for WIZARD KIM: Review Paper—Topic Proposal & Reference Page
eldrba
out12.pdf
CLINICAL RESEARCH ARTICLE
Personal values in soldiers after military deployment: associations with mental health and resilience
Peter Zimmermann1*, Susanne Firnkes2, Jens T. Kowalski1, Johannes Backus2, Stefan Siegel1, Gerd Willmund1 and Andreas Maercker3
1German Armed Forces Center for Military Mental Health, Berlin, Germany; 2German Armed Forces 1st Army Division, Hannover, Germany; 3Institute of Clinical Psychology, Psychopathology and Clinical Intervention, University of Zürich, Zürich, Switzerland
Background: After military deployment, soldiers are at an increased risk of developing posttraumatic psychiatric disorders. The correlation of personal values with symptoms, however, has not yet been examined
within a military context.
Method: Schwartz’s Portrait Values Questionnaire (PVQ), the Posttraumatic Stress Diagnostic Scale (PDS), and the 11-item version of the Resilience Scale (RS-11) were completed by 117 soldiers of the German Armed
Forces who had recently been deployed to Afghanistan (n �40 undergoing initial psychiatric treatment, n �77 untreated). Results: Logistic regression showed that the value types of hedonism ( �), power ( �), tradition (�), and universalism (�) were significantly correlated with the probability and severity of PTSD and whether the participant was in treatment or not. The effects were partially mediated by the RS-11 scale values.
Conclusions: Value types seem to be associated with psychiatric symptoms in soldiers after deployment. These results could contribute to the further development of therapeutic approaches.
Keywords: Beliefs/values; war; logistic regression; treatment readiness; active duty soldiers
Responsible Editor: Rita Rosner, KU Eichstaett-Ingolstadt, Germany.
*Correspondence to: Peter Zimmermann, Bundeswehrkrankenhaus, Abt. VIB Psychotraumazentrum,
Scharnhorststr. 13, 10115 Berlin, Germany, Email: [email protected]
For the abstract or full text in other languages, please see Supplementary files under Article Tools online
Received: 29 September 2013; Revised: 4 April 2014; Accepted: 8 April 2014; Published: 5 May 2014
I n recent years, German Armed Forces (Bundeswehr)
soldiers have increasingly sought treatment in
Bundeswehr hospitals for deployment-related psy-
chiatric disorders. The most common diagnosis is post-
traumatic stress disorder (PTSD) (Kowalski et al., 2012;
Zimmermann, Hahne, & Ströhle, 2009). There is also
an increased risk for other symptoms in the military,
such as alcohol dependence or anxiety (Wittchen et al.,
2012). The probability of developing a certain disorder
and the severity of symptoms depend on the distribution
of individual risk and resilience factors as well as on the
distribution of stressful experiences during deployment,
which have shown to have discriminant validity when
it comes to symptoms (Dias, Sales, Cardoso & Kleber,
2014; Pietrzak, Whealin, Stotzer, Goldstein, & Southwick,
2011).
Risk and resilience factors can include characteristics
of the values and norms of traumatized persons (Litz
et al., 2009; Siegel & Zimmermann, 2010), although this
dimension has not yet been included as complementary
diagnostic criteria for PTSD in either the ICD-10 or the
DSM-V.
Research on this topic has been very limited. Thus far,
studies have focused on associations between posttrau-
matic symptoms and personal values in victims of crime
and people with adjustment disorders following critical
life events. The results have shown intercultural variations
(Maercker et al., 2009; Müller, Forstmeier, Wagner, &
Maercker, 2011). Additional data are available on the
impact of values on addictions (Dollinger & Kobayashi,
2003; Galdós & Sánchez, 2010).
No empirical studies on personal value orientations
and psychiatric symptoms have been conducted within
the military, even though the well-defined and time-
limited stressors of out-of-area deployment provide ideal
scientific conditions.
The small number of available studies is surprising,
considering that the concepts of individual values and
PSYCHOTRAUMATOLOGY EUROPEAN JOURNAL OF
�
European Journal of Psychotraumatology 2014. # 2014 Peter Zimmermann et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 Unported (CC-BY 4.0) License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
1
Citation: European Journal of Psychotraumatology 2014, 5: 22939 - http://dx.doi.org/10.3402/ejpt.v5.22939 (page number not for citation purpose)
their effects on attitudes and behavioral patterns have
been a matter of scientific interest since the 1950s
(Kluckhohn, 1951; Rokeach, 1973). Existing approaches
have gained new impulses from Schwartz’s work and
from his ‘‘Theory of Basic Human Values’’ (Schwartz,
1992). Schwartz described values as: ‘‘desirable, trans-
situational goals, varying in importance, that serve as
guiding principles in the life of a person or other social
entity.’’ On the basis of associated motivational goals, he
defined 10 interrelated value types (Table 1). These values
feature either corresponding or contradictory motiva-
tions that are connected with specific consequences for
activities. Interest in change and new experiences, which
is an aspect of the ‘‘stimulation (ST)’’ value, will most
likely not go hand in hand with ‘‘tradition (TR)’’ and
its associated interest in conservation of customs and
habits. ‘‘Conformity’’ and ‘‘TR,’’ in contrast, both lead to
an increased desire to fulfill external expectations. Such
considerations have led to a circumplex model of values,
representing a motivational continuum (Fig. 1) in which
adjacent values are similar, while opposite values tend to
contrast each other (Hinz, Brähler, Schmidt, & Albani,
2005).
