Active Duty Military Personnel Research Articles

2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Gender-based Analysis of the Correlates of Hazardous and Binge Drinking among Canadian Active Duty Military Personnel

Alcohol misuse is prevalent among military personnel and has been associated with increased risk of psychosocial problems and physical health issues. Research suggests that military men and women exhibit distinct drinking patterns and differ in terms of alcohol-related problems. However, very little information exits on the gender-specific factors related to alcohol misuse. Information on the environment, such as rurality of serving areas, related to risky drinking among military populations is also scarce. This study examined demographic, military, psychosocial, geographical, and health indicators related to alcohol misuse among a representative sample of active-duty Canadian military members who reported drinking alcohol. Logistic regressions were used to assess the correlates of hazardous drinking and binge drinking among women and men separately. Among women, being younger, single, and experiencing mental health issues were related to risky drinking. Among men, being younger, in the Navy, self-reporting symptoms of psychological distress, and having difficulty coping with anger were related to hazardous drinking, whereas, binge drinking was related to younger age, being single, rurality of serving area, anger management, and poor overall health. Results provide support for gender-specific prevention and intervention strategies and highlight the importance of tailoring programs and policies to the needs of at-risk geographical areas.

A Military Community Cohort Study Reveals Single Nucleotide Polymorphisms in Inflammation Mediator Genes That Associate With Type 2 Diabetes.

Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder characterized by hyperglycemia of varying degrees. Genetic and lifestyle variations are known to influence the onset and severity of T2DM. Among the genetic variations reported to confer susceptibility to the disease are certain single nucleotide polymorphisms (SNPs). Here, we report the analysis of 18 such SNPs in a military community cohort of 716 subjects, comprising 477 diabetic and 239 control subjects. The population studied included active-duty military personnel, veterans, and their families. The SNPs analyzed in this work occur in nine different genes, comprising six interleukin (IL) genes (IL1A, IL1B, IL4, IL6, IL10, and IL18), fatty acid amide hydrolase (FAAH) gene, and cannabinoid receptors 1 and 2 genes (CNR1, CNR2). The products of these genes are players in different conditions, including inflammation, a process linked with diabetes. The T2DM and control (no diabetes) DNA samples were acquired from an archived sample repository (Center for Advanced Molecular Detection, 59th Medical Wing, U.S. Air Force, Joint Base San Antonio [JBSA]-Lackland, TX). The blood samples had been previously collected from gender- and race-mixed cohorts under a protocol approved by the 59th Medical Wing Institutional Review Board. Single nucleotide polymorphism (SNP) genotyping was done by real-time Polymerase Chain Reaction (PCR) using TaqMan assay reagents. The statistical analysis software 9.3 (SAS 9.3) was used for statistical analyses to reveal associations between the SNP genotypes and T2DM. Out of the 18 SNPs analyzed, six showed statistically significant association with T2DM in the overall cohort (P < .05). The odds ratio for these associations varied from 1.57 to 3.16. The rs16944 T/T homozygous genotype (IL1B) showed the strongest association with T2DM, with P = .005. In the White cohort, five of these six SNPs and one other, rs806368 (cannabinoid receptor 1), associate with T2DM. However, the gender-specific analysis of the White cohort revealed only two SNP associations with T2DM in the female cohort, rs16944 (IL1B) and rs2295632 (FAAH), both also showing association in the overall mixed cohort. Likewise, four SNPs showed T2DM association in the White male cohort, with rs187238 (IL18) being uniquely significant in this group. The IL1B SNP rs16944 showed consistent statistically significant association with T2DM and therefore is likely a promising biomarker for T2DM. We note, however, that this association in a generic sense may be with the inflammatory process that accompanies T2DM and not per se with T2DM.

Prevalence of Fibromyalgia Syndrome in Active-Duty Military Personnel.

Previous research with civilian populations has found strong associations between fibromyalgia (FM) and posttraumatic stress disorder (PTSD). We undertook this study to investigate the prevalence of FM in military service members with and without PTSD. Participants were active duty military personnel recruited into either an epidemiologic cohort study of service members before a military deployment or 1 of 3 PTSD treatment trials. Instruments used to document FM and PTSD included the PTSD Checklist-Stressor-Specific Version, the PTSD Symptom Scale-Interview, and the 2012 American College of Rheumatology FM questionnaire. Across the 4 studies, 4,376 subjects completed surveys. The prevalence of FM was 2.9% in the predeployment cohort, and the prevalence was significantly higher in individuals with PTSD (10.8%) compared with those without PTSD (0.8%). In the treatment trials, all of the participants met criteria for PTSD before starting treatment, and the prevalence of FM was 39.7%. The prevalence of FM in active duty service members preparing to deploy is similar to that reported for the general population of the US but is higher than expected for a predominantly male cohort. Furthermore, the prevalence of FM was significantly higher in service members with comorbid PTSD and was highest among those seeking treatment for PTSD. Further investigation is needed to determine the factors linking PTSD and FM.

