Active Duty Military Personnel Research Articles

The Interpersonal Guilt Rating Scale 15 Item Self-Report Version (IGRS-15s): Exploring the Factor Structure and Psychometric Properties in a Sample of American Post 9/11 Active-Duty and Veteran Military Personnel

The Interpersonal Guilt Rating Scale 15 Item Self-Report Version (IGRS-15s): Exploring the Factor Structure and Psychometric Properties in a Sample of American Post 9/11 Active-Duty and Veteran Military Personnel

Cognitive–behavioural conjoint therapy versus prolonged exposure for PTSD in military service members and veterans: results and lessons from a randomized controlled trial

ABSTRACT Background: Military personnel and veterans are at heightened risk for exposure to traumatic events and posttraumatic stress disorder (PTSD), as well as intimate relationship problems associated with PTSD. Objective: The purpose of this study was to evaluate the relative efficacy of CBCT and PE in improving intimate relationship functioning in active duty military personnel or veterans and their intimate partners; both conditions were hypothesized to significantly improve PTSD. Method: In this study, 32 military service members or veterans with PTSD and their intimate partners were randomized to receive either Cognitive–Behavioral Conjoint Therapy for PTSD (n = 15; CBCT; [Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: Harnessing the healing power of relationships. Guilford]), a trauma-focused couple therapy, or Prolonged Exposure (n = 17; PE; [Foa, E. B., Hembree, E. A., Dancu, C. V., Peterson, A. L., Cigrang, J. A., & Riggs, D. S. (2008). Prolonged exposure treatment for combat-related stress disorders – provider’s treatment manual [unpublished]. Department of Psychiatry, University of Pennsylvania]), a front-line evidence-based individual treatment for PTSD. Results: There were significant challenges with recruitment and a significant difference in dropout from treatment for the two therapies (65% for PE; 27% for CBCT). Treatment dropout was differentially related to pre-treatment relationship functioning; those with below average relationship functioning had higher dropout in PE compared with CBCT, whereas those with above average relationship functioning did not show differential dropout. In general, CBCT led to relational improvements, but this was not consistently found in PE. Clinician- and self-reported PTSD symptoms improved with both treatments. Conclusions: This study is the first to test a couple or family therapy against a well-established, front-line recommended treatment for PTSD, with expected superiority of CBCT over PE on relationship outcomes. Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout on trial analyses are discussed. This trial provides further support for the efficacy of CBCT in the treatment of PTSD and enhancement of intimate relationships.

Genome-Wide Analysis of Exertional Rhabdomyolysis in Sickle Cell Trait Positive African Americans.

Sickle cell trait (SCT), although generally a benign carrier state of hemoglobin S (HbAS), is a risk factor for exertional rhabdomyolysis (ERM), a rare but potentially fatal consequence of highly intense physical exercise, particularly among active-duty military personnel and high-performance athletes. The association between SCT and ERM is poorly understood. The objective of this study was to elucidate the genetic basis of ERM in an SCT-positive African American cohort. SCT-positive African Americans with a personal history of ERM (cases, n = 30) and without history of ERM (controls, n = 53) were enrolled in this study. Whole-genome sequencing was performed on DNA samples isolated from peripheral white blood cells. Participants' demographic, behavioral, and medical history information was obtained. An additional 131 controls were extracted from SCT-positive subjects of African descent from the 1000 Genomes Project. SCT carriers with ERM were characterized by myotoxicity features, significant muscle involvement dominated by muscle weakness, and severe pain and substantial increase in serum creatine kinase, with a mean value of 50,480 U/L. A distinctive feature of the SCT individuals with ERM was exertional collapse, which was reported in 53.3% of the cases in the study cohort. An important factor for the development of ERM was the duration and frequency of strenuous physical activity in the cases compared to the controls. Whole-genome sequencing identified 79,696 protein-coding variants. Genome-wide association analysis revealed that the p.C477R, rs115958260 variant in the SLC44A3 gene was significantly associated with ERM event in SCT-positive African Americans. The study results suggest that a combination of vigorous exercise and a genetic predisposing factor is involved in ERM.

The Impact of COVID-19 on Health Behavior Engagement and Psychological and Physical Health Among Active Duty Military Enrolled in a Weight Management Intervention: An Exploratory Study.

