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Biomedical subjects

Charles W Hoge

Publications and source records attributed to Charles W Hoge.

At least 19 recordsLinked to original sources
PubMed2007

Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans.

OBJECTIVE: Studies of soldiers from prior wars conducted many years after combat have shown associations between combat-related posttraumatic stress disorder (PTSD) and physical health problems. The current Iraq war has posed a considerable PTSD risk, but the association with physical health has not been well studied. METHOD: The authors studied 2,863 soldiers using standardized self-administered screening instruments 1 year after their return from combat duty in Iraq. RESULTS: Among all participants, 16.6% met screening criteria for PTSD. PTSD was significantly associated with lower ratings of general health, more sick call visits, more missed workdays, more physical symptoms, and high somatic symptom severity. These results remained significant after control for being wounded or injured. CONCLUSIONS: The high prevalence of PTSD and its strong association with physical health problems among Iraq war veterans have important implications for delivery of medical services. The medical burden of PTSD includes physical health problems; combat veterans with serious somatic concerns should be evaluated for PTSD.

Absenteeism↗
PubMed2006

Millennium Cohort: the 2001-2003 baseline prevalence of mental disorders in the U.S. military.

OBJECTIVES: The 12-month prevalence of common mental illnesses in the United States is estimated to be 26%, accounting for an increasing fraction of all disability in the general population. The U.S. military is a unique group involved in response and defense during times of conflicts and disasters. The mental health of service members affects organizational productivity and effectiveness and is of great importance to the health of U.S. military members and public health in general. STUDY DESIGN AND SETTING: In the present report, the authors describe the baseline prevalence of mental disorders in a large U.S. military cohort, the Millennium Cohort, established for a 22-year longitudinal study of the health effects of military service. Using crude and weighted prevalence and multivariable logistic regression, the mental health morbidity of the Millennium Cohort is reported for various demographics. RESULTS: These analyses suggest that although the cohort compares favorably to other populations, there are military subpopulations, including women, younger, less educated, single, white, short-term service, enlisted, and Army members, who are at greater odds for some mental disorders. CONCLUSION: With ongoing U.S. involvement in combat operations around the world, these baseline data are essential to assessing long-term mental health morbidity in U.S. military service members.

Adolescent↗
PubMed2006

Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan.

CONTEXT: The US military has conducted population-level screening for mental health problems among all service members returning from deployment to Afghanistan, Iraq, and other locations. To date, no systematic analysis of this program has been conducted, and studies have not assessed the impact of these deployments on mental health care utilization after deployment. OBJECTIVES: To determine the relationship between combat deployment and mental health care use during the first year after return and to assess the lessons learned from the postdeployment mental health screening effort, particularly the correlation between the screening results, actual use of mental health services, and attrition from military service. DESIGN, SETTING, AND PARTICIPANTS: Population-based descriptive study of all Army soldiers and Marines who completed the routine postdeployment health assessment between May 1, 2003, and April 30, 2004, on return from deployment to Operation Enduring Freedom in Afghanistan (n = 16,318), Operation Iraqi Freedom (n = 222,620), and other locations (n = 64,967). Health care utilization and occupational outcomes were measured for 1 year after deployment or until leaving the service if this occurred sooner. MAIN OUTCOME MEASURES: Screening positive for posttraumatic stress disorder, major depression, or other mental health problems; referral for a mental health reason; use of mental health care services after returning from deployment; and attrition from military service. RESULTS: The prevalence of reporting a mental health problem was 19.1% among service members returning from Iraq compared with 11.3% after returning from Afghanistan and 8.5% after returning from other locations (P<.001). Mental health problems reported on the postdeployment assessment were significantly associated with combat experiences, mental health care referral and utilization, and attrition from military service. Thirty-five percent of Iraq war veterans accessed mental health services in the year after returning home; 12% per year were diagnosed with a mental health problem. More than 50% of those referred for a mental health reason were documented to receive follow-up care although less than 10% of all service members who received mental health treatment were referred through the screening program. CONCLUSIONS: Combat duty in Iraq was associated with high utilization of mental health services and attrition from military service after deployment. The deployment mental health screening program provided another indicator of the mental health impact of deployment on a population level but had limited utility in predicting the level of mental health services that were needed after deployment. The high rate of using mental health services among Operation Iraqi Freedom veterans after deployment highlights challenges in ensuring that there are adequate resources to meet the mental health needs of returning veterans.

