To evaluate predeployment sleep duration and insomnia symptoms in relation to the development of mental health symptoms.
Longitudinal cohort study.
The Millennium Cohort Study survey is administered ...via a secure website or US mail.
Data were from 15,204 participants who completed their first deployment between the submissions of 2 consecutive Millennium Cohort questionnaires (2001-2008).
N/A.
Using self-reported data from the Millennium Cohort Study we evaluated the association of predeployment sleep duration and insomnia symptoms on the development of new-onset mental disorders among deployers. Multivariable logistic regression was used to estimate the odds of developing posttraumatic stress disorder (PTSD), depression, and anxiety, while adjusting for relevant covariates including combat-related trauma. The study outcomes were assessed using validated instruments, including the PTSD checklist-civilian version, and the PRIME-MD Patient Health Questionnaire. We identified 522 people with new-onset PTSD, 151 with anxiety, and 303 with depression following deployment. In adjusted models, combat-related trauma and predeployment insomnia symptoms were significantly associated with higher odds of developing posttraumatic stress disorder, depression, and anxiety postdeployment.
Sleep characteristics, especially insomnia symptoms, are related to the development of mental disorders following military deployments. Assessment of insomnia symptoms predeployment may help to better identify those at highest risk for subsequent adverse mental health outcomes.
Gehrman P; Seelig AD; Jacobson IG; Boyko EJ; Hooper TI; Gackstetter GD; Ulmer CS; Smith TC; for the Millennium Cohort Study Team. Predeployment sleep duration and insomnia symptoms as risk factors for new-onset mental health disorders following military deployment.
2013;36(7):1009-1018.
Examine the relationship between self-reported sleep parameters and indicators of resilience in a US military population (n = 55,021).
Longitudinal analyses (2001-2008) were conducted using ...subjective data collected from Millennium Cohort Study questionnaires and objective data from military records that included demographics, military health, and deployment information. Subjective sleep duration and insomnia symptoms were collected on the study questionnaire. Resilience metrics included lost work days, self-rated health, deployment, frequency and duration of health care utilization, and early discharge from the military. Generalized estimating equations and survival analyses were adjusted for demographic, military, behavioral, and health covariates in all models.
The presence of insomnia symptoms was significantly associated with lower self-rated health, more lost work days, lower odds of deployment, higher odds of early discharge from military service early, and more health care utilization. Those self-reporting < 6 h (short sleepers) or > 8 h (long sleepers) of sleep per night had similar findings, except for the deployment outcome in which those with the shortest sleep were more likely to deploy.
Poor sleep is a detriment to service members' health and readiness. Leadership should redouble efforts to emphasize the importance of healthy sleep among military service members, and future research should focus on the efficacy of interventions to promote healthy sleep and resilience in this population.
A commentary on this article appears in this issue on page 963.
To determine the associations between deployment in support of the wars in Iraq and Afghanistan and sleep quantity and quality.
Longitudinal cohort study
The Millennium Cohort Study survey is ...administered via a secure website or US mail.
Data were from 41,225 Millennium Cohort members who completed baseline (2001-2003) and follow-up (2004-2006) surveys. Participants were placed into 1 of 3 exposure groups based on their deployment status at follow-up: nondeployed, survey completed during deployment, or survey completed postdeployment.
N/A.
Study outcomes were self-reported sleep duration and trouble sleeping, defined as having trouble falling asleep or staying asleep. Adjusted mean sleep duration was significantly shorter among those in the deployed and postdeployment groups compared with those who did not deploy. Additionally, male gender and greater stress were significantly associated with shorter sleep duration. Personnel who completed their survey during deployment or postdeployment were significantly more likely to have trouble sleeping than those who had not deployed. Lower self-reported general health, female gender, and reporting of mental health symptoms at baseline were also significantly associated with increased odds of trouble sleeping.
Deployment significantly influenced sleep quality and quantity in this population though effect size was mediated with statistical modeling that included mental health symptoms. Personnel reporting combat exposures or mental health symptoms had increased odds of trouble sleeping. These findings merit further research to increase understanding of temporal relationships between sleep and mental health outcomes occurring during and after deployment.
