Sexual Assault and Disabling PTSD in Active Duty Service Women
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Sexual assault in the military is a major concern and may result in significant health problems, such as post-traumatic stress disorder (PTSD). Those developing disabling PTSD symptoms may require a disability evaluation. We examined disability evaluation trends for service women with PTSD to better understand characteristics associated with inability to continue Active Duty service. This is a retrospective review of disability reports and electronic medical records for 322 Active Duty women diagnosed with and treated for PTSD by psychiatrists and psychologists at a large military treatment facility between 2011 and 2014. Service women requiring medical disability evaluation for PTSD (n = 159) were included in the study as "IDES cases" (Integrated Disability Evaluation System – IDES). A similar number of women, randomly selected from those seeking care for PTSD but not requiring disability evaluation during the same period, were included in the "control" group (n = 163). Analyzes done to evaluate differences between groups (IDES cases vs. controls) included demographic and service-related characteristics, history of chronic pain, and PTSD index trauma types, such as pre-military trauma and military sexual trauma (MST). Logistic regression was performed to identify the factors associated with inclusion in IDES. MST was the most frequent PTSD index trauma in the IDES group (73.6% vs. 44.8% of control group) and the most significant factor associated with IDES inclusion (OR 2.6, p = 0.032). Those in the IDES group had significantly greater number of mental health visits for PTSD (IDES: m = 68.6 vs. controls: m = 29.6) and more frequent chronic pain history (IDES 40.9% vs. controls 19.6%) than those in the control group. Approximately 65% of women in both groups had a history of childhood abuse, but childhood abuse, as a PTSD index trauma, was negatively associated with IDES inclusion (OR 0.293, p = 0.006). Active Duty service women with PTSD and a MST index trauma are much more likely to require disability evaluation (IDES) than those with PTSD due to other trauma types. IDES evaluation for conditions such as PTSD may result in early termination of military service and is a potential downstream consequence of MST. Service women requiring greater numbers of mental health visits for PTSD treatment may benefit from a multidisciplinary approach to treating concurrent health conditions, such as chronic pain. Those providing care for service women should evaluate for MST, chronic pain and pre-military trauma, such as childhood abuse; and aggressively treat these conditions to prevent PTSD and disability.Keywords:
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The objective of this study was to examine the way in which the oral health of recruits changed during the 4 years immediately after entry on active duty.In 1998, 1,331 dental records of recruits in the 1994 Tri-Service Comprehensive Oral Health Survey were located, and treatment data were analyzed.Class 1, treatment complete or no treatment indicated, was achieved by 61.2% (95% confidence interval, 58.4-64.0) of service members during the 4-year study period. Army, Navy, and Marine Corps percentages did not significantly differ in the range of 50% to 60%. The Air Force was significantly higher at 89.5% achieving class 1.All services were successful in achieving and maintaining operational readiness among 1994 recruits who spent 93% of their first 4 years of military service in a deployable oral health status (class 1 or 2). A significant number of recruits (38.8%) never achieved complete oral health (class 1).
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Despite recruitment of U.S. military personnel from areas where leprosy is endemic, and despite assignment of personnel to endemic areas, the prevalence of leprosy among active duty personnel and dependents has never been reported. During the period 1970–1983, leprosy was diagnosed in 89 active duty U.S. military personnel and 54 dependents at U.S. military hospitals and clinics. The incidence of leprosy in the military was low, but greater than that in the general U.S. production. The military medical community must be cognizant of the clinical presentation of leprosy because of continued recruitment from and assignment of personnel to leprosy-endemic areas.
