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Canadian Journal of Psychiatry. Revue... Sep 2023Military sexual trauma (MST) is an ongoing problem. We used a 2002 population-based sample, followed up in 2018, to examine: (1) the prevalence of MST and non-MST in...
Prevalence and Correlates of Military Sexual Trauma in Service Members and Veterans: Results From the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey.
INTRODUCTION
Military sexual trauma (MST) is an ongoing problem. We used a 2002 population-based sample, followed up in 2018, to examine: (1) the prevalence of MST and non-MST in male and female currently serving members and veterans of the Canadian Armed Forces, and (2) demographic and military correlates of MST and non-MST.
METHODS
Data came from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (n = 2,941, ages 33 years + ). Individuals endorsing sexual trauma were stratified into MST and non-MST and compared to individuals with no sexual trauma. The prevalence of lifetime MST was computed, and correlates of sexual trauma were examined using multinomial regression analyses.
RESULTS
The overall prevalence of MST was 44.6% in females and 4.8% in males. Estimates were comparable between currently serving members and veterans. In adjusted models in both sexes, MST was more likely among younger individuals (i.e., 33-49 years), and MST and non-MST were more likely in those reporting more non-sexual traumatic events. Among females, MST and non-MST were more likely in those reporting lower household income, non-MST was less likely among Officers, and MST was more likely among those with a deployment history and serving in an air environment. Unwanted sexual touching by a Canadian military member or employee was the most prevalent type and context of MST.
INTERPRETATION
A high prevalence of MST was observed in a follow-up sample of Canadian Armed Forces members and veterans. Results may inform further research as well as MST prevention efforts.
Topics: Male; Female; Humans; Veterans; Mental Health; Military Sexual Trauma; Prevalence; Follow-Up Studies; Sex Offenses; Canada; Military Personnel; Stress Disorders, Post-Traumatic
PubMed: 36124372
DOI: 10.1177/07067437221125292 -
Biology Nov 2023Military aviators endure high cognitive loads and hypoxic environments during flight operations, impacting the autonomic nervous system (ANS). The synergistic effects of...
Military aviators endure high cognitive loads and hypoxic environments during flight operations, impacting the autonomic nervous system (ANS). The synergistic effects of these exposures on the ANS, however, are less clear. This study investigated the simultaneous effects of mild hypoxia and high cognitive load on the ANS in military personnel. This study employed a two-factor experimental design. Twenty-four healthy participants aged between 19 and 45 years were exposed to mild hypoxia (14.0% O), normoxia (21.0% O), and hyperoxia (33.0% O). During each epoch ( = 5), participants continuously performed one 15 min and one 10 min series of simulated, in-flight tasks separated by 1 min of rest. Exposure sequences (hypoxia-normoxia and normoxia-hyperoxia) were separated by a 60 min break. Heart rate (HR), heart rate variability (HRV), and O saturation (SpO) were continuously measured via an armband monitor (Warfighter Monitor, Tiger Tech Solutions, Inc., Miami, FL, USA). Paired and independent -tests were used to evaluate differences in HR, HRV, and SpO within and between exposure sequences. Survival analyses were performed to assess the timing and magnitude of the ANS responses. Sympathetic nervous system (SNS) activity during hypoxia was highest in epoch 1 (HR: +6.9 bpm, = 0.002; rMSSD: -9.7 ms, = 0.003; SDNN: -11.3 ms, = 0.003; SpO: -8.4%, < 0.0000) and appeared to slightly decline with non-significant increases in HRV. During normoxia, SNS activity was heightened, albeit non-significantly, in epoch 1, with higher HR (68.5 bpm vs. 73.0 bpm, = 0.06), lower HRV (rMSSD: 45.1 ms vs. 38.7 ms, = 0.09 and SDNN: 52.5 ms vs. 45.1 ms, = 0.08), and lower SpO (-0.7% = 0.05). In epochs 2-4, HR, HRV, and SpO trended towards baseline values. Significant between-group differences in HR, HRV, and O saturation were observed. Hypoxia elicited significantly greater HRs (+5.0, = 0.03), lower rMSSD (-7.1, = 0.03), lower SDNN (-8.2, = 0.03), and lower SpO (-1.4%, = 0.002) compared to normoxia. Hyperoxia appeared to augment the parasympathetic reactivation reflected by significantly lower HR, in addition to higher HRV and O relative to normoxia. Hypoxia induced a greater ANS response in military personnel during the simultaneous exposure to high cognitive load. The significant and differential ANS responses to varying O levels and high cognitive load observed highlight the importance of continuously monitoring multiple physiological parameters during flight operations.
