Associations Between Mental and Physical Health Conditions and Occupational Impairments in the U.S. Military

A cross-sectional study of the association between sleep disturbance profiles, unmet mental health or substance use needs, and presenteeism among United States activity-duty service members using the 2018 health-related behaviours survey (HRBS)

Inadequate sleep, unmet mental health or substance use needs (unmet needs), and presenteeism are prevalent among military populations. This study aimed to cross-sectionally determine the association between sleep disturbance profiles, unmet needs, and presenteeism in US active-duty service members, both separately and combined. Data were collected from the 2018 Health-Related Behaviours Survey. The response rate was 9.6%. Presenteeism was collected as the number of days (0-30) then collapsed for analysis. Latent class analysis (LCA) was used to classify service members into sleep disturbance profiles. Odds ratios and confidence intervals (CIs) were estimated by binary and ordinal logistic models. Approximately 21% of the 17,166 service members reported at least one presentee day (95% CI: 19.8%-21.8%). Persistent presenteeism was 13.6% (95% CI: 12.7-14.4%). Four sleep disturbance profiles were identified by LCA: (1) high sleep disturbance (reported in 22.5%), (2) short sleep duration (26%), (3) trouble sleeping (6.9%), and (4) none to slight sleep disturbance (reference, 44.6%). Female sex, being separated/divorced/widowed, short sleep duration, trouble sleeping, high sleep disturbance, unmet needs, and both unmet needs and inadequate sleep together were associated with higher odds of high presenteeism levels and persistent presenteeism. Bachelor's or higher educated, 25-34-year-old, Hispanic/Latinx, Officer, Air Force, and Coast Guard service members were associated with lower odds of high presenteeism levels and persistent presenteeism. Despite the decreasing trends between 2015 and 2018, the high prevalence of presenteeism presents a significant burden on work productivity and readiness that behavioural modification may alter.

Longitudinal associations among resilience, social isolation, and gender in U.S. Iraq and Afghanistan-era veterans

Negative mental health outcomes are prevalent among veterans exposed to military-related stressors and are associated with social isolation. Limited research exists on resilience following military separation and its impact on social isolation in veterans. We examined resilience against military-related stressors and 2-year longitudinal associations with social isolation indicators; gender differences were also explored. U.S. military veterans (N = 351, 70.4% men) who deployed to the wars in and around Iraq and Afghanistan following the September 11, 2001, terrorist attacks (9/11) were recruited as part of a longitudinal assessment study examining predictors of postdeployment adjustment. Using a residualization approach, resilience was approximated as low stressor reactivity (SR), calculated by regressing mental health onto military-related stressor exposure. Military-related stressors were significantly associated with posttraumatic stress disorder (PTSD) related to both events during post-9/11 deployment (deployment event) and outside of post-9/11 deployment (other event), functional disability, and depression. After correcting for multiple comparisons, only SR derived from depressive symptoms predicted more closeness difficulties in social relationships longitudinally, B = 0.50, q = .023. Women also demonstrated higher SR than men regarding other event-related PTSD symptoms, B = -0.52, q < .001; functional disability, B = -0.28, q = .028; and depression, B = -0.34, q = .012. Results suggest that veterans with higher depressogenic reactivity to military-related stressors were more likely to endorse discomfort with closeness than those with lower depressogenic reactivity. Women veterans may also be more impacted by nondeployment traumatic distress, psychosocial dysfunction, and depression in response to military-related stressors.

Mental health and meaning in life in Chinese military personnel: a cross-lagged analysis

BACKGROUND

The burgeoning field of research on the dual-factor model of mental health (DFM) has highlighted its significance, yet the applicability of the DFM in military personnel and its longitudinal relationships with different dimensions of meaning in life remains unclear. This study aimed to clarify the applicability of the DFM for military personnel and to investigate longitudinal relationships between the dual factors of mental health (negative factor, positive factor) and the two dimensions of meaning in life (presence of meaning, search for meaning) in military personnel.

METHODS

In this study, data were collected in two waves (April and August 2023) from 227 Chinese military personnel. We constructed a dual-factor model with depression as the negative factor and subjective well-being as the positive factor, and we compared it with a single-factor model to determine if DFM could be applied to military personnel. We also constructed a cross-lagged model to investigate longitudinal relationships between depression, subjective well-being, presence of meaning, and search for meaning.

RESULTS

According to the findings, military personnel fit better with the DFM than with the single-factor model. Cross-lagged analysis results revealed that both the presence of meaning and the search for meaning negatively predicted depression and positively predicted subjective well-being.

