Mental health among a nationally representative sample of United States Military Reserve Component Personnel

Prevalence and correlates of destructive behaviors in the US Naval Surface Forces from 2010-2020

PURPOSE

To estimate the prevalence of domestic violence, sexual assault, and suicide for United States Navy (USN) personnel between 2010 and 2020 and identify potential associated factors.

METHODS

Official report data were used to calculate prevalence rates and odds ratios, accounting for sample and general USN population demographic data to assess differences in over- or underrepresentation of destructive behaviors.

RESULTS

Domestic violence and sexual assault offenders tended to be younger lower-ranked males. For sexual assaults, offenders were three times more likely to be senior to the victim, which was not the case for domestic violence. Females were overrepresented in terms of suicidal ideation and attempts relative to the USN population, while males accounted for more actual suicides. The relative rates of suicidal ideation and attempts for females exceeded those for males (i.e., comparing the sample rate against the USN male and female populations), but the sample proportion for completed suicides (compared to the USN population) were greater for males than for females. Those in the junior enlisted (E1-E3) paygrades exhibited greater odds of suicide attempts versus suicidal ideations relative to those in the Petty Officers (E4-E6) paygrades, although E4-E6s completed more suicides.

CONCLUSION

The descriptive profile of destructive behaviors in a representative sample of USN personnel provides an overview of the possible factors associated with destructive behaviors and includes an exploration of the relational dynamics and nature of the incidents. The results suggest that sexual assault and domestic violence are characterized by unique relational dynamics and that these destructive behaviors should not necessarily be classified together as male-oriented aggressions (i.e., mainly perpetrated by males against female victims). Those in the E1-E3 and E4-E6 paygrades displayed different patterns in suicidal ideation, attempts, and actual suicides. The results highlight individual characteristics to help inform the development of targeted policies, practices, and interventions for military and other hierarchical organizations (e.g., police).

Symptoms of depression, anxiety, and post-traumatic stress disorder and their relationship to health-related behaviors in over 12,000 US military personnel: Bi-directional associations

Background Military personnel are at greater risk of psychological disorders and related symptoms than civilians. Limited participation in health-promoting behaviors may increase presence of these disorders. Alternatively, these symptoms may limit engagement in health-promoting behaviors. Methods Self-reported data from the 2015 Department of Defense Health Related Behaviors Survey were used to assess bi-directional relationships between health-related behaviors (obesity, physical activity [PA], alcohol, smoking, sleep) and self-reported psychological disorders (generalized anxiety disorder [GAD], depression, post-traumatic disorder [PTSD]) in U.S. military personnel. Outcomes Among 12 708 respondents (14.7% female; 28.2% 17-24 y; 13.7% obese), self-reported depression was reported by 9.2%, GAD by 13.9%, and PTSD by 8.2%. Obesity and short sleep were associated with self-reported depression, GAD, and PTSD; current smoking was associated with higher odds of GAD; higher levels of vigorous PA were associated with lower odds of GAD; higher levels of moderate PA associated with lower odds of PTSD; and higher alcohol intake associated with higher odds of depression and PTSD. Self-reported depression, GAD, and PTSD were associated with higher odds of short sleep, obesity, and low levels of PA. Interpretation Obesity, short sleep, and limited engagement in health-promoting behaviors are associated with higher likelihood of self-reported psychological disorders, and vice-versa. Encouraging and improving health-promoting behaviors may contribute to positive mental health in military personnel.

Is deployment status the critical determinant of psychosocial problems among reserve/guard soldiers?

