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Osborne AK, Wilson-Menzfeld G, McGill G, Kiernan MD. Military service and alcohol use: a systematic narrative review. Occup Med (Lond) 2022; 72:313-323. [PMID: 35674143 PMCID: PMC9272263 DOI: 10.1093/occmed/kqac045] [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] [Indexed: 11/18/2022] Open
Abstract
Background Despite research highlighting the role of alcohol in military life, specifically in relation to mental health and certain combat experiences, there is no synthesised evidence looking at the relationship between military service and alcohol use. Aims To synthesize and examine evidence exploring the relationship between military service and alcohol use. Methods Six databases were examined across a 10-year period. Papers were included if they involved a military population and focused on alcohol use. From 4046 papers identified, 29 papers were included in the review. Results Military characteristics and experience were linked to high levels of alcohol use across military populations. Societal and cultural factors also played a role in alcohol use in military populations. Predatory behaviour of alcohol establishments, pressures to conform, an acceptance of alcohol use, and the role of religious services and military affiliated social networks were all considered. Excessive drinking impacted physical and mental health. Those diagnosed with PTSD and associated symptoms appeared to have greater alcohol use. Conclusions This review identified certain characteristics and experiences of military service that are associated with higher levels of alcohol use. It is important to identify risk factors for alcohol misuse to develop appropriate policy, targeting prevention.
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Affiliation(s)
- A K Osborne
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - G Wilson-Menzfeld
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - G McGill
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - M D Kiernan
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
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2
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Palmer L, Norton S, Jones M, Rona RJ, Goodwin L, Fear NT. Trajectories of alcohol misuse among the UK Armed Forces over a 12-year period. Addiction 2022; 117:57-67. [PMID: 34288194 PMCID: PMC9292297 DOI: 10.1111/add.15592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/13/2020] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
AIM To identify the main trajectories of alcohol misuse among UK military personnel from 12 years after the start of the Iraq war (2003) and the factors associated with each trajectory. DESIGN Longitudinal cohort study with three phases of data collection (2004-06, 2007-09 and 2014-16). SETTING United Kingdom. PARTICIPANTS Serving and ex-serving personnel of the UK Armed Forces (n = 7111) participating at Phase 1 and at least one follow-up phase of the King's Centre for Military Health Research (KCMHR) cohort study. MEASUREMENTS Trajectories of alcohol misuse were derived from scores using the Alcohol Use Disorders Identification Test (AUDIT-10) over three data collection phases. Demographic and military characteristics were collected and, among the key covariates, post-traumatic stress disorder (PTSD) was measured using the PTSD checklist (PCL-C) and childhood interpersonal stress and violence was measured using items from the Adverse Childhood Experiences questionnaire. FINDINGS Five trajectories of alcohol misuse were identified, including 'no misuse' (n = 2249, 31.6%) and 'hazardous' (n = 3398, 47.8%), 'harmful' (n = 832, 11.7%), 'severe-to-hazardous' (n = 258, 5.3%) and 'severe' (n = 374, 3.6%) drinking. Substantial changes were evident only among severe drinkers, where more than half reduced over the study period. The factors most strongly associated with belonging to harmful/severe drinking classes were young age, male gender and childhood adversities and antisocial behaviour. Severe drinkers at Phase 1 were more likely to report probable PTSD and shorter military careers and were less likely to serve as Officers. Persistent severe drinkers were less likely to serve in the RAF compared to the Army and were more likely to be reserves. Not misusing alcohol was also associated with reserve status and having left service. CONCLUSIONS In a cohort of approximately 7000 UK military personnel, trajectories of alcohol misuse appeared stable between 2004 and 2016. More than half of severe drinkers made substantial improvements over the period, but 68% of the cohort continued to drink hazardously or harmfully. Lack of change for the majority of the sample signals the need for strategies to address alcohol misuse and its cultural and psychosocial drivers.
