Title: How do active duty army personnel view the relationships between firearms and suicide? The role of sociopsychological factors, firearm ownership status, and lifetime history of suicidal thoughts and behaviors

Abstract:

Background: Firearms are the primary method by which US military personnel die by suicide, and those at highest risk tend to store firearms unsafely. Promoting secure firearm storage practices is a major component of the Department of Defense's suicide prevention strategy, but perceptions about firearms being associated with suicide risk may impact such efforts.

Purpose: This study examined perceptions that (1) firearm ownership and (2) storage practices are associated with suicide risk and whether key sociopsychological factors (e.g., entrapment, threat perceptions, honor ideology) were associated with these beliefs in a sample of Active Duty (AD) enlisted Army personnel. We then examined if associations varied as a function of firearm ownership or a lifetime history of suicidal thoughts and/or behaviors (STBs).

Methods: Survey data about sociopsychological factors and ownership-suicide risk beliefs and storage-suicide risk beliefs were collected from 399 AD Army personnel. Multiple regression and multigroup path analyses were used. 

Results: Greater intolerance of uncertainty and entrapment, and weaker honor ideology, were associated with greater ownership-suicide risk beliefs, whereas being a parent of a minor child was linked with weaker ownership-suicide risk beliefs. None of the variables examined were associated with storage-suicide risk beliefs. Participants with a lifetime history of STBs who had higher threat perceptions endorsed weaker ownership-suicide risk beliefs.

Conclusion: AD Army personnel may tend to believe that firearm ownership and storage practices are largely unrelated to suicide risk. More tailored messaging and suicide-gun violence prevention efforts are likely needed. Findings have important implications for military suicide prevention efforts.

Citation: Edwards Daruwala, S. E., Allan, N., Tucker, R., Bryan, C. J., Dretsch, M. N., Trachik, B., & Bozzay, M. L. (2025). How do active duty army personnel view the relationships between firearms and suicide? The role of sociopsychological factors, firearm ownership status, and lifetime history of suicidal thoughts and behaviors. Social Psychiatry and Psychiatric Epidemiology, 1-13. https://doi.org/10.1007/s00127-025-02858-8

Links:

• PMID: 39953167
• https://doi.org/10.1007/s00127-025-02858-8

Title: Improving explainability of post-separation suicide attempt prediction models for transitioning service members: insights from the Army Study to Assess Risk and Resilience in Servicemembers — Longitudinal Study

Abstract:

Background and objectives: Traumatic brain injury (TBI) is a concern for US service members and veterans (SMV), leading to heterogeneous psychological and cognitive outcomes. We sought to identify neuropsychological profiles of mild TBI (mTBI) and posttraumatic stress disorder (PTSD) among the largest SMV sample to date.

Methods: We analyzed cross-sectional baseline data from SMV with prior combat deployments enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Latent profile analysis identified symptom profiles using 35 indicators, including physical symptoms, depression, quality of life, sleep quality, postconcussive symptoms, and cognitive performance. It is important to note that the profiles were determined independently of mTBI and probable PTSD status. After profile identification, we examined associations between demographic variables, mTBI characteristics, and PTSD symptoms with symptom profile membership.

Results: The analytic sample included 1,659 SMV (mean age 41.1 ± 10.0 years; 87% male); among them 29% (n = 480) had a history of non-deployment-related mTBI only, 14% (n = 239) had deployment-related mTBI only, 36% (n = 602) had both non-deployment and deployment-related mTBI, and 30% (n = 497) met criteria for probable PTSD. A 6-profile model had the best fit, with separation on all indicators (p < 0.001). The model revealed distinct neuropsychological profiles, representing a combination of 3 self-reported functioning patterns: high (HS), moderate (MS), and low (LS), and 2 cognitive performance patterns: high (HC) and low (LC). The profiles were (1) HS/HC: n=301, 18.1%; (2) HS/LC: n=294, 17.7%; (3) MS/HC: n=359, 21.6%; (4) MS/LC: n=316, 19.0%; (5) LS/HC: n=228, 13.7%; and (6) LS/LC: n=161, 9.7%. SMV with deployment-related mTBI tended to be grouped into lower functioning profiles and were more likely to meet criteria for probable PTSD. Conversely, SMV with no mTBI exposure or non-deployment-related mTBI were clustered in higher functioning profiles and had a lower likelihood of meeting criteria for probable PTSD.

Discussion: Findings suggest varied symptom and functional profiles in SMV, influenced by injury context and probable PTSD comorbidity. Despite diagnostic challenges, comprehensive assessment of functioning and cognition can detect subtle differences related to mTBI and PTSD, revealing distinct neuropsychological profiles. Prioritizing early treatment based on these profiles may improve prognostication and support efficient recovery.

Citation: Edwards, E. R., Geraci, J. C., Gildea, S. M., Houtsma, C., Holdcraft, J. A., Kennedy, C. J., ... & Kessler, R. C. (2025). Improving explainability of post-separation suicide attempt prediction models for transitioning service members: insights from the Army Study to Assess Risk and Resilience in Servicemembers—Longitudinal Study. Translational Psychiatry, 15(1), 37. https://doi.org/10.1038/s41398-025-03248-z

Links:

• PMID: 39885116
• https://doi.org/10.1038/s41398-025-03248-z

Title: Diagnosis of Alcohol Use Disorder and Deaths Related to Alcohol, Drug Overdose, or Suicide among Post-9/11 Active Duty Service Members and Veterans Following Traumatic Brain Injury

Summary: The goal of this systematic review was to examine the efficacy of behavioral health care treatments for posttraumatic stress disorder, depression, and anxiety delivered via telehealth.

Abstract:

Objectives: The association between traumatic brain injury (TBI) and alcohol use disorder (AUD) is known, but the extent of TBI's role in developing AUD remains unclear. This study examines the association between TBI severity with subsequent AUD diagnosis, and hazard for death due to alcohol, drug overdose, or suicide.

