Active Duty US Army Research Articles

The collaborative assessment and management of suicidality (CAMS) versus enhanced care as usual (E-CAU) with suicidal soldiers: Moderator analyses from a randomized controlled trial

ABSTRACTGiven historically high rates of suicide among military personnel over the past decade the present study analyzed whether key demographic, military, and research-based variables moderated clinical treatment outcomes of 148 suicidal active duty US Army soldiers. This is a secondary analysis of data from a randomized controlled trial comparing the collaborative assessment and management of suicidality (CAMS) to enhanced care as usual (E-CAU; Jobes et al., 2017). Nine potential moderator variables were derived from the suicidology literature, military-specific considerations, and previous CAMS research; these were sex, age, marital status, race, lifetime suicide attempts, combat deployments, time in service, initial distress, and borderline personality disorder diagnosis. The clinical outcomes included six suicide- and mental health-related variables. Six of the eight significant moderator findings in this study showed CAMS outperforming E-CAU in certain subgroups with medium to large effect sizes ranging from 0.48 to 1.50. Collectively, the results suggest that CAMS was associated with the greatest improvement among lower complexity soldier patients, particularly those with lower initial distress and fewer deployments. Those who were married or older generally responded better to CAMS, although the results were not entirely consistent with respect to age. CAMS’s effectiveness for married soldiers and those with lower initial distress was a particularly robust finding that persisted when adjusting more stringently for multiple testing. This study sheds light on several factors associated with the success of CAMS among suicidal soldiers that can assist in matching the treatment to those that may benefit the most.

Risk for Lower Extremity Injury After Concussion: A Matched Cohort Study in Soldiers.

Background Rates of lower extremity musculoskeletal injury are reportedly higher in professional and collegiate athletes following concussions. However, there is a paucity of evidence on this relationship in individuals who are not high-level athletes. Objectives To examine the risk of acute lower extremity musculoskeletal injury in soldiers within 2 years of an incident concussion, compared to matched nonconcussed soldiers. Methods This was a matched-cohort study that used the medical encounter and personnel data of active-duty US Army soldiers from 2005 to 2011. Incident concussions were identified using International Classification of Diseases-Ninth Revision codes in medical encounter data of all soldiers from 2005 to 2009. One nonconcussed soldier in the US Army during the same month was matched by age, sex, rank, length of service, deployment status, and military career field to each concussed soldier. Hazard ratio (HR) and 95% confidence interval (CI) were calculated for the risk of lower extremity injury within 2 years of the incident concussion. Monthly HRs were compared to identify differences in injury rates between the groups, and an HR for the period of greatest difference was also calculated. Results A total of 23 044 individuals (11 522 concussed and 11 522 nonconcussed) were included in the study. Within 2 years of concussion, the hazard of lower extremity injury was 38% greater in concussed compared to nonconcussed soldiers (HR, 1.38; 95% CI: 1.30, 1.46), while the 15-month hazard was 45% greater (HR, 1.45; 95% CI: 1.36, 1.56). Conclusion The rate of lower extremity musculoskeletal injury among this population of physically active adults is higher following concussion, and the risk remains elevated for more than a year following injury. Level of Evidence Prognosis, level 2b. J Orthop Sports Phys Ther 2018;48(7):533-540. Epub 8 May 2018. doi:10.2519/jospt.2018.8053.

Gender differences in limited duty time for lower limb injury.

Among active-duty military personnel, lower limb musculoskeletal injuries and related conditions (injuries) frequently arise as unintended consequences of physical training. These injuries are particularly common among women. The practical impact of such injuries on temporary military occupational disability has not been estimated with precision on a large scale. To determine the proportion of service time compromised by limited duty days attributable to lower limb injuries, characterize the time affected by these limitations in terms of specific lower limb region and compare the limited duty time between male and female soldiers. Administrative data and individual limited duty assignments (profiles) were obtained for active-duty US Army personnel who served in 2014. Lower limb injury-related profiles were used to calculate the percent of person-time requiring duty limitations by gender and body region. The study group was 568 753 soldiers of whom 14% were women. Nearly 13% of service days for active-duty US Army soldiers required limited duty for lower limb injuries during 2014. Knee injuries were responsible for 45% of those days. Within integrated military occupations, female soldiers experienced 27-57% more time on limited duty for lower limb injuries compared with men. The substantial amount of limited duty for lower limb musculoskeletal injuries among soldiers highlights the need for improvement in training-related injury screening, prevention and timely treatment with particular attention to knee injuries. The excessive impact of lower limb injuries on female soldiers' occupational functions should be a surveillance priority in the current environment of expanding gender-integrated training.

