Guard/Reserve service members and mental health outcomes following deployment: Results from the Veterans’ Health Study

Boscarino, Joseph A.; Adams, Richard E.; Urosevich, Thomas G.; Hoffman, Stuart N.; Kirchner, H. Lester; Dugan, Ryan J.; Boscarino, Joseph J.; Withey, Carrie A; Figley, Charles R.

doi:10.1016/j.genhosppsych.2019.03.002

Cited by 3 publications

(13 citation statements)

References 11 publications

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“…14,15 As described below, the genetic risk factors for PTSD that we assessed were among outpatients, all of whom were formerly deployed military veterans receiving care in a large multi-hospital system in central Pennsylvania. [16][17][18][19] Although the number of veterans in these settings with PTSD has varied, about 7-10% of them have been diagnosed with current PTSD in recent years, 16,18,20 which is consistent with the prevalence rate in the current study.…”

Section: Introductionsupporting

confidence: 84%

“…The population for the current study included a sample of community-based veterans of Vietnam, Persian Gulf, Iraq/ Afghanistan, and/or other recent conflicts, who were receiving care in a large non-VA multihospital system in Pennsylvania. 17,18 We examined post-deployment PTSD status among a cross-sectional survey of 1730 veterans, who were receiving outpatient care in Pennsylvania at a Geisinger Clinic facility. Approximately 95% of the veterans were male (mean age=61.4 [SD=12.1]).…”

Section: Methods Samplementioning

confidence: 99%

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<p>Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics</p>

Hu¹,

Chu²,

Urosevich³

et al. 2020

NDT

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Background: Previously we reported a genetic risk score significantly improved PTSD prediction among a trauma-exposed civilian population. In the current study, we sought to assess this prediction among a trauma-exposed military population. Methods: We examined current PTSD diagnosis and PTSD symptom severity among a random sample of 1042 community-based US military veterans. Main effects and interaction effects were assessed for PTSD genetic risk by trauma exposure using cross-product terms for PTSD x trauma exposures, including combat, lifetime trauma, and adverse childhood exposures. The PTSD risk variants studied were within genetic loci previously associated with PTSD, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variants, which were used to calculate a total PTSD genetic risk score (range=0-8, mean=3.6, SD=1.4). Results: Based on DSM-5 PTSD criteria, 7.1% of veterans (95% CI=5.6-8.8) met criteria for current PTSD. The PTSD genetic risk count was significantly higher among PTSD cases vs noncases (3.92 vs 3.55, p=0.027). Since the PTSD genetic risk score was not significant in the PTSD diagnosis model, we assessed this association using PTSD symptom severity. Because these symptom data were skewed (mean=9.54, SD=12.71, range=0-76), we used negative binomial regression to assess this outcome. This symptom model included a PTSD genetic risk score, demographic factors, trauma exposures, current insomnia, current depression, concussion history, and attention-deficit disorder, expressed as incident rate ratios (IRR), which is an estimate of oneunit increase in PTSD severity, given other variables are held constant. Variables in the final model included age and sex (both p<0.001), PTSD genetic risk (IRR=1.02, p=0.028), warzone tours (IRR=0.94, p=0.003), childhood abuse (IRR=1.50, p<0.0001), current depression (IRR=1.89, p<0.0001), current insomnia (IRR=2.58, p<0.0001), low social support (IRR=1.19, p<0.0001), attention-deficit disorder (IRR=1.51, p<0.0001), agreeable personality (IRR=0.77, p<0.0001), and concussion (IRR=1.38, p<0.0001). Significant interactions were detected for combat and lifetime trauma exposure by PTSD genetic risk (both p<0.0001), suggesting that the impact of trauma exposures on PTSD severity was lower when the PTSD genetic risk was higher. Conclusion: Both warzone and non-warzone factors predicted current PTSD symptoms among veterans, including a PTSD genetic risk score. Interaction effects were detected for combat exposure and lifetime trauma by genetic risk score for PTSD symptoms, suggesting that PTSD symptom manifestation was more dependent on PTSD risk variants than the level of trauma or combat exposure. This suggests that controlling for other factors, the absence of genetic risk variants may confer PTSD resilience. Further research is planned.

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Section: Introductionsupporting

confidence: 84%

Section: Methods Samplementioning

confidence: 99%

<p>Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics</p>

Hu¹,

Chu²,

Urosevich³

et al. 2020

NDT

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“… 88 Nevertheless, while there were significant differences found between the veterans, as reported elsewhere, there were fewer differences detected in the final adjusted multivariable analyses. 7 , 25 In part, this was likely because of the relatively small number of veterans who reported suicidal behaviors (ie, suicide attempts or suicide plans), which were combined into a single category due to their low numbers, potentially biasing our results. This may have limited our ability to detect at statistically significant difference.…”

Section: Discussionmentioning

confidence: 99%

“… 58 , 65 As we had no measure to judge the severity of these events in our survey, we collapsed these into three categories: less than 3 traumatic events, 3–5 events, and 6 or more events, as has been done in other traumatic stress disorder studies. 6 , 24 , 25 , 40 , 59 , 66 , 67 A total of 21% of respondents experienced 6 or more lifetime traumatic events in the current study and we used this to define “high” lifetime traumatic event exposure. 68 This traumatic event scale was developed from other trauma studies, was used in previous research, and has demonstrated good reliability and validity.…”