Methods: Data from a national US military/veteran cohort (October 1999-September 2016, followed until September 2020) were analyzed using Fine-Gray competing risk models to investigate the relationships between TBI exposure, subsequent AUD, and hazards of death due to specific causes (alcohol, drug overdose, or suicide).

Results: TBI severity correlated with an increased likelihood of an incident AUD diagnosis: mild TBI (hazard ratio [HR]: 1.25, 95% confidence interval [CI] 1.22-1.27), moderate-severe TBI (HR: 1.34, 95% CI 1.32-1.37), and penetrating TBI (HR: 1.90, 95% CI 1.86-1.94). For those who developed AUD, TBI was associated with a higher hazard of death from specific causes such as alcohol, drug overdose, or suicide (HR: 2.47 (95% CI 2.03-3.02) for mild TBI, 4.25 (95% CI 3.49-5.17) for moderate-severe TBI, and 3.39 (95% CI 2.80-4.13) for penetrating TBI.

Conclusions: Veterans with TBI were more likely to develop AUD and experience increased mortality, even after adjusting for demographic and clinical factors. Care strategies that are sensitive to the cognitive and/or emotional impairments associated with varying levels of TBI may lead to better outcomes, reducing both AUD and mortality rates. Further research is needed to develop evidence-based methods for integrating TBI and AUD care.

Citation: Song, K., Amuan, M. E., Adams, R. S., Kennedy, E., Gordon, A. J., Carlson, K. F., ... & Pugh, M. J. (2024). Diagnosis of Alcohol Use Disorder and Deaths Related to Alcohol, Drug Overdose, or Suicide among Post-9/11 Active Duty Service Members and Veterans Following Traumatic Brain Injury. Journal of Addiction Medicine, 10-1097. https://doi.org/10.1097/ADM.0000000000001445

Links:

• PMID: 39898522
• https://doi.org/10.1097/ADM.0000000000001445
  

Title: Evaluating the Acceptability and Feasibility of Collecting Passive Smartphone Data to Estimate Psychological Functioning in U.S. Service Members and Veterans: A Pilot Study

Abstract:

Introduction: This study investigated the acceptability and feasibility of digital phenotyping in a military sample with a history of traumatic brain injury and co-occurring psychological and cognitive symptoms. The first aim was to evaluate the acceptability of digital phenotyping by (1a) quantifying the proportion of participants willing to download the app and rates of dropout and app discontinuation and (1b) reviewing the stated reasons for both refusing and discontinuing use of the app. The second aim was to investigate technical feasibility by (2a) characterizing the amount and frequency of transferred data and (2b) documenting technical challenges. Exploratory aim 3 sought to leverage data on phone and keyboard interactions to predict if a participant (a) is depressed and (b) has depression that improves over the course of the study.

Materials and methods: A passive digital phenotyping app (Mindstrong Discovery) functioned in the background of the participants' smartphones and passively collected phone usage and typing kinematics data.

Results: Fifteen out of 16 participants (93.8%) consented to install the app on their personal smartphone devices. Four participants (26.7%) discontinued the use of the app partway through the study, primarily because of keyboard usability and technical issues. Fourteen out of 15 participants (93.3%) had at least one data transfer, and the median number of days with data was 40 out of a possible 57 days. The exploratory machine learning models predicting depression status and improvement in depression performed better than chance.

Conclusions: The findings of this pilot study suggest that digital phenotyping is acceptable and feasible in a military sample and provides support for future larger investigations of this technology.

Citation: Schultz, L. S., Murphy, M. A., Donegan, M., Knights, J., Baker, J. T., Thompson, M. F., ... & Gray, J. C. (2025). Evaluating the Acceptability and Feasibility of Collecting Passive Smartphone Data to Estimate Psychological Functioning in US Service Members and Veterans: A Pilot Study. Military Medicine, 190(1-2), 285-292. https://doi.org/10.1093/milmed/usae144

Links:

• PMID: 38619334
• https://doi.org/10.1093/milmed/usae144

Title: The Association of Mental Health Symptoms to Post-Traumatic Nightmares Among Treatment Seeking Active Duty Service Members

Abstract:

Introduction: Posttraumatic nightmares (PTNs) are common among service members with a history of combat or mission-related trauma and are associated with decreased well-being. Unfortunately, beyond establishing an association between mental health symptoms and PTNs, the existing literature fails to provide a more comprehensive understanding of factors associated with PTNs. The effectiveness of current recommended treatments is frequently debated, with the literature varying in levels of support. Treatment of PTN is complicated, given their association with a number of mental health difficulties including posttraumatic stress disorder (PTSD), anxiety, and depression. The present study sought to better delineate the association of these difficulties with PTNs, in an effort to inform and improve treatments for the nation's service members.

Materials and methods: This study utilized de-identified data collected during standard procedures for an interdisciplinary intensive outpatient program for service members with a history of traumatic brain injury and/or psychological health conditions (N = 1,550). Study analyses were performed under a Walter Reed National Military Medical Center institutional review board-approved protocol. Three cross-sectional forward likelihood ratio logistic regressions predicting the presence of PTNs were conducted while controlling for the alpha-blocker prazosin, as it is recommended for the treatment of PTSD-associated nightmares. Separate models were created for posttraumatic stress symptoms (PTSS), depression, and anxiety because of multicollinearity concerns. Additional variables considered for inclusion were psychological symptoms (e.g., suicide ideation, postconcussive symptoms), satisfaction with life, sleep (e.g., pain that disrupts sleep, early awakenings, sleepiness), demographics (e.g., sex, race/ethnicity, marital status, age), and military characteristics (e.g., rank, branch, special operator status, time in service).