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Previously, researchers investigated the career accomplishments of USU medical graduates using the data from a USU alumni survey. To better understand if such accomplishments are related to military retention, the current study investigates the relationship between accomplishments (such as military career milestones and academic achievement) and military retention.Utilizing the responses to the alumni survey sent to USU graduates in the Classes of 1980 to 2017, the researchers investigated the relationship between a series of survey items (e.g., military rank, medical specialties, and operation experiences) and military retention.Among the respondents who had a deployment history in support of an operational mission, 206 (67.1%) stayed longer than their initial active duty service or planned on staying longer than their current active duty service commitment. Fellowship directors (n = 65, 72.3%) showed a higher retention rate than other positions. The PHS alumni had the highest retention rate (n = 39, 69%) of the military branches, whereas physicians in medical specialties with higher demand (e.g., otolaryngology and psychiatry) showed less promising retention.By conducting future research on underlying reasons as to why full-time clinicians, junior physicians, and physicians in medical specialties with higher demand showed less promising retention, stakeholders will be able to identify what needs to be addressed to retain highly skilled physicians in the military.
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United States military medical planning must reevaluate the practices of combat casualty resuscitation, transportation, and triage to secondary echelon care. Analysis of the experiences of other medical commands, such as that of the Israeli Defense Force, offers insight into improvements in equipment and training that are achievable with minimal cost. Training programs must involve formal instruction in Advanced Trauma Life Support for the combat corpsman, and ongoing experience in trauma surgery for personnel who are placed in the role of military surgeons. Today in military medicine there exists a major deficiency of expertise in trauma care, arising through a near total lack of involvement in active trauma surgery on the part of military medical training facilities. Civilian trauma centers offer an abundance of opportunity for military-like casualty management, and successful efforts at our command have integrated active duty personnel into this experience.
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Chronic pain related to musculoskeletal conditions is the leading cause of medical discharge from active duty military service. The present study is the first randomized controlled trial of an interdisciplinary pain treatment program (functional restoration, FR) to decrease chronic musculoskeletal pain and increase functioning in an active duty military population. Sixty-six military participants were randomly assigned to either an FR treatment group or a standard anesthesia pain clinic treatment comparison group. A repeated measures design was employed and data were analyzed for pre- to post-treatment differences, as well as for 6-months and 1-year post-treatment outcomes. Findings revealed significantly greater improvements for the FR group on self-reported pain, disability, functional status, and fitness for military duty at the post-treatment and follow-up points, relative to the comparison group. These results clearly demonstrate the efficacy and military relevance of a FR program for active duty military personnel who have chronic musculoskeletal pain disorders.
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ABSTRACT Introduction U.S. Navy Medicine’s temporary limited duty (LIMDU) program is the primary vehicle for managing the medical care and subsequent career outcomes of the ill and injured active component (AC) Sailors and Marines to ensure a medically ready force. Before the LIMDU Sailor and Marine Readiness Tracker System (SMART) came online, it was very difficult to examine LIMDU program administration metrics, patients’ experiences during LIMDU, and their subsequent health and career outcomes. This study examined the LIMDU patient population’s demographic, military career, and LIMDU-specific characteristics; identified characteristics that differed significantly by military service; and evaluated potentially modifiable factors associated with patient outcomes. Materials and Methods A comprehensive SMART extract was used to identify all AC Sailors and Marines in active LIMDU status between October 1, 2016, and September 30, 2019. The SMART extract was merged with comprehensive administrative military personnel data by patient identifiers to create a longitudinal dataset and to conduct descriptive statistics, bivariate, and multivariate logistic regression analyses for this study. The sample included 26,591 AC Sailors and Marines with complete SMART and military personnel records who ended LIMDU on or before September 30, 2019. Results During the study’s 3-year period, Navy Medicine’s rate of initial LIMDU entry by AC personnel increased each year from 2,041 in FY2017 to 2,424 in FY2019 per 100,000 personnel. At the time of initial entry, most LIMDU patients were male (76%), E4–E6 paygrades (54%), and had a single diagnosis recorded in their SMART records (66%). Pain patients (23%) constituted the largest diagnostic group, followed closely by musculoskeletal patients (23%), and then mental and behavioral health patients (20%). Variables that might reflect administration practices of the program did not differ significantly by service, suggesting good internal standardization of LIMDU administration across Navy Medicine. However, bivariate and multivariate analyses identified significant differences by service for almost all personal demographic, LIMDU-specific, and post-LIMDU military career sample characteristics measured at the last LIMDU close date or later. Study results suggested that the Navy and Marine Corps referred Sailors and Marines to start LIMDU for different medical reasons; to receive care from different military treatment facilities; to close LIMDU with different final actions; and to experience different post-LIMDU career outcomes. Conclusion Navy Medicine’s SMART data is an important new resource for LIMDU program evaluation and population-level patient research, despite the data limitations and concerns identified and addressed by this study. The study results provide a baseline empirical understanding about the LIMDU patient population. Further research is necessary to interrogate the validity of these results over a longer period and to initiate other lines of inquiry. While the construction of the larger project’s LIMDU patient population longitudinal dataset required a significant initial investment, future dividends from ongoing work are anticipated. Results derived from verified SMART data will benefit Navy Medicine, operational commands, and LIMDU patients alike by informing continuing efforts to improve patient health and career outcomes, identify and implement best clinical and administrative practices, and optimize force readiness.
