RESUMEN
BACKGROUND: Prevention of PTSD requires identification of subpopulations contributing most to the population burden of PTSD. This study examines the relative contribution of subthreshold PTSD and probable PTSD on future PTSD in a representative military cohort. METHODS: We analyze data on 3,457 U.S. National Guard members from the state of Ohio, assessed by telephone annually from 2008 to 2014. At each wave, participants were classified into one of three groups based on the PTSD Checklist: probable PTSD (DSM-IV-TR criteria), subthreshold PTSD (Criterion A1, at least one symptom in each cluster, symptom lasting longer than 30 days, and functional impairment), and no PTSD. We calculated the exposure rate, risk ratio (RR), and population attributable fraction (PAF) to determine the burden of future probable PTSD attributable to subthreshold PTSD compared to probable PTSD. RESULTS: The annualized prevalence of subthreshold PTSD and probable PTSD was respectively 11.9 and 5.0%. The RR for probable PTSD was twice as great among respondents with probable PTSD the prior interview than that of those with subthreshold PTSD (7.0 vs. 3.4); however, the PAF was considerably greater in participants with subthreshold PTSD the prior interview (PAF = 35%; 95% confidence interval (CI) = 26.0-42.9%) than in those with probable PTSD (PAF = 28.0%; 95% CI = 21.8-33.8%). Results were robust to changes in subthreshold PTSD definition. CONCLUSIONS: Subthreshold PTSD accounted for a substantial proportion of this population's future PTSD burden. Population-based preventive interventions, compared to an approach focused exclusively on cases of diagnosable PTSD, is likely to affect the greatest reduction in this population's future PTSD burden.
Asunto(s)
Personal Militar/psicología , Trastornos por Estrés Postraumático/fisiopatología , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Personal Militar/estadística & datos numéricos , Ohio , Prevalencia , Trastornos por Estrés Postraumático/clasificación , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/terapia , Adulto JovenRESUMEN
Studies have shown that combat-area deployment is associated with increases in alcohol use; however, studying the influence of deployment on alcohol use faces 2 complications. First, the military considers a confluence of factors before determining whether to deploy a service member, creating a nonignorable exposure and unbalanced comparison groups that inevitably complicate inference about the role of deployment itself. Second, regression analysis assumes that a single effect estimate can approximate the population's change in postdeployment alcohol use, which ignores previous studies that have documented that respondents tend to exhibit heterogeneous postdeployment drinking behaviors. Therefore, we used propensity score matching to balance baseline covariates for the 2 comparison groups (deployed and nondeployed), followed by a variable-oriented difference-in-differences approach to account for the confounding and a person-oriented approach using a latent growth mixture model to account for the heterogeneous response to deployment in this prospective cohort study of the US Army National Guard (2009-2014). We observed a nonsignificant increase in estimated monthly drinks in the first year after deployment that regressed to predeployment drinking levels 2 years after deployment. We found a 4-class model that fit these data best, suggesting that common regression analyses likely conceal substantial interindividual heterogeneity in postdeployment alcohol-use behaviors.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Trastornos de Combate/epidemiología , Personal Militar/estadística & datos numéricos , Adulto , Consumo de Bebidas Alcohólicas/psicología , Trastornos de Combate/psicología , Interpretación Estadística de Datos , Diseño de Investigaciones Epidemiológicas , Femenino , Humanos , Masculino , Personal Militar/psicología , Puntaje de Propensión , Análisis de Regresión , GuerraRESUMEN
Research exploring spirituality in military populations is a relatively new field with limited published reports. This study used the Spiritual Well-Being Scale to examine the association of spiritual well-being with suicidal ideation/behavior, posttraumatic stress disorder (PTSD), and depression and alcohol use disorders in a randomized sample of Ohio Army National Guard soldiers. The participants were 418 soldiers, mostly white and male, with nearly three-quarters indicating that they had been deployed at least once during their careers. Higher spirituality, especially in the existential well-being subscale, was associated with significantly less lifetime PTSD, depression, and alcohol use disorders and with less suicidal ideation over the past year. Future research in this area may benefit from a longitudinal design that can assess spirituality and mental health behaviors in addition to diagnoses at different time points, to begin to explore spirituality in a larger context.