Results: PTSS (odds ratio [OR]: 1.13), anxiety (OR: 1.19), and depression (OR: 1.19) were associated with increased odds of PTNs when controlling for prazosin. Each of the final models accounted for a significant amount of variance in the presence/absence of PTN. The included variables differed across models. The PTSS model included pain that disrupted sleep, postconcussive symptoms, special operator status, and early awakenings. The anxiety model included postconcussive symptoms, pain that disrupted sleep, special operator status, and prazosin use. The depression model included postconcussive symptoms, pain that disrupted sleep, special operator status, difficulty falling asleep within 30 min, and prazosin use. Although most variables were associated with an increased odds of PTNs, postconcussive symptoms in the PTSS model and special operator status in all 3 models were associated with decreased odds of PTNs. These findings are illustrated in Tables 2 to 4.

Conclusions: Findings support the association of PTSS, anxiety, and depression to PTNs, and, importantly, suggest that other factors may be equally or more important in understanding PTNs. Notably, increased odds of PTNs were observed among patients with pain that disrupts their sleep. The cross-sectional nature of the study allows examination of these co-occurring symptoms as they would present in the clinic, potentially informing assessment and treatment strategies; however, it precludes consideration of temporal relationships. Results highlight the importance of considering comorbid symptoms and relevant military characteristics to gain a more complete understanding of PTNs. Future research utilizing longitudinal methods are needed to inform the temporal/causal aspects of these relationships.

Citation: Paxton Willing, M. M., Tate, L. L., Riggs, D. S., DeGraba, T. J., Sours Rhodes, C., & Pickett, T. C. (2025). The Association of Mental Health Symptoms to Post-Traumatic Nightmares Among Treatment Seeking Active Duty Service Members. Military Medicine, 190(1-2), e440-e447. https://doi.org/10.1093/milmed/usae334

Links:

• PMID: 39078746
• https://doi.org/10.1093/milmed/usae334

Title: Research Letter: Relationship of Blood Biomarkers of Inflammation With Acute Concussion Symptoms and Recovery in the CARE Consortium

Abstract:

Objective: Determine the association of inflammatory biomarkers with clinical measures and recovery in participants with concussion.

Setting: Multicenter study in National Collegiate Athletic Association member institutions including military service academies.

Participants: Four hundred twenty-two participants with acute concussion.

Design: Clinical visits and blood draws were completed preinjury and at multiple visits postconcussion (0-12 hours, 12-36 hours, and 36-60 hours postinjury). Clinical measures included Sport Concussion Assessment Tool (SCAT) symptom severity, Balance Error Scoring System, Standardized Assessment of Concussion (SAC), Brief Symptom Inventory-18 (BSI-18) scores, time to initiation of graduated return-to-play (RTP) protocol, and time to RTP. Interleukin (IL)-6, IL-10, IL-8, IL-1 receptor antagonist (RA), tumor necrosis factor (TNF), c-reactive protein, and vascular endothelial growth factor (VEGF) were measured in serum. Prespecified analyses focused on IL-6 and IL-1RA at 0 to 12 hours; exploratory analyses were conducted with false discovery rate correction.

Results: For prespecified analyses, IL-1RA at 0 to 12 hours in female participants was positively associated with more errors on the SAC (B(standard error, SE) = 0.58(0.27), P < .05) and worse SCAT symptom severity (B(SE) = 0.96(0.44), P < .05). For exploratory analyses, higher levels of IL-1RA at 12 to 36 hours were associated with higher global (B(SE) = 0.55(0.14), q < 0.01), depression (B(SE) = 0.45(0.10), q < 0.005), and somatization scores on the BSI (B(SE) = 0.46(0.12), q < 0.01) in participants with concussion; Higher TNF at 12 to 36 hours was associated with fewer errors on the SAC (B(SE) = - 0.46(0.14), q < 0.05). Subanalyses showed similar results for male participants and participants who were athletes. No associations were discovered in nonathlete cadets. Higher IL-8 at 0 to 12 hours was associated with slower RTP in female participants (OR = 14.47; 95% confidence interval, 2.96-70.66, q < 0.05); no other associations with recovery were observed.

Conclusions: Peripheral inflammatory markers are associated with clinical symptoms following concussion and potentially represent one mechanism for psychological symptoms observed postinjury. Current results do not provide strong support for a potential prognostic role for these markers.

Citation: Meier, T. B., Huber, D. L., Goeckner, B. D., Gill, J. M., Pasquina, P., Broglio, S. P., ... & CARE Consortium Investigators. (2025). Relationship of blood biomarkers of inflammation with acute concussion symptoms and recovery in the CARE consortium. The Journal of Head Trauma Rehabilitation, 40(1), E23-E28. https://doi.org/10.1097/HTR.0000000000000956

Links:

• PMID: 38833710
• https://doi.org/10.1097/HTR.0000000000000956
  

Title: Factors Associated With Mental Healthcare Utilization Among United States Military Personnel With Posttraumatic Stress Disorder or Depression Symptoms

Citation:
Sharifian, N., LeardMann, C. A., Kolaja, C. A., Baccetti, A., Carey, F. R., Castañeda, S. F., ... & Millennium Cohort Study Team. Factors Associated With Mental Healthcare Utilization Among United States Military Personnel With Posttraumatic Stress Disorder or Depression Symptoms. American journal of preventive medicine, 68(2), 289-299. https://doi.org/10.1016/j.amepre.2024.10.006

Links:

• PMID: 39419231
• https://doi.org/10.1016/j.amepre.2024.10.006

Title: Epigenome-wide association studies identify novel DNA methylation sites associated with PTSD: a meta-analysis of 23 military and civilian cohorts

Abstract:

Background: The occurrence of post-traumatic stress disorder (PTSD) following a traumatic event is associated with biological differences that can represent the susceptibility to PTSD, the impact of trauma, or the sequelae of PTSD itself. These effects include differences in DNA methylation (DNAm), an important form of epigenetic gene regulation, at multiple CpG loci across the genome. Moreover, these effects can be shared or specific to both central and peripheral tissues. Here, we aim to identify blood DNAm differences associated with PTSD and characterize the underlying biological mechanisms by examining the extent to which they mirror associations across multiple brain regions.

