A Review of Military Health Research Using a Social–Ecological Framework

2018 ◽  
Vol 32 (4) ◽  
pp. 1078-1090 ◽  
Author(s):  
Pauline Lubens ◽  
Tim A. Bruckner
Keyword(s):  
Health Outcomes ◽  
Military Personnel ◽  
Health Research ◽  
Military Service ◽  
Federal State ◽  
Post Traumatic Stress ◽  
Care Needs ◽  
Military Health ◽  
Social Ecological ◽  
Combat Deployment

Objective: We aim to contextualize the growing body of research on the sequelae of military service in the wars in Afghanistan and Iraq. We employ a social–ecological (SE) framework for the taxonomy of military health research and classify risk as arising from the individual, family, community, and the institutional levels. We intend for this review to inform enhanced health promotion efforts in military communities. Data Source: Articles reviewed were extracted from Web of Science, PubMed, and Scopus. Inclusion and Exclusion Criteria: Research focused on somatic and psychological sequelae of combat deployment published from 2001—the year the war in Afghanistan began—through the end of 2014. We excluded studies of non-US military personnel, other systematic reviews, meta-analyses, book chapters, and theoretical papers. Data Extraction: We examined and summarized the aims, participants, methods, study design, SE framework tier, risk factors, and health outcomes. Data Synthesis: Studies were categorized according to SE tier, whether they focused on somatic, behavioral, or psychological outcomes, and by risk factor. Results: Of the 352 peer-reviewed papers, 84% focused on war’s sequelae on the index military personnel, and 75% focused on mental or behavioral health outcomes—mostly on post-traumatic stress disorder. We find comparatively little research focusing on the family, community, or institutional tiers. Conclusions: We know relatively little about how family and community respond to the return of personnel from combat deployment; how family resources affect the health of returning military personnel; and how a war’s persistence presents challenges for federal, state, and local agencies to meet military health-care needs. Such work is especially salient as US troops return home from war—particularly in communities where there are substantial military populations.

scholarly journals Mental Health Outcomes Among Military Service Members After Severe Injury in Combat and TBI

2019 ◽  
Vol 185 (5-6) ◽  
pp. e711-e718 ◽  
Author(s):  
David L Chin ◽  
John E Zeber
Keyword(s):  
Mental Health ◽  
Health Outcomes ◽  
Traumatic Stress ◽  
Military Service ◽  
Mental Health Outcomes ◽  
Service Members ◽  
Post Traumatic Stress ◽  
Military Service Members ◽  
Severe Tbi ◽  
Post Traumatic

Abstract Introduction Studies examining the mental health outcomes of military personnel deployed into combat zones have focused on the risk of developing post-traumatic stress disorder conferred by mild or moderate traumatic brain injury (TBI). However, other mental health outcomes among veterans who sustained critical combat injuries have not been described. Materials and Method We examined the associations of moderate and severe TBI and combat injury with the risk for anxiety and mood disorders, adjustment reactions, schizophrenia and other psychotic disorders, cognitive disorders, and post-traumatic stress disorder. We conducted a retrospective cohort study of U.S. military service members critically injured in combat during military operations in Iraq and Afghanistan from February 1, 2002, to February 1, 2011. Health care encounters from (1) the Department of Defense (DoD) Trauma Registry (TR), (2) acute and ambulatory care in military facilities, and (3) civilian facilities are reimbursed by Tricare. Service members who sustained severe combat injury require critical care. We estimated the risk of mental health outcomes using risk-adjusted logit models for demographic and clinical factors. We explored the relationship between TBI and the total number of mental health diagnoses. Results Of the 4,980 subjects who met inclusion criteria, most injuries occurred among members of the Army (72%) or Marines (25%), with mean (SD) age of 25.5(6.1) years. The prevalence of moderate or severe TBI was 31.6% with explosion as the most common mechanism of injury (78%). We found 71% of the cohort was diagnosed with at least one poor mental health condition, and the adjusted risk conferred by TBI ranged from a modest increase for anxiety disorder (odds ratio, 1.27; 95% confidence interval [CI], 1.11–1.45) to a large increase for cognitive disorder (odds ratio, 3.24; 95% CI, 2.78–3.77). We found TBI was associated with an increased number of mental health diagnoses (incidence rate ratio, 1.52; 95% CI, 1.42–1.63). Conclusions Combat-associated TBI may have a broad effect on several mental health conditions among critically injured combat casualties. Early recognition and treatment for trauma-associated mental health are crucial to improving outcomes among service personnel as they transition to post-deployment care in the DoD, Department of Veterans Affairs, or community health systems.

