Psychological Services 2014, Vol. 11, No. 2, 229 –234

© 2013 American Psychological Association 1541-1559/14/$12.00 DOI: 10.1037/a0034892

Perceived Organizational Support, Posttraumatic Stress Disorder Symptoms, and Stigma in Soldiers Returning From Combat Christie L. Kelley and Thomas W. Britt

Amy B. Adler

Clemson University

US Army Medical Research Unit - Europe, Walter Reed Army Institute of Research

Paul D. Bliese This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Walter Reed Army Institute of Research Research has shown that perceived organizational support (POS), or how much employees believe their organizations value their contributions and well-being, is an important predictor of employee mental health outcomes. To support employee mental health in high-risk occupations, organizations may want to identify variables that explain the relationship between POS and posttraumatic stress disorder (PTSD). Using a longitudinal design and a military sample, the present study found a relationship between POS and stigma as well as PTSD symptoms. Stigma partially mediated the relationship between POS at Time 1 and PTSD symptoms at Time 2. The partial mediation indicates that a supportive environment may also create a climate of reduced stigma in which soldiers may be comfortable addressing PTSD symptoms. Both results suggest positive actions that organizations can take to support employee mental health. Keywords: perceived organizational support, stigma, symptoms

help the organization (Eisenberger, Armeli, Rexwinkel, Lynch, & Rhoades, 2001; Eisenberger et al., 1990; Shore & Wayne, 1993). As a moderator, POS has also been related to chronic pain and performance. Byrne and Hochwarter (2006) found that in situations of high POS, people with chronic pain still maintained levels of performance. Low POS, along with elevated levels of chronic pain, was related to decreased task performance. This research provides evidence that the negative effects of chronic pain on performance can potentially be reduced by POS. The only article we could find examining the relationship between POS and mental health symptoms among military personnel was by Barnes, Nickerson, Adler, and Litz (2013). These authors recently published one of the few studies relating POS to mental health outcomes after highly stressful events. Barnes et al. (2013) investigated the relationship between POS and PTSD symptoms among service members on a peacekeeping mission to Kosovo. The authors found that higher levels of POS were related to lower symptoms of PTSD at four different time periods, ranging from before the peacekeeping deployment, to during the deployment, to after the deployment. Although POS has been related to well-being, chronic pain, and stress symptoms in service members (Barnes et al., 2013; Byrne & Hochwarter, 2006; Rhoades & Eisenberger, 2002), with the exception of the study by Barnes et al., (2013), the relationship between POS and PTSD symptoms has not yet been systematically examined. PTSD symptoms are a particularly relevant concern for employees in high-risk occupations. Given that POS is associated with overall improvements in work climate and well-being, POS should also create conditions that would help reduce the number of PTSD symptoms reported by employees in high-risk occupations. The military represents one high-risk occupational context that exemplifies the importance of POS in reducing PTSD symptoms.

Perceived organizational support (POS) is defined as the belief employees have that their “organization values [their] contributions and cares about their well-being” (Eisenberger, Huntington, Hutchison, & Sowa, 1986, p. 501). POS encompasses how committed an organization is to the employees and how committed an employee is to an organization (Eisenberger et al., 1986). The current study uses a longitudinal design and military personnel to investigate the relationships among POS, the stigma of treatmentseeking for psychological problems, and posttraumatic stress disorder (PTSD) symptoms. POS has been positively correlated with various organizational variables, including work attendance (Eisenberger et al., 1986), job performance (Eisenberger, Fasolo, & Davis-LaMastro, 1990), and job satisfaction (Eisenberger, Cummings, Armeli & Lynch, 1997). POS has also been positively associated with organizational citizenship behaviors (OCBs; Shore & Wayne, 1993) and affective commitment, defined as the extent to which an employee wants to

This article was published Online First December 23, 2013. Christie L. Kelley and Thomas W. Britt, Department of Psychology, Clemson University; Amy B. Adler, US Army Medical Research Unit Europe, Walter Reed Army Institute of Research; Paul D. Bliese, Department of Military Psychiatry, Walter Reed Army Institute of Research. The authors thank Shawn Abrahamson, Rachel Eckford, Paul Kim, Robert Klocko, Matthew McGinnis, Christina O’Neill, Angela Salvi, Steven Terry, Allison Whitt, Lisa Williams, Michael Wood, and Kathleen Wright for their work on the study. The views expressed in this article are those of the authors and do not necessarily represent the official policy or position of the U.S. Army Medical Command or the Department of Defense. Correspondence concerning this article should be addressed to Christie L. Kelley, 4631 1/2 Clarissa Avenue, Los Angeles, CA 90027. E-mail: [email protected] 229

