Psychiatric Aeromedical Evacuations of Deployed Active Duty U.S. Military Personnel During Operations Enduring Freedom, Iraqi Freedom, and New Dawn

Peterson, Alan L.; Hale, Willie J.; Baker, Monty T.; Cigrang, Jeffrey A.; Moore, Brian A; Straud, Casey L; Dukes, Susan; Young‐McCaughan, Stacey; Gardner, Cubby L.; Arant-Daigle, Deborah; Pugh, Mary Jo; Christians, Iman Williams; Mintz, Jim

doi:10.1093/milmed/usy188

Cited by 28 publications

(19 citation statements)

References 13 publications

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“…Suicide rates among military veterans are estimated to be 22% higher than among non‐veteran adults, with an average of 20 veteran deaths by suicide per day (Department of Veterans Affairs, 2016). Suicidal ideation (SI) and suicide attempts are also prevalent among active duty service members and can result in discharge from military service (Peterson et al, 2018). SI is often a precursor to suicide attempts and death by suicide (e.g., Dobscha et al, 2014; Miranda, Ortin, Scott, & Shaffer, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder

et al. 2020

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Background Suicidal thoughts are common among veterans with posttraumatic stress disorder (PTSD). The aim of this study was to examine the prevalence and correlates of four courses of suicidal (SI) among veterans receiving residential PTSD treatment. Methods A total of 1,807 veterans receiving residential PTSD treatment at Department of Veterans Affairs medical facilities who completed self‐report measures at admission and discharge were included. Results The prevalence of SI courses were No SI (33.6%), Remitted SI (23.0%), SI onset (6.0%), and Chronic SI (37.4%). There were group differences between the four SI courses in PTSD symptoms at baseline, magnitude of PTSD symptom change during treatment, race/ethnicity and baseline depression, substance use, physical functioning, and pain. Chronic SI was associated with highest baseline PTSD, depression, substance use, pain and worse physical functioning. Remitted SI course was associated with greatest pre‐posttreatment PTSD improvement, followed by No SI, Chronic SI, and SI Onset. Multinomial logistic regressions revealed that PTSD symptom improvement and baseline PTSD symptoms most consistently related to symptomatic SI courses compared to less symptomatic or No SI courses. Receipt of trauma‐focused psychotherapy (none, some, or adequate) and length of stay were not related to SI courses and did not differ between groups. Conclusions Findings indicate that treating PTSD symptoms could be impactful for reducing suicidal thoughts. Although many veterans had remitted or reduced severity of SI at discharge, a significant proportion of veterans reported SI at discharge (43.4%), potentially highlighting the need for suicide specific treatment interventions within the context of PTSD treatment.

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Section: Introductionmentioning

confidence: 99%

“…in discharge from military service (Peterson et al, 2018). SI is often a precursor to suicide attempts and death by suicide (e.g., Dobscha et al, 2014;Miranda, Ortin, Scott, & Shaffer, 2014).…”

Section: Introductionmentioning

confidence: 99%

Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder

et al. 2020

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“… 1 Wounded service members, including approximately 10% who suffered from psychiatric disorders such as TBI, were aeromedically evacuated to hospitals in select countries for advanced care critical for survival between 2001 and 2013. 2 During these up to 9 h flights, the cabin pressure is usually maintained at the equivalent to 8000 ft altitude. The mild hypoxia that accompanies such hypobaric conditions is thought to be one of several stressors that could cause secondary injury to TBI patients during these flights.…”

Section: Introductionmentioning

confidence: 99%

Hypobaria-Induced Oxidative Stress Facilitates Homocysteine Transsulfuration and Promotes Glutathione Oxidation in Rats with Mild Traumatic Brain Injury

