Use of mental health services by children and youth in Ontario military families compared with the general population: a retrospective cohort study

BACKGROUND

In Canada, more than 64 000 children are growing up with 1 or both parents in the military. We compared mental health service use by children and youth in military families versus the general population, to understand potential mental health service gaps.

METHODS

This was a matched retrospective cohort study of children and youth (aged < 20 yr) of members of the Canadian Armed Forces posted to Ontario between Apr. 1, 2008, and Mar. 31, 2013, with follow-up to Mar. 31, 2017, using provincial administrative health data at ICES. We created a comparison group of children and youth in the general population, matched 4:1 by age, sex and geography. We compared the use and frequency of mental health-related physician visits, emergency department visits and hospital admissions, and the time to first service use, using regression models.

RESULTS

This study included 5478 children and youth in military families and a matched cohort of 21 912 children and youth in the general population. For visits and admissions for mental health reasons, children and youth in military families were more likely to see a family physician (adjusted relative risk [RR] 1.25, 95% confidence interval [CI] 1.17 to 1.34), less likely to see a pediatrician (adjusted RR 0.87, 95% CI 0.79 to 0.96), equally likely to see a psychiatrist, and as likely to visit an emergency department or be admitted to hospital as the matched cohort. Children and youth in military families had the same frequency of use of outpatient mental health services. The time to first visit for mental health reasons was shorter to see a family physician (adjusted days difference [DD] -57, 95% CI -80 to -33) and longer to see a psychiatrist (adjusted DD 103, 95% CI 43 to 163) for children and youth in military families.

INTERPRETATION

Children and youth in military families use mental health services differently from those in the general population. Provincial policies aimed at increasing access to mental health specialists for children and youth in military families, alongside targeted federal services and programming through military organizations, are needed.

High sensitivity and specificity screening for clinically significant intimate partner violence

The U.S. Preventive Services Task Force has recommended that clinicians screen patients for intimate partner violence (IPV). This article aims to develop and test the first screeners for clinically significant physical and psychological IPV (i.e., acts meeting criteria in the International Classification of Diseases (11th ed.; ICD-11; World Health Organization, 2019) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013). The goal was to derive screeners that (1) are maximally brief, while still achieving high sensitivity and specificity; (2) assess perpetration and victimization when either men or women are reporting; and (3) use ICD-11/DSM-5 criteria as the reference standard. Random samples of active duty service members at 82 installations worldwide were obtained via e-mail invitation (2006: N = 54,543; 2008: N = 48,909); their response rates were excellent for long general population surveys with no payment (2006: 44.7%, 2008: 49.0%). The population of spouses at the participating installation was invited by mailed postcard (2006: N = 19,722; 2008: N = 12,127; response rates-2006: 12.3%, 2008: 10.8%). Clinically significant physical intimate partner violence can be effectively screened with as few as four items, with sensitivities > 90% and specificities > 95%; clinically significant psychological intimate partner violence can be screened with two items. Men and women can be screened with equivalent accuracy, as can those committing the violence and those victimized by it. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Summary of the 2018-2019 influenza season among Department of Defense service members and other beneficiaries

The Armed Forces Health Surveillance Branch conducts weekly surveillance of influenza activity among Department of Defense (DoD) populations each influenza season. This report provides a summary of the data from the 2018-2019 influenza season. Ambulatory data for influenza-like illnesses (ILIs), influenza hospitalization data, and lab data for influenza-confirmed cases were used for the surveillance. The 2018-2019 season differed from past seasons in that it was much longer, had a later peak, and the predominant strain of influenza changed from influenza A(H1N1)pdm09 at the beginning of the season to influenza A(H3N2) in the middle of the season. Non-service member beneficiaries accounted for the majority of ILI-related encounters and hospitalizations. However, there were still 149 influenza-related hospitalizations among service members during the 2018- 2019 season. Continued weekly surveillance of influenza among DoD populations is crucial to track increases in activity each season and the potential emergence of new and/or severe influenza subtypes.

Family Readiness Groups: Helping deployed Army National Guard soldiers and their families

Many have espoused the benefits of Family Readiness Groups (FRGs) for families of deployed soldiers. These include fostering family well-being (main effect) and buffering the family against the negative effects of stressful life events (moderating effect). Yet, few published studies have tested these hypothesized relationships. Survey responses gathered from returning deployed Army National Guard soldiers (N = 4,568 soldiers in 50 company-sized units) gave the opportunity to test hypothesized benefits of FRGs, both main and buffering effects. Half the sample of soldiers reported their families as having used FRGs. Two-thirds of the soldiers reported FRGs as being helpful to their families. On the whole, results supported hypotheses: More effective coping among family members was associated with FRG use (main effect), and FRGs appeared most beneficial to spouses who experienced more stressful events (buffering effect). FRG use and its associations with helpfulness to family and with family coping suggest FRGs are important resources for families of deployed soldiers, in particular, for families of reservists. Future directions for research and practice are proposed.