More than 200 studies in 60 countries have confirmed
the 10 value types and their circumplex structure
(Schwartz et al., 2001). There have also been several
approaches in which individual values have been
grouped. Schwartz had already divided the values into
four second-order value types (Fig. 1): openness to
change; self-enhancement; self-transcendence; and con-
servation (Schwartz, 2003). Maercker suggested dif-
ferentiating between ‘‘traditional’’ and ‘‘modern’’ values
and found discriminant validity for both groups in the
severity of symptoms of PTSD (Maercker et al., 2009;
Müller et al., 2011).
Genetic and environmental factors have been identified
in the development of different values. The question
of whether values represent a time-stable disposition to
personality structures or whether they are subject to
environmental influences, such as military deployments,
has not been finally answered, however (Schermer,
Feather, Zhu, & Martin, 2008). The test�retest stability of value assessment has generally been high in recent
studies but has also shown a sensitivity to life events that
has had a limited yet significant impact on value changes.
This effect has been greater than the impact of age (Bardi,
Lee, Hofmann-Towfigh & Soutar, 2009).
The availability and acceptance of social support as
well as the capability or willingness to articulate emotions
or talk about symptoms could be possible links between
values and the development of psychiatric symptoms,
such as adjustment disorders, grief reactions, and PTSD
(Brewin, Andrews, & Valentine, 2000; Maercker et al.,
2009; Müller et al., 2011).
Furthermore, personal resilience, which has been
examined in recent studies as a moderating variable for
mental health in the military and in civilian life, might
also be associated with values in this regard (Maercker,
Gäbler, Schützwohl, O’Neil, & Müller, 2013; Sleijpen,
June ter Heide, Mooren, Boeije, & Kleber, 2013; Streb,
Häller, & Michael, 2013). According to Werner (1993,
2012) as well Noeker and Petermann (2008), resilient
Table 1. Definition and scale means (M) of value types
Universalism
M: 2.96 (0.88)
Understanding, appreciation, tolerance, and
protection for the welfare of other people
Benevolence
M: 3.66 (0.69)
Preservation and enhancement of the welfare
of people with whom one is in frequent
personal contact
Conformity
M: 3.28 (0.82)
Restraint of actions, inclinations, and impulses
likely to upset or harm others and violate
social expectations or norms
Tradition
M: 2.38 (0.72)
Respect, commitment, and acceptance of
customs and ideas that traditional culture or
religion provide the self
Security
M: 3.35 (0.85)
Safety, harmony and stability of society, of
relationships and of self
Power
M: 2.57 (1.05)
Social status and prestige, control or
dominance over people, and resources
Achievement
M: 3.16 (1.06)
Personal success through demonstrating
competence according to social standards
Hedonism
M: 3.27 (1.09)
Pleasure and sensuous gratification for
oneself
Stimulation
M: 2.77 (1.07)
Excitement, novelty, and challenge in life
Self-Direction
M: 3.63 (0.73)
Independent thought and action; choosing,
creating, exploring
Note. Adapted from the basic human values theory by Schwartz et al. (2001). M, mean values of the value types in the sample and
(Standard Deviation).
Fig. 1. Circumplex structure of personal values based on
Schwartz et al., 2001.
Peter Zimmermann et al.
2 (page number not for citation purpose)
Citation: European Journal of Psychotraumatology 2014, 5: 22939 - http://dx.doi.org/10.3402/ejpt.v5.22939
people are able to adapt to adverse, often traumatic
environments, resulting in healthy long-term psychologi-
cal functioning and better developmental outcomes.
Resilience is enhanced by adaptive systems on four dif-
ferent levels: personal competencies (coping strategies,
self-regulation, motivation, learning); family systems
(attachment, parent�child interaction, parenting); re- sources of social networks (school, peers); and society
and culture (norms, values) (Hampel & Petermann,
2006).
Outside the military, personal values have started to be
integrated into psychotherapeutic methods over the last
few years, and study results have also provided insight
into the role of values in the development of diseases.
Fegg et al. (2010) were able to strengthen personal values
in clinical patients with carcinoma, who subsequently
reported an increased sense of meaning in life and quality
of life. Additional findings have suggested that a value-
based psychotherapeutic approach could facilitate the
development of emotional self-regulation (Fujita & Han,
2009).
Within the Bundeswehr, efforts have recently been
made to incorporate changes in values and feelings of
guilt and shame into traumatherapeutic methods. Pilot
studies have indicated that, for patients with deployment
experience, behavioral group therapy seems to be an
appropriate setting in which to address these complex
issues because group coherence makes it easier to
verbalize and endure associated emotions (Alliger-Horn
& Zimmermann, 2010).
A prerequisite for any treatment, however, is the
interest of soldiers in receiving help, which seems to be
dependent on attitudes toward mental health services
and unit stigma (Brown, Creel, Engel, Herell, & Hoge,
2011). These factors might also be dependent on personal
values. The issue is especially relevant since a recent study
has shown that only 50% of interviewed German soldiers
were seeking any sort of counseling for PTSD after de-
ployment to Afghanistan and only 20% were in psychia-
tric treatment (Wittchen et al., 2012).
Therefore, the aim of this study was to determine
characteristic value types in Bundeswehr soldiers after
deployment to Afghanistan and their correlation with the
prevalence and severity of PTSD and on the willingness
of soldiers to undergo treatment. Based on the small
amount of existing data, it was hypothesized that certain
value types would be associated with decreased (modern
values) or increased (traditional values) frequency and
symptom severity of PTSD in soldiers after deployment.
Values are part of the resilience construct and thus
resilience might be a mediating variable to explain the
associations. A mediation analysis should be performed
separately for prevalence and severity of PTSD as both
dimensions might lead to different views on the planning
of therapeutic resources and processes. As values are
also connected to perceived social support and fear of
stigma, they might be predictors of interest in psychiatric
treatment.
