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Jannace KC, Pompeii L, de Porras DGR, Perkison WB, Yamal JM, Trone DW, Rull RP. Risk of Traumatic Brain Injury in Deployment and Nondeployment Settings Among Members of the Millennium Cohort Study. J Head Trauma Rehabil 2024:00001199-990000000-00164. [PMID: 39019486 DOI: 10.1097/htr.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
OBJECTIVE To describe and quantify the prevalence and risk of deployment and nondeployment service-related traumatic brain injury (TBI) among participants of the Millennium Cohort Study. SETTING Survey data. PARTICIPANTS 28 759 Millennium Cohort Study participants who were active duty, Reserves, or National Guard at the time of the survey. DESIGN Cross-sectional secondary data analysis. MAIN MEASURES Estimates of prevalence and rates of TBI were calculated. Multivariable Poisson regression estimated rate ratios of TBI overall and stratified by deployment and nondeployment settings. RESULTS The rate of TBI over the 362 535 person-years (PY) was 2.95 p/100 PY. the nondeployment rate was 2.15 p/100 PY, with a significantly higher rate (11.38 p/100 PY) in deployment settings. Bullets/blasts were the most common TBI mechanisms in deployed settings, while sports/physical training and military training were common in nondeployed settings. CONCLUSIONS The risk of TBI as well as its mechanism varies by deployment and nondeployment, suggesting that targeted prevention strategies are needed to reduce the risk for TBI among military personnel based on their deployment status.
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Affiliation(s)
- Kalyn C Jannace
- Author Affiliations: Southwest Center for Occupational and Environmental Health, UTHealth School of Public Health, West Houston, Texas (Drs Jannace, Pompeii, and Perkison); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland (Dr Jannace); The Center for Rehabilitation Sciences Research, Uniformed Services University for the Health Sciences, Bethesda, Maryland (Dr Jannace); Institute for Stroke and Cerebrovascular Disease, UTHealth School of Public Health, Houston, Texas (Dr Yamal); and Deployment Health Research Department, Naval Health Research Center, San Diego, California (Drs Trone and Rull) Department of Environmental and Occupational Health, UT School of Public Health San Antonio, UT Health San Antonio, San Antonio, TX, USA( Drs Gimeno Ruiz de Porras)
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Wang T, Tang H, Li X, Wu L, Li N, Zhang W, Shao Q, Cai M, Shang L. Development and preliminary evaluation of the Comprehensive Health Self-Assessment Questionnaire (CHSAQ) for individuals in the Chinese People Liberation Army. BMC Public Health 2024; 24:610. [PMID: 38408976 PMCID: PMC10895798 DOI: 10.1186/s12889-024-18085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE There is currently no widely accepted multidimensional health assessment questionnaire for individuals in the Chinese People Liberation Army (PLA). This study developed a multidimensional health survey questionnaire (Comprehensive Health Self-Assessment Questionnaire, CHSAQ) suitable for personnel in the PLA and conducted a preliminary examination of its reliability, validity, and discriminative ability. METHODS After 183 items from 32 dimensions were selected to form the initial version of the CHSAQ, three groups of soldiers were selected from May 2022 to April 2023 and completed three survey rounds (with 183, 131, and 55 valid items). The items were screened based on classic test theory. After screening, the final questionnaire entries were formed, the structure of the questionnaire was explored through exploratory factor analysis and confirmatory factor analysis, and its reliability, structural validity, and discriminative ability were evaluated. RESULTS The final questionnaire consisted of 8 dimensions and 55 items on job satisfaction, anxiety and depression, daily activities, physical function, the otolaryngology system, the integumentary system, sleep disorders, and the visual system. The total cumulative variance contribution rate was 64.648% according to exploratory factor analysis. According to the confirmatory factor analysis, the normed fit index (NFI) was 0.880, and the comparison fit index (CFI) was 0.893 (close to 0.90). The Cronbach's α coefficient of the total questionnaire was 0.970, the split half reliability coefficient was 0.937, and the retest reliability coefficient was 0.902. The results are presented as different pairwise comparisons. CONCLUSION Our study developed a self-report questionnaire for evaluating the comprehensive health status of personnel in the PLA in accordance with the standard procedure for questionnaire development. Our findings also showed that the CHSAQ for individuals in the PLA has good reliability and structural validity.
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Affiliation(s)
- Tao Wang
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
- The Medical Department, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Han Tang
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Xinrui Li
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Lin Wu
- Department of Military Medical Psychology, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ning Li
- Department of Psychiatry, Xijing Hospital, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Wei Zhang
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
| | - Qiongjie Shao
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China
- Department of Thoracic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Min Cai
- Department of Psychiatry, Xijing Hospital, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China.
| | - Lei Shang
- Department of Health Statistics, School of Public Health, the Fourth Military Medical University, 710032, Xi'an, Shaanxi, China.
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Jannace KC, Pompeii L, Gimeno Ruiz de Porras D, Perkison WB, Yamal JM, Trone DW, Rull RP. Occupation and Risk of Traumatic Brain Injury in the Millennium Cohort Study. Mil Med 2023; 188:e3057-e3065. [PMID: 35253039 PMCID: PMC9418381 DOI: 10.1093/milmed/usac035] [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: 10/12/2021] [Revised: 12/21/2021] [Accepted: 02/01/2022] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is an occupational health hazard of military service. Few studies have examined differences in military occupational categories (MOC) which take into consideration the physical demands and job requirements across occupational groups. METHODS This study was approved by the University of Texas Health Science Center at Houston Institutional Review Board. Data for this cross-sectional study were obtained from the Naval Health Research Center's Millennium Cohort Study, an ongoing DoD study. Univariate analyses were employed to calculate frequencies and proportions for all variables. Bivariate analyses included unadjusted odds ratios (OR) and 95% CI for the association between all variables and TBI. Multivariable logistic regression was used to calculate adjusted ORs and 95% CIs to assess the association between MOC and TBI, adjusted for potential confounders: sex, race/ethnicity, rank, military status, branch of service, before-service TBI, and panel. Logistic regression models estimated odds of TBI for each MOC, and stratified models estimated odds separately for enlisted and officer MOCs. RESULTS Approximately 27% of all participants reported experiencing a service-related TBI. All MOCs were statistically significantly associated with increased odds of service-related TBI, with a range of 16 to 45%, except for "Health Care" MOCs (OR: 1.01, 95% CI 0.91-1.13). Service members in "Infantry/Tactical Operations" had the highest odds (OR: 1.45, 95% CI 1.31-1.61) of service-related TBI as compared to "Administration & Executives." Among enlisted service members, approximately 28% reported experiencing a service-related TBI. Among enlisted-specific MOCs, the odds of TBI were elevated for those serving in "Infantry, Gun Crews, Seamanship (OR: 1.79, 95% CI 1.58-2.02)," followed by "Electrical/Mechanical Equipment Repairers (OR: 1.23, 95% CI 1.09-1.38)," "Service & Supply Handlers (OR 1.21, 95% CI 1.08-1.37)," "Other Technical & Allied Specialists (OR 1.21, 95% CI 1.02-1.43)," "Health Care Specialists (OR 1.19, 95% CI 1.04-1.36)," and "Communications & Intelligence (OR: 1.16, 95% CI 1.02-1.31)," compared to "Functional Support & Administration." Among officer service members, approximately 24% reported experiencing a service-related TBI. After adjustment the odds of TBI were found to be significant for those serving as "Health Care Officers" (OR: 0.65, 95% CI: 0.52-0.80) and "Intelligence Officers" (OR: 1.27, 95% CI: 1.01-1.61). CONCLUSIONS A strength of this analysis is the breakdown of MOC associations with TBI stratified by enlisted and officer ranks, which has been previously unreported. Given the significantly increased odds of service-related TBI reporting within enlisted ranks, further exploration into the location (deployed versus non-deployed) and mechanism (e.g., blast, training, sports, etc.) for these injuries is needed. Understanding injury patterns within these military occupations is necessary to increase TBI identification, treatment, and foremost, prevention.Results highlight the importance of examining specific occupational categories rather than relying on gross categorizations, which do not account for shared knowledge, skills, and abilities within occupations. The quantification of risk among enlisted MOCs suggests a need for further research into the causes of TBI.
