Journal of Mental Health
ISSN: 0963-8237 (Print) 1360-0567 (Online) Journal homepage: http://www.tandfonline.com/loi/ijmh20
Non-deployment factors affecting psychological
wellbeing in military personnel: literature review
Samantha K. Brooks & Neil Greenberg
To cite this article: Samantha K. Brooks & Neil Greenberg (2017): Non-deployment factors
affecting psychological wellbeing in military personnel: literature review, Journal of Mental
Health, DOI: 10.1080/09638237.2016.1276536
To link to this article: http://dx.doi.org/10.1080/09638237.2016.1276536
Published online: 28 Jan 2017.
Submit your article to this journal
Article views: 2
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at
http://www.tandfonline.com/action/journalInformation?journalCode=ijmh20
Download by: [King's College London]
Date: 01 February 2017, At: 15:38
http://tandfonline.com/ijmh
ISSN: 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 military
personnel: 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
Keywords
Background: Most military mental health research focuses on the impact of deployment-related
stress; less is known about how everyday work-related factors affect wellbeing.
Aims: This systematic narrative literature review aimed to identify non-deployment-related
factors contributing to the wellbeing of military personnel.
Method: Electronic literature databases were searched and the findings of relevant studies were
used to explore non-deployment-related risk and resilience factors.
Results: Fifty publications met the inclusion criteria. Determinants of non-deployment stress
were identified as: relationships with others (including leadership/supervisory support; social
support/cohesion; harassment/discrimination) and role-related stressors (role conflict; commitment and effort-reward imbalance; work overload/job demands; family-related issues/work-life
balance; and other factors including control/autonomy, physical work environment and
financial strain). Factors positively impacting wellbeing (such as exercise) were also identified.
Conclusions: The literature suggests that non-deployment stressors present a significant
occupational health hazard in routine military environments and interpersonal relationships at
work are of fundamental importance. Findings suggest that in order to protect the wellbeing of
personnel and improve performance, military organisations should prioritise strengthening
relationships between employees and their supervisors/colleagues. Recommendations for
addressing these stressors in British military personnel were developed.
Military, leadership, management,
organisational culture, social support
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
Correspondence: Samantha K. Brooks, King’s College London, King’s
Centre for Military Health Research, Weston Education Centre,
Cutcombe Road, London SE5 9RJ, UK. Tel: 020 7848 0267. E-mail:
[email protected]
History
Received 13 June 2016
Revised 23 August 2016
Accepted 16 October 2016
Published online 25 January 2017
2014/15, there is a need to identify factors of stress beyond
those associated with being in a combat zone. Though nondeployment 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 nondeployment 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 colleagues), 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
2
S. K. Brooks & N. Greenberg
(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-deployment stressors to make suggestions for how stress can be
reduced in routine military environments.
Method
Type of review
This systematic narrative review involved systematic searching 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 hypothesis). 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 outcomes, or report whether there were inconsistencies in
the literature if some studies reported significant associations 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 components: military terms (e.g. Army, Navy), other high-risk
occupation terms (e.g. police, fire fighter) and wellbeingrelated 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;
J Ment Health, Early Online: 1–11
Cochrane; EMBASE; Health Management Information
Consortium; MEDLINE; PsycINFO; Science Direct; and
Web of Science. Resulting citations were downloaded to
EndNoteß 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 methodology; 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 assessment 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 definition 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-changeably, 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
Non-deployment predictors of wellbeing
DOI: 10.1080/09638237.2016.1276536
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.
3
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
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 psychological 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 subordinates’ poor instrumental functioning, socio-emotional functioning and mental health in the Israeli military (Davidovitz
et al., 2007).
Sexual harassment was associated with higher risk of turnover
in the US military personnel (Nye et al., 2010) and lower coworker 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 psychological distress in Australian Navy personnel (McDougall &
Drummond, 2010).
Social support and cohesion
Commitment, over-commitment and effort-reward imbalance
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 (LanghinrichsenRohling et al., 2011). Hatch et al. (2013), comparing UK
service personnel and those who left the service, found
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 personnel 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).