Asunto(s)
Depresión/psicología , Personal Militar/psicología , Satisfacción Personal , Espiritualidad , Trastornos por Estrés Postraumático/psicología , Ideación Suicida , Intento de Suicidio/psicología , Adolescente , Adulto , Trastornos Relacionados con Alcohol , Depresión/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Personal Militar/estadística & datos numéricos , Ohio , Trastornos por Estrés Postraumático/epidemiología , Intento de Suicidio/estadística & datos numéricos , Adulto JovenRESUMEN
Alcohol use disorders (AUD) are commonly comorbid with anxiety and mood disorders; however, a strategy for AUD prevention remains unclear in the presence of three competing etiological models that each recommends different high-risk groups. Therefore, the investigation of the three hypotheses in a characteristically unique cohort is critical to identifying pervasive characteristics of AUD that can inform a universal prevention strategy. The current study evaluated the temporality and onset of comorbid AUD and psychiatric disorders in a representative sample of 528 Ohio Army National Guard soldiers using structured clinical interviews from 2009 to 2012. We examined temporality both statistically and graphically to identify patterns that could inform prevention. General estimating equations with dichotomous predictor variables were used to estimate odds ratios between comorbid psychiatric disorders and AUDs. An annualized rate of 13.5 % persons per year was diagnosed with any AUD between 2010 and 2012. About an equal proportion of participants with comorbid psychiatric disorders and AUD initiated the psychiatric disorder prior to the AUD and half initiated the psychiatric disorder after the AUD. Regardless of onset, however, the majority (80 %) AUD initiated during a short interval between the ages of 16 and 23. Focused primary prevention during this narrow age range (16-23 years) may have the greatest potential to reduce population mental health burden of AUD, irrespective of the sequencing of comorbid psychiatric disorder.
Asunto(s)
Alcoholismo/psicología , Trastornos Mentales/complicaciones , Personal Militar , Adulto , Alcoholismo/complicaciones , Alcoholismo/prevención & control , Femenino , Humanos , MasculinoRESUMEN
We examined the relationship between posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and human immunodeficiency virus (HIV) risk behavior among the Ohio Army National Guard (OHARNG). We analyzed data collected from a sample of OHARNG enlisted between June 2008 and February 2009. Participants completed interviews assessing HIV risk activities defined by the Behavioral Risk Factor Surveillance System, and were screened for PTSD and MDD based on DSM-IV criteria according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994). Logistic regression was used to examine the independent and combined effects of PTSD and MDD on past-year HIV risk behavior. Of 2,259 participants, 142 (6.3%) reported at least 1 past-year HIV risk behavior. In adjusted models, relative to soldiers with neither disorder, screening positive for MDD only was associated with HIV risk behavior (adjusted odds ratio [AOR] = 2.33, 95% CI = [1.15, 4.71]), whereas PTSD was not significant (AOR = 1.60, 95% CI = [0.80, 3.20]). Participants with both PTSD and depression were most likely to report HIV risk behavior (AOR = 2.75, 95% CI = [1.06, 7.11]). Soldiers with PTSD and MDD may be at greater risk for HIV infection due to increased engagement in HIV risk behavior. Integrated interventions to address mental health problems and reduce HIV risk behavior are in need of development and evaluation.
