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Introduction Subsyndromal PTSD (sub-PTSD) is associated with functional impairment and increased risk for full PTSD. This study examined factors associated with progression from sub-PTSD to full PTSD symptomatology among previously deployed military veterans. Materials and Methods Data were drawn from a longitudinal survey of Navy and Marine Corps personnel leaving military service between 2007 and 2010 administered immediately before separation (baseline) and ~1 year later (follow-up). Survey measures assessed PTSD symptoms at both times; the baseline survey also assessed potential predictors of symptom change over time. Logistic regression models were used to identify predictors of progression from sub-PTSD to full PTSD status. Results Compared to those with no or few PTSD symptoms at baseline, individuals with sub-PTSD were almost three times more likely to exhibit full PTSD symptomatology at follow-up. Risk factors for symptom increase among those with sub-PTSD included moderate or high levels of combat exposure and utilization of fewer positive coping behaviors. Use of prescribed psychotropic medication was protective against symptom increase. Conclusion This study identified several predictors of symptom increase in military veterans with sub-PTSD. Interventions targeting modifiable risk factors for symptom escalation, including behavioral and pharmacological treatments, may reduce rates of new-onset PTSD in this population.

The Marine Resiliency Study-II examined changes in symptomatology across a deployment cycle to Afghanistan. U.S. Servicemembers (N=1041) received clinical testing at two time points either bracketing a deployment (855) or not (186). Factor analyses were used to generate summary and change scores from Time 1 to Time 2. A between-subject design was used to examine changes across the deployment cycle with deployment (low-trauma, high-trauma, and non-deployed) and social support (low vs. high) as the grouping variables. Insomnia increased post-deployment regardless of deployment trauma (std. effect for high-trauma and low-trauma=0.39 and 0.26, respectively). Only the high-trauma group showed increased PTSD symptoms and non-perspective-taking (std. effect=0.40 and 0.30, respectively), while low-trauma showed decreased anxiety symptoms after deployment (std. effect=-0.17). These associations also depend on social support, with std. effects ranging from-0.22 to 0.51. When the groups were compared, the high-trauma deployed group showed significantly worse PTSD and non-perspective-taking than all other groups. Similar to studies in other military divisions, increased clinical symptoms were associated with high deployment stress in active duty Servicemembers, and social support shows promise as a moderator of said association.

Growing research recognizes the reciprocal relationship between stressful life events and psychiatric health, yet this topic has seldom been examined in military populations. This study examined the reciprocal relationships between psychological symptoms and stressful life events over time among veterans of Operations Iraqi Freedom and Enduring Freedom. Service members (N = 1,599) completed surveys when separating from service and approximately one year later. Surveys assessed demographic characteristics, impulsivity, combat exposure, noncombatrelated stressful life events, and symptoms of PTSD, depression, and substance abuse. Structural equation modeling showed that both depression and PTSD symptoms predicted future stressful life events; this relationship was fully mediated by substance abuse for depression, but not for PTSD symptoms. Consistent with some previous research, noncombat stressors showed stronger and more pervasive effects on mental health symptoms than did combat exposure. Impulsivity eme...

The primary aim of this study was to evaluate whether being treated for mental health or nonbattle physical injury during military combat deployment was associated with higher risk for postdeployment mental disorders and poorer career outcomes than seen in the general combat-deployed population. Service members treated in theater for mental health (n = 964) or noncombat injury (n = 853) were compared with randomly sampled personnel (n = 7,220) from the general deployed population on diagnosed mental disorders and early separation from service. Deployment, medical, and career information were obtained from Department of Defense archival databases. Over half of the personnel who received mental health treatment while deployed were diagnosed with 1 or more mental disorders postdeployment and/or were separated from service before completing their full-term enlistment. This was significantly higher than expected compared to the general deployed group, adjusting for demographic/military characteristics and mental health history (adjusted odds ratios [ORs] ranging 1.62 to 2.96). Frequencies of problems also were higher in the mental health-treated group than in the group treated for nonbattle physical injuries (significant adjusted ORs ranging 1.65 to 2.58). The documented higher risks for postdeployment adjustment problems suggested that especially those treated in theater by mental health providers might benefit from postdeployment risk-reduction programs.

Understanding risk factors for physical aggression among recently separated combat veterans is important for prevention. We examined longitudinal and concurrent risk factors in the year following military separation. A total of 474 Marines completed questionnaires prior to separation and again in the first year of civilian life. In multivariate analyses, younger age, greater combat exposure, and post-traumatic stress disorder (PTSD) or depression symptoms were associated with increased risk of physical aggression after separation. Problem alcohol use was a significant risk factor concurrently but not longitudinally. This study underscores the need to examine multiple time points and risk factors.