PubMed: 37997997
DOI: 10.3390/biology12111398 -
JAMA Health Forum Oct 2023Understanding how the active duty military population's mental health care use is associated with local military and civilian psychiatrist capacity is critical in...
IMPORTANCE
Understanding how the active duty military population's mental health care use is associated with local military and civilian psychiatrist capacity is critical in designing the optimal allocation of mental health resources from both sectors to improve the mental health of military personnel.
OBJECTIVE
To evaluate whether the probability of mental health care visits by military personnel changes when psychiatrist capacity changes in their communities, when capacity is measured separately for military treatment facilities and civilian sectors.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study of active duty US military service members between January 1, 2016, and September 30, 2020, combines data from the Defense Health Agency, the National Plan and Provider Enumeration System, and the US Census. Data were collected and analyzed from June 2022 to July 2023.
MAIN OUTCOMES AND MEASURES
The main outcome was the probability of making at least 1 mental health care visit in a given quarter at military treatment facilities and in civilian settings. Linear probability models with 2-dimensional fixed effects at individual and community levels were implemented to estimate changes in individual outcomes when community psychiatrist capacity changed.
RESULTS
This study includes 1 958 421 US service members (83% men; mean [SD] age at baseline, 28.4 [8.0] years). Thirteen percent of service members did not have military treatment facility psychiatrists available within a 30-minute driving time, and 66% lived in communities with a psychiatrist shortage (<1 psychiatrist per 20 000 relevant population), while 9% lived in communities with high (>3 psychiatrists per 20 000 relevant population) military treatment facility psychiatrist capacity. Five percent of service members lived in communities with no civilian psychiatrists within a 30-minute driving time, while 66% lived in communities with high civilian psychiatrist capacity. The mean quarterly mental health care visit rates to military treatment facilities and civilian settings were 7% and 2%, respectively. The probability of a mental health care visit to a military treatment facility increased by 0.95 percentage points (95% CI, 0.79-1.10 percentage points; equivalent to 14%) when the individual experienced a change in military treatment facility capacity from no psychiatrist to high capacity. The probability of a mental health care visit to a civilian setting increased by 0.57 percentage points (95% CI, 0.38-0.76 percentage points; equivalent to 32%) when civilian capacity changed from no psychiatrist to high capacity. The magnitude of responses to military treatment facility capacity changes remained similar in communities that already had high civilian capacity.
CONCLUSIONS AND RELEVANCE
This cohort study of the US military population suggests that active duty military personnel rely largely on military treatment facilities for their mental health care and that there are meaningful responses to military treatment facility psychiatrist capacity changes even in communities with high civilian psychiatric capacity. Realigning military treatment facility psychiatrists across communities with shortages and high-capacity military treatment facilities, as well as addressing nongeographical barriers in the civilian sector, remain critical to achieve the optimal balance between military and civilian care provision.
Topics: Male; Humans; Child; Female; Military Personnel; Mental Health; Cohort Studies; Mental Health Services; Probability
PubMed: 37801306
DOI: 10.1001/jamahealthforum.2023.3330 -
BMC Public Health Dec 2023Despite recognition in the West that military veterans experience more mental health issues than the general population, little research has focused on this subject in...
BACKGROUND
Despite recognition in the West that military veterans experience more mental health issues than the general population, little research has focused on this subject in China. This study examined the associations between male veterans' military experience and depression in China.
METHODS
A sample of 12,914 men including 669 veterans was included in the final analysis and propensity score matching, multivariable regressions and fixed effect model were used.
RESULTS
The military experience was associated with a lower likelihood of depression in male veterans. In the subgroup analysis, military experience was associated with a lower likelihood of depression among married and urban male veterans. Military experience was also associated with a lower likelihood of depression in both "junior college and above" and "below junior college" groups. In contrast, evidence was lacking regarding the associations between military experience and depression for unmarried and rural veterans.