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Affiliation(s)
- Laura Palmer
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Sam Norton
- Centre for Rheumatic Diseases and Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Margaret Jones
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Roberto J. Rona
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Laura Goodwin
- Department of PsychologyUniversity of LiverpoolEleanor Rathbone Building LiverpoolUK,Liverpool Centre for Alcohol ResearchLiverpool Health PartnersLiverpoolUK
| | - Nicola T. Fear
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK,Academic Department of Military Mental HealthInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
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3
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Hummel KV, Trautmann S, Venz J, Thomas S, Schäfer J. Repetitive negative thinking: transdiagnostic correlate and risk factor for mental disorders? A proof-of-concept study in German soldiers before and after deployment to Afghanistan. BMC Psychol 2021; 9:198. [PMID: 34924023 PMCID: PMC8686273 DOI: 10.1186/s40359-021-00696-2] [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: 06/11/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Disorder-specific forms of Repetitive Negative Thinking (RNT) are associated with multiple diagnostic categories, indicating a transdiagnostic nature. Few studies examined content-independent RNT processes across groups of diagnosed mental disorders. Moreover, theory describes RNT processes as critically involved in the etiology of mental disorders, empirical evidence however is scarce. We first tested the transdiagnostic nature by examining levels of RNT across groups of internalizing and externalizing mental disorders compared to healthy individuals and explored RNT levels in a comorbid disorder-group. Second, we examined whether RNT predicts incident psychopathology. METHODS In a sample of German soldiers (n = 425) scheduled for deployment in Afghanistan, we compared RNT levels between diagnosed groups with alcohol use disorders, anxiety disorders and healthy individuals cross-sectionally. Exploratory analyses were conducted comparing a comorbid disorder-group to healthy individuals and to both single-disorder-groups. Longitudinally, we examined the predictive value of pre-deployment RNT levels for incident psychopathology after deployment (n = 167). RNT was measured using the Perseverative Thinking Questionnaire (PTQ), DSM-IV diagnoses were assessed using the standardized Composite International Diagnostic Interview (CIDI). RESULTS Cross-sectional comparisons revealed that soldiers with alcohol use disorders and anxiety disorders showed significantly higher degrees of RNT compared to healthy soldiers. RNT levels in those with comorbid disorders were significantly higher compared to healthy soldiers but also compared to both single-disorder-groups. Longitudinal analyses revealed that higher levels of RNT prior to deployment were associated with a higher risk to have any incidental mental disorder after deployment. This however is only attributable to individuals with a PTQ score above a cut-off of 15. CONCLUSIONS Findings provide evidence for RNT as a transdiagnostic correlate and a vulnerability factor for the development of mental disorders.
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Affiliation(s)
- Katrin V Hummel
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | | | - John Venz
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - Sarah Thomas
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - Judith Schäfer
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
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4
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Kim JY, Kim J, Park S, Fear N. Workplace victimization and alcohol misuse among junior military personnel: Mediating the role of anger. J Affect Disord 2021; 294:638-644. [PMID: 34332364 DOI: 10.1016/j.jad.2021.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 06/19/2021] [Accepted: 07/11/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Workplace victimization is one of most serious problems for affecting alcohol misuse in junior military personnel (JMP) that has been largely overlooked in research attention. Studies on workplace victimization and alcohol misuse indicate anger as mediator. Workplace victimization may affect alcohol misuse (in)directly through the mediator. METHODS A sample of JMP (N = 815) completed an offline survey, consisting of the revised Conflict Tactics Scale-2, Composite International Diagnostic Interview Screening Scale, and the Alcohol Use Disorders Identification Test. Frequency, t-test and chi-square test, and mediation analyses were conducted to assess the effects of workplace victimization on alcohol misuse, mediated via anger. RESULTS Victims in the workplace showed higher level of anger and alcohol misuse. In mediation analyses, workplace victimization was related to higher levels of anger, which, in turn, were associated with greater alcohol misuse. LIMITATIONS Study limitations included the use of cross-sectional data with the use of retrospective self-report. CONCLUSION Workplace victimization in JMP is prevalent (17.7%), and alcohol misuse is associated with effects of workplace victimization and anger with full mediation path. Findings suggest that eliminating workplace victimization against JMP and intervention for anger should be focused upon, and implemented for online alcohol misuse prevention in the military context.
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Affiliation(s)
- Jae Yop Kim
- School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Joonbeom Kim
- Interdisciplinary Graduate Program in Social Welfare Policy, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
| | - Sookyung Park
- School of Social Welfare, Yonsei University, Seoul, Republic of Korea
| | - Nicola Fear
- Diretor of the King's Centre for Military Health Research, King's College London, London, United Kingdom
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5
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Hoopsick RA, Homish DL, Vest BM, Bartone PT, Homish GG. Resilience to Hazardous Drinking Among Never-Deployed Male United States Army Reserve and National Guard Soldiers. Alcohol Clin Exp Res 2021; 45:566-576. [PMID: 33503277 DOI: 10.1111/acer.14561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Negative emotions related to never having been deployed to active duty are associated with an increased risk of hazardous drinking among United States Army Reserve/National Guard (USAR/NG) soldiers. Resiliency factors are known to buffer the effects of combat on hazardous drinking among service members who have been deployed, but it is not known whether these factors are protective for never-deployed service members, or which domains of hazardous drinking might be affected. Therefore, we examined the effects of a range of resiliency factors (i.e., marital satisfaction, psychological hardiness, intrinsic religiosity) on the relation between nondeployment emotions (NDE) and domains of hazardous drinking. METHODS We drew a subset of data from Operation: Soldiers