The COVID-19 pandemic profoundly affected the health and well-being of people globally. Some studies suggest individuals with overweight or obesity may have been more adversely impacted by pandemic restrictions. Additionally, military personnel may have been more vulnerable to stress during the pandemic because of job demands (e.g., work in close quarters). Our research group was conducting a randomized clinical trial of a weight management intervention in active duty military personnel with overweight or obesity when the COVID-19 pandemic struck. Thus, we collected additional pandemic-related data from participants enrolled during the COVID-19 pandemic and conducted exploratory analyses to understand how the pandemic affected their stress levels and perceived abilities to engage in health behaviors like exercise and healthy eating. The aims of this exploratory study were to: (1) assess associations between pandemic-related stress and health behaviors with body fat percentage (BF%) and psychological and physical health, and (2) explore how pandemic-related stress and health behaviors affected BF% during and after the intervention. A total of 29 active duty Navy personnel (55% female, 69% White) were enrolled after the onset of pandemic restrictions and completed measures assessing pandemic-related stress and health behaviors as well as measures of general psychological and physical health before the intervention. BF% was collected at 5 timepoints, including baseline, during, and following the intervention. Bivariate correlations assessed associations at baseline. Linearmixed-effects longitudinal models explored how pandemic-related stress and health behaviors affected BF%. Post-hoc analyses evaluated the effects of pandemic factors on BF% at each timepoint. Most participants perceived of the pandemic as increasing stress and detracting from their abilities to engage in health behaviors (i.e., exercise and healthy eating). Higher pandemic stress was significantly associated with reporting exercise and healthy eating as more difficult, worse overall health, and more anxiety and general stress. Reporting exercise as harder during the pandemic also was associated with more psychological distress at baseline. A linearmixed- effects model controlling for age, sex, and number of intervention sessions attended revealed endorsing "exercise as harder" was associated with higher BF%. Post-hoc regression analyses revealed rating "exercise as harder" significantly predicted higher BF% 3 months post-intervention (B = 0.65, P = .01), whereas pandemic stress was not significantly associated with higher BF% at 3 month (B =0.14, P = .08) or 6 month (B = 0.21, P = .09) follow-up. As expected, most participants perceived of the pandemic as heightening stress and interfering with engagement in health behaviors. It is possible that pandemic-related stress may have exacerbated weight gain-promoting behaviors and/or interfered with achievement of desired weight management outcomes. Outside the context of the pandemic, it may be beneficial for healthcare providers to screen individuals for stress and perceptions of ease of engagement in health behaviors before enrollment in a weight management intervention. Further, tailoring interventions to mitigate stress and promote perceptions of ease in engaging in health behaviors may promote better weight management outcomes.

Effects of added trunk load on the in vivo kinematics of talocrural and subtalar joints during landing

BackgroundLanding from heights is a common movement for active-duty military personnel during training. And the additional load they carry while performing these tasks can affect the kinetics and ankle kinematic of the landing. Traditional motion capture techniques are limited in accurately capturing the in vivo kinematics of the talus. This study aims to investigate the effect of additional trunk load on the kinematics of the talocrural and subtalar joints during landing, using a dual fluoroscopic imaging system (DFIS). MethodsFourteen healthy male participants were recruited. Magnetic resonance imaging was performed on the right ankle of each participant to create three-dimensional (3D) models of the talus, tibia, and calcaneus. High-speed DFIS was used to capture the images of participants performing single-leg landing jumps from a height of 40 cm. A weighted vest was used to apply additional load, with a weight of 16 kg. Fluoroscopic images were acquired with or without additional loading condition. Kinematic data were obtained by importing the DFIS data and the 3D models in virtual environment software for 2D–3D registration. The kinematics and kinetics were compared between with or without additional loading conditions. ResultsDuring added trunk loading condition, the medial-lateral translation range of motion (ROM) at the talocrural joint significantly increased (p < 0.05). The subtalar joint showed more extension at 44–56 ms (p < 0.05) after contact. The subtalar joint was more eversion at 40–48 ms (p < 0.05) after contact under the added trunk load condition. The peak vertical ground reaction force (vGRF) significantly increased (p < 0.05). ConclusionsWith the added trunk load, there is a significant increase in peak vGRF during landing. The medial-lateral translation ROM of the talocrural joint increases. And the kinematics of the subtalar joint are affected. The observed biomechanical changes may be associated with the high incidence of stress fractures in training with added load.

