Association between mental health conditions diagnosed during initial eligibility for military health care benefits and subsequent deployment, attrition, and death by suicide among active duty service members.

OBJECTIVE: To examine incidence of mental health diagnoses during initial service of U.S. active duty military members and identify associations with deployment, attrition, and suicide. METHODS: A retrospective cohort of 576,502 service members (SMs) newly enlisted between 2003 and 2006 was identified. Data included medical encounter, deployment and attrition, and suicide. Multivariable logistic regression models examine the association between mental health diagnoses coded within the SMs' first 6 months of eligibility for health care benefits and deployment. Multivariable Cox proportional hazards models quantify the association between mental health diagnoses and attrition and suicide. RESULTS: The cumulative incidence of mental health diagnoses was approximately 9% at 6 months of service. Adjustment, depressive, and anxiety disorders were most common. Those with any mental health diagnosis during initial eligibility had increased risk of early attrition and were 77% less likely to deploy. Early mental health diagnoses were not statistically significantly associated with death by suicide. CONCLUSION: Mental health diagnoses during initial eligibility are common and associated with reduced odds of deployment and increased risk of early attrition. Policies designed to either retain or discharge SMs with a mental health diagnosis identified during initial training merit close examination in light of these findings.

Studies on the moss flora of the Bío-Bío Region of Chile: Part 3.

This is the final report on the moss flora of the Bío-Bío Region (Región VIII) in south-central Chile where collections were made in 2001-2003. Reported in this paper are one species new to South America, four species new to Chile and 16 species new to the Region. With these new additions the total number of taxa in the Bío-Bío Region is 343, corresponding to 331 species and 12 infraspecific taxa. A complete checklist of the mosses for all the provinces in the Region is presented.

Pharmacologic considerations for serotonin reuptake inhibitor use by aviators.

Physicians frequently use serotonin reuptake inhibitors (SRIs) to treat a variety of psychiatric and medical conditions, many of which occur in aviators. SRIs are efficacious for treating acute conditions and may also prove useful for prophylaxis against recurrence through maintenance dosage. Aviators must meet standard safety criteria in order to use medications while performing flying duties, and must receive individual waivers as well. This article reviews the particular threats that serotonergic agents pose to aviation safety. Some SRIs may prove safer than others to use in the aviation environment, but such medications will require appropriate ground testing, and must provide aeromedically safe control of the symptoms for which they are prescribed.

Aeromedical regulation of aviators using selective serotonin reuptake inhibitors for depressive disorders.

This report, prepared at the request of the Aerospace Medical Association (AsMA), reviews the present status of aeromedical regulation of depressive disorders and antidepressant medications, emphasizing the role of serotonin specific reuptake inhibitors (SSRIs). Aeromedical certifying authorities (CAs) generally prohibit pilots from flying with a diagnosed depressive disorder, and also prohibit flying while taking antidepressant medications, including SSRIs. Some CAs are reassessing these prohibitions, which are based on long aeromedical practices, in view of changing medical management of depressive disorders. Many pilots choose to fly while depressed, with or without medications, because of the long grounding periods mandated by current policies. Some SSRIs have very few aeromedically significant side effects. Modern psychiatric practice calls for long-term use of medication following clinical recovery from depressive disorders in order to prevent recurrent episodes. Given these and other factors, AsMA proposes that CAs remove the current absolute prohibitions against pilots flying while taking SSRIs, and adopt aeromedical protocols that include carefully controlled follow-up and review. AsMA urges all certificatory and regulatory authorities to consider immediately instituting a policy of using study groups to manage depressed aviators who require SSRI antidepressants. Protocols designed to aggressively manage the full spectrum of adverse possibilities related to SSRI use may enable the safe use of SSRIs in formerly depressed aviators who suffer no aeromedically significant side effects. In these closely managed cases of depressive disorders, special issuances or waivers for SSRI use are justified.