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Lippa SM, Bailie JM, French LM, Brickell TA, Lange RT. Lifetime blast exposure is not related to cognitive performance or psychiatric symptoms in US military personnel. Clin Neuropsychol 2024:1-23. [PMID: 38494345 DOI: 10.1080/13854046.2024.2328881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
Objective: The present study aimed to examine the impact of lifetime blast exposure (LBE) on neuropsychological functioning in service members and veterans (SMVs). Method: Participants were 282 SMVs, with and without history of traumatic brain injury (TBI), who were prospectively enrolled in a Defense and Veterans Brain Injury Center (DVBIC)-Traumatic Brain Injury Center of Excellence (TBICoE) Longitudinal TBI Study. A cross-sectional analysis of baseline data was conducted. LBE was based on two factors: Military Occupational Speciality (MOS) and SMV self-report. Participants were divided into three groups based on LBE: Blast Naive (n = 61), Blast + Low Risk MOS (n = 96), Blast + High Risk MOS (n = 125). Multivariate analysis of variance (MANOVA) was used to examine group differences on neurocognitive domains and the Minnesota Multiphasic Personality Inventory-2 Restructured Form. Results: There were no statistically significant differences in attention/working memory, processing speed, executive functioning, and memory (Fs < 1.75, ps > .1, ηp2s < .032) or in General Cognition (Fs < 0.95, ps > .3, ηp2s < .008). Prior to correction for covariates, lifetime blast exposure was related to Restructured Clinical (F(18,542) = 1.77, p = .026, ηp2 = .055), Somatic/Cognitive (F(10,550) = 1.99, p = .033, ηp2 = .035), and Externalizing Scales (F(8,552) = 2.17, p = .028, ηp2 = .030); however, these relationships did not remain significant after correction for covariates (Fs < 1.53, ps > .145, ηp2s < .032). Conclusions: We did not find evidence of a relationship between LBE and neurocognitive performance or psychiatric symptoms. This stands in contrast to prior studies demonstrating an association between lifetime blast exposure and highly sensitive blood biomarkers and/or neuroimaging. Overall, findings suggest the neuropsychological impact of lifetime blast exposure is minimal in individuals remaining in or recently retired from military service.
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Affiliation(s)
- Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- Naval Hospital Camp Pendleton, Oceanside, CA, USA
- General Dynamics Information Technology, Fairfax, VA, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
| | - Tracey A Brickell
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- General Dynamics Information Technology, Fairfax, VA, USA
| | - Rael T Lange
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Bethesda, MD, USA
- General Dynamics Information Technology, Fairfax, VA, USA
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Bailie JM, Lippa SM, Hungerford L, French LM, Brickell TA, Lange RT. Cumulative Blast Exposure During a Military Career Negatively Impacts Recovery from Traumatic Brain Injury. J Neurotrauma 2024; 41:604-612. [PMID: 37675903 DOI: 10.1089/neu.2022.0192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Sub-concussive injuries have emerged as an important factor in the long-term brain health of athletes and military personnel. The objective of this study was to explore the relationship between service member and veterans (SMVs) lifetime blast exposure and recovery from a traumatic brain injury (TBI). A total of 558 SMVs with a history of TBI were examined. Lifetime blast exposure (LBE) was based on self-report (M = 79.4, standard deviation = 392.6; range = 0-7500) categorized into three groups: Blast Naive (n = 121), Low LBE (n = 223; LBE range 1-9), and High LBE (n = 214; LBE >10). Dependent variables were the Neurobehavioral Symptom Inventory (NSI) and Post-traumatic Stress Disorder Checklist-Civilian (PCL-C) and the Traumatic Brain Injury Quality of Life (TBI-QOL). Analyses controlled for demographic factors (age, gender, and race) as well as TBI factors (months since index TBI, index TBI severity, and total number lifetime TBIs). The Blast Naive group had significantly lower NSI and PCL-C scores compared with the Low LBE group and High LBE group, with small to medium effect sizes. On the TBI-QOL, the Blast Naïve group had better quality life on 10 of the 14 scales examined. The Low LBE did not differ from the High LBE group on the PCL-C, NSI, or TBI-QOL. Blast exposure over an SMV's career was associated with increased neurobehavioral and post-traumatic stress symptoms following a TBI. The influence of psychological trauma associated with blasts may be an important factor influencing symptoms as well as the accuracy of self-reported estimates of LBE.
