Post-combat invincibility: violent combat experiences are associated with increased risk-taking propensity following deployment

Emergency Department Use Among Combat and Non-Combat Post-9/11 Military Veterans

INTRODUCTION

Most post-9/11 Veterans have completed at least 1 combat deployment-a known factor associated with adverse health outcomes. Such Veterans are known to have unmet health care needs, and the emergency department (ED) may serve as a safety net, yet little is known about whether combat status is associated with more frequent ED use. We sought to evaluate the relationship between combat status and frequency of ED use among post-9/11 Veterans and assess the most common reasons for ED visits.

MATERIALS AND METHODS

This retrospective cohort study consisted of post-9/11 Veterans who enrolled in U.S. Department of Veterans Affairs (VA) care between fiscal years (FYs) 2005 and 2015. Data were obtained from the VA Corporate Data Warehouse. Incidence rates for ED visits for combat and non-combat Veterans were compared from FY 2010 to 2019 using zero-inflated negative binomial regression. The most frequent reasons for ED visits were determined using International Classification of Diseases codes. This study was approved by the Stanford Institutional Review Board.

RESULTS

Among 1.3 million Veterans included in analyses, 70.4% had deployed to a combat zone. The mean (SD) age of our cohort was 32.6 (5.0) years and 83.5% of Veterans were male. After controlling for other factors, combat Veterans had 1.84 times the rate of ED visits compared to non-combat Veterans (95% CI, 1.83-1.85). Only combat Veterans had a mental health-related ED visit (suicidal ideations) among the top 3 reasons for ED presentation.

CONCLUSIONS

Those who deployed to a combat zone had a significantly higher rate of ED use compared to those who did not. Further, mental health-related ED diagnoses appeared to be more prevalent in combat Veterans. These findings highlight the unique health care needs faced by combat Veterans and emphasize the importance of tailored interventions and support services for this specific population.

Ukraine: Meeting the mental health needs of service veterans

The current conflict in Ukraine is a tragedy of epic proportions that without doubt is causing serious psychological damage with inevitable long term consequences affecting combatants, civilians, not to mention displaced refugees. This paper focuses on the mental health needs of service veterans returning home to a country, devastated by the current conflict.

Pre-deployment aggressiveness, combat exposure and moral injury as contributors to posttraumatic stress symptoms among combatants: A two-year prospective study

Combatants who are exposed to events which transgress deeply held moral beliefs might face lasting psychopathological outcomes such as Moral Injury (MI) and posttraumatic stress symptoms (PTSS). However, insight about pre-deployment personality factors which might facilitate the MI process and its negative consequences is sparse. In this prospective study, we examined pre-deployment aggressiveness as a possible predictor of exposure to combat and potentially morally injurious events (PMIEs), trauma-related guilt and shame and PTSS among Israeli active-duty combatants. A sample of 335 active-duty Israeli combatants participated in a 2.5-year prospective study with three waves of measurements (T1: 12 months before enlistment, T2: 6 months following enlistment-pre deployment, and T3: 18 months following enlistment-post deployment). Participants' characteristics were assessed via semi-structured interviews (T1) and validated self-report measures of aggressiveness (T2), combat exposure, PMIEs and PTSS (T3) between 2019 and 2021. Results show that higher levels of pre-deployment aggressiveness predicted both combat exposure and PMIEs-'betrayal'. Combat exposure mediated the association between aggressiveness and PTSS post deployment. Importantly, pre-deployment aggressiveness was significantly associated with the PMIEs-'betrayal' that are associated with trauma-related guilt and shame, which in turn were associated with high levels of PTSS post deployment. Our results highlight the implications of pre-deployment aggressiveness for different forms of exposure to potentially traumatic events during military service. Identification of at-risk combatants for PTSS following exposure to PMIEs of betrayal might provide these combatants with a tailor-made type of preparation regarding moral and ethical situations, which should be investigated in future studies.

PECULIARITIES OF FORMATION OF CADETS' PSYCHOLOGICAL RESILIENCE AND PHYSICAL READINESS FOR COMBAT STRESS

OBJECTIVE

The aim: To investigate the impact of special physical training sessions on the formation of cadets' psychological resilience and physical readiness for the stress factors of future professional and combat activities.

PATIENTS AND METHODS

Materials and methods: The research involved 96 cadets (men) in the 2nd training year of S. P. Koroliov Zhytomyr Military Institute (Ukraine) aged 18-20 years, who were divided into two groups: the experimental (E, n = 47) and the control (C, n = 49). The cadets of the E group studied according to the authors' program, and the C group cadets - according to the existing program. Cadets' psychological resilience was studied using psycho-diagnostic methods aimed at assessing their volitional qualities. Cadets' physical fitness was assessed by the tests of general and special physical training.

RESULTS

Results: It was found that the level of general physical training of the E and the C group cadets was significantly the same (p > 0.05) at the end of the research but in terms of special physical training and psychological readiness, the E group cadets had all indicators significantly (p < 0.05-0.001) better than those of the C group.

CONCLUSION

Conclusions: It has been proved that the special physical training sessions conducted according to the authors' program were more effective than the existing program in forming cadets' physical readiness and psychological resilience for stress factors of future professional and combat activities.

The effect of combat exposure on sexually transmitted diseases

Traumatic exposures can affect beliefs and behaviors related to the spread of sexually transmitted diseases (STDs), a persistent public health problem. I leverage a natural experiment created by variation in US military deployment location assignments to estimate how combat exposure changes a surviving deployed male veteran's probability of acquiring a sexually transmitted disease. I analyze longitudinal data from 1994 to 2008 on 485 deployed veterans with information theoretic methods to reduce the sensitivity of estimates to small samples, an infrequently observed outcome, and highly correlated covariates. For veterans assigned to a combat zone, I estimate combat exposure results in a 5.4 percentage point increase in the probability of acquiring an STD. Additional estimations provide evidence suggesting risky behaviors involving substance use or multiple sexual partners may serve as pathways from combat exposure to STDs. My results are relevant to discussions regarding STD screening and care needs for trauma exposed individuals.

A bidirectional examination of mental health symptoms and perceptions of leader support: Which comes first?

Leader support for psychological health (LSPH) has been identified as an important factor in the prediction of mental health symptoms among warfighters. Although research has examined the relationship between LSPH and mental health symptoms, the extent to which this relationship is bidirectional has been underexplored. Consequently, the present study examined the longitudinal relationships between perceived LSPH and mental health symptoms (depression and PTSD) among military personnel over a 5-month period. We found that perceived LSPH at Time 1 (T1) was associated with fewer mental health symptoms at Time 2 (T2); however, mental health symptoms at T1 were also associated with lower perceptions of LSPH at T2. The results differed slightly based on the type of symptoms experienced, but the relationships between perceived LSPH and symptoms did not vary based on whether soldiers had been exposed to combat. However, it is important to note that the overall sample had low combat experience. Despite this, these findings may suggest that the assumption that leader support can enhance soldier mental health may fail to consider that the symptoms themselves may also affect how leaders are perceived. Therefore, organizations such as the military should consider both directions to optimally understand the relationship between leaders and subordinate mental health.

