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Lawson SC, Arif M, Hoopsick RA, Homish DL, Homish GG. Exploring Racial/Ethnic Disparities in Substance Dependence and Serious Psychological Distress among US Veterans. J Racial Ethn Health Disparities 2024; 11:2945-2957. [PMID: 37603224 PMCID: PMC10879463 DOI: 10.1007/s40615-023-01753-9] [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: 01/09/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES There are substantial racial/ethnic disparities in substance use and mental health among civilian populations, but few studies have examined these disparities in veterans using a nationally representative sample. Thus, we examined differences in substance dependence and serious psychological distress (SPD) by race/ethnicity among a national sample of US veterans. METHODS We pooled cross-sectional data from the 2015-2019 waves of the National Survey on Drug Use and Health (N = 7,653 veterans aged 18-64 years). Regression models were utilized to examine racial/ethnic differences in DSM-IV substance dependence and SPD with a Benjamini-Hochberg correction applied. RESULTS Compared to non-Hispanic White veterans: American Indian/Alaska Native veterans had significantly higher odds of past-year alcohol dependence (AOR = 2.55, 95% CI: 1.28, 5.08); Asian American veterans had significantly lower odds of past-year alcohol dependence (AOR = 0.12, 95% CI: 0.02, 0.62); non-Hispanic Black (AOR = 0.60, 95% CI: 0.48, 0.77), Hispanic (AOR = 0.47, 95% CI: 0.34, 0.65), and veterans of more than one race (AOR = 0.55, 95% CI: 0.36, 0.83) had significantly lower odds of past-month nicotine dependence; Asian American veterans had significantly lower odds of past-year illicit drug dependence (AOR = 0.05, 95% CI: 0.01, 0.35); and non-Hispanic Black veterans had significantly lower odds of past-year SPD (AOR = 0.69, 95% CI: 0.55, 0.85) after correction for multiple comparisons. CONCLUSION Overall, racial/ethnic disparities in substance dependence and SPD among veterans are not as stark as in civilian populations, but some disparities remain.
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Affiliation(s)
- Schuyler C Lawson
- Graduate Research Assistant, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Mehreen Arif
- Graduate Research Assistant, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Rachel A Hoopsick
- Assistant Professor, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana-Champaign, Champaign, IL, USA
| | - D Lynn Homish
- Project Director, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Professor and Chair, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Mathes Winnicki BM, Lee DJ, Hawn SE, Livingston NA, Marx BP, Keane TM. Alcohol consumption and dependence risk among male and female Veterans: Trajectories and predictors. Drug Alcohol Depend 2024; 257:111138. [PMID: 38430789 DOI: 10.1016/j.drugalcdep.2024.111138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND With few exceptions, previously conducted research on hazardous drinking among Veterans has employed samples in which the majority of participants identify as male. In addition, past studies have solely focused on alcohol consumption, rather than associated risk for dependence. In this study, we expanded upon the extant literature by investigating sex differences in trajectories and predictors of change in alcohol consumption and dependence risk among post-9/11 Veterans. METHODS A national sample of 1649 Veterans (50.0% female) were recruited in a five-wave longitudinal study that followed Veterans for up to 16 years after deployment. We used growth curve modeling to investigate trajectories of change in alcohol consumption and dependence risk among men and women Veterans. We examined predictors of growth, including demographics, support and resources, psychiatric symptoms, and trauma exposure. RESULTS Among male Veterans, alcohol consumption and dependence risk remained stagnant, which is in contrast to past work using non-Veteran samples. For female Veterans, consumption exhibited initial reductions that decelerated, and dependence risk reduced at a continuous rate. PTSD diagnosis was a significant predictor of individual differences in growth for men. Psychiatric symptoms (i.e., PTSD diagnosis, probable depression diagnosis, suicidal ideation) and psychosocial functioning were significant predictors of decreasing alcohol use for women. CONCLUSIONS Results highlight important sex differences in patterns and predictors of change in alcohol consumption and dependence risk among post-9/11 Veterans. Findings are discussed in relation to screening for hazardous alcohol use and intervention strategies in this at-risk population.
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Affiliation(s)
- Brittany M Mathes Winnicki
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
| | - Daniel J Lee
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States; Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Sage E Hawn
- Department of Psychology, Old Dominion University, Norfolk, VA, United States
| | - Nicholas A Livingston
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States; Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Brian P Marx
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States; Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Terence M Keane
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States; Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
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3
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Campbell-Sills L, Kautz JD, Choi KW, Naifeh JA, Aliaga PA, Jain S, Sun X, Kessler RC, Stein MB, Ursano RJ, Bliese PD. Effects of prior deployments and perceived resilience on anger trajectories of combat-deployed soldiers. Psychol Med 2023; 53:2031-2040. [PMID: 34802475 PMCID: PMC9124235 DOI: 10.1017/s0033291721003779] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Problematic anger is frequently reported by soldiers who have deployed to combat zones. However, evidence is lacking with respect to how anger changes over a deployment cycle, and which factors prospectively influence change in anger among combat-deployed soldiers. METHODS Reports of problematic anger were obtained from 7298 US Army soldiers who deployed to Afghanistan in 2012. A series of mixed-effects growth models estimated linear trajectories of anger over a period of 1-2 months before deployment to 9 months post-deployment, and evaluated the effects of pre-deployment factors (prior deployments and perceived resilience) on average levels and growth of problematic anger. RESULTS A model with random intercepts and slopes provided the best fit, indicating heterogeneity in soldiers' levels and trajectories of anger. First-time deployers reported the lowest anger overall, but the most growth in anger over time. Soldiers with multiple prior deployments displayed the highest anger overall, which remained relatively stable over time. Higher pre-deployment resilience was associated with lower reports of anger, but its protective effect diminished over time. First- and second-time deployers reporting low resilience displayed different anger trajectories (stable v. decreasing, respectively). CONCLUSIONS Change in anger from pre- to post-deployment varies based on pre-deployment factors. The observed differences in anger trajectories suggest that efforts to detect and reduce problematic anger should be tailored for first-time v. repeat deployers. Ongoing screening is needed even for soldiers reporting high resilience before deployment, as the protective effect of pre-deployment resilience on anger erodes over time.