scholarly journals Music Therapy With Military Populations: A Scoping Review

2019 ◽  
Vol 56 (4) ◽  
pp. 315-347 ◽  
Author(s):  
Lori F Gooding ◽  
Diane G Langston
Keyword(s):  
Music Therapy ◽  
Scoping Review ◽  
Military Personnel ◽  
Military Service ◽  
Service Members ◽  
Music Intervention ◽  
Post Traumatic Stress ◽  
Clinical Program ◽  
Types Of Information ◽  
Therapy Treatment

Abstract Music therapy treatment is increasingly being used to promote health, enhance quality of life, and improve functioning in military personnel, but evidence on the use of music interventions with military service members is still emerging. The purpose of this scoping review was to synthesize the available literature regarding music therapy treatment with military personnel by identifying the types of information available, key characteristics, and gaps in the knowledge base. The review was completed using the methodological framework proposed by Arksey and O’Malley. A total of 27 publications met the criteria for review. The results included anecdotal reports, white papers/ briefs, case studies, historical reviews, clinical program descriptions, and research studies. Both active duty and veteran service members were represented in the literature, and post-traumatic stress disorder and traumatic brain injury were the most commonly listed conditions among those served. Music therapy services were offered in both group and individual formats, and drumming was the most common music intervention cited. Most publications accurately represented music therapy, and the historical reviews highlighted the connection between the development of the field of music therapy and the use of music with military personnel. Several gaps were identified, including a lack of specificity in reporting, low levels of evidence, and limited inclusion of women service members.

scholarly journals Mental health outcomes in US and UK military personnel returning from Iraq

2014 ◽  
Vol 204 (3) ◽  
pp. 200-207 ◽  
Author(s):  
Josefin Sundin ◽  
Richard K. Herrell ◽  
Charles W. Hoge ◽  
Nicola T. Fear ◽  
Amy B. Adler ◽  
...  
Keyword(s):  
Mental Health ◽  
Alcohol Consumption ◽  
Health Outcomes ◽  
Military Personnel ◽  
Physical Symptoms ◽  
Combat Exposure ◽  
Mental Health Outcomes ◽  
Military Health ◽  
Hazardous Alcohol ◽  
Hazardous Alcohol Consumption

BackgroundResearch of military personnel who deployed to the conflicts in Iraq or Afghanistan has suggested that there are differences in mental health outcomes between UK and US military personnel.AimsTo compare the prevalence of post-traumatic stress disorder (PTSD), hazardous alcohol consumption, aggressive behaviour and multiple physical symptoms in US and UK military personnel deployed to Iraq.MethodData were from one US (n= 1560) and one UK (n= 313) study of post-deployment military health of army personnel who had deployed to Iraq during 2007–2008. Analyses were stratified by high- and low-combat exposure.ResultsSignificant differences in combat exposure and sociodemographics were observed between US and UK personnel; controlling for these variables accounted for the difference in prevalence of PTSD, but not in the total symptom level scores. Levels of hazardous alcohol consumption (low-combat exposure: odds ratio (OR) = 0.13, 95% CI 0.07–0.21; high-combat exposure: OR = 0.23, 95% CI 0.14–0.39) and aggression (low-combat exposure: OR = 0.36, 95% CI 0.19–0.68) were significantly lower in US compared with UK personnel. There was no difference in multiple physical symptoms.ConclusionsDifferences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD. Adjusting for self-reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.

scholarly journals Differences in problem alcohol drinking by military service type among male professional military personnel in South Korea using Military Health Survey data

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e045279
Author(s):  
Jeongok Park ◽  
Eunyoung Jung ◽  
Eunkyoung Bae
Keyword(s):  
Family Support ◽  
Air Force ◽  
Military Personnel ◽  
Alcohol Drinking ◽  
Military Service ◽  
Problem Drinking ◽  
Military Health ◽  
Factors Associated ◽  
Service Type ◽  
Sleep Satisfaction

