Mental health care utilization and stigma in the military: comparison of Asian Americans to other racial groups.

Objective: To investigate race disparities in the US Military among Asian, White, Black, Native American and Other, seeking mental health care in the context of stigma defined by perceived damage to career.Design: Using 2008 survey data taken from US military personnel, mental disorders including depression, generalized anxiety disorder, suicidal ideation, suicidal attempt and post-traumatic stress disorder serious psychological distress (as defined in Kessler - 6), as well as seeking mental health care in past 12 months and stigma were dichotomized and weighted logistic regression models were used.Results: A significant race disparity existed in seeking mental health care when data were stratified by stigma and depression adjusted for demographic variables. Compared to Asians with depression that perceived stigma, Blacks were more likely to seek mental health care (OR with 95% confidence interval for Asians: 3.97[2.21, 7.15], Black: 9.25[6.02, 14.20], p < .005) adjusting for demographic variables. Similar results held for other mental disorders with the exception of suicide attempts and serious psychological distress. Compared to Asians with serious psychological distress who did not perceive stigma, only Whites were more likely to seek mental health care (OR for Asians: 3.27[2.15, 4.97], White: 6.47[4.60, 9.11], p < .005). Among those without a mental health disorder, regardless of the presence or absence of perceived stigma, there was no disparity between any two race groups in seeking mental health care.Conclusion: Among individuals having perceived stigma with mental health disorders, Asian American active-duty personnel may be less likely to use mental health care when compared to non-Asian peers.

Contraceptive prescriptions for US servicewomen, 2008-2013.

OBJECTIVE: To determine the proportion and characteristics of US servicewomen who were prescribed contraception between 2008 and 2013 and to estimate the prevalence of contraceptive utilization among women who deployed during the surveillance period. STUDY DESIGN: This is a descriptive study of all servicewomen of child-bearing potential serving in the active component of the US armed forces at any time between 2008 and 2013. We estimated contraceptive utilization status using pharmacy, procedural and diagnostic codes as recorded in the Defense Medical Surveillance System and Pharmacy Data Transaction Service. Estimates of contraceptive utilization were compared by demographic and military variables, including deployment status. Poisson regression with robust error variance was used to estimate adjusted prevalence ratios and 95% confidence intervals. RESULTS: Among eligible servicewomen (N=375,847), 68.7% received at least one form of contraception during the surveillance period. Contraceptive methods included short acting only (55.6%), long-acting (11.9%), permanent (1.0%) and barrier methods (0.2%). An additional 8.2% received counseling services only without an associated procedure or prescription. After adjusting by several demographic variables, receipt of contraception was highest among women aged 25-29 years and lowest among those aged 17-19 and 45-49 years. Receipt of any contraception was similar across racial/ethnic groups, although Hispanic and black, non-Hispanic women were more likely to receive long-acting reversible contraception. Of those who deployed (N=131,597), 53.6% received contraception before or during their deployment, with 7.9% using long-acting contraception. CONCLUSION: US servicewomen utilize contraception at high levels, with few demographic disparities. Gaps still exist, especially among the youngest women and around the time of deployment. IMPLICATIONS: US servicewomen are prescribed contraception at high levels, but utilization is lower in the youngest servicewomen and around the time of deployment. Such data provide opportunities for development and evaluation of interventions designed to improve access to contraceptive services for all servicewomen and to reduce the rate of unintended pregnancy.

Risk of Mental Health Disorders Following an Initial Diagnosis of Postpartum Depression, Active Component, U.S. Armed Forces, 1998-2010.

Postpartum depression (PPD) is one of the most common psychiatric conditions of the postpartum period. Several studies have found an association between PPD and other mental health disorders. The Defense Medical Surveillance System (DMSS) was used to identify a cohort of primiparous service women with PPD between 1998 and 2010 and match them by month of delivery to a cohort of women without PPD. During the surveillance period, there were 5,203 incident cases of PPD with a crude rate of 44.9 per 1,000 person-years. Individuals in the PPD cohort, when compared to their matched controls, were at higher risk for subsequent depressive disorders (adjusted hazard ratio [HR]: 7.3 [95% CI: 5.2-10.3]), anxiety disorders (adjusted HR: 3.2 [95% CI: 2.5-4.0]), and bipolar disorders (adjusted HR: 4.7 [95% CI: 1.9-11.9]). There were higher rates of these mental health diagnoses among individuals who eventually left service. Early screening, support, and treatment are essential during this vulnerable postpartum time frame to preserve the female fighting force.

Notes from the field: investigation of contacts of a health care worker who worked while ill with pertussis--Maryland, August-September 2014.

On September 5, 2014, the public health department of a Maryland hospital was notified of a case of Bordetella pertussis infection confirmed by polymerase chain reaction (PCR) in a staff health care worker (HCW). The HCW experienced onset of diarrhea and malaise (nonrespiratory symptoms atypical of the catarrhal phase of pertussis) on August 26. By September 2, paroxysms of coughing led the HCW to consult a colleague, who ordered the PCR test, prescribed a 5-day course of azithromycin, and advised avoidance of patient care until treatment completion. Contrary to the hospital's infection control policy, neither the HCW nor the colleague reported the presumptive diagnosis of pertussis to the hospital's public health department. The HCW continued to work in the outpatient department until the positive PCR result was received on September 5, at which time the hospital's public health department was first notified. The hospital barred the HCW from further work at the hospital while ill, and, in collaboration with local and state public health counterparts, began a contact investigation and stratified patient and HCW contacts by level of exposure.