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U.S. Army mortuary affairs (MA) soldiers experience stressors of deployment and exposure to the dead, increasing risk for post-traumatic stress and depression. This study examines Troop Education for Army Morale, a postdeployment early intervention based on Psychological First Aid. MA soldiers (N = 126) were randomized to intervention or comparison groups 1-month postdeployment. Intervention sessions were held at 2, 3, 4, and 7 months. Assessments of post-traumatic stress disorder (PTSD), depression, and quality of life (QOL) were conducted at 1, 2, 3, 4, 7, and 10 months for both groups. At baseline, 25.0% of the total sample had probable PTSD (17-item PTSD Checklist M = 35.4, SD = 16.9) and 23.6% had probable depression (9-item Patient Health Questionnaire Depression Scale M = 7.8, SD = 6.9). Over 10 months, PTSD and depression symptoms decreased and QOL improved for the total sample. At study conclusion, intervention and comparison groups were not different. Intervention group males showed a transient symptom increase at 2 to 3 months. Males attended fewer intervention sessions than females. Lower attendance was associated with more symptoms and lower QOL. Higher attendance was associated with greater intervention benefits. Findings highlight the need for better understanding postdeployment interventions and facilitating attendance. Further intervention for MA soldiers is indicated., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)

Importance: Suicide attempts in the US Army have risen in the past decade. Understanding the association between suicide attempts and deployment, as well as method and timing of suicide attempts, can assist in developing interventions., Objective: To examine suicide attempt risk factors, methods, and timing among soldiers currently deployed, previously deployed, and never deployed at the time this study was conducted., Design, Setting, and Participants: This longitudinal, retrospective cohort study of Regular Army-enlisted soldiers on active duty from 2004 through 2009 used individual-level person-month records to examine risk factors (sociodemographic, service related, and mental health), method, and time of suicide attempt by deployment status (never, currently, and previously deployed). Administrative data for the month before each of 9650 incident suicide attempts and an equal-probability sample of 153 528 control person-months for other soldiers were analyzed using a discrete-time survival framework., Main Outcomes and Measures: Suicide attempts and career, mental health, and demographic predictors were obtained from administrative and medical records., Results: Of the 9650 enlisted soldiers who attempted suicide, 86.3% were male, 68.4% were younger than 30 years, 59.8% were non-Hispanic white, 76.5% were high school educated, and 54.7% were currently married. The 40.4% of enlisted soldiers who had never been deployed (n = 12 421 294 person-months) accounted for 61.1% of enlisted soldiers who attempted suicide (n = 5894 cases). Risk among those never deployed was highest in the second month of service (103 per 100 000 person-months). Risk among soldiers on their first deployment was highest in the sixth month of deployment (25 per 100 000 person-months). For those previously deployed, risk was highest at 5 months after return (40 per 100 000 person-months). Currently and previously deployed soldiers were more likely to attempt suicide with a firearm than those never deployed (currently deployed: OR, 4.0; 95% CI, 2.9-5.6; previously deployed: OR, 2.7; 95% CI, 1.8-3.9). Across deployment status, suicide attempts were more likely among soldiers who were women (currently deployed: OR, 3.4; 95% CI, 3.0-4.0; previously deployed: OR, 1.5; 95% CI, 1.4-1.7; and never deployed: OR, 2.4; 95% CI, 2.3-2.6), in their first 2 years of service (currently deployed: OR, 1.9; 95% CI, 1.5-2.3; previously deployed: OR, 2.2; 95% CI, 1.9-2.7; and never deployed: OR, 3.1; 95% CI, 2.7-3.6), and had a recently received a mental health diagnosis in the previous month (currently deployed: OR, 29.8; 95% CI, 25.0-35.5; previously deployed: OR, 22.2; 95% CI, 20.1-24.4; and never deployed: OR, 15.0; 95% CI, 14.2-16.0). Among soldiers with 1 previous deployment, odds of a suicide attempt were higher for those who screened positive for depression or posttraumatic stress disorder after return from deployment and particularly at follow-up screening, about 4 to 6 months after deployment (depression: OR, 1.4; 95% CI, 1.1-1.9; posttraumatic stress disorder: OR, 2.4; 95% CI, 2.1-2.8)., Conclusions and Relevance: Identifying the timing and risk factors for suicide attempt in soldiers requires consideration of environmental context, individual characteristics, and mental health. These factors can inform prevention efforts.