A general assumption that deployment is the primary catalyst for psychological and social difficulties may contribute to underrecognition and undertreatment of problems among never-deployed service members (i.e., having no history of ever being deployed). We aimed to determine if ever-deployed (i.e., having a history of at least one deployment) and never-deployed United States Army Reserve and National Guard (USAR/NG) soldiers differed in mental health, substance use, and resiliency factors, and to determine the relative influence of deployment status and each of these factors on poor psychosocial outcomes. We analyzed a subset of data from Operation: SAFETY (Soldiers and Families Excelling Through the Years) (N = 404), an ongoing study examining the health and well-being of USAR/NG soldiers. Bivariate analyses demonstrated that soldiers did not significantly differ across a range of measures on the basis of deployment status (ps > 0.05). In fact, Factor Analyses and Discriminant Function Analysis revealed that deployment status was the least salient factor to psychosocial problems among the measured variables and that the observed variables could not accurately discriminate between ever-deployed and never-deployed soldiers, F(8, 374) = 1.34, p > .05. Measures of mental health and substance use were more salient to psychosocial problems (ps < .05). Measures of resiliency loaded negatively onto psychosocial problems (ps < .05), indicating that they contribute to better well-being. Targeting screening and intervention efforts only on soldiers who have been deployed will miss opportunities to intervene on an equally affected group. Resiliency factors should be considered as intervention targets. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Problems with Social Acceptance and Social Victimization Predict Substance Use among US Reserve/Guard Soldiers

The effects of negative social interactions/experiences on substance use have largely been studied in civilian populations, but less is known about United States Army Reserve/National Guard (USAR/NG) soldiers-a high-risk group. We examined the associations between problems with social acceptance, social victimization, and substance use among USAR/NG soldiers, and examined potential differences by deployment history. The sample consisted of soldiers who completed baseline and 1-year follow-up assessments (N = 445) of Operation: SAFETY, an ongoing study of USAR/NG soldiers. We examined the effects of baseline problems with social acceptance/social victimization on nonmedical use of prescription drugs (NMUPD), illicit drug use, frequent heavy drinking (FHD), and alcohol problems at follow-up. Significant effects were small in magnitude but consistent in direction. Greater problems with social acceptance were associated with higher odds of NMUPD and illicit drug use. Greater social victimization was associated with higher odds of NMUPD and illicit drug use. There were no differences by deployment history. Problems with social acceptance/social victimization were not associated with FHD or alcohol problems. Problems with social acceptance/social victimization may contribute to drug use among USAR/NG soldiers. Intervention programs should address social issues, regardless of deployment history.

Mental Health and Suicidality in Separating U.S. Reserve and National Guard Personnel

OBJECTIVE

We examined the association of U.S. Reserve Component (RC) personnel separating from military service with the risk of mental health problems at three time periods.

METHODS

Structured interviews were conducted with a nationally representative sample of 1,582 RC personnel at baseline and three follow-up waves from 2010 to 2013. Multivariate logistic regression analyses examined posttraumatic stress disorder (PTSD), major depressive disorder (MDD), binge drinking, suicide ideation, and mental health diagnosis by a health provider.

RESULTS

Approximately 10%, 20%, and 28% of RC personnel reported separating from military service at waves 2-4. At an estimated 6 months since leaving military service, there were no differences between those who left and those who remained in service. However, at 1 year after leaving service, those who had left had a higher risk of MDD, suicidal ideation, and reporting having mental health diagnosis by a health provider. At 1.6 years after leaving military service, those who had left had a higher risk of reporting having mental health diagnosis by a health provider. The results were essentially unchanged after adjusting for baseline mental disorder for each outcome.

CONCLUSION

Results suggest a higher risk of mental health problems in RC veterans separating, compared to those who remained in the military. This risk may not occur immediately following separation but may occur within the first year or two after separation. Transition from military to civilian life may be a critical period for interventions to address the unique needs of the RC's citizen-soldiers and reduce their risk of adverse mental health outcomes.