Posttraumatic stress disorder, Veterans Health Administration use, and care-seeking among recent-era U.S. veterans.

The current study investigated the associations among probable posttraumatic stress disorder (PTSD), recent Veterans Health Administration (VHA) health care use, and care-seeking for PTSD in U.S. military veterans. Analyses were conducted among 19,691 active duty military personnel enrolled in the Millennium Cohort Study who separated from the military between 2000 and 2012 and were weighted to the 1,130,103 active duty personnel who separated across this time period. VHA utilization was identified from electronic medical records in the year before survey completion, and PTSD care-seeking and PTSD symptoms were assessed through self-report on the 2014-2016 survey; thus, the observation period regarding care-seeking and VHA use encompassed 2013-2016. Veterans with probable PTSD were more likely to use VHA services than those without probable PTSD, aOR = 1.12, 95% CI [1.01, 1.24], although the strongest association with recent VHA use was a depression diagnosis, aOR = 2.47, 95% CI [2.26, 2.70]. Among veterans with probable PTSD, the strongest predictor of care-seeking was recent VHA use compared to community care, aOR = 4.01, 95% CI [3.40, 4.74); reporting a diagnosis of depression was the second strongest predictor of PTSD care-seeking, OR = 2.99, 95% CI [2.53, 3.54]. However, the absolute number of veterans with probable PTSD who were not seeking care was approximately equivalent between veterans using VHA services and those not using VHA services. Additionally, certain groups were identified as being at risk of not seeking care, namely Air Force veterans and veterans with high physical and mental functioning despite substantial PTSD symptoms.

Strategies of Hearing Preservation With Military Personnel: A Scoping Review.

The purpose of this study was to map the strategies used in hearing health education with military personnel during the Hearing Preservation Program (HPP). This study is a scoping review, with electronic searches conducted in online databases and gray literature: Latin American and Caribbean Literature in Health Sciences, PubMed/Medline, Scopus, Web of Science, ASHAWire, Google Scholar, and ProQuest Dissertation & Theses. Only studies describing, analyzing, or evaluating the application of the HPP to active duty or training military personnel were included. A total of 3,478 references were retrieved, and 12 studies met the inclusion criteria. The strategies were classified into five categories: focus group aimed at exploring knowledge and perceptions regarding hearing health (five studies), training on the proper fitting of hearing protection devices (four studies), the utilization of audiovisual materials (seven studies), questionnaires administrated before and after educational intervention (five studies), and feedback survey concerning the implemented hearing health education (three studies). There are five strategies that aimed at assessing knowledge and attitudes, improving hearing health education, facilitating information access, and evaluating the applied actions. https://doi.org/10.23641/asha.25219589.

Overview and Design of the Child Maltreatment in Military Families Life Course Study

Objective This report presents an overview of the objectives, design, and analytic strategy of the Child Maltreatment in Military Families Life Course Study, an investigation of factors associated with child maltreatment in active duty military families. Method: The study uses a case-control retrospective research design and discrete-time survival methodology to examine service member demographic characteristics, family characteristics, military-related characteristics, and military family life events associated with child maltreatment incidents that meet the Department of Defense definition of child abuse or neglect. The sample includes all active duty families with a first occurrence of child maltreatment anytime between Fiscal Year (FY) 2009 and FY 2018 (n = 28,684), and a representative sample of control families with children under age of 18 during the same period (n = 589,417). Analyses include child maltreatment and domestic abuse data from the Family Advocacy Program Central Registry; sponsor socio-demographic, military-related, and family data from the Active Duty Military Personnel Master and Defense Enrollment Eligibility Reporting System data files; deployment data from the Contingency Tracking System; and mental health data from the Medical Data Repository. Results and Conclusions: Study results identify risk and protective factors associated with child maltreatment in military families, subgroups at elevated risk of child maltreatment, and periods of heightened risk during the military family life course. These results are expected to improve the ability to identify families most at-risk for particular types of child maltreatment and inform prevention strategies that promote the health and safety of military families.