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Affiliation(s)
- Kalyn C Jannace
- Southwest Center for Occupational and Environmental Health, UTHealth School of Public Health, West Houston, TX 77030, USA
- The Center for Rehabilitation Sciences Research, Uniformed Services University for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- The Center for Rehabilitation Sciences Research, Uniformed Services University for the Health Sciences, Bethesda, MD 20814, USA
| | - Lisa Pompeii
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health, UTHealth School of Public Health, West Houston, TX 77030, USA
| | - William Brett Perkison
- Southwest Center for Occupational and Environmental Health, UTHealth School of Public Health, West Houston, TX 77030, USA
| | - Jose-Miguel Yamal
- Institute for Stroke and Cerebrovascular Disease, UTHealth School of Public Health, Houston, TX 77030, USA
| | - Daniel W Trone
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA 92152, USA
| | - Rudolph P Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA 92152, USA
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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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Cigarette smoking patterns among U.S. military service members before and after separation from the military. PLoS One 2021; 16:e0257539. [PMID: 34606513 PMCID: PMC8489722 DOI: 10.1371/journal.pone.0257539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/03/2021] [Indexed: 11/28/2022] Open
Abstract
U.S. military Service members have consistently smoked more than the general population and the prevalence of smoking is even higher among U.S. veterans. Our study examined cigarette smoking patterns among Service members before and after military separation to better understand the disproportionate rate of smoking among veterans. Data from the Millennium Cohort Study were used. All study participants were in the military at baseline and some transitioned from the military to civilian life during the observation period. We investigated any impact of military separation on smoking, as well as other potential risk factors for smoking. Overall, we observed higher smoking prevalence among veterans than Service members. Additionally, we found that Service members smoked more while approaching their separation from the military. Longitudinal analysis revealed military separation was not a risk factor for smoking, as we had hypothesized. Baseline smoking was the most influential predictor of current smoking status. Other significant factors included alcohol consumption, life stressors, and mental health conditions, among others. Military separation was not a risk factor for smoking. However, Service members in the process of transitioning out of the military, as well as high alcohol consumers and Service members with mental health conditions, may be at higher risk of smoking. Including smoking prevention/cessation programs in pre-separation counseling sessions and developing smoking screening and cessation programs targeting specific high-risk subgroups may reduce smoking among Service members and veterans.
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Judkins JL, Smith K, Moore BA, Morissette SB. Alcohol use disorder in active duty service members: Incidence rates over a 19-year period. Subst Abus 2021; 43:294-300. [PMID: 34214408 DOI: 10.1080/08897077.2021.1941512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Alcohol use is a concerning issue for the military given its potential negative impact on human performance. Limited data are available regarding the incidence of alcohol use disorder in the military, which is critical to understand to evaluate force readiness, as well as for preventative initiatives and treatment planning. The aim was to examine the alcohol use disorder incidence rates (overall and across demographics) among active duty service members from 2001 to 2018. Methods: Data on 208,870 active duty service members between 2001 and 2018 from the Defense Medical Epidemiology Database was examined. Incidence rates were analyzed to determine the diagnostic rates of AUD (including both alcohol abuse and dependence), which were then examined by sex, age, service branch, military pay grade, marital status, and race. Results: Incidence rates of AUD in active duty service members (per 1,000 service members) ranged from 6.45 to 10.50 for alcohol abuse and 5.21 to 7.11 for alcohol dependence. Initial diagnoses of new-onset AUD occurred most frequently within 20-24 year-old, white, male, and non-married U.S. Army service members in the enlisted pay grades of E-1 to E-4. Statistically significant differences (p <.001) were found between observed and expected counts across all examined demographic variables. Conclusions: To our knowledge, this is the first study to provide a comprehensive examination of AUD incidence rates in an active-duty military population over an extended 18-year period and during the last decade. Incidence rates were higher than expected for alcohol dependence and lower than expected for alcohol abuse. Given the untoward effects of AUD on overall health and force readiness, active-duty service members may benefit from more advanced preventative interventions to decrease incidence rates of AUD over time. Future research should use these data to develop targeted interventions for the demographics at greatest risk.
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Affiliation(s)
- Jason L Judkins
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Kendra Smith
- College of Liberal and Fine Arts, University of Texas, San Antonio, TX, USA
| | - Brain A Moore
- Psychological Sciences, Kennesaw State University, Kennesaw, GA, USA
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Corry NH, Williams CS, Radakrishnan S, McMaster HS, Sparks AC, Briggs-King E, Karon SS, Stander VA. Demographic Variation in Military Life Stress and Perceived Support Among Military Spouses. Mil Med 2021; 186:214-221. [PMID: 33499525 DOI: 10.1093/milmed/usaa386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Military spouses play a critical role in supporting military service members, and thus, their experiences may have a significant impact on the well-being, readiness, and resilience of the U.S. Armed Forces. Research suggests that military spouses experience unique stressors as a result of military life, but few studies have assessed demographic factors associated with their experiences of military life and perceived support. MATERIALS AND METHODS Using data from the Millennium Cohort Family Study, a nationwide survey of 9,872 married spouses of service members with 2 to 5 years of military service, this study examined differences in experiences of military life and perceived support across multiple understudied subgroups of military spouses. Key outcomes included military-related stressors (e.g., deployment-related experiences), perceived social support, and perceived military efforts to provide support. RESULTS Military life stress and perceived support differed across military spouse, service member, and family characteristics. Results indicated that spouses who are older than age 35 or are married to enlisted service members in the Army, Navy, or Marines are more likely to experience heightened military stress or less perceived social support. Dual-military couples reported experiencing less stress associated with military life and perceiving more social support and support from the military, compared with spouses who have never served in the military. CONCLUSION These findings may help guide effective channeling of resources and outreach to potentially vulnerable military families.
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Affiliation(s)
- Nida H Corry
- Division of Health and Environment, Abt Associates, Rockville, MD 20852, USA
| | | | | | - Hope S McMaster
- Military and Veteran's Health Operation, Leidos, Reston, VA 20190, USA.,Deployment Health, Naval Health Research Center, San Diego, CA 92106, USA
| | - Alicia C Sparks
- Division of Health and Environment, Abt Associates, Rockville, MD 20852, USA
| | | | - Samantha S Karon
- Division of Health and Environment, Abt Associates, Rockville, MD 20852, USA
| | - Valerie A Stander
- Deployment Health, Naval Health Research Center, San Diego, CA 92106, USA
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Greig F, McManus S, Fear NT. Dementia in veterans and non-veterans in England: a cross-sectional survey. Occup Med (Lond) 2021; 71:34-40. [PMID: 33410882 DOI: 10.1093/occmed/kqaa213] [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: 01/02/2023] Open
Abstract
BACKGROUND Concerns have been raised that military veterans are at greater risk of dementia due to increased rates of depression, post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) found in this population. The prevalence of dementia in English veterans and whether this is different to non-veterans, however, are currently unknown. AIMS To study the risk of dementia in the English veteran population, we aimed to calculate the prevalence of dementia in a group of veterans and compare this with a similar group, with no history of military service. METHODS Male veterans and non-veterans aged over 64 years old were identified from the 2007 Adult Psychiatric Morbidity Survey, a national survey of community-dwelling adults in England. This survey was conducted via face-to-face interviews and incorporated questions on previous military service. Dementia was screened by using the modified Telephone Interview of Cognitive Status (TICS-M). RESULTS A total of 496 male veterans and 294 non-veterans were identified. TICS-M scores indicated possible dementia in 24% of veterans and 26% non-veterans; after adjusting for age, the odds of possible dementia was significantly lower in veterans than non-veterans (adjusted OR 0.56; 95% CI 0.38-0.84, P < 0.01). CONCLUSIONS English male veterans were less likely to have dementia than similar male non-veterans. This study did not find any evidence to support the view that dementia is more common in veterans than non-veterans.
