US Army Soldiers 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.

Timing and Predictors of Mild and Severe Heat Illness among New Military Enlistees.

Heat illnesses are important and potentially fatal conditions among physically active individuals. We determined predictors of heat illness among enlistees in a large military population experiencing common physical activity patterns. We estimated the adjusted odds of mild (MHI) and severe (SHI) heat illness associated with demographic, health-related, and geographic factors among active-duty, US Army soldiers enlisting between January 2011 and December 2014 (N = 238,168) using discrete-time multivariable logistic regression analyses. We observed 2612 incident cases of MHI and 732 incident cases of SHI during 427,922 person-years of follow-up, with a mean and median of 21.6 and 21 months per subject. During the first 6 duty months, 71.3% of the MHIs and 60.2% of the SHIs occurred, peaking at month 2. The odds of MHI quadrupled among those with prior SHI (odds ratio [OR], 4.02; 95% confidence interval [CI], 2.67-6.03). Body mass index (BMI) extremes increased the odds substantially (OR at BMI ≥30 kg·m: for MHI, 1.41 (CI, 1.19-1.67); for SHI, 1.94 (CI, 1.47-2.56); OR at BMI <18.5 kg·m: for MHI, 1.50 (CI, 1.01-2.21); for SHI, 2.26 (CI, 1.16-4.39)). Tobacco use was associated with a 55% increase (CI, 1.37-1.77) in MHI odds. The odds of MHI increased if taking nonsteroidal anti-inflammatory drugs, opioids, or methylphenidate stimulants. Lower age and lower entry aptitude scores were associated with progressively increased MHI odds. Most heat illnesses occurred at the outset of service, indicating the need for focused prevention methods at the initiation of military duty. Prior heat illness, BMI extremes, medications, and tobacco use represent potentially actionable risk factors to address by education, policy, and/or clinician intervention.

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.

Adjusting Suicide Rates in a Military Population: Methods to Determine the Appropriate Standard Population.

The choice of the standard population is important when calculating adjusted rates for a military population: results can influence policies and funding allocations for programs and initiatives for suicide prevention. We describe the methodological considerations and decision-making process used in choosing a standard population for adjusting rates to compare suicide among US Army soldiers and the general US population. We examined 5 different standard populations, using the direct method to adjust annual suicide rates for the Army and the US population, 2004 to 2015, for age and for age and sex. The pattern of the Army and US population age- and sex-adjusted rates remained consistent with crude rates when adjusted to any of the Army standard population distributions. Using an Army distribution as the standard population produces suicide rates consistent with routine messaging about suicide trends among Army soldiers.

Associations of Time-Related Deployment Variables With Risk of Suicide Attempt Among Soldiers

There has been limited systematic examination of whether risk of suicide attempt (SA) among US Army soldiers is associated with time-related deployment variables, such as time in service before first deployment, duration of first deployment, and dwell time (DT) (ie, length of time between deployments). To examine the associations of time-related deployment variables with subsequent SA among soldiers who had deployed twice. Using administrative data from January 1, 2004, through December 31, 2009, this longitudinal, retrospective cohort study identified person-month records of active-duty Regular Army enlisted soldiers who had served continuously in the US Army for at least 2 years and deployed exactly twice. The dates of analysis were March 1 to December 1, 2017. There were 593 soldiers with a medically documented SA during or after their second deployment. An equal-probability sample of control person-months was selected from other soldiers with exactly 2 deployments (n = 19 034). Logistic regression analyses examined the associations of time in service before first deployment, duration of first deployment, and DT with subsequent SA. Suicide attempts during or after second deployment were identified using US Department of Defense Suicide Event Report records and International Classification of Diseases, Ninth Revision, Clinical Modification E950 to E958 diagnostic codes. Independent variables were constructed from US Army personnel records. Among 593 SA cases, most were male (513 [86.5%]), white non-Hispanic (392 [66.1%]), at least high school educated (477 [80.4%]), currently married (398 [67.1%]), and younger than 21 years when they entered the US Army (384 [64.8%]). In multivariable models adjusting for sociodemographics, service-related characteristics, and previous mental health diagnosis, odds of SA during or after second deployment were higher among soldiers whose first deployment occurred within the first 12 months of service vs after 12 months (odds ratio, 2.0; 95% CI, 1.6-2.4) and among those with a DT of 6 months or less vs longer than 6 months (odds ratio, 1.6; 95% CI, 1.2-2.0). Duration of first deployment was not associated with subsequent SA. Analysis of 2-way interactions indicated that the associations of early deployment and DT with SA risk were not modified by other characteristics. Multivariable population-attributable risk proportions were 14.2% for deployment within the first 12 months of service and 4.0% for DT of 6 months or less. Time in service before first deployment and DT are modifiable risk factors for SA risk among soldiers.

