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MacGregor AJ, Dougherty AL, Crouch DJ, Dye JL. Sex Differences in Screening Positive for Post-Traumatic Stress Disorder After Combat Injury. Mil Med 2024:usae050. [PMID: 38771005 DOI: 10.1093/milmed/usae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/08/2023] [Accepted: 02/21/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION U.S. military women were at risk of combat exposure and injury from asymmetric warfare during the conflicts in Iraq and Afghanistan. Previous research has yielded mixed results when examining sex differences in PTSD following operational deployment. To date, no study has explored sex differences in PTSD after combat injury. MATERIALS AND METHODS This retrospective study included U.S. military service men and women who experienced a combat injury in Iraq or Afghanistan (March 2003 to March 2013) and completed a Post-Deployment Health Assessment (PDHA) within 1 year of injury. The PDHA is administered at the end of deployment and includes the 4-item Primary Care PTSD Screen. The prevalence of screening positive for PTSD was evaluated by sex using a chi-square test. Multivariable logistic regression was used to assess the association between sex and PTSD while adjusting for covariates. RESULTS The study sample included 16,215 injured military personnel (666 women and 15,549 men). The average time between injury and PDHA was 132 days (SD = 91.0). Overall, women had a higher prevalence of screening positive for PTSD than men (48.3% vs. 40.9%, P < .001). In multivariable regression, women had higher odds than men of screening positive for PTSD (odds ratio, 1.34; 95% confidence interval, 1.14-1.57). Psychiatric history was the strongest predictor of screening positive for PTSD regardless of sex (odds ratio, 1.59; 95% confidence interval, 1.45-1.74). CONCLUSIONS In this novel study of military service members, women were more likely to screen positive for PTSD than men after combat injury. Strategies to mitigate PTSD, enhance resiliency, and incorporate psychological care into injury rehabilitation programs for women may be needed for future U.S. military conflicts where they will play a larger role in combat operations.
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Affiliation(s)
- Andrew J MacGregor
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
| | - Amber L Dougherty
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, Inc., San Diego, CA 92106, USA
| | - Daniel J Crouch
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
| | - Judy L Dye
- Epidemiology and Data Management Support, Naval Health Research Center, San Diego, CA 92106, USA
- Leidos, Inc., San Diego, CA 92106, USA
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Kearns NT, Trachik B, Fawver B, Osgood J, Dretsch MN. Alcohol motivations associated with frequency of alcohol use, binge drinking, and alcohol problems among active duty junior enlisted soldiers and non-commissioned officers. Alcohol 2024; 115:23-31. [PMID: 37684009 DOI: 10.1016/j.alcohol.2023.09.001] [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: 05/10/2023] [Revised: 08/15/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
Problematic alcohol use is a serious threat to the behavioral health of active-duty Service Members (ADSM), resulting in numerous calls from governmental agencies to better understand mechanistic factors contributing to alcohol misuse within the military. Alcohol use motives are reliable predictors of alcohol-related behaviors and are considered malleable targets for prevention and intervention efforts. However, empirical research indicates that drinking motives vary across contextually distinct populations. Although some research has been conducted among veteran and reservist populations, limited work has been specifically focused on ADSM and no research has evaluated motives and alcohol metrics among ADSM based on military rank. Participants for the current study included 682 ADSM recruited from a large military installation in the U.S. Structural equation modeling evaluated associations between four drinking motives (i.e., enhancement, social, conformity, coping) and three alcohol misuse metrics (i.e., alcohol frequency, binge frequency, alcohol problems). Three models were evaluated: one full (combined) model and two separate models based on military rank - junior enlisted (i.e., E1-E4) and non-commissioned officers (NCOs) (i.e., E5-E9). Results for junior enlisted ADSM indicated that coping and enhancement motives were most strongly associated with all alcohol misuse metrics. However, among NCOs, results indicated that alcohol problems were only associated with coping motives. Notably, results also indicated that alcohol use motives accounted for substantively more variance across all alcohol-related metrics among NCOs. Findings generally support extant military-related literature indicating use of alcohol for coping (e.g., with anxiety) as the motivation most consistently associated with increased alcohol misuse. However, novel findings highlight enhancement motives - using alcohol to attain some positive internal reward - as another, often stronger, motivation impacting alcohol use outcomes. Further, findings highlight notable distinctions between alcohol use motives (i.e., coping vs. enhancement) and the impact of alcohol use motives (i.e., effect size) on alcohol metrics between junior enlisted and NCOs.