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Affiliation(s)
| | - Jason D. Kautz
- Department of Organizations, Strategy, and International Management, University of Texas at Dallas, Dallas, TX, USA
| | - Karmel W. Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Boston, MA, USA
| | - James A. Naifeh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Pablo A. Aliaga
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Robert J. Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Paul D. Bliese
- Department of Management, Darla Moore School of Business, University of South Carolina, Columbia, SC, USA
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Azil AA, Yusof ZYM, Marhazlinda J. Clustering of Health and Oral Health-Compromising Behaviours in Army Personnel in Central Peninsular Malaysia. Healthcare (Basel) 2023; 11:healthcare11050640. [PMID: 36900645 PMCID: PMC10000684 DOI: 10.3390/healthcare11050640] [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: 01/03/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Health- and oral health-compromising behaviours (HOHCBs) impact the health readiness of military personnel, resulting in decreased fitness performance, thus affecting combat readiness. This study aimed to identify the clustering patterns and number of HOHCBs in army personnel in Central Peninsular Malaysia. Thus, a cross-sectional study using a multistage sampling technique and a validated 42-item online questionnaire was conducted to assess ten health (medical screening, physical activity, sedentary lifestyle, smoking status, alcohol consumption, substance abuse, aggressive behaviours, sleep, and road safety habits) and five oral health behaviour domains (tooth brushing, fluoridated toothpaste use, flossing, dental visits, and bruxism). Each HOHCB was dichotomised into healthy and health-compromising behaviour and analysed using hierarchical agglomerative cluster analysis (HACA). With the majority being males (92.5%), of other ranks (96.8%), and healthy (83.9%), 2435 army members of a mean age of 30.3 years (SD = 5.9) participated, with a response rate of 100%. HACA identified two clustering patterns: (i) 'high-risk behaviours' (30 HOHCBs) and (ii) 'most common risk behaviours' (12 HOHCBs) with a mean clustering number of 14.1 (SD = 4.1). In conclusion, army personnel in Central Peninsular Malaysia displayed 2 broad HOHCB clustering patterns, 'high-risk' and 'most common risk', with an average of 14 HOHCB clusters per person.
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Affiliation(s)
- Ahmad Asyraf Azil
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Dental Services Section, Health Services Division Malaysian Armed Forces, Kuala Lumpur 50634, Malaysia
| | - Zamros Yuzadi Mohd Yusof
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Jamaludin Marhazlinda
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence: ; Tel.: +60-3-79674866
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5
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Griffith J. Combat events and negative emotions associated with postdeployment illicit drug use among Army National Guard soldiers. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2148580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- James Griffith
- National Center for Veterans Studies, University of Utah
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6
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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: 16] [Impact Index Per Article: 5.3] [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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7
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Moradi Y, Dowran B, Sepandi M. The global prevalence of depression, suicide ideation, and attempts in the military forces: a systematic review and Meta-analysis of cross sectional studies. BMC Psychiatry 2021; 21:510. [PMID: 34654386 PMCID: PMC8520236 DOI: 10.1186/s12888-021-03526-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/08/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Given the wide range of depressive disorders, suicidal ideation and suicide attempts in various military studies around the world, determining the exact prevalence of these disorders in line with health planning as well as care and treatment service designing for military forces can be useful. The aim of the present meta-analysis was to determine the pooled prevalence of depressive disorders, suicide thoughts, and attempts in the military. METHODS The present systematic review and meta-analysis study was performed based on PRISMA criteria in 5 steps of the search strategy, screening and selection of articles, data extraction, evaluation of article quality and meta-analysis. International databases (PubMed (Medline), Scopus, Web of science, Embase (Elsevier), PsycInfo (Ovid), Cochrane CENTRAL (Ovid)) were searched using related keywords extracted from Mesh and Emtree. After screening and final selection of articles, data were extracted and qualitative evaluation was performed using the NOS checklist. RESULTS The results of meta-analysis showed that the prevalence of depression in active military forces and veterans was 23% (%95 CI: 20-26%) and 20% (%95 CI: 18-22%), respectively. In addition, the prevalence of suicidal ideation and attempts in the military was 11% (%95 CI: 10-13%) and 11% (%95 CI: 9-13%), respectively. The prevalence of suicide ideation and attempts in drug-using military was 18% (%95 CI: 7-33%) and 30% (%95 CI: 23-36%), respectively. The prevalence of suicidal ideation and attempts in military consuming alcohol were 9% (%95 CI: 4-13%) and 8% (%95 CI: 7-10%), respectively. In militaries with AIDS / HIV, the prevalence of suicide attempts was 5% (%95 CI: 4-8%). CONCLUSION Therefore, it is necessary to develop and design training and intervention programs in order to increase the awareness of the military, especially veterans, to prevent the occurrence of suicide and depression.