Understanding features of community strength both on and off the military installation will help identify and address the needs of military families. This study introduced a measure to identify adequacy of community resources for military families. Using confirmatory factor analysis with data from 717 service users (M age = 37.3 yr., SD = 10.6) representing four large U.S. Army installations, two domains of community resource adequacy were identified: resources on the installation and resources off the installation. This measure could be used in health research with military families and in improving resources available to this population.

The death of a military service member in war provokes feelings of distress and pride in mortuary workers who process the remains. To further understand their reactions, the authors interviewed 34 military and civilian personnel to learn more about their work stresses and rewards. They review stresses of anticipation, exposure, and experience in handling the dead and explore the personal, supervisory, and leadership strategies to reduce negative effects and promote personal growth. These results can be applied to many other situations requiring planning, implementing, and supervising mortuary operations involving mass death.

Objective: To determine the relationship between length of soldier deployment and self-reports of moderate and severe spousal violence., Methods: The Conflict Tactics Scale was used to measure self-reports of behaviors exhibited in marital conflict. Surveys were administered to a 15% random sample of 26,835 deployed and nondeployed married active duty U.S. Army men and women in the 50 United States during the period 1990 to 1994. Multinomial logistic regression and ordered probit analysis were used to estimate the probabilities of moderate and severe violence by length of deployment., Results: After controlling for demographic variables, the probability of severe aggression was significantly greater for soldiers who had deployed in the past year compared with soldiers who had not deployed., Conclusions: Deployment contributes a significant but small increase to the probability of self-reported spousal aggression during a 1-year period. Although deployment is a military operation, similar effects may be observed in certain civilian occupations.

The association between alcohol use and substantiated incidents of nonmutual and mutual domestic violence between U.S. Army enlisted soldiers and their spouses was examined for the period 1998-2004. Maltreatment was always more severe in nonmutual incidents. Female victims experienced more severe maltreatment than males. Male offenders and victims were more likely to be drinking than females. For victims of both sexes, severity was greater when offenders were drinking. Older males were more likely to be offenders in nonmutual incidents. White males were more likely than Black or Hispanic males to be offenders in nonmutual incidents. There is a need for both domestic violence and alcohol treatment programs to focus on the increased risk of abuse when alcohol is involved.

The pattern and severity of substantiated mutual and nonmutual spouse abuse between U.S. Army enlisted personnel and their spouses was determined for 1998 to 2002. The number of nonmutual and mutual abuse victims was equal in 1998, but by 2002 there were about twice as many non mutual as mutual victims. The rate per thousand of mutual abuse decreased by 58% while that of nonmutual abuse decreased by 13%. The rate per thousand of female victims was always greater than male victims for non-mutual abuse and the severity of abuse of female victims was always more severe than male victims. The active duty female had the highest risk of becoming a victim. These patterns of mutual and nonmutual domestic abuse in the U.S. Army suggest that prevention and educational approaches could be developed that would be useful to prevention specialists and to clinicians as the Army pursues avenues to reduce domestic violence.

The transitional compensation (TC) program of the U.S. Army provides financial and other benefits to the families of service members discharged for child or spouse maltreatment. We analyzed the TC records of the 347 offenders, 337 spouses (160 victims and 177 nonvictims) who were applicants for benefits, and 820 children (244 victims and 576 nonvictims). One hundred fifty-two spouses were physically abused and eight were sexually abused. One hundred eighty-two children were sexually abused, 61 were physically abused, and one was emotionally abused. The Army Central Registry (ACR) of child and spouse maltreatment cases was examined to determine whether the TC offenders and victims had a history of prior maltreatment and to assess its severity. Ninety percent of the TC offenders had an ACR history as child or spouse maltreatment offenders. Seventy-four percent of the TC child abuse victims had an ACR history as victims, and 81 percent of the TC spouse abuse victims had such a history. The severity of maltreatment in the ACR of TC child and spouse victims was greater than the overall severity of maltreatment for those in the ACR database who were not in the TC database. Other children in the family who had not been identified as TC victims also had an ACR history that was more severe. Health and social service agencies should be aware of the TC program and be knowledgeable about its benefits for family members of soldiers discharged for abuse-related offenses.

Aggression by a random sample of female soldiers (N = 1,185) toward their employed (n = 840) and unemployed (n = 345) civilian husbands was measured by the Conflict Tactics Scale. When age, race, rank, years married, and the number of previous marriages were held constant, severe aggression toward unemployed male spouses was significantly greater than toward employed spouses.