Five-Year Impacts of Family Stressors and Combat Threat on the Mental Health of Afghanistan and Iraq War Veterans

Relative Risk of All-Cause Medical Evacuation for Behavioral Health Conditions in U.S. Central Command

INTRODUCTION

Behavioral health disorders are the leading category of evacuations from the U.S. Central Command (USCENTCOM) area of responsibility. Understanding the relative risk of behavioral health conditions associated with all-cause evacuation is important for the allocation of resources to reduce the evacuation burden.

MATERIALS AND METHODS

Data from the USTRANSCOM Regulating and Command & Control Evacuation System and Theater Medical Data Store covering personnel deployed to the USCENTCOM area of responsibility between January 1, 2017 and December 31, 2021 were collected and analyzed. All individuals who were diagnosed with a behavioral health-specific ICD-9 (290-316) or ICD-10 (F00-F99) code during the period were included. Using the earliest medical encounter, the number of individuals diagnosed with a particular code and the frequency individuals were evacuated being diagnosed with any code were calculated.

RESULTS

The mean monthly USCENTCOM population during this period was 62,535. A total of 22,870 individuals were diagnosed with a behavioral health-related disorder during the study period. Of this population, 1,414 individuals required an evacuation. The relative risk of the top 30 diagnosis codes used during the initial visit of individuals during the study period was calculated. Within this group of initial diagnoses, F32.9 'Major depressive disorder, single episode, unspecified' had the highest proportion evacuated at 15.9%.

CONCLUSIONS

There is a broad array of behavioral health-specific diagnoses used initially in the care of behavioral health disorders with a great variation in their association with evacuation risk. Variations of diagnoses associated with anxiety, depressive, and adjustment disorders are most associated with eventual evacuation.

Differences in military personnel's hardiness depending on their leadership levels and combat experience: An exploratory pilot study

Constant challenges and permanently stressful conditions at military workplaces demand high levels of hardiness for military personnel. We aimed to determine possible differences in Ukrainian military personnel's hardiness depending on their leadership levels and existing combat experience. The study involved 543 Ukrainian service members (85.8% male and 14.2% female, aged 18 to 61 years). We used the Professional Hardiness Questionnaire and the Brief Resilience Scale. The obtained data showed that the higher leadership levels the military personnel had, the higher their hardiness was (up to the company commander level in our study). We revealed a significant predominance of professional challenge acceptance in the structure of military personnel's hardiness, followed by professional control and professional commitment. This proportion of professional hardiness components did not differ depending on service members' leadership levels. Additionally, we showed significantly higher hardiness stability after participating in combat operations in military leaders compared to service members without subordinates. Our findings necessitate hardiness examination during military personnel selection and its development during military training, in particular for deployment.

Military personnel's stress reactivity during pre-deployment in a war zone

Many studies have been conducted on the numerous negative post-deployment outcomes for military personnel. However, data on service members' pre-deployment stress reactivity are absent. This is a serious gap in existing research, as stress has an important regulatory role. This study aimed to determine possible manifestations of military personnel's stress reactivity during pre-deployment in a war zone in eastern Ukraine. The study involved 270 Ukrainian service members (all male, aged 18 to 58 years). Sample 1 (n = 108) were preparing to be deployed for the first time, sample 2 (n = 84) were preparing to be deployed and had previous experience of deployment, and sample 3 (n = 108) were not preparing to deploy and had no previous deployment experience. We used the Ukrainian adaptation of the Giessen Subjective Complaints List (GBB-24), the Symptom Checklist-90-Revised (SCL-90-R), the Short Screening Scale for DSM-IV posttraumatic stress disorder and the Combat Exposure Scale (CES). We found that indicators for physical complaints, psychological problems and psychopathological and posttraumatic symptoms among service members from samples 1 and 2 were significantly higher than those of sample 3 in 15 of 18 cases (p < 0.001-0.05). The indicators obtained for sample 2 were higher than those of sample 1 in six of nine cases (p < 0.001-0.05). Both our study hypotheses were confirmed. The present findings can be used to develop efficient psychological interventions for military personnel during pre-deployment in a war zone.

Psychological Stress-Induced Immune Response and Risk of Alzheimer's Disease in Veterans from Operation Enduring Freedom and Operation Iraqi Freedom

PURPOSE

Psychological stress is a significant health problem in veterans and their family members. Traumatic brain injury (TBI) and stress lead to the onset, progression, and worsening of several inflammatory and neurodegenerative diseases in veterans and civilians. Alzheimer's disease (AD) is a progressive, irreversible neuroinflammatory disease that causes problems with memory, thinking, and behavior. TBIs and chronic psychological stress cause and accelerate the pathology of neuroinflammatory diseases such as AD. However, the precise molecular and cellular mechanisms governing neuroinflammation and neurodegeneration are currently unknown, especially in veterans. The purpose of this review article was to advance the hypothesis that stress and TBI-mediated immune response substantially contribute and accelerate the pathogenesis of AD in veterans and their close family members and civilians.

METHODS

The information in this article was collected and interpreted from published articles in PubMed between 1985 and 2020 using the key words stress, psychological stress, Afghanistan war, Operation Enduring Freedom (OEF), Iraq War, Operation Iraqi Freedom (OIF), Operation New Dawn (OND), traumatic brain injury, mast cell and stress, stress and neuroimmune response, stress and Alzheimer's disease, traumatic brain injury, and Alzheimer's disease.

FINDINGS

Chronic psychological stress and brain injury induce the generation and accumulation of beta-amyloid peptide, amyloid plaques, neurofibrillary tangles, and phosphorylation of tau in the brain, thereby contributing to AD pathogenesis. Active military personnel and veterans are under enormous psychological stress due to various war-related activities, including TBIs, disabilities, fear, new environmental conditions, lack of normal life activities, insufficient communications, explosions, military-related noise, and health hazards. Brain injury, stress, mast cell, and other immune cell activation can induce headache, migraine, dementia, and upregulate neuroinflammation and neurodegeneration in veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. TBIs, posttraumatic stress disorder, psychological stress, pain, glial activation, and dementia in active military personnel, veterans, or their family members can cause AD several years later in their lives. We suggest that there are increasing numbers of veterans with TBIs and stress and that these veterans may develop AD late in life if no appropriate therapeutic intervention is available.

IMPLICATIONS

Per these published reports, the fact that TBIs and psychological stress can accelerate the pathogenesis of AD should be recognized. Active military personnel, veterans, and their close family members should be evaluated regularly for stress symptoms to prevent the pathogenesis of neurodegenerative diseases, including AD.