Prompted by the COVID-19 pandemic’s significant threat to the health and readiness, the U.S. Army has implemented a range of preventive public health measures like travel restrictions, changes to training formats and schedules, stay-at-home orders and childcare facility closures or restrictions.
Though necessary safety precautions, these measures can also cause disruption, anxiety or fear in the lives of Soldiers and their families. Added stress not only impacts latent behavioral health conditions in the individual, but can also endanger the entire unit by limiting performance, readiness and cohesion.
To address this critical knowledge gap, a team of behavioral scientists from the Walter Reed Army Institute of Research and U.S. Army Public Health Center joined forces to organize the Behavioral Health Advisory Team—or BHAT.
Building off the model of WRAIR’s mental health advisory teams—deployable units that conduct comprehensive behavioral health surveillance of Service Members in combat theaters—the BHAT surveyed more than 20,000 Soldiers across the globe in the Spring of 2020 about perceptions of COVID-19, leadership response, behavioral health concerns and use of risk mitigation strategies.
“The study was designed to inform evidence-based recommendations for both leadership and public health communications strategies to slow the spread of the virus and mitigate its behavioral health impact. It also allows us to make strategic and actionable recommendations across different echelons of Army leadership,” said Dr. Phillip Quartana, a research psychologist at WRAIR and BHAT’s principal investigator.
The BHAT found that Soldiers have some common fears and concerns about the pandemic, including concerns about unit or mission readiness, restricted opportunities for social opportunities, changing rules and regulations related to COVID-19, someone close to them getting the virus and access to medical care.
The severity of these fears and concerns was linked to behavioral health symptoms—Soldiers with the greatest degree of fears and concerns about the pandemic were up to four times more likely to screen positive for depression or anxiety, though it is unclear which is the cause.
While the BHAT found that nearly one in five Soldiers should consider further evaluation for a potential behavioral health problem, it also reported that rates of depression or anxiety with moderate or extreme related impairment—as well as more serious concerns like thoughts of being better off dead and hurting oneself—were generally consistent with pre-pandemic rates and below rates observed during Operation Iraqi Freedom and Operation Enduring Freedom. Importantly, experts stress caution comparing data across studies that utilize different methodologies.
The majority of Soldiers rated their leaders as responsive and supportive during the pandemic. In fact, Soldiers with the highest leader ratings were 2-3 times less likely to screen positive for depression or anxiety than those with the lowest ratings, underscoring existing work suggesting that effective leadership correlates with a lower risk of screening positive for some behavioral health difficulties.
Soldiers emphasized the need for accurate, up-to-date and understandable information about travel policies, facts and statistics related to COVID-19, how to protect oneself and others, how to maintain mission readiness and how to cope and manage the stress of the pandemic.
"Since the beginning of this crisis, the Army Public Health Center has been a source of accurate and understandable COVID-19 health information," said Dr. Amy Millikan Bell, a preventive medicine physician and the medical advisor at APHC who contributed to the study.
She continued, “as we continue to navigate the pandemic and its impact on the Army, it’s critically important that leaders communicate available guidance on ways Soldiers and their families can protect themselves and lower their risk of spreading the infection. APHC’s website maintains up-to-date information products on COVID-19 based on Centers for Disease Control and Prevention and Army policy.”
Based on these results, the BHAT provided specific strategies for unit and line-level leadership to be supportive and responsive to the impact of the COVID-19 pandemic (examples of specific strategies leaders can use can be found here).
More broadly, they encouraged leaders to work closely with public affairs officers to ensure up-to-date messaging related to COVID-19, coping and stress management and any potential mission-specific impact of the pandemic as well as make certain that Soldiers are aware of available resources and telehealth opportunities to assist with managing the personal and relational impact of the stress around the pandemic.
Given the persistence of the pandemic, the BHAT hopes to continue tracking the behavioral and public health impact of COVID-19.
“We are planning a follow-up survey in October of this year and we hope to continue tracking these outcomes throughout 2021,” said Quartana. “As this virus continues to disrupt Warfighter’s lives and military operations, we may see shifting trends in behavioral health indicators. Continuing this work will allow us to provide the most accurate data and relevant solutions to leadership and stakeholders across the Army.”