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Adams RS, Forster JE, Gradus JL, Hoffmire CA, Hostetter TA, Larson MJ, Smith AA, Walsh CG, Brenner LA. Divergent trends in accidental deaths since return from an Afghanistan/Iraq deployment among army soldiers. Ann Epidemiol 2024; 91:23-29. [PMID: 38185289 DOI: 10.1016/j.annepidem.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE Accidental death is a leading cause of mortality among military members and Veterans; however, knowledge is limited regarding time-dependent risk following deployment and if there are differences by type of accidental death. METHODS Longitudinal cohort study (N = 860,930) of soldiers returning from Afghanistan/Iraq deployments in fiscal years 2008-2014. Accidental deaths (i.e., motor vehicle accidents [MVA], accidental overdose, other accidental deaths), were identified through 2018. Crude and age-adjusted mortality rates, rate ratios, time-dependent hazard rates and trends postdeployment were compared across demographic and military characteristics. RESULTS During the postdeployment observation period, over one-third of deaths were accidental; most were MVA (46.0 %) or overdoses (37.9 %). Across accidental mortality categories (all, MVA, overdose), younger soldiers (18-24, 25-29) were at higher risk compared to older soldiers (40+), and females at lower risk than males. MVA death rates were highest immediately postdeployment, with a significant decreasing hazard rate over time (annual percent change [APC]: -6.5 %). Conversely, accidental overdose death rates were lowest immediately following deployment, with a significant increasing hazard rate over time (APC: 9.9 %). CONCLUSIONS Observed divergent trends in risk for the most common types of accidental deaths provide essential information to inform prevention and intervention planning for the immediate postdeployment transition and long-term.
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Affiliation(s)
- Rachel Sayko Adams
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, MA, USA; Brandeis University, The Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA, USA; Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA.
| | - Jeri E Forster
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA
| | - Jaimie L Gradus
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Claire A Hoffmire
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA
| | - Trisha A Hostetter
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
| | - Mary Jo Larson
- Brandeis University, The Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA, USA
| | - Alexandra A Smith
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
| | - Colin G Walsh
- Vanderbilt University Medical Center, Departments of Biomedical Informatics, Medicine, and Psychiatry, Nashville, TN, USA
| | - Lisa A Brenner
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA; University of Colorado, Departments of Psychiatry and Neurology, Anschutz Medical Campus, Aurora, CO, USA
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Carlson KF, Gilbert TA, DeFrancesco S, Wright DA, Shen X, Cook LJ. Accuracy of behavioral health variables in Oregon national violent death reporting system data: a linked cohort study. Inj Epidemiol 2022; 9:29. [PMID: 36100875 PMCID: PMC9469595 DOI: 10.1186/s40621-022-00393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background The National Violent Death Reporting System (NVDRS) collects data on the circumstances of violent deaths, and all firearm-related deaths, across states and territories in the USA. This surveillance system is critical to understanding patterns and risk factors for these fatalities, thereby informing targets for prevention. NVDRS variables include behavioral health conditions among decedents, but the validity of the reported behavioral health data is unknown. Using Department of Veterans Affairs (VA) healthcare records as a criterion standard, we examined the accuracy of NVDRS-reported behavioral health variables for veteran decedents in a sample state (Oregon) between 2003 and 2017.
Methods We linked Oregon NVDRS data to VA healthcare data to identify veteran decedents who used VA services within two years of death. Veterans’ VA diagnoses within this time frame, including depression, post-traumatic stress disorder (PTSD), anxiety, and substance use disorders, were compared to behavioral health variables identified in the Oregon NVDRS. Concordance, sensitivity, and correlates of sensitivity were examined over time and by decedent characteristics.
Results We identified 791 VA-using veterans with violent and/or firearm-related fatal injuries documented in the Oregon NVDRS between 2003 and 2017. In this cohort, the Oregon NVDRS accurately identified only 49% of decedents who were diagnosed with depression, 45% of those diagnosed with PTSD, and 17% of those diagnosed with anxiety by the VA. Among 211 veterans diagnosed by the VA with a substance use disorder, the Oregon NVDRS coded only 56% as having a substance use problem. In general, the sensitivity of behavioral health variables in the Oregon NVDRS remained the same or decreased over the study period; however, the sensitivity of PTSD diagnoses increased from 21% in 2003–2005 to 54% in 2015–2017. Sensitivity varied by some decedent characteristics, but not consistently across behavioral health variables.
Conclusions NVDRS data from one state missed more than half of behavioral health diagnoses among VA-using veterans who died from violence or from firearm injuries. This suggests that reports of behavioral health conditions among decedents nationally may be severely undercounted. Efforts to improve validity of these variables in state NVDRS data are needed.