Blood lead level surveillance among pediatric beneficiaries in the Military Health System, 2010-2017

The EpiData Center (EDC) has provided routine blood lead level (BLL) surveillance for Department of Defense (DoD) pediatric beneficiaries since 2011. Data for this study were collected and compiled from raw laboratory test records obtained from the Composite Health Care System Health Level 7 (HL7)-formatted chemistry data, allowing an overview of the number of tests performed and the number of elevated results. Between 2010 and 2017, there were 177,061 tests performed among 162,238 pediatric beneficiaries tested. Using only the highest test result per year for each individual, 169,917 tests were retained for analysis, of which 1,334 (0.79%) test results were considered elevated. The percentage of children with elevated BLLs generally decreased over the time period for children of every service affiliation. All tests throughout this time frame were evaluated using current standards and the protocol followed by the Centers for Disease Control and Prevention and the Department of the Navy (DON). The adoption of a standardized BLL surveillance methodology across the DoD supports a cohesive approach to an evolving public health surveillance topic.

Diabetes mellitus and gestational diabetes, active and reserve component service members and dependents, 2008-2018

During 2008-2018, a total of 12,582 active component service members received incident diagnoses of any diabetes mellitus (DM), for a crude overall incidence rate of 84.8 per 100,000 person-years. More than four-fifths of incident cases were type 2 DM. The overall rates of this form of DM among Asian/Pacific Islander and non-Hispanic black active and reserve component service members were 1.5 or more times the rates among their respective counterparts in other race/ethnicity groups. Crude annual rates of type 2 DM diagnoses among active and reserve component members peaked in 2010 and then decreased to their lowest points in 2018. From 2010 through 2018, decreases in rates of incident type 2 DM diagnoses were observed among active and reserve component members in all subgroups examined (sex, age, race/ethnicity, service), with the greatest slopes of decline seen among service members aged 40 years or older, Asian/Pacific Islanders, and Army members. During 2008-2018, total counts of incident diagnoses of type 2 DM among Military Health System (MHS) dependents decreased by 66.0%, from 29,625 to 10,066. The overall crude prevalence of gestational DM ranged from 7.3% among active component service women to 8.4% among female MHS dependents. Comparisons to data from U.S. civilian populations are made when appropriate.

Tick-borne encephalitis surveillance in U.S. military service members and beneficiaries, 2006-2018

The risk of tick-borne encephalitis (TBE) among U.S. military service members and beneficiaries residing in or traveling to Europe has not been assessed since the 1990s. The primary objective of this study was to assess the current risk of TBE in this population. Records of reportable medical events, inpatient and outpatient care, and laboratory test results were searched for TBE cases between 2006 and 2018. There were 8 individuals who met the case definition for TBE over the 13-year interval; 7 cases occurred during 2017 or 2018. Outpatient records did not identify any additional verified cases of TBE but revealed a large number of misclassified diagnoses. The risk of TBE among U.S. military service members and beneficiaries is low but may have increased in recent years. Military members and their dependents residing in Europe or Asia generally have a risk for TBE similar to that of other residents of the host nation. Additionally, there may be locations or activities that place certain individuals or units at increased risk for TBE, thus warranting additional control measures such as active surveillance, enhanced personal protective measures, and vaccination.

The prediction incidence of the three most common cancers among Iranian military community during 2007-2019: a time series analysis

OBJECTIVE

Cancers are one of the most important public health problems in Iran. Because of the importance of cancers, the purpose of the current study was to the prediction of the future incidence of the most common cancers among Iranian military community (MC) by using the time series analysis during 2007 to 2019.

METHODS

In the current cross-sectional study, all registered cancers among Iranian MC entered the study. To select the best model of prediction, various methods including autocorrelation function (ACF), partial autocorrelation function (PACF), and Akaike information criterion (AIC) statistics were used. All analysis was performed by using ITSM, stata14, and Excel2010 software.

RESULTS

The most prevalent cancers among Iranian MC were breast, prostate, and colon cancers respectively. The time series analysis was shown that the trend of all mentioned cancers in Iranian MC will increase in the coming years.

