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.
To determine whether deployment with combat exposures was associated with new-onset or continued alcohol consumption, binge drinking, and alcohol-related problems.
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.
New-onset and continued heavy weekly drinking, binge drinking, and alcohol-related problems at follow-up.
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.
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.
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.
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.
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.
Suicide mortality from the Department of Defense Medical Mortality Registry and the National Death Index.
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.
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.
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.
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.
Resumen
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。
•Commonly reported symptoms are headache, throat pain and lethargy.•A large number of healthcare workers report more than four symptoms.•Those with physical symptoms had higher rates of depression, ...anxiety, stress, PTSD.•Those with physical symptoms had higher mean scores in the IES-R, DASS subscales.•Association between physical symptoms and psychological outcomes may be bidirectional.
Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers.
Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated.
Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54–5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36–3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27–7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12–4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales.
Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded.
•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.
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.
The recent COVID-19 pandemic has raised the visibility of health care workers to the level of public heroes. We study this phenomenon by exploring how nonphysician health care workers, who ...traditionally believed they were invisible and undervalued, perceive their newfound elevated status during the pandemic. Drawing from a qualitative study of 164 health care workers, we find that participants interpreted the sudden visibility and social valorization of their work as temporary and treated it with skepticism, incredulity, and as devoid of genuinely transformative power. We seek to contribute to the recent call to develop novel approaches to understanding the contours of the paradoxical nature of invisibility in the workplace by offering insights into what makes "invisible" workers accept or reject publicly driven elevation in their sudden social valorization.
Little is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.AimsWe examined the prevalence of mental ...disorders and alcohol misuse, whether this differed between serving and ex-serving regular personnel and by deployment status.
This is the third phase of a military cohort study (2014-2016; n = 8093). The sample was based on participants from previous phases (2004-2006 and 2007-2009) and a new randomly selected sample of those who had joined the UK armed forces since 2009.
The prevalence was 6.2% for probable post-traumatic stress disorder, 21.9% for common mental disorders and 10.0% for alcohol misuse. Deployment to Iraq or Afghanistan and a combat role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel.
The findings highlight an increasing prevalence of post-traumatic stress disorder and a lowering prevalence of alcohol misuse compared with our previous findings and stresses the importance of continued surveillance during service and beyond.
All authors are based at King's College London which, for the purpose of this study and other military-related studies, receives funding from the UK Ministry of Defence (MoD). S.A.M.S., M.J., L.H., D.P., S.M. and R.J.R. salaries were totally or partially paid by the UK MoD. The UK MoD provides support to the Academic Department of Military Mental Health, and the salaries of N.J., N.G. and N.T.F. are covered totally or partly by this contribution. D.Mu. is employed by Combat Stress, a national UK charity that provides clinical mental health services to veterans. D.MacM. is the lead consultant for an NHS Veteran Mental Health Service. N.G. is the Royal College of Psychiatrists' Lead for Military and Veterans' Health, a trustee of Walking with the Wounded, and an independent director at the Forces in Mind Trust; however, he was not directed by these organisations in any way in relation to his contribution to this paper. N.J. is a full-time member of the armed forces seconded to King's College London. N.T.F. reports grants from the US Department of Defense and the UK MoD, is a trustee (unpaid) of The Warrior Programme and an independent advisor to the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee (unpaid) of Combat Stress and Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid). S.W. is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, the Department of Health, Public Health England or the UK MoD.
The goal of this study was to investigate and identify risk factors for suicide among all active duty members of the US military during 2005 or 2007.
The study used a cross-sectional design and ...included the entire active duty military population. Study sample sizes were 2,064,183 for 2005 and 1,981,810 for 2007. Logistic regression models were used.
Suicide rates for all services increased during this period. Mental health diagnoses, mental health visits, selective serotonin reuptake inhibitors (SSRIs), sleep prescriptions, reduction in rank, enlisted rank, and separation or divorce were associated with suicides. Deployments to Operation Enduring Freedom or Operation Iraqi Freedom were also associated with elevated odds ratios for all services in the 2007 population and for the Army in 2005.
Additional research needs to address the increasing rates of suicide in active duty personnel. This should include careful evaluation of suicide prevention programs and the possible increase in risk associated with SSRIs and other mental health drugs, as well as the possible impact of shorter deployments, age, mental health diagnoses, and relationship problems.