The evolution of mental health outcomes across a combat deployment cycle: A longitudinal study of the Guam Army National Guard

In the United States, National Guard soldiers have been called upon at unprecedented rates since 2001 to supplement active duty military forces. Frequent military deployments generate many occupational and environmental stressors for these citizen-soldiers, from serving in a dangerous zone to being away from family and home for long periods of time. Whereas there is a substantial amount of research focused on deployment-related health outcomes in relation to active duty (i.e., full-time) military populations, reserve forces are less understood. This study focuses on a United States Army National Guard combat unit deployed to Afghanistan. This prospective longitudinal study was conducted over the course an operational deployment cycle (i.e., before, during, and after) to document the evolution of salient mental health outcomes (i.e., post-traumatic stress, depression, general anxiety, and aggression). The findings show that both combat (e.g., killing others) and non-combat (e.g., boredom) stressors negatively affect mental health outcomes, and the severity of these outcomes increases over the course of a deployment cycle. Of special note, the study reveals key gender differences in the evolution of post-traumatic stress (PTS), depression, and anxiety across a deployment cycle: females report increased PTS, depression, and anxiety 6 months post-deployment, whereas the levels reported by males stabilize at their mid-deployment levels. The findings offer insights for medical providers and policymakers in developing more targeted health promotion campaigns and interventions, especially at the post-deployment phase.

Alcohol use and its association with sexual risk behaviors in the Armed Forces of the Republic of the Congo

Background

Previous research has shown alcohol misuse amplifies the risk of acquiring sexually transmitted infections [STIs], including HIV, by increasing high risk sexual behaviors. Military populations are particularly vulnerable to both alcohol misuse and STIs due to the unique conditions of military service. This study estimated the prevalence of probable hazardous and harmful alcohol use and examined associations with transactional sex, sex with a sex worker, and multiple sexual partners among military personnel in the Armed Forces of the Republic of the Congo (FAC).

Methods

A secondary analysis of data collected from a 2014 seroprevalence and behavioral epidemiology risk survey was performed. Participants included 703 active duty male service members 18 years of age or older who reported ever having sex. Patterns of harmful and hazardous drinking were measured with the Alcohol Use Disorders Identification Test (AUDIT). Participants with an AUDIT score ≥ 8 (indicative of probable hazardous and harmful alcohol use, and possible alcohol dependence) were compared to those with an AUDIT score ≤ 7.

Results

A total of 15.8% received a score of 8 or higher on the AUDIT. These participants were more likely to be lower educated and of lower military rank. In separate multivariable models, an AUDIT score ≥ 8 was significantly associated with higher odds of sex with a commercial sex worker and having multiple sexual partners.

Conclusions

Study results emphasize the need to address patterns of harmful and hazardous alcohol use in the FAC and integrate alcohol misuse education into the HIV prevention program. The development of military-specific interventions to reduce alcohol-related risky sexual behaviors are also needed. Lastly, implementing policies such as restricting alcohol availability and sales on military bases, and adding warning labels to advertisements and containers may provide a more comprehensive response to reduce problematic alcohol use.

Body Composition and Physical Fitness Tests Among US Army Soldiers: A Comparison of the Active and Reserve Components

OBJECTIVES

US Army reserve soldiers and active-duty soldiers differ in their daily work demands and supporting resources, yet research on reservists' health and fitness is lacking. The objectives of this study were to (1) determine whether physical test failure rates and health behaviors differed between active-duty soldiers and reserve soldiers and (2) establish which demographic and health behavioral factors were associated with failing physical tests.

METHODS

We analyzed a sample of 239 329 US Army active-duty and reserve soldiers surveyed from September 2013 through March 2015 using the Global Assessment Tool. We extracted data on soldier demographic characteristics and health behaviors, as well as Body Composition Test (BCT) and Army Physical Fitness Test (APFT) results. We compared the 2 groups using the active-to-reserve adjusted odds ratio (aOR) for each variable. We used logistic regression models to determine which variables were associated with failing these tests.

