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Jacobson IG, Harbertson J, Sharifian N, Rull RP, Steele CT, Russell DW. Sleep health among US Navy afloat versus ashore personnel in the Millennium Cohort Study. J Sleep Res 2024:e14207. [PMID: 38764130 DOI: 10.1111/jsr.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 05/21/2024]
Abstract
Despite emerging public concern regarding the sleep health of military personnel over the past two decades, there remains a dearth of research examining sleep health among naval personnel assigned to sea duty. This study examined sleep metrics (e.g. fatigue, short sleep duration) and mental (e.g. posttraumatic stress disorder, depression) and physical health (e.g. type 2 diabetes, bodily pain) outcomes among naval personnel with recent sea duty (i.e. afloat) compared with naval personnel with recent shore duty (i.e. ashore). Prevalence ratios and mean differences for all outcomes were estimated and adjusted for demographic and military variables, and subsequently stratified by obesity. Sleep metrics were similar between afloat and ashore sailors except for short sleep duration, while sailors with recent shore duty had poorer physical health compared with those with recent sea duty. Stratified analyses suggested naval personnel with obesity had a higher proportion of nearly all adverse sleep-related health outcomes than those without obesity. Among participants without obesity, afloat personnel were more likely to report very short sleep (≤ 5 hours) and fewer hours of average nightly sleep, but were less likely to report physical health outcomes compared with ashore personnel. These findings suggest potential differences in sleep metrics and sleep-related health outcomes between afloat and ashore naval personnel. Additional research examining sleep outcomes using more objective measures is required to further investigate these findings, which may inform strategies to foster consolidated sleep despite environmental and occupational challenges in order to maintain high-performing naval personnel.
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Affiliation(s)
- Isabel G Jacobson
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Judith Harbertson
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Neika Sharifian
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Rudolph P Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | | | - Dale W Russell
- US Navy, Commander, Naval Surface Forces, Coronado, California, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Agimi Y, Hai T, Gano A, Stuessi K, Gold J, Kaufman R, McKinney G. Clinical Trajectories of Comorbidity Associated With Military-Sustained Mild Traumatic Brain Injury: Pre- and Post-Injury. J Head Trauma Rehabil 2024:00001199-990000000-00150. [PMID: 38758066 DOI: 10.1097/htr.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND AND OBJECTIVE In the US military, traumatic brain injury (TBI) is of distinct importance, at home and in the deployed setting, and is considered a "signature injury of the wars in Afghanistan and Iraq." Since 2000, an estimated 468 424 service members (SMs) have been diagnosed with at least one TBI. We examined the clinical trajectories of a group of 18 comorbidities before and after a military-sustained mild TBI (mTBI). METHODS Without making assumptions on causality, a group of 18 conditions often co-occurring with mTBI were identified through literature review and TBI subject matter workgroup consensus. Using data from Military Health System Data Repository, we identified SMs whose first lifetime military mTBI occurred between October 1, 2016, and October 30, 2019. Correlation analyses were used to determine the linear relationship between comorbidities prior to and after mTBI diagnosis. Changes in the period prevalence of comorbidities was calculated. RESULTS We identified 42 018 SMs with a first lifetime military mTBI, of which 77.6% had at least one comorbidity. Identified SMs were mostly young (46.1% ages 18-24 years), male (81.4%), and White (64.1%). Up to 180 days prior to an mTBI, the most frequently identified conditions were sleep-related conditions (21.7%), headaches (19.4%), posttraumatic stress disorders (PTSDs) (17.8%), anxiety disorders (11.3%), and cervicogenic disorders (eg, cervicalgia) (10.9%). In the period following mTBI diagnosis, the prevalence of diagnosed conditions increased, especially for visual disturbances (327.2%), cognitive conditions (313.9%), vestibular conditions (192.6%), those related to headache (152.2%), and hearing (72.9%). Sleep-related conditions showed moderate positive correlation with a group of co-occurring conditions, led by cognitive conditions (ϕc = 0.50), anxiety disorders (ϕc = 0.42), PTSDs (ϕc =0.43), and headaches and related conditions (ϕc = 0.38). CONCLUSION Results indicate that caring for SMs with mild TBI requires a holistic approach, one that considers the complex nature of SM conditions, prior to sustaining their mTBI, as well as after injury. We found a complex correlation of conditions that suggest SMs with mTBI are undergoing a multifaceted experience, one that may require the development of a targeted multidimensional clinical practice recommendation and practice.
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Affiliation(s)
- Yll Agimi
- Author Affiliations: Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, Maryland (Drs Agimi, Stuessi, Gold, and McKinney and Mss Hai, Gano, and Kaufman); and General Dynamics Information Technology, Falls Church, Virginia (Drs Agimi, Stuessi, and Gold and Mss Hai, Gano, and Kaufman)
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Gaffey AE, Chang TE, Brandt CA, Haskell SG, Dhruva SS, Bastian LA, Levine A, Skanderson M, Burg MM. Blood Pressure Control and Maintenance in a Prospective Cohort of Younger Veterans: Roles of Sex, Race, Ethnicity, and Social Determinants of Health. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.22.24306203. [PMID: 38712220 PMCID: PMC11071551 DOI: 10.1101/2024.04.22.24306203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background Proactive blood pressure (BP) management is particularly beneficial for younger Veterans, who have a greater prevalence and earlier onset of cardiovascular disease than non-Veterans. It is unknown what proportion of younger Veterans achieve and maintain BP control after hypertension onset and if BP control differs by demographics and social deprivation. Methods Electronic health records were merged from Veterans who enrolled in VA care 10/1/2001-9/30/2017 and met criteria for hypertension - first diagnosis or antihypertensive fill. BP control (140/90 mmHg), was estimated 1, 2, and 5 years post-hypertension documentation, and characterized by sex, race, and ethnicity. Adjusted logistic regressions assessed likelihood of BP control by these demographics and with the Social Deprivation Index (SDI). Results Overall, 17% patients met criteria for hypertension (n=198,367; 11% of women, median age 41). One year later, 59% of men and 65% of women achieved BP control. After adjustment, women had a 72% greater odds of BP control than men, with minimal change over 5 years. Black adults had a 22% lower odds of BP control than White adults. SDI did not significantly change these results. Conclusions In the largest study of hypertension in younger Veterans, 41% of men and 35% of women did not have BP control after 1 year, and BP control was consistently better for women through 5 years. Thus, the first year of hypertension management portends future, long-term BP control. As social deprivation did not affect BP control, the VA system may protect against disadvantages observed in the general U.S. population.
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Affiliation(s)
- Allison E. Gaffey
- VA Connecticut Healthcare System, West Haven, CT
- Department of Internal Medicine (Cardiovascular Medicine)
| | - Tiffany E. Chang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Cynthia A. Brandt
- VA Connecticut Healthcare System, West Haven, CT
- Department of Biostatistics, Yale School of Medicine
| | - Sally G. Haskell
- VA Connecticut Healthcare System, West Haven, CT
- Department of Internal Medicine (General Medicine), Yale School of Medicine
| | - Sanket S. Dhruva
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
- Section of Cardiology, Department of Medicine, UCSF School of Medicine
| | - Lori A. Bastian
- VA Connecticut Healthcare System, West Haven, CT
- Department of Internal Medicine (General Medicine), Yale School of Medicine
| | | | | | - Matthew M. Burg
- VA Connecticut Healthcare System, West Haven, CT
- Department of Internal Medicine (Cardiovascular Medicine)
- Department of Anesthesiology, Yale School of Medicine
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Oltvolgyi CG, Meurk C, Heffernan E. Suicide and suicidality in Australian Defence Force veterans: A systematic scoping review. Aust N Z J Psychiatry 2024:48674241246443. [PMID: 38650320 DOI: 10.1177/00048674241246443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Increased suicidality and suicide deaths among veterans of the Australian Defence Force have gained recent prominence. A systematic scoping review was conducted to identify, summarise and synthesise the existing literature relating to Australian veteran suicide and suicidality, with the objective of identifying future research priorities. METHODS We conducted a PRISMA-compliant systematic search on PubMed/MEDLINE, Embase and CINAHL databases for all manuscripts reporting primary data on suicide and suicidality in Australian veterans. The search was supplemented by grey literature and a search of reference lists. Manuscripts of any study type, published in the English language since the Vietnam era, were eligible for inclusion. RESULTS A total of 26 articles and reports, utilising a variety of mostly quantitative approaches, were included in the review. Findings, especially in larger and more recent studies, indicate increased suicidality in the veteran population. Suicide deaths appeared to increase with transition out of the military. Mental illness was identified as an important risk factor for suicide and suicidality. Current service was identified as a protective factor against suicide. There was mixed evidence regarding the impact of operational deployment on suicide and suicidality. CONCLUSIONS Gaps were identified in relation to the relative contributions to risk from transition, the various psychosocial correlates (for example, relationships, finances, employment), pre-service factors and the extent to which these are causal or mediating in nature. A better understanding of health service utilisation would also aid in targeting preventive efforts. Future research in these areas is warranted.
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Affiliation(s)
- Csongor G Oltvolgyi
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Carla Meurk
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Ed Heffernan
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- Queensland Forensic Mental Health Service, Brisbane, QLD, Australia
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Rønning L, Nordstrand AE, Hjemdal O, Bøe HJ. Gender differences in mental health outcomes among Afghanistan veterans exposed to war zone trauma. J Trauma Stress 2024; 37:307-317. [PMID: 38270838 DOI: 10.1002/jts.23015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
Research has sought to identify whether women have an increased risk of developing mental health problems following military trauma compared to men, but the results are mixed. This study examined gender differences in a range of mental health outcomes within three levels of war zone trauma exposure and investigated gender differences in risk and protective factors associated with clinical mental health problems. Using data from a cross-sectional, postdeployment survey, a sample of Norwegian veterans of recent military operations in Afghanistan (N = 6,205, 8.3% women) were sorted according to reported war zone trauma exposure level (low, medium, high), then assessed for symptoms of posttraumatic stress disorder (PTSD), posttraumatic distress, anxiety, depression, insomnia, and alcohol problems. The findings revealed that men who reported low war zone exposure had lower levels of posttraumatic distress symptoms than women, d = -0.20, p = .040, but were more likely to report symptoms of alcohol problems within the low, d = 0.33, p < .001; medium, d = 0.39, p < .001; and high, d = 0.37, p = .049, exposure groups; however, these differences disappeared when all symptom variables were combined into one clinical mental health problem variable. Women with a clinical mental health problem were less likely to report war zone exposure than men, OR = 0.93, 95% CI [0.90, 0.97], p = .001. Findings suggest that although gender differences in mental health symptoms exist, male and female veterans with mental health problems may share more similarities than previously recognized.
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Affiliation(s)
- Line Rønning
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Espetvedt Nordstrand
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans Jakob Bøe
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
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DeBlois JP, London AS, Heffernan KS. Hypertension at the nexus of veteran status, psychiatric disorders, and traumatic brain injury: Insights from the 2011 Behavioral Risk Factor Surveillance System. PLoS One 2024; 19:e0298366. [PMID: 38498456 PMCID: PMC10947695 DOI: 10.1371/journal.pone.0298366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/24/2024] [Indexed: 03/20/2024] Open
Abstract
Variable military service-related experiences, such as combat exposure, psychiatric disorders (PD), and traumatic brain injuries (TBI), may differentially affect the likelihood of having health care professional-identified high blood pressure (i.e., hypertension). PURPOSE Compare the odds of self-reported hypertension among non-combat and combat veterans with and without PD/TBI to non-veterans and each other. METHODS We used data from men from the 2011 Behavioral Risk Factor Surveillance System and distinguished: non-veterans (n = 21,076); non-combat veterans with no PD/TBI (n = 3,150); combat veterans with no PD/TBI (n = 1,979); and veterans (combat and non-combat) with PD and/or TBI (n = 805). Multivariable, hierarchical logistic regression models included exogenous demographic, socioeconomic attainment and family structure, health behavior and conditions, and methodological control variables. RESULTS One-third of men reported having been told at least once by a medical professional that they had high blood pressure. Bivariate analyses indicated that each veteran group had a higher prevalence of self-reported hypertension than non-veterans (design-based F = 45.2, p<0.001). In the fully adjusted model, no statistically significant differences in the odds of self-reported hypertension were observed between non-veterans and: non-combat veterans without PD/TBI (odds ratio [OR] = 0.92); combat veterans without PD/TBI (OR = 0.87); veterans with PD and/or TBI (OR = 1.35). However, veterans with PD and/or TBI had greater odds of reporting hypertension than both combat and non-combat veterans without PD/TBI (p<0.05). DISCUSSION Military service-related experiences were differentially associated with a survey-based measure of hypertension. Specifically, veterans self-reporting PD and/or TBI had significantly higher odds of self-reporting hypertension (i.e., medical provider-identified high blood pressure).
