Functioning and psychiatric symptoms among military men and women exposed to sexual stressors

OBJECTIVE

The goal was to describe military men's and women's functioning and psychiatric symptoms according to their military sexual stressor exposure.

METHOD

A cross-sectional survey of 204 Army soldiers and 611 other active duty troops (487 men and 327 women) was performed.

RESULTS

Forty-five percent of men and 80% of women reported at least one sexual stressor type (i.e., sexual identity challenges, sexual harassment, or sexual assault). After adjustment, subjects reporting more types of sexual stressors had poorer physical, work, role, and social functioning; more-severe post-traumatic stress disorder, depression, and anxiety symptoms; and more somatic concerns, compared with subjects reporting fewer or no sexual stressor types (all p < or = 0.004). Interactions by gender were insignificant (all p > 0.11). Within sexual stressor category, men and women reported similar mean adjusted functioning and psychiatric symptoms.

CONCLUSIONS

For both men and women, impaired functioning and more severe psychiatric symptoms were more common among those reporting more types of sexual stressors.

The impact of deactivation uncertainty, workload, and organizational constraints on reservists' psychological well-being and turnover intentions

This study assessed the impact of the activation of U.S. Army reservists after terrorists attacked the United States on September 11, 2001. A total of 263 soldiers completed a survey and participated in focus groups. The model's stressors were deactivation uncertainty, workload, and organizational constraints. The outcomes were well-being and turnover intentions. In general, most stressors did predict the proposed outcomes. That is, with high deactivation uncertainty, workload, or organizational constraints, reservists reported low psychological well-being and high turnover intentions. Commanders and policymakers can use our findings when addressing ways to improve reservists' psychological health and to decrease turnover intentions. Specifically, reservists need more predictability and the needed organizational conditions (i.e., proper workload levels and equipment) while activated and deployed to protect our country.

Prevalence and Epidemiology of Pathological Gambling at Naval Medical Center Portsmouth Psychiatry Clinic

OBJECTIVE

Gambling has exploded in popularity, but pathological gambling (PG) is infrequently diagnosed. The objectives of this study were to calculate the prevalence of PG in a psychiatry clinic, to determine whether PG is underdiagnosed, and to analyze risk factors for PG.

METHODS

A survey was completed by 584 outpatients presenting to the Naval Medical Center Portsmouth psychiatry clinic over 6 months. Epidemiological data, smoking status, and alcohol use were assessed, and the South Oaks Gambling Screen was administered.

RESULTS

The prevalence of PG determined with the South Oaks Gambling Screen was 1.4%. The electronically documented prevalence of PG was 0.04%. Male subjects, smokers, and subjects with an alcohol problem were more likely to have a gambling problem. Active duty members did not have statistically significantly higher rates of PG.

CONCLUSIONS

PG is markedly underdiagnosed. Military members are not at elevated risk for PG, relative to their dependents. Further research and greater awareness of PG are needed.

Psychiatric Medications for Deployment: An Update

OBJECTIVE

This article discusses issues regarding the usage of psychotropic medications during military deployments, with emphasis on Operation Iraqi Freedom.

METHOD

The role of psychotropic medications in the Army combat stress control doctrine is reviewed and compared with operational experiences of psychiatrists who have deployed to Iraq, Bosnia, and Egypt.

RESULTS

Many issues regarding psychotropic medications experienced by deployed psychiatrists are not discussed in the Army combat stress control doctrine.

CONCLUSION

The advent of new psychotropic medications, the changes in the types of conflicts fought, and the role of National Guard and Reserve forces in current conflicts have all had an impact on the role and usage of psychotropic medications during military deployments.

Relationship between patterns of alcohol use and negative alcohol-related outcomes among U.S. Air Force recruits

The negative impact of alcohol use on workplace performance is of significant concern to the U.S. military, given the costs associated with recruiting, hiring, and training personnel. However, little is known about the extent of potential alcohol use problems of recruits. We examined the history of alcohol-related problems among recruits entering the Air Force (N=37858). Although the average age of recruits was <21 years, 78% reported consuming alcohol and 49% reported binging before basic military training. Recruits who drank reported having negative alcohol-related outcomes (NAROs). In fact, >95% reported that they or someone else had been injured as a result of their drinking and that a relative, friend, doctor, or other health care worker has been concerned about their drinking. The remaining NAROs were reported by approximately one-quarter of those who drank. However, recruits who reported binge drinking were substantially more likely to report more NAROs, such as morning drinking, inability to stop drinking, having others be concerned about their drinking, having blackouts, fighting, having injured or been injured, feeling guilty about their drinking, and wanting to reduce the amount they drink. Results suggest that alcohol-related problems are common among recruits before basic military training and screening for future problems may be beneficial.