How did the Brazilian military use to get sick before Covid-19? An analysis of the hospitalization profile of the active-duty personnel in the Brazilian Army Central Hospital from 1998 to 2018

Background: The covid-19 pandemic showed how understanding the epidemiology of specific populations is extremely necessary for adequate health care. For this, it is necessary to know the health-disease profile of the military population (which differs from civilians), but free from the biases that the exceptional events of this catastrophe could generate. Aims: The study aims to characterize the temporal trend and the profile of hospitalizations of active-duty military admitted to the Brazilian Army Central Hospital from 1998 January 1st to 2018 December 31st (before Covid-19 pandemic). Methodology: Analytical cross-sectional study with non-nominal secondary data from the records of the Hospital Information System of the Brazilian Army Central Hospital. Simple linear regression (p&lt;0.005) and descriptive statistics were performed. Results: 20,292 hospitalizations were recorded in the period, of which 93.2% were for males (no change in time trend) and 6.2% were for female (with a significant increase in the historical series). Among males, the predominant age bracket was “21 to 30 years old” (44.5%), “brown” race (47.3%), “Corporals and Soldiers” ranks (61.8%) and hospitalized by the group of specialties of “Orthopedics, Traumatology, and Rheumatology” (33.9%). For females, the predominant age bracket was “31 to 40 years old” (51.4%), “white” race (55%), “Non-commissioned officers” ranks (58.9%) and hospitalized by the group of specialties “Gynecology and Obstetrics” (43, 1%). Conclusions: During the studied period, among the active-duty military personnel hospitalized, there was a predominance of males, young, Corporals and Soldiers with musculoskeletal impairment.

An alternative approach to TOMM cutoff scores using a large sample of military personnel

The accuracy of neuropsychological assessments relies on participants exhibiting their true abilities during administration. The Test of Memory Malingering (TOMM) is a popular performance validity test used to determine whether an individual is providing honest answers. While the TOMM has proven to be highly sensitive to those who are deliberately exaggerating their symptoms, there is a limited explanation regarding the significance of using 45 as a cutoff score. The present study aims to further investigate this question by examining TOMM scores obtained in a large sample of active-duty military personnel (N = 859, M = 26 years, SD = 6.14, 97.31% males, 72.44% white). Results indicated that no notable discrepancies existed between the frequency of participants who scored a 45 and those who scored slightly below a 45 on the TOMM. The sensitivity and specificity of the TOMM were derived using the forced-choice recognition (FCR) scores obtained by participants on the California Verbal Learning Test, Second Edition (CVLT-II). The sensitivity for each trial of the TOMM was 0.84, 0.55, and 0.63, respectively; the specificity for each trial of the TOMM was 0.69, 0.93, and 0.92, respectively. Because sensitivity and specificity rates are both of importance in this study, balanced accuracy scores were also reported. Results suggested that various alternative cutoff scores produced a more accurate classification compared to the traditional cutoff of 45. Further analyses using Fisher’s exact test also indicated that there were no significant performance differences on the FCR of the CVLT-II between individuals who received a 44 and individuals who received a 45 on the TOMM. The current study provides evidence on why the traditional cutoff may not be the most effective score. Future research should consider employing alternative methods which do not rely on a single score.

Effectiveness of Autograft and Allograft Transplants in Treating Athletic Patients With Osteochondral Lesions of the Talus.

