Publications by authors named "Valerie A Stander"

29 Publications

  • Page 1 of 1

Sexual health difficulties among service women: the influence of posttraumatic stress disorder.

J Affect Disord 2021 Sep 5;292:678-686. Epub 2021 Jun 5.

Leidos, San Diego, CA, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.

Background Sexual health among service women remains understudied, yet is related to health and quality of life. This study examined if the associations between recent combat and sexual assault with sexual health difficulties were mediated by mental disorders and identified factors associated with sexual health difficulties among service women. Methods Data from two time points (2013 and 2016) of the Millennium Cohort Study, a large military cohort, were used. The outcome was self-reported sexual health difficulties. Mediation analyses examined probable posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) as intermediate variables between recent combat and sexual assault with the sexual health difficulties. Multivariable logistic regression modeling was used to examine the association of demographic, military, historical mental health, life stressors, and physical health factors with sexual health difficulties. Results Of the 6,524 service women, 13.5% endorsed experiencing sexual health difficulties. Recent combat and sexual assault were significantly associated with sexual health difficulties. Probable PTSD mediated the associations of recent combat and sexual assault with sexual health difficulties; probable MDD did not mediate these relationships. Other significant factors associated with sexual health difficulties included enlisted rank, historical mental disorders, childhood trauma, and disabling injury. Limitations Use of self-reported data, outcome not assessed using a standardized measure and future studies may benefit from examining other mediators. Conclusion Our findings that combat and sexual assault may have negative effects on service women's sexual health suggest that treatment options and insurance coverage for sexual health problems should be expanded.
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http://dx.doi.org/10.1016/j.jad.2021.05.089DOI Listing
September 2021

Demographic Variation in Military Life Stress and Perceived Support Among Military Spouses.

Mil Med 2021 01;186(Suppl 1):214-221

Deployment Health, Naval Health Research Center, San Diego, CA 92106, USA.

Introduction: Military spouses play a critical role in supporting military service members, and thus, their experiences may have a significant impact on the well-being, readiness, and resilience of the U.S. Armed Forces. Research suggests that military spouses experience unique stressors as a result of military life, but few studies have assessed demographic factors associated with their experiences of military life and perceived support.

Materials And Methods: Using data from the Millennium Cohort Family Study, a nationwide survey of 9,872 married spouses of service members with 2 to 5 years of military service, this study examined differences in experiences of military life and perceived support across multiple understudied subgroups of military spouses. Key outcomes included military-related stressors (e.g., deployment-related experiences), perceived social support, and perceived military efforts to provide support.

Results: Military life stress and perceived support differed across military spouse, service member, and family characteristics. Results indicated that spouses who are older than age 35 or are married to enlisted service members in the Army, Navy, or Marines are more likely to experience heightened military stress or less perceived social support. Dual-military couples reported experiencing less stress associated with military life and perceiving more social support and support from the military, compared with spouses who have never served in the military.

Conclusion: These findings may help guide effective channeling of resources and outreach to potentially vulnerable military families.
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http://dx.doi.org/10.1093/milmed/usaa386DOI Listing
January 2021

Sexual Health Problems among Service Men: The Influence of Posttraumatic Stress Disorder.

J Sex Res 2021 Jan 11:1-13. Epub 2021 Jan 11.

Leidos, Reston, VA, USA.

Military operational stressors, such as combat exposure, may increase the risk of sexual health problems. This study examined factors associated with sexual health problems, and tested the mediating effect of probable posttraumatic stress disorder (PTSD) on the association between stressors (i.e., combat deployment and sexual assault) and sexual health problems among U.S. service men. Using multivariable logistic regression ( = 16,603) and Cox proportional hazards models ( = 15,330), we estimated the risk of self-reported sexual health difficulties and sexual dysfunction medical encounters, respectively. Mediation analyses examined the effect of probable PTSD as an intermediate factor between high combat deployment and sexual assault on sexual health problems. Approximately 9% endorsed sexual health difficulties and 8% had a sexual dysfunction. Risk factors for these sexual health problems included older age, lower education level, enlisted rank, disabling injury, certain medical conditions, and higher body mass index. Probable PTSD significantly mediated the associations between high combat with sexual health problems and sexual assault with sexual dysfunction. Additionally, high combat was directly associated with sexual health difficulties. These findings indicate a relationship between these stressors and sexual health problems which suggests that treatment options should be expanded, especially to include psychogenic sexual dysfunctions.
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http://dx.doi.org/10.1080/00224499.2020.1855622DOI Listing
January 2021

Posttraumatic Stress Disorder Symptom Clusters in Service Members Predict New-Onset Depression Among Military Spouses.

J Trauma Stress 2021 02 3;34(1):229-240. Epub 2020 Sep 3.

Deployment Health Department, Naval Health Research Center, San Diego, CA.