Methods: As the Psychiatric Genomics Consortium (PGC) PTSD Epigenetics Workgroup, we conducted the largest cross-sectional meta-analysis of epigenome-wide association studies (EWASs) of PTSD to date, involving 5077 participants (2156 PTSD cases and 2921 trauma-exposed controls) from 23 civilian and military studies. PTSD diagnosis assessments were harmonized following the standardized guidelines established by the PGC-PTSD Workgroup. DNAm was assayed from blood using either Illumina HumanMethylation450 or MethylationEPIC (850K) BeadChips. A common QC pipeline was applied. Within each cohort, DNA methylation was regressed on PTSD, sex (if applicable), age, blood cell proportions, and ancestry. An inverse variance-weighted meta-analysis was performed. We conducted replication analyses in tissue from multiple brain regions, neuronal nuclei, and a cellular model of prolonged stress.

Results: We identified 11 CpG sites associated with PTSD in the overall meta-analysis (1.44e-09 < p < 5.30e-08), as well as 14 associated in analyses of specific strata (military vs civilian cohort, sex, and ancestry), including CpGs in AHRR and CDC42BPB. Many of these loci exhibit blood-brain correlation in methylation levels and cross-tissue associations with PTSD in multiple brain regions. Methylation at most CpGs correlated with their annotated gene expression levels.

Conclusions: This study identifies 11 PTSD-associated CpGs, also leverages data from postmortem brain samples, GWAS, and genome-wide expression data to interpret the biology underlying these associations and prioritize genes whose regulation differs in those with PTSD.

Citation: Katrinli, S., Wani, A. H., Maihofer, A. X., Ratanatharathorn, A., Daskalakis, N. P., Montalvo-Ortiz, J., ... & Traumatic Stress Brain Research Group. (2024). Epigenome-wide association studies identify novel DNA methylation sites associated with PTSD: a meta-analysis of 23 military and civilian cohorts. Genome Medicine, 16, 147. https://doi.org/10.1101/2024.07.15.24310422

Links:

• PMID: 39072012
• https://doi.org/10.1101/2024.07.15.24310422

Title: Chronic Traumatic Encephalopathy, Family History of Mental Illness, and Aggression in Brain Donors With Repetitive Head Impact Exposure

Abstract:

Background and objectives: Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with exposure to repetitive head impacts, including from contact sports and military service. Although CTE case reports have commonly described aggression during midlife, recent studies failed to show associations between CTE tau burden and aggression. First-degree family history of mental illness (1°FHMI) is a well-established risk factor of aggression. We tested the hypothesis that CTE pathology moderates the association between 1°FHMI and aggression, providing an explanation for the lack of association previously observed.

Methods: This was a retrospective examination of consecutive, deceased, male brain donors with repetitive head impact exposure from the Understanding Neurologic Injury and Traumatic Encephalopathy Study at Boston University from 2014 to 2021. Neuropathologists diagnosed CTE using established National Institute of Neurological Disorders and Stroke criteria. Informants were administered the Brown-Goodwin Assessment for Lifetime History of Aggression (BGLHA) and were queried regarding 1°FHMI. Exploratory factor analysis evaluated BGLHA factor structure. Stratified by CTE status, linear regression analyses examined relationships between 1°FHMI and standardized adult BGLHA scores and factor scores. Models were adjusted for race, age at death, education, years of contact sport play, military history, substance use treatment history, psychologically traumatic event history, and BGLHA childhood score.

Results: Among 845 brain donors, the mean age at death was 60.3 (SD = 19.6) years. 589 donors (69.7%) had CTE, and 383 donors (45.3%) had a 1°FHMI. 1°FHMI was significantly associated with standardized adult BGLHA scores in those with CTE, but not in those without CTE (CTE present: β = 0.16, 95% CI 0.02-0.29; CTE absent: β = 0.10, 95% CI -0.12 to 0.32). The largest effects were observed among those with CTE, aged 40-59 years (CTE present: β = 0.64, 95% CI 0.32-0.96; CTE absent: β = 0.05, 95% CI -0.44 to 0.54), particularly for BGLHA factors of emotional dysregulation/impulsiveness (CTE present: β = 1.68, 95% CI 0.78-2.58; CTE absent: β = 0.09, 95% CI -1.20 to 1.37) and antisocial behavior (CTE present: β = 1.56, 95% CI 0.64-2.47; CTE absent: β = 0.10, 95% CI -1.19 to 1.40).

Discussion: Among brain donors exposed to repetitive head impacts, CTE pathology moderated the effect of 1°FHMI on BGLHA scores, with the largest effects in midlife. Predisposition to mental illness and CTE pathology may increase risk of aggression beyond each risk factor's additive effects. Prospective studies are needed to confirm these results.

Citation: Uretsky, M., Nair, E., Burton, R., Cronin, S. W., Rousseau, D., Tuz-Zahra, F., ... & Mez, J. (2024). Chronic Traumatic Encephalopathy, Family History of Mental Illness, and Aggression in Brain Donors With Repetitive Head Impact Exposure. Neurology, 103(12), e210056. https://doi.org/10.1212/WNL.000000000021005

Links:

• PMID: 39602665
• https://doi.org/10.1212/WNL.000000000021005

Title: Mental and Physical Health-Related Quality of Life Following Military Polytrauma

Abstract:

Introduction: The long-term impact of deployment-related trauma on mental and physical health-related quality of life (HRQoL) among military personnel is not well understood. We describe the mental and physical HRQoL among military personnel following deployment-related polytrauma after their discharge from the hospital and examine factors associated with HRQoL and longitudinal trends.