Tchantchou

Miller²,

Goodfellow

et al. 2021

J Cent Nerv Syst Dis

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Background: United States service members injured in combat theatre are often aeromedically evacuated within a few days to regional military hospitals. Animal and epidemiological research indicates that early exposure to flight hypobaria may worsen brain and other injuries. The mechanisms by which secondary exposure to hypobaria worsen trauma outcomes are not well elucidated. This study tested the hypothesis that hypobaria-induced oxidative stress and associated changes in homocysteine levels play a role in traumatic brain injury (TBI) pathological progression caused by hypobaria. Methods: Male Sprague Dawley rats were exposed to a 6 h hypobaria 24 h after mild TBI by the controlled cortical impact. Plasma and brain tissues were assessed for homocysteine levels, oxidative stress markers or glutathione metabolism, and behavioral deficits post-injury in the absence and presence of hypobaria exposure. Results: We found that hypobaria after TBI increased oxidative stress markers, altered homocysteine metabolism, and promoted glutathione oxidation. Increased glutathione metabolism was driven by differential upregulation of glutathione metabolizing genes. These changes correlated with increased anxiety-like behavior. Conclusion: These data provide evidence that hypobaria exposure after TBI increases oxidative stress and alters homocysteine elimination likely through enhanced glutathione metabolism. This pathway may represent a compensatory mechanism to attenuate free radical formation. Thus, hypobaria-induced enhancement of glutathione metabolism represents a potential therapeutic target for TBI management.

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“…Previous studies that have examined characteristics of behavioral health evacuees have found this population more likely to be young and female (Rundell, 2006; Wilmoth et al., 2015), divorced or widowed (Peterson et al., 2018; Rundell, 2006; Wilmoth et al., 2015) and to be serving with a junior–enlisted rank in the Army (Peterson et al., 2018). The literature is mixed regarding associations between mental health problems in service members and marital status (Hourani, Williams, & Kress, 2006; Mayo, MacGregor, Dougherty, & Galarneau, 2013; Nasky, Hines, & Simmer, 2009; Nock et al., 2014; Ursano et al., 2014, 2015) as well as parental status (Hourani et al., 2006; Jobe‐Shields, Flanagan, Killeen, & Back, 2015; Wilmoth et al., 2015).…”

mentioning

confidence: 99%

Development of a Tool to Predict Risk of Behavioral Health Evacuation From Combat

Thornquist

Leonard

Fraine³

et al. 2020

Journal of Traumatic Stress

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In the present study, we examined administrative data on 667,437 deployments of at least 30 days duration to Iraq and Afghanistan from 2011 through the end of 2016 to determine risk factors for evacuation from the combat zone for behavioral health reasons. Demographic data, military‐specific data, responses on predeployment mental health assessments, and presence of previous treatment for psychiatric conditions were entered into a logistic regression based on expert determination, distinguishing the 2,133 behavioral health evacuations from those deployments that either did not end in evacuation or included evacuations for reasons other than behavioral health. The model, derived from a random half of the sample (training set), was verified on the other half (validation set). Predictor variables used in the model were calendar year; gender; age; rank; marital status; parental status; number of prior war zone deployments; branch of service; screens for symptoms of posttraumatic stress disorder, depression, and hazardous alcohol use on the predeployment mental health assessment; and prior substance‐ and non–substance‐related behavioral health diagnoses. Odds ratios (range: 1.05–3.85) for selected variables that contributed to the model were used to assign risk scores in the Behavioral Health Evacuation Risk Tool, which can aid predicting which service members are more likely to be evacuated from combat for behavioral health reasons, thus indicating where resources can be allocated for behavioral health referrals and war zone care.

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Psychiatric Aeromedical Evacuations of Deployed Active Duty U.S. Military Personnel During Operations Enduring Freedom, Iraqi Freedom, and New Dawn

Cited by 28 publications

References 13 publications

Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder

Courses of suicidal ideation among military veterans in residential treatment for posttraumatic stress disorder

Hypobaria-Induced Oxidative Stress Facilitates Homocysteine Transsulfuration and Promotes Glutathione Oxidation in Rats with Mild Traumatic Brain Injury

Development of a Tool to Predict Risk of Behavioral Health Evacuation From Combat

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