Method
Participants The participants in this study were 117 Bundeswehr
soldiers who had returned from their deployment to
Afghanistan within the previous 12 months. Power
analyses had revealed that 120 participants would be
necessary in a multiple linear regression analysis [severity
of PTSD] to reach an effect size of f �0.4 (large effect, Cohen’s f2 �0.167) with a probability of 97%. This calculation was based on the hypothesis that three values
would be identified as a predictor to increase the explana-
tory power of the model by 10% in addition to the RS-11
(30%). Nine women and 108 men with an average age
of 28.8 years (SD �6.8) participated. Of those 117 soldiers, 77 had not undergone psychiatric treatment since
their return. Forty participants were assessed at the very
beginning of outpatient or inpatient treatment for deploy-
ment-related mental illness at the Bundeswehr hospital
in Berlin. PTSD was the primary diagnosis in 24 subjects,
while a further six were diagnosed with adjustment
disorder, five with depression, two with addictive disorders
and three with other psychiatric illness.
Instruments and procedures The participants completed the Portrait Values Ques-
tionnaire (PVQ) (according to Schwartz, 2003; Schwartz
et al., 2001), the Posttraumatic Stress Diagnostic Scale
(PDS) (Foa, Cashman, Jaycox, & Perry, 1997), and the
11-item German version of the Resilience Scale (RS-
11) (Wagnild & Young, 1993). The questions asked in
the testing sessions covered the 4 weeks preceding the
evaluation.
The primary diagnoses of the clinical patients were
based on clinical interviews with medical doctors or
clinical psychologists with at least 5 years of training in
clinical psychiatry in accordance with the WHO Interna-
tional Classification of Diseases, tenth edition (ICD-10).
The diagnoses were re-evaluated and confirmed by two
study researchers based on the patient charts. As some
of the first study participants expressed concerns that
they might be recognizable by their answers, detailed
socio-biographical information, such as rank, unit and
education, was no longer collected in order to prevent
aggravation or dissimulation of symptoms. Types of
trauma exposure were also not determined in this study.
In 40 items, the PVQ (Schwartz et al., 2001, 2003)
measures the degree to which each one of 10 basic values
(Table 1) is present, with two to six items attributed to
each value type. In two sentences each, these items briefly
portray a fictional person and outline a perception or
Personal values in soldiers after deployment
Citation: European Journal of Psychotraumatology 2014, 5: 22939 - http://dx.doi.org/10.3402/ejpt.v5.22939 3 (page number not for citation purpose)
action that is associated with a particular value. Respon-
dents can rate their similarity to the person described on
a scale from 1 (not similar at all) to 6 (very similar). The
responses to the portraits of each value type are averaged.
The PVQ attained a Cronbach’s alpha of 0.55 (median of
the value scales) in the validation studies (Schwartz, 2003;
Schwartz et al., 2001), in other investigations it reached
0.70�0.74 (Maercker et al., 2009). In this study sample, the median Cronbach’s alpha was 0.54 (median of the
value scales). It was used despite this low level because
most of the subscales showed acceptable or good values.
Test�retest reliability fell in the range of 0.66�0.88. Pearson’s correlation between Schwartz Value Survey
(SVS) and PVQ was 0.95 (pB0.001).
The PDS was developed by Foa in the early 1990s as
a screening instrument for diagnosing PTSD with high
specificity (82% consistency with the Structured Clinical
Interview of Diagnoses (SCID) diagnostic interview for
the Diagnostic and Statistical Manual of Diseases (DSM)).
The cut-off for detecting PTSD used in this study was
27 on the global score. The severity of symptoms is mea-
sured both in an overall score as well as in subscores
relating to the symptom clusters of intrusion, hyperar-
ousal, and avoidance. In evaluation studies, it yielded
satisfactory results in terms of test quality with a
Cronbach’s alpha of 0.92 and a test�retest reliability of kappa �0.74 (Foa et al., 1997).
The 11-item version of the RS by Wagnild and Young
(1993) was translated into German in 2004 (RS-11).
The original version with 25 items included two subscales
that covered the fields of ‘‘Personal Competence’’ (self-
reliance, independence, mastery, resourcefulness, perse-
verance) and ‘‘Acceptance of Self and Life’’ (adaptability,
tolerance, a flexible perception of the self, and life). In
the German short version, these items were condensed into
11 items in a unidimensional model without loss of validity
(Schumacher, Leppert, Gunzelmann, Strauß, & Brähler,
2004). Evaluation by means of a population-based sample
(N �2,031) showed item-total correlations ranging from ris �0.50 to 0.75 and good internal consistency, with a Cronbach’s alpha of 0.91 (Schumacher et al., 2004).
Statistical analysis Schwartz’s 10 value types were the primary explanatory
variables of the study. The normal distribution assump-
tion had to be confirmed before parametric evaluation
methods could be applied. The Kolmogorov-Smirnov test
did not show any abnormalities in the residuals of the
10 value types (i.e., after deduction of the group average
values); it only revealed significant scores for self-direction
(SD) and universalism (UN) (p �0.022 and 0.032, res- pectively), which implied a possible non-normal distribu-
tion. Deviation from normal distribution, however, was
not high, so normal distribution was assumed for all of
the value types in the following analysis.
Multiple logistic regression was performed in the
whole sample (including both treatment and non-treat-
ment groups) with the response variable of presence of
PTSD in the PDS scale, while multiple linear regression
was performed with the response variable of PTSD
severity. Value types, RS-11 total score, age, and sex
were explanatory variables. In a step-by-step approach,
value types (in the order of their predictive value) and
RS-11 total score were successively incorporated into the
model. Afterwards a mediation analysis was performed
with the RS-11 sum scale values as mediator and value
types as predictor. Standardization followed MacKinnon
and Dwyer (1993). For indirect effects the Sobel test was
used.
