Holding and rupture: Describing post-traumatic stress among former UK Army and Royal Marine personnel deployed to Iraq and Afghanistan.

Former UK military personnel who were previously deployed to Iraq and Afghanistan in combat roles have exhibited elevated levels of Post-Traumatic Stress Disorder (PTSD) compared to other groups. The present qualitative analyses used semi-structured interviews and a framework analysis to compare the experiences of symptomatic (N=10) and asymptomatic (N=7) former Army and Royal Marine personnel who were exposed to combat. Participants were drawn from a large UK military health and wellbeing cohort study and were sampled based upon probable PTSD status using scores from the PTSD Checklist-Civilian Version (PCL-C). All symptomatic participants attributed the development of post-traumatic stress to deployment events, with one additionally ascribing symptoms to childhood events. Among the participants, post-traumatic stress was temporarily buffered, and held at bay, by the holding function of various military structures, including the military collective; cultural and ethical frameworks that helped to organise traumatic experiences; an operational necessity for psychological compartmentalisation and even the distraction of deployment itself. Leaving the military appeared to elicit a global rupture of these supports. As a result, the military-to-civilian transition led to an intensification of post-traumatic stress, including deployment-related memories, among the symptomatic participants. In contrast, asymptomatic participants tended to report continuity of their holding structures across the lifespan, especially across the military-to-civilian transition. The onset and maintenance of post-traumatic stress may thus be explained by an interplay between the capacity of holding structures and the magnitude of lifetime rupture. Overall, findings might provide an explanation for the widening discrepancies between those with enduring post-traumatic stress and those without and further research is required to determine the fit of our findings for other groups and contexts. This approach further illustrates the need to situate individual experiences of post-traumatic stress in wider structural, ecological, cultural and ethical contexts.

Morbidity burdens attributable to various illnesses and injuries among deployed active and reserve component service members of the U.S. Armed Forces, 2023.

This report updates previous analyses of health care burden distributions among active and reserve component service members of the U.S. Armed Forces in deployed settings. Musculoskeletal disorders in combination with administrative and other health services (ICD-10 "Z" codes) accounted for more than half of all medical encounters in 2023 among service members deployed to the U.S. Central Command (CENTCOM) and Africa Command (AFRICOM). Three common injury conditions occurred among male and female service members deployed to U.S. CENTCOM and U.S. AFRICOM: other back problems, arm and shoulder injuries, and knee injuries.

Medical evacuations out of U.S. Central and Africa commands among the active and reserve components of the U.S. Armed Forces, 2023

This report summarizes the nature, numbers, and trends of conditions for which military members were medically evacuated from the U.S. Central Command (CENTCOM) or Africa Central Command (AFRICOM) operations during 2023, with historical comparisons to the previous 4 years. Mental health disorders and injuries were the most common diagnostic categories in 2023 among service members medically evacuated from U.S. Central Command (CENTCOM) and U.S. Africa Command (AFRICOM). In 2023, 724 service members were medically evacuated from CENTCOM and 225 were evacuated from AFRICOM, with hospitalization required for 197 (27.2%) and 50 (22.2%), respectively. Most service members who were medically evacuated from CENTCOM or AFRICOM were returned to full duty status following their post-evacuation hospitalizations or outpatient evaluations. In 2023, evacuations for both battle and non-battle injuries from U.S. CENTCOM increased, following a period of decline. The number of service members medically evacuated in 2023 from AFRICOM remained unchanged from the previous year.

Identifying Predictors of Positive and Negative Affect at Mid-Deployment Among Military Medical Personnel.