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Affiliation(s)
- F Greig
- South London and Maudsley NHS Foundation Trust, London, UK.,Older Adults Liaison Service, Croydon University Hospital, Croydon, UK
| | - S McManus
- National Centre for Social Research, London, UK.,Violence and Society Centre, School of Health Sciences, City University, London, UK
| | - N T Fear
- King's Centre for Military Health Research and Academic Department for Military Mental Health, King's College London, Weston Education Centre, London, UK
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Longitudinal Examination of the Influence of Individual Posttraumatic Stress Disorder Symptoms and Clusters of Symptoms on the Initiation of Cigarette Smoking. J Addict Med 2019; 12:363-372. [PMID: 29864086 DOI: 10.1097/adm.0000000000000421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether specific individual posttraumatic stress disorder (PTSD) symptoms or symptom clusters predict cigarette smoking initiation. METHODS Longitudinal data from the Millennium Cohort Study were used to estimate the relative risk for smoking initiation associated with PTSD symptoms among 2 groups: (1) all individuals who initially indicated they were nonsmokers (n = 44,968, main sample) and (2) a subset of the main sample who screened positive for PTSD (n = 1622). Participants were military service members who completed triennial comprehensive surveys that included assessments of smoking and PTSD symptoms. Complementary log-log models were fit to estimate the relative risk for subsequent smoking initiation associated with each of the 17 symptoms that comprise the PTSD Checklist and 5 symptom clusters. Models were adjusted for demographics, military factors, comorbid conditions, and other PTSD symptoms or clusters. RESULTS In the main sample, no individual symptoms or clusters predicted smoking initiation. However, in the subset with PTSD, the symptoms "feeling irritable or having angry outbursts" (relative risk [RR] 1.41, 95% confidence interval [CI] 1.13-1.76) and "feeling as though your future will somehow be cut short" (RR 1.19, 95% CI 1.02-1.40) were associated with increased risk for subsequent smoking initiation. CONCLUSIONS Certain PTSD symptoms were associated with higher risk for smoking initiation among current and former service members with PTSD. These results may help identify individuals who might benefit from more intensive smoking prevention efforts included with PTSD treatment.
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Fridman J, Barrett LF, Wormwood JB, Quigley KS. Applying the Theory of Constructed Emotion to Police Decision Making. Front Psychol 2019; 10:1946. [PMID: 31572250 PMCID: PMC6749088 DOI: 10.3389/fpsyg.2019.01946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022] Open
Abstract
Law enforcement personnel commonly make decisions in stressful circumstances, where the costs associated with errors are high and sometimes fatal. In this paper, we apply a powerful theoretical approach, the theory of constructed emotion (TCE), to understand decision making under evocative circumstances. This theory posits that the primary purpose of a brain is to predictively regulate physiological resources to coordinate the body's motor activity and learning in the short term, and to meet the body's needs for growth, survival, and reproduction in the long term. This process of managing the brain and body's energy needs, called allostasis, is based on the premise that a brain anticipates bodily needs and attempts to meet those needs before they arise (e.g., vestibular activity that raises sympathetic nervous system activity before standing), because this is more efficient than responding to energetic needs after the fact. In this view, all mental events-cognition, emotion, perception, and action-are shaped by allostasis, and thus all decision making is embodied, predictive, and concerned with balancing energy needs. We also posit a key role for the autonomic nervous system (ANS) in regulating short-term energy expenditures, such that the ANS influences experience and behavior under stressful circumstances, including police decision making. In this paper, we first explain the core features of the TCE, and then offer insights for understanding police decision making in complex, real-world situations. In so doing, we describe how the TCE can be used to guide future studies of realistic decision making in occupations in which people commonly make decisions in evocative situations or under time pressure, such as in law enforcement.
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Affiliation(s)
- Joseph Fridman
- Department of Psychology, Northeastern University, Boston, MA, United States
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Jolie B. Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, United States
| | - Karen S. Quigley
- Department of Psychology, Northeastern University, Boston, MA, United States
- Edith Nourse Rogers Memorial Veterans Hospital, Center for Healthcare Organization and Implementation Research, Bedford, MA, United States
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McMaster HS, Stander VA, Williams CS, Woodall KA, O'Malley CA, Bauer LM, Davila EP. Engaging military couples in marital research: does requesting referrals from service members to recruit their spouses introduce sample bias? BMC Med Res Methodol 2018; 18:114. [PMID: 30355317 PMCID: PMC6201494 DOI: 10.1186/s12874-018-0575-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 10/15/2018] [Indexed: 11/30/2022] Open
Abstract
Background While enrolling dyads in research studies is not uncommon, there is limited literature on the utility of different recruitment strategies and the resulting selection biases. This paper examined two recruitment strategies used to enroll military couples in a longitudinal study, assessing the impact of both strategies on the representativeness of the final study sample. Method Descriptive and bivariate analyses were conducted to 1) identify characteristics associated with spouse referral, 2) compare response rates based on recruitment strategy and assess whether recruitment strategy modified correlates of response propensity among spouses, and 3) assess whether referred spouse characteristics differed from non-referred spouses in the final sample. The study sample consisted of married US service members with 2–5 years of military service as of October 2011 and their spouses. Results Service members who referred their spouses to participate in the Millennium Cohort Family Study were more likely to be male, have children, serve in the Army, and have combat deployment experience than those who did not refer their spouse. Nearly two-thirds (n = 5331, 64.9%) of referred spouses participated in the Family Study, compared with less than one-third (n = 3458, 29.5%) of directly contacted spouses. Spouse characteristics also differed significantly between recruitment groups. Conclusions Overall results suggest that minimal bias was introduced by using a referral recruitment methodology. Service members appeared to be more likely to refer their spouses if they perceived the research topic as relevant to their spouse, such that male service members with combat deployment experience were more likely to refer female spouses caring for multiple children. Referred spouses were significantly more likely to respond to the Millennium Cohort Family Study survey than those who were directly contacted; however, the overall success rate of using a referral strategy was less than recruiting spouses through direct contact. Differences between referred spouses and spouses contacted directly mirrored service member referring characteristics.
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Affiliation(s)
- Hope Seib McMaster
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD, 20817, USA.