Osteochondral lesions of the talus (OLTs) represent 50% of ankle sprains and are most common in athletes who play competitive sports or are on active military duty. OLTs can cause significant physical damage if left untreated and may inflict financial burdens and mental health issues. Over the years, replacement surgeries, mainly autologous osteochondral transplantation (AOT) and osteochondral allograft transplantation (OAT), have become instrumental in treating OLTs. However, these procedures’ effectiveness in returning to full fitness to resume competitive sports or active duty has not been well-established. This systematic review attempts to help this population cohort better understand OLTs and highlight the existing clinical evidence on AOT and OAT effectiveness in treating such patients. We performed a literature search between March 2022 through September 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Of eligible studies evaluating surgical outcomes of AOT and OAT in sportspeople and active-duty military personnel, 86% of patients who received AOT returned to competitive sports or active duty compared to 61% who received OAT. Additionally, on average, patients who underwent AOT returned to full fitness in five months rather than in 16 months for those who underwent OAT. As highlighted in this review, the limited evidence indicates that AOT may lead sportspeople and active-duty military personnel to return to pre-injury levels and resume athletic activities sooner. It is challenging to assume the same for OAT, given the limited studies in athletic cohorts with OLTs. Nevertheless, AOT and OAT are crucial surgical options that can significantly benefit competitive sportspeople and military personnel in resuming their careers.

Mental Health States of Soldiers with Histories of Corona Virus Disease 2019 Infection in Taiwan

Objectives: According to the most recent studies on the mental health impacts of coronavirus disease 2019 (COVID-19), psychological effects are salient in the community, but they are not obvious in the military population. In the study, we intended to examine mental health state and suicide ideation among soldiers with past histories of COVID-19 and to compare them with non-infected controls. Methods: We recruited 193 active-duty military personnel from northern Taiwan and collected their responses of a series of copies of the questionnaire, i.e., Beck's Depression Inventory for depression, Beck's Anxiety Inventory for anxiety, Davidson Trauma Scale for symptoms of posttramatic stress disorder (PTSD), Pittsburgh Sleep Quality Index for sleep disturbance and sleep dissatisfaction, and Five-item Brief Symptom Rating Scale for suicide ideation. Results: Among our samples, about 58.5% (113/193) reported a past history of COVID-19 infection (infected group) at least once. More than 85% had vaccinated in more than two doses. The infected soldier group presented themselves significantly higher magnitude (1.92 ± 0.54) of impacts on their lives than noninfected control group (1.72 ± 0.66, p &lt; 0.05). The discrepancy in life impact between infected and non-infected groups was significantly more salient in male soldiers (p &lt; 0.05) comparing with female. In male soldiers, most mental health states were higher in the non-infected group than the infected group but nonsignificant. Conclusion: This study shows the common and differences in mental health states and suicide ideation between COVID-19 infected and non-infected soldiers in Taiwan and genders. In line with the findings of current studies, our results showed nonsignificant differences between male and female groups in the military population although significant differences among the community population. Further studies with larger sample sizes and more details are needed to confirm our assumption.

Combined effects of time-of-day and simulated military operational stress on perception-action coupling performance

ABSTRACT Perception-action coupling, the ability to ‘read and react’ to the environment, is essential for military personnel to operate within complex and unpredictable environments. Exposure to military operational stressors (e.g., caloric restriction, sleep loss, physical exertion), including around-the-clock operations, may compromise perception-action coupling, thereby impacting performance and safety. We examined the combined effects of simulated military operational stress (SMOS) and time-of-day on perception-action coupling. Fifty-seven active duty and reservist military personnel (45 M; 26.4 ± 5.6 years) completed a 5-day SMOS protocol that included two consecutive days of caloric restriction, and sleep restriction, and disruption. Participants completed a tablet-based perception-action coupling task (PACT) that involves perceiving whether virtual balls fit through virtual apertures. Familiarization occurred on day 0. Eight trials across day 1 (18:00, 22:00), 2 (04:00, 18:00, 22:00) and 3 (04:00, 18:00, 22:00) were analyzed. Mixed models were run to examine the interactive and main effects of day, and time-of-day on PACT response speed and accuracy outcomes. PACT response speed and accuracy outcomes improved at 18:00 and 22:00, whereas performance at 04:00 deteriorated across days. Perception-action coupling performance was resilient to SMOS, except in the early morning when the circadian drive for sleep is high, and the effects of sleep loss are more prominent.