Gender Disparities Within US Army Orthopedic Surgery: A Preliminary Report.

Women account for approximately 15% of the active duty US Army, and studies show that women may be at an increased risk of musculoskeletal injury during sport and military training. Nationally, the field of orthopedic surgery comprises 14% women, lagging behind other surgical fields. Demographics for US Military orthopedic surgeons are not readily available. Similarly, demographic data of graduating medical students entering Military Medicine are not reported. We hypothesize that a gender disparity within military orthopedics will be apparent. We will compare the demographic profile of providers to our patients and hypothesize that the two groups are dissimilar. Secondarily, we examine the demographics of military medical students potentially entering orthopedics from the Uniformed Services University of the Health Sciences (USUHS) or the Health Professions Scholarship Program. A census was formed of all US Army active duty orthopedic surgeons to include staff surgeons and residents, as well as US Army medical student graduates and orthopedic patients. There are 252 Army orthopedic surgeons and trainees; 26 (10.3%) are women and 226 (89.7%) are men. There were no significant demographic differences between residents and staff. Between 2014 and 2017, the 672 members of the USUHS graduating classes included 246 Army graduates. Of those, 62 (25%) were female. Army Health Professions Scholarship Program graduated 1,072 medical students, with women comprising 300 (28%) of the group. No statistical trends were seen over the 4 yr at USUHS or in Health Professions Scholarship Program. In total, 2,993 orthopedic clinic visits during the study period were by Army service members, 23.6% were women. There exists a gender disparity among US Army orthopedic surgeons, similar to that seen in civilian orthopedics. Gender equity is also lacking among medical students who feed into Army graduate medical education programs. The gender profile of our patient population is not reflected by that of providers. Because patients prefer providers of the same gender, this is a limitation to patient satisfaction and access to care for musculoskeletal injuries. Further study is underway to identify perceptions and potential causes of these disparities, including the critical perspective of our patients. In addition to the inherent benefits offered by diversity (e.g., expanding the talent pool and more perspectives for decision-making), ultimately it affords a greater ability to maintain a fit and ready force.

Internet and In-Person Cognitive Behavioral Therapy for Insomnia in Military Personnel: A Randomized Clinical Trial.

Compare in-person and unguided Internet-delivered cognitive behavioral therapy for insomnia (CBTi) with a minimal contact control condition in military personnel. A three-arm parallel randomized clinical trial of 100 active duty US Army personnel at Fort Hood, Texas. Internet and in-person CBTi were comparable, except for the delivery format. The control condition consisted of phone call assessments. Internet and in-person CBTi performed significantly better than the control condition on diary-assessed sleep efficiency (d = 0.89 and 0.53, respectively), sleep onset latency (d = -0.68 and -0.53), number of awakenings (d = -0.42 and -0.54), wake time after sleep onset (d = -0.88 and -0.50), the Insomnia Severity Index (d = -0.98 and -0.51), and the Dysfunctional Beliefs and Attitudes About Sleep Scale (d = -1.12 and -0.54). In-person treatment was better than Internet treatment on self-reported sleep quality (d = 0.80) and dysfunctional beliefs and attitudes about sleep (d = -0.58). There were no differences on self-reported daytime sleepiness or actigraphy-assessed sleep parameters (except total sleep time; d = -0.55 to -0.60). There were technical difficulties with the Internet treatment which prevented tailored sleep restriction upward titration for some participants. Despite the unique, sleep-disrupting occupational demands of military personnel, in-person and Internet CBTi are efficacious treatments for this population. The effect sizes for in-person were consistently better than Internet and both were similar to those found in civilians. Dissemination of CBTi should be considered for maximum individual and population benefits, possibly in a stepped-care model.

Underreporting of Musculoskeletal Injuries in the US Army: Findings From an Infantry Brigade Combat Team Survey Study.