Combat exposure and behavioral health in U.S. Army Special Forces

Although combat has been found to be associated with adverse health outcomes, little is known about the impact of specific combat exposures, particularly among specialized personnel. This study examined the association of different types of combat exposures with behavioral health outcomes, and whether these associations differed by Army occupational specialization: General Purpose Forces infantrymen (n = 5,361), Ranger Qualified infantrymen (n = 308), and Special Forces personnel (n = 593). Multivariable regression models estimated the association of combat severity, type of combat event (fighting, killing, threat to oneself, death/injury of others), and type of killing with mental health disorders, trouble sleeping, and problem drinking. Combat severity, each type of combat event, and killing noncombatants were associated with adverse health outcomes after adjusting for covariates and other combat exposures. Except for trouble sleeping, these associations did not differ by occupational specialization, though the prevalence and odds of outcomes were generally lower for Special Forces personnel.

Military-to-civilian transition strains and risky behavior among post-9/11 veterans

Many military veterans face significant challenges in civilian reintegration that can lead to troublesome behavior. Drawing on military transition theory (MTT) and using data from a survey of post-9/11 veterans in two metropolitan areas (n = 783), we investigate previously unexamined relationships between post-discharge strains, resentment, depression, and risky behavior, taking into account a set of control variables, including combat exposure. Results indicated that unmet needs at time of discharge and perceived loss of military identity are associated with increased risky behavior. Much of the effects of unmet discharge needs and loss of military identity are mediated by depression and resentment toward civilians. The results of the study are consistent with insights from MTT, providing evidence of specific ways in which transitions can affect behavioral outcomes. Moreover, the findings highlight the importance of helping veterans meet their post-discharge needs and adapt to changing identity, in order to reduce the risk of emotional and behavioral problems.

Pooled analysis of all-cause and cause-specific mortality among Nordic military veterans following international deployment

OBJECTIVES

To investigate all-cause and cause-specific mortality risks, including deaths from external, cardiovascular and cancer causes, among deployed Nordic military veterans in comparison to the general population in each country.

DESIGN

Pooled analysis.

SETTING

Denmark, Norway, Finland and Sweden.

PARTICIPANTS

Military veterans deployed between 1990 and 2010 were followed via nationwide registers and compared with age-sex-calendar-year-specific rates in the general population using pooled standardised mortality ratios (SMRs).

MAIN OUTCOMES

All-cause and cause-specific mortality retrieved from each country's Causes of Death Register, including deaths from external, cardiovascular and cancer causes.

RESULTS

Among 83 584 veterans 1152 deaths occurred of which 343 were from external causes (including 203 suicides and 129 traffic/transport accidents), 134 from cardiovascular causes and 297 from neoplasms. Veterans had a lower risk of death from any cause (pooled SMR 0.58, 95% CI 0.52 to 0.64), external causes (0.71, 95% CI 0.64 to 0.79), suicide (0.77, 95% CI 0.67 to 0.89), cardiovascular causes (0.54, 95% CI 0.46 to 0.64) and neoplasms (0.78, 95% CI 0.70 to 0.88). There was no difference regarding traffic/transport accidents for the whole period (1.10, 95% CI 0.92 to 1.31) but the pooled point estimate was elevated, though not statistically significant, during the first 5 years (1.17, 95% CI 0.89 to 1.53) but not thereafter (1.01, 95% CI 0.77 to 1.34). For all other causes of death, except suicide, statistically significantly lower risk among veterans was observed both during the first 5 years and thereafter. For suicide, no difference was observed beyond 5 years. Judged from the country-specific SMR estimates, there was a high degree of consistency although statistically significant heterogeneity was found for all-cause mortality.

CONCLUSIONS

Nordic military veterans had lower overall and cause-specific mortality than the general population for most outcomes, as expected given the predeployment selection process. Though uncommon, fatal traffic/transport accidents were an exception with no difference between deployed military veterans and the general population.

You are not in the army now! A field study on the impact of a Preparation for Civilian Life program on young soldiers

Recent years have seen the implementation of educational programs aimed at developing future orientation and better employability skills, mostly for people new to or returning to the job market. In a field study, we investigated the impact of a 5-day program on reintegration to civilian life on young Israeli combat soldiers' time preferences, gratitude, patriotism, and perceptions of their combat experience. Questionnaires administered before and after the program revealed a positive effect on future orientation but a negative effect on gratitude and perceptions of the combat experience. Although the positive effect on future orientation is in line with the program design, the negative effects found should be taken into consideration when planning or improving similar educational programs.

Teachers in the Top Management Team and Corporate Social Responsibility

Firms are required to consider all stakeholders’ interests and achieve coordinated development of the company, society, and the environment. Teachers are often associated with high moral standards and dedication to others. Top managers in the top management team (TMT) are responsible as corporate executives for corporate governance and outcomes. How top managers’ teaching experience affects corporate social responsibility (CSR) therefore becomes a meaningful question. Based on A-share listed firms in China from 2010 to 2019, we empirically analyze the effects of teachers as top managers on firm CSR performance. According to our sample, 13.75% of A-share listed firms have top managers with teaching experience in the TMT. We find that the occurrence of teachers in the TMT has a positive impact on CSR, especially on sub-indicators like shareholder responsibility; employee responsibility; supplier, customer, and consumer responsibility; and environmental responsibility. Firms with more teachers in the TMT exhibit higher CSR performance. Further results indicate that this effect is significant only when top managers are also directors on the board. We use the propensity score matching method to alleviate the endogeneity problem and obtain robust results.

