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Miggantz EL, Prince JR, Walter KH, Jackson E, Ray TN, Hollingsworth JC, Zong ZY, Meza-Lopez R, Gilmore AK, Orchowski LM, Davis KC. Sexual Assault Research in the Military: Is Oversampling Necessary for Representativeness? Mil Med 2024; 189:298-305. [PMID: 39160860 DOI: 10.1093/milmed/usae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Sexual assault in the U.S. Military is a serious concern. Recruiting representative samples of service members to participate in sexual assault research is essential for understanding the scope of the problem and generating data that can inform prevention and intervention efforts. Accordingly, the current study aims to examine response and completion rates of an anonymous survey of sexual assault and alcohol use among active duty sailors aged 18 to 24 with the overarching goal of achieving a representative sample and informing future recruitment efforts. MATERIALS AND METHODS This study was approved by the Institutional Review Board at the Naval Health Research Center. The study involved an anonymous survey of sexual assault and alcohol use among 612 active duty sailors aged 18 to 24. Since 79.6% of Navy service members are men and 20.4% are women, women were oversampled to achieve sufficient representation. Survey invitations were emailed to 12,031 active duty sailors: 64.3% (n = 7,738) men and 35.7% (n = 4,293) women. RESULTS Response rates were disproportionate, with 3.0% (n = 234) of male and 8.8% (n = 377) of female sailors responding to the study invitation. Survey completion rates, however, were similar between male and female sailors (81.2% and 80.1% for male and female personnel, respectively). CONCLUSION Results demonstrated that female sailors were significantly more likely than male sailors to participate in a study of sexual assault and alcohol use. However, once enrolled in the study, male and female sailors completed the 234-item questionnaire at a similar rate. Study findings highlight the challenges of engaging male service members in sexual assault-related research. Despite the disproportionately high representation of men in the military, sexual assault researchers may need to sample according to the overall distribution of gender in the military or perhaps even oversample men to achieve a representative sample.
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Affiliation(s)
- Erin L Miggantz
- Leidos, Inc., 4161 Campus Point Court, San Diego, CA 92121, USA
- Psychological Health and Readiness Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Jessica R Prince
- Department of Psychology, Georgia State University, Atlanta, GA 30302-5010, USA
| | - Kristen H Walter
- Psychological Health and Readiness Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Elaine Jackson
- Department of Psychology, Georgia State University, Atlanta, GA 30302-5010, USA
| | - Travis N Ray
- Leidos, Inc., 4161 Campus Point Court, San Diego, CA 92121, USA
- Psychological Health and Readiness Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Julia C Hollingsworth
- Leidos, Inc., 4161 Campus Point Court, San Diego, CA 92121, USA
- Psychological Health and Readiness Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Zoe Y Zong
- Department of Psychiatry and Behavioral Health, Rhode Island Hospital, Providence, RI 02904, USA
| | - Richard Meza-Lopez
- Department of Psychiatry and Behavioral Health, Rhode Island Hospital, Providence, RI 02904, USA
| | - Amanda K Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA 30302-3995, USA
| | - Lindsay M Orchowski
- Department of Psychiatry and Behavioral Health, Rhode Island Hospital, Providence, RI 02904, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02904, USA
| | - Kelly Cue Davis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, 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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Miggantz EL, Orchowski LM, Beltran JL, Walter KH, Hollingsworth JC, Cue Davis K, Zong ZY, Meza-Lopez R, Hutchins A, Gilmore AK. Alcohol-involved sexual assault in the US military: a scoping review. Eur J Psychotraumatol 2023; 14:2282020. [PMID: 38010375 PMCID: PMC10993808 DOI: 10.1080/20008066.2023.2282020] [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: 06/05/2023] [Accepted: 10/28/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Sexual assault and alcohol use are significant public health concerns, including for the United States (US) military. Although alcohol is a risk factor for military sexual assault (MSA), research on the extent of alcohol-involvement in MSAs has not been synthesised.Objective: Accordingly, this scoping review is a preliminary step in evaluating the existing literature on alcohol-involved MSAs among US service members and veterans, with the goals of quantifying the prevalence of alcohol-involved MSA, examining differences in victim versus perpetrator alcohol consumption, and identifying additional knowledge gaps.Method: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews, articles in this review were written in English, published in 1996 or later, reported statistics regarding alcohol-involved MSA, and included samples of US service members or veterans who experienced MSA during military service.Results: A total of 34 of 2436 articles identified met inclusion criteria. Studies often measured alcohol and drug use together. Rates of reported MSAs that involved the use of alcohol or alcohol/drugs ranged from 14% to 66.1% (M = 36.94%; Mdn = 37%) among servicemen and from 0% to 83% (M = 40.27%; Mdn = 41%) among servicewomen. Alcohol use was frequently reported in MSAs, and there is a dearth of information on critical event-level characteristics of alcohol-involved MSA. Additionally, studies used different definitions and measures of MSA and alcohol use, complicating comparisons across studies.Conclusion: The lack of event-level data, and inconsistencies in definitions, measures, and sexual assault timeframes across articles demonstrates that future research and data collection efforts require more event-level detail and consistent methodology to better understand the intersection of alcohol and MSA, which will ultimately inform MSA prevention and intervention efforts.