Asunto(s)
Trastorno Depresivo Mayor/psicología , Infecciones por VIH/psicología , Infecciones por VIH/transmisión , Personal Militar/psicología , Asunción de Riesgos , Trastornos por Estrés Postraumático/psicología , Adolescente , Adulto , Factores de Edad , Alcoholismo/diagnóstico , Alcoholismo/epidemiología , Alcoholismo/psicología , Estudios Transversales , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Femenino , Infecciones por VIH/epidemiología , Encuestas Epidemiológicas , Humanos , Acontecimientos que Cambian la Vida , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Ohio , Factores Sexuales , Factores Socioeconómicos , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Abuso de Sustancias por Vía Intravenosa/diagnóstico , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/psicología , Encuestas y Cuestionarios , Sexo Inseguro/psicología , Sexo Inseguro/estadística & datos numéricos , Adulto JovenRESUMEN
To examine antidepressant management practices in primary care, patients (N = 148) given an antidepressant for at least one month completed the Beck Depression Inventory (BDI-II), the Patient Health Questionnaire-9 (PHQ-9), and a demographic survey. Participants' mean age was 50.7 yr. and 80% were women. Patients' charts indicated whether physicians had made changes to prescribed antidepressants or dose either 6 wk. before or 6 wk. after study entry. For the 87% of participants whose depression status could be determined, 10% met dysthymic disorder criteria and only 33% had had a medication change in the previous month. Major depressive disorder occurred in 37% but only 18% had had a medication change. Co-existing dysthymic disorder and major depressive disorder were diagnosed in 34%, with 24% receiving a medication change. Participants not receiving a medication change had mean BDI-II scores indicating moderate depression. Lack of antidepressant adjustment suggests physicians may need to monitor depressive symptoms closely using protocols and prompts.
Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Distímico/tratamiento farmacológico , Pautas de la Práctica en Medicina , Atención Primaria de Salud , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/psicología , Trastorno Distímico/diagnóstico , Trastorno Distímico/psicología , Femenino , Adhesión a Directriz , Humanos , Masculino , Persona de Mediana Edad , Inventario de Personalidad , Garantía de la Calidad de Atención de Salud , Prevención Secundaria , Resultado del TratamientoRESUMEN
Advanced magnetic resonance imaging (MRI) techniques provide the means of studying both the structural and the functional properties of various brain regions, allowing us to address the relationship between the structural changes in human brain regions and the activity of these regions. However, analytical approaches combining functional (fMRI) and structural (sMRI) information are still far from optimal. In order to improve the accuracy of measurement of structural properties in active regions, the current study tested a new analytical approach that repeated a surface-based analysis at multiple planes crossing different depths of cortex. Twelve subjects underwent a fear conditioning study. During these tasks, fMRI and sMRI scans were acquired. The fMRI images were carefully registered to the sMRI images with an additional correction for cortical borders. The fMRI images were then analyzed with the new multiple-plane surface-based approach as compared to the volume-based approach, and the cortical thickness and volume of an active region were measured. The results suggested (1) using an additional correction for cortical borders and an intermediate template image produced an acceptable registration of fMRI and sMRI images; (2) surface-based analysis at multiple depths of cortex revealed more activity than the same analysis at any single depth; (3) projection of active surface vertices in a ribbon fashion improved active volume estimates; and (4) correction with gray matter segmentation removed non-cortical regions from the volumetric measurement of active regions. In conclusion, the new multiple-plane surface-based analysis approaches produce improved measurement of cortical thickness and volume of active brain regions. These results support the use of novel approaches for combined analysis of functional and structural neuroimaging.
Asunto(s)
Corteza Cerebral/anatomía & histología , Corteza Cerebral/fisiología , Extinción Psicológica/fisiología , Miedo/fisiología , Imagen por Resonancia Magnética/métodos , Red Nerviosa/anatomía & histología , Red Nerviosa/fisiología , Adulto , Algoritmos , Mapeo Encefálico/métodos , Potenciales Evocados/fisiología , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Smaller hippocampal volume is associated with more severe posttraumatic stress disorder (PTSD) symptoms years after traumatic experiences. Posttraumatic stress symptoms appear early following trauma, but the relationship between hippocampal volume and PTSD symptom severity during early posttrauma periods is not well understood. It is possible that the inverse relationship between hippocampal volume and PTSD symptom severity is already present soon after trauma. To test this possibility, we prospectively examined the association between hippocampal volumes and severity of PTSD symptoms within weeks to months after trauma due to a motor vehicle collision. METHODS: Structural magnetic resonance imaging scans of 44 survivors were collected about 2 weeks and again at 3 months after a motor vehicle collision to measure hippocampal volumes. The PTSD Checklist was used to evaluate PTSD symptoms at each scan time. Full (n = 5) or partial (n = 6) PTSD was evaluated using the Clinician-Administered PTSD Scale at 3 months. RESULTS: Left hippocampal volumes at both time points negatively correlated with PTSD Checklist scores, and with subscores for re-experiencing symptoms at 3 months. Left hippocampal volumes at 3 months also negatively correlated with hyperarousal symptoms at 3 months. Finally, neither left nor right hippocampal volumes significantly changed between 2 weeks and 3 months posttrauma. CONCLUSIONS: The results suggest that small hippocampal volume at early posttrauma weeks is associated with increased risk for PTSD development. Furthermore, the inverse relationship between hippocampal volume and PTSD symptoms at 3 months did not arise from posttrauma shifts in hippocampal volume between 2 weeks and 3 months after trauma.