INTRODUCTION: Positive and negative affect influence an individual's ability to utilize available physical, psychological, and social resources to maximize responses to life events. Little research has examined the factors that influence the development of positive affect or reduction of negative affective responses among deployed military personnel. The present study aimed to investigate the relationship between deployment-related stressors and symptoms of behavioral health concerns with affectivity among deployed U.S. service members. MATERIALS AND METHODS: Participants were 1148 U.S. Air Force medical personnel deployed to Balad, Iraq, between 2004 and 2011. All participants completed self-report measures of PTSD symptoms, general military and combat exposure, stress, and affectivity. The Institutional Review Board at Wilford Hall Medical Center, the Air Force Personnel Survey Program, and the U.S. Army's Joint Combat Casualty Research Team reviewed and approved the study. RESULTS: Most respondents (89%, 1,018/1,139) reported a positive military experience, but many respondents reported exposure to a potentially traumatic event during deployment. For example, seeing dead or seriously injured Americans (47%, 523/1,123) was the most common exposure reported by participants. A large portion of personnel (21%, 232/1,089) reported clinical levels of PTSD symptoms (score of 33 or higher on the Posttraumatic Stress Disorder Checklist-Military version). Risk factors, including PTSD symptoms, combat exposure, and stress, explained 39% of the variance in negative affect, R2 = 0.39, F(1046) = 224.96, P < .001. Conversely, these risk and resilience factors, including PTSD symptoms, combat exposure, stress, and general military experiences, explained 28% of the variance in positive affect, R2 = 0.28, F(1050) = 103.79, P < .001. No significant gender differences were found between models predicting positive and negative affect. CONCLUSIONS: Negative mood states may be partly an epiphenomenon of PTSD, which has been shown to be safely and effectively treated in the deployed environment. Social support during deployments is uniquely associated with a positive mood. These findings extend beyond the military and into any high-stress occupation wherein leaders could interpret these findings as a need to build or reinforce efforts to provide opportunities to sustain healthy relationships in personnel. These critical indigenous resources support mission readiness and enable the maintenance of positive psychological health.

Disease and Non-Battle Injury in Deployed Military: A Systematic Review and Meta-analysis.

INTRODUCTION: Disease and non-battle injury (DNBI) has historically been the leading casualty type among service members in warfare and a leading health problem confronting military personnel, resulting in significant loss of manpower. Studies show a significant increase in disease burden for DNBI when compared to combat-related injuries. Understanding the causes of and trends in DNBI may help guide efforts to develop preventive measures and help increase medical readiness and resiliency. However, despite its significant disease burden within the military population, DNBI remains less studied than battle injury. In this review, we aimed to evaluate the recently published literature on DNBI and to describe the characteristics of these recently published studies. MATERIALS AND METHODS: This systematic review is reported in the Prospective Register of Systematic Reviews database. The systematic search for published articles was conducted through July 21, 2022, in Cumulative Index of Nursing and Allied Health, Cochrane Library, Defense Technical Information Center, Embase, and PubMed. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses, the investigators independently screened the reference lists on the Covidence website (covidence.org). An article was excluded if it met any of the following criteria: (1) Published not in English; (2) published before 2010; (3) data used before 2001; (4) case reports, commentaries, and editorial letters; (5) systematic reviews or narrative reviews; (6) used animal models; (7) mechanical or biomechanical studies; (8) outcome was combat injury or non-specified; (9) sample was veterans, DoD civilians, contractors, local nationals, foreign military, and others; (10) sample was U.S. Military academy; (11) sample was non-deployed; (12) bioterrorism study; (13) qualitative study. The full-text review of 2 independent investigators reached 96% overall agreement (166 of 173 articles; κ = 0.89). Disagreements were resolved by a third reviewer. Study characteristics and outcomes were extracted from each article. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis of pooled estimates of incidence rates for disease (D), non-battle injury (NBI), and combined DNBI was created using random-effects models. RESULTS: Of the 3,401 articles, 173 were included for the full review and 29 (16.8%) met all inclusion criteria. Of the 29 studies included, 21 (72.4%) were retrospective designs, 5 (17.2%) were prospective designs, and 3 (10.3%) were surveys. Across all studies, the median number of total cases reported was 1,626 (interquartile range: 619.5-10,203). The results of meta-analyses for 8 studies with reported incidence rates (per 1,000 person-years) for D (n = 3), NBI (n = 7), and DNBI (n = 5) showed pooled incidence rates of 22.18 per 1,000 person-years for D, 19.86 per 1,000 person-years for NBI, and 50.97 per 1,000 person-years for combined DNBI. Among 3 studies with incidence rates for D, NBI, and battle injury, the incidence rates were 20.32 per 1,000 person-years for D, 6.88 per 1,000 person-years for NBI, and 6.83 per 1,000 person-years for battle injury. CONCLUSIONS: DNBI remains the leading cause of morbidity in conflicts involving the U.S. Military over the last 20 years. More research with stronger designs and consistent measurement is needed to improve medical readiness and maintain force lethality. LEVEL OF EVIDENCE: Systematic Review and Meta-Analysis, Level III.

