Active Military Personnel Research Articles

Military PTSD: All Psychotherapeutic Roads Might Lead to Rome but They Need Repaving

Treating post-traumatic stress disorder (PTSD) in active military personnel remains challenging. No controlled studies on the currently recommended

The Risk of Chronic Gastrointestinal Disorders Following Acute Infection with Intestinal Parasites.

Background: Infectious gastroenteritis (IGE) is caused by numerous bacterial, viral, and parasitic pathogens. A history of IGE has been shown in previous studies to increase the risk of developing chronic gastrointestinal disorders and other chronic conditions. As bacteria and viruses represent the majority of pathogen-specific causes of IGE, post-infectious studies have primarily focused on these organisms. The objective of this study was to investigate an association between a history of parasite-associated IGE and the subsequent development of chronic post-infectious gastrointestinal and non-gastrointestinal disorders in a military population.Methods: International Classification of Diseases, 9th Revision Clinical Modification (ICD-9-CM) diagnostic coding data for primary exposures and outcomes were obtained for a retrospective cohort study of active component military personnel from 1998 to 2013. Exposed subjects consisted of individuals with documented infection with one of ten parasitic pathogens. Unexposed subjects were matched to exposed subjects on demographic and operational deployment history parameters. Adjusted odds ratios (aORs) were estimated using logistic regression for several chronic disorders previously shown to be associated with a history of IGE.Results: A total of 896 subjects with a parasitic exposure were matched to 3681 unexposed subjects for multivariate regression analysis. Individuals infected with Balantidium coli, Ascaris lumbricoides, Strongyloides stercoralis, Necator americanus/Ancylostoma duodenale, and Taenia spp. had higher aOR for development of several chronic gastrointestinal disorders when compared with unexposed subjects after controlling for various covariates.Conclusion: We found that parasite-associated enteric infection increases the risk of development of post-infectious chronic gastrointestinal disorders in a military population. These results require confirmation in similar populations and in the developing world where infection with these parasites is endemic. Further understanding of disease burden and causal mechanisms should direct primary prevention and potential disease interception strategies.

Repetitive Mild Closed Head Injury Alters Protein Expression and Dendritic Complexity in a Mouse Model.

Worldwide head injuries are a growing problem. In the United States alone, 1.7 million people suffer a head injury each year. While most of these injuries are mild, head injury sufferers still sustain symptoms that can have major medical and economical impacts. Moreover, repetitive mild head injuries, like those observed in active military personnel and athletes, have demonstrated a more severe and long-term set of consequences. In an effort to better understand the delayed pathological changes following multiple mild head injuries, we used a mouse model of mild closed head injury (with no motor deficits observed by rotarod testing) and measured dendritic complexity at 30 days after injury and potentially related factors up to 60 days post-injury. We found an increase in TDP-43 protein at 60 days post-injury in the hippocampus and a decrease in autophagy factors three days post-injury. Alterations in dendritic complexity were neuronal subtype and location specific. Measurements of neurotropic factors suggest that an increase in complexity in the cortex may be a consequence of neuronal loss of the less connected neurons.

A U.S. military perspective on the promise of Situational Crime Prevention for combating terrorism

ABSTRACTThis study investigates the relationship between Situational Crime Prevention (hereafter, SCP) and terrorism by systematically examining the attitudes and perceptions of active military personnel regarding the techniques of SCP as a promising tool to combat terrorist attacks. Study participants (n = 155) represent all major branches of the U.S. military and have been deployed two or more times to international locations that have either (1) been classified as ‘high risk’ for terrorism or (2) experienced actual terrorist activity. From an academic perspective, the study’s findings address one of the major SCP ‘research needs’ outline by Clarke and Newman in their book Outsmarting the terrorists [(2006). Westport, CT: Praeger Security International]; that is, the need to gain knowledge about terrorism by conducting systematic interviews with terrorism experts (p. 233). Additionally, from an applied standpoint, results presented here are used to formulate research-based conclusions useful for determining which of the many SCP techniques show the most promise for reducing/blocking opportunities for terrorism – and why these tactics may be effective in active terrorist locations.

Deployment-Related Traumatic Events and Suicidal Behaviours in a Nationally Representative Sample of Canadian Armed Forces Personnel.