Gender differences in the associations of body mass index, physical fitness and tobacco use with lower extremity musculoskeletal injuries among new US Army soldiers

BackgroundMusculoskeletal (MSK) injuries are a leading cause of morbidity among US Army soldiers, especially among women and the newly enlisted. While extremes of body mass index (BMI), low physical fitness...

Deployment and Preterm Birth Among US Army Soldiers.

With increasing integration of women into combat roles in the US military, it is critical to determine whether deployment, which entails unique stressors and exposures, is associated with adverse reproductive outcomes. Few studies have examined whether deployment increases the risk of preterm birth; no studies (to our knowledge) have examined a recent cohort of servicewomen. We therefore used linked medical and administrative data from the Stanford Military Data Repository for all US Army soldiers with deliveries between 2011 and 2014 to estimate the associations of prior deployment, recency of deployment, and posttraumatic stress disorder with spontaneous preterm birth (SPB), adjusting for sociodemographic, military-service, and health-related factors. Of 12,877 deliveries, 6.1% were SPBs. The prevalence was doubled (11.7%) among soldiers who delivered within 6 months of their return from deployment. Multivariable discrete-time logistic regression models indicated that delivering within 6 months of return from deployment was strongly associated with SPB (adjusted odds ratio = 2.1, 95% confidence interval: 1.5, 2.9). Neither multiple past deployments nor posttraumatic stress disorder was significantly associated with SPB. Within this cohort, timing of pregnancy in relation to deployment was identified as a novel risk factor for SPB. Increased focus on servicewomen's pregnancy timing and predeployment access to reproductive counseling and effective contraception is warranted.

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.

Trauma exposure interacts with the genetic risk of bipolar disorder in alcohol misuse of US soldiers.

To investigate whether trauma exposure moderates the genetic correlation between substance use disorders and psychiatric disorders, we tested whether trauma exposure modifies the association of genetic risks for mental disorders with alcohol misuse and nicotine dependence (ND) symptoms. High-resolution polygenic risk scores (PRSs) were calculated for 10 732 US Army soldiers (8346 trauma-exposed and 2386 trauma-unexposed) based on genome-wide association studies of bipolar disorder (BD), major depressive disorder, and schizophrenia. The main finding was a significant BD PRS-by-trauma interaction with respect to alcohol misuse (P = 6.07 × 10-3 ). We observed a positive correlation between BD PRS and alcohol misuse in trauma-exposed soldiers (r = 0.029, P = 7.5 × 10-3 ) and a negative correlation in trauma-unexposed soldiers (r = -0.071, P = 5.61 × 10-4 ). Consistent (nominally significant) result with concordant effect, directions were observed in the schizophrenia PRS-by-trauma interaction analysis. The variants included in the BD PRS-by-trauma interaction showed significant enrichments for gene ontologies related to high voltage-gated calcium channel activity (GO:0008331, P = 1.51 × 10-5 ; GO:1990454, P = 4.49 × 10-6 ; GO:0030315, P = 2.07 × 10-6 ) and for Beta1/Beta2 adrenergic receptor signaling pathways (P = 2.61 × 10-4 ). These results indicate that the genetic overlap between alcohol misuse and BD is significantly moderated by trauma exposure. This provides molecular insight into the complex mechanisms that link substance abuse, psychiatric disorders, and trauma exposure.

Prospective risk factors for post-deployment heavy drinking and alcohol or substance use disorder among US Army soldiers.