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Affiliation(s)
- Jacob P. DeBlois
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States of America
| | - Andrew S. London
- Department of Sociology, Syracuse University, Syracuse, NY, United States of America
| | - Kevin S. Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States of America
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Lin PY, Lee YH, Wang RS, Chen TY, Li YJ, Wu YH, Hsu TF, Chang YC. Correlates of the Veterans Visiting Emergency Departments in Taiwan: A Comparison Before and After the Coronavirus Disease 2019 Pandemic. Mil Med 2024; 189:e148-e156. [PMID: 37256764 DOI: 10.1093/milmed/usad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/12/2023] [Accepted: 05/14/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Taiwan has a substantial number of veterans, but knowledge regarding their emergency department (ED) visits during the coronavirus disease 2019 (COVID-19) pandemic remains limited. This study examined the characteristics of veterans' ED visits during Taiwan's COVID-19 epidemic. METHODS This was a cross-sectional study conducted at the ED of a large veteran medical center located in Taipei, Taiwan, from May 2018 to October 2021. We analyzed the numbers and features of visits in summer and autumn according to the first wave of the COVID-19 epidemic in Taiwan in 2021. RESULTS Medical institutions were positively associated with veteran status. Emergency department complaints of trauma (adjusted odds ratio [AOR] = 1.15, 95% CI: 1.06-1.25; summer P < .01) and chest pain/tightness (AOR = 1.65, 95% CI: 1.45-1.87; summer P < .01; AOR = 1.4, 95% CI: 1.26-1.55; P < .01) were associated with increased odds of being a veteran. Triage levels above 2 were positively associated with veteran status in the autumn model (AOR = 1.14, 95% CI: 1.07-1.22; P < .01). Patients hospitalized after ED visits were associated with reduced odds of veteran status (P < .01). Those who spent a long time in the ED were more likely to be veterans than those who spent a shorter time in the ED (P < .01). Veterans were less likely to visit the ED regardless of the time frame of the study period (P < .01), except during the COVID-19 outbreak in the autumn (2019-2020). CONCLUSIONS The distinctions in ED visits highlighted the individuality of veterans' medical needs. Our findings suggest that the veteran medical system can add to the focus on improving senior-friendly care, fall prevention, quality of life of institutionalized veterans, access for homeless veterans, and care for ambulatory care-sensitive conditions.
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Affiliation(s)
- Pei-Ying Lin
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yen-Han Lee
- Department of Health Sciences, University of Central Florida, Orlando, FL 32816, USA
| | - Ren-Siang Wang
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Tze-Yin Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Yi-Jing Li
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Yu-Hsuan Wu
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Teh-Fu Hsu
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei 112, Taiwan
| | - Yen-Chang Chang
- Center for General Education, National Tsing Hua University, Hsinchu 30013, Taiwan
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Olapeju B, Ahmed AE, Chu K, Yoon J, Mancuso JD. Perceived Health Status and Medical Conditions Among US Active-Duty Service Members. Psychol Res Behav Manag 2023; 16:5121-5138. [PMID: 38146390 PMCID: PMC10749538 DOI: 10.2147/prbm.s429341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023] Open
Abstract
Purpose This paper investigates the association between self-reported perceived health status and doctor-informed medical conditions among US active duty service members (ADSM). Methods Data are from the 2018 Health-Related Behaviors Survey - a cross-sectional survey weighted to represent the US military (N = 17166). Perceived good health status was defined as having a response choice of "good", "very good", or "excellent" to the question: Would you say your overall physical health is ___? Medical conditions were based on self-reported presence of nine clinical conditions. Analysis included weighted prevalence and log-binomial regression models to explore relationships between ADSM characteristics with perceived good health status as well as concordance between perceived status and medical conditions. Results ADSM rated their health to be excellent (14.6%), very good (37.7%), good (36.2%), fair (9.7%) and poor (1.7%). About 88.5% perceived a good (to excellent) health status. Perceived good health status was negatively associated with the number of medical conditions present (adjusted odds ratio (aOR): ranging from 0.78 to 0.92) as well as several health behaviors (aOR): ranging from 0.86 to 0.98) and other sociodemographic factors. Among all ADSMs, 51% perceived good health in the absence of medical conditions, while 8% perceived poor health status in the presence of medical conditions. Concordance between perceived health status and medical conditions was significantly lower among ADSM who were older (aOR: 0.61; 95% CI: 0.54-0.69), with dependent children (aOR: 0.89; 95% CI: 0.84-0.95), or had been deployed (aOR: 0.89, 95% CI: 0.84-0.95). Conclusion The prevalence of perceived good health status among ADSMs was consistent with those documented in the general US population. The interrelationships between ADSM's perceptions, medical conditions and sociodemographic characteristics may have implications for their health literacy and utilization of health services. Study findings suggest that interventions promoting healthy behaviors, health literacy and treatment-seeking may influence perceived health status and mitigate medical conditions among ADSM, thus improving the US Military readiness, resilience and mission success.
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Affiliation(s)
- Bolanle Olapeju
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Anwar E Ahmed
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kasi Chu
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jangho Yoon
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - James D Mancuso
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Wilson N, Clement C, Summers JA, Thomson G, Harper G. Impact of war on veteran life span: natural experiment involving combat versus non-combat exposed military personnel. BMJ Mil Health 2023; 169:505-509. [PMID: 34937743 DOI: 10.1136/bmjmilitary-2021-001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/18/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION There is still uncertainty around the impact of combat exposure on the life span of war veterans. Therefore we made use of a natural experiment to study the impact on veteran life span of combat versus non-combat exposure in World War II (WW2). METHODS The combat-exposed military personnel were derived from a random (10%) sample of the military roll of the 28th (Māori) Battalion from New Zealand. One non-combat cohort was the 15th Reinforcements of this same Battalion, since the war ended before they reached the front line. The other non-combat cohort were Māori personnel who were only involved in Jayforce, which occupied Japan at the end of the WW2. Data on life span were mainly derived from an official repository of birth and death records, but supplemented with other sources, including military files. RESULTS When comparing life spans of service veterans, there was no statistically significant reduction for the average life span of the 234 combat-exposed veterans in our sample from the 28th (Māori) Battalion (66.7 years), relative to the Māori veterans from two non-combat cohorts: the 132 personnel in the 15th Reinforcements (67.2 years) and the 147 personnel in Jayforce (66.9 years). CONCLUSIONS Despite a very high level of wounding in the combat-exposed group (48%), there were no statistically significant reductions in life span between this group and comparable non-combat exposed veterans. This finding contrasts to life span reductions found in a similar study of New Zealand veterans of WW1.
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Affiliation(s)
- Nick Wilson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - C Clement
- Independent researcher, Te Puke, New Zealand
| | - J A Summers
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - G Thomson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - G Harper
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Larson MJ, Ritter G, Adams RS. Opioid prescribing to US military members. Reg Anesth Pain Med 2023:rapm-2023-105067. [PMID: 37903624 PMCID: PMC11058102 DOI: 10.1136/rapm-2023-105067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 11/01/2023]
Affiliation(s)
- Mary Jo Larson
- Institute for Behavioral Health, Brandeis University Heller School for Social Policy and Management, Waltham, Massachusetts, USA
| | - Grant Ritter
- Institute for Behavioral Health, Brandeis University Heller School for Social Policy and Management, Waltham, Massachusetts, USA
| | - Rachel Sayko Adams
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Strand LA, Rudvin I, Martinsen JI, Fadum EA, Grimsrud TK. Lifelong differences in cancer incidence and mortality between subgroups of similar socioeconomic status in the Royal Norwegian Navy. Occup Environ Med 2023; 80:514-521. [PMID: 37474304 DOI: 10.1136/oemed-2023-108877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES In a previous cohort study of 28 300 Navy servicemen, vessel crews showed higher cancer incidence and mortality than did land-based personnel. We have extended the follow-up to look for changes in cancer risk, and to explore temporal trends in cancer incidence and cancer mortality during more than six decades of follow-up. METHODS Cancer incidence and total cancer mortality were compared with the general population by calculating standardised ratios (standardised incidence ratios (SIRs), standardised mortality ratios) for the entire follow-up, with temporal trends through seven consecutive 10-year time spans from individual entry to follow-up. Rates were compared between the subgroups using Poisson regression, expressed as rate ratios (RRs). RESULTS Cancer incidence in Navy servicemen suggested a healthy soldier effect limited to the first three decades of follow-up and confined to land-based personnel. Overall, vessel crews showed 13% higher cancer incidence and 36% higher cancer mortality than other Navy servicemen. Some of the differences may be explained by a higher risk in vessel crews of cancers known to have less than 25% 5-year relative survival (RR=1.71), such as cancers of the lung, liver, pancreas and mesothelioma. CONCLUSION Through most of the observation time, vessel crews had an overall cancer SIR that was higher than that of land-based personnel. Much of this excess involved cancers with a generally poor prognosis, linked to lifestyle and work environment. The contrasts in cancer incidence and mortality between the two subgroups of Navy servicemen persisted through more than six decades.
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Affiliation(s)
- Leif Aage Strand
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Norway
| | - Inger Rudvin
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Norway
| | - Jan Ivar Martinsen
- Institute of Population based Cancer Research, Cancer Registry of Norway, Oslo, Norway
| | - Elin Anita Fadum
- Institute of Military Epidemiology, Norwegian Armed Forces Joint Medical Services, Ullensaker, Norway
- Institute for Studies of the Medical Profession, Oslo, Norway
| | - Tom K Grimsrud
- Institute of Population based Cancer Research, Cancer Registry of Norway, Oslo, Norway
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Mitchell NA, McCauley M, O’Brien D, Wilson CE. Mental health and resilience in the Irish defense forces during the COVID-19 global pandemic. MILITARY PSYCHOLOGY 2023; 35:383-393. [PMID: 37615557 PMCID: PMC10453996 DOI: 10.1080/08995605.2021.2007728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
The Irish Defense Forces (DF) responded to the COVID-19 pandemic and national public health crisis by deploying personnel to aid domestic civil authorities in medical and care settings, contact tracing, logistics, and operations. Current research on COVID-19 reveals increased psychological distress among frontline workers and the general public. Resilience has previously been associated with lower levels of psychological distress. This study sets out to test these associations, and to examine mental health differences between DF personnel deployed in Ireland on pandemic-related duties (DIPD) and non-DIPD. Participants were 231 DF members who completed the: Connor-Davidson Resilience Scale-10, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Coronavirus Threat Questionnaire, Brief Trauma Questionnaire, Post-traumatic Stress Disorder Checklist-5, and Alcohol Use Disorder Identification Test. Independent t-tests revealed no differences between DIPD and non-DIPD on measures of psychological distress or on self-rated mental health prior to COVID-19 (PC19) and during COVID-19 (DC19). Results of multiple hierarchical regression analyses revealed that depression predicted lower levels of resilience, while multiple traumatic events predicted higher levels of resilience. The total adjusted variance explained by the model was 25%. Clinical and policy implications for improving access to psychological support within the DF and military populations are discussed.
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Affiliation(s)
- Nicola A. Mitchell
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Mathew McCauley
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
- Military Clinical Psychology, Office of the DMB, Defence Forces Ireland, Dublin, Ireland
| | - Dorota O’Brien
- Military Clinical Psychology, Office of the DMB, Defence Forces Ireland, Dublin, Ireland
| | - Charlotte E. Wilson
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
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Sullivan-Baca E, Rehman R, Haneef Z. An Update on the Healthy Soldier Effect in U.S. Veterans. Mil Med 2023; 188:3199-3204. [PMID: 35652579 DOI: 10.1093/milmed/usac151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/20/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The healthy soldier effect (HSE) describes a phenomenon of enduring health and lower mortality among veterans due in part to initial screening procedures and health care access. Although early data were supportive of a broad HSE among former military members, more recent investigations have suggested a possible attenuation of the effect with older age. The present study aimed to provide an update of the HSE using an expansive Veterans Health Administration (VHA)-wide sample with a particular focus on age and sex effects. MATERIALS AND METHODS Mortality data for veterans within the VHA were obtained from the VHA Support Service Center program office and compared to mortality data from the general U.S. population spanning FY2014 to the second quarter of FY2020. The standardized mortality ratio (SMR) was calculated for the overall sample and for age- and sex-specific cohorts. Mortality rate ratios were also calculated and compared across sexes. RESULTS Lower SMRs were observed in veterans compared to the general U.S. population (SMR 0.866). This effect was most prominent in younger and very old veterans, although a higher mortality was seen in the 55- to 64-year age cohort (SMR 1.371 for males and 1.074 for females). The HSE in females was lower than that in males in the <55-year age group but became higher in older cohorts. CONCLUSIONS This is the largest investigation to date examining the HSE in U.S. veterans and includes younger veterans from more recent military eras. Higher mortality among the 55- to 74-year age groups merits further investigation, as does the relatively higher mortality among older female veterans. Our findings have implications for the provision of health care and preventative care to these veterans most at risk for higher mortality.