| | - Valerie A Stander
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
| | - Christianna S Williams
- Abt Associates, Inc., Central Park West, Suite 210, 5001 South Miami Boulevard, Durham, NC, 27703, USA
| | - Kelly A Woodall
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD, 20817, USA
| | | | - Lauren M Bauer
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD, 20817, USA
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Bøg M, Filges T, Jørgensen AMK. Deployment of personnel to military operations: impact on mental health and social functioning. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-127. [PMID: 37131363 PMCID: PMC8427986 DOI: 10.4073/csr.2018.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This Campbell systematic review examines the effects of deployment on mental health. The review summarizes evidence from 185 studies. All studies used observational data to quantify the effect of deployment. This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment). Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. Plain language summary Deployment to military operations negatively affects the mental health functioning of deployed military personnel: While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel.What is this review about?: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health.The primary condition under consideration is deployment to an international military operation. Deployment to a military operation is not a uniform condition; rather, it covers a range of scenarios. Military deployment is defined as performing military service in an operation at a location outside the home country for a limited time period, pursuant to orders.The review included studies that reported outcomes for individuals who had been deployed. This review looked at the effect of deployment on mental health outcomes. The mental health outcomes are: post-traumatic stress disorder (PTSD), major depressive disorder (MDD), common mental disorders (depression, anxiety and somatisation disorders) and substance-related disorders.By identifying the major effects of deployment on mental health and quantifying these effects, the review can inform policy development on deployment and military activity as well as post-deployment support for veterans. In this way the review enables decision-makers to prioritise key areas.What are the main findings of this review?: What studies are included?: This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment).Does deployment have an effect on mental health?: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive.What do the findings of this review mean?: The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long-lasting.Overall the risk of bias in the majority of included studies was high. While it is difficult to imagine a randomised study design to understand how deployment affects mental health, other matters such as changes to personnel policy, or unanticipated shocks to the demand for military personnel, could potentially be a rich source of quasi-experimental variation.How up-to-date is this review?: The review authors searched for studies up to 2017. This Campbell systematic review was published in March 2018. Executive summary BACKGROUND: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health. Research suggests that the increased risk to mental health is mainly due to the hazards of war, combat exposure: firing weapons, road side bombs, seeing fellow soldiers, friends, civilians, and enemies being injured, maimed or killed. These experiences may lead to severe mental stress. The adverse impact on mental health is the psychological cost of war, and it is of interest to policymakers to learn the magnitude of these effects. This review sets out to synthesise available evidence about the consequences of deployment for deployed military personnel in the mental health and social functioning domains.OBJECTIVES: The objective of this review isto synthesise the consequences of deployment to military operation on the mental health and social functioning of deployed military personnel.SEARCH METHODS: We searched electronic databases, grey literature, and references from primary studies and related reviews. No language or date restrictions were applied to the searches. We searched the following electronic databases: Academic Search Elite, Cochrane Library, EMBASE, ERIC, MEDLINE, PsycINFO, Science Citation Index, Social Science Citation Index, SocINDEX, as well as the Nordic platforms: bibliotek.dk, BIBSYS, and LIBRIS. The conclusions of this review are based on the most recent searches performed. The last search was performed in April 2017.SELECTION CRITERIA: Primary studies had to meet the following inclusion criteria: Participants: The participants should be military personnel.Intervention: The condition should be deployment to a military operation.Comparison: The relevant comparisons were either comparing a) deployed military personnel to non-deployed military personnel, b) deployed military personnel to military personnel deployed elsewhere, for example personnel deployed to non-combat operations, c) military personnel deployed to the same operation but stratified by combat exposure.Outcomes: The study should report on one or more mental health outcomes, and/or social functioning for the deployed participants. In particular studies should report on one or more of the following mental health outcomes: PTSD, major depression, substance abuse or dependence (including alcohol), and common mental disorders (depression and anxiety disorders). The following social functioning outcomes were relevant: employment, and homelessness.Study Designs: Both experimental and quasi-experimental designs with a comparison group were eligible for inclusion in the review. Studies were excluded if they: Reported on deployments taking place before 1989.Used a within group pre-post study design.Did not report on at least one of the mental health or social functioning outcomes. DATA COLLECTION AND ANALYSIS: The total number of potentially relevant studies constituted31,049records. A total of 185 studies met the inclusion criteria and were critically appraised by the review authors. The final selection of 185 studies was from 13 different countries.Forty eight of the 185 studies did not report effect estimates or provide data that would allow the calculation of an effect size and standard error. Fifty four studies were excluded because of overlapping samples. The majority of those studies were from USA but the main reason for not using studies from USA in the synthesis was lack of information to calculate an effect size. Nearly half the studies from the UK could not be used in the synthesis due to overlap of data samples. Forty three studies were judged to have a very high risk of bias (5 on the scale) and, in accordance with the protocol, we excluded these from the data synthesis on the basis that they would be more likely to mislead than inform., Thus a total of 40 studies, from five different countries, were included in the data synthesis.Random effects models were used to pool data across the studies. We used the odds ratio. Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were calculated. The meta-analyses were carried out by time since exposure (short, medium, long, and other time since exposure) and by type of comparison (deployed versus non-deployed, all deployed but stratified by either combat operations versus non-combat operations, or stratified by combat exposure). We performed single factor subgroup analysis. The assessment of any difference between subgroups was based on 95% confidence intervals. Funnel plots were used to assess the possibility of publication bias. Sensitivity analysis was used to evaluate whether the pooled effect sizes were robust across components of methodological quality.MAIN RESULTS: The findings were mixed, depending on the outcome, the time since exposure and the approach (deployed versus non-deployed termed absolute or stratified by extent of combat termed relative) used to investigate the effect. It was not possible to analyse the outcomes homelessness and employment. All studies that could be used in the data synthesis reported on the impact of deployment on mental health; PTSD, depression, substance use or common mental disorder.For assessments taken less than 24 months since exposure the evidence was inconclusive either because too few studies reported results in the short and medium term and/or the degree of heterogeneity between studies was large.For assessments taken at other time points (a variable number of months since exposure) the evidence was inconclusive for the relative comparisons due to either too few studies or a substantial degree of heterogeneity between studies. For the absolute comparison the analysis of common mental disorder was inconclusive, whereas the average effects of PTSD and depression were positive and statistically significant (PTSD odds ratio (OR) was 1.91 (95% confidence interval (CI): 1.28 to 2.85) and OR=1.98 (95% CI: 1.05 to 3.70) for depression). The analysis concerning substance use indicated that deployed participants did not have higher odds of screening positive for substance use compared to non-deployed participants (OR=1.15 (95% CI: 0.98 to 1.36)).For assessments taken more than 24 months post exposure, meta-analyses indicated that the odds of screening positive for PTSD, depression, substance use and common mental disorder were higher for participants in the deployed group compared to participants in the group that were not deployed (PTSD OR=3.31 (95% CI: 2.69 to 4.07), OR=2.19 (95% CI: 1.58 to 3.03) for depression, OR=1.27 (95% CI: 1.15 to 1.39) for substance use, and OR=1.64 (95% CI: 1.38 to 1.96) for common mental disorder). Likewise, participants reporting high combat exposure had higher odds of screening positive for PTSD and depression than participants reporting lower exposure for long term assessments (PTSD OR=3.05 (95% CI: 1.94 to 4.80) and OR=1.81 (95% CI: 1.28 to 2.56) for depression). The analyses of substance use and common mental disorder were inconclusive due to too few studies.On the basis of the prevalence of mental health problems in pre-deployed or non-deployed population based comparison sampleswe would therefore expect the long term prevalence of PTSD in post-deployed samples to be in the range 6.1 - 14.9%, the long term prevalence of depression to be in the range from 7.6% to 18%, the long term prevalence of substance use to be in the range from 2.4% to 17.5% and the prevalence of common mental disorder to be in the range from 10% to 23%.Sensitivity analyses resulted in no appreciable change in effect size, suggesting that the results are robust.It was only possible to assess the impact of two types of personnel characteristics (branch of service and duty/enlistment status) on the mental health outcomes. We found no evidence to suggest that the effect of deployment on any outcomes differ between these two types of personnel characteristics.AUTHORS' CONCLUSIONS: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. We focused on the effect of deployment on PTSD (post-traumatic stress disorder), depression, substance abuse/dependence, and common mental disorders (depression and anxiety disorders). For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all domains, particularly on PTSD. There is increased political awareness of the need to address post deployment mental health problems. The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long lasting. Mental illness is of particular concern in the military for operational reasons, but they may be hard to detect in the military setting because a military career is intimately linked with mental and physical strength.It was not possible to examine a number of factors which we had reason to expect would impact on the magnitude of the effect. This would have been particularly relevant from a policy perspective because these are direct parameters that one could use to optimally "organize" deployment in order to minimize impacts on mental health functioning.While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel. The next step is to begin to examine preventive measures and policies for organizing deployment, in order to minimize the effects on mental health.
