Using the Draw-A-Story Drawing Test to Predict Perceived Stress, Military Life Adjustment, and Resilience

sustainability Article Using the Draw-a-Story Drawing Test to Predict Perceived Stress, Military Life Adjustment, and Resilience Juliet Jue 1,* and Jung-Hee Ha 2 1 Department of Art Therapy, Hanyang Cyber University, Seoul 04763, Korea 2 Graduate School of Counseling Psychology, Hanyang University, Seoul 04763, Korea; [email protected] * Correspondence: [email protected]; Tel.: +82-10-4216-0903 Abstract: In this study, we investigated how effectively a Draw-a-Story drawing test can predict the perceived stress, military life adjustment, and resilience of soldiers. A total of 276 conscripted male soldiers participated in the study. The research tools included the Perceived Stress Scale, the Military Life Adjustment Scale, the Connor–Davidson Resilience Scale (Korean version), and the Draw-a-Story drawing test. The results of the correlation and regression analyses were as follows. First, perceived stress, military life adjustment, resilience, and DAS emotional content were all mutually correlated. The DAS self-image was positively correlated only with resilience. Second, emotional content predicted soldiers’ perceived stress, military life adjustment, and resilience at significant levels. Meanwhile, our regression analysis showed that self-image did not have significant predictive power. In this paper, we discuss the implications for predictive power of our findings regarding the two measures of DAS; we also propose that DAS could serve as a tool to predict the mental states of soldiers. Citation: Jue, J.; Ha, J.-H. Using the Keywords: perceived stress; military life adjustment; resilience; Draw-a-Story; soldiers Draw-a-Story Drawing Test to Predict Perceived Stress, Military Life Adjustment, and Resilience. Sustainability 2021, 13, 7383. 1. Introduction https://doi.org/10.3390/ Drawings express the thoughts, feelings, intentions, and experiences of the people su13137383 who draw them [1]. This projective function makes drawing assessments valuable as auxiliary tools for evaluating individuals’ minds. Although issues of reliability and validity Academic Editor: Ans Vercammen persist in measuring and interpreting results [2], researchers have frequently used drawing assessments as psychological tests [3,4]. Received: 12 May 2021 Seeking to examine the effectiveness of a drawing test with a population whose Accepted: 28 June 2021 Published: 1 July 2021 mental states need to be assessed with various methods, we chose conscripted soldiers as subjects. Although Korea is close to advanced countries in terms of economic level, Publisher’s Note: MDPI stays neutral including personal income and industrial development, there is still a lot of room for with regard to jurisdictional claims in improvement in personal life satisfaction. Notably, Korea has not ended the war and is published maps and institutional affil- operating a conscripted military system. Thus, improving the psychological health and iations. adaptation of conscript soldiers is necessary for a sustainable society. In Korea, military service is obligatory for male adults, and an average of 300,000 men serve as military personnel a year [5]. Conscripted soldiers in the Korean army are generally between 19 and 25 years old; they live in barracks while enlisted and serve 18-month terms. Military organizations have strict rules and hierarchies, and individual freedoms are Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. limited. Conscript soldiers are, therefore, more likely to experience significant stress during This article is an open access article military service, and the physical and/or psychological difficulties of adjusting to the distributed under the terms and military environment can lead some to cause problems. Thus, evaluating and measuring conditions of the Creative Commons their psychological states can help prevent issues in advance and ensure that necessary Attribution (CC BY) license (https:// interventions are promptly performed. creativecommons.org/licenses/by/ The subjective stress experienced by soldiers while serving in the military is called 4.0/). military service stress [6]. It includes military-specific factors such as unit environment Sustainability 2021, 13, 7383. https://doi.org/10.3390/su13137383 https://www.mdpi.com/journal/sustainability Sustainability 2021, 13, 7383 2 of 13 and interpersonal relationships, as well as external factors such as relationships with family and friends and economic problems [7]. Military service stress affects soldiers’ mental health and their adaptation to military life [7–9]. When soldiers’ stress reaches overwhelming levels, it can lead to conflict, self-destructive behaviors, and crime within the military [10–12]. Job stress can even cause soldiers to have