Post-Traumatic Stress Disorder and Blast Exposure in Active-Duty Military Service Members

Objective: Active-duty military personnel in the current wars have experienced unique stressors that deviate from standard PTSD assessment and diagnosis. This situation calls for a refinement of military-related PTSD assessment. To this end, this study assessed the utility of the Trauma Symptom Inventory (TSI) in diagnosing PTSD among active-duty military personnel. The past literature has validated the TSI using populations with a small sample size. Hence, this study aimed to fill the gap by using a large sample size of 670 military members to examine whether the TSI is useful for military populations. Setting: Participants were referred to Carolina Psychological Health Services, in Jacksonville, North Carolina by military neurologists and other qualified medical officers from the Naval Hospital in Camp Lejeune, a military base located in Jacksonville, NC, for neuropsychological evaluation due to reported cognitive deficits related to military deployment (i.e., head injury due to exposure to blast injuries). Participants: Based on clinical diagnosis, comprehensive neuropsychological testing, and self-reported data, personnel were classified into four groups: blast exposure (n = 157), PTSD diagnosis (n = 90), both blast exposure and PTSD (n = 283), and neither blast exposure nor PTSD (n = 140), which helps provide a comprehensive picture of the utility of the TSI. Results: The TSI’s 10 clinical scales could distinguish between all groups. Discriminant function analysis showed that an optimally weighted combination of scales correctly predicted 66.67% of PTSD-positive cases and 35.11% of PTSD-negative cases. Conclusion: These findings provide support for the use of the TSI in the assessment of PTSD in active-duty military personnel. Due to the release of TSI-2, there is a need to replicate this data. However, the validity data has indicated a high concordance between the TSI and TSI-2, bolstering confidence in the current findings of the study.

Exploring the Associations of Emotion Regulation and Trait Resilience with the Efficacy of Cognitive Processing Therapy for Active Duty Military Personnel with PTSD

Exploring the Associations of Emotion Regulation and Trait Resilience with the Efficacy of Cognitive Processing Therapy for Active Duty Military Personnel with PTSD

Military Veteran Matriculation in US Physician Associate/Assistant Programs.

This study aims to determine whether veterans have differential access to physician associate/assistant (PA) education by examining likelihood of matriculation relative to nonveteran peers. We explore associations between veteran status and likelihood of matriculation for change over time and whether effects differ among active duty versus non-active-duty applicants. Multivariate logistic regression was used to investigate associations between self-identified military status and likelihood of PA program matriculation in five Centralized Applicant Services for Physician Assistants admissions cycles (2012-2013, 2014-2015, 2016-2017, 2018-2019, 2020-2021). Models controlled for age, sex, race/ethnicity, patient care experience hours, total undergraduate grade point average, and number of applications submitted and applied a Bonferroni correction for alpha inflation. Veteran applicant numbers were small across the study time frame but increased from 2012 (n = 708) to 2020 (n = 978), representing a 38% increase over the lookback period. Despite growth, the proportion of veterans in the matriculant pool has decreased from 4.2% in 2012 to 3.0% in 2020. In unadjusted models, military status was not strongly associated with odds of matriculation. In adjusted models, both veteran and active-duty status were associated with higher odds of matriculation, although this increase was not statistically significant at the 0.005 level for applicants on active-duty. Military veterans and active-duty military personnel have higher likelihood of matriculation into US PA programs relative to nonveteran peers. The proportion of veterans in the matriculant pool has decreased over time. This suggests that while PA programs seems to value previous military experience, further efforts to evaluate and address barriers to military veterans in applying for admissions is needed.

Force plate assessments in reconnaissance marine training company

The ability to obtain dynamic movement assessments using force plate technology holds the promise of providing more detailed knowledge of the strength, balance and forces generated by active-duty military personnel. To date, there are not well-defined use cases for implementation of force plate assessments in military training environments. We sought to determine if force plate technology assessments could provide additional insights, related to the likelihood of graduation, beyond that provided by traditional physical fitness tests (PFT’s), in an elite Marine training school. Serial force plate measures were also obtained on those Marines successfully completing training to determine if consistent measures reflecting the effects of training on muscle skeletal load-over-time could be accurately measured. A pre-training force plate assessment performed in 112 Marines did not predict graduation rates. For Marines who successfully completed the course, serial measures obtained throughout training were highly variable for each individual and no firm conclusions could be drawn related to load imposed or the fitness attained during training.

