further strength was that we found our results fit well
with other existing models. For example, we found support for
the HSE’s (2007) six primary sources of work stress:
demands, control, support, negative workplace relationships
and role were all identified as key factors influencing the
wellbeing of military personnel. While the final source of
stress proposed by the HSE, change and whether employees
feel involved in organisational changes, was not discussed
explicitly in the literature, it could be argued that our findings
relating to autonomy and control are related to this. Future
research may consider exploring the relationship between
wellbeing and aspects of change in military personnel.
The review also provided support for several existing
models regarding stress at work: for example, the effort-
reward imbalance model (Siegrist, 1996) which suggests that
a lack of reciprocity between rewards (e.g. money, esteem,
career opportunities, positive feedback, feeling valued) and
effort at work can lead to negative emotions. A small amount
of the reviewed literature indicated that a lack of reciprocity
between rewards and effort appeared to lead to stress.
Findings also lent support to Karasek’s (1979) job decision
latitude model, which proposes that employees experience
adverse health consequences if their work makes high
demands while allowing little personal control, and the job
demands–control–support model (Johnson & Hall, 1988),
with a lack of reciprocity between demands and control also
being an important stressor.
Limitations
Studies came mainly from North America or Europe, perhaps
due to the choice to limit the search to English-language
papers; future reviews might consider translating foreign-
language papers. However, we did not limit the review to
certain countries and did include several papers from Asia and
Australia. It is important to note that there are fundamental
differences between military organisations of different
nations, and different political systems and circumstances in
different countries could impact on results. However, this
review highlights that in spite of the major differences,
personnel across the world appear to be affected by similar
non-deployment stressors in similar ways. Secondly, most
papers included were cross-sectional. More prospective and
longitudinal studies are needed to clarify the direction of
associations. Thirdly, as this review was exploratory in nature,
we have not explored the findings further than identifying
stressors; that is, we have not examined the interrelatedness of
the themes and how certain stressors may influence the
impact of other stressors. Future research could consider
building on existing models to tie together the various themes
found in this review. Fourth, we acknowledge that the review
would have benefited from having multiple reviewers assess
papers for inclusion: where there was uncertainty about
including papers, these were discussed with the second
author, but the majority of screening was performed by one
reviewer and so there is a possibility for bias. Fifth, though
our decision to limit the review to quantitative studies meant
that all findings presented here had been subject to statistical
8 S. K. Brooks & N. Greenberg J Ment Health, Early Online: 1–11
analysis and thus are more easily comparable, it may be useful
for future reviews to include qualitative studies. This may
support the findings presented here or identify additional
stressors. Finally, the meaning of concepts such as ‘‘stress’’
and ‘‘strain’’ were likely to vary between studies; this review
has used the terms as they were used in the individual articles.
Despite these limitations, this study remains a comprehensive
review of non-deployment stressors in the military.
Conclusions
While certain work-related aspects which may cause stress
cannot easily be changed (e.g. workload), the Armed Forces
can work with employees to ensure that they are supported,
their worries are listened to and they are taught mechanisms
to cope with their anxieties. Stressors such as lack of support
from leaders, poor cohesion and social conflict with col-
leagues, harassment at work and job-related issues such as
role conflict and work overload present a significant occupa-
tional health hazard in the routine military work environment.
In order to protect the wellbeing of personnel, the military
should aim to prioritise strengthening relationships between
employees and their supervisors/co-workers, and continue to
eliminate sources of job stress such as discrimination and
harassment in the workplace.
Declaration of interest
Financial support was received from the Headquarters Land
Forces (HQLF). NG runs a psychological health consultancy
which provides TRiM training amongst other services.
References
Allen ES, Rhoades GK, Stanley SM, Markman HJ. (2011). On the homefront: Stress for recently deployed army couples. Family Process, 50,235–47.
Bass BM, Avolio BJ, Jung DI, Berson Y. (2003). Predicting unitperformance by assessing transformational and transactional leader-ship. J Appl Psychol, 88, 207–18.