CONCLUSIONS

The DFM had good applicability among military personnel. Both the presence of meaning and the search for meaning could improve military mental health, suggesting that both dimensions of meaning in life may be potential targets for improving military mental health.

The Effect of a Combined Mindfulness and Yoga Intervention on Soldier Mental Health in Basic Combat Training: A Cluster Randomized Controlled Trial

Background

Depression, anxiety, and sleep problems are prevalent in high-stress occupations including military service. While effective therapies are available, scalable preventive mental health care interventions are needed. This study examined the impact of a combined mindfulness and yoga intervention on the mental health of soldiers in Basic Combat Training (BCT).

Methods

U.S. Army soldiers (N = 1,896) were randomized by platoon to an intervention or training-as-usual condition. Soldiers in the intervention condition completed Mindfulness-Based Attention Training (MBAT), engaged in daily 15 min mindfulness practice, and participated in 30 minutes of hatha yoga 6 days per week. Surveys were administered at baseline (T1, prior to training), week 4 of BCT (T2), week 6 (T3), and week 9 (T4).

Results

A significant time-by-condition interaction predicting positive screens for depression found that screens decreased at a faster rate from T1 to T4 in the intervention condition (-12.6%) compared to training-as-usual (-7.2%) (b = -0.18, SE = 0.07, p = 0.028). While positive anxiety screens decreased over time across conditions, the time-by-condition interaction found no significant differences in the rate of these decreases by condition (b = 0.09, SE = 0.09, p = 0.273). A significant time-by-condition interaction predicting positive screens for sleep problems found that sleep problems decreased in the intervention condition (-1.4%) but increased in training-as-usual (2.0%) (b = -0.68, SE = 0.16, p = 0.027).

Conclusion

The mindfulness and yoga intervention was associated with a greater reduction in positive screens for depression and sleep problems among soldiers during high-stress training. Limitations include reliance on self-report and the inability to disaggregate the effects of mindfulness versus yoga. Mindfulness and yoga may enable personnel in high-stress occupations to sustain their mental health even in the context of significant psychological demands. This trial is registered with NCT05550610.

Heterogeneity in Unmet Treatment Need and Barriers to Accessing Mental Health Services Among U.S. Military Service Members with Serious Psychological Distress

The goal of the current study is to examine heterogeneity in mental health treatment utilization, perceived unmet treatment need, and barriers to accessing care among U.S. military members with probable need for treatment. Using data from the 2018 Department of Defense Health Related Behavior Survey, we examined a subsample of 2,336 respondents with serious psychological distress (SPD; past-year K6 score ≥ 13) and defined four mutually exclusive groups based on past-year mental health treatment (treated, untreated) and self-perceived unmet treatment need (recognized, unrecognized). We used chi-square tests and adjusted regression models to compare groups on sociodemographic factors, impairment (K6 score; lost work days), and endorsement of treatment barriers. Approximately 43% of respondents with SPD reported past-year treatment and no unmet need (Needs Met). The remainder (57%) met criteria for unmet need: 18% endorsed treatment and recognized unmet need (Treated/Additional Need); 7% reported no treatment and recognized unmet need (Untreated/Recognized Need); and 32% reported no treatment and no unmet need (Untreated/Unrecognized Need). Compared to other groups, those with Untreated/Unrecognized Need tended to be younger (ages 18-24; p = 0.0002) and never married (p = 0.003). The Treated/Additional Need and Untreated/Recognized Need groups showed similar patterns of treatment barrier endorsement, whereas the Untreated/Unrecognized Need group endorsed nearly all barriers at lower rates. Different strategies may be needed to increase appropriate mental health service use among different subgroups of service members with unmet treatment need, particularly those who may not self-perceive need for treatment.

The Impact of the Workload and Traumatic Stress on the Presenteeism of Midwives: The Mediating Effect of Psychological Detachment

Objectives

Midwives are at high risk of presenteeism, which may impact the quality of midwifery and maternal and infant health outcomes. However, no research has been conducted to investigate the relationship between workload, traumatic stress, psychological detachment, and presenteeism among midwives. This study, therefore, aimed at exploring the mediating effects of psychological detachment on workload, traumatic stress, and presenteeism among midwives.

Method

A multicenter cross-sectional study was conducted among 547 midwives in Jiangsu Province. Participants completed the National Aeronautics and Space Administration task load index, traumatic stress impact subscale for midwives, psychological detachment scale, and Stanford presenteeism scale and provided sociodemographic information. The mediating effects of psychological detachment were assessed using Mplus.

