Publications

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

Research Publication 2
Title Publication Date/Location
Combat exposure and behavioral health in U.S. Army Special Forces PLoS One 2022 Jun 28;17(6):e0270515

Rivera AC, LeardMann CA, Rull RP, Cooper A, Warner S, Faix D, Deagle E, Neff R, Caserta R, Adler AB, Millennium Cohort Study Team

In this cross-sectional study using Millennium Cohort Study data, various types of combat, such as combat severity, fighting, threat to oneself, and killing noncombatants, were consistently associated with mental health disorders, trouble sleeping, and problem drinking among all three Army occupational specialization investigated (General Purpose Forces infantrymen, Ranger Qualified infantrymen, and Special Forces personnel). However, with few exceptions, Special Forces personnel and Ranger Qualified infantrymen had lower prevalence of these adverse outcomes. Findings suggest that even elite personnel may be negatively impacted by experiencing combat, thus trainings and interventions focused on moral conflict reasoning and resolution may help to mitigate some of these adverse behavioral outcomes.

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The Millennium Cohort Study: The First 20 Years of Research Dedicated to Understanding the Long-Term Health of US Service Members and Veterans Annals of Epidemiology 2022 Mar;67:61-72

Belding JN, Castañeda SF, Jacobson IG, LeardMann CA, Porter B, Powell TM, Kolaja CA, Seelig AD, Matsuno RK, Carey FR, Rivera AC, Trone DW, Sheppard B, Walstrom J, Boyko EJ, Rull RP, For The Millennium Cohort Study Team

In commemoration of the 20th anniversary of the Millennium Cohort Study, this paper provides a summary of the study design, key findings, and future directions. Published findings are summarized and categorized into 3 core areas (psychological health, physical health, and health-related behaviors) and several crosscutting areas culminating in more than 120 publications to date. The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts.

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The effect of combat exposure on financial problems International Review of Economics and Finance 2022 May;79:241-257

Ackerman A, Porter, B

This paper examined whether combat exposure led to new-onset financial problems and financial stress among 64,508 veterans using 2001-2016 data from the Millennium Cohort Study. The average predicted probability of developing a new major financial problem (such as bankruptcy) and greater financial stress increased 0.44% (21% relative to the mean probability) following a single combat exposure and increased 0.90% (43% relative to the mean probability) following multiple combat exposures. The likelihood of financial decline resulting from combat exposure were greater for veterans with poorer pre-deployment mental or physical health, veterans in enlisted ranks, and younger veterans between the ages of 26 and 36. These results translate to a crude cost estimate of lost productivity of at least $41 million and up to 3,629 bankruptcies for the 2.7 million veterans (1.34 per 1,000) deployed from 2001 through 2016.

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Health Disparities Among Lesbian, Gay, and Bisexual Service Members and Veterans American Journal of Preventive Medicine 2022 Oct;63(4):521-531

Carey FR, LeardMann CA, Lehavot K, Jacobson IG, Kolaja CA, Stander VA, Rull RP, Millennium Cohort Study Team

This study examined whether differences in mental, physical, and behavioral health exist by sexual orientation among active duty and Reserve/National Guard service members and veterans (N=96,930). Lesbian, gay, and bisexual (LGB) individuals (3.6% of the sample) were more likely to screen positive for post-traumatic stress disorder, depression, anxiety, binge eating, problematic anger, multiple somatic symptoms, and insomnia than heterosexual individuals. LGB women reported more adverse health outcomes (overweight and obesity, smoking, problem/risky drinking) than heterosexual women. Gay and bisexual men reported some adverse health outcomes (e.g., smoking and problem drinking) but better physical health (e.g., less overweight/obesity) than heterosexual men. These results suggest that LGB service members experience health disparities, despite many having equal eligibility for health care, highlighting the need for improved equity initiatives that promote cultural responsiveness, acceptance, and approaches to support the healthcare needs of LGB military members.

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The relative impact of injury and deployment on mental and physical quality of life among military service members PLoS One 2022 Sep 29;17(9):e0274973

Kolaja CA, Castañeda SF, Woodruff SI, Rull RP, Armenta RF

Deployment and injury status was associated with poorer mental and physical quality of life (QOL) with clinically significant decreases in physical QOL observed for those who deployed and were injured, either in battle or nonbattle settings, compared with uninjured deployers.

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Brief Report: Menstrual Suppression Among U.S. Female Service Members in the Millennium Cohort Study Medical Surveillance Monthly Report 2022 Sept 29(9), 19-22

Zhu Y, Kolaja CA, Stamas N, Matsuno RK, Rull RP; Millennium Cohort Study Team

This study examined the prevalence of self-reported menstrual suppression among U.S. female active duty personnel (N=22,920) at two time points (2008, 2013) by demographic and military characteristics. Menstrual suppression increased significantly overall from 2008 (2.5%) to 2013 (3.8%) and among younger age groups (aged 18-34), non-Hispanic White individuals, Army, Navy, or Air Force personnel. The highest prevalence of menstrual suppression was reported in 2013 among those who deployed in the past year (4.7%) or worked in health care (5.1%) or combat specialties (4.7%). Increased health education is needed to support the health care needs and readiness of female service members.

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Combat Experience, New-Onset Mental Health Conditions, and Posttraumatic Growth in U.S. Service Members Psychiatry Fall 2021;84(3):276-290

Jacobson IG, Adler AB, Roenfeldt KA, Porter,B., LeardMann CA, Rull RP, Hoge CW

Research on posttraumatic growth (PTG) after traumatic experiences has raised questions on measurement, validity, and clinical utility. We longitudinally examined PTG among Millennium Cohort Study deployers (n=8,732), who screened negative for PTSD and depression at time 1, using a measure that improved upon previous psychometric issues. A strong inverse correlation was found between PTG scores at time 2 and new onset mental health problems (PTSD, depression), where lower growth scores correlated with worse mental health (i.e. higher PTSD or depression screening scores). Only 5% of participants who screened positive for a mental health problem at time 2 experienced positive growth. Results suggest that measurement of PTG is not independent from mental health problems following combat experiences and thus challenge the clinical utility of the PTG construct.

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A Comparison of the PRIME-MD PHQ-9 and PHQ-8 in a Large Military Prospective Study, The Millennium Cohort Study Journal of Affective Disorders May 2013; 148(1): 77-83

Wells TS, Horton JL, LeardMann CA, Jacobson IG, and Boyko EJ

The PHQ-9 is a validated tool for depression screening, however recently an abbreviated version (PHQ-8) is increasingly being used in survey research that excludes the last and most sensitive item. This study compared the performance of the PHQ-8 with the PHQ-9 in a large, population-based sample of current and former military service members. Excellent agreement was detected between the two instruments, suggesting that the PHQ-8 performs well when screening for depression in similar populations.

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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

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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