and Families Excelling Through the Years (N = 112 never-deployed male soldiers), an ongoing study of USAR/NG soldiers. Regression models examined the main effects of NDE on each of the domains of hazardous drinking (i.e., total Alcohol Use Disorders Identification Test [AUDIT] score, consumption subscale, dependence subscale, alcohol-related problems subscale) and effect modification of each of the resiliency factors on the relations between NDE and the domains of hazardous drinking, separately. Final models controlled for years of military service, rank (enlisted vs. officer), number of military friends in the social network, and depression. RESULTS Greater NDE were associated with a higher total AUDIT score, alcohol consumption, and alcohol dependence (ps < 0.05), but not alcohol-related problems (p > 0.05). Marital satisfaction and psychological hardiness buffered the effects of NDE on total AUDIT score and alcohol dependence (p < 0.05). Intrinsic religiosity only modified the effect of NDE on total AUDIT score. None of the resiliency factors modified the effects of NDE on alcohol consumption or alcohol-related problems. CONCLUSIONS Soldiers with greater NDE had a greater risk of hazardous drinking in the presence of low resilience. Interventions to promote resiliency are an important consideration for protecting USAR/NG soldiers from hazardous drinking, regardless of their deployment history.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bonnie M Vest
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Paul T Bartone
- Institute for National Strategic Studies, National Defense University, Washington, DC, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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6
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Szabo YZ, Breeding T, Hejl C, Guleria RS, Nelson SM, Zambrano-Vazquez L. Cortisol as a Biomarker of Alcohol Use in Combat Veterans: A Literature Review and Framework for Future Research. J Dual Diagn 2020; 16:322-335. [PMID: 32493131 PMCID: PMC7483986 DOI: 10.1080/15504263.2020.1771504] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: Alcohol use and alcohol use disorders (AUDs) are an increasing concern among veterans, particularly those from recent conflicts in Iraq and Afghanistan. The study of biomarkers in alcohol use and AUD has moved to enhancing the understanding of the development and maintenance of AUDs, as well as investigating its association with clinical severity and potential predictors of treatment response. Cortisol, a glucocorticoid known as a stress hormone, has been linked with both stress and trauma, as well as increased alcohol suppression effects. Method/Results: The present review summarizes existing literature and presents suggestions for future research to evaluate whether cortisol may be a possible biomarker of alcohol use disorder risk in combat veterans. Specifically, aspects of combat deployments and high levels of PTSD, coupled with the stress of reintegration may dysregulate cortisol and increase risk to AUD. There may also be bidirectional impacts, such that alcohol is used as a coping mechanism and can dysregulate hypothalamic pituitary adrenal (HPA) axis functioning and cortisol. Conclusions: In the context of this framework, cortisol may serve as a biomarker for the development of AUD, as well as a biomarker of risk or relapse. This review ends with both theoretical and clinical implications, as well as directions for future research.
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Affiliation(s)
- Yvette Z Szabo
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.,Department of Psychiatry, Texas A&M College of Medicine, Bryan, TX, USA.,Department of Health, Human Performance and Recreation, Baylor University, Waco, TX, USA
| | - Tessa Breeding
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Christina Hejl
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA
| | - Rakeshwar S Guleria
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.,Institute of Biomedical Studies, Baylor University, Waco, TX, USA
| | - Steven M Nelson
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.,Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.,Center for Vital Longevity, University of Texas at Dallas, Dallas, TX, USA
| | - Laura Zambrano-Vazquez
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.,Department of Psychiatry, Texas A&M College of Medicine, Bryan, TX, USA.,Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
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7
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Wesemann U, Willmund GD, Ungerer J, Kreim G, Zimmermann PL, Bühler A, Stein M, Kaiser J, Kowalski JT. Assessing Psychological Fitness in the Military - Development of an Effective and Economic Screening Instrument. Mil Med 2019; 183:e261-e269. [PMID: 29596663 DOI: 10.1093/milmed/usy021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 02/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background There are a high number of soldiers with deployment-related and non-deployment-related mental health problems in the German Armed Forces (Bundeswehr): This has led to an increase in mental disorders and a decrease in quality of life. To tackle these problems and to strengthen resources among the Bundeswehr personnel, this study aims at developing a screening instrument for assessing the psychological fitness of soldiers on the basis of questionnaire scales. In this approach, psychological fitness describes a soldier's ability to integrate and enhance his/her mental and emotional capabilities using resources and trainable skills. Methods Bundeswehr combat soldiers (N = 361) answered questionnaires about resilience (RS-11), sense of coherence (SOC-L9), quality of life (WHOQOL-BREF), mental disorders (PHQ-D) and post-traumatic growth (PTG). Additionally, they were interviewed by trained troop psychologists both before and after their deployment in Afghanistan from January to June 2014. The screening model is based on self-report data; the psychological fitness in the standardized interview serves as a validation standard. Findings A linear logistic regression model was performed that includes the social relationship and the psychological scale from WHOQOL-BREF and the somatoform and the stress scale from PHQ. This model allows specialists a first assessment between participants who are psychologically fit before and after deployment and those who are less so. The chosen cutoff for sensitivity is between 70% and 79% and for specificity between 70% and 85%. Discussion This screening approach is still not applicable to large populations like that of the Bundeswehr, which currently has about 170,000 soldiers but it is limited to deployed combat troops. Classifying psychological fitness allows specialists to differentiate between people in need of special training or additional diagnostic measures and those in need of sustaining their fitness regularly at the earliest possible stage. A follow-up study that is representative of deployed and non-deployed military personnel will examine whether these results can be transferred to the entire Bundeswehr and whether the validity of the interview can be established.
