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Aurora P, Paquette CE, Beckham JC, Pugh MJ, Kimbrel NA, Calhoun PS. Mental health treatment utilization among Gulf War era veterans with probable alcohol use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209295. [PMID: 38272121 PMCID: PMC11060892 DOI: 10.1016/j.josat.2024.209295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/17/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Alcohol use disorder (AUD) is prevalent among veterans, and excessive alcohol use is associated with significant mental and physical health consequences. Currently, the largest cohort of veterans seeking services at the VA are those from the 1990s Gulf War Era. This cohort of veterans is unique due to the nature of their deployment resulting in a myriad of unexplained symptoms collectively known as "Gulf War Illness" and higher rates of mental health problems. The present study sought to examine the association between probable AUD and mental health treatment utilization in a sample of 1126 (882 male) Gulf War-era veterans. METHODS Veterans completed a self-report survey including the AUDIT-C, questions about mental health treatment engagement, and demographic questions. RESULTS Results demonstrated that approximately 20 % of the sample screened positive for probable AUD, determined by standard AUDIT-C cutoff scores. Among those screening positive for AUD, 25 % reported engaging in mental health treatment in the past year. Veterans with probable AUD who use VA care had 3.8 times the odds of receiving mental health services than veterans not using VA care. Use of mental health services was associated with mental health comorbidity and identifying as Black/African American. CONCLUSIONS The results of the present study highlight a significant unmet need for mental health treatment among Gulf War-era veterans with AUD.
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Affiliation(s)
- Pallavi Aurora
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.
| | - Catherine E Paquette
- Durham VA Health Care System, Durham, NC, USA; Department of Psychology and Neuroscience, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Jean C Beckham
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Mary Jo Pugh
- School of Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA; VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Nathan A Kimbrel
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S Calhoun
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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Sun X, Tan J, Chen Y, Liu Y, Dong GH, Yang BY, Li N, Wang L, Li S, Chen G, Guo Y. The association between long-term exposure to outdoor artificial light at night and poor sleep quality among Chinese veterans: A multi-city study. Int J Hyg Environ Health 2023; 252:114218. [PMID: 37429120 DOI: 10.1016/j.ijheh.2023.114218] [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: 01/03/2023] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND A handful of previous studies have reported the association between exposure to outdoor artificial light at night (ALAN) and sleep problems. However, evidence for such association is limited in low- and middle-income countries. This study aimed to examine the association between outdoor ALAN exposure and sleep quality in veterans across different regions of China. METHODS Within the network of the Chinese Veteran Clinical Research Platform, we selected 7258 participants from 277 veteran communities in 18 cities across China during December 2009 and December 2011, using a multi-stage stratified cluster sampling strategy. Face-to-face interviews with the participants were conducted by trained investigators. We used the Pittsburgh Sleep Quality Index (PSQI) to assess participants' sleep quality. We defined poor sleep quality as a PSQI global score >7. The 3-year average exposure to outdoor ALAN prior to the baseline interview was calculated using satellite imagery data, according to participants' geolocation information. The association of ALAN exposure with sleep quality was examined using the mixed-effects logistic regression models with natural cubic splines. RESULTS The exposure-response curve for sleep quality associated with ALAN exposure was nonlinear, with a threshold value of 49.20 nW/cm2/sr for the 3-year average exposure to outdoor ALAN prior to the baseline interview. Higher ALAN exposure above the threshold was associated with increased risk of poor sleep quality. After adjusting for potential confounders, the odds ratios (and 95%CI, 95% confidence intervals) were 1.15 (0.97, 1.36) and 1.45 (1.17, 1.78) at the 75th and 95th percentiles of ALAN against the threshold. The association of ALAN exposure with poor sleep quality was more pronounced in veterans with depression than those without. Higher OR of poor sleep quality at the 75th percentile of ALAN against the threshold was observed in veterans with depression than those without [2.09 (1.16, 3.76) vs. 1.09 (0.92, 1.30)]. CONCLUSIONS Long-term exposure to outdoor ALAN was associated with higher risk of poor sleep quality in Chinese veterans. Effective outdoor ALAN management may help to reduce the burden of sleep disorders in Chinese veterans.
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Affiliation(s)
- Xinyi Sun
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jiping Tan
- Geriatric Neurology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100039, China
| | - Yan Chen
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yuewei Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Guang-Hui Dong
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China
| | - Luning Wang
- Geriatric Neurology Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100039, China
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Gongbo Chen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
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Patel TA, Mann AJ, Nomamiukor FO, Blakey SM, Calhoun PS, Beckham JC, Pugh MJ, Kimbrel NA. Correlates and clinical associations of military sexual assault in Gulf War era U.S. veterans: Findings from a national sample. J Trauma Stress 2022; 35:1240-1251. [PMID: 35355332 PMCID: PMC9357137 DOI: 10.1002/jts.22825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/18/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022]
Abstract
Military sexual assault (MSA) is a prevalent issue among military personnel that can have direct implications on postmilitary mental health. Gulf War era U.S. veterans represent the first cohort in which women veterans were integrated into most aspects of military service except for combat. The present study sought to build on prior studies by identifying characteristics associated with the occurrence of MSA and clinical correlates of MSA and examining how these differ between men and women. This study analyzed cross-sectional survey data from a national sample of treatment-seeking Gulf War era veterans. Participants (N = 1,153) reported demographic information, clinical outcomes, military background, and history of MSA. MSA was more common among female veterans (n = 100, 41.3%) than male veterans (n = 32, 3.6%). The odds of experiencing MSA were approximately 19 times higher for female veterans relative to their male peers, OR = 18.92, p < .001. Moreover, as expected, MSA was robustly associated with probable current posttraumatic stress disorder, probable current depression, and past-year suicidal ideation in female veterans, whereas combat exposure was robustly associated with these sequelae in male veterans. The present findings confirm that a large proportion of female veterans from the Gulf War era experienced MSA and highlight the deleterious correlates of MSA on veterans' mental health. Sex differences of correlates of MSA and subsequent clinical associations are highlighted.
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Affiliation(s)
- Tapan A. Patel
- Florida State University, Department of Psychology, Tallahassee, Florida, USA
| | - Adam J. Mann
- University of Toledo, Department of Psychology, Toledo, Ohio, USA
| | - Faith O. Nomamiukor
- University of North Carolina at Greensboro, Department of Psychology, Greensboro, North Carolina, USA
| | - Shannon M. Blakey
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, USA,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, USA,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina, USA
| | - Jean C. Beckham
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, USA,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina, USA
| | - Mary J. Pugh
- Informatics Decision-Enhancement and Analytic Center of Innovation, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA,University of Utah, School of Medicine, Department of Medicine, Salt Lake City, Utah, USA
| | - Nathan A. Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina, USA,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA,VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA,Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina, USA
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Blakey SM, Griffin SC, Grove JL, Peter SC, Levi RD, Calhoun PS, Elbogen EB, Beckham JC, Pugh MJ, Kimbrel NA. Comparing psychosocial functioning, suicide risk, and nonsuicidal self-injury between veterans with probable posttraumatic stress disorder and alcohol use disorder. J Affect Disord 2022; 308:10-18. [PMID: 35398395 PMCID: PMC9133145 DOI: 10.1016/j.jad.2022.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/19/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are each common among Unites States (U.S.) military veterans and frequently co-occur (i.e., PTSD+AUD). Although comorbid PTSD+AUD is generally associated with worse outcomes relative to either diagnosis alone, some studies suggest the added burden of comorbid PTSD+AUD is greater relative to AUD-alone than to PTSD-alone. Furthermore, nonsuicidal self-injury (NSSI) is more common among veterans than previously thought but rarely measured as a veteran psychiatric health outcome. This study sought to replicate and extend previous work by comparing psychosocial functioning, suicide risk, and NSSI among veterans screening positive for PTSD, AUD, comorbid PTSD+AUD, and neither disorder. METHODS This study analyzed data from a national sample of N = 1046 U.S. veterans who had served during the Gulf War. Participants self-reported sociodemographic, functioning, and clinical information through a mailed survey. RESULTS Veterans with probable PTSD+AUD reported worse psychosocial functioning across multiple domains compared to veterans with probable AUD, but only worse functioning related to controlling violent behavior when compared to veterans with probable PTSD. Veterans with probable PTSD+AUD reported greater suicidal ideation and NSSI than veterans with probable AUD, but fewer prior suicide attempts than veterans with probable PTSD. LIMITATIONS This study was cross-sectional, relied on self-report, did not verify clinical diagnoses, and may not generalize to veterans of other military conflicts. CONCLUSIONS Findings underscore the adverse psychiatric and functional outcomes associated with PTSD and comorbid PTSD+AUD, such as NSSI, and highlight the importance of delivering evidence-based treatment to this veteran population.
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Affiliation(s)
- Shannon M. Blakey
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,RTI International; Research Triangle Park, NC,Corresponding Author: Shannon M. Blakey, PhD, RTI International, 3040 E. Cornwallis Rd, Research Triangle Park, NC 27709, Phone: 919-485-5427, Fax: 919-416-8033,
| | - Sarah C. Griffin
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC
| | - Jeremy L. Grove
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC
| | | | | | - Patrick S. Calhoun
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC
| | - Eric B. Elbogen
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC,VA National Center on Homelessness Among Veterans; Tampa, FL
| | - Jean C. Beckham
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC
| | - Mary J. Pugh
- VA Salt Lake City Healthcare System, Salt Lake City; UT,University of Utah School of Medicine Department of Medicine; Salt Lake City, UT
| | - Nathan A. Kimbrel
- Durham VA Health Care System; Durham, NC,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center; Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC
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Health-Related Quality of Life by Gulf War Illness Case Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084425. [PMID: 35457293 PMCID: PMC9026791 DOI: 10.3390/ijerph19084425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 12/02/2022]
Abstract
This study examines how health-related quality of life (HRQOL) and related indices vary by Gulf War illness (GWI) case status. The study population included veterans from the Gulf War Era Cohort and Biorepository (n = 1116). Outcomes were physical and mental health from the Veterans RAND 12 and depression, post-traumatic stress (PTSD), sleep disturbance, and pain. Kansas (KS) and Centers for Disease Control and Prevention (CDC) GWI definitions were used. Kansas GWI derived subtypes included GWI (met symptom criteria; no exclusionary conditions (KS GWI: Sym+/Dx−)) and those without GWI: KS noncase (1): Sym+/Dx+, KS noncase (2): Sym−/Dx+, and noncase (3): Sym−/Dx−. CDC-derived subtypes included CDC GWI severe, CDC GWI mild-to-moderate and CDC noncases. Case status and outcomes were examined using multivariable regression adjusted for sociodemographic and military-related characteristics. Logistic regression analysis was used to examine associations between GWI case status and binary measures for depression, PTSD, and severe pain. The KS GWI: Sym+/Dx− and KS noncase (1): Sym+/Dx+ groups had worse mental and physical HRQOL outcomes than veterans in the KS noncase (2): Sym−/Dx+ and KS noncase (3): Sym−/Dx− groups (ps < 0.001). Individuals who met the CDC GWI severe criteria had worse mental and physical HRQOL outcomes than those meeting the CDC GWI mild-to-moderate or CDC noncases (ps < 0.001). For other outcomes, results followed a similar pattern. Relative to the less symptomatic comparison subtypes, veterans who met the Kansas symptom criteria, regardless of exclusionary conditions, and those who met the CDC GWI severe criteria experienced lower HRQOL and higher rates of depression, PTSD, and severe pain.