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Affiliation(s)
- Nathan T Kearns
- Walter Reed Army Institute of Research - West (WRAIR-W), 9933A W. Johnson St., Joint Base Lewis-McChord, Washington, United States.
| | - Benjamin Trachik
- Walter Reed Army Institute of Research - West (WRAIR-W), 9933A W. Johnson St., Joint Base Lewis-McChord, Washington, United States
| | - Bradley Fawver
- Walter Reed Army Institute of Research - West (WRAIR-W), 9933A W. Johnson St., Joint Base Lewis-McChord, Washington, United States
| | - Jeffrey Osgood
- Walter Reed Army Institute of Research - West (WRAIR-W), 9933A W. Johnson St., Joint Base Lewis-McChord, Washington, United States
| | - Michael N Dretsch
- Walter Reed Army Institute of Research - West (WRAIR-W), 9933A W. Johnson St., Joint Base Lewis-McChord, Washington, United States
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Lee YJ, Palmer J, Cline AC, Lee H. Factors Influencing the Health Care Utilization Among People With Depression and/or Anxiety Symptoms. J Am Psychiatr Nurses Assoc 2023:10783903231197655. [PMID: 37724452 PMCID: PMC10988633 DOI: 10.1177/10783903231197655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND This analysis aimed to examine the factors predictive of service utilization among patients with anxiety and/or depression. Quick and appropriate treatment for anxiety and depression can reduce disease burden and improve social functioning. Currently, less than half of the population with comorbid anxiety and depression receives the recommended treatment. AIMS This analysis aims to identify factors predictive of utilizing mental health treatment for those with anxiety and/or depression by analyzing intrinsic, patient-centered factors. METHOD This study is a cross-sectional cohort analysis using National Health Interview Survey (NHIS) 2019 data. The sample size is 7,156 adults aged 18 to 64 with family incomes ≤100% of the federal poverty level. We used multivariate logistic regression analysis to identify factors predictive of care utilization in this population. Variables of interest include scores on Patient Health Questionnaire-8 (PHQ-8) and Generalized Anxiety Disorder-7 (GAD-7), service utilization, level of social functioning, having a usual source for care, and previous mental health care utilization. Additional covariates were age, gender, race, country of origin, education, marital status, and insurance coverage. RESULTS Twenty-one percent of respondents reported using mental health services. Factors predictive of care utilization were older age, female gender, limited social functioning, having a usual source of care, and insurance coverage. CONCLUSION There are significant barriers to receiving quick and appropriate care for anxiety and/or depression. Strategies should focus on reducing barriers for young adults, men, and the uninsured/underinsured. Strategies for integrating mental health services into primary care could increase the percentage of people with anxiety and/or depression who receive services.