The average age of the group that underwent treatment
differed significantly from that of the group that did not
undergo treatment (t(115) �3.21; p �0.002). In addition, age had a significant impact on the soldiers’ attitudes
towards ST, UN, benevolence (BE) and security (SE).
As a consequence, age had to be controlled for in the
main evaluations. The results were also controlled for sex.
Multivariate analysis of variance was performed to
compare the treatment group and the non-treatment
group.
All of the participants provided informed consent.
The study was approved by the ethics committee of the
Charité University Berlin (no. EA1/203/13).
Results The predominant value types of the whole sample
were BE (M �3.66), SD (M �3.63), SE (M �3.35), conformity (M �3.28), and hedonism (HE) (M �3.27) (Table 1).
Table 2 shows the Pearson correlations between the
value types and age, resilience and PTSD severity.
Table 2. Correlations between value types and age, resilience
and PTSD severity
Value type Age RS-11 PTSD severity
UN 0.24** 0.13 0.08
BE 0.26** 0.03 .09
CO 0.17 0.08 0.10
TR 0.17 �.04 0.16
SE 0.27** 0.12 0.07
PO �0.03 0.34** �0.26**
AC �0.07 0.32** �0.19*
HE �0.18 0.43** �0.43**
ST �0.33** 0.30** �0.25**
SD 0.11 0.40** �0.00
Note. Pearson coefficient; *pB0.05; **pB0.01. UN, universalism;
BE, benevolence; CO, conformity; TR, tradition; SE, security; PO, power; AC, achievement; HE, hedonism; ST, stimulation; SD,
self-direction.
Peter Zimmermann et al.
4 (page number not for citation purpose)
Citation: European Journal of Psychotraumatology 2014, 5: 22939 - http://dx.doi.org/10.3402/ejpt.v5.22939
The regression model used to predict the probability
of PTSD, developed from the value types while taking
into account age and sex (Table 3), showed power (PO),
HE (both negative ( �) correlation), and UN (positive (�) correlation) to have significant effects. This model classified 83.5% of the subjects correctly as to the
presence of PTSD. The variables UN and TR showed a
strong correlation (Pearson’s r �0.60, pB0.001). In fact, TR could have replaced UN in the model without
a significant decrease in the quality of the model. If
both UN and TR were included in the model at the same
time, however, neither was significant.
If the RS-11 was included in the model, HE was no
longer significant but UN (�) and power ( �) remained significant. A total of 86.2% of the subjects were correctly
classified, thus making the model that takes resilience
into account better than the one that did not include
RS-11.
A mediation analysis (Baron & Kenny, 1986;
MacKinnon & Dwyer, 1993) with UN, PO, and HE
as predictors and resilience as mediator (controlled for
age and sex) showed that the effect of UN on PTSD
probability was mostly direct, the correlation of PO was
roughly two thirds direct, while the one of HE was
equal parts directly and indirectly (Table 4).
The severity of PTSD (Table 5) was significantly
correlated with HE ( �). With RS-11 included in the model, the significance of HE was retained, with an
additional significant effect of SD (�). Again, the explanatory power of the model was increased by the
inclusion of resilience.
Mediation analysis showed that the effect of HE on
PTSD severity was almost equal parts direct and indirect,
while the effect of SD was inconsistent: direct and indirect
effects operated in opposite directions (Table 6).
The differences in value orientations established be-
tween the group receiving initial treatment and the
untreated group were, on the whole, significant (Pillai’s
trace: F(10.104) �2.72; p �0.005; controlled for age/sex). The two groups also differed significantly in resilience
scores on the RS-11 scale, with the group not in therapy
achieving a higher score (M �63.52; SD �7.47) than the therapy group at the beginning of treatment (M �50.51; SD �12.87; t(114) �6.88; pB0.001). Differences be- tween the groups (after correction of the significance
level for 10 post-hoc tests to pB0.005) were particularly
significant for the value types of power (PO) and HE. The
group that did not receive treatment achieved higher
scores for these values than the group that did (Table 7).
Discussion The objective of this study was to describe the value types
of Bundeswehr soldiers after deployment to Afghanistan
and to identify associations with the probability and
severity of posttraumatic stress as well as with psychiatric
treatment readiness. Given the cross-sectional design of
the study, the results must be interpreted with caution,
but there are currently no empirical studies in which
value types and their relationships with mental health
were evaluated in a military context.
The predominant value types of this sample were,
starting with the highest mean rating, BE, SD, SE,Table 3. Regression model for probability of PTSD
Variable R OR p
Results without RS-11 (Cox-Snell-r2 �0.235)
Universalism (UN) 0.84 2.32 0.024
Power (PO) �0.66 0.52 0.029
Hedonism (HE) �0.72 0.48 0.010
Results incl. RS-11 (Cox-Snell-r2 �0.338)
RS-11 �0.12 0.89 B0.001
Universalism (UN) 1.09 2.97 0.014
Power (PO) �0.62 0.54 0.046
Note. Values controlled for age and sex (both always n.s.; not
shown). OR, odds ratio; R, regression coefficient.
Table 4. Results of mediation analysis for probability of
PTSD
Variable
Direct
effect
Predictor
on mediator
Indirect
effect
Total
effect
Universalism (UN) 1.13 0.37 �0.04 0.84
(standardized) 0.42 �0.01 0.36
(p�0.012) (p�0.760) (p�0.760) (p�0.024)
Power (PO) �0.49 2.20 �0.25 �0.66
(standardized) �0.18 �0.09 �0.29
(p�0.135) (p�0.037) (p�0.067) (p�0.029)
Hedonism (HE) �0.40 3.78 �0.42 �0.72
(standardized) �0.150 �0.16 �0.31
(p�0.191) (p�0.001) (p�0.009) (p�0.010)
Note. Mediator: RS-11; effect of mediator on outcome: �0.112; standardized: �0.042; pB0.001; values controlled for age and sex (both always n.s.; not shown); standardization after MacKinnon & Dwyer, 1993; Sobel test used for indirect effects.