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Forsberg CW, Estrada SA, Baraff A, Magruder KM, Vaccarino V, Litz BT, Friedman MJ, Goldberg J, Smith NL. Risk factors for suicide in the Vietnam-era twin registry. Suicide Life Threat Behav 2022; 52:631-641. [PMID: 35499385 DOI: 10.1111/sltb.12848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The risk of suicide among Veterans is of major concern, particularly among those who experienced a combat deployment and/or have a history of PTSD. DESIGN AND METHODS This was a retrospective cohort study of post-discharge suicide among Vietnam-era Veterans who are members of the Vietnam Era Twin (VET) Registry. The VET Registry is a national sample of male twins from all branches of the military, both of whom served on active duty between 1964 and 1975. Military service and demographic factors were available from the military records. Service in-theater was based on military records; combat exposure and PTSD symptoms were assessed in 1987 by questionnaire. Mortality follow-up, from discharge to 2016, is identified from Department of Veterans Affairs, Social Security Administration, and National Death Index records; suicide as a cause of death is based on the International Classification of Death diagnostic codes from the death certificate. Statistical analysis used Cox proportional hazards regression to estimate the association of Vietnam-theater service, combat exposure, and PTSD symptoms with suicide while adjusting for military service and demographic confounding factors. RESULTS From the 14,401 twins in the VET Registry, there were 147 suicide deaths during follow-up. In adjusted analyses, twins who served in the Vietnam theater were at similar risk of post-discharge suicide compared with non-theater Veterans; there was no association between combat and suicide. An increase in severity of PTSD symptoms was significantly associated with an increased risk of suicide in adjusted analyses (hazard ratio = 1.13 per five-point increase in symptom score; 95% CI: 1.02-1.27). CONCLUSIONS Service in the Vietnam theater is not associated with greater risk of suicide; however, PTSD symptom severity poses a degree of risk of suicide in Vietnam-era Veterans. Adequate screening for PTSD in Veterans may be promising to identify Veterans who are at increased risk of suicide.
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Affiliation(s)
- Christopher W Forsberg
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA
| | - Santiago A Estrada
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA
| | - Aaron Baraff
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA
| | - Kathryn M Magruder
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, US Department of Veteran Affairs, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University, Boston, Massachusetts, USA
| | - Matthew J Friedman
- Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA.,National Center for PTSD, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center Department of Veterans Affairs, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Pethrus CM, Vedtofte MS, Neovius K, Borud EK, Neovius M. Pooled analysis of all-cause and cause-specific mortality among Nordic military veterans following international deployment. BMJ Open 2022; 12:e052313. [PMID: 35414543 PMCID: PMC9006836 DOI: 10.1136/bmjopen-2021-052313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To investigate all-cause and cause-specific mortality risks, including deaths from external, cardiovascular and cancer causes, among deployed Nordic military veterans in comparison to the general population in each country. DESIGN Pooled analysis. SETTING Denmark, Norway, Finland and Sweden. PARTICIPANTS Military veterans deployed between 1990 and 2010 were followed via nationwide registers and compared with age-sex-calendar-year-specific rates in the general population using pooled standardised mortality ratios (SMRs). MAIN OUTCOMES All-cause and cause-specific mortality retrieved from each country's Causes of Death Register, including deaths from external, cardiovascular and cancer causes. RESULTS Among 83 584 veterans 1152 deaths occurred of which 343 were from external causes (including 203 suicides and 129 traffic/transport accidents), 134 from cardiovascular causes and 297 from neoplasms. Veterans had a lower risk of death from any cause (pooled SMR 0.58, 95% CI 0.52 to 0.64), external causes (0.71, 95% CI 0.64 to 0.79), suicide (0.77, 95% CI 0.67 to 0.89), cardiovascular causes (0.54, 95% CI 0.46 to 0.64) and neoplasms (0.78, 95% CI 0.70 to 0.88). There was no difference regarding traffic/transport accidents for the whole period (1.10, 95% CI 0.92 to 1.31) but the pooled point estimate was elevated, though not statistically significant, during the first 5 years (1.17, 95% CI 0.89 to 1.53) but not thereafter (1.01, 95% CI 0.77 to 1.34). For all other causes of death, except suicide, statistically significantly lower risk among veterans was observed both during the first 5 years and thereafter. For suicide, no difference was observed beyond 5 years. Judged from the country-specific SMR estimates, there was a high degree of consistency although statistically significant heterogeneity was found for all-cause mortality. CONCLUSIONS Nordic military veterans had lower overall and cause-specific mortality than the general population for most outcomes, as expected given the predeployment selection process. Though uncommon, fatal traffic/transport accidents were an exception with no difference between deployed military veterans and the general population.
