Mental Health and Suicidality in Separating U.S. Reserve and National Guard Personnel

Wiley

Epidemiol Psychiatr Sci

et al. 2021

Aims. Markedly elevated adverse mental health symptoms were widely observed early in the coronavirus disease-2019 (COVID-19) pandemic. Unlike the U.S., where cross-sectional data indicate anxiety and depression symptoms have remained elevated, such symptoms reportedly declined in the U.K., according to analysis of repeated measures from a large-scale longitudinal study. However, nearly 40% of U.K. respondents (those who did not complete multiple follow-up surveys) were excluded from analysis, suggesting that survivorship bias might partially explain this discrepancy. We therefore sought to assess survivorship bias among participants in our longitudinal survey study as part of The COVID-19 Outbreak Public Evaluation (COPE) Initiative. Methods. Survivorship bias was assessed in 4039 U.S. respondents who completed surveys including the assessment of mental health as part of The COPE Initiative in April 2020 and were invited to complete follow-up surveys. Participants completed validated screening instruments for symptoms of anxiety, depression and insomnia. Survivorship bias was assessed for (1) demographic differences in follow-up survey participation, (2) differences in initial adverse mental health symptom prevalence adjusted for demographic factors and (3) differences in follow-up survey participation based on mental health experiences adjusted for demographic factors. Results. Adjusting for demographics, individuals who completed only one or two out of four surveys had significantly higher prevalence of anxiety and depression symptoms in April 2020 (e.g. one-survey v. four-survey, anxiety symptoms, adjusted prevalence ratio [aPR]: 1.30, 95% confidence interval [CI]: 1.08-1.55, p = 0.0045; depression symptoms, aPR: 1.43, 95% CI: 1.17-1.75, p = 0.00052). Moreover, individuals who experienced incident anxiety or depression symptoms had significantly higher adjusted odds of not completing follow-up surveys (adjusted odds ratio [aOR]: 1.68, 95% CI: 1.22-2.31, p = 0.0015, aOR: 1.56, 95% CI: 1.15-2.12, p = 0.0046, respectively). Conclusions. Our findings reveal significant survivorship bias among longitudinal survey respondents, indicating that restricting analytic samples to only respondents who provide repeated assessments in longitudinal survey studies could lead to overly optimistic interpretations of mental health trends over time. Cross-sectional or planned missing data designs may provide more accurate estimates of population-level adverse mental health symptom prevalence than longitudinal surveys.

Section: Introductionmentioning

confidence: 99%

Uncovering survivorship bias in longitudinal mental health surveys during the COVID-19 pandemic

Wiley

Epidemiol Psychiatr Sci

et al. 2021

“…Feeling sad in unfavorable situations such as military situations and operational locations can be one of the reasons for the increase in the prevalence of depression or in some way the occurrence of depression and its symptoms in the military. This relationship indicates the existence of a relation between activity abnormalities, mood and thoughts with social or occupational environments [ 23 , 39 – 42 ]. On the other hand, the military may not be very interested in their job and, therefore, they have unpleasant moods and thoughts such as sadness, grief, despair and worry, which can make a military person prone to depression [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

The global prevalence of depression, suicide ideation, and attempts in the military forces: a systematic review and Meta-analysis of cross sectional studies

2021

Background Given the wide range of depressive disorders, suicidal ideation and suicide attempts in various military studies around the world, determining the exact prevalence of these disorders in line with health planning as well as care and treatment service designing for military forces can be useful. The aim of the present meta-analysis was to determine the pooled prevalence of depressive disorders, suicide thoughts, and attempts in the military. Methods The present systematic review and meta-analysis study was performed based on PRISMA criteria in 5 steps of the search strategy, screening and selection of articles, data extraction, evaluation of article quality and meta-analysis. International databases (PubMed (Medline), Scopus, Web of science, Embase (Elsevier), PsycInfo (Ovid), Cochrane CENTRAL (Ovid)) were searched using related keywords extracted from Mesh and Emtree. After screening and final selection of articles, data were extracted and qualitative evaluation was performed using the NOS checklist. Results The results of meta-analysis showed that the prevalence of depression in active military forces and veterans was 23% (%95 CI: 20–26%) and 20% (%95 CI: 18–22%), respectively. In addition, the prevalence of suicidal ideation and attempts in the military was 11% (%95 CI: 10–13%) and 11% (%95 CI: 9–13%), respectively. The prevalence of suicide ideation and attempts in drug-using military was 18% (%95 CI: 7–33%) and 30% (%95 CI: 23–36%), respectively. The prevalence of suicidal ideation and attempts in military consuming alcohol were 9% (%95 CI: 4–13%) and 8% (%95 CI: 7–10%), respectively. In militaries with AIDS / HIV, the prevalence of suicide attempts was 5% (%95 CI: 4–8%). Conclusion Therefore, it is necessary to develop and design training and intervention programs in order to increase the awareness of the military, especially veterans, to prevent the occurrence of suicide and depression.

“…Feeling sad in unfavorable situations such as military situations and operational locations can be one of the reasons for the increase in the prevalence of depression or in some way the occurrence of depression and its symptoms in the military. This relationship indicates the existence of a relation between activity abnormalities, mood and thoughts with social or occupational environments (32)(33)(34)(35)(36). On the other hand, the military may not be very interested in their job and, therefore, they have unpleasant moods and thoughts such as sadness, grief, despair and worry, which can make a military person prone to depression (37,38).…”

Section: Discussionmentioning

confidence: 99%

The Global Prevalence of Depression, Suicide Ideation, and Attempts in the Military Forces: A Systematic Review and Meta-Analysis of Cross Sectional Studies

Moradi

Dowran

Sepandi

2021

Preprint

Background Given the wide range of depressive disorders, suicidal ideation and suicide attempts in various military studies around the world, determining the exact prevalence of these disorders in line with health planning as well as care and treatment service designing for military forces can be useful. The aim of the present meta-analysis was to determine the pooled prevalence of depressive disorders, suicide thoughts, and attempts in the military. Methods The present systematic review and meta-analysis study was performed based on PRISMA criteria in 5 steps of the search strategy, screening and selection of articles, data extraction, evaluation of article quality and meta-analysis. International databases (PubMed, Scopus, Web of Sciences, Embase, Cochrane, PsycInfo) were searched using related keywords extracted from Mesh and Emtree. After screening and final selection of articles, data were extracted and qualitative evaluation was performed using the NOS checklist. Results The results of meta-analysis showed that the prevalence of depression in active military forces and veterans was 23% (%95 CI: 20–26 %) and 20% (%95 CI: 18–22 %), respectively. In addition, the prevalence of suicidal ideation and attempts in the military was 11% (%95 CI: 10–13 %) and 11% (%95 CI: 9–13 %), respectively. The prevalence of suicide ideation and attempts in drug-using military was 18% (%95 CI: 7–33 %) and 30% (%95 CI: 23–36 %), respectively. The prevalence of suicidal ideation and attempts in military consuming alcohol were 9% (%95 CI: 4–13 %) and 8% (%95 CI: 7–10 %), respectively. In militaries with AIDS / HIV, the prevalence of suicide attempts was 5% (%95 CI: 4–8 %). Conclusion Therefore, it is necessary to develop and design training and intervention programs in order to increase the awareness of the military, especially veterans, to prevent the occurrence of suicide and depression.