Enhancing the Management of Deployment-Limiting Medical Conditions in the U.S. Department of Navy Leveraging Electronic Health Records and Predictive Analytics Methods.

INTRODUCTION: Deployment-limiting medical conditions (DLMCs) such as debilitating injuries and conditions may interfere with the ability of military service members (SMs) to deploy. SMs in the United States (U.S.) Department of the Navy (DoN) with DLMCs who are not deployable should be placed in the medically restricted status of limited duty (LIMDU) or referred to the Physical Evaluation Board (PEB) for Service retention determination. It is critical to identify SMs correctly and promptly with DLMCs and predict their return-to-duty (RTD) to ensure the combat readiness of the U.S. Military. In this study, an algorithmic approach was developed to identify DoN SMs with previously unidentified DLMCs and predict whether SMs on LIMDU will be able to RTD. MATERIALS AND METHODS: Five years of historical data (2016-2022) were obtained from inpatient and outpatient datasets across direct and purchased care from the Military Health System (MHS) Data Repository (MDR). Key fields included International Classification of Diseases diagnosis and procedure codes, Current Procedure Terminology codes, prescription medications, and demographics information such as age, rank, gender, and service. The data consisted of 44,580,668 medical encounters across 1,065,224 SMs. To identify SMs with unidentified DLMCs, we developed an ensemble model combining outputs from multiple machine learning (ML) algorithms. When the ML ensemble model predicted a SM to have high risk scores, despite appearing healthy on administrative reports, their case was reviewed by expert clinicians to investigate for previously unidentified DLMCs; and such feedback served to validate the developed algorithms. In addition, leveraging 1,735,422 encounters (60,433 SMs) from LIMDU periods, we developed four separate ML models to estimate RTD probabilities for SMs after each medical encounter and predict the final LIMDU outcome. RESULTS: The ensemble model had 0.91 area under the receiver operating characteristic curve (AUROC). Out of 236 (round one) and 314 (round two) SMs reviewed by clinicians, 127 (54%) and 208 (66%) SMs were identified with a previously unidentified or undocumented DLMC, respectively. Regarding predicting RTD for SMs placed on LIMDU, the best performing ML model achieved 0.76 AUROC, 68% sensitivity, and 71% specificity. CONCLUSION: Our research highlighted potential benefits of using predictive analytics in a medical assessment to identify SMs with DLMCs and to predict RTD outcomes once placed on LIMDU. This capability is being deployed for real-time clinical decision support to enhance health care provider's deployability assessment capability, improve accuracy of the DLMC population, and enhance combat readiness of the U.S Military.

Symptoms of Posttraumatic Stress Disorder Among Japanese Peacekeepers Deployed in South Sudan.

Importance: Peacekeepers in United Nations missions experience potentially traumatic events, resulting in increased risk for posttraumatic stress disorder (PTSD). Understanding the course and risk factors of PTSD symptom severity is crucial to ensure personnel safety. Objective: To investigate the incidence of PTSD, symptom severity trajectories, and potential risk factors associated with adverse trajectories among Japanese peacekeepers deployed in South Sudan. Design, Setting, and Participants: Data for this 6-year prospective cohort study were collected from December 2011 to December 2018 from Japan Ground Self-Defense Force personnel deployed at the United Nations Mission in South Sudan, corresponding to before and up to 78 months after deployment. Of 3799 potential participants, 80 were excluded because of multiple deployments and 757 because of missing data, incomplete responses, or not providing informed consent. Therefore, 2962 participants were included in the analysis. Data analysis was performed from February 2022 to February 2024. Exposure: The participants were deployed to United Nations Mission in South Sudan for 6 months. Main Outcomes and Measures: The 22-item Impact of Event Scale-Revised was used to assess PTSD symptoms, with 25 or more points indicating probable PTSD (p-PTSD). Sociodemographic data were collected, and the 30-item General Health Questionnaire was administered before deployment to identify risk factors for PTSD symptom severity. Results: In the 2962 participants studied (2901 [97.9%] male; mean [SD] age, 33.9 [7.2] years), the incidence of p-PTSD was 3.95%. Latent growth mixture models identified 4 symptom severity trajectories: resilient (2143 [72.3%]), recovery (479 [16.2%]), protracted (182 [6.1%]), and delayed (158 [5.3%]). Multinomial logistic regression showed that sleep disturbance was a common risk factor for the 2 most severe trajectories (protracted: odds ratio [OR], 1.29; 95% CI, 1.08-1.54; delayed: OR, 1.26; 95% CI, 1.03-1.53), whereas older age (OR, 1.25; 95% CI, 1.06-1.48), anxiety and dysphoria (OR, 1.45; 95% CI, 1.20-1.75), and general illness (OR, 1.30; 95% CI, 1.06-1.59) were associated with the protracted trajectory. Conclusions and Relevance: This cohort study found that approximately 4% of the participants developed p-PTSD and identified 4 distinct PTSD symptom trajectories. The findings suggest that addressing sleep disturbance and general health issues could effectively prevent PTSD symptoms among peacekeepers.