Table 5. Regression model for severity of PTSD
Variable R T p
Results without RS-11 (r2 �0.20)
Hedonism (HE) �0.32 �4.56 B0.001
Results incl. RS-11 (r2 �0.43)
RS-11 �0.04 �6.17 B0.001
Hedonism (HE) �0.21 �3.13 0.002
Self-direction (SD) 0.33 3.39 0.001
Note. Values controlled for age and sex (both always n.s.; not shown). R, regression coefficient.
Personal values in soldiers after deployment
Citation: European Journal of Psychotraumatology 2014, 5: 22939 - http://dx.doi.org/10.3402/ejpt.v5.22939 5 (page number not for citation purpose)
conformity, and HE (Table 1). A telephone survey of
1,078 participants randomly selected from the German
adult population showed different priorities: SD, UN,
BE, SE, and HE (Schoen, 2009).
Thus, the results suggest differences in value orien-
tations of soldiers compared to the general population.
It remains unclear, however, if the differences are due to
Bundeswehr recruitment processes, to military socializa-
tion or to deployment-related experiences. This requires
further study.
HE was negatively correlated with the probability and
severity of PTSD in the analysis of the complete study
sample. Similarly, power (PO) was negatively correlated
with the probability of PTSD. As expected, TR and UN,
which lie opposite to HE and power in the circular
structure of Schwartz’s value model, had a contrary effect
on probability.
Overall, values were weaker than resilience in multi-
variate prediction of symptom probability and severity.
In the mediation analysis, the effect of UN on PTSD
probability was mostly direct, the one of PO was roughly
two thirds direct, and of HE was equal parts direct and
indirect (mediated by RS-11 scale values). The effect of
HE on PTSD severity was almost equal parts direct and
indirect, while the effect of SD was inconsistent: direct
and indirect effects operated in opposite directions.
It seems interesting that probability and severity of
PTSD were differently correlated with values. UN and
power affected probability but not severity, thus indicat-
ing that values might have specific effects in the percep-
tion of stress-related symptoms.
All in all, the results concerning SD and power have
limited value due to the low Cronbach’s alpha (both
0.54) of these subscales. By contrast, HE and UN had
acceptable or good values (0.88/0.75).
The influence of resilience on military-related or
civilian posttraumatic symptoms has been proven in
numerous studies (Maercker et al., 2013; Streb et al.,
2013). It has not yet been investigated, however, how the
concepts of values and resilience are connected. Both
could represent time-stable personality traits (Noeker &
Petermann, 2008; Werner, 2012) that are directly related.
In contrast, it can be hypothesized that values might
change due to numerous stressful or traumatic life events,
such as deployment experiences (Bardi et al., 2009;
Wittchen et al., 2012). Longitudinal studies, with mea-
surements before and after deployment, might help
clarify this question, but such studies have not been
performed to date.
The impact of values as time-stable personality traits
on mental health might be explained by subsequent
tendencies in how people address mental health issues
and how people perceive social support. In accordance
with our results, Maercker et al. (2009) found a sig-
nificant negative correlation between so-called ‘‘modern’’
values (achievement, HE, ST) and the severity of PTSD
in German victims of violence. Conversely, ‘‘traditional’’
values (conformity, BE, TR) were linked to an exacerba-
tion of symptoms. The authors explained this finding
with a perceived improvement in the social acceptance of
victimhood that is associated with these modern values,
which results in less fear of isolation and ostracism.
Other studies have described mentally ill subjects with
traditional values as feeling a stronger sense of social
ostracism and guilt about their symptoms (Bennet-
Herbert & Dunkel-Schetter, 1992). These associations
could explain our study results, too, particularly with
respect to HE and TR.
Table 6. Results of mediation analysis for severity of PTSD
Variable
Direct
effect
Predictor
on mediator
Indirect
effect
Total
effect
Hedonism (HE) �0.21 3.62 �0.15 �0.36
(p �0.002) (pB0.001) (p �0.001) (pB0.001)
Self-direction 0.33 4.37 �0.187 0.16
(SD) (p �0.001) (p �0.002) (p �0.005) (p �0.158)
Note. Mediator: RS-11; effect of mediator on outcome: �0.041; pB0.001; values controlled for age and sex (both always n.s.; not shown); Sobel test used for indirect effects.
Table 7. Value types of soldiers in psychiatric�psychother- apeutic treatment (1) and of soldiers not in any such
treatment (2)
Variable Group M SD
Adjusted for
age and sex
Universalism (UN) 1 2.86 0.917 t(113) ��0.94
2 3.15 0.789 p �0.333
Benevolence (BE) 1 3.59 0.711 t(113) ��0.78
2 3.81 0.644 p �0.439
Conformity (CO) 1 3.19 0.842 t(113) ��1.10
2 3.45 0.751 p �0.273
Tradition (TR) 1 2.29 0.725 t(113) ��1.27
2 2.55 0.701 p �0.206
Security (SE) 1 3.27 0.829 t(113) ��0.51
2 3.50 0.877 p �0.609
Power (PO) 1 2.80 0.895 t(113) �3.36
2 2.13 1.178 p �0.001
Achievement (AC) 1 3.33 0.949 t(113) �2.19
2 2.85 1.199 p �0.031
Hedonism (HE) 1 3.54 0.912 t(113) �3.48
2 2.75 1.210 p �0.001
Stimulation (ST) 1 2.98 1.025 t(113) �2.07
2 2.37 1.064 p �0.041
Self-direction (SD) 1 3.62 0.700 t(113) �0.24
2 3.64 0.792 p �0.812
Note. M, mean; SD, standard deviation.