CONCLUSIONS
Individual characteristics could influence the relationship between military experience and depression in male veterans, and the mental health of veterans should be paid more attention and guaranteed.
Topics: Humans; Male; Depression; Veterans; Military Personnel; Mental Health; Longitudinal Studies
PubMed: 38062444
DOI: 10.1186/s12889-023-17317-9 -
Journal of Preventive Medicine and... Sep 2023This study investigated the association between baseline exposures to particulate matter with a diameter < 2.5 microns (PM2.5) and subsequent temporal changes in PM2.5...
OBJECTIVES
This study investigated the association between baseline exposures to particulate matter with a diameter < 2.5 microns (PM2.5) and subsequent temporal changes in PM2.5 exposure with the incidence of type 2 diabetes among Royal Thai Army personnel.
METHODS
A retrospective cohort study was conducted using nationwide health check-up data from 21 325 Thai Army personnel between 2018 and 2021. Multilevel mixed-effects parametric survival statistics were utilized to analyze the relationship between baseline (i.e., PM2.5-baseline) and subsequent changes (i.e., PM2.5-change) in PM2.5 exposure and the occurrence of type 2 diabetes. Hazard ratios (HRs) and 95% confidence intervals (CIs) were employed to assess this association while considering covariates.
RESULTS
There was a significant association between both PM2.5 baseline and PM2.5-change and the incidence of type 2 diabetes in a dose-response manner. Compared to quartile 1, the HRs for quartiles 2 to 4 of PM2.5-baseline were 1.11 (95% CI, 0.74 to 1.65), 1.51 (95% CI, 1.00 to 2.28), and 1.77 (95% CI, 1.07 to 2.93), respectively. Similarly, the HRs for quartiles 2 to 4 of PM2.5-change were 1.41 (95% CI, 1.14 to 1.75), 1.43 (95% CI, 1.13 to 1.81) and 2.40 (95% CI, 1.84 to 3.14), respectively.
CONCLUSIONS
Our findings contribute to existing evidence regarding the association between short-term and long-term exposure to PM2.5 and the incidence of diabetes among personnel in the Royal Thai Army.
Topics: Humans; Air Pollutants; Diabetes Mellitus, Type 2; Air Pollution; Retrospective Studies; Military Personnel; Southeast Asian People; Environmental Exposure; Particulate Matter
PubMed: 37828872
DOI: 10.3961/jpmph.23.292 -
Frontiers in Psychiatry 2023Marital status is a robust sociodemographic predictor of sleep. Having to live apart from spouse may have different implications than those of cohabitants or singles,...
BACKGROUND
Marital status is a robust sociodemographic predictor of sleep. Having to live apart from spouse may have different implications than those of cohabitants or singles, especially in military personnel. Further research on this group will help provide knowledge in advance and facilitate early targeted interventions.
METHODS
An online questionnaire study was conducted from July to November 2021. A total of 1,832 male military personnel completed the questionnaire. The marital status was measured by a self-reported single choice question. Pittsburgh sleep quality index (PSQI), Epworth Sleepiness Scale (ESS) and The Dysfunctional Beliefs and Attitudes about sleep scale (DBAS-16) were used to measure sleep-related outcomes. Inverse probability weighting (IPW) was applied to reduce the effects of confounding. Logistic regression was used to analyze the relationship between marital status and sleep and explore the impact of living together or not.
RESULTS
After inverse probability weighting, the prevalence of poor sleep quality, sleepiness and dysfunctional beliefs were 16.1, 20.1 and 7.1%, respectively. One-way ANOVA results for the means of both groups were statistically significantly different, except for the sleep latency and sleep disturbance dimensions of PSQI. Participants who were married were more likely to have poor sleep quality (OR: 1.408, 95% CI: [1.10, 1.80]), to have daytime sleepiness (OR: 1.560, 95% CI: [1.27, 1.92]) and to develop dysfunctional beliefs and attitudes (OR: 2.497, 95% CI: [1.65, 3.80]) than those who were unmarried. Further analysis showed that the odds of developing poor sleep quality and DBAS in participants who married but living apart were significantly bigger than those unmarried (OR: 1.548 and 3.991, respectively.), while there were no significant differences in the odds of daytime sleepiness (OR: 0.738, = 0.050). Age was a protective factor for the development of bad sleep outcomes, while family economic was an independent risk factor.