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Numerous studies have documented the relationship between combat deployments and symptoms of PTSD. Studies have estimated that between 12% and 20% of U.S. combat soldiers returning from Operation Iraqi Freedom meet the criteria for PTSD (Hoge et al., 2004). More recently, Thomas et al. (2010) examined a sample of Active Components and National Guard infantry brigade combat teams and found that between 8.5% and 14.0% reported significant levels of PTSD 3 and 12 months after returning from deployment. Thomas et al. (2010) also found that between 23.2% and 31.1% of the sample experienced some functional impairment due to PTSD. PTSD has been shown to negatively affect everyday functioning and has been related to decreased well-being, quality of life, and psychosocial adjustment (American Psychiatric Association, 2000; Schonfeld et al., 1997). According to Renshaw, Rodrigues, and Jones (2009), combat-related PTSD has also been linked to decreased marital satisfaction. Although PTSD symptoms are associated with interpersonal distress and other health problems, many combat veterans with PTSD symptoms do not seek the treatment they need; Kolkow, Spira, Morse, and Grieger (2007) suggest that the stigma of seeking treatment for psychological problems may be largely responsible. Occupationally related stigma is important because it can prevent employees from seeking mental health services if they are concerned about the judgment of their coworkers and supervisors. By impeding employees from getting professional help, stigma may keep problems, such as PTSD symptoms, from being addressed (e.g., Couture & Penn, 2003; Holmes & River, 1998). The degree to which stigma occurs in an occupational environment is likely to reflect the degree to which the occupational environment is supportive overall (Britt & McFadden, 2012). Indeed, POS should help create a positive work climate in which employees and supervisors feel they can turn to one another for help, suggesting that stigma levels should be low in high POS environments. The stigma of seeking treatment for psychological problems in the military has been documented in several studies. Britt (2000) found that service members deployed on a peacekeeping mission believed that disclosing a psychological problem was significantly more stigmatizing than disclosing a medical problem. Soldiers reported that if they disclosed a psychological problem it would negatively affect their career and were also less likely to indicate that they would follow through with a referral for psychological problems. Hoge et al. (2004) also found that many U.S. soldiers returning from Iraq and Afghanistan did not want to receive help because they believed they would be seen as weak and treated differently by unit leadership. Soldiers also worried that members of their unit would lose confidence in them and that leadership would blame them for the psychological problem if they sought treatment. In addition to the implication of stigma for treatment seeking, prior researchers also found that reports of stigma are greater among military personnel who meet screening criteria for various mental health problems (Hoge et al., 2004) and who score higher on measures of depression and PTSD (Britt et al., 2008). With longitudinal designs, it is possible to examine whether perceptions of stigma predict future mental health symptoms or whether those with mental health symptoms perceive more stigma (GreeneShortridge, Britt, & Castro, 2007). Wright and Britt (2013) recently examined the relationship between stigma and mental health symptoms over a 2-month time period and found that perceptions