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Affiliation(s)
| | - Rizwana Rehman
- Epilepsy Centers of Excellence, Durham VA Medical Center, Durham, NC 27705, USA
| | - Zulfi Haneef
- Neurology Care Line, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
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14
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Grimm CJ, de Terte I, Hodgetts D, Kearney S. Narratives of holistic mental health recovery in New Zealand Defence Force personnel. MILITARY PSYCHOLOGY 2023:1-11. [PMID: 37643328 DOI: 10.1080/08995605.2023.2250708] [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: 05/23/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
Research on military mental health recovery has tended to focus on therapy outcomes while backgrounding the role of diverse healing influences. The New Zealand Defence Force (NZDF) is a bicultural military integrated with Māori customs and cultural perspectives on holistic health and wellbeing. This study used narrative analysis to examine the semi-structured interviews of 21 active duty NZDF personnel who had accessed mental healthcare to understand what factors contributed to their return to wellness. Narratives described an orientation toward recovery as a process, where many interrelated wellbeing and social factors together supported the return to health. Culturally available Māori wellbeing metaphors were adopted as heuristics by service members in their storying of growth and healing. Findings are considered in terms of how wellbeing and recovery are conceptualized and promoted within militaries with diverse cultures. Discussion focuses on how narratives within military institutions can promote resilience and support service member recovery from mental distress.
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Affiliation(s)
- Carsten James Grimm
- Directorate of Health, New Zealand Defence Force, Wellington, New Zealand
- School of Psychology, Manawatu Campus, Massey University, Palmerston North, New Zealand
| | - Ian de Terte
- School of Psychology, Wellington Campus, Massey University, Wellington, New Zealand
| | - Darrin Hodgetts
- School of Psychology, Albany Campus, Massey University, Auckland, New Zealand
| | - Stephen Kearney
- Directorate of Health, New Zealand Defence Force, Wellington, New Zealand
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15
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St Cyr K, Kurdyak P, Smith PM, Mahar AL. Mental health service use among Canadian veterans within the first 5 years following service: methodological considerations for comparisons with the general population. Occup Environ Med 2023; 80:462-468. [PMID: 37230751 PMCID: PMC10423507 DOI: 10.1136/oemed-2022-108772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Previous research comparing veteran and civilian mental health (MH) outcomes often assumes stable rates of MH service use over time and relies on standardisation or restriction to adjust for differences in baseline characteristics. We aimed to explore the stability of MH service use in the first 5 years following release from the Canadian Armed Forces and the Royal Canadian Mounted Police, and to demonstrate the impact of using increasingly stringent matching criteria on effect estimates when comparing veterans with civilians, using incident outpatient MH encounters as an example. METHODS We used administrative healthcare data from veterans and civilians residing in Ontario, Canada to create three hard-matched civilian cohorts: (1) age and sex; (2) age, sex and region of residence; and (3) age, sex, region of residence and median neighbourhood income quintile, while excluding civilians with a history of long-term care or rehabilitation stay or receipt of disability/income support payments. Extended Cox models were used to estimate time-dependent HRs. RESULTS Across all cohorts, time-dependent analyses suggested that veterans had a significantly higher hazard of an outpatient MH encounter within the first 3 years of follow-up than civilians, but differences were attenuated in years 4-5. More stringent matching decreased baseline differences in unmatched variables and shifted the effect estimates, while sex-stratified analyses revealed stronger effects among women compared with men. CONCLUSIONS This methods-focused study demonstrates the implications of several study design decisions that should be considered when conducting comparative veteran and civilian health research.
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Affiliation(s)
- Kate St Cyr
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MacDonald Franklin OSI Research Centre, St Joseph's Health Care London, London, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Peter M Smith
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Alyson L Mahar
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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Morrison DA, Riley CA, Tolisano AM. Assessing the Impact of Military Service on Patient Health Literacy in an Otolaryngology Clinic. Mil Med 2023; 188:e333-e338. [PMID: 34190320 DOI: 10.1093/milmed/usab260] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To examine the impact of military service on health literacy. STUDY DESIGN Prospective, cross-sectional study. SUBJECTS AND METHODS The validated Brief Health Literacy Screen (BHLS) with military supplement was administered to sequential adult patients (military and civilian) treated at two outpatient academic military otolaryngology clinics between November and December 2019. Inadequate health literacy, defined by a BHLS score ≤9, was the primary outcome measure. Secondary outcome measures included comparisons of inadequate BHLS scores with patient demographics and history of military service. RESULTS Three hundred and eighty-two patients were evaluated during the study period. The median age was 48-57 years, with a majority being male (230, 60.2%), White (264, 69.1%), married (268, 70.2%), and active duty military (303, 79.3%). A minority reported history of PTSD (39, 13%) or traumatic brain injury (29, 9.6%). Overall, very few subjects (10, 2.6%) demonstrated inadequate health literacy. Patients with prior (1.6% vs 6.3%, P < .05) or current (0% vs 5.0%, P < .05) military service had lower rates of inadequate health literary as compared to civilians. Gender, race, marital status, history of PTSD, and history of traumatic brain injury did not significantly impact health literacy. In a multivariate regression model exploring history of military service, age was not predictive of inadequate health literacy. CONCLUSIONS Both history of and current military service predict higher health literacy rates for patients treated at military otolaryngology clinics. Widely accessible health care and mandatory health evaluations for service members to maintain deployment readiness may contribute to this finding but warrant additional study.
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Affiliation(s)
- Danielle A Morrison
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Anthony M Tolisano
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Gaffey AE, Han L, Ramsey CM, Skanderson M, Dziura J, Driscoll M, Burg MM, Brandt CA, Bastian LA, Haskell SG. Post-9/11 deployment history and the incidence of breast cancer among women veterans. Ann Epidemiol 2023; 77:98-102. [PMID: 36470323 DOI: 10.1016/j.annepidem.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine if women Veterans who deployed in support of Operations Enduring Freedom/Iraqi Freedom (OEF/OIF) would show a greater likelihood of breast cancer (BC) than other women Veterans. METHODS This was a retrospective cohort study of women aged <60 years who received Veterans Affairs medical center primary care, 2001-2021. The exposure was OEF/OIF deployment and the outcome was a BC diagnosis after entering Veterans Affairs care. Poisson models evaluated the association between deployment and BC incidence, covarying demographics, lifestyle factors, and hormonal contraceptive and hormone replacement therapy use. Analyses were also stratified by age and race, and a sensitivity analysis adjusted for healthcare utilization over the initial 2 years. RESULTS Of 576,601 women, 24.6% (n = 141,935) deployed during post-9/11 conflicts. Across follow-up [median: 8.2 years], 1.2% women were diagnosed with BC. Those who deployed in support of OEF/OIF were 23% less likely to be diagnosed with BC than women who did not deploy (95% CI: 0.73, 0.86). The association remained in stratified models and when including healthcare utilization. CONCLUSIONS Despite the exposures of OEF/OIF deployment, there was a significantly lower incidence of BC among women who deployed versus not, possibly due to a healthy soldier effect or to differences in screening.
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Affiliation(s)
- Allison E Gaffey
- VA Connecticut Healthcare System, West Haven; Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, CT.
| | - Ling Han
- VA Connecticut Healthcare System, West Haven; Department of Internal Medicine, Program on Aging, Yale School of Medicine, New Haven, CT; Yale Center of Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Christine M Ramsey
- VA Connecticut Healthcare System, West Haven; Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT
| | | | - James Dziura
- VA Connecticut Healthcare System, West Haven; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Mary Driscoll
- VA Connecticut Healthcare System, West Haven; Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Matthew M Burg
- VA Connecticut Healthcare System, West Haven; Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, CT; Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven; Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven; Department of Internal Medicine (General Medicine), Yale School of Medicine, New Haven, CT
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven; Department of Internal Medicine (General Medicine), Yale School of Medicine, New Haven, CT
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18
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Wilson N, Clement C, Summers JA, Thomson G, Harper G. Differential lifespan impacts on veterans by war exposure in the First World War. BMJ Mil Health 2022:e002278. [PMID: 36581499 DOI: 10.1136/military-2022-002278] [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: 10/03/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION There remains uncertainty around the impact of war on the lifespan of First World War (WW1) veterans. In particular, study comparison groups do not typically consider the 'healthy soldier effect'. METHODS We obtained lifespan data on a random sample of 857 war-exposed New Zealand WW1 veterans and compared this with lifespans of a non-war military cohort (n=1039). This comparison was possible as the non-war-cohort arrived in Europe too late to participate in the war, allowing a 'natural experiment' that avoided the 'healthy solider effect'. RESULTS The lifespan comparisons indicated lower mean lifespan in the war-exposed veteran cohort compared with the non-war veteran cohort (69.7 vs 71.1 years; p=0.0405). This gap persisted (range: 0.8-1.1 years) but was no longer statistically significant when only considering the non-Māori ethnic grouping (nearly all European/Pākehā personnel), when excluding additional deaths in the immediate postwar period up to 31 December 1923, and when excluding participation in any other wars. This was the case in both analysis of variance and Cox proportional hazards regression adjusting for year of birth and occupational status. Within the war-exposed cohort, there were suggestive patterns of increasing lifespan with increasing occupational status and military rank (eg, 69.5, 70.0 and 70.7 mean years as group-level occupational status progressively increased). There were also stark differences in lifespan of 8.3 years between Māori (Indigenous) and non-Māori veterans (p=0.0083). CONCLUSIONS The pattern of reduced lifespan in war-exposed versus non-war-exposed veterans was compatible with a smaller previous New Zealand study with comparable methodology. Veterans who were Māori had significantly lower lifespans than non-Māori veterans. There are a number of feasible avenues to further improve this type of work with existing data sources.
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Affiliation(s)
- Nick Wilson
- Public Health, University of Otago Wellington, Wellington, New Zealand
| | - C Clement
- Independent Genealogist, Te Puke, New Zealand
| | - J A Summers
- Public Health, University of Otago Wellington, Wellington, New Zealand
| | - G Thomson
- Public Health, University of Otago Wellington, Wellington, New Zealand
| | - G Harper
- Massey University, Palmerston North, New Zealand
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Lee SY, Lee HK, Yoon CG, Jeon H, Saunders JB. Does Drinking Culture Induce Problematic Alcohol Use? Evidence From a Military Representative Survey in Korea. Psychiatry Investig 2022; 19:937-948. [PMID: 36444157 PMCID: PMC9708860 DOI: 10.30773/pi.2021.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine the relationship between problematic alcohol use and contributing factors among Korean professional soldiers. METHODS Cross-sectional data of 2,646 participants collected by 2014 military-wide representative health survey was analyzed. Multivariate logistic models were used to identify contributing factors for problematic alcohol use. Problematic alcohol use was defined by the Alcohol Use Disorders Identification Test (AUDIT) questionnaire as hazardous (8≤ AUDIT <16) or harmful (AUDIT ≥16). Tolerant drinking culture was measured by the Drinking Culture Questionnaire. RESULTS Hazardous alcohol use was found in 56.9% of men and 46.8% of women and harmful use in a further 16.2% of men and 5.4% of women. In univariate analyses, perceived health status, subjective sleep quality, depression, and drinking culture were related to the outcome variable. In multivariate models controlling covariates, the likelihood of problematic alcohol use was significantly increased by man gender, being single, current/past smoking, and tolerant/permissive drinking culture. In those with harmful alcohol consumption, tolerant drinking culture was a particularly powerful influence. CONCLUSION A substantial proportion of Korean professional soldiers demonstrated problematic alcohol use. Tolerant drinking culture was shown to have a significant influence on problematic alcohol use in the military. Our findings underscore the need for public health policies that address this drinking culture to mitigate negative health consequences and preserve the forces' combat readiness.
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Affiliation(s)
- Seung-Yup Lee
- Department of Medical and Health Operation, Armed Forces Medical Command, Seongnam, Republic of Korea.,Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae Kook Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Gyo Yoon
- Department of Medical and Health Operation, Armed Forces Medical Command, Seongnam, Republic of Korea.,Preventive Medicine Program, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Hankaram Jeon
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - John B Saunders
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia
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Kolaja C, Castañeda SF, Woodruff SI, Rull RP, Armenta RF. The relative impact of injury and deployment on mental and physical quality of life among military service members. PLoS One 2022; 17:e0274973. [PMID: 36174060 PMCID: PMC9522035 DOI: 10.1371/journal.pone.0274973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
US service members injured in the recent conflicts in Iraq and Afghanistan were more likely to survive than those in previous conflicts because of advances in medicine and protective gear. However, there is limited research examining the long-term impact of injuries while deployed on physical and mental quality of life (QOL) among service members. We used data from two time-points with an average follow-up period of 4.27 years (SD = 2.13; n = 118,054) to prospectively examine the association between deployment and injury status with QOL. Data were derived from the Millennium Cohort Study surveys (2001 to 2016) and linked with the Department of Defense Trauma Registry (DoD-TR) among a cohort of US service members from all branches and components. The primary predictor (a combination of deployment and injury status) was comprised of the following four categories: 1) not deployed, 2) deployed and not injured, 3) deployed and non-battle injured, and 4) deployed and battle injured. Demographic, military, psychological and behavioral health, and life stress factors were adjusted for in multivariable models. Outcomes of interest were physical and mental QOL from the Short-Form Health Survey for Veterans (VR-36) measured at ~4 year follow-up. Between group comparisons indicated that those deployed and battle-injured had the greatest decline in both mental (-3.82) and physical (-10.13) QOL scores over time (p < .05). While deployment and injury status were associated with poorer mental and physical QOL in adjusted models; only the association between deployment and injury status with physical QOL was clinically meaningful (more than 2.5). In adjusted models, Time 1 mental and physical QOL explained most of the variance (23–25%) in Time 2 mental and physical health QOL as compared to other covariates (e.g., injury and deployment, and other sociodemographic factors increased variance by ~5%). Time 1 QOL was the most significant predictor of later QOL, but those injured while deployed experienced significant and meaningful decrements to long-term physical QOL. This suggests that prevention and rehabilitation interventions should focus on improving physical health among injured service members to avoid long-term adverse effects.