Section: Methodsmentioning

confidence: 99%

“… 7 Understanding deployment-related risk factors among veterans is imperative for more effective prevention and treatment of mental health disorders among the veteran population. 25 In addition, we would expect that veterans would have both risk and protective factors related to suicide, including level of support, service history, personality factors among others. 26–29 This knowledge is also important for both VA and non-VA providers, since recent policy changes in the US have expanded access to health care for veterans outside of the VA healthcare system.…”

Section: Introductionmentioning

confidence: 99%

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Genetic and Psychosocial Risk Factors Associated with Suicide Among Community Veterans: Implications for Screening, Treatment and Precision Medicine

Boscarino¹,

Adams²,

Urosevich³

et al. 2022

PGPM

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Introduction Since veteran suicide is a concern and our knowledge of predictive factors is still limited, our objective was to assess risk factors for suicide, including genetic factors, among deployed veterans. Methods For this study, we surveyed 1730 veterans who were outpatients in a multi-hospital system in Pennsylvania. Altogether, 1041 veterans (60%) provided a DNA sample. The genetic risk variants investigated were within loci previously associated with PTSD and substance misuse, including CRHR1 , CHRNA5 , RORA , and FKBP5 genetic variations, which were used to calculate a polygenic risk score (range=0–8, mean=3.6, SD=1.4). Results Most veterans (56.2%) were deployed to Vietnam while significant numbers were deployed to Iraq, Afghanistan, and other post-Vietnam conflicts. Overall, 95.1% of the veterans were male, their mean age was 56.2 (SD=12), and 95.6% were Caucasian. Among the veterans, 24% had high combat exposure. The prevalence of lifetime suicidal thoughts was 11.3%. Additionally, 5.7% ever developed a suicide plan or attempted suicide in their lifetimes. Among those with a history of a lifetime suicide attempt or suicide plan, the PTSD genetic risk score was significantly higher (OR=3.96 vs 3.55, p=0.033), but for suicidal thoughts, this association was not significant (p=0.717). In multivariable analysis (MVA) logistic regression, significant predictors of attempting suicide or having a suicide plan were history of depression (OR=5.04, p<0.001), PTSD genetic risk score (OR=1.25, p=0.036), history of childhood abuse/neglect (OR=2.24, p=0.009), and lifetime marijuana use (OR= 1.56, p=0.020). Conversely, rural residence was protective for suicide risk (OR=0.49; p=0.031). For suicidal thoughts, in the MVA genetic risk score was not significant (p=0.697), but history of child abuse/neglect (p<0.001), history of depression (p>0.001), low psychological resilience (p=0.004), and lifetime marijuana use (p=0.022) were significant. Discussion In this study, we identified genetic risk variants and other predictors for suicide among veterans that may have implications for future screening and clinical care. Further research is advised.

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Impact and Risk of Moral Injury Among Deployed Veterans: Implications for Veterans and Mental Health

et al. 2022

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The impact of “moral injury” (MI) among deployed veterans, defined as actions in combat that violate a veteran's moral beliefs and result in psychological distress, has increasingly become a significant clinical concern separate from other trauma- and stressor-related disorders. MI involves severe distress over violations of core beliefs often followed by feelings of guilt and conflict and is common among veterans with PTSD. While the psychological impact of PTSD is well-documented among veterans, this has been done less so with respect to MI. We studied MI among 1,032 deployed veterans who were outpatients in a large non-profit multi-hospital system in central Pennsylvania. The study included active duty and Guard/Reserve members, as well as veterans who were not Department of Veterans Affairs (VA) service users. Our hypothesis was that, controlling for other risk factors, veterans with high MI would have current mental disorders. Our secondary hypothesis was that MI would be associated with other psychopathologies, including chronic pain, sleep disorders, fear of death, anomie, and use of alcohol/drugs to cope post deployment. Most veterans studied were deployed to Vietnam (64.1%), while others were deployed to post-Vietnam conflicts in Iraq and Afghanistan and elsewhere. Altogether, 95.1% of the veterans were male and their mean age was 61.6 years (SD = 11.8). Among the veterans, 24.4% had high combat exposure, 10.9% had PTSD, 19.8% had major depressive disorder, and 11.7% had a history of suicidal thoughts. Based on the Moral Injury Events Scale (MIES), 25.8% had high MI post deployment, defined as a score above the 75th percentile. Results show that high MI among veterans was associated with current global mental health severity and recent mental health service use, but not suicidal thoughts. In addition, as hypothesized, MI was also associated with pain, sleep disorders, fear of death, anomie, use of alcohol/drugs to cope post-deployment, and poor unit support/morale during deployment. Deployed veterans with MI are more likely to have current mental health disorders and other psychological problems years after deployment. Further research is advised related to the screening, assessment, treatment, and prevention of MI among veterans and others after trauma exposures.

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Guard/Reserve service members and mental health outcomes following deployment: Results from the Veterans’ Health Study

Cited by 3 publications

References 11 publications

<p>Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics</p>

<p>Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics</p>

Genetic and Psychosocial Risk Factors Associated with Suicide Among Community Veterans: Implications for Screening, Treatment and Precision Medicine

Impact and Risk of Moral Injury Among Deployed Veterans: Implications for Veterans and Mental Health

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