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Affiliation(s)
- Carl-Martin Pethrus
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | | | | | - Einar K Borud
- Norwegian Armed Forces Joint Medical Services, Oslo, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
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Strand LÅ, Rudvin I, Borud EK, Bøe HJ, Nordstrand AE, Fadum EA. Cause-Specific Mortality Among Norwegian Veterans Deployed to Afghanistan Between 2001 and 2019. Mil Med 2022; 188:usac075. [PMID: 35348722 DOI: 10.1093/milmed/usac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Norwegian military forces participated in the military campaign Operation Enduring Freedom in Afghanistan starting in 2001. Military personnel often show a "healthy soldier effect" in terms of lowered all-cause mortality when compared to the general population. However, military service in conflict areas is associated with an increased risk of death from external causes such as transport accidents and suicide after discharge. We aimed to investigate cause-specific mortality in a cohort of 9,192 Norwegian (7.5% women) veterans deployed to Afghanistan between 2001 and 2019. MATERIALS AND METHODS We followed cohort members from their first day of service in Afghanistan through 2019. We computed standardized mortality ratios (SMRs) with 95% CIs by comparing the observed number of deaths in our cohort with the expected number of deaths in the general population. Standardized mortality ratios were calculated for the full follow-up period among men and women separately, and among men only for two time periods: during deployment and after discharge from service in Afghanistan. RESULTS We observed 77 deaths (3 women and 74 men), 10 of which occurred during deployment (war casualties, 1 woman and 9 men); all others occurred after discharge. All-cause mortality in women did not differ from that in the general population (SMR = 0.52, 95% CI 0.11-1.53). For men, the observed all-cause mortality was lower than the expected rate for the full follow-up period (SMR = 0.55, 95% CI 0.43-0.69), during deployment, and after discharge, while deaths because of transport accidents after discharge (13 cases) were more than twice as high as expected rates (SMR = 2.36, 95% CI 1.26-4.04). The 11 observed suicides gave a nonstatistically significant, lower suicide risk compared to the expected rates (SMR = 0.66, 95% CI 0.33-1.18). CONCLUSION In accordance with the "healthy soldier effect," military service in Afghanistan was generally associated with a lower than expected risk of death both during deployment and after discharge. The risk of death from transport accidents was higher than expected after discharge, while the observed incidence of suicide did not differ from the expected rate in the general population.
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Affiliation(s)
- Leif Åge Strand
- Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Sessvollmoen N-2018, Norway
| | - Inger Rudvin
- Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Sessvollmoen N-2018, Norway
| | - Einar Kristian Borud
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø N-9019, Norway
| | - Hans Jakob Bøe
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, Oslo 0015, Norway
- Department of Psychology, University of Oslo, Oslo 0373, Norway
| | | | - Elin Anita Fadum
- Norwegian Armed Forces Joint Medical Services, Institute of Military Medicine and Epidemiology, Sessvollmoen N-2018, Norway
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Huseth-Zosel AL, Hammer KD. Risky Driving Behaviors for Older Adults: Differences by Veteran's Status. J Community Health 2018; 43:827-832. [PMID: 29478237 DOI: 10.1007/s10900-018-0489-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Veterans are at an increased risk of being injured or killed in motor vehicle crashes, potentially due to their proclivity to engage in risky driving behaviors. However, most research in this area has focused on driving behaviors of veterans who have recently returned home after deployment. No research has focused on risky driving behaviors of older veterans (aged 65 or older) and if risky driving behaviors extend beyond the time period immediately following return from deployment. The purpose of this research is to determine if differences exist in risky driving behaviors of veterans and non-veterans aged 65 or older. This study used data from the 2011 National Health and Aging Trend Study (NHATS), a nationally representative, longitudinal survey of community-dwelling, Medicare beneficiaries aged 65 or older. Binary logistic regression analyses were conducted in 2017 to determine if veteran's status was predictive of specific risky driving behaviors. Veteran's status was found to be predictive of specific driving behaviors for adults aged 65 and older, with non-veterans significantly more likely than veterans to: not currently drive; avoid driving at night; avoid driving alone; avoid driving on busy roads or highways; and avoid driving in bad weather. The results of this study highlight the need to further understand the effects of veteran's status on risky driving behaviors among older adults, specifically, whether veteran's status compounds driving-related risks associated with aging-related physical and mental changes.
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Affiliation(s)
- Andrea L Huseth-Zosel
- Department of Public Health, North Dakota State University, Dept. 2662, PO Box 6050, Fargo, ND, 58108-6050, USA.