The role of inhibitory processes in the relationship between subsyndromal PTSD symptoms and aggressive behaviour

The issue of aggressive behaviours among military populations is important for a number of reasons, including the potential associated occupational, social and functional impacts. Controlled aggressive behaviour is an adaptive requirement of some military roles, however, this aggression can become maladaptive when uncontrolled, or contextually inappropriate. Elevated aggression among deployed veterans has been identified in a number of studies, although the reasons for it are not well understood. Deployed populations have elevated levels of stress and trauma exposure, have higher rates of childhood and other lifetime trauma exposures and have a heightened risk for subsyndromal or full PTSD. Both trauma exposure and PTSD have been found to be associated with executive function deficits, and increased anger and aggressive behaviours. The purpose of this paper was to explore the contribution of both early PTSD symptoms and cognitive disinhibition in predicting increased aggressive behaviour following deployment in a healthy active serving cohort. After controlling for pre-deployment PTSD symptoms and cognitive function, there were significant main effects of both PTSD symptoms and cognitive function on increased aggression at post-deployment. Furthermore, the positive association between PTSD symptoms and post-deployment aggression was moderated by response inhibition deficits in the domains of false positive errors as well as faster reaction times. Subsidiary analyses showed that the effects of increased reaction time in particular increased the likelihood of PTSD symptoms being coupled with increased aggression. These findings highlight the potential effects of repeated occupational stress exposure and point to possible cognitive adaptations and long-term risk for disorder.

Predictors of Incident Severe Acute Respiratory Syndrome Coronavirus 2 Positivity in a Veteran Population

OBJECTIVES

We explored factors related to testing positive for severe acute respiratory coronavirus 2 (SARS-CoV-2) to identify populations most at risk for this airborne pathogen.

METHODS

Data were abstracted from the medical record database of the U.S. Department of Veterans Affairs and from public sources. Veterans testing positive were matched in a 1:4 ratio to those at a similar timepoint and local disease burden who remained negative between March 1, 2020, and December 31, 2020. Multivariable logistic regression was used to calculate odds ratios for the association of each potential risk factor with a positive test result.

RESULTS

A total of 24,843 veterans who tested positive for SARS-CoV-2 were matched with 99,324 controls. Cases and controls were similar in age, sex, ethnicity, and rurality, but cases were more likely to be Black, reside in low-income counties, and suffer from dementia. Multivariable analysis demonstrated highest risk for Black veterans, those with dementia or diabetes, and those living in nursing homes or high-poverty areas. Veterans living in counties likely to be more adherent to public health guidelines were at the lowest risk.

CONCLUSIONS

Our results are similar to those from studies of other populations and add to that work by accounting for several important proxies for risk. In particular, this work has implications for the value of infection control measures at the population level in helping to stem widespread outbreaks of this type.

The Military Injuries: Understanding Post-Traumatic Epilepsy Study: Understanding Relationships among Lifetime Traumatic Brain Injury History, Epilepsy, and Quality of Life

Understanding risk for epilepsy among persons who sustain a mild (mTBI) traumatic brain injury (TBI) is crucial for effective intervention and prevention. However, mTBI is frequently undocumented or poorly documented in health records. Further, health records are non-continuous, such as when persons move through health systems (e.g., from Department of Defense to Veterans Affairs [VA] or between jobs in the civilian sector), making population-based assessments of this relationship challenging. Here, we introduce the MINUTE (Military INjuries-Understanding post-Traumatic Epilepsy) study, which integrates data from the Veterans Health Administration with self-report survey data for post-9/11 veterans (n = 2603) with histories of TBI, epilepsy and controls without a history of TBI or epilepsy. This article describes the MINUTE study design, implementation, hypotheses, and initial results across four groups of interest for neurotrauma: 1) control; 2) epilepsy; 3) TBI; and 4) post-traumatic epilepsy (PTE). Using combined survey and health record data, we test hypotheses examining lifetime history of TBI and the differential impacts of TBI, epilepsy, and PTE on quality of life. The MINUTE study revealed high rates of undocumented lifetime TBIs among veterans with epilepsy who had no evidence of TBI in VA medical records. Further, worse physical functioning and health-related quality of life were found for persons with epilepsy + TBI compared to those with either epilepsy or TBI alone. This effect was not fully explained by TBI severity. These insights provide valuable opportunities to optimize the resilience, delivery of health services, and community reintegration of veterans with TBI and complex comorbidity.

Mortality Among Male U.S. Army Soldiers Within 18 Months of Separation

INTRODUCTION

Understanding how soldiers die after separation from military service, particularly those who die shortly after separating from service, may help to identify opportunities to ease transitions to civilian life.

MATERIALS AND METHODS

Mortality data were analyzed for male U.S. Army soldiers who died within 18 months of their separation from service (from 1999 to 2011). Descriptive statistics were calculated for natural, accidental, suicidal, homicidal, undetermined, and legal/operation of war deaths and were stratified by age, component, time in service, and type of discharge. Crude and age-adjusted mortality rates, standardized for all years using the 2004 Regular Army population, were also calculated. The Public Health Review Board of the U.S. Army Public Health Center approved this study as Public Health Practice.

RESULTS

Of the 1,884,653 male soldiers who separated from service during the study period, 3,819 died within 18 months of separation. A majority of all separations were Reserve or National Guard (58%), and 62% of decedents were in the Reserve or National Guard. Deaths from natural causes (38%) were the most common, followed by accident deaths (34%), suicides (20%), homicides (6%), undetermined deaths (2%), and legal/operation of war deaths (<1%). For overall mortality, age-adjusted rates were higher among the male U.S. population when compared to male soldiers who had separated from the Army.

CONCLUSIONS

The time period immediately following separation from the Army presents a unique challenge for many soldiers. Developing more effective pre-separation prevention programs that target specific risks requires knowing the causes of death for natural deaths, suicides, and accidents. Over half of all deaths occurring shortly after separation from service are preventable. Continued surveillance of specific causes of preventable deaths following separation can improve pre-separation prevention programs and transitions to post-service care.

PTSD and Attitudes Toward Guns Following Interpersonal Trauma

Gun violence is a serious public health concern that is currently grossly understudied. Gun attitudes are a potential risk factor for gun violence; however, factors related to gun attitudes have not been identified. Mental illness such as posttraumatic stress disorder (PTSD) is commonly discussed as a key factor in gun violence, despite research lacking in this area, and it is unknown whether symptoms of PTSD and probable PTSD are associated with more positive attitudes toward guns. The aim of the current study was to investigate the relations between PTSD symptoms and gun attitudes among 265 undergraduate students who experienced at least one interpersonal traumatic event (M_age = 24.69 years, SD = 7.15 years, 75.6% female, 61.1% White). Path analysis revealed that individuals with PTSD symptoms above clinical cutoff were not more likely to have more positive gun attitudes. However, the PTSD symptom clusters evinced distinct relations with gun attitudes. Intrusion and avoidance symptoms were related to gun beliefs regarding protection, with intrusion symptoms being linked to a stronger belief that guns provide protection from crime and victimization (β = .23), whereas avoidance symptoms were inversely associated with this belief (β = -.22). Interestingly, neither trauma related in feelings and thoughts nor arousal and reactivity corresponded with gun attitudes. Certain PTSD symptom clusters may be relevant in understanding gun beliefs, with specific symptoms exhibiting distinct ties to gun attitudes.