Adult↗
PubMed2006

The effects of prior combat experience on the expression of somatic and affective symptoms in deploying soldiers.

OBJECTIVE: Deployment to a combat zone is undoubtedly an extremely stressful experience. It was hypothesized that, when faced with an impending wartime deployment, soldiers with prior combat experience would report minimal emotional problems accompanied by high rates of somatic complaints compared with combat-naive soldiers. METHODS: Self-reports of posttraumatic stress disorder (PTSD) and affective and somatic complaints were collected from 2068 U.S. soldiers just prior to combat deployment during Operation Iraqi Freedom. RESULTS: Although the percentage of soldiers scoring positive for PTSD was nearly identical for the experienced and inexperienced groups, scores on the Affective and Somatic scales differed as a function of prior combat history. Previous combat experience was associated with lower affective and greater somatic complaints relative to combat-naive soldiers. CONCLUSIONS: Consistent with theories of stress reaction, repression, and somatic amplification, combat-experienced soldiers reported limited affective complaints but greater somatic complaints relative to soldiers without combat experience.

Combat Disorders↗
PubMed2006

Strengthening the validity of population-based suicide rate comparisons: an illustration using U.S. military and civilian data.

The objectives of this study were to generate precise estimates of suicide rates in the military while controlling for factors contributing to rate variability such as demographic differences and classification bias, and to develop a simple methodology for the determination of statistically derived thresholds for detecting significant rate changes. Suicide rate estimates were calculated for the military population and each service branch over 11 years, directly standardized to the 2000 U.S. population. Military rates were highly comparable across branches and were approximately 20% lower than the civilian rate. Direct adjustment essentially controlled for the demographic confounds in this sample. Applying the Poisson-based method, we demonstrate that suicide rate fluctuations as large as 20-40% in any year may be attributed to random error.

Adolescent↗
PubMed2006

Assessing risk propensity in American soldiers: preliminary reliability and validity of the Evaluation of Risks (EVAR) scale--English version.

Risk-taking propensity is a critical component of judgment and decision-making in military operations. The Evaluation of Risks scale (EVAR) was recently developed to measure state and trait aspects of risk proneness. The scale, however, was psychometrically normed in French and no data are available for the English translation. We administered the English version of the EVAR to 165 U.S. soldiers to obtain reliability, validity, and normative data for English-speaking respondents. Confirmatory factor analysis suggested that the factor structure of the English EVAR differs from that obtained in the French studies. Instead, a three-factor solution, including recklessness/impulsivity, self-confidence, and need for control, emerged. Internal consistency was comparable to the French version. EVAR scores correlated with age, military rank, and years of service, and discriminated soldiers with histories of high-risk behavior. The data support the reliability and validity of the English version of the EVAR for evaluating risk propensity in U.S. soldiers.

Adolescent↗
PubMed2005

The occupational burden of mental disorders in theU.S. military: psychiatric hospitalizations, involuntary separations, and disability.

OBJECTIVE: A recent study showed that among U.S. military personnel, mental disorders were the leading medical correlate of separation from military service. The reasons for this association have not been determined. The purpose of this study was to characterize the risk and reasons for service separation for soldiers hospitalized with mental disorders compared with those hospitalized for other illnesses. METHOD: Population-based electronic health care data were linked with data on separations and disability. The authors constructed a cohort of 13,971 U.S. Army soldiers first hospitalized in 1998 and followed them for up to 2 years following this first hospitalization. RESULTS: The rate of service separation 6 months after first hospitalization was 45% among personnel whose primary hospital discharge diagnosis was a mental disorder, 27% among those with a secondary mental disorder discharge diagnosis, and 11% among those hospitalized for all other medical conditions. Separation from military service due to medical disability, misconduct and other legal problems, unauthorized work absences, behavior related to personality disorders, and alcohol rehabilitation failure was significantly more common following hospitalization for a mental disorder than for other medical conditions. Mental disorders were also significantly associated with medical separations in which there was evidence that the condition existed prior to service. CONCLUSIONS: In the military, the occupational impact of mental disorders compared with other medical conditions appears to be mediated not only by greater disease chronicity and severity but also by a variety of behavioral problems including misconduct, legal problems, unauthorized absences, and alcohol/drug-related problems. The study also points to the difficulties inherent in screening for mental disorders prior to entry into military service.