Enhancing resiliency and optimizing readiness in military personnel through psychological flexibility training: design and methodology of a randomized controlled trial.

Enhancing resiliency and optimizing readiness in military personnel is a high priority for the U.S. Department of Defense. Most military resiliency-enhancement programs are evidence-informed interventions. However, few randomized studies have demonstrated efficacy of any intervention or training program to enhance resiliency and prevent the development of psychological health symptoms in military personnel when exposed to operational stressors. This manuscript provides an overview of the theoretical foundation, research design, and research methods of a preventive intervention trial designed to evaluate the efficacy of a training program to enhance resiliency and prevent psychological health symptoms in military personnel. The resiliency training intervention is based on Acceptance and Commitment Therapy (ACT), an evidence-based intervention with broad empirical support for improving functioning in those living with psychological and medical conditions. This study will evaluate the efficacy of a two-day training program based on ACT for fostering psychological flexibility, the central target in ACT, for enhancing resiliency, and for preventing the development of psychological health symptoms. The research participants will be a non-clinical population of active duty military personnel (N = 600). The ACT-based training program (n = 300) will be compared to a military resiliency training as usual, known as Master Resilience Training (n = 300). Assessment measures will be administered at the baseline assessment, after training, prior to a military deployment, and after returning from a deployment. Qualitative interviews will be conducted to provide feedback on the training program.Clinical Trial Registration: NCT05094115.

Perceptions and experiences of web-prolonged exposure for posttraumatic stress disorder: A mixed-methods study.

Web-based prolonged exposure therapy (Web-PE) has potential to increase the reach of effective posttraumatic stress disorder (PTSD) treatment. While there is initial support for the efficacy of Web-PE, no studies have examined the perceptions and experiences of participants receiving PE in this novel, Web based format. We used a mixed-methods convergent design to examine and integrate quantitative and qualitative data of participant perceptions and experiences of Web-PE. Treatment-seeking active duty military personnel or veterans (N = 29) who received Web-PE completed posttreatment surveys about perceptions of Web-PE and a brief qualitative interview. Thematic coding was used to identify qualitative themes, which were integrated with quantitative data in a joint display. Although many were initially skeptical of experiencing benefit, participants reported that Web-PE was helpful. They appreciated the flexibility of online therapy and reported that self-motivation was important for engagement. Web-PE therapists were well-regarded, although additional therapist support and technical improvements to the Web-PE program were suggested. Scores on the perceptions of Web-PE survey, PTSD survey, and other quantitative data corroborated the qualitative themes. Perceptions and experience of Web-PE are favorable and help to highlight the strengths (e.g., flexibility) and challenges (e.g., requiring self-motivation) associated with Web-treatment for PTSD. The results of this study may inform further development of Web-PE or other Web-based treatment programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Management of severe defects of humerus in combat patients injured in Russo-Ukrainian war

IntroductionRusso-Ukrainian war is associated with application of high-energy weapon, causing severe multifragmental injuries to the bones an associating with severe bone defects.The aim of the study was to evaluate various methods to treat combat patients with severe defects of humerus and to demonstrate the experience of orthopedic war surgeons in managing gunshot injuries to the humerus defects in the ongoing war. Patients and methodsA 24 patients were active-duty military personnel of Armed Forces of Ukraine. These patients were diagnosed with severe humerus defects due to gunshot injury in battlefield zone in various areas of Ukraine. Data was collected within period between February, 24th 2022 till January, 01st 2023. The following approaches were applied to replace bone defect: preoperative 3D printing with polyetheretherketone (PEEK) as orthobiological material; closed reduction, percutaneous lag screw and Ilizarov external fixation; vascularized fibula grafting. ResultsData analyses of the segmental defects of humerus showed 5 cm defect in 3 (13 %) patients, from 5 to 10 cm in 4 (17 %) patients, over 10 cm in 17 (71 %) patients. Analyses were performed in these 17 (71 %) patients, showing 5 patients treated with 3D-printed PEEK implants, 6 patients with vascular-pedicle graft of fibula, 6 patients with closed reduction, percutaneous lag screw, Ilizarov external fixation. Osteomyelitis was diagnosed in one case (20 %) after the use of PEEK implants, requiring to remove both PEEK implant and metal implants followed by application of the antibiotic joint spacers and Ex-Fix fragments of the humerus. In our opinion, the osteomyelitis happened due to inadequate debridement of the wound and non-compliance with the conversion criteria (replacement of the fixation method). The mean length of hospital stay was 5.5 months for patients treated with 3D-printed PEEK implants. ConclusionsClosed reduction, percutaneous lag screw and Ilizarov external fixation as well as vascularized fibula grafting are associated with good outcomes in management of the patients with severe humerus defect due to gunshot injury. 3D printing and PEEK implants could also be considered for the reconstructions of the humerus multifragmental fractures with a bone defect over 10 cm associated with gunshot injury due to high-energy weapon in the war settings.