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6
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Lim ICZY, Tam WWS, Chudzicka-Czupała A, McIntyre RS, Teopiz KM, Ho RC, Ho CSH. Prevalence of depression, anxiety and post-traumatic stress in war- and conflict-afflicted areas: A meta-analysis. Front Psychiatry 2022; 13:978703. [PMID: 36186881 PMCID: PMC9524230 DOI: 10.3389/fpsyt.2022.978703] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With the rise of fragility, conflict and violence (FCV), understanding the prevalence and risk factors associated with mental disorders is beneficial to direct aid to vulnerable groups. To better understand mental disorders depending on the population and the timeframe, we performed a systematic review to investigate the aggregate prevalence of depression, anxiety and post-traumatic stress symptoms among both civilian and military population exposed to war. METHODS We used MEDLINE (PubMed), Web of Science, PsycINFO, and Embase to identify studies published from inception or 1-Jan, 1945 (whichever earlier), to 31-May, 2022, to reporting on the prevalence of depression, anxiety and post-traumatic stress symptoms using structured clinical interviews and validated questionnaires as well as variables known to be associated with prevalence to perform meta-regression. We then used random-effects bivariate meta-analysis models to estimate the aggregate prevalence rate. RESULTS The aggregate prevalence of depression, anxiety and post-traumatic stress during times of conflict or war were 28.9, 30.7, and 23.5%, respectively. Our results indicate a significant difference in the levels of depression and anxiety, but not post-traumatic stress, between the civilian group and the military group respectively (depression 34.7 vs 21.1%, p < 0.001; anxiety 38.6 vs 16.2%, p < 0.001; post-traumatic stress: 25.7 vs 21.3%, p = 0.256). The aggregate prevalence of depression during the wars was 38.7% (95% CI: 30.0-48.3, I 2 = 98.1%), while the aggregate prevalence of depression post-wars was 29.1% (95% CI: 24.7-33.9, I 2 = 99.2%). The aggregate prevalence of anxiety during the wars was 43.4% (95% CI: 27.5-60.7, I 2 = 98.6%), while the aggregate prevalence of anxiety post-wars was 30.3% (95% CI: 24.5-36.9, I 2 = 99.2%). The subgroup analysis showed significant difference in prevalence of depression, and anxiety between the civilians and military group (p < 0.001). CONCLUSION The aggregate prevalence of depression, anxiety and post-traumatic stress in populations experiencing FCV are 28.9, 30.7, and 23.5%, respectively. There is a significant difference in prevalence of depression and anxiety between civilians and the military personnels. Our results show that there is a significant difference in the prevalence of depression and anxiety among individuals in areas affected by FCV during the wars compared to after the wars. Overall, these results highlight that mental health in times of conflict is a public health issue that cannot be ignored, and that appropriate aid made available to at risk populations can reduce the prevalence of psychiatric symptoms during time of FCV. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=337486, Identifier 337486.
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Affiliation(s)
- Isis Claire Z Y Lim
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wilson W S Tam
- Alice Lee School of Nursing, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Braxia Scientific Corp., Toronto, ON, Canada
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Psychological Medicine, National University Health System, Singapore, Singapore
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7
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Toomey R, Alpern RE, Reda DJ, Baker DG, Vasterling JJ, Blanchard MS, Eisen SA. A cohort study of neuropsychological functioning in spouses of U.S. Gulf War veterans. Life Sci 2021; 284:119894. [PMID: 34450171 DOI: 10.1016/j.lfs.2021.119894] [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: 02/28/2021] [Revised: 08/01/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
AIMS Veterans of the 1991 Gulf War reported symptoms in their spouses that mirrored veterans' symptoms following their return from the war, including problems with attention and memory. Neuropsychological functioning in these spouses has not been examined with objective tests. This study sought to determine if these spouses exhibited deficits in neuropsychological functioning. MAIN METHODS Spouses of a national cohort of 1991 Gulf War deployed (n = 470) and non-deployed veterans (n = 524) were examined with neuropsychological tests in 1999-2001. KEY FINDINGS Neuropsychological tests were factor analyzed yielding five factors: verbal memory, visual memory, attention/working memory, visual organization, and motor speed. Spouses of deployed and nondeployed veterans did not differ on mean factor scores, percentage of impaired factors, or individual test scores. Spouse attention/working memory was related to their having diagnoses of PTSD or anxiety disorders, or self-reported symptoms of current anxiety. Spouse visual memory was related to a diagnosis of current depression. Spouse motor speed was related to their own status of having chronic multisymptom illness (CMI). SIGNIFICANCE Spouses of Gulf War deployed and nondeployed veterans demonstrated similar neuropsychological functioning, although spouses with psychiatric diagnoses and symptoms, or CMI demonstrated neuropsychological impairments characteristic of those conditions, suggesting that monitoring spouses for these conditions and impairments may be warranted. This pattern of relative weaknesses mirrors some of the previously reported findings for Gulf War veterans, although the veterans displayed neuropsychological impairments beyond what was accounted for by these conditions.
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Affiliation(s)
- Rosemary Toomey
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Renee E Alpern
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Domenic J Reda
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Dewleen G Baker
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; VA Center of Excellence for Stress and Mental Health and VA San Diego Healthcare System, San Diego, CA, USA
| | - Jennifer J Vasterling
- Department of Psychiatry, School of Medicine, Boston University, Boston, MA, USA; National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | | | - Seth A Eisen
- School of Medicine, Washington University, St. Louis, MO, USA
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8
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Blakey SM, Halverson TF, Evans MK, Patel TA, Hair LP, Meyer EC, DeBeer BB, Beckham JC, Pugh MJ, Calhoun PS, Kimbrel NA. Experiential avoidance is associated with medical and mental health diagnoses in a national sample of deployed Gulf War veterans. J Psychiatr Res 2021; 142:17-24. [PMID: 34314990 PMCID: PMC8429252 DOI: 10.1016/j.jpsychires.2021.07.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/17/2021] [Accepted: 07/21/2021] [Indexed: 12/14/2022]
Abstract
A substantial minority of deployed Gulf War veterans developed posttraumatic stress disorder (PTSD), depression, and several chronic illnesses. Although military combat and exposure to certain nuclear, biological, and chemical agents (NBCs) increase risk for post-deployment health problems, they do not fully explain many Gulf War veteran health diagnoses and are not viable treatment targets. Experiential avoidance (EA; one's unwillingness to remain in contact with unpleasant internal experiences) is a modifiable psychosocial risk factor associated with PTSD and depression in veterans as well as pain and gastrointestinal diseases in the general population. In this study, we recruited a national sample of deployed Gulf War veterans (N = 454) to test the hypothesis that greater EA would be significantly associated with higher lifetime odds of PTSD, depression, "Gulf War Illness" (GWI/CMI), and other chronic illnesses common in this veteran cohort. Participants completed a self-report battery assessing demographic, military-related, and health-related information. Multivariate analyses showed that after adjusting for age, sex, race, combat exposure, and NBC exposure, worse EA was associated with higher lifetime odds of PTSD, depression GWI/CMI, gastrointestinal problems, irritable bowel syndrome, arthritis, fibromyalgia, and chronic fatigue syndrome (ORs ranged 1.25 to 2.89; effect sizes ranged small to large), but not asthma or chronic obstructive pulmonary disease. Our findings suggest medical and mental health providers alike should assess for EA and potentially target EA as part of a comprehensive, biopsychosocial approach to improving Gulf War veterans' health and wellbeing. Study limitations and future research directions are also discussed.
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Affiliation(s)
- Shannon M Blakey
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA.
| | - Tate F Halverson
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
| | - Mariah K Evans
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Tapan A Patel
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
| | - Lauren P Hair
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Eric C Meyer
- University of Pittsburgh Department of Rehabilitation Science and Technology, 4028 Forbes Tower, Pittsburgh, PA, 15260, USA.
| | - Bryann B DeBeer
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center, 1700 N Wheeling St, G-3-116M, Aurora, CO, 80045, USA; Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, 12631 E 17th Ave, Aurora, CO, 80045, USA.
| | - Jean C Beckham
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Mary J Pugh
- VA Salt Lake City Healthcare System, 500 Foothill Dr, Salt Lake City, UT, 84148, USA; University of Utah School of Medicine Department of Medicine, 30 N. 1900 E, Salt Lake City, UT, 84132, USA.
| | - Patrick S Calhoun
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
| | - Nathan A Kimbrel
- Durham VA Health Care System, 508 Fulton Street, Durham, NC, 27705, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3022 Croasdaile Dr., Durham, NC, 27705, USA; Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3625, Durham, NC, 27710, USA.
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9
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Physical health, behavioral and emotional functioning in children of gulf war veterans. Life Sci 2021; 282:119777. [PMID: 34197885 DOI: 10.1016/j.lfs.2021.119777] [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: 02/27/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We examined whether the prevalence of medical and behavioral conditions is higher in children of deployed veterans (DVs) versus non-deployed veterans (NDVs) after the 1991 Gulf War. METHODS We examined 1387 children of 737 veterans. Children ages 2-18 had physical exams and parental reports of physical history and behavior. RESULTS Physical health was analyzed using GEE models. Behavioral health [total, internalizing, and externalizing behavior problems (TBP, IBP, EBP)] was analyzed with mixed-effects regression models. Analyses were conducted by age group (2-3, 4-11, 12-18), and gender (ages 4-11, 12-18). Children of DVs ages 2-3 had significantly worse dentition (13.9% vs. 4.8%, P = 0.03) and more EBP {least square means (lsmeans) 54.31 vs. 47.59, P = 0.02}. Children of DVs ages 4-11 had significantly more obesity (18.8% vs. 12.7%, P = 0.02). Among children 4-11, male children of DVs had significantly more TBP (lsmeans 70.68 vs. 57.34, P = 0.003), IBP (lsmeans 63.59 vs. 56.16, P = 0.002) and EBP (lsmeans 61.60 vs. 52.93, P = 0.03), but female children did not. For children ages 12-18, male children of DVs had more EBP (lsmeans 63.73 vs. 43.51, P = 0.008), while female children of DVs had fewer EBP (lsmeans 45.50 vs. 50.48, P = 0.02). Veteran military characteristics and mental health, and children's social status and health, including obesity, predicted children's TBP for one or more age groups. CONCLUSIONS Children of DVs experienced worse dentition, greater obesity, and more behavioral problems compared to NDV children, suggesting adverse health effects associated with parental deployment in need of further exploration.