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Affiliation(s)
- Young Ji Lee
- Young Ji Lee, PhD, MSN, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Josh Palmer
- Joshua Palmer, DNP, PMHNP-BC, RN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Alice Curtis Cline
- Alice Curtis Cline, MSN, CNM. PhD, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Heeyoung Lee
- Heeyoung Lee, PhD, PMHNP-BC, FAAN, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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Dean FM, Beymer MR, Schaughency KCL, Kaplansky GF, Allman MWR, Anke KM. Cross-Sectional Examination of Physical Abuse Victimization Differences Between Lesbian, Gay, Bisexual, and Heterosexual Service Members in the U.S. Military, 2018. LGBT Health 2023; 10:S70-S78. [PMID: 37754919 DOI: 10.1089/lgbt.2023.0122] [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] [Indexed: 09/28/2023] Open
Abstract
Purpose: The primary objective was to analyze the association between sexual orientation and physical abuse victimization using a representative sample from the U.S. active-duty military population. The secondary objective was to determine if differences exist by sexual orientation in perceived barriers (e.g., stigma) to mental health care utilization among physical abuse victimization survivors. Methods: The 2018 Department of Defense Health Related Behaviors Survey (HRBS) (n = 17,166 active-duty respondents) was used for analysis. Weighted logistic regressions and Poisson regressions were used for multivariable analyses, controlling for demographic and military variables. Results: Approximately 93.7% of respondents identified as heterosexual or straight, 2.3% identified as gay or lesbian, and 4% as bisexual. Bisexual active-duty service members had 1.5-fold greater odds of reporting any form of physical abuse victimization (adjusted odds ratio: 1.50 and 95% confidence interval: 1.07-2.10). However, there was no difference observed between gay/lesbian and heterosexual service members for physical abuse victimization. Among survivors of physical abuse victimization, bisexual (p = 0.0038) and gay (p < 0.0001) service members were more likely to report more than one mental health care barrier compared to their heterosexual counterparts. Conclusions: Bisexual service members were more likely to experience physical abuse victimization when compared to their heterosexual counterparts. In addition, gay and bisexual survivors of physical abuse were more likely to experience barriers to mental health care. Tailored interventions should explore strategies to prevent victimization and disparities in mental health care utilization by sexual orientation.
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Affiliation(s)
- Frances M Dean
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, The University of Michigan, Ann Arbor, Michigan, USA
- School of Social Work, The University of Michigan, Ann Arbor, Michigan, USA
- Division of Behavioral and Social Health Outcomes Practice (BSHOP), Defense Centers for Public Health-Aberdeen, Defense Health Agency, Aberdeen Proving Ground, Maryland, USA
| | - Matthew R Beymer
- Division of Behavioral and Social Health Outcomes Practice (BSHOP), Defense Centers for Public Health-Aberdeen, Defense Health Agency, Aberdeen Proving Ground, Maryland, USA
| | - Katherine C L Schaughency
- Division of Behavioral and Social Health Outcomes Practice (BSHOP), Defense Centers for Public Health-Aberdeen, Defense Health Agency, Aberdeen Proving Ground, Maryland, USA
- Headquarters of the Department of the Army, Army Resilience Directorate, Arlington, Virginia, USA
| | - Gabrielle F Kaplansky
- Division of Behavioral and Social Health Outcomes Practice (BSHOP), Defense Centers for Public Health-Aberdeen, Defense Health Agency, Aberdeen Proving Ground, Maryland, USA
- General Dynamics Information Technology, Reston, Virginia, USA
| | - Matthew W R Allman
- Disease Epidemiology Program, Defense Centers for Public Health-Aberdeen, Defense Health Agency, Aberdeen Proving Ground, Maryland, USA
- Cherokee Nation Strategic Programs, Tulsa, Oklahoma, USA
| | - Kirsten M Anke
- Division of Behavioral and Social Health Outcomes Practice (BSHOP), Defense Centers for Public Health-Aberdeen, Defense Health Agency, Aberdeen Proving Ground, Maryland, USA
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Grimm CJ, de Terte I, Hodgetts D, Kearney S. Narratives of holistic mental health recovery in New Zealand Defence Force personnel. MILITARY PSYCHOLOGY 2023:1-11. [PMID: 37643328 DOI: 10.1080/08995605.2023.2250708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
Research on military mental health recovery has tended to focus on therapy outcomes while backgrounding the role of diverse healing influences. The New Zealand Defence Force (NZDF) is a bicultural military integrated with Māori customs and cultural perspectives on holistic health and wellbeing. This study used narrative analysis to examine the semi-structured interviews of 21 active duty NZDF personnel who had accessed mental healthcare to understand what factors contributed to their return to wellness. Narratives described an orientation toward recovery as a process, where many interrelated wellbeing and social factors together supported the return to health. Culturally available Māori wellbeing metaphors were adopted as heuristics by service members in their storying of growth and healing. Findings are considered in terms of how wellbeing and recovery are conceptualized and promoted within militaries with diverse cultures. Discussion focuses on how narratives within military institutions can promote resilience and support service member recovery from mental distress.