Cohort Studies↗
PubMed2005

Psychological screening procedures for deploying U.S. Forces.

This study examined the validity of psychological measures used in screening for the U.S. Army with 885 soldiers before a 6-month peacekeeping rotation in Kosovo. Content validity and construct validity were assessed by evaluating the clinical domains, comparing clinician assessments of functioning, and assessing risk factors for screening positive. Construct validity and content validity were demonstrated. Risks, benefits, and future directions of the Army's psychological screening research program are discussed.

Humans↗
PubMed2004

Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

BACKGROUND: The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. METHODS: We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. RESULTS: Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. CONCLUSIONS: This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care.

Adolescent↗
PubMed2004

Projecting mental disorder prevalence from national surveys to populations-of-interest--an illustration using ECA data and the U. S. Army.

BACKGROUND: Psychiatric epidemiology can further public health practice and inform mental health policy through the development of methodologies that provide rapid and cost efficient estimation of the prevalence of mental disorders at the local, regional, and population levels. OBJECTIVE: The aim of this study was to illustrate an efficient method for the estimation of mental disorder prevalence in population groups where no direct prevalence data are available. This study demonstrated a new method to extrapolate prevalences from a national calibration survey to a target population where no observations are available and sociodemographic differences are prominent. METHOD: We restricted the ECA sample to full-time employed participants (approximately 10,500) and used the total active duty U. S. Army population (approximately 460,000) for illustration. Sociodemographic data for the Army came from the official military database (mid-year 2000). Our logistic regression projections represented an extension of sociodemographic-driven synthetic methods used among demographers. Outcomes were lifetime prevalences for 13 DIS/DSM disorders. RESULTS: Compared to the ECA employed population, extrapolations to the Army revealed lower/similar estimates for nine of 13 DIS/DSM disorders. Projections were twice as high for alcohol abuse/dependence and antisocial personality, and one-third higher for social phobia and schizophrenia in the Army. Estimates compared favorably to one other military prevalence study, and to results derived using traditional standardization/adjustment methods based on the ECA sample weighted to the working general population. CONCLUSIONS: The synthetic estimation technique using ECA data to project lifetime prevalences for the U. S. Army generated sound estimates while illustrating an attractive method to extrapolate national data to demographically diverse communities seeking policy-relevant data.

Adult↗
PubMed2004

Mental health impact of 9/11 Pentagon attack: validation of a rapid assessment tool.

BACKGROUND: Following the tragic events of 9/11/2001, the Pentagon Post Disaster Health Assessment (PPDHA) survey was created to identify healthcare needs and concerns among Pentagon personnel and to assure that appropriate care and information was provided. The PPDHA was fielded from October 15, 2001, to January 15, 2002. Fundamental in this assessment was the evaluation of the mental health impact as a result of the attack. METHODS: Although a number of standardized instruments exist for mental health domains, most are lengthy and could not be used as a rapid health assessment. Instead, a short screening instrument consisting of 17 questions was developed that covered important mental health symptom domains, mental health functioning, and possible predictive risk factors. High-risk groups for post-traumatic stress disorder (PTSD), depression, panic attacks, generalized anxiety, and alcohol abuse were assessed, and validation of risk groups was assessed across functional levels. RESULTS: Overall, 1837 (40%) respondents met the screening criteria for any of the symptom domains of interest 1 to 4 months after the attack: PTSD (7.9%), depression (17.7%), panic attacks (23.1%), generalized anxiety (26.9%), or alcohol abuse (2.5%). Mental health risk groups were highly correlated with self-reported reduced daily functioning and use of counseling services. Additionally, risk factors known to be associated with mental health problems after traumatic events were strongly predictive of the high-risk categories identified. CONCLUSIONS: Mental health concerns were common among Pentagon employees in the 4 months after the 9/11 attack. Data from this study suggested that the short mental health screening instrument had validity and can serve as a prototype for rapid public health assessment of the mental health impact of future traumatic events.