Behnke AO, MacDermid SM, Anderson JC, Weiss HM. (2010). Ethnicvariations in the connection between work-induced family separationand turnover intent. J Family Issues, 31, 626–55.
Brasher KS, Dew ABC, Kilminster SG, Bridger RS. (2010).Occupational stress in submariners: The impact of isolated andconfined work on psychological well-being. Ergonomics, 53, 305–13.
Brasher KS, Sparshott KF, Weir ABC, et al. (2012). Two year follow-upstudy of stressors and occupational stress in submariners. Occup Med(Lond), 62, 563–5.
Bray RM, Pemberton MR, Lane ME, et al. (2010). Substance use andmental health trends among US military active duty personnel: Keyfindings from the 2008 DoD Health Behavior Survey. Military Med,175, 390–9.
Bridger R, Dew A, Brasher K, et al. (2009). Chronic and acutepsychological strain in Naval personnel. Occup Med (Lond), 59,454–8.
Bridger R, Kilminster S, Slaven G. (2007). Occupational stress and strainin the Naval Service: 1999 and 2004. Occup Med (Lond)), 57, 92–7.
Bridger RS, Brasher K, Dew A, Kilminster S. (2011). Job stressors innaval personnel serving on ships and in personnel serving ashore overa twelve month period. Appl Ergonomics, 42, 710–18.
Britt TW, Stetz MC, Bliese PD. (2004). Work-relevant values strengthenthe stressor-strain relation in elite army units. Military Psychol, 16,1–17.
Bryan CJ, McNaughton-Cassill M, Osman A. (2013). Age andbelongingness moderate the effects of combat exposure on suicidalideation among active duty Air Force personnel. J Affect Disord, 150,1226–9.
Bryson A, Forth J, Stokes L. (2014). Does worker wellbeing affectworkplace performance? Department for Business Innovation andSkills. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/366637/bis-14-1120-does-worker-wellbeing-affect-workplace-performance-final.pdf.
Campbell DJ, Nobel OB-Y. (2009). Occupational stressors in militaryservice: A review and framework. Military Psychol, 21(Suppl 2),S47–67.
Carter-Visscher R, Polusny MA, Murdoch M, et al. (2010).Predeployment gender differences in stressors and mental healthamong US National Guard troops poised for Operation Iraqi FreedomDeployment. J Trauma Stress, 23, 78–85.
Charbonneau D, MacIntyre A. (2011). A tool for senior professionaldevelopment in the Canadian Forces. Available from: http://www.iamps.org/IAMPS_2011_Paper_Charbonneau_MacIntyre.pdf.
Davidovitz R, Mikulincer M, Shaver PR, et al. (2007). Leaders asattachment figures: Leaders’ attachment Orientations predict leader-ship-related mental representations and followers’ performance andmental health. J Personal Soc Psychol, 93, 632–50.
Demerouti E, Geurts S, Bakker AB, Euwema M. (2004). The impact ofshiftwork on work-home conflict, job attitudes and health.Ergonomics, 47, 987–1002.
Dolan CA, Adler AB, Thomas JL, Castro CA. (2005). Operations tempoand soldier health: The moderating effect of wellness behavior.Military Psychol, 17, 157–74.
Drew G. (2009). A ‘‘360’’ degree view for individual leadershipdevelopment. J Manage Develop, 28, 581–92.
Drummond M, Jefferson T. (1996). Guidelines for authors and peerreviewers of economic submissions to the BMJ. The BMJ EconomicEvaluation Working Party. BMJ, 313, 275–83.
Dupre KE, Day AL. (2007). The effects of supportive management andjob quality on the turnover intentions and health of military personnel.Hum Resource Manag, 46, 185–201.
Effective Public Health Practice Project (EPHPP). (2009). Qualityassessment tool for quantitative studies. Available from: http://www.ephpp.ca/tools.html.
