2019 Combat Veteran Research Study:

Camaraderie based events and their impact on depression, anxiety and pain

SC Rugged Maniac - March 16th, 2019

Purpose of Study:

To collect pre and post event data scores in combat veterans participating in the South Carolina Rugged Maniac, 5K Obstacle Course, and Mud Run. To further our understanding of how physical activity and camaraderie based events impact combat veteran resiliency, anxiety, depression, mental health and overall well-being. 

Participants:

Combat Veterans from the United States Armed Forces with "Combat Action" verified by submission of DD214. 

Method:

Measures Used:

  1. Anxiety: Generalized Anxiety Disorder 7-items (GAD-7) -   Is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research. The 7-item anxiety scale (GAD-7) demonstrates good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment. Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability.

    The internal consistency of the GAD-7 is excellent (Cronbach α = .92). Test-retest reliability was also good (intraclass correlation = 0.83). Comparison of scores derived from the self-report scales with those derived from the MHP-administered versions of the same scales yielded similar results (intraclass correlation = 0.83), indicating good procedural validity.

    (Spitzer RL, Kroenke K, Williams JBW, Löwe B. A Brief Measure for Assessing Generalized Anxiety DisorderThe GAD-7. Arch Intern Med. 2006;166(10):1092–1097. doi:10.1001/archinte.166.10.1092) https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/410326?alert=1&alert=1

  2. Depression: Patient Health Questionnaire (PHQ-9)   Is a self‐administered version of the PRIME‐MD diagnostic instrument for common mental disorders. The PHQ‐9 is the depression module, which scores each of the 9 DSM‐IV criteria as “0” (not at all) to “3” (nearly every day). In addition to making criteria‐based diagnoses of depressive disorders, the PHQ‐9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ‐9 a useful clinical and research tool.

    The internal reliability of the PHQ‐9 is excellent, with a Cronbach's α of 0.89 in the PHQ Primary Care Study and 0.86 in the PHQ Ob‐Gyn Study. Test‐retest reliability of the PHQ‐9 was also excellent. Correlation between the PHQ‐9 completed by the patient in the clinic and that administered telephonically by the MHP within 48 hours was 0.84, and the mean scores were nearly identical (5.08 vs 5.03).

    (Kroenke, K. , Spitzer, R. L. and Williams, J. B. (2001), The PHQ‐9. Journal of General Internal Medicine, 16: 606-613. doi:10.1046/j.1525-1497.2001.016009606) https://onlinelibrary.wiley.com/doi/full/10.1046/j.1525-1497.2001.016009606.x

Subjects: Verified combat veterans confidentially complete the provided assessment scales using an online platform from their smartphones prior to and upon completion of the event. A text is sent to each participant by the research director which includes a direct link to complete the scales. Neither names nor other identifiable information are collected on the scales.

Event: The event is a 5 kilometer (3.1 mile) mud run including 25 obstacles of various levels of challenge. Participants are part of team Operation Vet Fit and Warrior Surf Foundation. Each participant receives an event and T-shirt, Medal, Photos, Food, and Beverages upon completion. Participant registration fees for the event and all costs are covered by the research team. 

Results: 

Generalized Anxiety (GAD-7) scores. Results are pending event and data collection and analysis - Check back late March 2019. 

Patient Health Questionnaire (PHQ-9) scores Results are pending event and data collection and analysis - Check back late March 2019. 

Discussion: 

Report pending event data collection and analysis - Check back late March 2019. 

Previously Completed Study Below

2018 Combat Veteran Research Study Information

Purpose of Study:

To collect data on pre and post measure scores in combat veterans participating in the South Carolina Rugged Maniac, 5K Obstacle Course, and Mud Run. To further our understanding of how physical activity and camaraderie based events impact combat veteran resiliency, anxiety, depression, mental health and overall well-being. 

Participants:

Combat Veterans from the United States Armed Forces with "Combat Action" verified by submission of DD214. 

Method:

Measures Used:

  1. Beck's Depression Inventory (BDI) - Pre and Post event

  2. Becks Anxiety Inventory (BAI) - Pre and Post event

  3. Post Traumatic Checklist -5 (PCL-5) - Pre and Post event

  4. Impact of Events - Revised (IES-R) - Pre Event only

  5. Dissociative Experiences Scale - (DES-B) - Pre Event only

  6. Post Traumatic Growth Inventory (PTGI) - Pre and Post event

  7. Combat Exposure Scale (CES) - Pre Event only

Subjects: Verified combat veterans confidentially completed each of the provided assessment scales prior to and upon completion of the event. Neither names nor other identifiable information were collected. Of the 8 subjects provided the scales, 5 were completed satisfactorily for inclusion into the dataset for analysis.

Event: The event is a 5 kilometer (3.1 mile) mud run including 25 obstacles of various levels of challenge. Participants were be part of team Operation Vet Fit and Warrior Surf Foundation. Each participant receive an event and team T-shirt, Medal, Photos, Food, and Beverages upon completion. Participant registration fees for the event and all costs were covered by the research team. 

Results: 

Combat Exposure Scale (CES) scores. Mean score 24.6 representing "Moderate to Heavy Exposure" with a Standard Deviation of 2.3. 

Impact of Events scores (IES-R) Overall IES-R rating was “Powerful” with a mean score of 29.4 albeit a larger SD of 13.79 (due to one outlier)

Post Traumatic Stress (PCL-5) Scores were representative of their combat experiences with a mean PCL-5 scores 33.6 pre-event and 42.75 post-event with a SD of 14.12 and 14.29 respectively. (interesting to see the scores increase post event while depression and anxiety scores were reduced)

Dissociation data using the DES-B Dissociation symptoms were not present, mean score of 11 and a SD of 2.8.

Depression - Pre event BDI scores represented borderline depression at 15.6 with a SD of 7.06 while post event scores dropped to 9.75, Normal, with a SD of only 3.95. 

Anxiety - Pre event BAI scores represented Moderate anxiety at 25.8 with a SD of 12.05 while post event scores dropped to 20, Mild anxiety, with a SD of 17.96 (due to one outlier)

Discussion: 

As hypothesized, team/unit/camaraderie based exercise and fitness events are effective at reducing anxiety and depression amongst the combat veteran population. The small size of this sample makes scientific determinations ill-advised. However, the findings are promising and should encourage future research and collaboration with larger sample sizes amongst the combat veteran community. This is a key area where our agency will be investing a sizable portion of our time and resources.