Study
Abstract
PURPOSE:
Multiple physical symptoms (MPS) have historically been observed after deployment to a combat zone and are often disabling in nature. This study examined longitudinal trends in MPS status and its relationship to deployment in U.S. military service members.
METHODS:
Using longitudinal data from panel 1 participants in the Millennium Cohort Study (n = 76,924), MPS status was assessed at three time points (2001-2008) using the 15-item Patient Health Questionnaire. Probability of reporting MPS was analyzed using mixed-effects multinomial logit regression, with time and deployment experience as main explanatory variables.
RESULTS:
After adjustment for demographic, military, and health characteristics, service members who deployed with combat were significantly more likely to report MPS at each time point compared with those not deployed (odds ratio [OR] and 95% confidence interval [CI] for wave 1 = 1.49 [1.47-1.52], wave 2 = 1.73 [1.69-1.78], wave 3 = 2.08 [2.03-2.12]), and those who deployed without combat (OR and CI for wave 1 = 2.66 [2.59-2.74], wave 2 = 1.81 [1.75-1.87]; wave 3 = 1.68 [1.63-1.74]).
CONCLUSIONS:
Longitudinal trends indicate that the probability of reporting MPS has increased consistently over time only for those deployed, regardless of combat experience.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: December 01, 2015
-
Citation: McCutchan PK, Liu X, LeardMann CA, Smith TC, Boyko EJ, Gore KL, Freed MC, Engel CC. Deployment, combat, and risk of multiple physical symptoms in the US military: A prospective cohort study. Ann Epidemiol. 2015 Dec 11.
Study
Abstract
Estimates of the risk of tuberculosis (TB) infection resulting from overseas deployment among U.S. military service members have varied widely, and have been plagued by methodological problems. The purpose of this study was to estimate the incidence of TB infection in the U.S. military resulting from deployment. Three populations were examined: 1) a unit of 2,228 soldiers redeploying from Iraq in 2008, 2) a cohort of 1,978 soldiers followed up over 5 years after basic training at Fort Jackson in 2009, and 3) 6,062 participants in the 2011-2012 National Health and Nutrition Examination Survey (NHANES). The risk of TB infection in the deployed population was low-0.6% (95% confidence interval [CI]: 0.1-2.3%)-and was similar to the non-deployed population. The prevalence of latent TB infection (LTBI) in the U.S. population was not significantly different among deployed and non-deployed veterans and those with no military service. The limitations of these retrospective studies highlight the challenge in obtaining valid estimates of risk using retrospective data and the need for a more definitive study. Similar to civilian long-term travelers, risks for TB infection during deployment are focal in nature, and testing should be targeted to only those at increased risk.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: December 01, 2015
-
Citation: Mancuso JD, Geurts M. Challenges in Obtaining Estimates of the Risk of Tuberculosis Infection During Overseas Deployment. Am J Trop Med Hyg. 2015 Dec 9;93(6):1172-8.
Study
Abstract
INTRODUCTION:
Accurate prognosis assessment after non-small-cell lung cancer (NSCLC) diagnosis is an essential step for making effective clinical decisions. This study is aimed to develop a prediction model with routinely available variables to assess prognosis in patients with NSCLC in the U.S. Military Health System.
METHODS:
We used the linked database from the Department of Defense's Central Cancer Registry and the Military Health System Data Repository. The data set was randomly and equally split into a training set to guide model development and a testing set to validate the model prediction. Stepwise Cox regression was used to identify predictors of survival. Model performance was assessed by calculating area under the receiver operating curves and construction of calibration plots. A simple risk scoring system was developed to aid quick risk score calculation and risk estimation for NSCLC clinical management.