Military operations in Iraq and Afghanistan have brought increased attention to posttraumatic stress disorder (PTSD) among service members and, more recently, its impact on spouses. Existing research has demonstrated that PTSD among service members is associated with depression among military spouses. In the current study, we extended these findings by using data from service member-spouse dyads enrolled in the Millennium Cohort Family Study for which the service member had evidence of PTSD (n = 563). Prospective analyses identified the association between PTSD symptom clusters reported by the service member and new-onset depression among military spouses. Over the 3-year study period, 14.4% of these military spouses met the criteria for new-onset depression. In adjusted models, service member ratings of symptoms in the effortful avoidance cluster, odds ratio (OR) = 1.61, 95% CI [1.03, 2.50], predicted an increased risk of new-onset depression among military spouses, whereas reexperiencing symptoms, adjusted OR = 0.57; 95% CI [0.32, 1.01], were marginally protective. These findings suggest that PTSD symptom clusters in service members differentially predict new-onset depression in military spouses, which has implications for treatment provision.
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http://dx.doi.org/10.1002/jts.22575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984456PMC
February 2021

High-risk and Long-term Opioid Prescribing to Military Spouses in the Millennium Cohort Family Study.

Mil Med 2020 09;185(9-10):e1759-e1769

Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106.

Introduction: The use and misuse of opioids by active service members has been examined in several studies, but little is known about their spouses' opioid use. This study estimates the number of military spouses who received high-risk or long-term opioid prescriptions between 2010 and 2014, and addresses how the Military Health System can help prevent risky prescribing in order to improve military force readiness.

Materials And Methods: This study used data from the Millennium Cohort Family Study, a nationwide survey of 9,872 spouses of service members with 2 to 5 years of military service, augmented with information from the military's Pharmacy Data Transaction Service about prescriptions for controlled drugs dispensed to these service members' spouses. Our objectives were to estimate the prevalence of opioid prescribing indicative of long-term use (≥60 day supply or at least one extended-release opioid prescription in any 3-month period) and, separately, high-risk use (daily dosage of ≥90 morphine mg equivalent or total dosage of ≥8,190 morphine mg equivalent, or prescriptions from more than three pharmacies, or concurrent prescriptions). For each of these dependent variables, we conducted bivariate analyses and multiple logistic regression models using information about spouses' physical health, sociodemographic characteristics, substance use behaviors, perceived social support, and stresses associated with military stress, among others. Informed consent, including consent to link survey responses to medical and personnel records, was obtained from all participants. The Naval Health Research Center's Institutional Review Board and the Office of Management and Budget approved the study.

Results: Spouses were predominantly female (86%), had not served in the military themselves (79%), and were spouses of enlisted (91%) active duty (86%) service members. Almost half (47.6%) of spouses obtained at least one opioid prescription during the 2-year observation window, and 8.5% had received opioid prescriptions that posed risk to their health. About 7% met the criteria for receipt of high-risk opioid prescriptions, 3% obtained opioids from three or more pharmacies during a 3-month period, and 4% of spouses who received any opioids received both long-term and high-risk prescriptions. Adverse childhood experiences, physical pain, and lack of social support were associated with increased odds of obtaining high-risk opioid prescriptions.

Conclusions: Approximately 48% of military spouses had used Military Health System insurance to fill at least one opioid prescription during the 2-year observation period. The Department of Defense has taken measures to minimize high-risk opioid prescribing, including passing prescribing guidelines in 2017, establishing the controlled drug management analysis reporting tool, establishing a pain management education and training program, and more. These efforts should continue to expand as reducing the numbers of service members and spouses at risk for adverse events may be effective in reducing opioid misuse and improve the overall health and safety of military spouses and thus, the readiness of the U.S. Armed Forces.
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http://dx.doi.org/10.1093/milmed/usaa146DOI Listing
September 2020

Alcohol misuse and separation from military service: A dyadic perspective.

Addict Behav 2020 11 15;110:106512. Epub 2020 Jun 15.

Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106, USA.

Objective: Alcohol misuse is a prevalent problem among military service members and their spouses. Service member alcohol misuse may contribute to poor job performance, legal infractions, and failure to meet physical standards. Spousal alcohol misuse may indicate problems with military life. However, limited information is available about how alcohol misuse in military families affects occupational outcomes, specifically military attrition.

Method: The current study examined 7,965 opposite sex married couples from the Millennium Cohort Family Study with one military and one civilian/veteran partner. Both partners reported on three measures of alcohol misuse (binge drinking, alcohol problems, and heavy weekly drinking). The associations between each partner's measures of alcohol misuse and subsequent military separation were evaluated using logistic regression. Sex, concordance of alcohol misuse, mental health, and service branch were explored as moderators.

Results: In fully adjusted models, service member alcohol problems were directly related to military separation. Additionally, service member heavy weekly drinking was strongly associated with military separation among female service members but not male service members. Service member and spouse binge drinking interacted such that when only one partner reported binge drinking military separation was less likely, but both partners' binge drinking conveyed a marginally increased risk of military separation.