of stigma at Time 1 predicted a change in mental health symptoms (PTSD symptoms, depression, suicidal ideation) over the time period, but that mental health symptoms did not predict a change in perceptions of stigma across the same time period. These results suggest that perceiving stigma can exacerbate mental health symptoms among soldiers after a deployment. Despite the research connecting stigma to undesirable outcomes, relatively little research has examined how organizations such as the military might contribute to reducing stigma-related concerns. In one of the early studies examining the relationship between organizational variables and stigma, Britt, Greene, Castro, and Hoge (2006) found that quality of leadership and the existence of a family-friendly unit climate were negatively related to the stigma of seeking treatment for psychological problems. Likewise, Wright et al. (2009) found that ratings of officer leadership were negatively associated with perceptions of stigma associated with the receipt of mental health treatment. In another study, Britt, Wright, and Moore (2012) examined active-duty soldiers from a brigade combat team that returned from a 15-month deployment in Afghanistan. The authors found that positive and negative noncommissioned officer (NCO) and officer leader behaviors predicted overall stigma and barriers to care. Although leadership is integrally related to overall perceptions of organizational support, POS reflects a larger relationship between the organization and the employee. POS is a reciprocal social exchange relationship between the employer and employee focusing on the quality of the relationship (Cropanzano & Mitchell, 2005). For example, when an employer is supportive, employees are more likely to reciprocate by decreasing deleterious work behaviors (Cropanzano & Mitchell, 2005). Utilizing the norm of reciprocity and its application to organizations, Eisenberger et al. (1986) provided the initial theoretical background for POS. Eisenberger et al. (1986) defined POS as “the perception that the organization values [the employees’] contributions and cares about their well-being” (p. 501). Employees create global beliefs about an organization that describe how willing the organization is as a whole to distribute rewards. The global beliefs formed by employees include how committed an organization is to the employees in addition to the employees’ commitment to an organization (Eisenberger et al., 1986). An environment in which the organization cares about the well-being of the employees should be associated with decreased psychological symptoms. Employees may report fewer symptoms of PTSD if they feel supported by their organization. For example, Maguen, Vogt, King, and Litz (2006) suggested that to overcome trauma, a support system is necessary. Pietrzak et al. (2010) also distinguished between types of support and suggested that unit member support and social support are negatively related to symptoms of PTSD. Similar to unit support and leadership (e.g., Adler, Vaitkus, & Martin, 1996; Britt, Davison, Bliese, & Castro, 2004; Solomon, Mikulincer, & Hobfoll, 1986), POS should be associated with fewer PTSD symptoms after occupationally related potentially traumatic events. Furthermore, POS may work indirectly through stigma to decrease psychological symptoms if the associated reduction in stigma enhances the psychological health of employees. For example, in a qualitative study, Ellison et al. (2003) found that when choosing to disclose a psychological problem in the workplace, a few people specifically stated that they disclosed their problem

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PERCEIVED ORGANIZATIONAL SUPPORT, STIGMA, AND PTSD

because of a supportive work environment (i.e., high POS). As discussed earlier, Wright and Britt (2013) also found that perceptions of stigma predicted a change in mental health symptoms over time. The current study uses a longitudinal design to examine whether POS at Time 1 is prospectively related to symptoms of PTSD at Time 2 and whether the stigma of seeking treatment for psychological problems is a mediator of the relationship. The sample included U.S. soldiers who had returned from a combat deployment. The hypothesized mediated relationship was tested for the overall sample and for soldiers who indicated they had a stress or emotional problem at Time 1. This subsample was selected for analysis given that prior authors have argued that the stigma of seeking treatment for psychological problems should be especially relevant for those individuals who believe they have a mental health problem (Greene-Shortridge et al., 2007).

Method Participants and Procedure The participants were active-duty U.S. soldiers (N ⫽ 636) in a brigade combat team who had recently returned from a 15-month combat deployment in Iraq. These soldiers represented various occupational specialties. The soldiers in the present sample were deployed to Iraq from August 2006 through November 2007. During this time period, the United States committed a surge of troops to address increased insurgent attacks. Britt, Adler, Bliese, and Moore (2013) found that this sample of soldiers had reported an average of 13 combat experiences, ranging from receiving small-arms fire and rocket attacks to seeing dead bodies and human remains. Given the number of potentially traumatic events experienced by soldiers, we expected reports of PTSD symptoms after the deployment. Among the 1,658 soldiers who completed the Time 1 survey, 636 soldiers completed the Time 2 survey, for a response rate of 38%. Such a response rate is not unusual in military samples (Adler et al., 2009; Britt, Adler, & Bartone, 2001) because service members frequently move to new duty stations or may not be present on the dates of testing because of numerous obligations (i.e., training and other mission-related travel). Men accounted for 96% of the sample. The breakdown for rank was 69% juniorenlisted (E1–E4), 26% NCOs (E5–E9), and 5% officers (O1–O3 and warrant officers). Of the 636 personnel in the matched sample, 310 (49%) reported having a psychological problem. For Time 1, the data were collected 4 months postdeployment during February and March 2008. The Time 2 data were collected 8 months later. Both surveys were administered on U.S. Army bases in Germany, and all participants included in the present study completed the Time 1 and Time 2 survey. Data were collected as part of a larger study on postdeployment transition (see Adler, Britt, Castro, McGurk, & Bliese, 2011).1 The study was approved by the Institutional Review Board of the Walter Reed Army Institute of Research, and 72% of 2,297 eligible participants provided their written informed consent and participated in the study.