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Affiliation(s)
- Yousef Moradi
- grid.411521.20000 0000 9975 294XHealth Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran ,grid.484406.a0000 0004 0417 6812Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Behnaz Dowran
- grid.411521.20000 0000 9975 294XBehavioral Sciences Research Center, Life style institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mojtaba Sepandi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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8
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Hahn CK, Jarnecke AM, Calhoun C, Melkonian A, Flanagan JC, Back SE. Sexual Harassment and Assault During Deployment: Associations with Treatment Outcomes Among Veterans with Co-occurring PTSD and SUD. MILITARY PSYCHOLOGY 2021; 34:12-22. [PMID: 35340543 PMCID: PMC8942369 DOI: 10.1080/08995605.2021.1964901] [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: 03/07/2021] [Accepted: 08/03/2021] [Indexed: 01/03/2023]
Abstract
Sexual trauma is common and increases risk for posttraumatic stress disorder (PTSD), substance use disorders (SUD), and depression among veterans. Limited research has examined the impact of sexual harassment and assault during deployment on treatment outcomes among veterans with co-occurring PTSD and SUD. The current study examined frequency of exposure to sexual harassment and assault during deployment as a predictor of treatment outcomes among a primarily male sample of U.S military veterans diagnosed with current PTSD and SUD. A secondary analysis was performed using data from a randomized clinical trial examining the efficacy of Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) compared to Relapse Prevention (RP). Data from 69 veterans (91.3% male) who were deployed while in the service were analyzed using mixed models to determine whether frequency of exposure to sexual harassment and assault during deployment impacted changes in PTSD symptom severity, percent days using substances, and depressive symptoms during treatment. Over one-third of the sample (36.2%) reported exposure to sexual harassment and/or assault during deployment. Frequency of exposure to sexual harassment and assault during deployment was not a predictor of treatment outcome in any of the models, suggesting a similar response to treatment among those with varying frequency of exposure to sexual harassment and assault during deployment. Veterans with co-occurring PTSD and SUD who have been exposed to sexual harassment and assault during deployment may benefit from integrated trauma-focused treatments and treatments focused on decreasing SUD symptoms.
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Affiliation(s)
- Christine K. Hahn
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amber M. Jarnecke
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Casey Calhoun
- Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alex Melkonian
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Julianne C. Flanagan
- Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Sudie E. Back
- Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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9
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Longitudinal Investigation of Military-specific Factors Associated With Continued Unhealthy Alcohol Use Among a Large US Military Cohort. J Addict Med 2021; 14:e53-e63. [PMID: 31821191 PMCID: PMC7280069 DOI: 10.1097/adm.0000000000000596] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To examine whether military separation (Veteran), service component (active duty, Reserve/National Guard), and combat deployment are prospectively associated with continuing unhealthy alcohol use among US military service members.
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10
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MacMillan T, Corrigan MJ, Coffey K, Tronnier CD, Wang D, Krase K. Exploring Factors Associated with Alcohol and/or Substance Use During the COVID-19 Pandemic. Int J Ment Health Addict 2021; 20:1814-1823. [PMID: 33519318 PMCID: PMC7837073 DOI: 10.1007/s11469-020-00482-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 12/18/2022] Open
Abstract
This study explored the relationship between alcohol and substance use in the general population during the early stages of COVID-19 as related to individual, family, and community stressors. A convenience sample of adults who resided in the USA and Canada was utilized. An online survey was conducted. Over one-third of the sample reported utilizing alcohol and substances as a means to cope during the pandemic. A linear regression revealed that use of social media as a source of information, being personally affected by COVID-19, experiencing child care challenges, and not being associated with a religious community were related to increased likeliness for alcohol and/or substance use. Future research should explore these concepts further within the general population.
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Affiliation(s)
- Thalia MacMillan
- Department Chair, SUNY Empire State College, Saratoga Springs, NY USA
| | | | - Kevin Coffey
- SUNY Empire State College, Saratoga Springs, NY USA
| | | | - Donna Wang
- Springfield College, Springfield, MA USA
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11
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Kolaja CA, Porter B, Powell TM, Rull RP. Multiple imputation validation study: addressing unmeasured survey data in a longitudinal design. BMC Med Res Methodol 2021; 21:5. [PMID: 33407168 PMCID: PMC7789687 DOI: 10.1186/s12874-020-01158-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background Questionnaires used in longitudinal studies may have questions added or removed over time for numerous reasons. Data missing completely at a follow-up survey is a unique issue for longitudinal studies. While such excluded questions lack information at one follow-up survey, they are collected at other follow-up surveys, and covariances observed at other follow-up surveys may allow for the recovery of the missing data. This study utilized data from a large longitudinal cohort study to assess the efficiency and feasibility of using multiple imputation (MI) to recover this type of information. Methods Millennium Cohort Study participants completed the 9-item Patient Health Questionnaire (PHQ) depression module at 2 time points (2004, 2007). The suicidal ideation item in the module was set to missing for the 2007 assessment. Several single-level MI models using different sets of predictors and forms of suicidal ideation were used to compare self-reported values and imputed values for this item in 2007. Additionally, associations with sleep duration and smoking status, which are related constructs, were compared between self-reported and imputed values of suicidal ideation. Results Among 63,028 participants eligible for imputation analysis, 4.05% reported suicidal ideation on the 2007 survey. The imputation models successfully identified suicidal ideation, with a sensitivity ranging between 34 and 66% and a positive predictive value between 36 and 42%. Specificity remained above 96% and negative predictive value above 97% for all imputed models. Similar associations were found for all imputation models on related constructs, though the dichotomous suicidal ideation imputed from the model using only PHQ depression items yielded estimates that were closest with the self-reported associations for all adjusted analyses. Conclusions Although sensitivity and positive predictive value were relatively low, applying MI techniques allowed for inclusion of an otherwise missing variable. Additionally, correlations with related constructs were estimated near self-reported values. Therefore, the other 8 depression items can be used to estimate suicidal ideation that was completely missing from a survey using MI. However, these imputed values should not be used to estimate population prevalence. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-020-01158-w.