Investigations of drinking behavior across military deployment cycles are scarce, and few prospective studies have examined risk factors for post-deployment alcohol misuse. Prevalence of alcohol misuse was estimated among 4645 US Army soldiers who participated in a longitudinal survey. Assessment occurred 1-2 months before soldiers deployed to Afghanistan in 2012 (T0), upon their return to the USA (T1), 3 months later (T2), and 9 months later (T3). Weights-adjusted logistic regression was used to evaluate associations of hypothesized risk factors with post-deployment incidence and persistence of heavy drinking (HD) (consuming 5 + alcoholic drinks at least 1-2×/week) and alcohol or substance use disorder (AUD/SUD). Prevalence of past-month HD at T0, T2, and T3 was 23.3% (s.e. = 0.7%), 26.1% (s.e. = 0.8%), and 22.3% (s.e. = 0.7%); corresponding estimates for any binge drinking (BD) were 52.5% (s.e. = 1.0%), 52.5% (s.e. = 1.0%), and 41.3% (s.e. = 0.9%). Greater personal life stress during deployment (e.g., relationship, family, or financial problems) - but not combat stress - was associated with new onset of HD at T2 [per standard score increase: adjusted odds ratio (AOR) = 1.20, 95% CI 1.06-1.35, p = 0.003]; incidence of AUD/SUD at T2 (AOR = 1.54, 95% CI 1.25-1.89, p < 0.0005); and persistence of AUD/SUD at T2 and T3 (AOR = 1.30, 95% CI 1.08-1.56, p = 0.005). Any BD pre-deployment was associated with post-deployment onset of HD (AOR = 3.21, 95% CI 2.57-4.02, p < 0.0005) and AUD/SUD (AOR = 1.85, 95% CI 1.27-2.70, p = 0.001). Alcohol misuse is common during the months preceding and following deployment. Timely intervention aimed at alleviating/managing personal stressors or curbing risky drinking might reduce risk of alcohol-related problems post-deployment.

Prevalence, predictors and correlates of insomnia in US army soldiers.

The objective of this study was to investigate the rates, predictors and correlates of insomnia in a national sample of US Army soldiers. Data were gathered from the cross-sectional survey responses of the All-Army Study, of the Army Study to Assess Risk and Resilience in Service members. Participants were a representative sample of 21 499 US Army soldiers who responded to the All-Army Study self-administered questionnaire between 2011 and 2013. Insomnia was defined by selected DSM-5 criteria using the Brief Insomnia Questionnaire. The results highlight significant functional difficulties associated with insomnia among US soldiers, as well as insights into predictors of insomnia specific to this population. Insomnia was present in 22.76% of the sample. Predictors of insomnia status in logistic regression included greater number of current mental health disorders, less perceived open lines of communication with leadership, less unit member support and less education. Insomnia had global, negative associations with health, social functioning, support, morale, work performance and Army career intentions. The results provide the strongest evidence to-date that insomnia is common in a military population, and is associated with a wide array of negative factors in the domains of health, military readiness and intentions to remain in military careers.

Prior Mental Disorders and Lifetime Suicidal Behaviors Among US Army Soldiers in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

We report on associations of retrospectively reported temporally prior mental disorders and Army career characteristics with subsequent first onset of suicidal behaviors in a large, representative sample of US Army soldiers who participated in the Consolidated All-Army Survey of the Army Study to Assess Risk and Resilience in Servicemembers (N=29,982). Results reveal that among men and women, all self-reported lifetime disorders measured (some assessed with screening scales) are associated with subsequent onset of suicide ideation. Among men, three disorders characterized by agitation and impulsiveness (intermittent explosive disorder, panic disorder, and substance disorders) predict the transition from suicide ideation to attempt. For both men and women, being in the Regular Army (vs. National Guard or Army Reserve) predicts suicide attempts in the total sample. For men, a history of deployment and junior rank are predictors of suicide attempts after adjusting for preenlistment disorders but not accounting for pre- and postenlistment disorders, suggesting that postenlistment disorders account for some of the increased suicide risk among these career characteristics. Overall, these results highlight associations between mental disorders and suicidal behaviors, but underscore limitations predicting which people with ideation attempt suicide.

Sickle Cell Trait and Heat Injury Among US Army Soldiers.

There is concern that sickle cell trait (SCT) increases risk of exertional collapse, a primary cause of which is heat injury. However, to our knowledge, no population-based studies among active individuals have addressed this, representing a critical evidence gap. We conducted a retrospective cohort study of SCT-tested African-American soldiers who were on active duty in the US Army anytime between January 2011 and December 2014. Using Cox proportional hazards models and adjusting for demographic and medical factors, we observed no significant associations between SCT and either mild heat injury (hazard ratio (HR) = 1.15, 95% confidence interval (CI): 0.84, 1.56; n = 45,999) or heat stroke (HR = 1.11, 95% CI: 0.44, 2.79; n = 46,183). Risk of mild heat injury was substantially higher among soldiers with recent prescriptions for antipsychotic agents (HR = 3.25, 95% CI: 1.33, 7.90). Risk of heat stroke was elevated among those with a prior mild heat injury (HR = 17.7, 95% CI: 8.50, 36.7) and among overweight and obese individuals (HR = 2.91 (95% CI: 1.38, 6.17) and HR = 4.04 (95% CI: 1.72, 9.45), respectively). In a setting where universal precautions are utilized to mitigate risk of exertion-related illnesses, SCT is not associated with either mild heat injury or heat stroke.