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Schneiderman AI, Dougherty DD, Fonseca VP, Wolters CL, Bossarte RM, Arjomandi M. Diagnosing Chronic Obstructive Pulmonary Disease Among Afghanistan and Iraq Veterans: Veterans Affair's Concordance With Clinical Guidelines for Spirometry Administration. Mil Med 2018; 182:e1993-e2000. [PMID: 28885968 DOI: 10.7205/milmed-d-16-00332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Early diagnosis and treatment of chronic obstructive pulmonary disease (COPD) can slow disease progression. The Department of Veterans Affairs (VA)/Department of Defense Clinical Practice Guidelines (CPG), established to improve patient outcomes, recommend the use of spirometry in the COPD diagnostic process. The aims of this study were to assess VA health care providers' performance related to CPG-recommended spirometry administration in the evaluation of newly diagnosed COPD among veterans, determine the patient characteristics that may influence the adherence rate, and compare VA concordance rates to those of other health plans. METHODS Administrative health care data related to Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) veterans was used to identify newly diagnosed COPD cases and the proportion of cases receiving spirometry. Cases were defined as veterans who had their first medical encounter with a coded diagnosis of COPD ≥ 6 months after their initial VA health care evaluation. The relationship between prediagnostic and comorbid conditions and the administration of CPG-concordant spirometry was examined using regression analyses. FINDINGS Among the 923,646 OEF/OIF/OND veterans receiving VA health care between January 2002 and December 2014, 32,076 (3%) had a coded diagnosis of COPD. Among those, 22,156 (69%) were identified as newly diagnosed COPD cases; only 6,827 (31%) had CPG-concordant spirometry. Concordant spirometry was more likely to occur in veterans aged ≥40. A pre-existing tobacco use disorder marginally changed the concordance rate. DISCUSSION VA provider adherence to CPG-concordant spirometry would decrease the prevalence of false-positive COPD cases and lead to more targeted disease treatment. Future research should focus on such cases by assessing the association between COPD diagnosis and bronchodilator responsiveness.
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Affiliation(s)
- Aaron I Schneiderman
- Department of Veterans Affairs (10P4Q), Post-Deployment Health Services, Epidemiology Program, 810 Vermont Avenue, Washington, DC 20420
| | - Deborah D Dougherty
- Under Contract to Intellica Corporation, 8521 Leesburg Pike Suite 600, Vienna, VA 22182
| | - Vincent P Fonseca
- Intellica Corporation, 209 West Poplar Street, San Antonio, TX 78212
| | - Charles L Wolters
- Under Contract to Intellica Corporation, 8521 Leesburg Pike Suite 600, Vienna, VA 22182
| | - Robert M Bossarte
- West Virginia University Injury Control Research Center, Research Ridge Suite 201, 3606 Collins Ferry Road, Morgantown, WV 26505
| | - Mehrdad Arjomandi
- San Francisco VAMC and University of California San Francisco, 4150 Clement Street, San Francisco, CA 94121
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Lubens P, Bruckner TA. A Review of Military Health Research Using a Social–Ecological Framework. Am J Health Promot 2018; 32:1078-1090. [DOI: 10.1177/0890117117744849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: We aim to contextualize the growing body of research on the sequelae of military service in the wars in Afghanistan and Iraq. We employ a social–ecological (SE) framework for the taxonomy of military health research and classify risk as arising from the individual, family, community, and the institutional levels. We intend for this review to inform enhanced health promotion efforts in military communities. Data Source: Articles reviewed were extracted from Web of Science, PubMed, and Scopus. Inclusion and Exclusion Criteria: Research focused on somatic and psychological sequelae of combat deployment published from 2001—the year the war in Afghanistan began—through the end of 2014. We excluded studies of non-US military personnel, other systematic reviews, meta-analyses, book chapters, and theoretical papers. Data Extraction: We examined and summarized the aims, participants, methods, study design, SE framework tier, risk factors, and health outcomes. Data Synthesis: Studies were categorized according to SE tier, whether they focused on somatic, behavioral, or psychological outcomes, and by risk factor. Results: Of the 352 peer-reviewed papers, 84% focused on war’s sequelae on the index military personnel, and 75% focused on mental or behavioral health outcomes—mostly on post-traumatic stress disorder. We find comparatively little research focusing on the family, community, or institutional tiers. Conclusions: We know relatively little about how family and community respond to the return of personnel from combat deployment; how family resources affect the health of returning military personnel; and how a war’s persistence presents challenges for federal, state, and local agencies to meet military health-care needs. Such work is especially salient as US troops return home from war—particularly in communities where there are substantial military populations.
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Affiliation(s)
- Pauline Lubens
- Program in Public Health, University of California, Irvine, CA, USA
| | - Tim A. Bruckner
- Program in Public Health, University of California, Irvine, CA, USA
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McFarlane AC, Van Hooff M. The challenges and benefits of conducting linked epidemiological and neurobiological health surveillance into the impacts of military deployment in Australia. Aust N Z J Psychiatry 2018; 52:107-109. [PMID: 29216736 DOI: 10.1177/0004867417745999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander C McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, SA, Australia
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Kaplan GG. Editorial: the Millennium study cohort-evaluating environmental determinates of IBD in the 21st century. Aliment Pharmacol Ther 2017; 46:63-64. [PMID: 28589585 DOI: 10.1111/apt.14077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- G G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
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McMaster HS, LeardMann CA, Speigle S, Dillman DA. An experimental comparison of web-push vs. paper-only survey procedures for conducting an in-depth health survey of military spouses. BMC Med Res Methodol 2017; 17:73. [PMID: 28441932 PMCID: PMC5405460 DOI: 10.1186/s12874-017-0337-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 04/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Previous research has found that a “web-push” approach to data collection, which involves contacting people by mail to request an Internet survey response while withholding a paper response option until later in the contact process, consistently achieves lower response rates than a “paper-only” approach, whereby all respondents are contacted and requested to respond by mail. Method An experiment was designed, as part of the Millennium Cohort Family Study, to compare response rates, sample representativeness, and cost between a web-push and a paper-only approach; each approach comprised 3 stages of mail contacts. The invited sample (n = 4,935) consisted of spouses married to U.S. Service members, who had been serving in the military between 2 and 5 years as of October, 2011. Results The web-push methodology produced a significantly higher response rate, 32.8% compared to 27.8%. Each of the 3 stages of postal contact significantly contributed to response for both treatments with 87.1% of the web-push responses received over the Internet. The per-respondent cost of the paper-only treatment was almost 40% higher than the web-push treatment group. Analyses revealed no meaningfully significant differences between treatment groups in representation. Conclusion These results provide evidence that a web-push methodology is more effective and less expensive than a paper-only approach among young military spouses, perhaps due to their heavy reliance on the internet, and we suggest that this approach may be more effective with the general population as they become more uniformly internet savvy.
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Affiliation(s)
- Hope Seib McMaster
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA.
| | - Cynthia A LeardMann
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Steven Speigle
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Don A Dillman
- Department of Sociology and the Social and Economic Sciences Research Center, Washington State University, Pullman, WA, 99164, USA
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Landes SD, Wilder J, Williams D. The effect of race and birth cohort on the veteran mortality differential. Soc Sci Med 2017; 179:36-44. [DOI: 10.1016/j.socscimed.2017.02.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 01/11/2017] [Accepted: 02/21/2017] [Indexed: 01/18/2023]
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Porter CK, Welsh M, Riddle MS, Nieh C, Boyko EJ, Gackstetter G, Hooper TI. Epidemiology of inflammatory bowel disease among participants of the Millennium Cohort: incidence, deployment-related risk factors, and antecedent episodes of infectious gastroenteritis. Aliment Pharmacol Ther 2017; 45:1115-1127. [PMID: 28230274 DOI: 10.1111/apt.13991] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/05/2016] [Accepted: 01/26/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Crohn's disease (CD) and ulcerative colitis (UC) are two pathotypes of inflammatory bowel disease (IBD) with unique pathology, risk factors and significant morbidity. AIM To estimate incidence and identify IBD risk factors in a US military population, a healthy subset of the US population, using information from the Millennium Cohort Study. METHODS Incident IBD was identified from medical encounters from 2001 to 2009 or by self-report. Our primary risk factor of interest, infectious gastroenteritis, was identified from medical encounters and self-reported post-deployment health assessments. Other potential risk factors were assessed using self-reported survey responses and military personnel files. Hazard ratios were estimated using Cox proportional hazards analysis. RESULTS We estimated 23.2 and 21.9 diagnoses per 100 000 person-years, respectively, for CD and UC. For CD, significant risk factors included [adjusted hazard ratio (aHR), 95% confidence interval]: current smoking (aHR: 2.7, 1.4-5.1), two life stressors (aHR: 2.8, 1.4-5.6) and prior irritable bowel syndrome (aHR: 4.7, 1.5-15.2). There was no significant association with prior infectious gastroenteritis. There was an apparent dose-response relationship between UC risk and an increasing number of life stressors. In addition, antecedent infectious gastroenteritis was associated with almost a three-fold increase in UC risk (aHR: 2.9, 1.4-6.0). Moderate alcohol consumption (aHR: 0.4, 0.2-0.6) was associated with lower UC risk. CONCLUSIONS Stressful conditions and the high risk of infectious gastroenteritis in deployment operations may play a role in the development of IBD in military populations. However, observed differences in risk factors for UC and CD warrant further investigation.