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Affiliation(s)
- Claire A Kolaja
- Leidos, Inc, 140 Sylvester Road, San Diego, CA, 92106, USA. .,Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
| | - Ben Porter
- Leidos, Inc, 140 Sylvester Road, San Diego, CA, 92106, USA.,Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
| | - Teresa M Powell
- Leidos, Inc, 140 Sylvester Road, San Diego, CA, 92106, USA.,Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
| | - Rudolph P Rull
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
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12
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Porter B, Bonanno GA, Bliese PD, Phillips CJ, Proctor SP. Combat and Trajectories of Physical Health Functioning in U.S. Service Members. Am J Prev Med 2019; 57:637-644. [PMID: 31564607 DOI: 10.1016/j.amepre.2019.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Previous research has demonstrated that different forms of mental health trajectories can be observed in service members, and that these trajectories are related to combat. However, limited research has examined this phenomenon in relation to physical health. This study aims to determine how combat exposure relates to trajectories of physical health functioning in U.S. service members. METHODS This study included 11,950 Millennium Cohort Study participants who had an index deployment between 2001 and 2005. Self-reported physical health functioning was obtained 5 times between 2001 and 2016 (analyzed in 2017), and latent growth mixture modeling was used to identify longitudinal trajectories from these assessments. Differences in the shape and prevalence of physical health functioning trajectories were investigated in relation to participants' self-reported combat exposure over the index deployment. RESULTS Five physical health functioning trajectories were identified (high-stable, delayed-declining, worsening, improving-worsening, and low-stable). Combat exposure did not influence the shape of trajectories (p=0.12) but did influence trajectory membership. Relative to personnel not exposed to combat, participants reporting combat exposure were more likely to be in the delayed-declining, worsening, and low-stable classes and less likely to be in the high-stable class. However, the high-stable class (i.e., the most optimal class) was the most common trajectory class among not exposed (73.0%) and combat-exposed (64.5%) personnel. CONCLUSIONS Combat exposure during military deployment is associated with poorer physical health functioning trajectories spanning more than a decade of follow-up. However, even when exposed to combat, consistently high physical health functioning is the modal response.
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Affiliation(s)
- Ben Porter
- Leidos, Reston, Virginia.; Department of Defense Center for Deployment Health Research, Naval Health Research Center, San Diego, California.
| | | | - Paul D Bliese
- Darla Moore School of Business, University of South Carolina, Columbia, South Carolina
| | - Christopher J Phillips
- Department of Defense Center for Deployment Health Research, Naval Health Research Center, San Diego, California
| | - Susan P Proctor
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts; Research Service, VA Boston Healthcare System, Boston, Massachusetts
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Longitudinal Examination of the Influence of Individual Posttraumatic Stress Disorder Symptoms and Clusters of Symptoms on the Initiation of Cigarette Smoking. J Addict Med 2019; 12:363-372. [PMID: 29864086 DOI: 10.1097/adm.0000000000000421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether specific individual posttraumatic stress disorder (PTSD) symptoms or symptom clusters predict cigarette smoking initiation. METHODS Longitudinal data from the Millennium Cohort Study were used to estimate the relative risk for smoking initiation associated with PTSD symptoms among 2 groups: (1) all individuals who initially indicated they were nonsmokers (n = 44,968, main sample) and (2) a subset of the main sample who screened positive for PTSD (n = 1622). Participants were military service members who completed triennial comprehensive surveys that included assessments of smoking and PTSD symptoms. Complementary log-log models were fit to estimate the relative risk for subsequent smoking initiation associated with each of the 17 symptoms that comprise the PTSD Checklist and 5 symptom clusters. Models were adjusted for demographics, military factors, comorbid conditions, and other PTSD symptoms or clusters. RESULTS In the main sample, no individual symptoms or clusters predicted smoking initiation. However, in the subset with PTSD, the symptoms "feeling irritable or having angry outbursts" (relative risk [RR] 1.41, 95% confidence interval [CI] 1.13-1.76) and "feeling as though your future will somehow be cut short" (RR 1.19, 95% CI 1.02-1.40) were associated with increased risk for subsequent smoking initiation. CONCLUSIONS Certain PTSD symptoms were associated with higher risk for smoking initiation among current and former service members with PTSD. These results may help identify individuals who might benefit from more intensive smoking prevention efforts included with PTSD treatment.
