Active Duty Soldiers Research Articles

Violent Childhood Experiences and Intimate Partner Violence Among Married U.S. Soldiers Who Deployed to Iraq

ABSTRACTThe association between intimate partner violence perpetration and violent adverse childhood experiences has not been established among Active Duty soldiers who have served in the Afghanistan and Iraq wars. In this study, 691 Active Duty soldiers were surveyed anonymously 6 months after they returned from Iraq. Results show that 9.8% of soldiers (n = 67) perpetrated intimate partner violence in the past year and that experiencing childhood physical abuse and sexual abuse were independently associated with intimate partner violence after adjusting for other risk factors. The findings of this study may help fill gaps in the understanding of this association and can help better identify soldiers at risk for perpetrating intimate partner violence.

Establishing Outbreak Thresholds for Army Active Duty Soldiers, 2013–2016

Establishing Outbreak Thresholds for Army Active Duty Soldiers, 2013–2016

The Cultural Context of Loneliness: Risk Factors in Active Duty Soldiers

Loneliness has been shown to predict mental health problems and suicide in active duty soldiers. In the present study, we examined distal (e.g., demographic & socioeconomic characteristics) to proximal factors (e.g., platoon relations, relationship quality) that were associated with loneliness in active duty soldiers in the U.S. Army. Results revealed a set of factors that were associated with loneliness in active duty soldiers, including age, frequency of contact with friends and family by phone, childhood trauma, self-reported overall emotional health, intra-platoon harassment, perceived stress, perceived platoon cohesion and support, organizational citizenship behavior, relationship satisfaction with friends, and relationship satisfaction with platoon members. The association between loneliness and both perceived stress and relationship satisfaction with platoon members reached a moderate effect size in the multivariate models. Although some of predictors overlap with those identified in studies of civilians, most were unique to soldiers. Implications are discussed for understanding loneliness in an organization like the military and for the early identification of and intervention with active duty soldiers who may be at risk for mental and behavioral problems.

Effects of short inter-repetition rest periods on power output losses during the half squat exercise

BACKGROUND: Cluster training is being increasingly used to develop muscular power. OBJECTIVE: To determine the effects of short inter-repetition rest (IRR) periods on the capacity to maintain maximal levels of power output. METHODS:In afirst session, 16 active-duty soldiers performed a progressive loading test toestablish the load linked tomaximal power (optimal load, OL), and the half squat 1-repetition maximum. In Session 2, six individual sets of repetitions performed to failure (or a maximum of 20 repetitions) were conducted using the loads OL, low (LL, 15% below OL), and high (HL, 15% above OL) as quickly as possible. For each load, participants performed one set without rest between repetitions (CR, continuous repetition protocol), and another set with 6 s of rest between repetitions (IRR protocol). RESULTS: The number of repetitions participants performed before exceeding a power loss threshold of 15% were higher in the IRR versus the CR protocol by 218% (11 vs. 35), 86% (7 vs. 13), and 175% (4 vs. 11) for LL, OL, and HL, respectively. CONCLUSIONS: A 6 s interval between repetitions is sufficient to induce partial recovery in participants, and could therefore improve muscle power output.

Developing predictive models for return to work using the Military Power, Performance and Prevention (MP3) musculoskeletal injury risk algorithm: a study protocol for an injury risk assessment programme

BackgroundMusculoskeletal injuries are a primary source of disability in the US Military, and low back pain and lower extremity injuries account for over 44% of limited work days annually. History...

Urologic Diseases in Korean Military Population: a 6-year Epidemiological Review of Medical Records.

We sought to describe the incidence rate of the urologic disease in the Korean military by reviewing diagnoses made in active duty soldiers from 2008 to 2013. A total of 72,248 first visits were generated in the Defense Medical Statistics Information System (DMSIS) with its gradually increasing trend over 6 years. A sharp increase of first visit was observed after implementation of the regular health check-up for all conscripted soldiers since 2013. Urolithiasis, prostatitis, epididymoorchitis, urethritis, and varicocele were prevalent. Prostatitis was the highest diagnosis made in the outpatient service, while varicocele was ranked the highest in the inpatient service. The incidence rates of urologic disease varied from 12.3 to 34.2 cases per 1,000 person-years. The urologic disease in conscripted men showed different distribution when we separated the population into conscripted and professional soldiers. Epididymoorchitis was the highest disease followed by urolithiasis, dysuresia, and balanoposthitis in 2013. This study underscores that the urologic disease has spent significant amount of health care resources in the Korean military. This calls for further study to find any significant difference and contributing factors of the urologic disease in the military and the civilian population.