Inhalant abuse in the military: an unrecognized threat

Although inhalant abuse represents the third most commonly abused class of drugs in the military, it is a frequently overlooked form of substance abuse in the active duty population. Inhalants' lack of visibility is also evident in the civilian community. In both the civilian and military communities, the factors leading to underrecognition of inhalant abuse include high availability, low cost, lack of drug screening and drug treatment programs, and frequent misdiagnosis by clinicians. This review seeks to inform care providers about the prevalence, health risks, diagnosis, and treatment of inhalant abuse in the active duty population, and encourages clinicians to be more aggressive in the identification of this serious but underrecognized problem.

Long-term course of post-traumatic stress disorder (PTSD) in German soldiers: effects of inpatient eye movement desensitization and reprocessing therapy and specific trauma characteristics in patients with non-combat-related PTSD

OBJECTIVE

In this study, we retrospectively evaluated a patient population of 89 German soldiers who received inpatient treatment for post-traumatic stress disorder at the German Armed Forces Hospital in Hamburg from 1998 to 2003.

METHODS

Patients were nonrandomly assigned to a treatment group who received eye movement desensitization and reprocessing and a comparison group with general hospital treatment and relaxation training. Follow-up information was obtained 29 months post-treatment. Trauma-related symptoms were assessed using the Impact of Event Scale and the Post-Traumatic Stress Scale (PTSS-10) as parameters of improvement.

RESULTS

The Impact of Event Scale showed that inpatient trauma therapy with eye movement desensitization and reprocessing significantly improved the course of post-traumatic stress disorder. In addition, the Impact of Event Scale indicated a significantly poorer long-term outcome for patients who had been confronted with death during their traumatic experience. Other factors tested were of no significant influence.

CONCLUSIONS

These results may influence further treatment strategies for traumatized German soldiers.

Alcohol withdrawal requiring massive prolonged benzodiazepine infusion

The objective of this case report is to describe a patient with prolonged alcohol withdrawal requiring massive standing doses of benzodiazepines. The setting is the medical intensive care unit of the Tripler Army Medical Center, Honolulu, Hawaii. The patient is a 58-year-old alcohol-dependent male presenting with mental status changes and agitation following an uncomplicated cystoprostatectomy, who ultimately required massive doses of benzodiazepines to treat his symptoms effectively. We conclude that symptom-triggered therapy proved ineffective in this case due to inability to achieve adequate frequency of assessments. Ultimately, a lengthy, high-dose, fixed interval benzodiazepine regimen was required. The 5-week period of intensive care illustrated that scheduled doses of benzodiazepines may be required and massive and prolonged doses are sometimes necessary. Adherence to a slow-weaning protocol understood by an interdisciplinary team was critical to this patient's recovery. Additionally, toxicity from the high-dose medication was not observed.

Suicide rate among former Swedish peacekeeping personnel

Increased suicide rates for military personnel suffering from post-traumatic stress disorders have been reported in various countries. Although it is known that some peacekeepers are exposed to potentially traumatic events and are thus at risk of suffering from post-traumatic stress reactions, only a few studies have examined suicide rates in this group. Therefore, the aim of this study was to investigate the suicide rate among former Swedish peacekeeping personnel. We compared 39,768 former Swedish peacekeepers to the general population in the National General Population Registry and the Cause-of-Death Registry. A lower number of suicides was found among former Swedish peacekeepers than in the general population. In conclusion, Swedish personnel serving in international peace-keeping operations do not show a higher suicide rate than the general population. Unique problems associated with this research area are discussed.

Post-Traumatic Stress Disorder and Depression in Health Care Providers Returning from Deployment to Iraq and Afghanistan

OBJECTIVE

This study examines risk factors for post-traumatic stress disorder (PTSD), depression, and mental health care use among health care workers deployed to combat settings.

METHODS

Anonymous surveys were administered to previously deployed workers at a military hospital. PTSD and depression were assessed by using the PTSD Checklist and the Patient Health Questionnaire depression scale, respectively. Deployment exposures and perceived threats during deployment were also assessed.

