Nondeployed Military Personnel Research Articles

Repetitive sulfur dioxide exposure in mice models post-deployment respiratory syndrome.

Soldiers deployed to Iraq and Afghanistan have a higher prevalence of respiratory symptoms than nondeployed military personnel and some have been shown to have a constellation of findings on lung biopsy termed post-deployment respiratory syndrome (PDRS). Since many of the subjects in this cohort reported exposure to sulfur dioxide (SO2), we developed a model of repetitive exposure to SO2 in mice that phenocopies many aspects of PDRS, including adaptive immune activation, airway wall remodeling, and pulmonary vascular (PV) disease. Although abnormalities in small airways were not sufficient to alter lung mechanics, PV remodeling resulted in the development of pulmonary hypertension and reduced exercise tolerance in SO2-exposed mice. SO2 exposure led to increased formation of isolevuglandins (isoLGs) adducts and superoxide dismutase 2 (SOD2) acetylation in endothelial cells, which were attenuated by treatment with the isoLG scavenger 2-hydroxybenzylamine acetate (2-HOBA). In addition, 2-HOBA treatment or Siruin-3 overexpression in a transgenic mouse model prevented vascular remodeling following SO2 exposure. In summary, our results indicate that repetitive SO2 exposure recapitulates many aspects of PDRS and that oxidative stress appears to mediate PV remodeling in this model. Together, these findings provide new insights regarding the critical mechanisms underlying PDRS.NEW & NOTEWORTHY We developed a mice model of "post-deployment respiratory syndrome" (PDRS), a condition in Veterans with unexplained exertional dyspnea. Our model successfully recapitulates many of the pathological and physiological features of the syndrome, revealing involvement of the ROS-isoLGs-Sirt3-SOD2 pathway in pulmonary vasculature pathology. Our study provides additional knowledge about effects and long-term consequences of sulfur dioxide exposure on the respiratory system, serving as a valuable tool for future PDRS research.

Behavioral health and treatment-seeking behaviors among deployed vs. non-deployed service members: How impactful is deployment on well-being?

ABSTRACT Increasing attention has been dedicated to studying behavioral health of non-deployed military personnel. This investigation explored the impacts of a variety of sociodemographic and health factors on key behavioral health outcomes among active duty personnel. A secondary analysis was conducted using 2014 Defense Health Agency Health Related Behaviors Survey data (unweighted n = 45,762, weighted n = 1,251,606). Three logistic regression models investigated factors associated with reporting symptomatology consistent with depression, anxiety, and stress. We found that after adjusting for sociodemographic and other health variables (e.g., sleep), deployment was associated with stress but not anxiety or depression. Although deployed personnel were more likely to report increased levels of stress overall, few differences with respect to the sources of stressors were identified. While behavioral health screening and treatment needs may differ for non-deployed and deployed personnel, programs to support mental and physical well-being among all service members should be robustly promoted.

Work Fatigue in a Non-Deployed Military Setting: Assessment, Prevalence, Predictors, and Outcomes.

Although work fatigue represents an important issue among military personnel in combat settings, little attention has been paid to work fatigue in the non-deployed setting. This issue was addressed by (a) validating the Three-Dimensional Work Fatigue Inventory (3D-WFI) among non-deployed military personnel, (b) assessing the prevalence of work fatigue in a non-deployed setting, and (c) exploring several potential predictors and outcomes of work fatigue in this setting. Data came from a large national probability sample (N = 1375) of non-deployed Royal Canadian Air Force military personnel. Results demonstrated that the 3D-WFI provided a psychometrically sound assessment of physical, mental, and emotional work fatigue among military personnel, which was invariant across sex, age, military component, and military role. All three types of work fatigue were highly prevalent among military personnel in a non-deployed setting. In terms of predictors, job demands were positively associated, and distributive justice, perceived organizational support, physical activity and sleep quality were negatively associated with each type of work fatigue, whereas role ambiguity was positively associated with mental and emotional work fatigue, and interpersonal justice was negatively associated with physical and emotional fatigue. Abusive supervision and sleep quantity were unrelated to work fatigue. In terms of outcomes, the three types of fatigue were positively associated with workplace cognitive failures and work-to-family conflict. In contrast, mental and emotional work fatigue were negatively related to military morale and positively associated with turnover intentions. This study demonstrates that work fatigue is a critical issue among military personnel in non-deployed settings, and an essential issue for military policy development.