Peter Zimmermann et al.
6 (page number not for citation purpose)
Citation: European Journal of Psychotraumatology 2014, 5: 22939 - http://dx.doi.org/10.3402/ejpt.v5.22939
The results, however, have been replicable only to a
limited extent. In an elderly Swiss population sample,
traditional values were associated with less stress result-
ing from adjustment disorders and grieving processes
(Müller et al., 2011). The inconsistency of findings was
evident in another study of 275 subjects from various
countries, in which the value types of ST and HE and,
surprisingly, BE were correlated with the perception of
better social support (Goodwin, Costa, & Adonu, 2004).
In addition, the described correlation between values
and perceived social support cannot explain why HE
and power were less pronounced in our study group
of subjects receiving psychiatric treatment. A similarly
unexpected association in a military context was reported
by Brown et al. (2011), who found that greater interest in
therapy was associated with higher fear of unit stigma.
Due to these contradictory findings, additional ratio-
nales should be discussed: it seems possible that values
like UN go hand in hand with more pronounced empathy
for the fates of others (Schwartz, 1996) and thus may lead
to an increase in suffering from posttraumatic memories
and symptoms. A common part of traumatogenic ex-
periences in a military operation is witnessing serious
harm to the civilian population but also to fellow soldiers
in the course of combat action. In a prevalence study of
the Bundeswehr (Wittchen et al., 2012), soldiers deployed
to Afghanistan in 2009/2010 reported that they saw de-
stroyed houses and villages (76.4%), encountered injured
women and children without being able to help (32%),
saw dead and injured fellow soldiers (31.3%, with 1.9%
experiencing the incident in question in close proximity),
dead bodies and body parts (29.6%) and witnessed vio-
lence among the local population (21%). A clear differ-
entiation of deployment experiences, which would have
served to correlate them to value types, was, however,
not part of this study.
The effect of power might be due to a negative
item correlation with PTSD symptoms, as feelings of
helplessness and powerlessness are part of the traumatic
experience according to DSM-IV and ICD-10 diagnostic
classifications. These topics demand further research.
There have been only a few findings that support the
hypothesis of a change in personal values due to military
deployment. In a civilian study, life events had a significant
impact on test�retest reliability of value measurement in a longitudinal assessment of an adult study population
(Bardi et al., 2009).
This concept would correspond with the results on
Posttraumatic Growth (Tedeschi & Calhoun, 2004). Post-
traumatic Growth includes five dimensions that underlie
on-going positive changes after traumatic experiences
and might show significant overlap with values: greater
appreciation of life and a changed sense of priorities,
warmer, more intimate relationships with others, greater
sense of personal strength, recognition of new possibilities
or paths for one’s life and spiritual development.
Although the questions regarding the time-stability
of values and the possible impact of external influences,
such as military deployment or therapeutic approaches,
have not yet been answered, the first clinical experiences
have been gathered based on our study results. These
experiences have suggested that interventions aimed at
UN or TR as personal values and subsequent feelings
of failure and related guilt after traumatic stress might
have relieving effects and could help patients accept
values in line with a critical but fair self-assessment.
Thus value orientations might become an important
part of psychotraumatological treatment settings in the
future (Zimmermann, Biesold, Barre, & Lanczik, 2007).
Accordingly, the affirmation of personal values in par-
ticipants of an experimental study design, using the
Trier Social Stress Test, led to a reduced stress reaction,
measured as cortisol response compared to controls
(Creswell et al., 2005).
While the lack of impact of sex on the statistical
model was expected, the results of age were surprising.
In international surveys, sex has also been found to have
little correlations with value types (Schwartz et al., 2001).
Age, however, has been shown to be significantly cor-
related with the extent to which any one value type was
pronounced (Schwartz et al., 2001). The homogenous
age structure of this sample with a low rate of female
participants might explain the differences.
Limitations This study was limited in its predictive power due to its
cross-sectional design, which did not allow us to establish
clear causal attributions of deployment-related stressors,
changes in values, and psychiatric illness. The small
sample size was another limitation. Inferences about
the prevalence of mental illness were also problematic,
as only self-report measurements were obtained and no
standardized diagnostic interviews were conducted as
part of this study, although the PDS corresponds quite
well to such interviews.
The results of this study are not readily applicable to
other subject groups, such as policemen and firefighters,
because the development of values is closely linked to the
subjects’ cultural environment, socio-demographic fac-
tors, work environment, and experiences to be processed.
Nevertheless, these occupational groups also face extreme
work-related stress and their hierarchical structures with
predominantly male staff suggest further similarities.
To our knowledge, there have not been any studies in
these populations either.
Conclusions Despite its methodological limitations, this study suggests
that there are associations between value types (especially
Personal values in soldiers after deployment
Citation: European Journal of Psychotraumatology 2014, 5: 22939 - http://dx.doi.org/10.3402/ejpt.v5.22939 7 (page number not for citation purpose)
HE, power, TR, and UN) and mental health as well as
treatment readiness in soldiers after military deployment.
Further research is required to determine other influen-
cing variables, such as perceived stigma and resilience,
and whether these results might be applicable to forces
with other types of stress, such as police forces and fire-
fighters. Such research should be longitudinal in design,
with measurements before and after deployment, and
should take the nature of stressful events experienced into
account.
As cultural aspects beyond the direct military environ-
ment might influence the development of values, other
armed forces should also conduct similar studies to allow
for comparisons. Such an international comparison could
result in additional insights into the development of
values and relevant influencing factors.