Results

The mean score of midwives' presenteeism was 17.09±3.56. Presenteeism was positively associated with both workload and traumatic stress (both P < 0.01) and negatively associated with psychological detachment (P < 0.01) among midwives. Psychological detachment partially mediated the relationships between (a) workload and presenteeism (β = 0.005, P < 0.05) and (b) traumatic stress and presenteeism (β = 0.006, P < 0.05), with mediating effects of 11.90% and 10.00%, respectively.

Conclusions

Presenteeism among midwives is at moderately high levels and requires attention from nursing managers. Psychological detachment is a mediating variable of the relationship between workload, traumatic stress, and presenteeism among midwives. Implications for Nursing Management. This study has implications for decreasing midwives' presenteeism in practical terms. Specifically, it is crucial that care managers attempt to adjust midwives' work patterns, reduce their workload, and provide organizational support for work-related traumatic stress. Moreover, our findings also indicate that psychological detachment is probably an essential element that is worthy of attention.

Psychological and functional outcomes following a randomized controlled trial of surf and hike therapy for U.S. service members

Introduction

Exercise-based interventions have established benefits for the treatment of depression and other psychological outcomes; however, limited data exist evaluating psychological, social, and functional outcomes for exercise outdoors.

Methods

The current study sought to expand knowledge about the breadth of effects following outdoor exercise interventions by using data from a randomized control trial comparing Surf and Hike Therapy among 96 U.S. active duty service members with major depressive disorder (MDD). Assessments examining psychological symptoms and functioning were completed before and after the 6-week programs, and 3 months following program completion. Participants also completed assessments before and after each exercise session. Multilevel modeling was used to determine whether psychological and functional outcomes (anxiety, positive and negative affect, resilience, pain, and physical and social functioning) improved for service members receiving Surf or Hike Therapy, and whether improvements differed by intervention.

Results

Study findings showed improved anxiety (p < 0.001), negative affect (p < 0.001), psychological resilience (p = 0.013), and social functioning (p < 0.001) following program participation, with no differences by intervention. Positive affect, pain, and physical functioning did not significantly improve after the program. Within sessions, positive affect (p < 0.001) and pain (p = 0.036) changed, and to a greater extent for those in the Surf Therapy condition.

Conclusion

Study results suggest that both Surf Therapy and Hike Therapy can improve psychological symptoms and social functioning impairments that commonly co-occur among service members with MDD, but Surf Therapy may provide enhanced immediate effects on positive affect and pain.

Clinical trial registration

ClinicalTrials.gov, NCT03302611.

The association between kinesiophobia and functional limitations in service members with knee pain

BACKGROUND

Knee diagnoses account for more than 50% of lower extremity musculoskeletal conditions in non-deployed US Service members. However, there is limited information regarding kinesiophobia in Service members with non-operative knee diagnoses.

HYPOTHESES

The objectives of this study were to determine the prevalence of high levels of kinesiophobia in US military Service members with knee pain across different knee diagnoses, and to determine the relationships between kinesiophobia and lower extremity function and/or specific functional limitations in Service members with knee pain. It was hypothesized Service members with knee pain would exhibit high levels of kinesiophobia across all knee diagnoses examined, and higher levels of both kinesiophobia and pain would be associated with worse self-reported function in this population. It was also hypothesized higher levels of kinesiophobia would be associated with functional activities with high knee loading.

DESIGN

Retrospective cohort study.

LEVEL OF EVIDENCE

IV.

METHODS

Sixty-five US Service members presenting to an outpatient physical therapy clinic were included in this study (20 females; age = 30.8 ± 7.7 years; height = 1.74 ± 0.9 m; mass = 80.7 ± 16.2 kg). Inclusion criterion was the presence of knee pain (duration = 50 ± 59 months); exclusion criterion was knee pain as a sequela of knee surgery. Data regarding demographic, pain chronicity, pain by Numeric Rating Scale (NRS), Tampa Scale of Kinesiophobia (TSK), and Lower Extremity Functional Scale (LEFS) were retrospectively obtained from patients' medical records. A high level of kinesiophobia was defined as a TSK score of greater than 37 points. Patient diagnoses included: osteoarthritis (n = 16); patellofemoral pain syndrome (n = 23); and other non-operative knee diagnoses (n = 26). Commonality analysis was utilized to determine the effects of age, height, mass, NRS, and TSK on LEFS score. Predictor values were interpreted as <1% = negligible, >1% = small; >9% = moderate, >25% = large. Additionally, exploratory item-specific analyses examined the strength of the relationships between kinesiophobia and LEFS item responses. Binary logistic regression determined if difficulty with an individual LEFS item could be predicted from either NRS or TSK score. Statistical significance was set at P < 0.05.

