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Nightmares are often associated with psychiatric disorders and acute stress. This study explores how the COVID‐19 pandemic may have influenced the content of nightmares. A sample of N = 419 US adults completed online surveys about sleep and COVID‐19 experiences. Participants were asked about the degree to which they agreed with statements linking greater general stress, worse overall sleep and more middle‐of‐the‐night insomnia with the COVID‐19 pandemic. They were also asked if, during the pandemic, they experienced nightmares related to various themes. Logistic regression analyses examined each nightmare content as outcome and increased stress, worse sleep and more middle‐of‐the‐night insomnia as predictors, adjusted for age, sex and race/ethnicity. Those who reported greater general COVID‐related stress were more likely to have nightmares about confinement, failure, helplessness, anxiety, war, separation, totalitarianism, sickness, death, COVID and an apocalypse. Those who reported worsened sleep were more likely to have nightmares about confinement, oppression, failure, helplessness, disaster, anxiety, evil forces, war, domestic abuse, separation, totalitarianism, sickness, death, COVID and an apocalypse. Those who reported worsened middle‐of‐the‐night insomnia were more likely to have nightmares about confinement, oppression, failure, helplessness, disaster, anxiety, war, domestic abuse, separation, totalitarianism, sickness, death, COVID and an apocalypse. These results suggest that increased pandemic‐related stress may induce negatively‐toned dreams of specific themes. Future investigation might determine whether (and when) this symptom indicates an emotion regulation mechanism at play, or the failure of such a mechanism. [ABSTRACT FROM AUTHOR]

Background: By March 2020, the World Health Organization declared the COVID-19 crisis as a worldwide pandemic and many local governments instituted stay-at-home orders and closed non-essential businesses. Within the United States, tens of millions of workers lost their jobs and financial security during the first few weeks of the national response, in an attempt to slow the global pandemic. Because of the enormity of the pandemic and its potential impact on mental health, the objective of the present study was to document the prevalence of mental health problems and their association with pandemic-related job loss during the third week of the nationwide shutdown. Methods: Mental health was assessed via online questionnaires among a representative sample of 1,013 U.S. adults on April 9–10, 2020. Rates of clinically significant mental health outcomes were compared between participants who lost their job as a result of COVID-19 restrictions (17.4%) vs. those who did not (82.6%). Bivariate multiple logistic regression identified factors that were predictive of, and protective against, mental health problems. Results: The prevalence of clinically significant symptoms was significantly higher than prior population estimates, ranging from 27 to 32% for depression, 30 to 46% for anxiety disorders, 15 to 18% for acute/post-traumatic stress, 25% for insomnia, and 18% for suicidal ideation. Prevalence estimates were 1.5–1.7 times higher for those who reported job loss due to COVID-19 restrictions than those who did not. Mental health problems were predicted by worry over financial instability, insomnia, social isolation, and alcohol consumption, while getting outside more often, perceived social support, and older age were protective against these problems. Conclusions: During the first 3 weeks of lockdowns/stay-at-home restrictions, mental health problems, including depression, anxiety, insomnia, and acute stress reactions were notably elevated relative to prior population estimates. Job loss related to the nationwide shutdown was particularly associated with poorer mental health. These findings provide a baseline of mental health functioning during the first weeks of the national emergency and lockdown orders in response to COVID-19. [ABSTRACT FROM AUTHOR]

Institutional review board (IRB) delays may hinder the successful completion of federally funded research in the U.S. military. When this happens, time-sensitive, mission-relevant questions go unanswered. Research participants face unnecessary burdens and risks if delays squeeze recruitment timelines, resulting in inadequate sample sizes for definitive analyses. More broadly, military members are exposed to untested or undertested interventions, implemented by well-intentioned leaders who bypass the research process altogether. To illustrate, we offer two case examples. We posit that IRB delays often appear in the service of managing institutional risk, rather than protecting research participants. Regulators may see more risk associated with moving quickly than risk related to delay, choosing to err on the side of bureaucracy. The authors of this article, all of whom are military-funded researchers, government stakeholders, and/or human subject protection experts, offer feasible recommendations to improve the IRB system and, ultimately, research within military, veteran, and civilian populations. [ABSTRACT FROM AUTHOR]

Objective: The Evaluation of Risks (EVAR) scale has been used to assess risk-taking propensity in military samples. This report provides preliminary reliability, validity, and normative data on a modified version of the instrument designed to facilitate data entry with optical scanners, the Evaluation of Risks-Bubble Sheet version (EVAR-B). Methods: 2,015 U.S. Army soldiers completed the EVAR-B and a survey assessing risk-related behaviors 3 months after returning home from combat deployment in Iraq. Results: EVAR-B demonstrated acceptable internal consistency and reliability and correlated significantly with independent measures of self reported risk-taking behavior, including alcohol use and aggressive behavior, in the weeks preceding the survey. Tentative cut-offs significantly differentiated heavy drinkers, dangerous drivers, and soldiers reporting recent aggressive outbursts. Normative data are provided for comparison with future studies. Conclusions: The EVAR-B is a reliable and valid measure of risk-taking propensity, which provides enhanced flexibility for administration and scoring in large surveys and field environments. [ABSTRACT FROM AUTHOR]