Worldwide, there has been substantial controversy with respect to whether military deployment is a risk factor for suicidal behaviour. The present study examined the relationship between lifetime exposure to deployment and deployment-related traumatic events (DRTEs) and past-year suicidal ideation (SI), suicidal plans (SP), and suicidal attempts (SA). Data were analysed from the 2013 Canadian Forces Mental Health Survey (8161 respondents; response rate, 79.8%; aged 18-60 years). A total of 12 individual items assessed exposure to DRTEs (e.g., combat, witnessing human atrocities, feeling responsible for the death of Canadian or ally personnel, knowing someone who was injured or killed). We examined each individual DRTE type as well as the number of types of DRTEs in relation to suicidal behaviour. Lifetime deployment was not significantly associated with suicidal behaviour. In models adjusted for sociodemographic variables, most of the individual DRTE items and the DRTE count variable were significantly associated with suicidal behaviours (adjusted odds ratio ranged between 1.10 and 5.32). When further adjusting for child abuse exposure, these associations were minimally attenuated, and some became nonsignificant. In models adjusting for mental disorders and child abuse, most DRTEs and number of types of DRTEs became nonsignificant in relation to SI, SP, and SA. Active military personnel exposed to increasing number of DRTEs are at increased risk for SI, SP, and SA. However, most of the association between DRTEs and suicidal behaviour is accounted for by child abuse exposure and mental disorders.

Superior Labral Anterior-Posterior (SLAP) Tears in the Military.

Context:Given the notable physical demands placed on active members of the military, comprehension of recent trends in management and outcomes of superior labral anterior-posterior (SLAP) tears in this patient population is critical for successful treatment.Evidence Acquisition:Electronic databases, including PubMed, MEDLINE, and Embase, were reviewed for the years 1985 through 2016.Study Design:Database review.Level of Evidence:Level 5.Results:Active members of the military are at increased risk of sustaining shoulder injuries, particularly SLAP tears. Recent trends in management of SLAP lesions have shifted toward operative intervention. In the correct patient population, repairs of superior labrum tears demonstrate improved function and pain. Surgical repair of SLAP tears, especially in young and active military personnel, is supported.Conclusion:Military personnel are at greater risk of suffering a SLAP tear in comparison with their civilian counterparts. Surgical repair of these lesions is advocated in this subpopulation when the patient is younger than approximately 36 years of age, and if older, biceps tenodesis is likely superior.

A Virtual Reality avatar interaction (VRai) platform to assess residual executive dysfunction in active military personnel with previous mild traumatic brain injury: proof of concept

Purpose: This proof of concept study tested the ability of a dual task walking protocol using a recently developed avatar-based virtual reality (VR) platform to detect differences between military personnel post mild traumatic brain injury (mTBI) and healthy controls.Methods: The VR platform coordinated motion capture, an interaction and rendering system, and a projection system to present first (participant-controlled) and third person avatars within the context of a specific military patrol scene. A divided attention task was also added. A healthy control group was compared to a group with previous mTBI (both groups comprised of six military personnel) and a repeated measures ANOVA tested for differences between conditions and groups based on recognition errors, walking speed and fluidity and obstacle clearance.Results: The VR platform was well tolerated by both groups. Walking fluidity was degraded for the control group within the more complex navigational dual tasking involving avatars, and appeared greatest in the dual tasking with the interacting avatar. This navigational behaviour was not seen in the mTBI group.Conclusions: The present findings show proof of concept for using avatars, particularly more interactive avatars, to expose differences in executive functioning when applying context-specific protocols (here for the military).Implications for rehabilitationVirtual reality provides a means to control context-specific factors for assessment and intervention.Adding human interaction and agency through avatars increases the ecologic nature of the virtual environment.Avatars in the present application of the Virtual Reality avatar interaction platform appear to provide a better ability to reveal differences between trained, military personal with and without mTBI.

Rationale and study design of a trial of mindfulness-based cognitive therapy for preventing suicidal behavior (MBCT-S) in military veterans

BackgroundAlthough suicide ranks 10th as a cause of death in the United States, and 1st among active military personnel, there are surprisingly few evidence-based therapies addressing suicidality, and development of new treatments is limited. This paper describes a clinical trial testing a novel therapy for reducing suicide risk in military veterans. The intervention, Mindfulness-Based Cognitive Therapy for Preventing Suicide Behavior (MBCT-S), is a 10-week group intervention adapted from an existing treatment for depression (Mindfulness-Based Cognitive Therapy – MBCT). MBCT-S incorporates the Safety Planning Intervention, which is currently implemented throughout the Veterans Health Administration (VHA) for veterans at high suicide risk. MethodsMBCT-S is being tested in a VHA setting using an intention-to-treat, two-group randomized trial design in which 164 high suicide risk veterans are randomized to either VHA Treatment As Usual (TAU; n=82) or TAU+MBCT-S (n=82). Our primary outcome measure, suicide-related event, defined to include suicide preparatory behaviors, self-harm behavior with suicidal or indeterminate intent, suicide-related hospitalizations and Emergency Department (ED) visits, will be measured through five assessments administered by blinded assessors between baseline and 12months post-baseline. We will measure suicide attempts and suicide deaths as a secondary outcome, because of their anticipated low incidence during the study period. Secondary outcomes also include severity of suicidal ideation, hopelessness and depression. SignificanceThis study has the potential to significantly enhance the quality and efficiency of VHA care for veterans at suicide risk and to substantially improve the quality of life for veterans and their families.