Body composition as a marker of performance and health in military personnel.

Body composition standards are set to ensure operational readiness in active-duty military personnel. To meet body composition standards, some individuals, however, may engage in unhealthy weight control behaviors (i.e., weight cycling and disordered eating). The objectives of this review are to: (1) evaluate the evidence regarding body composition and the associations to physical and military specific performance; (2) discuss body composition and potential health consequences; and (3) examine the evidence of weight cycling and disordered eating behaviors in military personnel for weight control. A systematic search to identify peer-reviewed research articles was conducted in PubMed on 2/20/2023 using Medical Subject Headings (MeSH) including but not limited to "Military Personnel", "Tactical Athlete", "Weight Loss", "Body Composition", and "Weight Cycling". A total of 225 research articles were identified. The list was narrowed down to articles from the last 20 years (2003-2023) in military personnel. Only studies in which percent body fat was directly measured were included resulting in 17 research articles for this review. Evidence-based research is limited on the relationship between body composition and operational readiness. Weight cycling and disordered eating behaviors also has been reported for weight control, yet additional research is needed. Specifically, future research should focus on female service members, racial and ethnic differences, age, and postpartum status and include other service branches (i.e., Air Force and Navy). A comprehensive survey on weight cycling, disordered eating, and weight management would be valuable to determine the prevalence and extent of this issue. This information along with performance data would guide policy makers on the relevance and appropriateness of existing body composition standards.

Randomized Controlled Trials to Treat Obesity in Military Populations: A Systematic Review and Meta-Analysis.

In recent years, overweight and obesity have reached an alarmingly high incidence and prevalence worldwide; they have also been steadily increasing in military populations. Military personnel, as an occupational group, are often exposed to stressful and harmful environments that represent a risk factor for disordered eating, with major repercussions on both physical and mental health. This study aims to explore the effectiveness of weight loss interventions and assess the significance of current obesity treatments for these populations. Three online databases (PubMed, PsycInfo, and Web of Science) were screened to identify randomized controlled trials (RCTs) aiming to treat obesity in active-duty military personnel and veterans. Random-effects meta-analyses were conducted for body weight (BW) and body mass index (BMI) values, both longitudinally comparing treatment groups from pre-to-post intervention and cross-sectionally comparing the treatment group to controls at the end of the intervention. A total of 21 studies were included: 16 cross-sectional (BW: n = 15; BMI: n = 12) and 16 longitudinal (BW: n = 15; BMI: n = 12) studies were meta-analyzed, and 5 studies were narratively synthesized. A significant small overall BW and BMI reduction from baseline to post-intervention was observed (BW: g = -0.10; p = 0.015; BMI: g = -0.32; p < 0.001), together with a decreased BMI (g = -0.16; p = 0.001) and nominally lower BW (g = -0.08; p = 0.178) in the intervention group compared to controls at the post-intervention time-point. Despite limitations, such as the heterogeneity across the included interventions and the follow-up duration, our findings highlight how current weight loss interventions are effective in terms of BW and BMI reductions in military populations and how a comprehensive approach with multiple therapeutic goals should be taken during the intervention.