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Posttraumatic Stress Disorder Symptom Association With Subsequent Risky and Problem Drinking Initiation. J Addict Med 2019; 12:353-362. [PMID: 29870423 DOI: 10.1097/adm.0000000000000420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) and unhealthy alcohol use are commonly associated conditions. It is unknown whether specific symptoms of PTSD are associated with subsequent initiation of unhealthy alcohol use. METHODS Data from the first 3 enrollment panels (n = 151,567) of the longitudinal Millennium Cohort Study of military personnel were analyzed (2001-2012). Complementary log-log models were fit to estimate whether specific PTSD symptoms and symptom clusters were associated with subsequent initiation of 2 domains of unhealthy alcohol use: risky and problem drinking (experience of 1 or more alcohol-related consequences). Models were adjusted for other PTSD symptoms and demographic, service, and health-related characteristics. RESULTS Eligible study populations included those without risky (n = 31,026) and problem drinking (n = 67,087) at baseline. In adjusted analyses, only 1 PTSD symptom-irritability/anger-was associated with subsequent increased initiation of risky drinking (relative risk [RR] 1.05, 95% confidence interval [CI] 1.00-1.09) at least 3 years later. Two symptom clusters (dysphoric arousal [RR 1.17, 95% CI 1.11-1.23] and emotional numbing [RR 1.30, 95% CI 1.22-1.40]) and 5 symptoms (restricted affect [RR 1.13, 95% CI 1.08-1.19], sense of foreshortened future [RR 1.12, 95% CI 1.06-1.18], exaggerated startle response [RR 1.07, 95% CI 1.01-1.13], sleep disturbance [RR 1.11, 95% CI 1.07-1.15], and irritability/anger [RR 1.12, 95% CI 1.07-1.17]) were associated with subsequent initiation of problem drinking. CONCLUSIONS Findings suggest that specific PTSD symptoms and symptom clusters are associated with subsequent initiation of unhealthy alcohol use.
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Derefinko KJ, Hallsell TA, Isaacs MB, Salgado Garcia FI, Colvin LW, Bursac Z, McDevitt-Murphy ME, Murphy JG, Little MA, Talcott GW, Klesges RC. Substance Use and Psychological Distress Before and After the Military to Civilian Transition. Mil Med 2019; 183:e258-e265. [PMID: 29420791 DOI: 10.1093/milmed/usx082] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Those currently serving in the military constitute a vulnerable population given their high-risk status for substance use, and population data suggest that veterans continue to engage in significant substance use long after their military service ends. Recent research suggests that the separation transition from active duty to civilian life may be critical in terms of the future functioning of the veteran. Methods We sought to explore substance use prevalence, as well as potential emotional distress among veterans by retrospectively assessing substance use during active duty and following separation to examine possible changes in use over this period. This study assessed substance use and emotional distress in veterans (N = 80; 90% male) across the military to civilian transition. Findings Repeated measures tests indicated that endorsement of alcohol use, cigarette use, and prescription drug misuse was similar during active duty and post-separation, and marijuana and hard drug use endorsement increased significantly in the 6-mo period post-separation. Further, comorbid use of different substances was common. Active duty levels of anxiety/depression and aggressive feelings were maintained from active duty to post-separation, and feeling alone and military-based trauma symptoms increased significantly. Finally, participants indicated that only a minority of the veterans they knew were doing emotionally well or did not have alcohol/substance use issues. Discussion These findings indicate a clear need for substance use and psychological intervention availability before and after transition to enable veterans to transition to civilian life effectively. Based on the many issues at work during the transition process, programs may do well to focus more specifically on identification of problems and raising awareness, rather than awaiting more severe issues in the future. Validation of the difficulties of the separation transition, veterans' feelings of isolation, and the importance of veteran community support may help newly transitioning veterans find advocates who may help them navigate existing assistance programs.
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Affiliation(s)
- Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | - Troy A Hallsell
- Department of History, The University of Memphis, Memphis, TN 38152-3450
| | - Matthew B Isaacs
- Department of History, The University of Memphis, Memphis, TN 38152-3450
| | - Francisco I Salgado Garcia
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | - Lauren W Colvin
- Research Informatics for the Cancer Center, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | | | - James G Murphy
- Department of Psychology, University of Memphis, 400 Innovation Drive, Memphis, TN 38152
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
| | - Gerald W Talcott
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
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Abstract
Insomnia is commonly reported by military populations, especially those with comorbid mental and physical health conditions. Co-occurring conditions result in an altered presentation of insomnia symptoms, and complicate provision of cognitive-behavioral therapy for insomnia (CBT-I), requiring supplementary assessment or modifications to traditional techniques. CBT-I has consistently demonstrated positive outcomes for active-duty service members and veterans, even in the context of significant comorbidities such as post-traumatic stress disorder, depression, sleep apnea, and chronic pain. Despite its promise, studies of CBT-I in some populations, including women and individuals with substance use disorders, remain relatively understudied in active-duty and veteran populations.