Outcomes and complications of triceps tendon repair following acute rupture in American military personnel

IntroductionTriceps tendon ruptures are uncommon injuries primarily occurring in young, active males or elderly individuals with various systemic diseases. Relatively little is known about the epidemiology of this injury, or the results of surgical management in high-demand populations. The purpose of this study was to define the incidence and outcomes of surgical treatment in active duty American military personnel. Patients and methodsThe Military Data Repository (MDR) was queried for all active duty military personnel undergoing surgical repair or reconstruction of a triceps tendon rupture between January 2012 and December 2014. The electronic health records of all patients with at least 12 months clinical follow-up were searched for demographic information, injury details, preoperative imaging findings, post-operative complications, and ability to return to duty following surgical repair. Incidence was calculated based on total active duty population in the MDR over the study period. Risk factors for postoperative complication and inability to return to duty following surgical repair were assessed using univariate analyses. ResultsA total of 54 acute triceps tendon ruptures were identified in the search, of which 48 had at least 12 months follow-up and complete post-operative records. The incidence of acute triceps tendon rupture was 1.1 per 100,000 person-years. Twelve patients experienced post-operative complications, six of which were traumatic re-ruptures within four months of the index surgery. No patient had a post-operative infection or atraumatic repair failure. 94% of patients were able to return to active military service following surgical repair. Enlisted rank was a significant risk factor for a post-operative complication, but no factor predicted inability to return to active duty service. ConclusionsSurgical repair of acute triceps tendon ruptures reliably restores strength and function even in high-demand individuals. In our population, traumatic rerupture was the most common complication.

Return to Active Duty After Autologous Chondrocyte Implantation for Knee Cartilage Defects in US Marines

Return to Active Duty After Autologous Chondrocyte Implantation for Knee Cartilage Defects in US Marines

Incidence of Norovirus-Associated Medical Encounters among Active Duty United States Military Personnel and Their Dependents.

BackgroundNorovirus is a leading cause of gastroenteritis episodes and outbreaks in US military deployments, but estimates of endemic disease burden among military personnel in garrison are lacking.MethodsDiagnostic codes from gastroenteritis-associated medical encounters of active duty military personnel and their beneficiaries from July 1998–June 2011 were obtained from the Armed Forces Health Surveillance Center. Using time-series regression models, cause-unspecified encounters were modeled as a function of encounters for specific enteropathogens. Model residuals (representing unexplained encounters) were used to estimate norovirus-attributable medical encounters. Incidence rates were calculated using population data for both active duty and beneficiary populations.ResultsThe estimated annual mean rate of norovirus-associated medically-attended visits among active duty personnel and their beneficiaries was 292 (95% CI: 258 to 326) and 93 (95% CI: 80 to 105) encounters per 10,000 persons, respectively. Rates were highest among beneficiaries <5 years of age with a median annual rate of 435 (range: 318 to 646) encounters per 10,000 children. Norovirus was estimated to cause 31% and 27% of all-cause gastroenteritis encounters in the active duty and beneficiary populations, respectively, with over 60% occurring between November and April. There was no evidence of any lag effect where norovirus disease occurred in one population before the other, or in one beneficiary age group before the others.ConclusionsNorovirus is a major cause of medically-attended gastroenteritis among non-deployed US military active duty members as well as in their beneficiaries.

Prevalence of Knee Osteoarthritis in 100 Athletically Active Veteran Soccer Players Compared With a Matched Group of 100 Military Personnel

Background: Although knee injuries in professional soccer (football) have been extensively studied, the prevalence of knee osteoarthritis (OA) in veteran players is not well documented. Purpose: To investigate the prevalence of knee OA in retired professional soccer players in comparison with a group of athletically active military personnel. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A group of 100 veteran Greek soccer players aged 35 to 55 years (mean [±SD] age, 46.90 ± 5.9 years) were examined for knee OA and were administered the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. A matched group of 100 athletically active military personnel served as a comparison group. Results: The sonographic prevalence of OA was significantly higher in the veteran soccer group (52%) than in the military group (33%) (n = 200; P = .010). This difference remained significant even after excluding participants with a history of knee surgery (44.1% vs 25.3%, respectively) (n = 151; P = .010). Femoral cartilage thickness was similar between the 2 groups (P = .473), while altered knee alignment had no effect on the prevalence of OA (P = .740). With the exception of perceived pain being more prevalent in the military group, there were no other statistically significant differences between the 2 groups in KOOS values. Conclusion: Veteran soccer players had a higher sonographic prevalence of knee OA but better pain scores than a matched group of athletically active military personnel.

