A large body of research has been produced in recent years investigating posttraumatic stress disorder (PTSD) among military personnel following deployment to Iraq and Afghanistan, resulting in ...apparent differences in PTSD prevalence. We compare prevalence estimates for current PTSD between military subgroups, providing insight into how groups may be differentially affected by deployment. Systematic literature searches using the terms PTSD, stress disorder, and acute stress, combined with terms relating to military personnel, identified 49 relevant papers. Studies with a sample size of less than 100 and studies based on data for treatment seeking or injured populations were excluded. Studies were categorized according to theatre of deployment (Iraq or Afghanistan), combat and noncombat deployed samples, sex, enlistment type (regular or reserve and or National Guard), and service branch (for example, army, navy, and air force). Meta-analysis was used to assess PTSD prevalence across subgroups. There was large variability in PTSD prevalence between studies, but, regardless of heterogeneity, prevalence rates of PTSD were higher among studies of Iraq-deployed personnel (12.9%; 95% CI 11.3% to 14.4%), compared with personnel deployed to Afghanistan (7.1%; 95% CI 4.6% to 9.6%), combat deployed personnel, and personnel serving in the Canadian, US, or UK army or the navy or marines (12.4%; 95% CI 10.9% to 13.4%), compared with the other services (4.9%; 95% CI 1.4% to 8.4%). Contrary to findings from within-study comparisons, we did not find a difference in PTSD prevalence for regular active-duty and reserve or National Guard personnel. Categorizing studies according to deployment location and branch of service identified differences among subgroups that provide further support for factors underlying the development of PTSD.
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Obesity is a major health problem in the United States and a growing concern among members of the military. Posttraumatic stress disorder (PTSD) has been associated with overweight and obesity and ...may increase the risk of those conditions among military service members. Disordered eating behaviors have also been associated with PTSD and weight gain. However, eating disorders remain understudied in military samples. We investigated longitudinal associations among PTSD, disordered eating, and weight gain in the Millennium Cohort Study, which includes a nationally representative sample of male (n = 27,741) and female (n = 6,196) service members. PTSD at baseline (time 1; 2001-2003) was associated with disordered eating behaviors at time 2 (2004-2006), as well as weight change from time 2 to time 3 (2007-2008). Structural equation modeling results revealed that the association between PTSD and weight change from time 2 to time 3 was mediated by disordered eating symptoms. The association between PTSD and weight gain resulting from compensatory behaviors (vomiting, laxative use, fasting, overexercise) was significant for white participants only and for men but not women. PTSD was both directly and indirectly (through disordered eating) associated with weight change. These results highlight potentially important demographic differences in these associations and emphasize the need for further investigation of eating disorders in military service members.
Equal opportunity in the workplace is thought to be the direct legacy of the civil rights and feminist movements and the landmark Civil Rights Act of 1964. Yet, as Frank Dobbin demonstrates, ...corporate personnel experts--not Congress or the courts--were the ones who determined what equal opportunity meant in practice, designing changes in how employers hire, promote, and fire workers, and ultimately defining what discrimination is, and is not, in the American imagination. Dobbin shows how Congress and the courts merely endorsed programs devised by corporate personnel. He traces how the first measures were adopted by military contractors worried that the Kennedy administration would cancel their contracts if they didn't take "affirmative action" to end discrimination. These measures built on existing personnel programs, many designed to prevent bias against unionists. Dobbin follows the changes in the law as personnel experts invented one wave after another of equal opportunity programs. He examines how corporate personnel formalized hiring and promotion practices in the 1970s to eradicate bias by managers; how in the 1980s they answered Ronald Reagan's threat to end affirmative action by recasting their efforts as diversity-management programs; and how the growing presence of women in the newly named human resources profession has contributed to a focus on sexual harassment and work/life issues.