Conclusions: Prevalence of alcohol misuse was high among military families. Service member alcohol misuse was more strongly related to military separation than spouse alcohol misuse. Additionally, heavy weekly drinking among female service members may be an indicator of a significant issue that merits interventions aimed at retaining these service members.
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http://dx.doi.org/10.1016/j.addbeh.2020.106512DOI Listing
November 2020

Military Life Stressors, Family Communication and Satisfaction: Associations with Children's Psychosocial Outcomes.

J Child Adolesc Trauma 2020 Mar 21;13(1):75-87. Epub 2019 May 21.

2Department of Psychiatry and the Behavioral Sciences, Duke University Medical Center, Durham, NC USA.

Families experience multiple stressors as a result of military service. The purpose of this study was to examine facets of military life and family factors that may impact child psychosocial and mental health functioning. Using baseline data from the Millennium Cohort Family Study, this study examined family demographics and composition (age, number of children), military life stressors (injury, family, and deployment stressors), family communication and satisfaction as assessed by the Family Adaptability and Cohesion Evaluation Scale-IV, parental social functioning assessed via the Short Form Health Survey-36, and child mental health and behavioral functioning (parental reports of clinician-diagnosed mental health conditions such as depression) and an adapted version of the Strengths and Difficulties Questionnaire. Injury- and family-related military stressors were significant indicators of heightened risk for child mental health conditions, whereas greater levels of parental social functioning and family satisfaction were associated with lower risk of child mental health conditions. Differential associations were found in child functioning when military-related variables (e.g., service component), sociodemographic, and family composition factors (number and age of the children in the home) were examined. These findings underscore the importance of examining the "whole child" within the broader ecological and military family context to understand factors associated with children's mental and behavioral health. The results from the present study highlight the complex relationships that may be at play, which, in turn, have considerable implications for the development of policies to support children and families encountering multiple stressors related to a parent's military service.
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http://dx.doi.org/10.1007/s40653-019-00259-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7163866PMC
March 2020

Longitudinal trajectories of comorbid PTSD and depression symptoms among U.S. service members and veterans.

BMC Psychiatry 2019 12 13;19(1):396. Epub 2019 Dec 13.

Leidos, 11951 Freedom Drive, Reston, VA, 20190, USA.

Background: Posttraumatic stress disorder (PTSD) often co-occurs with other psychiatric disorders, particularly major depressive disorder (MDD). The current study examined longitudinal trajectories of PTSD and MDD symptoms among service members and veterans with comorbid PTSD/MDD.

Methods: Eligible participants (n = 1704) for the Millennium Cohort Study included those who screened positive at baseline for both PTSD (PTSD Checklist-Civilian Version) and MDD (Patient Health Questionnaire). Between 2001 and 2016, participants completed a baseline assessment and up to 4 follow-up assessments approximately every 3 years. Mixture modeling simultaneously determined trajectories of comorbid PTSD and MDD symptoms. Multinomial regression determined factors associated with latent class membership.

Results: Four distinct classes (chronic, relapse, gradual recovery, and rapid recovery) described symptom trajectories of PTSD/MDD. Membership in the chronic class was associated with older age, service branch, deployment with combat, anxiety, physical assault, disabling injury/illness, bodily pain, high levels of somatic symptoms, and less social support.

Conclusions: Comorbid PTSD/MDD symptoms tend to move in tandem, and, although the largest class remitted symptoms, almost 25% of participants reported chronic comorbid symptoms across all time points. Results highlight the need to assess comorbid conditions in the context of PTSD. Future research should further evaluate the chronicity of comorbid symptoms over time.
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http://dx.doi.org/10.1186/s12888-019-2375-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911296PMC
December 2019

Association of military life experiences and health indicators among military spouses.

BMC Public Health 2019 Nov 12;19(1):1517. Epub 2019 Nov 12.

Military Population Health Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.

Background: The health and well-being of military spouses directly contribute to a robust military force by enabling the spouse to better support the active duty member's career. In order to understand the overall health and well-being of military spouses, we assessed health indicators among military spouses using the Healthy People 2020 framework and examined associations of these health indicators with military experiences and psychosocial factors.

Methods: Using data from the Millennium Cohort Family Study, a U.S. Department of Defense-sponsored survey of 9872 spouses of service members with 2-5 years of military service, we examined attainment of Healthy People 2020 goals for spouses and service members, including healthy weight, exercise, sleep, and alcohol and tobacco use. Multivariable logistic regression models assessed associations of spouse health indicators with stressful military life experiences and social support, adjusting for demographics and military descriptors. The spousal survey was administered nationwide in 2011.

Results: The majority of military spouses met each health goal assessed. However, less than half met the healthy weight and the strength training goals. Reporting greater perceived family support from the military was associated with better behavioral health outcomes, while having no one to turn to for support was associated with poorer outcomes. Using the Healthy People 2020 objectives as a framework for identifying key health behaviors and benchmarks, this study identified factors, including military-specific experiences, that may contribute to physical health behaviors and outcomes among military spouses. With respect to demographic characteristics, the findings are consistent with other literature that women are more likely to refrain from risky substance use and that greater education is associated with better overall health outcomes.