Correlates and reasons for mental health treatment dropout among active duty soldiers.

Many soldiers who seek treatment for mental health problems drop out of treatment before it is complete. The present study examined factors that are associated with dropout among active duty soldiers. Soldiers who had sought treatment (N = 260) responded to measures of beliefs about mental health treatment, mental health symptoms, treatment-seeking behaviors, and treatment dropout. Fifty-seven soldiers reported dropping out before treatment was completed. Commonly endorsed reasons for dropout were that soldiers were too busy with work and a preference to handle the symptoms oneself. A series of logistic regressions revealed that depression symptoms (odds ratio [OR] = 1.07), functional impairment (OR = 1.49), career stigma (OR = 1.70), differential treatment stigma (OR = 1.62), practical barriers (OR = 1.76), negative beliefs about treatment (OR = 1.98), and self-reliance (OR = 1.78) were associated with an increased likelihood of dropout. Positive beliefs about treatment were associated with a decreased likelihood of dropout (OR = 0.60). Functional impairment, career stigma, and self-reliance remained unique predictors in a final forward conditional regression. These findings highlight the need for interventions to support service members in treatment by educating them on the benefits of treatment and reducing practical barriers. (PsycINFO Database Record

Causes of Primary Total Hip Arthroplasty in Active Duty Soldiers-Are Recurrent Medical Assessments Associated With Reduced Rates of Secondary Osteoarthritis in This Population?

The purpose of this study was to analyze the different causes of symptomatic osteoarthritis (OA) of the hip joint in active duty soldiers requiring a total hip arthroplasty and the hypothesis that soldiers had a reduced prevalence of secondary OA as a result of a selection process that has taken place through multiple medical assessments during their military career. We analyzed patient records from 2006 to 2012 for male patients ≤60 years with OA of the hip and indication for total hip arthroplasty in a military hospital in which civilian patients are also treated. About 44 military patients (MP) and 69 civilian patients (CP) were included. The prevalence of different causes of OA of the hip did not differ significantly in both groups (primary OA MP: 59.1% [n = 26], CP: 56.5% [n = 39]; dysplasia MP: 25.0% [n = 11], CP: 24.6% [n = 17]; femoral head necrosis MP: 11.4% [n = 5], CP: 13% [n = 9]; post-traumatic OA MP: 4.5% [n = 2], CP: 5.8% [n = 4]). In conclusion, recurrent medical assessments that are usually based alone on clinical examinations were not able to reduce the prevalence of prearthrotic deformities as a joint-specific risk factor for the development of symptomatic hip OA in our military collective.

Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD).

Prolonged exposure (PE) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD) but there is limited research with active-duty military populations. Virtual reality exposure (VRE) has shown promise but randomized trials are needed to evaluate efficacy relative to existing standards of care. This study evaluated the efficacy of VRE and PE for active duty soldiers with PTSD from deployments to Iraq and Afghanistan. Active-duty soldiers (N = 162) were randomized to 10-sessions of PE, VRE, or a minimal attention waitlist (WL). Blinded assessors evaluated symptoms at baseline, halfway through treatment, at posttreatment, and at 3- and 6-month follow-ups using the Clinician Administered PTSD Scale (CAPS). Intent-to-treat analyses found that both PE and VRE resulted in significant reductions in PTSD symptoms relative to those in the WL. The majority of patients demonstrated reliable change in PTSD symptoms. There was no difference between PE and VRE regarding treatment drop out before completing 10 sessions (44 and 41% for VRE and PE, respectively). Contrary to hypotheses, analyses at posttreatment did not show that VRE was superior to PE. Post hoc analyses found that PE resulted in significantly greater symptom reductions than VRE at 3- and 6-month follow-up. Both treatments significantly reduced self-reported stigma. PE is an efficacious treatment for active-duty Army soldiers with PTSD from deployments to Iraq or Afghanistan. Results extend previous evidence supporting the efficacy of PE to active-duty military personnel and raise important questions for future research on VRE. (PsycINFO Database Record

The Relationship Between Deployment Frequency and Cumulative Duration, and Discharge for Disability Retirement Among Enlisted Active Duty Soldiers and Marines.