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Measures POS. POS was assessed at Time 1 and Time 2 using a modified version of the Eisenberger et al. (1986) eight-item Survey of Perceived Organizational Support (SPOS). The modified items replaced the word “employer” with “unit.” A sample question is “My unit really cares about my well-being.” The response categories were also modified from a 7-point Likert-type scale to a 5-point Likert-type scale with 1 ⫽ strongly disagree and 5 ⫽ strongly agree. Cronbach’s ␣ for the scale in this study was .90 at Time 1 and .91 at Time 2. Psychological problems. The presence of a psychological problem was assessed at Time 1 using the question “Are you currently experiencing a stress, emotional, alcohol, or family problem related to deployment?” Respondents expressed their agreement with this item on a 4-point Likert-type scale with 1 ⫽ no, 2 ⫽ yes, mild, 3 ⫽ yes, moderate, and 4 ⫽ yes, severe. This variable was recoded into two categories (1 ⫽ yes or 0 ⫽ no) given that approximately equivalent numbers of soldiers reported no psychological problem or a psychological problem that was mild, moderate, or severe. PTSD symptoms. PTSD symptoms were assessed using the PTSD Checklist (PCL), a 17-item PTSD scale (Blanchard, JonesAlexander, Buckley, & Forneris, 1996; Weathers, Litz, Herman, Huska, & Keane, 1993). Respondents expressed their agreement with each item on a 5-point Likert-type scale with 1 ⫽ not at all and 5 ⫽ extremely. Questions referring to reactions experienced by soldiers such as “Repeated, disturbing memories, thoughts, or images of the stressful experience” were used to assess PTSD symptoms. An average of the items in this measure was used for all analyses. Cronbach’s ␣ for the scale in this study was .94 at Time 1 and .95 at Time 2. Stigma of seeking treatment for psychological problems. Stigma of seeking treatment for psychological problems was assessed using five items from Hoge et al. (2004). Participants were instructed to indicate their agreement with how much a given factor would influence their decision to seek treatment were they to develop a mental health problem. A sample item was “My unit leadership might treat me differently.” Respondents expressed their agreement with each item on a 5-point Likert-type scale ranging from 1 ⫽ strongly disagree to 5 ⫽ strongly agree. An average of the items in this measure was used for all analyses. The items were only asked at Time 1 given the focus of stigma as a predictor of mental health outcomes as compared with being an outcome of mental health problems. Cronbach’s ␣ for the scale in this study at Time 1 was .89.

Analysis Plan To test the hypotheses, a Pearson correlation was used to test for relationships between the hypothesized variables. Multiple regression was used to test whether there was a relationship among POS, the severity of PTSD symptoms, and stigma. To test the mediating 1 The measures of POS and PTSD symptoms from this larger study were used in a recently published article by Britt, Adler, Bliese, and Moore (2013), Journal of Traumatic Stress, 26, 1– 8, addressing morale as a buffer against the negative effects of combat exposure. This manuscript used POS as a control variable and did not focus on POS as a predictor of PTSD symptoms or address stigma as a mediator of that relationship.

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Table 1 Means, Standard Deviation, and Correlations of Measured Variables Variable 1. 2. 3. 4. 5.

POS T1 POS T2 PTSD T1 PTSD T2 Stigma T1

M

SD

1

4.11 3.84 1.83 1.87 2.93

1.23 1.32 .79 .87 .92

(.90) .57ⴱⴱⴱ ⫺.31ⴱⴱⴱ ⫺.28ⴱⴱⴱ ⫺.31ⴱⴱⴱ

2 (.91) ⫺.19ⴱⴱⴱ ⫺.28ⴱⴱⴱ ⫺.21ⴱⴱⴱ

3

Table 3 Stigma at Time 1 As a Mediator of the Relationship Between POS at Time 1 and PTSD Symptoms at Time 2 for all Participants 4

5

(.94) .69ⴱⴱⴱ .24ⴱⴱⴱ

(.95) .24ⴱⴱⴱ

(.89)

Note. Internal consistency reliability estimates are plotted on the diagonal. T1 ⫽ Time 1, T2 ⫽ Time 2. ⴱⴱⴱ p ⬍ .001 (two-tailed). This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Unstand. Beta Weight

Model Model 1 POS–Stigma Model 2 POS–PTSD Model 3 POS–PTSD Stigma–PTSD ⴱⴱⴱ

hypothesis, Preacher and Hayes’ (2008) SPSS Macro for Multiple Mediation was used to test the indirect effect of stigma on the POS-PTSD symptoms relationship. Furthermore, bootstrapping was used to examine the mediating relationship with 5,000 resamples. Consistent with other studies (e.g., Adler et al., 2009), rank and gender were controlled in the multiple regressions and tests of mediation.