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Affiliation(s)
- Claire Kolaja
- Leidos Inc., San Diego, California, United States of America
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, United States of America
- * E-mail:
| | - Sheila F. Castañeda
- Leidos Inc., San Diego, California, United States of America
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, United States of America
| | - Susan I. Woodruff
- San Diego State University, School of Social Work, San Diego, California, United States of America
| | - Rudolph P. Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, United States of America
| | - Richard F. Armenta
- Department of Kinesiology, College of Education, Health and Human Services, California State University, San Marcos, San Marcos, California, United States of America
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De Angelis R, Piciocchi A, Bugani M, Rossi S, Lastilla M, Vento R, Autore A, Sebastiani N, Palomba S, Manno V, Battilomo S, Belmonte S, Pulliero A, Izzotti A. Long term mortality and morbidity of Italian soldiers after deployment in Iraq as related to biomarkers assessment: Results of the SIGNUM study. ENVIRONMENTAL RESEARCH 2022; 211:113029. [PMID: 35227675 DOI: 10.1016/j.envres.2022.113029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The health profile of military veterans deployed in foreign operative theatres was assessed by several international studies because of potential exposure to depleted uranium and other pollutants. Here we reported results of 15-year epidemiological surveillance assessing long-term health effects in a cohort of Italian soldiers deployed in Iraq in 2004-2005 and participating in a biomonitoring campaign to identify potential genotoxic exposure to environmental xenobiotics before and after deployment (n = 981, SIGNUM cohort). METHODS We evaluated mortality and hospitalization risks of the SIGNUM cohort retrospectively until 2016 and 2018 respectively. A wide cohort of military personnel never deployed abroad (n = 114,260) and the general Italian population were used as control populations in risk assessment. Causes of death and diagnoses of hospitalization were derived through deterministic record linkage with official national databases of mortality and hospital discharge. Standardized Mortality Ratio (SMR) and Standardized Hospitalization Ratio (SHR) were computed adjusting according to sex, age, area of birth, and calendar year. Differential pre-post deployment in xenobiotics concentrations and early effect biomarkers (oxidative DNA alterations and micronuclei) measured in blood serum were analysed in relation to cancer hospitalization. RESULTS Mortality risk due to pathologies was more than halved compared to the general population (SMR = 0.41, 95% CI 0.11-1.05) and not significantly different compared to soldiers never deployed abroad (SMR = 0.69, 95% CI 0.19-1.68). Similarly overall hospitalization risk due to pathologies was decreased with respect to the general population (SHR = 0.86, 95% CI 0.80-0.92) and comparable to the control military group (SHR = 0.99, 95% CI: 0.93-1.06). For haematological cancers a decreased hospitalization risk compared to the Italian general population was observed (SHR = 0.38, 95% CI 0-0.92). No statistically significant differences emerged in the patterns of biomarkers in association with cancer hospitalization. CONCLUSION The study confirms the so called 'healthy warrior' effect for the SIGNUM veterans and showed no correlation between cancer occurrence and biomonitoring markers measured on field.
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Affiliation(s)
- R De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanita, Rome, Italy
| | - A Piciocchi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanita, Rome, Italy
| | - M Bugani
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanita, Rome, Italy
| | - S Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanita, Rome, Italy
| | - M Lastilla
- Aerospace Medicine Institute, Italian Air Force, Rome, Italy
| | - R Vento
- Epidemiological Observatory, General Inspectorate of Military Health, Rome, Italy
| | - A Autore
- Epidemiological Observatory, General Inspectorate of Military Health, Rome, Italy
| | - N Sebastiani
- General Inspectorate of Military Health, Rome, Italy
| | - S Palomba
- General Inspectorate of Military Health, Rome, Italy
| | - V Manno
- Service of Statistics, Istituto Superiore di Sanità, Rome, Italy
| | - S Battilomo
- Directorate of Digitalisation, Health Information System and Statistics, Ministry of Health, Rome, Italy
| | - S Belmonte
- Directorate of Digitalisation, Health Information System and Statistics, Ministry of Health, Rome, Italy
| | - A Pulliero
- Department of Health Sciences, University of Genoa, Italy
| | - A Izzotti
- Department of Experimental Medicine, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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Garcia A, Kretzmer TS, Dams-O'Connor K, Miles SR, Bajor L, Tang X, Belanger HG, Merritt BP, Eapen B, McKenzie-Hartman T, Silva MA. Health Conditions Among Special Operations Forces Versus Conventional Military Service Members: A VA TBI Model Systems Study. J Head Trauma Rehabil 2022; 37:E292-E298. [PMID: 34698680 DOI: 10.1097/htr.0000000000000737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine traumatic brain injury (TBI) characteristics and comorbid medical profiles of Special Operations Forces (SOF) Active Duty Service Member/Veterans (ADSM/Vs) and contrast them with conventional military personnel. SETTING The 5 Veterans Affairs (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS A subset of participants in the VA TBI Model Systems multicenter longitudinal study with known SOF status. These included 157 participants who identified as SOF personnel (average age = 41.8 years; 96% male, 81% active duty), and 365 who identified as Conventional Forces personnel (average age = 37.4 years; 92% male, 30% active duty). DESIGN Retrospective analysis of prospective cohort, cross-sectional. MAIN MEASURES The Health Comorbidities Interview. RESULTS SOF personnel were more likely to have deployed to a combat zone, had more years of active duty service, and were more likely active duty at time of TBI. SOF personnel were more likely to have had mild TBI (vs moderate/severe) and their TBI caused by violent mechanism. SOF personnel had a higher number of comorbidities, with more diagnoses of chronic pain, osteoarthritis, hyperlipidemia, hip fractures, and obstructive sleep apnea. CONCLUSION SOF personnel are at a higher risk for multimorbidity after TBI. Current rehabilitation practices should incorporate early screening and treatment of common conditions in this population, while future practices may benefit from a focus on prevention.
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Affiliation(s)
- Amanda Garcia
- Mental Health and Behavioral Sciences Section (MHBSS) (Drs Garcia, Kretzmer, Miles, Bajor, and Silva) and Physical Medicine & Rehabilitation Service (Dr Merritt), James A. Haley Veterans' Hospital, Tampa, Florida; Traumatic Brain Injury Center of Excellence (TBI CoE), Tampa, Florida (Dr Garcia); Departments of Neurology (Dr Dams-O'Connor) and Rehabilitation and Human Performance (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York City, New York; Departments of Psychiatry and Behavioral Neurosciences (Drs Miles, Bajor, Belanger, and Silva), Internal Medicine (Dr Silva), and Psychology (Dr Silva), University of South Florida, Tampa, Florida; Harvard Medical School, Boston, Massachusetts (Dr Bajor); Tampa VA Research and Education Foundation, Inc, Temple Terrace, Florida (Dr Tang); United States Special Operations Command (USSOCOM), Tampa, Florida (Dr Belanger); St Michael's Inc, Woodbridge, Virginia (Dr Belanger); VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Eapen); National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center (WRNMMC), Bethesda, Maryland (Dr McKenzie-Hartman); and F. Edward Hébert School of Medicine (SOM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland (Dr McKenzie-Hartman)
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McBride D, Samaranayaka A, Richardson A, Gardner D, Shepherd D, Wyeth E, de Graaf B, Derrett S. Factors associated with self-reported health among New Zealand military veterans: a cross-sectional study. BMJ Open 2022; 12:e056916. [PMID: 35613796 PMCID: PMC9134175 DOI: 10.1136/bmjopen-2021-056916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To identify factors associated with better or poorer self-reported health status in New Zealand military Veterans. DESIGN A cross-sectional survey. PARTICIPANTS The participants of interest were the 3874 currently serving Veterans who had been deployed to a conflict zone, but all Veterans were eligible to participate. STUDY VARIABLES The EQ-5D-5L, asking about problems across five dimensions (mobility, self-care, usual activities, pain or discomfort and anxiety or depression), with five levels of severity (eg, no, slight, moderate, severe or extreme problems), also containing a Visual Analogue Scale (EQ-VAS) to self-assess health state, scaled from 0 (worst) to 100 (best) imagined health.Hypothetical relationships with better health were positive social support, sleep and psychological flexibility; with poorer health, post-traumatic stress, exposure to psychological trauma, distress and hazardous drinking. RESULTS The EQ5-D-5L was completed by 1767 Veterans, 1009 serving, a response rate of 26% from that group, 1767 completing the EQ5-D, 1458 who had deployed, 288 who had not and the 21 who did not provide deployment data. Of these, 247 were not used in the analysis due to missing values in one or more variables, leaving 1520 for analysis.A significantly higher proportion of Veterans reported 'any problems' rather than 'no problems' with four EQ-5D dimensions: mobility, self-care, usual activities and pain or discomfort, but no difference in anxiety or depression. Age, length of service, deployment, psychological flexibility and better sleep quality were associated with higher EQ-VAS scores; distress with lower EQ-VAS scores. CONCLUSION In this sample of New Zealand Veterans, psychological flexibility and good sleep are associated with better self-rated health, and distress and poor sleep with diminished health. These factors might be used as sentinel health indicators in assessing Veteran health status, and cognitive-behavioural therapy encompassing these domains may be useful in improving the health of New Zealand Veterans.
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Affiliation(s)
- David McBride
- Department of Preventive and Social Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | - Ariyapala Samaranayaka
- Biostatistics Centre, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - Amy Richardson
- Preventive and Social Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | - Dianne Gardner
- Department of Psychology, Massey University, Palmerston North, New Zealand
| | - Daniel Shepherd
- Health Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, University of Otago, Dunedin, New Zealand
| | - Brandon de Graaf
- Injury Prevention Research Unit, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | - Sarah Derrett
- Preventive and Social Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
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Kendall GM, Little MP. The new study of UK nuclear test veterans. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:10.1088/1361-6498/ac6a23. [PMID: 35543442 PMCID: PMC11267482 DOI: 10.1088/1361-6498/ac6a23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Gerry M Kendall
- Cancer Epidemiology Unit, Oxford Population Health, University of Oxford Old Road Campus, Oxford, OX3 7LF, United Kingdom
| | - Mark P Little
- 3821 Newark St NW, Apt B440, Washington DC 20016-3024, United States of America
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Gromatsky M, Edwards ER, Sullivan SR, van Lissa CJ, Lane R, Spears AP, Mitchell EL, Armey MF, Cáceda R, Goodman M. Characteristics of suicide attempts associated with lethality and method: A latent class analysis of the Military Suicide Research Consortium. J Psychiatr Res 2022; 149:54-61. [PMID: 35231792 DOI: 10.1016/j.jpsychires.2022.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
While suicide prevention is a national priority, particularly among service members and veterans (SMVs), understanding of suicide-related outcomes remains poor. Person-centered approaches (e.g., latent class analysis) have promise to identify unique risk profiles and subgroups in the larger population. The current study identified latent subgroups characterized by prior self-directed violence history and proximal risk factors for suicide among suicide attempt survivors, and compared subgroups on demographics and most-lethal attempt characteristics. Participants included civilians and SMVs reporting lifetime suicide attempt(s) (n = 2643) from the Military Suicide Research Consortium. Two classes emerged from Common Data Elements: suicide attempt and non-suicidal self-injury frequency, suicide attempt method, perceived likelihood of future suicide, suicide disclosure, suicide intent, and perceived and actual lethality of attempt. A Higher-Risk History class was characterized by greater intent to die, certainty about attempt fatality and method lethality, belief injury would be medically unfixable, and likelihood of prior non-suicidal self-injury. A Lower-Risk History class was characterized by greater ambivalence toward death and methods. Higher-Risk class members were more likely to be male, older, SMVs, have less formal education, use firearms as most-lethal attempt method, and require a higher degree of medical attention. Lower-Risk class members were more likely to be female, civilian, use cutting as most-lethal attempt method, and require less medical attention for attempts. Findings have implications for risk assessments and highlight the importance of subjective perceptions about suicidal behavior. Further investigation of real-time individual-level is necessary, especially for SMVs who may be at greatest risk for potentially lethal suicidal behavior.