Background:Musculoskeletal injury is a significant threat to readiness in the US Army. Current injury surveillance methods are constrained by accurate injury reporting. Input into electronic medical records or databases therefore may not accurately reflect injury incidence. The purpose of this study was to evaluate injury reporting among active-duty US Army soldiers to explore potential limitations of surveillance approaches.Hypothesis:A significant number of injuries go unreported to medical personnel.Study Design:Cross-sectional study.Level of Evidence:Level 4.Methods:Surveys were completed by soldiers assigned to an Army Infantry Brigade Combat Team. Survey questions inquired about injuries sustained in the previous 12 months, injury onset, and whether injuries were reported to a medical provider. Participants were asked to rank reasons for accurately reporting, underreporting, and/or exaggerating injuries. Chi-square analyses were used to compare differences among underreported injuries in terms of injury onset (gradual vs acute) and sex.Results:A total of 1388 soldiers reported 3202 injuries that had occurred in the previous 12-month period, including 1636 (51%) that were reported and 1566 (49%) that were identified as not reported to medical personnel. More than 49% of reported injuries were described as acute and 51% were described as chronic. Injury exaggeration was reported by 6% of soldiers. The most common reasons for not reporting injuries were fear that an injury might affect future career opportunities and avoidance of military “profiles” (mandated physical restrictions).Conclusion:Approximately half of musculoskeletal injuries in a Brigade Combat Team were not reported.Clinical Relevance:Unreported and untreated injuries can lead to reinjury, chronic pain, performance decrements, and increased costs associated with disability benefits. Additionally, unreported injuries can undermine injury surveillance efforts aimed at reducing the musculoskeletal injury problem in the military.

Long-acting contraceptive placement among us army servicewomen

Objectives: We aimed to quantify the uptake of long-acting reversible contraceptive (LARC) methods — that is, intrauterine devices (IUD) and hormonal implants — among active-duty female soldiers in the US Army; and describe characteristics associated with LARC method uptake. Methods: We analyzed the Stanford Military Data Repository, which includes all digitally recorded health encounters for active-duty US Army soldiers from 2011 to 2014. We calculated percentages of soldiers receiving LARC methods and used multivariable logistic regression to test for associations between LARC method placement and diverse demographic and military characteristics. Results: Among 114,615 servicewomen aged 18–44 (median observation period 38 months, IQR, 30–47), 14.2% received a LARC method (8.5% IUDs, 6.4% implants). While annual IUD insertions were stable, implant insertions steadily increased between 2011 and 2014 (from 1468 to 2468/year). Implant uptake was more common among younger women: 44% of placements occurred among women younger than 23, compared with 22% of IUDs. Having had a child increased the likelihood of implant placement and more than doubled IUD placement (OR, 1.28; 95% CI, 1.18–1.38; OR, 2.20; 95% CI, 2.08–2.34, respectively). Married women were more likely to receive an IUD (OR, 1.60; 95% CI, 1.52–1.70), but marital status was not associated with implant placement. Conclusions: Uptake of contraceptive implants is increasing among women soldiers, while IUD uptake remains stable. Unmarried soldiers are less likely to receive IUDs and soldiers without children are less likely to receive either LARC method, suggesting a continued need for education about method safety and reversibility with the goal of preventing unintended pregnancies among women in the army.

Effect of Mandatory Unit and Individual Physical Training on Fitness in Military Men and Women.

The purpose of this study was to look at the effect of additional individual physical training (PT) in addition to mandatory unit PT as well as other risk factors on physical fitness. A cross-sectional design. This study was conducted on a US military installation. Participants were 6290 male and 558 female active duty US Army soldiers in 3 light infantry brigades. Participants completed self-administered questionnaires asking about individual characteristics, PT, and physical fitness. Cut points were established for soldiers scoring within the top 33% for each of the 3 Army Physical Fitness Test events (2-mile run, sit-ups, and push-ups) and top 50% in each of the tests combined for overall performance. Odds ratios and 95% confidence intervals from multivariate analyses were calculated. Variables impacting physical fitness performance of men and women included increased body mass index, leading unit PT sessions, and individual distance running mileage. Other variables impacting physical performance for men included increased age, smoking, and individual resistance training. Soldiers performing additional individual PT demonstrated a positive influence on fitness compared to unit PT participation alone. Increased age and being overweight/obese negatively influenced physical fitness. To enhance fitness performance through unit PT, running by ability groups and resistance training should be encouraged by leadership.