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Griffith J. Relationships of deployment and combat experiences to postdeployment negative health conditions among Army National Guard soldiers. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1565908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- James Griffith
- National Center for Veterans Studies, University of Utah, Salt Lake City, Utah
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18
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Watterson J, Gabbe B, Dietze P, Bowring A, Rosenfeld JV. Comparing short versions of the Alcohol Use Disorders Identification Test (AUDIT) in a military cohort. J ROY ARMY MED CORPS 2018; 165:312-316. [DOI: 10.1136/jramc-2018-001024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 11/03/2022]
Abstract
BackgroundThe Alcohol Use Disorders Identification Test (AUDIT) is widely used for monitoring harmful alcohol consumption among high-risk populations. A number of short versions of AUDIT have been developed for use in time-constrained settings. In military populations, a range of AUDIT variations have been used, but the optimal combination of AUDIT items has not been determined.MethodsA total of 952 participants (80% male), recruited as part of a wider study, completed the AUDIT-10. We systematically assessed all possible combinations of three or four AUDIT items and established AUDIT variations using the following statistics: Cronbach’s alpha (internal consistency), variance explained (R2) and Pearson’s correlation coefficient (concurrent validity).ResultsMedian AUDIT-10 score was 7 for males and 6 for females, and 380 (40%) participants were classified as having a score indicative of harmful or hazardous alcohol use (≥8) according to WHO classifications.A novel four-item AUDIT variation (3, 4, 8 and 9) performed consistently higher than established variations across statistical measures; it explained 85% of variance in AUDIT-10, had a Pearson’s correlation of 0.92 and Cronbach’s alpha was 0.63. The FAST, an established shortened AUDIT variant, together with several other four-item novel variants of AUDIT-10 performed similarly. The AUDIT-C performed consistently low on all measures, but with a satisfactory level of internal consistency (75%).ConclusionShortened AUDIT variations may be suitable alternatives to the full AUDIT for screening hazardous alcohol consumption in military populations. Four-item AUDIT variations focused on short-term risky drinking and its consequences performed better than three item versions.Trial registration numberACTRN12614001332617.
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Miller MB, DiBello AM, Carey KB, Pedersen ER. Blackouts as a Moderator of Young Adult Veteran Response to Personalized Normative Feedback for Heavy Drinking. Alcohol Clin Exp Res 2018; 42:1145-1153. [PMID: 29602274 DOI: 10.1111/acer.13637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Blackouts-or periods of alcohol-induced amnesia for all or part of a drinking event-have been identified as independent predictors of alcohol-related harm that may be used to identify individuals who would benefit from intervention. However, little is known about the prevalence and impact of blackouts among Veterans. This study examined blackouts as a moderator of young adult veteran response to a brief, online personalized normative feedback (PNF) intervention for heavy drinking. METHODS Veterans scoring ≥3/4 (women/men) on the Alcohol Use Disorders Identification Test completed a baseline and 1-month assessment as part of a larger intervention trial (N = 571; 83% male; age M = 28.9, SD = 3.3). Participants were randomized to alcohol PNF (n = 285) or a video game attention control (n = 286). Hierarchical regression was used to examine the interaction between intervention condition and blackouts on alcohol-related outcomes at 1-month follow-up. RESULTS At baseline, 26% of participants reported loss of memory for drinking events in the past 30 days. The interaction between condition and blackouts was significant, such that PNF participants who had experienced blackouts at baseline reported greater decreases in drinking quantity at 1 month than those who had not, and only PNF participants who had experienced baseline blackouts reported a decrease in alcohol problems at follow-up. CONCLUSIONS PNF appears to be particularly effective for individuals who have experienced alcohol-induced blackout, perhaps because blackouts prime them for feedback on their alcohol use. While other negative consequences may also prime individuals for behavior change, blackouts are posited as a particularly useful screening tool because they are prevalent among young adults, have a strong association with alcohol-related harm, and are assessed in widely used clinical measures.
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Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri.,Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Angelo M DiBello
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Kate B Carey
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
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Trone DW, Powell TM, Bauer LM, Seelig AD, Peterson AV, Littman AJ, Williams EC, Maynard CC, Bricker JB, Boyko EJ. Smoking and drinking behaviors of military spouses: Findings from the Millennium Cohort Family Study. Addict Behav 2018; 77:121-130. [PMID: 28992577 DOI: 10.1016/j.addbeh.2017.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 09/12/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The associations between stressful military experiences and tobacco use and alcohol misuse among Service members are well documented. However, little is known about whether stressful military experiences are associated with tobacco use and alcohol misuse among military spouses. METHODS Using 9872 Service member-spouse dyads enrolled in the Millennium Cohort Family Study, we employed logistic regression to estimate the odds of self-reported cigarette smoking, risky drinking, and problem drinking among spouses by Service member deployment status, communication regarding deployment, and stress associated with military-related experiences, while adjusting for demographic, mental health, military experiences, and Service member military characteristics. RESULTS Current cigarette smoking, risky drinking, and problem drinking were reported by 17.2%, 36.3%, and 7.3% of military spouses, respectively. Current deployment was not found to be associated with spousal smoking or drinking behaviors. Communication about deployment experiences with spouses was associated with lower odds of smoking, but not with risky or problem drinking. Spouses bothered by communicated deployment experiences and those who reported feeling very stressed by a combat-related deployment or duty assignment had consistently higher odds of both risky and problem drinking. CONCLUSIONS Our findings suggest that contextual characteristics about the deployment experience, as well as the perceived stress of those experiences, may be more impactful than the simple fact of Service member deployment itself. These results suggest that considering the impact of deployment experiences on military spouses reveals important dimensions of military community adaptation and risk.