Neuropsychological Profiles of Deployment-Related Mild Traumatic Brain Injury: A LIMBIC-CENC Study.

BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is a concern for US service members and veterans (SMV), leading to heterogeneous psychological and cognitive outcomes. We sought to identify neuropsychological profiles of mild TBI (mTBI) and posttraumatic stress disorder (PTSD) among the largest SMV sample to date. METHODS: We analyzed cross-sectional baseline data from SMV with prior combat deployments enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Latent profile analysis identified symptom profiles using 35 indicators, including physical symptoms, depression, quality of life, sleep quality, postconcussive symptoms, and cognitive performance. It is important to note that the profiles were determined independently of mTBI and probable PTSD status. After profile identification, we examined associations between demographic variables, mTBI characteristics, and PTSD symptoms with symptom profile membership. RESULTS: The analytic sample included 1,659 SMV (mean age 41.1 ± 10.0 years; 87% male); among them 29% (n = 480) had a history of non-deployment-related mTBI only, 14% (n = 239) had deployment-related mTBI only, 36% (n = 602) had both non-deployment and deployment-related mTBI, and 30% (n = 497) met criteria for probable PTSD. A 6-profile model had the best fit, with separation on all indicators (p < 0.001). The model revealed distinct neuropsychological profiles, representing a combination of 3 self-reported functioning patterns: high (HS), moderate (MS), and low (LS), and 2 cognitive performance patterns: high (HC) and low (LC). The profiles were (1) HS/HC: n=301, 18.1%; (2) HS/LC: n=294, 17.7%; (3) MS/HC: n=359, 21.6%; (4) MS/LC: n=316, 19.0%; (5) LS/HC: n=228, 13.7%; and (6) LS/LC: n=161, 9.7%. SMV with deployment-related mTBI tended to be grouped into lower functioning profiles and were more likely to meet criteria for probable PTSD. Conversely, SMV with no mTBI exposure or non-deployment-related mTBI were clustered in higher functioning profiles and had a lower likelihood of meeting criteria for probable PTSD. DISCUSSION: Findings suggest varied symptom and functional profiles in SMV, influenced by injury context and probable PTSD comorbidity. Despite diagnostic challenges, comprehensive assessment of functioning and cognition can detect subtle differences related to mTBI and PTSD, revealing distinct neuropsychological profiles. Prioritizing early treatment based on these profiles may improve prognostication and support efficient recovery.

The role of unit cohesion and perceived resilience in substance use disorder.

Soldiers have high rates of substance use disorders (SUD), often in the aftermath of stressors experienced during military deployments. There are several factors that protect against SUD. For example, individual factors like perceived resilience and group factors such as unit cohesion may make someone less likely to abuse substances. However, there is little research on the differential influence of these resilience factors on SUD over and above deployment stressors. In this study, we examined the relative effects of perceived resilience, unit cohesion, and deployment stressors on SUD in a sample of 21,449 active duty and reserve soldiers from the U.S. Army (primarily White and male, mean age = 28.66, SD = 7.41) using structural equation modeling. We found that unit cohesion (ß = -.17) and perceived resilience (ß = -.16) had negative effects on SUD over and above deployment stressors. The study findings clarify research on resilience to SUD and have implications for addressing substance use in the military, specifically regarding the importance of building unit cohesion.

Longitudinal measurement invariance and growth curve modeling of psychological resilience across the deployment cycle.

