Objective:The authors assessed the effectiveness of a systematic method of predeployment mental health screening to determine whether screening decreased negative outcomes during deployment in Iraq's ...combat setting.
Method:Primary care providers performed directed mental health screenings during standard predeployment medical screening. If indicated, on-site mental health providers assessed occupational functioning with unit leaders and coordinated in-theater care for those cleared for deployment. Mental health-related clinical encounters and evacuations during the first 6 months of deployment in 2007 were compared for 10,678 soldiers from three screened combat brigades and 10,353 soldiers from three comparable unscreened combat brigades.
Results:Of 10,678 soldiers screened, 819 (7.7%, 95% confidence interval CI=7.2–8.2) received further mental health evaluation; of these, 74 (9.0%, 95% CI=7.1–11.0) were not cleared to deploy and 96 (11.7%, 95% CI=9.5–13.9) were deployed with additional requirements. After 6 months, soldiers in screened brigades had significantly lower rates of clinical contacts than did those in unscreened brigades for suicidal ideation (0.4%, 95% CI=0.3–0.5, compared with 0.9%, 95% CI=0.7–1.1), for combat stress (15.7%, 95% CI=15.0–16.4, compared with 22.0%, 95% CI=21.2–22.8), and for psychiatric disorders (2.9%, 95% CI=2.6–3.2, compared with 13.2%, 95% CI=12.5–13.8), as well as lower rates of occupational impairment (0.6%, 95% CI=0.4–0.7, compared with 1.8%, 95% CI=1.5–2.1) and air evacuation for behavioral health reasons (0.1%, 95% CI=0.1–0.2, compared with 0.3%, 95% CI=0.2–0.4).
Conclusions:Predeployment mental health screening was associated with significant reductions in occupationally impairing mental health problems, medical evacuations from Iraq for mental health reasons, and suicidal ideation. This predeployment screening process provides a feasible system for screening soldiers and coordinating mental health support during deployment.
IMPORTANCE: The US Army experienced a sharp increase in soldier suicides beginning in 2004. Administrative data reveal that among those at highest risk are soldiers in the 12 months after inpatient ...treatment of a psychiatric disorder. OBJECTIVE: To develop an actuarial risk algorithm predicting suicide in the 12 months after US Army soldier inpatient treatment of a psychiatric disorder to target expanded posthospitalization care. DESIGN, SETTING, AND PARTICIPANTS: There were 53 769 hospitalizations of active duty soldiers from January 1, 2004, through December 31, 2009, with International Classification of Diseases, Ninth Revision, Clinical Modification psychiatric admission diagnoses. Administrative data available before hospital discharge abstracted from a wide range of data systems (sociodemographic, US Army career, criminal justice, and medical or pharmacy) were used to predict suicides in the subsequent 12 months using machine learning methods (regression trees and penalized regressions) designed to evaluate cross-validated linear, nonlinear, and interactive predictive associations. MAIN OUTCOMES AND MEASURES: Suicides of soldiers hospitalized with psychiatric disorders in the 12 months after hospital discharge. RESULTS: Sixty-eight soldiers died by suicide within 12 months of hospital discharge (12.0% of all US Army suicides), equivalent to 263.9 suicides per 100 000 person-years compared with 18.5 suicides per 100 000 person-years in the total US Army. The strongest predictors included sociodemographics (male sex odds ratio (OR), 7.9; 95% CI, 1.9-32.6 and late age of enlistment OR, 1.9; 95% CI, 1.0-3.5), criminal offenses (verbal violence OR, 2.2; 95% CI, 1.2-4.0 and weapons possession OR, 5.6; 95% CI, 1.7-18.3), prior suicidality OR, 2.9; 95% CI, 1.7-4.9, aspects of prior psychiatric inpatient and outpatient treatment (eg, number of antidepressant prescriptions filled in the past 12 months OR, 1.3; 95% CI, 1.1-1.7), and disorders diagnosed during the focal hospitalizations (eg, nonaffective psychosis OR, 2.9; 95% CI, 1.2-7.0). A total of 52.9% of posthospitalization suicides occurred after the 5% of hospitalizations with highest predicted suicide risk (3824.1 suicides per 100 000 person-years). These highest-risk hospitalizations also accounted for significantly elevated proportions of several other adverse posthospitalization outcomes (unintentional injury deaths, suicide attempts, and subsequent hospitalizations). CONCLUSIONS AND RELEVANCE: The high concentration of risk of suicide and other adverse outcomes might justify targeting expanded posthospitalization interventions to soldiers classified as having highest posthospitalization suicide risk, although final determination requires careful consideration of intervention costs, comparative effectiveness, and possible adverse effects.
Burnout is a personal and occupational phenomenon that has been associated with negative physical and psychological outcomes in medical staff. Additionally, there are implications for healthcare ...organizations, as those staff who are burned out are more likely to have lower productivity or leave the organization. As with the Covid-19 pandemic, future national emergencies and potentially large-scale conflicts will require similar and likely even larger scale responses from the U.S. Military Health System, thus it is important to understand burnout in this population so that the readiness of the staff and the military can remain at a high level.