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Affiliation(s)
- Jason M Bailie
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, California, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
| | - Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- Naval Medical Center San Diego, San Diego, California, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- University of British Columbia, Vancouver, British Columbia, Canada
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- General Dynamics Information Technology, Fairfax, Virginia, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- University of British Columbia, Vancouver, British Columbia, Canada
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Crombach A, Rukundo-Zeller AC, Vukojevic V, Nandi C, Bambonye M, de Quervain DJF, Papassotiropoulos A, Elbert T. Differential methylation of linoleic acid pathway genes is associated with PTSD symptoms - a longitudinal study with Burundian soldiers returning from a war zone. Transl Psychiatry 2024; 14:32. [PMID: 38238325 PMCID: PMC10796347 DOI: 10.1038/s41398-024-02757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
Soldiers may be exposed to traumatic stress during combat deployment and thus are at risk for developing posttraumatic stress disorder (PTSD). Genetic and epigenetic evidence suggests that PTSD is linked to forming stress-related memories. In the current study, we investigated post-deployment associations of PTSD symptoms with differential DNA methylation in a sample of Burundian soldiers returning from the African Union Mission in Somalia's war zone. We used a matched longitudinal study design to explore epigenetic changes associated with PTSD symptoms in N = 191 participants. PTSD symptoms and saliva samples were collected at 1-3 (t1) and 9-14 months (t2) after the return of the soldiers to their home base. Individuals with either worsening or improving PTSD symptoms were matched for age, stressful, traumatic and self-perpetrated events prior to the post-assessment, traumatic and violent experiences between the post- and the follow-up assessment, and violence experienced during childhood. A mixed model analysis was conducted to identify top nominally significantly differentially methylated genes, which were then used to perform a gene enrichment analysis. The linoleic acid metabolism pathway was significantly associated with post-deployment PTSD symptoms, after accounting for multiple comparisons. Linoleic acid has been linked to memory and immune related processes in previous research. Our findings suggest that differential methylation of linoleic acid pathway genes is associated with PTSD and thus may merit closer inspection as a possible mediator of resilience.
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Affiliation(s)
- Anselm Crombach
- Department of Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Saarland University,, Saarbrücken, Germany.
- Department of Psychology, Université Lumière de Bujumbura, Bujumbura, Burundi.
| | - Anja C Rukundo-Zeller
- Department of Psychology, Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Vanja Vukojevic
- Department of Biomedicine, Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Corina Nandi
- Department of Psychology, Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Manassé Bambonye
- Department of Psychology, Université Lumière de Bujumbura, Bujumbura, Burundi
| | - Dominique J-F de Quervain
- Department of Biomedicine, Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Andreas Papassotiropoulos
- Department of Biomedicine, Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Thomas Elbert
- Department of Psychology, Université Lumière de Bujumbura, Bujumbura, Burundi
- Department of Psychology, Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany
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Russell PD, Judkins JL, Blessing A, Moore B, Morissette SB. Incidences of anxiety disorders among active duty service members between 1999 and 2018. J Anxiety Disord 2022; 91:102608. [PMID: 36029531 DOI: 10.1016/j.janxdis.2022.102608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 05/11/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Anxiety disorders can impact the health, performance, and retention of military service members. To inform prevention initiatives and long-term treatment planning, incidence rates across anxiety disorders were evaluated among U.S. active-duty service members over a 20-year period. METHOD Data were extracted from the Defense Medical Epidemiological Database to examine incidence rates of generalized anxiety disorder (GAD), panic disorder (PD), agoraphobia (AG), social anxiety disorder (SAD), obsessive compulsive disorder (OCD), agoraphobia with panic disorder (AWPD), agoraphobia without history of panic disorder (AWOPD), and unspecified anxiety disorder (UAD) among 151,844 service members between 1999 and 2018 in relation to sex, age, race, marital status, military pay grade, service branch. RESULTS Incidence rates of anxiety disorders increased significantly over the 20-year period. Anxiety disorder incidence rates ranged widely from 0.01 to 23.70 (per 1000 service members). There were significant differences in observed versus expected diagnostic rates across all demographic variables examined (p < 0.001). CONCLUSION Incidence rates varied considerably across the anxiety disorders, with UAD being the highest. These data highlight the importance of health care professionals attending to anxiety disorders, in order to plan for service member needs, develop preventative interventions, address early detection, and deliver treatments to improve combat readiness.