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Affiliation(s)
- Molly Gromatsky
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Emily R Edwards
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah R Sullivan
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Caspar J van Lissa
- Methodology & Statistics, Social and Behavioural Sciences, Utrecht University, Netherlands; Open Science Community Utrecht, Utrecht University, Netherlands
| | - Robert Lane
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Angela Page Spears
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Emily L Mitchell
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Michael F Armey
- Psychosocial Research Program, Butler Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ricardo Cáceda
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY, USA; Psychiatry Service, Northport Veterans Affairs Medical Center, Northport, NY, USA
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Pethrus CM, Vedtofte MS, Neovius K, Borud EK, Neovius M. Pooled analysis of all-cause and cause-specific mortality among Nordic military veterans following international deployment. BMJ Open 2022; 12:e052313. [PMID: 35414543 PMCID: PMC9006836 DOI: 10.1136/bmjopen-2021-052313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To investigate all-cause and cause-specific mortality risks, including deaths from external, cardiovascular and cancer causes, among deployed Nordic military veterans in comparison to the general population in each country. DESIGN Pooled analysis. SETTING Denmark, Norway, Finland and Sweden. PARTICIPANTS Military veterans deployed between 1990 and 2010 were followed via nationwide registers and compared with age-sex-calendar-year-specific rates in the general population using pooled standardised mortality ratios (SMRs). MAIN OUTCOMES All-cause and cause-specific mortality retrieved from each country's Causes of Death Register, including deaths from external, cardiovascular and cancer causes. RESULTS Among 83 584 veterans 1152 deaths occurred of which 343 were from external causes (including 203 suicides and 129 traffic/transport accidents), 134 from cardiovascular causes and 297 from neoplasms. Veterans had a lower risk of death from any cause (pooled SMR 0.58, 95% CI 0.52 to 0.64), external causes (0.71, 95% CI 0.64 to 0.79), suicide (0.77, 95% CI 0.67 to 0.89), cardiovascular causes (0.54, 95% CI 0.46 to 0.64) and neoplasms (0.78, 95% CI 0.70 to 0.88). There was no difference regarding traffic/transport accidents for the whole period (1.10, 95% CI 0.92 to 1.31) but the pooled point estimate was elevated, though not statistically significant, during the first 5 years (1.17, 95% CI 0.89 to 1.53) but not thereafter (1.01, 95% CI 0.77 to 1.34). For all other causes of death, except suicide, statistically significantly lower risk among veterans was observed both during the first 5 years and thereafter. For suicide, no difference was observed beyond 5 years. Judged from the country-specific SMR estimates, there was a high degree of consistency although statistically significant heterogeneity was found for all-cause mortality. CONCLUSIONS Nordic military veterans had lower overall and cause-specific mortality than the general population for most outcomes, as expected given the predeployment selection process. Though uncommon, fatal traffic/transport accidents were an exception with no difference between deployed military veterans and the general population.
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Affiliation(s)
- Carl-Martin Pethrus
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | | | | | - Einar K Borud
- Norwegian Armed Forces Joint Medical Services, Oslo, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
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Carey FR, Jacobson IG, Roenfeldt KA, Rull RP. Association of deployment with maintenance of healthy weight among active duty service members in the Millennium Cohort Study. Obes Sci Pract 2022; 8:247-253. [PMID: 35388350 PMCID: PMC8976537 DOI: 10.1002/osp4.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Understanding body size in relation to deployment readiness can inform Department of Defense fitness policies. This study examined longitudinal associations between deployment and changes in body mass index (BMI) among active duty service members. Methods Service branch-specific changes in BMI post-deployment were examined using logistic regression models among active duty Millennium Cohort Study participants without obesity at baseline (n = 22,995). BMI was categorized using self-reported height and weight as healthy weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2). Number of deployments between baseline and follow-up and initial deployment lengths (in months, using service branch-specific deployment times) were examined. Results Among the pooled population and specifically Army and Marine Corps service members without obesity, those with longer deployments were significantly less likely to maintain a non-obese BMI than those deploying for shorter lengths. Each additional deployment increased the likelihood of maintaining a non-obese BMI post-deployment for personnel in the Army, Marine Corps, and within the pooled population. Conclusions Multiple deployments may support healthy weight maintenance; longer deployments may adversely impact weight maintenance. Future research should determine modifiable behaviors related to weight gain post-deployment to inform fitness policies designed to optimize service member readiness and deployability.
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Affiliation(s)
- Felicia R. Carey
- Deployment Health Research DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
- Leidos, Inc.San DiegoCaliforniaUSA
| | - Isabel G. Jacobson
- Deployment Health Research DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
- Leidos, Inc.San DiegoCaliforniaUSA
| | - Kimberly A. Roenfeldt
- Deployment Health Research DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
- Leidos, Inc.San DiegoCaliforniaUSA
| | - Rudolph P. Rull
- Deployment Health Research DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
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Strand LÅ, Rudvin I, Borud EK, Bøe HJ, Nordstrand AE, Fadum EA. Cause-Specific Mortality Among Norwegian Veterans Deployed to Afghanistan Between 2001 and 2019. Mil Med 2022; 188:usac075. [PMID: 35348722 DOI: 10.1093/milmed/usac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Norwegian military forces participated in the military campaign Operation Enduring Freedom in Afghanistan starting in 2001. Military personnel often show a "healthy soldier effect" in terms of lowered all-cause mortality when compared to the general population. However, military service in conflict areas is associated with an increased risk of death from external causes such as transport accidents and suicide after discharge. We aimed to investigate cause-specific mortality in a cohort of 9,192 Norwegian (7.5% women) veterans deployed to Afghanistan between 2001 and 2019. MATERIALS AND METHODS We followed cohort members from their first day of service in Afghanistan through 2019. We computed standardized mortality ratios (SMRs) with 95% CIs by comparing the observed number of deaths in our cohort with the expected number of deaths in the general population. Standardized mortality ratios were calculated for the full follow-up period among men and women separately, and among men only for two time periods: during deployment and after discharge from service in Afghanistan. RESULTS We observed 77 deaths (3 women and 74 men), 10 of which occurred during deployment (war casualties, 1 woman and 9 men); all others occurred after discharge. All-cause mortality in women did not differ from that in the general population (SMR = 0.52, 95% CI 0.11-1.53). For men, the observed all-cause mortality was lower than the expected rate for the full follow-up period (SMR = 0.55, 95% CI 0.43-0.69), during deployment, and after discharge, while deaths because of transport accidents after discharge (13 cases) were more than twice as high as expected rates (SMR = 2.36, 95% CI 1.26-4.04). The 11 observed suicides gave a nonstatistically significant, lower suicide risk compared to the expected rates (SMR = 0.66, 95% CI 0.33-1.18). CONCLUSION In accordance with the "healthy soldier effect," military service in Afghanistan was generally associated with a lower than expected risk of death both during deployment and after discharge. The risk of death from transport accidents was higher than expected after discharge, while the observed incidence of suicide did not differ from the expected rate in the general population.
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Affiliation(s)
- Leif Åge Strand
- Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Sessvollmoen N-2018, Norway
| | - Inger Rudvin
- Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Sessvollmoen N-2018, Norway
| | - Einar Kristian Borud
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø N-9019, Norway
| | - Hans Jakob Bøe
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, Oslo 0015, Norway
- Department of Psychology, University of Oslo, Oslo 0373, Norway
| | | | - Elin Anita Fadum
- Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Sessvollmoen N-2018, Norway
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Maier T, Rappel M, Rhee DS, Brill S, Maderner J, Pijahn F, Gündel H, Radermacher P, Friemert B, Becker HP, Waller C. Mental but no bio-physiological long-term habituation to repeated social stress: A study on soldiers and the influence of mission abroad. Front Psychiatry 2022; 13:1011181. [PMID: 36590640 PMCID: PMC9797525 DOI: 10.3389/fpsyt.2022.1011181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Soldiers regularly participate in missions abroad and subjectively adapt to this situation. However, they have an increased lifetime cardiovascular risk compared to other occupational groups. To test the hypothesis that foreign deployment results in different stress habituation patterns, we investigated long-term psychological and bio-physiological stress responses to a repeated social stress task in healthy soldiers with and without foreign deployment. Ninety-one female and male soldiers from the BEST study (German armed forces deployment and stress) participated three times in the Trier Social Stress Test for groups (TSST-G) prior to, 6-8 weeks after and 1 year after the mission abroad and were compared to a control group without foreign deployment during the study period. They completed the State-Trait-Anxiety Inventory scale (STAI), the Primary Appraisal Secondary Appraisal questionnaire (PASA) and the Multidimensional Mood State Questionnaire (MDBF). Salivary cortisol and α-amylase, blood pressure, heart rate and heart rate variability were determined. Soldiers showed mental habituation over the three times with a significant decrease after the TSST-G in anxiousness (STAI) and cognitive stress appraisal (PASA), they were calmer and reported better mood (MDBF). Prior to the social stress part, the mood (MDBF) declined significantly. None of the biological and physiological markers showed any adaptation to the TSST-G. Mission abroad did not significantly influence any measured psychobiological marker when compared to soldiers without foreign deployment. Foreign deployment does not result in alterations in psychobiological social stress response patterns over 1 year after mission abroad which indicates that adaptation to acute social stress is highly maintained in healthy soldiers. The discrepancy between subjective perception and objective stress response has numerous clinical implications and should receive more attention.
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Affiliation(s)
- Tanja Maier
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, Ulm, Germany
| | - Manuela Rappel
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, Ulm, Germany
| | - Dae-Sup Rhee
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, Ulm, Germany
| | | | - Julia Maderner
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, Ulm, Germany
| | - Friederike Pijahn
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, Ulm, Germany
| | - Harald Gündel
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, Ulm, Germany
| | - Peter Radermacher
- Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University, Ulm, Germany
| | | | | | - Christiane Waller
- Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, Ulm, Germany.,Department of Psychosomatics and Psychotherapeutic Medicine, Paracelsus Medical University, Nuremberg, Germany
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Belding JN, Castañeda SF, Jacobson IG, LeardMann CA, Porter B, Powell TM, Kolaja CA, Seelig AD, Matsuno RK, Carey FR, Rivera AC, Trone DW, Sheppard B, Walstrom J, Boyko EJ, Rull RP, For The Millennium Cohort Study Team. The Millennium Cohort Study: The First 20 Years of Research Dedicated to Understanding the Long-Term Health of US Service Members and Veterans. Ann Epidemiol 2021; 67:61-72. [PMID: 34906635 DOI: 10.1016/j.annepidem.2021.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/22/2023]
Abstract
The Millennium Cohort Study, the US Department of Defense's largest and longest running study, was conceived in 1999 to investigate the effects of military service on service member health and well-being by prospectively following active duty, Reserve, and National Guard personnel from all branches during and following military service. In commemoration of the Study's 20th anniversary, this paper provides a summary of its methods, key findings, and future directions. Recruitment and enrollment of the first 5 panels occurred between 2001 and 2021. After completing a baseline survey, participants are requested to complete follow-up surveys every 3 to 5 years. Study research projects are categorized into 3 core portfolio areas (psychological health, physical health, and health-related behaviors) and several cross-cutting areas and have culminated in more than 120 publications to date. For example, some key Study findings include that specific military service-related factors (e.g., experiencing combat, serving in certain occupational subgroups) were associated with adverse health-related outcomes and that unhealthy behaviors and mental health issues may increase following the transition from military service to veteran status. The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts.
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Key Words
- Abbreviations
- Army STARRS, Army Study to Assess Risk and Resilience in Servicemembers
- DoD, Department of Defense
- Millennium Cohort Study, military, veterans, deployment, risk factors, protective factors, physical health, mental health, health-related behaviors, longitudinal cohort
- OEF, Operation Enduring Freedom
- OIF, Operation Iraqi Freedom
- OND, Operation New Dawn
- PTSD, posttraumatic stress disorder
- VA, Department of Veterans Affairs
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Affiliation(s)
- Jennifer N Belding
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Sheila F Castañeda
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Isabel G Jacobson
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Cynthia A LeardMann
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Ben Porter
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA; Mississippi State University, Mississippi State, Mississippi, USA
| | - Teresa M Powell
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Claire A Kolaja
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Amber D Seelig
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rayna K Matsuno
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Felicia R Carey
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Anna C Rivera
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Daniel W Trone
- Naval Health Research Center, San Diego, California, USA
| | - Beverly Sheppard
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Jennifer Walstrom
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Edward J Boyko
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rudolph P Rull
- Naval Health Research Center, San Diego, California, USA.
