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Objectives. Our objective was to analyze the association between deployment characteristics and diagnostic rates for major depression and substance use disorder among active duty personnel.

Objectives. Our objective was to analyze the association between deployment characteristics and diagnostic rates for major depression and substance use disorder among active duty personnel.

This abbreviated version provided by author request. ; The article of record as published may be found at http://dx.doi.org/10.1016/S2215-0366(16)30304-2 ; Background U.S. military suicides have increased significantly 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 service members. Methods Retrospective multivariate analysis of all U.S. military personnel between 2001-2011 (N=110,035,573 person-quarters, representing 3,795,823 service members). Outcome was death by suicide, either during service or post-separation. Cox proportional hazard models at the person-quarter level were used to examine associations of deployment, mental disorders, history of unlawful activity, stressful life events, and other demographic and service factors with suicide death. Findings The strongest predictors of suicide were current and past diagnoses of self-inflicted injuries, major depression, bipolar disorder, substance use disorder, and other mental health conditions (comparing to those with no history of diagnoses, hazard ratio, HR, ranged from 1.4 [CI, 1.14- 1.72] to 8.34 [CI, 6.71-10.37]). Compared to those never deployed, hazards were lower among the currently-deployed (HR=0.50; CI,0.40-0.61) but significantly higher in the quarters following first deployment (HR=1.51; CI, 1.17-1.96). Hazard of suicide was elevated within the first year of separation from the military (HR=2.49; CI,2.12-2.91), and remained high for those who separated 6 or more years ago (HR=1.63; CI,1.45-1.82). Interpretation Elevated hazard of suicide death varies by time-since-exposure to deployment, mental health diagnoses, and other stressful life events. Continued monitoring is particularly needed for these high-risk individuals. Additional information should be gathered to address the persistent elevated risks of suicides among service members after separation.

This study used the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel to determine whether traumatic brain injury (TBI) is associated with past year drinking-related consequences. The study sample included currently-drinking personnel who had a combat deployment in the past year and were home for ≥6 months (N = 3,350). Negative binomial regression models were used to assess the incidence rate ratios of consequences, by TBI-level. Experiencing a TBI with a loss of consciousness >20 minutes was significantly associated with consequences independent of demographics, combat exposure, posttraumatic stress disorder, and binge drinking. The study's limitations are noted.

This study estimates the effect of deployment location and length on the risk of developing PTSD, relative to what it would normally be from the normal military operations. We use a random sample of activity-duty enlisted personnel serving between 2001 and 2006. We identify PTSF cases from TRICARE medical records and link deployment information from Contingency Tracking System. Comparing to those in other duties around the world, deployment to Iraq/Afghanistan increases the odds of developing PTSD substantially, with the largest effect observed for the Navy (OR=0.06, p<0.01) and the smallest for the Air Force (OR=1.25, p<0.01). A deployment longer that 180 days increases the odds of PTSD by 1.11 times to 2.84 times, depending on the service, compared to a tour under 120 days. For Army and Navy, a deployment to Iraq/Afghanistan further exacerbates the adverse effect of tour length. Our research identifies the extent of PTSD across services and quantifies the adverse effect of tour length. Our research identifies the extent of PTSD across services and quantifies the risks associated with OEF/OIF deployment intensity. Further research is needed for effective monitoring and preventitive measures of PTSD on the active duty population.

An association between combat exposure and postdeployment behavioral health problems has been demonstrated among U.S. military service members returning from Afghanistan or Iraq in predominantly male samples, yet few studies have focused on the experiences of women. Using data from the longitudinal, observational Substance Use and Psychological Injury Combat (SUPIC) study, this study explored the self-report of 4 combat exposure items and postdeployment behavioral health screening results for 42,397 Army enlisted women who returned from Afghanistan or Iraq from fiscal years 2008 through 2011. We ran multivariate logistic regression models to examine how a constructed composite combat exposure score (0, 1, 2, 3+) was associated with screening positive postdeployment for posttraumatic stress disorder (PTSD), depression, or at-risk drinking among active duty (AD) and National Guard/Reserve (NG/R) women. AD and NG/R women commonly reported being wounded, injured, assaulted, or hurt (17.3% and 29.0%, respectively). In all 6 multivariate models, Army women with any report of combat exposure had increased odds of the behavioral health problem (i.e., PTSD, depression, or at-risk drinking). The magnitude of the association between combat exposure and PTSD was most striking, indicating increased odds of PTSD as combat exposure score increased. AD and NG/R women with a combat exposure score of 3+ had increased odds of PTSD, 20.7, 95% CI [17.0, 25.1] and 27.8, 95% CI [21.0, 36.9], respectively. Women who reported combat exposure may benefit from early prevention and confidential intervention to promote postdeployment health and reduce long-term behavioral health problems.

Purpose. To assess the status of U.S. military retirees and their spouses 38 to 64 years of age relative to select Healthy People 2010 objectives and to identify sociodemographic characteristics associated with select health behaviors. Design. Cross-sectional analyses with self-reported standardized measures from the U.S. Department of Defense Population Health Survey, 2003. Setting. The continental United States. Subjects. U.S. military retirees and their spouses 38 to 64 years of age. Measures. Data for this study were self-reported responses to the Population Health Survey. Dichotomous variables were created to indicate whether each Healthy People 2010 objective had been met. Each objective was measurable with the survey by using the definitions set forth in Healthy People 2010. These objectives included healthy weight and obesity based on body mass index (height and weight); daily fruit, vegetable, and grain-product consumption; physical inactivity, moderate physical activity, and vigorous physical activity; binge drinking; cigarette use; and smoking-cessation attempts. Results. The study population did not meet any of the Healthy People 2010 objectives included in this study. Sociodemographic characteristics that were associated with this result included being male, not having a college degree, and a less-than-excellent self-reported general health status. Conclusion. Health-promotion interventions are needed to improve the health status of this population and to achieve the goals set forth in Healthy People 2010.