Concerns of relationship mistreatment, emotional abuse, and physical abuse in deployed military medical personnel: Prevalence and risk factors

The aims of this study were to identify self-reported point-prevalence rates of concerns about relationship mistreatment, emotional abuse, and physical abuse among military medical personnel and to evaluate demographic and military risk factors associated with these concerns. Participants (N = 721) were U.S. Air Force military medical personnel (61.4% male) deployed to Iraq between 2004 and 2011 who reported being either married or engaged. Most of the sample expressed at least some concern for mistreatment (79.0%), emotional abuse (70.8%), or physical abuse (66.3%) in their relationship. Caucasians were more likely to endorse emotional abuse concerns compared with other racial groups (p = .04). Men (p = .02) and service members who identified as Christians (p = .03) were more likely to endorse physical abuse concerns compared to their respective counterparts. Results suggest that relationship abuse concerns may be more common than expected among deployed military medical personnel. Demographic factors were associated with abuse concerns while military service characteristics and probable posttraumatic stress disorder diagnosis were not associated with abuse concerns. Future research should examine abuse concerns in population-based studies of military personnel and evaluate the longitudinal trajectory of outcomes associated with relationship abuse among active duty military personnel across the deployment cycle.

Digital phenotyping to improve prediction of suicidal urges in treatment: Study protocol

Digital phenotyping offers a powerful approach for forecasting risk for suicidal ideation or attempts over time. This method may serve as an especially useful strategy for understanding associations between sleep disorder symptoms and suicidal ideation and behavior. Sleep disorder symptoms predict suicidal ideation and behavior in cross-sectional research among active-duty military personnel, but few studies have examined longitudinal associations between sleep disorder symptoms and suicidal thoughts and behaviors in service members. In this study, we will use digital phenotyping to intensively assess Marines for 28 days through a combination of active and passive assessment strategies. Marines with suicidal ideation or a suicide attempt in the past month will be recruited from Camp Lejeune, NC and provided with a Fitbit device and receive ecological momentary assessments (EMA) of suicidal urges several times throughout the day. Using dynamic multilevel models, we will explore the impact of sleep disorder symptoms on next-day suicide urges, as well as mediators of these effects. This study has the potential to inform optimal strategies to assess suicide risk in treatment. These findings will inform the development and implementation of real-time interventions to reduce risk for suicide among military personnel. • Sleep disorder symptoms significant increase risk for suicide. • We will use digital phenotyping to evaluate how changes in sleep predict changes in suicidal ideation among Marines. • Results will have key implications for suicide prevention among active-duty service members.

Association of military-specific reaction time performance with physical fitness and visual skills.

BackgroundThe aim of the present study was to explore whether military-specific reaction time (RT) test performance is affected by individuals’ physical and visual skills.MethodIn a single testing session, the military-specific Simple and Go, No-Go RT, aerobic power (20-m Multistage Shuttle Run test), maximal upper- and lower-body mechanical capacities (bench press and squat against different loads), and visual skills (multiple object tracking and dynamic visual acuity) of 30 young men (15 active-duty military personnel and 15 sport science students) were evaluated.ResultsThe main findings revealed that the Simple RT and Go, No-Go RT presented (1) with aerobic power non-significant small correlations in military personnel (r = −0.39 and −0.35, respectively) and non-significant negligible correlations in sport science students (r = −0.10 and 0.06, respectively), (2) inconsistent and generally non-significant correlations with the maximal mechanical capacities of the upper- and lower-body muscles (r range = −0.10, 0.67 and −0.27, 0.48, respectively), (3) non-significant correlations with visual skills (r magnitude ≥ 0.58) with the only exception of the Go, No-Go RT that was significantly correlated to all visual variables in the group of students (i.e., students who achieved better results during visual tests had shorter RT; r magnitude ≥ 0.58), and (4) none of the physical and visual variables significantly predicted the Simple RT or Go, No-Go RT.ConclusionAltogether, these results indicate that military-specific RT performance is generally independent of physical and visual skills in both military personnel and active university students.

COVID-19 Booster Vaccination in the U.S. Military, August 2021–January 2022

IntroductionA booster dose of messenger RNA vaccine protects against severe COVID-19 outcomes. This study examined the incidence of COVID-19 booster vaccination among active-duty U.S. military servicemembers between August 2021 and January 2022, factors associated with vaccination uptake, and trends over time.MethodsThis was a retrospective cohort study of active-duty military personnel using data from the Defense Medical Surveillance System. Participants were included if they served in the active component from August 2021 through January 2022 and were eligible to receive a COVID-19 booster dose by January 2022. Adjusted hazard ratio estimates of time to booster vaccination were calculated using Cox proportional hazards regression.ResultsLower booster vaccine uptake was seen in the U.S. military (25%) than among the general U.S. population at the same time (45%). Booster vaccination increased with older age, with greater education, with higher income, among women, and among those stationed overseas; it decreased with previous COVID-19 infection and use of the Janssen vaccine. There were no significant racial or ethnic disparities in booster vaccination.ConclusionsIn the absence of a compulsory vaccination policy, lower booster vaccine uptake was seen among servicemembers than among the general U.S. population, particularly among members who were younger, were male, Marines, and had a previous history of infection. Low vaccination rates not only increase the risk of acute and long-term health effects from COVID-19 among servicemembers, but they also degrade the overall readiness of the U.S. military.