Materials and methods: The U.S. military personnel with battlefield-related trauma enrolled in the Trauma Infectious Diseases Outcomes Study were surveyed using SF-8 Health Surveys at 1 month post-discharge (baseline) and at follow-up intervals over 2 years. Inclusion in the longitudinal analysis required baseline SF-8 plus responses during early (3 and/or 6 months) and later follow-up periods (12, 18, and/or 24 months). Associations of demographics, injury characteristics, and hospitalization with baseline SF-8 scores and longitudinal changes in SF-8 scores during follow-up were examined. Survey responses were used to calculate the Mental Component Summary score (MCS) and the Physical Component Summary score (PCS). The MCS focuses on vitality, mental health, social functioning, and daily activity limitations, whereas PCS is related to general health, bodily pain, physical functioning, and physical activity limitations. Longitudinal trends in SF-8 scores were assessed using chi-square tests by comparing the median score at each timepoint to the median 1-month (baseline) score, as well as comparing follow-up scores to the immediately prior timepoint (e.g., 6 months vs. 3 months). Associations with the 1-month baseline SF-8 scores were assessed using generalized linear regression modeling and associations with longitudinal changes in SF-8 were examined using generalized linear regression modeling with repeated measures.

Results: Among 781 enrollees, lower baseline SF-8 total scores and PCS were associated with spinal and lower extremity injuries (P < .001) in the multivariate analyses, whereas lower baseline MCS was associated with head/face/neck injuries (P < .001). Higher baseline SF-8 total was associated with having an amputation (P = .009), and lower baseline SF-8 total was also associated with sustaining a traumatic brain injury (TBI; P = .042). Among 524 enrollees with longitudinal follow-up, SF-8 scores increased, driven by increased PCS and offset by small MCS decreases. Upward SF-8 total score and PCS trends were associated with time post-hospital discharge and limb amputation (any) in the multivariate analyses (P < .05), whereas downward trends were independently associated with spinal injury and developing any post-discharge infection (P ≤ .001). Patients with lower extremity injuries had lower-magnitude improvements in PCS over time compared to those without lower extremity injuries (P < .001). Upward MCS trend was associated with higher injury severity (P = .003) in the multivariate analyses, whereas downward trends were independently associated with having a TBI (P < .001), time post-hospital discharge (P < .001), and occurrence of post-discharge infections (P = .002).

Conclusions: Overall, HRQoL increased during the 2-year follow-up period, driven by PCS improvement. Increasing HRQoL was associated with time since hospital discharge and limb amputation, whereas a downward trend in HRQoL was associated with spinal injury and post-discharge infection. The longitudinal decline in MCS, driven by TBI occurrence, time since hospital discharge, and developing post-discharge infections, emphasizes the importance of longitudinal mental health care in this population.

Citation: McDonald, J. R., Wagoner, M., Shaikh, F., Sercy, E., Stewart, L., Knapp, E. R., ... & Tribble, D. R. (2024). Mental and Physical Health-Related Quality of Life Following Military Polytrauma. Military Medicine, 189(11-12), 2550-2561. https://doi.org/10.1093/milmed/usae055

Links:

• PMID: 38421743
• https://doi.org/10.1093/milmed/usae055

Title: A prediction model for differential resilience to the effects of combat-related stressors in US army soldiers

Abstract:

Objectives: To develop a composite score for differential resilience to effects of combat-related stressors (CRS) on persistent DSM-IV post-traumatic stress disorder (PTSD) among US Army combat arms soldiers using survey data collected before deployment.

Methods: A sample of n = 2542 US Army combat arms soldiers completed a survey shortly before deployment to Afghanistan and then again two to three and 8-9 months after redeployment. Retrospective self-reports were obtained about CRS. Precision treatment methods were used to determine whether differential resilience to persistent PTSD in the follow-up surveys could be developed from pre-deployment survey data in a 60% training sample and validated in a 40% test sample.

Results: 40.8% of respondents experienced high CRS and 5.4% developed persistent PTSD. Significant test sample heterogeneity was found in resilience (t = 2.1, p = 0.032), with average treatment effect (ATE) of high CRS in the 20% least resilient soldiers of 17.1% (SE = 5.5%) compared to ATE = 3.8% (SE = 1.2%) in the remaining 80%. The most important predictors involved recent and lifetime pre-deployment distress disorders.

Conclusions: A reliable pre-deployment resilience score can be constructed to predict variation in the effects of high CRS on persistent PTSD among combat arms soldiers. Such a score could be used to target preventive interventions to reduce PTSD or other resilience-related outcomes.

Citation: Kessler, R. C., Bossarte, R. M., Hwang, I., Luedtke, A., Naifeh, J. A., Nock, M. K., ... & Ursano, R. J. (2024). A prediction model for differential resilience to the effects of combat‐related stressors in US army soldiers. International Journal of Methods in Psychiatric Research, 33(4), e70006. https://doi.org/10.1002/mpr.70006

Links:

• PMID: 39475323
• https://doi.org/10.1002/mpr.70006
  

Title: Rethinking Stigma: Prejudicial Beliefs Impact Psychiatric Treatment in U.S. Soldiers

Abstract:

Two thirds of military personnel diagnosed with posttraumatic stress disorder (PTSD) do not engage in treatment. We examined the degree that prejudicial beliefs about people with PTSD negatively affected psychiatric medication acceptance. Public stigma is best defined as negative stereotypes regarding individuals being judged as inferior or weak for having PTSD. In comparison, self-stigma includes internalized negative prejudices about illness control and stability. An important preliminary stage in developing self-stigma is first developing prejudicial beliefs about those with an illness. Active duty soldiers on a U.S. Army post completed surveys of prejudicial beliefs, public stigma, negative beliefs about psychiatric medications, and PTSD symptoms. Soldiers' Post Deployment Health Reassessment and medical records were accessed to determine the relation between their survey answers and responses to a later offer of psychiatric medication. Importantly, increased prejudicial beliefs (but not public stigma) that oneself is to blame for having PTSD were associated with a reduced likelihood of accepting psychiatric medication. Increased age was also associated with increased likelihood of accepting medication. Antistigma efforts to date may have limited effectiveness by targeting public-stigma rather than self-stigma prejudicial beliefs about personal responsibility in the development of PTSD. The relevance of this finding is vital to developing public health campaigns that maximize treatment acceptance.