RESULTS:
The study subjects were 5054 patients diagnosed with NSCLC between 1998 and 2007. Age, sex, tobacco use, tumor stage, histology, surgery, chemotherapy, peripheral vascular disease, cerebrovascular disease, and diabetes mellitus were identified as significant predictors of survival. Calibration showed high agreement between predicted and observed event rates. The area under the receiver operating curves reached 0.841, 0.849, 0.848, and 0.838 during 1, 2, 3, and 5 years, respectively.
CONCLUSIONS:
This is the first NSCLC prognosis model for quick risk assessment within the Military Health System. After external validation, the model can be translated into clinical use both as a web-based tool and through mobile applications easily accessible to physicians, patients, and researchers.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center/Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: December 01, 2015
-
Citation: Lin J, Carter CA, McGlynn KA, Zahm SH, Nations JA, Anderson WF, Shriver CD, Zhu K. A Prognostic Model to Predict Mortality among Non-Small-Cell Lung Cancer Patients in the U.S. Military Health System. J Thorac Oncol. 2015 Dec;10(12):1694-702.
Study
Abstract
BACKGROUND:
Historic improvements in operative trauma care have been driven by war. It is unknown whether recent battlefield innovations stemming from conflicts in Iraq/Afghanistan will follow a similar trend. The objective of this study was to survey trauma medical directors (TMDs) at level 1-3 trauma centers across the United States and gauge the extent to which battlefield innovations have shaped civilian practice in 4 key domains of trauma care.
METHODS:
Domains were determined by the use of a modified Delphi method based on multiple consultations with an expert physician/surgeon panel: (1) damage control resuscitation (DCR), (2) tourniquet use, (3) use of hemostatic agents, and (4) prehospital interventions, including intraosseous catheter access and needle thoracostomy. A corresponding 47-item electronic anonymous survey was developed/pilot tested before dissemination to all identifiable TMD at level 1-3 trauma centers across the US.
RESULTS:
A total of 245 TMDs, representing nearly 40% of trauma centers in the United States, completed and returned the survey. More than half (n = 127; 51.8%) were verified by the American College of Surgeons. TMDs reported high civilian use of DCR: 95.1% of trauma centers had implemented massive transfusion protocols and the majority (67.7%) tended toward 1:1:1 packed red blood cell/fresh-frozen plasma/platelets ratios. For the other 3, mixed adoption corresponded to expressed concerns regarding the extent of concomitant civilian research to support military research and experience. In centers in which policies reflecting battlefield innovations were in use, previous military experience frequently was acknowledged.
CONCLUSION:
This national survey of TMDs suggests that military data supporting DCR has altered civilian practice. Perceived relevance in other domains was less clear. Civilian academic efforts are needed to further research and enhance understandings that foster improved trauma surgeon awareness of military-to-civilian translation.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: December 01, 2015
-
Citation: Haider AH, Piper LC, Zogg CK, Schneider EB, Orman JA, Butler FK, et. al., Military-to-civilian translation of battlefield innovations in operative trauma care. Surgery. 2015 Dec;158(6):1686-95.
Study
Abstract
PRIMARY OBJECTIVES:
To measure common psychiatric conditions after military deployment with blast exposure and test relationships to post-concussion syndrome (PCS) symptoms and mild traumatic brain injury (mTBI) history.
RESEARCH DESIGN:
Cross-sectional.
METHODS AND PROCEDURES:
Service members or Veterans (n = 107) within 2 years of blast exposure underwent structured interviews for mTBI, post-traumatic stress disorder (PTSD) and multiple mood and anxiety diagnoses.
MAIN OUTCOMES AND RESULTS:
MTBI history and active PTSD were both common, additionally 61% had at least one post-deployment mood or anxiety disorder episode. Psychiatric diagnoses had a high degree of comorbidity. Most dramatically, depression was 43-times (95% CI = 11-165) more likely if an individual had PTSD. PCS symptoms were greater in those with post-deployment PTSD or mood diagnosis. However, neither mTBI nor blast exposure history had an effect on the odds of having PTSD, mood or anxiety condition.