Risk and Protective Factors for Difficulty Controlling Violent Behavior in National Guard and Reserve Service Members

Violent behavior is an important problem for military service members and veterans. A representative cohort of U.S. Reserve and National Guard personnel (N = 1,293) were interviewed to assess self-reported problems controlling violent behavior, deployment traumas, posttraumatic stress disorder (PTSD), alcohol abuse, and social support. Poisson regression models were used to estimate the associations of violent behavior with risk and protective factors. Problems controlling violent behavior were uncommon among male (3.3%) and female (1.7%) service members. Adjusted prevalence ratios (aPR) showed associations between violent behavior and deployment traumas (aPR = 1.67, 95% confidence interval [CI] = [1.34, 2.08]), PTSD (aPR = 9.95, 95% CI = [5.09, 19.48]), and PTSD symptom severity (aPR for each additional PTSD symptom = 1.07, 95% CI = [1.06, 1.09]). Social support was associated with lower prevalence of violent behavior (aPR = 0.62, 95% CI = [0.52, 0.76]). The association between violent behavior and alcohol abuse was not statistically significant (aPR = 1.94, 95% CI = [0.92, 4.09]). Results were consistent when the population was restricted to personnel who had deployed to a war zone. Problems controlling violent behavior were less common in this cohort than has been documented in other studies. Associations of violent behavior with risk and protective factors are consistent with prior research.

Military TBI—What civilian primary care providers should know

In June 2019, the Department of Veterans Affairs (VA) launched the VA Mission Act, which expanded veterans’ health-care access to the private sector. Since civilian primary care providers may see more veterans in their practice, it will be important to understand the unique experiences, comorbidities, and culture of this population in order to provide optimal care. Military service members (SMs) are at an increased risk for traumatic brain injury (TBI), and comorbidities, such as post traumatic stress disorder (PTSD), increasing the likelihood of prolonged symptoms. Military training and repetitive low-level blast exposure may cause symptoms similar to TBI or increase long-term negative effects in SMs. Military culture often has a strong influence in this population. Those who serve in the military identify with military values and have a strong team mentality, which places emphasis on the mission above all else, not accepting defeat, and not ever leaving a fellow SM behind. These values can impact the way a SM/veteran seeks care and/or communicates with his or her health-care provider. Taking a detailed history to understand how these factors apply, as well as screening for mental health comorbidities, are recommended. Understanding the military cultural influences can assist in promoting a stronger therapeutic alliance and encourage more open communication. Ultimately, it is the trusting and respectful relationship between the SM/veteran and the provider that will determine the most effective treatment and result in the most effective resolution of TBI and comorbid symptoms.

Risk and protective factors for offending among UK Armed Forces personnel after they leave service: a data linkage study

BACKGROUND

A proportion of ex-military personnel who develop mental health and social problems end up in the Criminal Justice System. A government review called for better understanding of pathways to offending among ex-military personnel to improve services and reduce reoffending. We utilised data linkage with criminal records to examine the patterns of offending among military personnel after they leave service and the associated risk (including mental health and alcohol problems) and socio-economic protective factors.

METHOD

Questionnaire data from a cohort study of 13 856 randomly selected UK military personnel were linked with national criminal records to examine changes in the rates of offending after leaving service.

RESULTS

All types of offending increased after leaving service, with violent offending being the most prevalent. Offending was predicted by mental health and alcohol problems: probable PTSD, symptoms of common mental disorder and aggressive behaviour (verbal, property and threatened or actual physical aggression). Reduced risk of offending was associated with post-service socio-economic factors: absence of debt, stable housing and relationship satisfaction. These factors were associated with a reduced risk of offending in the presence of mental health risk factors.

CONCLUSIONS

Ex-military personnel are more likely to commit violent offences after leaving service than other offence-types. Mental health and alcohol problems are associated with increased risk of post-service offending, and socio-economic stability is associated with reduced risk of offending among military veterans with these problems. Efforts to reduce post-service offending should encompass management of socio-economic risk factors as well as mental health.

The Mediating Role of Alexithymia in the Association Between Adverse Childhood Experiences and Postdeployment Mental Health in Canadian Armed Forces Personnel

Recent studies showing an association between adverse childhood experiences and the development of alexithymia in military personnel have generated interest regarding the role of alexithymia in the pathway linking childhood trauma exposure to mental health disorders. Accordingly, the current study was conducted to (a) examine the associations among adverse childhood experiences, alexithymia, and symptoms of depression and posttraumatic stress disorder (PTSD) among recently deployed Canadian military personnel and (b) assess the mediating role of alexithymia in these associations. Data collected from 2,927 members of the Canadian Armed Forces at baseline and after their return from an overseas deployment were subjected to a prospective path analysis. The results of the path analysis, R² = .35, pointed to a significant direct effect of childhood adversity on postdeployment mental health symptoms. Contrary to our expectations, the results also pointed to a negative indirect effect of childhood neglect, suggesting that childhood neglect contributed to lower levels of postdeployment depression and PTSD symptoms through the dimension of alexithymia related to difficulty in describing feelings. These patterns of associations, for the most part, persisted even when accounting for combat exposure during recent deployments, R² = .42. The present results are discussed in light of study limitations and methodological considerations, and policy and clinical implications are noted.

Deployment Experiences and Suicidal Behaviors Related to Interpersonal Violence Perpetration Among Army National Guard Soldiers

An issue of major policy interest in the U.S. military has been interpersonal violence (IPV), especially relative to the frequent and lengthy deployments of U.S. service members to Iraq and Afghanistan. Lacking, however, are estimates of perpetrators of IPV, in particular, for reservists who have been 30% of the ground combat force. In the present study, Army National Guard soldiers (N = 4,567 in 50 company-sized units) responded to questions about deployment and combat, IPV, and suicidal behaviors. Over a tenth (12.2%) of the soldiers reported having done any aggressive behaviors toward significant others or children during postdeployment. More lengthy and repeated deployments were associated with perpetration of IPV. Having killed or wounded someone and having experienced some form of combat trauma were much more strongly associated with IPV perpetration. Suicidal behaviors were associated with having committed IPV, with the greatest risk associated with suicide attempts. Findings are discussed in terms of underlying mechanisms of both IPV perpetration and suicidal behaviors.

Toward a "Dashboard" Indicator of Retention in U.S. Navy Personnel

INTRODUCTION

Retention is a top priority for the U.S. Navy. However, our understanding of factors influencing retention of Navy personnel is limited. Current research implies that poor mental health, low appraisals of unit cohesion, low leadership satisfaction, and low social support may adversely affect retention. There is a need to understand how these and other factors influence retention in U.S. Navy personnel. We evaluated a broad range of factors influencing job satisfaction and career intentions (proxies of retention) in a large sample of Navy service members.