RESULTS

There were 102 respondents (36% response rate). Nine percent (n=9) met the criteria for PTSD and 5% (n=5) met the criteria for depression. Direct and perceived threats of personal harm were risk factors for PTSD; exposure to wounded or dead patients did not increase risk. Those who met the criteria for PTSD were more likely to seek mental health care after but not before their deployment.

CONCLUSIONS

For health care workers returning from a warfare environment, threat of personal harm may be the most predictive factor in determining those with subsequent PTSD.

Post-Traumatic Stress Disorder and Service Utilization in a Sample of Service Members from Iraq and Afghanistan

OBJECTIVE

The purpose of this study was to evaluate levels of post-traumatic stress disorder (PTSD), depression, alcohol abuse, quality of life, and mental health service utilization among returnees from Operation Enduring Freedom and Operation Iraqi Freedom.

METHODS

One hundred twenty returnees, enrolled for health care at a midwestern Veterans Affairs medical center, completed questionnaires approximately 6 months after their return from deployment.

RESULTS

PTSD levels (12%) were consistent with previous research while problematic drinking levels were also elevated (33%). PTSD and, to a lesser degree, alcohol abuse were associated with lower quality of life in multiple domains, even when controlling for the influence of depression. Of those screening positive for PTSD, 56% reported using mental health services. Only 18% of those screening positive for alcohol abuse reported using such services.

CONCLUSIONS

PTSD and alcohol problems are prevalent in Operation Enduring Freedom/Operation Iraqi Freedom returnees and associated with lower quality of life. Mental health service utilization is limited, even among returnees enrolled for Veterans Affairs health care.

Reactivation of combat stress after a family member's enlistment

Reactivation of traumatic stress syndromes classically occurs in individuals who have recovered from acute stress reactions or from post-traumatic stress disorder. Triggers of traumatic reactivation may resemble the circumstances of the original trauma or may be less specific, connected to life events such as illness or retirement. In Israel, because of the continuous reminders of combat, reactivation of combat stress has been studied closely. A family member's enlistment is a potential trigger for reactivation. This article explores the general meaning of enlistment for family members, and the reactivation that may accompany that enlistment, through the examination of two cases.

Premilitary intimate partner violence and attrition from the U.S. Navy

A prospective study of U.S. Navy recruits (N = 5,498) examined whether premilitary intimate partner violence (IPV) was associated with attrition. Overall, more than one-fourth of recruits reported premilitary physical IPV and more than two-thirds reported premilitary verbal IPV. Women reported more perpetration and receipt of IPV than men, and married or cohabiting respondents reported more IPV than single respondents. Both perpetration and receipt of IPV significantly predicted attrition within 4 years. However, after controlling for other forms of IPV, only receipt of physical IPV significantly predicted attrition. In only one analysis did associations between IPV and attrition vary according to marital status or gender; premilitary receipt of verbal IPV had different effects on women and men.

Cohesion, Burnout, and Past Trauma in Tri-Service Medical and Support Personnel

Past research suggests that the negative consequences related to exposure to traumatic events and injury may impact cohesive work relationships. Additionally, trauma and low cohesive relationships independently predict poorer psychological and physical health in service members. The objective of the present study was to examine the interrelationships between exposure to traumatic events, burnout, and cohesion among tri-service medical and support staff. Surveys were administered to 253 U.S. Army, Army Reserve Units, U.S. Air Force, and U.S. Navy personnel upon arrival in Hawaii for participation in a stressful, 2-week training exercise. Results showed that history of trauma was correlated with poorer view of officers and higher levels on two components of burnout. We discuss how findings can apply to prevention and early intervention efforts.

Psychotic Symptoms in Combat-Related Post-Traumatic Stress Disorder

The presence of psychotic symptoms in post-traumatic stress disorder (PTSD) has already been recognized. Using the Structured Clinical Interview Diagnostic and Statistical Manual, we searched for and assessed psychotic symptoms in 91 males suffering from combat-related PTSD. Hallucinations and delusions were present in 20% of patients. We divided all patients into three groups: the group with hallucinations and delusions, the group without these symptoms, and the group with "subthreshold" psychotic symptoms. Using the Harvard Trauma Questionnaire, Clinician-Administered PTSD Scale, and Structured Clinical Interview Diagnostic and Statistical Manual, we investigated differences between groups in the intensity of traumatization, severity of PTSD symptoms, and the frequency of depression. There were no significant differences between groups; however, there was one exception: severity of hyperarousal symptoms was positively correlated with occurrence of psychotic symptoms.