Common variants in serotonin and corticosteroid receptor genes influence human stress in laboratory settings. Little is known of their combined effects, especially in high stress environments. This study evaluated distinct and combined effects of polymorphisms in the serotonin transporter (5HTTLPRL/S), glucocorticoid receptor (Bcl1C/G), and mineralocorticoid (−2C/G) receptor genes on adrenocortical and cardiovascular responses to intense, realistic stress. One hundred and forty four healthy, active-duty military men were studied before, during, and 24 h after a stressful 12-day survival course. Dependent variables were cortisol, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP). 5HTTLPR SS carriers revealed higher overall cortisol concentrations than L carriers (p = .022). 5HTTLPR L carriers demonstrated higher stress-induced HR than non-carriers (SS) yet rebounded to a lower recovery value (p = .026), while Bcl1 G carriers showed higher mean stress-induced HR than non-carriers (CC) (p = .047). For DBP, 5HTTLPR S carriers showed higher overall values than non-carriers (LL) (p = .043), Bcl1 GG were higher than C carriers (p = .039), and −2C/G G carriers exceeded non-carriers (CC) (p = .028). A “high” composite genotype group revealed substantially higher overall cortisol concentrations than a “low” composite genotype group (p < .001), as was the case for DBP (p = .037). This study revealed a synergistic effect of common polymorphisms on the acute stress response in healthy men. Pending additional study, these findings may have implications for drug discovery, gene therapy, and stress inoculation strategies.

The goals of the present study were to (a) examine change in rates of problem alcohol/substance use among a sample of veterans between their last year of military service and their first year following separation, (b) identify predictors of continued problem use in the first year after separation, and (c) evaluate the hypothesis that avoidant coping, posttraumatic stress disorder (PTSD) symptoms, and chronic stress place individuals at particularly high risk for continued problem use.Participants (N = 1,599) completed self-report measures before and during the year following separation. Participants who endorsed either having used more than intended or wanting or needing to cut down during the past year were considered to have problem use.Of 742 participants reporting problem substance use at baseline, 42% reported continued problem substance use at follow-up ("persistors"). Persistors reported more trouble adjusting to civilian life, had a greater likelihood of driving while intoxicated, and had a greater likelihood of aggression. Multivariate analyses showed that avoidant coping score at baseline and higher PTSD symptom score and greater sensation seeking at follow up predicted continued problem use.Understanding risk factors for continued problem use is a prerequisite for targeted prevention of chronic problems and associated negative life consequences.

Evidence points to heightened physiological arousal in response to acute stress exposure as both a prospective indicator and a core characteristic of posttraumatic stress disorder (PTSD). Because females may be at higher risk for PTSD development, it is important to evaluate sex differences in acute stress reactions. This study characterized sex differences in cardiovascular and subjective stress reactions among military survival trainees. One hundred and eighty-five military members (78% males) were studied before, during, and 24 h after stressful mock captivity. Cardiovascular (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP]) and dissociative states were measured at all three time points. Psychological impact of mock captivity was assessed during recovery. General linear modeling with repeated measures evaluated sex differences for each cardiovascular endpoint, and causal steps modeling was used to explore interrelationships among sex, cardiovascular reactions and psychological impact of mock captivity. Although females had lower SBP than males at all three time points, the difference was most pronounced at baseline and during stress. Accordingly, females showed greater residual elevation in SBP during recovery. Females had lower DBP at all three time points. In addition, females reported greater psychological impact of mock captivity than males. Exploratory causal steps modeling suggested that stress-induced HR may partially mediate the effect of sex on psychological impact of mock captivity. In conclusion, this study demonstrated sex-specific cardiovascular stress reactions in military personnel, along with greater psychological impact of stress exposure in females. This research may elucidate sex differences in PTSD development.

Anger and anger expression (ANGX) are concerns in the U.S. military population and have been linked to stress dysregulation, heart disease, and poor coping behaviors.We examined associations between depression, pain, and anger expression among military veterans.Subjects (N = 474) completed a depression scale, a measure of pain across the last 4 weeks, and an ANGX scale. A multiple regression model assessed the independent and additive relationships of depression and pain to ANGX.Almost 40% of subjects met the case definition for either major or minor depression. Subjects reported low-to-moderate levels of pain (mean = 6.3 of possible 20) and somewhat frequent episodes of ANGX. As expected, depression and pain were positively associated (r = 0.42, p0.001) and crossover effects of antidepressant and pain medication were shown. Specifically, frequency of antidepressant medication use was inversely associated with pain symptoms (r = -0.20, p0.001) and frequency of pain medication use was inversely linked to depressive symptoms (r = -0.21, p0.001). In a multiple regression model, depression (β = 0.58, p0.001) and pain (β = 0.21, p0.05) showed independent and additive relationships to ANGX (F = 41.5, p0.001, R(2)adj = 0.31).This study offers empirical support for depression-pain comorbidity and elucidates independent and additive contributions of depression and pain to ANGX.

Little empirical data exist regarding candidness of service members' responses on the mandated Post-Deployment Health Reassessment (PDHRA) administered 3 to 6 months postdeployment. This study reports on the agreement between responses from U.S. Marines on a subset of the military-administered mandatory PDHRA items and answers to the same subset of items embedded in confidential research surveys. Results show that personnel are clearly underreporting certain symptoms and conditions on the mandatory PDHRA. The most dramatic increases in reporting on the research study's PDHRA items, as indicated by the percentage ratio, were for self-harming ideation and concern about harming others, each of which has about 14 times the endorsement percentage on the survey as on the official PDHRA. Lack of agreement for some items may be the result of resolution or onset of more acute conditions, but disagreement on sensitive behavioral concerns suggests that mandated PDHRAs are not effective screens for those domains.