CONCLUSIONS:
These findings support that psychiatric conditions beyond PTSD are common after military combat deployment with blast exposure. They also highlight the non-specificity of post-concussion type symptoms. While some researchers have implicated mTBI history as a contributor to post-deployment mental health conditions, no clear association was found. This may partly be due to the more rigorous method of retrospective mTBI diagnosis determination.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense and Veterans Brain Injury Center
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: December 01, 2015
-
Citation: Walker WC, Franke LM, McDonald SD, Sima AP, Keyser-Marcus L. Prevalence of mental health conditions after military blast exposure, their co-occurrence, and their relation to mild traumatic brain injury. Brain Inj. 2015 Dec;29(13-14):1581-8.
Study
Abstract
Posttraumatic stress disorder (PTSD) is a prevalent condition among military service members and civilians who have experienced traumatic events. Stimulant use has been postulated to increase the risk of incident PTSD; however, research in this area is lacking. In this study, the association between receipt of prescription stimulants and PTSD was examined in a secondary analysis among active duty U.S. military members (n = 25,971), participating in the Millennium Cohort Study, who completed a baseline (2001-2003) and two follow-up surveys (between 2004-2008). Prescription stimulant data were obtained from the military Pharmacy Data Transaction Service. PTSD was assessed using the PTSD Checklist-Civilian Version and incident PTSD was defined as meeting the criteria at follow-up among those who did not have a history of PTSD at baseline. Overall, 1,215 (4.7%) persons developed new-onset PTSD during follow-up. Receipt of prescription stimulants were significantly associated with incident PTSD, hazard ratio = 5.09, 95% confidence interval [3.05, 8.50], after adjusting for sociodemographic factors, military characteristics, attention-deficit/hyperactivity disorder, baseline mental and physical health status, deployment experiences, and physical/sexual trauma. Findings suggested that prescription stimulants are associated with incident PTSD among military personnel; these data may inform the underlying pathogenesis of and preventive strategies for PTSD.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: December 01, 2015
-
Citation: Crum-Cianflone NF, Frasco MA, Armenta RF, Phillips CJ, Horton J, Ryan MA, Russell DW, LeardMann C. Prescription Stimulants and PTSD Among U. S. Military Service Members. J Trauma Stress. 2015 Dec;28(6):585-9.
Study
Abstract
BACKGROUND:
Patients diagnosed with prostate cancer (PCa) are presented with several treatment options of similar efficacy but varying side effects. Understanding how and why patients make their treatment decisions, as well as the effect of treatment choice on long-term outcomes, is critical to ensuring effective, patient-centered care. This study examined treatment decision-making in a racially diverse, equal-access, contemporary cohort of patients with PCa counseled on treatment options at a multidisciplinary clinic.
METHODS:
A prospective cohort study was initiated at the Walter Reed National Military Medical Center (formerly Walter Reed Army Medical Center) in 2006. Newly diagnosed patients with PCa were enrolled before attending a multidisciplinary clinic. Patients completed surveys preclinic and postclinic to assess treatment preferences, reasons for treatment choice, and decisional regret.
RESULTS:
As of January 2014, 925 patients with PCa enrolled in this study. Surgery (54%), external radiation (20%), and active surveillance (12%) were the most common primary treatments for patients with low- and intermediate-risk PCa, whereas patients with high-risk PCa chose surgery (34%) or external radiation with neoadjuvant hormones (57%). Treatment choice differed by age at diagnosis, race, comorbidity status, and calendar year in both univariable and multivariable analyses. Patients preferred to play an active role in the decision-making process and cited doctors at the clinic as the most helpful source of treatment-related information. Almost all patients reported satisfaction with their decision.