Citation: Aikins, D. E., Wargo Aikins, J., Consolino, T., Geraci, J. C., & Morrissey, P. (2024). Rethinking stigma: Prejudicial beliefs impact psychiatric treatment in U.S. soldiers. Psychological Services, 10.1037/ser0000912. https://doi.org/10.1037/ser0000912

Links:

• PMID: 39509200
• https://doi.org/10.1037/ser0000912
  

Title: Interactive effects of genetic liability and combat exposure on risk of alcohol use disorder among US service members

Abstract:

Background: An improved understanding of pathways to alcohol use disorder (AUD) among service members may inform efforts to reduce the substantial impact of AUD on this population. This study examined whether the relationship between a service-related risk factor (combat exposure) and later AUD varied based on individual differences in genetic liability to AUD.

Methods: The sample consisted of 1203 US Army soldiers of genetically determined European ancestry who provided survey and genomic data in the Army STARRS Pre/Post Deployment Study (PPDS; 2012-2014) and follow-up survey data in wave 1 of the STARRS Longitudinal Study (2016-2018). Logistic regression was used to estimate the conditional effect of combat exposure level (self-reported in PPDS) on odds of probable AUD diagnosis at follow-up, as a function of a soldier's polygenic risk score (PRS) for AUD.

Results: The direct effect of combat exposure on AUD risk was non-significant (AOR=1.12, 95 % CI=1.00-1.26, p=.051); however, a significant combat exposure x PRS interaction was observed (AOR=1.60, 95 % CI=1.03-2.46, p=.033). Higher combat exposure was more strongly associated with elevated AUD risk among soldiers with heightened genetic liability to AUD.

Conclusions: The effect of combat exposure on AUD risk appeared to vary based on a service member's level of genetic risk for AUD. Continued investigation is warranted to determine whether PRS can help stratify AUD risk within stress-exposed groups such as combat-deployed soldiers. Such efforts might reveal opportunities to focus prevention efforts on smaller subgroups at the intersection of having both environmental exposures and genetic vulnerability to AUD.

Citation: Campbell-Sills, L., Choi, K. W., Strizver, S. D., Kautz, J. D., Papini, S., Aliaga, P. A., ... & Bliese, P. D. (2024). Interactive effects of genetic liability and combat exposure on risk of alcohol use disorder among US service members. Drug and Alcohol Dependence, 264, 112459. https://doi.org/10.1016/j.drugalcdep.2024.112459

Links:

• PMID: 39393159
• https://doi.org/10.1016/j.drugalcdep.2024.112459

Title: Clinical and functional assessment of SARS-CoV-2 sequelae among young marines – a panel study

Abstract:

Background: Long-term SARS-CoV-2 adverse health outcomes are of significant concern, especially among young adults with the potential for the greatest long-term morbidity. We sought to assess and characterize these outcomes in a cohort of Marines.

Methods: We used a cohort of US Marines from a previous longitudinal, prospective observational study of acute SARS-CoV-2, most of whom were enrolled prior to infection. A panel study was established to assess for post-acute sequelae of COVID-19 (PASC), defined as symptoms at least 4 weeks after symptom onset or diagnosis. Symptoms were assessed through questionnaires and validated quality of health metrics. Periodic US Marine Corps fitness testing metrics provided an additional standardized functional assessment and were compared to a pre-pandemic cohort.

Findings: Globally dispersed Marine participants (n = 899) seen an average of 330 days following initial enrollment were predominately male (n = 825, 91.7%), White (n = 613, 71.6%) or Black (n = 149, 17.4%) with a median age of 18 years (interquartile range: 18-19). Among 798 SARS-CoV-2 infected participants, 197 (24.7%) developed PASC. The most prevalent symptoms were loss of taste and/or smell (n = 82; 41.6%), shortness of breath (n = 74; 37.6%), and cough (n = 45; 22.8%). Those with PASC had higher rates and severity of somatic (p < 0.0001), general depressive (p < 0.0001), and anxiety (p = 0.005) symptoms. Compared to a historic cohort of Marines, participants with PASC scored worse on their physical fitness assessments due to slower run times (p = 0.002). Those with PASC continued to have decreased physical performance one year after completing initial training.

Interpretation: In this population of healthy young adult US Marines with mostly either asymptomatic or mild acute COVID-19, one fourth reported physical, cognitive, or psychiatric long-term sequelae of infection. The Marines affected with PASC showed evidence of long-term decrease in functional performance suggesting that SARS-CoV-2 infection may negatively affect health for a significant proportion of young adults.

Citation: Porter, C. K., Beckett, C. G., Cooper, E., White, L., Wallace, D., Jakubski, S., ... & Letizia, A. G. (2024). Clinical and functional assessment of SARS-CoV-2 sequelae among young marines–a panel study. Lancet Regional Health-Americas, 39, 100909. https://doi.org/10.1016/j.lana.2024.100909

Links:

• PMID: 39507365
• https://doi.org/10.1016/j.lana.2024.100909
  

Title: Blood-based DNA methylation and exposure risk scores predict PTSD with high accuracy in military and civilian cohorts

Abstract:

Background: Incorporating genomic data into risk prediction has become an increasingly popular approach for rapid identification of individuals most at risk for complex disorders such as PTSD. Our goal was to develop and validate Methylation Risk Scores (MRS) using machine learning to distinguish individuals who have PTSD from those who do not.