suicidal thoughts [13]. Thus, periodically evaluating soldiers’ subjective stress levels is crucial. Adapting to military life is closely related to military service stress [9]. Higher service stress levels negatively impact soldiers’ adjustment to military life. Adaptation to military life is a major concern for conscript soldiers—an analysis of the content of telephone counseling with conscript soldiers found that 2428 soldiers, or 40.9%, were experiencing maladjustment to their units [14]. Maladjustment-related suicide among soldiers is also a regular occurrence, causing between 70 and 100 death every year [15]. Therefore, periodically evaluating soldiers’ adjustment to military life is an important means of preventing casualties. One particular psychological factor can help soldiers overcome the adversity caused by high stress levels or difficulties adapting to military life. Resilience refers to a person’s internal resources and overall ability to adapt to changes in their environments [16]. It acts as an internal protective factor that positively affects people’s lives [17,18], helping them manage stress and adapt to difficult environments [17–20]. Previous studies have tested the effects of resilience in various populations. Kim, Park, and Kwon [21] revealed that nurses with higher resilience levels burn out less. Likewise, research has shown that childcare workers with higher resilience levels experience lower levels of burnout [22]. In a similar vein, research on college students has reported that resilience has an important mediating effect, lowering their stress levels and improving their psychological well- being [23]. Meanwhile, a study of soldiers found that resilience plays a psychological modulatory effect—when army soldiers experience complex traumas that can lead to suicidal actions, resilience has a mediating effect in this process [24]. Similarly, resilience has been shown to mediate the relationships between the factors that influence adaptation to military life [25–27]. Thus, military service stress, adjustment to military life, and resilience are interrelated. Soldiers who can show resilience in military life will be able to reduce the stress they experience in the military [28]. Resilience can be developed through training [29], time, and individual effort [30]. In the case of stress, if administrators can identify soldiers’ stress before it reaches extreme levels, they might help soldiers control or alleviate it. Therefore, it is important to assess stress levels, resilience, and military life adaptation in order to improve conscript soldiers’ quality of life and realize a sustainable military environment. The purpose of this study was to determine the effectiveness of a drawing assessment as a method of evaluating and predicting soldiers’ mental states. We chose to examine Silver’s Draw-a-Story (DAS) test. This drawing test is testee-friendly because it provides stimulus drawings that it asks subjects to refer to as they draw their own pictures [1,4,31]. For this reason, the DAS is not difficult, even for those who say they do not know what to draw. The DAS has been implemented to examine a variety of people, including firefighting officials [32], subway engineers who experienced accidents on duty [33], North Korean defectors [34], and burn victims [35]. A previous study that administered the DAS to soldiers found that it can be used to effectively determine depressive status [36]. Another study found that DAS can be used to assess depression and suicidal ideation levels in soldiers [37]. Based on this theoretical background, we set out to examine how effectively the DAS test predicts conscript soldiers’ military service stress, military life adjustment, and resilience. To achieve this goal, we established the following research hypotheses. Hypothesis 1. The DAS scales will show significant correlations with military service stress, military life adjustment, and resilience of soldiers. Hypothesis 2. The emotional content scale in the DAS will predict military service stress, military life adjustment, and resilience, respectively. Sustainability 2021, 13, 7383 3 of 13 Hypothesis 3. The self-image scale in the DAS will predict military service stress, military life adjustment, and resilience, respectively. 2. Methods 2.1. Participants A total of 280 Korean conscript soldiers participated in this survey. After excluding four incomplete questionnaires, we used 276 responses in our analysis. The participants were all male, their average age was 20.96 years (S.D. = 1.27, Min. = 19.0, Max. = 27.0), and their average service period was 11.19 months (S.D. = 5.48). Other demographic characteristics of the participants are presented in Table1. Table 1. Participants’ general characteristics (N = 276). Variable Frequency

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