RESULTS

The odds of failing the BCT (aOR = 0.76; 95% confidence interval [CI], 0.73-0.78) or the APFT (aOR = 0.31; 95% CI, 0.30-0.32) were lower among active-duty soldiers than among reservists, and the odds of doing high levels of high-intensity interval training (aOR = 1.47; 95% CI, 1.42-1.51), resistance training (aOR = 1.45; 95% CI, 1.42-1.48), and vigorous physical activity (aOR = 2.92; 95% CI, 2.86-2.98) were higher among active-duty soldiers than among reservists. The odds of using tobacco (aOR = 1.37; 95% CI, 1.35-1.40), binge drinking alcohol (aOR = 1.11; 95% CI, 1.09-1.13), having insomnia (aOR = 1.46; 95% CI, 1.43-1.48) or mild depression (aOR = 1.50; 95% CI, 1.48-1.53), and sustaining a physical activity-related injury (aOR = 2.52; 95% CI, 2.47-2.57) were higher among active-duty soldiers than among reservists.

CONCLUSIONS

Policy makers and military leaders could use this information to implement health screenings and tailor health-promotion, intervention, and treatment programs.

Post-deployment Mental Health in Reserve and National Guard Service Members: Deploying With or Without One's Unit and Deployment Preparedness

Background

Given the greater prevalence of post-deployment mental health concerns among reservists, the higher likelihood of deploying without their regular unit, and potentially lower rates of deployment preparedness, we examined associations between deploying with or without one's regular unit (individual augmentee status, IAS), deployment preparedness, and mental health problems including post-traumatic stress disorder (PTSD), depression (MDD), and binge drinking in a nationally representative sample of Reserve Component (RC) Army and Marine-enlisted males (n = 705).

Methods

A series of multivariate regressions examined the association of mental health with IAS and deployment preparedness, adjusting for demographics. To examine whether deployment preparedness varied by IAS, an IAS × deployment preparedness interaction was included.

Findings

In an adjusted model, being an individual augmentee and low deployment preparedness were associated with any mental health problem (screening positive for PTSD, MDD, binge drinking, or any combination of the three). There was a significant IAS × deployment preparedness interaction. Mental health problems did not vary by preparedness among individual augmentees. Participants deploying with regular units with low-medium preparedness had greater risk for mental health problems (odds ratio [OR] = 3.69, 95% confidence interval [CI] = 1.78-7.62 and OR = 2.29, 95% CI = 1.12-4.71), than those with high preparedness. RC-enlisted male personnel who deployed without their regular unit were five times more likely to have a mental health problem, and were 61% more likely to report binge drinking. Additionally, those with lower levels of deployment preparedness were up to three times more likely to have a mental health problem and up to six times more likely to report PTSD.

Discussion

The current investigation found that both IAS and deployment preparedness were associated with negative mental health outcomes in a large representative sample of previously deployed RC-enlisted male personnel. In particular, low deployment preparedness was associated with an increased likelihood of PTSD, and deploying without one's regular unit was associated with increased rates of binge drinking. There were also significant main and interaction effects of IAS and deployment preparedness on having a mental health problem. It is possible that limiting the number of RC personnel deploying without their regular unit may help to decrease alcohol misuse among U.S. Armed Services reservists during and after future conflicts. Also, to the extent that deployment preparedness is a modifiable risk factor, future studies should examine whether increasing deployment preparedness could mitigate some of the correlates of deployment-related trauma exposure. Finally, future investigation is needed to explain why those who deploy without their regular unit, but who report high deployment preparedness, remain at elevated risk for mental health problems. It is possible that individual augmentees can benefit from a specific preparation for deployment. Those deploying without their regular unit had higher rates of mental health problems regardless of preparedness. These findings have implications for deployment preparedness training for those deploying without their regular unit.