RESULTS

High levels of kinesiophobia were identified in 43 individuals (66%). NRS and TSK explained 19.4% and 8.6% of the unique variance in LEFS, and 38.5% and 20.5% of total variance, respectively. Age, height, and mass explained negligible to small proportions of the unique variance in LEFS. TSK and NRS were independent predictors for 13/20 individual LEFS items, with odds ratios ranging from 1.12 to 3.05 (P < 0.05).

CONCLUSION

The majority of US Service members in this study exhibited high levels of kinesiophobia. Kinesiophobia was significantly related to self-reported functional scores and performance on individual functional tasks in Service members with knee pain.

CLINICAL RELEVANCE

Treatment strategies addressing both fear of movement and pain reduction in patients with knee pain may help optimize functional outcomes.

Longitudinal Associations of PROMIS-29 Anxiety and Depression Symptoms With Low Back Pain Impact in a Sample of U.S. Military Service Members

INTRODUCTION

The Impact Stratification Score (ISS) is a measure of the impact of chronic low back pain (LBP) consisting of nine Patient-Reported Outcomes Measurement Information System (PROMIS-29) items, but no studies have examined the ISS or its association with psychological symptoms in military samples. This study examines longitudinal associations between psychological symptoms and the ISS among military service members.

MATERIAL AND METHODS

The study involved secondary data analysis of a sample of active duty U.S. military service members aged 18-50 years with LBP (n = 733). Participants completed the PROMIS-29 at three time points during treatment: baseline (time 1, T1), week 6 of treatment (time 2, T2), and week 12 of treatment (time 3, T3). The impact of LBP was quantified using the ISS (ranging from 8 = least impact to 50 = greatest impact). Psychological symptoms were assessed as PROMIS-29 anxiety and depression scores. Separate autoregressive cross-lagged models examined reciprocal associations of ISSs with anxiety, depression, and emotional distress scores from T1 to T3.

RESULTS

Within each time point, the ISS was significantly and positively correlated with anxiety and depression. In autoregressive cross-lagged models, anxiety and depression predicted the ISS at the next time point and associations were similar in magnitude (e.g., anxiety T2 to ISS T3: β = 0.12, P < .001; depression T2 to ISS T3: β = 0.12, P <.001). The ISS did not predict future depression or emotional distress scores at any time point, but the ISS at T2 was significantly, positively associated with anxiety scores at T3 (β = 0.07, P = .04).

CONCLUSION

Psychological symptoms consistently and prospectively predict the impact of LBP as measured by the ISS among service members undergoing pain treatment. The ISS may also be associated with future anxiety but not depression. PROMIS-29 anxiety and depression items may be useful adjunctive measures to consider when using the ISS to support LBP treatment planning and monitoring with service members.

Military service branch differences in alcohol use, tobacco use, prescription drug misuse, and mental health conditions

INTRODUCTION

Rates of substance use and mental health conditions vary across military service branches, yet branches also differ notably in terms of demographics and deployment experiences. This study examines whether branch differences in substance use and mental health outcomes persist after adjustment for a comprehensive set of demographic and deployment-related factors.

METHODS

Data on 16,699 Armed Forces Active Duty service members were from the 2015 Department of Defense Health Related Behaviors Survey. Service branch-specific prevalences were estimated for self-reports of heavy episodic drinking (HED), possible alcohol use disorder (AUD), current smoking, e-cigarette use, smokeless tobacco use, prescription drug misuse, probable post-traumatic stress disorder (PTSD), probable depression, and probable anxiety. Using logistic regression, we assessed whether branch differences persisted after adjusting for an extensive array of demographic factors (among full sample) and deployment/combat factors (among ever-deployed subgroup).

RESULTS

HED, AUD, smoking, e-cigarette use, smokeless tobacco use, depression, and anxiety were highest in the Marine Corps; prescription drug misuse and PTSD were highest in the Army. HED, AUD, smoking, smokeless tobacco use, PTSD, depression, and anxiety were lowest in the Air Force; e-cigarette use and prescription drug misuse were lowest in the Coast Guard. Demographics and deployment/combat experiences differed across branches. After adjustment, service members in the Army, Marine Corps and Navy exhibited nearly 2-3 times the odds of multiple mental health conditions and substance use behaviors relative to the Air Force.

CONCLUSION

Service branch differences were not fully explained by variation in demographics and deployment/combat experiences.