ObjectivesAlcohol drinking prevalence in Korea is higher than in other countries and is associated with various social and health problems. Korean culture tends to be tolerant of alcohol drinking and to regard it as an important medium for maintaining good interpersonal relationships in one’s social life. Although alcohol drinking is a means of relieving stress, especially among soldiers, who engage in more binge drinking than civilians, there is lack of research focused on problem drinking among soldiers. Therefore, the purpose of this study was to explore the extent of problem drinking across all military services and to identify factors associated with problem drinking by military service type.DesignSecondary data analysis.SettingDataset of the Military Health Survey in 2015.ParticipantsAltogether, 2252 male professional military personnel were included in this study.Main outcome measureProblem drinking in this study was defined as at-risk drinking and alcohol abuse or dependence with an Alcohol Use Disorders Identification-Korean (AUDIT-K) score of 10 points or higher.ResultsThe average AUDIT-K score was 7.38±4.10 points. The prevalence of problem drinking was 16.4% for the Army, 34.5% for the Navy and 32.1% for the Air Force. Factors associated with problem drinking for each military service type were sleep satisfaction (OR 2.33, 95% CI 1.284 to 4.236) and family support (OR 0.66, 95% CI 0.487 to 0.904) in the Army, smoking status (OR 1.85, 95% CI 1.130 to 3.039) and sleep satisfaction (OR 2.29, 95% CI 1.142 to 4.574) in the Navy and marital status (OR 0.60, 95% CI 0.382 to 0.951), smoking (past smokers and non-smokers OR 2.81, 95% CI 1.593 to 4.973, current smokers and non-smokers OR 1.68, 95% CI 1.114 to 2.544), subjective oral health (OR 1.83, 95% CI 1.011 to 3.297) and family support (OR 0.63, 95% CI 0.45 to 0.88) in the Air Force.ConclusionWhen implementing health projects to address drinking problems, it is necessary to ensure that service-type-specific factors are considered for integrated management.

scholarly journals Pharmacoeconomic analysis of drug supply of the military personnel with chronic bronchitis

2021 ◽  
Vol 14 (3) ◽  
pp. 336-342
Author(s):  
O. V. Plieshkova ◽  
O. V. Bielozorova ◽  
M. V. Bilous ◽  
D. V. Drozdov ◽  
A. V. Nikituk
Keyword(s):  
Chronic Bronchitis ◽  
Military Personnel ◽  
Military Service ◽  
Pharmacoeconomic Analysis ◽  
Economic Benefits ◽  
Expert Assessment ◽  
Drug Supply ◽  
Military Health ◽  
The Cost ◽  
The Military

Despite the superiority of bronchitis in the structure of respiratory diseases in the military personnel, its course develops with certain peculiarities due to the peculiarities of military service. Consequently, the optimization of the costs of providing the military personnel with medicines is becoming more and more of medical and social importance. Reasonable selection of medicines in the treatment of chronic bronchitis is the result of the choice of effective and safe drugs, considering the cost of the components for military health care. Aim. To perform a pharmacoeconomic analysis of drug supply to the military personnel with chronic bronchitis. Materials and methods. The materials of the study were a database of drugs registered in Ukraine, presented on the official website of the State Institution “State Expert Center” of the Ministry of Health of Ukraine. The study employed “cost – effectiveness” method, which allows comparing the cost of a particular treatment method and its effectiveness. Results. The scheme of the pharmacoeconomic analysis method has been offered. According to the results of the previously formed list of drugs for the treatment of military personnel with chronic bronchitis, a further analysis of the proposed range of drugs is conducted using an expert survey. By calculating the efficacy ratio within each presented pharmacotherapeutic group, a 10-item list of the most optimal drugs for the treatment of chronic bronchitis has been compiled. Conclusions. Pharmacoeconomic analysis of medical supply to the military personnel is a constructive solution in the process of identifying manufacturers as potential suppliers of medicines to cover the needs of the medical service of the Armed Forces of Ukraine. Based on the results of the pharmacoeconomic analysis of the drug supply to military personnel with chronic bronchitis, a recommended list of drugs for their treatment has been formed. However, this list can be expanded to include drugs with the highest efficacy – according to the expert assessment. In the future it may become the basis for inclusion of drugs in the clinical protocols of medical care and could be used for the development of cost standards for the relevant nosological forms, which will improve the efficiency and quality of treatment and will provide economic benefits.

scholarly journals Associations between earplug use and hearing loss in ROK military personnel