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Affiliation(s)
- Erin L. Miggantz
- Leidos, Inc., San Diego, CA, USA
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA, USA
| | - Lindsay M. Orchowski
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jessica L. Beltran
- Leidos, Inc., San Diego, CA, USA
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA, USA
| | - Kristen H. Walter
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA, USA
| | - Julia C. Hollingsworth
- Leidos, Inc., San Diego, CA, USA
- Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, CA, USA
| | - Kelly Cue Davis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Phoenix, AZ, USA
| | - Zoe Y. Zong
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Richard Meza-Lopez
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Anna Hutchins
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Amanda K. Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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Osilla KC, Gore KL, Pedersen ER, Hummer JF, DeYoreo M, Manuel JK, McKay JR, Kim JP, Nameth K. Study protocol for a sequential multiple assignment randomized trial to reduce risky drinking among service members and their partners. Contemp Clin Trials 2023; 133:107324. [PMID: 37652360 PMCID: PMC10591961 DOI: 10.1016/j.cct.2023.107324] [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: 05/08/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Military spouses and partners in relationships with a heavy drinking service member report high levels of mental health concerns and consequences, which are compounded when both partners drink heavily. Military spouses and partners -termed "concerned partners" (CPs)-may be an important gateway for motivating service members (SMs) to seek care. However, CPs may first need to reduce their own drinking and improve their communication to effectively support and encourage changes for their service member partner. Partners Connect is a web-based intervention aimed at improving communication and relationship quality and increasing SM help-seeking. METHODS The current study design is a two-stage Sequential Multiple Assignment Randomized Trial (SMART) to develop an adaptive CP intervention to decrease CP drinking and increase SM help-seeking. CPs aged 18 and older (n = 408) will be recruited via social media and followed for six months. In stage one, we will randomize CPs to either a 4-session web-based intervention (Partners Connect) or to receive communication resources from the Gottman Institute website. The goal is to have CPs invite their SM to complete an online personalized normative feedback (PNF) session. If their SM completes the PNF at stage one, CPs will be considered "responders," if the SM does not complete, CPs who are "non-responders" will be re-randomized during stage two to receive either (1) a CRAFT workbook or (2) phone-based CRAFT if in Partners Connect; or (1) Partners Connect or (2) a CRAFT workbook if in Gottman. DISCUSSION By first intervening with the service member's CP, we aim to better equip them to engage their service member partner in treatment services. In doing so, we develop a model that increases treatment accessibility and appeal among a group that may not otherwise seek care. CLINICALTRIALS gov Identifier: NCT05619185.
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Affiliation(s)
- Karen Chan Osilla
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA.