Methods: Elastic Net was used to develop three risk score models using a discovery dataset (n = 1226; 314 cases, 912 controls) comprised of 5 diverse cohorts with available blood-derived DNA methylation (DNAm) measured on the Illumina Epic BeadChip. The first risk score, exposure and methylation risk score (eMRS) used cumulative and childhood trauma exposure and DNAm variables; the second, methylation-only risk score (MoRS) was based solely on DNAm data; the third, methylation-only risk scores with adjusted exposure variables (MoRSAE) utilized DNAm data adjusted for the two exposure variables. The potential of these risk scores to predict future PTSD based on pre-deployment data was also assessed. External validation of risk scores was conducted in four independent cohorts.

Results: The eMRS model showed the highest accuracy (92%), precision (91%), recall (87%), and f1-score (89%) in classifying PTSD using 3730 features. While still highly accurate, the MoRS (accuracy = 89%) using 3728 features and MoRSAE (accuracy = 84%) using 4150 features showed a decline in classification power. eMRS significantly predicted PTSD in one of the four independent cohorts, the BEAR cohort (beta = 0.6839, p=0.006), but not in the remaining three cohorts. Pre-deployment risk scores from all models (eMRS, beta = 1.92; MoRS, beta = 1.99 and MoRSAE, beta = 1.77) displayed a significant (p < 0.001) predictive power for post-deployment PTSD.

Conclusion: The inclusion of exposure variables adds to the predictive power of MRS. Classification-based MRS may be useful in predicting risk of future PTSD in populations with anticipated trauma exposure. As more data become available, including additional molecular, environmental, and psychosocial factors in these scores may enhance their accuracy in predicting PTSD and, relatedly, improve their performance in independent cohorts.

Citation: Wani, A. H., Zhao, X., Katrinli, S., Ketema, E., Maihofer, A. X., Aiello, A. E., ... & Uddin, M. (2023). Blood-based DNA methylation and exposure risk score predicts PTSD with high accuracy in military and civilian cohorts. BMC Med Genomics 17, 235 (2024). https://doi.org/10.1186/s12920-024-02002-6

Links:

• PMID: 39334086
• https://doi.org/10.1186/s12920-024-02002-6

Title: Sleep disorder symptoms and suicidal urges among US Marines seeking suicide treatment: Findings from an intensive daily assessment study

Abstract:

Background: Rates of suicide in United States Marines are among the highest in the military, and sleep disorder symptoms are a known risk factor for suicide in the military. Intensive ecological momentary assessments (EMA) might improve the ability to detect periods that are characterized by increased suicidal ideation. Marines who were at high risk for suicide were intensively assessed for one month on sleep, suicidal urges, posttraumatic stress disorder (PTSD) and depression symptoms.

Methods: U.S. Marines (N = 40) who had a past month suicide attempt or suicidal urges with intent were sent EMA for 28 days. Mixed effects models explored associations among daily sleep, suicidal urges, PTSD, and depression symptoms.

Results: Worsened sleep indicators on a given night significantly predicted higher maximum values of suicide urges the following day. Worse sleep quality the prior night was moderately associated with more severe PTSD symptoms and depression symptoms. Greater severity of PTSD symptoms and depression symptoms were strongly associated with both the maximum value and the range of suicide urges. PTSD and depression symptoms mediated the relationship between sleep quality and suicidal urges. Participants reported that 0000-0300 had the greatest elevation in endorsement of highest suicide urges.

Limitations: This study had a small sample size may not generalize beyond active duty Marines.

Conclusions: Poor sleep quality and other sleep markers were an important risk factor for suicidal urges among U.S. Marines. This relationship was mediated by exacerbations in PTSD and depression symptoms. Interventions are needed to interrupt suicide risk during and following nights with poor sleep.

Citation: Brown, L. A., Zhu, Y., Feler, B., Kautz, M., Taylor, D. J., Pruiksma, K. E., ... & Wiley, J. (2024). Sleep disorder symptoms and suicidal urges among US Marines seeking suicide treatment: Findings from an intensive daily assessment study. Journal of Psychiatric Research, 178, 388-396. https://doi.org/10.1016/j.jpsychires.2024.08.040

Links:

• PMID: 39214033
• https://doi.org/10.1016/j.jpsychires.2024.08.040
  

Title: Associations between avoidant/restrictive food intake disorder profiles and trauma exposure in veteran men and women

Abstract:

Objective: Trauma exposure, particularly interpersonal trauma, is prevalent among individuals with eating disorders (EDs), and trauma exposure and the subsequent development of posttraumatic stress disorder have been associated with poorer outcomes for ED treatment. To our knowledge, there are no published investigations of trauma exposure among individuals with avoidant/restrictive food intake disorder (ARFID), a new diagnosis introduced by the Diagnostic and Statistical Manual of Mental Disorders-5. We investigated associations between trauma exposure and ARFID profiles in a sample of U.S. military veteran men and women.

Methods: Participants in this cross-sectional study included 1494 veterans randomly selected from the population of post-9/11 veterans who had separated from military service within the previous 18 months. They completed a survey assessing EDs, including the Nine Item ARFID Screen and trauma exposure.

Results: Results revealed that 9.8% of the sample exceeded cutoffs for any ARFID profile, with the picky eating profile being the most common. Trauma exposure was prevalent among participants who exceeded cutoffs for ARFID, particularly the picky eating profile.

Discussion: Findings highlight the importance of addressing EDs, including ARFID, in veterans. It will be important to examine the extent to which trauma and trauma-related disorders impact treatment outcomes for individuals with ARFID.

