Active Duty Personnel Research Articles

Associations among psychological health problems, intimate-relationship problems, and suicidal ideation among United States Air Force active-duty personnel

ABSTRACT Linkages among psychological health problems, intimate relationship distress, and suicide risk have been widely studied, but less is known about how these factors interact, especially in military populations. With steady increases in suicide rates among active military and post-service members (SMs), it is critical to better understand the relation among known risk factors. The current study addresses this gap by testing a model hypothesizing that the association between intimate-relationship problems and suicidal ideation is mediated by individual mental health symptoms. We tested this model on a sample of 862 active-duty Air Force members in committed relationships. The sample consisted of 35.0% women and 64.8% men, with an average age of 21.9 years and a mean relationship length of 2.8 years. Findings supported the hypothesized statistical mediation model. Results indicated that relationship problems contribute to psychological health problems, which, in turn, are related to suicidal ideation. These findings may help direct suicide intervention and prevention protocols that consider intimate relationship distress as a significant risk factor. Limitations and further implications for policies regarding suicide prevention in the armed forces are discussed.

Deployment stressors, mental health outcomes, and protective factors among wives of reserve soldiers during the Israel-Hamas War: A latent profile analysis approach.

Deployment to active conflict zones significantly affects military families, with spouses often experiencing heightened stress and mental health challenges. However, research on non-US military spouses, particularly those of reserve soldiers, who may face unique stressors compared to active-duty personnel, remains scarce. This study examined perceived stress profiles among Israeli spouses of reserve soldiers during the ongoing Israel-Hamas War, and their associations with deployment stressors, mental health outcomes, and psychological protective factors. A volunteer sample of Israeli spouses of reserve soldiers (n=293) responded to self-report questionnaires in a cross-sectional study. Using latent profile analysis of the ratings of perceived stress, three distinct profiles were identified: low (35.1%), moderate (43.5%), and high (21.3%). Higher levels of deployment stressors (e.g., fear of spouse getting physically injured) predicted membership in the moderate and high-stress profiles, while better household management was associated with lower stress profiles. The high-stress profile reported significantly greater symptoms of depression and anxiety compared to the low and moderate stress profiles. In contrast, the low-stress profile exhibited higher levels of resilience, self-compassion, and perceived social support. These findings highlight the variability in spouses' stress responses during wartime deployment and identify key factors associated with psychological adjustment. Results suggest that deployment-related fears, household management abilities, and psychological resources are crucial in shaping stress profiles and mental health outcomes among military spouses.

The Impact of Anterior Pelvic Tilt on Return to Duty/Return to Run in Active Duty Personnel After Hip Arthroscopy for Femoroacetabular Impingement.

Annually, 300,000 soldiers are rendered medically nondeployable because of musculoskeletal injuries (MSKIs). Of this population, nearly 10,000 (3.3%) involve injuries to the hip. Factors related to these injuries impose significant healthcare, financial, and readiness burdens on the Army system, degrading overall mission readiness. The purpose of this retrospective study was to assess for correlation between increased anterior pelvic tilt and a lower likelihood for return to duty/return to run (RTD/RTR) in active duty personnel who underwent hip arthroscopy for femoroacetabular impingement (FAI), thus identifying increased anterior pelvic tilt as a potential prognostic indicator for RTD/RTR. Ninety-two active duty U.S. Army service members aged 18 years or older who underwent hip arthroscopy for FAI at the William Beaumont Army Medical Center from September 1, 2014, to September 1, 2019, were included. Utilizing a retrospective review of existing data, the amount of anterior pelvic tilt, as estimated on a presurgical weight-bearing anterior-posterior pelvis radiograph using the distance from the pubic symphysis to the transischial line, was measured and compared to postoperative RTD/RTR statuses, assessing for correlation. The overall RTD rate was 39.1% with a 22.8% RTR rate. Only 6.5% (6/92) of subjects returned to full, unrestricted duty and running. Logistic regression analyses showed that individuals with increased anterior pelvic tilt (≥7°) were 2.6 times less likely to RTD and 2.9 times less likely to RTR compared to those with minimal or no anterior pelvic tilt (<7°) (respectively, odds ratio (OR) 2.619; 95% CI, 1.107-6.195; P = .029 and OR 2.897; 95% CI, 1.041-8.059; P = .042). Results support the study teams' hypothesis that increased anterior pelvic tilt is associated with a lower odds of RTD/RTR. Statistical analysis confirmed the correlation between an increased amount of anterior pelvic tilt and a lower odds of RTD and RTR after hip arthroscopy for FAI in active duty U.S. Army personnel. This information can be used in patient counseling to better inform shared decision-making, provide more thorough informed consent, and help determine the optimal timing for surgical intervention, thus contributing to better stewardship of medical resources and decreasing the ever-growing financial healthcare burden. These findings will spur future research to consider the causes and optimal treatment of anterior pelvic tilt, positively impacting the culture of Army medicine by focusing on preventive and targeted treatments in order to preserve and grow the force.