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Affiliation(s)
- Patricia D Russell
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
| | - Jason L Judkins
- United States Army Research Institute of Environmental Medicine, 10 General Greene Ave., Natick, MA 01760, USA
| | - Alexis Blessing
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Brian Moore
- Department of Psychological Science, Kennesaw State University, 1000 Chastain Road NW, Kennesaw, GA 30144, USA
| | - Sandra B Morissette
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
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Adler AB, Gutierrez IA, Gomez SAQ, Beymer MR, Santo TJ, Thomas JL, Cates DS, Bell AM, Quartana PJ. US soldiers and the role of leadership: COVID-19, mental health, and adherence to public health guidelines. BMC Public Health 2022; 22:943. [PMID: 35546398 PMCID: PMC9092038 DOI: 10.1186/s12889-022-13345-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies have documented the impact of domain-specific leadership behaviors on targeted health outcomes in employees. The goal of the present study was to determine the association between specific leadership behaviors addressing COVID-19 and US soldiers’ mental health and adherence to COVID-19 public health guidelines. Methods An electronic, anonymous survey was administered to US Army soldiers across three major commands (N = 7,829) from December 2020 to January 2021. The primary predictor of interest was soldiers’ ratings of their immediate supervisors’ behaviors related to COVID-19. The outcomes were soldiers’ mental health (i.e., depression and generalized anxiety) and adherence to COVID-19 public health guidelines. Covariates were rank, gender, ratings of immediate supervisors’ general leadership, level of COVID-19 concerns, and COVID-19 status (e.g., tested positive, became seriously ill). Logistic regressions were used to model the unique association of COVID-19 leadership behaviors with outcomes after adjusting for covariates. Results High levels of COVID-19 leadership behaviors were associated with lesser likelihood of soldiers’ screening positive for depression (AOR = 0.46; 95% CI [0.39, 0.54]) and anxiety (AOR = 0.54; 95% CI [0.45, 0.64]), and greater likelihood of frequent adherence to preventive health guidelines (AORs = 1.58; 95% CI [1.39, 1.80] to 2.50; 95% CI [2.01, 3.11]). Conclusion Higher levels of COVID-19 leadership behaviors may support soldiers’ mental health and encourage their adherence to COVID-19 public health guidelines. Given the link between these leader behaviors and soldier adaptation to the pandemic over and above general leadership, training for supervisors should focus on targeting specific health-promoting behaviors. Results can inform leader training for the military and other high-risk occupations.
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Affiliation(s)
- Amy B Adler
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA.
| | - Ian A Gutierrez
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | | | - Matthew R Beymer
- US Army Public Health Center, Aberdeen Proving Ground, Aberdeen, MD, USA
| | | | | | - David S Cates
- Nebraska Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amy Millikan Bell
- US Army Public Health Center, Aberdeen Proving Ground, Aberdeen, MD, USA
| | - Phillip J Quartana
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
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Merghati Khoei E, Rezaei Z, Mohraz M, Brady KT, Killeen T, Korte JE, Bayat A, Yousefi H. Gender differences in post-traumatic stress disorder and depression among Iranian population with substance use disorder. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2051624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Effat Merghati Khoei
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahed Rezaei
- Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Kathleen T. Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Therese Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey E. Korte
- Department of Public Health Sciences, School of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alireza Bayat
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Habib Yousefi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
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Enns MW, Mota N, Afifi TO, Bolton SL, Richardson JD, Patten SB, Sareen J. Course and Predictors of Major Depressive Disorder in the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey: Cours et Prédicteurs du Trouble de Dépression Majeure Dans l'Enquête de Suivi Sur la Santé Mentale Auprès Des Membres des Forces Armées Canadiennes et des ex-Militaires. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:971-981. [PMID: 33406886 PMCID: PMC8649828 DOI: 10.1177/0706743720984677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The present report is the first study of Canadian military personnel to use longitudinal survey data to identify factors that determine major depressive episodes (MDEs) over a period of 16 years. METHODS The study used data from the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS) collected in 2018 (n = 2,941, response rate 68.7%) and linked baseline data from the same participants that were collected in 2002 when they were Canadian Regular Force members. The study used structured interviews to identify 5 common Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders and collected demographic data, as well as information about traumatic experiences, childhood adversities, work stress, and potential resilience factors. Respondents were divided into 4 possible MDE courses: No Disorder, Remitting, New Onset, and Persistent/Recurrent. Relative risk ratios (RRRs) from multinomial regression models were used to evaluate determinants of these outcomes. RESULTS A history of anxiety disorders and post-traumatic stress disorder (RRRs: 1.50 to 20.55), mental health service utilization (RRRs: 1.70 to 12.34), veteran status (RRRs: 1.64 to 2.15), deployment-associated traumatic events (RRRs: 1.71 to 2.27), sexual traumas (RRRs: 1.91 to 2.93), other traumas (RRRs: 1.67 to 2.64), childhood adversities (RRRs: 1.39 to 1.97), avoidance coping (RRRs 1.09 to 1.49), higher frequency of religious attendance (RRRs: 1.54 to 1.61), and work stress (RRRs: 1.05 to 1.10) were associated with MDE courses in most analyses. Problem-focused coping (RRRs: 0.73 to 0.91) and social support (RRRs: 0.95 to 0.98) were associated with protection against MDEs. CONCLUSIONS The time periods following deployment and trauma exposure and during the transition from active duty to veteran status are particularly relevant for vulnerability to depression in military members. Interventions that enhance problem-focused coping and social support may be protective against MDEs in military members.
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Affiliation(s)
- Murray W. Enns
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Departments of Clinical Health Psychology and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O. Afifi
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shay-Lee Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J. Don Richardson
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jitender Sareen
- Departments of Psychiatry and Psychology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Mota N, Bolton SL, Enns MW, Afifi TO, El-Gabalawy R, Sommer JL, Pietrzak RH, Stein MB, Asmundson GJG, Sareen J. Course and Predictors of Posttraumatic Stress Disorder in the Canadian Armed Forces: A Nationally Representative, 16-Year Follow-up Study: Cours et prédicteurs du trouble de stress post-traumatique dans les Forces armées canadiennes: une étude de suivi de 16 ans nationalement représentative. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:982-995. [PMID: 33522288 PMCID: PMC8649830 DOI: 10.1177/0706743721989167] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study examined baseline risk and protective predictors and interim correlates of the persistence/recurrence, remission, and onset of posttraumatic stress disorder (PTSD) in a 16-year prospective, nationally representative sample of Canadian Forces members and veterans. METHODS The 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey is a prospective study of 2,941 regular force service members and veterans who participated in the 2002 Canadian Community Health Survey on Mental Health and Wellbeing: Canadian Forces Supplement (n = 5,155; ages 15 to 64 years; response rate 68%). PTSD diagnoses in 2002 and 2018 were used to create 4 groups: (1) no lifetime, (2) remitted, (3) new onset, and (4) persistent/recurrent PTSD. Multinomial regressions were conducted to identify predictors of PTSD courses. RESULTS Female sex, being a junior noncommissioned member (vs. officer), and land (vs. air) operations in 2002 were associated with all PTSD courses relative to no lifetime PTSD (relative risk ratio [RRR] range: 1.28 to 3.65). After adjusting for sociodemographic variables, baseline predictors of all PTSD courses included lifetime mental disorder, history of mental health care utilization, all trauma type categories (deployment-associated, sexual, "other"), and the number of lifetime traumatic events (RRR range: 1.14 to 8.95). New ("since 2002") traumas, transitioning to veteran status, and alcohol dependence were mostly associated with the new onset and persistent/recurrent PTSD courses (RRR range: 1.79 to 4.31), while mental health care utilization and greater avoidance coping were associated with all PTSD courses (RRR range: 1.10 to 17.87). Protective factors for several PTSD courses at one or both time points included social support, social network size, and problem-focused coping (RRR range: 0.71 to 0.98). CONCLUSIONS This is the first population-based survey to examine the longitudinal course of PTSD in Canadian Forces members. Prevention and intervention programs focused on bolstering social support and active coping strategies as possible protective factors/correlates may help mitigate the development and persistence of PTSD.