CONCLUSION
Marital status appear important for sleep quality, daytime sleepiness and sleep beliefs. The effect of living apart or not should be considered separately as an important predictor of sleep.
PubMed: 37575585
DOI: 10.3389/fpsyt.2023.1178235 -
The Journal of Trauma and Acute Care... Aug 2023At the University of Alabama at Birmingham (UAB), a multi-tiered military-civilian partnership (MCP) has evolved since 2006. We aimed to outline this model to facilitate... (Review)
Review
BACKGROUND
At the University of Alabama at Birmingham (UAB), a multi-tiered military-civilian partnership (MCP) has evolved since 2006. We aimed to outline this model to facilitate potential replication nationally.
METHODS
We performed a comprehensive review of the partnership between UAB, the United States Air Force Special Operations Command, and the Department of Defense (DoD) reviewing key documents and conducting interviews with providers. As a purely descriptive study, this project did not involve any patient data acquisition or analysis and therefore was exempt from institutional review board approval per institutional policy.
RESULTS
At the time of this review, six core programs existed targeting training, clinical proficiency, and research. Training: (1) The Special Operations Center for Medical Integration and Development trains up to 144 combat medics yearly. (2) UAB trains one integrated military Surgery resident yearly with two additional civilian-sponsored military residents in Emergency Medicine. (3) UAB's Surgical Critical Care Fellowship had one National Guard member with two incoming Active-Duty, one Reservist and one prior service member in August 2022. Clinical Proficiency: (4) UAB hosts four permanently assigned United States Air Force Special Operations Command Special Operations Surgical Teams composed of general surgeons, anesthesiologists, certified registered nurse anesthetists, surgical technologists, emergency physicians, critical care registered nurses, and respiratory therapists totaling 24 permanently assigned active-duty health care professionals. (5) In addition, two fellowship-trained Air Force Trauma Critical Care Surgeons, one Active-Duty and one Reservist, are permanently assigned to UAB. These clinicians participate fully and independently in the routine care of patients alongside their civilian counterparts. Research: (6) UAB's Division of Trauma and Acute Care Surgery is currently conducting nine DoD-funded research projects totaling $6,482,790, and four research projects with military relevance funded by other agencies totaling $15,357,191.
CONCLUSION
The collaboration between UAB and various elements within the DoD illustrates a comprehensive approach to MCP. Replicating appropriate components of this model nationally may aid in the development of a truly integrated trauma system best prepared for the challenges of the future.
LEVEL OF EVIDENCE
Economic and Value-based Evaluations; Level IV.
Topics: Humans; United States; Military Personnel; Critical Care; Surgeons; Health Personnel; Allied Health Personnel
PubMed: 37184467
DOI: 10.1097/TA.0000000000004051 -
Ui Sahak Aug 2023This research examines the expansion and characteristics of the Korean Army's chain of medical evacuation in 1948-1953. The most important goal of the chain of medical...
This research examines the expansion and characteristics of the Korean Army's chain of medical evacuation in 1948-1953. The most important goal of the chain of medical evacuation was to conserve fighting strength, which cannot be achieved only by sending the sick and wounded to the rear for treatment. It was more important to maintain as many mission-capable wounded soldiers on the frontline. Therefore, triage for conserving strength was the priority in the evacuation process, and military doctors conducting triage played a significant role. Focusing on military doctors, this article studies the instability of the Korean Army's medical evacuation chain. Although Korea was liberated from Japanese colonial rule in August 1945, Korea had no army or army medical services. With the support of KMAG, the Korean Army was able to build a nationwide evacuation chain during the Korean War. However, the expansion of the medical evacuation chain resulted in instability. At the heart of the instability was manpower, rather than organization and transportation. Koreans had almost no experience with the military medical services before 1948, and during the Korean War, most doctors, who had been conscripted after the outbreak of the war, were not trained as military doctors. Therefore, the Korean Army had no other choice but to conduct medical evacuations using mobilized civilian doctors who were not sufficiently trained as military doctors. The escalating war revealed the problems of civilian doctors in military uniforms. Unlike the goal of the chain of medical evacuation, they easily evacuated patients and were reluctant to release patients to return to their duties. Korean Army doctors who were not sufficiently trained as military doctors struggled between the goals of military medical services and those of medical care. Consequently, the military doctors and the instability of the medical evacuation chain during the Korean War reflect the fundamental tension between war and medicine.