The concept of resilience is embedded within military culture and professional identity. To date, temporal changes in individuals' perceptions of their own resilience have not been systematically assessed in highstakes occupational contexts, like the military. The current study examined change in selfreported resilience over time by: (1) examining the longitudinal measurement invariance of the Brief Resilience Scale (BRS); (2) assessing the longitudinal pattern of resilience across a combat deployment cycle; and (3) examining predictors of postdeployment resilience and change in resilience scores across time. U.S. Army soldiers assigned to a combat brigade completed a survey at four time points over the course of a deployment cycle: (a) prior to deployment to Afghanistan; (b) during deployment; (c) immediately following return to home station; and (d) approximately 2-3 months thereafter. The longitudinal measurement invariance of the BRS was established. Growth curve modeling indicated that, on average, self-reported resilience decreased across the deployment cycle, but there was considerable individual variation in the rate of change. Of note, loneliness, as measured during deployment, predicted the rate of change in self-reported resilience over time. Results have implications for the longitudinal analysis of resilience and for the development of interventions with military personnel.

The nature and impacts of deployment-related encounters with children among Canadian military Veterans: a qualitative analysis.

Background: As armed conflict grows increasingly complex, the involvement of children in armed violence across diverse roles is rising. Consequently, military personnel are more likely to encounter children during deployment. However, little is known about deployment-related encounters with children and their impact on the mental health of military personnel and Veterans.Objective: This study qualitatively examines the nature and impacts of deployment-related encounters with children.Methods: We conducted semi-structured interviews with 16 Canadian Armed Forces Veterans, eliciting rich information on the nature of child encounters on deployment, the psycho-social-spiritual impacts of these encounters, and perceptions of support. Interview transcripts were analysed using thematic analysis.Results: Six primary themes were identified: types of encounters (i.e. factual aspects of deployment-related encounters with children), contextual factors (i.e. aspects of the mission, environment, and personal context relevant to one's experience of the encounter), appraisals of encounters (i.e. sensory or sense-making experiences relevant to the encounter), impacts of encounters (i.e. psycho-social, existential, and occupational impacts), coping strategies engaged in both during and after deployment, and support experiences, describing both formal and informal sources of support.Conclusions: Encounters with children are diverse and highly stressful, resulting in impacts pertinent to mental health, including psychological and moral distress, and difficulties with identity, spirituality, and relationships. These impacts are prompted by complex interactions among appraisals, expectations of morality, cultural norms, and professional duties and are amplified by various personal factors (e.g. childhood maltreatment history, parenthood), feelings of unpreparedness, and lack of post-deployment support. Implications for prevention, intervention, and policy are discussed with the aim of informing future efforts to safeguard and support military personnel facing a high likelihood of encounters with children.

Deployment-related encounters with children result in diverse impacts, including psychological and moral distress, along with disruptions in identity, spirituality, and interpersonal relationships.Encounters with children during military deployments are diverse and highly stressful, characterized by complex interactions among appraisals and expectations of morality, cultural norms, and professional duties.Emphasis on feeling unprepared for encounters with children highlights the need for future efforts to safeguard and support military personnel facing such situations.

Deployment to Military Bases With Open Burn Pits and Respiratory and Cardiovascular Disease.

Importance: Many veterans who served in Afghanistan and Iraq during Operations Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) were deployed to military bases with open burn pits and exposed to their emissions, with limited understanding of the long-term health consequences. Objective: To determine the association between deployment to military bases where open burn pits were used for waste disposal and the subsequent risk of developing respiratory and cardiovascular diseases. Design, Setting, and Participants: This retrospective observational cohort study used Veterans Health Administration medical records and declassified deployment records from the Department of Defense to assess Army and Air Force veterans who were deployed between 2001 and 2011 and subsequently received health care from the Veterans Health Administration, with follow-up through December 2020. Data were analyzed from January 2023 through February 2024. Exposure: Duration of deployment to military bases with open burn pits. Main Outcomes and Measures: Diagnosis of asthma, chronic obstructive pulmonary disease, interstitial lung disease, hypertension, myocardial infarction, congestive heart failure, ischemic stroke, and hemorrhagic stroke. Results: The study population included 459 381 OEF and OIF veterans (mean [SD] age, 31.6 [8.7] years; 399 754 [87.0%] male). Median (IQR) follow-up from end of deployment was 10.9 (9.4-12.7) years. For every 100 days of deployment to bases with burn pits, veterans experienced increased adjusted odds for asthma (adjusted odds ratio [aOR], 1.01; 95% CI, 1.01-1.02), chronic obstructive pulmonary disease (aOR, 1.04; 95% CI, 1.02-1.07), hypertension (aOR, 1.02; 95% CI, 1.02-1.03), and ischemic stroke (aOR, 1.06; 95% CI, 0.97-1.14). Odds of interstitial lung disease, myocardial infarction, congestive heart failure, or hemorrhagic stroke were not increased. Results based on tertiles of duration of burn pit exposures were consistent with those from the continuous exposure measures. Conclusions and Relevance: In this cohort study, prolonged deployment to military bases with open burn pits was associated with increased risk of developing asthma, COPD, and hypertension. The results also point to a possible increased risk in ischemic stroke. The novel ability to use integrated data on deployment and health outcomes provides a model for additional studies of the health impact of environmental exposures during military service.