| | - Kristie L Gore
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202, USA
| | - Eric R Pedersen
- University of Southern California Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, USA
| | - Justin F Hummer
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA 90407-2138, USA
| | - Maria DeYoreo
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA 90407-2138, USA
| | - Jennifer K Manuel
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Ave, San Francisco, CA 94143, USA
| | - James R McKay
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Crescenz VAMC, Philadelphia, PA, USA
| | - Jane P Kim
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Katherine Nameth
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1070 Arastradero Road, Palo Alto, CA 94304, USA
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Tran DD, Davis JP, Tucker JS, Bricker JB, Lee DS, Fitzke RE, Pedersen ER. Cigarette Smoking and Depression Among U.S. Veterans: Longitudinal Associations With Posttraumatic Stress Disorder. Nicotine Tob Res 2023; 25:1496-1504. [PMID: 37094359 PMCID: PMC10347971 DOI: 10.1093/ntr/ntad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 03/09/2023] [Accepted: 04/21/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Cigarette smoking and depression are associated with morbidity and mortality. Among veterans, approximately 22% are current smokers and 11%-15% have been diagnosed with depression. Although prior research suggests a strong association between smoking and depression among veterans, little research has examined trajectories of smoking and depressive symptoms and their correlates over time in this population. AIMS AND METHODS Using parallel process growth curve modeling, we examined the longitudinal relationship between smoking and depression and tested whether posttraumatic stress disorder (PTSD) symptoms predict smoking and depression trajectories over 18 months (February 2020-August 2021). Veterans were recruited for an online, longitudinal study and responded to surveys across five-time points (baseline N = 1230; retention = 79.3%-83.3% across waves). RESULTS Associations indicated that more frequent smoking at baseline was associated with steeper increases in depression symptom severity, and greater depression severity at baseline was associated with a less steep decrease in smoking frequency over time. PTSD was associated with less smoking at time 1 but more frequent smoking at times 3-5 as well as greater depression across all time points. CONCLUSIONS Findings provide support that the growth trajectories of smoking and depression are linked, and PTSD symptoms are associated with these trajectories among veterans. Addressing these factors simultaneously in veteran treatment centers or through tobacco cessation efforts may be beneficial. IMPLICATIONS This study offers strong evidence that the growth trajectories of smoking and depression are linked, and PTSD symptoms affect these trajectories among veterans, who represent a largely understudied population despite high rates of substance use and mental health problems. Results of this study strengthen the case for a more integrated treatment approach in which both smoking and mental health concerns are simultaneously addressed, which may yield more beneficial physical health and clinical outcomes for post-9/11 veterans.
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Affiliation(s)
- Denise D Tran
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CAUSA
| | | | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
- Department of Psychology, University of Washington, Seattle, WA USA
| | - Daniel S Lee
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Reagan E Fitzke
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
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Adler AB, LeardMann CA, Villalobos J, Jacobson IG, Forbes D. Association of Problematic Anger With Long-term Adjustment Following the Military-to-Civilian Transition. JAMA Netw Open 2022; 5:e2223236. [PMID: 35862043 PMCID: PMC9305378 DOI: 10.1001/jamanetworkopen.2022.23236] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/05/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Few studies have examined the role of problematic anger in long-term adjustment of service members transitioning out of the military. Objective To determine the prevalence of problematic anger during the military-to-civilian transition period and the association of problematic anger with adjustment to civilian life. Design, Setting, and Participants This cohort study used 2 waves of survey data administered approximately 5 years apart (time 1 [T1; September 26, 2014, to August 25, 2016] and time 2 [T2; October 23, 2019, to August 31, 2021]) from the Millennium Cohort Study, a population-based military study. Participants were US active-duty service members within 24 months of separating from military service at T1. Statistical analysis was performed from September 2021 to May 2022. Exposures Problematic anger was operationalized as scoring at least 12 points on the 5-item Dimensions of Anger Reactions scale at T1. Main Outcomes and Measures Behavioral and functional health (depression, posttraumatic stress disorder, problem drinking, functional limitations), relationship health (relationship quality, coping with parental demands, social support), and economic health (major financial problems, financial insecurity, homelessness, employment status) were assessed at T2. Covariates, assessed at T1, included demographics, military characteristics, mental health, problem drinking, and physical health. Results Of the 3448 participants, 2625 (76.1%) were male, 217 (6.3%) were Hispanic, 293 (8.5%) were non-Hispanic Black, and 2690 (78.0%) were non-Hispanic White; the mean (SD) age was 40.1 (8.5) years; 826 (24.0%) met criteria for problematic anger. Prevalence of problematic anger was 15.9% (95% CI, 12.2%-19.7%) 24 months prior to military separation and 31.2% (95% CI, 26.2%-36.2%) 24 months following separation. After adjusting for covariates, problematic anger was associated with greater likelihood of behavioral and functional health outcomes (eg, posttraumatic stress disorder: adjusted odds ratio, 1.55, 95% CI, 1.23-1.96), relationship health difficulties (eg, low social support: aOR, 1.66; 95% CI, 1.23-2.24), and economic difficulties (eg, substantial financial insecurity: aOR, 1.64; 95% CI, 1.13-2.39) at T2. Conclusions and Relevance This cohort study found an association between prevalence of problematic anger during the military-to-civilian transition and problematic anger with subsequent adjustment difficulties among US service members. These findings suggest the need to equip service members proactively with skills to identify and manage anger as a way to support them before and during this period of transition.