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Affiliation(s)
- Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital, Scharnhorststr. 13, Berlin, Germany
| | - Gerd D Willmund
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital, Scharnhorststr. 13, Berlin, Germany
| | - Jörn Ungerer
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital, Scharnhorststr. 13, Berlin, Germany
| | - Günter Kreim
- German Armed Forces Office, Department P III 5, Bonn, Germany
| | - Peter L Zimmermann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital, Scharnhorststr. 13, Berlin, Germany
| | - Antje Bühler
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital, Scharnhorststr. 13, Berlin, Germany
| | - Michael Stein
- Experimental Psychological Unit, Helmut Schmidt University/University of the Federal Armed Forces, Holstenhofweg 85, Hamburg, Germany
| | - Jakob Kaiser
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital, Scharnhorststr. 13, Berlin, Germany
| | - Jens T Kowalski
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital, Scharnhorststr. 13, Berlin, Germany.,German Armed Forces Office, Department P III 5, Bonn, Germany.,Experimental Psychological Unit, Helmut Schmidt University/University of the Federal Armed Forces, Holstenhofweg 85, Hamburg, Germany
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8
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Wooten NR, Brittingham JA, Pitner RO, Tavakoli AS, Jeffery DD, Haddock KS. Purchased Behavioral Health Care Received by Military Health System Beneficiaries in Civilian Medical Facilities, 2000-2014. Mil Med 2019; 183:e278-e290. [PMID: 29420772 PMCID: PMC6027075 DOI: 10.1093/milmed/usx101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/15/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014. Materials and Methods Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study. Results From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78.8%) and care was most often received in EDs (56%). Most commonly treated diagnoses included mood, tobacco use, and alcohol use disorders. ED visits were associated with being treated for anxiety (excluding post-traumatic stress disorder; Adjusted odds ratio [AOR]: 9.14 [95% confidence interval (CI): 8.26, 10.12]), alcohol use disorders (AOR = 1.67 [95% CI: 1.53, 1.83]), tobacco use (AOR = 1.16 [95% CI: 1.06, 1.26]), nondependent cocaine abuse (AOR = 5.47 [95% CI: 3.28, 9.12]), nondependent mixed/unspecified drug abuse (AOR = 7.30 [95% CI: 5.11, 10.44]), and psychosis (AOR = 1.38 [95% CI: 1.20, 1.58]). Compared with adults age 60 yr and older, adolescents (ages 12–17 yr), and adults under age 60 yr were more likely to be treated for suicidal ideation, adjustment, mood, bipolar, post-traumatic stress disorder, nondependent cocaine, and mixed/unspecified drug abuse. Adults under age 60 yr also had increased odds of being treated for tobacco use disorders, alcohol use disorders, and opioid/combination opioid dependence compared with adults age 60 yr and older. Conclusions Over the past 15 yr, purchased behavioral health care received by MHS beneficiaries in acute care facilities increased significantly. MHS beneficiaries received the majority of purchased behavioral health care for mental health disorders and were treated most often in the ED. Receiving behavioral health care in civilian EDs raises questions about access to outpatient behavioral health care and patient-centered care coordination between civilian and military facilities. Given the influx of new Veterans Health Administration users from the MHS, findings have implications for military, veteran, and civilian facilities providing behavioral health care to military and veteran populations.
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Affiliation(s)
- Nikki R Wooten
- College of Social Work, University of South Carolina, Hamilton College, Columbia, SC
| | - Jordan A Brittingham
- Arnold School of Public Health, University of South Carolina, 921 Assembly St., Columbia, SC
| | - Ronald O Pitner
- College of Social Work, University of South Carolina, Hamilton College, Columbia, SC
| | - Abbas S Tavakoli
- College of Nursing, University of South Carolina, 1601 Greene St., Columbia, SC
| | - Diana D Jeffery
- Clinical Support Division, Health Operations Directorate, Defense Health Agency, U.S. Department of Defense, 7700 Arlington Blvd, Suite 5101, Falls Church, VA
| | - K Sue Haddock
- Research Service, WJB Dorn Veterans Administration Medical Center, 6439 Garners Ferry Road, Columbia, SC
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9
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The role of childhood trauma and stress reactivity for increased alcohol craving after induced psychological trauma: an experimental analogue study. Psychopharmacology (Berl) 2018; 235:2883-2895. [PMID: 30203300 DOI: 10.1007/s00213-018-4979-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/17/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Traumatic events are associated with alcohol use problems with increased alcohol craving as a potential mediator. There is still a lack of knowledge regarding the causal nature of this association and its underlying mechanisms. This study investigated the effects of acute trauma exposure on alcohol craving in healthy individuals considering the role of stress reactivity and childhood trauma (CT) using a laboratory randomized controlled design. METHODS Ninety-five healthy participants were randomly exposed to a trauma or a neutral film. History of CT, and pre- to post-film changes in craving (craving reactivity, CR), anxiety, skin conductance, heart rate, and saliva cortisol levels were assessed. Moreover, associations between trauma film exposure and CR, the moderating role of CT, and associations between CT, stress reactivity, and trauma-induced CR were analyzed. RESULTS Relative to the neutral film, the trauma film elicited an increase in CR in females but not in males. In males but not in females, the association between trauma film exposure and CR was moderated by CT, with trauma-induced CR increasing with the number of CT. In males, CT was related to decreased cortisol reactivity and increased heart rate and skin conductance response of which skin conductance was also associated with CR. DISCUSSION These findings provide further evidence for a causal link between traumatic experiences and CR. While this association seems to be stronger in females, males might still be at risk in case of other vulnerability factors such as CT, with altered sympathetic stress reactivity as a potential contributing mechanism.