Preexisting mental disorders are not always considered in mental health studies with military populations, even though prior diagnoses may be a risk factor for additional psychiatric harm stemming from combat exposure, as well as postdeployment behavioral problems. The objectives of this study were to investigate postcombat psychiatric and career outcomes among Marines with preexisting mental disorder diagnoses who deployed to combat in Iraq, Afghanistan, or Kuwait from 2002 to 2008. Marines with a preexisting diagnosis were 3.6 times (p < .001) more likely to have at least 1 postdeployment mental health disorder within 6 months postdeployment compared with Marines with no prior psychiatric diagnoses. Marines with a preexisting diagnosis were also 1.8 (p < .001) times more likely to receive a new-onset psychiatric diagnosis within 6 months postdeployment, indicating that postdeployment mental health concerns in this cohort extend beyond continuation of earlier disorders. Additionally, demotions and separation were significantly associated with having any preexisting mental health diagnoses (yielding odds ratios of 2.34 and 2.00, p < .001, respectively. Based on the current findings, it may be advisable to mandate a full medical and psychiatric record review during deployment health screening as part of new initiatives to address whether combat exposure has worsened preexisting conditions or compounded them with new-onset concerns.

Objective: This purpose of this study was to determine the incidence and types of preexisting mental disorders among military personnel who received mental health services in an Iraqi war zone. Methods: The study examined psychiatric histories of 1,078 American military personnel (Marines, 65%; Army, 23%; Navy, 11%; and Air Force

The objective of this longitudinal study was to determine psychosocial predictors of military misconduct in a cohort of Marine Corps war veterans. The study included data from 20,746 male Marines who completed a life history questionnaire during initial basic training and were subsequently deployed to a combat zone. Associations between psychosocial variables, psychiatric diagnoses, and subsequent misconduct outcomes were analyzed using Cox proportional hazards regression. The strongest predictors of misconduct outcomes (bad conduct discharges and military demotions) were psychiatric diagnoses and young age at first combat deployment. The results indicate that combat-related psychological disorders may manifest in numerous harmful ways, including impulsive, disruptive, and antisocial behavior. We recommend that the association between misconduct and psychiatric disorders be more explicitly acknowledged in research and treatment efforts involving military war veterans and other trauma victims.

The effect of combat and operational stress on the mental health of military personnel is a major concern. The objective of this study was to identify factors associated with possible posttraumatic stress disorder (PTSD). A questionnaire was completed by 1,569 Marines who deployed in support of conflicts in Iraq and Afghanistan (2002-2007). Using the PTSD Checklist with a cutoff score of 44, 17.1% of the sample screened positive for possible PTSD. Of 9 demographic and psychosocial factors examined in relation to PTSD, 4 were significant in a multivariate analysis: deployment-related stressors, combat exposure, marital status, and education. Deployment-related stressors had a stronger association with PTSD than any other variable. This is an important finding because deployment-related stressors are potentially modifiable.

Objective: Posttraumatic stress disorder (PTSD) is an important source of morbidity in military personnel, but its relationship with characteristics of battle injury has not been well defined. The aim of this study was to characterise the relationship between injury-related factors and PTSD among a population of battle injuries. Patients and methods: A total of 831 American military personnel injured during combat between September 2004 and February 2005 composed the study population. Patients were followed through November 2006 for diagnosis of PTSD (ICD-9 309.81) or any mental health outcome (ICD-9 290-319). Results: During the follow-up period, 31.3% of patients received any type of mental health diagnosis and 17.0% received a PTSD diagnosis. Compared with minor injuries those with moderate (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.61–3.48), serious (OR, 4.07; 95% CI, 2.55–6.50), and severe (OR, 5.22; 95% CI, 2.74–9.96) injuries were at greater risk of being diagnosed with any mental health outcome. Similar results were found for serious (OR, 3.03; 95% CI, 1.81–5.08) and severe (OR, 3.21; 95% CI, 1.62– 6.33) injuries with PTSD diagnosis. Those with gunshot wounds were at greater risk of any mental health diagnosis, but not PTSD, in comparison with other mechanisms of injury (OR 2.07; 95% CI, 1.35, 3.19). Diastolic blood pressure measured postinjury was associated with any mental health outcome, and the effect was modified by injury severity. Conclusions: Injury severity was a significant predictor of any mental health diagnosis and PTSD diagnosis. Gunshot wounds and diastolic blood pressure were significant predictors of any mental health diagnosis, but not PTSD. Further studies are needed to replicate these results and elucidate potential mechanisms for these associations.

A better understanding of factors influencing human responses to acute stress is needed to enhance prevention and treatment of stress-related disorders. In the current study, the authors examined predictors of acute stress symptoms during intense military training in 35 men. In univariate and multivariate models, perceived stress, passive coping, and emotion-focused coping during daily living predicted acute stress symptoms in response to realistic survival training, whereas active coping and problem-focused coping did not. Baseline stress levels and coping styles, both of which may be modifiable, appear to play a fundamental role in the human response to acute uncontrollable stress. Additional research is needed to better elucidate the relative and interactive contributions of behavioral predictors of acute stress.