| | - Kimberly D Hammer
- Research Service, Fargo VA Health Care System, 2101 North Elm Street, Fargo, ND, 58102, USA
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Patterns of zolpidem use among Iraq and Afghanistan veterans: A retrospective cohort analysis. PLoS One 2018; 13:e0190022. [PMID: 29360821 PMCID: PMC5779650 DOI: 10.1371/journal.pone.0190022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 12/06/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although concern exists regarding the adverse effects and rate of zolpidem use, especially long-term use, limited information is available concerning patterns of zolpidem use. OBJECTIVE To examine the prevalence and correlates of zolpidem exposure in Iraq and Afghanistan Veterans (IAVs). METHODS A retrospective cohort study of zolpidem prescriptions was performed with National Veterans Health Administration (VHA) data. We gathered national VA inpatient, outpatient, and pharmacy data files for IAV's who received VA care between fiscal years (FY) 2013 and 2014. The VA pharmacy database was used to identify the prevalence of long term (>30 days), high-dose zolpidem exposure (>10mg immediate-release; >12.5mg extended-release) and other medications received in FY14. Baseline characteristics (demographics, diagnoses) were identified in FY13. Bivariate and multivariable analyses were used to examine the demographic, clinical, and medication correlates of zolpidem use. RESULTS Of 493,683 IAVs who received VHA care in FY 2013 and 2014, 7.6% (n = 37,422) were prescribed zolpidem in FY 2014. Women had lower odds of high-dose zolpidem exposure than men. The majority (77.3%) of IAVs who received zolpidem prescriptions had long-term use with an average days' supply of 189.3 days and a minority (0.9%) had high-dose exposure. In multivariable analyses, factors associated with long-term zolpidem exposure included age greater than 29 years old, PTSD, insomnia, Selim Index, physical 2-3 conditions, opioids, antidepressants, benzodiazepines, atypical antipsychotics, and stimulants. High dose exposure was associated with PTSD, depression, substance use disorder, insomnia, benzodiazepines, atypical antipsychotics, and stimulant prescriptions. CONCLUSION The current practices of insomnia pharmacotherapy in IAVs fall short of the clinical guidelines and may reflect high-risk zolpidem prescribing practices that put Iraq and Afghanistan Veterans at risk for adverse effects of zolpidem and poor health outcomes.
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Bullman TA, Kang HK, Smolenski DJ, Skopp NA, Gahm GA, Reger MA. Risk of motor vehicle accident death among 1.3 million veterans of the Iraq and Afghanistan wars. TRAFFIC INJURY PREVENTION 2017; 18:369-374. [PMID: 27589092 DOI: 10.1080/15389588.2016.1206201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We conducted a cohort study of recent wartime veterans to determine the postservice mortality risk due to motor vehicle accidents (MVAs). METHODS Veterans were identified from the Defense Manpower Data Center records. Deployment to te Iraq or Afghanistan war zone was determined from the Contingency Tracking System. Vital status of 317,581 deployed and 964,493 nondeployed veterans was followed from their discharge dates between 2001 to 2007 until earlier of date of death or December 31, 2009. Underlying causes of death were obtained from the National Death Index Plus. RESULTS Based on 9,353 deaths (deployed, 1,650; nondeployed, 7,703), of which 779 were MVA deaths as drivers (166; 613), both cohorts had 25 to 24% lower mortality risk from all causes but had 44 to 45% higher risk of MVA deaths relative to the U.S. general population. The higher MVA mortality risk was not associated with deployment to the war zone. After controlling for age, sex, race, marital status, branch of service, and rank, the risk for deployed veterans was comparable to that of nondeployed veterans (hazard ratio = 0.91; 95% confidence interval, 0.77-1.09). CONCLUSIONS Veterans exhibit significantly higher risk of MVA deaths compared to the U.S. general population. However, deployment to the Iraq or Afghanistan war was not associated with the excess risk.
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Affiliation(s)
- Tim A Bullman
- a Office of Public Health , U.S. Department of Veterans Affairs , Washington , D.C
| | - Han K Kang
- b Institute for Clinical Research , Washington , D.C
| | - Derek J Smolenski
- c National Center for Telehealth and Technology , U.S. Department of the Army , Tacoma , Washington
| | - Nancy A Skopp
- c National Center for Telehealth and Technology , U.S. Department of the Army , Tacoma , Washington
| | - Gregory A Gahm
- c National Center for Telehealth and Technology , U.S. Department of the Army , Tacoma , Washington
| | - Mark A Reger
- c National Center for Telehealth and Technology , U.S. Department of the Army , Tacoma , Washington
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Strand LA, Martinsen JI, Fadum EA, Borud EK. External-cause mortality among 21 609 Norwegian male military peacekeepers deployed to Lebanon between 1978 and 1998. Occup Environ Med 2017; 74:573-577. [PMID: 28270446 DOI: 10.1136/oemed-2016-104170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/24/2017] [Accepted: 02/10/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate external-cause mortality among 21 609 Norwegian male military peacekeepers deployed to Lebanon during 1978-1998. METHODS The cohort was followed from the 1st day of deployment through 2013, and mortality during deployment and post discharge was assessed using SMRs calculated from national rates in Norway. Poisson regression was used to see the effect of high-conflict versus low-conflict exposure. RESULTS For the total cohort, external-cause mortality was within expected values during deployment (SMR=0.80) and post discharge (SMR=1.05). In the low-conflict exposure group, a lower mortality from all external causes (SMR=0.77), transport accidents (SMR=0.55) and accidental poisoning (SMR=0.53) was seen. The high-conflict exposure group showed an elevated mortality from all external causes (SMR=1.20), transport accidents (SMR=1.51) and suicide (SMR=1.30), but these risks were elevated only during the first 5 years after discharge. This group also showed elevated mortality from all external causes (rate ratio, RR=1.49), and for transport accidents (RR=3.30) when compared with the low-conflict exposure group. CONCLUSIONS Overall external-cause mortality among our peacekeepers was equal to national rates during deployment and post discharge. High-conflict exposure was associated with elevated mortality from all external causes, transport accidents and suicide during the first 5 years after discharge from service.