CONCLUSIONS:
This is one of the first prospective cohort studies to examine treatment decision-making in an equal-access, multidisciplinary clinic setting. Studies of this cohort would aid in understanding and improving the PCa decision-making process.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center/Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: December 01, 2015
-
Citation: Hurwitz LM, Cullen J, Elsamanoudi S, Kim DJ, Hudak J, Colston M, et.al., A prospective cohort study of treatment decision-making for prostate cancer following participation in a multidisciplinary clinic. Urol Oncol. 2015 Dec 15.
Study
Abstract
This analysis estimated the incidence rates of acute respiratory infections (ARIs) during the first year of military service for service members in 16 cohorts (designated 1999 through 2014) based on the years in which they began their service. That first year of service was divided into two separate follow-up periods: the first 3 months of service (corresponding to the period of initial entry training) and the next 9 months of service (months 4-12). The surveillance period covered service members whose first years of service were before and after the 2011 resumption of the administration of adenovirus vaccines, types 4 and 7, to enlisted trainees at the beginning of their initial training periods. In general, the findings were that incidence rates of ARIs were relatively high for the cohorts who did not receive the vaccines, and that the rates were dramatically lower in the cohorts (2012-2014) who did receive the vaccines. These observations pertained to both the first 3 months of service and the next 9 months of service. Possible interpretations of these findings and the limitations of the study methods are discussed.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Armed Forces Health Surveillance Center
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: December 01, 2015
-
Citation: O'Donnell FL, Taubman SB. Follow-up analysis of the incidence of acute respiratory infections among enlisted service members before and after the 2011 resumption of adenovirus vaccination of basic trainees. MSMR. 2015 Dec;22(12):2-7.
Study
Abstract
OBJECTIVES:
Sexually transmitted infection (STI) prevalence and risk behavior may differ at different phases of deployment. We examined STI prevalence and sexual behavior in the predeployment time period (12 months prior) among recently deployed shipboard US Navy and Marine Corps military personnel.
METHODS:
Data were collected from 1938 male and 515 female service members through an anonymous, self-completed survey assessing sexual behaviours and STI acquisition characteristics in the past 12 months. Cross-sectional sex-stratified descriptive statistics are reported.
RESULTS:
Overall, 67% (n=1262/1896) reported last sex with a military beneficiary (spouse, n=931, non-spouse service member, n=331). Among those with a sexual partner outside their primary partnership, 24% (n=90/373) reported using a condom the last time they had sex and 30% (n=72/243) reported their outside partner was a service member. In total, 90% (n=210/233) reported acquiring their most recent STI in the USA (88%, n=126/143 among those reporting ≥1 deployments and an STI ≥1 year ago) and a significantly higher proportion (p<0.01) of women than men acquired the STI from their regular partner (54% vs 21%) and/or a service member (50% vs 26%).
CONCLUSIONS:
Findings suggest a complex sexual network among service members and military beneficiaries. Findings may extend to other mobile civilian and military populations. Data suggest most STI transmission within the shipboard community may occur in local versus foreign ports but analyses from later time points in deployment are needed. These data may inform more effective STI prevention interventions.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center
- Congressionally Mandated: No
- Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
- Release Date/Publication: December 01, 2015
-
Citation: Harbertson J, Scott PT, Moore J, Wolf M, Morris J, Thrasher S et.al., Sexually transmitted infections and sexual behaviour of deploying shipboard US military personnel: a cross-sectional analysis. Sex Transm Infect. 2015 Dec;91(8):581-8.
Study
Abstract
Musculoskeletal injuries (MSIs) are a concern for the military community because of medical expenses, possible disability, and separation from the military. This study investigated the prevalence of MSIs in deployed aeromedical evacuation (AE) populations reported on Post-Deployment Health Assessment (PDHA) forms. A secondary aim was to examine the relationship between the occurrence of self-reported MSIs on PDHAs and a subsequent medical diagnosis. Flight nurses (Air Force Specialty Code [AFSC] 46F) and AE technicians (AETs) (AFSC 4N0 with a flight duty badge) who completed a PDHA during 2008-2010 were investigated. Data from the test population were compared with a control group of deployed ground-based counterparts. During this time period, 1,366 and 1,959 PDHAs were completed by the AE nursing and AET groups, respectively. At least 1 MSI was reported by 18% of AE nurse and 19% of AET compared with 23% of non-AE nurse and 25% of non-AET PDHAs. Of these individuals with reported MSIs, 35% and 44% of AE nurse and AET PDHAs, respectively, had a diagnosis matching their MSIs. Identifying the prevalence of MSIs in the unique AE environment can lead to the development of preventative and ergonomic solutions, minimizing the risk of MSIs and improving mission success.
