Avishai Antonovsky

Background: Military service is a significant stressor for posttraumatic stress disorder (PTSD) and suicidal ideation (SI). The study aimed to examine direct and indirect associations between unit social support, sense of coherence (SOC), PTSD, and SI. Method: This cross-sectional study included 140 Israeli soldiers ( M _age 20.41 [ SD = 1.19]). Data were extracted from self-report questionnaires. Mediation analyses were used to evaluate direct and indirect associations between unit social support (DRRI-2), SOC (SOC-13), PTSD (PCL-5), and SIS (Beck Suicide Ideation Scale). Results: Correlational analyses revealed that unit social support and SOC were positively related to each other, while both were negatively associated with PTSD symptoms and SI. A positive relationship existed between PTSD symptoms and SI, confirming their connection. Path analyses revealed two main patterns: first, unit social support was negatively associated with SI, but this relationship worked via two pathways, one through its negative relationship with PTSD symptoms and one through its positive relationship with SOC. Second, SOC was negatively associated with SI, primarily by reducing PTSD symptoms. Limitations: This is a cross-sectional study with no experimental manipulation; causal inferences are limited. Conclusion: SOC is negatively related to PTSD and SI, a finding in-line with longitudinal studies, which reveal SOC's buffering effect on these two outcomes. This highlights the importance of interventions aimed at enhancing soldiers' SOC, which could contribute to mitigating suicidality.

Introduction: The present study’s central aim was to examine two questions: (1) Will there be differences in mental health outcomes between medics and non-medics who sought help at the Israeli Combat Reaction Unit (CRU)? (2) Will there be differences in mental health outcomes between combatants and non-combatants?Materials and Methods: This cross-sectional study included files of 1,474 Israeli Defense Forces ex-service members (89% combatants, of whom 13% were medics; 11% non-combatants, of whom 6% were medics), who filled out questionnaires on admission for evaluation at the CRU.Dependent variables were mental health measures and included two PTSD measures (Clinician-Administered PTSD Scale and PTSD Checklist for DSM-5), Beck Depression Inventory, Dissociative Experience Scale, and Brief Symptom Inventory. Military profession (medics vs. non-medics) and status (combatant vs. non-combatant) were the independent variables. Background variables were also examined.Results: We found no substantial differences between medics and non-medics in the mental health measures. When looking at combat and non-combat separately, the non-combat medics (CMs), in general, were in better mental health conditions than the other three groups— CMs, non-medic combatants, and non-medic non-combatants—all of whom had similar scores in the mental health measures. However, compared to the rest, non-CMs took considerably longer years before approaching the CRU.Conclusions: The elapsed time to seek help for non-MCs was explained by their reluctance to seek help, not being combatants, and being medics who are portrayed as resilient. Recommendations for encouraging this subgroup to seek help were given.

Summary: While many military positions are characterized by rigorous routines and long-hour shifts, some positions also require the practice of sensitivity and empathy alongside diligence and attention. Prolonged exposure to such conditions may promote emotional exhaustion, depersonalization and diminished self-accomplishment perception, all part of work-related burnout which may affect soldiers’ ability to practice their duty. The service in the Israel Defense Forces (IDF) checkpoint unit is an example of such conditions due to the soldiers’ constant interaction with civilian population. In this questionnaire-based cross-sectional study which included 404 responders from the IDF checkpoint battalions, we examined the effects of demographical, situational and personal variables on soldiers’ burnout. A hierarchical multivariate linear regression (R2 = 0.47) identified sense of coherence, the core concept in the salutogenic model of health, as the most prominent protective factor, followed by service motivation and perceived well-being (WB). Taken together, the results revealed several factors associated with military work-related burnout. These findings can serve as a base for burnout prevention programs, which may potentially improve not only the soldiers’ WB but also the interfaces between military and civilian populations.

Tunnel operations produce unique psychophysiological activation that is correlated with cognitive impairment and lower performance. This study introduces a new concept: subterranean operational potential (SOP) and assesses its psychophysiological correlates for performance prediction in underground spaces. 138 soldiers of elite infantry battalions, with/without previous experience, who participated in a simulation of tunnel warfare. Physical, psychological, cognitive style, and performance measures were collected. SOP has three sub-components: performance, leadership, and orientation. Leadership and performance both were negatively correlated with perceived stress. Claustrophobia was negatively correlated with leadership. The cognitive style was positively correlated with performance. Saliva cortisol levels were significantly higher before the simulation. Inexperienced and experienced differed in the change in before-after saliva cortisol levels.

Background: The present study examined personality, situational and organizational predictors of burnout during COVID-19 in a military setting, based on the salutogenic theory of health (Antonovsky, 1987). Method: Questionnaires were completed by 116 reserve Israeli Home Front Command medical staff (71% males). Background variables (e.g., gender), personality variables (self-efficacy and sense of coherence - SOC), situational variables (state-anxiety, self-rated health and sense of threat) and organizational variables (satisfaction with military’s and government’s handling of the COVID-19 crisis) were measured as predictors of burnout. Results: Females had higher levels of state anxiety and burnout compared to males. Females also reported a lower level of satisfaction with the military’s handling of the COVID-19 crisis than males. SOC and state anxiety were the only statistically significant predictors of burnout after controlling for sociodemographic variables. The entire model explained 59.4% of the burnout variance. Conclusion: In accordance with salutogenic theory, SOC is associated with active adaptation through use of generalized and specific resistance resources to avoid burnout in a stressful milieu. Psychological support, psychoeducation and simulation training are offered to increase manageability in crisis situations. Limitations: Following a large dropout rate due to being quarantined, the final sample size was much smaller than planned. Also, although previous longitudinal studies have found SOC to be a causal factor in burnout, the present cross-sectional design limits such conclusions.