MATERIALS AND METHODS

Seven hundred and ninety-eight U.S. Navy men and women participated in this study as part of the Naval Unit Behavioral Health Needs Survey (NHRC.2014.0006). Independent variables included personal and unit morale, unit cohesion, affective organizational commitment, social support, behavioral health, sleep, leadership satisfaction, and perceived stress. Dependent variables include job satisfaction and career intentions. Separate multivariate regression models examined the unique and combined associations of independent and demographic variables with each dependent variable, respectively.

RESULTS

Regression models accounted for 48% of variance in job satisfaction and 55% of variance in career intentions, respectively. The most robust predictors of job satisfaction were affective organizational commitment (i.e., one's emotional attachment to, identification with, and involvement in an organization), depressive symptoms, unit cohesion, and perceived stress; primary predictors of career intentions included affective organizational commitment, years of military service, marital status, and race/ethnicity.

CONCLUSION

In this study, we identified diverse predictors of job satisfaction and career intentions of Navy men and women, with overall models accounting for substantial variance in both outcomes. This study informs evidence-based policies, programs, practices, and processes designed to influence job satisfaction, career intentions, and retention in U.S. Navy service members. These study findings also inform the development of a dashboard indicator of retention of U.S. Navy men and women.

PTSD's risky behavior criterion: Associated risky and unhealthy behaviors and psychiatric correlates in a nationally representative sample

Criterion E2 ("reckless or self-destructive behavior") was added to the DSM-5 posttraumatic stress disorder (PTSD) criteria to reflect the established association between PTSD and risky and unhealthy behaviors (RUBs); however, previous research has questioned its clinical significance. To determine whether criterion E2 adequately captures reckless/self-destructive behavior, we examined the prevalence and associations of RUBs (e.g., substance misuse, risky sexual behaviors) with criterion E2 endorsement. Further, we examined associations between criterion E2 and psychiatric conditions (e.g., depressive disorders, anxiety disorders) in a population-based sample of trauma-exposed adults. We analyzed data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 36,309). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 assessed lifetime DSM-5 psychiatric conditions and self-reported RUBs. Among trauma-exposed adults (n = 23,936), multiple logistic regressions examined criterion E2's associations with RUBs and psychiatric conditions. After adjusting for covariates, all RUBs were associated with E2 endorsement (AOR range: 1.58-3.97; most prevalent RUB among those who endorsed E2: greater substance use than intended [57.0 %]) except binge eating, and E2 endorsement was associated with increased odds of PTSD, bipolar disorder, substance use disorders, and schizotypal, borderline, and antisocial personality disorders (AOR range: 1.65-2.75), and decreased odds of major depressive disorder (AOR = 0.76). Results support the clinical significance of criterion E2 through identifying associated RUBs and distinct correlates. These results may inform screening and intervention strategies for at-risk populations.

Mental disorders and medical conditions associated with causing injury or death: A population-based study

The aim of the present study is to examine mental disorders and medical conditions associated with causing harm to another person in the general adult population. The sample (n=22,138) was drawn from a cross-sectional survey designed to characterize mental health needs in France. Twelve-month DSM-IV axis I mental disorders and medical conditions, and lifetime occurrence of potentially traumatic events were assessed with the Composite International Diagnostic Interview-SF Overall, 2% (n=430) of the sample reported having injured or killed someone. Causing harm was associated with male gender, lower education level, and being unemployed. The great majority (85%) of those who caused harm had experienced two or more additional potentially traumatic events. When adjusting for gender, employment status, education and number of events experienced, causing harm was associated with certain anxiety disorders, drug dependence and lifetime suicide attempt but not with major depression or post-traumatic stress disorder. Furthermore, causing harm was not associated with medical conditions in multivariate analyses. These results highlight the need for clinicians to be particularly attentive to the psychological burden that may be experienced by those who have harmed or killed someone.

Driving Outside the Wire: Examining Factors Impacting Veterans' Postdeployment Driving

Combat Veterans (CVs) deployed to Iraq or Afghanistan experience driving difficulty, based on medical conditions and/or deployment exposures, elevating their risk of motor vehicle crash-related injury or death. To address grounded theory rigor and incorporate constructs such as the Person Environment Occupation Performance model, we revised the Hannold et al. (2013) conceptual framework. We conducted two focus groups with seven CVs. Conceptual framework revisions were based on an iterative process and thematic analysis. We elicited CVs' perspectives on deployment training, driving pre- and postdeployment, strategies, and intervention preferences. Personal, environmental, and task factors underpinned CVs' driving. Participants described triggers (e.g., stressful stimuli), use of environmental (e.g., car controls) or personal (e.g., avoiding traffic) strategies, and outcomes of appropriate or risky driving. Findings illustrated CVs' driving difficulty and informed development of a Veteran-centric driving intervention. Improving driving fitness has implications for Veterans' participation and community integration.

Combat exposure, post-traumatic stress symptoms, and health-related behaviors: the role of sleep continuity and duration

STUDY OBJECTIVES

Aggression, substance misuse, and other health risk behaviors are common among combat veterans. We examined whether sleep quality and quantity predict the association between combat exposure, post-traumatic stress symptoms, and adverse health-related behaviors.

METHODS

Soldiers (N = 2420) from a brigade combat team completed surveys assessing combat experiences, and psychological and behavioral health factors, approximately 3 months following deployment to Afghanistan in 2011.

RESULTS

Respondents were 93.5% male; 73% were age 18-29 years old. The response rate was 80% (3076/3832); 94% (2876/3076) of the soldiers who attended the recruitment briefings consented to participate in this research. Complete data were available across the variables used in this study for up to 2420 soldiers. Sleep continuity disturbance accounted for the association of combat exposure with post-traumatic stress symptoms and aggression, alcohol use, and risky behavior. Moreover, for soldiers who reported sleep duration of <6 hr per day, the indirect association of combat exposure and post-traumatic stress on aggression, alcohol use, risky behavior, and opioid use was strongest.

CONCLUSIONS

This study is the first to model sleep problems as a predictor of the association between combat exposure and post-traumatic stress symptoms and frequently reported health-related behavior problems. Sleep disturbance is highly prevalent among Warfighters. While not fully preventable in operational contexts, these problems can be effectively mitigated postdeployment with appropriate policy and intervention resources. Improving the sleep characteristics of combat-exposed soldiers following deployment should reduce subsequent post-traumatic stress and related health compromising behavior, thereby enhancing force readiness.