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Affiliation(s)
- Leif Aage Strand
- Institute of Military Epidemiology, Norwegian Armed Forces Medical Services, Sessvollmoen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | | | - Elin Anita Fadum
- Institute of Military Epidemiology, Norwegian Armed Forces Medical Services, Sessvollmoen, Norway.,Uit The Arctic University of Norway, Institute of Community Medicine, Tromsø, Norway
| | - Einar Kristian Borud
- Institute of Military Epidemiology, Norwegian Armed Forces Medical Services, Sessvollmoen, Norway.,Uit The Arctic University of Norway, Institute of Community Medicine, Tromsø, Norway
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Carlson KF, O’Neil ME, Forsberg CW, McAndrew LM, Storzbach D, Cifu DX, Sayer NA. Risk of hospitalization due to motor vehicle crashes among Iraq and Afghanistan War Veterans diagnosed with traumatic brain injury. NeuroRehabilitation 2016; 39:351-61. [DOI: 10.3233/nre-161367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kathleen F. Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, OR, USA
- School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Maya E. O’Neil
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, OR, USA
- Department of Psychiatry and Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
| | - Christopher W. Forsberg
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, OR, USA
| | - Lisa M. McAndrew
- Department of Educational and Counseling Psychology, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
- University at Albany, State University of New York, Albany, NY, USA
| | - Daniel Storzbach
- Neuropsychiatry Section, VA Portland Health Care System, Portland, OR, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - David X. Cifu
- Physical Medicine and Rehabilitation Services, Veterans Health Administration, Department ofVeterans Affairs, Washington, D.C., USA
- Physical Medicine and Rehabilitation Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Nina A. Sayer
- Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA
- Departments of Medicine and Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
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Regasa LE, Thomas DM, Gill RS, Marion DW, Ivins BJ. Military Deployment May Increase the Risk for Traumatic Brain Injury Following Deployment. J Head Trauma Rehabil 2016; 31:E28-35. [DOI: 10.1097/htr.0000000000000155] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bollinger MJ, Schmidt S, Pugh JA, Parsons HM, Copeland LA, Pugh MJ. Erosion of the healthy soldier effect in veterans of US military service in Iraq and Afghanistan. Popul Health Metr 2015; 13:8. [PMID: 25798075 PMCID: PMC4367975 DOI: 10.1186/s12963-015-0040-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 02/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background This research explores the healthy soldier effect (HSE) – a lower mortality risk among veterans relative to the general population—in United States (US) veterans deployed in support of operations in Iraq and Afghanistan (OEF/OIF/OND). While a HSE has been affirmed in other OEF/OIF/OND populations, US veterans of OEF/OIF/OND have not been systematically studied. Methods Using US Department of Veterans Affairs (VA) administrative data, we identified veterans who (1) had been deployed in support of OEF/OIF/OND between 2002 and 2011 and (2) were enrolled in the VA health care system. We divided the VA population into VA health care utilizers and non-utilizers. We obtained Department of Defense (DOD) administrative data on the OEF/OIF/OND population and obtained VA and DOD mortality data excluding combat deaths from the analyses. Indirect standardization was used to compare VA and DOD cohorts to the US population using total population at risk to compute the Standardized Mortality Ratio (SMR). A directly standardized relative risk (DSRR) was calculated to enable comparisons between cohorts. To compare VA enrollee mortality on military specific characteristics, we used a DOD population standard. Results The overall VA SMR of 2.8 (95% Confidence Interval [CI] 2.8-2.9), VA utilizer SMR of 3.2 (95% CI 3.1-3.3), VA non-utilizer SMR of 0.9 (95% CI 0.8-1.1), and DOD SMR of 1.5 (95% CI 1.4-1.5) provide no evidence of a HSE in any cohort relative to the US standard population. Relative to DOD, both the total VA population SMR of 2.1 (95% CI 2.0-2.2) and the SMR for VA utilizers of 2.3 (95% CI 2.3-2.4) indicate mortality twice what would be expected given DOD mortality rates. In contrast, the VA enrollees who had not used clinical services had 40% lower than expected mortality relative to DOD. Conclusions No support was found for the HSE among US veterans of OEF/OIF/OND. These findings may be attributable to a number of factors including post-deployment risk-taking behavior, an abbreviated follow up period, and the nature of the OEF/OIF/OND conflict.