CONTEXT High rates of alcohol misuse after deployment have been reported among personnel returning from past conflicts, yet investigations of alcohol misuse after return from the current wars in Iraq ...and Afghanistan are lacking. OBJECTIVES To determine whether deployment with combat exposures was associated with new-onset or continued alcohol consumption, binge drinking, and alcohol-related problems. DESIGN, SETTING, AND PARTICIPANTS Data were from Millennium Cohort Study participants who completed both a baseline (July 2001 to June 2003; n=77 047) and follow-up (June 2004 to February 2006; n=55 021) questionnaire (follow-up response rate = 71.4%). After we applied exclusion criteria, our analyses included 48 481 participants (active duty, n = 26 613; Reserve or National Guard, n = 21 868). Of these, 5510 deployed with combat exposures, 5661 deployed without combat exposures, and 37 310 did not deploy. MAIN OUTCOME MEASURES New-onset and continued heavy weekly drinking, binge drinking, and alcohol-related problems at follow-up. RESULTS Baseline prevalence of heavy weekly drinking, binge drinking, and alcohol-related problems among Reserve or National Guard personnel who deployed with combat exposures was 9.0%, 53.6%, and 15.2%, respectively; follow-up prevalence was 12.5%, 53.0%, and 11.9%, respectively; and new-onset rates were 8.8%, 25.6%, and 7.1%, respectively. Among active-duty personnel, new-onset rates were 6.0%, 26.6%, and 4.8%, respectively. Reserve and National Guard personnel who deployed and reported combat exposures were significantly more likely to experience new-onset heavy weekly drinking (odds ratio OR, 1.63; 95% confidence interval CI, 1.36-1.96), binge drinking (OR, 1.46; 95% CI, 1.24-1.71), and alcohol-related problems (OR, 1.63; 95% CI, 1.33-2.01) compared with nondeployed personnel. The youngest members of the cohort were at highest risk for all alcohol-related outcomes. CONCLUSION Reserve and National Guard personnel and younger service members who deploy with reported combat exposures are at increased risk of new-onset heavy weekly drinking, binge drinking, and alcohol-related problems.
Cet ouvrage, qui résulte d’une collaboration entre auteurs belges, français et canadiens propose différentes perspectives touchant la gestion des ressources humaines. Il cherche à sortir des ...prescriptions normatives auxquelles nous sommes généralement habitués. Il se démarque notamment par une approche davantage orientée vers les paradigmes pluraliste et critique, ainsi que par la diversité des textes qu’il contient, des thématiques qui y sont traitées et des regards disciplinaires sur la fonction. Il s’inscrit également dans un courant davantage humaniste, sans toutefois nier la dualité sociale et économique de la fonction. Enfin, il a aussi pour ambition de contribuer à la professionnalisation de ce champ qui est à la fois théorique et pratique.
IMPORTANCE: A pressing question in military suicide prevention research is whether deployment in support of Operation Enduring Freedom or Operation Iraqi Freedom relates to suicide risk. Prior ...smaller studies report differing results and often have not included suicides that occurred after separation from military service. OBJECTIVE: To examine the association between deployment and suicide among all 3.9 million US military personnel who served during Operation Enduring Freedom or Operation Iraqi Freedom, including suicides that occurred after separation. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort design used administrative data to identify dates of deployment for all service members (October 7, 2001, to December 31, 2007) and suicide data (October 7, 2001, to December 31, 2009) to estimate rates of suicide-specific mortality. Hazard ratios were estimated from time-dependent Cox proportional hazards regression models to compare deployed service members with those who did not deploy. MAIN OUTCOMES AND MEASURES: Suicide mortality from the Department of Defense Medical Mortality Registry and the National Death Index. RESULTS: Deployment was not associated with the rate of suicide (hazard ratio, 0.96; 99% CI, 0.87-1.05). There was an increased rate of suicide associated with separation from military service (hazard ratio, 1.63; 99% CI, 1.50-1.77), regardless of whether service members had deployed or not. Rates of suicide were also elevated for service members who separated with less than 4 years of military service or who did not separate with an honorable discharge. CONCLUSIONS AND RELEVANCE: Findings do not support an association between deployment and suicide mortality in this cohort. Early military separation (<4 years) and discharge that is not honorable were suicide risk factors.