Trauma, Aggression, and Post Conflict Perpetration of Community Violence in Female Former Child Soldiers-A Study in Eastern DR Congo

OBJECTIVE

Former combatants are exposed to multiple traumatic stressors during conflict situations and usually participate in perpetration of violence. Ongoing perpetration of violence in post conflict areas, linked to mental health problems and appetitive aggression, destabilises peace keeping efforts. The aim of this study is to investigate lifetime exposure to violence and the relationship between this exposure and mental health and current violent behaviour in a sample of female former child soldiers with a history of perpetration of violence in Eastern DR Congo.

METHODS

98 female former child soldiers who had been abducted and forcibly recruited during the M23 insurgency (2012-2014) were assessed for lifetime exposure to trauma including perpetration of violence, clinical outcomes (PTSD and appetitive aggression), and current violent behaviour.

RESULTS

Female former child soldiers had been exposed to extremely high levels of trauma including perpetration of violence and presented with high levels of mental health problems. Linear regression models showed that current violent behaviour was predicted by both PTSD and appetitive aggression.

CONCLUSIONS

Trauma exposure predicts ongoing perpetration of violence post conflict via the resulting mental health problems. The findings imply that if PTSD and appetitive aggression symptoms are successfully treated, ongoing violent behaviour in the community post conflict will also decrease.

Examination of the effects of impulsivity and risk-taking propensity on alcohol use in OEF/OIF/OND Veterans

Introduction

A strong association between posttraumatic stress disorder (PTSD) and problematic alcohol use has been demonstrated among Veteran populations exposed to combat trauma. Several traits, such as higher levels of risk-taking propensity (RTP) and impulsivity (e.g., negative urgency [NU]), are associated with both increased PTSD symptom-atology and greater alcohol use problems.

Methods

The present study examined the effects of NU and RTP on alcohol use (measured by average weekly alcohol consumption and number of binge drinking days in 1 month), as well as their potential moderating effects on the association between PTSD symptom severity and alcohol use in a sample of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) US Veterans. We hypothesized that NU and RTP would both significantly predict alcohol use and moderate the relation between PTSD symptom severity and alcohol use, such that the association between PTSD symptoms and alcohol use would be greater among individuals high compared to low in NU and RTP.

Results

As hypothesized, the main effects of RTP and NU were significantly positively associated with average weekly alcohol consumption and the number of binge drinking days in the past month. However, neither NU nor RTP moderated the relation between PTSD and either alcohol variable.

Discussion

NU and RTP may represent transdiagnostic risk markers for PTSD and alcohol use problems; however, the current study did not support an exploratory role of NU or RTP in the association between PTSD and alcohol use phenotypes.

Prevalence and covariates of problematic gambling among a US military cohort

The availability of and participation in gambling has increased substantially the past several decades, however studies of military members' gambling behaviors are limited. The present study aimed to investigate potential problematic gambling and its association with demographics and behavioral characteristics in a US military cohort. We analyzed cohort data from a telephone survey during 2015-2016 of 1553 Ohio Army National Guard members. We assessed potential problematic gambling by using the 3-item National Opinion Research Center Diagnostic Screen-Loss of Control, Lying, and Preoccupation Screen (NODS-CLiP). Potential correlates examined were demographics, depression, suicidal ideation, smoking status, alcohol use, legal and financial problems, perceived general health status, pain, and impulsivity. Results indicated past-year frequent gambling (at least once per week) and lifetime potential problematic gambling was reported by 13% and 8% of respondents, respectively. Problematic gambling and past-year gambling behaviors were associated in a dose-response relationship from 18% among soldiers gambling once per week to 44% among those gambling 4 or more times per week. Correlates of screening positive for potential problematic gambling included the following: being male, currently unmarried, having left the Guard or retired, minor depression, alcohol dependence, legal problems, and increased pain. Given the higher prevalence of frequent gambling in this military cohort (8%), nearly twice the US prevalence (5%), and the association with negative psychological and behavioral outcomes, routine screening of gambling frequency and problem gambling may be needed to ensure military and veteran populations live the healthiest lives possible.

Cyr K, Sareen J, Elhai JD, Zamorski MA. Comorbidity Patterns of Psychiatric Conditions in Canadian Armed Forces Personnel

OBJECTIVE

Posttraumatic stress disorder (PTSD) is often accompanied by other mental health conditions, including major depressive disorder (MDD), substance misuse disorders, and anxiety disorders. The objective of the current study is to delineate classes of comorbidity and investigate predictors of comorbidity classes amongst a sample of Canadian Armed Forces (CAF) Regular Force personnel.

METHODS

Latent class analyses (LCAs) were applied to cross-sectional data obtained between April and August 2013 from a nationally representative random sample of 6700 CAF Regular Force personnel who deployed to the mission in Afghanistan.

RESULTS

MDD was the most common diagnosis (8.0%), followed by PTSD (5.3%) and generalized anxiety disorder (4.7%). Of those with a mental health condition, LCA revealed 3 classes of comorbidity: a highly comorbid class (8.3%), a depressed-only class (4.6%), and an alcohol use-only class (3.1%). Multinomial logit regression showed that women (adjusted relative risk ratio [ARRR] = 2.77; 95% CI, 2.13 to 3.60; P < 0.01) and personnel reporting higher trauma exposure (ARRR = 4.18; 95% CI, 3.13 to 5.57; P < 0.01) were at increased risk of membership in the comorbid class compared to those without a mental health condition. When compared to those with no mental health condition, experiencing childhood abuse increased the risk of being in any comorbidity class.

CONCLUSIONS

Results provide further evidence to support screening for and treatment of comorbid mental health conditions. The role of sex, childhood abuse, and combat deployment in determining class membership may also prove valuable for clinicians treating military-related mental health conditions.

Moral Injury, Substance Use, and Posttraumatic Stress Disorder Symptoms Among Military Personnel: An Examination of Trait Mindfulness as a Moderator

Mindfulness-based approaches have been suggested as possible methods to treat moral injury in military personnel. However, empirical research has yet to evaluate if mindfulness acts as a protective factor for the possible negative effects of moral injury, such as alcohol use, drug use, or posttraumatic stress disorder (PTSD) symptoms. In this study, we investigated if five facets of mindfulness (i.e., observing, nonjudging, nonreactivity, awareness, and describing) moderated associations between moral injury and the outcomes of PTSD symptoms, alcohol misuse, and drug abuse symptoms in a sample of military personnel. Participants were 244 military personnel (the majority were former military members) who had been deployed at least once during the Iraq War, War in Afghanistan, other wars, or humanitarian missions. The study results indicated that nonjudging, β = -.22, and awareness, β = -.25, had significant attenuating effects on the association between moral injury and drug abuse symptoms. However, observing, β = .17; nonreactivity, β = .23; and describing, β = .15, had significant synergistic effects (i.e., they strengthened the association between moral injury and drug abuse symptoms). There were no significant moderation effects on the associations between moral injury and PTSD symptoms or between moral injury and alcohol misuse. Our results provide initial evidence that not all facets of mindfulness may protect against the challenges of coping with moral injury. Directions for future research and implications for practice are discussed.