Core Mental Health Clinician Capacity and Use Rates in the US Military

Active duty service members have higher mental health stress and cannot choose where to live. It is imperative to understand how geographic access may be associated with their ability to obtain mental health treatment and how the COVID-19 pandemic was associated with these patterns. To identify changes in the prevalence and intensity of mental health care use when service members experienced changes in core mental health clinician (defined to include psychiatrists, psychiatric nurse practitioners, clinical psychologists and social workers, and marriage and family therapists) capacity in their communities and whether patterns changed from before to after the onset of the COVID-19 pandemic. This retrospective cohort study of the active duty population between January 1, 2016, and December 31, 2022, was conducted using individual fixed-effects models to estimate changes in the probability of mental health care visits and visit volume when a person moved across communities with adequate core mental health clinician capacity (≥1 clinician/6000 beneficiaries), shortage areas (<1 clinician/6000 beneficiaries), and areas with 0 clinicians within a 30-minute drive time. All US active duty service members stationed in the continental US, Hawaii, and Alaska were included. Data were analyzed from January through July 2024. The first set of outcomes captured the probability of making at least 1 mental health care visit in a given quarter; the second set of outcomes captured the intensity of visits (ie, the number of visits log transformed). This study included 33 039 840 quarterly observations representing 2 461 911 unique active duty service members from the Army, Navy, Marines, and Air Force (1 959 110 observations among Asian or Pacific Islander [5.9%], 5 309 276 observations among Black [16.1%], 5 287 168 observations among Hispanic [16.0%], and 18 739 827 observations among White [56.7%] individuals; 27 473 563 observations among males [83.2%]; mean [SD] age, 28.20 [7.78] years). When an active duty service member moved from a community with adequate capacity at military treatment facilities to one with 0 clinicians within a 30-minute drive, the probability of a mental health visit to any clinician decreased by 1.13 percentage points (95% CI, -1.21 to -1.05 percentage points; equivalent to a 11.6% relative decrease) and the intensity of total visits was reduced by 7.7% (95% CI, -9.0% to -6.5%). The gap increased from before to after the onset of the COVID-19 pandemic, from 8.5% (equivalent to -0.82 percentage points [95% CI, -0.92 to -0.73 percentage points]) to 16.2% (equivalent to -1.58 percentage points [95% CI, -1.70 to -1.46 percentage points]) in the probability of visiting any clinician type for mental health. In this study, active duty personnel assigned to locations without core military mental health clinicians within a 30-minute drive time were less likely to obtain mental health care and had fewer mental health care visits than those in communities with adequate military mental health capacity even if there was adequate coverage from the civilian sector. The care disparity increased after the onset of the COVID-19 pandemic.