CONCLUSIONS

The trend of most prevalent cancers among Iranian MC was increasing but the different factors like the growth of population size and improving the registration system should be regarded.

Evaluation of serological testing for Lyme disease in Military Health System beneficiaries in Germany, 2013-2017

Lyme disease diagnostic workups conducted on active and retired U.S. service members and their dependents at U.S. Air Force military treatment facilities (MTFs) in Germany between 2013 and 2017 were assessed to determine the appropriateness of laboratory testing and antibiotic prescriptions. Of the 1,176 first-tier immunoassays, 1,114 (94.7%) were negative, and of the 285 immunoglobulin M (IgM) immunoblots, 242 (84.9%) followed a negative first-tier assay or were performed without an antecedent first-tier assay. Eighty-three positive IgM immunoblot tests were adjudicated using modified published criteria, of which 40 (48.2%) were deemed false positives. Thirtytwo patients with false-positive tests were treated with an antibiotic. Additionally, 30 patients with uncomplicated erythema migrans could have been treated without laboratory confirmation. Understanding the use and limitations of 2-tier diagnostic criteria, as well as the common pitfalls in diagnosing Lyme disease, may help prevent overdiagnosis, reduce unnecessary testing, and promote antibiotic stewardship.

Department of Defense end-of-season influenza vaccine effectiveness estimates for the 2017-2018 season

The Department of Defense (DoD) generates influenza vaccine effectiveness (VE) estimates each season. The Armed Forces Health Surveillance Branch Air Force (AFHSB-AF) satellite, Naval Health Research Center Operational Infectious Disease Directorate at the Naval Health Research Center (NHRCOID), and the Armed Forces Health Surveillance Branch (AFHSB) all conduct influenza surveillance and perform test-negative case-control analyses to estimate seasonal influenza VE for DoD populations. The mid-season estimates contribute to the aggregate data utilized by the Food and Drug Administration's Vaccine and Related Biological Products Advisory Committee to select the composition of the influenza vaccine for the next influenza season. The full season data provide DoD with direct estimates for force health protection decisions. The 2017-2018 DoD influenza season was predominated by influenza A(H3N2) with varying levels of adjusted overall VE estimates. AFHSB-AF satellite's VE for dependents was moderate at 49% (95% confidence interval [CI]: 42%-55%) for all strains. NHRC-OID's VE among dependents was moderate-high at 63% (95% CI: 50%-73%) for all strains. AFHSB service member VE was low at 18% (95% CI: 4%-30%). These estimates highlight the need for continued influenza surveillance and VE estimate calculations each season among the different DoD populations as circulating strains and VE may change annually.

Assessment of 12 influenza-like illness case definitions using Department of Defense Global, Laboratory-based Influenza Surveillance Program data, 2011-2014

Despite the growth in influenza surveillance programs, standardization of a globally accepted influenza-like illness (ILI) case definition remains difficult. With 2011-2014 Department of Defense Global, Laboratory-based Influenza Surveillance Program (DISP) data, 12 case definitions were evaluated using a combination of ILI case definitions from the Centers for Disease Control and Prevention, World Health Organization, and the DISP. The sensitivity, specificity, positive and negative predictive values, and odds ratios for each case definition were calculated. Additionally, area under the curve (AUC) was calculated for a receiver operating characteristic (ROC) curve to compare the case definitions. Between 2 October 2011 and 27 September 2014, 52.3% (5,575 of 10,662) of respiratory specimens submitted met the inclusion criteria. The case definition for the DISP had a sensitivity of 54.6% and specificity of 63.7%. Case definitions should be selected according to the objectives of the surveillance system and resources available. Sensitive case definitions capture a larger proportion of cases but at the cost of testing more specimens. Definitions with higher specificity result in fewer false positives but may miss more cases.

Department of Defense Birth and Infant Health Registry: select reproductive health outcomes, 2003-2014

Established following a 1998 directive, the Department of Defense Birth and Infant Health Registry (Registry) team conducts surveillance of select reproductive health outcomes among military families. Data are compiled from the Military Health System Data Repository and Defense Manpower Data Center to define the Registry cohort and outcomes of interest. Outcomes are defined using ICD-9/ICD-10 and Current Procedural Terminology codes, and include: pregnancy outcomes (e.g., live births, losses), birth defects, preterm births, and male:female infant sex ratio. This report includes data from 2003-2014 on 1,304,406 infants among military families and 258,332 pregnancies among active duty women. Rates of common adverse infant and pregnancy outcomes were comparable to or lower than those in the general US population. These observations, along with prior Registry analyses, provide reassurance that military service is not independently associated with increased risks for select adverse reproductive health outcomes. The Registry's diverse research portfolio demonstrates its unique capabilities to answer a wide range of questions related to reproductive health. These data provide the military community with information to identify successes and areas for improvement in prevention and care.

