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The goal of this study is to repeat a survey administered in 2010 to assess for changes in mental health among United States Air Force aircrew operating Predator/Reaper remotely piloted aircraft, also commonly referred to as drones. Participants were assessed for self-reported sources of occupational stress, levels of clinical distress using the Outcome Questionnaire-45.2, and symptoms of posttraumatic stress disorder (PTSD) using the PTSD Checklist-Military Version. A total of 1,094 aircrew responded to the web-based survey composed of the commercially available standardized instruments mentioned above. The survey also contained nonstandardized items asking participants to report the main sources of their occupational stress, as well as questions addressing demographics and work-related characteristics. The estimated response rate to the survey was 49%. Study results reveal the most problematic self-reported stressors are operational: low manning, extra duties/administrative tasks, rotating shift work, and long hours. The results also reveal 10.72% of operators self-reported experiencing high levels of distress and 1.57% reported high levels of PTSD symptomology. The results are lower than findings from the 2010 survey and from soldiers returning from Iraq and Afghanistan. Implications of the study and recommendations for United States Air Force line leadership and mental health providers are discussed., Presented at the Military Health System Research Symposium in Fort Lauderdale, FL, August 2012. Published in Military Medicine, v179 n8 p63-70, August Supplement 2014. Prepared in collaboration with Prince Research and Analytic Solutions,Stafford, VA and Neurostat Analytical Solutions, San Antonio, TX.

Crew resource management (CRM) is the effective use of all available resources-human, equipment, and information to ensure mission completion and reduce mishaps. The purpose of this study was to describe patient safety-related attitudes of U.S. Air Force flight surgeons and family physicians and ascertain the impact of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), Patient Centered Medical Home (PCMH), and aviation CRM (aCRM) training on those attitudes. Active duty Air Force flight and family medicine physicians were surveyed in a cross-sectional manner with a web-based, Air Force enhanced Safety Attitudes Questionnaire (SAQ). Responses were scored according to published SAQ computation scales and analyzed with Excel statistical tools and SPSS statistical software. Attitudes among Air Force flight surgeons and family physicians were similar to one another, generally positive with regard to teamwork, safety, and stress recognition, and less so in other SAQ domains. Training in TeamSTEPPS, PCMH, and aCRM was not associated with more positive patient safety-related attitudes. Air Force physicians trained in CRM-related concepts did not perceive higher levels of teamwork, safety, job satisfaction, stress recognition, confidence in leadership, or work conditions. Rank and major command as covariates were weakly associated with differences in attitudes. Training in TeamSTEPPS, PCMH, or aCRM was not associated with improvement in safety-related attitudes among Air Force flight surgeons or family physicians. Further study is warranted to ascertain the effectiveness of such programs, either in their concepts, deployment, and/or sustainment.

The purpose of this study is to assess the factorial structure regarding a commercially available computer-based intelligence test given to U.S. Air Force (USAF) pilot training candidates (manned as well as unmanned) during medical flight screening. Principal components analysis was conducted on the intelligence test scores from the computer-based Multidimensional Aptitude Battery-Second Edition (MAB-II). This test was administered to 10,612 USAF pilot training candidates. Subtest and measurement model correlations were estimated. Confirmatory factor analysis using the MAB-II showed positive correlations between specific subtests. The results of factor analyses suggest MAB-II intelligence test scores are best suited to a three-factor model unique to the rated USAF pilot population. In addition to verbal- and performance-based intelligence quotients, a visual reasoning and working memory intelligence quotient composed of the arithmetic, digit symbol, and spatial analyses subtests appears in test scores for this population. This finding is in contrast to the two-factor measurement model used for the general population. The results of the study support an alternative way for conceptualizing and reorganizing MAB-II intelligence test subtest scores to better account for the relationship between test scores from USAF pilot training candidates. The relationship of these test scores must be well understood to effectively evaluate how specific cognitive aptitudes are related to (and/or affected by) changes in any particular subtest. Rather than just measure global cognitive ability, it is recommended that neuropsychologists and clinical psychologists remain sensitive to the pattern and factor analyses of subtests that comprise the global score of intelligence for this commercially available intelligence test. This is especially important when the purpose of a psychological evaluation is to assess the cognitive strengths and weaknesses of a specific individual., Prepared in collaboration with NeuroStat Analytical Solutions, LLC, San Antonio, TX.