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Affiliation(s)
- Natalie Mota
- Departments of Clinical Health Psychology and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shay-Lee Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murray W. Enns
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O. Afifi
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Departments of Anesthesiology, Perioperative and Pain Medicine, and Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jordana L. Sommer
- Departments of Psychology and Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Murray B. Stein
- Departments of Psychiatry and of Family Medicine and Public Health, University of California San Diego, La Jolla, and VA San Diego Healthcare System, San Diego, CA, USA
| | - Gordon J. G. Asmundson
- Department of Psychology and Anxiety and Illness Behaviours Lab, University of Regina, Regina, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Coenen P, van der Molen HF. What work-related exposures are associated with post-traumatic stress disorder? A systematic review with meta-analysis. BMJ Open 2021; 11:e049651. [PMID: 34433603 PMCID: PMC8388294 DOI: 10.1136/bmjopen-2021-049651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Although there is evidence that work-related exposures cause post-traumatic stress disorder (PTSD), there are few quantitative studies assessing the degree to which these factors contribute to PTSD. This systematic review with meta-analysis identified work-related exposures associated with PTSD, and quantified their contribution to this disorder. METHODS We searched Medline, PsycINFO, Embase, PILOTS and Web of Science (2005-10 September 2019) for longitudinal studies on work-related exposures and PTSD. We described included articles, and conducted meta-analyses for exposures with sufficient homogeneous information. We performed subgroup analyses for risk of bias, study design and PTSD ascertainment. We assessed evidence quality using Grades of Recommendations, Assessment, Development and Evaluation, and estimated population attributable fractions. RESULTS After screening 8590 records, we selected 33 studies (n=5 719 236). From what was moderate quality evidence at best, we identified various work-related exposures that were associated with PTSD, mainly involving individuals in the military and first responder (eg, police or fire brigade) occupations. These exposures included the number of army deployments (OR: 1.15 (95% CI 1.14 to 1.16)), combat exposure (OR 1.89 (95% CI 1.46 to 2.45)), army deployment (OR 1.79 (95% CI 1.45 to 2.21)) and confrontation with death (OR 1.63 (95% CI 1.41 to 1.90)). Effects were robust across subgroups and exposures attributed modestly (7%-34%) to PTSD. We identified additional exposures in other occupations, including life threats, being present during an attack, and hearing about a colleague's trauma. CONCLUSIONS We identified various work-related exposures associated with PTSD and quantified their contribution. While exposure assessment, PTSD ascertainment and inconsistency may have biased our findings, our data are of importance for development of preventive interventions and occupational health guidelines.
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Affiliation(s)
- Pieter Coenen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henk F van der Molen
- Department of Public and Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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10
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Elliman TD, Schwalb ME, Krauss S, Mikoski P, Adler AB. US Army Drill Sergeants: Stressors, Behavioral Health, and Mitigating Factors. Mil Med 2021; 186:767-776. [PMID: 33491063 DOI: 10.1093/milmed/usab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The role of the drill sergeant is one of the most challenging within the US Army, involving unusually long hours and little time off, for a minimum of 2 years. The current study sought to examine the behavioral health of this population and identify risk factors that might be addressed by policy changes. MATERIALS AND METHODS In total, 856 drill sergeants across all Army basic training sites completed surveys from September to November of 2018. Drill sergeants identified factors that had caused stress or worry during their assignment. Rates were measured for behavioral health outcomes including depression, insomnia, anxiety, burnout, functional impairment, alcohol misuse, aggression, and low morale. Potential risk and resilience factors included time as a drill sergeant, sleep, route of assignment, general leadership, health-promoting leadership, and drill sergeant camaraderie. The study was approved by the Walter Reed Army Institute of Research Institutional Review Board. RESULTS The most commonly experienced stressors were finding time to exercise, lack of sleep, and long work hours. Percentages of drill sergeants meeting behavioral health screening criteria were 19% for depression, 27% for moderate-to-severe insomnia, 14% for generalized anxiety disorder, 48% for high burnout, 32% for functional impairment, 35% for moderate alcohol misuse, 32% for off-duty aggression, and 25% for low morale. Rates for most outcomes were associated with time spent as a drill sergeant, with behavioral health issues peaking during 13-18 months. Poorer outcomes were also associated with fewer hours of sleep and initial unhappiness regarding involuntary assignment to the role of drill sergeant, while better outcomes were associated with higher ratings of general leadership, health-promoting leadership, and drill sergeant camaraderie. CONCLUSIONS This study is the first to examine behavioral health and morale of drill sergeants and to identify risk and resilience factors. Suggestions for policy changes include increasing the number of drill sergeants to decrease workload and allow sufficient time for recovery and sleep.
