US military suicides have increased substantially over the past decade and currently account for almost 20% of all military deaths. We investigated the associations of a comprehensive set of ...time-varying risk factors with suicides among current and former military service members.
We did a retrospective multivariate analysis of all US military personnel between 2001 and 2011 (n=110 035 573 person-quarter-years, representing 3 795 823 service members). Outcome was death by suicide, either during service or post-separation. We used Cox proportional hazard models at the person-quarter level to examine associations of deployment, mental disorders, history of unlawful activity, stressful life events, and other demographic and service factors with death by suicide.
The strongest predictors of death by suicide were current and past diagnoses of self-inflicted injuries, major depression, bipolar disorder, substance use disorder, and other mental health conditions (compared with service members with no history of diagnoses, the hazard ratio HR ranged from 1·4 95% CI 1·14-1·72 to 8·34 6·71-10·37). Compared with service members who were never deployed, hazard rates of suicide (which represent the probability of death by suicide in a specific quarter given that the individual was alive in the previous quarter) were lower among the currently deployed (HR 0·50, 95% CI 0·40-0·61) but significantly higher in the quarters following first deployment (HR 1·51 1·17-1·96 if deployed in the previous three quarters; 1·14 1·06-1·23 if deployed four or more quarters ago). The hazard rate of suicide increased within the first year of separation from the military (HR 2·49, 95% CI 2·12-2·91), and remained high for those who had separated from the military 6 or more years ago (HR 1·63, 1·45-1·82).
The increased hazard rate of death by suicide for military personnel varies by time since exposure to deployment, mental health diagnoses, and other stressful life events. Continued monitoring is especially needed for these high-risk individuals. Additional information should be gathered to address the persistently raised risk of suicide among service members after separation.
Partly funded by the Naval Research Program.
This Element reviews the evidence for three workplace conditions that matter for improving quality and safety in healthcare: staffing; psychological safety, teamwork, and speaking up; and staff ...health and well-being at work. The authors propose that these are environmental prerequisites for improvement. They examine the relationship between staff numbers and skills in delivering care and the attainment of quality of care and the ability to improve it. They present evidence for the importance of psychological safety, teamwork, and speaking up, noting that these are interrelated and critical for healthcare improvement. They present evidence of associations between staff well-being at work and patient outcomes. Finally, they suggest healthcare improvement should be embedded into the day-to-day work of frontline staff; adequate time and resources must be provided, with quality as the mainstay of professionals' work. Every day at every level, the working context must support the question 'how could we do this better?' This title is also available as Open Access on Cambridge Core.
Substantial media attention has focused on suicide among Canadian Public Safety Personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police). The attention has raised ...significant concerns about the mental health impact of public safety service, as well as interest in the correlates for risk of suicide. There have only been two published studies assessing lifetime suicidal behaviors among Canadian PSP. The current study was designed to assess past-year and lifetime suicidal ideation, plans, and attempts amongst a large diverse sample of Canadian PSP. Estimates of suicidal ideation, plans, and attempts were derived from self-reported data from a nationally administered online survey. Participants included 5,148 PSP (33.4% women) grouped into six categories (i.e., Call Centre Operators/Dispatchers, Correctional Workers, Firefighters, Municipal/Provincial Police, Paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported past-year and lifetime suicidal ideation (10.1%, 27.8%), planning (4.1%, 13.3%), or attempts (0.4%, 4.6%). Women reported significantly more lifetime suicidal behaviors than men (ORs = 1.15 to 2.62). Significant differences were identified across PSP categories in reports of past-year and lifetime suicidal behaviors. The proportion of Canadian PSP reporting past-year and lifetime suicidal behaviors was substantial. The estimates for lifetime suicidal behaviors appear consistent with or higher than previously published international PSP estimates, and higher than reports from the general population. Municipal/Provincial Police reported the lowest frequency for past-year and lifetime suicidal behaviors, whereas Correctional Workers and Paramedics reported the highest. The results provide initial evidence that substantial portions of diverse Canadian PSP experience suicidal behaviors, therein warranting additional resources and research.