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Affiliation(s)
- Mary J Bollinger
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, Texas USA ; Department of Medicine, Division of Hospital Medicine, University of Texas Health Science Center, San Antonio, Texas USA
| | - Susanne Schmidt
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, Texas USA
| | - Jacqueline A Pugh
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, Texas USA ; Department of Medicine, Division of Hospital Medicine, University of Texas Health Science Center, San Antonio, Texas USA
| | - Helen M Parsons
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, Texas USA
| | - Laurel A Copeland
- Central Texas Veterans Health Care System, Department of Veterans Affairs, 1901 Veterans Memorial Drive, Temple, Texas 76504 USA ; Center for Applied Health Research, Baylor Scott & White Health, 2102 Birdcreek Drive, Temple, Texas 76502 USA
| | - Mary Jo Pugh
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, Texas USA ; Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, Texas USA
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Phillips M, Bazrgari B, Shapiro R. The effects of military body armour on the lower back and knee mechanics during toe-touch and two-legged squat tasks. ERGONOMICS 2014; 58:492-503. [PMID: 25343226 DOI: 10.1080/00140139.2014.970589] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED While effective in the prevention of otherwise lethal injuries, military body armour (BA) has been suggested to reduce warfighter's performance and increase injury-related musculoskeletal conditions. Providing the significant role of joint biomechanics in both performance and risk of injury, the immediate and prolonged effects of wearing BA on biomechanics of the lower back and knee during toe-touch (TT) and two-legged squat (TLS) tasks were investigated. The immediate effects of BA were an increase of >40 ms (p ≤ 0.02) in flexion duration of the dominant joint and an ∼1 s (p ≤ 0.02) increase in overall task duration as well as an ∼18% (p = 0.03) decrease in the lumbopelvic rhythm ratio near the mid-range of trunk flexion. In general the prolonged duration of wearing BA (i.e. 45 min of walking) was not found to cause more changes in our measures than walking without BA. PRACTITIONER SUMMARY The effects of wearing military BA on biomechanics of the lower back and knee during TT and TLS tasks were investigated. The immediate effects of BA were increased flexion duration, increased overall trial duration and decreased lumbopelvic rhythm near the mid-range of trunk flexion.
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Affiliation(s)
- Megan Phillips
- a Department of Biomedical Engineering , University of Kentucky , Lexington , KY , USA
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Hoggatt KJ, Prescott MR, Goldmann E, Tamburrino M, Calabrese JR, Liberzon I, Galea S. The prevalence and correlates of risky driving behavior among National Guard soldiers. TRAFFIC INJURY PREVENTION 2014; 16:17-23. [PMID: 25260973 DOI: 10.1080/15389588.2014.896994] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Previous studies have reported that risky driving is associated with deployment and combat exposure in military populations, but there is limited research on risky driving among soldiers in the National Guard and Reserves, a group increasingly deployed to active international conflicts. The goal of this analysis was to assess the prevalence of risky driving and its demographic, mental health, and deployment-related correlates among members of the Ohio Army National Guard (OHARNG). METHODS The study group comprised 2,616 eligible OHARNG soldiers enlisted as of June 2008, or who enlisted between June 2008 and February 2009. The main outcome of interest was the prevalence of risky driving behavior assessed using six questions: "How often do you use seat belts when you drive or ride in a car?"; "In the past 30 days, how many times have you driven when you've had perhaps too much to drink?"; "In the past year, have you ever become impatient with a slow driver in the fast lane and passed them on the right?"; "In the past year have you crossed an intersection knowing that the traffic lights have already changed from yellow to red?"; "In the past year have you disregarded speed limits late at night or early in the morning?"; and "In the past year have you underestimated the speed of an oncoming vehicle when attempting to pass a vehicle in your own lane?" We fit multiple logistic regression models and derived the adjusted prevalence of risky driving behavior for soldiers with mental health conditions, deployment experience, exposure to combat or trauma, and psychosocial stressors or supports. RESULTS The prevalence of risky driving was higher in soldiers with a history of mental health conditions, deployment to a conflict area, deployment-related traumatic events, and combat or post-combat stressors. In contrast, the prevalence of risky driving was lower for soldiers who reported high levels of psychosocial support. CONCLUSIONS Efforts to mitigate risky driving in military populations may be more effective if they incorporate both targeted messages to remediate dangerous learned driving behaviors and psychosocial interventions to build resilience and address underlying stressors and mental health symptoms.
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Affiliation(s)
- Katherine J Hoggatt
- a VA Greater Los Angeles Healthcare System, VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP) , Sepulveda , California
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Newnam S, Collie A, Vogel AP, Keleher H. The impacts of injury at the individual, community and societal levels: a systematic meta-review. Public Health 2014; 128:587-618. [PMID: 25065515 DOI: 10.1016/j.puhe.2014.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 04/06/2014] [Accepted: 04/07/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Injury is a major public health problem. While the impacts of injury on the injured person are well documented, there is relatively little knowledge about the impacts of injury on those individuals and groups in the community connected to the injured person. This study seeks to describe this breadth of research using a meta-review methodology. STUDY DESIGN Systematic meta-review. METHODS To gain a better understanding of the known impacts of injury on family, community and society, a systematic meta-review of injury outcomes research literature was conducted. Seventy-eight peer-reviewed published literature reviews were included in the meta-review. RESULTS Of these, 70 reported outcomes at the level of the injured person including mortality, body functions, activity and participation limitations. Nine reviews reported impacts at the level of the community including impacts on family members, work colleagues and carers. Six studies reported impacts at the societal level including economic, health system and injury compensation system impacts. CONCLUSIONS In summary, the meta-review identified a substantial body of knowledge at the individual level outcomes of injury, and a relative lack of information regarding the community and societal impacts of injury. An injury outcome framework is proposed on the basis of the findings of the meta-review to guide future research activity, particularly with regard to injury outcome domains where there is currently limited evidence. A comprehensive framework that takes account of all levels of impact is necessary for effective policies, systems and strategies to support recovery following injury.