Cross-sectional
Longitudinal
Cross-sectional
Archival
Cross-sectional
UK
UK
US
UK
UK
UK
US
US
US
Israel
Nether-lands
US
Canada
UK
Brazil
Nether-lands
UK
UK
US
US
US
US
US
Brasher et al., 2010
Brasher et al., 2012
Bray et al., 2010
Bridger et al., 2007
Bridger et al., 2009
Bridger et al., 2011
Britt et al, 2004
Bryan et al., 2013
Carter-Visscher et al., 2010
Davidovitz et al., 2007
Demerouti et al., 2004
Dolan et al., 2005
Dupre & Day, 2007
Fear et al., 2009
França et al., 2011
Goedhard & Goedhard, 2005
Harvey et al., 2011
Hatch et al., 2013
Hopkins-Chadwick &
Ryan-Wenger, 2009
Hourani et al., 2012
Karrasch, 2003
Langhinrichsen-Rohling
et al., 2011
Lemaire & Graham, 2011
1740
475
1412
52 780
6511 serving personnel vs. 1753
service leaders
50
237
126
4991
7766
84 in study 1; 549 in
study 2; 541 in
study 3
3122
1422
450
2596 at T1; 1305 at
T2
1208
273
522
1707 in study 1;
1749 in study 2
1207 at T1; 1305 at
T2
105 submariners vs.
105 Royal Navy
control group
144 submariners vs.
144 Royal Navy
control group
28 546
1594
33 189
300 couples
Participants (n)
Mixed – not reported
Marines
Army
Air Forces
Air Forces
Army, Royal Navy, Royal Air
Force
Military police
Army
Army, Royal Air Force, naval
services
Army, Royal Navy, Royal
Marines, Royal Air Force
Military police
Army
‘‘Military personnel’’
All Israeli Defense Forces
Army Rangers
Air Forces
Army
Royal Navy
Royal Navy
Army, Navy, Air Force, Marine
Corps, Coast Guard
Royal Navy
Submariners, Royal Navy
Army
Army, Navy, Air Force,
Marines, Coast Guard
Submariners, Royal Navy
Army
Service
Social support and cohesion
Harassment and discrimination
Social support and cohesion; Work (over)load
and job demands; Other role-related factors
Social support and cohesion
Work (over)load and job demands
Social support and cohesion
Work (over)load and job demands
Work (over)load and job demands
Social support and cohesion
Work (over)load and job demands
Positive impact on wellbeing
Leadership and supervisory support; Social
support and cohesion; Role conflict; Family
issues/work-life balance
Other role-related factors
Leadership and supervisory support; Social
support and cohesion; Role conflict
Leadership and supervisory support;
Commitment, over-commitment and effortreward imbalance; Work (over)load and job
demands; Family issues/work-life balance
Commitment, over-commitment and effortreward imbalance; Other role-related factors
Positive impact on wellbeing
Social support and cohesion
Social support and cohesion; Family issues/
work-life balance
Leadership and supervisory support
Family issues/work-life balance
Leadership and supervisory support; Social
support and cohesion; Commitment, overcommitment and effort-reward imbalance
Commitment, over-commitment and effortreward imbalance
Family issues/work-life balance; Other rolerelated factors
Leadership and supervisory support
Family issues/work-life balance
Themes included
S. K. Brooks & N. Greenberg
Cross-sectional
Prospective observational
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
3 cross-sectional studies
Cross-sectional
Cross-sectional
Cross-sectional
Prospective longitudinal
Longitudinal
2 cross-sectional studies
Cross-sectional
Longitudinal (2-year follow-up
of Brasher et al., 2010)
Cross-sectional (first phase
of a cohort study)
Cross-sectional – experimental
Cross-sectional
US
US
Bass et al., 2003
Behnke et al., 2010
Cross-sectional
Design
US
Country
Allen et al., 2011
Reference
Table 1. Summary of included literature.
