The Air Force Deployment Transition Center: Assessment of Program Structure, Process, and Outcomes.

It is often accepted as common knowledge that military personnel benefit from decompression time between a war zone and the home station. To capitalize on the potential benefits of a decompression period paired with support services, the U.S. Air Force established the Deployment Transition Center (DTC) at Ramstein Air Base in Germany in July 2010. The DTC provides airmen returning from combat missions with an opportunity to decompress and share lessons learned before returning to their home stations. The authors of this study evaluate the structure, processes, and outcomes of the DTC program. They find that, although a majority of participants found the DTC program worthwhile, a comparison of DTC participants and similar airmen who did not participate the program shows no evidence that the program helps reduce posttraumatic stress disorder symptoms, depressive symptoms, binge drinking, or social conflicts with family and coworkers. In addition, one of the DTC program elements appears to be similar to posttraumatic debriefing interventions, which several studies have found to be either ineffective or harmful. For these reasons, if the main goals of the DTC program are to improve behavioral health and social conflict outcomes, the authors recommend that the DTC program be discontinued or redesigned and Air Force resources invested in alternative programs. However, if the DTC program has other goals, such as providing rest and relaxation to airmen after a difficult deployment or capturing after-action information, then the authors recommend that these goals be documented and the DTC program be more specifically tailored to them.

[1]  J. Kenardy,et al.  Early psychological interventions to treat acute traumatic stress symptoms. , 2010, The Cochrane database of systematic reviews.

[2]  Charles W Hoge,et al.  Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. , 2006, JAMA.

[3]  Judy Drennan,et al.  Online Alcohol Interventions: A Systematic Review , 2010, Journal of medical Internet research.

[4]  Daniel R. Kivlahan,et al.  Brief Alcohol Screening and Intervention for College Students (Basics): A Harm Reduction Approach , 1999 .

[5]  이광영,et al.  부산지역 근로자들에서 Alcohol use disorders identification test(AUDIT)점수와 혈청 간 효소 수치들의 연관성 조사 , 2003 .

[6]  D. Weiss,et al.  Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. , 2003, Psychological bulletin.

[7]  W. Nash,et al.  Review of VA/DOD Clinical Practice Guideline on management of acute stress and interventions to prevent posttraumatic stress disorder. , 2012, Journal of rehabilitation research and development.

[8]  S. Wessely,et al.  Post-deployment BATTLEMIND training for the UK Armed Forces: a cluster-randomised controlled trial , 2011, Occupational and Environmental Medicine.

[9]  B. Garber,et al.  Evaluation of a third-location decompression program for Canadian Forces members returning from Afghanistan. , 2012, Military medicine.

[10]  Paul D Bliese,et al.  Battlemind debriefing and battlemind training as early interventions with soldiers returning from iraq: Randomization by platoon. , 2009, Journal of consulting and clinical psychology.

[11]  K. Jackson,et al.  Web-based alcohol prevention for incoming college students: a randomized controlled trial. , 2010, Addictive behaviors.

[12]  J. Bisson,et al.  Psychological treatment of post-traumatic stress disorder (PTSD). , 2007, The Cochrane database of systematic reviews.

[13]  A. Donabedian Methods for deriving criteria for assessing the quality of medical care. , 1980, Medical care review.

[14]  J. Lunceford,et al.  Stratification and weighting via the propensity score in estimation of causal treatment effects: a comparative study , 2004, Statistics in medicine.

[15]  Multiple session early psychological interventions for the prevention of post-traumatic stress disorder. , 2009, The Cochrane database of systematic reviews.

[16]  C. Brewin,et al.  Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. , 2000, Journal of consulting and clinical psychology.

[17]  S. Wessely,et al.  Use of psychological decompression in military operational environments. , 2008, Military medicine.

[18]  Greg Ridgeway,et al.  Toolkit for Weighting and Analysis of Nonequivalent Groups , 2014 .

[19]  Margaret C. Harrell,et al.  Deployment Experiences of Guard and Reserve Families: Implications for Support and Retention , 2008 .

[20]  M. Horowitz Stress Response Syndromes: PTSD, Grief and Adjustment Disorders , 1997 .

[21]  S. Wessely,et al.  The subjective utility of early psychosocial interventions following combat deployment. , 2011, Occupational medicine.

[22]  Mark B. Powers,et al.  A meta-analytic review of prolonged exposure for posttraumatic stress disorder. , 2010, Clinical psychology review.

[23]  Julie A. Uhernik,et al.  Psychological FirstAid:An Evidence Informed Approach forAcute Disaster Behavioral Health Response , 2009 .

[24]  R. Spitzer,et al.  The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener , 2003, Medical care.

[25]  M. Larimer,et al.  Identification, prevention and treatment: a review of individual-focused strategies to reduce problematic alcohol consumption by college students. , 2002, Journal of studies on alcohol. Supplement.

[26]  J. Avorn,et al.  Variable selection for propensity score models. , 2006, American journal of epidemiology.

[27]  J. Bisson,et al.  Randomised controlled trial of psychological debriefing for victims of acute burn trauma , 1997, British Journal of Psychiatry.

