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

Title Publication Date/Location
Risk factors for relapse to problem drinking among current and former US military personnel: A prospective study of the Millennium Cohort. Drug and Alcohol Dependence 2015; 148:93-101.

Williams EC, Frasco MA, Jacobson IG, Maynard C, Littman AJ, Seelig AD, Crum-Cianflone NF, Nagel A, Boyko EJ.

This study investigated demographic, military, behavioral, and health characteristics associated with relapse among current and former military members with remittent problem drinking. The findings from this study suggest 16% of this population relapse. Several military and non-military characteristics were found to predict relapse, including being in the Reserve/National Guard compared to Active-duty and screening positive for mental health conditions. Targeted intervention to prevent relapse may be indicated for particular subgroups.

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Associations of military divorce with mental, behavioral, and physical health outcomes BMC Psychiatry 2015; 15:128

Wang L, Seelig AD, MacDermid Wadsworth S, McMaster HS, Alcarez J, Crum-Cianflone NF

This prospective study investigated the associations of recent divorce with health outcomes among US Service members. Findings indicate that recent divorce is associated with adverse mental health outcomes, including new-onset PTSD and depression, and risky behaviors, such as smoking initiation and new-onset alcohol-related problems, after adjusting for relevant demographics and covariates. Given these findings, it is important to make sure resources are available to support recently divorced Service members, since divorce may not only affect personal quality of life, but also military force readiness.

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Longitudinal assessment of gender differences in the development of PTSD among US military personnel deployed in support of the operations in Iraq and Afghanistan Journal of Psychiatric Research 2015;68:30-36

Jacobson IG, Donoho CJ, Crum-Cianflone NF, Maguen S

Using prospective data from Millennium Cohort Study participants, a propensity score matching technique was used to match 1 male with each female using demographic, military, and behavioral factors including baseline sexual assault. After stratifying by combat experience and adjusting for sexual assault at follow-up, findings revealed no significant gender differences for new-onset postdeployment PTSD among men and women including among those who experienced combat.

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Sexual trauma and adverse health and occupational outcomes among men serving in the US Military Journal of Traumatic Stress 2016 Apr;29(1):132-40

Millegan J, Wang L, LeardMann CA, Miletich D, Street AE

This study examined the association of recent sexual trauma with health and occupational outcomes among US Service men using longitudinal Millennium Cohort data (2004-2013). Findings from this study indicated that recent sexual trauma, sexual harassment or sexual assault, is associated with adverse physical health and mental health among Service men, after adjustment for relevant covariates. Men who reported sexual trauma were more likely to have left military service and experience post-service disability or unemployment. Results demonstrate that, among Service men, sexual trauma is significantly associated with adverse health and functionality extending to post-military life. Findings support the need for developing more effective prevention strategies and services to reduce the burden of sexual trauma of Service men.

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Deployment, combat, and risk of multiple physical symptoms in the US Military: A prospective cohort study Annals of Epidemiology 2016 Feb;26(2):122-8

McCutchan PK, Liu X, LeardMann CA, Smith TC, Boyko EJ, Gore KL, Freed MC, Engel CC

This study examined longitudinal trends in multiple physical symptoms and its relationship to deployment among US military service members and veterans. Those who had deployed and experienced combat were significantly more likely to report multiple physical symptoms at each time point compared with those not deployed and those who deployed without combat, after adjustment for demographic, military, and health characteristics. Longitudinal trends indicate that the probability of reporting multiple physical symptoms has increased consistently over time only for those deployed, regardless of combat experience.

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Longitudinal associations among PTSD, disordered eating, and weight gain in military men and women American Journal of Epidemiology 2016 Jul 1;184(1):33-47

Mitchell KS, Porter B, Boyko EJ, Field AE

This study examined longitudinal associations between PTSD, disordered eating, and weight change in Millennium Cohort data from U.S. military Service members who completed the baseline survey and first and second follow-up surveys. The association between PTSD and weight change from time 2 to time 3 was partially mediated by disordered eating symptoms measured at time 2, specifically compensatory behaviors (vomiting, laxative use, fasting, over-exercise). In stratified models, the association between PTSD and weight gain via compensatory behaviors was significant for men and for non-Hispanic white participants only. Results highlight potentially important demographic differences in these associations and emphasize the need for further investigation of eating disorders in military Service members.

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Obesity and associated adverse health outcomes among US military members: Findings from the Millennium Cohort Study Obesity 2016 Jul;24(7):1582-1589

Rush T, LeardMann CA, Crum-Cianflone NF

This study examined body weight among Service members and Veterans over time (2001-2007), finding a doubling of the prevalence of obesity. Obesity rates were significantly higher among veterans, including among those recently discharged from service. The study found that military personnel, even during service time, experienced weight gain and the development of obesity. Individuals with obesity had higher rates of adverse physical, mental, and functional health, suggesting that weight control should be a DoD and national priority.

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Mental Health and Comorbidities in U.S. Military Members Military Medicine 2016 June;181(6):537-45

Crum-Cianflone NF, Powell TM, LeardMann CA, Russell DR, Boyko EJ

This study examined incidence rates of mental and behavioral disorders using self-reported and electronic medical record data from US Servicemembers who joined the military after September 11th, 2001. Combat deployers had the highest incidence rates of PTSD, panic/anxiety disorder, and any mental disorder. Of those with recent PTSD, 73% concurrently developed at least one other incident mental or behavioral conditions. Most diagnoses were not represented in the medical records. Findings indicate the high burden of these conditions that are greatly underestimated using medical data alone, demonstrating the value of survey data and screening tools among this population.

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Sleep and health resilience metrics in a large military cohort Sleep 2016 May;39(5):1111-1120

Seelig AD, Jacobson IG, Donoho CJ, Trone DW, Crum-Cianflone NF, Balkin TJ

The presence of insomnia symptoms was significantly associated with worse self-rated health, more lost work days, lower odds of deployment, higher odds of leaving military service early, and more health care utilization, after adjustment for demographic, military, behavioral and other health covariates. Findings were similar for those reporting less than 6 hours of sleep per night. Future research should focus on the efficacy of interventions to promote healthy sleep in military populations.

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The Epidemiology of Irritable Bowel Syndrome in the US Military: Findings from the Millennium Cohort Study American Journal of Gastroenterology 2016;111:93-104

Riddle MS, Welsh M, Porter CK, Nieh C, Boyko EJ, Gackstetter GD, Hooper TI

This study describes the incidence of irritable bowel syndrome (IBS) and its association with antecedent infectious gastroenteritis among Millennium Cohort Study participants using survey data and post-deployment health assessments and medical encounter data in the military health system. Consistent with other studies, the risk of IBS increased after acute enteric infection. Novel findings included increased risk of incident IBS among those with post-traumatic stress disorder (PTSD) and preceding life stressors, as well as stronger associations between infectious gastroenteritis and IBS among those with antecedent depression or anxiety. These results reinforce the need to prevent acute gastrointestinal infections and their chronic consequences among our Service members. Additional studies on the underlying biopsychosocial mechanisms of IBS may help to explain these findings.

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