Increased Risk of Functional Gastrointestinal Sequelae After Clostridium difficile Infection Among Active Duty United States Military Personnel (1998–2010)

Some acute enteric infections are associated with the development of functional gastrointestinal disorders, most commonly irritable bowel syndrome but also other functional and organic gastrointestinal sequelae. Clostridium difficile infection has increased in incidence and severity, however, few studies have evaluated functional disorders after this infection. We evaluated the epidemiology and sequelae of C difficile in the US military population by using the US Department of Defense's Armed Forces Health Surveillance Center Defense Medical Ecounter Database. We then performed a retrospective cohort study of 891 active-duty US military personnel who developed C difficile from 1998to 2010 and 3231 matched subjects who had not been exposed to C difficile. Subjects were identified based on International Classification of Diseases, 9th revision, Clinical Modification codes for C difficile disease. C difficile was associated independently with increased rate ratios (RRs) for incident irritable bowel syndrome (RR, 6.1; 95% confidence interval [CI], 2.9-12.9), gastroesophageal reflux disease (GERD) (RR, 1.9; 95% CI, 1.4-2.6), dyspepsia (RR, 3.3; 95%, 1.4-7.7), and constipation (RR, 2.2; 95% CI, 1.3-3.7). Approximately 14.1%of subjects with C difficile later were identified with one of these functional gastrointestinal disorders (FGDs), compared with 6% of controls. Community- and health care-associated Cdifficile were associated at similar rates with these sequelae. Patients were at increased risk for FGDs within 3 months of a Cdifficile episode, with one additional case of FGD developing for every 12 diagnoses of C difficile. The incidence of community- and health care-associated C difficile has increased in the US military population from 1998 through 2010. As for other gastrointestinal infections, C difficile disease is associated with clinically relevant functional sequelae in this military population.

Vitamin D Correlation with Testosterone Concentration in US Army Special Operations Personnel

Vitamin D has been positively correlated with testosterone in older men, but these hormonal relationships have not been examined in younger, active military personnel. Therefore, the purpose of this study was to identify significant correlations between vitamin D and testosterone concentrations in male Special Operations Soldiers. This retrospective analysis examined unique cases of serum vitamin D assessments ordered at Womack Army Medical Center, Fort Bragg, NC, from January 2012 – September 2013. Inclusion criteria were male Special Operations soldiers who had a total testosterone assessment within 21 days of vitamin D assessment, yielding 312 service member records. Mean serum vitamin D concentrations were 29.9±9.6 ng/ml (range 10‐63), with 52% of subjects in the deficient range of &lt;30 ng/ml according to the Army Medical Department guidelines. In vitamin D deficient subjects, serum vitamin D concentrations were a significant positive predictor of total testosterone when controlling for age and body mass index. Independent Variable Testosterone in Vitamin D Deficient Men (n=135) β Ρ Vitamin D 8.429 0.008 Age ‐2.604 0.183 Body Mass Index ‐1.569 0.678 Model R2 0.062 These data indicate that deficient vitamin D concentrations may inhibit testosterone production and potentially limit human performance. Operational stress of military training has been shown to suppress testosterone concentrations in healthy men, causing muscle catabolism and fatigue, symptoms also characteristic of vitamin D deficiency. Given that more than half of male soldiers had insufficient vitamin D status in a southern latitude, measuring vitamin D concentrations in collaboration with testosterone assessments may be warranted.No funding was used to support this work.

The Transgender Military Experience

Although there have been studies that focus on the experiences of the gay and lesbian population serving in the United States military, few have focused on the experience of active duty transgender service members. Transgender individuals transgress the binary conception of gender by deviating from societal gender norms associated with assigned sex at birth. The Department of Defense has set policies and standards that reflect a binary conception of gender, with a focus on conformity. We argue that able-bodied gender variant service personnel are just as capable of serving their country as anyone else. Because of the repercussions associated with active duty transgender military personnel, our sample is small and involves nine clandestine service members and two international service members who wanted to share their stories from a different perspective. Snowball sampling was aimed at finding current active duty and reserve transgender service members. Using a combination of telephone interviews and questionnaires, data were collected from active duty transgender service personnel throughout the United States and two from international militaries that allow transgender people to serve. Data collection focused on the overall experiences of the participants along with questions regarding workplace discrimination, suggestions for policy changes, and their views about the overturn of Don’t Ask, Don’t Tell. Our findings add to a growing source of information about the transgender military experience in the U.S. armed forces and the importance of overturning discriminatory workplace policies that negatively impact transgender service members.