Understanding antisocial behavior and organizational misconduct is an important objective, because these maladaptive behaviors are disruptive and costly to organizations and to society as a whole. The objective of this study was to identify psychosocial risk factors for misconduct and antisocial behavior in a sample of Navy personnel. A group of sailors (n = 158) who had engaged in significant misconduct were compared with a demographically similar group of sailors (n = 288) who had not engaged in misconduct and who were in good standing with the Navy. The psychosocial variables that emerged as the most important risk factors for antisocial behavior were alcohol use (odds ratio [OR] = 2.42), high impulsivity (OR = 2.20), high trait hostility (OR = 1.79), and antisocial behavior of friends (OR = 1.65). The implications of these results for the military and for research on antisocial behavior are discussed.

Psychosocial factors may have an important impact on injury recovery and return to work. To explore the influence of psychosocial factors in a cohort of injured military personnel, data were collected from 166 Marine Corps basic training recruits with musculoskeletal injuries. This sample was followed prospectively to determine whether they graduated from basic training or were discharged from the Marines. Demographic, injury-related, and psychosocial factors were analyzed to determine predictors of failure to graduate from basic training. The strongest risk factors for failing to graduate were not expecting to graduate, low or uncertain career intentions, lack of determination, psychological distress, and low organizational commitment. In the final multivariate logistics model, two predictors of failure to graduate emerged: not expecting to graduate and low or uncertain career intentions. The results suggest that interventions to reduce attrition in injured military populations should be designed to counter pessimistic expectations and emphasize career opportunities.

Previous studies indicate that smokers attrite from military service at significantly higher rates than nonsmokers. The purpose of the current effort is twofold: (1) to examine the implications of treating smoking status as a third military accession quality indicator along with educational credentials and mental ability, and (2) to explore preservice psychosocial and health differences between smokers and nonsmokers in support of hypothesis development about reasons for elevated attrition rates in smokers. The results indicate that individuals who smoke tobacco prior to entering military service are almost twice as likely to attrite as nonsmokers, even after statistically controlling for education and mental ability. Moreover, smokers report higher rates of psychosocial and health problems prior to military service. These results support using smoking status as a personnel quality indicator for recruiting and assignment purposes and indicate that smokers, as a group, enter the military with identifiable psychosocial and physical vulnerabilities.

Little is known about sleep in elite military populations who are exposed to higher operational demands, unpredictable training, deployment, and mission cycles. Twenty-nine Naval Special Warfare (NSW) Operators wore an actiwatch for an 8-day/7-night period for objective sleep assessment and completed a nightly sleep log. A total of 170 nights of actigraphically recorded sleep were collected. When comparing objectively versus subjectively recorded sleep parameter data, statistically significant differences were found. Compared with sleep log data, actigraphy data indicate NSW Operators took longer to fall asleep (an average of 25.82 minutes), spent more time awake after sleep onset (an average of 39.55 minutes), and demonstrated poorer sleep efficiency (83.88%) (ps0.05). Self-reported sleep quality during the study period was 6.47 (maximum score = 10). No relationships existed between the objectively derived sleep indices and the self-reported measure of sleep quality (rs = -0.29 to 0.09, all ps0.05). Strong inter-relationships existed among the subjectively derived sleep indices (e.g., between self-reported sleep quality and sleep efficiency; r = 0.61, p0.001). To our knowledge, this is the first study to objectively and subjectively quantify sleep among NSW Operators. These findings suggest sleep maintenance and sleep efficiency are impaired when compared to normative population data.

Mental disorders represent an important source of morbidity among U.S. military personnel and are a common reason for early separation from the military. The objective of this study was to identify factors predictive of hospitalization for mental health disorders in a large sample of enlisted Navy personnel. Demographic variables and a variety of psychosocial variables assessed on the Sailors' Health Inventory Program questionnaire were studied as predictors of psychiatric hospitalization. Three psychiatric categories were examined: adjustment reaction, personality disorder, and all other mental health disorders. Several variables were significantly predictive of all three categories of psychiatric hospitalization: female gender, low education level, history of abuse (physical, emotional, or sexual), and tobacco smoking. The results of this study support efforts to develop better psychological screening methods and potential interventions aimed at helping recruits adapt to military life.

The Sailors Health Inventory Program (SHIP) questionnaire is a medical and psychosocial history questionnaire completed by all Navy recruits. This study was an investigation of the potential usefulness of the SHIP questionnaire for screening to reduce basic training attrition. The sample consisted of 66,690 Navy recruits. Although the most valid individual SHIP items for predicting attrition tended to be psychological or behavioral in nature, a composite of 40 diverse SHIP questions (including medical questions) was found to be the best overall attrition predictor. Further analyses revealed that the 40-item composite is a considerably more powerful attrition predictor than is either educational credential or mental ability score, which together are currently the U.S. military's primary attrition management tools. Finally, the consequences of using different cutoff scores on the 40-item composite were simulated so that various hypothetical screening strategies could be considered.