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Affiliation(s)
- Toby D Elliman
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Molly E Schwalb
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Stephen Krauss
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Peter Mikoski
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Amy B Adler
- Research Transition Office, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
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Adams RE, Hu Y, Figley CR, Urosevich TG, Hoffman SN, Kirchner HL, Dugan RJ, Boscarino JJ, Withey CA, Boscarino JA. Risk and protective factors associated with mental health among female military veterans: results from the veterans' health study. BMC WOMENS HEALTH 2021; 21:55. [PMID: 33557798 PMCID: PMC7869200 DOI: 10.1186/s12905-021-01181-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/13/2021] [Indexed: 11/10/2022]
Abstract
Background This study focuses on factors that may disproportionately affect female veterans’ mental health, compared to men, and is part of a larger study assessing the prevalence of mental health disorders and treatment seeking among formerly deployed US military service members. Methods We surveyed a random sample of 1,730 veterans who were patients in a large non-VA hospital system in the US. Based on previous research, women were hypothesized to be at higher risk for psychological problems. We adjusted our results for confounding factors, including history of trauma, childhood abuse, combat exposure, deployments, stressful life events, alcohol misuse, psychological resources, and social support. Results Among the veterans studied, 5% were female (n = 85), 96% were White (n = 1,161), 22.9% were Iraq/Afghanistan veterans (n = 398), and the mean age was 59 years old (SD = 12). Compared to males, female veterans were younger, unmarried, college graduates, had less combat exposure, but were more likely to have lifetime PTSD (29% vs. 12%.), depression (46% vs. 21%), suicidal ideation (27% vs. 11%), and lifetime mental health service use (67% vs. 47%). Females were also more likely to have low psychological resilience and to have used psychotropic medications in the past year. Using multivariate logistic regression analyses that controlled for risk and protective factors, female veterans had greater risk for lifetime PTSD, depression, suicidal thoughts, and for lifetime use of psychological services, compared to males. Since 95% of the population in this study were male and these results may have been statistically biased, we reran our analyses using propensity score matching. Results were consistent across these analyses. Conclusion Using a sample of post-deployment veterans receiving healthcare services from a large non-VA health system, we find that female veterans are at greater risk for lifetime psychological problems, compared to male veterans. We discuss these findings and their implications for service providers.
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Affiliation(s)
- Richard E Adams
- Department of Sociology, Kent State University, 215 Merrill Hall, 700 Hilltop Drive, Kent, OH, 44242-0001, USA
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Charles R Figley
- Tulane Traumatology Institute, Tulane University, 127 Elk Place, New Orleans, LA, 70112, USA
| | - Thomas G Urosevich
- Ophthalmology Service, Geisinger Clinic, 126 Market Way, Mount Pocono, PA, 18344, USA
| | - Stuart N Hoffman
- Department of Sleep Medicine, Geisinger Clinic, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Ryan J Dugan
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Joseph J Boscarino
- Clinical Psychology Department, William James College, 1 Wells Ave, Newton, MA, 02459, USA
| | - Carrie A Withey
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, MC 44-00, Danville, PA, 17822, USA.