2020 ◽  
pp. jramc-2019-001378
Author(s):  
Hwi Jun Kim ◽  
S Y Oh ◽  
S Y Won ◽  
H J Kim ◽  
T K Kim ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Air Force ◽  
Logistic Regression Analysis ◽  
Military Personnel ◽  
Military Service ◽  
Military Health ◽  
The Republic ◽  
The Military

IntroductionThe easiest way to prevent noise-induced hearing loss (NIHL) is to wear earplugs. The Republic of Korea (ROK) Ministry of National Defense (MND) is supplying earplugs to prevent NIHL, but many patients still suffer from this. We speculated that earplugs would have a high NIHL rate, depending on the rate of use of earplugs, regardless of the rate of supply. Therefore, we conducted this study to investigate the relationship between the use of earplugs and hearing loss by ROK military personnel.MethodsThe study used data from the Military Health Survey conducted in 2014–2015, which included 13 470 questionnaires completed by ROK military personnel. Hearing loss and earplug use were self-reported. Logistic regression analysis was used to assess associations between earplug use and hearing loss.ResultsThe study sample included 13 470 ROK military personnel (response rate of 71.2%) (Army, 8330 (61.8%); Navy/Marines, 2236 (16.6%); and Air Force, 2904 (21.6%)). Overall, 18.8% of Korean military personnel reported that they always wore earplugs, and 2.8% reported hearing loss. In logistic regression analysis, there were significant differences in the rates of hearing loss associated with wearing earplugs sometimes (OR=1.48, 95% CI 1.07 to 2.05) and never wearing earplugs (OR=1.53, 95% CI 1.12 to 2.10). In subgroup analysis, in Air Force, non-combat branch, forward area and long-term military service personnel increased hearing loss was associated with not wearing earplugs.ConclusionOur study confirmed that within the ROK military, there is an association between hearing loss and lack of earplug use. In the ROK MND, Army, Navy/Marines and Air Force headquarters must provide guidelines for the use of earplugs during field training to protect military personnel’s hearings and, if necessary, need to be regulated or institutionalised.

Prospective study of anxiety, post-traumatic stress and depression on postural control, gait, otolith and visuospatial function in military service members with persistent post-concussive symptoms

2019 ◽  
pp. 271-287
Author(s):  
◽  
Andrew Lewandowski ◽  
Lindell K. Weaver ◽  
◽  
◽  
...  
Keyword(s):  
Brain Injury ◽  
Postural Control ◽  
Traumatic Stress ◽  
Military Service ◽  
Service Members ◽  
Post Traumatic Stress ◽  
High Anxiety ◽  
Affective Symptoms ◽  
Military Service Members ◽  
Post Traumatic

Purpose: Military service members often report both affective and vestibular complaints after mild traumatic brain injury (mTBI), but associations between symptoms and vestibular deficits can be subtle and inconsistent. Methods: From two complementary studies, one of military service members with persistent post-concussive symptoms after mTBI (NCT01611194) and the other of adult volunteers with no history of brain injury (NCT01925963), affective symptoms were compared to postural control, gait, otolith and visuospatial function. Results: The studies enrolled 71 participants with mTBI and 75 normative controls. Participants with mTBI had significantly reduced postural equilibrium on the sensory organization test (SOT), and more so in those with high anxiety or post-traumatic stress. Cervical and ocular vestibular evoked myogenic potentials (cVEMP; oVEMP) showed prolonged latencies in mTBI participants compared to controls; oVEMPs were significantly delayed in mTBI participants with high anxiety, post-traumatic stress or depression. A subset of the mTBI group had abnormal tandem gait and high anxiety. Anxiety, posttraumatic stress, and depression did not correlate with performance on the 6-Minute Walk Test, visuospatial neuropsychological measures, and the Satisfaction with Life Scale in the mTBI group. Conclusions: In this study military service members with mTBI reported affective symptoms, concurrently with vestibular-balance concerns. Worse scores on affective measures were associated with abnormal findings on measures of postural control, gait and otolith function.

scholarly journals Helminth infections in the US military: from strongyloidiasis to schistosomiasis

2021 ◽  
Author(s):  
Alyssa R Lindrose ◽  
Indrani Mitra ◽  
Jamie Fraser ◽  
Edward Mitre ◽  
Patrick W Hickey
Keyword(s):  
Military Personnel ◽  
International Classification Of Diseases ◽  
Data Repository ◽  
Military Health ◽  
Intestinal Nematode ◽  
Us Military ◽  
Helminth Infections ◽  
The Us ◽  
East And Southeast Asia ◽  
The Military