Association of suicidal ideation with trajectories of deployment-related PTSD symptoms

This study examined the association between suicidal ideation and posttraumatic stress disorder (PTSD) symptom trajectories in a nationally representative sample of United States Reserve Component soldiers. PTSD symptoms related to a traumatic event during the most recent deployment were assessed in four annual waves in 2010-2013 among 682 Reserve Component soldiers. Latent Growth Mixture Modeling (LGMM) was used to examine the longitudinal trajectories of PTSD symptoms. The association between the PTSD trajectories and suicidal ideation at waves 2 to 4 was examined in logistic regression analyses. Four trajectories were identified: resilience (73.0%), recovery (11.7%), late onset (11.6%) and chronic (3.6%). Pairwise comparisons demonstrated significant differences between trajectories in risk of suicidal ideation. Among the chronic trajectory group, 50.9% reported suicidal ideation (25.8% late onset group; 11.3% recovery group; 4.0% resilience group). After controlling for baseline characteristics, the late onset and chronic trajectory groups were more likely to have suicidal ideation than the resilience and recovery trajectories, respectively. Findings suggest the late onset and chronic trajectories of PTSD symptoms are associated with higher risk of suicidal ideation. They support the importance of follow-up assessment of suicide risk even among individuals with low PTSD symptoms at homecoming.

Racial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010-2015

Background. Black and Latino minorities have traditionally had poorer access to primary care than non-Latino Whites, but these patterns could change with the Affordable Care Act (ACA). To guide post-ACA efforts to address mental health service disparities, we used a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care. Methods. Data were obtained from the Medical Expenditures Panel Survey (MEPS), a two-year panel study of healthcare use, satisfaction with care, and costs of services in the United States (US). We pooled data from six waves (14–19) of participants with serious psychological distress to examine racial, ethnic, and nativity disparities in medical and mental health visits to primary care (PC) and specialty mental health (SMH) providers around the time of ACA reforms, 2010–2015. Results. Of the 2747 respondents with serious psychological distress, 1316 were non-Latino White, 632 non-Latino Black, 532 identified as Latino with Mexican, Central American, or South American (MCS) origins, and 267 as Latino with Caribbean island origins; 525 were foreign/island born. All racial/ethnic groups were less likely than non-Latino Whites to have any PC visit. Of those who used PC, non-Latino Blacks were less likely than Whites to have a PC mental health visit, while foreign born MCS Latinos were less likely to visit an SMH provider. Conditional on any mental health visit, Latinos from the Caribbean were more likely than non-Latino Whites to visit SMH providers versus PC providers only, while non-Latino Blacks and US born MCS Latinos received fewer PC mental health visits than non-Latino Whites. Conclusion. Racial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services.

Influence of military component and deployment-related experiences on mental disorders among Canadian military personnel who deployed to Afghanistan: a cross-sectional survey

OBJECTIVE

The primary objective was to explore differences in mental health problems (MHP) between serving Canadian Armed Forces (CAF) components (Regular Force (RegF); Reserve Force (ResF)) with an Afghanistan deployment and to assess the contribution of both component and deployment experiences to MHP using covariate-adjusted prevalence difference estimates. Additionally, mental health services use (MHSU) was descriptively assessed among those with a mental disorder.

DESIGN

Data came from the 2013 CAF Mental Health Survey, a cross-sectional survey of serving personnel (n=72 629). Analyses were limited to those with an Afghanistan deployment (population n=35 311; sampled n=4854). Logistic regression compared MHP between RegF and ResF members. Covariate-adjusted prevalence differences were computed.

PRIMARY OUTCOME MEASURE

The primary outcomes were MHP, past-year mental disorders, identified using the WHO's Composite International Diagnostic Interview, and past-year suicide ideation.