Conclusions: Findings suggest that enhanced social and military support and tailored programming for military spouses may improve health outcomes and contribute to the well-being of military couples. Such programming could also bolster force readiness and retention.
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http://dx.doi.org/10.1186/s12889-019-7804-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852757PMC
November 2019

Engaging military couples in marital research: does requesting referrals from service members to recruit their spouses introduce sample bias?

BMC Med Res Methodol 2018 10 24;18(1):114. Epub 2018 Oct 24.

Emory University, 201 Dowman Drive, Atlanta, GA, 30322, USA.

Background: While enrolling dyads in research studies is not uncommon, there is limited literature on the utility of different recruitment strategies and the resulting selection biases. This paper examined two recruitment strategies used to enroll military couples in a longitudinal study, assessing the impact of both strategies on the representativeness of the final study sample.

Method: Descriptive and bivariate analyses were conducted to 1) identify characteristics associated with spouse referral, 2) compare response rates based on recruitment strategy and assess whether recruitment strategy modified correlates of response propensity among spouses, and 3) assess whether referred spouse characteristics differed from non-referred spouses in the final sample. The study sample consisted of married US service members with 2-5 years of military service as of October 2011 and their spouses.

Results: Service members who referred their spouses to participate in the Millennium Cohort Family Study were more likely to be male, have children, serve in the Army, and have combat deployment experience than those who did not refer their spouse. Nearly two-thirds (n = 5331, 64.9%) of referred spouses participated in the Family Study, compared with less than one-third (n = 3458, 29.5%) of directly contacted spouses. Spouse characteristics also differed significantly between recruitment groups.

Conclusions: Overall results suggest that minimal bias was introduced by using a referral recruitment methodology. Service members appeared to be more likely to refer their spouses if they perceived the research topic as relevant to their spouse, such that male service members with combat deployment experience were more likely to refer female spouses caring for multiple children. Referred spouses were significantly more likely to respond to the Millennium Cohort Family Study survey than those who were directly contacted; however, the overall success rate of using a referral strategy was less than recruiting spouses through direct contact. Differences between referred spouses and spouses contacted directly mirrored service member referring characteristics.
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http://dx.doi.org/10.1186/s12874-018-0575-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6201494PMC
October 2018

Mental Health of Children of Deployed and Nondeployed US Military Service Members: The Millennium Cohort Family Study.

J Dev Behav Pediatr 2018 12;39(9):683-692

Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.

Objective: Families experience multiple stressors as a result of military service. The purpose of this study was to investigate the associations among service member deployment experiences, family and military factors, and children's mental health using baseline data from the Millennium Cohort Family Study, a study designed to evaluate the health and mental health effects of military service on families, including children.

Method: This study examined administrative data on deployment status (combat, noncombat, and no deployments), as well as service member- and spouse-reported data on deployment experiences and family functioning in relation to the mental health of children in the family who were aged 9 to 17 years.

Results: Most children were not reported to have mental health, emotional, or behavioral difficulties regardless of parental deployment status. For an important minority of children, however, parental deployments with combat, compared with those with no deployment, were associated with a parental report of attention-deficit disorder/attention-deficit hyperactivity disorder and depression as diagnosed by a clinical provider, after accounting for demographics, psychosocial context, and military factors. Children's odds of a parental report of depression were significantly higher in both the combat and the noncombat deployment groups than in the no deployment group.

Conclusion: These findings extend our understanding of the association between parental deployments and children's mental health, with implications for services and training mental health providers serving military families.
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http://dx.doi.org/10.1097/DBP.0000000000000606DOI Listing
December 2018

Predictors of Posttraumatic Stress Disorder, Anxiety Disorders, Depressive Disorders, and Any Mental Health Condition Among U.S. Soldiers and Marines, 2001-2011.

J Trauma Stress 2018 08 19;31(4):568-578. Epub 2018 Jul 19.

RTI International, Research Triangle Park, North Carolina, USA.

Understanding mental health disorder diagnosis and treatment seeking among active-duty military personnel is a topic with both clinical and policy implications. It has been well documented in military populations that individual-level military experience, including deployment history and combat exposure, influences mental health outcomes, but the impact of unit-level factors is less well understood. In the current study, we used administrative longitudinal data to examine a comprehensive set of unit- and individual-level predictors of posttraumatic stress disorder (PTSD), non-PTSD anxiety disorders, depressive disorders, and overall mental health diagnoses among Army and Marines Corps personnel. Using Cox survival models for time-dependent variables, we analyzed time from military accession (between January 1, 2001 and December 31, 2011) until first mental health diagnosis for 773,359 soldiers and 332,093 Marines. Prior diagnosis of a substance abuse disorder during one's military career, hazard ratios (HRs) = 1.68-3.10, and cumulative time spent deployed, HRs = 1.11-2.04, were the most predictive risk factors for all outcomes. Male sex, HRs = 0.35-0.57, and officer rank, HRs = 0.13-0.23, were the most protective factors. Unit-level rate of high deployment stress was a small but significant predictor of all outcomes after controlling for individual-level deployment history and other predictors, HRs = 1.01-1.05. Findings suggest both unit- and individual-level risk and protective factors of mental health diagnoses associated with treatment seeking. Clinical, including mental health assessment and management, and policy implications related to the military environment and the individual as it relates to mental health disorders are discussed.
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http://dx.doi.org/10.1002/jts.22316DOI Listing
August 2018