OBJECTIVES: To determine the proportion of Army soldiers who utilized care in the Veterans Health Administration (VHA) Polytrauma System of Care (PSC) within the post-deployment year, and to describe prevalence of polytrauma diagnoses, and receipt of opioids, nonpharmacologic treatments (NPT), and mental health treatments in the VHA during the year following first PSC utilization. SETTING: VHA's four-tiered integrated PSC network of specialized rehabilitation services for military members and veterans with polytrauma. PARTICIPANTS: Soldiers and veterans who used the PSC during the post-deployment year after an Afghanistan or Iraq deployment ending in fiscal years 2008–2011. DESIGN: Population-based cohort study MAIN MEASURES: Prevalence of polytrauma diagnoses (i.e., traumatic brain injury [TBI], posttraumatic stress disorder [PTSD], and chronic pain), VHA utilization rates of opioid prescriptions, NPT, and specialty mental health treatment within one year of PSC utilization. RESULTS: 2.6% of the sample (n=16,590) used the PSC during the post-deployment year. Among PSC users, chronic pain (76.5%), PTSD (53.1%), and TBI (48.6%) were common and more frequently found together than in isolation. 26.6% filled an opioid prescription, 35.5% received at least one NPT, and 83.8% received specialty mental health treatment in the VHA within one year of PSC utilization. CONCLUSION: Chronic pain was the most common polytrauma condition among PSC users, highlighting the importance of incorporating interdisciplinary pain management approaches within the PSC, with an effort to reduce reliance on long-term opioid therapy and improve rehabilitation.

Background: Chronic low-back pain (LBP) is a frequent cause of work absence and disability, and is frequently associated with long-term use of opioids. Objective: To describe military readiness-related outcomes at follow-up in soldiers with LBP grouped by the type of early treatment received for their LBP. Treatment groups were based on receipt of opioid or tramadol prescription and receipt of nonpharmacologic treatment modalities (NPT). Design, Subjects, Measures: A retrospective longitudinal analysis of U.S. soldiers with new LBP episodes persisting more than 90 days between October 2012 and September 2014. Early treatment groups were constructed based on utilization of services within 30 days of the first LBP claim. Outcomes were measured 91–365 days after the first LBP claim. Outcomes were constructed to measure five indicators of limitations of military readiness: military duty limitations, pain-related hospitalization, emergency room visit for LBP, pain score of moderate/severe, and prescription for opioid/tramadol. Results: Among soldiers with no opioid receipt in the prior 90 days, there were 30,612 new episodes of LBP, which persisted more than 90 days. Multivariable logistic regression models found that compared to the reference group (no NPT, no opioids/tramadol receipt), soldiers who received early NPT-only had lower likelihoods for military duty limitations, pain-related hospitalization, and opioid/tramadol prescription at follow-up, while soldiers' that started with opioid receipt (at alone or follow-up in conjunction with NPT) exhibited higher likelihoods on many of these negative outcomes. Conclusion: This observational study of soldiers with a new episode of LBP and no opioid receipt in the prior 90 days suggests that early receipt of NPT may be associated with small, significant gains in ability to function as a soldier and reduced reliance on opioid/tramadol medication. While further research is warranted, increased access to NPT at the beginning of LBP episodes should be considered.

Little is known about the rates and predictors of substance use treatment received in the Military Health System among Army soldiers diagnosed with a postdeployment substance use disorder (SUD). We used data from the Substance Use and Psychological Injury Combat study to determine the proportion of active duty (n=338,708) and National Guard/Reserve (n=178,801) enlisted soldiers returning from an Afghanistan/Iraq deployment in fiscal years 2008 to 2011 who had a SUD diagnosis in the first 150 days postdeployment. Among soldiers diagnosed with a SUD, we examined the rates and predictors of substance use treatment initiation and engagement according to the Healthcare Effectiveness Data and Information Set criteria. In the first 150 days postdeployment 3.3% of active duty soldiers and 1.0% of National Guard/Reserve soldiers were diagnosed with a SUD. Active duty soldiers were more likely to initiate and engage in substance use treatment than National Guard/Reserve soldiers, yet overall, engagement rates were low (25.0% and 15.7%, respectively). Soldiers were more likely to engage in treatment if they received their index diagnosis in a special behavioral health setting. Efforts to improve substance use treatment in the Military Health System should include initiatives to more accurately identify soldiers with undiagnosed SUD. Suggestions to improve substance use treatment engagement in the Military Health System will be discussed.

SUPIC will examine whether early detection and intervention for post-deployment problems among Army Active Duty and National Guard/Reservists returning from Iraq or Afghanistan are associated with improved long-term substance use and psychological outcomes. This paper describes the rationale and significance of SUPIC, and presents demographic and deployment characteristics of the study sample (N=643,205), and self-reported alcohol use and health problems from the subsample with matched post-deployment health assessments (N=487,600). This longitudinal study aims to provide new insight into the long-term post-deployment outcomes of Army members by combining service member data from the Military Health System and Veterans Health Administration.