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Palacios-Ceña D, Fernández-de-las-Peñas C, Palacios-Ceña M, de-la-Llave-Rincón AI, Florencio LL. Working on the Frontlines of the COVID-19 Pandemic: A Qualitative Study of Physical Therapists' Experience in Spain. Phys Ther 2021; 101:6124776. [PMID: 33517462 PMCID: PMC7928649 DOI: 10.1093/ptj/pzab025] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/31/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Knowledge of the experiences of health care professionals who have actively worked on the first line of the COVID-19 pandemic could help to identify specific professional duties focused on health assistance objectives. No qualitative study has yet been published, to our knowledge, describing the experience of physical therapists during the COVID-19 pandemic. The purpose of this study was to describe and explore the experiences and perspectives of physical therapists working in public hospitals in Madrid, Spain, during the COVID-19 pandemic. METHODS A qualitative exploratory study was conducted based on an interpretive framework. Thirty physical therapists working at 11 national public hospitals during the COVID-19 outbreak were recruited by purposeful sampling and snowball techniques. In-depth interviews and researchers' field notes were used to collect data. Interviews were transcribed verbatim. Inductive thematic analysis was used to identify emerging themes. RESULTS After identifying 3912 codes and 13 categories, 3 themes emerged. The first theme was "call of duty"; as COVID-19 infection dramatically spread, the hospitals were contaminated and overwhelmed, and all floors were converted into COVID-19 wards. The second theme was "working in war time." Every day, therapists were given "the war report," receiving their orders, meeting protective personal equipment requirements, and confronting fear. The third theme was "when I arrive at home." Working during the pandemic had an impact on the therapists' families and the information shared with them. CONCLUSIONS Physical therapists described the COVID-19 outbreak as an apocalyptic and unexpected war. Comprehensive support is needed for all frontline health care professionals. The COVID-19 outbreak revealed that health care systems were not prepared for a pandemic. IMPACT To our knowledge, this is the first qualitative study to be published describing the experience of physical therapists during the COVID-19 pandemic.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain,Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Madrid, Spain
| | - César Fernández-de-las-Peñas
- Address all correspondence to César Fernández de las Peñas, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, SPAIN. Telephone number: + 34 91 488 88 84; Fax number: +34 91 488 89 57; /
| | - María Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain,Research Group of Manual Therapy, Dry Needling and Therapeutic Exercise of Universidad Rey Juan Carlos (GITM-URJC) Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Ana I de-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain,Research Group of Manual Therapy, Dry Needling and Therapeutic Exercise of Universidad Rey Juan Carlos (GITM-URJC) Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain,Research Group of Manual Therapy, Dry Needling and Therapeutic Exercise of Universidad Rey Juan Carlos (GITM-URJC) Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Petereit-Haack G, Bolm-Audorff U, Romero Starke K, Seidler A. Occupational Risk for Post-Traumatic Stress Disorder and Trauma-Related Depression: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9369. [PMID: 33327657 PMCID: PMC7765156 DOI: 10.3390/ijerph17249369] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022]
Abstract
There is evidence suggesting that occupational trauma leads to post-traumatic stress disorder (PTSD) and depression. However, there is a lack of high-quality reviews studying this association. We, therefore, conducted a systematic review with a meta-analysis to summarize the evidence of occupational trauma on PTSD and depression. After a database search on studies published between 1994 and 2018, we included 31 studies, of which only four had a low risk of bias. For soldiers exposed to wartime deployment, the pooled relative risk (RR) was 2.18 (95% CI 1.83-2.60) for PTSD and 1.15 (95% CI 1.06-1.25) for depression. For employees exposed to occupational trauma, there also was an increased risk for PTSD (RR = 3.18; 95% CI 1.76-5.76) and for depression (RR = 1.73; 95% CI 1.44-2.08). The overall quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was moderate; the evidence was high only for the association between workers after exposure to trauma and development of PTSD. The study results indicate an increased risk of PTSD and depression in soldiers after participation in war and in employees after occupational trauma.
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Affiliation(s)
- Gabriela Petereit-Haack
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany;
| | - Ulrich Bolm-Audorff
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany;
- Institute and Outpatient Clinic for Occupational and Social Medicine, University Medical Center Giessen, Justus-Liebig-University, 35392 Giessen, Germany
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.S.)
- Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09111 Chemnitz, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.S.)