Prevalence of psychiatric morbidity in United States military spouses: The Millennium Cohort Family Study.

Depress Anxiety 2018 09 10;35(9):815-829. Epub 2018 May 10.

New York University School of Medicine,, Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury, New York, USA, NY.

Background: Approximately half of US service members are married, equating to 1.1 million military spouses, yet the prevalence of psychiatric morbidity among military spouses remains understudied. We assessed the prevalence and correlates of eight mental health conditions in spouses of service members with 2-5 years of service.

Method: We employed baseline data from the Millennium Cohort Family Study, a 21-year longitudinal survey following 9,872 military-affiliated married couples representing all US service branches and active duty, Reserve, and National Guard components. Couples were surveyed between 2011 and 2013, a period of high military operational activity associated with Operation Iraqi Freedom and Operation Enduring Freedom. Primary outcomes included depression, anxiety, posttraumatic stress disorder (PTSD), panic, alcohol misuse, insomnia, somatization, and binge eating, all assessed with validated self-report questionnaires.

Results: A total of 35.90% of military spouses met criteria for at least one psychiatric condition. The most commonly endorsed conditions were moderate-to-severe somatization symptoms (17.63%) and moderate-to-severe insomnia (15.65%). PTSD, anxiety, depression, panic, alcohol misuse, and binge eating were endorsed by 9.20%, 6.65%, 6.05%, 7.07%, 8.16%, and 5.23% of spouses, respectively. Having a partner who deployed with combat resulted in higher prevalence of anxiety, insomnia, and somatization. Spouses had lower prevalence of PTSD, alcohol misuse, and insomnia but higher rates of panic and binge eating than service members. Both members of a couple rarely endorsed having the same psychiatric problem.

Conclusions: One third of junior military spouses screened positive for one or more psychiatric conditions, underscoring the need for high-quality prevention and treatment services.
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http://dx.doi.org/10.1002/da.22768DOI Listing
September 2018

Assessing and adjusting for non-response in the Millennium Cohort Family Study.

BMC Med Res Methodol 2017 01 28;17(1):16. Epub 2017 Jan 28.

Military Population Health Directorate at the Naval Health Research Center, 140 Sylvester Road, 92106, San Diego, CA, USA.

Background: In conducting population-based surveys, it is important to thoroughly examine and adjust for potential non-response bias to improve the representativeness of the sample prior to conducting analyses of the data and reporting findings. This paper examines factors contributing to second stage survey non-response during the baseline data collection for the Millennium Cohort Family Study, a large longitudinal study of US service members and their spouses from all branches of the military.

Methods: Multivariate logistic regression analysis was used to develop a comprehensive response propensity model.

Results: Results showed the majority of service member sociodemographic, military, and administrative variables were significantly associated with non-response, along with various health behaviours, mental health indices, and financial and social issues. However, effects were quite small for many factors, with a few demographic and survey administrative variables accounting for the most substantial variance.

Conclusions: The Millennium Cohort Family Study was impacted by a number of non-response factors that commonly affect survey research. In particular, recruitment of young, male, and minority populations, as well as junior ranking personnel, was challenging. Despite this, our results suggest the success of representative population sampling can be effectively augmented through targeted oversampling and recruitment, as well as a comprehensive survey weighting strategy.
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http://dx.doi.org/10.1186/s12874-017-0294-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5273843PMC
January 2017

Sexual Harassment and Assault in the U.S. Military: A Review of Policy and Research Trends.

Mil Med 2016 Jan;181(1 Suppl):20-7

Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521.

Recently, there has been increasing concern regarding the problem of sexual violence in the military. Because sexual harassment and assault are more closely intertwined in the military than in most civilian contexts, the military context affords a unique opportunity to study the interrelationships between these two types of sexual violence. In this review, we briefly summarize existing research on military sexual trauma prevalence rates, effects on victims, and risk factors, as well as prevention and response programs in the military context. In each of these topic areas, we emphasize issues unique to the complex interplay between sexual harassment and assault in the military and make recommendations for future research.
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http://dx.doi.org/10.7205/MILMED-D-15-00336DOI Listing
January 2016

Etiology of depression comorbidity in combat-related PTSD: a review of the literature.