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10
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Saitz R, Heeren TC, Zha W, Hingson R. Transitions To and From At-Risk Alcohol Use in Adults in the United States. JOURNAL OF SUBSTANCE USE 2018; 24:41-46. [PMID: 30559602 DOI: 10.1080/14659891.2018.1497101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction The objective of this research was to study transitions to and from at-risk alcohol use. Methods Logistic regression analyses (done 2015-2016) assessed transitions to and from past-year at-risk drinking in a representative sample of U.S. adults surveyed twice (in 2001-2 and 2004-5). Results Among 34,653 adults, 28% reported at-risk use at time 1. Of those, 73% had at-risk use at time 2. Of those without at-risk use at time 1, 15% reported at-risk use at time 2. Positive high-risk drinking transition predictors were, at time 1, being young, male, white, childless, in good to excellent health, ever smoking, using drugs, military membership (time 1 but not 2), and becoming divorced or separated by time 2. Positive low-risk drinking transition predictors were being elderly (age ≥65), female, non-white, never smoking or using drugs, no alcohol use disorder, alcohol treatment, and, after time 1, having children. Conclusions Many adults transition to and from at-risk alcohol use; youth is the strongest positive predictor of transition to at-risk and not transitioning to low-risk drinking. Persons transitioning to legal drinking age are most likely to transition to high-risk and least likely to low-risk drinking.
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Affiliation(s)
- Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health; Clinical Addiction Research and Education Unit, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Wenxing Zha
- Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
| | - Ralph Hingson
- Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
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11
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Richmond RR, Henebry AD. A Maisonneuve Fracture in an Active Duty Sailor: A Case Report. Mil Med 2018; 183:e278-e280. [PMID: 29415223 DOI: 10.1093/milmed/usx080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/04/2017] [Indexed: 11/13/2022] Open
Abstract
Maisonneuve fractures are relatively well known in the sports medicine, and orthopedic communities, however, can be commonly missed among primary care providers. The following case outlines an active duty 35-yr-old female patient who presented with acute pain on the left ankle and lower leg after she misjudged a step. The injury is a combination of high fibular and medial malleolar fractures with a disruption of the tibiofibular syndesmosis ligaments. This is a result of extreme external rotation and pronation of a fixed foot. The proper diagnosis is reliant on ankle and tibiofibular films, to include orthogonal views. This case serves as a reminder to always examine joints above and below the injury site, obtain orthogonal views of a fracture, as well as the unstable nature of syndesmosis injuries. This fracture is commonly a sports-related injury; thus, it is particularly important for military providers to be aware of Maisonneuve fractures and the common pitfalls in diagnosis and treatment.
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Affiliation(s)
- Ryan R Richmond
- Naval Health Branch Clinic Naval Air Technical Training Command, Naval Hospital Pensacola, 6000 West Highway 98, Pensacola, FL 32512
| | - Andrew D Henebry
- Department of Orthopedics, Naval Hospital Pensacola, 6000 West Highway 98, Pensacola, FL 32512
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Bartone PT, Johnsen BH, Eid J, Hystad SW, Laberg JC. Hardiness, avoidance coping, and alcohol consumption in war veterans: A moderated-mediation study. Stress Health 2017; 33:498-507. [PMID: 27885790 DOI: 10.1002/smi.2734] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/17/2016] [Accepted: 10/25/2016] [Indexed: 11/09/2022]
Abstract
Military personnel often engage in excessive alcohol use after returning from deployments. Thus far, research has paid scant attention to personality factors that may increase or diminish the risk for increased alcohol consumption in this population. The present study explores how psychological hardiness, avoidance coping, and stress exposure may interact to influence alcohol consumption patterns in soldiers following deployment. U.S. Army National Guard soldiers (N = 357) were surveyed shortly after returning from combat operations in Afghanistan. Conditional process analysis was used to test for mediation and moderation effects. Mediation effects were further tested in a replication sample of Norwegian Army soldiers (N = 230) deployed to Kosovo. Findings show that hardiness is a significant (negative) predictor of increased alcohol use and that this relation is mediated by avoidance coping. Further, this effect was moderated by combat stress exposure in the U.S. sample, such that the mediation is stronger for those with greater exposure (moderated-mediation). Avoidance coping also mediated the effects of hardiness on alcohol consumption in the Norwegian sample. These findings suggest that avoidance coping and hardiness may be fruitful areas for interventions aimed at reducing risky drinking in high-stress groups like the military.