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Bullman T, Schneiderman A, Dursa E. Cause-specific mortality risks among U.S. veterans: 25 years after their service in the 1990-1991 gulf war. Ann Epidemiol 2021; 57:1-6. [PMID: 33581241 DOI: 10.1016/j.annepidem.2021.01.005] [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: 09/15/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE There is concern about adverse health effects related to military service in the 1990-1991 Gulf War. This study assessed cause-specific mortality risks among Veterans who served in the war. METHODS The mortality of 621,244 veterans deployed to the Gulf War was compared to that of 745,704 Veterans who served during the war but were not deployed to the Gulf Theater. Cause-specific mortality of both deployed and nondeployed was also compared to that of the US general population. RESULTS There was no increased risk of disease-specific mortality among deployed Veterans compared to nondeployed. Deployed Veterans did have an increased risk of motor vehicle deaths compared to nondeployed Veterans, (hazard ratio, 1.12, 95% confidence interval, 1.04-1.21). Cause-specific mortality of both deployed and non-deployed Veterans was less than that of the US population. When stratified by gender, only female Veterans, both deployed and nondeployed, had increased risks of suicide compared to the female US population (standardized mortality ratio, 1.40; 95% confidence interval, 1.13-1.71 and standardized mortality ratio, 1.22; 95% confidence interval, 1.05-1.40, respectively). CONCLUSION There was no increased risk of disease mortality among Veterans of the 1990-1991 Gulf War. Both deployed and nondeployed female Veterans had increased risks of suicide compared to US female population.
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Affiliation(s)
- Tim Bullman
- Post Deployment Health Services, US Department of Veterans Affairs, Washington DC.
| | - Aaron Schneiderman
- Post Deployment Health Services, US Department of Veterans Affairs, Washington DC
| | - Erin Dursa
- Post Deployment Health Services, US Department of Veterans Affairs, Washington DC
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Quaglietti S. Creating a Hope Narrative for Veterans in Recovery Using Photography and Written Expression. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2020. [DOI: 10.1080/15401383.2020.1783415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Shahini M, Rescorla LA, Shala M, Ukshini S. Living on the Edge: Emotional and Behavioral Problems in a Sample of Kosovar Veterans and Wives of Veterans 16 Years Postwar. Front Psychiatry 2019; 10:598. [PMID: 31572226 PMCID: PMC6753182 DOI: 10.3389/fpsyt.2019.00598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/29/2019] [Indexed: 11/18/2022] Open
Abstract
Aim: This study aimed to explore the effects of war traumatic exposure on emotional and behavioral problems in a sample of Kosovar war veterans and the wives of veterans 16 years after the 1998-1999 war, as well as whether the level of education, income, well-being, and substance use are predictors for emotional and behavioral problems. Methods: Self-report data were obtained from 373 adults, 247 male war veterans (66.2% of the sample) and 126 wives of other male war veterans (33.8% of the sample). The sample was recruited from a list of war veterans provided by the Kosovar National Association of War Veterans. The mean age of participants was 45.42 [standard deviation (SD), 7.64] years. Measurements comprised a sociodemographic brief structured interview, the Well-Being Index (WHO-5), the Harvard Trauma Questionnaire, and the Adult Self Report (ASR). Logistic regression analysis was conducted to explore if the demographic variables were predictors for ASR general scales and subscales. Multivariate analysis of covariance was performed by adding as covariates the continuous variables pointed out in the logistic regression analysis as discriminating factors between the groups. Post hoc analyses were corrected, and we estimated partial η2 to measure the effect size. Results: The higher traumatic exposure during the war, the greater the tendency to have emotional problems and behavioral problems for both kinds of participants. The result showed that there were no differences on the prevalence of emotional and behavioral problems between the two groups, and both veterans and wives of veterans had no differences on seeking professional help for their emotional and behavioral problems. Wives of veterans living in rural areas showed higher scores on almost all ASR scales compared with those living in urban areas or even with those of veterans from urban and rural areas. Veterans with elementary education level had the highest scores compared with other groups. Veterans with poor well-being had the highest scores compared with other groups. Using Internalizing, Externalizing, and Total Problems as outcome variables and trauma exposure, smoking, drinking alcohol, and well-being as predictors, we found that the model was a significant predictor for both male and female participants on these three scales. Conclusion: The relationship found between the level of exposure to traumatic events and emotional and behavior problems, as well as the factors that moderated such relations, in war veterans and their wives, should help global mental health researchers address the contextual dimensions of this relationship and identify better ways to prevent and treat those problems.
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Affiliation(s)
- Mimoza Shahini
- Department of Psychiatry, University Clinical Center of Kosovo, Pristina, Kosovo
| | - Leslie A. Rescorla
- Department of Psychology, Bryn Mawr College, Bryn Mawr, PA, United States
| | - Merita Shala
- Department of Education, Mitrovica University, Mitrovica, Kosovo
| | - Shqipe Ukshini
- Department of Psychology, University Clinical Center of Kosovo, Pristina, Kosovo
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Toomey R, Alpern R, Reda DJ, Baker DG, Vasterling JJ, Blanchard M, Eisen SA. Mental health in spouses of U.S. Gulf War veterans. Psychiatry Res 2019; 275:287-295. [PMID: 30953873 DOI: 10.1016/j.psychres.2019.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 11/27/2022]
Abstract
Veterans' spouses are at risk for mental distress and substance use. We examined long term psychological functioning in spouses from a national cohort of 1991 Gulf War era veterans. From clinical interviews, spouses of deployed veterans (n = 488) did not have a greater prevalence of post-war mental disorders compared to spouses of non-deployed veterans (n = 536); however, in couples that were living together since the war, there was an increased risk of anxiety disorders or any one disorder. On questionnaires, the impact varied but was most consistently observed in more severe depression and greater functional impairment in spouses of deployed compared to non-deployed veterans. If a veteran developed post-war anxious/depressive disorders or any one mental disorder, the matched spouse was more likely to develop post-war anxious/depressive disorders or any one mental disorder, respectively. Veteran combat exposure did not similarly increase the risk of spouse post-war mental disorders. Greater spouse self-reported symptomatology was observed in spouses of veterans with anxious/depressive disorders even when controlling for deployment. In summary, the war conferred greater risk for spouse mental disorders and distress for spouses of veterans with mental health disorders, with some increased risk for spouses of deployed veterans, especially in couples together since the war.
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Affiliation(s)
- Rosemary Toomey
- Department of Psychological and Brain Sciences, College of Arts and Sciences, Boston University, 900 Commonwealth Ave., Boston, MA, USA.
| | - Renee Alpern
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Domenic J Reda
- Cooperative Study Program Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Dewleen G Baker
- VA Center of Excellence for Stress and Mental Health and VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Jennifer J Vasterling
- National Center for PTSD and Psychology Service, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts, USA
| | | | - Seth A Eisen
- School of Medicine, Washington University, St. Louis, MO, USA
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Farizatto KLG, Almeida MF, Long RT, Bahr BA. Early Synaptic Alterations and Selective Adhesion Signaling in Hippocampal Dendritic Zones Following Organophosphate Exposure. Sci Rep 2019; 9:6532. [PMID: 31024077 PMCID: PMC6484076 DOI: 10.1038/s41598-019-42934-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/11/2019] [Indexed: 11/09/2022] Open
Abstract
Organophosphates account for many of the world's deadliest poisons. They inhibit acetylcholinesterase causing cholinergic crises that lead to seizures and death, while survivors commonly experience long-term neurological problems. Here, we treated brain explants with the organophosphate compound paraoxon and uncovered a unique mechanism of neurotoxicity. Paraoxon-exposed hippocampal slice cultures exhibited progressive declines in synaptophysin, synapsin II, and PSD-95, whereas reduction in GluR1 was slower and NeuN and Nissl staining showed no indications of neuronal damage. The distinctive synaptotoxicity was observed in dendritic zones of CA1 and dentate gyrus. Interestingly, declines in synapsin II dendritic labeling correlated with increased staining for β1 integrin, a component of adhesion receptors that regulate synapse maintenance and plasticity. The paraoxon-induced β1 integrin response was targeted to synapses, and the two-fold increase in β1 integrin was selective as other synaptic adhesion molecules were unchanged. Additionally, β1 integrin-cofilin signaling was triggered by the exposure and correlations were found between the extent of synaptic decline and the level of β1 integrin responses. These findings identified organophosphate-mediated early and lasting synaptotoxicity which can explain delayed neurological dysfunction later in life. They also suggest that the interplay between synaptotoxic events and compensatory adhesion responses influences neuronal fate in exposed individuals.
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Affiliation(s)
- Karen L G Farizatto
- Biotechnology Research and Training Center, University of North Carolina-Pembroke, Pembroke, North Carolina, USA
| | - Michael F Almeida
- Biotechnology Research and Training Center, University of North Carolina-Pembroke, Pembroke, North Carolina, USA
| | - Ronald T Long
- Biotechnology Research and Training Center, University of North Carolina-Pembroke, Pembroke, North Carolina, USA.,Department of Biology, University of North Carolina-Pembroke, Pembroke, North Carolina, USA
| | - Ben A Bahr
- Biotechnology Research and Training Center, University of North Carolina-Pembroke, Pembroke, North Carolina, USA. .,Department of Biology, University of North Carolina-Pembroke, Pembroke, North Carolina, USA. .,Department of Chemistry and Physics, University of North Carolina-Pembroke, Pembroke, North Carolina, USA.
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15
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Pruitt LD, Smolenski DJ, Bush NE, Tucker J, Issa F, Hoyt TV, Reger MA. Suicide in the Military: Understanding Rates and Risk Factors Across the United States’ Armed Forces. Mil Med 2019; 184:432-437. [PMID: 30423136 DOI: 10.1093/milmed/usy296] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/04/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
This paper presents data from the United States Department of Defense Suicide Event Report System for years 2012–2015 to detail descriptive, longitudinal rate data and risk factor profiles associated with military suicide. The annual findings were aggregated from all U.S. military suicide deaths and suicide attempts. Data elements included the most common method of suicide (firearms), most common behavioral health diagnoses (substance abuse/dependence), common life stressors (failed intimate–partner relationships), and an individual’s history of operational deployment. Age- and sex-adjusted rates for the Services were compared with rates for the U.S. adult population. Results showed that the current reporting period (2015) is similar to patterns that have been observed over the preceding years and to patterns reported in the overall U.S. adult population. Suicide rates remain elevated but stable for both the Active and Reserve Components of the Military Services compared to historical levels observed prior to 2003. Finally, we discuss common errors and misinterpretations that can occur when analyzing surveillance data.