Clin Psychol Rev 2014 Mar 19;34(2):87-98. Epub 2013 Dec 19.

Behavioral Sciences and Epidemiology Department, Naval Health Research Center, San Diego, CA, USA.

Posttraumatic stress disorder is often diagnosed with other mental health problems, particularly depression. Although PTSD comorbidity has been associated with more severe and chronic symptomology, relationships among commonly co-occurring disorders are not well understood. The purpose of this study was to review the literature regarding the development of depression comorbid with combat-related PTSD among military personnel. We summarize results of commonly tested hypotheses about the etiology of PTSD and depression comorbidity, including (1) causal hypotheses, (2) common factor hypotheses, and (3) potential confounds. Evidence suggests that PTSD may be a causal risk factor for subsequent depression; however, associations are likely complex, involving bidirectional causality, common risk factors, and common vulnerabilities. The unique nature of PTSD-depression comorbidity in the context of military deployment and combat exposure is emphasized. Implications of our results for clinical practice and future research are discussed.
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http://dx.doi.org/10.1016/j.cpr.2013.12.002DOI Listing
March 2014

Changes in healthcare use across the transition from civilian to military life.

Int J Health Plann Manage 2014 Apr-Jun;29(2):e186-204. Epub 2013 Apr 8.

Behavioral Science and Epidemiology Program, Naval Health Research Center, San Diego, California, USA.

Patterns of healthcare use in a sample of young adults entering the US Navy (N=1137) were examined in a longitudinal survey study. Baseline data provided information about healthcare use as a civilian, whereas follow-up data were used to examine changes in patterns of use over time following entry into the Military Health System (MHS). Entrance into the MHS was marked by increased use of preventive care. Although few systematic differences were noted with respect to socioeconomic status or race/ethnicity, women consistently used more healthcare than did men, and women's use increased more over time; however, this increase was largely driven by pregnancy during military service. Findings suggest that individuals with access to universal healthcare are likely to increase their overall use of services. However, these effects were quite small in absolute terms, and they were strongest for preventive care rather than more intensive and expensive services. Published 2013. This article is a US Government work and is in the public domain in the USA.
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http://dx.doi.org/10.1002/hpm.2176DOI Listing
May 2016

Evaluation of a sexual assault education/prevention program for female U.S. Navy personnel.

Mil Med 2011 Oct;176(10):1178-83

Research, Development and Performance Management, Navy Fleet and Family Support Program, Navy Installations Command, Millington Detachment, 5720 Integrity Drive, Millington, TN 38055-6510, USA.

The U.S. Navy Sexual Assault Intervention Training (SAIT) program for women was evaluated in a randomized clinical trial. The SAIT uses multiple presentation modalities (lecture, slides, discussion, film) to provide information related to sexual assault, including risk factors, consequences, prevention, and relevant military regulations. Female personnel who had completed basic training (N = 550) participated in the SAIT or a Comparison condition, and then completed measures of rape knowledge, empathy for rape victims, and acceptance of rape myths (false beliefs about rape justifying sexual violence). Results showed that the SAIT increased factual knowledge about rape. In addition, the SAIT increased empathy with rape victims in some groups of women. However, the program did not reduce women's rape myth acceptance. Given the enormity of the problem of sexual assault and these promising initial findings, additional research on the efficacy of the SAIT is clearly warranted.
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http://dx.doi.org/10.7205/milmed-d-10-00298DOI Listing
October 2011

Effects of combat deployment on risky and self-destructive behavior among active duty military personnel.

J Psychiatr Res 2011 Oct 6;45(10):1321-31. Epub 2011 May 6.

Behavioral Science and Epidemiology, Naval Health Research Center, San Diego, CA 92106-3521, USA.

Although research has documented negative effects of combat deployment on mental health, few studies have examined whether deployment increases risky or self-destructive behavior. The present study addressed this issue. In addition, we examined whether deployment effects on risky behavior varied depending on history of pre-deployment risky behavior, and assessed whether psychiatric conditions mediated effects of deployment on risky behavior. In an anonymous survey, active duty members of the U.S. Marine Corps and U.S. Navy (N = 2116) described their deployment experiences and their participation in risky recreational activities, unprotected sex, illegal drug use, self-injurious behavior, and suicide attempts during three time frames (civilian, military pre-deployment, and military post-deployment). Respondents also reported whether they had problems with depression, anxiety, or PTSD during the same three time frames. Results revealed that risky behavior was much more common in civilian than in military life, with personnel who had not deployed, compared to those who had deployed, reporting more risky behavior and more psychiatric problems as civilians. For the current time period, in contrast, personnel who had deployed (versus never deployed) were significantly more likely to report both risky behavior and psychiatric problems. Importantly, deployment was associated with increases in risky behavior only for personnel with a pre-deployment history of engaging in risky behavior. Although psychiatric conditions were associated with higher levels of risky behavior, psychiatric problems did not mediate associations between deployment and risky behavior. Implications for understanding effects of combat deployment on active duty personnel and directions for future research are discussed.
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http://dx.doi.org/10.1016/j.jpsychires.2011.04.003DOI Listing
October 2011

Evaluation of a sexual assault education/prevention program for male U.S. Navy personnel.