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Abdur-Rahman IT, Watkins EY, Jarvis BP, Beymer MR, Schoenbaum M, Bossarte RM, Pecko JA, Cox KL. Mortality Among Male U.S. Army Soldiers Within 18 Months of Separation. Mil Med 2021; 186:e988-e995. [PMID: 33230545 DOI: 10.1093/milmed/usaa511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/30/2020] [Accepted: 11/10/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Understanding how soldiers die after separation from military service, particularly those who die shortly after separating from service, may help to identify opportunities to ease transitions to civilian life. MATERIALS AND METHODS Mortality data were analyzed for male U.S. Army soldiers who died within 18 months of their separation from service (from 1999 to 2011). Descriptive statistics were calculated for natural, accidental, suicidal, homicidal, undetermined, and legal/operation of war deaths and were stratified by age, component, time in service, and type of discharge. Crude and age-adjusted mortality rates, standardized for all years using the 2004 Regular Army population, were also calculated. The Public Health Review Board of the U.S. Army Public Health Center approved this study as Public Health Practice. RESULTS Of the 1,884,653 male soldiers who separated from service during the study period, 3,819 died within 18 months of separation. A majority of all separations were Reserve or National Guard (58%), and 62% of decedents were in the Reserve or National Guard. Deaths from natural causes (38%) were the most common, followed by accident deaths (34%), suicides (20%), homicides (6%), undetermined deaths (2%), and legal/operation of war deaths (<1%). For overall mortality, age-adjusted rates were higher among the male U.S. population when compared to male soldiers who had separated from the Army. CONCLUSIONS The time period immediately following separation from the Army presents a unique challenge for many soldiers. Developing more effective pre-separation prevention programs that target specific risks requires knowing the causes of death for natural deaths, suicides, and accidents. Over half of all deaths occurring shortly after separation from service are preventable. Continued surveillance of specific causes of preventable deaths following separation can improve pre-separation prevention programs and transitions to post-service care.
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Affiliation(s)
- Ihsan T Abdur-Rahman
- U.S. Army Public Health Center, Clinical Public Health and Epidemiology Directorate, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, MD 21010, USA
| | - Eren Y Watkins
- U.S. Army Public Health Center, Clinical Public Health and Epidemiology Directorate, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, MD 21010, USA
| | | | - Matthew R Beymer
- U.S. Army Public Health Center, Clinical Public Health and Epidemiology Directorate, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, MD 21010, USA
| | | | - Robert M Bossarte
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV 26505, USA.,VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY 14424, USA
| | - Joseph A Pecko
- U.S. Army Public Health Center, Clinical Public Health and Epidemiology Directorate, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, MD 21010, USA
| | - Kenneth L Cox
- U.S. Army Public Health Center, Clinical Public Health and Epidemiology Directorate, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, MD 21010, USA
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Teplova AE, Bakker HAHM, Perry SIB, van Etten-Jamaludin FS, Plat MCJ, Bekkers MBM. The Impact of Deployment and Combat Exposure on Physical Health Among Military Personnel: A Systematic Review of Incidence, Prevalence, and Risks. Mil Med 2021; 187:e1074-e1085. [PMID: 34296281 DOI: 10.1093/milmed/usab302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The impact of deployment and combat on mental health of military personnel is well described. Less evidence is available to demonstrate and summarize the incidence, prevalence, and risks of these exposures on physical health. This study aims to (1) systematically review the available literature to determine the incidence and prevalence of physical health conditions among military personnel during and after deployment and (2) investigate the risks of deployment and combat exposure on physical health. METHODS A systematic review using the PubMed and EMBASE databases was performed. The literature search was limited to articles written in English, published from 2000 through 2019. The quality of studies was assessed with the Joanna Briggs Institute Appraisal Checklist. The results were grouped per system or condition of physical health and presented by forest plots without a combined effect size estimate. RESULTS Thirty-two studies were found eligible for this review. We identified a wide variety of incidence and prevalence rates of numerous physical health conditions and a high heterogeneity across the included studies. Acute respiratory symptoms, diarrhea, musculoskeletal injuries, pain, and tinnitus were found to be the most incident or prevalent conditions. Except for hearing loss, no associations with deployment and physical health problems were observed. An increased risk for asthma, headache, hearing loss, and pain was reported in relation to the combat exposure. CONCLUSION Given the characteristics of included studies and extracted data, the magnitude of the found differences in incidence and prevalence rates is most likely to be due to methodological heterogeneity. The specific exposures (e.g., infrastructure, environmental conditions, and activities during deployment) are suggested to be the determinants of (post) deployment physical health problems and need to be addressed to decrease the impact of deployment. Findings from this systematic review highlight which conditions should be addressed in response to service members' health and wellness needs in the (post)deployment phase and may be used by clinicians, researchers, and policy-makers. However, knowledge gaps regarding the potential risk factors during deployment and combat still exist. Studies using consistent methods to define and measure the physical health conditions and specific exposures are needed.
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Affiliation(s)
- Alina E Teplova
- Department of Physical, Medicine and Rehabilitation, Basalt Rehabilitation, Medical Centre Haaglanden: Medisch Centrum Haaglanden, The Hague 2512 VA, The Netherlands
| | | | - Sander I B Perry
- Department of Data Science and Epidemiology, University of Amsterdam, University Medical Center Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Faridi S van Etten-Jamaludin
- Research Support, Medical Library AMC, University of Amsterdam, University Medical Center Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Marie-Christine J Plat
- Expertcentre Force Health Protection, Military Healthcare Organisation, Ministry of Defence, Doorn 3941 PW, The Netherlands
| | - Margaretha B M Bekkers
- Expertcentre Force Health Protection, Military Healthcare Organisation, Ministry of Defence, Doorn 3941 PW, The Netherlands
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Bloeser K, Lipkowitz-Eaton J. Disproportionate multimorbidity among veterans in middle age. J Public Health (Oxf) 2021; 44:28-35. [PMID: 34056660 DOI: 10.1093/pubmed/fdab149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/16/2021] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of multimorbidity among middle-aged veterans. Multimorbidity holds implications for planning for a population with high health care utilization, poor quality of life and marked need for interdisciplinary care. METHODS The current study used the US 2017 Behavior Risk Factor Surveillance System to measure multimorbidity in three ways: (1) reporting two or more health conditions, (2) reporting two or more conditions controlling for demographic characteristics (e.g. income) and health risk behaviors (e.g. smoking) and (3) a weighted index using health-related quality of life. RESULTS After age 25, veterans' risk for multimorbidity increased across all age groups. The increased odds of reporting multimorbidity was highest when comparing veterans aged 35-44 to non-veterans of the same ages. Veterans aged 35-44 are 50% (adjusted odds ratios (AOR) 1.50, 95% confidence interval (CI) 1.16, 1.94) to 80% (AOR 1.80, 95% CI 1.46, 2.23) more likely to report multimorbidity when compared with same aged non-veterans. CONCLUSIONS Younger veterans may benefit from comprehensive interdisciplinary services to aid in the treatment of multiple medical conditions. Failure to account for the impact of chronic conditions on quality of life may lead to an underestimate of the health care needs of veterans across the lifespan.
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Affiliation(s)
- Katharine Bloeser
- Hunter College of the City University of New York, Silberman School of Social Work, 2180 Third Avenue, New York, NY 10035, USA.,The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA.,The War Related Illness and Injury Study Center, The Washington DC VA Medical Center, 50 Irving Street NW, Washington, DC 20422, USA
| | - Jennifer Lipkowitz-Eaton
- The War Related Illness and Injury Study Center, The Washington DC VA Medical Center, 50 Irving Street NW, Washington, DC 20422, USA
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Kumar RG, Jayasinghe N, Walker RL, Gibbons LE, Power MC, Larson EB, Crane PK, Dams-O'Connor K. Association of remote traumatic brain injury and military employment with late-life trajectories of depressive symptom severity. J Affect Disord 2021; 281:376-383. [PMID: 33348181 PMCID: PMC8887889 DOI: 10.1016/j.jad.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) and military service are common lifetime exposures among current older adults that may affect late-life mental health. The objective of the present study was to evaluate the association between TBI with loss of consciousness (LOC) and military employment and late-life depressive symptom severity trajectory. METHODS 1445 males and 2096 females adults at least 65 years old without dementia or recent TBI were enrolled and followed biennially for up to 10 years in the Adult Changes in Thought study from Kaiser Permanente Washington in Seattle, Washington. RESULTS Using group-based trajectory modeling, we documented four distinct depressive symptom severity trajectories that followed a similar course in males and females (Minimal, Decreasing, Increasing, and Persistent). In multinomial regression analyses, TBI with LOC in males was associated with greater likelihood of Persistent versus Minimal depressive symptom severity compared to individuals without TBI (OR = 1.51, 95% CI: 1.01, 2.27; p=0.046). Males reporting past military employment had greater likelihood of Decreasing versus Minimal depressive symptom severity compared to individuals without past military employment (OR = 1.54, 95% CI: 1.03, 2.31; p=0.035). There was no association between TBI or military employment and depression trajectories in females, and no evidence of effect modification by age or between exposures. LIMITATIONS Lifetime history of TBI was ascertained retrospectively and may be subject to recall bias. Also, past military employment does not presuppose combat exposure. CONCLUSIONS Remote TBI and past military employment are relevant to late-life trajectories of depressive symptom severity in dementia-free older males.
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Affiliation(s)
- Raj G Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai
| | - Nimali Jayasinghe
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai; Department of Psychiatry, Weill Cornell Medicine
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute
| | | | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University
| | - Eric B Larson
- Department of Medicine, University of Washington; Kaiser Permanente Washington Health Research Institute
| | - Paul K Crane
- Department of Medicine, University of Washington
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai; Department of Neurology, Icahn School of Medicine at Mount Sinai. kristen.dams-o'
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McKay KA, Smith KA, Smertinaite L, Fang F, Ingre C, Taube F. Military service and related risk factors for amyotrophic lateral sclerosis. Acta Neurol Scand 2021; 143:39-50. [PMID: 32905613 PMCID: PMC7756624 DOI: 10.1111/ane.13345] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The cause of amyotrophic lateral sclerosis (ALS) is unknown, but occupations have been explored as a potential proxy measure of risk. There is a substantial body of literature connecting military service to ALS. We aimed to summarize and assess the quality of this evidence. METHODS Systematic review of the literature, including observational studies which explored one of the following exposures: general military service (army, air force, marines, or navy); or specific exposures associated with military service measured among military personnel. The outcome of interest was ALS incidence, which could include onset, diagnosis, or death from ALS. RESULTS A total of 2642 articles were screened. Following exclusion, 19 articles remained for inclusion in the systematic review, including 1 meta-analysis and 18 original observational studies. Most studies were of moderate quality. In general, the relationship between military service was suggestive of an increased risk, particularly among Gulf War and WWII veterans. Exposure to pesticides (including Agent Orange) certain chemicals (exhaust, burning agents), heavy metals, and head trauma appeared to increase the risk of ALS among military personnel. CONCLUSIONS There is a possible association between military service and the subsequent development of ALS; however, the evidence was limited. Studies were generally hindered by small sample sizes and inadequate follow-up time. Future studies should endeavor to objectively measure specific exposures, or combinations thereof, associated with military service, as this will be of vital importance in implementing preventative strategies into military organizations.
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Affiliation(s)
- Kyla A. McKay
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Centre for Molecular Medicine Karolinska Institutet Stockholm Sweden
| | - Kelsi A. Smith
- Clinical Epidemiology Division Department of Medicine Solna, Karolinska Institutet Stockholm Sweden
| | - Lidija Smertinaite
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Fang Fang
- Unit of Integrative Epidemiology Insitute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Caroline Ingre
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Fabian Taube
- School of Public Health and Community Medicine Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Swedish Armed Forces Center for Defence Medicine Gothenburg Sweden
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Shepherd S, Sherman DK, MacLean A, Kay AC. The Challenges of Military Veterans in Their Transition to the Workplace: A Call for Integrating Basic and Applied Psychological Science. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 16:590-613. [PMID: 33316201 DOI: 10.1177/1745691620953096] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Long-standing structural features of the military have created a culture and society that is dramatically different and disconnected from civilian society. Thus, veterans transitioning to civilian society face a number of challenges related to fulfilling basic psychological needs (e.g., need for structure and order, belonging) and civilians' reliance on stereotypes to understand military veterans. In an attempt to enrich the understanding of these challenges, we integrate social psychological theories and insights with research from sociology, clinical psychology, military psychology, and organizational behavior. Theories of compensatory control, stereotype threat, and stereotyping are drawn on to help explain the psychological challenges that veterans may encounter during their transition to civilian society. We present recent research that leverages these theories to understand issues veterans face. This theoretical integration illustrates the opportunity and potential for psychological researchers to conduct basic and applied research in the context of veterans and for clinicians and managers to draw on basic theory to inform programs and interventions.