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Affiliation(s)
- S Newnam
- Monash Injury Research Institute (MIRI), Building 70, Monash University, VIC 3800, Australia.
| | - A Collie
- Institute for Safety, Compensation and Recovery Research (ISCRR), Level 11, 499 St Kilda Rd, Melbourne, VIC 3004, Australia; School of Public Health and Preventive Medicine, Monash University, Commercial Road, Prahran, VIC 3181, Australia.
| | - A P Vogel
- University of Melbourne, School of Health Sciences, 550 Swanston Street, Parkville, VIC 3010, Australia.
| | - H Keleher
- School of Public Health and Preventive Medicine, Monash University, Commercial Road, Prahran, VIC 3181, Australia.
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Combes RD. A critical review of anaesthetised animal models and alternatives for military research, testing and training, with a focus on blast damage, haemorrhage and resuscitation. Altern Lab Anim 2014; 41:385-415. [PMID: 24329746 DOI: 10.1177/026119291304100508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Military research, testing, and surgical and resuscitation training, are aimed at mitigating the consequences of warfare and terrorism to armed forces and civilians. Traumatisation and tissue damage due to explosions, and acute loss of blood due to haemorrhage, remain crucial, potentially preventable, causes of battlefield casualties and mortalities. There is also the additional threat from inhalation of chemical and aerosolised biological weapons. The use of anaesthetised animal models, and their respective replacement alternatives, for military purposes -- particularly for blast injury, haemorrhaging and resuscitation training -- is critically reviewed. Scientific problems with the animal models include the use of crude, uncontrolled and non-standardised methods for traumatisation, an inability to model all key trauma mechanisms, and complex modulating effects of general anaesthesia on target organ physiology. Such effects depend on the anaesthetic and influence the cardiovascular system, respiration, breathing, cerebral haemodynamics, neuroprotection, and the integrity of the blood-brain barrier. Some anaesthetics also bind to the NMDA brain receptor with possible differential consequences in control and anaesthetised animals. There is also some evidence for gender-specific effects. Despite the fact that these issues are widely known, there is little published information on their potential, at best, to complicate data interpretation and, at worst, to invalidate animal models. There is also a paucity of detail on the anaesthesiology used in studies, and this can hinder correct data evaluation. Welfare issues relate mainly to the possibility of acute pain as a side-effect of traumatisation in recovered animals. Moreover, there is the increased potential for animals to suffer when anaesthesia is temporary, and the procedures invasive. These dilemmas can be addressed, however, as a diverse range of replacement approaches exist, including computer and mathematical dynamic modelling of the human body, cadavers, interactive human patient simulators for training, in vitro techniques involving organotypic cultures of target organs, and epidemiological and clinical studies. While the first four of these have long proven useful for developing protective measures and predicting the consequences of trauma, and although many phenomena and their sequelae arising from different forms of trauma in vivo can be induced and reproduced in vitro, non-animal approaches require further development, and their validation and use need to be coordinated and harmonised. Recommendations to these ends are proposed, and the scientific and welfare problems associated with animal models are addressed, with the future focus being on the use of batteries of complementary replacement methods deployed in integrated strategies, and on greater transparency and scientific cooperation.
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17
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Johnston BD. What we know. Inj Prev 2013; 19:369. [PMID: 24264593 DOI: 10.1136/injuryprev-2013-041085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sheppard SC, Earleywine M. Using the unmatched count technique to improve base rate estimates of risky driving behaviours among veterans of the wars in Iraq and Afghanistan. Inj Prev 2013; 19:382-6. [PMID: 23407743 DOI: 10.1136/injuryprev-2012-040639] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Few studies have investigated base rate estimates of risky driving behaviours among veterans of the wars in Afghanistan and Iraq despite evidence suggesting such behaviours result in increased death rates. In addition, published estimates of driving behaviours may be subject to a significant response bias via the impact of perceived mental health stigma on honest self-reporting. AIM The present study compared the unmatched count technique, a form of randomised response technique used to mitigate biased responding, with traditional anonymous self-report to gain information about base rates of risky driving behaviours among combat veterans. METHODS Cross-sectional data gathered as part of a study of attitudes and behaviours related to military service provided estimates of target activities. Six facets of risky driving (horn honking, carrying firearms in the vehicle, drinking and driving, screaming at other drivers, following other drivers to complain, and tailgating) were assessed. RESULTS In our sample of 1351 combat veterans, the unmatched count technique revealed significantly higher rates relative to traditional anonymous assessment specifically for horn honking in anger (22.1% vs 13.6%), carrying firearms (51.1% vs 32.2%), and drinking and driving (77.8% vs 54.0%). There were no significant differences for the remaining three items. CONCLUSIONS The high level of morbidity associated with risky driving and motor vehicle crashes is a significant concern in the combat veteran population. These data suggest the presence of a strong response bias associated with endorsing certain risky driving behaviours, potentially leading to serious underestimation of these problem behaviours in standard anonymous questionnaires.