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.

Risk for Lower Extremity Injury Following Concussion

Concussions may increase the risk for subsequent lower extremity injuries in physically active people. PURPOSE: Examine concussion as a risk factor for lower extremity (LE) injury in soldiers with no history of LE injury. METHODS: Medical encounter data for all active duty US Army soldiers from 2005-2009 were used to identify soldiers who sustained a concussion by way of International Classification of Diseases, Ninth Revision (ICD-9) codes. Soldiers with a history of a LE injury were excluded from the study. LE injuries were defined according to the fractures, dislocations, sprains, and strains ICD-9 codes from the Barell injury diagnosis matrix. Matched controls (age, sex, and military occupational specialty [MOS]) were selected from the population of soldiers in the Army during the same month as each concussion case. Soldiers were followed from the time of incident concussion or matching until: 1) a lower extremity injury, 2) loss to follow-up, or 3) conclusion of a 24-month follow-up period. Using concussion as the primary risk factor, a Cox Proportional Hazard Ratio (HR) was calculated for LE injury, controlling for matched factors, time in military service, and race. Life table methods were used to evaluate LE injury rates for qualitative comparison between the two groups across the 24-month follow-up period. RESULTS: From 2005 to 2009, incident concussions were identified in 7,981 soldiers without a history of LE injuries. Of these cases, 1,892 (~24%) experienced a LE injury within 2 years following concussion. Concussed soldiers were at 53% greater risk of LE injury over the 24-month follow-up period (HR=1.53, 95%CI [1.42, 1.65]) compared to controls. On qualitative examination of unadjusted injury rates, the greatest difference in the rate of LE injuries appeared during the first 6 months post-concussion. CONCLUSION: These results suggest that a concussion puts soldiers at increased risk for sustaining a LE injury. This risk may be greatest during the first several months post-concussion. These findings may have implications for managing people returning to activity after concussion. The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government.

Prediction of all-cause occupational disability among US Army soldiers

IntroductionLong-term occupational disability rates associated with eventual discharges from military service have risen sharply among active-duty US Army soldiers during the last three decades, with important implications for soldier health...

EVALUATING POTENTIAL IATROGENIC SUICIDE RISK IN TRAUMA-FOCUSED GROUP COGNITIVE BEHAVIORAL THERAPY FOR THE TREATMENT OF PTSD IN ACTIVE DUTY MILITARY PERSONNEL.

To determine whether group cognitive processing therapy-cognitive only version (CPT-C) is associated with iatrogenic suicide risk in a sample of active duty US Army personnel diagnosed with posttraumatic stress disorder (PTSD). Possible iatrogenic effects considered include the incidence and severity of suicide ideation, worsening of preexisting suicide ideation, incidence of new-onset suicide ideation, and incidence of suicide attempts among soldiers receiving group CPT-C. Comparison with group present-centered therapy (PCT) was made to contextualize findings. One hundredeight soldiers (100 men, eight women) diagnosed with PTSD were randomized to receive either group CPT-C or group PCT. PTSD diagnosis was confirmed via structured clinician interview. Suicide ideation, depression severity, and PTSD severity were assessed at pretreatment, weekly during treatment, and 2 weeks, 6 months, and 12 months posttreatment. Rates of suicide ideation significantly decreased across both treatments. Among soldiers with pretreatment suicide ideation, severity of suicide ideation significantly decreased across both treatments and was maintained for up to 12 months posttreatment. Exacerbation of preexisting suicide ideation was uncommon in both treatments. New-onset suicide ideation was rare and similar across both treatments (<16%). There were no suicide attempts during treatment or follow-up in either group. Change in depression symptoms predicted change in suicide risk. Suicide-related outcomes were similar across both treatments and primarily associated with comorbid depression. Suicide-related outcomes in group CPT-C were rare and comparable to patterns observed in an active, nontrauma-focused therapy, even among soldiers who entered treatment with suicide ideation. NCT01286415, https://clinicaltrials.gov/ct2/show/NCT01286415.