First-term attrition, defined as failing to complete the contracted first enlistment term, is one of the most serious and costly problems faced by the U.S. Navy. This study was an investigation of 1-year Navy attrition in relation to demographic factors and variables assessed by the Sailors' Health Inventory Program (SHIP) questionnaire, a medical and psychosocial history questionnaire completed by all Navy recruits. Overall attrition, as well as specific categories of attrition (e.g., medical, behavioral, and administrative), were studied. The sample consisted of 66,690 Navy recruits whose status (retention vs. attrition) could be tracked to the 1-year mark. The strongest predictors of overall attrition were educational level, self-reported history of shortness of breath, ever being suspended or expelled from school, history of depression/excessive worry, fainting or dizziness, and recurrent back pain. Many other medical and psychosocial items from SHIP were also predictive of attrition. Similar factors were associated with different categories of attrition (e.g., medical, behavioral). The implications of these findings for attrition reduction strategies are discussed.

Reports of functional problems are common among Veterans who served post-9/11 (more than 25% report functional difficulties in at least one domain). However, little prospective work has examined the risk and protective factors for functional difficulties among Veterans. In a sample of recently separated Marines, we used stepwise logistic and multiple regressions to identify predictors of functional impairment, including work-related problems, financial problems, unlawful behavior, activity limitations due to mental health symptoms, and perceived difficulty reintegrating into civilian life. Posttraumatic stress disorder symptoms assessed both before and after military separation significantly predicted functional difficulties across all domains except unlawful behavior. Certain outcomes, such as unlawful behavior and activity limitations due to mental health symptoms, were predicted by other or additional predictors. Although several forms of functioning were examined, the list was not exhaustive. The results highlight a number of areas where targeted interventions may facilitate the reintegration of military servicemembers into civilian life.

Psychological problems are the single most common reason for attrition from U.S. Navy basic training. A contributing factor is that, although military entrance processing station physicians assess numerous aspects of physical health, there is little rigor behind attempts to identify psychological disorders. In the present study, we highlight previous research indicating that patterns of physical health symptoms can provide a gauge of psychological dysfunction. We also report significant relationships between physical symptoms, anxiety, and depression in a sample of more than 2,000 sailors. Therefore, given the links between physical symptoms and psychological problems, it may be feasible for physicians who screen military applicants to use routinely gathered physical health information as part of an improved system to detect psychological disorders.

Using data from 2379 American Navy recruits, the present study examined several issues related to interpretation and use of the Cognitive Failures Questionnaire (CFQ), including dimensionality, relationships with actual mishaps, and the relationship to handedness. With regard to dimensionality, evidence suggests that the CFQ measures only two replicable factors, a dominant ‘general cognitive failures’ factor and a minor name-processing factor. The analysis of actual mishaps suggests a linkage between high CFQ scores and accidents, a finding in agreement with other research showing that many accidents result from distractibility, poor selective attention and mental error. Other results indicate that, although both CFQ scores and accident rates are elevated in left-handers, a causal linkage cannot be inferred.

The Enhanced Computer-Administered Test (ECAT) battery was selected by a Joint-Services panel of testing experts tasked with finding computerized tests that were likely to increase validity when ad...

Whether traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder (PTSD) has been difficult to determine because of the prevalence of comorbid conditions, overlapping symptoms, and cross-sectional samples.To examine the extent to which self-reported predeployment and deployment-related TBI confers increased risk of PTSD when accounting for combat intensity and predeployment mental health symptoms.As part of the prospective, longitudinal Marine Resiliency Study (June 2008 to May 2012), structured clinical interviews and self-report assessments were administered approximately 1 month before a 7-month deployment to Iraq or Afghanistan and again 3 to 6 months after deployment. The study was conducted at training areas on a Marine Corps base in southern California or at Veterans Affairs San Diego Medical Center. Participants for the final analytic sample were 1648 active-duty Marine and Navy servicemen who completed predeployment and postdeployment assessments. Reasons for exclusions were nondeployment (n = 34), missing data (n = 181), and rank of noncommissioned and commissioned officers (n = 66).The primary outcome was the total score on the Clinician-Administered PTSD Scale (CAPS) 3 months after deployment.At the predeployment assessment, 56.8% of the participants reported prior TBI; at postdeployment assessment, 19.8% reported sustaining TBI between predeployment and postdeployment assessments (ie, deployment-related TBI). Approximately 87.2% of deployment-related TBIs were mild; 250 of 287 participants (87.1%) who reported posttraumatic amnesia reported less than 24 hours of posttraumatic amnesia (37 reported ≥ 24 hours), and 111 of 117 of those who lost consciousness (94.9%) reported less than 30 minutes of unconsciousness. Predeployment CAPS score and combat intensity score raised predicted 3-month postdeployment CAPS scores by factors of 1.02 (P .001; 95% CI, 1.02-1.02) and 1.02 (P .001; 95% CI, 1.01-1.02) per unit increase, respectively. Deployment-related mild TBI raised predicted CAPS scores by a factor of 1.23 (P .001; 95% CI, 1.11-1.36), and moderate/severe TBI raised predicted scores by a factor of 1.71 (P .001; 95% CI, 1.37-2.12). Probability of PTSD was highest for participants with severe predeployment symptoms, high combat intensity, and deployment-related TBI. Traumatic brain injury doubled or nearly doubled the PTSD rates for participants with less severe predeployment PTSD symptoms.Even when accounting for predeployment symptoms, prior TBI, and combat intensity, TBI during the most recent deployment is the strongest predictor of postdeployment PTSD symptoms.