Multiple studies have reported the prevalence of posttraumatic stress disorder (PTSD) in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans; however, these studies have been ...limited to populations who use the Department of Veterans Affairs (VA) for health care, specialty clinic populations, or veterans who deployed. The 3 aims of this study were to report weighted prevalence estimates of a positive screen for PTSD among OEF/OIF and nondeployed veterans, demographic subgroups, and VA health care system users and nonusers. The study analyzed data from the National Health Study for a New Generation of U.S. Veterans, a large population‐based cohort of OEF/OIF and OEF/OIF‐era veterans. The overall weighted prevalence of a positive screen for PTSD in the study population was 13.5%: 15.8% among OEF/OIF veterans and 10.9% in nondeployed veterans. Among OEF/OIF veterans, there was increased risk of a positive screen for PTSD among VA health care users (OR = 2.71), African Americans (OR = 1.61), those who served in the Army (OR = 2.67), and those on active duty (OR = 1.69). The same trend with decreased magnitude was observed in nondeployed veterans. PTSD is a significant public health problem in OEF/OIF‐era veterans, and should not be considered an outcome solely related to deployment.
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Spanish s by the Asociación Chilena de Estrés Traumático (ACET)
Varios estudios han reportado la prevalencia de trastorno por estrés post‐traumático (TEPT) en veteranos de las Operaciones de Libertad Duradera y Libertad Iraquí (OLD/OLI); sin embargo, estos estudios se han limitado a poblaciones que usan el sistema de salud del Departamento de Asuntos Veteranos (AV), especialmente poblaciones clínicas, o veteranos que fueron enviados a la Guerra. Los 3 objetivos de este estudio fueron reportar estimaciones de la prevalencia ponderada para un chequeo positivo de TEPT entre los subgrupos demográficos OLD/OLI y los veteranos no enviados a la Guerra, y los usuarios y no usuarios del Sistema de salud de AV. El estudio analizó los datos del Estudio Nacional de Salud para una Nueva Generación de Veteranos Norteamericanos, basado en una cohorte de una gran población de veteranos de OLD/OLI y de la era OLD/OLI. La prevalencia total ponderada de un chequeo positivo para TEPT en la población de estudio fue de 13.5%: 15.8% entre los veteranos OLD/OLI y 10.9% en los veteranos no enviados a la Guerra. Entre los veteranos OLD/OLI, hubo un mayor riesgo de chequeo positivo para TEPT en los usuarios del Sistema de salud AV OR=2.71), afroamericanos (OR=1.61), aquellos que sirvieron a la Armada (OR=2.67) y en servicio activo (OR=1.69). La misma tendencia con una menor magnitud se observa en veteranos no enviados a la Guerra. El TEPT es un problema de salud pública significativo en los veteranos de la era OLD/OLI y no debería ser considerado una consecuencia exclusiva de relacionada al despliegue a zona de Guerra.
抽象
Traditional and Simplified Chinese s by AsianSTSS
標題：大型人口世代的OEF/OIF和OEF/OIF年代退役軍中PTSD正篩查的患病率。
撮要：我們有很多維持和平和伊拉克自由行動(OEF/OIF)退役兵創傷後壓力症(PTSD)的流行率研究。但這些研究局限在退役軍人部門(VA)使用醫療服務人羣、專科診所病人或被調配老兵。本研究有3個目的：報告OEF/OIF和未調派退役兵、人口子組別、和VA醫療服務使用者/非使用者中有PTSD正篩查的加權患病率估量。一個OEF/OIF和OEF/OIF時代退役兵的大型人口世代研究，即美國全國新生代退役兵健康研究數據作分析。PTSD正篩查的綜合加權患病率是13.5%，OEF/OIF退役軍是15.8%，而非調派退役兵則為10.9%。在OEF/OIF退役兵中，VA醫療服務使用者(OR=2.71) 、非裔美國人(OR=1.61) 、在陸軍中曾服役者(OR=2.67)和現役士兵(OR=1.69)都有較高PTSD正篩查風險。但非調派者有相同趨勢但減退幅度。PTSD在OEF/OIF年代退役軍中是顯著的公共健康問題，而非只與調派任務有關係。
标题：大型人口世代的OEF/OIF和OEF/OIF年代退役军中PTSD正筛查的患病率。
撮要：我们有很多维持和平和伊拉克自由行动(OEF/OIF)退役兵创伤后压力症(PTSD)的流行率研究。但这些研究局限在退役军人部门(VA)使用医疗服务人羣、专科诊所病人或被调配老兵。本研究有3个目的：报告OEF/OIF和未调派退役兵、人口子组别、和VA医疗服务使用者/非使用者中有PTSD正筛查的加权患病率估量。一个OEF/OIF和OEF/OIF时代退役兵的大型人口世代研究，即美国全国新生代退役兵健康研究数据作分析。PTSD正筛查的综合加权患病率是13.5%，OEF/OIF退役军是15.8%，而非调派退役兵则为10.9%。在OEF/OIF退役兵中，VA医疗服务使用者(OR=2.71) 、非裔美国人(OR=1.61) 、在陆军中曾服役者(OR=2.67)和现役士兵(OR=1.69)都有较高PTSD正筛查风险。但非调派者有相同趋势但减退幅度。PTSD在OEF/OIF年代退役军中是显著的公共健康问题，而非只与调派任务有关系。