B - 42 Evaluating the MMPI-3 Somatic/Cognitive Scales in Service Members and Veterans with Mild Traumatic Brain Injury (mTBI)

Abstract Objective Research on the Minnesota Multiphasic Personality Inventory, 3 (MMPI-3) Somatic/Cognitive scales is limited, but primarily focused on their relationships with symptom and performance validity tests. This study expands prior literature by providing extensive Somatic/Cognitive Scale correlates with symptom validity tests and neurocognitive measures in a sample of active-duty personnel and veterans. Method The study included Active-duty Service Members (n = 22) and Veterans (n = 31). Various measures of cognitive abilities and symptom validity were examined as a function of the Cognitive Complaints (COG) scale. Results Moderate to large differences were observed between COG groups across all MMPI-3 overreporting scales and all somatic/cognitive scales, save the NUC scale (g = 0.66–1.31 [excluding NUC]). Groups differed on three Memory Complaints Inventory memory scales: General (g = 0.89), Visuo-spatial (g = 0.62), and Verbal (g = 0.97). No significant differences were observed across cognitive tests (e.g., WAIS, CVLT). COG was moderately associated with all MMPI-3 overreporting and most somatic/cognitive scales (r = 0.30–0.72). Small to moderate correlations were observed between COG and most external validity and neurocognitive measures (r = 0.05–0.60). Conclusions Results suggest the COG scale primarily captures subjective distress rather than objective neurocognitive performance, consistent with prior work (Gervais et al., 2009). These patterns are especially pronounced in emotional, social, and somatic symptom domains. Additionally, COG scores were associated with MMPI-3 overreporting scores, but COG had weaker associations with external neurocognitive and symptom validity measures. These results suggest that COG has weak convergent validity with other self-report measures of cognition (e.g., Neurobehavioral Symptom Inventory).

B - 130 Application of Item Response Theory to the MMPI-2-RF Response Bias Scale-19 (RBS-19)

Abstract Objective RBS is a cognitive overreporting scale on the MMPI-family of instruments. Recent efforts to refine the scale removed nine items lacking conceptual and empirical relationships to cognitive dysfunction (Ingram et al., 2024; Ratcliffe et al., 2022). This revised scale version (RBS-19) demonstrated improved utility and classification accuracy, although the improvements were small. Albertorio et al (2024) found that the RBS could be reduced to 14 items and identified potential “critical items”. This study uses IRT in a database of Active-Duty personnel to explore reduced item RBS forms. Method Using a 2-parameter IRT model, we examined cognitive overreporting across the 19-item MMPI-2-RF RBS-19 Scale. Participants (n = 326; 96% male) were divided into pass-all vs fail 2+ standalone PVTs for criterion-based comparisons (e.g., ROC analysis and mean difference), with indetermined profiles removed. Results Results indicate good theta coverage. Two items (24 and 26) were removed due to low α (2). RBS-14/17/19 all had similar AUC (0.72 vs 0.71 vs 0.72) and similar effect sizes between groups. Conclusions IRT analyses supported a 17-item RBS scale rather than the 14 or 19 item versions in this sample. However, no “critical items” emerged in this sample. Such differences may reflect changes in factor structure based on referral reason (Boress et al., 2023).

Effects of permethrin-treated uniforms on tick submissions to a military passive tick surveillance program.

Permethrin-treated clothing is often recommended as a first line of defense against tick-borne diseases. In 2012, the permethrin factory-treated Army Combat Uniform was first made available to active duty Soldiers, Army National Guard, Army Reserve Enlisted Soldiers, and the Senior/Junior Reserve Officers Training Corps. Subsequently, Air Force and Marine Corps personnel were also offered permethrin factory-treated uniforms. Here, we use the passive surveillance data collected through the Military Tick Identification/Infection Confirmation Kit (MilTICK) program to determine the effectiveness of permethrin-treated uniforms at protecting Department of Defense personnel from exposure to tick-borne pathogens in the United States. We analyzed whether submissions by self-reported users of the permethrin-treated uniforms had smaller proportions of engorged ticks, certain cohorts of MilTICK users were better protected than others, and specific tick species were better repelled than others. We found that permethrin use resulted in significantly lower proportions of engorged ticks submitted across MilTICK users. Army and Army National Guard personnel reported more permethrin-treated uniform use than other services. For submissions from active duty personnel serving in uniform, the proportion of tick engorgement in the presence of permethrin increased over time, possibly indicating that permethrin-treated uniforms suffer from reduced performance over the life of the garment. We also found that while permethrin reduced all tick species' ability to feed until engorgement or repletion, blacklegged tick adult females were better able to resist permethrin's lethal effects than lone star tick and American dog tick adult females. Permethrin-treated clothing plays an important role in keeping military personnel safe from tick-borne diseases.