- Publication Status: Published
- Sponsoring Organization: Air Force
- Sponsoring Office:
- Congressionally Mandated: No
- Funding Source: Air Force
- Release Date/Publication: December 01, 2015
-
Citation: Fouts BL, Serres JL, Dukes SF, Maupin GM, Wade ME, Pohlman DM. Investigation of Self-Reported Musculoskeletal Injuries on Post-Deployment Health Assessment Forms for Aeromedical Evacuation Personnel. Mil Med. 2015 Dec;180(12):1256-61
Study
Abstract
BACKGROUND:
Limb injuries comprise 50-60% of U.S. Service member's casualties of wars in Afghanistan and Iraq. Combat-related vascular injuries are present in 12% of this cohort, a rate 5 times higher than in prior wars. Improvements in medical and surgical trauma care, including initial in-theatre limb salvage approaches (IILS) have resulted in improved survival and fewer amputations, however, the long-term outcomes such as morbidity, functional decline, and risk for late amputation of salvaged limbs using current process of care have not been studied. The long-term care of these injured warfighters poses a significant challenge to the Department of Defense (DoD) and Department of Veterans Affairs (VA).
METHODS/DESIGN:
The VA Vascular Injury Study (VAVIS): VA-DoD Extremity Injury Outcomes Collaborative, funded by the VA, Health Services Research and Development Service, is a longitudinal cohort study of Veterans with vascular extremity injuries. Enrollment will begin April, 2015 and continue for 3 years. Individuals with a validated extremity vascular injury in the Department of Defense Trauma Registry will be contacted and will complete a set of validated demographic, social, behavioral, and functional status measures during interview and online/ mailed survey. Primary outcome measures will: 1) Compare injury, demographic and geospatial characteristics of patients with IILS and identify late vascular surgery related limb complications and health care utilization in Veterans receiving VA vs. non-VA care, 2) Characterize the preventive services received by individuals with vascular repair and related outcomes, and 3) Describe patient-reported functional outcomes in Veterans with traumatic vascular limb injuries.
DISCUSSION:
This study will provide key information about the current process of care for Active Duty Service members and Veterans with polytrauma/vascular injuries at risk for persistent morbidity and late amputation. The results of this study will be the first step for clinicians in VA and military settings to generate evidence-based treatment and care approaches to these injuries. It will identify areas where rehabilitation medicine and vascular specialty care or telehealth options are needed to allow for better planning, resource utilization, and improved DoD-to-VA care transitions.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Government, academic, or industry source other than Federal Government
- Release Date/Publication: February 01, 2015
-
Citation: Shireman PK, Rasmussen TE, Jaramillo CA, Pugh MJ. VA Vascular Injury Study (VAVIS): VA-DoD extremity injury outcomes collaboration. BMC Surg. 2015 Feb 3;15:13. doi: 10.1186/1471-2482-15-13.