Sociodemographic Profile of Women Entering a Military Substance Use Disorder Treatment Center

This retrospective study reviewed medical records to determine sociodemographic characteristics of women in a substance use treatment center at a Pacific Regional Medical Command facility. Data were collected from records between September 1, 1999, and August 31, 2002. Three questions were investigated, as follows. (1) What are the sociodemographic characteristics of women entering substance abuse treatment? (2) Are there coexisting conditions (psychiatric history and/or family history of abuse or psychiatric conditions) that accompany the substance abuse problem? (3) What are the referral sources for patients entering treatment? Data were analyzed by using descriptive statistics. The sample was primarily Caucasian, between 18 and 25 years of age. The most frequently occurring conditions were depression and anxiety. The smallest number of referrals was from primary care managers. The findings support the need for thorough screening and assessment for substance use in women and assessment of primary care managers' compliance, knowledge, and skills in evaluating substance use in women.

Psychophysiological assessment of stress and screening of health risk in peacekeeping operations

Medical surveillance for military personnel participating in peacekeeping missions (PKMs) is required to define the effect of stress on health status. The aim of this study was to determine the effect of stress on the autonomic cardiovascular control and health risk of 72 Bulgarian peacekeepers participating in a PKM in Kosovo. The assessment of psychophysiological stress and determination of stress characteristics were implemented with analysis of heart rate variability and personal interviews. As a response to the cumulative exposure to the effect of stress on cognitive function, we observed reductions in parasympathetic function and baroreceptor modulation of heart rhythm. The alteration in cardiovascular control was registered as decreases in short-term variability and spectral powers of cardiointervals in the respiratory sinus arrhythmia and Traube-Hering-Mayer bands. The advantage of psychophysiological stress assessment and screening of health risk in PKMs is that results indicate the mechanisms of the effects of stress on cognitive function and health status.

How are substance use disorders addressed in VA psychiatric and primary care settings? Results of a national survey

OBJECTIVE

This study examined interventions for substance use disorders within the Department of Veterans Affairs (VA) psychiatric and primary care settings.

METHODS

National random samples of 83 VA psychiatry program directors and 102 primary care practitioners were surveyed by telephone. The survey assessed screening practices to detect substance use disorders, protocols for treating patients with substance use disorders, and available treatments for substance use disorders.

RESULTS

Respondents reported extensive contact with patients with substance use problems. However, a majority reported being ill equipped to treat substance use disorders themselves; they usually referred such patients to specialty substance use disorder treatment programs.

CONCLUSIONS

Offering fewer specialty substance use disorder services within the VA may be problematic: providers can refer patients to specialty programs only if such programs exist. Caring for veterans with substance use disorders may require increasing the capacity of and establishing new specialty programs or expanding the ability of psychiatric programs and primary care practitioners to provide such care.

The prevalence of temporomandibular disorders in war veterans with post-traumatic stress disorder

The purposes of this study were to assess the prevalence of temporomandibular disorders in Croatian war veterans suffering from post-traumatic stress disorder (PTSD) and to analyze the impact of the disease on mandibular function. One hundred eighty-two male subjects participated in the study. The examined group consisted of 94 subjects who had taken part in the war in Croatia and for whom PTSD had previously been diagnosed. Patients were compared with an age- and gender-matched group of subjects who had not taken part in the war and for whom PTSD was excluded by means of a psychiatric examination. The study used a clinical examination and standard questionnaire. Statistically significant differences were found in almost all measured parameters. With regard to restricted movements, overbite, and overjet, the differences obtained did not have clinical significance. The most significant differences were found in the parameters of pain. Headache was experienced by 63.83% of the subjects with PTSD, facial pain by 12.77%, and pain in the region of the jaw by 10.64%. Headache was the most intense pain, with an average intensity of 4.92 on a scale of 0 to 10. Pain on loading, temporomandibular joint clicking, and intrameatal tenderness were more prevalent in the PTSD group than in the healthy control group. The study supports the concept that PTSD patients are at increased risk for the development of temporomandibular disorder symptoms.