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Affiliation(s)
- Amy B. Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Cynthia A. LeardMann
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, Inc, San Diego, California
| | - Javier Villalobos
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, Inc, San Diego, California
| | - Isabel G. Jacobson
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Leidos, Inc, San Diego, California
| | - David Forbes
- Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Carlton, VIC, Australia
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Schuler MS, Wong EC, Ramchand R. Military service branch differences in alcohol use, tobacco use, prescription drug misuse, and mental health conditions. Drug Alcohol Depend 2022; 235:109461. [PMID: 35487079 DOI: 10.1016/j.drugalcdep.2022.109461] [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: 04/19/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Rates of substance use and mental health conditions vary across military service branches, yet branches also differ notably in terms of demographics and deployment experiences. This study examines whether branch differences in substance use and mental health outcomes persist after adjustment for a comprehensive set of demographic and deployment-related factors. METHODS Data on 16,699 Armed Forces Active Duty service members were from the 2015 Department of Defense Health Related Behaviors Survey. Service branch-specific prevalences were estimated for self-reports of heavy episodic drinking (HED), possible alcohol use disorder (AUD), current smoking, e-cigarette use, smokeless tobacco use, prescription drug misuse, probable post-traumatic stress disorder (PTSD), probable depression, and probable anxiety. Using logistic regression, we assessed whether branch differences persisted after adjusting for an extensive array of demographic factors (among full sample) and deployment/combat factors (among ever-deployed subgroup). RESULTS HED, AUD, smoking, e-cigarette use, smokeless tobacco use, depression, and anxiety were highest in the Marine Corps; prescription drug misuse and PTSD were highest in the Army. HED, AUD, smoking, smokeless tobacco use, PTSD, depression, and anxiety were lowest in the Air Force; e-cigarette use and prescription drug misuse were lowest in the Coast Guard. Demographics and deployment/combat experiences differed across branches. After adjustment, service members in the Army, Marine Corps and Navy exhibited nearly 2-3 times the odds of multiple mental health conditions and substance use behaviors relative to the Air Force. CONCLUSION Service branch differences were not fully explained by variation in demographics and deployment/combat experiences.
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Affiliation(s)
- Megan S Schuler
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202, USA.
| | - Eunice C Wong
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, USA
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Palmer L, Norton S, Jones M, Rona RJ, Goodwin L, Fear NT. Trajectories of alcohol misuse among the UK Armed Forces over a 12-year period. Addiction 2022; 117:57-67. [PMID: 34288194 PMCID: PMC9292297 DOI: 10.1111/add.15592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/13/2020] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
AIM To identify the main trajectories of alcohol misuse among UK military personnel from 12 years after the start of the Iraq war (2003) and the factors associated with each trajectory. DESIGN Longitudinal cohort study with three phases of data collection (2004-06, 2007-09 and 2014-16). SETTING United Kingdom. PARTICIPANTS Serving and ex-serving personnel of the UK Armed Forces (n = 7111) participating at Phase 1 and at least one follow-up phase of the King's Centre for Military Health Research (KCMHR) cohort study. MEASUREMENTS Trajectories of alcohol misuse were derived from scores using the Alcohol Use Disorders Identification Test (AUDIT-10) over three data collection phases. Demographic and military characteristics were collected and, among the key covariates, post-traumatic stress disorder (PTSD) was measured using the PTSD checklist (PCL-C) and childhood interpersonal stress and violence was measured using items from the Adverse Childhood Experiences questionnaire. FINDINGS Five trajectories of alcohol misuse were identified, including 'no misuse' (n = 2249, 31.6%) and 'hazardous' (n = 3398, 47.8%), 'harmful' (n = 832, 11.7%), 'severe-to-hazardous' (n = 258, 5.3%) and 'severe' (n = 374, 3.6%) drinking. Substantial changes were evident only among severe drinkers, where more than half reduced over the study period. The factors most strongly associated with belonging to harmful/severe drinking classes were young age, male gender and childhood adversities and antisocial behaviour. Severe drinkers at Phase 1 were more likely to report probable PTSD and shorter military careers and were less likely to serve as Officers. Persistent severe drinkers were less likely to serve in the RAF compared to the Army and were more likely to be reserves. Not misusing alcohol was also associated with reserve status and having left service. CONCLUSIONS In a cohort of approximately 7000 UK military personnel, trajectories of alcohol misuse appeared stable between 2004 and 2016. More than half of severe drinkers made substantial improvements over the period, but 68% of the cohort continued to drink hazardously or harmfully. Lack of change for the majority of the sample signals the need for strategies to address alcohol misuse and its cultural and psychosocial drivers.