Physical Discomfort And Relationship To Performance During A 12-mile March In US Army Soldiers

Long road marches carrying heavy loads are a common military task. While it is anecdotally accepted that discomfort related to physical pain and soreness increases during long marches, there is little data available which has quantified this discomfort or determined its effect on march performance. PURPOSE: To quantify pain and soreness (P&S) during a 12-mile march and determine how it affects pacing. METHODS: While carrying a load weighing ~46.4 kg, 46 male and 26 female Soldiers performed a 12 mile foot march. A mandatory rest break of 10 minutes was enforced at the 3 and 9 mile marks, and a 30 minute break was enforced at the 6 mile mark. Time splits were taken every 3 miles. At the start, each rest point, and finish, soldiers rated their P&S from 0 (No Discomfort) to 3 (Extremely Uncomfortable) using an image of the body mapped into 21 regions (scale adapted from Dimov et al, AIHAJ, 2000). Increases in P&S over time were assessed using rmANOVA. Correlations were examined between changes in P&S (finish-start) for each site and load carried per body mass and with changes in pace (time for last 3 miles – time for first 3 miles). RESULTS: Total march time was 244 ± 35 minutes (mean ± SD). Average overall P&S of the 21 body regions increased during the march from 0.13 ± 0.11 prior to the march to 0.46 ± 0.24 at the end (p<0.01 for trend), and did not significantly differ by sex (p=0.24). Of the 71 soldiers, 64 (90%) reported a P&S of 2 or 3 for at least one body region, with 36 (51%) reporting a P&S of 3. The sites of the greatest soreness were the shoulders (End P&S 1.99±0.96) and the feet (End P&S 1.36±1.20) (p<0.05 for both). Significant increases in P&S were observed in the neck, shoulders, mid-to-lower back, hips/waist, thighs, legs/feet, and ankles (p≤0.05 for trends). Load carried per body mass correlated with changes in neck P&S (r=0.24, p=0.04). Increases in P&S of the hips/waist were associated with decreasing their pace (r=0.32, p=0.01). DISCUSSION: Due to the high load over a long distance, P&S increased over the march and may have interfered with performance. These data provide quantitative evidence of the changes in reported physical discomfort during long marches. To minimize soldier discomfort and improve performance, improvements in road march policy, equipment ergonomics, and training of proper gear fitting should target these body regions.

Development and validation of the Speech Reception in Noise (SPRINT) Test

Since 1992, the Speech Recognition in Noise Test, or SPRINT, has been the standard speech-in-noise test for assessing auditory fitness-for-duty of US Army Soldiers with hearing loss. The original SPRINT test consisted of 200 monosyllabic words presented at a Signal-to-Noise Ratio (SNR) of +9 dB in the presence of a six-talker babble noise. Normative data for the test was collected on 319 hearing impaired Soldiers, and a procedure for making recommendations about the disposition of military personnel on the basis of their SPRINT score and their years of experience was developed and implemented as part of US Army policy. In 2013, a new 100-word version of the test was developed that eliminated words that were either too easy or too hard to make meaningful distinctions among hearing impaired listeners. This paper describes the development of the original 200-word SPRINT test, along with a description of the procedure used to reduce the 200-word test to 100 words and the results of a validation study conducted to evaluate how well the shortened 100-word test is able to capture the results from the full 200-word version of the SPRINT.

Body Mass Index at Accession and Incident Cardiometabolic Risk Factors in US Army Soldiers, 2001-2011.