Study
Abstract
Base rates of low ANAM4 TBI-MIL scores were calculated in a convenience sample of 733 healthy male active duty soldiers using available military reference values for the following cutoffs: ≤2nd percentile (2 SDs), ≤5th percentile, <10th percentile, and <16th percentile (1 SD). Rates of low scores were also calculated in 56 active duty male soldiers who sustained an mTBI an average of 23 days (SD = 36.1) prior. 22.0% of the healthy sample and 51.8% of the mTBI sample had two or more scores below 1 SD (i.e., 16th percentile). 18.8% of the healthy sample and 44.6% of the mTBI sample had one or more scores ≤5th percentile. Rates of low scores in the healthy sample were influenced by cutoffs and race/ethnicity. Importantly, some healthy soldiers obtain at least one low score on ANAM4. These base rate analyses can improve the methodology for interpreting ANAM4 performance in clinical practice and research.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense and Veterans Brain Injury Center
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: February 01, 2015
-
Citation: Ivins BJ, Lange RT, Cole WR, Kane R, Schwab KA, Iverson GL. Using base rates of low scores to interpret the ANAM4 TBI-MIL battery following mild traumatic brain injury. Arch Clin Neuropsychol. 2015 Feb;30(1):26-38.
Study
Abstract
BACKGROUND:
The U.S. population has shown increasing rates of overweight and obesity in recent years, but similar analyses do not exist for U.S. military personnel. It is important to understand these patterns in the military because of their impact on fitness and readiness.
PURPOSE:
To assess prevalence and trends in overweight/obesity among U.S. service members and to examine the associations of sociodemographic characteristics, exercise, depression, and substance use with these patterns.
METHODS:
Analyses performed in 2013 used five large population-based health-related behavior surveys conducted from 1995 to 2008. Main outcome measures were overweight and obesity among active duty military personnel based on BMI.
RESULTS:
Combined overweight and obesity (BMI≥25) increased from 50.6% in 1995 to 60.8% in 2008, primarily driven by the rise in obesity (BMI≥30) from 5.0% to 12.7%. For overweight, military women showed the largest increase. For obesity, all sociodemographic groups showed significant increases, with the largest among warrant officers, senior enlisted personnel, and people aged 36-45 years. Adjusted multinomial logit analyses found that service members aged 26 years and older, men, non-Hispanic blacks and Hispanics, enlisted personnel, married personnel, and heavy drinkers had the highest risk both for overweight and obesity.
CONCLUSIONS:
Combined overweight and obesity in active duty personnel rose to more than 60% between 1995 and 2008, primarily because of increased obesity. The high prevalence of overweight and obesity needs attention and has implications for Department of Defense efforts to improve the health, fitness, readiness, and quality of life of the Active Forces.
- Publication Status: Published
- Sponsoring Organization: Undetermined
- Sponsoring Office:
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: February 01, 2015
-
Citation: Reyes-Guzman CM, Bray RM, Forman-Hoffman VL, Williams J. Overweight and obesity trends among active duty military personnel: a 13-year perspective. Am J Prev Med. 2015 Feb;48(2):145-53.
Study
Abstract
Objective:
To determine the association between psychiatric evacuation from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) and demographic, military, and deployment characteristics of deploying Service members. The increased frequency of psychiatric evacuations since 2004 has been anecdotally attributed to the cumulative effects of multiple deployments, or the increased reliance on Reserve and National Guard units, but quantitative evidence is lacking.
Study Design:
This observational study used retrospectively-collected deployment and aeromedical evacuation records to calculate psychiatric evacuation rates, characterize the evacuation circumstances, and quantify the rates of re-deployment after evacuation. Descriptive statistics were used to compare characteristics for psychiatric evacuees with those of other deployers. Binary logistic regression analysis was used to assess the likelihood of psychiatric evacuation based on Service, component, personal demographics, year of military accession, theater of first deployment, and number of deployments. Statistical significance was assessed at a 95% confidence level.
Population Studied:
All Service members evacuated from OEF/OIF from January 2003 through September 2010 with a primary or secondary psychiatric diagnosis (ICD-9 codes 290 – 319), on their evacuation record; and a 20% random sampling of all other deployers who did not psychiatrically evacuate (N = 364,047).