Citation: Mitchell, K. S., Serier, K. N., Smith, B. N., & Vogt, D. Associations between avoidant/restrictive food intake disorder profiles and trauma exposure in veteran men and women. Journal of Clinical Psychology, 80(12), 2344–2356. https://doi.org/10.1002/jclp.23743

Links:

• PMID: 39264021
• https://doi.org/10.1002/jclp.23743
  

Title: Neuropsychological Profiles of Deployment-Related Mild Traumatic Brain Injury: A LIMBIC-CENC Study

Abstract:

Background and objectives: Traumatic brain injury (TBI) is a concern for US service members and veterans (SMV), leading to heterogeneous psychological and cognitive outcomes. We sought to identify neuropsychological profiles of mild TBI (mTBI) and posttraumatic stress disorder (PTSD) among the largest SMV sample to date.

Methods: We analyzed cross-sectional baseline data from SMV with prior combat deployments enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Latent profile analysis identified symptom profiles using 35 indicators, including physical symptoms, depression, quality of life, sleep quality, postconcussive symptoms, and cognitive performance. It is important to note that the profiles were determined independently of mTBI and probable PTSD status. After profile identification, we examined associations between demographic variables, mTBI characteristics, and PTSD symptoms with symptom profile membership.

Results: The analytic sample included 1,659 SMV (mean age 41.1 ± 10.0 years; 87% male); among them 29% (n = 480) had a history of non-deployment-related mTBI only, 14% (n = 239) had deployment-related mTBI only, 36% (n = 602) had both non-deployment and deployment-related mTBI, and 30% (n = 497) met criteria for probable PTSD. A 6-profile model had the best fit, with separation on all indicators (p < 0.001). The model revealed distinct neuropsychological profiles, representing a combination of 3 self-reported functioning patterns: high (HS), moderate (MS), and low (LS), and 2 cognitive performance patterns: high (HC) and low (LC). The profiles were (1) HS/HC: n=301, 18.1%; (2) HS/LC: n=294, 17.7%; (3) MS/HC: n=359, 21.6%; (4) MS/LC: n=316, 19.0%; (5) LS/HC: n=228, 13.7%; and (6) LS/LC: n=161, 9.7%. SMV with deployment-related mTBI tended to be grouped into lower functioning profiles and were more likely to meet criteria for probable PTSD. Conversely, SMV with no mTBI exposure or non-deployment-related mTBI were clustered in higher functioning profiles and had a lower likelihood of meeting criteria for probable PTSD.

Discussion: Findings suggest varied symptom and functional profiles in SMV, influenced by injury context and probable PTSD comorbidity. Despite diagnostic challenges, comprehensive assessment of functioning and cognition can detect subtle differences related to mTBI and PTSD, revealing distinct neuropsychological profiles. Prioritizing early treatment based on these profiles may improve prognostication and support efficient recovery.

Citation: de Souza, N. L., Lindsey, H. M., Dorman, K., Dennis, E. L., Kennedy, E., Menefee, D. S., ... & Esopenko, C. (2024). Neuropsychological Profiles of Deployment-Related Mild Traumatic Brain Injury: A LIMBIC-CENC Study. Neurology, 102(12), e209417. https://doi.org/10.1212/WNL.0000000000209417

Links:

• PMID: 38833650
• https://doi.org/10.1212/WNL.0000000000209417
  

Title: Combat Medics' Preparedness to Serve as Behavioral Health Extenders in Forward Environments

Citation: Mesias, G. A., Nugent, K. L., Clarke-Walper, K. M., Sampson, M. K., & Wilk, J. E. (2024). Combat Medics’ Preparedness to Serve as Behavioral Health Extenders in Forward Environments. Military Medicine, 189(Supplement_3), 332-340. https://doi.org/10.1093/milmed/usae121

Links:

• PMID: 39160863
• https://doi.org/10.1093/milmed/usae121
  

Title: Amplified PTSD Symptoms From Self-Attributed Moral Transgressions Are Linked to Internalized Moral Identity During Military Deployment

Abstract:

Introduction: Military personnel frequently experience stressful, morally challenging situations that can lead to posttraumatic stress disorder (PTSD). The relationships between moral identity, transgressive acts, and symptoms related to posttraumatic stress disorder (i.e., posttraumatic stress symptoms; PTSS) among U.S. Army Soldiers were assessed.

Materials and methods: A convenience cohort of 1,547 soldiers completed a survey assessing moral identity and PTSS before deployment. A subset of 505 soldiers completed another survey assessing transgressive acts and PTSS during deployment. Exploratory and confirmatory factor analyses were conducted to determine the underlying factor structure of the measures of moral identity and transgressive acts. Generalized linear modeling, robustness checks, and sensitivity analysis were used to evaluate the predictive relationships.

Results: Moral identity did not directly predict PTSS during deployment. However, self-attributed and betrayal-based transgressive acts were significant predictors. Specifically, self-attributed transgressive acts and PTSS were moderated by internalized moral identity; individuals with a higher internalized moral identity experienced more severe PTSS following self-attributed transgressive acts. These findings were consistent across various model checks, including covariate adjustments, data imputation, and the application of a data quality filter.

Conclusions: The study highlights the significant role of self-attributed moral transgressions during deployment in the development of PTSS among military service members-especially in those with a strong internalized moral identity. This finding suggests a "target of opportunity" for the development of intervention strategies that mitigate PTSS by addressing the moral dimensions of military service.

Citation: Sowden, W. J., & Jones, R. L. (2024). Amplified PTSD symptoms from self-attributed moral transgressions are linked to internalized moral identity during military deployment. Military Medicine, 189 (Supplement_3), 156–164. https://doi.org/10.1093/milmed/usae064

Links:

• PMID: 38554270
• https://doi.org/10.1093/milmed/usae064