Why Leaders Choose War: The Psychology of Prevention


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Older service members aged 46 to 64 are less likely to be heavy drinkers than civilians of the same age 3. Military personnel aged 18 to 25, however, exhibit significantly higher rates of heavy drinking than their civilian counterparts Although the rate of heavy drinking has remained mostly constant, binge drinking five or more drinks for males, or four or more drinks for females, on a single occasion at least once in the past 30 days among active-duty service members increased from There are signs that this increase may have slowed, however, because between and there was no significant change in binge drinking across all services.

The binge drinking rate in the Navy increased from In the Marine Corps had the highest rate of binge drinking Compared to civilians, military personnel binge drink at a higher rate Civilians aged 46 to 64, however, binge drink at a higher rate than service members of the same age In the Army, incidents of drug and alcohol abuse in soldiers increased from 28, offenses in to 34, in and then decreased by 9.

Those recent decreases were coupled with increased rates of referral for drug and alcohol treatment. In fiscal year FY , there were more than 24, referrals of soldiers to the Army Substance Abuse Program; about 50 percent of those referred were enrolled. Forty-three percent of active-duty Army personnel reported binge drinking within the preceding month.

Although 12 percent of soldiers reported alcohol problems on the Post Deployment Health Re-Assessment see Appendix F , only 2 percent have been referred for further evaluation or treatment.


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Alcohol abuse is associated with several risk factors related to combat service, such as exposure to the threat of death or injury, witnessing atrocities, depression and PTSD symptoms, and a diagnosis of PTSD Burnett-Zeigler et al. According to self-report data, the illicit drug use rate excluding prescription drugs among active-duty military was 2.

Across services, usage rates range from 3. Deployment seems to be a factor in illicit drug usage rates.

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Illicit drug use, including prescription drugs, among active-duty personnel increased from 5. Rates were also below 2 percent in reserve personnel not on active duty, but they exceeded 2 percent in National Guard personnel not on active duty. Drugs tested for included amphetamines, cocaine, ecstasy, marijuana, MDA methylenedioxyamphetamine , opioids, and phencyclidine. Illicit drug usage excluding prescriptions is lower among active-duty service members than among civilians for all age groups and overall 2.

About 14 percent of U. The report defines polypharmacy as the use of four or more prescription medications of which at least one is a psychotropic drug or a controlled substance, and it notes that the number of soldiers receiving polypharmacy increased in FY — from , to , Since prescription drug misuse has increased dramatically across services—from 2 percent in to 4 percent in to nearly 12 percent in Bray et al.

Bray et al. By service, the Army had the highest rate of prescription drug misuse In reviewing the literature on alcohol misuse among active-duty service members, Returning Home from Iraq and Afghanistan IOM, a found that heavy alcohol use was higher among those deployed to any operational theater than among the non-deployed. Other risk factors for increased alcohol use or misuse among active-duty service members include perceived high work stress, being younger, being male, experiencing the threat of death or injury, higher frequency of deployment, greater cumulative time deployed, and diagnosis of PTSD.

Among Army service members, being age 45 or older, male, smoking cigarettes, having a substance use disorder, being a victim of preadolescent sexual abuse among women , having a major psychiatric disorder, prior legal problems, a history of motor vehicle accidents, and poor family support were all risk factors for misuse of opioids Department of the Army, Among recently returned National Guardsmen, Burnett-Zeigler et al. National Guardsmen frequently reported that stigma and concerns about their military careers were barriers to their seeking treatment.

Looking at risk factors by deployment phase, Ferrier-Auerbach et al. However, psychological health status was not a predictor of drinking among the pre-deployed National Guard. Among post-deployed National Guardsmen, Kehle et al. PTSD symptom severity was a predictor for alcohol-use disorder in the study population. Substance use disorders SUDs frequently appear together with other psychological health conditions. Seal et al. Additionally, Stecker et al.

Nazarian et al. Suicide is a lethal self-inflicted action, a suicide attempt is a nonfatal action, and suicidal ideation refers to suicidal thoughts, such as wishing to commit suicide.