Outpatient Prescriptions for Insomnia Medications During the First Year Following Combat-Related Amputations.

Sleep-related disorders are associated with pain, fatigue, and deficits in cognitive performance, which may interfere with successful rehabilitation. The study objectives were to (1) quantify outpatient prescriptions for insomnia medications during the first year following combat-related amputations, (2) examine longitudinal changes in prescriptions for insomnia medications, and (3) analyze patient characteristics associated with prescriptions for insomnia medications. This was a retrospective study of DoD casualty records from the Expeditionary Medical Encounter Dataset and prescriptions for outpatient medications from the Pharmacy Data Transaction Service. Patients were a total of 1,651 U.S. service members who sustained major limb amputations in Operations Iraqi and Enduring Freedom from 2001 through 2017 and had outpatient prescriptions for any medication during the first year postinjury. Prescriptions for medications recommended for insomnia were low-dose antidepressants, anxiolytic sedatives, benzodiazepines, melatonin receptor agonist, and low-dose quetiapine. These prescription medications were analyzed by medication type, postinjury time, and patient characteristics during the first year postinjury. During the first year postinjury, 78% of patients (1,291 of 1,651) had outpatient prescriptions for insomnia medications, primarily anxiolytic sedative drugs (e.g., zolpidem), averaging a total of 86 prescription days (median = 66). The prevalence of these prescriptions declined substantially during the first year, from 57% of patients during the first quarter to 28% during the fourth quarter postinjury. In univariate analyses, multiple patient characteristics, including high Injury Severity Score, continued opioid and non-opioid analgesic prescriptions, and diagnoses of chronic pain, mood disorder, and posttraumatic stress disorder, were significantly associated with higher prevalence and duration of outpatient prescriptions for insomnia medications. The present results indicate a high prevalence of outpatient prescriptions for insomnia medications following combat-related amputations, a prevalence that is substantially higher than previously reported among active duty personnel. These findings can inform DVA/DoD guidelines for amputation care and insomnia among military subpopulations. The results highlight the need for more research on the treatment of insomnia during early postinjury rehabilitation among patients who sustained serious combat injuries.

Utilization of antiobesity medications within the Military Health System.

The prevalence of overweight and obesity among beneficiaries of the Military Health System (MHS) is 41.6% and 30.5%, respectively. This incurs significant medical, fiscal, and military readiness costs. It is not currently known how the utilization of antiobesity medications (AOMs) within the MHS compares with that in the Veterans Health Administration or the private sector. Our aim was to assess the utilization of AOMs within the MHS. A cross-sectional study was conducted using data gathered from the MHS Data Repository and the inclusion of all adult TRICARE Prime and Plus beneficiaries ages 18 to 64 years who were prescribed at least one TRICARE-approved AOM during the years 2018 to 2022. The total study population included 4,414,127 beneficiaries, of whom 1,871,780 were active-duty service members. The utilization of AOMs among the eligible population was 0.56% (0.44% among active-duty personnel). Liraglutide was the most-prescribed AOM (36% of the total). Female sex, age greater than or equal to 30 but less than 60 years, and enlisted or warrant officer rank were all associated with statistically significant higher odds of receiving AOMs. Comparable with the US private sector, the MHS significantly underutilizes AOMs, including among active-duty service members, despite coverage of AOMs since 2018.