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Affiliation(s)
- Laura Palmer
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Sam Norton
- Centre for Rheumatic Diseases and Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Margaret Jones
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Roberto J. Rona
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Laura Goodwin
- Department of PsychologyUniversity of LiverpoolEleanor Rathbone Building LiverpoolUK,Liverpool Centre for Alcohol ResearchLiverpool Health PartnersLiverpoolUK
| | - Nicola T. Fear
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK,Academic Department of Military Mental HealthInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
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Belding JN, Castañeda SF, Jacobson IG, LeardMann CA, Porter B, Powell TM, Kolaja CA, Seelig AD, Matsuno RK, Carey FR, Rivera AC, Trone DW, Sheppard B, Walstrom J, Boyko EJ, Rull RP, For The Millennium Cohort Study Team. The Millennium Cohort Study: The First 20 Years of Research Dedicated to Understanding the Long-Term Health of US Service Members and Veterans. Ann Epidemiol 2021; 67:61-72. [PMID: 34906635 DOI: 10.1016/j.annepidem.2021.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/22/2023]
Abstract
The Millennium Cohort Study, the US Department of Defense's largest and longest running study, was conceived in 1999 to investigate the effects of military service on service member health and well-being by prospectively following active duty, Reserve, and National Guard personnel from all branches during and following military service. In commemoration of the Study's 20th anniversary, this paper provides a summary of its methods, key findings, and future directions. Recruitment and enrollment of the first 5 panels occurred between 2001 and 2021. After completing a baseline survey, participants are requested to complete follow-up surveys every 3 to 5 years. Study research projects are categorized into 3 core portfolio areas (psychological health, physical health, and health-related behaviors) and several cross-cutting areas and have culminated in more than 120 publications to date. For example, some key Study findings include that specific military service-related factors (e.g., experiencing combat, serving in certain occupational subgroups) were associated with adverse health-related outcomes and that unhealthy behaviors and mental health issues may increase following the transition from military service to veteran status. The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts.
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Key Words
- Abbreviations
- Army STARRS, Army Study to Assess Risk and Resilience in Servicemembers
- DoD, Department of Defense
- Millennium Cohort Study, military, veterans, deployment, risk factors, protective factors, physical health, mental health, health-related behaviors, longitudinal cohort
- OEF, Operation Enduring Freedom
- OIF, Operation Iraqi Freedom
- OND, Operation New Dawn
- PTSD, posttraumatic stress disorder
- VA, Department of Veterans Affairs
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Affiliation(s)
- Jennifer N Belding
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Sheila F Castañeda
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Isabel G Jacobson
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Cynthia A LeardMann
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Ben Porter
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA; Mississippi State University, Mississippi State, Mississippi, USA
| | - Teresa M Powell
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Claire A Kolaja
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Amber D Seelig
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rayna K Matsuno
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Felicia R Carey
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Anna C Rivera
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Daniel W Trone
- Naval Health Research Center, San Diego, California, USA
| | - Beverly Sheppard
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Jennifer Walstrom
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Edward J Boyko
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rudolph P Rull
- Naval Health Research Center, San Diego, California, USA.