A Lack of Generalizability—Total Knee Demographics in the Active Duty Population

ABSTRACT Introduction Age and sex are known demographic risk factors for requiring revision surgery following primary total knee arthroplasty (TKA). Military service members are a unique population with barriers to long-term follow up after surgery. This study aims to compare demographic data between active duty military personnel and a nationwide sample to identify differences that may impact clinical and economic outcomes. Methods A retrospective observational analysis was performed using the Military Health System Data Repository (MDR) and the National Surgical Quality Improvement Program (NSQIP). Databases were queried for patients undergoing primary TKA between January 1, 2015 and December 31, 2020. The MDR was queried for demographic data including age, sex, duty status, facility type, geographic region, history of prior military deployment, history of deployment-related health condition, branch of military service, and military rank. National Surgical Quality Improvement Program was queried for age and sex. Median age between populations was compared with the Mann–Whitney U test, and gender was compared with a chi-squared test. Results During the study period, 2,094 primary TKA patients were identified from the MDR, and 357,865 TKA patients were identified from the NSQIP database. Military TKA patients were 79.4% male with a median age of 49.0, and NSQIP TKA patients were 38.9% were male, with a median age of 67. Military TKA patients were significantly more likely to be male (P &amp;lt; .001) and younger (P &amp;lt; .001). Conclusion Patients undergoing TKA in the military are younger and more likely to be male compared to national trends. Current evidence suggests these factors may place them at a significant revision risk in the future. The application of quality metrics based on nationwide demographics may not be applicable to military members within the Military Health System.

Impact ofthe COVID-19 Pandemic onIndicators ofPsychological Health andSuicidal Ideation Within an Active Duty U.S. Military Population.

The COVID-19 pandemic has had a significant impact on the psychological health of individuals. The pandemic has contributed to increased anxiety, elevated rates of depression, and worsening suicidal ideation among civilians. Reported rates of burnout are also elevated as employees and employers adapted to ever-changing work environments, finding it increasingly difficult to maintain a work-life balance. The objective of this study is to determine how the COVID-19 pandemic impacted the psychological health and rates of suicidal ideation of active duty military personnel in the USA. A total of 2055 military personnel and military-adjacent employees stationed at a U.S. Air Force base completed a self-report survey that was administered six times from January 2020 to December 2021. Validated scales assessed measures of psychological health and suicidal ideation. General Estimating Equations were used to examine how indicators of time and psychological health predicted suicidal ideation in a military population. Life satisfaction, happiness, feeling life is worthwhile, depression severity, and suicidal ideation did not statistically change across the six time points. Worry (P < .01) and depression (P < .001) did decrease significantly, while burnout (P = .01) significantly increased across these time points. Feeling life is worthwhile significantly predicted reduced suicidal ideation (B = -.19; SE = 0.05), while depression (B = 0.11; SE = 0.03), depression severity (B = 0.24; SE = 0.05), worry (B = 0.06; SE = 0.02), and burnout (B = 0.15; SE = 0.07) predicted increased suicidal ideation. The rates of depression and worry decreased throughout the pandemic for those in the study while rates of suicidal ideation remained constant, demonstrating the potential resilience of military personnel and military-adjacent employees in response to the COVID-19 pandemic. However, burnout increased and significantly predicted elevated rates of suicidal ideation, highlighting the importance of focusing on reducing workplace stressors for military personnel.

Incidence of Suicidal Ideation and Suicide Attempt Based on Time in a Deployed Environment.

Knowing when suicidal ideation (SI) or suicide attempt (SA) is most likely to occur in a deployed environment would aid in focusing prevention efforts. This study aims to determine when evacuation for SA and SI is most likely to occur based on the absolute and relative number of months in a deployed setting. This is a case-control study of active-duty military personnel evacuated from the U.S. Central Command area of responsibility for SI or an SA between April 1, 2020, and March 30, 2021. The arrival month and expected departure month were identified for all the included evacuees. The month of evacuation and proportion of completed deployment were compared. Secondary outcomes of mental health diagnosis or need for a waiver was also examined. A total of 138 personnel evacuated for SI or attempted suicide during the 12-month study period were included in the analysis. Evacuations occurring during month 3 of deployment were significantly higher (P < .0001) than those during other months. The 30% and 50% completion point of deployment had statistically higher frequencies of evacuations for SI/SA (<.0001). A secondary analysis revealed that 25.4% of the individuals had a documented preexisting behavioral health condition before deployment (P < .0001). Specific points along a deployment timeline were significant predictors for being evacuated for SI and SA.