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Affiliation(s)
- Larry D Pruitt
- Psychological Health Center of Excellence, Defense Health Agency (J-9), 1335 East-West Hwy Suite 900, Silver Spring, MD
| | - Derek J Smolenski
- Psychological Health Center of Excellence, Defense Health Agency (J-9), 1335 East-West Hwy Suite 900, Silver Spring, MD
| | - Nigel E Bush
- Psychological Health Center of Excellence, Defense Health Agency (J-9), 1335 East-West Hwy Suite 900, Silver Spring, MD
| | - Jennifer Tucker
- Psychological Health Center of Excellence, Defense Health Agency (J-9), 1335 East-West Hwy Suite 900, Silver Spring, MD
| | - Fuad Issa
- Psychological Health Center of Excellence, Defense Health Agency (J-9), 1335 East-West Hwy Suite 900, Silver Spring, MD
| | - Timothy V Hoyt
- Connected Health Branch, Defense Health Agency (J-3), 9933 West Hayes Street, Box 339500 MS 34, Joint Base Lewis-McChord, WA
| | - Mark A Reger
- VA Puget Sound Health Care System, Tacoma, Washington, 9600 Veterans Dr (A-116), Tacoma, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA
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Baez S, Santamaría-García H, Ibáñez A. Disarming Ex-Combatants' Minds: Toward Situated Reintegration Process in Post-conflict Colombia. Front Psychol 2019; 10:73. [PMID: 30761041 PMCID: PMC6361777 DOI: 10.3389/fpsyg.2019.00073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/10/2019] [Indexed: 01/23/2023] Open
Abstract
Collective violence in the context of armed conflict impacts the economy, health systems, and social stability of affected countries. This is considered a complex phenomenon with interwoven biological, psychological, social, cultural, and political factors. However, most of the research on this topic still lacks suitable established integrative approaches to assess multilevel perspectives. Social, cognitive and affective mental processes (SCAMP) are critical factors that should be considered in multilevel approaches. In this article, we critically discuss some of the classically isolated approaches used in violence research, the absence of successful interventions for ex-combatants reintegration, and the specific neglect of SCAMP in these interventions. We present the case of post-conflict Colombia as a unique opportunity to study the different roots of collective violence, and we call for a more robust and situated approach to understanding of and intervention in this multifaceted phenomenon. In addition, we suggest a two-stage approach for addressing ex-combatants’ reintegration programs, which considers the situated nature of post-conflict scenarios and the urgent need for evidence-based interventions. This approach focuses on the comprehensive scientific assessment of specific factors involved in violence exposure and the subsequent design of successful interventions. The implementation of this approach will contribute to the effective reintegration of individuals who have been exposed to extreme violence for more than 50 years.
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Affiliation(s)
- Sandra Baez
- Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia
| | - Hernando Santamaría-García
- Centro de Memoria y Cognición, Intellectus-Hospital Universitario San Ignacio, Bogotá, Colombia.,Physiology and Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience, Institute of Cognitive and Translational Neuroscience, INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council, Buenos Aires, Argentina.,Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
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17
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Fox A, Helmer D, Tseng CL, McCarron K, Satcher S, Osinubi O. Autonomic Symptoms in Gulf War Veterans Evaluated at the War Related Illness and Injury Study Center. Mil Med 2018; 184:e191-e196. [DOI: 10.1093/milmed/usy227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/30/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Apollonia Fox
- War Related Illness and Injury Study Center, 385 Tremont Ave
- Mailstop 129
- VA New Jersey Healthcare, East Orange, NJ
| | - Drew Helmer
- War Related Illness and Injury Study Center, 385 Tremont Ave
- Mailstop 129
- VA New Jersey Healthcare, East Orange, NJ
- Rutgers, New Jersey Medical School, 185 South Orange Avenue, Newark, NJ
| | - Chin-Lin Tseng
- War Related Illness and Injury Study Center, 385 Tremont Ave
- Mailstop 129
- VA New Jersey Healthcare, East Orange, NJ
| | - Kelly McCarron
- War Related Illness and Injury Study Center, 385 Tremont Ave
- Mailstop 129
- VA New Jersey Healthcare, East Orange, NJ
| | - Serena Satcher
- War Related Illness and Injury Study Center, 385 Tremont Ave
- Mailstop 129
- VA New Jersey Healthcare, East Orange, NJ
| | - Omowunmi Osinubi
- War Related Illness and Injury Study Center, 385 Tremont Ave
- Mailstop 129
- VA New Jersey Healthcare, East Orange, NJ
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18
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Ciarleglio MM, Aslan M, Proctor SP, Concato J, Ko J, Kaiser AP, Vasterling JJ. Associations of Stress Exposures and Social Support With Long-Term Mental Health Outcomes Among U.S. Iraq War Veterans. Behav Ther 2018; 49:653-667. [PMID: 30146134 DOI: 10.1016/j.beth.2018.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/31/2017] [Accepted: 01/06/2018] [Indexed: 11/30/2022]
Abstract
The long-term mental health effects of war-zone deployment in the Iraq and Afghanistan wars on military personnel are a significant public health concern. Using data collected prospectively at three distinct assessments during 2003-2014 as part of the Neurocognition Deployment Health Study and VA Cooperative Studies Program Study #566, we explored how stress exposures prior, during, and after return from deployment influence the long-term mental health outcomes of posttraumatic stress disorder (PTSD), depression, anxiety disorders, and problem drinking. Longer-term mental health outcomes were assessed in 375 service members and military veterans an average of 7.5 years (standard deviation = 1.0 year) after the initial (i.e., "index") Iraq deployment following their predeployment assessment. Anxiety disorder was the most commonly observed long-term mental health outcome (36.0%), followed by depression (24.5%), PTSD (24.3%), and problem drinking (21.0%). Multivariable regression models showed that greater postdeployment stressors, as measured by the Post-Deployment Life Events scale, were associated with greater risk of depression, anxiety disorders, and problem drinking. Anxiety disorder was the only outcome affected by predeployment stress concerns. In addition, greater postdeployment social support was associated with lower risk of all outcomes except problem drinking. These findings highlight the importance of assessing postdeployment stress exposures, such as stressful or traumatic life events, given the potential impact of these stressors on long-term mental health outcomes. This study also highlights the importance of postdeployment social support as a modifiable protective factor that can be used to help mitigate risk of long-term adverse mental health outcomes following war-zone exposure.
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Affiliation(s)
- Maria M Ciarleglio
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA; Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Mihaela Aslan
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA; Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Susan P Proctor
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA; Research Service, VA Boston Healthcare System, Boston, Massachusetts, USA; Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - John Concato
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA; Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - John Ko
- Clinical Epidemiology Research Center, VA Cooperative Studies Program, West Haven, Connecticut, USA
| | - Anica Pless Kaiser
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jennifer J Vasterling
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA; Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.
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Bøg M, Filges T, Jørgensen AMK. Deployment of personnel to military operations: impact on mental health and social functioning. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-127. [PMID: 37131363 PMCID: PMC8427986 DOI: 10.4073/csr.2018.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This Campbell systematic review examines the effects of deployment on mental health. The review summarizes evidence from 185 studies. All studies used observational data to quantify the effect of deployment. This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment). Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. Plain language summary Deployment to military operations negatively affects the mental health functioning of deployed military personnel: While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel.What is this review about?: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health.The primary condition under consideration is deployment to an international military operation. Deployment to a military operation is not a uniform condition; rather, it covers a range of scenarios. Military deployment is defined as performing military service in an operation at a location outside the home country for a limited time period, pursuant to orders.The review included studies that reported outcomes for individuals who had been deployed. This review looked at the effect of deployment on mental health outcomes. The mental health outcomes are: post-traumatic stress disorder (PTSD), major depressive disorder (MDD), common mental disorders (depression, anxiety and somatisation disorders) and substance-related disorders.By identifying the major effects of deployment on mental health and quantifying these effects, the review can inform policy development on deployment and military activity as well as post-deployment support for veterans. In this way the review enables decision-makers to prioritise key areas.What are the main findings of this review?: What studies are included?: This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment).Does deployment have an effect on mental health?: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive.What do the findings of this review mean?: The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long-lasting.Overall the risk of bias in the majority of included studies was high. While it is difficult to imagine a randomised study design to understand how deployment affects mental health, other matters such as changes to personnel policy, or unanticipated shocks to the demand for military personnel, could potentially be a rich source of quasi-experimental variation.How up-to-date is this review?: The review authors searched for studies up to 2017. This Campbell systematic review was published in March 2018. Executive summary BACKGROUND: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health. Research suggests that the increased risk to mental health is mainly due to the hazards of war, combat exposure: firing weapons, road side bombs, seeing fellow soldiers, friends, civilians, and enemies being injured, maimed or killed. These experiences may lead to severe mental stress. The adverse impact on mental health is the psychological cost of war, and it is of interest to policymakers to learn the magnitude of these effects. This review sets out to synthesise available evidence about the consequences of deployment for deployed military personnel in the mental health and social functioning domains.OBJECTIVES: The objective of this review isto synthesise the consequences of deployment to military operation on the mental health and social functioning of deployed military personnel.SEARCH METHODS: We searched electronic databases, grey literature, and references from primary studies and related reviews. No language or date restrictions were applied to the searches. We searched the following electronic databases: Academic Search Elite, Cochrane Library, EMBASE, ERIC, MEDLINE, PsycINFO, Science Citation Index, Social Science Citation Index, SocINDEX, as well as the Nordic platforms: bibliotek.dk, BIBSYS, and LIBRIS. The conclusions of this review are based on the most recent searches performed. The last search was performed in April 2017.SELECTION CRITERIA: Primary studies had to meet the following inclusion criteria: Participants: The participants should be military personnel.Intervention: The condition should be deployment to a military operation.Comparison: The relevant comparisons were either comparing a) deployed military personnel to non-deployed military personnel, b) deployed military personnel to military personnel deployed elsewhere, for example personnel deployed to non-combat operations, c) military personnel deployed to the same operation but stratified by combat exposure.Outcomes: The study should report on one or more mental health outcomes, and/or social functioning for the deployed participants. In particular studies should report on one or more of the following mental health outcomes: PTSD, major depression, substance abuse or dependence (including alcohol), and common mental disorders (depression and anxiety disorders). The following social functioning outcomes were relevant: employment, and homelessness.Study Designs: Both experimental and quasi-experimental designs with a comparison group were eligible for inclusion in the review. Studies were excluded if they: Reported on deployments taking place before 1989.Used a within group pre-post study design.Did not report on at least one of the mental health or social functioning outcomes. DATA COLLECTION AND ANALYSIS: The total number of potentially relevant studies constituted31,049records. A total of 185 studies met the inclusion criteria and were critically appraised by the review authors. The final selection of 185 studies was from 13 different countries.Forty eight of the 185 studies did not report effect estimates or provide data that would allow the calculation of an effect size and standard error. Fifty four studies were excluded because of overlapping samples. The majority of those studies were from USA but the main reason for not using studies from USA in the synthesis was lack of information to calculate an effect size. Nearly half the studies from the UK could not be used in the synthesis due to overlap of data samples. Forty three studies were judged to have a very high risk of bias (5 on the scale) and, in accordance with the protocol, we excluded these from the data synthesis on the basis that they would be more likely to mislead than inform., Thus a total of 40 studies, from five different countries, were included in the data synthesis.Random effects models were used to pool data across the studies. We used the odds ratio. Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were calculated. The meta-analyses were carried out by time since exposure (short, medium, long, and other time since exposure) and by type of comparison (deployed versus non-deployed, all deployed but stratified by either combat operations versus non-combat operations, or stratified by combat exposure). We performed single factor subgroup analysis. The assessment of any difference between subgroups was based on 95% confidence intervals. Funnel plots were used to assess the possibility of publication bias. Sensitivity analysis was used to evaluate whether the pooled effect sizes were robust across components of methodological quality.MAIN RESULTS: The findings were mixed, depending on the outcome, the time since exposure and the approach (deployed versus non-deployed termed absolute or stratified by extent of combat termed relative) used to investigate the effect. It was not possible to analyse the outcomes homelessness and employment. All studies that could be used in the data synthesis reported on the impact of deployment on mental health; PTSD, depression, substance use or common mental disorder.For assessments taken less than 24 months since exposure the evidence was inconclusive either because too few studies reported results in the short and medium term and/or the degree of heterogeneity between studies was large.For assessments taken at other time points (a variable number of months since exposure) the evidence was inconclusive for the relative comparisons due to either too few studies or a substantial degree of heterogeneity between studies. For the absolute comparison the analysis of common mental disorder was inconclusive, whereas the average effects of PTSD and depression were positive and statistically significant (PTSD odds ratio (OR) was 1.91 (95% confidence interval (CI): 1.28 to 2.85) and OR=1.98 (95% CI: 1.05 to 3.70) for depression). The analysis concerning substance use indicated that deployed participants did not have higher odds of screening positive for substance use compared to non-deployed participants (OR=1.15 (95% CI: 0.98 to 1.36)).For assessments taken more than 24 months post exposure, meta-analyses indicated that the odds of screening positive for PTSD, depression, substance use and common mental disorder were higher for participants in the deployed group compared to participants in the group that were not deployed (PTSD OR=3.31 (95% CI: 2.69 to 4.07), OR=2.19 (95% CI: 1.58 to 3.03) for depression, OR=1.27 (95% CI: 1.15 to 1.39) for substance use, and OR=1.64 (95% CI: 1.38 to 1.96) for common mental disorder). Likewise, participants reporting high combat exposure had higher odds of screening positive for PTSD and depression than participants reporting lower exposure for long term assessments (PTSD OR=3.05 (95% CI: 1.94 to 4.80) and OR=1.81 (95% CI: 1.28 to 2.56) for depression). The analyses of substance use and common mental disorder were inconclusive due to too few studies.On the basis of the prevalence of mental health problems in pre-deployed or non-deployed population based comparison sampleswe would therefore expect the long term prevalence of PTSD in post-deployed samples to be in the range 6.1 - 14.9%, the long term prevalence of depression to be in the range from 7.6% to 18%, the long term prevalence of substance use to be in the range from 2.4% to 17.5% and the prevalence of common mental disorder to be in the range from 10% to 23%.Sensitivity analyses resulted in no appreciable change in effect size, suggesting that the results are robust.It was only possible to assess the impact of two types of personnel characteristics (branch of service and duty/enlistment status) on the mental health outcomes. We found no evidence to suggest that the effect of deployment on any outcomes differ between these two types of personnel characteristics.AUTHORS' CONCLUSIONS: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. We focused on the effect of deployment on PTSD (post-traumatic stress disorder), depression, substance abuse/dependence, and common mental disorders (depression and anxiety disorders). For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all domains, particularly on PTSD. There is increased political awareness of the need to address post deployment mental health problems. The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long lasting. Mental illness is of particular concern in the military for operational reasons, but they may be hard to detect in the military setting because a military career is intimately linked with mental and physical strength.It was not possible to examine a number of factors which we had reason to expect would impact on the magnitude of the effect. This would have been particularly relevant from a policy perspective because these are direct parameters that one could use to optimally "organize" deployment in order to minimize impacts on mental health functioning.While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel. The next step is to begin to examine preventive measures and policies for organizing deployment, in order to minimize the effects on mental health.
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Bowes MA, Ferreira N, Henderson M. The influence of psychosocial factors in veteran adjustment to civilian life. Clin Psychol Psychother 2018; 25:583-600. [PMID: 29575290 DOI: 10.1002/cpp.2182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 11/09/2022]
Abstract
AIM Although most veterans have a successful transition to civilian life when they leave the military, some struggle to cope and adjust to the demands and challenges of civilian life. This study explores how a variety of psychosocial factors influence veteran adjustment to civilian life in Scotland, UK, and which of these factors predict a poor adjustment. METHODS One hundred and fifty-four veterans across Scotland completed a set of questionnaires that measured veteran adjustment difficulty, quality of life, mental health, stigma, self-stigma, attitude towards help-seeking, likelihood of help-seeking, experiential avoidance, reappraisal and suppression. RESULTS Veteran adjustment difficulty and quality of life were significantly correlated to a number of psychosocial factors. Mental health, experiential avoidance and cognitive reappraisal were found to be predictors of veteran adjustment difficulty, and experiential avoidance and cognitive reappraisal partially mediated the relationship between mental health and veteran adjustment, with experiential avoidance being the stronger mediator. DISCUSSION Our findings suggest that early assessment of experiential avoidance and cognitive reappraisal and the provision of relevant emotion regulation skills training could potentially reduce the veteran's need for more complex (and costly) psychological interventions in the future. Implications for veterans, as well as the services and professionals involved with veteran transition and health care are discussed.
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Affiliation(s)
| | - Nuno Ferreira
- Department of Clinical and Health Psychology, University of Nicosia, Nicosia, Cyprus
- Department of Clinical and Health Psychology, University of Edinburgh, Edinburgh, UK
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Quaglietti S. Using Photography to Explore Recovery Themes With Veterans. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2018. [DOI: 10.1080/15401383.2018.1425174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
SummaryThe psychiatric problems of combat returnees are a topical and important issue given the ongoing conflicts in Iraq and Afghanistan. Despite the media prominence afforded to post-traumatic stress disorder, the most common disorders in the UK armed forces post-deployment are depression, alcohol misuse and anxiety disorders. Although the majority of service personnel do well after leaving military life, a minority who leave with psychiatric problems appear to be at risk of social exclusion and ongoing ill health. Reserve veterans are at greater risk as they do not have access to the usual support networks of the regular military. Steps to improve the knowledge and expertise of primary care services about veterans' mental health issues and increasing the availability of treatment options are important and are underway.
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Barth SK, Kang HK, Bullman T. All-Cause Mortality Among US Veterans of the Persian Gulf War: 13-Year Follow-up. Public Health Rep 2016; 131:822-830. [PMID: 28123229 DOI: 10.1177/0033354916676278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We determined cause-specific mortality prevalence and risks of Gulf War deployed and nondeployed veterans to determine if deployed veterans were at greater risk than nondeployed veterans for death overall or because of certain diseases or conditions up to 13 years after conflict subsided. METHODS Follow-up began when the veteran left the Gulf War theater or May 1, 1991, and ended on the date of death or December 31, 2004. We studied 621 901 veterans who served in the 1990-1991 Persian Gulf War and 746 247 veterans who served but were not deployed during the Gulf War. We used Cox proportional hazard models to calculate rate ratios adjusted for age at entry to follow-up, length of follow-up, race, sex, branch of service, and military unit. We compared the mortality of (1) Gulf War veterans with non-Gulf War veterans and (2) Gulf War army veterans potentially exposed to nerve agents at Khamisiyah in March 1991 with those not exposed. We compared standardized mortality ratios of deployed and nondeployed Gulf War veterans with the US population. RESULTS Male Gulf War veterans had a lower risk of mortality than male non-Gulf War veterans (adjusted rate ratio [aRR] = 0.97; 95% confidence interval [CI], 0.95-0.99), and female Gulf War veterans had a higher risk of mortality than female non-Gulf War veterans (aRR = 1.15; 95% CI, 1.03-1.28). Khamisiyah-exposed Gulf War army veterans had >3 times the risk of mortality from cirrhosis of the liver than nonexposed army Gulf War veterans (aRR = 3.73; 95% CI, 1.64-8.48). Compared with the US population, female Gulf War veterans had a 60% higher risk of suicide and male Gulf War veterans had a lower risk of suicide (standardized mortality ratio = 0.84; 95% CI, 0.80-0.88). CONCLUSION The vital status and mortality risk of Gulf War and non-Gulf War veterans should continue to be investigated.
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Affiliation(s)
- Shannon K Barth
- Epidemiology Program, Post-Deployment Health Services, Office of Patient Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Han K Kang
- Epidemiology Program, Post-Deployment Health Services, Office of Patient Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Tim Bullman
- Epidemiology Program, Post-Deployment Health Services, Office of Patient Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
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Bonde JP, Utzon-Frank N, Bertelsen M, Borritz M, Eller NH, Nordentoft M, Olesen K, Rod NH, Rugulies R. Risk of depressive disorder following disasters and military deployment: systematic review with meta-analysis. Br J Psychiatry 2016; 208:330-6. [PMID: 26892850 DOI: 10.1192/bjp.bp.114.157859] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/28/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous studies describe the occurrence of post-traumatic stress disorder following disasters, but less is known about the risk of major depression. AIMS To review the risk of depressive disorder in people surviving disasters and in soldiers returning from military deployment. METHOD A systematic literature search combined with reference screening identified 23 controlled epidemiological studies. We used random effects models to compute pooled odds ratios (ORs). RESULTS The average OR was significantly elevated following all types of exposures: natural disaster OR = 2.28 (95% CI 1.30-3.98), technological disaster OR = 1.44 (95% CI 1.21-1.70), terrorist acts OR = 1.80 (95% CI 1.38-2.34) and military combat OR = 1.60 (95% CI 1.09-2.35). In a subset of ten high-quality studies OR was 1.41 (95% CI 1.06-1.87). CONCLUSIONS Disasters and combat experience substantially increase the risk of depression. Whether psychological trauma per se or bereavement is on the causal path is unresolved.