Asunto(s)
Trastorno Depresivo Mayor/patología , Hipocampo/patología , Tamaño de los Órganos/fisiología , Trastornos por Estrés Postraumático/patología , Adolescente , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Trastornos por Estrés Postraumático/diagnóstico , Sobrevivientes , Lóbulo Temporal/patología , Factores de Tiempo , Adulto JovenRESUMEN
Mild traumatic brain injury (mTBI) patients frequently experience emotion dysregulation symptoms, including post-traumatic stress. Although mTBI likely affects cortical activation and structure, resulting in cognitive symptoms after mTBI, early effects of mTBI on cortical emotion processing circuits have rarely been examined. To assess early mTBI effects on cortical functional and structural components of emotion processing, we assessed cortical activation to fearful faces within the first 2 weeks after motor vehicle collision (MVC) in survivors who did and did not experience mTBI. We also examined the thicknesses of cortical regions with altered activation. MVC survivors with mTBI (n = 21) had significantly less activation in left superior parietal gyrus (SPG) (-5.9, -81.8, 33.8; p = 10-3.623), left medial orbitofrontal gyrus (mOFG) (-4.7, 36.1, -19.3; p = 10-3.231), and left and right lateral orbitofrontal gyri (lOFG) (left: -16.0, 41.4, -16.6; p = 10-2.573; right: 18.7, 22.7, -17.7; p = 10-2.764) than MVC survivors without mTBI (n = 23). SPG activation in mTBI survivors within 2 weeks after MVC was negatively correlated with subsequent post-traumatic stress symptom severity at 3 months (r = -0.68, p = 0.03). Finally, the SPG region was thinner in the mTBI survivors than in the non-mTBI survivors (F = 11.07, p = 0.002). These results suggest that early differences in activation and structure in cortical emotion processing circuits in trauma survivors who sustain mTBI may contribute to the development of emotion-related symptoms.
Asunto(s)
Accidentes de Tránsito/psicología , Conmoción Encefálica/diagnóstico por imagen , Conmoción Encefálica/psicología , Emociones , Red Nerviosa/diagnóstico por imagen , Corteza Prefrontal/diagnóstico por imagen , Accidentes de Tránsito/tendencias , Adulto , Emociones/fisiología , Expresión Facial , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/tendencias , Masculino , Persona de Mediana Edad , Red Nerviosa/fisiología , Adulto JovenRESUMEN
OBJECTIVE: We investigated the incidence of first-onset psychiatric disorders among Ohio Army National Guard members and the sociodemographic and military factors associated with these incident disorders. We aimed to identify potential risk factors and mitigating factors for a range of psychiatric disorders in a representative military sample. METHODS: We analyzed data on a representative sample of 528 Ohio Army National Guard members who were assessed in person annually for first-onset psychiatric disorders from 2008 through 2012 using structured clinical interviews. We used a multivariable discrete-time Cox proportional hazard model to determine risk factors of first-onset anxiety or mood disorders. RESULTS: The annualized incidence rate of any first-onset psychiatric disorder was 9.8 per 100 person-years at risk. Alcohol use disorder and major depressive disorder had the highest incidence rates among the unique disorders under study (5.0 and 4.2 per 100 person-years at risk, respectively). We found an association between respondents endorsing past-year deployment and a 29% increase in the risk of incident anxiety or mood disorder, whereas the past-year experience of any non-deployment traumatic event was associated with a 32% increase in risk of incident anxiety or mood disorder. CONCLUSION: Soldiers experience a substantial burden of first-onset alcohol use disorder and major depressive disorder annually; the experience of non-deployment-related traumatic events contributes substantially to increasing risk, suggesting that any effort aimed at mitigating mood and anxiety disorders in this population must consider the soldier's life experience and military experience.