The frequency and duration of deployments associated with increased morbidity is a significant concern for force health protection within the military population. Understanding the association between deployment and disability may provide a clearer understanding of factors adversely affecting U.S. military force readiness. A case-control analysis was conducted using records on enlisted active duty personnel in the Army and Marine Corps who were evaluated for a musculoskeletal disability and received a final disability disposition between FY 2003 and 2012. The study compared deployment, deployment frequency, and total time deployed in personnel who received musculoskeletal disability retirement to those with a musculoskeletal disability discharge other than retirement. For females and males in either service, any deployment was associated with an increased risk of disability retirement (adjusted odds ratios [aOR] [95% confidence intervals (CI)]: males 1.76 [1.65-1.87]; females 1.41 [1.21-1.64]). Furthermore, increasing number of deployments (3+ deployments males aOR [95% CI]: 2.21 [1.92-2.53]) and time spent deployed (24+ months Army Males aOR [95% CI]: 2.07 [1.79-2.40]) significantly increased the odds for disability retirement. Increasing frequency and duration of military deployments has an increased risk of disability retirement in service members with a musculoskeletal disability. Further research on this relationship is needed in a more representative sample of the U.S. military population.

Adult ADHD Symptomatology in Active Duty Army Personnel: Results From the Army Study to Assess Risk and Resilience in Servicemembers

Objective: Although the prevalence of adult ADHD has been well established in the general population, few studies have examined the prevalence of ADHD symptoms in the military. Method: The present study used data from 21,449 active duty soldiers, whose responses were collected as part of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Positive ADHD screens were identified using two alternative scoring methods of the Adult Self-Report ADHD Scale Screener. Results: The estimated prevalence of ADHD in this sample was 7.6% and 9.0% depending on diagnostic method. Contrary to initial hypotheses that ADHD would be highest in the 18- to 19-year-old age-group, the age distribution of ADHD in this study was centered around the 25- to 29-year-old age-group. Conclusions: The findings of this study indicate that adult ADHD symptoms are common in Army personnel, and are not limited to the youngest cohorts. Implications on screening, administrative policy, and future research directions are also discussed.

Fatty Acid Blood Levels, Vitamin D Status, Physical Performance, Activity, and Resiliency: A Novel Potential Screening Tool for Depressed Mood in Active Duty Soldiers.

This study examined whether blood fatty acid levels, vitamin D status, and/or physical activity are associated with physical fitness scores; a measure of mood, Patient Health Questionnaire-9; and a measure of resiliency, Dispositional Resiliency Scale-15 in active duty Soldiers. 100 active duty males at Fort Hood, Texas, underwent a battery of psychometric tests, anthropometric measurements, and fitness tests, and they also provided fasting blood samples for fatty acid and vitamin D analysis. Pearson bivariate correlation analysis revealed significant correlations among psychometric tests, anthropometric measurements, physical performance, reported physical inactivity (sitting time), and fatty acid and vitamin D blood levels. On the basis of these findings, a regression equation was developed to predict a depressed mood status as determined by the Patient Health Questionnaire-9. The equation accurately predicted depressed mood status in 80% of our participants with a sensitivity of 76.9% and a specificity of 80.5%. Results indicate that the use of a regression equation may be helpful in identifying Soldiers at higher risk for mental health issues. Future studies should evaluate the impact of exercise and diet as a means of improving resiliency and reducing depressed mood in Soldiers.

Self-Management of Unreported Musculoskeletal Injuries in a U.S. Army Brigade.

There is a paucity of literature describing the accuracy of musculoskeletal injury reporting in the U.S. Army. To investigate symptom-management behaviors as well as factors associated with seeking medical treatment among active duty Soldiers who reported that they had concealed at least one musculoskeletal injury. Anonymous surveys were completed by Soldiers (N = 1,388; 1,269 males, 74 females, and 45 no response) assigned to an Infantry Brigade Combat Team. Soldiers were asked to self-report injuries sustained in the last 12 months and whether or not they reported those injuries to a medical provider. Descriptive statistics were used to analyze treatment alternatives. Chi-square test was used to assess any significant relationships between injury and various demographics. There were 808 (58%) Soldiers who stated they had an injury that they did not report. Over-the-counter pain relief medication (81%) was the most commonly selected alternative treatment. Over-the-counter pain medication was frequently used for symptom management among Soldiers who did not report their injury to a medical provider.

Genetics and Other Risk Factors for Past Concussions in Active-Duty Soldiers.