Results Correlations Among the Measured Variables Means, standard deviations, and correlations for the measured variables at both time periods are presented in Tables 1 and 2. As hypothesized, POS at Time 1 was negatively correlated with stigma at Time 1, r ⫽ ⫺.31, p ⬍ .001. Also as hypothesized, POS was negatively correlated with PTSD symptoms at Time 1, r ⫽ ⫺.31, p ⬍ .001, and Time 2, r ⫽ ⫺.28 p ⬍ .001. Finally, as hypothesized, stigma was positively related to symptoms of PTSD at Time 1, r ⫽ .24, p ⬍ .001, and Time 2, r ⫽ .24, p ⬍ .001.

SE

df

t value

.23

.03

637

⫺8.11ⴱⴱⴱ

⫺.20

.03

639

⫺7.30ⴱⴱⴱ

⫺.16 .16

.03 .04

636 636

⫺5.74ⴱⴱⴱ 4.28ⴱⴱⴱ

.09

.08

.08

.10

.10

In terms of the full sample, POS at Time 1 was negatively related to PTSD symptoms at Time 2, t(637) ⫽ ⫺7.30, p ⬍ .001, and stigma at Time 1, t(637) ⫽ ⫺8.11, p ⬍ .001, such that participants perceiving more POS had lower ratings of PTSD symptoms and perceived less stigma. Stigma at Time 1 was also positively related to PTSD symptoms at Time 2, t(637) ⫽ 4.28, p ⬍ .001, such that those who perceived higher stigma at Time 1 also had higher self-ratings of PTSD symptoms at Time 2. The indirect effect was significant and accounted for 19% of the total effect of POS on PTSD symptoms, z ⫽ ⫺3.79, p ⬍ .001. In terms of the partial sample of only those soldiers who reported a psychological problem at Time 1, POS at Time 1 was also negatively related to PTSD symptoms at Time 2, t(256) ⫽ ⫺3.29, p ⬍ .01, and stigma at Time 1, t(256) ⫽ ⫺4.25, p ⬍ .001. Stigma at Time 1 was also positively related to PTSD symptoms at Time 2, t(256) ⫽ 2.70, p ⬍ .01. The significant indirect effect of stigma also accounted for 22% of the total effect of POS on PTSD symptoms, z ⫽ ⫺2.29, p ⬍ .05.

M

SD

1

2

3.91 3.47 2.12 2.23 3.08

1.28 1.33 .84 .91 .90

(.91) .47ⴱⴱ ⫺.29ⴱⴱ ⫺.24ⴱⴱ ⫺.27ⴱⴱ

(.89) ⫺.04 ⫺.16ⴱⴱ ⫺.16ⴱⴱ

3

(.93) .62ⴱⴱ .19ⴱⴱ

4

(.94) .19ⴱⴱ

The current study examined POS as a predictor of the stigma of seeking treatment for psychological problems and symptoms of PTSD in employees engaged in a high-risk occupation. At Time 1, perceptions of POS were negatively related to the perceived stigma of seeking treatment for psychological problems as well as symptoms of PTSD. In addition, stigma and POS at Time 1 were both

Table 4 Stigma at Time 1 As a Mediator of the Relationship Between POS at Time 1 and PTSD Symptoms at Time 2 for Participants Reporting a Problem

Table 2 Means, Standard Deviation, and Correlations of Measured Variables for Participants Reporting a Problem

POS T1 POS T2 PTSD T1 PTSD T2 Stigma T1

.09

Discussion

The results for the meditational analyses for all participants are provided in Table 3 and for participants reporting a mental health problem at Time 1 in Table 4. The control variables of rank and gender did not influence the results; therefore, they were not included in the final analyses. In both samples, the mediation hypothesis was supported such that stigma at Time 1 partially mediated the relationship between POS at Time 1 and symptoms of PTSD at Time 2.

1. 2. 3. 4. 5.

Adjusted R2

p ⬍ .001.

Mediation Analyses

Variable

R2

5

(.92)

Note. Internal consistency reliability estimates are plotted on the diagonal. T1 ⫽ Time 1, T2 ⫽ Time 2. ⴱⴱ p ⬍ .01 (two-tailed).

Model Model 1 POS–Stigma Model 2 POS–PTSD Model 3 POS–PTSD Stigma–PTSD ⴱⴱ

p ⬍ .01.

ⴱⴱⴱ

Unstand. Beta Weight

SE

df

t value

⫺.19

.04

309

⫺4.25ⴱⴱⴱ

⫺.17

.04

309

⫺4.40ⴱⴱⴱ

⫺.15 .14

.04 .06

308 308

⫺3.29ⴱⴱⴱ 2.70ⴱⴱ

p ⬍ .001.