United States Air Force (USAF) AC-130 gunship sensor operators (SOs) represent a unique group of enlisted airmen in a high-demand, high-risk position where they have a central role in reconnaissance, surveillance, and aerial precision-strike operations in combat. Although there is research on the influence and role of personality traits regarding USAF pilots and other high-demand, high-risk aviation-related military positions, there has been much less focus on the personality traits of AC-130 gunship SOs. To fill the gap in the literature, the NEO Personality Inventory-Revised (NEO PI-R) was administered to enlisted airmen who had successfully passed training (n = 59) as well as failed training (n = 20) in an effort to (a) assess how the personality traits of such a specialized group of enlisted airmen (SO incumbents) differ from the civilian general population, (b) assess how key personality traits (e.g., neuroticism, extraversion, openness, agreeableness, conscientiousness) for incumbents differ from enlisted airmen who failed training, (c) develop occupationally specific normative data and distribution of personality scores for use in aeromedical clinical psychological evaluations, and (d) illustrate the value of using occupationally specific normative data and cutoff values regarding personality test scores to improve the selection of future candidates who have a greater probability of success in training. Results assist military and civilian clinical psychologists with the interpretation of NEO PI-R psychological test scores for SO applicants and incumbents and inform decision makers on personality traits that may be useful in the selection process for this career field.

U.S. Air Force (USAF) MQ-1 Predator and MQ-9 Reaper sensor operators (SOs) have a critical role in intelligence, surveillance, reconnaissance (ISR); basic surface attack; and close air support (CAS) operations. The duties of the Predator/Reaper SOs are perceived by subject matter experts as having high levels of intelligence and visual-spatial aptitudes to successfully pass training and adapt to operational challenges. To date, there are no studies that assess the cognitive functioning of such a high-demand and critical enlisted career field, despite its important role in current USAF aviation. To fill the gap in the current literature, this study obtained intelligence testing on USAF Predator/Reaper SOs (n=51) and AC-130 gunship SOs (n=62) in an effort to (a) obtain normative intelligence data on incumbents to assess how such a specialized group of enlisted aircrew differs from the civilian, nonaircrew general population; (b) assess how the cognitive aptitudes (i.e., visual learning/memory, spatial analysis, visual attention to detail, and visual-constructive abilities) of incumbents specifically differ from SOs with ISR and CAS duties within a manned aircraft (i.e., AC-130); and (c) develop a distribution of intelligence tests scores for Predator/Reaper SO incumbents for use in aeromedical evaluations. The results of the study revealed that Predator/Reaper SOs have a significantly higher level of cognitive functioning in areas of visual construction and perceptual reasoning, visual attention to detail, spatial reasoning, visual learning and coding, as well as general conceptual reasoning. There were no significant differences in aptitude test scores between Predator/Reaper and AC-130 gunship SOs, indicating both groups share similar cognitive strengths.

The U.S. Air Force remotely piloted aircraft MQ-1 Predator and MQ-9 Reaper sensor operators (SOs) represent a group of enlisted airmen in a high-demand, high-precision, aviation-related position where they have a pivotal role in precision-strike aerial operations. This study evaluated psychological baseline test scores from the NEO Personality Inventory-Revised (NEO PI-R) on enlisted airmen who became operational Predator/Reaper SOs in an effort to assess how key personality traits (e.g., neuroticism, extraversion, openness, agreeableness, conscientiousness) distinguished them from peers in the civilian, general population as well as AC-130 gunship SOs. This study also developed occupationally specific normative data and distribution of personality scores for use in aeromedical evaluations of Predator/Reaper SO training applicants and incumbents. The results of the study shed light on objective personality traits and differences and assist military psychologists and flight surgeons with the interpretation of NEO PI-R test scores when evaluating the suitability and fitness for duty of training applicants and incumbents for such a unique and demanding career field. A case study and clinical vignette are provided to illustrate the practical application of study findings., Prepared in collaboration with Eagle Applied Sciences, San Antonio, TX and Medpro, Wright-Patterson AFB, OH.