Musculoskeletal Pain and Headache in the Active Duty Military Population: An Integrative Review.

Since 2001, the U.S. Armed Forces' training and deployment have greatly increased, escalating the risk of injury and pain-related issues both at home station and deployment environments. This integrative review examines the incidence, prevalence, and risk factors for musculoskeletal pain (MSP) and headaches in active duty (AD) military populations. Peer-reviewed research published between 2001 and 2016 was identified relevant to MSP and headache in AD military personnel using MeSH terms in key biomedical databases. Inclusion criteria were: epidemiological studies examining MSP or headache as primary or secondary outcome; samples that included AD populations; and studies conducted in the theater of operations, at home station, and in military treatment or Veterans Health Administration facilities. Twenty-six articles met inclusion criteria. Low back pain (LBP) was the most prevalent MSP diagnosis. The incidence of LBP was 40.5 per 1,000 person-years and was comparable to nonmilitary populations. Inflammation and pain from overuse comprised the largest proportion of injury mechanism, accounting for about 82% of all injuries among nondeployed military personnel. The risk of MSP was greater for AD, female, Army, enlisted personnel, and those with greater time in a motor vehicle. Evidence suggests posttraumatic headache, occurring in up to 92% of military personnel who have sustained a mild traumatic brain injury, is associated with chronic daily headaches. Nurses must recognize the consequences military service can have on the development of pain. Nurses have an opportunity to positively impact the health and well-being of military and veteran populations through early recognition and treatment of pain. The findings from this review underscore considerable magnitude of MSP in military personnel and expose modifiable risk factors and potential targets for designing nurse-led interventions to improve pain and symptoms in military subpopulations.

Assessing Psychological Fitness in the Military - Development of an Effective and Economic Screening Instrument.

There are a high number of soldiers with deployment-related and non-deployment-related mental health problems in the German Armed Forces (Bundeswehr): This has led to an increase in mental disorders and a decrease in quality of life. To tackle these problems and to strengthen resources among the Bundeswehr personnel, this study aims at developing a screening instrument for assessing the psychological fitness of soldiers on the basis of questionnaire scales. In this approach, psychological fitness describes a soldier's ability to integrate and enhance his/her mental and emotional capabilities using resources and trainable skills. Bundeswehr combat soldiers (N = 361) answered questionnaires about resilience (RS-11), sense of coherence (SOC-L9), quality of life (WHOQOL-BREF), mental disorders (PHQ-D) and post-traumatic growth (PTG). Additionally, they were interviewed by trained troop psychologists both before and after their deployment in Afghanistan from January to June 2014. The screening model is based on self-report data; the psychological fitness in the standardized interview serves as a validation standard. A linear logistic regression model was performed that includes the social relationship and the psychological scale from WHOQOL-BREF and the somatoform and the stress scale from PHQ. This model allows specialists a first assessment between participants who are psychologically fit before and after deployment and those who are less so. The chosen cutoff for sensitivity is between 70% and 79% and for specificity between 70% and 85%. This screening approach is still not applicable to large populations like that of the Bundeswehr, which currently has about 170,000 soldiers but it is limited to deployed combat troops. Classifying psychological fitness allows specialists to differentiate between people in need of special training or additional diagnostic measures and those in need of sustaining their fitness regularly at the earliest possible stage. A follow-up study that is representative of deployed and non-deployed military personnel will examine whether these results can be transferred to the entire Bundeswehr and whether the validity of the interview can be established.

Combat, Casualties, and Compensation: Evidence from Iraq and Afghanistan

Our research examines the effect of combat deployments to Iraq and Afghanistan on casualties. We use restricted data from the Defense Manpower Data Center (DMDC) and Social Security Administration (SSA) to construct a panel of all U.S. Active Duty service members having served at some point during the years 2001-2012. Casualties disproportionately occur at higher rates among (i) young, white, males (ii) enlisted personnel (iii) less educated personnel (iv) and those in combat job types. Our estimates indicate that overall U.S. military personnel who deployed in an individual year to Iraq or Afghanistan had a 48 per 100,000 higher probability of death than non-deployed military personnel who remained stateside. The increased fatal injury risk of deployed U.S. military personnel is 15 times higher than the national average civilian workplace fatality rate, but roughly equal to the fatal injury risk faced in some of the most dangerous civilian occupations. Our estimates suggest a compensating wage differential equal to $808 per month would be appropriate, in comparison to the current status quo of $225 per month in danger pay (and additional tax benefits) provided to U.S. military personnel deployed into combat zones. The additional compensation should also be adjusted by service or job type.