Principle Findings:
After applying sample weights, a total of 0.3% (n = 5887) deployers experienced one or more psychiatric evacuations. Relative to other deployers, psychiatric evacuees were significantly over-represented by females (14.8% versus 11.4%); age group 17 – 24 years (55.4% versus 44.8); whites (69.9% versus 65.6%); and those with a high school diploma or less (83.8% versus 73.6%); those never married (49.1% versus 47.8%); and those with one or two dependents (37.1% versus 34.7%). Elevated psychiatric evacuation rates were observed inconsistently across both combat and noncombat duty assignments. A total of 3951 (67.1%) of evacuees evacuated upon first deployment and 1553 (26.4%) of evacuees evacuated on second deployment. Among all psychiatric evacuees, 4754 (80.8%) never turned to theater or redeployed after they evacuated. Depression (24.9%), post-traumatic stress disorder (24.9%), and psychotic illness (18.4%) accounted for two-thirds of evacuation diagnoses. Drug and alcohol-related disorders accounted for less than 3% of psychiatric evacuations. After adjusting for personal demographics and deployment characteristics, Army Active Duty members had the highest likelihood of psychiatric evacuation, followed by Army National Guard (AOR = 0.852, 95% CI 0.790, 0.919), Army Reserve (AOR = 0.825, 95% CI 0.740, 0.919), Navy Reserve (AOR = 0.585, 95% CI 0.461, 0.742), and Marine Active Duty (AOR = 0.390, 95% CI 0.353, 0.0.430).
Conclusions:
This study identified psychiatric evacuation as primarily an Army burden, and an Active Duty burden within the Army. While other studies have linked violent combat-related exposures to adverse, post-deployment mental and behavioral health outcomes, the contribution of multiple deployments or prolonged combat exposure to an outcome of psychiatric evacuation is not apparent in these findings. Further study is warranted to isolate and mitigate the underlying causes of this growing and costly contributor to unit attrition.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense Health Agency (formerly TRICARE Management Activity)
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: January 01, 2015
-
Citation: Wilmoth MC, Williams TV, et.al., Factors associated with psychiatric evacuation among service members deployed to operation enduring freedom and operation iraqi freedom, january 2004 to september 2010. Mil Med. 2015 Jan;180(1):53-60.
Study
Abstract
Understanding the factors that influence veterans' functional outcome after deployment is critical to provide appropriately targeted care. Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) have been related to disability, but other psychiatric and behavioral conditions are not as well examined. We investigated the impact of deployment-related psychiatric and behavioral conditions on disability among 255 OEF/OIF/OND service members and veterans. Structured clinical interviews assessed TBI and the psychiatric conditions of depression, PTSD, anxiety, and substance use. Self-report questionnaires assessed disability and the behavioral conditions of sleep disturbance and pain. Over 90% of participants had a psychiatric and/or behavioral condition, with approximately half presenting with ≥ 3 conditions. Exploratory factor analysis revealed 4 clinically relevant psychiatric and behavioral factors which accounted for 76.9% of the variance: (a) depression, PTSD, and military mTBI (deployment trauma factor); (b) pain and sleep (somatic factor); (c) anxiety disorders, other than PTSD (anxiety factor); and (d) substance abuse or dependence (substance use factor). Individuals with the conditions comprising the deployment trauma factor were more likely to be substantially disabled than individuals with depression and PTSD, but no military mTBI, OR = 3.52; 95% CI [1.09, 11.37]. Depression, PTSD, and a history of military mTBI may comprise an especially harmful combination associated with high risk for substantial disability.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense and Veterans Brain Injury Center
- Congressionally Mandated: No
- Funding Source:
- Release Date/Publication: February 01, 2015
-
Citation: Lippa SM, Fonda JR, Fortier CB, Amick MA, Kenna A, Milberg WP, McGlinchey RE. Deployment-related psychiatric and behavioral conditions and their association with functional disability in OEF/OIF/OND veterans. J Trauma Stress. 2015 Feb;28(1):25-33.
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