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Chauhan VS, Nautiyal S, Garg R, Chauhan KS. To identify predictors of relapse in cases of alcohol dependence syndrome in relation to life events. Ind Psychiatry J 2018; 27:73-79. [PMID: 30416295 PMCID: PMC6198591 DOI: 10.4103/ipj.ipj_27_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Relapse is a complex and dynamic phenomenon that appears to be determined by biological, psychological, and social factors and an interaction among these. This study examined the association between demographic variables, clinical parameters, and psychosocial factors that predict the vulnerability to relapse in cases of alcohol dependence syndrome. MATERIALS AND METHODS Structured assessments of clinical/demographic parameters, relapse precipitants, life events, and dysfunction were carried out among patients with alcohol dependence syndrome (n = 100) who had relapsed and compared with those (n = 100) who had managed to remain abstinent. RESULTS Patients who had relapsed were found to have significantly more positive family history of substance use, past history of alcohol-related comorbidity, experienced a higher number of undesirable life events, and higher negative mood states and social anxiety and dysfunction in social, vocational, personal, family, and cognitive spheres compared to patients who had remained abstinent. CONCLUSIONS Relapse in alcohol dependents is an interaction of many factors, and multiple layers of assessment may be required to predict relapse. This study provided further evidence in support of the importance of certain clinical/psychosocial factors in relapse in substance dependence. It provides the basis for investigating the correlates of relapse in a wide range of behavioral and substance use problems.
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Affiliation(s)
| | | | - Rajat Garg
- Department of Psychiatry, Airforce Hospital, Halwara, Punjab, India
| | - Kirti S Chauhan
- Department of Human Development, University of Jammu, Jammu and Kashmir, India
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Miller MB, DiBello AM, Carey KB, Pedersen ER. Insomnia moderates the association between alcohol use and consequences among young adult veterans. Addict Behav 2017; 75:59-63. [PMID: 28704711 DOI: 10.1016/j.addbeh.2017.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Symptoms of insomnia and heavy alcohol use tend to co-occur among military and veteran samples. The current study examined insomnia as a moderator of the association between alcohol use and related consequences among young adult veterans in an effort to extend and replicate findings observed in samples of civilian young adults. METHOD Young adult veterans (N=622; 83% male; age M=29.0, SD=3.4) reporting alcohol use in the past year completed measures of insomnia severity, alcohol use, and alcohol-related consequences as part of a larger intervention trial. Participants were classified as screening 'positive' (n=383, 62%) or 'negative' (n=239, 38%) for insomnia using the Insomnia Severity Index. Hierarchical regression was used to examine the interaction between drinking quantity and insomnia on alcohol-related consequences. Predictor and outcome variables were measured concurrently. RESULTS Both a greater number of drinks per week and a positive insomnia screen were associated with more alcohol-related consequences. Drinks per week and insomnia screen interacted to predict alcohol-related consequences, such that the effect of drinking on alcohol-related consequences was stronger in the context of a positive versus negative insomnia screen. CONCLUSION Drinking is associated with more alcohol-related consequences in the presence of clinically significant insomnia symptoms. These findings replicate those documented in civilian young adults and indicate that insomnia may be an appropriate target for alcohol prevention and intervention efforts among young adult veterans.
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Seelig AD, Rivera AC, Powell TM, Williams EC, Peterson AV, Littman AJ, Maynard C, Street AE, Bricker JB, Boyko EJ. Patterns of Smoking and Unhealthy Alcohol Use Following Sexual Trauma Among U.S. Service Members. J Trauma Stress 2017; 30:502-511. [PMID: 28906037 DOI: 10.1002/jts.22214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 11/08/2022]
Abstract
In the first known longitudinal study of the topic, we examined whether experiencing sexual assault or sexual harassment while in the military was associated with increased risk for subsequent unhealthy alcohol use and smoking among U.S. service members in the Millennium Cohort Study (2001-2012). Adjusted complementary log-log models were fit to estimate the relative risk of (a) smoking relapse among former smokers (men: n = 4,610; women: n = 1,453); (b) initiation of unhealthy alcohol use (problem drinking and/or drinking over recommended limits) among those with no known history of unhealthy alcohol use (men: n = 8,459; women: n = 4,816); and (c) relapse among those previously reporting unhealthy alcohol use (men: n = 3,487; women: n = 1,318). Men who reported experiencing sexual assault while in the military had sixfold higher risk for smoking relapse: relative risk (RR) = 6.62; 95% confidence interval (CI) [2.34, 18.73], than men who did not. Women who reported experiencing sexual assault while in the military had almost twice the risk for alcohol relapse: RR = 1.73; 95% CI [1.06, 2.83]. There were no other significant associations. These findings suggest that men and women may respond differently following sexual trauma, and support future concerted policy efforts by military leadership to prevent, detect, and intervene on sexual assault.
