The following manuscripts have been published or are currently in press. Listings are in chronological order, unless otherwise noted.
| Title | Publication | Date/Location |
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| Mental Health and Comorbidities in U.S. Military Members | Military Medicine | 2016 June;181(6):537-45 |
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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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| Measuring Aggregated and Specific Combat Exposures: Associations Between Combat Exposure Measures and Posttraumatic Stress Disorder, Depression, and Alcohol-Related Problems | Journal of Traumatic Stress | 2018 Apr;31:296-306 |
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Porter B, Hoge CW, Tobin LE, Donoho CJ, Castro CA, Luxton DD, Faix D This study compared two measures of combat exposure and showed that both measures were similarly predictive of poor mental health. The unique contributions of specific exposures to poor mental health were also examined. While all combat exposure items were related to poor mental health, relatively stronger independent associations were observed for certain exposures (e.g., witnessing instances of physical abuse). |
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| Magnitude of Problematic Anger and its Predictors in the Millennium Cohort | BMC Public Health | 2020;20(1):1168 |
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Adler AB, LeardMann CA, Roenfeldt KA, Jacobson IG, Forbes D Among sample of service members and Veterans (N= 90,266), 17% screened positive for problematic anger. Numerous independent factors were associated with an increased risk of problematic anger (e.g., PTSD, depression, financial problems, problem drinking) and decreased risk of problem anger (e.g., positive perspective, self-mastery). Developing interventions that target problematic anger in the military is critical given its high prevalence, distinction from other mental disorders, role in impeding effective PTSD treatment, and impact on vocational and interpersonal functioning. |
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| Longitudinal Trajectories of Comorbid PTSD and Depression Symptoms Among U.S. Service Members and Veterans | BMC Psychiatry | 2019 Dec 13;19(1):396 |
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Armenta RF, Walter KH, Geronimo-Hara TR, Porter B, Stander V, LeardMann CA, for the Millennium Cohort Study Team This study examined the patterns of PTSD and depression symptoms over time among those with probable comorbid PTSD and depression at baseline. We found that PTSD and depression symptoms tended to move in tandem. Although many service members and veterans experienced a reduction of symptoms over time, one quarter of individuals reported high levels of PTSD and depression symptoms during the almost 12 years of follow-up. Notable factors associated with elevated comorbid PTSD/depression symptoms included older age, combat experiences, and having other co-occurring health problems. Results highlight the need for comprehensive assessment and treatment of comorbid PTSD/depression. |
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| Longitudinal Investigation of Military-Specific Factors Associated with Continued Unhealthy Alcohol Use Among a Large US Military Cohort | Journal of Addiction Medicine | 2020 Jul-Aug; 14(4): e53–e63 |
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Jacobson IG, Williams EC, Seelig AD, Littman AJ, Maynard CC, Bricker JB, Rull RR, Boyko EJ, for the Millennium Cohort Study Team This study examined military-specific risk factors for continued unhealthy alcohol use (e.g. heavy weekly, heavy episodic, and problem drinking) among service members screening positive on two consecutive surveys. Service members in the Reserve/Guard (compared with Active Duty) and those who separated from military service during follow-up (compared with those remaining on active service) had an elevated risk for continuing unhealthy drinking across all three dimensions of unhealthy alcohol use. |
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| Longitudinal Examination of the Influence of Individual Posttraumatic Stress Disorder Symptoms and Clusters of Symptoms on the Initiation of Cigarette Smoking | Journal of Addiction Medicine | Sep/Oct;12(5):363-372 |
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Seelig AD, Bensley KM, Williams EC, Armenta RF, Rivera AC, Peterson AV, Jacobson IG, Littman AJ, Maynard C, Bricker JB, Rull RP, Boyko EJ for the Millennium Cohort Study Team This study examined the risk for smoking initiation by each of the 17 PTSD symptoms that characterize the disorder. No significant associations between specific PTSD symptoms and subsequent smoking initiation were observed in this study population. Among the subsample who screened positive for PTSD, "feeling irritable or having angry outbursts" and "feeling as though your future will somehow be cut short" were associated with a higher risk of subsequent smoking initiation. |
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| Longitudinal associations of military-related factors on self-reported sleep among U.S. service members | Sleep | 2021 Dec 10;44(12):zsab168 |
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Cooper AD, Kolaja CA, Markwald RR, Jacobson IG, Chinoy ED This study examined military factors in relation to the development and reoccurrence of short sleep duration (≤5 hours or 6 hours) and insomnia symptoms (i.e., trouble falling asleep or staying asleep in the past month)over a 3-15 year follow-up period. Military factors consistently associated with an increased risk for development and/or reoccurrence of short sleep duration and insomnia symptoms included active duty service, Army or Marine Corps service, combat deployment, and longer than average deployment lengths. Officers and noncombat deployers had decreased risk for either poor sleep characteristic. Length of service and separation from the military were complex factors; each lowered risk for ≤5 hours sleep but increased risk for insomnia symptoms. Findings suggest that efforts to improve sleep prioritization and implement interventions targeting at-risk military populations, behaviors, and other significant factors are warranted. |
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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 |
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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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| Longitudinal Assessment of Self-Reported Recent Back Pain and Combat Deployment in the Millennium Cohort Study | Spine | 2016;41:1754–1763 |
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Granado NS, Pietrucha A, Ryan M, Boyko EJ, Hooper TI, Smith B, Smith TC Among military personnel, back pain is among the most frequent reasons for medical visits and lost duty time, and has been associated with pain-related disability. This study found that 15.5% of participants reported recent back pain at follow-up. Our study confirmed the high burden of this condition in the military, showing that deployers with combat experiences had a 38% higher odds of reporting back pain at follow-up, and 27% higher odds of repeated back pain, compared with deployers without combat experiences. Additionally, exposures associated with a physically demanding work environment were related to a higher risk of back pain. This well-defined group of military personnel would potentially benefit from integrated prevention efforts focused on mitigating and eliminating back pain over time. |
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| Longitudinal Assessment of Mental Disorders, Smoking, and Hazardous Drinking Among a Population-Based Cohort of US Service Members | Journal of Addiction Medicine | 2014 Jul-Aug;8(4):271-281 |
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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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