ANALYSING RESERVE FORCES AS AN ENABLER FACTOR FOR ACTIVE MILITARY

The continuum degradation of the international security environment represents a negative effect of the unbalanced power that followed the end of the Cold War. With only one superpower controlling the international order it is almost impossible to prevent and manage numerous crisis and conflicts which happened all around the world at any time. Therefore, the idea of changing the current world order acquires greater and greater valences in the mind of regional powers. At the same time, the military conflict evolves and is highly influenced by the new risks and threats that appeared at national, regional and international security environments. Recent events demonstrate that we have to fight today wars and be prepared for the tomorrow ones at the same time. Preparing the population for defense and, implicitly, developing a culture of security within civil society, alongside the revitalization of the voluntary reserve, are vital and the only elements that can contribute to harnessing the society's volunteerism and accessing the potential available at this moment in Romanian society for achieving resilience and acceptable internal security. This is essential for fulfilling the objective of a possible regeneration of the active military force. Therefore, the role of reserve forces and reservists, including volunteer ones, in this new operating environment is continuing increasing and their importance inside national military forces acquires a new connotation for more and more missions. Apart for being just a human resource to replace lost active-duty personnel, reservists can enhance the resilience at national and military levels and fill up gaps or niche positions. This material will analyse how reserve forces were used in the current wars in line with new security environment paradigm and will propose some real ways ahead for the Romanian Armed Forces to develop such enabling operational resources.

Understanding Women's Transitions from Military to Department of Veterans Affairs Care.

Background: Over the past two decades, increasing numbers of women have served in the military, with women now comprising 17.3% of active-duty personnel and 21.4% of National Guard and reserves. During military service, women often incur painful musculoskeletal (MSK) injuries related to carrying heavy loads and wearing ill-fitting gear. While women may receive initial care for these injuries under the auspices of the Department of Defense (DoD), these injuries often linger and further treatment in required as women transition to Department of Veterans Affairs (VA) care. However, little is known about this transition process, and whether women are given adequate information and support regarding how to access VA care after their military service has ended. Research Design: To better understand these issues, we interviewed 65 women veterans with military service-related MSK injuries about their transition from DoD to VA care. Results: Six major themes emerged from the interviews. Those themes were: (1) Military injuries are often related to ill-fitting gear or carrying heavy loads; (2) Stigma/discrimination related to military injuries; (3) Limited assistance with transition between DoD and VA to manage ongoing injuries and pain; (4) Women have a difficult time managing perceptions and expectations of their weight after military service; (5) Childcare is a substantial burden for veterans in self-care; and (6) veterans desire peer-support services to help them stay healthy. Conclusions: Based on these findings, DoD and VA should continue to work together to develop programs to educate and support women as they transition from military to VA care. Furthermore, VA should consider developing peer support programs for women Veterans who may require additional support to maintain health, especially among Veteran mothers who have complex family responsibilities that may limit their ability to focus on their own health.

Informing the Need for a SARS-CoV-2 Booster Based on the Immune Responses Among Young Healthy Adults to Variants Circulating in Late 2023.

COVID-19 remains a global public health challenge due to new immune-evasive SARS-CoV-2 variants and heterogeneous immunity. In this cross-sectional study, we evaluated the adaptive immune responses in US active duty personnel who completed a COVID-19 primary vaccine series and had heterogenous SARS-CoV-2 vaccination and infection histories to 3 previously dominant variants (ancestral, Delta, BA.5) and 3 circulating variants (XBB.1.5, EG.5, and BA.2.86) in late 2023. Analyses were based on the most recent exposure in terms of timing (within or beyond 12 months) and type (vaccine or infection). Significant reduction was observed in binding antibodies, neutralization antibodies, memory B cells, and CD8+ T cells against circulating variants when compared with previous variants. The reduction in antibody response was more pronounced in those whose most recent exposure was >12 months from enrollment. In contrast, the CD4+ T-cell response was largely consistent across all tested variants. The type of most recent exposure was not a significant factor in determining the magnitude of current immune responses. Administration of the XBB.1.5-based booster is likely to enhance cross-reactive humoral responses against SARS-CoV-2 circulating lineages. Ongoing surveillance of immune responses to emerging variants is needed for informing vaccine composition and timing.

