Health-Promoting Leadership during an Infectious Disease Outbreak: A Cross-sectional Study of US Soldiers Deployed to Liberia

Abstract Background Infectious disease outbreaks are uniquely stressful for non-medical essential employees. Promoting the health of these workers is vital to minimize their distress and to ensure they are able to continue in their professional capacity. One way to support worker health is for supervisors to engage in behaviors that promote their employees’ behavioral health, wellbeing, and attitudes towards preventive medicine practices. Methods The present study examined if health-promoting leadership contributes to these outcomes in employees operating in an epidemic. Active-duty soldiers (N = 173) deployed to provide non-medical support in Liberia during the 2014 Ebola crisis completed surveys assessing posttraumatic stress disorder (PTSD), depression, anxiety, sleep problems, burnout, morale and attitudes, and rating their leaders on health-promoting behaviors. An exploratory factor analysis identified two leadership factors, one focused on psychological health and one on preventive medicine behaviors. Results Using mixed effects logistic regression, after adjusting for general leadership and soldier rank, health-promoting leadership focused on psychological health was associated with decreased odds of PTSD, depression, anxiety, and burnout, and increased odds of high morale and avoiding unnecessary risk. Health-promoting leadership behaviors focused on preventive medicine were associated with decreased odds of depression and anxiety, and increased odds of high morale, understanding the level of risk from disease, positive attitudes towards the deployment and preventive practices, and avoiding unnecessary risk. Conclusions Findings suggest health-promoting leadership behaviors could be valuable for employees responding to infectious disease outbreaks. Future research should examine whether training leaders in these skills can improve outcomes for non-medical employees in both military and civilian settings.