This assessment was designed to examine levels of burnout among United States Military Health System (MHS) staff working at Army installations and the factors that influence the development of burnout.
Anonymous data was collected from 13,558 active-duty U.S. Soldiers and civilian MHS employees. Burnout was measured using the Copenhagen Burnout Inventory and the Mini-Z.
Results showed nearly half of staff who responded (48%) reported being burned out, an increase since last measured in 2019 (31%). Factors related to increased burnout included concerns about work/life balance and workload, low job satisfaction and feeling disconnected from others. Burnout was associated with increases in adverse physical and behavioral health (BH) outcomes.
Results indicate that burnout is a common problem across MHS Army staff and is related to significant adverse health consequences for the individual and reduced retention of staff for the organization. These findings highlight the need to address burnout through policies that standardize health care delivery policies and practices, providing support to leadership to promote a healthy workplace, and individual support to those who experience burnout.
•Rates of burnout in U.S. military healthcare staff rose significantly since 2019.•Burnout in U.S. military healthcare staff was associated with poor health outcomes.•Burnout may reduce retention of staff in the U.S. Military Health System.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract
Introduction
The division psychiatrist has been a bedrock U.S. Army institution for nearly 100 years. The role of the position in combat is well established, but its role in garrison has ...historically been less well defined. Prevention of behavioral health casualties has long been a governing objective of the division psychiatrist and forms the cornerstone of the behavioral health (BH) readiness concept. Accordingly, the Army’s increased emphasis on readiness mandates that the division psychiatrist maximize BH force readiness through applied prevention methods. This process begins in garrison, and the crucible of recent protracted conflict has yielded effective BH screening principles applied in that environment. Despite this achievement, an evolving operational environment threatens the blanket effectiveness of BH screening and prevention in garrison. This article examines the historical evolution of the division psychiatrist’s role in garrison, elucidates division psychiatry BH readiness principles in garrison, and expands on previously documented division psychiatry led efforts to maximize BH readiness levels.
Materials and Methods
A historical review of the division psychiatrist was conducted in order to analyze the role of the position in BH prevention operations. Identified division psychiatry preventive lessons are leveraged against current BH readiness challenges resulting in proposed solutions from a division psychiatry perspective.
Results
The historical trajectory of the division psychiatrist’s role in garrison prevention operations has advanced significantly in the last 17 years. With the advent of evidence-based BH readiness findings, the division psychiatrist’s garrison readiness duties have expanded to include analysis of unit BH readiness levels. By applying pre-deployment screening principles in new ways to existing BH readiness platforms, the division psychiatrist can analyze BH readiness levels much earlier than immediately prior to deployment. The resultant BH readiness feedback allows for individualized readiness improvements for the BH systems that serve Army units. The division psychiatrist is the natural proponent of such readiness efforts, and will require staff officer, consultant, liaison, and trainer skill sets in order to be successful.
Conclusions
The division psychiatrist’s role must adapt to a changing operational environment in order to preserve and build on historical successes. The recommended end state would see the division psychiatrist maintaining a robust pre/post-deployment BH screening process and organizing the regular analysis of BH readiness levels to optimize existing BH clinical platforms. Systematically pursued, this would not only maximize BH readiness, but dramatically enhance safety and the provision of resources towards soldier health and welfare across the Army. The division psychiatrist should lead this effort.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The cumulative strain of 14 years of war on service members, veterans, and their families, together with continuing global threats and the unique stresses of military service, are likely to be felt ...for years to come. Scientific as well as political factors have influenced how the military has addressed the mental health needs resulting from these wars. Two important differences between mental health care delivered during the Iraq and Afghanistan wars and previous wars are the degree to which research has directly informed care and the consolidated management of services. The U.S. Army Medical Command implemented programmatic changes to ensure delivery of high-quality standardized mental health services, including centralized workload management; consolidation of psychiatry, psychology, psychiatric nursing, and social work services under integrated behavioral health departments; creation of satellite mental health clinics embedded within brigade work areas; incorporation of mental health providers into primary care; routine mental health screening throughout soldiers’ careers; standardization of clinical outcome measures; and improved services for family members. This transformation has been accompanied by reduction in psychiatric hospitalizations and improved continuity of care. Challenges remain, however, including continued underutilization of services by those most in need, problems with treatment of substance use disorders, overuse of opioid medications, concerns with the structure of care for chronic postdeployment (including postconcussion) symptoms, and ongoing questions concerning the causes of historically high suicide rates, efficacy of resilience training initiatives, and research priorities. It is critical to ensure that remaining gaps are addressed and that knowledge gained during these wars is retained and further evolved.
Sexual Assault in the Military Castro, Carl Andrew; Kintzle, Sara; Schuyler, Ashley C. ...