Ample evidence links stress to psychiatric and neurological disease. Although many studies examine stress hormone secretion and receptor activity, exciting new developments signify a shift in focus to neuromodulatory systems influencing neuronal development, survival, and neuroplasticity. The purpose of this study was to characterize salivary nerve growth factor (sNGF) responses to intense stress exposure in healthy military members undergoing survival training. A second purpose was to explore effects of age, sex, education, and body mass index (BMI). One hundred sixteen military members (80% male) were studied before, during, and 24 h after a stressful mock-captivity exercise. sNGF was measured at all three time points. Reactivity, recovery, and residual elevation of sNGF were computed. General linear modeling with repeated measures evaluated effect of stress exposure, as well as the roles of age, sex, education, and BMI. sNGF increased 137% from baseline to intense stress. During recovery, sNGF remained elevated an average of 67% above baseline (i.e., residual elevation). Men showed greater sNGF reactivity than women quantified by larger absolute T1-T2Δ (+148.1 pg/mL vs. +64.9 pg/mL, p0.017). A noteworthy trend of higher sNGF concentrations in low BMI participants was observed (p=0.058). No effects of age or education were shown. This study shows substantial reactivity and residual elevation of sNGF in response to intense stress exposure in healthy humans. Further research is needed to refine the sNGF assay, fully characterize the sNGF stress response, delineate correlates and mechanisms, and validate therapeutic applications.

Limited research exists regarding the rates of and outcomes associated with psychiatric comorbidity among active duty military personnel. This study investigated the rates of comorbid psychiatric diagnoses among 81,720 U.S. Marines, and assessed the relationships between preexisting comorbid disorders and risk of psychiatric hospitalizations and attrition from service. The study used medical, deployment, and personnel records for all Marines who enlisted between 2002 and 2005. The baseline rate of comorbidity was 1.3% for Marines who deployed during the first term of service, and 6.3% for Marines who did not deploy. The most common baseline comorbidity among deployed Marines was mood disorders with anxiety disorders, and mood and adjustment disorders among nondeployed Marines. Logistic regression analyses revealed Marines with comorbid diagnoses before deployment were over three times more likely to attrite (odds ratio = 3.4, p0.001) and over five times more likely to be hospitalized for psychiatric symptoms (odds ratio = 5.1, p0.001) following deployment than those with no diagnoses. Similar patterns emerged among nondeployers. Outcomes associated with comorbid conditions were substantially worse than outcomes for single conditions. These findings demonstrate that Marines with a history of comorbid psychiatric diagnoses are at a much greater risk for adverse outcomes, specifically attrition from the military and psychiatric hospitalization.

Background Most previous research that has examined mental health among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combatants has relied on self-report measures to assess mental health outcomes; few studies have examined predictors of actual mental health diagnoses. The objective of this longitudinal investigation was to identify predictors of psychiatric disorders among Marines who deployed to combat in Iraq and Afghanistan. Methods The study sample consisted of 1113 Marines who had deployed to Iraq or Afghanistan. Demographic and psychosocial predictor variables from a survey that all Marines in the sample had completed were studied in relation to subsequent psychiatric diagnoses. Univariate and multivariate logistic regression were used to determine the influence of the predictors on the occurrence of psychiatric disorders. Results In a sample of Marines with no previous psychiatric disorder diagnoses, 18% were diagnosed with a new-onset psychiatric disorder. Adjusting for other variables, the strongest predictors of overall psychiatric disorders were female gender, mild traumatic brain injury symptoms, and satisfaction with leadership. Service members who expressed greater satisfaction with leadership were about half as likely to develop a mental disorder as those who were not satisfied. Unique predictors of specific types of mental disorders were also identified. Conclusions Overall, the study’s most relevant result was that two potentially modifiable factors, low satisfaction with leadership and low organizational commitment, predicted mental disorder diagnoses in a military sample. Additional research should aim to clarify the nature and impact of these factors on combatant mental health.

Gender differences in spatial ability were evaluated for two computerized dynamic (one power and one speed) and two static paper and pencil (one power and one speed) tests over sessions. Four factors were evaluated in a factorial design: gender, practice (i.e. session), paper and pencil vs dynamic (i.e. computerized) spatial tests, and power vs speed. A total of 250 paid volunteer men and women were tested in a counterbalanced design over two sessions. Results revealed two significant (P < 0.05) triple interactions involving gender, session, and power vs speed as well as dynamic vs paper and pencil tests. Although men generally did better than women and all subjects improved with practice, women improved at a faster rate for the speeded computer task and were not statistically different from the men at session 2. Future research should be directed toward two main thrusts: the effects of practice on the power tests and the effect of practice on the predictive validity of the speeded computerized tests.

Previous research indicates that low scores on the Raven's Advanced Progressive Matrices (RAPM) test are associated with increased cortical glucose utilization during problem solving. We hypothesized that previous results may reflect the neurophysiological consequences of patterns of effort requirements; that is, high-effort expenditure from lower aptitude participants (for whom the problems are hard) and low-effort expenditure from higher aptitude participants (for whom the problems are easy). In this experiment, positron emission tomography (PET) data were gathered on participants (N = 28) who solved easy and hard problems that were tailored to the participants' own ability levels, thereby eliminating aptitude group differences in effort requirements. Contrary to previous results, high aptitude was associated with high cortical glucose use. Average aptitude participants showed diminished glucose use in the hard condition. A significant Group X Condition X Hemisphere Effect was also noted, with greater right hemisphere activation in the hard condition for the high-aptitude group. These results demonstrate that the relation of cerebral glucose use and cognitive ability is sensitive to participant and task selection.