Adult↗
PubMed2004

Suicide surveillance in the U.S. Military--reporting and classification biases in rate calculations.

The military has a well-defined population with suicide prevention programs that have been recognized as possible models for civilian suicide prevention efforts. Monitoring prevention programs requires accurate reporting. In civilian settings, several studies have confirmed problems in the reporting and classification of suicides. This analysis evaluated whether suicides were underreported or misclassified under accident or undetermined manner of death in the military system. We reviewed all 1998 and 1999 military deaths using official death reports and compared these data with additional sources, most importantly the DoD Medical Mortality Registry. We assessed for evidence of expressed suicidal intent and past psychiatric history among deaths classified as undetermined and accidents due to gunshot, overdose, drowning, falls, or asphyxia. Using sources other than official records, we found 17% more suicides than were reported, and an additional 4% of deaths that were suspicious for suicide. This study suggests that reporting and classification errors may account for 21% additional suicides in the military. These findings are comparable to rates seen in civilian studies and add to the literature regarding the problems inherent in using administrative death classification data for medical surveillance purposes.

Adult↗
PubMed2004

Characteristics of repeat users of an inpatient psychiatry service at a large military tertiary care hospital.

OBJECTIVE: The purpose of this study was to identify clinical and demographic variables that correlated with readmission to a large tertiary care military psychiatric inpatient service located in the Washington, DC area. METHODS: Data from 983 consecutive inpatient admissions (comprised of 814 individual patients) over a 13-month period (July 1999-July 2000) were abstracted from medical records for retrospective analysis. Repeat users were defined as those individuals receiving two or more inpatient admissions to Walter Reed Army Medical Center during the study period. Statistical comparisons were made between repeat and single admission groups to identify variables predictive of rehospitalization. RESULTS: Of 814 individual patients under study, 117 (14%) were identified as repeat users. A history of childhood psychiatric problems, previous psychiatric hospitalization, current or past substance abuse, legal problems, and presence of a psychotic or nonbipolar mood disorder were associated with readmission after controlling for active duty status. Current comorbid substance use or personality disorder diagnoses were not predictive. Having at least one child was protective against readmission. The 117 repeat users accounted for 3,838 (37%) of the total 10,393 hospital bed-days during the study period. Logistic regression analysis of all variables correlated with readmission demonstrated statistical significance for past psychiatric hospitalization and age of onset of psychiatric problems before age 18 when active duty status, age, and gender variables were included in the equation. CONCLUSIONS: This study is one of the largest to investigate predictors of rehospitalization in a population that enjoys universal "free" access to comprehensive mental health care services and other benefits of employment. This retrospective analysis documented three important facts: That there seem to be only minor differences between military and civilians with respect to variables associated with psychiatric rehospitalization, that a relatively small proportion of patients accounted for a disproportionately large number of inpatient bed-days, and that an unexpectedly high proportion of active duty patients admitted to this study site reported childhood psychiatric problems and psychiatric hospitalizations before their first hospitalization at Walter Reed Army Medical Center.

Adult↗
PubMed2003

Priorities for psychiatric research in the U.S. military: an epidemiological approach.

Among the 1.4 million active duty U.S. military service members, 6% receive outpatient treatment for a mental disorder each year. Over 25% of these service members leave military service within 6 months, a rate that is more than two times higher than the rate following treatment for any other illness category. There is clearly a need to define psychiatric research priorities and an unprecedented opportunity to enhance the field of psychiatric research in general using the well-characterized military population. The first priority is to better define the burden of mental disorders in terms of incidence, prevalence, severity, risk factors, and health care use. The impact of mental disorders on occupational functioning, particularly among new recruits, needs to be better characterized. Suicide research should include efforts to validate mortality data, define the normal level of rate variability, and establish surveillance for clusters. The highly structured occupational environment of the military lends itself to studies of preventive interventions designed to reduce disability or occupational attrition resulting from mental/behavioral problems.

Epidemiologic Methods↗