4
J Ment Health, Early Online: 1–11
Cross-sectional
Cross-sectional
Australia
Canada
US
US
Malaysia
Canada
Canada
US
US
India
US
Oman
UK
US
US
Eastern Europe
Slovenia
US
Switzerland
US
US
US
McDougall & Drummond,
2010
Meyer et al., 2013
Mitchell et al., 2011
Mitchell et al., 2012
Mohd Bokti & Abu Talib, 2009
Mota et al., 2012
Nelson et al., 2011
Nye et al., 2010
Odle-Dusseau et al., 2013
Pawar & Rathod, 2007
Pflanz & Ogle, 2006
Redman et al., 2011
Rona et al., 2009
Sachau et al., 2012
Sanchez et al., 2004
Sani et al., 2012
Selic et al., 2012
Settles et al., 2012
Stocker et al., 2010
Thomas et al., 2005
Walsh et al., 2010
Wilcove et al., 2009
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Part of a longitudinal study
Cross-sectional
Longitudinal
Cross-sectional
Cross-sectional
2 cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Brazil
Martins & Lopes, 2013
Cross-sectional
Brazil
Martins & Lopes, 2012
695
1394
16 833
150
390
1925
228
1203
24 881
1885
235
28 296 in study 1;
19 960 in study 2
478
5077
809
5155 Regulars vs.
3286 Reservists
8441
1592
1663
40
6501
75
506
506
Army
Army
Navy
Royal Navy, Royal Marines,
Army, Royal Air Force
Air Force law enforcement
Air Force, Army, Marine
Corps, Navy
Army
Army
Mixed – not reported
Armed Forces Career Officers
Air Force
Department of Defence and
Coast Guard
Army
Navy
Air Force
Mixed – land, air, sea/communi-cations
Mixed – not reported
Army
Army
Navy
Mixed – not reported
Navy
Army
Army
Positive impact on wellbeing
Social support and cohesion
Harassment and discrimination
Commitment, over-commitment and effortreward imbalance
Work (over)load and job demands
Social support and cohesion
Other role-related factors
Family issues/work-life balance
Work (over)load and job demands
Family issues/work-life balance
Role conflict
Leadership and supervisory support; Social
support and cohesion; Work (over)load and
job demands; Family issues/work-life balance
Leadership and supervisory support; Positive
impact on wellbeing
Social support and cohesion
Social support and cohesion; Social support and
cohesion
Harassment and discrimination
Commitment, over-commitment and effortreward imbalance
Commitment, over-commitment and effortreward imbalance; Positive impact on
wellbeing
Role conflict; Work (over)load and job demands;
Positive impact on wellbeing
Commitment, over-commitment and effortreward imbalance
Social support and cohesion
Social support and cohesion
Leadership and supervisory support; Work
(over)load and job demands
Social support and cohesion
DOI: 10.1080/09638237.2016.1276536
Non-deployment predictors of wellbeing
5
6
S. K. Brooks & N. Greenberg
J Ment Health, Early Online: 1–11
Table 2. Overview: factors affecting wellbeing.
Category
Relationships with others: Leadership and Supervisory Support
Relationships with others: Social Support and Cohesion
Relationships with others: Harassment and Discrimination
Role-related Stressors: Role Conflict
Role-related Stressors: Commitment, Over-commitment and EffortReward Imbalance
Role-related Stressors: Work (Over)load and Job Demands
Role-related Stressors: Family Issues/Work-Life Balance
Role-related Stressors: Other Role-related Factors
Positive Impact on Wellbeing
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 (França
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
Examples
Support, feedback, leadership style
Sense of belonging/camaraderie at work, relationships with colleagues/
family/friends
Sexual harassment, perceived tokenism
Role clarity, role conflict
Over-commitment, effort-reward imbalance, feeling valued
Demands, resources, control, workload, long hours, shift work
Separation, concerns about family, demands at work/home
Control/autonomy, ability to participate in decision-making; physical work
environment; financial strain
Fitness, exercise, role identification, trust in the organisation
intentions (Behnke et al., 2010) and psychological symptoms
(Carter-Visscher et al., 2010). Poor work-life balance significantly 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 environment; 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
DOI: 10.1080/09638237.2016.1276536
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 nondeployment stressors in military personnel. Military organisations 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 supervisors 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 twiceyearly 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
Non-deployment predictors of wellbeing
7
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 organisations 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 exception 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 organisations 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 interventions 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
8
S. K. Brooks & N. Greenberg
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 (OdleDusseau 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 readiness 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 opportunities 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 subordinates 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
J Ment Health, Early Online: 1–11
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 effortreward 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 foreignlanguage 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
DOI: 10.1080/09638237.2016.1276536
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 colleagues, harassment at work and job-related issues such as
role conflict and work overload present a significant occupational 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 home
front: Stress for recently deployed army couples. Family Process, 50,
235–47.