This study provided data supporting Ericsson and Simon's (1980) conclusion that, within the framework of human information processing, verbal reports can provide a valid and informative source of data. One hundred nine volunteer participants were tested on a battery of microcomputerized tasks. After each task, participants were given a self-report questionnaire concerning perceived difficulty and effort expended. One hundred participants returned and were randomly assigned to either an incentive or a no-incentive condition for retest. As a group, participants in the incentive condition reported expending significantly more effort than did participants who received no incentive. There was a parallel between verbal reports (metacognition) and actual performance on the more difficult task, whereas, for some participants, verbal report data proved to be a more sensitive indicator than performance on less difficult tasks. In each case, verbal data either paralleled or augmented the analysis of perform...

When vocational aptitude batteries are expanded by adding new tests, the most common way to measure validity gains is to regress various criteria onto the subtest scores from the old and new batteries and contrast the results. A rarely tried approach that may be of equal value, however, is to examine “accidental” validity gains for a recalculated general intelligence (or g) score based on the new battery, because many psychologists have argued that the majority of test validity comes from g rather than specific abilities. In this article, we examine validity differences for a g score calculated on the Armed Services Vocational Aptitude Battery (ASVAB) alone versus the ASVAB plus nine diverse experimental tests selected for their potential importance and uniqueness from the ASVAB. Although no validity gain for expanded g was observed for final school grade criteria, a 6% validity gain was obtained for hands-on performance measures. A gain of this size is of practical importance in the armed forces.

Although the effects of combat deployment on posttraumatic stress disorder have been extensively studied, little is known about the effects of combat deployment on depression and anxiety. This study examined the factors associated with anxiety and depression in a sample of 1560 US Marines who were deployed to Iraq and Afghanistan. Eleven demographic and psychosocial factors were studied in relation to depression and anxiety. Five factors emerged as significant in relation to depression: deployment-related stressors, combat exposure, attitudes toward leadership, mild traumatic brain injury symptoms, and marital status. The same factors, with the exception of marital status, emerged as significant in relation to anxiety. Deployment-related stressors had a stronger association with both depression and anxiety than any other variable, including combat exposure. This finding is important because deployment-related stressors are potentially modifiable by the military. Language: en

This study compared the rates of mental disorders between Marines who re-enlisted and Marines who separated after 1 term, distinguishing between Marines who were and were not recommended for re-enlistment.Participants included 28,693 male Marines enlisting for 4-year terms between 2002 and 2003, including 9,338 who re-enlisted after 1 term, 18,177 who voluntarily separated after 1 term, and 1,184 who were not recommended for re-enlistment and separated after 1 term.Analysis revealed disproportionately high rates of mental disorders among Marines not recommended for re-enlistment (Odds Ratio = 8.5, 95% Confidence Interval 7.5-9.8) compared with Marines who re-enlisted. Mental disorder prevalence was also elevated among service members who voluntarily separated after 1 term (Odds Ratio = 1.2, 95% Confidence Interval 1.1-1.3). Several specific categories of disorders, including personality disorders, substance use disorders, and post-traumatic stress disorder, predicted re-enlistment status.These results suggest that mental disorders influence personnel retention in diverse ways, including heightened turnover, which could have a substantial impact on military manpower costs.

Military personnel deployed in support of combat operations are at significantly higher risk for mental health problems. However, much of what we know about combat-related mental health comes from postdeployment assessments. This study describes the mental health of 1,336 treatment-seeking deployed U.S. military personnel and interventions recommended by military mental health providers in Iraq from January 2006 to January 2007. Cases were primarily young enlisted men, most of whom were on their first combat deployment. Marines made up the majority of the cases (60%), but there were also large numbers of Army and Navy personnel. The most common psychiatric diagnoses were anxiety disorders (31%, including 11% with posttraumatic stress disorder), followed by adjustment (27%) and mood disorders (25%, including 22% with depression). Medication was the most commonly prescribed treatment for patients with psychiatric diagnoses but was often combined with recommendations for psychotherapy/counseling and/or behavioral modifications. The findings illustrate the distribution of mental health conditions seen among treatment-seeking troops while actively serving in a combat environment and the interventions recommended for them. Further examination of postdeployment health outcomes may help to facilitate the development of more effective acute intervention strategies in theater.

The Marine Resiliency Study (MRS) is a prospective study of factors predictive of posttraumatic stress disorder (PTSD) among approximately 2,600 Marines in 4 battalions deployed to Iraq or Afghanistan. We describe the MRS design and predeployment participant characteristics. Starting in 2008, our research team conducted structured clinical interviews on Marine bases and collected data 4 times: at predeployment and at 1 week, 3 months, and 6 months postdeployment. Integrated with these data are medical and career histories from the Career History Archival Medical and Personnel System (CHAMPS) database. The CHAMPS database showed that 7.4% of the Marines enrolled in MRS had at least 1 mental health diagnosis. Of enrolled Marines, approximately half (51.3%) had prior deployments. We found a moderate positive relationship between deployment history and PTSD prevalence in these baseline data.