Fear NT, Rubin GJ, Hatch S, et al. (2009). Job strain, rank, and mentalhealth in the UK Armed Forces. Int J Occup Environ Health, 15,291–8.
Franca EL, Silva NA, Lunardi RR, et al. (2011). Shift work is a source ofstress among Military Police in Amazon, Brazil. Neurosciences, 16,384–6. Available from https://www.researchgate.net/publication/51702978_Shift_work_is_a_source_of_stress_among_Military_Police_in_Amazon_Brazil.
Goedhard RG, Goedhard WJA. (2005). Work ability and perceived workstress. Int Congr Ser, 1280, 79–83.
Greenberg N, Langston V, Jones N. (2008). Trauma Risk Management(TRiM) in the UK Armed Forces. J Royal Army Med Corps, 154,124–7.
Harvey SB, Hatch SL, Jones M, et al. (2011). Coming home: Socialfunctioning and the mental health of UK Reservists on return fromdeployment to Iraq or Afghanistan. Ann Epidemiol, 21, 666–72.
Hatch SL, Harvey SB, Dandeker C, et al. (2013). Life in and after theArmed Forces: Social networks and mental health in the UK military.Sociol Health Illn, 35, 1045–64.
Health and Safety Executive (HSE). (2007). What is stress? Availablefrom: http://www.hse.gov.uk/stress/furtheradvice/whatisstress.htm.
Hopkins-Chadwick DL, Ryan-Wenger N. (2009). Stress in junior enlistedAir Force women with and without children. West J Nurs Res, 31,409–27.
Hourani L, Bender RH, Weimer B, et al. (2012). Longitudinal study ofresilience and mental health in marines leaving military service. JAffect Disord, 139, 154–65.
HSE. (2007). Managing the causes of work-related stress: A step-by-stepapproach using the Management Standards HSG218 (Second edition).Surrey: HSE Books.
Johnson JV, Hall EM. (1988). Job strain, work place social support andcardiovascular disease: A cross sectional study of a random sample ofthe Swedish working population. Am J Pub Health, 78, 1336–42.
Karasek RA. (1979). Job demands, job decision latitude, and mentalstrain: Implications for job design. Admin Sci Quart, 24, 285–308.
Karrasch AI. (2003). Antecedents and consequences of organizationalcommitment. Military Psychol, 15, 225–36.
Langhinrichsen-Rohling J, Snarr JD, Slep AM, United States Air ForceFamily Advocacy Program. (2011). Risk for suicidal ideation in the
DOI: 10.1080/09638237.2016.1276536 Non-deployment predictors of wellbeing 9
U.S. Air Force: An ecological perspective. J Consult Clin Psychol, 79,600–12.
Lemaire CM, Graham DP. (2011). Factors associated with suicidalideation in OEF/OIF veterans. J Affect Disord, 130, 231–8.
Martins LCX, Lopes CS. (2012). Military hierarchy, job stress andmental health in peacetime. Occup Med (Lond), 62, 182–7.
Martins LCX, Lopes CS. (2013). Rank, job stress, psychological distressand physical activity among military personnel. BMC Public Health,13, 716.
McDougall L, Drummond PD. (2010). Personal resources moderate therelationship between work stress and psychological strain of submari-ners. Military Psychol, 22, 385–98.
Meyer JP, Kam C, Goldenberg I, Bremner NL. (2013). Organizationalcommitment in the military: Application of a profile approach.Military Psychol, 25, 381–401.
Mitchell MM, Gallaway MS, Millikan A, Bell MR. (2011). Combatstressors predicting perceived stress among previously deployedsoldiers. Military Psychol, 23, 573–86.
Mitchell MM, Gallaway MS, Millikan AM, Bell M. (2012). Interactionof combat exposure and unit cohesion in predicting suicide-relatedideation among post-deployment soldiers. Suicide Life Threat Behav,42, 486–94.