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Affiliation(s)
- Paul T Bartone
- Center for Technology and National Security Policy, National Defense University, Washington, DC, USA.,Department of Psychosocial Sciences, University of Bergen, Bergen, Norway
| | - Bjorn H Johnsen
- Department of Psychosocial Sciences, University of Bergen, Bergen, Norway
| | - Jarle Eid
- Department of Psychosocial Sciences, University of Bergen, Bergen, Norway
| | - Sigurd W Hystad
- Department of Psychosocial Sciences, University of Bergen, Bergen, Norway
| | - Jon C Laberg
- Department of Psychosocial Sciences, University of Bergen, Bergen, Norway
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Goodwin L, Norton S, Fear N, Jones M, Hull L, Wessely S, Rona R. Trajectories of alcohol use in the UK military and associations with mental health. Addict Behav 2017; 75:130-137. [PMID: 28734152 DOI: 10.1016/j.addbeh.2017.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/28/2017] [Accepted: 07/10/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There are higher levels of alcohol misuse in the military compared to the general population. Yet there is a dearth of research in military populations on the longitudinal patterns of alcohol use. This study aims to identify group trajectories of alcohol consumption in the UK military and to identify associations with childhood adversity, deployment history and mental disorder. METHODS Data on weekly alcohol consumption across an eight year period and three phases of a UK military cohort study (n=667) were examined using growth mixture modelling. RESULTS Five alcohol trajectory classes were identified: mid-average drinkers (55%), abstainers (4%), low level drinkers (19%), decreasing drinkers (3%) and heavy drinkers (19%). Alcohol consumption remained stable over the three periods in all classes, other than in the small decreasing trajectory class. Individuals in the heavy drinking class were more likely to have deployed to Iraq. Abstainers and heavy drinkers were more likely to report post-traumatic stress disorders at baseline compared to average drinkers. CONCLUSIONS Heavy drinkers in the UK military did not change their drinking pattern over a period of eight years. This highlights the need to develop effective preventive programmes to lessen the physical and psychological consequences of long-term heavy alcohol use. Individuals with a mental health problem appeared more likely to either be drinking at a high level or to be abstaining from use.
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Bravo AJ, Kelley ML, Hollis BF. Work stressors, sleep quality, and alcohol-related problems across deployment: A parallel process latent growth modeling approach among Navy members. Stress Health 2017; 33:339-347. [PMID: 27723222 DOI: 10.1002/smi.2712] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/30/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022]
Abstract
This study examined how work stressors were associated with sleep quality and alcohol-related problems among U.S. Navy members over the course of deployment. Participants were 101 U.S. Navy members assigned to an Arleigh Burke-class destroyer who experienced an 8-month deployment after Operational Enduring Freedom/Operation Iraqi Freedom. Approximately 6 weeks prior to deployment, 6 weeks after deployment, and 6 months reintegration, participants completed measures that assessed work stressors, sleep quality, and alcohol-related problems. A piecewise latent growth model was conducted in which the structural paths assessed if work stressors influenced sleep quality or its growth over time, and in turn if sleep quality influenced alcohol-related problems intercepts or growth over time. A significant indirect effect was found such that increases in work stressors from pre- to postdeployment predicted decreases in sleep quality, which in turn were associated with increases in alcohol-related problems from pre- to postdeployment. These effects were maintained from postdeployment through the 6-month reintegration. Findings suggest that work stressors may have important implications for sleep quality and alcohol-related problems. Positive methods of addressing stress and techniques to improve sleep quality are needed as both may be associated with alcohol-related problems among current Navy members.