A comprehensive evaluation of insomnia, obstructive sleep apnea and comorbid insomnia and obstructive sleep apnea in US military personnel.

The aim of this study was to characterize the sleep disorders of insomnia, obstructive sleep apnea (OSA), and comorbid insomnia and OSA (COMISA) in active duty military personnel. Prospective observational study of 309 military personnel with a mean age of 37.17 years (SD = 7.27). Participants served in four branches of the U.S. military (47.9% Air Force, 38.8% Army, 11.3% Navy, and 1.9% Marines). Sleep diagnoses were rendered after video-polysomnography and a clinical evaluation. Validated self-report measures assessed insomnia severity, excessive daytime sleepiness, sleep quality, disruptive nocturnal behaviors, nightmare disorder, shift work disorder (SWD), sleep impairment, fatigue, posttraumatic stress disorder (PTSD) symptoms, anxiety, depression, and traumatic brain injury (TBI). General linear models and Pearson chi-square tests were used for between-group differences in data analyses. Insomnia was diagnosed in 32.7%, OSA in 30.4% and COMISA in 36.9%. Compared to military personnel with OSA alone, those with insomnia only and COMISA had significantly greater insomnia severity, disruptive nocturnal behaviors, sleep-related impairment, rates of nightmare disorder, and poorer sleep quality (all Ps < .05). They also reported greater symptoms of fatigue, PTSD, anxiety, and depression (all Ps < .05). There were no significant differences among the three sleep disorder diagnostic groups on sleepiness, SWD, or TBI. Military personnel with insomnia only and COMISA overall report worsened symptoms of sleep disorders, sleep-related impairment, fatigue, and psychiatric disorders than those with OSA. Results highlight the importance of a comprehensive assessment for sleep-related impairment, sleep, and comorbid disorders in military personnel with clinically significant sleep disturbances.

Recruiting Sexual and Gender Minority United States Military Personnel for Research Via Peer Networks: Addressing the Challenges

Novel sampling methods have been utilized to reach “hidden” and “hard-to-reach” populations. These communities are referred to in this way because they are also stigmatized and may not wish to disclose their identities to researchers. Men who have sex with men, people who inject drugs, and female sex workers, for example, have been sampled using respondent driven sampling (RDS) worldwide. RDS leverages the social ties between members of a group to build rapport and acceptance of a research endeavor, which results in high levels of participation through peer-to-peer recruitment. Despite the success of “state of the art” RDS in reaching “hidden” populations, researchers have encountered challenges in implementing “state of the art” RDS studies in multiple contexts and have addressed these challenges through novel adaptations to the methodology including situations where populations have weak ties to each other, difficulty reaching seed participants, and small personal networks which limit length of recruitment chains and increases number of seeds. In the context of a study of LGBT military personnel using RDS, we adapted seed recruitment methods, explored analytic approaches, and implemented a comprehensive fraud checking protocol to determine if these adaptations would successfully produce a diverse sample of LGBT active duty military personnel. The present paper describes the steps taken to overcome some of the common challenges encountered by other researchers in reaching hidden populations using RDS and offers methodological insights to other researchers who seek to work with this population of interest.

Veteran’s Treatment Courts: will More be Necessary Now that the 20-Year War on Terror has Concluded for US Soldiers?