Mohd Bokti NL, Abu Talib M. (2009). A preliminary study onoccupational stress and job satisfaction among male Navy personnelat a Naval base in Lumut, Malaysia. J Int Soc Res, 2, 299–307.Available from: http://www.sosyalarastirmalar.com/cilt2/sayi9pdf/mohdbokti_abutalib.pdf.
Mota NP, Medved M, Wang JL, et al. (2012). Stress and mental disordersin female military personnel: Comparisons between the sexes in amale dominated profession. J Psychiatric Res, 46, 159–67.
Murphy CM. (2012). Writing an effective review article. J Med Toxicol,8, 89–90.
Nelson C, Cyr KS, Corbett B, et al. (2011). Predictors of posttraumaticstress disorder, depression, and suicidal ideation among CanadianForces personnel in a National Canadian Military Health Survey.J Psychiatric Res, 45, 1483–8.
Nye CD, Brummel BJ, Drasgow F. (2010). Too good to be true?Understanding change in organizational outcomes. J Manage, 36,1555–77.
Odle-Dusseau HN, Herleman HA, Britt TW, et al. (2013). Family-supportive work environments and psychological strain: A longitu-dinal test of two theories. J Occup Health Psychol, 18, 27–36.
Pawar AA, Rathod J. (2007). Occupational stress in naval personnel.Med J Armed Forces India, 63, 154–6.
Pflanz SE, Ogle AD. (2006). Job stress, depression, work performance,and perceptions of supervisors in military personnel. Military Med,171, 861–5.
Redman T, Dietz G, Snape E, van der Borg W. (2011). Multipleconstituencies of trust: A study of the Oman military. Int J HumResource Manage, 22, 2384–402.
Rona RJ, Hooper R, Jones M, et al. (2009). The contribution ofprior psychological symptoms and combat exposure to post Iraqdeployment mental health in the UK military. J Trauma Stress, 22,11–19.
Sachau DA, Gertz J, Matsch M, et al. (2012). Work-life conflict andorganizational support in a military law enforcement agency. J PoliceCriminal Psychol, 27, 63–72.
Sage CAM, Brooks SK, Jones N, Greenberg N. (2016). Attitudes towardsmental health and help-seeking in railway workers. Occup Med(Lond), 66, 118–21.
Sanchez RP, Bray RM, Vincus AA, Bann CM. (2004). Predictors of jobsatisfaction among active duty and reserve/guard personnel in the USmilitary. Military Psychol, 16, 19–35.
Sani F, Herrera M, Wakefield JRH, et al. (2012). Comparing socialcontact and group identification as predictors of mental health. Br JSoc Psychol, 51, 781–90.
Schalk DMJ, et al. (2010). Interventions aimed at improvingthe nursing work environment: A systematic review. Implement Sci,5, 34.
Selic P, Petek D, Serec M, Makovec MR. (2012). Self-rated health andits relationship to health/life problems and coping strategies inmembers of the professional Slovenian Armed Forces. Coll Antropol,36, 1175–82.
Settles IH, Buchanan NT, Colar BK. (2012). The impact of race and rankon the sexual harassment of black and white men in the U.S. military.Psychol Men Masculin, 13, 256–63.
Siegrist J. (1996). Adverse health effects of high-effort/low-rewardconditions. J Occup Health Psychol, 1, 27–41.
Smith AC, Larew C. (2013). Strengthening role clarity in acute carenurse case managers: Application of the synergy model in staffdevelopment. Profession Case Manage, 18, 190–8.
Snilstveit B, Oliver S, Vojtkova M. (2012). Narrative approaches tosystematic review and synthesis of evidence for international devel-opment policy and practice. J Develop Effect, 4, 409–29.
Stocker D, Jacobshagen N, Semmer NK, Annen H. (2010). Appreciationat work in the Swiss Armed Forces. Swiss J Psychol, 69, 117–24.
Thomas JL, Adler AB, Castro CA. (2005). Measuring operationstempo and relating it to military performance. Military Psychol, 17,137–56.