Current psycchiatry reports/Current psychiatry reports,
07/2015, Volume:
17, Issue:
7
Journal Article
Peer reviewed
Open access
Military sexual assault is a pervasive problem throughout the military services, despite numerous initiatives to end it. No doubt the military’s lack of progress stems from the complexity of sexual ...assaults, yet in order to develop effective strategies and programs to end sexual assault, deep understanding and appreciation of these complexities are needed. In this paper, we describe the root causes and numerous myths surrounding sexual assault, the military cultural factors that may unintentionally contribute to sexual assault, and the uncomfortable issues surrounding sexual assault that are often ignored (such as the prevalence of male sexual assault within the military). We conclude by offering a broad, yet comprehensive set of recommendations that considers all of these factors for developing effective strategies and programs for ending sexual assault within in the military.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Posttraumatic stress disorder (PTSD) occurs in an estimated 8% of men and 20% of women who are exposed to traumatic events. PTSD is a trauma- and stress-related disorder associated with significant ...psychosocial morbidity, substance abuse, and other negative physical health outcomes. The hallmarks of PTSD include exposure to a traumatic event; reexperiencing the event or intrusion symptoms; avoidance of people, places, or things that serve as a reminder of the trauma; negative mood and thoughts associated with the trauma; and chronic hyperarousal symptoms. Self-report questionnaires can assist clinicians in identifying anxiety problems associated with traumatic events. For patients who meet criteria for PTSD, trauma-focused psychotherapy and pharmacotherapy improve symptoms. Benzodiazepines and atypical antipsychotics are not recommended because studies have shown that adverse effects outweigh potential health benefits. Primary care physicians should monitor patients with PTSD for comorbid conditions such as substance abuse, mood disorders, and suicidality, and should refer patients to behavioral health specialists and support groups when appropriate.
Antidepressant discontinuation syndrome Warner, Christopher H; Bobo, William; Warner, Carolynn ...
American family physician,
2006-Aug-01, 20060801, Volume:
74, Issue:
3
Journal Article
Peer reviewed
Antidepressant discontinuation syndrome occurs in approximately 20 percent of patients after abrupt discontinuation of an antidepressant medication that was taken for at least six weeks. Typical ...symptoms of antidepressant discontinuation syndrome include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. These symptoms usually are mild, last one to two weeks, and are rapidly extinguished with reinstitution of antidepressant medication. Antidepressant discontinuation syndrome is more likely with a longer duration of treatment and a shorter half-life of the treatment drug. A high index of suspicion should be maintained for the emergence of discontinuation symptoms, which should prompt close questioning regarding accidental or purposeful self-discontinuation of medication. Before antidepressants are prescribed, patient education should include warnings about the potential problems associated with abrupt discontinuation. Education about this common and likely underrecognized clinical phenomenon will help prevent future episodes and minimize the risk of misdiagnosis.
Summary Background Breakdowns in the ethical conduct of soldiers towards non-combatants on the battlefield are of grave concern in war. Evidence-based training approaches to prevent unethical conduct ...are scarce. We assessed the effectiveness of battlefield-ethics training and factors associated with unethical battlefield conduct. Methods The training package, based on movie vignettes and leader-led discussions, was administered 7 to 8 months into a 15-month high-intensity combat deployment in Iraq, between Dec 11, 2007, and Jan 30, 2008. Soldiers from an infantry brigade combat team (total population about 3500) were randomly selected, on the basis of company and the last four digits of each soldier's social security number, and invited to complete an anonymous survey 3 months after completion of the training. Reports of unethical behaviour and attitudes in this sample were compared with a randomly selected pre-training sample from the same brigade. The response patterns for ethical behaviour and reporting of ethical violations were analysed with chi-square analyses. We developed two logistic regression models using self-reported unethical behaviours as dependent variables. Factors associated with unethical conduct, including combat experiences and post-traumatic stress disorder (PTSD), were assessed with validated scales. Findings Of 500 randomly selected soldiers 421 agreed to participate in the anonymous post-training survey. A total of 397 soldiers of the same brigade completed the pre-training survey. Training was associated with significantly lower rates of unethical conduct of soldiers and greater willingness to report and address misconduct than in those before training. For example, reports of unnecessary damage or destruction of private property decreased from 13·6% (54 of 397; 95% CI 10·2–17·0) before training to 5·0% (21 of 421; 2·9–7·1) after training (percent difference −63·2%; p<0·0001), and willingness to report a unit member for mistreatment of a non-combatant increased from 36·0% (143 of 397; 31·3–40·7) to 58·9% (248 of 421; 54·2–63·6; percent difference 63·6; p<0·0001). Nearly all participants (410 97%) reported that training made it clear how to respond towards non-combatants. Combat frequency and intensity was the strongest predictor of unethical behaviour; PTSD was not a significant predictor of unethical behaviour after controlling for combat experiences. Interpretation Leader-led battlefield ethics training positively influenced soldiers' understanding of how to interact with and treat non-combatants, and reduced reports of ethical misconduct. Unethical battlefield conduct was associated with high-intensity combat but not with PTSD. Funding None.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
PDF