Research has documented higher risks for mental health problems among service members deployed to war zones, yet a research limitation has been that assessment has generally occurred often years after combat exposure. The Operational Stress Control and Readiness program integrated mental health practitioners with 1st Marine Division units serving in Iraq. This team documented mental health visits between January 2006 and January 2007 and developed the Theater Mental Health Encounter Database (TMHED). This report describes the TMHED study design, measures, and cases. Of 1336 patients (3180 patient visits), 10% were women, 75% were high school educated, 55% were mid-paygrade enlisted, and 63% were on their first combat deployment. Compared with the overall deployed population, patient percentages included higher percentages of Marines and Navy personnel but lower percentages of Army and Air Force personnel, more junior enlisted but fewer officers, and fewer college graduates. TMHED provides an unprecedented opportunity to study early psychiatric intervention in a combat zone and prospectively examines postdeployment health and career outcomes.

Suicides have markedly increased among military personnel in recent years. We used path analysis to examine factors associated with suicidal/self-harming ideation among male Navy and Marine Corps personnel transitioning to civilian life. Roughly 7% of men (Sailors = 5.3%, Marines = 9.0%) reported ideation during the previous 30 days. Results suggest that combat exposure, substance abuse, and resilience are associated with suicidal ideation/self-harming thoughts through the mediation of posttraumatic stress disorder symptoms and/or depression symptoms. Substance abuse plays a moderating role. Resilience had a direct effect only among the Marines. Implications for improving the transition to civilian life are discussed.

Research on mentally retarded subjects indicates that the well established relationship between learning rate and intelligence is not accompanied by a comparable relationship between forgetting rate and intelligence. To date, however, almost nothing is known about the link between intelligence and forgetting when subjects are exclusively drawn from the normal ability ranges. In the present study, one hundred and sixteen normal young men were asked to recall problem solutions after performing a distractor task consisting of one, two, or three speeded math items. The results indicate that longer distractor intervals result in diminished recall, but, more importantly, that high and low ability subjects forget at equal rates.

The Naval Health Research Center was tasked by Headquarters Marine Corps with assessing the process by which the Marine Corps Substance Abuse Counseling Centers (SACCs) address clients with stress concerns and behavioral health conditions stemming from deployment, such as post-traumatic stress disorder (PTSD) and combat operational stress. The following report details findings from the scientific literature and SACC site assessments, and provides specific recommendations. It documents the current treatment approach with regard to substance abuse clients with co-occurring mental health concerns at selected Marine Corps SACCs; and it reviews and recommends best practices for screening, referrals, treatment, patient education, and case management. The overall purpose is to provide recommendations that will lead to optimal treatment of SACC clients suffering from PTSD and other military-related behavioral health conditions.

The objective of this study was to identify factors associated with antisocial behavior in 1,543 Marines who deployed to combat zones in support of conflicts in Iraq and Afghanistan during 2002-2007. Five factors were associated with antisocial behavior in multivariate analyses: post-traumatic stress disorder (PTSD) symptoms, deployment-related stressors, combat exposure, younger age, and being divorced. PTSD symptoms had a stronger association with antisocial behavior than any other variable. A unique and important finding of this study was the association between deployment-related stressors and a higher incidence of antisocial behavior. Because deployment-related stressors are potentially modifiable, the military may be able to address them in concrete ways such as by shortening deployments and improving communication with home.

The U.S. government, Department of Defense, and Department of Veterans Affairs have a long-term commitment to veterans of the U.S. Military. Personnel who are veterans of combat, in particular, deserve the highest level of care. However, many of them may not be willing to seek professional help services. The Postdeployment User Guide (PUG) offers an alternative mode of support for persons that need nonclinical assistance, and will make use of self-help as a delivery option. Although there are a number of professional and online resources available, this project was conceptualized from a positive psychology perspective as a hands-on guide to the process of adjustment during return from deployment applicable to all veterans. In either workbook or online format, the PUG includes simple interventions and exercises that combat veterans can complete on their own within 10 different content areas: goal setting, personal growth, personal thoughts, career, and legal affairs. It also provides personnel with online resources, emphasizing DoD sponsored programs. The workbook includes information regarding how to seek professional help services. Furthermore, the guide includes some assessments and information that might be helpful to the user in evaluating whether self-help or professional help might be best for them in specific aspects of their lives.

The objective of this longitudinal study was to identify risk factors for combat-related psychiatric disorders. The sample consisted of 6442 enlisted U.S. Marines who completed a questionnaire during basic training, deployed to a combat zone with no prior psychiatric diagnoses, and completed a postdeployment assessment form. Cox proportional hazards regression was used to determine associations between predeployment and postdeployment self-reports and subsequent mental health outcomes. During the observation period, 6.8% of the sample were diagnosed with a psychiatric disorder. The strongest predictors of postdeployment psychiatric disorders were, in order of importance, low paygrade, hospitalization during deployment, low education, preservice smoking, and post-traumatic stress disorder symptoms at deployment's end. The impact of war zone variables was smaller than expected. It was recommended that the combat experience section of the military's postdeployment assessment form be expanded to enhance the military's ability to identify and refer personnel who may be at risk for psychiatric disorders.