Bridging the Gap: The Vital Role of Nursing in Caring for Military Members and Veterans and Their Families.

In 2011, a national call from The White House set in motion an initiative for action called Joining Forces to serve America's military families. This initiative, led by then-First Lady Michelle Obama and Dr. Jill Biden, was intended to unite public and private sectors to ensure active military service members, veterans, and their families had the educational, employment, and wellness resources they needed to succeed. Although the nursing profession started to respond to this call to action, it was never embraced as a priority. With nearly three million active-duty personnel, nearly one million reservists, more than 18 million veterans, and millions more families of our military and veteran community, it is time for the largest health care workforce to lead the care and wellness of our military and veteran community. [J Contin Educ Nurs. 2024;55(5):217-219.].

Overweight/obesity, gestational weight gain, postpartum weight retention, and maternal/neonatal complications in the military.

The objective of this study was to examine the prevalence of overweight/obesity and excessive gestational weight gain (GWG) among military beneficiaries and to assess associations of these risk factors with maternal/neonatal complications and substantial postpartum weight retention (PPWR). We obtained data for 48,391 TRICARE beneficiaries who gave birth in 2018 or 2019 in the United States. We used logistic regression and ANOVA to examine relationships among overweight/obesity, GWG, maternal/neonatal complications, and substantial PPWR. Most TRICARE beneficiaries (75%) had excessive GWG, and 42% had substantial PPWR. Dependents were less likely than active-duty women to have excessive GWG (odds ratio [OR] = 0.73, 95% CI: 0.60-0.88). Women with excessive GWG were three times more likely to have substantial PPWR (OR = 3.57, 95% CI: 3.14-4.06). Those with excessive GWG were more likely to have maternal/neonatal complications (e.g., pregnancy-induced hypertension, cesarean delivery). Excessive GWG is frequent among TRICARE beneficiaries, particularly active-duty personnel, and is strongly associated with costly maternal/neonatal complications. Substantial PPWR is also common in this population, with excessive GWG as a key risk factor.

Transgender older adults' prior military service: Mental health differences by gender identification.

Despite a proportionally higher likelihood of serving, the role of prior military service in the mental health of transgender individuals is understudied. Research on the impact of military service on mental health tends to be proximal. We examined the distal relationship between prior military service, identity stigma, and mental health among transgender older adults, drawing comparisons between transgender men and women. We conducted a series of weighted multivariate linear models to predict the relationships between prior military service, identity stigma, perceived stress, and depression among 183 transgender women and men aged 51-87 (M = 60.11, SD = 0.668) using 2014 data from the National Health, Aging, and Sexuality/Gender Study. Prior military service was negatively associated with depression and perceived stress; identity stigma was positively associated with both. Prior military service and lower depression and perceived stress were significant for transgender men, but not women. Identity stigma was significant with depression and perceived stress among transgender women, but not transgender men. Our preliminary findings suggest that prior military service may serve as a protective factor for mental health among transgender men, but not transgender women. We need to better understand how military experience interacts with other characteristics, such as differing gender identities influences the mental health of transgender service members. Further research is needed to inform underlying mechanisms whereby military service differentially impacts mental health by gender identity so all active-duty personnel can share in the many benefits that accrue from military service, including protective effects on mental health in later life. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Study protocol: Identifying transcriptional regulatory alterations of chronic effects of blast and disturbed sleep in United States Veterans.