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Affiliation(s)
- J P Bonde
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - N Utzon-Frank
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - M Bertelsen
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - M Borritz
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - N H Eller
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - M Nordentoft
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - K Olesen
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - N H Rod
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
| | - R Rugulies
- J. P. Bonde, DMSc, N. Utzon-Frank, MD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Bertelsen, PhD, Danish Veteran Centre, Copenhagen; M. Borritz, PhD, N. H. Eller, DMSc, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital; M. Nordentoft, DMSc, Psychiatric Centre Bispebjerg, Bispebjerg University Hospital; K. Olesen, PhD, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, and Department of Public Health, University of Copenhagen; N. H. Rod, DMSc, Department of Public Health, University of Copenhagen; R. Rugulies, PhD, Department of Public Health, University of Copenhagen, National Research Centre for the Working Environment, and Department of Psychology, University of Copenhagen, Denmark
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Major depression and depressive symptoms in Australian Gulf War veterans 20 years after the Gulf War. J Affect Disord 2016; 189:77-84. [PMID: 26409313 DOI: 10.1016/j.jad.2015.09.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/14/2015] [Accepted: 09/09/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Risk of major depression (depression) was elevated in Australia's Gulf War veterans in a 2000-2002 (baseline) study. A follow up study has measured the Gulf War-related risk factors for depression, also the current prevalence and severity of depression, use of anti-depressant medication, and persistence, remittance or incidence of depression since baseline in Gulf War veterans and a military comparison group. METHODS Participants completed the Composite International Diagnostic Interview v.2.1, the 9-item Patient Health Questionnaire and the Military Service Experience Questionnaire, and consented to Repatriation Pharmaceutical Benefits Scheme (RPBS) and PBS linkage. RESULTS Prevalence of depression (9.7% Gulf War veterans and 7.7% comparison group; adj RR=1.2, 95% CI 0.8-1.7), and pattern of persistence, remittance and incidence of depression since baseline, were similar in the two groups, however veterans reported slightly more severe symptoms (adj median difference 1, 95% CI 0.26-1.74) and were more likely to have been dispensed anti-depressant medication (adj RR=1.56, 95% CI 1.05-2.32). Depression amongst veterans was associated with self-reported Gulf War-related stressors in a dose-response relationship (adj RR 1.06, 95% CI 1.02-1.09). LIMITATIONS Lower participation rates at follow up resulted in reduced statistical power compared with baseline, Gulf War related stressor data collected at baseline was at risk of recall bias, and RPBS and PBS databases do not capture all dispensed Nervous System medications. CONCLUSIONS More than 20 years after the Gulf War, veterans are experiencing slightly more severe depressive symptoms than a military comparison group, and depression continues to be associated with Gulf War-related stressors.
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Piermartiri T, Pan H, Figueiredo TH, Marini AM. α-Linolenic Acid, A Nutraceutical with Pleiotropic Properties That Targets Endogenous Neuroprotective Pathways to Protect against Organophosphate Nerve Agent-Induced Neuropathology. Molecules 2015; 20:20355-80. [PMID: 26569216 PMCID: PMC6332275 DOI: 10.3390/molecules201119698] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 10/29/2015] [Accepted: 11/03/2015] [Indexed: 01/23/2023] Open
Abstract
α-Linolenic acid (ALA) is a nutraceutical found in vegetable products such as flax and walnuts. The pleiotropic properties of ALA target endogenous neuroprotective and neurorestorative pathways in brain and involve the transcription factor nuclear factor kappa B (NF-κB), brain-derived neurotrophic factor (BDNF), a major neuroprotective protein in brain, and downstream signaling pathways likely mediated via activation of TrkB, the cognate receptor of BDNF. In this review, we discuss possible mechanisms of ALA efficacy against the highly toxic OP nerve agent soman. Organophosphate (OP) nerve agents are highly toxic chemical warfare agents and a threat to military and civilian populations. Once considered only for battlefield use, these agents are now used by terrorists to inflict mass casualties. OP nerve agents inhibit the critical enzyme acetylcholinesterase (AChE) that rapidly leads to a cholinergic crisis involving multiple organs. Status epilepticus results from the excessive accumulation of synaptic acetylcholine which in turn leads to the overactivation of muscarinic receptors; prolonged seizures cause the neuropathology and long-term consequences in survivors. Current countermeasures mitigate symptoms and signs as well as reduce brain damage, but must be given within minutes after exposure to OP nerve agents supporting interest in newer and more effective therapies. The pleiotropic properties of ALA result in a coordinated molecular and cellular program to restore neuronal networks and improve cognitive function in soman-exposed animals. Collectively, ALA should be brought to the clinic to treat the long-term consequences of nerve agents in survivors. ALA may be an effective therapy for other acute and chronic neurodegenerative disorders.
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Affiliation(s)
- Tetsade Piermartiri
- Molecular and Cellular Biology Graduate School Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Hongna Pan
- Department of Neurology and Program in Neuroscience, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Taiza H Figueiredo
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Ann M Marini
- Department of Neurology and Program in Neuroscience, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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Pan H, Piermartiri TCB, Chen J, McDonough J, Oppel C, Driwech W, Winter K, McFarland E, Black K, Figueiredo T, Grunberg N, Marini AM. Repeated systemic administration of the nutraceutical alpha-linolenic acid exerts neuroprotective efficacy, an antidepressant effect and improves cognitive performance when given after soman exposure. Neurotoxicology 2015; 51:38-50. [PMID: 26386148 DOI: 10.1016/j.neuro.2015.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/04/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
Exposure to nerve agents results in severe seizures or status epilepticus caused by the inhibition of acetylcholinesterase, a critical enzyme that breaks down acetylcholine to terminate neurotransmission. Prolonged seizures cause brain damage and can lead to long-term consequences. Current countermeasures are only modestly effective against the brain damage supporting interest in the evaluation of new and efficacious therapies. The nutraceutical alpha-linolenic acid (LIN) is an essential omega-3 polyunsaturated fatty acid that has a wide safety margin. Previous work showed that a single intravenous injection of alpha-linolenic acid (500 nmol/kg) administered before or after soman significantly protected against soman-induced brain damage when analyzed 24h after exposure. Here, we show that administration of three intravenous injections of alpha-linolenic acid over a 7 day period after soman significantly improved motor performance on the rotarod, enhanced memory retention, exerted an anti-depressant-like activity and increased animal survival. This dosing schedule significantly reduced soman-induced neuronal degeneration in four major vulnerable brain regions up to 21 days. Taken together, alpha-linolenic acid reduces the profound behavioral deficits induced by soman possibly by decreasing neuronal cell death, and increases animal survival.
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Affiliation(s)
- Hongna Pan
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Tetsade C B Piermartiri
- Molecular and Cellular Biology Graduate School Program, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Jun Chen
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - John McDonough
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Craig Oppel
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Wafae Driwech
- Pharmacology Branch, Research Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, United States
| | - Kristin Winter
- Pharmacology Branch, Research Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, United States
| | - Emylee McFarland
- Pharmacology Branch, Research Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, United States
| | - Katelyn Black
- Pharmacology Branch, Research Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, United States
| | - Taiza Figueiredo
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Neil Grunberg
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Ann M Marini
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
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Blore JD, Sim MR, Forbes AB, Creamer MC, Kelsall HL. Depression in Gulf War veterans: a systematic review and meta-analysis. Psychol Med 2015; 45:1565-1580. [PMID: 25697603 DOI: 10.1017/s0033291714001913] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although post-traumatic stress disorder (PTSD) has been a focus of attention in 1990/1991 Gulf War veterans, the excess risk of depression has not been clearly identified. We investigated this through a systematic review and meta-analysis of studies comparing depression in Gulf War veterans to depression in a comparison group of non-deployed military personnel. METHOD Multiple electronic databases and grey literature were searched from 1990 to 2012. Studies were assessed for eligibility and risk of bias according to established criteria. RESULTS Of 14 098 titles and abstracts assessed, 14 studies met the inclusion criteria. Gulf War veterans had over twice the odds of experiencing depression [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.88-2.76] and dysthymia or chronic dysphoria (OR 2.39, 95% CI 2.0-2.86) compared to non-deployed military personnel. This finding was robust in sensitivity analyses, and to differences in overall risk of bias and psychological measures used. CONCLUSIONS Despite divergent methodologies between studies, depression and dysthymia were twice as common in Gulf War veterans and are important medical conditions for clinicians and policymakers to be aware of in managing Gulf War veterans' health.
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Affiliation(s)
- J D Blore
- Faculty of Medicine, Nursing and Health Sciences,Monash Centre for Occupational and Environmental Health (MonCOEH),School of Public Health and Preventive Medicine,Monash University,L5,The Alfred Centre,Melbourne,VIC,Australia
| | - M R Sim
- Faculty of Medicine, Nursing and Health Sciences,Monash Centre for Occupational and Environmental Health (MonCOEH),School of Public Health and Preventive Medicine,Monash University,L5,The Alfred Centre,Melbourne,VIC,Australia
| | - A B Forbes
- Faculty of Medicine,Nursing and Health Sciences,School of Public Health and Preventive Medicine,Monash University,L6,The Alfred Centre,VIC,Australia
| | - M C Creamer
- Department of Psychiatry,Australian Centre for Posttraumatic Mental Health,The University of Melbourne,Parkville,VIC,Australia
| | - H L Kelsall
- Faculty of Medicine, Nursing and Health Sciences,Monash Centre for Occupational and Environmental Health (MonCOEH),School of Public Health and Preventive Medicine,Monash University,L5,The Alfred Centre,Melbourne,VIC,Australia
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Russell MC, Figley CR. Investigating Recurrent Generational Wartime Behavioral Health Crises: Part 2 of a Preliminary Analysis. PSYCHOLOGICAL INJURY & LAW 2015. [DOI: 10.1007/s12207-015-9223-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reinhard MJ, Nassif TH, Bloeser K, Dursa EK, Barth SK, Benetato B, Schneiderman A. CAM utilization among OEF/OIF veterans: findings from the National Health Study for a New Generation of US Veterans. Med Care 2015; 52:S45-9. [PMID: 25397822 DOI: 10.1097/mlr.0000000000000229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is increasingly seen as an adjunct to traditional plans of care. This study utilized a representative sample of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans and OEF/OIF-era veterans to explore the prevalence and characteristics of CAM users. RESEARCH DESIGN The National Health Study for a New Generation of US Veterans (NewGen) is a longitudinal health study of a population-based cohort of OEF/OIF (deployed) and OEF/OIF-era (nondeployed) veterans. Data from the 2009-2011 NewGen survey (n=20,563) were analyzed to determine prevalence of CAM use by demographic and military characteristics, the types of CAM modalities used, and where the modalities were sought. Results were weighted to the entire population of OEF/OIF and OEF/OIF-era veterans. RESULTS There was no statistically significant association between CAM use and deployment. Those who used Department of Veterans Affairs (VA) health care after separation were more likely to be CAM users compared with those who did not use VA care; however, the majority of veterans using CAM are using it outside the VA health care system. Massage was the most prevalent CAM modality followed by chiropractic treatment; males were less likely to use CAM than women. CONCLUSIONS CAM modalities are being utilized by OEF/OIF veterans for health problems mainly outside the VA. Policymakers should determine appropriate use of these modalities.