Le nombre de suicides survenus parmi les membres du personnel de la sécurité publique (PSP) au Canada (PSP : les travailleurs de services correctionnels, répartiteurs, pompiers, ambulanciers et policiers) a fait l'objet d'une importante attention médiatique. Cette attention a suscité des préoccupations importantes concernant l'impact de la santé mentale du service de la sécurité publique, ainsi qu'un intérêt au niveau des corrélations avec les risques de suicide. Il n'y a eu que deux études publiées sur les comportements suicidaires au long d'une vie parmi les membres du personnel de la sécurité publique au Canada. L'étude actuelle a été conçue pour évaluer le nombre d'idées, de projets et de tentatives de suicide au cours de la dernière année et pendant toute une vie parmi un large échantillon diversifié de membres du personnel de sécurité publique canadien. Les estimations d'idées, de projets et de tentatives de suicide ont été calculées à partir de données autodéclarées provenant d'une enquête nationale effectuée en ligne. Les participants comprenaient 5 148 membres du PSP (dont 33,4% de femmes) regroupés en six catégories (c.-à-d. opérateurs/répartiteurs de centre d'appels, travailleurs de services correctionnels, pompiers, policiers municipaux et provinciaux, ambulanciers et agents de la Gendarmerie royale du Canada). D'importantes proportions de participants ont déclaré avoir été victimes d'idées suicidaires (10,1 %, 27,8 %), de projets suicidaires (4,1 %, 13,3 %) ou de tentatives suicidaires (0,4 %, 4,6 %). Les femmes ont signalé un nombre significativement plus élevé de comportements suicidaires au long de leur vie que les hommes (rapport des cotes = 1,15 à 2,62). Des différences significatives ont été relevées entre les différentes catégories de membres du PSP en ce qui a trait aux déclarations de comportements suicidaires au cours de la dernière année et tout au long d'une vie. La proportion de membres du PSP canadien ayant déclaré avoir été victime de comportements suicidaires au cours de la dernière année ou au long de leur vie était considérable. Les estimations de comportements suicidaires au long d'une vie semblent être cohérentes avec les estimations de PSP internationales publiées précédemment et plus élevées que les déclarations de la population générale. Les policier municipaux/provinciaux ont connu la plus basse fréquence de comportements suicidaires au cours de la dernière année et au long de leur vie alors que les travailleurs des services correctionnels et les ambulanciers ont connu la fréquence la plus haute. Ces résultats apportent des premières preuves à l'effet que des portions importantes de membres divers du PSP canadien affichent des comportements suicidaires, justifiant la nécessité de ressources et de recherches supplémentaires.
Frederick R. Gabriel graduated from medical school in 1940, entered the US Army, and was assigned to the newly-created 39th Station Hospital. His letters from the Pacific theater—especially ...from Guadalcanal, Angaur, and Saipan—capture the everyday life of a soldier physician. His son, Michael P. Gabriel, a professional historian, has faithfully preserved, edited, and annotated that correspondence to add a new dimension to our understanding of the social history of World War II, which he presents here in  Physician Soldier: The South Pacific Letters of Captain Fred Gabriel from the 39th Station Hospital .  Like most wartime hospitals, the 39th Station Hospital was positioned in a rear area and saw limited direct action. And like most wartime hospitals, the 39th Station Hospital spent each day confronting the injuries and casualties of frontline combat. Gabriel supervised a ward and oversaw the unit’s laboratory, serving a hospital that provided care to four hundred patients at a time. Gabriel’s letters home capture this experience and more, providing a revealing look into day-to-day life in the Pacific theater. He discusses the training of medical officers and female nurses, recreational activities such as Bob Hope’s USO show, and even his thoughts on the death of FDR, the end of the war in Europe, and ultimately the horrors of the atomic bomb.
Traces affective and aesthetic dimensions of medical imaging
technologies
Introduced in Phnom Penh around 1990, at the twilight of
socialism and after two decades of conflict and upheaval,
ultrasound ...took root in humanitarian and then privatized medicine.