The Effectiveness of Evidence-Based Treatments in Treatment of Active Military Personnel and Their Families

Between 338,000 and 520,000 active duty military personnel are estimated to have posttraumatic stress disorder (PTSD). Multiple randomized controlled trial (RCT) studies exist regarding the efficacy of PTSD evidence-based treatments (EBTs); however, it was recommended in the literature that future research on PTSD psychotherapies be conducted on genuine therapies with committed therapists, ideally treatments as practiced in the community, working with samples of patients resembling those seen in the community. We analyzed archival clinical outcome data from U.S. military clientele, being seen in military community counseling centers, who received a PTSD-EBT, eye movement desensitization and reprocessing (EMDR). Out of 99 archival cases, 65 were active duty military personnel. PTSD was identified as the primary diagnosis for 65 of the clients; of these 65 cases, 42 involved combat, whereas 23 were noncombat related. Across all outcome measures used, the results after EMDR treatment indicated significant improvement. These findings demonstrated the effectiveness of using PTSD-EBT in treating active military populations in general and EMDR in particular. Future implications for conducting effectiveness research are examined.

Population estimates of undocumented incident traumatic brain injuries among combat-deployed US military personnel.

To estimate the number of undocumented incident traumatic brain injuries (TBIs) among active component US military personnel serving in Iraq and Afghanistan prior to policy changes implemented in late 2006 and 2010 that improved TBI documentation. Negative binomial regression was used to model monthly incident TBI counts between December 2010 and June 2012 (N = 19) and then estimate expected monthly counts of incident TBIs during 2 periods: January 2003-October 2006 and November 2006-November 2010. Monthly amputation counts from Department of Defense surveillance data were used as a proxy for changing injury rates. Monthly active component deployment estimates derived from the Congressional Research Service, Brookings Institution, and Defense Manpower Data Center were used to estimate the size of the at-risk population each month. The difference between expected monthly incident TBI counts and reported counts is presented as the estimated number of undocumented incident TBIs. The full model estimates that 21 257 active component military personnel experienced undocumented incident TBIs while deployed in Iraq or Afghanistan between January 2003 and October 2006, more than 4 times the 5272 incident TBIs documented during that period. A sizeable majority of Iraq and Afghanistan combat veterans who experienced incident TBI while deployed prior to November 2006 are likely to have had their injuries undocumented, creating challenges for clinical care, disability evaluation, and future research.

PRM150 - Predicting Suicidal Behavior In Veterans And Active Military Personnel: Possibilities For Electronic Deployment To Discover A Predictive Assessment

PRM150 - Predicting Suicidal Behavior In Veterans And Active Military Personnel: Possibilities For Electronic Deployment To Discover A Predictive Assessment

Suicides in the Military: The Post-Modern Combat Veteran and the Hemingway Effect

Suicides in the military have increased over the last ten years. Much effort has been focused on suicide prevention and treatment, as well as understanding the reasons for the sharp increase in military suicides. Despite this effort, the definitive causes of military suicides remain elusive. Further, highly effective suicide prevention and treatment approaches have not yet been developed. The purpose of this article is to present a short review of the current state of suicide prevention interventions within the context of the military. The root causes of suicidal behavior and the role of combat in the military are each discussed. Interpersonal-psychological theory of suicide and the military transition theory are introduced as guiding frameworks for understanding suicides and suicidal behavior amongst active military personnel and military veterans. The article concludes with a set of recommendations for moving forward in understanding and addressing suicides in the military.

Barriers to Psychiatric Care among Military and Veteran Populations in the US: The Effect of Stigma and Prejudice on Psychological and Pharmacological Treatment

This paper addresses the importance of understanding veterans' individual beliefs and the effects of stigma on pharmacological and psychological treatment among active military personnel and veterans. The discussion can assist treating clinicians in reducing barriers to treatment and increasing compliance with effective psychological and pharmacological interventions for this population. The author has conducted more than 3000 interviews with veterans from World War II (WWII), the Korean War, the Vietnam War, Gulf War, and the wars in Iraq and Afghanistan who applied for service connected Veterans Administration compensation due to mental health conditions. A summary of the responses from veterans regarding their reaction to psychiatric treatment is given and compared to the findings of other provided preliminary studies regarding the effect of individual beliefs and stigma on treatment compliance.