The increasing operational demand for MQ-1 Predator and MQ-9 Reaper remotely piloted aircraft (RPA) in support of intelligence, surveillance, and reconnaissance missions as well as precision-strike operations in theaters of conflict has led to a substantial rise in operational hours, shift work, and exposure to combat-related events (e.g., destruction of enemy assets and combatants) for operators. As a result of the continual need to sustain a high operational tempo, there are concerns among line commanders and aeromedical leadership regarding the prevalence of occupational burnout. There is also concern that there are differences across units for risk of occupational burnout and that active duty crew members are at higher risk when compared with National Guard/Reserve operators. This study surveyed 426 officer and enlisted operators (pilots and sensor operators). Although a wide range of stressors may contribute to elevated levels of burnout, the majority of occupational stress was reported to stem from operational stress and not exposure to combat (e.g., live video feed regarding the destruction or death of enemy combatants and ground forces). In general, the results revealed that active duty operators are more than twice as likely to suffer from the facets of occupational burnout involving emotional exhaustion and cynicism. Active duty as well as National Guard/Reserve operators attributed shift work, shift changes, hours worked, and simultaneously serving as a warfighter in theater while returning home and managing domestic roles and responsibilities at home to their burnout levels.

Remotely Piloted Aircraft (RPA) operations in Iraq, Afghanistan, and other areas of operation are escalating as the force protection capabilities of such aircraft are fully realized in surveillance, reconnaissance, and precision-strike operations. Never in the history of warfare have uninhabited vehicles assumed such a critical role in such a vast array of theater operations. As a result, the aircrew of RPA aircraft work around the clock to provide support capabilities, flying one of the world's most advanced aerial weapons systems. However, there is minimal research on the assessment and selection of enlisted aircrew (i.e., Sensor Operators, SOs) who fill a critical role. At the present time, there are no published studies on the critical attributes of successful MQ-1 Predator and MQ-9 Reaper SOs. The purpose of this study was to consolidate data from several subject matter experts regarding the attributes needed to successfully complete training and adapt to operational demands. The results of the study aim to increase understanding of specific psychological attributes critical to performance, and to improve aeromedical assessment and selection procedures.

Intelligence testing and neuropsychological screening is critical to USAF medical flight screening and aeromedical waiver procedures for pilots. A confirmatory factor analysis was conducted on the intelligence test scores from the Multidimensional Aptitude Battery (MAB-II) and neuropsychological screening from the five first-level indices of the MicroCog. The sample consisted of 10,612 USAF pilot applicants selected for training. Subtest correlations and measurement models were estimated for both tests. A joint factor analysis using the measurement models of the MAB-II and MicroCog showed positive correlations between factors identified for the two tests and between subtests measuring specific cognitive aptitudes. Similarities and differences among scores are discussed. Normative tables demonstrate cognitive aptitudes for USAF pilot applicants are in the high average to superior range when compared to the general population. The normative tables improve interpretation of scores for USAF pilots and an aeromedical clinical case vignette is provided to illustrate practical applications of the study., Prepared in collaboration with Operational Technologies Corporation, San Antonio, TX and Eagle Applied Sciences, San Antonio, TX. The original document contains color images.

This article is a descriptive utilization study of a United States Air Force (USAF) outpatient mental health clinic at a remote Air Base in northern Iraq over an 8-month period (Nov 07 - Jun 08). This study provides a description of the clinic and psychological services (i.e., intake and triage, hospitalization, aeromedical evacuations and follow-up care), and utilization data of military personnel seeking care. The study follows the outline of a previously published study (Chappelle & Lumley, 2006) for those interested in comparing services and utilization data between northern and southern regions of Iraq over similar lengths of time. The study also provides recommendations to USAF military mental health providers preparing to serve the mental health needs of military personnel during their deployment., Prepared in cooperation with Air Mobility Command, Fairchild AFB, WA.