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Military health care providers experience considerable stressors related to their exposure to death and traumatic injuries in others. This study used survey data from 799 active duty U.S. Army Combat Medics deployed to Operation Iraqi Freedom/Operation Enduring Freedom. Military experiences, combat exposures, and mental health care seeking of active duty Combat Medics were explored and compared across both genders. Barriers to care were also assessed. Male and female Combat Medics reported surprisingly similar experiences, exposures, and health issues. Overall, results indicate no striking differences in barriers for females compared to their male counterparts, suggesting the barriers to utilization of mental health services may be consistent across gender. Although medics endorsed barriers and stigma related to mental health counseling services, they still sought these health services. Female and male medics who endorsed barriers were more likely to report seeking services than those who did not endorse barriers. This study provides an initial description of utilization of mental health counseling services for U.S. Army Combat Medics, the majority of whom were involved in combat operations in Afghanistan or Iraq. Our findings indicate that comprehensive assessment of the military experiences and combat exposures is needed to appreciate their potential influence on military health care providers.
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Objective: To examine military, demographic, and psychosocial predictors of military retention following operational deployment. Methods: Military status 12 months following return from Iraq deployment was assessed via service records in 740 regular active duty Army Soldiers. Potential predictors of military retention were derived from prospectively administered in-person interviews and questionnaires conducted within 3 months following return from Iraq. Results: At 12 months following return from deployment, 18.1% (n = 134) of the sample had separated from military service. Cox proportional hazards analyses, adjusting for demographic, military, and psychosocial predictors, identified several factors that were independently associated with military attrition: less than (vs. equal to or more than) 6 years military experience (hazards ratio [HR], 3.98; 95% CI, 2.12–7.45); unmarried (vs. married) status (HR, 1.51; 95% CI, 1.06–2.16); and lower (vs. higher) levels of self-reported unit support during deployment (HR, 2.22; 95% CI, 1.42–3.47). Conclusions: Service members early in their career may be especially prone to military attrition. With regard to military retention, our findings suggest that it may be particularly important to develop initiatives that target organizational cohesion and support.
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Adolescent pregnancy is a significant public health problem in the United States, but little is known about this condition in military-affiliated populations. This article reviews what is known about adolescent pregnancy among (1) dependent children of active duty and retired personnel and (2) active duty military personnel. Sparse and conflicting evidence exists regarding the prevalence of, the risk factors for, and the impacts of pregnancy in the dependent child population. Limited evidence regarding active duty service members reveals risky behavior by young military personnel, failure to effectively use contraception, and resulting pregnancies that consume military resources and diminish deployability and retention. We suggest research questions for further study that could lead to interventions targeting unintended adolescent pregnancy and its attendant tolls on health, budgets, military readiness, and fighting strength.
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We studied a group of active duty military personnel with well-defined, lumbar discogenic, radicular pain syndromes. Our study group included 29 patients, 12 of whom required surgery during the study period. Three of the 29 patients had to be medically retired from active military service. Two patients required permanent limited-duty assignment and 10 others required prolonged (6 months or more) periods of limited duty. These findings highlight the significant adverse impact of lumbar disk disease on fitness for full active duty in military personnel.
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