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Affiliation(s)
- Matthew J Reinhard
- *War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center †Georgetown University Medical School, Department of Psychiatry ‡American University School of Education, Teaching and Health §US Department of Veterans Affairs, Office of Public Health, Post Deployment Health, Epidemiology Program, Washington, DC ∥Veterans Affairs Greenville NC CBOC ¶East Carolina University, College of Nursing, Greenville, NC
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Kelsall HL, Wijesinghe MSD, Creamer MC, McKenzie DP, Forbes AB, Page MJ, Sim MR. Alcohol Use and Substance Use Disorders in Gulf War, Afghanistan, and Iraq War Veterans Compared With Nondeployed Military Personnel. Epidemiol Rev 2015; 37:38-54. [DOI: 10.1093/epirev/mxu014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Physical Health, Mental Health, and Utilization of Complementary and Alternative Medicine Services Among Gulf War Veterans. Med Care 2014; 52:S39-44. [DOI: 10.1097/mlr.0000000000000223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Restrepo JE, Yara EA, Cano Betancur J, Tavera LN. [Emotional Profile of a Group of Colombian Military Victims of Landmines or Improvised Explosive Devices]. ACTA ACUST UNITED AC 2014; 43:87-95. [PMID: 26574963 DOI: 10.1016/j.rcp.2014.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 01/18/2014] [Accepted: 02/13/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Antipersonnel Mines (MAP) and Improvised Explosive Devices (IEDs) are frequently used in Colombia as an armed resource without the need for direct combat. The Department of Antioquia has the highest number of events associated with the detonation of such battle techniques. There are no studies on the psychological effects that appear as a result of accidents with Antipersonnel Mines and IEDs in the military population. OBJECTIVE To establish the psychological profile of a group of military victims of MAP and AEI, and a control group of soldiers who were not victims from the analysis of four emotional variables (depression, anxiety, anger and stress). METHODS The research was conducted using a case-control design in a .quantitative, comparative, descriptive and cross-sectional study. PARTICIPANTS A sample of 80 soldiers assigned to the Seventh Division of the National Army of Colombia at Medellin, Antioquia. The sample included a group of 30 military cases and 50 soldiers as controls. RESULTS The anxiety state, trait anxiety, state anger, and trait anger variables showed statistically significant differences between groups. There were no significant differences in the variables depression and stress between groups variables. There was no depression, anxiety, or stress in either of the two groups, but there were clinically significant levels of anger in both groups.
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Affiliation(s)
- Jorge Emiro Restrepo
- Facultad de Psicología, Universidad Cooperativa de Colombia, Medellín, Colombia.
| | | | | | - Luz Navia Tavera
- Facultad de Psicología, Universidad Cooperativa de Colombia, Medellín, Colombia
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Volumetric analysis of amygdala, hippocampus, and prefrontal cortex in therapy-naive PTSD participants. BIOMED RESEARCH INTERNATIONAL 2014; 2014:968495. [PMID: 24745028 PMCID: PMC3972941 DOI: 10.1155/2014/968495] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 02/12/2014] [Accepted: 02/13/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In our study we have hypothesized that volume changes of amygdala, hippocampus, and prefrontal cortex are more pronounced in male posttraumatic stress disorder participants. MATERIAL AND METHODS We have conducted a study of 79 male participants who underwent MRI brain scanning. PTSD diagnosis was confirmed in 49 participants. After MRI was taken all scans were software based volume computed and statistically processed. RESULTS We found that left amygdala is the most significant parameter for distinction between PTSD participants and participants without PTSD. There were no significant differences in volumes of hippocampi and prefrontal cortices. Roc curve method outlined left amygdala AUC = 0.898 (95% CI = 0.830-0.967) and right amygdala AUC = 0.882 (95% CI = 0.810-0.954) in the group of PTSD participants which makes both variables highly statistically significant. CONCLUSION The present investigation revealed significant volume decrease of left amygdala in PTSD patients. Concerning important functions of the amygdala and her neuroanatomical connections with other brain structures, we need to increase number of participants to clarify the correlation between impared amygdala and possible other different brain structures in participants with PTSD.
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Vaughan CP, Johnson TM, Goode PS, Redden DT, Burgio KL, Markland AD. Military Exposure and Urinary Incontinence among American Men. J Urol 2014; 191:125-9. [DOI: 10.1016/j.juro.2013.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2013] [Indexed: 11/24/2022]
Affiliation(s)
- Camille P. Vaughan
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama and Atlanta, Georgia
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Theodore M. Johnson
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama and Atlanta, Georgia
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University, Atlanta, Georgia
| | - Patricia S. Goode
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama and Atlanta, Georgia
- Center for Aging, University of Alabama at Birmingham, Birmingham, Alabama
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David T. Redden
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama and Atlanta, Georgia
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kathryn L. Burgio
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama and Atlanta, Georgia
- Center for Aging, University of Alabama at Birmingham, Birmingham, Alabama
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alayne D. Markland
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama and Atlanta, Georgia
- Center for Aging, University of Alabama at Birmingham, Birmingham, Alabama
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Ojo JO, Abdullah L, Evans J, Reed JM, Montague H, Mullan MJ, Crawford FC. Exposure to an organophosphate pesticide, individually or in combination with other Gulf War agents, impairs synaptic integrity and neuronal differentiation, and is accompanied by subtle microvascular injury in a mouse model of Gulf War agent exposure. Neuropathology 2013; 34:109-27. [DOI: 10.1111/neup.12061] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/14/2013] [Accepted: 08/15/2013] [Indexed: 11/27/2022]
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McNeil RB, Thomas CM, Coughlin SS, Hauser E, Huang GD, Goldstein KM, Johnson MR, Dunn-Thomas T, Provenzale DT. An assessment of survey measures used across key epidemiologic studies of United States Gulf War I Era veterans. Environ Health 2013; 12:4. [PMID: 23302181 PMCID: PMC3599123 DOI: 10.1186/1476-069x-12-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 12/24/2012] [Indexed: 05/13/2023]
Abstract
Over the past two decades, 12 large epidemiologic studies and 2 registries have focused on U.S. veterans of the 1990-1991 Gulf War Era. We conducted a review of these studies' research tools to identify existing gaps and overlaps of efforts to date, and to advance development of the next generation of Gulf War Era survey tools. Overall, we found that many of the studies used similar instruments. Questions regarding exposures were more similar across studies than other domains, while neurocognitive and psychological tools were the most variable. Many studies focused on self-reported survey results, with a range of validation practices. However, physical exams, biomedical assessments, and specimen storage were not common. This review suggests that while research may be able to pool data from past surveys, future surveys need to consider how their design can yield data comparable with previous surveys. Additionally, data that incorporate recent technologies in specimen and genetic analyses would greatly enhance such survey data. When combined with existing data on deployment-related exposures and post-deployment health conditions, longitudinal follow-up of existing studies within this collaborative framework could represent an important step toward improving the health of veterans.
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Affiliation(s)
- Rebecca B McNeil
- Durham Epidemiologic Research and Information Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Catherine M Thomas
- Durham Epidemiologic Research and Information Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Steven S Coughlin
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Hauser
- Durham Epidemiologic Research and Information Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - Grant D Huang
- Cooperative Studies Program, Office of Research and Development, Department of Veterans Affairs, Washington, DC, USA
| | | | - Marcus R Johnson
- Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | | | - Dawn T Provenzale
- Durham Epidemiologic Research and Information Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Durham Veterans Affairs Medical Center, Durham, NC, USA
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Steenkamp MM, Nickerson A, Maguen S, Dickstein BD, Nash WP, Litz BT. Latent classes of PTSD symptoms in Vietnam veterans. Behav Modif 2012; 36:857-74. [PMID: 22798638 DOI: 10.1177/0145445512450908] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors examined heterogeneity in posttraumatic stress disorder (PTSD) symptom presentation among veterans (n = 335) participating in the clinical interview subsample of the National Vietnam Veterans Readjustment Study. Latent class analysis was used to identify clinically homogeneous subgroups of Vietnam War combat veterans. Consistent with previous research, three classes emerged from the analysis, namely, veterans with no disturbance (61.4% of the cohort), intermediate disturbance (25.6%), and pervasive disturbance (12.5%). The authors also examined physical injury, war-zone stressor exposure, peritraumatic dissociation, and general dissociation as predictors of class membership. The findings are discussed in the context of recent conceptual frameworks that posit a range of posttraumatic outcomes and highlight the sizable segment of military veterans who suffer from intermediate (subclinical) PTSD symptoms.
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Segovia F, Moore JL, Linnville SE, Hoyt RE, Hain RE. Optimism predicts resilience in repatriated prisoners of war: a 37-year longitudinal study. J Trauma Stress 2012; 25:330-6. [PMID: 22615194 DOI: 10.1002/jts.21691] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Resilience, exhibiting intact psychological functioning despite exposure to trauma, is one perspective as to why some people who are exposed to trauma do not develop symptoms. This study examines the prisoner of war experience to expand our understanding of this phenomenon in extreme cases of trauma such as prolonged captivity, malnourishment, and physical and psychological torture. The study examined the United States' longest detained American prisoners of war, those held in Vietnam in the 1960s through early 1970s. A logistic regression analysis using resilience, defined as never receiving any psychiatric diagnosis over a 37-year follow-up period, as the outcome was performed (n = 224 with complete data). Six variables showing at least small effects emerged: officer/enlisted status, age at time of capture, length of solitary confinement, low antisocial/psychopathic personality traits, low posttraumatic stress symptoms following repatriation, and optimism. Odds ratios (ORs) and confidence intervals (CIs) confirmed the significance and relative strength of these variables, with a range from OR = 0.54, 95% CI [0.13, 2.29] to OR = 1.11, 95% CI [1.04, 1.17]. When all variables were examined continuously and categorically, dispositional optimism was the strongest variable, accounting for 17%, continuously, and 14%, categorically. We discuss optimism as a protective factor for confronting trauma and the possibility of training to increase it.
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Affiliation(s)
- Francine Segovia
- Robert E. Mitchell Center for Prisoner of War Studies, Navy Medicine Operational Training Center, Pensacola, FL, USA.
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Li B, Mahan CM, Kang HK, Eisen SA, Engel CC. Longitudinal health study of US 1991 Gulf War veterans: changes in health status at 10-year follow-up. Am J Epidemiol 2011; 174:761-8. [PMID: 21795757 DOI: 10.1093/aje/kwr154] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The authors assessed changes in the health status of US 1991 Gulf War-era veterans from a 1995 baseline survey to a 2005 follow-up survey, using repeated measurement data from 5,469 deployed Gulf War veterans and 3,353 nondeployed Gulf War-era veterans who participated in both surveys. Prevalence differences in health status between the 2 surveys were estimated for adverse health indices and chronic diseases for each veteran group. Persistence risk ratios and incidence risk ratios were calculated after adjustment for demographic and military service characteristics through Mantel-Haenszel stratified analysis. At 10-year follow-up, deployed veterans were more likely to report persistent poor health, as measured by the health indices (functional impairment, limitation of activities, repeated clinic visits, recurrent hospitalizations, perception of health as fair or poor, chronic fatigue syndrome-like illness, and posttraumatic stress disorder), than nondeployed veterans. Additionally, deployed veterans were more likely to experience new onset of adverse health (as measured by the indices) and certain chronic diseases than were nondeployed veterans. During the 10-year period from 1995 to 2005, the health of deployed veterans worsened in comparison with nondeployed veterans because of a higher rate of new onset of various health outcomes and greater persistence of previously reported adverse health on the indices.