Telemedicine in US Army soldiers with type 1 diabetes

A retrospective study of a telemedicine clinic for active duty US Army soldiers with type 1 diabetes was conducted. Fifty-one consecutive patients (mean age 33.9 years) were enrolled into the clinic. All soldiers with known or newly diagnosed type 1 diabetes received three weekly office visits for intensive diabetes education. After this, all communication occurred via a messaging system consisting of texting, web-based download, and/or email to a diabetes management team. For urgent matters, 24/7 direct paging or telephone access was provided. Routine adjustments in insulin dosing were accomplished via email. Soldiers were followed for a mean of 17.1 months. Baseline, three-month, and end of study glycated hemoglobin (A1C) values were 9.8, 7.3, and 6.9, respectively. There were no significant differences in end of study A1C levels between patients with known vs. newly diagnosed type 1 diabetes, nor were there any differences between those patients who received insulin via pump therapy vs. multiple daily injections. Telemedicine was safe and effective in lowering A1C levels in US Army soldiers with type 1 diabetes.

Epidemiology of Ankle Sprains and the Risk of Separation From Service in U.S. Army Soldiers.

Retrospective cohort study. To report the incidence rate of ankle sprains in active-duty soldiers and to examine if soldiers who sustain ankle sprain injuries are more likely to leave the Army than those who do not sustain an ankle sprain. Ankle sprains are one of the most common musculoskeletal injuries in physically active people and have been identified as the most common foot or ankle injury in active-duty Army personnel, with a rate of 103 sprains per 1000 soldiers per year. Data were analyzed on the entire active-duty US Army population from 2000 to 2006 (n = 1 014 042). A semi-parametric Cox proportional hazard model was built. The overall incidence rate for ankle sprains was 45.14 per 1000 person-years. After controlling for length of service prior to the study period, soldiers who sustained a single ankle sprain were 27% less likely (relative risk ratio = 0.73; 95% confidence interval: 0.73, 0.75) to leave the service than soldiers who had no documented history of an ankle sprain. However, this trend toward increased service time no longer held true for those who sustained a recurrent sprain (risk ratio = 1.07; 95% confidence interval: 0.99, 1.15). It appears that individuals who sustain an incident ankle sprain have longer time in service in the Army than those who do not sustain this injury. However, this trend toward longer service time no longer held true for soldiers who sustained a recurrent. Prognosis, level 2b.

The Prevalence of Meniscal Tears in Young Athletes Undergoing Revision Anterior Cruciate Ligament Reconstruction

The purpose of this study was to determine the incidence of meniscal injury, specifically medial meniscal injury, in US Army soldiers undergoing revision anterior cruciate ligament (ACL) reconstruction. A retrospective review was performed of all patients who underwent revision ACL reconstruction from 2002 to 2011 at our institution. A complete chart review was performed to identify the prevalence of meniscal pathology identified at the time of revision ACL surgery. Patient demographic data and meniscal injury patterns were analyzed. Sixty-seven patients were identified, with a mean age of 28 years. The mean time to revision reconstruction was 67 months. Most patients (64.1%) reported a distinct reinjury. Reinjury was reported as the cause for revision ACL reconstruction in 43 patients. In this subgroup the mean time from reinjury to revision surgery was 13.9 months. Meniscal pathology was identified in 50 patients (74.6%). Medial meniscal tears were noted in 38 patients (56.7%), a rate significantly greater than that previously described (P= .008). Lateral meniscal tears were noted in 26 patients (38.8%), which was similar to previously published data (P= .52). The prevalence of meniscal injury at the time of revision ACL reconstruction in active-duty US Army soldiers is nearly identical to that of previously published data looking at a civilian population (74.6% v 74%) in the Multicenter ACL Revision Study (MARS) cohort. However, the incidence of medial meniscal injury was greater in the active-duty population than in the civilian population (56.7% v 40%). The observed increase in the prevalence of medial meniscal pathology is likely multifactorial, relating to the unique demands on young military athletes in both combat and training environments, rate of reinjury, and various delays to treatment after reinjury. Level IV, therapeutic case series.