How do you see me? The impact of perceived societal recognition on PTSD symptoms amongst Norwegian peacekeepers.

Background: The peacekeeper role is different to that of traditional combat, however, peacekeepers, like combat soldiers, may also be exposed to high levels of dangerous and/or potentially morally injurious events (PMIEs).Objective: It was hypothesized that given the centrality of societal approval for the peacekeeping mission, in addition to the known relevance of perceived social support, perceived societal recognition would influence PTSD symptoms (PTSS) and depression. It was hypothesized that perceived societal recognition would moderate the effect of exposure to potentially traumatic events and PMIEs on psychological outcomes.Method: 8341, predominantly male, former UNIFIL peacekeepers, almost three decades following deployment, answered a survey to determine the impact of perceived social support and perceived societal recognition, on PTSS and depression symptoms. Hierarchical regression analyses were performed for PTSS and depression separately and moderation analysis was performed for perceived societal recognition.Results: Exposure to potentially traumatic events showed the greatest predictive value for PTSS and exposure to PMIEs and potentially traumatic events were equally predictive of depression symptoms. While perceived social support presented the strongest buffer for PTSS and depression symptoms following UNIFIL deployment, perceived societal recognition also significantly contributed to the prediction of both PTSS and depression symptoms. There was a weak moderation effect of perceived societal recognition on trauma type in the development of PTSS.Conclusions: Even decades following peacekeeping deployment, military experiences have a significant impact on psychological functioning. This impact is both from the types of events experienced and from the perception of social and societal support upon return home.

Peacekeepers receive little attention in general military research and their missions are often directly influenced by public perception.The current study found that key military traumas; danger based and moral injury based events, were prevalent in the peacekeeper population and predicted PTSD symptoms and depression symptoms respectively.While there was a weak moderation effect, perceived societal recognition was a unique predictor of PTSD symptoms. Those who perceived negative levels of societal recognition of the UNIFIL mission had greater PTSD symptoms than those who perceived neutral or positive levels of societal recognition.

Associations of humor, morale, and unit cohesion on posttraumatic stress disorder symptoms.

Military personnel experience many stressors during deployments that can lead to symptoms of posttraumatic stress disorder (PTSD). However, not all military personnel who are exposed to deployment stressors develop PTSD symptoms. Recent research has explored factors that contribute to military personnel resilience, a multifaceted and multidetermined construct, as a means to mitigate and prevent PTSD symptoms. Much of this research has focused on the effects of individual-level factors (e.g., use of coping strategies like humor, the morale of individual unit members), with some research focusing on unit-level factors (e.g., the cohesiveness of a unit). However, there is little research exploring how these factors relate to each other in mitigating or reducing PTSD symptoms. In this study, we examined the association between deployment stressors, perceived unit cohesion, morale, humor, and PTSD symptoms in a sample of 20,901 active-duty military personnel using structural equation modeling. Results indicated that perceived unit cohesion, humor, and morale were positively associated with each other and negatively associated with PTSD symptoms over and above the effect of deployment stressors. These findings highlight the influence of resilience factors on PTSD symptoms beyond their substantial overlap and have implications for future research as well as the potential development of interventions for military personnel.

What predicts personal growth following a deployment? An examination of National Guard soldiers through the lens of posttraumatic growth.