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Affiliation(s)
- Bo Li
- Institute for Clinical Research, Inc., Washington DC, USA
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Smith TC, Jacobson IG, Hooper TI, LeardMann CA, Boyko EJ, Smith B, Gackstetter GD, Wells TS, Amoroso PJ, Gray GC, Riddle JR, Ryan MAK. Health impact of US military service in a large population-based military cohort: findings of the Millennium Cohort Study, 2001-2008. BMC Public Health 2011; 11:69. [PMID: 21281496 PMCID: PMC3041662 DOI: 10.1186/1471-2458-11-69] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 01/31/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combat-intense, lengthy, and multiple deployments in Iraq and Afghanistan have characterized the new millennium. The US military's all-volunteer force has never been better trained and technologically equipped to engage enemy combatants in multiple theaters of operations. Nonetheless, concerns over potential lasting effects of deployment on long-term health continue to mount and are yet to be elucidated. This report outlines how findings from the first 7 years of the Millennium Cohort Study have helped to address health concerns related to military service including deployments. METHODS The Millennium Cohort Study was designed in the late 1990s to address veteran and public concerns for the first time using prospectively collected health and behavioral data. RESULTS Over 150,000 active-duty, reserve, and National Guard personnel from all service branches have enrolled, and more than 70% of the first 2 enrollment panels submitted at least 1 follow-up survey. Approximately half of the Cohort has deployed in support of operations in Iraq and Afghanistan. CONCLUSION The Millennium Cohort Study is providing prospective data that will guide public health policymakers for years to come by exploring associations between military exposures and important health outcomes. Strategic studies aim to identify, reduce, and prevent adverse health outcomes that may be associated with military service, including those related to deployment.
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Affiliation(s)
- Tyler C Smith
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
| | - Isabel G Jacobson
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
| | - Tomoko I Hooper
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
| | - Cynthia A LeardMann
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
| | - Edward J Boyko
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
| | - Besa Smith
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
| | - Gary D Gackstetter
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
| | - Timothy S Wells
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
| | - Paul J Amoroso
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
| | - Gregory C Gray
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
| | - James R Riddle
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
| | - Margaret AK Ryan
- Center for Deployment Health Research, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, USA
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Understanding the neuropsychological consequences of deployment stress: a public health framework. J Int Neuropsychol Soc 2011; 17:1-6. [PMID: 21083962 DOI: 10.1017/s1355617710001116] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Complaints of neuropsychological dysfunction have emerged among subsets of military personnel after almost every major deployment involving western nations in recent history. Although deployments have been characterized by a range of neural risk factors, psychological stress is common to most prolonged deployments. This review uses a public health framework to address associations between deployment-related stress and neuropsychological performance. Specifically, the review covers mechanisms by which deployment-related psychological stress may affect neuropsychological functioning, considers the advantages and disadvantages of approaching the question from a public health perspective, and discusses how epidemiological research may sort out questions regarding course, cause, and effect.
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Temporal relationships between Gulf War deployment and subsequent psychological disorders in Royal Australian Navy Gulf War veterans. Soc Psychiatry Psychiatr Epidemiol 2010; 45:843-52. [PMID: 19763364 DOI: 10.1007/s00127-009-0134-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 08/21/2009] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although much has been published on the effects of the 1990/1991 Gulf War on the psychological health of veterans, few studies have addressed the pattern and timing of post-war development of psychological disorders. Our study aims to identify the most common psychological disorders that first appeared post-Gulf War, the period of peak prevalence and the sequence of multiple psychological disorders. METHODS The temporal progression of psychological disorders in male Australian naval Gulf War veterans with no prior psychological disorders was calculated across each year of the post-Gulf War period. DSM-IV diagnoses were obtained using the Composite International Diagnostic Interview. RESULTS Psychological disorder rates peaked in the first 2 years (1991-1992) following the Gulf War. Alcohol use disorders were the most likely to appear first. Classification and regression tree analysis found that risk of disorder was exacerbated if veterans had been exposed to a high number of potential psychological stressors during their military service. Lower military rank was associated with increased risk of alcohol disorders, particularly during the first 2 years post-Gulf War. In veterans with two or more disorders, anxiety disorders and alcohol disorders tended to appear before affective disorders. CONCLUSIONS Our study found that psychological disorders occur in sequence following Gulf War deployment. Our findings may help clinicians to anticipate, and better manage, multiple symptomatology. The findings may also assist veteran and defence organisations in planning effective mental health screening, management and prevention policy.
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Vasterling JJ, Proctor SP, Friedman MJ, Hoge CW, Heeren T, King LA, King DW. PTSD symptom increases in Iraq-deployed soldiers: comparison with nondeployed soldiers and associations with baseline symptoms, deployment experiences, and postdeployment stress. J Trauma Stress 2010; 23:41-51. [PMID: 20135698 DOI: 10.1002/jts.20487] [Citation(s) in RCA: 171] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This prospective study examined: (a) the effects of Iraq War deployment versus non-deployment on pre- to postdeployment change in PTSD symptoms and (b) among deployed soldiers, associations of deployment/postdeployment stress exposures and baseline PTSD symptoms with PTSD symptom change. Seven hundred seventy-four U.S. Army soldiers completed self-report measures of stress exposure and PTSD symptom severity before and after Iraq deployment and were compared with 309 soldiers who did not deploy. Deployed soldiers, compared with non-deployed soldiers, reported increased PTSD symptom severity from Time 1 to Time 2. After controlling for baseline symptoms, deployment-related stressors contributed to longitudinal increases in PTSD symptoms. Combat severity was more strongly associated with symptom increases among active duty soldiers with higher baseline PTSD symptoms.
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Affiliation(s)
- Jennifer J Vasterling
- VA National Center for PTSD, VA Boston Healthcare System, and Department of Psychiatry, Boston University School of Medicine, Boston, MA 02130, USA.
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Abstract
The aim of the present study was to provide a critical review of prevalence estimates of combat-related post-traumatic stress disorder (PTSD) among military personnel and veterans, and of the relevant factors that may account for the variability of estimates within and across cohorts, including methodological and conceptual factors accounting for differences in prevalence rates across nations, conflicts/wars, and studies. MEDLINE and PsycINFO databases were examined for literature on combat-related PTSD. The following terms were used independently and in combinations in this search: PTSD, combat, veterans, military, epidemiology, prevalence. The point prevalence of combat-related PTSD in US military veterans since the Vietnam War ranged from approximately 2% to 17%. Studies of recent conflicts suggest that combat-related PTSD afflicts between 4% and 17% of US Iraq War veterans, but only 3-6% of returning UK Iraq War veterans. Thus, the prevalence range is narrower and tends to have a lower ceiling among combat veterans of non-US Western nations. Variability in prevalence is likely due to differences in sampling strategies; measurement strategies; inclusion and measurement of the DSM-IV clinically significant impairment criterion; timing and latency of assessment and potential for recall bias; and combat experiences. Prevalence rates are also likely affected by issues related to PTSD course, chronicity, and comorbidity; symptom overlap with other psychiatric disorders; and sociopolitical and cultural factors that may vary over time and by nation. The disorder represents a significant and costly illness to veterans, their families, and society as a whole. Further carefully conceptualized research, however, is needed to advance our understanding of disorder prevalence, as well as associated information on course, phenomenology, protective factors, treatment, and economic costs.
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Affiliation(s)
| | - B. Christopher Frueh
- The Menninger Clinic and Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Ronald Acierno
- Veterans Affairs Medical Center and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Abstract
Many U.S. Gulf War-era veterans complained of poor cognition following the war. This study assessed neuropsychological functioning in veterans 10 years after the war through objective tests. 2189 Gulf War-era veterans (1061 deployed, 1128 non-deployed) were examined at 1 of 16 U.S. Veterans Affairs medical centers. Outcomes included neuropsychological domains derived from factor analysis and individual test scores. Deployed veterans performed significantly worse than non-deployed veterans on 2 of 8 factors (motor speed & sustained attention, analysis not corrected for multiple comparisons) and on 4 of 27 individual test variables (Trails A & B, California Verbal Learning Test-List B, and Continuous Performance Test sensitivity, with only Trails B surviving Bonferroni correction). Within deployed veterans, Khamisiyah exposure was negatively correlated with motor speed after controlling for emotional distress. Depressive symptoms and self-reported exposure to toxicants were independently and significantly associated with worse sustained attention. Other factors were also associated with self-reported exposures. The findings were not a result of differential effort across groups. Gulf War deployment is associated with subtle declines of motor speed and sustained attention, despite overall intact neuropsychological functioning. Evidence suggests that toxicant exposures influence both these functions, and depressive symptoms also influence attention.
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Chatterjee S, Rath ME, Spiro A, Eisen S, Sloan KL, Rosen AK. Gender differences in veterans health administration mental health service use: effects of age and psychiatric diagnosis. Womens Health Issues 2009; 19:176-84. [PMID: 19447322 DOI: 10.1016/j.whi.2009.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 03/13/2009] [Accepted: 03/16/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective of this study was to compare gender differences in mental health disease burden and outpatient mental health utilization among veterans utilizing Veterans Health Administration (VHA) mental health services in fiscal year 1999 (FY99), after the first Gulf War and significant restructuring of VHA services. METHODS We used logistic regression to examine the relationships among gender, age, diagnostic groups, and utilization of mental health and specialty mental health services in a national sample of veterans. The sample included 782,789 veterans with at least 1 outpatient visit in the VHA in FY99 associated with a mental health or substance abuse (SA) diagnosis. Subgroup analyses were performed for 4 diagnostic categories: 1) posttraumatic stress disorder (PTSD), 2) SA disorders, 3) bipolar and psychotic disorders, and 4) mood and anxiety disorders. MAIN FINDINGS Younger women veterans (<35 years old) were significantly less likely and older women (> or =35) more likely to use any mental health services in comparison with their male counterparts. Similar findings were observed for younger women diagnosed with SA or mood and anxiety disorders, but not among veterans with PTSD or bipolar and psychotic disorders, among whom no there were no gender or age differences. In the case of specialized services for SA or PTSD, women younger than 55 with SA or PTSD were significantly less likely to use services than men. CONCLUSION Women veterans underutilized specialty mental health services in relation to men but receipt of mental health care overall in FY99 varied by age and diagnosis. Examining gender differences alone, without taking other factors into account, may not provide an adequate picture of women veterans' current mental health service needs.
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Affiliation(s)
- Sharmila Chatterjee
- Center for Health Quality, Outcomes and Economic Research (CHQOER), Bedford VAMC (152), Bedford, Massachusetts 01730, USA.
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