Showing papers by "Charles W. Hoge published in 2012"

Posttraumatic stress disorder associated with combat service in Iraq or Afghanistan: reconciling prevalence differences between studies.

Abstract: Studies of posttraumatic stress disorder (PTSD) prevalence associated with deployment to Iraq or Afghanistan report wide variability, making interpretation and projection for research and public health purposes difficult. This article placed this literature within a military context. Studies were categorized according to deployment time-frame, screening case definition, and study group (operational infantry units exposed to direct combat versus population samples with a high proportion of support personnel). Precision weighted averages were calculated using a fixed-effects meta-analysis. Using a specific case definition, the weighted postdeployment PTSD prevalence was 5.5% (95% CI, 5.4-5.6) in population samples and 13.2% (12.8-13.7) in operational infantry units. Both population-level and unit-specific studies provided valuable and unique information for public health purposes; understanding the military context is essential for interpreting prevalence studies.

Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U.S. soldiers involved in combat deployments: association with postdeployment symptoms.

Abstract: ObjectivesSeveral studies have examined the relationship between concussion/mild traumatic brain injury (mTBI), posttraumatic stress disorder (PTSD), depression, and postdeployment symptoms. These studies indicate that the multiple factors involved in postdeployment symptoms are not accounted for in the screening processes of the Department of Defense/Veteran's Affairs months after concussion injuries. This study examined the associations of single and multiple deployment-related mTBIs on postdeployment health.MethodsA total of 1502 U.S. Army soldiers were administered anonymous surveys 4 to 6 months after returning from deployment to Iraq or Afghanistan assessing history of deployment-related concussions, current PTSD, depression, and presence of postdeployment physical and neurocognitive symptoms.ResultsOf these soldiers, 17% reported an mTBI during their previous deployment. Of these, 59% reported having more than one. After adjustment for PTSD, depression, and other factors, loss of consciousness was significantly associated with three postconcussive symptoms, including headaches (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.1-2.3). However, these symptoms were more strongly associated with PTSD and depression than with a history of mTBI. Multiple mTBIs with loss of consciousness increased the risk of headache (OR = 4.0, 95% CI = 2.4-6.8) compared with a single occurrence, although depression (OR = 4.2, 95% CI = 2.6-6.8) remained as strong a predictor.ConclusionsThese data indicate that current screening tools for mTBI being used by the Department of Defense/Veteran's Affairs do not optimally distinguish persistent postdeployment symptoms attributed to mTBI from other causes such as PTSD and depression. Accumulating evidence strongly supports the need for multidisciplinary collaborative care models of treatment in primary care to collectively address the full spectrum of postwar physical and neurocognitive health concerns. Language: en

Preventing Suicides in US Service Members and Veterans: Concerns After a Decade of War

Abstract: BEFORE THE WARS IN IRAQ AND AFGHANISTAN, THE INcidence of suicide in active duty US service members was consistently 25% lower than that in civilians, attributable to “healthy-worker” effects from career selection factors and universal access to health care. Between 2005 and 2009, the incidence of suicide in Army and Marine personnel nearly doubled. From 2009 through the first half of 2012, the incidence of suicide among Army soldiers remained elevated (22 per 100 000 per year), with the number dying of suicide each year exceeding the number killed in action. High rates of suicide have also been reported for US veterans, although incidence studies in veteran populations have drawn conflicting conclusions. The pressing question is why suicides increased so markedly in soldiers and Marines, but not in Navy or Air Force personnel (or in civilians). An obvious answer would be repeated ground combat tours. However, to date no study has definitively confirmed an independent association with deployment variables. This may be due to confounding factors such as higher service attrition for personnel with deployment-related mental health problems (contributing to healthy-worker effects). The optimal way to study militaryspecific risk factors is to follow individuals longitudinally beyond the time of their service, an endeavor few research groups are able to undertake. Although longitudinal studies may eventually establish deployment associations, current evidence suggests that such associations are likely to be weak and not independent of well-established risk factors, especially underlying mental health problems. A logical explanation for the high suicide rates in soldiers and Marines is the cumulative strain from the protracted war effort, across both deployed and garrison environments, causing higher population prevalences of mental disorders. If this explanation is accurate, the most effective medical intervention strategies are those that facilitate access to effective treatment. Determining the value of intervention strategies requires reliable effectiveness measures. However, military and veteran suicide research is hampered by problems with determination of “veteran” status on surveillance records; misclassifications of the manner of death; lack of integration of data from the US Department of Defense (DOD), Department of Veterans Affairs (VA), and National Death Index; and wide rate variability in population subgroups. Pressures exist to rapidly implement multicomponent prevention programs. However, apparent program successes based on observational evidence (eg, Air Force effort in the 1990s) cannot be replicated without knowing which components contributed to effectiveness. As the war effort in Afghanistan draws down, caution is advised in attributing future reductions in suicide rates to specific programs. Attention must stay focused on the most promising suicide intervention strategies within the broad categories of screening, education, and treatment, considering also potential iatrogenic effects.

Land Combat Study of an Army Infantry Division 2003-2009

Abstract: : Throughout the course of the wars in Afghanistan and Iraq, numerous studies have demonstrated the adverse mental and behavioral health effects on veterans. This report compiles data from multiple time-points between 2003 and 2009 to demonstrate behavioral and mental health trends across these years. Mental health rates increased between 2003 and 2008, but dropped in 2009. Alcohol misuse decreased between 2003 and 2009, but substance abuse increased through 2008. The use of mental health professionals increased throughout the years. Perceived stigma and organizational barriers to mental health care decreased over the years. These findings could be used to generate awareness of behavioral health trends among veterans and aid in understanding how best to allocate efforts to ameliorate the adverse effects of prolonged combat.