[28]  Barbara O. Rothbaum,et al.  A prospective examination of post-traumatic stress disorder in rape victims , 1992 .

[29]  Third location decompression for individual augmentees after a military deployment. , 2012, Occupational medicine.

[30]  R. McNally,et al.  Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress? , 2003, Psychological science in the public interest : a journal of the American Psychological Society.

[31]  N. Greenberg Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences and Services to Assist Recovery , 2009 .

[32]  M Srinivasan,et al.  Psychological Sequelae Following the Gulf War , 1994, British Journal of Psychiatry.

[33]  James W. Pennebaker,et al.  A Social Stage Model of Collective Coping: The Loma Prieta Earthquake and The Persian Gulf War , 1993 .

[34]  G. Arbanas Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , 2015 .

[35]  B. Garber,et al.  Drivers of the Perceived Value of a Third-Location Decompression Program for Canadian Forces Personnel Returning From Afghanistan , 2013 .

[36]  P. Schnurr,et al.  Change in posttraumatic stress disorder symptoms: do clinicians and patients agree? , 2008, Psychological assessment.

[37]  J. Sheikh,et al.  The primary care PTSD screen (PC-PTSD): development and operating characteristics , 2004 .

[38]  S. Wessely,et al.  Psycho-educational interventions designed to prevent deployment-related psychological ill-health in Armed Forces personnel: a review , 2010, Psychological Medicine.

[39]  Matt J. Gray,et al.  Early intervention for trauma: Current status and future directions. , 2006 .

[40]  B. Rothbaum,et al.  A prospective examination of post‐traumatic stress disorder in rape victims , 1992 .

[41]  Marie Davidian,et al.  Doubly robust estimation of causal effects. , 2011, American journal of epidemiology.

[42]  S Rose,et al.  Psychological debriefing for preventing post traumatic stress disorder (PTSD). , 2002, The Cochrane database of systematic reviews.

[43]  Donald Rubin,et al.  Estimating Causal Effects from Large Data Sets Using Propensity Scores , 1997, Annals of Internal Medicine.

[44]  B. Garber,et al.  Beyond battlemind: evaluation of a new mental health training program for Canadian forces personnel participating in third-location decompression. , 2012, Military medicine.

[45]  Laura Werber,et al.  An Assessment of Fiscal Year 2013 Beyond Yellow Ribbon Programs , 2015 .

[46]  E. Steyerberg,et al.  [Regression modeling strategies]. , 2011, Revista espanola de cardiologia.

[47]  Daniel F. McCaffrey,et al.  Comment: Demystifying Double Robustness: A Comparison of Alternative Strategies for Estimating a Population Mean from Incomplete Data , 2008, 0804.2962.

[48]  An Evaluation of the Implementation and Perceived Utility of the Airman Resilience Training Program. , 2014, Rand health quarterly.

[49]  Stuart Turner,et al.  Psychological treatments for chronic post-traumatic stress disorder , 2007, British Journal of Psychiatry.

[50]  J. Ruzek,et al.  Psychological First Aid Field Operations Guide. 2nd Edition. , 2006 .

[51]  A. Viera,et al.  Behavioral Counseling After Screening for Alcohol Misuse in Primary Care: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force , 2012, Annals of Internal Medicine.

[52]  Elizabeth A Stuart,et al.  Improving propensity score weighting using machine learning , 2010, Statistics in medicine.

[53]  R. Mayou,et al.  A randomised controlled trial of psychological debriefing for victims of road traffic accidents , 1996, BMJ.

[54]  Stevan E. Hobfoll,et al.  Five Essential Elements of Immediate and Mid–Term Mass Trauma Intervention: Empirical Evidence , 2021, Psychiatry.

[55]  Laura Werber,et al.  Support for the 21st-Century Reserve Force: Insights to Facilitate Successful Reintegration for Citizen Warriors and Their Families , 2013 .

[56]  Charles W Hoge,et al.  Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. , 2007, JAMA.

[57]  M. Larimer,et al.  Identification, prevention, and treatment revisited: individual-focused college drinking prevention strategies 1999-2006. , 2007, Addictive behaviors.

[58]  Zac E. Imel,et al.  The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: a meta-analysis of direct comparisons. , 2008, Clinical psychology review.

[59]  José Maria Paganni,et al.  Evaluating the quality of medical care. , 1966, The Milbank Memorial Fund quarterly.

[60]  D. McCaffrey,et al.  Propensity score estimation with boosted regression for evaluating causal effects in observational studies. , 2004, Psychological methods.

[61]  T. M. Davis,et al.  Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. , 2003, Archives of internal medicine.

[62]  Chris R Brewin,et al.  Systematic review of screening instruments for adults at risk of PTSD. , 2005, Journal of traumatic stress.

[63]  K. Wright,et al.  A group randomized trial of critical incident stress debriefing provided to U.S. peacekeepers. , 2008, Journal of traumatic stress.

[64]  N. Jones,et al.  Preventing psychological trauma in soldiers: the role of operational stress training and psychological debriefing. , 2000, The British journal of medical psychology.