Sexual trauma (ST), which includes both sexual harassment and sexual assault, is associated with a variety of adverse mental and physical health outcomes in military and civilian populations. ...However, little is known about whether certain individual or military attributes or prior experiences may modify the relationship between recent ST and mental or physical health outcomes. Data from a longitudinal cohort study of current and former military members were used to examine whether individual and military factors modify the association between recent ST and health outcomes (posttraumatic stress disorder, depression, multiple somatic symptoms, and insomnia). Results indicated that demographic (sex, sexual orientation, race/ethnicity) and military factors (service branch, service component, military separation) generally did not modify the main effect of ST on the outcomes examined. On the other hand, factors known to be protective (spirituality, social support) and risk factors (childhood trauma, combat deployment, and mental health status) did modify the effect of ST on multiple outcomes examined; notably, protective effects were diminished among those who experienced recent ST. Protective factors were associated with the lowest risk of adverse outcomes among those with no ST, while risk reduction was less among survivors of ST. Diminished impacts also were found for cumulative risk factors, with the influence of multiple individual risk factors associated with increased risk but in a subadditive manner. We conclude that the effect of recent ST on the outcomes examined was persistent in the presence of potential protective factors, but that it may be impacted by ceiling effects in combination with other risk factors.
Research has suggested that a higher risk of type 2 diabetes associated with sleep characteristics exists. However, studies have not thoroughly assessed the potential confounding effects of mental ...health conditions associated with alterations in sleep.
We prospectively assessed the association between sleep characteristics and self-reported incident diabetes among Millennium Cohort Study participants prospectively followed over a 6-year time period. Surveys are administered approximately every 3 years and collect self-reported data on demographics, height, weight, lifestyle, features of military service, sleep, clinician-diagnosed diabetes, and mental health conditions assessed by the PRIME-MD Patient Health Questionnaire and the PTSD Checklist-Civilian Version. Statistical methods for longitudinal data were used for data analysis.
We studied 47,093 participants (mean 34.9 years of age; mean BMI 26.0 kg/m2; 25.6% female). During 6 years of follow-up, 871 incident diabetes cases occurred (annual incidence 3.6/1,000 person-years). In univariate analyses, incident diabetes was significantly more likely among participants with self-reported trouble sleeping, sleep duration<6 h, and sleep apnea. Participants reporting incident diabetes were also significantly older, of nonwhite race, of higher BMI, less likely to have been deployed, and more likely to have reported baseline symptoms of panic, anxiety, posttraumatic stress disorder, and depression. After adjusting for covariates, trouble sleeping (odds ratio 1.21 95% CI 1.03-1.42) and sleep apnea (1.78 1.39-2.28) were significantly and independently related to incident diabetes.
Trouble sleeping and sleep apnea predict diabetes risk independent of mental health conditions and other diabetes risk factors.
The objective of this study was to define the risk of hearing loss among US military members in relation to their deployment experiences. Data were drawn from the Millennium Cohort Study. ...Self-reported data and objective military service data were used to assess exposures and outcomes. Among all 48,540 participants, 7.5% self-reported new-onset hearing loss. Self-reported hearing loss showed moderate to substantial agreement (k = 0.57-0.69) with objective audiometric measures. New-onset hearing loss was associated with combat deployment (adjusted odds ratio AOR = 1.63, 95% confidence interval CI = 1.49-1.77), as well as male sex and older age. Among deployers, new-onset hearing loss was also associated with proximity to improvised explosive devices (AOR = 2.10, 95% CI = 1.62-2.73) and with experiencing a combat-related head injury (AOR = 6.88, 95% CI = 3.77-12.54). These findings have implications for health care and disability planning, as well as for prevention programs.
The Millennium Cohort Study, the US Department of Defense's largest and longest running study, was conceived in 1999 to investigate the effects of military service on service member health and ...well-being by prospectively following active duty, Reserve, and National Guard personnel from all branches during and following military service. In commemoration of the Study's 20th anniversary, this paper provides a summary of its methods, key findings, and future directions.