Combat, Casualties, and Compensation: Evidence from Iraq and Afghanistan

Our research examines the effect of combat deployments to Iraq and Afghanistan on casualties. We use restricted data from the Defense Manpower Data Center (DMDC) and Social Security Administration (SSA) to construct a panel of all U.S. Active Duty service members having served at some point during the years 2001-2012. Casualties disproportionately occur at higher rates among (i) young, white, males (ii) enlisted personnel (iii) less educated personnel (iv) and those in combat job types. Our estimates indicate that overall U.S. military personnel who deployed in an individual year to Iraq or Afghanistan had a 48 per 100,000 higher probability of death than non-deployed military personnel who remained stateside. The increased fatal injury risk of deployed U.S. military personnel is 15 times higher than the national average civilian workplace fatality rate, but roughly equal to the fatal injury risk faced in some of the most dangerous civilian occupations. Our estimates suggest a compensating wage differential equal to $808 per month would be appropriate, in comparison to the current status quo of $225 per month in danger pay (and additional tax benefits) provided to U.S. military personnel deployed into combat zones. The additional compensation should also be adjusted by service or job type.

Deployment of personnel to military operations: impact on mental health and social functioning.

Deployment of personnel to military operations: impact on mental health and social functioning.

Depression in Gulf War veterans: a systematic review and meta-analysis.

Although post-traumatic stress disorder (PTSD) has been a focus of attention in 1990/1991 Gulf War veterans, the excess risk of depression has not been clearly identified. We investigated this through a systematic review and meta-analysis of studies comparing depression in Gulf War veterans to depression in a comparison group of non-deployed military personnel. Multiple electronic databases and grey literature were searched from 1990 to 2012. Studies were assessed for eligibility and risk of bias according to established criteria. Of 14 098 titles and abstracts assessed, 14 studies met the inclusion criteria. Gulf War veterans had over twice the odds of experiencing depression [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.88-2.76] and dysthymia or chronic dysphoria (OR 2.39, 95% CI 2.0-2.86) compared to non-deployed military personnel. This finding was robust in sensitivity analyses, and to differences in overall risk of bias and psychological measures used. Despite divergent methodologies between studies, depression and dysthymia were twice as common in Gulf War veterans and are important medical conditions for clinicians and policymakers to be aware of in managing Gulf War veterans' health.

Do soldiers seek more mental health care after deployment? Analysis of mental health consultations in the Netherlands Armed Forces following deployment to Afghanistan

BackgroundMilitary deployment to combat zones puts military personnel to a number of physical and mental challenges that may adversely affect mental health. Until now, few studies have been performed in Europe on mental health utilization after military deployment.ObjectiveWe compared the incidence of mental health consultations with the Military Mental Health Service (MMHS) of military deployed to Afghanistan to that of non-deployed military personnel.MethodWe assessed utilization of the MMHS by the full cohort of the Netherlands Armed Forces enlisted between 2008 and 2010 through linkage of mental health and human resource information systems.ResultsThe total population consisted of 50,508 military (18,233 deployed, 32,275 non-deployed), who accounted for 1,906 new consultations with the MMHS. The follow-up was limited to the first 2 years following deployment. We observed higher mental health care utilization in deployed vs. non-deployed military personnel; hazard ratio (HR), adjusted for sex, military branch and time in service, 1.84 [95% CI 1.61–2.11] in the first and 1.28 [1.09–1.49] in the second year after deployment. An increased risk of adjustment disorders (HR 2.59 [2.02–3.32] and 1.74 [1.30–2.32]) and of anxiety disorders (2.22 [1.52–3.25] and 2.28 [1.50–3.45]) including posttraumatic stress disorder (5.15 [2.55–10.40] and 5.28 [2.42–11.50]), but not of mood disorders (1.33 [0.90–1.97] and 1.11 [0.68–1.82]), was observed in deployed personnel in the first- and second-year post-deployment, respectively. Military personnel deployed in a unit with a higher risk of confrontation with potentially traumatic events had a higher HR (2.13 [1.84–2.47] and 1.40 [1.18–1.67]).ConclusionsThough absolute risk was low, in the first and second year following deployment to Afghanistan there was an 80 and 30% higher risk for mental health problems resulting in a consultation with the Dutch MMHS compared to military never deployed to Afghanistan. These observations underscore the need for an adequate mental health infrastructure for those returning from deployment.