Services have since multiplied, promising diagnostic information
and better prenatal and general health care. In Fixing the Image
Jenna Grant draws on years of ethnographic and archival research to
theorize the force and appeal of medical imaging in the urban
landscape of Phnom Penh. Set within long genealogies of technology
as tool of postcolonial modernity, and vision as central to skilled
diagnosis in medicine and Theravada Buddhism, ultrasound offers
stabilizing knowledge and elicits desire and pleasure, particularly
for pregnant women. Grant offers the concept of "fixing"-which
invokes repair, stabilization, and a dose of something to which one
is addicted-to illuminate how ultrasound is entangled with
practices of care and neglect across different domains. Fixing the
Image thus provides a method for studying technological practice in
terms of specific materialities and capacities of technologies-in
this case, image production and the permeability of the
body-illuminating how images are a material form of engagement
between patients, between patients and their doctors, and between
patients and their bodies.
In Project STAR, 11,571 students in Tennessee and their teachers were randomly assigned to classrooms within their schools from kindergarten to third grade. This article evaluates the long-term ...impacts of STAR by linking the experimental data to administrative records. We first demonstrate that kindergarten test scores are highly correlated with outcomes such as earnings at age 27, college attendance, home ownership, and retirement savings. We then document four sets of experimental impacts. First, students in small classes are significantly more likely to attend college and exhibit improvements on other outcomes. Class size does not have a significant effect on earnings at age 27, but this effect is imprecisely estimated. Second, students who had a more experienced teacher in kindergarten have higher earnings. Third, an analysis of variance reveals significant classroom effects on earnings. Students who were randomly assigned to higher quality classrooms in grades K-3—as measured by classmates' end-of-class test scores—have higher earnings, college attendance rates, and other outcomes. Finally, the effects of class quality fade out on test scores in later grades, but gains in noncognitive measures persist.
The suicide rate among US Army soldiers has increased substantially in recent years.
To estimate the lifetime prevalence and sociodemographic, Army career, and psychiatric predictors of suicidal ...behaviors among nondeployed US Army soldiers.
A representative cross-sectional survey of 5428 nondeployed soldiers participating in a group self-administered survey.
Lifetime suicidal ideation, suicide plans, and suicide attempts.
The lifetime prevalence estimates of suicidal ideation, suicide plans, and suicide attempts are 13.9%, 5.3%, and 2.4%. Most reported cases (47.0%-58.2%) had pre-enlistment onsets. Pre-enlistment onset rates were lower than in a prior national civilian survey (with imputed/simulated age at enlistment), whereas post-enlistment onsets of ideation and plans were higher, and post-enlistment first attempts were equivalent to civilian rates. Most reported onsets of plans and attempts among ideators (58.3%-63.3%) occur within the year of onset of ideation. Post-enlistment attempts are positively related to being a woman (with an odds ratio OR of 3.3 95% CI, 1.5-7.5), lower rank (OR = 5.8 95% CI, 1.8-18.1), and previously deployed (OR = 2.4-3.7) and are negatively related to being unmarried (OR = 0.1-0.8) and assigned to Special Operations Command (OR = 0.0 95% CI, 0.0-0.0). Five mental disorders predict post-enlistment first suicide attempts in multivariate analysis: pre-enlistment panic disorder (OR = 0.1 95% CI, 0.0-0.8), pre-enlistment posttraumatic stress disorder (OR = 0.1 95% CI, 0.0-0.7), post-enlistment depression (OR = 3.8 95% CI, 1.2-11.6), and both pre- and post-enlistment intermittent explosive disorder (OR = 3.7-3.8). Four of these 5 ORs (posttraumatic stress disorder is the exception) predict ideation, whereas only post-enlistment intermittent explosive disorder predicts attempts among ideators. The population-attributable risk proportions of lifetime mental disorders predicting post-enlistment suicide attempts are 31.3% for pre-enlistment onset disorders, 41.2% for post-enlistment onset disorders, and 59.9% for all disorders.
The fact that approximately one-third of post-enlistment suicide attempts are associated with pre-enlistment mental disorders suggests that pre-enlistment mental disorders might be targets for early screening and intervention. The possibility of higher fatality rates among Army suicide attempts than among civilian suicide attempts highlights the potential importance of means control (ie, restricting access to lethal means such as firearms) as a suicide prevention strategy.
