Operational Stress in Detainee Operations at Joint Task Force Guantanamo Bay Cuba Scott Johnston, PhD, ABPP CDR MSC USN Stephanie Raducha, BA Gali Goldwaser,

Operational Stress in Detainee Operations at Joint Task Force

Guantanamo Bay Cuba

Scott Johnston, PhD, ABPPCDR MSC USN

Stephanie Raducha, BAGali Goldwaser, PhD

Elizabeth J. Abou, BA Douglas C. Johnson, PhD

Naval Center for Combat & Operational Stress Control

Introduction• NCCOSC collaboration• Combat tours vs. GTMO

deployment• Questions

– Stress / PTSD– Working outside of rate– Beliefs of mental health

Life as a Guard at GTMO• History

– Camp X-Ray

• Safe, humane, legal and transparent care• Spotlight of the world• Tropical paradise

Sample

• N = 498• Guards and medical

personnel• Mid-deployment• Self report surveys• August 2009 –

November 2009

GTMO Guard DemographicsSex

84%

16%

MaleFemale

Age

42.8%

29.5%

22.9%

4.8%

0 10 20 30 40 50

18-24

25-29

30-39

40 plus

Ag

e G

rou

p

Percent

Rank (Pay Grade)

65%

0%

27.7%

5.6%

1.6%

0% 20% 40% 60% 80%

E1-3

E4-6

E7-9

O1-3

O4-8

Ran

k

Percent

Military Branch

68%

32%

NavyArmy

Measures• PTSD Checklist – military (PCL-M)• Patient Health Questionnaire (PHQ-9)• Perceived Stress Scale (PSS)• Response to Stressful Experiences Scale (RSES)• Beliefs about Psychotherapy• Neurocognitive Survey – Alcohol Section• NEO-N

PTSD Symptoms for GTMO Population vs. Combat Population

*Operation Iraqi Freedom National Guard Soldiers with moderate combat exposure who served from 2005 to 2006. (Renshaw et al., 2009).

0

5

10

15

20

25

30

35

40

45

50

GTMO Guards OIF Soldiers*Servicemember Group

Mea

n P

CL

-M S

core

0

2

4

6

8

10

12

14

16

18

20

GTMO Guards Marines &Soldiers in OIF*

Before Deplomentto Iraq

Service Member Groups

Pe

rce

nt

Me

eti

ng

Cri

teri

a f

or

PT

SD

Hoge data

GTMO data

*Marines and Soldiers exposed to combat while deployed to Operation Iraqi Freedom, Hoge et al., 2004. Based on PCL-M symptoms endorsed.

GTMO PTSD Rates Compared to Combat Vets and Pre-Deployment Rates

0%

5%

10%

15%

20%

25%

GTMOGuards

Not deployed DeployedwithoutCombat

Deployed withCombat

Service Member Group

Pe

rce

nt

Me

eti

ng

De

pre

ss

ion

Cri

teri

a

GTMO Population

Millennium Cohort Population

*Millennium Cohort data from: Wells et al., 2010. Depression criteria based on PHQ-9 score of 10 or greater.

Depression in GTMO Guards vs. Other Service Members

Increased risk for Depression• Hypotheses

– Psychological vs. kinetic warfare– Constriction vs. small unit autonomy

Working outside of your rate

• Rate = job• 52% work outside

their regular job• Training as

resilience factor

*All reported results are statistically significant (p<.05). Depression – Patient Health Questionnaire (PHQ-9); PTSD - PTSD Checklist – Military (PCL-M); Alcohol - CAGE Alcohol – primary care alcohol screener; Self refer - based on question: If you believed you had a mental health problem, would you ask for professional help?

Working Within vs. Outside Rate

Within Rate

Outside Rate

0

5

10

15

20

25

30

35

Depression PTSD Alcohol Self Refer

Measure

Me

an

Sc

ore

Beliefs in Mental Health• Stigma

– 50% don’t seek care

• If you believed you had a mental health problem, would you ask for professional help?

• If you believed you had a trooper under your leadership that had a mental health problem, would you refer them for professional help?

66%

28%

1%

5%

Refer Self & Refer Trooper

Not Refer Self & Refer Trooper

Refer Self & Not Refer Trooper

Not Refer Self & Not Refer Trooper

* Based on questions: 1) If you believed you had a mental health problem, would you ask for professional help? 2) If you believed you had a trooper under your leadership that had a mental health problem, would you refer them for professional help?

Willingness to Refer to Mental Health Treatment

Willingness to Refer with or without PTSD

*Will Refer Self, Won’t Refer Trooper; Won’t Refer Self, Won’t Refer Trooper are not reported.

0

10

20

30

40

50

60

70

80

PTSD No PTSD

Pe

rce

nta

ge

(%

)

Refer Self & Refer Trooper

Not Refer Self & Refer Trooper

Willingness to Refer with and without Depression

Refer Self & Refer Trooper

Not Refer Self & Refer Trooper

0

10

20

30

40

50

60

70

80

90

Depression No Depression

Per

cen

tag

e (%

)

*Will Refer Self, Won’t Refer Trooper; Won’t Refer Self, Won’t Refer Trooper are not reported.

Conclusions• Detainee operations are stressful

– Higher risk for depression

• Protective quality of working outside rate• Stigma is present

– More likely to refer other then self– Those at risk are less likely to seek mental health

Questions

CDR Scott [email protected]