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Affiliation(s)
- Carsten James Grimm
- Directorate of Health, New Zealand Defence Force, Wellington, New Zealand
- School of Psychology, Manawatu Campus, Massey University, Palmerston North, New Zealand
| | - Ian de Terte
- School of Psychology, Wellington Campus, Massey University, Wellington, New Zealand
| | - Darrin Hodgetts
- School of Psychology, Albany Campus, Massey University, Auckland, New Zealand
| | - Stephen Kearney
- Directorate of Health, New Zealand Defence Force, Wellington, New Zealand
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Clifton DR, Nelson DA, Sammy Choi Y, Edgeworth D, Shell D, Deuster PA. Financial Impact of Embedded Injury-Prevention Experts in US Army Initial Entry Training. J Athl Train 2023; 58:511-518. [PMID: 36583956 PMCID: PMC10496456 DOI: 10.4085/1062-6050-0353.22] [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] [Indexed: 12/31/2022]
Abstract
CONTEXT The US Army embedded injury-prevention experts (IPEs), specifically athletic trainers and strength and conditioning coaches, into initial entry training (IET) to limit musculoskeletal (MSK) conditions and their negative consequences. However, little is known about the financial impact of IPEs. OBJECTIVE To assess whether IPEs were associated with fewer sunk training costs due to MSK-related early discharges from service. DESIGN Retrospective cohort study. SETTING Database of US Army soldiers' administrative, medical, and readiness records. PATIENTS OR OTHER PARTICIPANTS A total of 198 166 soldiers (age = 20.7 ± 3.2 years, body mass index = 24.4 ± 3.5 kg/m2) who began IET during 2014 to 2017. MAIN OUTCOME MEASURE(S) Early discharge from service was defined as occurring within 6 months of beginning IET. All IET sites employed IPEs from 2011 to 2017, except for 2 sites during April to November 2015. Soldiers who began IET at these 2 sites during these times were categorized as not having IPE exposure. All others were categorized as having IPE exposure. The unadjusted association between IPE access and MSK-related early discharge from service was assessed using logistic regression. Financial impact was assessed by quantifying differences in yearly sunk costs between groups with and those without IPE exposure and subtracting IPE hiring costs. RESULTS Among 14 094 soldiers without IPE exposure, 2.77% were discharged early for MSK-related reasons. Among 184 072 soldiers with IPE exposure, 1.01% were discharged. Exposure to IPEs was associated with reduced odds of MSK-related early discharge (odds ratio = 0.36, 95% CI = 0.32, 0.40, P < .001) and a decrease in yearly sunk training costs of $11.19 to $20.00 million. CONCLUSIONS Employing IPEs was associated with reduced sunk costs because of fewer soldiers being discharged from service early for MSK-related reasons. Evidence-based recommendations should be developed for guiding policy on the roles and responsibilities of IPEs in the military to reduce negative outcomes from MSK conditions and generate a positive return on investment.