Commentary on the Special Issue on Moral Injury: Advances, Gaps in Literature, and Future Directions

We contextualize and provide commentary on articles in the current issue that address the nature, measurement, and consequences of exposure to potentially morally injurious events (PMIEs) and moral injury (MI). PMIEs involve acts of commission or omission of oneself and others and can include perpetration of, and failure to prevent, harm; MI includes "the lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations" (Litz et al., 2009). New and informative research aims to characterize types of PMIEs among military service members and veterans, including in multinational samples. There are also ongoing efforts to devise outcome scales that reliably capture broad MI outcome themes. Further, several new measures of MI assess emotional, cognitive, and behavioral responses of wrong-doing; the nature of distress following PMIEs in civilians, servicemembers, and veterans; and interpersonal consequences in youth. These are promising efforts toward ecologically valid definitions of a potential MI phenotype. Notably, PMIEs may or may not meet DSM PTSD Criterion A, yet early longitudinal data reveal predictive and reciprocal effects of MI and PTSD on one another. Further, a growing literature on MI outcomes beyond PTSD is identifying ways in which MI is linked to alcohol misuse and self-injurious behaviors. The sum of these efforts has led experts to consider the utility and shortcomings of extant PTSD interventions for individuals with MI. We address clinical implications of this emerging research domain, gaps in the literature, and future directions for research.

Internal consistency and factor structure of a brief scale assessing sensitivity to blood, injury, and mutilation

OBJECTIVE

US Army soldiers and military veterans experience high rates of post-traumatic stress disorder (PTSD). However, PTSD risk factors are not fully understood. Sensitivity to blood, injury, and mutilation (SBIM), which includes fear of being injured, seeing another person injured, and exposure to mutilation-relevant stimuli (e.g., blood, wounds) may be a PTSD risk factor that is identifiable prior to trauma exposure. Building on previous research that used a subset of items from the Mutilation Questionnaire (MQ), the aim of this study was to examine the reliability and validity of two brief scales assessing SBIM.

RESULTS

Data from two independent samples of male, US Army soldiers, was utilized to examine a brief 10-item SBIM measure (MQ-SBIM-10) and a shorter version 5-item SBIM measure (MQ-SBIM-5). Internal consistency was indexed by the Kuder-Richardson 20 formula. Construct validity was assessed using confirmatory factor analysis and results obtained from each sample, and from a combined sample. The MQ-SBIM-10 demonstrated acceptable internal consistency and the hypothesized one-factor structure. Although the MQ-SBIM-5 explained a substantial amount of the variance in the 10-item measure and had a one-factor structure, internal consistency of the 5-item measure was poor. Analyses supported the MQ-SBIM-10 as a reliable and cohesive measure of sensitivity to blood, injury, and mutilation.

Traumatic Brain Injury in the General Population: Incidence, Mental Health Comorbidity, and Functional Impact

Traumatic brain injury (TBI) is a relatively prevalent and burdensome condition with significant public health cost; however, epidemiological studies of TBI in the United States have rarely used nationally representative samples or included measures of functioning. Data were obtained from the third wave of the National Epidemiological Survey on Alcohol and Related Conditions. Of the 36,309 individuals surveyed, 193 (0.53% weighted) reported a past-year TBI. Results from weighted logistic regression modeling indicated that prior active duty military status, mood disorders, posttraumatic stress disorder, and nicotine use disorders were associated with greater odds of TBI. Annual household income greater than $20,000 was associated with lower odds of TBI. Regarding functioning, TBI was associated with greater impairment on SF-12 scales measuring mental and physical health and the organization subscale of the Executive Function Index. Results suggest that many individuals in the US population experience TBI each year and that such injuries are associated with impairment across multiple domains.

Offending behaviour, health and wellbeing of military veterans in the criminal justice system

BACKGROUND

A small but significant proportion of military veterans become involved in the criminal justice system (CJS) after leaving service. Liaison and Diversion (L&D) services aim to identify vulnerable offenders in order to provide them with the health/welfare support they need, and (where possible) divert them away from custody. An administrative database of L&D service-users was utilised to compare the needs of veterans with those of non-veteran L&D service-users.

METHOD

National data collected from 29 L&D services in 2015-2016 was utilised. Of the 62,397 cases, 1,067 (2%) reported previous service in the Armed Forces, and 48,578 had no previous service history. The associations between veteran status and socio-demographic characteristics, offending behaviour, health- and mental health-problems were explored. The associations between specific types of offending and mental health problems within the veterans in the sample were also investigated.

RESULTS

Veterans tended to be older, and less likely to be unemployed than non-veterans, but just as likely to have unstable living arrangements (including homelessness). Veteran status was associated with increased levels of interpersonal violence, motoring offences, anxiety disorders and hazardous drinking patterns. Veteran status was associated with decreased levels of acquisitive offending, schizophrenia, ADHD, and substance misuse. Among veterans, the presence of an anxiety disorder (umbrella term which included GAD, Phobias, PTSD etc.) was associated with increased interpersonal violence, alcohol misuse was associated with increased motoring offences, and substance use was associated with increased acquisitive offending.

CONCLUSIONS

Our study indicates that among offenders in the CJS who have been identified as needing health or welfare support, veterans differ from non-veterans in terms of their health and welfare needs and offending behaviour. These differences may be influenced by the impact of military service and the transition into civilian life. Our findings support the identification of military personnel within the CJS to provide appropriate interventions and support to improve outcomes and reduce offending.

Post-deployment family violence among UK military personnel

BACKGROUND

Research into violence among military personnel has not differentiated between stranger- and family-directed violence. While military factors (combat exposure and post-deployment mental health problems) are risk factors for general violence, there has been limited research on their impact on violence within the family environment. This study aims to compare the prevalence of family-directed and stranger-directed violence among a deployed sample of UK military personnel and to explore risk factors associated with both family- and stranger-directed violence.

METHOD

This study utilised data from a large cohort study which collected information by questionnaire from a representative sample of randomly selected deployed UK military personnel (n = 6711).

