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.
Whether traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder (PTSD) has been difficult to determine because of the prevalence of comorbid conditions, overlapping symptoms, ...and cross-sectional samples.
To examine the extent to which self-reported predeployment and deployment-related TBI confers increased risk of PTSD when accounting for combat intensity and predeployment mental health symptoms.
As part of the prospective, longitudinal Marine Resiliency Study (June 2008 to May 2012), structured clinical interviews and self-report assessments were administered approximately 1 month before a 7-month deployment to Iraq or Afghanistan and again 3 to 6 months after deployment. The study was conducted at training areas on a Marine Corps base in southern California or at Veterans Affairs San Diego Medical Center. Participants for the final analytic sample were 1648 active-duty Marine and Navy servicemen who completed predeployment and postdeployment assessments. Reasons for exclusions were nondeployment (n = 34), missing data (n = 181), and rank of noncommissioned and commissioned officers (n = 66).
The primary outcome was the total score on the Clinician-Administered PTSD Scale (CAPS) 3 months after deployment.
At the predeployment assessment, 56.8% of the participants reported prior TBI; at postdeployment assessment, 19.8% reported sustaining TBI between predeployment and postdeployment assessments (ie, deployment-related TBI). Approximately 87.2% of deployment-related TBIs were mild; 250 of 287 participants (87.1%) who reported posttraumatic amnesia reported less than 24 hours of posttraumatic amnesia (37 reported ≥ 24 hours), and 111 of 117 of those who lost consciousness (94.9%) reported less than 30 minutes of unconsciousness. Predeployment CAPS score and combat intensity score raised predicted 3-month postdeployment CAPS scores by factors of 1.02 (P < .001; 95% CI, 1.02-1.02) and 1.02 (P < .001; 95% CI, 1.01-1.02) per unit increase, respectively. Deployment-related mild TBI raised predicted CAPS scores by a factor of 1.23 (P < .001; 95% CI, 1.11-1.36), and moderate/severe TBI raised predicted scores by a factor of 1.71 (P < .001; 95% CI, 1.37-2.12). Probability of PTSD was highest for participants with severe predeployment symptoms, high combat intensity, and deployment-related TBI. Traumatic brain injury doubled or nearly doubled the PTSD rates for participants with less severe predeployment PTSD symptoms.
Even when accounting for predeployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of postdeployment PTSD symptoms.
For decades, military assistance in southern Somalia focused on building up a central state army. This reflects standard patterns of Western assistance worldwide. Yet the nature of Somali society and ...clan, greatly affected by the winnowing process of more than 30 years of conflict, means that most sub-clan groupings are more militarily effective than centralised forces deployed to unfamiliar areas. The centralised Somali National Army remains riven by clan itself, thoroughly politicised, and ineffective (with the exception of the Danab special forces). Based on fieldwork and interviews with military personnel who work in Somalia, Colin D Robinson and Jahara Matisek argue that these locally appropriate forces deserve assistance, albeit with some caveats, in the continuing struggle against Al-Shabaab.◼
When the First Crusade ended with the conquest of Jerusalem in 1099, jubilant crusaders returned home to Europe bringing with them stories, sacred relics, and other memorabilia, including banners, ...jewelry, and weapons. In the ensuing decades, the memory of the crusaders' bravery and pious sacrifice was invoked widely among the noble families of western Christendom. Popes preaching future crusades would count on these very same families for financing, leadership, and for the willing warriors who would lay down their lives on the battlefield. Despite the great risks and financial hardships associated with crusading, descendants of those who suffered and died on crusade would continue to take the cross, in some cases over several generations. Indeed, as Nicholas L. Paul reveals inTo Follow in Their Footsteps, crusading was very much a family affair.
Scholars of the crusades have long pointed to the importance of dynastic tradition and ties of kinship in the crusading movement but have failed to address more fundamental questions about the operation of these social processes. What is a "family tradition"? How are such traditions constructed and maintained, and by whom? How did crusading families confront the loss of their kin in distant lands? Making creative use of Latin dynastic narratives as well as vernacular literature, personal possessions and art objects, and architecture from across western Europe, Paul shows how traditions of crusading were established and reinforced in the collective memories of noble families throughout the twelfth and thirteenth centuries. Even rulers who never fulfilled crusading vows found their political lives dominated and, in some ways, directed by the memory of their crusading ancestors. Filled with unique insights and careful analysis,To Follow in Their Footstepsreveals the lasting impact of the crusades, beyond the expeditions themselves, on the formation of dynastic identity and the culture of the medieval European nobility.
Recent evidence indicates a high prevalence of child abuse exposure in modern US veterans, which may explain in part their higher likelihood of suicide relative to civilians. However, the ...relationship between child abuse exposure and suicide-related outcomes in military personnel relative to civilians is unknown. Furthermore, the associations among deployment-related trauma, child abuse exposure, and suicide-related outcomes in military personnel have not been examined.