Treatment of Sleep Disturbances in Military Personnel: The Potential to Improve Other Service-Related Illnesses

Treatment of Sleep Disturbances in Military Personnel: The Potential to Improve Other Service-Related Illnesses Recent studies demonstrate the integral nature of disturbed sleep in the symptoms and disorders of military personnel [1,2]. Sleep disturbances are not only an associated symptom of the servicerelated disorders of traumatic brain injury (TBI), depression and post-traumatic stress disorder (PTSD) but an inherent part of the military life-style [3]. Short, irregular sleep occurs in non-deployed military personnel and even more so in deployed military personnel [4,5]. For the most part, “sleep disturbances” are considered a result of deployment or service-related disorders, such as depression, pain, PTSD and TBI. Only recently are the sleep disorders of military personnel recognized as distinct diagnoses [6,7].

Physical, Psychological, and Functional Comorbidities of Multisymptom Illness in Australian Male Veterans of the 1991 Gulf War

Multisymptom illness is more prevalent in 1991 Gulf War veterans than in military comparison groups; less is known about comorbidities. The authors compared physical, psychological, and functional comorbidities in Australian male Gulf War I veterans with those in actively (non-Gulf) deployed and nondeployed military personnel by using a questionnaire and medical assessment in 2000-2002. Multisymptom illness was more common in male Gulf War veterans than in the comparison group (odds ratio (OR) = 1.80, 95% confidence interval (CI): 1.48, 2.19). Stratifying by deployment status in the comparison group made little difference in this association. Gulf War veterans with multisymptom illness had increased psychiatric disorders, including major depression (OR = 6.31, 95% CI: 4.19, 9.52) and posttraumatic stress disorder (OR = 9.77, 95% CI: 5.39, 18.59); increased unexplained chronic fatigue (OR = 13.32, 95% CI: 7.70, 23.05); and more reported functional impairment and poorer quality of life, but objective physical and laboratory outcomes were similar to those for veterans without multisymptom illness. Similar patterns were found in the comparison groups; differences across the 3 groups were statistically significant for only hospitalization, obstructive liver disease, and Epstein-Barr virus exposure. Multisymptom illness is more prevalent in Gulf War I veterans, but the pattern of comorbidities is similar for actively deployed and nondeployed military personnel.

Incarceration and Veterans of the First Gulf War

This study investigated the prevalence of incarceration and the association with deployment among veterans of the first Persian Gulf War (GW). A structured telephone interview of military personnel from Iowa deployed to the Persian Gulf and a comparison sample of nondeployed military personnel was conducted. The interview consisted of validated questions, validated instruments, and investigator-derived questions to assess relevant medical and psychiatric conditions. A total of 4,886 subjects were randomly drawn from one of four study domains, i.e., GW regular military, GW National Guard/Reserve, non-GW regular military, or non-GW National Guard/Reserve. Symptoms of medical conditions, psychiatric disorders, and health care utilization were the main outcome measures. Nearly one-quarter (845 of 3,695 subjects, 22.9%) had been incarcerated at some point before the interview ("ever incarcerated"). Ever incarcerated veterans had a higher frequency of psychiatric and medical comorbidity and higher rates of health care utilization. Ever incarcerated status was associated with male gender, enlisted rank, lower educational levels, low levels of military preparedness, discharge from service, cigarette smoking, antisocial traits, court martial and/or other military discipline, having seen a mental health professional, and having used illegal drugs. GW veterans who participated in combat had a modestly higher risk for incarceration after the GW than did noncombatants (odds ratio, 1.6; 95% confidence interval, 1.0-2.5). Military recruits with a history of incarceration more often displayed problematic behaviors, more often developed psychiatric/medical conditions, and had high rates of health care utilization. A history of incarceration may be a behavioral marker for substance abuse, antisocial behavior, and mental illness. Importantly, GW deployment carried no increased risk of subsequent incarceration overall.

