Background: Adaptation to combat and operational stress is influenced by many different risk and resilience factors. Different Service members adjust to stress and trauma in different ways; there is no single uniform response. Little is known about the different pathways of adjustment to combat and operational stress (trajectories). Because most past research has been cross-sectional, it has failed to provide useful information to military commanders and other authorities on how best to prepare for battle or to prevent problems in those likely to be at risk for chronic distress. Furthermore, without adequate information on different trajectories, treatments have remained "one-size-fits-all."

Objectives: The research conducted in the Assessment Core of the STRONG STAR (South Texas Research Organizational Network Guiding Studies on Trauma and Resilience) project is designed to provide information about how people adjust and adapt to operational stress. The object is to create a uniform set of measures to be utilized throughout the consortium, and to analyze the longitudinal data collected by the combined data from all the studies in the consortium. Each measure will be selected by the Assessment Core based on existing research showing the measure's utility in assessing a particular construct (e.g., post-traumatic stress disorder), as well as taking into consideration the ease of its use. The Assessment Core will be responsible for analyzing data collected in each of the studies and testing statistical models of different trajectories.

We expect to find distinct trajectories of adaptation to combat trauma: a Recovery Course characterized by an initially high level of symptoms followed by steady reduction of symptoms; a Chronic Course characterized by steady, high levels of symptoms following the traumatic event; an Enduring Resilience Course characterized by steady, low levels of symptoms; and a Delayed Course characterized by a sharp rise of symptoms over time. We will evaluate the prevalence of each trajectory and different factors predicting which individuals may likely follow which trajectory.

The information generated by this project will help inform the medical community about the different trajectories of recovery from operational stress that military personnel may take. This information is clinically relevant in that it may help us predict who will fare well and who will not, thus allowing us to develop improved interventions for operational stress. With more information about the various trajectories, we will be able to develop treatments tailored specifically to individuals of each trajectory. Because the Assessment Core will be working exclusively with de-identified data (data that has been stripped of any information that could link it back to the individual research participant), there are no foreseeable risks within the Core's work.

Primarily, this research will help military decision-makers, as it is specifically designed to assess and evaluate the effects of combat stress. In particular, because Service members often have limited time and resources with which to work, interventions designed in other elements of the STRONG STAR Consortium will be tailored specifically to the needs of Service members. However, this research will also inform other professionals working with individuals exposed to highly stressful or traumatic events. This project has received funding through 2012; it is expected that consumer-related outcomes will be achieved by or prior to the end of the funding period.