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Affiliation(s)
- Sean C Sheppard
- Department of Psychology, The University at Albany, State University of New York, , Albany, New York, USA
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Hannold M, Classen S, Winter S, Lanford DN, Levy CE. Exploratory pilot study of driving perceptions among OIF/OEF Veterans with mTBI and PTSD. ACTA ACUST UNITED AC 2013; 50:1315-30. [DOI: 10.1682/jrrd.2013.04.0084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/11/2013] [Indexed: 11/05/2022]
Affiliation(s)
| | - M. Hannold
- Rehabilitation Outcomes Research Center, Research Enhancement Award Program, North Florida/South Georgia (NF/SG) Department of Veterans Affairs Health System (VAHS), Gainesville, FL
| | | | - Sandra Winter
- Rehabilitation Outcomes Research Center, Research Enhancement Award Program, North Florida/South Georgia (NF/SG) Department of Veterans Affairs Health System (VAHS), Gainesville, FL
| | | | - Charles E. Levy
- Rehabilitation Outcomes Research Center, Research Enhancement Award Program, North Florida/South Georgia (NF/SG) Department of Veterans Affairs Health System (VAHS), Gainesville, FL
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Knapik J, Spiess A, Grier T, Sharp M, Lester M, Marin R, Jones B. Injuries before and after deployments to Afghanistan and Iraq. Public Health 2012; 126:498-506. [DOI: 10.1016/j.puhe.2012.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 08/30/2011] [Accepted: 01/24/2012] [Indexed: 11/29/2022]
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Effects of combat deployment on risky and self-destructive behavior among active duty military personnel. J Psychiatr Res 2011; 45:1321-31. [PMID: 21549392 DOI: 10.1016/j.jpsychires.2011.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 02/25/2011] [Accepted: 04/07/2011] [Indexed: 11/22/2022]
Abstract
Although research has documented negative effects of combat deployment on mental health, few studies have examined whether deployment increases risky or self-destructive behavior. The present study addressed this issue. In addition, we examined whether deployment effects on risky behavior varied depending on history of pre-deployment risky behavior, and assessed whether psychiatric conditions mediated effects of deployment on risky behavior. In an anonymous survey, active duty members of the U.S. Marine Corps and U.S. Navy (N = 2116) described their deployment experiences and their participation in risky recreational activities, unprotected sex, illegal drug use, self-injurious behavior, and suicide attempts during three time frames (civilian, military pre-deployment, and military post-deployment). Respondents also reported whether they had problems with depression, anxiety, or PTSD during the same three time frames. Results revealed that risky behavior was much more common in civilian than in military life, with personnel who had not deployed, compared to those who had deployed, reporting more risky behavior and more psychiatric problems as civilians. For the current time period, in contrast, personnel who had deployed (versus never deployed) were significantly more likely to report both risky behavior and psychiatric problems. Importantly, deployment was associated with increases in risky behavior only for personnel with a pre-deployment history of engaging in risky behavior. Although psychiatric conditions were associated with higher levels of risky behavior, psychiatric problems did not mediate associations between deployment and risky behavior. Implications for understanding effects of combat deployment on active duty personnel and directions for future research are discussed.
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Abstract
Suicide is an important public health problem in the demographic group that forms the bulk of military populations, namely young and middle-aged men. Suicide in the military also has special significance: certain aspects of military service can lead to serious mental disorders that increase the risk of suicidal behaviour. Moreover, military organizations have control over a broad range of factors (notably the direct delivery of mental health care) that could mitigate suicide risk. This article will review the literature on suicide risk in military organizations to answer the important question: Are military personnel at increased risk for suicide? Next, Mann et al.'s (2005) model for specific suicide preventive interventions in civilian settings will be reviewed and then expanded, with an emphasis on identifying special opportunities for suicide prevention in military organizations, including: 1) organizational interventions to mitigate work stress; 2) selection, resilience training, and risk factor reduction; 3) interventions to overcome barriers to care; and 4) systematic quality improvement efforts in mental health care. Finally, the evidence behind comprehensive suicide prevention programmes will be reviewed, with a special focus on the US Air Force's benchmark programme.
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Affiliation(s)
- Mark A Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, 1745 Alta Vista Drive, Ottawa, Ontario, Canada.
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