Publications

The following manuscripts have been published or are currently in press. Listings are in chronological order, unless otherwise noted.

Title Publication Date/Location
The impact of deployment experience and prior healthcare utilization on enrollment in a large military cohort study BMC Medical Research Methodology 2013 Jul 11;13:90

Horton JL, Jacobson IJ, Littman AJ, Alcaraz JE, Smith B, and Crum-Cianflone NF

This study compared the characteristics of invited subjects (responders and nonresponders) prior to the enrollment cycle. Military personnel who deployed in support of OIF/OEF and those who presented for routine outpatient care were significantly more likely to enroll in a longitudinal cohort study examining their health and military experiences, while those with baseline mental disorders or longer hospital stays were less likely to enroll. These findings, which controlled for demographic and other potential confounders, suggest differential enrollment by deployment experience and health status, and may help guide recruitment efforts in future studies.

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Predeployment sleep duration and insomnia symptoms as risk factors for new-onset mental health disorders following military deployment Sleep 2013 Jul 1;36(7):1009-1018

Gehrman P, Seelig AD, Jacobson IG, Boyko EJ, Hooper TI, Gackstetter GD, Ulmer CS, Smith TC

This study showed that combat-related trauma and predeployment insomnia symptoms were significantly associated with developing posttraumatic stress disorder, depression, and anxiety following deployment. Assessment of insomnia symptoms predeployment may help to better identify those at highest risk for subsequent adverse mental health outcomes.

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Combat Deployment is Associated with Sexual Harassment or Sexual Assault in a Large, Female Military Cohort Women's Health Issues 2013 Jul-Aug;23(4):e215-23

LeardMann CA, Pietrucha A, Magruder KM, Smith B, Murdoch M, Jacobson IG, Ryan MAK, Gackstetter G, Smith TC, for the Millennium Cohort Study Team

Among female service members, the 3-year cumulative incidence of sexual harassment was 9.4% and sexual assault was 2.1%. Significant risk factors for sexual trauma included prior deployment with combat experience, serving as a Marine, younger age, recent marital separation or divorce, positive screen for a prior mental health condition, moderate/severe life stress, and prior sexual trauma experiences. Understanding the factors associated with sexual harassment and assault can inform future policy and prevention efforts in order to eliminate sexual trauma.

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Sleep characteristics, mental health, and diabetes risk: a prospective study of U.S. military service members in the Millennium Cohort Study Diabetes Care 2013 Oct;36(10):3154-61

Boyko EJ, Seelig AD, Jacobson IG, Hooper TI, Smith B, Smith TC, Crum-Cianflone NF

We investigated whether poor sleep and mental health symptoms were independently related to diabetes risk. During 6 years of follow-up, the annual incidence rate for type 2 diabetes was 3.6/1,000 person years. After adjusting for covariates including mental health disorders like posttraumatic stress disorder and depression, both trouble sleeping and sleep apnea significantly predicted diabetes risk independent of these mental health conditions and other diabetes risk factors.

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The impact of prior deployment experience on civilian employment after military service Occupational and Environmental Medicine 2013; 70: 408-417

Horton JL, Jacobson IG, Wong CA, Wells TS, Boyko EJ, Smith B, Ryan MA, and Smith TC

Employment after military service, in particular after stressful deployment experiences, is a concern for many veterans and policymakers. Among this large cohort of veterans, we found that prior deployment and PTSD were not significantly associated with job status post-service; in contrast, depression, panic/anxiety disorder, and poor physical health increased the risk of unemployment among certain groups. These findings may guide policy for veterans most in need of post-military employment support.

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The association of predeployment and deployment-related factors on dimensions of postdeployment wellness in US military service members The American Journal of Health Promotion 2013;28:2, 56-66

Bagnell ME, LeardMann CA, McMaster HS, Boyko EJ, Smith B, Granado, NS, and Smith TC

This study found that the majority of participants were well post-deployment, and military factors associated with post-deployment wellness included not experiencing combat and being trained as a combat specialist. Modifiable factors significantly associated with post-deployment wellness were also detected, including normal BMI, not smoking, and being physically active.

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Risk factors associated with suicide in current and former US military personnel Journal of the American Medical Association 2013;310(5):496-506

LeardMann CA, Powell TM, Smith TC, Bell MR, Smith B, Boyko EJ, Hooper TI, Gackstetter GD, Ghamsary M, Hoge CW

Based on data from over 150,000 current and former service members from all service branches, 83 suicide deaths occurred in 707,493 person-years from 2001 through 2008 (11.73/100,000 person-years). Suicide risk was independently associated with depression, manic-depressive disorder, alcohol-related problems, and male gender. None of the deployment or military-related factors were associated with an increased risk for suicide. Assessing service members' prior psychiatric history as well as screening for and treating mental and substance abuse disorders may provide the best potential for mitigating suicide risk.

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Longitudinal assessment of mental disorders, smoking, and hazardous drinking among a population-based cohort of U.S. service members Journal of Addiction Medicine 2014 Jul-Aug;8(4):271-281

Smith TC, LeardMann CA, Smith B, Jacobson IG, Miller SC, Wells TS, Boyko EJ, Ryan MAK

This study investigated mental disorders in association with hazardous drinking and cigarette smoking. These prospective data highlight the inter-related nature of these symptoms and behaviors and the potentially complex bi-directional causal pathway. Military health professionals should consider the constellation of potential behaviors and symptoms during the treatment of specific mental health illnesses and negative health behaviors.

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Deployment-related depression screening results, 2001-2008: comparing clinical vs. research surveys American Journal of Preventative Medicine 2014 Nov;47(5):531-540

Welsh MM, PhD, Federinko SP, Burnett DG, Gackstetter GD, Boyko EJ, Seelig AD, Wells TS, and Hooper TI

This study compared depression symptoms reported on military-linked surveys, post-deployment health assessments, with responses from confidential surveys of the Millennium Cohort Study and then evaluated whether any factors were associated with discrepant responses. Moderate agreement was observed between paired survey responses. A higher proportion of active duty members, unmarried participants, and new accessions into military service endorsed depression symptoms on the confidential survey but not the military-linked survey. This study identifies potential subgroups to target for improving follow-up care for optimal mental health.

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Impact of combat deployment and Posttraumatic Stress Disorder on newly reported coronary heart disease among US Active Duty and Reserve forces Circulation 2014;129:1813-1820

Crum-Cianflone NF, Bagnell ME, Schaller E, Boyko EJ, Smith B, Maynard C, Ulmer CS, Vernalis M and Smith TC

This study evaluated the association of combat deployments and posttraumatic stress disorder (PTSD) on coronary heart disease among a young cohort of US service members. Experiencing combat deployment was associated with an increased odds of coronary heart disease by both self-report and medical record diagnosis after adjustment for demographic, military, and mental health characteristics. Screening positive for PTSD was not associated with CHD after adjustment. This study demonstrates that intense and acute stressful life experiences may increase the risk for coronary heart disease over a relatively short period among young adults.

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