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Gjerstad CL, Bøe HJ, Falkum E, Martinsen EW, Nordstrand AE, Tønnesen A, Reichelt JG, Lystad JU. Prevalence and Correlates of Mental Health Problems in Norwegian Peacekeepers 18-38 Years Postdeployment. J Trauma Stress 2020; 33:762-772. [PMID: 32810318 DOI: 10.1002/jts.22578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 11/09/2022]
Abstract
Peacekeeping missions involve experiences that may impact the mental health of participating soldiers. However, research on the long-term mental health consequences of peacekeeping is sparse. The present study aimed to find the prevalence of mental health problems (MHPs), possible MHP predictors, and associations between predictors and MHPs in Norwegian peacekeepers 18-38 years after deployment to a United Nations peacekeeping mission. We used data from a cross-sectional, postdeployment survey of Norwegian peacekeepers who served in Lebanon between 1978 and 1998 (N = 10,605). Participants were assessed for posttraumatic stress disorder (PTSD); anxiety; depression; insomnia; alcohol misuse; drug misuse; and exposure to pre-, peri-, and postdeployment stressors. Logistic regressions were executed to explore key variables associated with MHPs. Total MHP prevalence was 15.1%, 95% CI [14.4, 15.8]. The estimates for specific disorders were 0.1% for drug misuse, 3.4% for alcohol misuse, 4.0% for depression, 6.2% for PTSD, 6.4% for anxiety, and 9.3% for insomnia. Postdeployment stressors, OR = 1.91, 95% CI [1.79, 2.04]; employment status, OR = 1.41, 95% CI [1.33, 1.48]; and traumatic exposure during deployment, OR = 1.11, 95% CI [1.09, 1.12], were positively related to PTSD, χ2(17, N = 8,568) = 1,791.299, p < .001. Similar patterns were found for the other MHPs. Considering that most participants (84.9%) reported low symptom levels, our findings challenge the widespread public perception that most peacekeepers have MHPs. Moreover, our results indicate that future peacekeepers should be prepared for challenges they may face not only during deployment but also in the years following their homecoming.
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Affiliation(s)
- Christer Lunde Gjerstad
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hans Jakob Bøe
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway.,Division of Mental Health and Addiction, Kongsberg DPS, Vestre Viken Hospital Trust, Kongsberg, Norway
| | - Erik Falkum
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Egil Wilhelm Martinsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Andreas Espetvedt Nordstrand
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway.,Department of Psychology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnfinn Tønnesen
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway
| | | | - June Ullevoldsaeter Lystad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Section of Early Psychosis Treatment, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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15
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Wang HE, Campbell-Sills L, Kessler RC, Sun X, Heeringa SG, Nock MK, Ursano RJ, Jain S, Stein MB. Pre-deployment insomnia is associated with post-deployment post-traumatic stress disorder and suicidal ideation in US Army soldiers. Sleep 2019; 42:5228726. [PMID: 30508139 DOI: 10.1093/sleep/zsy229] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Indexed: 01/22/2023] Open
Abstract
Study Objectives Insomnia is prevalent among military personnel and may increase risk of mental disorders and suicidal ideation. This study examined associations of pre-deployment insomnia with post-deployment post-traumatic stress disorder (PTSD) and suicidal ideation among US Army soldiers. Methods Soldiers from three Brigade Combat Teams completed surveys 1-2 months before deploying to Afghanistan in 2012 (T0), on return from deployment (T1), 3 months later (T2), and 9 months later (T3). Logistic regression was performed to estimate associations of pre-deployment (T0) insomnia with post-deployment (T2 or T3) PTSD and suicidal ideation among respondents who completed surveys at all waves (n = 4645). A hierarchy of models incorporated, increasing controls for pre-deployment risk factors and deployment experiences. Results Pre-deployment insomnia was associated with increased risk of post-deployment PTSD (adjusted odds ratio [AOR] = 3.14, 95% confidence interval [CI] = 2.58% to 3.82%, p < .0005) and suicidal ideation (AOR = 2.78, 95% CI = 2.07% to 3.74%, p < .0005) in models adjusting for sociodemographic characteristics and prior deployment history. Adjustment for other pre-deployment risk factors and deployment experiences attenuated these associations; however, insomnia remained significantly associated with post-deployment PTSD (AOR = 1.50, 95% CI = 1.19% to 1.89%, p = .001) and suicidal ideation (AOR = 1.43, 95% CI = 1.04% to 1.95%, p = .027). Subgroup models showed that pre-deployment insomnia was associated with incident PTSD (AOR = 1.55, 95% CI = 1.17% to 2.07%, p = .003) and suicidal ideation (AOR = 1.67, 95% CI = 1.16% to 2.40%, p = .006) among soldiers with no pre-deployment history of these problems. Conclusions Pre-deployment insomnia contributed to prediction of post-deployment PTSD and suicidal ideation in Army soldiers, suggesting that detection of insomnia could facilitate targeting of risk mitigation programs. Future studies should investigate whether treatment of insomnia helps prevent PTSD and suicidal ideation among deployed service members.
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Affiliation(s)
- Hohui E Wang
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | | | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA.,VA San Diego Healthcare System, San Diego, CA
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