Risk factors for concussion in active-duty military service members are poorly understood. The present study examined the association between self-reported concussion history and genetics (apolipoprotein E [APOE], brain-derived neurotrophic factor [BDNF], and D2 dopamine receptor genes [DRD2]), trait personality measures (impulsive-sensation seeking and trait aggression-hostility), and current alcohol use. The sample included 458 soldiers who were preparing to deploy for Operation Iraqi Freedom/Operation Enduring Freedom. For those with the BDNF Met/Met genotype, 57.9% (11/19) had a history of one or more prior concussions, compared with 35.6% (154/432) of those with other BDNF genotypes (p = 0.049, odds ratio [OR] = 2.48). APOE and DRD2 genotypes were not associated with risk for past concussions. Those with the BDNF Met/Met genotype also reported greater aggression and hostility personality characteristics. When combined in a predictive model, prior military deployments, being male, and having the BDNF Met/Met genotype were independently associated with increased lifetime history of concussions in active-duty soldiers. Replication in larger independent samples is necessary to have more confidence in both the positive and negative genetic associations reported in this study.

Longitudinal trends in use of dietary supplements by U.S. Army personnel differ from those of civilians.

Prevalence and patterns of dietary supplement (DS) use by U.S. Army soldiers differ from the civilian population. Longitudinal trends in use of DSs by civilians have been examined, but are unavailable in subpopulations such as military service members. The present study examined longitudinal changes in DS use by soldiers. A standardized questionnaire on DS use was administered in 2006-2007 (N = 989) and 2010-2011 (N = 1196) to convenience samples of active duty soldiers. Data were weighted for total population demographics of age, sex, and rank. Regular use of DSs by soldiers increased significantly (56% ± 1.6% vs. 64% ± 1.7%; p ≤ 0.001) over the 4 years primarily because of an increase of DS use among the youngest 18- to 24-year-old soldiers (43.0% ± 2.5% vs 62.3% ± 2.4%; p ≤ 0.01). Protein (22% ± 1.4% vs. 26% ± 1.5%; p ≤ 0.001) and combination (10.0% ± 1.0% vs. 24% ± 1.4%; p ≤ 0.001) product consumption also increased over the 4 years. Individual vitamin and mineral use - including iron, magnesium, selenium, and vitamins A, B6, B12, and D - significantly increased as well (p ≤ 0.05). In addition, expenditures on DSs by soldiers increased over time (p < 0.01). Reasons reported by soldiers for DS use suggest use increased to meet the occupational demands of military service. Educational interventions to minimize inappropriate use of DSs by soldiers are necessary to reduce adverse events resulting from unnecessary use of DSs and the financial burden associated with their use.

Individual and environmental contingencies associated with multiple suicide attempts among U.S. military personnel

Suicidal behavior among U.S. military personnel persists as a significant public health issue. Previous research indicates the primary motive for suicide attempts among military personnel is the desire to reduce or alleviate emotional distress, a finding that converges with studies in nonmilitary samples. Much less is understood about the consequences of a first suicide attempt that could influence the occurrence of additional suicide attempts. In order to identify these contingencies, 134 active duty Soldiers who had attempted suicide (n=69 first-time attempters, n=65 multiple attempters) participated in structured interviews focused on their experiences immediately following their first attempt. Soldiers were more likely to have made multiple suicide attempts if they were younger at the time of their first attempt, were not admitted to a hospital or treatment program after their first attempt, or experienced emotional and psychological relief immediately afterwards. Results suggest that Soldiers who experience emotional and/or psychological relief immediately after their first suicide attempt or do not receive treatment are more likely to make additional suicide attempts.

Help-Seeking Behaviors Among Active-Duty Military Personnel: Utilization of Chaplains and Other Mental Health Service Providers

Military chaplains not only conduct religious services, but also provide counseling and spiritual support to military service members, operating as liaisons between soldiers and mental health professionals. In this study, active-duty soldiers (N = 889) reported help-seeking behaviors and mental health. Using logistic regressions, we describe the issues for which soldiers reported seeking help, then outline the characteristics of those who are most likely to seek help from a chaplain. Of the soldiers who sought help from a chaplain within the previous year, 29.9% reported high levels of combat exposure, 50.8% screened positive for depression, 39.1% had probable PTSD, and 26.6% screened positive for generalized anxiety disorder. The participant’s unit firing on the enemy, personally firing on the enemy, and seeing dead bodies or human remains predicted seeing a chaplain. Future research should examine ways to engage soldiers who have had more combat experiences with the chaplain community to address spiritual issues.