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Affiliation(s)
- Amber D Seelig
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Anna C Rivera
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Teresa M Powell
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Emily C Williams
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Arthur V Peterson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Alyson J Littman
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Charles Maynard
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Amy E Street
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jonathan B Bricker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
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Miller MB, DiBello AM, Carey KB, Borsari B, Pedersen ER. Insomnia severity as a mediator of the association between mental health symptoms and alcohol use in young adult veterans. Drug Alcohol Depend 2017; 177:221-227. [PMID: 28618286 PMCID: PMC5536856 DOI: 10.1016/j.drugalcdep.2017.03.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/22/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Prior research has documented associations between mental health and alcohol use, mental health and insomnia, and insomnia and alcohol use. This study examined insomnia severity as a mediator of the association between mental health and alcohol-related outcomes in young adult veterans. PROCEDURES Veterans aged 18-34 years (N=622, 83% male) who reported drinking in the past year completed assessments at baseline and one-month follow-up as part of a larger intervention trial. Participants reported symptoms of depression and posttraumatic stress disorder (PTSD) at baseline, insomnia severity at one month, and alcohol use and related consequences at baseline and one month. Mediation analyses using bootstrapped confidence intervals were used to examine the indirect effects of baseline mental health symptoms on alcohol-related outcomes at one month via insomnia severity. MAIN FINDINGS Insomnia severity was associated with both drinking quantity and alcohol-related consequences. Greater depressive (but not PTSD) symptoms were associated directly with more alcohol-related consequences. Neither depressive nor PTSD symptoms had direct effects on drinking quantity when controlling for the other mental health symptoms (e.g., depressive symptoms did not predict drinking quantity when controlling for symptoms of PTSD). However, symptoms of depression and PTSD predicted drinks per week and alcohol-related consequences indirectly through insomnia severity. CONCLUSIONS Symptoms of depression and PTSD increase risk for alcohol use and related consequences in part by increasing symptoms of insomnia. Findings suggest that insomnia may be an appropriate target for prevention and intervention efforts among heavy-drinking Veterans reporting symptoms of depression or PTSD.
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Affiliation(s)
- Mary Beth Miller
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA.
| | - Angelo M. DiBello
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA
| | - Kate B. Carey
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA
| | - Brian Borsari
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA; San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, 505 Parnassus Ave., San Francisco, CA 94143, USA.
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Seelig AD, Jacobson IG, Donoho CJ, Trone DW, Crum-Cianflone NF, Balkin TJ. Sleep and Health Resilience Metrics in a Large Military Cohort. Sleep 2016; 39:1111-20. [PMID: 26951391 PMCID: PMC4835310 DOI: 10.5665/sleep.5766] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 01/20/2016] [Indexed: 12/23/2022] Open
Abstract
STUDY OBJECTIVES Examine the relationship between self-reported sleep parameters and indicators of resilience in a US military population (n = 55,021). METHODS Longitudinal analyses (2001-2008) were conducted using subjective data collected from Millennium Cohort Study questionnaires and objective data from military records that included demographics, military health, and deployment information. Subjective sleep duration and insomnia symptoms were collected on the study questionnaire. Resilience metrics included lost work days, self-rated health, deployment, frequency and duration of health care utilization, and early discharge from the military. Generalized estimating equations and survival analyses were adjusted for demographic, military, behavioral, and health covariates in all models. RESULTS The presence of insomnia symptoms was significantly associated with lower self-rated health, more lost work days, lower odds of deployment, higher odds of early discharge from military service early, and more health care utilization. Those self-reporting < 6 h (short sleepers) or > 8 h (long sleepers) of sleep per night had similar findings, except for the deployment outcome in which those with the shortest sleep were more likely to deploy. CONCLUSIONS Poor sleep is a detriment to service members' health and readiness. Leadership should redouble efforts to emphasize the importance of healthy sleep among military service members, and future research should focus on the efficacy of interventions to promote healthy sleep and resilience in this population. COMMENTARY A commentary on this article appears in this issue on page 963.
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Affiliation(s)
| | | | - Carrie J. Donoho
- Naval Health Research Center, San Diego, CA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | | | - Thomas J. Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD
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Williams EC, Gupta S, Rubinsky AD, Jones-Webb R, Bensley KM, Young JP, Hagedorn H, Gifford E, Harris AHS. Racial/Ethnic Differences in the Prevalence of Clinically Recognized Alcohol Use Disorders Among Patients from the U.S. Veterans Health Administration. Alcohol Clin Exp Res 2016; 40:359-66. [DOI: 10.1111/acer.12950] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Emily C. Williams
- Veterans Health Administration (VA); Denver Seattle Center of Innovation for Veteran-Centered Value-Driven Care; VA Puget Sound Health Services Research & Development; Seattle Washington
- Department of Health Services; University of Washington; Seattle Washington
| | - Shalini Gupta
- VA Substance Use Disorders Quality Enhancement Research Initiative (SUD QUERI); VA Palo Alto Health Care System; Palo Alto California
| | - Anna D. Rubinsky
- VA Substance Use Disorders Quality Enhancement Research Initiative (SUD QUERI); VA Palo Alto Health Care System; Palo Alto California
| | - Rhonda Jones-Webb
- Division of Epidemiology and Community Health; Midwestern Center for Lifelong Learning in Public Health; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Kara M. Bensley
- Veterans Health Administration (VA); Denver Seattle Center of Innovation for Veteran-Centered Value-Driven Care; VA Puget Sound Health Services Research & Development; Seattle Washington
- Department of Health Services; University of Washington; Seattle Washington
| | - Jessica P. Young
- Veterans Health Administration (VA); Denver Seattle Center of Innovation for Veteran-Centered Value-Driven Care; VA Puget Sound Health Services Research & Development; Seattle Washington
| | - Hildi Hagedorn
- Minneapolis VA Health Care System; Minneapolis Minnesota
| | - Elizabeth Gifford
- VA Substance Use Disorders Quality Enhancement Research Initiative (SUD QUERI); VA Palo Alto Health Care System; Palo Alto California
| | - Alex H. S. Harris
- VA Substance Use Disorders Quality Enhancement Research Initiative (SUD QUERI); VA Palo Alto Health Care System; Palo Alto California
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