Injury related to blast exposure dramatically rose during post-911 era military conflicts in Iraq and Afghanistan. Mild traumatic brain injury (mTBI) is among the most common injuries following blast, an exposure that may not result in a definitive physiologic marker (e.g., loss of consciousness). Recent research suggests that exposure to low level blasts and, more specifically repetitive blast exposure (RBE), which may be subconcussive in nature, may also impact long term physiologic and psychological outcomes, though findings have been mixed. For military personnel, blast-related injuries often occur in chaotic settings (e.g., combat), which create challenges in the immediate assessment of related-injuries, as well as acute and post-acute sequelae. As such, alternate means of identifying blast-related injuries are needed. Results from previous work suggest that epigenetic markers, such as DNA methylation, may provide a potential stable biomarker of cumulative blast exposure that can persist over time. However, more research regarding blast exposure and associations with short- and long-term sequelae is needed. Here we present the protocol for an observational study that will be completed in two phases: Phase 1 will address blast exposure among Active Duty Personnel and Phase 2 will focus on long term sequelae and biological signatures among Veterans who served in the recent conflicts and were exposed to repeated blast events as part of their military occupation. Phase 2 will be the focus of this paper. We hypothesize that Veterans will exhibit similar differentially methylated regions (DMRs) associated with changes in sleep and other psychological and physical metrics, as observed with Active Duty Personnel. Additional analyses will be conducted to compare DMRs between Phase 1 and 2 cohorts, as well as self-reported psychological and physical symptoms. This comparison between Service Members and Veterans will allow for exploration regarding the natural history of blast exposure in a quasi-longitudinal manner. Findings from this study are expected to provide additional evidence for repetitive blast-related physiologic changes associated with long-term neurobehavioral symptoms. It is expected that findings will provide foundational data for the development of effective interventions following RBE that could lead to improved long-term physical and psychological health.

Interfacility Transfer Teams: A Pilot Study to Assess Viability as a Skill Sustainment Platform.

A US Naval hospital in the remote Pacific region has developed interfacility transfer (IFT) teams staffed by active duty personnel out of necessity due to a large percentage of critically ill patients requiring IFT and a lack of local resources. The IFT program underwent significant improvements in training and quality assurance in 2017. We sought to assess patient safety when transport was performed by our locally sourced and trained IFT teams. En route care (ERC) is a recognized critical capability gap in the US Navy requiring clinicians with current knowledge and skills to maintain competency. IFT programs may be a viable skill sustainment program for ERC clinicians. A database was created as part of the quality assurance program to collate information on patient demographics, level of care provided, reason for transport, and interventions provided by the transporting team. A retrospective review of these data was conducted with emphasis on the appropriateness of patient management and skill sustainment for active duty personnel. The project was deemed institutional review board exempt. Of the 1,193 patient care reports reviewed, interventions were required in 128 (10.7%) of patients and 58 (4.9%) required ventilator management. Medical deterioration occurred during 22 (1.8%) of the transports, with 20 (90.9%) of the deterioration episodes managed appropriately. No patient harm occurred. IFT teams with local training were able to safely transport critically ill patients with no adverse outcomes, defined as direct harm to the patients as a result of transport. Patient care during transports included routine interventions, ventilator management, and troubleshooting of patient deteriorations. Our data further suggest IFT programs may be a viable skill sustainment platform for ERC clinicians.

Review of mental healthcare provision by primary care physicians in the Department of Defense (DoD)