Asunto(s)
Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/etiología , Personal Militar/psicología , Trastornos del Humor/epidemiología , Trastornos del Humor/etiología , Humanos , Incidencia , Ohio/epidemiología , Factores de RiesgoRESUMEN
Accumulating evidence suggests traumatic experience can rapidly alter brain activation associated with emotion processing. However, little is known about acute changes in emotion neurocircuits that underlie PTSD symptom development. To examine acute alterations in emotion circuit activation and structure that may be linked to PTSD symptoms, thirty-eight subjects performed a task of appraisal of emotional faces as their brains were functionally and structurally studied with MRI at both two weeks and three months after motor vehicle collision (MVC). As determined by symptoms reported in the PTSD Checklist at three months, sixteen survivors developed probable PTSD, whereas the remaining 22 did not meet criteria for PTSD diagnosis (non-PTSD). The probable PTSD group had greater activation than the non-PTSD group in dorsal and ventral medial prefrontal cortex (dmPFC and vmPFC) while appraising fearful faces within two weeks after MVC and in left insular cortex (IC) three months after MVC. dmPFC activation at two weeks significantly positively correlated with PTSD symptom severity at two weeks (R = 0.462, P = 0.006) and three months (R = 0.418, p = 0.012). Changes over time in dmPFC activation and in PTSD symptom severity were also significantly positively correlated in the probable PTSD group (R = 0.641, P = 0.018). A significant time by group interaction was found for volume changes in left superior frontal gyrus (SFG, F = 6.048, p = 0.019) that partially overlapped dmPFC active region. Between two weeks and three months, left SFG volume decreased in probable PTSD survivors. These findings identify alterations in frontal cortical activity and structure during the early post-trauma period that appear to be associated with development of PTSD symptoms.
Asunto(s)
Encéfalo/diagnóstico por imagen , Emociones/fisiología , Trastornos por Estrés Postraumático/diagnóstico por imagen , Trastornos por Estrés Postraumático/psicología , Sobrevivientes , Accidentes de Tránsito , Adolescente , Adulto , Mapeo Encefálico , Expresión Facial , Miedo/psicología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estimulación Luminosa , Adulto JovenRESUMEN
BACKGROUND: The study of military-related mental health has been disproportionately focused on current symptomology rather than potentially more informative life course mental health. Indeed, no study has assessed age-of-onset and projected lifetime prevalence of disorders among reservists. METHODS: Age-of-onset and projected lifetime DSM-IV anxiety, mood, and substance use disorders were assessed in 671 Ohio Army National Guard soldiers aged 17-60 years. Between 2008 and 2012, face-to-face clinical assessments and surveys were conducted using the Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale. RESULTS: Lifetime prevalence of psychiatric disorders was 61%. Alcohol abuse/dependence (44%) and major depressive disorder (23%) were the most common disorders. The majority (64%) of participants reported disorders antedating enlistment. Median age-of-onset varied with anxiety disorders - particularly phobias and OCD - having the earliest (median=15 years) and mood disorders the latest median age-of-onset (median=21 years). LIMITATIONS: The study was limited by both the retrospective investigation of age-of-onset and the location of our sample. As our sample may not represent the general military population, our findings need to be confirmed in additional samples. CONCLUSIONS: Each psychiatric disorder exhibited a distinct age-of-onset pattern, such that phobias and OCD onset earliest, substance use disorders onset during a short interval from late-adolescence to early-adulthood, and mood disorders onset the latest. Our finding that the majority of participants reported disorders antedating enlistment suggests that an assessment of lifetime psychopathology is essential to understanding the mental health burden of both current and former military personnel.