Bass BM, Avolio BJ, Jung DI, Berson Y. (2003). Predicting unit
performance by assessing transformational and transactional leadership. J Appl Psychol, 88, 207–18.
Behnke AO, MacDermid SM, Anderson JC, Weiss HM. (2010). Ethnic
variations in the connection between work-induced family separation
and 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 and
confined work on psychological well-being. Ergonomics, 53, 305–13.
Brasher KS, Sparshott KF, Weir ABC, et al. (2012). Two year follow-up
study of stressors and occupational stress in submariners. Occup Med
(Lond), 62, 563–5.
Bray RM, Pemberton MR, Lane ME, et al. (2010). Substance use and
mental health trends among US military active duty personnel: Key
findings from the 2008 DoD Health Behavior Survey. Military Med,
175, 390–9.
Bridger R, Dew A, Brasher K, et al. (2009). Chronic and acute
psychological strain in Naval personnel. Occup Med (Lond), 59,
454–8.
Bridger R, Kilminster S, Slaven G. (2007). Occupational stress and strain
in the Naval Service: 1999 and 2004. Occup Med (Lond)), 57, 92–7.
Bridger RS, Brasher K, Dew A, Kilminster S. (2011). Job stressors in
naval personnel serving on ships and in personnel serving ashore over
a twelve month period. Appl Ergonomics, 42, 710–18.
Britt TW, Stetz MC, Bliese PD. (2004). Work-relevant values strengthen
the stressor-strain relation in elite army units. Military Psychol, 16,
1–17.
Bryan CJ, McNaughton-Cassill M, Osman A. (2013). Age and
belongingness moderate the effects of combat exposure on suicidal
ideation among active duty Air Force personnel. J Affect Disord, 150,
1226–9.
Non-deployment predictors of wellbeing
9
Bryson A, Forth J, Stokes L. (2014). Does worker wellbeing affect
workplace performance? Department for Business Innovation and
Skills. Available from: https://www.gov.uk/government/uploads/
system/uploads/attachment_data/file/366637/bis-14-1120-does-workerwellbeing-affect-workplace-performance-final.pdf.
Campbell DJ, Nobel OB-Y. (2009). Occupational stressors in military
service: 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 health
among US National Guard troops poised for Operation Iraqi Freedom
Deployment. J Trauma Stress, 23, 78–85.
Charbonneau D, MacIntyre A. (2011). A tool for senior professional
development 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 as
attachment figures: Leaders’ attachment Orientations predict leadership-related mental representations and followers’ performance and
mental health. J Personal Soc Psychol, 93, 632–50.
Demerouti E, Geurts S, Bakker AB, Euwema M. (2004). The impact of
shiftwork on work-home conflict, job attitudes and health.
Ergonomics, 47, 987–1002.
Dolan CA, Adler AB, Thomas JL, Castro CA. (2005). Operations tempo
and soldier health: The moderating effect of wellness behavior.
Military Psychol, 17, 157–74.
Drew G. (2009). A ‘‘360’’ degree view for individual leadership
development. J Manage Develop, 28, 581–92.
Drummond M, Jefferson T. (1996). Guidelines for authors and peer
reviewers of economic submissions to the BMJ. The BMJ Economic
Evaluation Working Party. BMJ, 313, 275–83.
Dupre KE, Day AL. (2007). The effects of supportive management and
job quality on the turnover intentions and health of military personnel.
Hum Resource Manag, 46, 185–201.
Effective Public Health Practice Project (EPHPP). (2009). Quality
assessment 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 mental
health in the UK Armed Forces. Int J Occup Environ Health, 15,
291–8.
França EL, Silva NA, Lunardi RR, et al. (2011). Shift work is a source of
stress 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 work
stress. 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: Social
functioning and the mental health of UK Reservists on return from
deployment to Iraq or Afghanistan. Ann Epidemiol, 21, 666–72.