Measles, mumps, rubella, and varicella among service members and other beneficiaries of the Military Health System, 2010-2016

Measles, mumps, rubella, and varicella (MMR/V) are highly communicable infectious diseases whose causative agents are spread through contact with contaminated surfaces or airborne droplets. Individuals at highest risk for MMR/V infections include infants, unvaccinated or inadequately vaccinated persons, individuals living in communities with low vaccination rates or in crowded and unsanitary conditions, and persons with compromised immune systems. During 2010-2016, there were 11 confirmed measles cases and 76 confirmed mumps cases among all Military Health System (MHS) beneficiaries. Only one of the confirmed cases of measles was in a service member. There were seven confirmed rubella cases among all MHS beneficiaries. Among service members, there were 62 confirmed cases of varicella during the surveillance period. The number of confirmed cases of varicella among service members dropped from 28 cases in 2010 and 27 cases in 2011 to seven confirmed cases in 2012. There were no confirmed cases of varicella among active and reserve component service members during 2013-2016. Recent trends in MMR/V in both military and civilian populations in the U.S. highlight the importance of primary and booster vaccinations.

Viral hepatitis C, active component, U.S. military service members and beneficiaries, 2008-2016

Hepatitis C virus (HCV) infection remains an important concern for the Military Health System (MHS). This report updates numbers and incidence rates of HCV infection of U.S. military service members and MHS beneficiaries, incorporating a surveillance period before and after 2012 screening policy changes for military members. From 2008 to 2016, there were 342 and 1,491 incident cases of acute and chronic hepatitis C, respectively, among active component members of the U.S. Armed Forces; crude overall incidence rates during the period were 2.8 (acute) and 12.2 (chronic) cases per 100,000 person-years. Annual incidence rates of chronic hepatitis C decreased over the surveillance period; however, rates of acute hepatitis C remained steady. There were 141 acute and 587 chronic incident cases among reserve/guard service members, with annual counts of both acute and chronic cases decreasing over the surveillance period. In addition, there were 2,541 acute and 21,418 chronic cases among non-service member beneficiaries, with annual counts of acute and chronic cases also decreasing steadily over the surveillance period. Given recent pharmaceutical advances in treatment, screening and linkage to care are critical to improving health outcomes for those with HCV infection.

The DoD Global, Laboratory-based, Influenza Surveillance Program: summary for the 2013-2014 influenza season

This report for the 2013-2014 influenza season summarizes the results of influenza surveillance carried out by the DoD Global, Laboratory-based, Influenza Surveillance Program, which is managed by the U.S. Air Force School of Aerospace Medicine Epidemiology Consult Service and Epidemiology Laboratory at Wright-Patterson Air Force Base, OH. Sentinel sites submitted 3,903 specimens for clinical diagnostic testing and 1,163 (29.8%) were positive for influenza virus. The predominant influenza subtype was influenza A(H1N1)pdm09, identified in 79.2% of all influenza-positive specimens. The other most common subtypes were influenza A(H3N2) (10.5%) and influenza B (10.1%). In August 2014, a human case of influenza A(H3N2) variant was identified in a patient with a history of exposure to swine. Adjusted vaccine effectiveness (VE) was calculated among 1,016 military dependents and retirees in the U.S. and was found to be 44.8% for all vaccine types. Uncertainties and other limitations associated with estimating VE are discussed.

Incidence of Salmonella infections among service members of the active and reserve components of the U.S. Armed Forces and among other beneficiaries of the Military Health System, 2000-2013

This report reviews the incidence of cases of typhoidal and non-typhoidal Salmonella infections based on diagnoses recorded in healthcare records and reported through the Armed Forces reportable medical event (RME) system. During 2000-2013, there were 1,815 incident cases of non-typhoidal Salmonella and 456 incident cases of typhoidal Salmonella diagnosed in the active component force. The crude incidence rate for non-typhoidal Salmonella was 0.91 cases per 10,000 person years (p-yrs) and the rate for typhoidal Salmonella was 0.23 cases per 10,000 p-yrs. Among retirees and family members, children under 5 years of age and those aged 75 years or older comprised the greatest number of non-typhoidal Salmonella cases. Preventive measures for reducing the risk of infection with Salmonella are discussed.