A possible suggestion based on the basis of the data
gathered here would be that addressing values could be
beneficial in clinical psychotraumatology settings in the
military work environment.
Conflict of interest and funding
There is no conflict of interest in the present study for any
of the authors.
References
Alliger-Horn, C., & Zimmermann, P. (2010). Comorbidity in
deployment-related psychiatric disorders and their treatment
with behavioural group therapy in the German Armed Forces
Hospital Berlin. Wehrmedizinische Monatsschrift, 54(6�7), 5�9. Bardi, A., Lee, J. A., Hofmann-Towfigh, N., & Soutar, G. (2009).
The structure of intraindividual value change. Journal of
Personality and Social Psychology, 97, 913�929. doi: 10.1037/ a0016617.
Baron, R. M., & Kenny, D. A. (1986). The moderator�mediator variable distinction in social psychological research: Concep-
tual, strategic and statistical considerations. Journal of Person-
ality and Social Psychology, 51, 1173�1182. Bennet-Herbert, T., & Dunkel-Schetter, C. (1992). Negative
social reactions to victims: An overview of responses and
their determinants. In L. Montada, S. H. Fillipp, & M. J.
Lerner (Eds.), Life crises and experiences of loss in adulthood
(pp. 172�181). Englewood Cliffs, NJ: Erlbaum. Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis
of risk factors for posttraumatic stress disorder in trauma-
exposed adults. Journal of Consulting and Clinical Psychology,
68(5), 748�766. Brown, M. C., Creel, A. H., Engel, C. C., Herrell, R. K., &
Hoge, C. W. (2011). Factors associated with interest in
receiving help for mental health problems in combat veterans
returning from deployment to Iraq. The Journal of Nervous
and Mental Disease, 199(10), 797�801. doi: 10.1097/NMD. 0b013e31822fc9bf.
Creswell, J. D., Welch, W. T., Taylor, S. E., Sherman, D. K.,
Gruenewald, T. L., & Mann, T. (2005). Affirmation of personal
values buffers neuroendocrine and psychological stress re-
sponses. Psychological Science, 16(11), 846�851.
Dias, A., Sales, L., Cardoso, R. M., & Kleber, R. (2014). Childhood
maltreatment in adult offspring of Portuguese war veterans
with and without PTSD. European Journal of Psychotrau-
matology, 5, 20198, doi: http://dx.doi.org/10.3402/ejpt.v5.20198
Dollinger, S. J., & Kobayashi, R. (2003). Value correlates of
collegiate alcohol abuse. Psychological Report, 93(3), 848�850. Fegg, M. J., Brandstätter, M., Kramer, M., Kögler, M., Haarmann-
Doetkotte, S. & Borasio, G. D. (2010). Meaning in life in
palliative care patients. Journal of Pain Symptom Management,
40(4), 502�509. doi: 10.1016/j.jpainsymman.2010.02.010. Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The
validation of a self-report measure of posttraumatic stress
disorder: The posttraumatic diagnostic scale. Psychological
Assessment, 9, 445�451. Fujita, K., & Han, H. A. (2009). Moving beyond deliberative
control of impulses: The effect of construal levels on evaluative
associations in self control conflicts. Psychological Science, 20,
799�804. doi: 10.1111/j.1467-9280.2009.02372.x. Galdós, J. S., & Sánchez, I. M. (2010). Relationship between cocaine
dependence treatment and personal values of openness to
change and conservation. Adicciones, 22(1), 51�58. Goodwin, R., Costa, P., & Adonu, J. (2004). Social support and
its consequences: ‘Positive’ and ‘deficiency’ values and their
implications for support and self-esteem. British Journal of
Social Psychology, 43, 465�474. Hampel, P., & Petermann, F. (2006). Perceived stress, coping, and
adjustment in adolescents. Journal of Adolescent Health, 38(4),
409�415. Hinz, A., Brähler, E., Schmidt, P., & Albani, C. (2005). Investigating
the circumplex structure of the Portrait Values Questionnaire
(PVQ). Journal of Individual Differences, 26, 185�193. doi: 10.1027/1614-0001.26.4.185.
Kluckhohn, C. (1951). Values and value-orientations in the theory
of action: An exploration in definition and classification. In T.
Parsons & E. Shils (Eds.), Towards a general theory of action
(pp. 388�433). Cambridge, MA: Harvard University Press. Kowalski, J. T., Hauffa, R., Jacobs, H., Höllmer, H., Gerber, W. D.,
& Zimmermann, P. (2012). Deployment-related stress disorder
in German soldiers: Utilization of psychiatric and psychother-
apeutic treatment. Deutsches Ärzteblatt International, 109(35� 36), 569�575. doi: 10.3238/arztebl.2012.0569.
Litz, B. T., Stein, N., Delanay, E., Lebowitz, L., Nash, W. P.,
Silve, C., et al. (2009). Moral injury and moral repair in war
veterans: A preliminary model and intervention strategy.
Clinical Psychology Review, 29, 695�706. doi: 10.1016/j.cpr. 2009.07.003.
MacKinnon, D. P., & Dwyer, J. H. (1993). Estimating mediated
effects in prevention studies. Evaluation Review, 17, 144�158. Maercker, A., Gäbler, I., O’Neil, J., Schützwohl, M., & Müller, M.
(2013). Long-term trajectories of PTSD or resilience in former
East German political prisoners. Torture, 23(1), 15�27. Maercker, A., Mohiyeddini, C., Müller, M., Xie, W., Hui Yang, Z.,
Wang, J., et al. (2009). Traditional versus modern values,
self-perceived interpersonal factors, and posttraumatic
stress in Chinese and German crime victims. Psychology and
Psychotherapy, 82(2), 219�232. doi: 10.1348/147608308X 380769.
