Joscelyn E. Fisher

Large-scale combat operations (LSCO) represent sustained, high-intensity warfare with near-peer adversaries involving massive casualty volumes. Military projections suggest 3000 casualties per day, approaching World War II intensity levels. LSCO will expose military personnel to continuous confrontation with death, producing psychological effects that threaten force preservation and mission continuity. Traditional centralized behavioral-health systems will be unable to sustain operations effectively under conditions of continuous exposure, contested evacuation, and specialist unavailability. Leadership emerges as the primary mechanism for force preservation, with influence increasing precisely when followers face the greatest threat. This narrative review examines three areas: (1) psychological consequences (stress reactions, grief, moral injury); (2) vulnerable populations (infantry, junior leaders, medics); and (3) leadership interventions including transformational leadership and grief-informed command practices. In contrast to centralized models, we propose a three-level operational framework: immediate unit-level peer support, embedded resource utilization through medics, chaplains, and behavioral health officers, and delayed professional intervention when feasible. This model positions leadership as the central mechanism for sustaining the fighting force amid continuous death exposure.

Digital social technologies, such as social media and online multiplayer video games (MVGs), have ushered in an era of peer relationships that evolve online, in addition to in person. This report reviews existing research about the dual role of social media and MVGs in shaping youth social connectedness, recognizing both their potential benefits and their associated risks on youth mental health. By providing evidence-based insights, it aims to inform strategies that optimize these technologies' advantages while safeguarding youth mental health and well-being. This report reviews peer-reviewed literature, clinical recommendations, reports, and surveys that assess youth usage of social media and MVGs and their associated psychological and physical health outcomes. Social media provides many opportunities for peer connection, including self-expression and social support, fostering positive social development and well-being. MVGs combine entertainment with collaboration, further strengthening social bonds. However, the use of these technologies has also been linked to negative outcomes, including social isolation, depression, anxiety, and sleep disorders. Publically-available, evidence-based resources can provide caregivers and professionals with guidance and clinical recommendations regarding youth social media and MVG use. Digital social technologies have become increasingly user-specific and immersive as the internet evolves and social media algorithms become more powerful. Additional research is required to understand how current youth usage of these technologies impacts physical and psychological outcomes. Future research should also investigate the differences in usage, outcomes, and the efficacy of treatments across youth sex and age.

Firearm-related injuries and fatalities among youth in the United States represent a critical public health crisis. Secure firearm storage (i.e., keeping guns unloaded, locked, and stored separately from ammunition) is a proven strategy to reduce these risks. However, many households do not consistently adopt these practices. This review examines four key family-level factors that influence firearm storage decisions: (a) early firearm socialization, (b) family decision-making dynamics, (c) other household safety practices, and (d) parent understanding of child development and motivations regarding storage. Findings indicate that interventions may benefit from empowering parents to reflect on their early firearm socialization experiences, improving their understanding of children’s development, integrating firearm safety into broader household safety frameworks, and promoting collaborative decision-making in multi-adult households. Future research should further investigate how these factors intersect to shape firearm storage practices, including the long-term effects of early firearm exposure through longitudinal studies, and variations across diverse family structures and contexts, including multigenerational households.

Although much has been learned about the physical and psychological impacts of deployment and combat injury on military service members, less is known about the effects of these experiences on military spouses. The present study examined self-reported mental health symptoms (using the Brief Symptom Inventory [BSI]-18 and the posttraumatic stress disorder [PTSD] Checklist [PCL-C]) in wives of service members who were combat-injured (CI; n = 60); noninjured with cumulative deployment longer than 11 months (NI-High; n = 51); and noninjured with cumulativel deployment less than 11 months (NI-Low; n = 53). 36.7% and 11.7% of CI wives endorsed above threshold symptoms on the PCL-C and overall BSI-18, respectively. Multivariate linear regressions revealed that being a CI wife was associated with higher PCL-C, overall BSI-18, and BSI-18 anxiety subscale scores compared to NI-Low wives in models adjusted for individual and family characteristics, as well as prior trauma and childhood adversities. Compared with the NI-High group, the CI group was associated with higher overall BSI-18 scores. While CI wives evidenced fewer mental symptoms than expected, these findings suggest a negative impact of service member's combat injury on wives' mental health above that attributable to deployment, highlighting the need for trauma-informed interventions designed to support the needs of military wives affected by combat injury.