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This book provides an accessible comprehensive exploration of phenomenological theory and research methods and is geared specifically to the needs of therapists and other health care professionals. ...An accessible exploration of an increasingly popular qualitative research methodologyExplains phenomenological concepts and how they are applied to different stages of the research process and to topics relevant to therapy practiceProvides practical examples throughout
•Suicide is one of the leading causes of preventable death among veterans.•This study examined mediators of military sexual trauma and suicidal behavior.•Mediators included PTSD, depression, and ...comorbid PTSD and depression diagnoses.•Comorbid PTSD and depression diagnoses had the largest indirect effect.•Treatments targeting comorbid PTSD and depression may reduce suicidal behaviors.
Exposure to military sexual trauma (MST) in veterans is associated with suicidal ideation. Previous research suggests there are mechanisms of this association, including posttraumatic stress disorder (PTSD) and depression. Research has yet to examine whether comorbid PTSD and depression mediate the association of MST and suicide and intentional self-inflicted injury, and whether this comorbidity confers a greater risk for suicide relative to PTSD-only and depression-only. The current study addressed this gap in our knowledge.
Screening results identifying MST exposure, PTSD and depression diagnoses, suicide and intentional self-inflicted injury, and demographic covariates in 435,690 Iraq/Afghanistan veterans were extracted from Veterans Health Administration (VHA) medical records. Veterans were included if they attended VHA from 2004-2014. Mediation was tested with path analyses.
Suicide and intentional self-inflicted injury was observed in 16,149 (3.71%) veterans. The indirect effect of suicide and intentional self-inflicted injury, given a positive screen for MST, was highest among veterans with comorbid PTSD and depression diagnoses (indirect effect=3.18%, 95% confidence interval CI 3.01%, 3.32%), with smaller probabilities observed for both PTSD-only (indirect effect=-0.18%, 95% CI -0.20%, -0.14%) and depression-only (indirect effect=0.56%, 95% CI 0.51%, 0.62%; ps<.05).
Data were limited to VHA-enrolled Iraq/Afghanistan veterans.
To reduce suicide risk among veterans with a history of MST, treatments may be most effective if they target comorbid PTSD and depression. Future research should examine the mechanisms through which comorbid PTSD and depression result in heightened risk for suicide and intentional self-inflicted injury.
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Posttraumatic stress disorder (PTSD) is a common psychiatric disorder among service members and veterans. The clinical course of PTSD varies between individuals, and patterns of symptom development ...have yet to be clearly delineated. Previous studies have been limited by convenience sampling, short follow-up periods, and the inability to account for combat-related trauma. To determine the trajectories of PTSD symptoms among deployed military personnel with and without combat exposure, we used data from a population-based representative sample of 8,178 US service members who participated in the Millennium Cohort Study from 2001 to 2011. Using latent growth mixture modeling, trajectories of PTSD symptoms were determined in the total sample, as well as in individuals with and without combat exposure, respectively. Overall, 4 trajectories of PTSD were characterized: resilient, pre-existing, new-onset, and moderate stable. Across all trajectories, combat-deployed service members diverged from non-combat-deployed service members, even after a single deployment. The former also generally had higher PTSD symptoms. Based on the models, nearly 90% of those without combat exposure remained resilient over the 10-year period, compared with 80% of those with combat exposure. Findings demonstrate that although the clinical course of PTSD symptoms shows heterogeneous patterns of development, combat exposure is uniformly associated with poor mental health.
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