Müller, M., Forstmeier, S., Wagner, B., & Maercker, A. (2011).
Traditional versus modern values and interpersonal factors
predicting stress response syndromes in a Swiss elderly
population. Psychology, Health and Medicine, 1�10, 631�640. doi: 10.1080/13548506.2011.564192.
Noeker, M., & Petermann, F. (2008). Resilience � functional adaptation to environmental adversity. Zeitschrift für Psychia-
trie, Psychologie und Psychotherapie, 56(4), 255�263.
Peter Zimmermann et al.
8 (page number not for citation purpose)
Citation: European Journal of Psychotraumatology 2014, 5: 22939 - http://dx.doi.org/10.3402/ejpt.v5.22939
Pietrzak, R. H., Whealin, J. M., Stotzer, R. L., Goldstein, M. B., &
Southwick, S. M. (2011). An examination of the relation
between combat experiences and combat-related posttraumatic
stress disorder in a sample of Connecticut OEF-OIF veterans.
Journal of Psychiatric Research, 45(12), 1579�1584. Rokeach, M. (1973). The nature of human values. New York: Free
Press.
Schermer, J. A., Feather, N. T., Zhu, G., & Martin, N. G. (2008).
Phenotypic, genetic, and environmental properties of the
portrait values questionnaire. Twin Research Human Genetics,
11(5), 531�537. doi: 10.1375/twin.11.5.531. Schoen, H. (2009). Basic values and attitudes toward foreign and
domestic policies in Germany. Retrieved November 15, 2013,
from http://www.uni-bamberg.de/fileadmin/uni/wissenschaft_
einricht/baces/pdf/Veroeffentlichungen_2010/Schoen_values_
attitudes.pdf
Schumacher, J., Leppert, K., Gunzelmann, T., Strauß, B., &
Brähler, E. (2004). The Resilience Scale � a questionnaire for the assessment of psychological resilience as a personality
trait. Zeitschrift für Klinische Psycholologie, Psychiatrie und
Psychotherapie, 53, 16�39. Schwartz, S. H. (1992). Universals in the content and structure of
values: Theoretical advances and empirical tests in 20 coun-
tries. In M. P. Zanna (Ed.), Advances in experimental social
psychology (pp. 79�95). New York: Academic Press. Schwartz, S. H. (1996). Value priorities and behavior: Applying
of theory of integrated value systems. In C. Seligman, J. M.
Olson, & M. P. Zanna (Eds.), The psychology of values: The
Ontario symposium (pp. 256�278). Hillsdale, NJ: Erlbaum. Schwartz, S. H. (2003). A proposal for measuring value orienta-
tions across nations. In European Social Survey (ESS) (Ed.),
Questionnaire development report (pp. 259�319) 2003. Re- trieved November 18, 2013, from http://naticent02.uuhost.uk.
uu.net/questionnaire/questionnaire_development/chapter_07.doc
Schwartz, S. H., Melech, G., Lehmann, A., Burgess, S., Harris, M.,
& Owens, V. (2001). Extending the cross-cultural validity of
the theory of basic human values with a different method
of measurement. Journal of Cross-Cultural Psychology, 32(5),
519�542.
Siegel, S., & Zimmermann, P. (2010). Moral injury in soldiers after
deployment. Wehrmedizinische Monatsschrift, 54(6�7), 1�4. Sleijpen, M., June ter Heide, F. J., Mooren, T., Boeije, H. R., &
Kleber, R. J. (2013). Bouncing forward of young refugees: A
perspective on resilience research directions. European Journal
of Psychotraumatology, 4, 20124, doi: http://dx.doi.org/10.
3402/ejpt.v5.20124
Streb, M., Häller, P., & Michael, T. (2013). PTSD in paramedics:
Resilience and sense of coherence. Behavioral Cognitive
Psychotherapy, 29, 1�12. Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth:
Conceptual foundations and empirical evidence. Psychological
Inquiry, 15(1), 1�18. Wagnild, G. M., & Young, H. M. (1993). Development and
psychometric evaluation of the Resilience Scale. Journal of
Nursing Measurement, 1, 165�178. Werner, E. E. (1993). Risk, resilience and recovery: Perspectives
from the Kauai longitudinal study. Development and
Psychopathology, 5, 503�515. Werner, E. E. (2012). Children and war: Risk, resilience, and
recovery. Deviant Psychopathology, 24(2), 553�8. Wittchen, H. U., Schönfeld, S., Kirschbaum, K., Thurau, C.,
Trautmann, S., Klotsche, R. & Zimmermann, P. (2012).
Traumatic experiences and posttraumatic stress disorder in
soldiers following deployment abroad � How big is the hidden problem? Deutsches Ärzteblatt International, 109(35�36), 559�568. doi: 10.3238/arztebl.2012.0559.
Zimmermann, P., Biesold, K. H., Barre, K., & Lanczik, M. (2007).
Long-term course of post-traumatic stress disorder in German
soldiers: Effects of inpatient eye movement desensitization
and reprocessing therapy and specific trauma characteristics in
patients with non-combat-related PTSD. Military Medicine,
172(5), 456�460. Zimmermann, P., Hahne, H. H., & Ströhle, A. (2009). Psychiatric
illness among Bundeswehr soldiers*Changes in the utilization of medical services in association with out-of-area deploy-
ments. Trauma und Gewalt, 3(4), 316�327.
Personal values in soldiers after deployment
Citation: European Journal of Psychotraumatology 2014, 5: 22939 - http://dx.doi.org/10.3402/ejpt.v5.22939 9 (page number not for citation purpose)
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