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Kuitunen‐Paul S, Rehm J, Lachenmeier DW, Kadrić F, Kuitunen PT, Wittchen H, Manthey J. Assessment of alcoholic standard drinks using the Munich composite international diagnostic interview (M-CIDI): An evaluation and subsequent revision. Int J Methods Psychiatr Res 2017; 26:e1563. [PMID: 28370786 PMCID: PMC6877198 DOI: 10.1002/mpr.1563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/05/2017] [Accepted: 02/24/2017] [Indexed: 01/16/2023] Open
Abstract
The quantity and frequency of alcohol consumption are crucial both in risk assessment as well as epidemiological and clinical research. Using the Munich Composite International Diagnostic Interview (M-CIDI), drinking amounts have been assessed in numerous large-scale studies. However, the accuracy of this assessment has rarely been evaluated. This study evaluates the relevance of drink categories and pouring sizes, and the factors used to convert actual drinks into standard drinks. We compare the M-CIDI to alternative drink assessment instruments and empirically validate drink categories using a general population sample (n = 3165 from Germany), primary care samples (n = 322 from Italy, n = 1189 from Germany), and a non-representative set of k = 22503 alcoholic beverages sold in Germany in 2010-2016. The M-CIDI supplement sheet displays more categories than other instruments (AUDIT, TLFB, WHO-CIDI). Beer, wine, and spirits represent the most prevalent categories in the samples. The suggested standard drink conversion factors were inconsistent for different pouring sizes of the same drink and, to a smaller extent, across drink categories. For the use in Germany and Italy, we propose the limiting of drink categories and pouring sizes, and a revision of the proposed standard drinks. We further suggest corresponding examinations and revisions in other cultures.
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Affiliation(s)
- Sören Kuitunen‐Paul
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
| | - Jürgen Rehm
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
- Social and Epidemiological Research DepartmentCenter for Addiction and Mental HealthTorontoCanada
- Addiction Policy, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
- Institute of Medical ScienceUniversity of Toronto, Faculty of Medicine, Medical Sciences BuildingTorontoCanada
- Department of PsychiatryUniversity of TorontoTorontoCanada
- WHO Collaborating Center for Mental Health and AddictionCenter for Addiction and Mental HealthTorontoCanada
| | - Dirk W. Lachenmeier
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
- Chemisches und Veterinäruntersuchungsamt (CVUA) KarlsruheKarlsruheGermany
| | - Firdeus Kadrić
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
| | - Paula T. Kuitunen
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
| | - Hans‐Ulrich Wittchen
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
- Center of Clinical Epidemiology and Longitudinal Studies (CELOS)Technische Universität DresdenDresdenGermany
| | - Jakob Manthey
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
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Do Alcohol Misuse, Service Utilisation, and Demographic Characteristics Differ between UK Veterans and Members of the General Public Attending an NHS General Hospital? J Clin Med 2016; 5:jcm5110095. [PMID: 27827830 PMCID: PMC5126792 DOI: 10.3390/jcm5110095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 11/29/2022] Open
Abstract
The aim of this paper was to provide insights into alcohol misuse within UK veterans to inform as to whether their presentations differ from the general public. This was done by exploring differences in the severity of alcohol misuse between UK veterans and the general public admitted to a general NHS hospital over an 18 month period using retrospective data. All patients admitted to the hospital were screened for alcohol misuse. Those deemed as experiencing problems were referred for specialist nurse-led support. A total of 2331 individuals were referred for this supported and administered with a standardised assessment that included measures of the severity of alcohol difficulties (AUDIT), dependency levels (LDQ), and assessed for the presence of withdrawal symptoms (CIWA-Ar). In addition, information was collected on service utilisation, referral category (medical or mental health), other substance misuse, and demographic characteristics. No differences were found between the severity of reported alcohol difficulties between veterans and non-veterans. Evidence was found to suggest that veterans were more likely to be referred for support with alcohol difficulties at an older age and to be admitted to hospital for longer periods of time. This could have considerable cost implications for the NHS. It was more common for veterans to present at hospital with physical health difficulties prior to being referred for support for alcohol.
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Schäfer J, Bernstein A, Zvielli A, Höfler M, Wittchen HU, Schönfeld S. ATTENTIONAL BIAS TEMPORAL DYNAMICS PREDICT POSTTRAUMATIC STRESS SYMPTOMS: A PROSPECTIVE-LONGITUDINAL STUDY AMONG SOLDIERS. Depress Anxiety 2016; 33:630-9. [PMID: 27175801 DOI: 10.1002/da.22526] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/18/2016] [Accepted: 04/24/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Attentional bias (AB) to threat is thought to play a key role in the development and maintenance of posttraumatic stress symptomatology (PTS). Empirical evidence though is inconsistent. Some studies report associations between AB towards, threat and PTS; other studies report associations between AB away from threat and PTS; yet other studies fail to find any association. We propose that prospective-longitudinal study of AB as a dynamic process, expressed from moment to moment in time, may help to understand these mixed findings and the role of AB in PTS. METHODS We tested cross-sectional and prospective-longitudinal associations between AB and PTS among German soldiers from pre- to post-deployment in Afghanistan (n = 144). AB to threat and positive emotion stimuli (angry/happy faces) was measured using the dot-probe task. PTS was assessed by the PTSD Checklist. The number of traumatic experiences was assessed using CIDI-traumatic experience lists for military. RESULTS We found that AB dynamics (i.e., towards, away, temporal variability) at pre- and post-deployment, with respect to angry and happy faces, predicted higher levels of PTS after deployment as a function of number of intermediate traumatic experiences. Traditional aggregated mean bias scores did not similarly prospectively predict PTS post deployment. CONCLUSIONS Findings indicate that AB to emotionally arousing stimuli may play an important function in the development and maintenance of PTS. We argue that mixed and null findings appear to be due to failure to model the within-subject temporal variability in AB expression. Theoretical, empirical, and clinical implications of these findings are discussed.