Individuals entering US Army service are generally young and healthy, but many are overweight, which may impact cardiometabolic risk despite physical activity and fitness requirements. This analysis examines the association between Soldiers’ BMI at accession and incident cardiometabolic risk factors (CRF) using longitudinal data from 731,014 Soldiers (17.0% female; age: 21.6 [3.9] years; BMI: 24.7 [3.8] kg/m2) who were assessed at Army accession, 2001–2011. CRF were defined as incident diagnoses through 2011, by ICD-9 code, of metabolic syndrome, glucose/insulin disorder, hypertension, dyslipidemia, or overweight/obesity (in those not initially overweight/obese). Multivariable-adjusted proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) between BMI categories at accession and CRF. Initially underweight (BMI<18.5 kg/m2) were 2.4% of Soldiers, 53.5% were normal weight (18.5−<25), 34.2% were overweight (25−<30), and 10.0% were obese (≥30). Mean age range at CRF diagnosis was 24–29 years old, with generally low CRF incidence: 228 with metabolic syndrome, 3,880 with a glucose/insulin disorder, 26,373 with hypertension, and 13,404 with dyslipidemia. Of the Soldiers who were not overweight or obese at accession, 5,361 were eventually diagnosed as overweight or obese. Relative to Soldiers who were normal weight at accession, those who were overweight or obese, respectively, had significantly higher risk of developing each CRF after multivariable adjustment (HR [95% CI]: metabolic syndrome: 4.13 [2.87–5.94], 13.36 [9.00–19.83]; glucose/insulin disorder: 1.39 [1.30–1.50], 2.76 [2.52–3.04]; hypertension: 1.85 [1.80–1.90], 3.31 [3.20–3.42]; dyslipidemia: 1.81 [1.75–1.89], 3.19 [3.04–3.35]). Risk of hypertension, dyslipidemia, and overweight/obesity in initially underweight Soldiers was 40%, 31%, and 79% lower, respectively, versus normal-weight Soldiers. BMI in early adulthood has important implications for cardiometabolic health, even within young, physically active populations.

Under Reporting of Suicide Ideation in US Army Population Screening: An Ongoing Challenge

Previous research in US Army Soldiers shows rates of mental health concerns as two to four times higher on anonymous surveys than on postdeployment health assessments. In this study, Soldiers presenting for health reassessment completed two questionnaires on suicide risk factors: one linked to the health assessment and one anonymous. About 5.1% of respondents reported suicide ideation on the anonymous questionnaire, 3.0% on the linked questionnaire, and 0.9% on the health reassessment. About 56.4% who reported suicide ideation anonymously told nobody of their thoughts. Current screening procedures identify only one in seven Soldiers experiencing suicide ideation and highlight the need for alternative risk-detection strategies.

Predicting and explaining behavioral intention and hand sanitizer use among US Army soldiers.

Using hand sanitizers can reduce bacterial contamination and is an efficient and inexpensive method of preventing infections. The purpose of this study was to explore the behavioral intention (low and absolute), attitudes, subjective norms, and perceived behavioral control of hand sanitizer use among US Army soldiers. A questionnaire was developed following an expert panel (N = 5) review and 2 pilot studies (N = 35) to ensure questionnaire validity and clarity. Surveys were distributed among nontrainee soldiers during lunch periods. A total of 201 surveys were collected. Results indicated that attitudes, subjective norms, and perceived behavioral controls explained 64% of the variance in behavioral intention. Attitude remained the strongest predictor of behavior (β = 0.70, P < .01), followed by subjective norms (β = 0.18; P < .01), with significant differences between low and absolute intenders. Soldiers with absolute intention to use hand sanitizers hold significantly different behavioral and normative beliefs than low intenders. Other soldiers create negative social pressure about using hand sanitizers, indicating that if other soldiers use hand sanitizers, they will refuse to do so. Intervention to ensure use of hand sanitizer should focus on strengthening behavioral and normative beliefs among low intenders. This should increase the overall well being of the military.

Longitudinal Examination of Posttraumatic Stress Disorder as a Long-Term Outcome of Iraq War Deployment.

The mental health toll of the Iraq and Afghanistan Wars on military veterans has been considerable, yet little is known about the persistence of these adverse outcomes, especially relative to predeployment status. We prospectively examined posttraumatic stress disorder (PTSD) as a long-term consequence of warzone deployment, integrating data collected from 2003-2014. In the Neurocognition Deployment Health Study, we measured PTSD symptoms in US Army soldiers before and shortly after Iraq War deployment. We used the PTSD Checklist-Civilian Version and a structured clinical interview (i.e., Clinician-Administered PTSD Scale) to reassess PTSD in 598 service members and military veterans a median of 7.9 years (interquartile range, 7.2-8.5 years) after an index Iraq deployment. At long-term follow-up, 24.7% (95% confidence interval (CI): 21.5, 28.4) of participants met the case definition for PTSD, which was an absolute increase of 14.2% from the percentage assessed postdeployment (10.5%; 95% CI: 7.8, 13.7) and of 17.3% from the percentage assessed predeployment (7.4%; 95% CI: 5.5, 9.8). These findings highlight that PTSD is an enduring consequence of warzone participation among contemporary military personnel and veterans. The largest increase in PTSD cases occurred between the postdeployment and long-term follow-up assessments, which suggests that adverse stress reactions cannot necessarily be expected to dissipate over time and actually may increase.

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.