Hatch SL, Harvey SB, Dandeker C, et al. (2013). Life in and after the
Armed 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? Available
from: http://www.hse.gov.uk/stress/furtheradvice/whatisstress.htm.
Hopkins-Chadwick DL, Ryan-Wenger N. (2009). Stress in junior enlisted
Air Force women with and without children. West J Nurs Res, 31,
409–27.
Hourani L, Bender RH, Weimer B, et al. (2012). Longitudinal study of
resilience and mental health in marines leaving military service. J
Affect Disord, 139, 154–65.
HSE. (2007). Managing the causes of work-related stress: A step-by-step
approach using the Management Standards HSG218 (Second edition).
Surrey: HSE Books.
Johnson JV, Hall EM. (1988). Job strain, work place social support and
cardiovascular disease: A cross sectional study of a random sample of
the Swedish working population. Am J Pub Health, 78, 1336–42.
Karasek RA. (1979). Job demands, job decision latitude, and mental
strain: Implications for job design. Admin Sci Quart, 24, 285–308.
Karrasch AI. (2003). Antecedents and consequences of organizational
commitment. Military Psychol, 15, 225–36.
Langhinrichsen-Rohling J, Snarr JD, Slep AM, United States Air Force
Family Advocacy Program. (2011). Risk for suicidal ideation in the
10
S. K. Brooks & N. Greenberg
U.S. Air Force: An ecological perspective. J Consult Clin Psychol, 79,
600–12.
Lemaire CM, Graham DP. (2011). Factors associated with suicidal
ideation in OEF/OIF veterans. J Affect Disord, 130, 231–8.
Martins LCX, Lopes CS. (2012). Military hierarchy, job stress and
mental health in peacetime. Occup Med (Lond), 62, 182–7.
Martins LCX, Lopes CS. (2013). Rank, job stress, psychological distress
and physical activity among military personnel. BMC Public Health,
13, 716.
McDougall L, Drummond PD. (2010). Personal resources moderate the
relationship between work stress and psychological strain of submariners. Military Psychol, 22, 385–98.
Meyer JP, Kam C, Goldenberg I, Bremner NL. (2013). Organizational
commitment in the military: Application of a profile approach.
Military Psychol, 25, 381–401.
Mitchell MM, Gallaway MS, Millikan A, Bell MR. (2011). Combat
stressors predicting perceived stress among previously deployed
soldiers. Military Psychol, 23, 573–86.
Mitchell MM, Gallaway MS, Millikan AM, Bell M. (2012). Interaction
of combat exposure and unit cohesion in predicting suicide-related
ideation among post-deployment soldiers. Suicide Life Threat Behav,
42, 486–94.
Mohd Bokti NL, Abu Talib M. (2009). A preliminary study on
occupational stress and job satisfaction among male Navy personnel
at 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 disorders
in female military personnel: Comparisons between the sexes in a
male 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 posttraumatic
stress disorder, depression, and suicidal ideation among Canadian
Forces 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). Familysupportive work environments and psychological strain: A longitudinal 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). Multiple
constituencies of trust: A study of the Oman military. Int J Hum
Resource Manage, 22, 2384–402.
J Ment Health, Early Online: 1–11
Rona RJ, Hooper R, Jones M, et al. (2009). The contribution of
prior psychological symptoms and combat exposure to post Iraq
deployment mental health in the UK military. J Trauma Stress, 22,
11–19.
Sachau DA, Gertz J, Matsch M, et al. (2012). Work-life conflict and
organizational support in a military law enforcement agency. J Police
Criminal Psychol, 27, 63–72.
Sage CAM, Brooks SK, Jones N, Greenberg N. (2016). Attitudes towards
mental health and help-seeking in railway workers. Occup Med
(Lond), 66, 118–21.
Sanchez RP, Bray RM, Vincus AA, Bann CM. (2004). Predictors of job
satisfaction among active duty and reserve/guard personnel in the US
military. Military Psychol, 16, 19–35.
Sani F, Herrera M, Wakefield JRH, et al. (2012). Comparing social
contact and group identification as predictors of mental health. Br J
Soc Psychol, 51, 781–90.