Mil Med 2010 Jun;175(6):429-34

Research, Development, and Performance Management, Navy Fleet and Family Support Program, Navy Installations Command, Millington Detachment, 5720 Integrity Drive, Millington, TN 38055-6510, USA.

A randomized clinical trial was conducted to evaluate the effectiveness of the Navy Sexual Assault Intervention Training (SAIT) program for men. A four-group Solomon design was used to control for possible pretest sensitization effects. Male Navy personnel (N = 1,505) were assessed for rape knowledge, rape myth acceptance (two scales), and rape empathy after participating in the SAIT program or viewing an educational video about HIV/AIDS (comparison condition). The SAIT program was found to be effective in increasing rape knowledge, reducing rape myth acceptance, and increasing empathy for rape victims. As expected, men who had exhibited previous coercive sexual behavior, compared with those who had not, reported lower levels of knowledge, higher levels of rape myth acceptance, and less rape empathy. However, the SAIT program was generally effective in changing men's knowledge, beliefs, and feelings on the key measures, regardless of participants' histories of coercive sexual behavior.
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http://dx.doi.org/10.7205/milmed-d-09-00218DOI Listing
June 2010

Do trauma symptoms mediate the relationship between childhood physical abuse and adult child abuse risk?

Child Abuse Negl 2010 May 31;34(5):332-44. Epub 2010 Mar 31.

Center for the Study of Family Violence and Sexual Assault, Northern Illinois University, DeKalb, IL 60115-2854, USA.

Objective: Although the intergenerational transmission of family violence has been well documented, the mechanisms responsible for this effect have not been fully determined. The present study examined whether trauma symptoms mediate the relationship between a childhood history of child physical abuse (CPA) and adult CPA risk, and whether any such mediation was similar for women and men.

Method: Female and male US Navy (USN) recruits (N=5,394) and college students (N=716) completed self-report measures of their history of child abuse (i.e., CPA and child sexual abuse [CSA]), exposure to intimate partner violence (IPV), current trauma symptoms, and adult CPA risk.

Results: As expected, there was a strong association between a childhood history of CPA and adult CPA risk. This association was significant even after controlling for demographic variables and childhood exposure to other forms of violence (CSA and IPV), and the strength of the relationship did not vary depending on demographics or exposure to other forms of violence. However, the association between a history of CPA and adult risk of CPA was stronger for individuals high in defensive avoidance compared to those low in defensive avoidance. The association between a history of CPA and adult CPA risk was largely, although not entirely, mediated by psychological trauma symptoms. Mediation was observed for both women and men in both the USN and college samples.

Conclusions: Trauma symptoms associated with a history of CPA accounted for a substantial part of the relationship between a history of CPA and adult CPA risk in both women and men.

Practice Implications: To the extent that trauma symptoms are a mechanism by which the intergenerational transmission of child abuse occurs, intervening to reduce trauma symptoms in CPA victims has the potential of reducing their risk of continuing the cycle of violence.
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http://dx.doi.org/10.1016/j.chiabu.2009.09.017DOI Listing
May 2010

Reports of rape reperpetration by newly enlisted male navy personnel.

Violence Vict 2009 ;24(2):204-18

Behavioral Sciences and Epidemiology Program, Naval Health Research Center, San Diego, CA 92186-5122, USA.

This study examined the frequency and characteristics of repeated attempted and completed rape (ACR) incidents reported by newly enlisted male navy personnel (N=1146) who participated in a longitudinal study during the transition from civilian to military life. Overall, 13% (n=144) reported engaging in sexual behavior that approximates legal definitions of ACR since the age of 14. Among those men, most (71%) reperpetrated ACR incidents (M = 6.36, SD = 9.55). Demographic variables were unrelated to perpetration history. Regardless of time period, respondents reported perpetrating primarily completed rather than attempted rape, perpetrating multiple ACR incidents rather than a single incident, using substances to incapacitate victims more frequently than force, and knowing their victim rather than targeting a stranger in completed rape incidents.
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http://dx.doi.org/10.1891/0886-6708.24.2.204DOI Listing
August 2009

Premilitary adult sexual assault victimization and perpetration in a Navy recruit sample.

J Interpers Violence 2008 Nov 4;23(11):1636-53. Epub 2008 Mar 4.

Naval Health Research Center, San Diego, California, USA.