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Affiliation(s)
- Steven Shepherd
- School of Marketing and International Business, Spears School of Business, Oklahoma State University
| | - David K Sherman
- Department of Psychological & Brain Sciences, University of California, Santa Barbara
| | - Alair MacLean
- Department of Sociology, Washington State University
| | - Aaron C Kay
- Fuqua School of Business & Department of Psychology and Neuroscience, Duke University
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37
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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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38
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Goodwin L, Leightley D, Chui ZE, Landau S, McCrone P, Hayes RD, Jones M, Wessely S, Fear NT. Hospital admissions for non-communicable disease in the UK military and associations with alcohol use and mental health: a data linkage study. BMC Public Health 2020; 20:1236. [PMID: 32912179 PMCID: PMC7488237 DOI: 10.1186/s12889-020-09300-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Since the recent conflicts in Iraq and Afghanistan, the short-term focus of military healthcare research has been on the consequences of deployment for mental health and on those wounded or injured in combat. Now that these conflicts have ended for the UK Armed Forces, it is important to consider the longer term physical and mental health consequences, and just as importantly, the links between these. The aims of this study were to determine the most common physical conditions requiring a hospital admission in UK military personnel and whether they were more common in personnel with a mental health condition, smokers, and/or those misusing alcohol compared to those without. METHODS Data linkage of a prospective UK military cohort study to electronic admitted patient care records for England, Wales and Scotland. Nine thousand nine hundred ninety military personnel completed phase 2 of a military cohort study (56% response rate, data collected from 2007 to 2009), with analyses restricted to 86% of whom provided consent for linkage to healthcare records (n = 8602). Ninety percent were male and the mean age at phase 2 was 36 years. The outcome was physical non communicable diseases (NCDs) requiring a hospital admission which occurred after phase 2 of the cohort when the mental health, smoking and alcohol use exposure variables had been assessed until the end of March 2014. RESULTS The most common NCDs requiring a hospital admission were gastrointestinal disorders 5.62% (95% Confidence Intervals (CI) 5.04, 6.19) and joint disorders 5.60% (95% CI 5.02, 6.18). Number of NCDs requiring a hospital admission was significantly higher in those with a common mental disorder (Hazard ratio (HR) 1.40 (95% CI 1.16-1.68), post-traumatic stress disorder (HR 1.78 (95% CI 1.32-2.40)) and in current smokers (HR 1.35 (95% CI 1.12-1.64) compared to those without the disorder, and non-smokers, respectively. CONCLUSIONS Military personnel with a mental health problem are more likely to have an inpatient hospital admission for NCDs compared to those without, evidencing the clear links between physical and mental health in this population.
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Affiliation(s)
- L Goodwin
- Department of Psychology, University of Liverpool, Room 2.31 Eleanor Rathbone Building, Liverpool, L69 7ZA, UK.
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Liverpool Centre for Alcohol Research, Liverpool Health Partners, Liverpool, UK.
| | - D Leightley
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Z E Chui
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S Landau
- Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - P McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - R D Hayes
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M Jones
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N T Fear
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Hinojosa R. Sex, Age, Race/Ethnicity, Veteran Status, and the Likelihood of Reporting Cardiovascular Conditions in the National Health Interview Survey. J Cardiovasc Nurs 2020; 34:215-221. [PMID: 30973492 DOI: 10.1097/jcn.0000000000000561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND This study explores the likelihood of reporting the presence of cardiovascular health conditions in the National Health Interview Survey, with a focus on the moderating effects of veteran status, race/ethnicity, age, sex, and functional status. METHOD Data from the 2012-2015 National Health Interview Survey examine 5 cardiovascular health conditions/risk factors (hypertension, coronary heart disease, heart conditions, stroke, and heart attack). RESULTS Age, sex, and functional status moderate the relationship between veteran status and cardiovascular conditions. Veterans who are younger (veteran × age) have a higher risk of reporting 1 cardiovascular condition compared with veterans who are older (relative risk [RR], 0.99; 95% confidence interval [CI], 0.99-0.99). Veterans with functional limitations (veteran × functional status) are at a lower risk of reporting 3 or more cardiovascular conditions compared with veterans with no functional limitations (RR, 0.73; 95% CI, 0.56-0.95). Interaction variables in the model (veteran × sex) show that female veterans had a higher risk than did female non-veterans of reporting 3 or more cardiovascular conditions compared with male veterans versus male non-veterans (RR, 0.71; 95% CI, 0.53-0.95). Race/ethnicity does not moderate the likelihood of reporting cardiovascular disease conditions in this sample. CONCLUSION This study demonstrates that previous military service is linked to the reporting of cardiovascular disease conditions by using nationally representative data to examine the moderating effects of veteran status on the relationship between race/ethnicity, sex, functional status, and age and cardiovascular disease for veterans living in the general US population. The findings suggest a waning healthy soldier effect for the youngest American veterans and indicate that female veterans' cardiovascular health is at greatest risk.
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Affiliation(s)
- Ramon Hinojosa
- Ramon Hinojosa, PhD Assistant Professor, University of Central Florida, Department of Sociology, Orlando
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40
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Boice JD, Cohen SS, Mumma MT, Chen H, Golden AP, Beck HL, Till JE. Mortality among U.S. military participants at eight aboveground nuclear weapons test series. Int J Radiat Biol 2020; 98:679-700. [PMID: 32602389 DOI: 10.1080/09553002.2020.1787543] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Approximately 235,000 military personnel participated at one of 230 U.S. atmospheric nuclear weapons tests from 1945 through 1962. At the Nevada Test Site (NTS), the atomic veterans participated in military maneuvers, observed nuclear weapons tests, or provided technical support. At the Pacific Proving Ground (PPG), they served aboard ships or were stationed on islands during or after nuclear weapons tests. MATERIAL AND METHODS Participants at seven test series, previously studied with high-quality dosimetry and personnel records, and the first test at TRINITY formed the cohort of 114,270 male military participants traced for vital status from 1945 through 2010. Dose reconstructions were based on Nuclear Test Personnel Review records, Department of Defense. Standardized mortality ratios (SMR) and Cox and Poisson regression models were used in the analysis. RESULTS Most atomic veterans were enlisted men, served in the Navy at the PPG, and were born before 1930. Vital status was determined for 96.8% of the veterans; 60% had died. Enlisted men had significantly high all-causes mortality SMR (1.06); officers had significantly low all-causes mortality SMR (0.71). The pattern of risk over time showed a diminution of the 'healthy soldier effect': the all-causes mortality SMR after 50 years of follow-up was 1.00. The healthy soldier effect for all cancers also diminished over time. The all-cancer SMR was significantly high after 50 years (SMR 1.10) primarily from smoking-related cancers, attributed in part to the availability of cigarettes in military rations. The highest SMR was for mesothelioma (SMR 1.56) which was correlated with asbestos exposure in naval ships. Prostate cancer was significantly high (SMR 1.13). Ischemic heart disease was significantly low (SMR 0.84). Estimated mean doses varied by organ were low; e.g., the mean red bone marrow dose was 6 mGy (maximum 108 mGy). Internal cohort dose-response analyses provided no evidence for increasing trends with radiation dose for leukemia (excluding chronic lymphocytic leukemia (CLL)) [ERR (95% CI) per 100 mGy -0.37 (-1.08, 0.33); n = 710], CLL, myelodysplastic syndrome, multiple myeloma, ischemic heart disease, or cancers of the lung, prostate, breast, and brain. CONCLUSION No statistically significant radiation associations were observed among 114,270 nuclear weapons test participants followed for up to 65 years. The 95% confidence limits were narrow and excluded mortality risks per unit dose that are two to four times higher than those reported in other investigations. Significantly elevated SMRs were seen for mesothelioma and asbestosis, attributed to asbestos exposure aboard ships.
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Affiliation(s)
- John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Sarah S Cohen
- EpidStrategies, a Division of ToxStrategies, Cary, NC, USA
| | | | - Heidi Chen
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
| | | | | | - John E Till
- Risk Assessment Corporation, Neeses, SC, USA
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41
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Strand LA, Martinsen JI, Fadum EA, Borud EK. Temporal trends in the healthy soldier effect in a cohort of Royal Norwegian Navy servicemen followed for 67 years. Occup Environ Med 2020; 77:775-781. [PMID: 32611649 DOI: 10.1136/oemed-2020-106475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate temporal trends in the 'healthy soldier effect' (HSE) among 28 300 Royal Norwegian Navy servicemen who served during 1950-2004. METHODS Standardised mortality ratios (SMRs) for all causes, diseases and external causes were calculated from national rates for the entire study period (1951-2017), and for seven successive follow-up periods after the first recorded day of Naval service, for the overall cohort and for two subgroups: land-based personnel and vessel crews. Poisson regression, expressed as rate ratios, was used to compare all-cause mortality between the subgroups. RESULTS In the overall cohort, SMRs for all-cause mortality increased steadily during the first six 10-year follow-up periods, from 0.52 to 0.94, which was still lower than national rates. After 60 years, the lower mortality compared with national rates was no longer statistically significant (SMR=0.93). Low non-neoplastic disease mortality contributed most to the longevity of the HSE. For neoplastic diseases, there was a mortality deficit only for the first and third 10-year follow-up periods. External-cause mortality rose to national rates after 40 years. An HSE was present among vessel crews, but their total mortality rate was 24% higher than that among land-based personnel, who also showed a longer-lasting HSE. CONCLUSIONS The HSE eroded gradually over time but was still present at 60 years of follow-up for all-cause mortality. The effect was strongest and most long-lived for non-neoplastic disease, lasted up to 40 years for external causes, and was relatively short for cancers. Land-based personnel showed stronger and longer-lasting HSE than vessel crews.
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Affiliation(s)
- Leif Aage Strand
- Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Norwegian Armed Forces, Ullensaker, Norway
| | - Jan Ivar Martinsen
- Institute of Population-based Research, Cancer Registry of Norway, Oslo, Norway
| | - Elin Anita Fadum
- Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Norwegian Armed Forces, Ullensaker, Norway
| | - Einar Kristian Borud
- Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Norwegian Armed Forces, Ullensaker, Norway.,Department of Community Medicine, UiT The Arctic University of Norway, Tromso, Norway
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42
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Ingram PB, Tarescavage AM, Ben-Porath YS, Oehlert ME. Comparing MMPI-2-Restructured Form Scores by Service Era for Veterans Assessed Within the Veteran Affairs Healthcare System. J Clin Psychol Med Settings 2020; 27:366-375. [PMID: 31471846 PMCID: PMC7223335 DOI: 10.1007/s10880-019-09650-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study compares profiles of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scale scores from 1492 VA test-takers who served during the Vietnam or Gulf War service eras. The sample includes all such cases collected at any VA posttraumatic stress disorder Clinical Teams across the United States between January 1, 2008 and May 31, 2015 using the MMPI-2 or MMPI-2-RF (via the VA Mental Health Assistant suite). Associations between gender and score differences were also examined. In contrast to past research using the MMPI-2, results of this study suggest that veterans are generally homogeneous in their MMPI-2-RF profiles across different periods of service. Specifically, the magnitudes of mean differences are small and not clinically significant. Thus, responses on the MMPI-2-RF do not appear influenced by service era. Implications for the clinical use of, and research with, the MMPI-2-RF are discussed within the VA healthcare system.
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Affiliation(s)
- Paul B Ingram
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.
- Dwight D. Eisenhower VAMC, Eastern Kansas Veteran Healthcare System, Leavenworth, KS, USA.
| | | | | | - Mary E Oehlert
- Dwight D. Eisenhower VAMC, Eastern Kansas Veteran Healthcare System, Leavenworth, KS, USA
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Pethrus CM, Frisell T, Reutfors J, Johansson K, Neovius K, Söderling JK, Bruze G, Neovius M. Violent crime among Swedish military veterans after deployment to Afghanistan: a population-based matched cohort study. Int J Epidemiol 2020; 48:1604-1613. [PMID: 31056695 PMCID: PMC6857751 DOI: 10.1093/ije/dyz084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the incidence of violent crime conviction among Swedish military veterans after deployment to Afghanistan versus non-deployed comparators. The main outcome was first conviction of a violent crime, retrieved from the Swedish National Council for Crime Prevention Register until December 31, 2013. METHODS This was a cohort study of military veterans identified through personnel registers regarding deployment to Afghanistan between 2002 and 2013 (n = 5894). To each military veteran, up to five non-deployed comparators identified via the Military Service Conscription Register were matched by age, sex, conscription year, cognitive ability, psychological assessment, self-reported mental health, body mass index, antidepressants/anxiolytics prescriptions and self-harm (fully matched comparators; n = 28 895). Multivariable adjustment was made for substance abuse and previous health care visits with psychiatric diagnoses. An additional comparator group matched only for age, sex and conscription year was also used (age-sex-matched comparators; n = 29 410). RESULTS During 21 898 person-years of follow-up (median = 3.6 years) there were 26 events among deployed military veterans compared with 98 in non-deployed fully matched comparators [12 vs 9 per 10 000 person-years, adjusted hazard ratio (aHR) 1.36; 95% confidence interval (CI) 0.88-2.10]. Among non-deployed age-sex-matched comparators there were 170 violent crime convictions (16 per 10 000 person-years; aHR 0.85; 95% CI 0.56-1.29). Factors associated with greater risk of violent crime convictions were younger age, lower scores on cognitive ability tests and psychological assessment, and convictions preceding deployment. CONCLUSION The violent crime conviction rate after returning from military deployment to Afghanistan was not different compared with non-deployed comparators in individuals without history of violent crime convictions.