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Affiliation(s)
- Daniel R. Clifton
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
- Womack Army Medical Center, Fort Bragg, NC
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | - D. Alan Nelson
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
- Womack Army Medical Center, Fort Bragg, NC
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | | | - Daniel Edgeworth
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
- Womack Army Medical Center, Fort Bragg, NC
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD
| | - Donald Shell
- Health Services Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Defense Health Headquarters, Falls Church, VA
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
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Hitch C, Toner P, Armour C. Enablers and barriers to military veterans seeking help for mental health and alcohol difficulties: A systematic review of the quantitative evidence. J Health Serv Res Policy 2023:13558196221149930. [PMID: 36636855 PMCID: PMC10363942 DOI: 10.1177/13558196221149930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Research exploring the enablers and barriers that exist for military veterans seeking to address their poor mental health has produced ambiguous results. To identify the enablers and barriers correctly, this study systematically reviews the literature, including research that included alcohol and had a clearly defined veteran population. METHODS Six databases were searched. Inclusion criteria specified that empirical studies related to veterans that had ceased military service and were seeking help for poor mental health and/or alcohol difficulties. Critical Appraisal Skills Programme and AXIS appraisal tools were used to assess quality and bias. A narrative synthesis approach was adopted for analysis. From 2044 studies screened, 12 were included featuring 5501 participants. RESULTS Forty-four enablers and barriers were identified, with thirty-two being statistically significant. Post-traumatic stress disorder had the greatest number of enabler/barrier endorsements to veterans seeking help. Depression, anxiety, experience and attitudes also acted as enablers/barriers. Most studies were of fair methodological quality. Limitations included that samples were skewed towards US army veterans. Little research exists concerning those that have ceased military service. CONCLUSIONS Veteran help-seeking is likely enabled by poor mental health symptomology and comorbidity, which suggests veterans reach a crisis point before they seek help. Further research on alcohol misuse and attitude formation is required. The field would also benefit from alternative study designs including qualitative studies with non-US participants.
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Affiliation(s)
- Catherine Hitch
- Stress Trauma and Related Conditions (STARC) Research Lab, School of Psychology, 1596Queen's University Belfast, Northern Ireland, UK
| | - Paul Toner
- School of Psychology, 1596Queen's University Belfast, Northern Ireland, UK
| | - Cherie Armour
- Stress Trauma and Related Conditions (STARC) Research Lab, School of Psychology, 1596Queen's University Belfast, Northern Ireland, UK
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Wallace J, Osmotherly P, Gabbett T, Spratford W, Niyonsenga T, Newman P. A Validated Injury Surveillance and Monitoring Tool for Fast Jet Aircrew: Translating Sports Medicine Paradigms to a Military Population. SPORTS MEDICINE - OPEN 2022; 8:92. [PMID: 35841441 PMCID: PMC9288569 DOI: 10.1186/s40798-022-00484-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
Background Military populations, including fast jet aircrew (FJA - aka fighter aircrew/pilots), commonly suffer from musculoskeletal complaints, which reduce performance and operational capability. Valid surveillance tools and agreed recordable injury definitions are lacking. Our objective was to develop and then evaluate the validity of a musculoskeletal complaints surveillance and monitoring tool for FJA. Methods A Delphi study with international experts sought consensus on recordable injury definitions and important content for use in a surveillance and monitoring tool for FJA. Using these results and feedback from end-users (FJA), the University of Canberra Fast Jet Aircrew Musculoskeletal Questionnaire (UC-FJAMQ) was developed. Following its use with 306 Royal Australian Air Force (RAAF) FJA over 4 × five-month reporting periods, validity of the UC-FJAMQ was evaluated via multi-level factor analysis (MFA) and compared with routine methods of injury surveillance. Results Consensus was achieved for: eight words/descriptors for defining a musculoskeletal complaint; six definitions of recordable injury; and 14 domains important for determining overall severity. The UC-FJAMQ was developed and refined. MFA identified three distinct dimensions within the 11 items used to determine severity: operational capability, symptoms, and care-seeking. MFA further highlighted that symptom severity and seeking medical attention were poor indicators of the impact musculoskeletal complaints have upon operational capability. One hundred and fifty-two episodes of time loss were identified, with the UC-FJAMQ identifying 79% of these, while routine methods identified 49%. Despite modest weekly reporting rates (61%), the UC-FJAMQ outperformed routine surveillance methods. Conclusions The UC-FJAMQ was developed to specifically address the complexities of injury surveillance with FJA, which are similar to those noted in other military and sporting populations. The results demonstrated the UC-FJAMQ to be sensitive and valid within a large group of FJA over 4 × five-month reporting periods. Adoption of consistent, sensitive, and valid surveillance methods will strengthen the FJA injury prevention literature, ultimately enhancing their health, performance, and operational capability. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00484-1.