RESULTS

The prevalence of family violence immediately following return from deployment was 3.6% and 7.8% for stranger violence. Family violence was significantly associated with having left service, while stranger violence was associated with younger age, male gender, being single, having a history of antisocial behaviour as well as having left service. Deployment in a combat role was significantly associated with both family and stranger violence after adjustment for confounders [adjusted odds ratio (aOR) = 1.92 (1.25-2.94), p = 0.003 and aOR = 1.77 (1.31-2.40), p < 0.001, respectively], as was the presence of symptoms of post-traumatic stress disorder, common mental disorders and aggression.

CONCLUSIONS

Exposure to combat and post-deployment mental health problems are risk factors for violence both inside and outside the family environment and should be considered in violence reduction programmes for military personnel. Further research using a validated measurement tool for family violence would improve comparability with other research.

Savouring as a moderator of the combat exposure-mental health symptoms relationship

Engaging in firefights or witnessing death and other types of combat experiences are occupational hazards associated with Post Traumatic Stress Disorder (PTSD) and depression in military personnel returning from combat deployments. The present study examined savouring beliefs as a moderator of the relationship between combat exposure and mental health symptoms among U.S. Army soldiers deployed to Operation Iraqi Freedom and Operation Enduring Freedom. Soldiers (N = 885) completed measures of combat exposure, savouring beliefs, PTSD, and depression. Savouring was negatively related to symptoms of PTSD and depression and moderated the relationship between combat exposure and PTSD and depression among military personnel. These findings demonstrate that savouring positive life experiences may be beneficial to overall positive mental health and potentially buffer negative mental health symptoms related to traumatic experiences. Discussion focuses on the possibility of training individuals exposed to trauma in savouring techniques.

Deployment-related trauma and post-traumatic stress disorder: does gender matter?

Objective: Military research has attempted to identify whether women have an increased vulnerability to mental health issues following deployment-related trauma, but findings have been mixed. Most studies have controlled for childhood abuse, but not other non-deployment trauma (e.g. life-threatening illness), which may partly explain previous mixed results. This study assessed gender differences in the association between deployment-related trauma and post-traumatic stress disorder (PTSD) while controlling for non-deployment trauma. Methods: Data came from the 2013 Canadian Forces Mental Health Survey. Regular or reserve personnel who had been deployed at least once were included in this study (n = 5980). Logistic regression was used to examine the interaction between gender and deployment-related trauma in predicting lifetime PTSD. Results: After controlling for non-deployment trauma, the association of gender with PTSD went from being significant to being marginally significant. The interaction between gender and deployment-related trauma was not significant. Conclusion: Though controlling for non-deployment trauma did not completely dissipate gender differences in PTSD, such differences were greatly reduced, indicating that these may be partly related to traumatic experiences outside deployment. As gender did not moderate the link between deployment-related trauma and PTSD, the findings suggest that trauma experienced while on deployment does not disproportionately affect women compared to their male counterparts.

Exploring Demographics and Health as Predictors of Risk-Taking in UK Help-Seeking Veterans

Risk-taking amongst veterans has severe consequences, yet few studies have examined factors that may predict risk-taking in help-seeking veteran populations. This paper presents a cross-sectional study involving a random sample of 667 UK help-seeking veterans, investigating the role of demographics, mental health and physical health presentations on the propensity for risk-taking. Out of 403 (73.4%) veterans, 350 (86.8%) reported risk-taking in the past month. We found that younger age, being in a relationship, probable PTSD, common mental health difficulties and traumatic brain injury were significantly associated with risk-taking. Additionally, a direct association was found between increased risk-taking and PTSD symptom clusters, including higher hyperarousal, elevated negative alterations in mood and cognition. Our findings provide initial evidence for demographic and mental health presentations as predictors of risk-taking in help-seeking veterans. Further research and longitudinal studies are needed to facilitate valid risk assessments, and early intervention for veteran services.

Medical-encounter mental health diagnoses, non-fatal injury and polypharmacy indicators of risk for accident death in the US Army enlisted soldiers, 2004-2009

Accidents are a leading cause of deaths in U.S. active duty personnel. Understanding accident deaths during wartime could facilitate future operational planning and inform risk prevention efforts. This study expands prior research, identifying health risk factors associated with U.S. Army accident deaths during the Afghanistan and Iraq war. Military records for 2004-2009 enlisted, active duty, Regular Army soldiers were analyzed using logistic regression modeling to identify mental health, injury, and polypharmacy (multiple narcotic and/or psychotropic medications) predictors of accident deaths for current, previously, and never deployed groups. Deployed soldiers with anxiety diagnoses showed higher risk for accident deaths. Over half had anxiety diagnoses prior to being deployed, suggesting anticipatory anxiety or symptom recurrence may contribute to high risk. For previously deployed soldiers, traumatic brain injury (TBI) indicated higher risk. Two-thirds of these soldiers had first TBI medical-encounter while non-deployed, but mild, combat-related TBIs may have been undetected during deployments. Post-Traumatic Stress Disorder (PTSD) predicted higher risk for never deployed soldiers, as did polypharmacy which may relate to reasons for deployment ineligibility. Health risk predictors for Army accident deaths are identified and potential practice and policy implications discussed. Further research could test for replicability and expand models to include unobserved factors or modifiable mechanisms related to high risk. PTSD predicted high risk among those never deployed, suggesting importance of identification, treatment, and prevention of non-combat traumatic events. Finally, risk predictors overlapped with those identified for suicides, suggesting effective intervention might reduce both types of deaths.

Exploring Canadians' and Europeans' Health Care Professionals' Perception of Biological Risks, Patient Safety, and Professionals' Safety Practices

Patient safety has become a worldwide concern in relation to infectious diseases (Ebola/severe acute respiratory syndrome/flu). During the pandemic, different sanitary responses were documented between Europe and North America in terms of vaccination and compliance with infection prevention and control measures. The purpose of this study was to explore the health care professionals' perceptions of biological risks, patient safety, and their practices in European and Canadian health care facilities. A qualitative-descriptive design was used to explore the perceptions of biological risks and patient safety practices among health care professionals in 3 different facilities. Interviews (n = 39) were conducted with health care professionals in Canada and Europe. The thematic analysis pinpointed 3 main themes: risk and infectious disease, patient safety, and occupational health and safety. These themes fit within safety cultures described by participants: individual culture, blame culture, and collaborative culture. The preventive terminology used in the European health care facility focuses on hospital hygiene from the perspective of environmental risk (individual culture). In Canadian health care facilities, the focus was on risk management for infection prevention either from a punitive perspective (blame culture) or from a collaborative perspective (collaborative culture). This intercultural dialogue described the contextual realities on different continents regarding the perceptions of health care professionals about risks and infections.