RESULTS

ResF personnel were less likely to be identified with a past-year anxiety disorder (adjusted OR (AOR)=0.72 (95% CI 0.58 to 0.90)), specifically both generalised anxiety disorder and panic disorder, but more likely to be identified with a past-year alcohol abuse disorder (AOR=1.63 (95% CI 1.04 to 2.58)). The magnitude of the covariate-adjusted disorder prevalence differences for component was highest for the any anxiety disorder outcome, 2.8% (95% CI 1.0 to 4.6); lower for ResF. All but one deployment-related experience variable had some association with MHP. The 'ever felt responsible for the death of a Canadian or ally personnel' experience had the strongest association with MHP; its estimated covariate-adjusted disorder prevalence difference was highest for the any (of the six measured) mental disorder outcome (11.2% (95% CI 6.6 to 15.9)). Additionally, ResF reported less past-year MHSU and more past-year civilian MHSU.

CONCLUSIONS

Past-year MHP differences were identified between components. Our findings suggest that although deployment-related experiences were highly associated with MHP, these only partially accounted for MHP differences between components. Additional research is needed to further investigate MHSU differences between components.

Narrative approach in understanding the drivers for resilience of military combat medics

INTRODUCTION

Qualitative insights may demonstrate how combat medics (CM) deal with stressors and identify how resilience can potentially develop. Yet, qualitative research is scant in comparison to the many quantitative studies of health outcomes associated with military service.

METHOD

Semistructured qualitative interviews were used to collect personal narratives of US Army CMs who had previously served in Iraq or Afghanistan.

RESULTS

Thematic analysis revealed three key driving forces for how resilience develops in the context of combat and war. The first was patriotism, which captures loyalty and full commitment to the military and its missions. The second was commitment to their family, reflecting the balance of responsibility to family of origin with the obligation one feels towards their military family. The last driving force was faith, or the drive to reach towards the transcendent to provide a moral compass and develop empathy in the face of difficult situations.

CONCLUSIONS

An individual's commitment to country, military family and faith strengthens their resilience, and this can be used to inform future research efforts as well as current clinical practice.

Domestic Civil Support Missions Can Aggravate Negative Mental Health Outcomes Among National Guardsmen: The Moderating Role of Economic Difficulties

Little research has addressed potentially negative health outcomes associated with domestic civil-oriented operations, but has focused instead on traditional military operations (e.g., combat). This study, conducted following a United States Defense Support to Civilian Authorities mission undertaken by National Guard forces (N = 330), showed that responding to such missions was linked to more negative mental health outcomes, including posttraumatic stress disorder (β = 0.23) and depression (β = 0.23), but only among those who reported difficulty meeting their basic socioeconomic needs and not among those who did not have difficulty meeting their basic needs. The study offers suggestions for identifying individuals who may be especially vulnerable to stressors.

Incidence of and risk for post-traumatic stress disorder and depression in a representative sample of US Reserve and National Guard

PURPOSE

We aim to determine the incidence rates (IR) of first-ever post-traumatic stress disorder (PTSD) and depression in a population-based cohort of US Reserve and National Guard service members.

METHODS

We used data from the US Reserve and National Guard Study (n = 2003) to annually investigate incident and recurrent PTSD and depression symptoms from 2010 to 2013. We estimated the IR and recurrence rate over 4 years and according to several sociodemographic and military characteristics.

RESULTS

From 2010 to 2013, IRs were 4.7 per 100 person-years for both PTSD and depression symptoms using the sensitive criteria, 2.9 per 100 person-years using the more specific criteria, recurrence rates for both PTSD and depression were more than 4 times as high as IRs, and IRs were higher among those with past-year civilian trauma, but not past-year deployment.

CONCLUSIONS

The finding that civilian trauma, but not past-year military deployment, is associated with an increased risk of PTSD and depression incidence suggest that Reserve National Guard psychopathology could be driven by other, nonmilitary, traumatic experiences.

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use

BACKGROUND

The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders.

OBJECTIVE

To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS).

DESIGN

Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics.

PARTICIPANTS

A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics.

MAIN MEASURES

We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year.

RESULTS

Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2-13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7-14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI = 1.0-19.0).

CONCLUSIONS

Access to a usual provider is associated with increased receipt of needed MHS. Patients who have a usual provider with PCMH qualities are more likely to receive mental health counseling.