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Suicide is a leading—as well as a growing—cause of death among U. DOD's suicide rate in was The Army, with In the U. It is difficult to determine the percentage of people who have suicidal ideation who go on to attempt or complete suicide. However, in a study of suicidal ideation and suicide attempts in a large number 52, of active-duty members of the Air Force, Snarr et al.

Risk factors for suicidal ideation among active-duty male personnel in the Air Force include not being married, being non-Christian, being junior enlisted, being employed as medical personnel, having alcohol problems, working longer hours, having poor social support, being dissatisfied with relationships, having poor coping ability, having experienced interpersonal violence, and being dissatisfied with the Air Force way of life. Among Air Force women, risk factors include lower rank, financial stress, alcohol problems, relationship dissatisfaction, interpersonal violence, poor social support, and being non-Christian.

Among both sexes, depression was the strongest predictor of suicidal ideation. Langhinrichsen-Rohling et al. At the individual level, depressive symptoms and alcohol problems were both risk factors for suicidal ideation. For mothers in the study population, however, alcohol problems actually decreased the risk of suicidal ideation. At the family level, relationship satisfaction reduced the risk of suicidal ideation, and interpersonal violence victimization increased the risk.


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For mothers, parent—child relationship satisfaction also reduced the risk for suicidal ideation. At the workplace level, dissatisfaction with the Air Force way of life was a strong predictor of suicidal ideation among men, and satisfaction with workplace relationships reduced the risk of suicidal ideation among women. At the community level, social support reduced the risk of suicidal ideation among both men and women.

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A perception of community unity was protective for men. The authors suggest that focusing on the non-individual and less-stigmatizing risk and protective factors at the workplace and community levels may be an effective strategy for the military's suicide prevention efforts Langhinrichsen-Rohling et al.

At least 90 percent of people who die by suicide have a psychological illness at the time of their death. Risk factors for completed suicide among service members include being male, white, under the age of 25 years, junior enlisted or high-school educated, and divorced. The suicide rate in divorced service members was 55 percent higher than that in married service members. Active-duty service members had a 70 percent higher risk of suicide than did deployed reserves and National Guard members.

Firearms accounted for 62 percent of all suicides, and drug overdose was the most frequent method of suicide attempts 57 percent DCOE, DOD data illustrate the relationship between psychological health disorders and suicide attempts. Among service members who attempted suicide in , a majority Among suicide attempters, A new study points to a similar pattern among suicide completers.

Among the Millennium Cohort, a large longitudinal sample of service members, the leading risk factors for suicide were depression, manic depressive disorder, and heavy or binge drinking or alcohol-related problems LeardMann et al. The study did not find an association between suicide and combat experience, cumulative days deployed, or number of deployments; however, the study did have some limitations, such as its self-report methodology, its definition of combat exposure, and a 31 percent participation rate.

The risk factors identified in this study suggest that the treatment of underlying psychiatric disorders, even though these disorders are not the only risk factor, is nonetheless a critical component of suicide prevention Engel, and that service members who have not deployed are also at elevated risk, so they should be considered in screening and prevention efforts. The overwhelming majority of civilians who die by suicide had untreated psychiatric disorders Henriksson et al. An analysis of the health care experiences that preceded suicide and suicide attempts in U.

Protective factors that make suicide less likely are not as well studied as risk factors, and most of the research on them has been carried out in civilian populations. In military populations, unit cohesion is one example of social support that buffers against the adverse effects of stress, the development of PTSD, and potentially suicidal behavior Brailey et al. In a 3-year longitudinal study of veterans, resilience was found to protect against suicidal thoughts and suicide attempts Youssef et al. Resilience in the study was measured by the well-validated Connor-Davidson Resilience Scale, which defines resilience as being able to thrive in the face of adversity.

Military family members play an integral role in the readiness and well-being of the military force. Recognizing this role, Returning Home from Iraq and Afghanistan IOM, a examined the evidence demonstrating that military family members have to deal with impairments in psychological and physical well-being, relationship problems, responsibilities as caregivers of children or wounded service members, and overwhelming household duties.

This section summarizes the findings from that report about the psychological health challenges and interpersonal violence affecting military spouses and children.