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Russell PD, Judkins JL, Blessing A, Moore B, Morissette SB. Incidences of anxiety disorders among active duty service members between 1999 and 2018. J Anxiety Disord 2022; 91:102608. [PMID: 36029531 DOI: 10.1016/j.janxdis.2022.102608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 05/11/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Anxiety disorders can impact the health, performance, and retention of military service members. To inform prevention initiatives and long-term treatment planning, incidence rates across anxiety disorders were evaluated among U.S. active-duty service members over a 20-year period. METHOD Data were extracted from the Defense Medical Epidemiological Database to examine incidence rates of generalized anxiety disorder (GAD), panic disorder (PD), agoraphobia (AG), social anxiety disorder (SAD), obsessive compulsive disorder (OCD), agoraphobia with panic disorder (AWPD), agoraphobia without history of panic disorder (AWOPD), and unspecified anxiety disorder (UAD) among 151,844 service members between 1999 and 2018 in relation to sex, age, race, marital status, military pay grade, service branch. RESULTS Incidence rates of anxiety disorders increased significantly over the 20-year period. Anxiety disorder incidence rates ranged widely from 0.01 to 23.70 (per 1000 service members). There were significant differences in observed versus expected diagnostic rates across all demographic variables examined (p < 0.001). CONCLUSION Incidence rates varied considerably across the anxiety disorders, with UAD being the highest. These data highlight the importance of health care professionals attending to anxiety disorders, in order to plan for service member needs, develop preventative interventions, address early detection, and deliver treatments to improve combat readiness.
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Affiliation(s)
- Patricia D Russell
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
| | - Jason L Judkins
- United States Army Research Institute of Environmental Medicine, 10 General Greene Ave., Natick, MA 01760, USA
| | - Alexis Blessing
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Brian Moore
- Department of Psychological Science, Kennesaw State University, 1000 Chastain Road NW, Kennesaw, GA 30144, USA
| | - Sandra B Morissette
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
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Born J, Frank C. The relative impact of barriers to care among military health services personnel: exploring differences using context specific scenarios. BMC Health Serv Res 2022; 22:607. [PMID: 35524306 PMCID: PMC9074225 DOI: 10.1186/s12913-022-07850-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Military health care providers often under access both physical and mental health care, yet research has predominantly focused on barriers to mental health care. This study explored a comprehensive set of barriers using hypothetical scenarios to quantify barrier impact on access to both mental and physical health care. Methods Canadian military health services personnel (N = 1033) completed one of two electronic surveys (assessing either physical health or other mental health barriers) that captured participant’s demographics, health, endorsement of barriers, intent to seek care, and whether the respondent would access care in different health scenarios (pneumonia, back injury, depression and post-traumatic stress disorder). Logistic regression was used to calculate odds of not accessing care (versus accessing care) for each of the four health scenarios. Results All barrier factors independently predicted increased odds of not accessing care for all four scenarios. When entered into an adjusted model none of the barrier factors significantly predicted accessing care in the physical health scenarios. Staffing and workload resources and Treatment preferences (e.g., self-treat) were significant predictors of accessing care in the mental health scenarios. Weak general intentions to access care was the strongest predictors of not accessing care across all four scenarios. Conclusions The impact of barriers on hypothetical care-seeking behaviour differs depending on the context for which one is accessing care, with access to resources and preference to self-treat driving mental health care seeking. Intent appears to be the most impactful predictor of accessing care potentially mediating the effect of other barrier types on care seeking. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07850-5.