Topics: Humans; Asian People; Military Personnel; Republic of Korea; Military Medicine; Triage; Transportation of Patients; Wounds and Injuries; Korean War
PubMed: 37718560
DOI: 10.13081/kjmh.2023.32.463 -
BMJ Military Health Nov 2023Anterior cruciate ligament (ACL) injury is common within the US military and represents a significant loss to readiness. Since recent changes to operational tempo, there...
INTRODUCTION
Anterior cruciate ligament (ACL) injury is common within the US military and represents a significant loss to readiness. Since recent changes to operational tempo, there has not been an analysis of ACL injury risk. The aim of this retrospective cohort study was to evaluate military occupation, sex, rank and branch of service on ACL injury risk in the US military from 2006 to 2018.
METHODS
The Defense Medical Epidemiology Database was queried for the number of US tactical athletes with International Classification of Diseases diagnosis codes 717.83 (old disruption of ACL), 844.2 (sprain of knee cruciate ligament), M23.61 (other spontaneous disruption of ACL) and S83.51 (sprain of ACL of knee) on their initial encounter. Relative risk and χ statistics were calculated to assess sex and military occupation effects on ACL injury. A multivariable negative binomial regression model evaluated changes in ACL injury incidence with respect to sex, branch of service and rank.
RESULTS
The study period displayed a significant decrease in the ACL injury rate at 0.18 cases per 1000 person-years or relative decrease of 4.08% each year (p<0.001) after averaging over the main and interactive effects of sex, rank and branch of service. The interaction effect of time with sex indicated a steeper decline in the incidence in men as compared with women. The risk of ACL injury by sex was modified by rank. The incidence among military personnel varied by occupation.
CONCLUSION
Despite the decline among tactical athletes over time, rates of ACL injury remain much higher than the general US population. Sex, rank, branch of service and military occupation were found to be risk factors for ACL injury. It is critical for policy makers to understand the salient risk factors for ACL injury to guide proactive measures to prevent injury.
Topics: Male; Humans; Female; Anterior Cruciate Ligament Injuries; Military Personnel; Retrospective Studies; Athletes; Sprains and Strains; Occupations
PubMed: 35165197
DOI: 10.1136/bmjmilitary-2021-002059 -
Sensors (Basel, Switzerland) Jul 2023The loadsol wireless in-shoe force sensors can be useful for in-field measurements. However, its accuracy is unknown in the military context, whereby soldiers have to...
The loadsol wireless in-shoe force sensors can be useful for in-field measurements. However, its accuracy is unknown in the military context, whereby soldiers have to carry heavy loads and walk in military boots. The purpose of this study was to establish the validity of the loadsol sensors in military personnel during loaded walking on flat, inclined and declined surfaces. Full-time Singapore Armed Forces (SAF) personnel ( = 8) walked on an instrumented treadmill on flat, 10° inclined, and 10° declined gradients while carrying heavy loads (25 kg and 35 kg). Normal ground reaction forces (GRF), perpendicular to the contact surface, were simultaneously measured using both the loadsol sensors inserted in the military boots and the Bertec instrumented treadmill as the gold standard. A total of eight variables of interest were compared between loadsol and treadmill, including four kinetic (impact peak force, active peak force, impulse, loading rate) and four spatiotemporal (stance time, stride time, cadence, step length) variables. Validity was assessed using Bland-Altman plots and 95% Limits of Agreement (LoA). Bias was calculated as the mean difference between the values obtained from loadsol and the instrumented treadmill. Results showed similar force-time profiles between loadsol sensors and the instrumented treadmill. The bias of most variables was generally low, with a narrow range of LoA. The high accuracy and good agreement with standard laboratory equipment suggest that the loadsol system is a valid tool for measuring normal GRF during walking in military boots under heavy load carriage.
Topics: Humans; Military Personnel; Gait; Shoes; Biomechanical Phenomena; Walking
PubMed: 37514763
DOI: 10.3390/s23146465