Senator John Kerry noted that September 11th was the worst day that we, as a nation, had ever seen; however, it served to unite us. For the families of the 2,977 victims, it was a day of immeasurable and unimaginable loss. For first responders, it was a living nightmare they willingly chose to return to for days, weeks, and months following the attacks so that the families impacted could have some measure of closure. Many of these experienced subsequent physical and mental health illnesses due to what they were exposed to. For others, it was a call to arms. A call to action and to begin serving something bigger than themselves. It was a call to enlist in the US military. It is reported that immediately following the September 11th attacks, over 180,000 American citizens enlisted in active-duty military with some claiming the events of 9/11 were the driving force behind their decision. The military reported that 1 year after 9/11 there were just over 1.4 million active-duty military personnel in the Army, Navy, Marine Corps, and Air Force combined. Since the beginning of the American military involvement in the Iraq and Afghanistan wars in 2001, it is estimated that approximately 1.9 US military personnel were deployed in 3 million missions lasting at least 30 days. Over 7,000 servicemembers have been killed, in post-9/11 wars, with thousands more sustaining critical life-changing injuries, including loss of limbs, traumatic brain injuries and the invisible injuries of posttraumatic stress disorder. This work consists of a content analysis, specifically focusing on the establishment and ongoing need of Veteran’s Treatment Courts (VTC), a specialty court established in 2008, as a direct response to a growing number of veterans, appearing on court dockets, who were addicted to drugs, alcohol, or suffering from undiagnosed/untreated mental illness due to exposure to traumatic events while on military deployment. Today there are 400 VTC across the country, but more of these courts and significantly more funding and resources are needed to address the invisible wounds and impact of a 20-year war. This article examines the literature in existence related to VTCs, including their missions, strategies, and recidivism success rates. It also examines where these VTCs are in relation to US military installations that experienced deployments, and the resources that are available and accessible to those veterans who agree to enter these diversion programs. Finally, it discusses any noted gaps in where VTCs should be and currently are not as well as the potential for deleterious outcomes for veterans who have honorably served their country and have either fallen through the system’s cracks or live in an underserved area of the country. These are wounded warriors that, absent being exposed to traumatic events in a war zone, may never have entered the criminal justice system.

Intimate Partner Violence (IPV) in Military and Veteran Populations: A Systematic Review of Population-Based Surveys and Population Screening Studies.

Intimate partner violence (IPV) may be a major concern in military and veteran populations, and the aims of this systematic review were to (1) provide best available estimates of overall prevalence based on studies that are most representative of relevant populations, and (2) contextualise these via examination of IPV types, impacts, and context. An electronic search of PsycINFO, CINHAL, PubMed, and the Cochrane Library databases identified studies utilising population-based designs or population screening strategies to estimate prevalence of IPV perpetration or victimisation reported by active duty (AD) military personnel or veterans. Random effects meta-analyses were used for quantitative analyses and were supplemented by narrative syntheses of heterogeneous data. Thirty-one studies involving 172,790 participants were included in meta-analyses. These indicated around 13% of all AD personnel and veterans reported any recent IPV perpetration, and around 21% reported any recent victimisation. There were higher rates of IPV perpetration in studies of veterans and health service settings, but no discernible differences were found according to gender, era of service, or country of origin. Psychological IPV was the most common form identified, while there were few studies of IPV impacts, or coercive and controlling behaviours. The findings demonstrate that IPV perpetration and victimisation occur commonly among AD personnel and veterans and highlight a strong need for responses across military and veteran-specific settings. However, there are gaps in understanding of impacts and context for IPV, including coercive and controlling behaviours, which are priority considerations for future research and policy.

Confirmatory factor analysis of the Comprehensive Assessment of acceptance and Commitment Therapy (CompACT) in active-duty military personnel

Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral treatment that targets psychological flexibility (PF), or the ability to persist in behavior consistent with values regardless of unwanted private experiences. The growing use of ACT necessitates an accurate assessment of PF. The Comprehensive Assessment of Acceptance and Commitment Therapy (CompACT) is a three-factor measure of PF (Openness to Experience, Valued Action, and Behavioral Awareness) whose psychometric properties have been examined in limited populations. The current study examined the factor structure and psychometric properties of the CompACT in U.S. military personnel who enrolled in a weight management randomized controlled trial.Military personnel who either failed or were at risk of failing the Navy's physical fitness assessment or had overweight/obese body mass index (BMI; N = 178, Mage = 29.15 years; MBMI = 33.13 kg/m2; 61.8% female) completed the CompACT and other questionnaires. Confirmatory factor analysis was used to evaluate the three-factor structure of the original 23-item CompACT (CompACT-23) as well as an 18-item version identified in a Portuguese sample (CompACT-18). Internal consistency and convergent validity with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and life satisfaction were examined.The three-factor structure of the CompACT-23 showed poor fit to the data while the fit of the CompACT-18 was acceptable, as indicated by three descriptive indices (χ2/df = 1.73, RMSEA = 0.069, SRMR = 0.074). All descriptive fit indices in addition to two comparative fit indices (AIC and BIC) indicated improved model fit over the CompACT-23. The CompACT-18 and its subscales exhibited adequate internal consistency (α = 0.768 to 0.861) and convergent validity in expected directions with measures of weight-related experiential avoidance, perceived stress, anxiety, depression, PTSD symptoms, and satisfaction with life.Results support using the refined, English language CompACT-18 as a three-factor measure of PF in populations such as U.S. military personnel who may benefit from weight management intervention. Future research should explore the content validity of the full measure and the removed items. Lost content could mean the CompACT-23 and the CompACT-18 differentially assess PF. Additional studies should examine psychometric properties in large and more diverse samples to further evaluate the appropriateness of the measure across populations. Longitudinal studies are needed to examine test-retest reliability and sensitivity to change.