National Guard soldiers experience unique reintegration challenges. In addition to managing the consequences of combat-related trauma, they also navigate multiple transitions between military and civilian life. Despite these obstacles, many soldiers report positive outcomes and personal growth due to deployment, a phenomenon most commonly referred to in the literature as posttraumatic growth (PTG). The current study explored PTG in National Guard soldiers using a multidimensional longitudinal approach, with the goal of validating reports of PTG in soldiers. Data were collected from National Guard soldiers at pre-deployment, reintegration, one year post-deployment and two years post-deployment. Informed by PTG theory, three PTG constructs were measured (perceived ability to handle stress, social support seeking, and purpose in life) at each of the four time points, with increases in these constructs indicating growth. Potential predictors of growth in these PTG constructs were also explored. Results from a repeated measure latent profile analysis indicated that PTG did occur in certain soldiers, and that higher optimism and less severe PTSD symptoms predict this growth. These findings emphasize the importance of making efforts to facilitate PTG in soldiers.

Longitudinal changes in lung function following post-9/11 military deployment in symptomatic veterans.

RATIONALE: Exposure to burn pit smoke, desert and combat dust, and diesel exhaust during military deployment to Southwest Asia and Afghanistan (SWA) can cause deployment-related respiratory diseases (DRRDs) and may confer risk for worsening lung function after return. METHODS: Study subjects were SWA-deployed veterans who underwent occupational lung disease evaluation (n = 219). We assessed differences in lung function by deployment exposures and DRRD diagnoses. We used linear mixed models to assess changes in lung function over time. RESULTS: Most symptomatic veterans reported high intensity deployment exposure to diesel exhaust and burn pit particulates but had normal post-deployment spirometry. The most common DRRDs were deployment-related distal lung disease involving small airways (DDLD, 41%), deployment-related asthma (DRA, 13%), or both DRA/DDLD (24%). Those with both DDLD/DRA had the lowest estimated mean spirometry measurements five years following first deployment. Among those with DDLD alone, spirometry measurements declined annually, adjusting for age, sex, height, weight, family history of lung disease, and smoking. In this group, the forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) ratio declined 0.2% per year. Those with more intense inhalational exposure had more abnormal lung function. We found significantly lower estimated FVC and total lung capacity five years following deployment among active duty participants (n = 173) compared to those in the reserves (n = 26). CONCLUSIONS: More intense inhalational exposures were linked with lower post-deployment lung function. Those with distal lung disease (DDLD) experienced significant longitudinal decline in FEV1/FVC ratio, but other DRRD diagnosis groups did not.

Deployment-related toxic exposures are associated with worsening mental and physical health after military service: Results from a self-report screening of veterans deployed after 9/11.

Exposure to toxins-such as heavy metals and air pollution-can result in poor health and wellbeing. Recent scientific and media attention has highlighted negative health outcomes associated with toxic exposures for U.S. military personnel deployed overseas. Despite established health risks, less empirical work has examined whether deployment-related toxic exposures are associated with declines in mental and physical health after leaving military service, particularly among the most recent cohort of veterans deployed after September 11, 2001. Using data from 659 U.S. veterans in the VISN 6 MIRECC Post-Deployment Mental Health Study, we tested whether self-reported toxic exposures were associated with poorer mental and physical health. At baseline, veterans who reported more toxic exposures also reported more mental health, ß = 0.14, 95% CI [0.04, 0.23], p = 0.004, and physical health symptoms, ß = 0.21, 95% CI [0.11, 0.30], p < 0.001. Over the next ten years, veterans reporting more toxic exposures also had greater increases in mental health symptoms, ß = 0.23, 95% CI [0.15, 0.31], p < 0.001, physical health symptoms, ß = 0.22, 95% CI [0.14, 0.30], p < 0.001, and chronic disease diagnoses, ß = 0.15, 95% CI [0.07, 0.23], p < 0.001. These associations accounted for demographic and military covariates, including combat exposure. Our findings suggest that toxic exposures are associated with worsening mental and physical health after military service, and this recent cohort of veterans will have increased need for mental health and medical care as they age into midlife and older age.

Sex Differences in Postinjury Health Profiles Among U.S. Military Personnel Following Deployment-Related Concussion.