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Affiliation(s)
- Jennifer Born
- Director General Military Personnel Research and Analysis, Department of National Defence, National Defence Headquarters, 101 Colonel By Drive, Ottawa, ON, K1A 0K2, Canada.
| | - Christine Frank
- Director General Military Personnel Research and Analysis, Department of National Defence, National Defence Headquarters, 101 Colonel By Drive, Ottawa, ON, K1A 0K2, Canada
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Campbell M, Auchterlonie JL, Andris Z, Cooper DC, Hoyt T. Mental Health Stigma in Department of Defense Policies: Analysis, Recommendations, and Outcomes. Mil Med 2021; 188:e1171-e1177. [PMID: 34791390 DOI: 10.1093/milmed/usab471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/11/2021] [Accepted: 10/27/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Mental health stigma is one of the most frequently reported barriers to mental health help-seeking in the military. Previous research has identified that stigma-increasing language in the United States military policies was a potential deterrent to treatment-seeking. In response to a 2016 Government Accountability Office report recommendation, the current study conducted a comprehensive review of Department of Defense and military service-specific policies to identify stigmatizing language provisions and recommend appropriate language changes. METHODS This review of policies comprised three sequential phases. First, a key-term search strategy was conducted on mental health (Phase 1) and substance misuse policies (Phase 2) to identify language that may contribute to stigma. Recommended language changes were identified, and the results of each phase were briefed to service-level Directors of Psychological Health. Approximately three years after initial identification, all mental health policies from Phase 1 for which language change recommendations had been made were examined to determine whether or not recommended changes had been incorporated (Phase 3). RESULTS Out of 285 mental health and substance misuse policies, 191 (67%) contained potentially stigmatizing language. Subsequent review of implementation showed that partial or full recommended language changes had been made in 58.9% of 129 mental health-related policies that had been re-issued. CONCLUSIONS This collaborative effort to identify and modify potentially stigmatizing language contributed to a substantial reduction in problematic policies across the military services. Future efforts should focus on reviewing new and re-issued policies to ensure that stigma-increasing language is not present as part of routine issuance. These efforts are part of ongoing work to address the association that language and terminology have on stigma and barriers to care.
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Affiliation(s)
- Marjorie Campbell
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD 20910, USA
| | - Jennifer L Auchterlonie
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD 20910, USA
| | - Zoe Andris
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD 20910, USA
| | - Denise C Cooper
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD 20910, USA
| | - Tim Hoyt
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, MD 20910, USA
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Fikretoglu D, Sharp ML, Adler AB, Bélanger S, Benassi H, Bennett C, Bryant R, Busuttil W, Cramm H, Fear N, Greenberg N, Heber A, Hosseiny F, Hoge CW, Jetly R, McFarlane A, Morganstein J, Murphy D, O'Donnell M, Phelps A, Richardson DJ, Sadler N, Schnurr PP, Smith P, Ursano R, Hooff MV, Wessely S, Forbes D, Pedlar D. Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective. Clin Psychol Rev 2021; 91:102100. [PMID: 34871868 DOI: 10.1016/j.cpr.2021.102100] [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] [Received: 04/30/2021] [Revised: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022]
Abstract
Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the past six years to update and broaden the discussion on pathways to mental healthcare in military populations. We find that at a broad population level, there is improvement in several indicators of mental health care access, with greater gains in initial engagement, time to first treatment contact, and subjective satisfaction with care, and smaller gains in objective indicators of adequacy of care. Among individual-level barriers to care-seeking, there is progress in improving recognition of need for care and reducing stigma concerns. Among organizational-level barriers, there are advances in availability of services and cultural acceptance of care-seeking. Other barriers, such as concerns around confidentiality, career impact, and deployability persist, however, and may account for some remaining unmet need. To address these barriers, new initiatives that are more evidence-based, theoretically-driven, and culturally-sensitive, are therefore needed, and must be rigorously evaluated to ensure they bring about additional improvements in pathways to care.