Perceived stress, heart rate, and blood pressure among adolescents with family members deployed in Operation Iraqi Freedom

This study compared the impact of the 2003 Operation Iraqi Freedom on heart rate (HR) and blood pressure (BP) and self-reported stress levels among three groups of self-categorized adolescents: (1) military dependents with family members deployed; (2) military dependents with no family members deployed; (3) civilian dependents. At the onset and end of the "major hostilities" of Operation Iraqi Freedom, 121 adolescents (mean age = 15.8 +/- 1.1 years) completed questionnaires evaluating the psychological impact of the war and were evaluated for HR and BP. The military deployed dependents exhibited significantly higher HR than other groups at both evaluations (both p < 0.04). Ethnicity by group interactions indicated that European American-deployed dependents had higher stress scores at both time points (p < 0.02). Military dependent European Americans exhibited higher systolic BP compared to the other groups on the second evaluation (p < 0.03).

Psychosis in the British Army: A 2-Year Follow-Up Study

BACKGROUND

Recent research into mental illness in military populations has tended to focus on minor mental illness and the consequences of trauma. The literature contains very little on serious mental illness, including its occupational implications.

AIMS

To identify the incidence and factors associated with nonaffective psychosis in British Army personnel, to evaluate service quality in terms of duration of untreated psychosis, and to identify predictors of occupational outcome after 2 years, to inform future management of similar cases.

METHODS

A retrospective study of the case notes of all Army personnel admitted to the U.K. military psychiatric inpatient facility in Catterick Garrison with a nonaffective psychosis over a 4-year period between 1999 and 2002 was performed.

RESULTS

There were 48 cases of nonaffective psychosis and 14 cases of schizophrenia, corresponding to mean annual incidences of 0.11 cases per 1,000 and 0.03 cases per 1,000, respectively. The mean duration of untreated psychosis was 11 months, and 29 cases (60%) were diagnosed and treated in < 4 months. Officer status and longer duration of service predicted retention. Only eight patients (16.7%) were still in service at 2 years.

CONCLUSIONS

These findings indicate (1) there is a low incidence of nonaffective psychosis, (2) the military performs well in early detection and intervention in psychosis, and (3) a well-established military career and the premorbid psychological stability this implies predict a good occupational outcome.

No Effect of Lunar Cycle on Psychiatric Admissions or Emergency Evaluations

It is a popularly held belief that psychiatric behavior worsens during a full moon. Research in this area has yielded mixed results. Records from Naval Medical Center San Diego for 1993-2001 were examined to see whether there were higher rates of psychiatric admission associated with particular phases of the moon. Records from 8,473 admissions revealed that there were no more admission on days with a full moon, a new moon, any quarter of the moon, a waxing moon, or a waning moon. This held true for psychiatric patients as a whole, as well as for individuals with particular diagnoses, such as those with a mood disorder or psychotic disorder. Records from 1,909 emergency psychiatric evaluations that occurred between 2002 and 2003 were also examined to see whether a higher percentage of patients might present, but not require hospitalization, during a particular phase of the moon. Once again, no significant effect was found. In summary, lunar phase was not associated in any significant way with psychiatric admissions or emergency presentation.

The role of aeronautical adaptability in the disqualification of a military flyer

INTRODUCTION

Possessing a stable personality plays a critical role in crew coordination, mission completion, and safety of flight in aviation. Presented is a naval flight officer whose personality traits were a threat to these key tenets and ultimately warranted removal from flight status.

CASE REPORT

A naval flight officer was twice referred to Human Factors Boards (HFBs) after concerns were raised about her emotional stability in and out of the cockpit. Her history revealed multiple clinical presentations revealing personality characteristics that should have raised immediate concern about her aeronautical adaptability. Formal psychiatric evaluation after her second HFB confirmed the presence of personality traits incompatible with aviation duty, but not until she had served nearly 4 yrs. as an aviation officer.

DISCUSSION

Aeronautical adaptability is a U.S. Naval term used to describe an individual's ability to work successfully in the aviation environment. Naval aviation personnel are considered not aeronautically adaptable/adapted if diagnosed with a "personality disorder or prominent personality traits that adversely affect flight safety, mission completion, or crew coordination". The Federal Aviation Administration, the U.S. Air Force, and the U.S. Army endorse similar concepts. Except for the U.S. Navy definition, aeronautical adaptability does not include formal DSM-IV-TR diagnoses, and, thus, flight surgeons and aviation medical examiners often make difficult aeromedical dispositions based on vague and subjective criteria.

CONCLUSIONS

Determining aeronautical adaptability is not a simple, solitary process. It requires heightened suspicion, continual surveillance of suspect aviators, and collaboration from aviation medical professionals to ensure aviation safety.