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10
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Sampson L, Cohen GH, Fink DS, Conroy C, Calabrese JR, Wryobeck JM, Elhai JD, King AP, Liberzon I, Galea S. Cohort profile: the Ohio Army National Guard Mental Health Initiative (OHARNG-MHI). Soc Psychiatry Psychiatr Epidemiol 2021; 56:2107-2116. [PMID: 34480595 PMCID: PMC8577754 DOI: 10.1007/s00127-021-02166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Rates of mental disorders in the United States military have increased in recent years. National Guard members may be particularly at risk for mental disorders, given their dual role as citizen-soldiers and their increased involvement in combat deployments during recent conflicts. The Ohio Army National Guard Mental Health Initiative (OHARNG-MHI) was launched to assess the prevalence, incidence, and potential causes and consequences of mental disorders in this unique population. METHODS OHARNG-MHI is a decade-long dynamic cohort study that followed over 3,000 National Guard members yearly through structured telephone interviews. RESULTS Findings thus far have applied a pre-, peri-, post-deployment framework, identifying factors throughout the life course associated with mental disorders, including childhood events and more recent events, both during and outside of deployment. An estimated 61% of participants had at least one mental disorder in their lifetime, the majority of which initiated prior to military service. Psychiatric comorbidity was common, as were alcohol use and stressful events. Latent class growth analyses revealed four distinct trajectory paths of both posttraumatic stress and depression symptoms across four years. Only 37% of soldiers with probable past-year mental disorders accessed mental health services in the subsequent year, with substance use disorders least likely to be treated. CONCLUSION Strengths of this study include a large number of follow-up interviews, detailed data on both military and non-military experiences, and a clinical assessment subsample that assessed the validity of the telephone screening instruments. Findings, methods, and procedures of the study are discussed, and collaborations are welcome.
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Affiliation(s)
- Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Gregory H. Cohen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, U.S.A
| | - David S. Fink
- New York State Psychiatric Institute, New York, NY, U.S.A
| | - Carla Conroy
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, U.S.A
| | - Joseph R. Calabrese
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, U.S.A
| | - John M. Wryobeck
- Department of Psychiatry, University of Toledo, Toledo, OH, U.S.A
| | - Jon D. Elhai
- Department of Psychology, University of Toledo, Toledo, OH, U.S.A
| | - Anthony P. King
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, U.S.A
| | - Israel Liberzon
- Department of Psychiatry, College of Medicine, Texas A&M, College Station, TX, U.S.A
| | - Sandro Galea
- Office of the Dean, Boston University School of Public Health, Boston, MA, U.S.A
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11
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Adams RE, Boscarino JA, Hoffman SN, Urosevich TG, Kirchner HL, Boscarino JJ, Dugan RJ, Withey CA, Figley CR. Psychological well-being and alcohol misuse among community-based veterans: results from the Veterans' Health Study. J Addict Dis 2021; 40:217-226. [PMID: 34521314 DOI: 10.1080/10550887.2021.1972747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Maladaptive drinking is an increasing concern among military policy makers and healthcare providers. The goal of this study was to assess how social and psychological factors relate to alcohol problems among post-deployed US veterans and how problematic drinking is associated with well-being. METHODS Data were collected via a telephone survey from a random sample of veterans receiving their healthcare from a large non-VA hospital system in central Pennsylvania (N = 1730). Interviewers inquired about participants' current alcohol consumption, using the CAGE and AUDIT-C scales, and health-related outcomes (general psychological distress, major depression, and self-reported health status). Analyses included demographic, military and nonmilitary stressful events, use of alcohol or drugs to cope post-deployment, use of psychiatric services, and personality characteristics as independent variables. Our sample was 95% male, 96% White, and had a mean age of 59 years old (SD = 12 years). RESULTS Analyses included demographic, military and nonmilitary stressful events, use of alcohol or drugs to cope post-deployment, use of psychiatric services, and personality characteristics as independent variables. Our sample was 95% male, 96% White, and had a mean age of 59 years old (SD = 12 years). Analyses for our drinking measures show that those who used drugs or alcohol to cope post-deployment were more likely to be problematic drinkers, while positive personality characteristics such as agreeableness and conscientiousness were related to fewer drinking problems. Multivariate logistic regressions for our well-being measures found that alcohol misuse was not related to distress or depression, but that a positive score on the AUDIT-C was associated with a lower likelihood of poor self-rated health. Using alcohol or drugs to cope was related to higher distress. DISCUSSION We conclude that service providers might consider using post-deployment AUDIT-C and the drugs and alcohol coping questions when screening for possible alcohol and mental health problems among veterans.
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Affiliation(s)
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA
| | - Stuart N Hoffman
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA
| | - Thomas G Urosevich
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA
| | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA
| | | | - Ryan J Dugan
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA
| | - Carrie A Withey
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA
| | - Charles R Figley
- Tulane Traumatology Institute, Tulane University, New Orleans, LA
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