Comparing Types of Yoga for Chronic Low Back and Neck Pain in Military Personnel: A Feasibility Randomized Controlled Trial.

BackgroundChronic low back pain (cLBP) and chronic neck pain (cNP) are highly prevalent conditions and common reasons for disability among military personnel. Yoga and other mind-body interventions have been shown to safely decrease pain and disability in persons with cLBP and/or cNP but have not been adequately studied in active duty military personnel. The objective of this study was to examine the feasibility and acceptability of delivering 2 types of yoga (hatha and restorative) to a sample of active-duty military personnel with cLBP/cNP.MethodsMilitary personnel with cLBP and/or cNP (n = 49; 59% men) were randomized to either hatha or restorative yoga interventions. Interventions consisted of in-person yoga 1-2x weekly for 12 weeks. Feasibility and acceptability were measured by rates of recruitment, intervention attendance, attrition, adverse events, and satisfaction ratings. Health outcomes including pain and disability were measured at baseline, 12 weeks, and 6 months. Means and effect sizes are presented.ResultsRecruitment was completed ahead of projections. Over 90% of participants agreed or strongly agreed that they enjoyed participation, liked the instructor, and would like to continue yoga. Retention rates were 86% and 80% at 12 week and 6 month assessments, respectively. Intervention attendance was adequate but lower than expected. There were small to moderate reductions in back-pain related disability, pain severity and pain interference, and improvements in quality of life, grip strength, and balance. In general, effects were larger for those who attended at least 50% of intervention classes. Participants with cNP tended to have smaller outcome improvements, but conclusions remain tentative given small sample sizes.ConclusionsResults demonstrate feasibility for conducting a randomized controlled comparative effectiveness trial of yoga for cLBP and cNP among active duty military personnel. Acceptability was also established. Ongoing work will enhance the intervention for cNP and establish feasibility at another military facility in preparation for a fully-powered comparative effectiveness trial.ClinicalTrials #NCT03504085; registered April 20, 2018.

The efficacy of 90-min versus 60-min sessions of prolonged exposure for PTSD: A randomized controlled trial in active-duty military personnel.

Prolonged exposure (PE) therapy is a first-line posttraumatic stress disorder (PTSD) treatment, but the manualized 90-min session format constitutes a barrier to adopting PE in most settings because they use 60-min sessions for scheduling and billing. We examined whether 60-min PE sessions were as effective and efficient as 90-min PE sessions. In total, 160 active-duty military personnel with PTSD were randomized to 8-15 sessions of 60- or 90-min PE sessions and assessed pre- and posttreatment, and 3- and 6-month posttreatment, using the Clinician Administered PTSD Scale for Diagnostic and Statistical Manual for Mental Disorders, 5th edition [DSM-5] (CAPS-5). Participants were also assessed weekly during treatment using the PTSD Checklist for DSM-5 (PCL-5). A 60-min PE was hypothesized to be noninferior to 90-min PE based on preliminary studies. Using intent-to-treat analyses, the 95% CI for the difference between 60- and 90-min PE was less than the noninferiority margin (4.69 for the CAPS-5 and 7.38 for the PCL-5) at all three endpoints, suggesting that the efficacy of 60-min PE was noninferior to that of 90-min PE. Similarly, the rate of improvement per session for 60-min PE was noninferior to the rate for 90-min sessions for the PCL-5. Sensitivity analyses and Bayes factors were consistent with these results. 60-min sessions of PE are noninferior to 90-min sessions with regard to both efficacy and efficiency. Thus, PE can be effectively delivered in shorter sessions, making it easier for behavioral health providers to implement within the military health system and in other mental health systems that use 60-min session appointments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).