Abstract Background Helminth infections caused by parasitic worms, including nematodes (roundworms), cestodes (tapeworms) and trematodes (flukes), can cause chronic symptoms and serious clinical outcomes if left untreated. The US military frequently conducts activities in helminth-endemic regions, particularly Africa, the Middle East and Southeast Asia. However, the military does not currently screen for these infections, and to date, no comprehensive surveillance studies have been completed to assess the frequency of helminth diagnoses in the military personnel and their families. Methods To determine the burden of helminth infections in the US Military Health System (MHS), we conducted a retrospective analysis of International Classification of Diseases (ICD)-9/10 diagnosis codes from all medical encounters in the MHS Data Repository (MDR) from fiscal years (FY) 2012 to 2018. Chart reviews were conducted to assign ICD diagnoses as incorrect, suspected, probable or confirmed based on the laboratory results and symptoms. Results Abstraction of MHS data revealed over 50 000 helminth diagnoses between FY 2012 and FY 2018. Of these, 38 445 of diagnoses were amongst unique subjects. After chart review, we found there were 34 425 validated helminth infections diagnosed amongst the unique subjects of US military personnel, retirees and dependents. Nearly 4000 of these cases represented infections other than enterobiasis. There were 351 validated strongyloidiasis diagnoses, 317 schistosomiasis diagnoses and 191 diagnoses of cysticercosis during the study period. Incidence of intestinal nematode infection diagnoses showed an upward trend, whilst the incidence of cestode infection diagnoses decreased. Conclusions The results of this study demonstrate that helminth infections capable of causing severe morbidity are often diagnosed in the US military. As helminth infections are often asymptomatic or go undiagnosed, the true burden of helminth infections in US military personnel and dependents may be higher than observed here. Prospective studies of US military personnel deployed to helminth-endemic areas may be indicated to determine if post-deployment screening and/or empirical treatment are warranted.

scholarly journals Post-traumatic stress impact on health outcomes in Gulf War Illness

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Mary Jeffrey ◽  
Fanny Collado ◽  
Jeffrey Kibler ◽  
Christian DeLucia ◽  
Steven Messer ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Short Form ◽  
Gulf War ◽  
Ptsd Symptoms ◽  
Symptom Presentation ◽  
Trauma Symptoms ◽  
Post Traumatic Stress ◽  
Gulf War Illness ◽  
Cut Point ◽  
Wide Range

Abstract Background Gulf War Illness (GWI) is a chronic, multi-symptomatic disorder affecting an estimated 25–32% of the returning military veterans of the 1990–1991 Persian Gulf War. GWI presents with a wide range of symptoms including fatigue, muscle pain, cognitive problems, insomnia, rashes and gastrointestinal issues and continues to be a poorly understood illness. This heterogeneity of GWI symptom presentation complicates diagnosis as well as the identification of effective treatments. Defining subgroups of the illness may help alleviate these complications. Our aim is to determine if GWI can be divided into distinct subgroups based on PTSD symptom presentation. Methods Veterans diagnosed with GWI (n = 47) and healthy sedentary veteran controls (n = 52) were recruited through the Miami Affairs (VA) Medical Health Center. Symptoms were assessed via the RAND short form health survey (36), the multidimensional fatigue inventory, and the Davidson trauma scale. Hierarchal regression modeling was performed on measures of health and fatigue with PTSD symptoms as a covariate. This was followed by univariate analyses conducted with two separate GWI groups based on a cut-point of 70 for their total Davidson Trauma Scale value and performing heteroscedastic t-tests across all measures. Results Overall analyses returned two symptom-based subgroups differing significantly across all health and trauma symptoms. These subgroups supported PTSD symptomatology as a means to subgroup veterans. Hierarchical models showed that GWI and levels of PTSD symptoms both impact measures of physical, social, and emotional consequences of poor health (ΔR2 = 0.055–0.316). However, GWI appeared to contribute more to fatigue measures. Cut-point analysis retained worse health outcomes across all measures for GWI with PTSD symptoms compared to those without PTSD symptoms, and healthy controls. Significant differences were observed in mental and emotional measures. Conclusions Therefore, this research supports the idea that comorbid GWI and PTSD symptoms lead to worse health outcomes, while demonstrating how GWI and PTSD symptoms may uniquely contribute to clinical presentation.

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