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Affiliation(s)
- Deniz Fikretoglu
- Defence Research and Development Canada, 1133 Sheppard Ave. West, Toronto, ON, Canada.
| | | | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | | | | | | | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | | | | | | | - Fardous Hosseiny
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rakesh Jetly
- Department of National Defence, Ottawa, ON, Canada
| | | | | | - Dominic Murphy
- Combat Stress, Leatherhead, Surrey, UK; King's College London, London, UK
| | - Meaghan O'Donnell
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Andrea Phelps
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Don J Richardson
- Parkwood Institute- St. Joseph's Health Care London, London, ON, Canada
| | - Nicole Sadler
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | | | - Patrick Smith
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | | | - Miranda Van Hooff
- Military and Emergency Services Health Australia (MESHA), Woodville, SA, Australia
| | | | - David Forbes
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - David Pedlar
- Canadian Institute for Military and Veteran Health Research, Queen's University, Kingston, ON, Canada
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Roche R, Manzi J, Bard K. A Patient-Centered Study Examining Self-Identification of Mental Health Challenges Among Female Military Officers. J Patient Cent Res Rev 2021; 8:134-139. [PMID: 33898646 PMCID: PMC8060039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Due to the expansion of leadership roles in the military for women, female military personnel now face stressors equal to, and yet unique from, their male counterparts. This pilot study surveyed 73 female U.S. Army officers regarding their experiences of leadership and mental wellness within the military. A mixed-methods survey was distributed via 2 private Facebook groups for female Army officers following an anonymized convenience sampling. This anonymous, patient-centered protocol was used to protect against known stigma surrounding disclosing mental health concerns in the military. Respondents were asked a series of questions including perceived mental health status and access to behavioral health services. Most respondents reported feelings of stress related to their roles as officers (86.6%). Self-reported feelings of anxiety (83.6%) and depression (65.7%) were high. In contrast, only 30.1% had ever received a formal diagnosis of anxiety or depression by a mental health professional. Our survey confirmed a large percentage, 65.7% of respondents, reported avoiding mental/behavioral health services. Female military officers are able to recognize their feelings as symptoms of anxiety and depression; however, many take active steps to hide these symptoms from their family members and senior officers and avoid seeking professional care.
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Affiliation(s)
- Rosellen Roche
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Joel Manzi
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Katelyn Bard
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
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Kyron MJ, Rikkers W, Bartlett J, Renehan E, Hafekost K, Baigent M, Cunneen R, Lawrence D. Mental health and wellbeing of Australian police and emergency services employees. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2021; 77:282-292. [PMID: 33653231 DOI: 10.1080/19338244.2021.1893631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Answering the Call, the Australian National Police and Emergency Services Mental Health and Wellbeing Study, surveyed 14,868 Australian ambulance, fire and rescue, police, and state emergency service employees. Emergency services personnel had lower rates of mental wellbeing and higher rates of psychological distress and probable PTSD than the general adult population. Overall 30% had low wellbeing, 21% had high and 9% had very high psychological distress, and 10% had probable PTSD. An estimated 5% had suicidal ideation and 2% had a suicide plan in the past 12 months, while 16% binge drink at least weekly. Only one in five of those with very high psychological distress or probable PTSD felt they received adequate support for their condition. These findings highlight the risk of mental health conditions associated with work in the emergency services sector.
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Affiliation(s)
- Michael J Kyron
- Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Wavne Rikkers
- Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Jennifer Bartlett
- Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Katherine Hafekost
- Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Rebecca Cunneen
- Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
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Theal R, Kerin JL, Romaniuk M. Psychosocial Outcomes of Australian Male and Female Veterans Following Participation in Peer-Led Adventure-Based Therapy. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i2.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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