Evidence suggests that military service by itself does not appear to significantly raise the probability of negative outcomes but that the likelihood of negative consequences for families rises with the amount of the service members' exposure to traumatic or life-altering experiences MacLean and Elder, In contrast, deployment to combat zones has been found to significantly predict a variety of negative outcomes, including marital conflict and intimate partner violence IOM, When service members display negative psychological symptoms, the likelihood of negative consequences for families rises substantially de Burgh et al.

Family members of the National Guard and reserves face unique challenges in the degree to which they are adequately prepared for deployment, supported during deployment, assisted following deployment, and prepared for subsequent deployments, which may have an impact on their psychological health. Relative to active-duty families, members of the National Guard and reserves and their families have limited access to military chaplains, family support programs, and all the other parts of the military landscape designed to support psychological health.

Moreover, community providers may not be sufficiently aware of or sufficiently trained to fulfill their needs DOD Task Force on Mental Health, Every deployment consists of a before-deployment, during-deployment, and afterdeployment period, and some researchers have attempted to examine what implications each of these deployment stages has for families, particularly spouses. The duration and content of these phases vary widely, however—suggesting caution about the confidence with which predictions can be made about the implications of these stages for families.

Nonetheless, for the sake of clarity it is helpful to organize the discussion on the psychological health of families according to pre-deployment, during deployment, and post-deployment. Before deployment, families must make legal, logistical, and emotional preparations for separation and for the possible injury or death of the deployed service member.

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Although it is logical that families would find this process difficult and stressful, few prospective studies of family members have been published. Returning Home from Iraq and Afghanistan IOM, a found in the limited existing research that spouses of service members expecting deployment reported substantially elevated stress levels and depressive symptoms, although baseline levels of these problems in this population are not well documented. Warner and colleagues reported that nearly one-quarter of spouses reported mild depressive symptoms, one-half reported symptoms consistent with depression, and one-tenth reported severe depressive symptoms.

In addition, service members who are anticipating separation expect their spouses will have difficulty coping at home during the forthcoming deployment. Approximately one-third of junior-enlisted members and members married less than 3 years indicated that their spouse would have a serious or very serious problem dealing with the deployment Spera, Several studies have examined the prevalence of psychological symptoms among military spouses in relation to deployment-related stressors.

In its review of the literature, Returning Home from Iraq and Afghanistan IOM, a found that deployment to a war theater is associated with increased psychological health problems, particularly depression and anxiety, among military spouses. The length of the deployment and the cumulative months of deployment predict increases in the likelihood of distress, but the number of deployments does not.

Additionally, a service member's psychological issues are related to increases in marital distress, relationship problems, and disruptions to family life. Eaton et al. The spouses and service members reported similar levels of major depression or generalized anxiety disorders Spouses were more likely than service members, however, to seek care 70 percent versus 40 percent and less likely to be impeded in doing so by worries about stigma.

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Mansfield et al. Compared with wives of non-deployed partners, spouses of deployed service members also used psychological health services at higher rates, which increased with deployment length. The likelihood of any psychological health diagnosis was 19 percent higher among women whose husbands had been deployed from 1 to 11 months A study by SteelFisher et al. Spouses who experienced deployment extension reported increased levels of psychological health problems relative to those who did not.

Half of the spouses reported frequent feelings of anxiety, and almost half reported frequent feelings of depression.

Why Leaders Choose War: The Psychology of Prevention Why Leaders Choose War: The Psychology of Prevention
Why Leaders Choose War: The Psychology of Prevention Why Leaders Choose War: The Psychology of Prevention
Why Leaders Choose War: The Psychology of Prevention Why Leaders Choose War: The Psychology of Prevention
Why Leaders Choose War: The Psychology of Prevention Why Leaders Choose War: The Psychology of Prevention
Why Leaders Choose War: The Psychology of Prevention Why Leaders Choose War: The Psychology of Prevention
Why Leaders Choose War: The Psychology of Prevention Why Leaders Choose War: The Psychology of Prevention
Why Leaders Choose War: The Psychology of Prevention Why Leaders Choose War: The Psychology of Prevention
Why Leaders Choose War: The Psychology of Prevention Why Leaders Choose War: The Psychology of Prevention

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