TROOP EDUCATION FOR ARMY MORALE (TEAM): A POST DEPLOYMENT EDUCATIONAL INTERVENTION
FOR MORTUARY AFFAIRS SOLDIERS
Quinn M. Biggs, Ph.D., M.P.H., Carol S. Fullerton, Ph.D., James E. McCarroll, Ph.D., M.P.H., Xian Liu, Ph.D., Leming Wang, M.S.,
Nicole Dacuyan, B.S., Douglas Zatzick, M.D., and Robert J. Ursano, M.D.
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD

BACKGROUNDNEW EDUCATIONAL INTERVENTIONTEAM (Troop Education for Army Morale): TEAM is a new education and skills
training intervention to help MA Soldiers and their spouses reduce distress and foster
adaptive coping in the months after deployment. TEAM integrates resources in thesocial context of home and unit to enhance the natural role of spouse and buddy
support. Spouses are offered an equivalent intervention.

RESULTS (CONT.)

Procedures: MA Soldiers at Fort Lee, Virginia were randomized to receive the TEAM

Linear Mixed Model of Longitudinal Trajectories of PCL-17 Score by Genderintervention or no intervention (comparison). Workshops were held at 2, 3, 4 & 7
months post deployment. Questionnaires were completed at 1, 2, 3, 4, 7 & 10 months
post deployment. Outcome measure was PTSD symptom severity.

principles of Psychological First Aid (PFA)1-3• Gender: 68% male, 32% female• Age: range 19 - 50 years (M = 28.1)• Education: 44.8% high school/GED; 55.2% some college/tech school or more
• Rank: 23.2% E-3 or lower; 56.8% E-4; 18.4% E-5 or higher; 1.6% O-3 or higher• Race: 57.6% White• Marital Status: 62.4% married; 46.4% live with spouse• PTSD Symptoms: PTSD Checklist (PCL-17): symptom total score (range 17 - 85).

403530was derived from a linear mixed model using the PCL score as the dependent
variable and time (baseline and five follow-ups), treatment (intervention vs.
comparison), and the time by treatment interaction as independent variables.
Covariates included the variable live with spouse and the interaction of treatment
and live with spouse. The SAS PROC MIXED procedure with spatial power option
was used to compute the fixed and random effects and derive the predicted PCL
scores at each time point.5

CalmingRESULTS1234710• Intervention group males had significantly higher PCL scores (up to 11 pointdifference) than comparison group males at month 2 (p = <.05) and month 3 (p =<.01).

• There were no significant differences in PCL scores between intervention groupfemales and comparison group females.
Limitations: self-selection for study enrollment and intervention attendance, self-report,
conducting the intervention during work hours, and participation that is dependent
upon Command and job duties.

SUMMARY AND IMPACT

Linear Mixed Model of Longitudinal Trajectories of PCL-17 Score

Cognitive-Behavioral Therapy:

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Time (months post deployment)• Linear Mixed Modeling: The longitudinal effect of treatment on PCL-17 scores

Psychological First Aid:

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Delivery of Intervention:• Referral resources• Educational handouts• Support through spouse and buddy

Goals: The training of Soldiers to:• Develop self-care skills and increase adaptive coping in response to stress• Identify when an individual is in need of care
• Provide early support to foster rapid recovery• Improve communication skills• Build supportive relationships• Promote health care seeking when needed• Overcome barriers to health care utilization• Address health risk behaviors (e.g., alcohol use)

Intervention

 There was no overall effect of the TEAM intervention on PTSD symptoms.

Comparison

 PTSD symptoms increased after baseline in intervention group males andsimultaneously decreased in comparison group males. While PTSD symptoms offemales in the intervention and comparison group tracked closely with one another.

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Estimated PCL Score

CBT is an approach to altering
SelfConnecting
Efficacy
thoughts and beliefs that lead tonegative emotions. It has been shownto treat and prevent PTSD when administered early after trauma exposure.
However, TEAM is education-based and NOT therapy or mental health treatment.

• Interactive group workshops• Toll-free phone line and email service• Website (resources, training materials)

Male Comparison

Measures:

SafetyHope &Optimism

Female Comparison
Male Intervention

Participants: N = 126 MA Soldiers (intervention n = 68; comparison n = 58)

and Cognitive Behavioral Therapy (CBT)4.

PFA is designed to reduce thedistress caused by traumaticevents and to foster short- andlong-term adaptive functioningand coping through the principles
of Safety, Calming, Connecting,Self-Efficacy, and Hope/Optimism.

Female Intervention
45Analyses: N = 125 (intervention n = 67; comparison n = 58)
Basis of the Intervention: TEAM training is based on the evidence-informed

50

Estimated PCL Score

U.S. Army Mortuary Affairs Soldiers (MA) recover,identify, and evacuate the remains of deceased
military personnel and their personal effects fromthe Middle East. Exposure to death and thecombat environment increases the risk of
posttraumatic distress and adjustment difficulties.

METHODS40

 At months 2 and 3, intervention content focuses on recognizing PTSD symptoms,
the importance of communication, and seeking help if needed. Increased
awareness of symptoms might be represented in an increase in symptom reporting.

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 Intervention efficacy may have been influenced by intervention intensity, numberand spacing of workshops, conducting workshops during work hours, delivery earlyin the post-deployment period, and voluntary attendance.

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2

3

4

7

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Time (months post deployment)• Intervention and comparison groups did not significantly differ in PCL score acrossthe six time points.

• Contrary to expectation, intervention group scores trend higher than comparisongroup scores in the first months of the intervention.

• At month 3, estimated PCL scores of the intervention group were significantly
higher than the comparison group (p = .04).

 These findings provide valuable avenues for redesign of intervention methods for
future intervention programs that seek to address the needs of MA personnel andother high-risk groups.
 Further analyses will determine TEAM’s effect on other measures of health andwell-being.
References:
1 Benedek DM & Fullerton CS (2007). Translating five essential elements into programs and practice. Psychiatry, 70, 345-349.
2 Hobfoll SE et al. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry, 70, 283-315.
3 National Child Traumatic Stress Network, Psychological First Aid: Field Operations Guide, 2nd Ed. 2006. Available: www.nctsn.org.
4 Bryant RA (2005). Psychosocial approaches to acute stress reactions. CNS Spectrums, 10, 116-122.
5 Littell RC et al. Analysis of Repeated Measures Data. In: SAS for Mixed Models 2nd Edition, pp. 198-203. Cary, NC: SAS Institute Inc., 2006.
Funded by U.S. Army Medical Research & Materiel Command, Congressionally Directed Medical Research Program Award W81XWH-08-2-0180
The views expressed in this presentation are those of the author(s) and do not reflect the official policy of the Department of Army, Navy,or Air Force; Department of Defense; or U.S. Government.