Schalk DMJ, et al. (2010). Interventions aimed at improving
the nursing work environment: A systematic review. Implement Sci,
5, 34.
Selic P, Petek D, Serec M, Makovec MR. (2012). Self-rated health and
its relationship to health/life problems and coping strategies in
members of the professional Slovenian Armed Forces. Coll Antropol,
36, 1175–82.
Settles IH, Buchanan NT, Colar BK. (2012). The impact of race and rank
on 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-reward
conditions. J Occup Health Psychol, 1, 27–41.
Smith AC, Larew C. (2013). Strengthening role clarity in acute care
nurse case managers: Application of the synergy model in staff
development. Profession Case Manage, 18, 190–8.
Snilstveit B, Oliver S, Vojtkova M. (2012). Narrative approaches to
systematic review and synthesis of evidence for international development policy and practice. J Develop Effect, 4, 409–29.
Stocker D, Jacobshagen N, Semmer NK, Annen H. (2010). Appreciation
at work in the Swiss Armed Forces. Swiss J Psychol, 69, 117–24.
Thomas JL, Adler AB, Castro CA. (2005). Measuring operations
tempo and relating it to military performance. Military Psychol, 17,
137–56.
Walsh BM, Matthews RA, Tuller MD, et al. (2010). A multilevel model
of the effects of Equal Opportunity Climate on job satisfaction in the
military. J Occup Health Psychol, 15, 191–207.
Weston MJ. (2010). Strategies for enhancing autonomy and control over
nursing practice. OJIN: Online J Iss Nurs, 15, 2.
Whybrow D, Jones N, Greenberg N. (2015). Promoting organizational
well-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 US
Navy: Impact on performance and career continuance. Military
Psychol, 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 exp
Military Deployment/or exp Military Training/or military.mp.
Armed force*.mp
Special force*.mp
Soldier*.mp
Service personnel.mp or exp service personnel/
War.mp or combat experience/or combat/
Troops.mp
Air force*.mp or air force personnel/
Army.mp or army personnel/
Naval personnel.mp or naval personnel/
Combine all with OR
Search 2; Non-operational stress*.mp or non operational stress.mp
Workplace stress*.mp or job stress/
Work-place stress*.mp
Occupat* stress*.mp or occupational stress/
Burnout.mp
Job strain*.mp or occupational strain*.mp
Work* function*.mp or job performance/
Occupational function*.mp
Team performance.mp
Organisational outcome*.mp or organizational outcome*.mp
Mental health.mp or mental health/
Wellbeing.mp or well-being.mp
Anxiety.mp or anxiety/
Stress.mp not post-traumatic not posttraumatic not PTSD
Work performance.mp
Combine all with OR
Search 1 AND Search 2
(Further search for other occupational populations not included in this
paper)
Search 3; High risk work* or high risk job* or high risk occupation*
Police.mp or police personnel/
Aid agencies or aid agency
Humanitarian aid
Relief work
Emergency relief
Rescue services or rescue workers/
Firefighter*.mp or fire fighters/
Law enforcement.mp or law enforcement/
Emergency response
DOI: 10.1080/09638237.2016.1276536
Hazardous work* or hazardous occupation*
Disaster recovery
Construction work.mp
Combine all with OR
Search 2 AND Search 3
Non-deployment predictors of wellbeing
11
answered with NA if the study took place at only one timepoint. 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 II: Quality appraisal
Section 1: Study design
(1)
(2)
(3)
(4)
The
The
The
The
research question is clearly stated
sample size is described.
sampling method is described.
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
Appendix III: Flow diagram of search and screening
process
Addional records idenfied
through other sources
(n = 5 )
Records idenfied through
database searching
(n = 8290 )
Records aer duplicates removed
(n = 6667 )
Titles screened
(n = 6667 )
Records excluded
(n = 5186 )
Abstracts screened
(n = 1481 )
Records excluded
(n = 1061 )
Full-text arcles assessed
for eligibility
(n = 420 )
Full-text arcles excluded
(n = 370 )
Studies included in
qualitave synthesis
(n = 50 )