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Affiliation(s)
- C K Porter
- Naval Medical Research Center, Silver Spring, MD, USA
| | - M Welsh
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - M S Riddle
- Naval Medical Research Center, Silver Spring, MD, USA
| | - C Nieh
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - E J Boyko
- Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - G Gackstetter
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - T I Hooper
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Riddle MS, Welsh M, Porter CK, Nieh C, Boyko EJ, Gackstetter G, Hooper TI. The Epidemiology of Irritable Bowel Syndrome in the US Military: Findings from the Millennium Cohort Study. Am J Gastroenterol 2016; 111:93-104. [PMID: 26729548 PMCID: PMC4759150 DOI: 10.1038/ajg.2015.386] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 11/01/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Functional gastrointestinal disorders occur more frequently among deployed veterans, although studies evaluating the relative impact of risk factors, including stress and antecedent infectious gastroenteritis (IGE), are limited. We examined risk factors for new-onset irritable bowel syndrome (IBS) among active duty participants in the military's Millennium Cohort Study. METHODS Medical encounter data from 2001 to 2009, limited to Cohort members on active duty, were used to identify incident IBS cases (any and highly probable). IGE was identified using medical encounter or self-report. Covariate data were obtained from the Millennium Cohort Study surveys and analyzed using Cox proportional hazards methods. RESULTS Overall, 41,175 Cohort members met the eligibility criteria for inclusion and 314 new-onset cases of IBS were identified among these. Significant risk factors (adjusted hazard ratio, 95% confidence interval) included antecedent IGE (2.05, 1.53-2.75), female gender (1.96, 1.53-2.52), number of life stressors (1: 1.82, 1.37-2.41; 2: 2.86, 2.01-4.06; 3+: 6.69, 4.59-9.77), and anxiety syndrome (1.74, 1.17-2.58). Limited to highly probable IBS, a stronger association with antecedent IGE was observed, particularly when based on medical encounter records (any IGE: 2.20, 1.10-4.43; medical encounter IGE only: 2.84, 1.33-6.09). Precedent anxiety or depression and IGE interacted with increased IBS risk compared with IGE alone. CONCLUSIONS These results confirm previous studies on the association between sociodemographic or life stressors and IBS. IGE was significantly associated with IBS risk. Whether deployed or not, US service members often encounter repeated exposure to high levels of stress, which, combined with other environmental factors such as IGE, may result in long-term debilitating functional gastrointestinal disorders.
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Affiliation(s)
- Mark S Riddle
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Marleen Welsh
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Chad K Porter
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Chiping Nieh
- Health Research and Analysis, Rockville, Maryland, USA
| | - Edward J Boyko
- Department of Veterans Affairs, Puget Sound Health Care System, Puget Sound, Washington, USA
| | - Gary Gackstetter
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tomoko I Hooper
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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LeardMann CA, Woodall KA, Littman AJ, Jacobson IG, Boyko EJ, Smith B, Wells TS, Crum-Cianflone NF. Post-traumatic stress disorder predicts future weight change in the Millennium Cohort Study. Obesity (Silver Spring) 2015; 23:886-92. [PMID: 25776806 DOI: 10.1002/oby.21025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/15/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To prospectively examine the association between post-traumatic stress disorder (PTSD) and weight change. METHODS Longitudinal analysis techniques were used to examine data (2001-2008) from Millennium Cohort Study participants, consisting of U.S. service members and veterans. Using the PTSD Checklist-Civilian Version, PTSD was assessed as none, resolved, new onset, or persistent. Subsequent weight change was assessed as stable (≤3% loss or gain), >3% weight loss, >3% but <10% weight gain, and ≥10% weight gain. RESULTS Of the 38,352 participants, 2391 (6.2%) had PTSD (838 resolved, 1024 new onset, and 529 persistent), and 11% of participants subsequently had ≥10% weight gain. In multivariable models, PTSD was associated with higher odds of ≥10% weight gain (new onset OR: 1.44 [95% CI: 1.20-1.73]; persistent OR: 1.51 [CI: 1.17-1.96]; resolved OR: 1.30 [CI: 1.05-1.60]) compared with those without PTSD. New-onset and persistent PTSD were also associated with higher odds of >3% weight loss (OR: 1.41 [CI: 1.17-1.71]; OR: 1.42 [CI: 1.09-1.86], respectively). CONCLUSIONS PTSD is independently associated with a higher risk of weight gain and loss, the former of which leads to a higher prevalence of overweight and obesity and a higher risk of comorbidities associated with excessive body adiposity.
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Affiliation(s)
- Cynthia A LeardMann
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
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22
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Weiner MW, Veitch DP, Hayes J, Neylan T, Grafman J, Aisen PS, Petersen RC, Jack C, Jagust W, Trojanowski JQ, Shaw LM, Saykin AJ, Green RC, Harvey D, Toga AW, Friedl KE, Pacifico A, Sheline Y, Yaffe K, Mohlenoff B. Effects of traumatic brain injury and posttraumatic stress disorder on Alzheimer's disease in veterans, using the Alzheimer's Disease Neuroimaging Initiative. Alzheimers Dement 2015; 10:S226-35. [PMID: 24924673 PMCID: PMC4392759 DOI: 10.1016/j.jalz.2014.04.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Both traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are common problems resulting from military service, and both have been associated with increased risk of cognitive decline and dementia resulting from Alzheimer's disease (AD) or other causes. This study aims to use imaging techniques and biomarker analysis to determine whether traumatic brain injury (TBI) and/or PTSD resulting from combat or other traumas increase the risk for AD and decrease cognitive reserve in Veteran subjects, after accounting for age. Using military and Department of Veterans Affairs records, 65 Vietnam War veterans with a history of moderate or severe TBI with or without PTSD, 65 with ongoing PTSD without TBI, and 65 control subjects are being enrolled in this study at 19 sites. The study aims to select subject groups that are comparable in age, gender, ethnicity, and education. Subjects with mild cognitive impairment (MCI) or dementia are being excluded. However, a new study just beginning, and similar in size, will study subjects with TBI, subjects with PTSD, and control subjects with MCI. Baseline measurements of cognition, function, blood, and cerebrospinal fluid biomarkers; magnetic resonance images (structural, diffusion tensor, and resting state blood-level oxygen dependent (BOLD) functional magnetic resonance imaging); and amyloid positron emission tomographic (PET) images with florbetapir are being obtained. One-year follow-up measurements will be collected for most of the baseline procedures, with the exception of the lumbar puncture, the PET imaging, and apolipoprotein E genotyping. To date, 19 subjects with TBI only, 46 with PTSD only, and 15 with TBI and PTSD have been recruited and referred to 13 clinics to undergo the study protocol. It is expected that cohorts will be fully recruited by October 2014. This study is a first step toward the design and statistical powering of an AD prevention trial using at-risk veterans as subjects, and provides the basis for a larger, more comprehensive study of dementia risk factors in veterans.