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Affiliation(s)
- Carl-Martin Pethrus
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Reutfors
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kari Johansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Jonas K Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Bruze
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Williamson V, Diehle J, Dunn R, Jones N, Greenberg N. The impact of military service on health and well-being. Occup Med (Lond) 2020; 69:64-70. [PMID: 30380097 DOI: 10.1093/occmed/kqy139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background While it is known that some UK Armed Forces (UK AF) personnel and veterans experience physical and mental health problems, the possible future healthcare needs of military veterans are unknown. Aims To estimate the number of military personnel who may experience physical and/or psychological health problems associated with their military service. Methods Data were obtained via Freedom of Information requests to several sources, including Defence Statistics. Raw data from research studies were also used where available. Data were analysed using meta-analytic methods to determine the rate of physical, mental or comorbid health problems in AF personnel. Results Musculoskeletal problems were the predominant reason for medical discharge from service. In terms of mental health, meta-analyses estimated that veteran reservists (part-time military members) previously deployed to operational areas had the highest proportion of general health problems (35%), previously deployed veteran regulars (those in full time military employment) and veteran reservists had the highest proportion of post-traumatic stress disorder (9%), and regular personnel with a deployment history had the highest proportion of alcohol problems (14%). Overall, our findings suggest that at least 67515 veterans are likely to suffer from mental and/or physical health problems at some point as a result of their service between 2001 and 2014. Conclusions The results of this study highlight that the difficulties personnel may face are largely musculoskeletal or mental health-related. These findings may help with planning the provision of future physical and mental health care and support for those who serve in the UK AF.
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Affiliation(s)
- V Williamson
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - J Diehle
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - R Dunn
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - N Jones
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
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Hinojosa R. Cardiovascular disease among United States military veterans: Evidence of a waning healthy soldier effect using the National Health Interview Survey. Chronic Illn 2020; 16:55-68. [PMID: 29940779 DOI: 10.1177/1742395318785237] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Cardiovascular disease is the most common chronic health condition affecting Americans. One important group of Americans that health researchers have noted as key to understanding general population health and wellbeing are veterans of the US military. The healthy soldier effect has been used to explain the health benefits of military service during and for a period of time after service. The purpose of this study is to examine the prevalence of cardiovascular disease in a national sample of veterans and non-veterans with specific attention paid to reported cardiovascular disease across ages. Methods A total of 150,067 veteran and non-veteran respondents from the National Health Interview Survey were examined for the likelihood of reporting the type and number of cardiovascular conditions. Results Veterans report higher rates of certain cardiovascular disease conditions and report a higher number of cardiovascular disease conditions compared to non-veterans. Veterans also reported higher numbers of cardiovascular disease conditions at younger ages (ages 25–65) compared to non-veteran counterparts. At older ages (ages 66 to 85+), non-veterans reported higher numbers of cardiovascular disease conditions compared to veterans. Discussion Our findings are consistent with research that indicates a waning healthy soldier effect for young veterans.
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Affiliation(s)
- Ramon Hinojosa
- Department of Sociology, University of Central Florida, Orlando, FL, USA
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Strand LA, Martinsen JI, Borud EK. A 5-Year Continued Follow-up of Cancer Risk and All-Cause Mortality Among Norwegian Military Peacekeepers Deployed to Kosovo During 1999-2016. Mil Med 2020; 185:e239-e243. [PMID: 31322664 DOI: 10.1093/milmed/usz179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/04/2019] [Accepted: 06/25/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION In 2012, Norwegian news media reported on cases of brain cancer among Norwegian peacekeeping troops who served in Kosovo, allegedly caused by exposure to depleted uranium fired during airstrikes before the peacekeepers arrived in 1999. A first study followed 6076 military men and women with peacekeeping service in Kosovo during 1999-2011 for cancers and deaths throughout 2011. The study did not support to the idea that peacekeeping service in Kosovo could lead to increased risk of brain cancer or other cancers. However, the average time of follow-up (10.6 years) was rather short for cancer development; therefore the aim of the present study was to evaluate cancer risk and general mortality in an updated cohort after 5 years of additional follow-up. MATERIALS AND METHODS The updated cohort consisted of 6,159 peacekeepers (5,884 men and 275 women) who served in Kosovo during 1999-2016 and were followed for cancer incidence and mortality from all causes combined throughout 2016. We calculated standardized incidence ratios (SIR) for cancer and standardized mortality ratios (SMR) from national population rates. Poisson regression was used to assess the effect of length of service (<1 year vs. ≥1 year) on cancer risk. RESULTS We observed 149 cancer cases and 75 deaths in the updated cohort. Observed cancer incidence did not exceed national rates. In men, the SIR for brain cancer was 0.73 (95% confidence interval (CI) 0.32-1.44), based on eight cases, while the risk of colon cancer was lowered (SIR = 0.14, 95% CI 0.00-0.79). The Poisson regression showed no effect of service duration on all-site cancer incidence. Mortality from all causes combined was lower than expected (SMR = 0.62, 95% CI 0.49-0.78) and in accordance with a "healthy soldier effect". CONCLUSION The extended follow-up did not give support to the suggestion that peacekeeping service in Kosovo could lead to increased risk of cancer.
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Affiliation(s)
- Leif Aage Strand
- Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Sessvollmoen Garnison, N-2018 Sessvollmoen, Norway
| | | | - Einar Kristian Borud
- Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Sessvollmoen Garnison, N-2018 Sessvollmoen, Norway.,UiT The Arctic University of Norway, Department of Community Medicine, Tromsø, Norway
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Bossarte R, Riggs-Donovan CA. Risk of Suicide and Other Adverse Outcomes among Servicemembers: Looking beyond the Military Experience. Psychiatry 2020; 83:259-261. [PMID: 32960165 DOI: 10.1080/00332747.2020.1804787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schmidt EM, Magruder K, Kilbourne AM, Stock EM, Cypel Y, El Burai Félix S, Serpi T, Kimerling R, Cohen B, Spiro A, Furey J, Huang GD, Frayne SM. Four Decades after War: Incident Diabetes among Women Vietnam-Era Veterans in the HealthViEWS Study. Womens Health Issues 2019; 29:471-479. [PMID: 31519465 DOI: 10.1016/j.whi.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We analyzed long-term differences in incident diabetes associated with military service in a warzone among women who served during the Vietnam War era. METHODS For HealthViEWS, the largest later-life study of women Vietnam War-era U.S. veterans, a population-based retrospective cohort who served during 1965-1973 completed a health interview in 2011-2012. This cohort included women deployed to Vietnam, near Vietnam, or who served primarily in the United States. We hypothesized a warzone exposure gradient: Vietnam (highest exposure), near Vietnam, and the United States (lowest exposure). We used an extended Cox regression to test for differences in incident diabetes by location of wartime service. RESULTS Of 4,503 women in the analysis, 17.7% developed diabetes. Adjusting for demographics and military service characteristics, hazard of incident diabetes was significantly lower initially in the Vietnam group compared with the U.S. group (hazard ratio, 0.33; 95% confidence interval, 0.15-0.69). However, lower diabetes hazard in the Vietnam group was not constant over time; rather, hazard accumulated faster over time in the Vietnam group compared with the U.S. group (hazard ratio, 1.38; 95% confidence interval, 1.11-1.72). No significant difference in diabetes hazard was found between the near Vietnam and U.S. groups. Older age during military service, minority race/ethnicity, and lower military rank were associated with a higher diabetes hazard. CONCLUSIONS Women deployed to a warzone might have protective health factors that lower risk for diabetes early in their military career, but delivery systems for long-term health should consider that a lower risk for chronic diseases like diabetes can wane quickly in the decades that follow warzone service.
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Affiliation(s)
- Eric M Schmidt
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California; Program Evaluation Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Central Office, Menlo Park, California.
| | - Kathryn Magruder
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
| | - Amy M Kilbourne
- Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Eileen M Stock
- Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Yasmin Cypel
- Epidemiology Program Post-Deployment Health Services, Office of Patient Care Services, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Suad El Burai Félix
- Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Tracey Serpi
- Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Rachel Kimerling
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California; National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, California
| | - Beth Cohen
- General Internal Medicine, San Francisco VA Medical Center, San Francisco, California; School of Medicine, University of California, San Francisco, California
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, Massachusetts; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts; Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts
| | | | - Grant D Huang
- Cooperative Studies Program Central Office, VA Office of Research and Development, Washington, District of Columbia
| | - Susan M Frayne
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California; Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California
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Yeung P, Allen J, Godfrey HK, Alpass F, Stephens C. Risk and protective factors for wellbeing in older veterans in New Zealand. Aging Ment Health 2019; 23:992-999. [PMID: 29781708 DOI: 10.1080/13607863.2018.1471584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objectives: To compare indicators relating to aging and health among veterans and non-veterans, and identify factors associated with subjective wellbeing (SWB) of older New Zealand veterans. Methods: Self-reported data were obtained from participants in a longitudinal cohort study of New Zealand older adults. Responses from 352 veterans and 1500 non-veterans (age range of 55-86 and gender matched) were selected as a comparison group on indicators related to health and aging. The association of these indicators with veterans' SWB were assessed using hierarchical regression. Results: Apart from being older, smoking more, and having more chronic conditions, veterans did not differ from non-veterans on indicators of health and wellbeing. Mental health, physical health, purpose in life, housing satisfaction, and capabilities (choice and freedom) accounted for a significant amount of variance in veterans' SWB. Conclusion: Our results suggest that older veterans do not differ greatly on indices of health and aging from their non-veteran peers. Results support previous findings that lower mental and physical health is associated with lower SWB for veterans. Building upon prior findings, the current results demonstrate that interventions focusing on enhancing a sense of purpose in life, supporting one's capability to achieve, and strengthening social and physical environment through social connectedness, may serve as protective factors for SWB in veterans.
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Affiliation(s)
- Polly Yeung
- a School of Social Work , Massey University , Palmerston North , New Zealand
| | - Joanne Allen
- b School of Psychology , Massey University , Palmerston North , New Zealand
| | - Hazel K Godfrey
- b School of Psychology , Massey University , Palmerston North , New Zealand.,c School of Psychology , Victoria University of Wellington , Wellington , New Zealand
| | - Fiona Alpass
- b School of Psychology , Massey University , Palmerston North , New Zealand
| | - Christine Stephens
- b School of Psychology , Massey University , Palmerston North , New Zealand
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Bullman T, Schneiderman A. Mortality experience of US veterans following service as international peacekeepers in Bosnia/Kosovo theater, 1996-2002. Cancer Epidemiol 2019; 62:101563. [PMID: 31344627 DOI: 10.1016/j.canep.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/12/2019] [Accepted: 07/01/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Beginning in 1996 US military personnel served as peacekeeping forces in Bosnia/Kosovo. No studies have assessed the long-term post-deployment health of this US cohort. Based on the health concerns raised in studies of military personnel from other countries, this study focused on mortality due to Leukemia, respiratory disease, respiratory cancer, and heart disease. METHODS This study compared the post-war cause-specific mortality of 53,320 veterans who deployed to Bosnia/Kosovo between 1996-2002 to that of 117,267 veterans who also served in the military between 1996-2002, but were not deployed to Bosnia/Kosovo. Expressed as standardized mortality ratios (SMR)s the cause-specific mortality for both deployed and non-deployed were compared separately to that of the US general population. Cause-specific mortality risks among Bosnia/Kosovo veterans relative to that of non-deployed veterans were assessed using Hazard Ratios (HR)s generated by Cox proportional-hazards models. RESULTS The overall mortality of both deployed and non-deployed veterans was almost half that of the US population, SMR = 0.59, 95%, C.I., 0.55-0.62 and SMR = 0.66, 95%, C.I., 0.64-0.68, respectively. Neither group of veterans had any excess of disease related mortality compared to that of the US population. Compared to non-deployed, deployed veterans did not experience any increased risks for any of the diseases of a priori interest. CONCLUSION It does not appear that US military deployed to Bosnia/Kosovo have any increased risks of disease related mortality. However, this study would not have been able to detect increased risk of cancers with latency periods that exceeded the 18 years of follow-up available in this study.
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Affiliation(s)
- Tim Bullman
- Post Deployment Health Services, US Department of Veterans Affairs, 810 Vermont Ave, Washington DC, 20420, United States.
| | - Aaron Schneiderman
- Post Deployment Health Services, US Department of Veterans Affairs, 810 Vermont Ave, Washington DC, 20420, United States.
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