The Psychiatric Ramifications of Moral Injury Among Veterans

The Psychiatric Ramifications of Moral Injury Among Veterans

Risk Factors for Mild Traumatic Brain Injury among US Army Soldiers

The Defense and Veterans Brain Injury Center (2015 DVBIC) reported more than 120,000 mild traumatic brain injury (mTBI) cases since the year 2000 among active duty US Army personnel. Increasing evidence suggests mTBI as a risk factor for development of mental health disorders (MHD) and post-traumatic stress disorder (PTSD). PURPOSE: To determine risk factors for mTBI, PTSD, and MHD and the association of mTBI and non-head injuries with subsequent PTSD and MHD among US Army active duty Soldiers. METHODS: This prospective cohort study utilized the Total Army Injury and Health Outcomes Database (TAIHOD) to analyze soldiers’ (N=1,261,297) medical encounter data between 2002 and 2011. International Classification of Diseases, Ninth Revision [ICD-9] codes were used to identify outcomes of interest: mTBI (CDC surveillance definition for mTBI), PTSD (ICD-9-CM 309.81), and MHD (ICD-9-CM codes to identify depression and anxiety, while excluding the diagnostic code of PTSD [ICD-9-CM 309.81]). Non-head (torso, spine, extremity) injuries were identified by ICD-9-CM codes using the Barell Injury Diagnosis Matrix. RESULTS: From 2002 to 2011 incident mTBI, PTSD, and MHD were found in: 79,505, 71,454, and 285,731 soldiers, respectively. The average injury rate per 1000 soldier years for mTBI, PTSD, and MHD were 17.23, 15.37, and 67.99, respectively. Sustaining a prior (>12 mos.) non-head injury was a significant risk factor for subsequent mTBI (OR 9.82, 95% CI 9.62-10.02). MTBI was associated with increased risk for both subsequent (>12 mos.) PTSD (OR 5.67, 95% CI 5.37-5.98) and MHD (OR 2.99, 95% CI 2.89-3.10). Non-head injury was associated with an increased risk for PTSD (OR 2.15, 95% CI 2.10-2.19) and MHD (OR 2.17, 95% CI 2.15-2.20) to a lesser degree than mTBI. CONCLUSION: Soldiers are at greater risk for developing PTSD and other MHDs for more than a year after an mTBI exposure versus non-head injuries. Identifying populations at risk for mTBI, and those with a previous mTBI exposure, are important consideration for mental health surveillance and intervention programs for both military and civilians. The views, opinions and/or findings contained herein are those of the authors and should not be construed as an official Department of the Army position, or policy.

Higher Pretreatment Blood Pressure Is Associated With Greater Posttraumatic Stress Disorder Symptom Reduction in Soldiers Treated With Prazosin

In a previously reported positive randomized controlled trial of the α1-adrenoreceptor (α1AR) antagonist prazosin for combat posttraumatic stress disorder (PTSD) in 67 active duty soldiers, baseline symptoms did not predict therapeutic response. If increased brain α1AR activation in PTSD is the target of prazosin treatment action, higher brain α1AR activation should predict greater prazosin efficacy. Although brain α1AR activation is not measurable, coregulated peripheral α1AR activation could provide an estimate of brain α1AR activation. Standing blood pressure (BP) is an accessible biological parameter regulated by norepinephrine activation of α1ARs on peripheral arterioles. Effects of baseline standing systolic and other BP parameters on PTSD outcome measures from the previously reported randomized controlled trial were analyzed using linear mixed-effects models. Prazosin participants (n = 32) and placebo participants (n = 35) were analyzed separately. In prazosin participants, each 10-mm Hg higher baseline standing systolic BP increment resulted in an additional 14-point reduction (improvement) of Clinician-Administered PTSD Scale total score at end point (p = .002). All other combinations of baseline BP parameters and PTSD outcome measures were similarly significant or demonstrated trends in the predicted direction. In placebo participants, there was no signal for a baseline BP effect on PTSD outcome measures. These findings suggest that higher standing BP is a biomarker that helps identify persons with combat PTSD who are likely to benefit from prazosin. These results also are consistent with α1AR activation contributing to PTSD pathophysiology in a subgroup of patients.