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Affiliation(s)
- Michael W Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA.
| | - Dallas P Veitch
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Jacqueline Hayes
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Thomas Neylan
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Jordan Grafman
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul S Aisen
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | | | - Clifford Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - William Jagust
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | - John Q Trojanowski
- Institute on Aging, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Alzheimer's Disease Core Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Udall Parkinson's Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert C Green
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Arthur W Toga
- Laboratory of Neuroimaging, Institute of Neuroimaging and Informatics, University of Southern California Los Angeles, Los Angeles, CA, USA
| | - Karl E Friedl
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Anthony Pacifico
- Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, Fort Detrick, MD, USA
| | - Yvette Sheline
- Department of Psychiatry, Washington University School of Medicine, Washington University, St. Louis, MO, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA
| | - Brian Mohlenoff
- Department of Psychiatry, University of California, San Francisco, CA, USA
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23
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Wells TS, Seelig AD, Ryan MAK, Jones JM, Hooper TI, Jacobson IG, Boyko EJ. Hearing loss associated with US military combat deployment. Noise Health 2015; 17:34-42. [PMID: 25599756 PMCID: PMC4918647 DOI: 10.4103/1463-1741.149574] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The objective of this study was to define the risk of hearing loss among US military members in relation to their deployment experiences. Data were drawn from the Millennium Cohort Study. Self-reported data and objective military service data were used to assess exposures and outcomes. Among all 48,540 participants, 7.5% self-reported new-onset hearing loss. Self-reported hearing loss showed moderate to substantial agreement (k = 0.57-0.69) with objective audiometric measures. New-onset hearing loss was associated with combat deployment (adjusted odds ratio [AOR] = 1.63, 95% confidence interval [CI] = 1.49-1.77), as well as male sex and older age. Among deployers, new-onset hearing loss was also associated with proximity to improvised explosive devices (AOR = 2.10, 95% CI = 1.62-2.73) and with experiencing a combat-related head injury (AOR = 6.88, 95% CI = 3.77-12.54). These findings have implications for health care and disability planning, as well as for prevention programs.
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24
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Hoencamp R, Idenburg FJ, van Dongen TTCF, de Kruijff LGM, Huizinga EP, Plat MCJ, Hoencamp E, Leenen LPH, Hamming JF, Vermetten E. Long-term impact of battle injuries; five-year follow-up of injured Dutch servicemen in Afghanistan 2006-2010. PLoS One 2015; 10:e0115119. [PMID: 25643003 PMCID: PMC4313947 DOI: 10.1371/journal.pone.0115119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022] Open
Abstract
Objectives Units deployed to armed conflicts are at high risk for exposure to combat events. Many battle casualties (BCs) have been reported in the recent deployment to Afghanistan. The long-term impact of these combat injuries, at their five-year end point, is currently unknown. To date, no systematic inventory has been performed of an identified group of BCs in comparison to non-injured service members from the same operational theatre. Design Observational cross-sectional cohort study. Setting Open online survey among Dutch BCs that deployed to Afghanistan (2006–2010). Participants The Dutch BCs (n = 62) were compared to two control groups of non-injured combat groups (battle exposed [n = 53], and non-battle exposed [n = 73]). Main Outcome Measures Participants rated their impact of trauma exposure (Impact of Events [IES]), post deployment reintegration (Post Deployment Reintegration Scale [PDRS]), general symptoms of distress (Symptom Checklist 90 [SCL-90]), as well as their current perceived quality of life (EuroQol-6D [EQ-6D]). Also cost effectiveness (Short From health survey [SF-36]) and care consumption were assessed (Trimbos/iMTA questionnaire). Results Over 90% of BCs were still in active duty. The mean scores of all questionnaires (IES, EQ-6D, SF-36, and SCL-90) of the BC group were significantly higher than in the control groups (p<0.05). The PDRS showed a significantly lower (p<0.05) outcome in the negative subscales. The mean consumption of care was triple that of both control groups. A lower score on quality of life was related to higher levels of distress and impact of trauma exposure. Conclusions This study showed a clear long-term impact on a wide range of scales that contributes to a reduced quality of life in a group of BCs. Low perceived cost effectiveness matched with high consumption of care in the BC group in comparison to the control groups. These results warrant continuous monitoring of BCs.
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Affiliation(s)
- Rigo Hoencamp
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- * E-mail:
| | - Floris J. Idenburg
- Department of Surgery, Medical Centre Haaglanden, The Hague, The Netherlands
| | | | - Loes G. M. de Kruijff
- Department of Physiatrist, Rehabilitation Center de Hoogstraat, Utrecht, The Netherlands
| | - Eelco P. Huizinga
- Department of Surgery, University Medical Centre, Utrecht, The Netherlands
| | - Marie-Christine J. Plat
- Force Health Protection, Expert Centre Force Health Protection Ministry of Defense, Utrecht, The Netherlands
| | - Erik Hoencamp
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Luke P. H. Leenen
- Department of Surgery, University Medical Centre, Utrecht, The Netherlands
| | - Jaap F. Hamming
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eric Vermetten
- Leiden University Medical Centre, Military Mental Health Research, Utrecht, The Netherlands
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25
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Welsh MM, Federinko SP, Burnett DG, Gackstetter GD, Boyko EJ, Seelig AD, Wells TS, Hooper TI. Deployment-related depression screening, 2001-2008: comparing clinical versus research surveys. Am J Prev Med 2014; 47:531-40. [PMID: 25241198 DOI: 10.1016/j.amepre.2014.07.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/26/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Potential adverse mental health effects of deployment, including depression, are an ongoing concern. Although a previous study assessed under-reporting of depression on post-deployment health assessments compared to anonymous surveys, those results were not examined at the individual level to identify demographic or military factors that may be associated with unwillingness to report depression symptoms. PURPOSE To compare self-reported depression symptoms on post-deployment health assessments with responses to the same depression questions on a research survey. METHODS This cross-sectional study analyzed depression screening responses from 2001 to 2008 from participants of the Millennium Cohort Study, a longitudinal military cohort study, who completed a post-deployment health assessment within 30 days of a research survey. Kappa statistics and percent positive and negative agreement were calculated. Demographic and military characteristics associated with discordant screening results were examined. Initial analyses were performed in 2011, with additional analyses in 2013. RESULTS Moderate agreement (κ=0.464) was observed between paired survey responses. A higher proportion of active duty members, the unmarried, and new accessions into military service endorsed depression symptoms on the research survey but not the military-linked survey. In stratified analyses, agreement was higher in Reserve/National Guard members than active duty (κ=0.561 vs 0.409). New active duty accessions showed lower agreement (κ=0.388), as did unmarried active duty participants (κ=0.304). CONCLUSIONS Deployment health surveys are important tools for identifying returning service members experiencing depression symptoms. However, these findings suggest that ongoing stigma and barriers to appropriate follow-up mental health care remain to be addressed in the military setting.
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Affiliation(s)
- Marleen M Welsh
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | - Susan P Federinko
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Daniel G Burnett
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Edward J Boyko
- Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Amber D Seelig
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
| | | | - Tomoko I Hooper
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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26
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Crum-Cianflone NF, Fairbank JA, Marmar CR, Schlenger W. The Millennium Cohort Family Study: a prospective evaluation of the health and well-being of military service members and their families. Int J Methods Psychiatr Res 2014; 23:320-30. [PMID: 24912670 PMCID: PMC6878226 DOI: 10.1002/mpr.1446] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/15/2013] [Indexed: 11/08/2022] Open
Abstract
The need to understand the impact of war on military families has never been greater than during the past decade, with more than three million military spouses and children affected by deployments to Operations Iraqi Freedom and Enduring Freedom. Understanding the impact of the recent conflicts on families is a national priority, however, most studies have examined spouses and children individually, rather than concurrently as families. The Department of Defense (DoD) has recently initiated the largest study of military families in US military history (the Millennium Cohort Family Study), which includes dyads of military service members and their spouses (n > 10,000). This study includes US military families across the globe with planned follow-up for 21+ years to evaluate the impact of military experiences on families, including both during and after military service time. This review provides a comprehensive description of this landmark study including details on the research objectives, methodology, survey instrument, ancillary data sets, and analytic plans. The Millennium Cohort Family Study offers a unique opportunity to define the challenges that military families experience, and to advance the understanding of protective and vulnerability factors for designing training and treatment programs that will benefit military families today and into the future.