Walsh BM, Matthews RA, Tuller MD, et al. (2010). A multilevel modelof the effects of Equal Opportunity Climate on job satisfaction in themilitary. J Occup Health Psychol, 15, 191–207.
Weston MJ. (2010). Strategies for enhancing autonomy and control overnursing practice. OJIN: Online J Iss Nurs, 15, 2.
Whybrow D, Jones N, Greenberg N. (2015). Promoting organizationalwell-being: A comprehensive review of Trauma Risk Management.Occup Med, 63, 549–55.
Wilcove GL, Schwerin MJ, Kline T. (2009). Quality of life in the USNavy: Impact on performance and career continuance. MilitaryPsychol, 21, 445–60.
Appendix I: Search strategy
Limits: full text, human, English language, 2003-13.Search 1; exp Military Personnel/or exp Military Psychology/or expMilitary Deployment/or exp Military Training/or military.mp.Armed force*.mpSpecial force*.mpSoldier*.mpService personnel.mp or exp service personnel/War.mp or combat experience/or combat/Troops.mpAir force*.mp or air force personnel/Army.mp or army personnel/Naval personnel.mp or naval personnel/Combine all with ORSearch 2; Non-operational stress*.mp or non operational stress.mpWorkplace stress*.mp or job stress/Work-place stress*.mpOccupat* stress*.mp or occupational stress/Burnout.mpJob strain*.mp or occupational strain*.mpWork* function*.mp or job performance/Occupational function*.mp
Team performance.mpOrganisational outcome*.mp or organizational outcome*.mpMental health.mp or mental health/Wellbeing.mp or well-being.mpAnxiety.mp or anxiety/Stress.mp not post-traumatic not posttraumatic not PTSDWork performance.mpCombine all with ORSearch 1 AND Search 2(Further search for other occupational populations not included in thispaper)Search 3; High risk work* or high risk job* or high risk occupation*Police.mp or police personnel/Aid agencies or aid agencyHumanitarian aidRelief workEmergency reliefRescue services or rescue workers/Firefighter*.mp or fire fighters/Law enforcement.mp or law enforcement/Emergency response
10 S. K. Brooks & N. Greenberg J Ment Health, Early Online: 1–11
Hazardous work* or hazardous occupation*Disaster recoveryConstruction work.mpCombine all with ORSearch 2 AND Search 3
Appendix II: Quality appraisal
Section 1: Study design
(1) The research question is clearly stated
(2) The sample size is described.
(3) The sampling method is described.
(4) The inclusion criteria are described.
Section 2: Data collection and methodology
(1) Standardised tools are used, or where measures are
designed for the study, attempts to ensure reliability and
validity have been made.
(2) Number of participants is described at each stage of the
study.
(3) Reasons for loss to follow-up are described.
(4) Data on non-participants is provided.
Section 3: Analysis and interpretation of results
(1) Details of statistical tests and confidence intervals where
appropriate are described.
(2) The answer to the study question is given.
(3) Conclusions follow from the data reported.
(4) Conclusions are accompanied by the appropriate caveats.
All questions answered with YES or NO with the exception of
‘‘Reasons for loss to follow-up are described’’ which was
answered with NA if the study took place at only one time-
point. In these cases, the percentage was calculated as a sum
of 11 responses rather than 12. All items were given equal
weight when determining the final score.
Appendix III: Flow diagram of search and screeningprocess
Records iden�fied through database searching
(n = 8290 )
Addi�onal records iden�fied through other sources
(n = 5 )
Records a�er duplicates removed (n = 6667 )
Titles screened (n = 6667 )
Records excluded (n = 5186 )
Full-text ar�cles excluded (n = 370 )
Abstracts screened (n = 1481 )
Records excluded (n = 1061 )
Full-text ar�cles assessed for eligibility
(n = 420 )
Studies included in qualita�ve synthesis
(n = 50 )
DOI: 10.1080/09638237.2016.1276536 Non-deployment predictors of wellbeing 11