To determine whether child abuse exposure is more prevalent in Canadian Armed Forces (CAF) personnel compared with the Canadian general population (CGP); to compare the association between child abuse exposure and suicidal ideation, suicide plans, and suicide attempts among the CAF and CGP; and to determine whether child abuse exposure has an additive or interaction effect on the association of deployment-related trauma and past-year suicidal ideation and suicide plans among Regular Forces personnel.
Data were collected from the following 2 nationally representative data sets: the 2013 Canadian Forces Mental Health Survey (CFMHS) for the CAF (8161 respondents; response rate, 79.8%) and the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH) for the CGP (23,395 respondents; response rate, 68.9% of these, 15,981 age-matched participants were drawn). Data were collected from April 15 to August 31, 2013, for the CFMHS and January 2 to December 31, 2012, for the CCHS-MH. Data were analyzed from October 2014 to October 22, 2015. Statistical weights were applied to both data sets.
Child abuse exposure, including physical abuse, sexual abuse, and exposure to intimate partner violence, and deployment-related trauma were assessed in relation to suicide-related outcomes.
Data were analyzed from 24 142 respondents aged 18 to 60 years (Regular Forces, 86.1% male and 13.9% female; Reserve Forces, 90.6% male and 8.9% female; and CGP, 49.9% male and 50.1% female). Any child abuse exposure was higher in the Regular Forces (47.7%; 95% CI, 46.4%-49.1%) and Afghanistan mission-deployed Reserve Forces (49.4%; 95% CI, 46.3%-51.5%) compared with the CGP (33.1%; 95% CI, 31.8%-34.4%). All types of child abuse exposures were associated with increased odds of suicidal ideation, suicide plans, and suicide attempts in the CGP (range of adjusted odds ratios AORs, 3.0 95% CI, 2.3-3.9 to 7.7 95% CI, 5.7-10.3; P < .05) and CAF (range of AORs, 1.7 95% CI, 1.0-2.9 to 6.3 95% CI, 4.2-9.5; P < .05), with many associations significantly weaker in military personnel relative to civilians. Additive effects for past-year suicide ideation (AOR, 2.7; 95% CI, 1.8-4.2) and past-year suicide plans (AOR, 4.6; 95% CI, 2.3-9.2) but not interactive effects for past-year suicide ideation (AOR, 1.2; 95% CI, 0.7-2.2) and past-year suicide plans (AOR, 0.8; 95% CI, 0.3-2.2) were noted between deployment-related trauma and child abuse exposure among Regular Forces personnel.
Individuals with a child abuse history may be more likely to enter the military, and child abuse exposure may increase the likelihood of suicide-related outcomes. Prevention efforts targeting child abuse may reduce suicide-related outcomes.
Introduction Insomnia is prevalent among Service Members (SMs) and Veterans and affected by interpersonal processes. This project explored how attachment style and perceived social support (SS) ...influence insomnia in military personnel. Analyses focused on appraisal type SS because the perception of available others may attenuate feelings of loneliness and stress, which negatively impact sleep. We hypothesized greater SS would be associated with lower insomnia severity for people with lower and greater anxious attachment, but only for those with lower avoidant attachment. We also hypothesized SS would mediate the relationship between anxious, but not avoidant attachment, and insomnia severity. Methods Ninety-nine SMs and Veterans (aged 19-67) completed self-report measures of attachment style, SS, and insomnia severity. Linear regression evaluated the main and interaction effects of attachment style and SS on insomnia. PROCESS in SPSS was used to examine mediating effects of SS. Anxious and avoidant attachment were examined separately. Results Anxious attachment, avoidant attachment, and SS were independently associated with insomnia severity (β=.29, β=.29, β=-.36; p<.01). Anxious attachment and SS better predicted insomnia severity than anxious attachment alone (ΔR2=.11, ΔF=12.51, p=.001). Similar findings emerged for avoidant attachment and SS (ΔR2=.10, ΔF=11.72, p=.001). Findings were not significant after adjusting for age, childhood trauma, and current PTSD and mood disorders. The interaction of anxious attachment by SS and avoidant attachment by SS on insomnia severity were not significant. SS partially mediated the relationship between anxious attachment and insomnia severity (indirect effect=.074, CI=.008,.154), but did not mediate the relationship between avoidant attachment and insomnia severity. Conclusion Findings are consistent with literature linking lower anxious attachment or greater SS with better sleep among military personnel. Results show an association between avoidant attachment and subjectively reported insomnia severity, additive effects of anxious or avoidant attachment and SS on insomnia severity, and a mediating role of SS on the relationship between anxious attachment and insomnia severity. As SS is modifiable, enhancement of SS in treatment of insomnia may yield increased benefits for SMs and Veterans. Support (If Any) DOD CDMRP & MOMRP (PR054993, PT073961, Log#11293006 (PI: Germain)
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