Abstract Aim Primary care visits in the United States increasingly involve the treatment of mental health concerns, and the Military Health System (MHS) is no exception. The authors characterize treatment trends of mental healthcare in military primary care. Subject and methods A retrospective analysis of 110 million primary care visits and 27 million behavioral healthcare visits from an MHS database evaluated frequencies and proportions of mental health-related care in both military and civilian healthcare facilities for the years 2017–2021. Prevalence ratios were compared with Poisson regression models by year and by characteristic, with potential linear trends evaluated. Results A notable amount of behavioral healthcare provision transitioned from military to civilian healthcare facilities during this period. A comparison showed that psychotropic medication prescriptions from primary care prescribers with primary care visits coded for psychiatric diagnoses were similar for dependents (16.5% vs. 15.5%) but nearly doubled for military (7.7% vs. 3.9%). Active-duty personnel seen by primary care providers in purchased care (PC) were more than twice as likely to have a behavioral health diagnosis as those seen in direct care (DC) (8.4% vs. 3.9%). Conclusion To the best of the authors’ knowledge, this study is the first to use a comprehensive database to evaluate behavioral healthcare provision trends in the MHS. This provides a baseline of healthcare burden numbers useful for determining the training needed for primary care clinicians to feel comfortable appropriately treating mental health conditions. Future research should focus on diagnostic differences between civilian and military healthcare facilities as well as prescription discrepancies for service members.

Military environmental exposures and risk of breast cancer in active-duty personnel and veterans: a scoping review.

The effects of military environmental exposures (MEE) such as volatile organic compounds (VOCs), endocrine-disrupting chemicals (EDCs), tactile herbicides, airborne hazards and open burn pits (AHOBP), and depleted uranium on health are salient concerns for service members and Veterans. However, little work has been done to investigate the relationship between MEE and risk of breast cancer. We conducted a scoping review on MEE, military deployment/service, and risk of breast cancer among active-duty service members and Veterans. PRISMA was used. PubMed, Embase, and citations of included articles were searched, resulting in 4,364 articles to screen: 28 articles were included. Most papers on military deployment and military service found a lower/equivalent risk of breast cancer when comparing rates to those without deployment or civilians. Exposure to VOCs due to military occupation or contaminated groundwater was associated with a slightly higher risk of breast cancer. Exposure to Agent Orange was not associated with an increased risk of breast cancer. Evidence regarding EDCs was limited. No paper directly measured exposure to AHOBP or depleted uranium, but deployments with known exposures to AHOBP or depleted uranium were associated with an equivalent/lower risk of breast cancer. Women are the fastest growing population within the military, and breast cancer poses a unique risk to women Veterans who were affected by MEE during their service. Unfortunately, the literature on MEE and breast cancer is mixed and limited, in part due to the Healthy Soldier Paradox and poor classification of exposure(s).

PTSD, depression, and treatment outcomes: A latent profile analysis among active duty personnel in a residential PTSD program

Depression frequently co-occurs with posttraumatic stress disorder (PTSD), including among active duty service members. However, symptom heterogeneity of this comorbidity is complex and its association with treatment outcomes is poorly understood, particularly among active duty service members in residential treatment. This study used latent profile analysis (LPA) to identify symptom-based subgroups of PTSD and depression among 282 male service members in a 10-week, residential PTSD treatment program with evidence-based PTSD psychotherapies and adjunctive interventions. The PTSD Checklist–Military Version and Patient Health Questionnaire-8 were completed by service members at pre- and posttreatment and weekly during treatment. Multilevel models compared subgroups on PTSD and depression symptom change across treatment. LPA indicated four subgroups provided optimal fit: Depressive (high depression severity, low PTSD avoidance; n = 33, 11.7%), Avoidant (high PTSD avoidance, moderate depression severity; n = 89, 31.6%), Moderate (moderate PTSD and depression severity; n = 27, 9.6%), and Distressed (high PTSD and depression severity; n = 133, 47.2%). Treatment response differed across classes for both PTSD and depression outcomes (time × LPA class interaction ps < 0.001). In PTSD models, post-hoc comparisons indicated the Moderate class was associated with less PTSD symptom improvement relative to the other classes (ps < 0.006). In depression models, symptom reduction was greatest for the Distressed and Depressive subgroups relative to the other two classes (ps < 0.009). Study results provide an initial model for two prevalent, impairing disorders among service members and show how these symptom-based subgroups may differentially respond to residential PTSD treatment.