Blended courage: Moral and psychological courage elements in mental health treatment seeking by active duty military personnel

We propose that seeking mental health care in an environment with heightened stigma may combine elements of both psychological and moral courage. Interviews of 32 active duty US Army personnel about their process of seeking current mental health care were analyzed for themes of voluntary action, personal risk, and noble or worthwhile goals (benefits). Risks and benefits were divided into internal risks and benefits, characteristic of psychological courage; and external risks and benefits, characteristic of moral courage. Concerns about external risks were themes in all narratives, while concerns about internal risks were themes in only about half of narratives. Both internal and external benefits of treatment were themes in approximately three-quarters of the narratives, whereas doubts about internal (but not external) benefits were also expressed at a similar rate. Thus, participants described an act of blended courage, with social risks of moral courage taken for wellness goals of psychological courage.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: Return to Duty in Active Duty US Army Patients

Minimally Invasive Transforaminal Lumbar Interbody Fusion: Return to Duty in Active Duty US Army Patients

Attitudes and behaviors of overweight or obese US Army Soldiers

The US Army is experiencing increasing rates of overweight and obesity. Understanding the factors associated with obesity within an environment of imposed weight restrictions and physical fitness is imperative. We conducted a retrospective review of electronic medical records of 832 overweight or obese active duty US Army Soldiers attending weight loss classes at Ft Bliss, TX in 2011–2012. The data included responses to a questionnaire on attitudes and behaviors regarding weight control. The mean age of Soldiers was 28.7 ± 7.4 years and 86% were male. 67% of Soldiers were obese and 33% were overweight. Obese Soldiers were more likely to be older, male, and non‐Hispanic black (p&lt;0.01). Obese Soldiers were more likely to binge eat (p&lt;0.0001) and tended to consume more juice or sugar‐sweetened beverages (p=0.06) than overweight Soldiers. Obese Soldiers had greater reported prevalence of anxiety and post traumatic stress disorder (p&lt;0.05). Past use of over‐the‐counter medications or dietary supplements for weight loss was higher among obese Soldiers (49% vs. 40%, p=0.02). Eating due to emotions or stress was higher among obese Soldiers (35% vs. 28%, p=0.03). Obese Soldiers were more likely to be in the earlier stages of readiness to change behaviors (p=0.01). These results suggest a role of stress in obesity of Soldiers, and highlight the importance of assessing individual attitudes and readiness in weight control.

Characterization of Voice Disorders in Deployed and Nondeployed US Army Soldiers

To evaluate voice disorder differences between deployed and nondeployed US army soldiers. Cross-sectional study. More than 1.3 million health records of active duty US army soldiers with no history of dysphonia were queried for voice disorder diagnoses over a 3.5-year period. A sample of 292 soldiers was further evaluated for known factors linked to dysphonia. US army soldiers were 1.13 times more likely to have a diagnosis of dysphonia if they were deployed. Risk factors and exposures common to patients with dysphonia were not statistically different between deployed and nondeployed soldiers. Additionally, the type of dysphonia diagnosis was not significantly different between deployed and nondeployed soldiers. US army soldiers deployed to war zones are more likely to be diagnosed with dysphonia. None of the reviewed parameters accounted for the difference in dysphonia rate between deployed and nondeployed soldiers, suggesting that occupational exposures of deployed soldiers account for the increase in the diagnoses of dysphonia.

Factors Associated With Physical Aggression Among US Army Soldiers

There are a growing number of studies that have approximated levels of aggression and associated outcomes among combat veterans returning from Iraq and Afghanistan using brief screening assessments. However, further research to evaluate the relative role of combat exposures and overt physical behaviors is required to further elucidate potential associations between military service, combat deployment, and overt physical aggression. The purpose of the current study was to assess the prevalence of self-reported physical aggression in a sample of US Army soldiers using an adaptation of the Revised Conflict Tactics Scale (CTS2), and examine factors associated with higher levels of aggression. A population-based cross-sectional study was conducted at a single US Army Installation within a sample of active duty US Army soldiers (n = 6,128) from two large units. Anonymous surveys were collected 6 months following deployment to measure overt aggressive behaviors, posttraumatic stress disorder, anxiety, depression, traumatic brain injury, and misuse of alcohol. There were a relatively higher number of minor and severe physical overt aggressive actions reported among soldiers who previously deployed, notably highest among deployed soldiers reporting the highest levels of combat intensity. Soldiers screening positive for the misuse of alcohol were also significantly more likely to report relatively higher levels of physical aggression. This study quantified overt aggressive behaviors and associated factors, showing increasing combat exposures may result in increased physical aggression. Clinicians treating service members returning from combat may consider assessing relative levels of combat.