Development and Validation of a Brief Warzone Stressor Exposure Index

Existing scales mainly focus on danger-based threats of death and bodily harm to assess exposure to traumatic events in war zone. However, major provocations and transgression of deeply held values and moral beliefs, as well as witnessing the suffering of others can be as traumatic as fear-inducing danger-based events. This raises the need for scales that assess both danger- and nondanger-based events among soldiers operating in modern war zones. Norwegian military personnel deployed to Afghanistan between late 2001 and end of 2020 were invited to participate in a cross-sectional survey with a final sample size of 6,205 (males: n = 5,693; 91.7%; mean age = 41.93 years). We applied data reduction techniques (e.g., exploratory factor analysis, EFA, and exploratory graph analysis, EGA, through a community detection algorithm) to develop a 12-item, three-factor model (personal threat, traumatic witnessing, and moral injury) of the Warzone Stressor Exposure Index (WarZEI). Confirmatory factor analysis showed support for the factor model, with evidence of concurrent, discriminant, and incremental validity. These results indicate the WarZEI is a reliable and valid measure for assessing exposure to warzone stressors that allows for heterogeneity and the multidimensional nature of exposure to warzone stressors.