Asunto(s)
Trastornos Mentales/epidemiología , Salud Mental/estadística & datos numéricos , Personal Militar/psicología , Adolescente , Adulto , Factores de Edad , Edad de Inicio , Trastornos de Ansiedad/epidemiología , Trastorno Depresivo Mayor/epidemiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Personal Militar/estadística & datos numéricos , Trastornos del Humor/epidemiología , Prevalencia , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
In a motor vehicle collision (MVC), survivors often receive mild traumatic brain injuries (mTBI). Although there have been some reports of early white matter changes after an mTBI, much less is known about early cortical structural changes. To investigate early cortical changes within a few days after an MVC, we compared cortical thickness of mTBI survivors with non-mTBI survivors, then reexamined cortical thickness in the same survivors 3 months later. MVC survivors were categorized as mTBI or non-mTBI based on concussive symptoms documented in emergency departments (EDs). Cortical thickness was measured from MRI images using FreeSurfer within a few days and again at 3 months after MVC. Post-traumatic stress symptoms and physical conditions were also assessed. Compared with the non-mTBI group (n = 23), the mTBI group (n = 21) had thicker cortex in the left rostral middle frontal (rMFG) and right precuneus gyri, but thinner cortex in the left posterior middle temporal gyrus at 7.2 ± 3.1 days after MVC. After 3 months, cortical thickness had decreased in left rMFG in the mTBI group but not in the non-mTBI group. The cortical thickness of the right precuneus region in the initial scans was positively correlated with acute traumatic stress symptoms for all survivors and with the number of reduced activity days for mTBI survivors who completed the follow-up. The preliminary results suggest that alterations in cortical thickness may occur at an early stage of mTBI and that frontal cortex structure may change dynamically over the initial 3 months after mTBI.
Asunto(s)
Lesiones Encefálicas/patología , Corteza Cerebral/patología , Síndrome Posconmocional/patología , Accidentes de Tránsito , Adolescente , Adulto , Lesiones Encefálicas/complicaciones , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/etiología , Adulto JovenRESUMEN
Posttraumatic stress disorder (PTSD) is comorbid with major depressive disorder (MDD; Kessler et al., 1995) and generalized anxiety disorder (GAD; Brown et al., 2001). We aimed to (1) assess discrete patterns of post-trauma PTSD-depression-GAD symptoms using latent profile analyses (LPAs), and (2) assess covariates (gender, income, education, age) in defining the best fitting class solution. The PTSD Checklist (assessing PTSD symptoms), GAD-7 scale (assessing GAD symptoms), and Patient Health Questionnaire-9 (assessing depression) were administered to 1266 trauma-exposed Ohio National Guard soldiers. Results indicated three discrete subgroups based on symptom patterns with mild (class 1), moderate (class 2) and severe (class 3) levels of symptomatology. Classes differed in symptom severity rather than symptom type. Income and education significantly predicted class 1 versus class 3 membership, and class 2 versus class 3. In conclusion, there is heterogeneity regarding severity of PTSD-depression-GAD symptomatology among trauma-exposed soldiers, with income and education predictive of class membership.