•The relationships between health-promoting behaviors, such as maintaining a healthy weight, exercising, and not smoking, and psychological disorders have been widely studied in civilian ...populations.•Often, but not universally, higher adherence to healthy behaviors is associated with lower risk of psychological disorders. Similarly, those with these disorders often, but not always, benefit from higher adherence to healthy behaviors.•Military personnel are at higher risk than civilian populations for certain psychological disorders, notably post-traumatic stress disorder. However, they are also generally more physically healthy owing largely to the military culture of fitness.•We answered the question of whether, in an already fit and healthy, but psychologically at-risk population, such as military personnel, relationships between health behaviors and mental health are similar to those in civilian populations.•We found that certain behaviors, notably maintaining a healthy weight and obtaining adequate sleep, are related to better mental health, across the disorders studied.•Additionally, certain psychological disorders may benefit from a concurrent treatment approach that targets specific health behaviors, for example, cigarette smoking in anxiety.
Background Military personnel are at greater risk of psychological disorders and related symptoms than civilians. Limited participation in health-promoting behaviors may increase presence of these disorders. Alternatively, these symptoms may limit engagement in health-promoting behaviors.
Methods Self-reported data from the 2015 Department of Defense Health Related Behaviors Survey were used to assess bi-directional relationships between health-related behaviors (obesity, physical activity PA, alcohol, smoking, sleep) and self-reported psychological disorders (generalized anxiety disorder GAD, depression, post-traumatic disorder PTSD) in U.S. military personnel.
Outcomes Among 12 708 respondents (14.7% female; 28.2% 17−24 y; 13.7% obese), self-reported depression was reported by 9.2%, GAD by 13.9%, and PTSD by 8.2%. Obesity and short sleep were associated with self-reported depression, GAD, and PTSD; current smoking was associated with higher odds of GAD; higher levels of vigorous PA were associated with lower odds of GAD; higher levels of moderate PA associated with lower odds of PTSD; and higher alcohol intake associated with higher odds of depression and PTSD. Self-reported depression, GAD, and PTSD were associated with higher odds of short sleep, obesity, and low levels of PA.
Interpretation Obesity, short sleep, and limited engagement in health-promoting behaviors are associated with higher likelihood of self-reported psychological disorders, and vice-versa. Encouraging and improving health-promoting behaviors may contribute to positive mental health in military personnel.
In October and November 2020, we conducted a survey of 2,678 healthcare workers (HCWs) involved in general population immunisation in France, French-speaking Belgium and Quebec, Canada to assess ...acceptance of future COVID-19 vaccines (i.e. willingness to receive or recommend these) and its determinants. Of the HCWs, 48.6% (n = 1,302) showed high acceptance, 23.0% (n = 616) moderate acceptance and 28.4% (n = 760) hesitancy/reluctance. Hesitancy was mostly driven by vaccine safety concerns. These must be addressed before/during upcoming vaccination campaigns.
<!CDATAFor years, opponents of outsourcing have argued that offshoring American jobs destroys our local industries, lays waste to American job creation, and gives foreigners the good jobs and income ...that would otherwise remain on our shores. Yet few Americans realize that a parallel dynamic is occurring in the healthcare sector--previously one of the most consistent sources of stable, dependable living-wage jobs in the entire nation.
Instead of outsourcing high-paying jobs overseas--as the manufacturing and service sectors do--hospitals and other healthcare companies insource healthcare labor from developing countries, giving the jobs to people who are willing to accept lower pay and worse working conditions than U.S. healthcare workers. As Dr. Tulenko shows, insourcing has caused tens of thousands of high-paying local jobs in the healthcare sector to effectively vanish from the reach of U.S. citizens, weakened the healthcare systems of developing nations, and constricted the U.S. health professional education system. She warns Americans about what she's seeing--a stunning story they're scarcely aware of, which impacts all of us directly and measurably--and describes how to create better American health professional education, more high-paying healthcare jobs, and improved health for the poor in the developing world.>
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