Risk-taking propensity is a critical component of judgment and decision-making in military operations. The Evaluation of Risks scale (EVAR) was recently developed to measure state and trait aspects of risk proneness. The scale, however, was psychometrically normed in French and no data are available for the English translation. We administered the English version of the EVAR to 165 U.S. soldiers to obtain reliability, validity, and normative data for English-speaking respondents. Confirmatory factor analysis suggested that the factor structure of the English EVAR differs from that obtained in the French studies. Instead, a three-factor solution, including recklessness/impulsivity, self-confidence, and need for control, emerged. Internal consistency was comparable to the French version. EVAR scores correlated with age, military rank, and years of service, and discriminated soldiers with histories of high-risk behavior. The data support the reliability and validity of the English version of the EVAR for evaluating risk propensity in U.S. soldiers. [ABSTRACT FROM AUTHOR]

The relations of nighttime polysomnographic sleep variables with daytime sleepiness scores on the Epworth Sleepiness Scale were assessed in a retrospective chart review of 38 patients referred to a sleep clinic. Of the variables assessed, only slow wave sleep was statistically significantly correlated with daytime sleepiness, regardless of whether the analysis was based on absolute minutes of slow wave sleep or percentage of total sleep time spent in slow wave sleep. Stepwise linear regression suggested that other polysomnographic variables did not provide additional predictive value beyond the two indices of slow wave sleep. Apparently, reduced quantity of slow wave sleep was weakly but significantly related to increased daytime sleepiness among these sleep-clinic patients.

Background: Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are common injuries among returning combat veterans from the wars in Iraq and Afghanistan. Although these combat injuries have been associated with increased sleep disruption, little is known about the nature and specificity of sleep problems within these common injury categories., Method: A retrospective chart review of 69 consecutive referrals to the Waiter Reed Army Medical Center sleep clinic was conducted. All cases were active duty soldiers who had recently returned from combat deployment in Iraq or Afghanistan. Data from polysomnographically (PSG) recorded sleep stages, sleepiness scales, and documented medical diagnoses were extracted from medical records. Sleep data were compared across diagnoses of PTSD, TBI, and other clinical conditions., Results: As expected, clinical sleep disturbances, including rates of obstructive sleep apnea, excessive awakenings, daytime sleepiness, and hypoxia, were high for the sample as a whole. However, no differences across diagnostic groups were found. Differences were observed, however, on PSG measures of sleep quality, suggesting more frequent arousals from sleep among patients with PTSD and greater slow wave sleep among those with TBI. Except for REM latency, medication status had virtually no effect on sleep variables., Conclusions: Among recently redeployed combat veterans, clinically significant sleep disturbances and problems with sleep-disordered breathing are common but nonspecific findings across primary diagnoses of PTSD, TBI, major depression, and anxiety disorder, whereas more subtle differences in sleep architecture and arousals as measured by overnight PSG recordings were modestly, but significantly, effective at distinguishing among the diagnostic groups.

Risk-taking propensity can be influenced by sensation-seeking traits and self-perceived invincibility. We hypothesized that the latter factor may reflect a stable trait that endures across situations and may influence risk-taking behavior. We developed and validated a 20-item scale, the Invincibility Belief Index (IBI) to measure this construct. The IBI demonstrated good internal consistency and excellent test-retest reliability in the development sample (n = 100) and sustained similar levels of reliability in a cross-validation sample (n = 74). Principal components analysis yielded three orthogonal factors measuring self-perceived impunity (immunity from consequences), boldness/audacity (self-assuredness and competitiveness), and adroitness (mental agility and survival skill). In the prediction of risk taking, IBI scores contributed additional unique variance beyond sensation-seeking scores alone. IBI scores demonstrated convergent and discriminant validity with concurrently administered measures. These preliminary results support the reliability and validity of the IBI as a brief measure of self-perceived vulnerability-invincibility in the face of adversity.

Objective: Deployment to a combat zone is undoubtedly an extremely stressful experience. It was hypothesized that, when faced with an impending wartime deployment, soldiers with prior combat experience would report minimal emotional problems accompanied by high rates of somatic complaints compared with combat-naive soldiers., Methods: Self-reports of posttraumatic stress disorder (PTSD) and affective and somatic complaints were collected from 2068 U.S. soldiers just prior to combat deployment during Operation Iraqi Freedom., Results: Although the percentage of soldiers scoring positive for PTSD was nearly identical for the experienced and inexperienced groups, scores on the Affective and Somatic scales differed as a function of prior combat history. Previous combat experience was associated with lower affective and greater somatic complaints relative to combat-naive soldiers., Conclusions: Consistent with theories of stress reaction, repression, and somatic amplification, combat-experienced soldiers reported limited affective complaints but greater somatic complaints relative to soldiers without combat experience.