Asunto(s)
Trastornos de Ansiedad/etiología , Depresión/etiología , Trastornos por Estrés Postraumático/etiología , Trastornos de Estrés Traumático/clasificación , Trastornos de Estrés Traumático/complicaciones , Adulto , Femenino , Humanos , Estudios Longitudinales , Masculino , Personal Militar , Modelos Estadísticos , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos , Encuestas y Cuestionarios , Índices de Gravedad del Trauma , Adulto JovenRESUMEN
OBJECTIVE: The individual and economic burden of psychiatric illnesses is substantial. Although treatment of psychiatric disorders mitigates the burden of illness, over half of military personnel with disorders do not receive mental health care. However, there is a paucity of research examining the relationship between psychiatric disorder categories and treatment-seeking behavior in representative military populations. This study aimed to document, by psychiatric disorder category, the annualized rate of Guard members who obtained psychiatric services and the factors associated with service utilization. METHODS: Face-to-face clinical assessments were conducted between 2008 and 2012 to assess lifetime and current psychiatric disorders and recent psychiatric service use among 528 Ohio Army National Guard soldiers. RESULTS: An annualized rate of 31% of persons per year accessed psychiatric services between 2010 and 2012. Persons with substance use disorders had the lowest annualized rate of service use, and these were the only disorders not predictive of accessing services. Current mood disorder, current anxiety disorder, and lifetime history of service use were the strongest predictors of recent service use. There were no socioeconomic or other group predictors of psychiatric service use. CONCLUSIONS: About half of the soldiers who could benefit from mental health services used them, yet soldiers with substance use disorders were predominantly going untreated. There were no differences in treatment utilization by group characteristics, suggesting no systematic barriers to care for particular groups. Efforts to encourage broader adoption of treatment seeking, particularly among persons with substance use disorders, are necessary to mitigate psychiatric health burden in this population.
Asunto(s)
Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Personal Militar/psicología , Personal Militar/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Ohio , Aceptación de la Atención de Salud/psicología , Estados UnidosRESUMEN
The goal of this study is to determine the pre-existing lifetime and current prevalence of DSM-IV Axis I disorders within the Ohio Army National Guard (OHARNG). Data was analyzed from the clinical subsample of the Ohio Army National Guard Mental Health Initiative (OHARNG MHI). Five hundred participants were provided with an in-depth clinical assessment using the Clinician-Administered PTSD Scale (CAPS) and the Structured Clinical Interview for DSM-IV-TR (SCID). Logistic regression examined the relationship between Axis I disorders and the number of deployments and gender. Prevalence of at least one DSM-IV lifetime disorder was 66.2%; substance use disorders were 52.2%, followed by mood disorders (30.0%) and anxiety disorders (22.0%). Prevalence of at least one current disorder was 24.8%; anxiety disorders (13.2%), mood disorders (7.6%), and substance use disorders (7.0%) were most frequent. Number of deployments was associated with PTSD (OR=8.27, 95% CI 2.10-32.59, p=0.003), alcohol use disorder (OR=1.77, 95% CI 1.07-2.92, p=0.025), and any substance use disorder (OR=1.85, 95% CI 1.12-3.05, p=0.016). Gender (OR=2.02, 95% CI 1.10-3.73, p=0.024) was associated with any mood disorder. The results provide baseline information on the most prevalent mental disorders within the OHARNG.
Asunto(s)
Trastornos Mentales/epidemiología , Personal Militar/psicología , Adolescente , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Ohio , Prevalencia , Adulto JovenRESUMEN
OBJECTIVE: Despite concerns about increased sexual harassment and assault after the 2013 legislation repealing the ban on women in combat, little research has examined military factors that could prevent sexual harassment and assault during deployment. This study examined whether unit support, which reflects the quality of service members' relationships within their unit, protects against sexual harassment and assault during deployment. METHODS: Participants were 1,674 Ohio Army National Guard service members who reported at least one deployment during a telephone survey conducted in 2008 and 2009. Participants completed measures of sexual harassment/assault, unit support, and psychosocial support. Logistic regression was used to model odds of sexual harassment/assault. RESULTS: Approximately 13.2% of men (n = 198) and 43.5% of women (n = 74) reported sexual harassment, and 1.1% of men (n = 17) and 18.8% of women (n = 32) reported sexual assault during their most recent deployment. Greater unit support was associated with decreased odds of sexual harassment and assault. CONCLUSIONS: A substantial proportion of men and women reported sexual harassment/assault. Greater unit support was associated with diminished odds of sexual harassment/assault during deployment. Programming designed to improve unit cohesion has the potential to reduce sexual harassment and assault.