Background: Women in the U.S. military are now authorized to serve in direct combat occupations. This may increase their risk of combat injuries, such as concussion, in future conflicts. Knowledge of sex differences in health profiles after concussion is paramount for military medical planning efforts. The purpose of this study was to assess sex-related differences in health profiles among U.S. military personnel following deployment-related concussion. Materials and Methods: We conducted a retrospective study of service members who sustained a concussion during combat deployment between 2004 and 2013. Postinjury diagnoses were abstracted from outpatient encounters in electronic health records for 24 months after concussion. We used hierarchical clustering to identify clusters, termed "health profiles," and logistic regression to determine whether sex predicted membership in the health profiles. Results: The study sample included 346 women and 4536 men with deployment-related concussion. Five postinjury health profiles were identified and classified as no morbidity, back pain, tinnitus/memory loss, posttraumatic stress disorder/postconcussion syndrome, and multimorbidity. Women relative to men had higher odds of membership in the back pain (odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.05-1.67) and multimorbidity profiles (OR = 1.44; 95% CI = 1.03-2.00) and lower odds than men in the tinnitus/memory loss profile (OR = 0.62; 95% CI = 0.42-0.91). Conclusions: Postinjury health profiles among U.S. service members differ by sex following deployment-related concussion, particularly with a higher burden of multimorbidity among women than men, which may require interdisciplinary care. Women also had higher odds of membership in the back pain profile and lower odds in the tinnitus/memory loss profile than men. To prepare for future military operations where women may have greater exposure to combat, continued research elucidating health-related sex differences after deployment-related concussion is imperative.

Amplified PTSD Symptoms From Self-Attributed Moral Transgressions Are Linked to Internalized Moral Identity During Military Deployment.

INTRODUCTION: Military personnel frequently experience stressful, morally challenging situations that can lead to posttraumatic stress disorder (PTSD). The relationships between moral identity, transgressive acts, and symptoms related to posttraumatic stress disorder (i.e., posttraumatic stress symptoms; PTSS) among U.S. Army Soldiers were assessed. MATERIALS AND METHODS: A convenience cohort of 1,547 soldiers completed a survey assessing moral identity and PTSS before deployment. A subset of 505 soldiers completed another survey assessing transgressive acts and PTSS during deployment. Exploratory and confirmatory factor analyses were conducted to determine the underlying factor structure of the measures of moral identity and transgressive acts. Generalized linear modeling, robustness checks, and sensitivity analysis were used to evaluate the predictive relationships. RESULTS: Moral identity did not directly predict PTSS during deployment. However, self-attributed and betrayal-based transgressive acts were significant predictors. Specifically, self-attributed transgressive acts and PTSS were moderated by internalized moral identity; individuals with a higher internalized moral identity experienced more severe PTSS following self-attributed transgressive acts. These findings were consistent across various model checks, including covariate adjustments, data imputation, and the application of a data quality filter. CONCLUSIONS: The study highlights the significant role of self-attributed moral transgressions during deployment in the development of PTSS among military service members-especially in those with a strong internalized moral identity. This finding suggests a "target of opportunity" for the development of intervention strategies that mitigate PTSS by addressing the moral dimensions of military service.

Interplay of combat deployment harassment, testosterone concentrations and post-deployment suicide risk in male veterans.

OBJECTIVE: Many combat veterans exhibit suicidal ideation and behaviour, but the relationships among experiences occurring during combat deployment and suicidality are still not fully understood. In this study, we tested the hypothesis that harassment during a combat deployment is associated with post-deployment suicidality and testosterone function. METHODS: Male combat veterans who made post-deployment suicide attempts and demographically matched veterans without a history of suicide attempts were enrolled in the study. Demographic and clinical parameters of study participants were assessed and recorded. Study participants were interviewed by a trained clinician using the Mini-International Neuropsychiatric Interview (MINI), the Deployment Risk and Resilience Inventory (DRRI) ­ Relationships within unit scale, the Scale for Suicidal Ideation (SSI), and the Brown­Goodwin Aggression Scale. Free testosterone levels were assessed in morning blood samples. RESULTS: DRRI harassment scores were higher and free testosterone levels were lower among suicide attempters in comparison with non-attempters. In the whole sample, DRRI harassment scores positively correlated with SSI scores and negatively correlated with free testosterone levels. Free testosterone levels negatively correlated with SSI scores. Aggression scale scores positively correlated with DRRI harassment scores among non-attempters but not among attempters. CONCLUSION: Our observations that harassment scores are associated with suicidality and testosterone levels, and suicidality is associated with testosterone levels may indicate that there is a link between deployment harassment, testosterone function and suicidality.