Recruitment and enrollment of the first 5 panels occurred between 2001 and 2021. After completing a baseline survey, participants are requested to complete follow-up surveys every 3–5 years.
Study research projects are categorized into 3 core portfolio areas (psychological health, physical health, and health-related behaviors) and several cross-cutting areas and have culminated in more than 120 publications to date. For example, some key Study findings include that specific military service-related factors (e.g., experiencing combat, serving in certain occupational subgroups) were associated with adverse health-related outcomes and that unhealthy behaviors and mental health issues may increase following the transition from military service to veteran status.
The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts.
We examined whether military service, including deployment and combat experience, were related to smoking initiation and relapse.
We included older (panel 1) and younger (panel 2) participants in the ...Millennium Cohort Study. Never smokers were followed for 3 to 6 years for smoking initiation, and former smokers were followed for relapse. Complementary log-log regression models estimated the relative risk (RR) of initiation and relapse by military exposure while adjusting for demographic, health, and lifestyle factors.
Deployment with combat experience predicted higher initiation rate (panel 1: RR = 1.44; 95% confidence interval CI = 1.28, 1.62; panel 2: RR = 1.26; 95% CI = 1.04, 1.54) and relapse rate (panel 1 only: RR = 1.48; 95% CI = 1.36, 1.62). Depending on the panel, previous mental health disorders, life stressors, and other military and nonmilitary characteristics independently predicted initiation and relapse.
Deployment with combat experience and previous mental disorder may identify military service members in need of intervention to prevent smoking initiation and relapse.
Highlights • We examined incidence and correlates of relapse to problem drinking among 6909 US service members and veterans. • 16% of remittent problem drinkers relapsed within 3 years. • We ...identified several subgroups of the population who had significantly increased risk for relapse, including Reservist and National Guard as well as combat deployers, veterans, and those who do not abstain from drinking. • Findings support routine monitoring and targeted intervention of remittent drinkers.
Introduction: The associations between stressful military experiences and tobacco use and alcohol misuse among Service members are well documented. However, little is known about whether stressful ...military experiences are associated with tobacco use and alcohol misuse among military spouses. Methods: Using 9872 Service member–spouse dyads enrolled in the Millennium Cohort Family Study, we employed logistic regression to estimate the odds of self-reported cigarette smoking, risky drinking, and problem drinking among spouses by Service member deployment status, communication regarding deployment, and stress associated with military-related experiences, while adjusting for demographic, mental health, military experiences, and Service member military characteristics. Results: Current cigarette smoking, risky drinking, and problem drinking were reported by 17.2%, 36.3%, and 7.3% of military spouses, respectively. Current deployment was not found to be associated with spousal smoking or drinking behaviors. Communication about deployment experiences with spouses was associated with lower odds of smoking, but not with risky or problem drinking. Spouses bothered by communicated deployment experiences and those who reported feeling very stressed by a combat-related deployment or duty assignment had consistently higher odds of both risky and problem drinking. Conclusions: Our findings suggest that contextual characteristics about the deployment experience, as well as the perceived stress of those experiences, may be more impactful than the simple fact of Service member deployment itself. These results suggest that considering the impact of deployment experiences on military spouses reveals important dimensions of military community adaptation and risk.
•This paper examines risk factors for current smoking, risky drinking, and problem drinking among spouses of U.S. Service members, while accounting for spouse demographics, family size and socio-economic status, as well as military information regarding the Service member•17.2% of spouses reported current cigarette smoking, 36.3% reported risky drinking, and 7.3% reported problem drinking•Current deployment of the Service member was not associated with a higher odds of smoking or drinking among spouses•Spouses of Service members who communicated about their deployment experiences were half as likely to smoke than spouses who did not communicate•Spouses bothered by hearing about deployment experiences, and spouses reporting feeling very stressed by a combat-related deployment or duty assignment had consistently higher odds of both risky and problem
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