Asunto(s)
Relaciones Interpersonales , Personal Militar/psicología , Acoso Sexual/psicología , Apoyo Social , Veteranos/psicología , Adulto , Femenino , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Personal Militar/estadística & datos numéricos , Ohio , Delitos Sexuales/estadística & datos numéricos , Acoso Sexual/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
BACKGROUND: There is a limited amount of data examining the relation between the onset of alcohol abuse/dependence and the experiences of soldiers prior to (pre), during (peri) and after (post) military deployment. Some deployment characteristics, e.g., military unit cohesion, are potentially modifiable in the context of reducing alcohol abuse/dependence peri-/post deployment. We investigated the associations between potentially modifiable deployment characteristics and peri-/post (incident) alcohol abuse/dependence among deployed Ohio Army National Guard (OHARNG) soldiers. METHODS: Using a sample of OHARNG (June, 2008 to February, 2009), eligible participants were ever been deployed and did not report alcohol abuse/dependence prior to deployment (final sample size=963). Interviews assessed soldiers' alcohol abuse/dependence, depression, PTSD, deployment related factors (e.g., exposure to warzone stressors) and three deployment characteristics (pre-deployment preparedness, unit support during deployment, and post-deployment social support). Associations between the three deployment characteristics and incident alcohol abuse/dependence (defined as abuse or dependence at any point during or after deployment) were estimated using logistic regression. RESULTS: Only pre-deployment preparedness was associated with incident alcohol abuse/dependence (a non-linear inverted-u shaped relation) when controlling for demographics, deployment related factors (e.g., exposure to warzone stressors), and the presence of psychopathology that exhibited peri-/post-deployment. We present these results graphically, plotting incident alcohol abuse/dependence over the levels of pre-deployment preparedness. CONCLUSIONS: The association between pre-deployment preparedness and alcohol abuse/dependence may be characterized as an inverted-U shaped function. Suggestions for how and whether to modify pre-deployment preparedness in an effort to reduce peri-/post-deployment alcohol abuse or dependence should await further research.
Asunto(s)
Alcoholismo/diagnóstico , Alcoholismo/epidemiología , Personal Militar/psicología , Apoyo Social , Adolescente , Alcoholismo/psicología , Depresión/diagnóstico , Depresión/psicología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Ohio , Factores de Riesgo , Adulto JovenRESUMEN
Posttraumatic stress disorder's (PTSD) four-factor dysphoria model has substantial empirical support (reviewed in Elhai & Palmieri, Journal of Anxiety Disorders, 25, 849-854, 2011; Yufik & Simms, Journal of Abnormal Psychology, 119, 764-776, 2010). However, debatable is whether the model's dysphoria factor adequately captures all of PTSD's emotional distress (e.g., Marshall et al., Journal of Abnormal Psychology, 119(1), 126-135, 2010), which is relevant to understanding the assessment and psychopathology of PTSD. Thus, the present study assessed the factor-level relationship between PTSD and emotional distress in 818 children/adolescents attending school in the vicinity of the 2008 Mumbai terrorist attacks. The effective sample had a mean age of 12.85 years (SD = 1.33), with the majority being male (n = 435, 53.8 %). PTSD and emotional distress were measured by the UCLA PTSD Reaction Index (PTSD-RI) and Brief Symptom Inventory-18 (BSI-18) respectively. Confirmatory factor analyses (CFA) assessed the PTSD and BSI-18 model fit; Wald tests assessed hypothesized PTSD-distress latent-level relations; and invariance testing examined PTSD-distress parameter differences using age, gender and direct exposure as moderators. There were no moderating effects for the PTSD-distress structural parameters. BSI-18's depression and somatization factors related more to PTSD's dysphoria than PTSD's avoidance factor. The results emphasize assessing for specificity and distress variance of PTSD factors on a continuum, rather than assuming dysphoria factor's complete accountability for PTSD's inherent distress. Additionally, PTSD's dysphoria factor related more to BSI-18's depression than BSI-18's anxiety/somatization factors; this may explain PTSD's comorbidity mechanism with depressive disorders.