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Affiliation(s)
- Judith Schäfer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Amit Bernstein
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Ariel Zvielli
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Michael Höfler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Sabine Schönfeld
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Thandi G, Sundin J, Ng-Knight T, Jones M, Hull L, Jones N, Greenberg N, Rona RJ, Wessely S, Fear NT. Alcohol misuse in the United Kingdom Armed Forces: A longitudinal study. Drug Alcohol Depend 2015; 156:78-83. [PMID: 26409753 DOI: 10.1016/j.drugalcdep.2015.08.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/22/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We assessed changes in Alcohol Use Disorders Identification Test (AUDIT) scores over time. We investigated the impact of life events and changes in mental health status on AUDIT scores over time in UK military personnel. METHODS A random representative sample of regular UK military personnel who had been serving in 2003 were surveyed in 2004-2006 (phase 1) and again in 2007-2009 (phase 2). The impact of changes in symptoms of psychological distress, probable post-traumatic stress disorder (PTSD), marital status, serving status, rank, deployment to Iraq/Afghanistan and smoking was assessed between phases. RESULTS We found a statistically significant but small decrease in AUDIT scores between phases 1 and 2 (mean change=-1.01, 95% confidence interval=-1.14, -0.88). Participants reported a decrease in AUDIT scores if they experienced remission in psychological distress (adjusted mean -2.21, 95% CI -2.58, -1.84) and probable PTSD (adjusted mean -3.59, 95% CI -4.41, -2.78), if they stopped smoking (adjusted mean -1.41, 95% CI -1.83, -0.98) and were in a new relationship (adjusted mean -2.77, 95% CI -3.15, -2.38). On the other hand, reporting new onset or persistent symptoms of probable PTSD (adjusted mean 1.34, 95% CI 0.71, 1.98) or a relationship breakdown (adjusted mean 0.53, 95% CI 0.07, 0.99) at phase 2 were associated with an increase in AUDIT scores. CONCLUSIONS The overall level of hazardous alcohol consumption remains high in the UK military. Changes in AUDIT scores were linked to mental health and life events but not with deployment to Iraq or Afghanistan.
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Affiliation(s)
- Gursimran Thandi
- Academic Department of Military Mental Health, King's College London, London, UK; King's Centre for Military Health Research, King's College London, London, UK.
| | - Josefin Sundin
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Terry Ng-Knight
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Margaret Jones
- King's Centre for Military Health Research, King's College London, London, UK
| | - Lisa Hull
- King's Centre for Military Health Research, King's College London, London, UK
| | - Norman Jones
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Neil Greenberg
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Roberto J Rona
- King's Centre for Military Health Research, King's College London, London, UK
| | - Simon Wessely
- King's Centre for Military Health Research, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, UK
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Hair cortisol concentrations and cortisol stress reactivity predict PTSD symptom increase after trauma exposure during military deployment. Psychoneuroendocrinology 2015; 59:123-33. [PMID: 26072152 DOI: 10.1016/j.psyneuen.2015.05.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/24/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Previous evidence on endocrine risk markers for posttraumatic stress disorder (PTSD) has been inconclusive. Here, we report results of the first prospective study to investigate whether long-term hair cortisol levels and experimentally-induced cortisol stress reactivity are predictive of the development of PTSD symptomatology in response to trauma during military deployment. METHODS Male soldiers were examined before deployment to Afghanistan and at a 12-month post-deployment follow-up using dimensional measures for psychopathological symptoms. The predictive value of baseline (i) hair cortisol concentrations (HCC, N=90) and (ii) salivary cortisol stress reactivity (measured by the Trier Social Stress Test, N=80) for the development of PTSD symptomatology after being exposed to new-onset traumatic events was analyzed. RESULTS Baseline cortisol activity significantly predicted PTSD symptom change from baseline to follow-up upon trauma exposure. Specifically, our results consistently revealed that lower HCC and lower cortisol stress reactivity were predictive of a greater increase in PTSD symptomatology in soldiers who had experienced new-onset traumatic events (explaining 5% and 10.3% of variance, respectively). Longitudinal analyses revealed an increase in HCC from baseline to follow-up and a trend for a negative relationship between HCC changes and the number of new-onset traumatic events. Additional pre-deployment analyses revealed that trauma history was reflected in lower HCC (at trend level) and that HCC were negatively related to stressful load. CONCLUSIONS Our data indicate that attenuated cortisol secretion is a risk marker for subsequent development of PTSD symptomatology upon trauma exposure. Future studies are needed to confirm our findings in other samples.
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