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A meta-analysis of 25 epidemiological studies estimated the prevalence of recent Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) major depression (MD) among U.S. military personnel. Best estimates of recent preva...
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A meta-analysis of 25 epidemiological studies estimated the prevalence of recent Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) major depression (MD) among U.S. military personnel. Best estimates of recent prevalence (standard error) were 12.0% (1.2) among currently deployed, 13.1% (1.8) among previously deployed, and 5.7% (1.2) among never deployed. Consistent correlates of prevalence were being female enlisted, young (ages 17:25), unmarried, and having less than a college education. Simulation of data from a national general population survey was used to estimate expected lifetime prevalence of MD among respondents with the sociodemographic profile and none of the enlistment exclusions of Army personnel. In this simulated sample, 16.2% (3.1) of respondents had lifetime MD and 69.7% (8.5) of first onsets occurred before expected age of enlistment. Numerous methodological problems limit the results of the meta-analysis and simulation. The article closes with a discussion of recommendations for correcting these problems in future surveillance and operational stress studies.
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Over the course of the last year, the study team received IRB approval and began recruiting participants at five of the six study sites (Joint Base Lewis-McChord, Ft. Bliss, Ft. Campbell, Ft. Carson, and Ft. Stewart). As of August...
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Over the course of the last year, the study team received IRB approval and began recruiting participants at five of the six study sites (Joint Base Lewis-McChord, Ft. Bliss, Ft. Campbell, Ft. Carson, and Ft. Stewart). As of August 31, 2012, 368 total referrals across the five active sites had been received; 179 participants had been enrolled and randomized into the study (86 participants into the STEPS UP arm; 93 participants into the optimized usual care arm); 53 participants completed the 3-month follow-up assessment; and 6 participants completed the 6-month follow-up. We are awaiting HRPO approval of our final site (Ft. Bragg); we anticipate beginning recruitment at Ft. Bragg in September 2012. Multiple amendments have been approved by the WRNMMC IRB, including an amendment that revised eligibility criteria and updated data collection forms. The study intervention has been refined to include a web-based care management support tool; nurse-assisted web- based cognitive-behavioral therapy options for PTSD and depression; a modularized telephonic cognitive-behavioral therapy option for PTSD and depression; and a preference-based stepped care approach to primary care PTSD and depression treatment sequencing. We have continued to hire and train site and centralized personnel.
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Although documentation that war inflicts psychological casualties dates back to the American Civil War, most research began after the Vietnam conflict, when studies focused primarily on posttraumatic stress disorder (PTSD). With o...
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Although documentation that war inflicts psychological casualties dates back to the American Civil War, most research began after the Vietnam conflict, when studies focused primarily on posttraumatic stress disorder (PTSD). With ongoing conflicts in Iraq and Afghanistan, there has been significant research to illuminate the epidemiology of war-related psychological casualties. Significant findings include an appreciation for the role combat plays in the development of mental disorders, including PTSD, depression, alcohol misuse, somatic symptoms, and others. Recent research has endeavored to understand and improve psychological resilience to temper the negative effects of combat on mental health. With over 2 million U.S. service members involved in the Iraq/Afghanistan conflicts, military mental health practitioners have observed a dramatic increase in the number of U.S. service members who have obtained care. Additionally, the Department of Defense has aggressively worked to improve mental health care. The Department of Veterans Affairs has seen increases in veterans seeking care for mental disorders, and it is adapting staffing levels to meet current and future needs. Scientists will continue efforts to better understand the determinants and prevention of combat-related mental disorders, and they will work with clinicians who strive to improve services and treatment modalities for veterans.
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Background: An important medical concern of the Iraq war is the potential long-term effect of mild traumatic brain injury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related mild traumat...
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Background: An important medical concern of the Iraq war is the potential long-term effect of mild traumatic brain injury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related mild traumatic brain injury is poorly understood. Methods: We surveyed 2525 U.S. Army infantry soldiers 3 to 4 months after their return from a year-long deployment to Iraq. Validated clinical instruments were used to compare soldiers reporting mild traumatic brain injury, defined as an injury with loss of consciousness or altered mental status (e.g., dazed or confused), with soldiers who reported other injuries. Results: Of 2525 soldiers, 124 (4.9%) reported injuries with loss of consciousness, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting loss of consciousness, 43.9% met criteria for post-traumatic stress disorder (PTSD), as compared with 27.3% of those reporting altered mental status, 16.2% with other injuries, and 9.1% with no injury. Soldiers with mild traumatic brain injury, primarily those who had loss of consciousness, were significantly more likely to report poor general health, missed workdays, medical visits, and a high number of somatic and postconcussive symptoms than were soldiers with other injuries. However, after adjustment for PTSD and depression, mild traumatic brain injury was no longer significantly associated with these physical health outcomes or symptoms, except for headache. Conclusions: Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems.
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摘要 :
Studies of soldiers from prior wars conducted many years after combat have shown associations between combat-related posttraumatic stress disorder (PTSD) and physical health problems. The current Iraqi War has posed a considerable...
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Studies of soldiers from prior wars conducted many years after combat have shown associations between combat-related posttraumatic stress disorder (PTSD) and physical health problems. The current Iraqi War has posed a considerable PTSD risk, but the association with physical health has not been well studied. The authors studied 2,863 soldiers using standardized self- administered screening instruments 1 year after their return from combat duty in Iraq. Among all participants, 16.6% met the screening criteria for PTSD. PTSD was significantly associated with lower ratings of general health, more sick call visits, more missed workdays, more physical symptoms, and high somatic symptom severity. These results remained significant after controlling for wounds and injuries. The authors conclude that the high prevalence of PTSD and its strong association with physical health problems among Iraqi War veterans have important implications for the delivery of medical services to these veterans. The medical burden of PTSD includes physical health problems; combat veterans with serious somatic concerns should be evaluated for PTSD.
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The 12-month prevalence of common mental illnesses in the United States is estimated to be 26 percent, accounting for a large and increasing fraction of all disability in the U.S. general population. The U.S. military is frequentl...
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The 12-month prevalence of common mental illnesses in the United States is estimated to be 26 percent, accounting for a large and increasing fraction of all disability in the U.S. general population. The U.S. military is frequently called upon as the first line of response or defense in conflicts and disasters, often resulting in service members' separation from family or home life for extended periods of time. Reports have suggested that personnel involved in combat operations or peacekeeping missions following combat may have increased symptoms of psychological distress, with one report recently suggesting significant risk of mental health problems after combat duty in Iraq and Afghanistan. The mental health of military service members affects organizational productivity and effectiveness and is of great importance to the U.S. military for retention, readiness, and mission capability. In this report, the authors describe the baseline prevalence of mental disorders in a large U.S. military cohort, the Millennium Cohort, that will be longitudinally followed until 2022. Using crude and weighted prevalence and multivariable logistic regression, the mental health morbidity of the Millennium Cohort is reported for a variety of demographic characteristics. The findings suggest a mentally healthier population than other comparison populations. However, the higher prevalence of alcohol abuse and the disproportionately higher burden of mental disorders among some subgroups -- members who are female, younger, less educated, single, White (non-Hispanic), short-term service, enlisted, and Army - - should prompt further clinical investigation and intervention. Further coordination between primary care providers, mental health specialists, and researchers is necessary to identify and prioritize critical areas for research and improvement of clinical services to protect the mental health of the U.S. military.
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