R2

Adjusted R2

.07

.07

.06

.06

.08

.07

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PERCEIVED ORGANIZATIONAL SUPPORT, STIGMA, AND PTSD

associated with symptoms of PTSD at Time 2. The relationships among stigma, POS, and symptoms of PTSD established the conditions necessary for testing the hypothesis that stigma would mediate the relationship between POS at Time 1 and symptoms of PTSD at Time 2. The mediational analyses indicated that a significant portion of the relationship between POS and symptoms of PTSD was a function of perceived stigma. Consistent with previous research documenting that POS is positively related to mental health outcomes such as well-being and is negatively affected by heightened stress, a factor that can increase the risk of PTSD (Barnes et al., 2013; Eisenberger et al., 1986), the current study also found that this relationship extends to symptoms of PTSD. The findings showing the negative relationship between POS and stigma are also consistent with results showing that other organizational variables (e.g., perceptions of leadership) are related to reports of stigma (Britt et al., 2012; Wright et al., 2009) and suggest that a positive unit climate is related to a reduced stigma associated with seeking treatment for mental health problems. A supportive environment (i.e., high POS) may create a climate of reduced stigma in which soldiers may be comfortable addressing PTSD symptoms. Considering that stigma accounted for only 19% of the variance in the relationship between POS at Time 1 and PTSD symptoms at Time 2 (22% for the sample indicating a stress or emotional problem), it is likely that other factors affect the relationship between POS and symptoms of PTSD. One factor may be that employees feeling valued and appreciated by their employers may be enough to affect symptoms of PTSD. Furthermore, POS is related to a host of positive outcomes, such as work attendance, job performance, affective commitment, and decreased strain, and these positive outcomes may also contribute to the negative relationship between POS and symptoms of PTSD. One other mechanism that may link POS with lower reports of PTSD symptoms is that POS is theoretically derived from the norm of reciprocity, which posits that people should help those who help them (Gouldner, 1960). Thus, it could be that unit members provide one another more support in normalizing their symptoms and helping one another to manage their symptoms. Likewise, employees may be more likely to want to give back to the organization and thus may take advantage of organizational mental health resources because they want to be fit enough to help other unit members and contribute to their organization.

Limitations and Future Research The current study has a few limitations. First, the measures were all self-report, which can lead to monomethod bias; however, this is more of an issue for cross-sectional than longitudinal designs (Spector, Zapf, Chen, & Frese, 2000). One specific example was the one-item self-report measure of a psychological problem. If this item were assessed in a less subjective way, then the results may have differed. A second limitation is that although the current study used a longitudinal design, the stigma measure was not assessed at both time periods, decreasing the ability to draw causal inferences (e.g., Zapf, Dormann, & Frese, 1996). Future research should test the effect of POS and PTSD symptoms on perceptions of stigma over time and assess how it is that POS and stigma result in fewer PTSD symptoms. A third limitation is that of generalizability. It is expected that the results found in a sample of soldiers recently returned from deploy-

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ment may generalize to other high-risk occupations. However, to address this issue, future research should replicate these findings in different organizations. Likewise, future research should examine the relationship between POS and stigma as a function of the high-risk occupational environment. Given the level of threat and exposure to potentially traumatic events, this occupational context may have the potential to lead to greater tolerance for psychological reactions and less overall stigma. Employees and the organization may view these reactions as relatively normal given the occupational demands. Future research should confirm the relationship of POS, stigma, and mental health problems in other occupational contexts. It may be that the relationship among POS, stigma, and mental health will not be found in low-risk occupational contexts. Follow-up studies should also expand the scope of psychological problems examined. PTSD symptoms were a key variable in this study because they are a prevalent concern in soldiers returning from a combat deployment and because there is a lack of research connecting POS with PTSD symptoms. However, other mental health outcomes that are associated with high-risk occupations should also be examined, such as alcohol problems, aggression, or depression. Focusing on these job-relevant psychological problems may expand the understanding of how POS, stigma, and psychological problems affect one another. Organizations may want to consider POS when attempting to decrease symptoms of PTSD and stigma associated with seeking treatment for psychological problems. Promoting a healthy work environment through POS may help decrease stigma and PTSD symptoms. These findings provide support for targeting positive and supportive organizational attitudes and behaviors into leadership training, policies, and early intervention programs designed to increase mental health in the workplace, particularly for high-risk occupations.

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Received March 9, 2013 Revision received August 20, 2013 Accepted September 4, 2013 䡲