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Affiliation(s)
- Nancy F Crum-Cianflone
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA; Department of Medicine, Naval Medical Center San Diego, San Diego, CA, USA
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27
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Worthen M, Rathod SD, Cohen G, Sampson L, Ursano R, Gifford R, Fullerton C, Galea S, Ahern J. Anger problems and posttraumatic stress disorder in male and female National Guard and Reserve Service members. J Psychiatr Res 2014; 55:52-8. [PMID: 24755257 PMCID: PMC4084757 DOI: 10.1016/j.jpsychires.2014.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 03/27/2014] [Accepted: 04/03/2014] [Indexed: 11/25/2022]
Abstract
Anger is a common problem among veterans and has been associated with posttraumatic stress disorder (PTSD). This study aimed to improve understanding of how anger and PTSD co-occur by examining gender differences and differences by whether the triggering traumatic event is deployment-related vs. civilian-related in current service members. A representative cohort of Reserve and National Guard service personnel (n = 1293) were interviewed to assess for deployment- or civilian-related traumas, PTSD, and anger. The prevalence of self-reported anger problems was estimated among male (n = 1036) and female (n = 257) service members. Log Poisson regression models with robust standard errors were used to estimate the associations of problems with anger with PTSD and PTSD symptom severity for men and women. Self-reported anger problems were common among male (53.0%) and female (51.3%) service members. Adjusted prevalence ratios (PR) showed associations between anger and PTSD connected to both civilian- and deployment-related traumas (PR were 1.77 (95% CI 1.52-2.05) and 1.85 (95% CI 1.62-2.12), respectively). PTSD symptom severity was also associated with anger. This study was cross-sectional and so a causal relationship between PTSD and anger cannot be established. Problems with anger are common among male and female current Guard and Reserve members. These findings suggest that anger treatment should be made available to current service members and that clinicians should assess anger problems irrespective of gender. Future research should examine the effectiveness of anger treatment protocols by gender.
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Affiliation(s)
| | | | | | | | - Robert Ursano
- Uniformed Services University of the Health Sciences
| | | | | | - Sandro Galea
- Columbia University Mailman School of Public Health
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28
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Boyko EJ, Seelig AD, Jacobson IG, Hooper TI, Smith B, Smith TC, Crum-Cianflone NF. Sleep characteristics, mental health, and diabetes risk: a prospective study of U.S. military service members in the Millennium Cohort Study. Diabetes Care 2013; 36:3154-61. [PMID: 23835691 PMCID: PMC3781550 DOI: 10.2337/dc13-0042] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Research has suggested that a higher risk of type 2 diabetes associated with sleep characteristics exists. However, studies have not thoroughly assessed the potential confounding effects of mental health conditions associated with alterations in sleep. RESEARCH DESIGN AND METHODS We prospectively assessed the association between sleep characteristics and self-reported incident diabetes among Millennium Cohort Study participants prospectively followed over a 6-year time period. Surveys are administered approximately every 3 years and collect self-reported data on demographics, height, weight, lifestyle, features of military service, sleep, clinician-diagnosed diabetes, and mental health conditions assessed by the PRIME-MD Patient Health Questionnaire and the PTSD Checklist-Civilian Version. Statistical methods for longitudinal data were used for data analysis. RESULTS We studied 47,093 participants (mean 34.9 years of age; mean BMI 26.0 kg/m2; 25.6% female). During 6 years of follow-up, 871 incident diabetes cases occurred (annual incidence 3.6/1,000 person-years). In univariate analyses, incident diabetes was significantly more likely among participants with self-reported trouble sleeping, sleep duration<6 h, and sleep apnea. Participants reporting incident diabetes were also significantly older, of nonwhite race, of higher BMI, less likely to have been deployed, and more likely to have reported baseline symptoms of panic, anxiety, posttraumatic stress disorder, and depression. After adjusting for covariates, trouble sleeping (odds ratio 1.21 [95% CI 1.03-1.42]) and sleep apnea (1.78 [1.39-2.28]) were significantly and independently related to incident diabetes. CONCLUSIONS Trouble sleeping and sleep apnea predict diabetes risk independent of mental health conditions and other diabetes risk factors.
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29
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Boyd MA, Bradshaw W, Robinson M. Mental health issues of women deployed to Iraq and Afghanistan. Arch Psychiatr Nurs 2013; 27:10-22. [PMID: 23352021 DOI: 10.1016/j.apnu.2012.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/16/2012] [Accepted: 10/18/2012] [Indexed: 11/26/2022]
Abstract
The number of women serving in the military and deployed to active-duty is unprecedented in the history of the United States. When women became a permanent sector of the U.S. Armed Services in 1948, their involvement was restricted to comprise only 2% of the military population; today women constitute approximately 14.5% of the 1.4 million active component and 18% of the 850,000 reserve component. Yet, little attention has been paid to the mental health needs of women military members. This review article highlights the history of women in the military and then focuses on the impact of combat exposure and injuries, military sexual trauma, alcohol use, and family separations which are associated with PTSD, depression, suicide, difficulty with reintegration, and homelessness.
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Affiliation(s)
- Mary Ann Boyd
- V.A. St. Louis Health Care System, St. Louis, Missouri 63125, USA.
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30
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Haus-Cheymol R, Boussaud M, Jougla E, Verret C, Decam C, Pommier de Santi V, Nivoix P, Duron S, Mayet A, Dia A, Meynard JB, Deparis X, Migliani R, Spiegel A. Mortality among active-duty male French Armed Forces, 2006-10. J Public Health (Oxf) 2012; 34:454-61. [PMID: 22378941 DOI: 10.1093/pubmed/fds016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the Armed Forces, knowledge about the causes of deaths is required in order to develop prevention strategies. This study presents the main characteristics of causes of deaths among male active-duty personnel in the French Armed Forces during the 2006-10 period and compares them with the general French male population. METHODS The data are provided by military public health surveillance. Comparisons of the specific mortality rates (MR) were performed using a Poisson regression. Standardized mortality ratios (SMRs) were calculated to compare mortality with the general French male population. RESULTS There were 1455 deaths among male active-duty personnel during the study period [MR: 100.9 per 100,000 person-years (PY); 95% confidence interval 95.7-106.1]. The 17-24 age group was characterized by violent deaths: transport accident (MR: 45.9 per 100,000 PY) and suicide (18.8 per 100 000 PY). Overall SMRs show significantly lower MR compared with the French national MR with the exception of SMR for transport accident and suicide in the 17-24 age group. CONCLUSIONS There is a significantly lower deficit of mortality compared with the French male general population, reflecting a strong healthy worker effect. However, health promotion programmes should continue to put emphasis on transport accident especially among the 17-24 age group.
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Affiliation(s)
- Rachel Haus-Cheymol
- Centre d'épidémiologie et de santé publique des armées, Ilôt Bégin, 94163 Saint Mandé Cedex, France.
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31
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Shen YC, Arkes J, Williams TV. Effects of Iraq/Afghanistan deployments on major depression and substance use disorder: analysis of active duty personnel in the US military. Am J Public Health 2012; 102 Suppl 1:S80-7. [PMID: 22390609 DOI: 10.2105/ajph.2011.300425] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Our objective was to analyze the association between deployment characteristics and diagnostic rates for major depression and substance use disorder among active duty personnel. METHODS Using active duty personnel serving between 2001 and 2006 (n = 678,382) and deployment information from the Contingent Tracking System, we identified individuals diagnosed with substance use disorders and major depression from TRICARE health records. We performed logistic regression analysis to assess the effect of deployment location and length on these diagnostic rates. RESULTS Increased odds of diagnosis with both conditions were associated with deployment to Iraq or Afghanistan compared with nondeployed personnel and with Army and Marine Corps personnel compared with Navy and Air Force personnel. Increases in the likelihood of either diagnosis with deployment length were only observed among Army personnel. CONCLUSIONS There were increased substance use disorders and major depression across services associated with combat conditions. It would be important to assess whether the public health system has adequate resources to handle the increasing need of mental health services in this population.
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Affiliation(s)
- Yu-Chu Shen
- Graduate School of Business and Public Policy, Naval Postgraduate School, Monterey, CA 93943, USA.
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