Estimating the Occurrence of Amyotrophic Lateral Sclerosis among Gulf War (1990–1991) Veterans Using Capture-Recapture Methods

Objective: Using data from a recent report that indicated a 2-fold higher risk of amyotrophic lateral sclerosis (ALS) among veterans of the 1991 Gulf War, we applied capture-recapture methodology to estimate possible under-ascertainment of ALS cases among deployed and non-deployed military personnel who were on active duty during that war. Study Design and Setting: One of the most serious concerns facing field epidemiological investigations is that of case ascertainment bias, particularly when it is differential among the study groups. Capture-recapture methods, however, have promise as an approach to assessing the impact of case ascertainment bias in such studies. To overcome potential limitations of any one approach, three different estimation methods were used: log-linear models, sample coverage, and ecological models, to obtain a comprehensive view of under-ascertainment bias in these populations. Results: All three approaches indicated differential undercount of ALS cases with modest under-ascertainment likely to have occurred among non-deployed military personnel, but little under-ascertainment among the deployed. After correcting the rates for under-ascertainment, the age-adjusted risk of ALS remained elevated among military personnel who had been deployed to S.W. Asia during the 1991 Gulf War, confirming the earlier report. Conclusions: Capture-recapture methods are a useful approach to assessing the magnitude of case ascertainment bias in epidemiological studies from which ascertainment-adjusted estimates of rates and relative risks can be calculated.

Gulf War Veterans With Anxiety

Veterans of the first Gulf War have higher rates of medical and psychiatric symptoms than nondeployed military personnel. To assess the prevalence of and risk factors for current anxiety disorders in Gulf War veterans, we administered a structured telephone interview to a population-based sample of 4886 military personnel from Iowa at enlistment. Participants were randomly drawn from Gulf War regular military, Gulf War National Guard/ Reserve, non-Gulf War regular military, and non-Gulf War National Guard/Reserve. Medical and psychiatric conditions were assessed through standardized interviews and questionnaires in 3695 subjects (76% participation). Risk factors were assessed using multivariate logistic regression models. Veterans of the first Gulf War reported a markedly higher prevalence of current anxiety disorders than nondeployed military personnel (5.9% vs. 2.8%; odds ratio = 2.1; 95% confidence interval = 1.3-3.1), and their anxiety disorders are associated with co-occurring psychiatric disorders. Posttraumatic stress disorder, panic disorder, and generalized anxiety disorder were each present at rates nearly twice expected. In our multivariate model, predeployment psychiatric treatment and predeployment diagnoses (posttraumatic stress disorder, depression, or anxiety) were independently associated with current anxiety disorder. Participation in Gulf War combat was independently associated with current posttraumatic stress disorder, panic disorder, and generalized anxiety disorder. Current anxiety disorders are relatively frequent in a military population and are more common among Gulf War veterans than nondeployed military personnel. Predeployment psychiatric difficulties are robustly associated with the development of anxiety. Healthcare providers and policymakers need to consider panic disorder and generalized anxiety disorder, in addition to posttraumatic stress disorder, to ensure their proper assessment, treatment, and prevention in veteran populations.

Gulf war illness—better, worse, or just the same? A cohort study

Objectives Firstly, to describe changes in the health of Gulf war veterans studied in a previous occupational cohort study and to compare outcome with comparable non-deployed military personnel. Secondly, to...

The Health Effects of Peacekeeping (Bosnia, 1992–1996): A Cross-Sectional Study—Comparison with Nondeployed Military Personnel

Our goal was to test the hypothesis that United Kingdom soldiers who were deployed to Bosnia had worse health than a nondeployed control group. We used data from a cross-sectional study designed to examine the health effects of service in the Persian Gulf War, which collected data in 1997 to 1998. We compared the two control groups--(personnel who were deployed to Bosnia and a nondeployed control group of military personnel (Era))--on a number of health-related outcomes, including physical functioning, symptoms and ailments, psychological health, fatigue, and post-traumatic stress reactions. The response rate for the Bosnia cohort was 62.9% and for the Era group 61.9%. A proportion of the Bosnia group had served in the Persian Gulf War and was found to have considerably worse health outcomes than the remaining Bosnia group or the Era group. The Bosnia group who had not served in the Persian Gulf War had broadly similar health outcomes to the Era group. The main differences were that the Bosnia-only group consumed more alcohol and reported more fatigue, hay fever, weight gain, irritability, avoidance, and night sweats. Apart from heavy alcohol consumption, the magnitude of these differences was small. The Bosnia-only group had slightly better physical functioning than the Era group, and there were two other symptoms and one ailment which were less common in the Bosnia-only group than in the Era group. This study indicates that the health of United Kingdom military personnel who served in Bosnia from 1992 to 1996 was generally good in 1997 to 1998. However, further surveillance of veterans of the Balkan's War is required in the light of recent concerns.