Female (n = 5,226) and male (n = 5,969) U.S. Navy recruits completed a survey assessing their premilitary histories of adult sexual assault (SA), defined as attempted or completed rape since the age of 14. The survey was completed under anonymous or identified conditions. Overall, 39% of women reported premilitary SA victimization and 13% of men admitted premilitary SA perpetration. As predicted, rates were significantly higher in the anonymous than in the identified condition. For the sample of women as a whole, marital status, ethnicity, and family income were associated with SA victimization; for men, only marital status was associated with SA perpetration. Compared to previous college samples, Navy recruits were more likely to have previous SA experience. Given the negative consequences associated with SA victimization and perpetration, the present study reinforces the desirability of developing additional treatment, education, and prevention programs to reduce the occurrence of SA among military recruits.
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http://dx.doi.org/10.1177/0886260508314325DOI Listing
November 2008

Premilitary sexual assault and attrition in the U.S. Navy.

Mil Med 2007 Mar;172(3):254-8

Behavioral Science and Epidemiology Department, Naval Health Research Center, San Diego, CA 92186-5122, USA.

A prospective study examined whether adult premilitary sexual victimization predicted women's military attrition. In a survey of female Navy recruits (N = 2,431), 56% reported some form of adult unwanted sexual contact before entering the military, with 25% reporting completed rape. Approximately one-third of respondents left the Navy before completing their 4-year term of service. When rape, attempted rape, and lower-level unwanted sexual contact were considered simultaneously, only rape predicted attrition. Women who reported premilitary rape, compared with those who did not, were 1.69 times more likely to leave the military. The pattern of results held across the 4-year period examined and after controlling for demographic predictors.
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http://dx.doi.org/10.7205/milmed.172.3.254DOI Listing
March 2007

Posttraumatic stress symptoms in Navy personnel: prevalence rates among recruits in basic training.

J Anxiety Disord 2007 30;21(6):860-70. Epub 2006 Dec 30.

Naval Health Research Center, Behavioral Science and Epidemiology Program, P.O. Box 85122, San Diego, CA 92186-5122, USA.

Individuals in the military are often required to endure high levels of stress as a result of demanding operational requirements or deployments. Individuals who enter the military with pre-existing mental health problems such as posttraumatic stress disorder (PTSD) are likely to be at heightened risk of adverse reactions to military stressors. The present study documents the prevalence of PTSD symptoms among new Navy recruits and compares the prevalence of PTSD symptomology among recruits to prevalence rates that have been reported for comparable civilian populations. Results suggest that 15 percent of new Navy recruits are experiencing measurable symptoms of posttraumatic stress. Prevalence of these symptoms among Navy recruits is comparable to that among civilian adolescent and young adult populations.
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http://dx.doi.org/10.1016/j.janxdis.2006.12.001DOI Listing
October 2007

Premilitary intimate partner violence and attrition from the U.S. Navy.

Mil Med 2006 Dec;171(12):1206-10

Naval Health Research Center, San Diego, CA 92186-5122, USA.

A prospective study of U.S. Navy recruits (N = 5,498) examined whether premilitary intimate partner violence (IPV) was associated with attrition. Overall, more than one-fourth of recruits reported premilitary physical IPV and more than two-thirds reported premilitary verbal IPV. Women reported more perpetration and receipt of IPV than men, and married or cohabiting respondents reported more IPV than single respondents. Both perpetration and receipt of IPV significantly predicted attrition within 4 years. However, after controlling for other forms of IPV, only receipt of physical IPV significantly predicted attrition. In only one analysis did associations between IPV and attrition vary according to marital status or gender; premilitary receipt of verbal IPV had different effects on women and men.
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http://dx.doi.org/10.7205/milmed.171.12.1206DOI Listing
December 2006

Childhood exposure to family violence and attrition in the Navy.

Mil Med 2004 Jun;169(6):465-9

Behavioral Science and Epidemiology Department, P.O. Box 85122, Naval Health Research Center, San Diego, CA 92186-5122, USA.

In a prospective study of U.S. Navy recruits (n = 5,491), we examined the relationship between childhood exposure to family violence (child physical abuse, child sexual abuse [CSA], and domestic violence) and attrition. Overall, 55% of recruits experienced one or more forms of childhood family violence and 34% of recruits attrited within 4 years after enlistment. Considered separately, each form of childhood violence was significantly associated with attrition. When considered simultaneously, all three types of childhood violence were associated with attrition in men, but only CSA was associated with attrition in women. Men and women who experienced all three types of childhood violence were 303% and 139%, respectively, more likely to attrite than recruits who reported no childhood violence. In analyses examining the timing of attrition, CSA was associated with early attrition, whereas child physical abuse and domestic violence were unrelated to timing of attrition.
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http://dx.doi.org/10.7205/milmed.169.6.465DOI Listing
June 2004

Childhood exposure to family violence and attrition in the Navy.

Mil Med 2004 Jun;169(6):465-9

Behavioral Science and Epidemiology Department, P.O. Box 85122, Naval Health Research Center, San Diego, CA 92186-5122, USA.

In a prospective study of U.S. Navy recruits (n = 5,491), we examined the relationship between childhood exposure to family violence (child physical abuse, child sexual abuse [CSA], and domestic violence) and attrition. Overall, 55% of recruits experienced one or more forms of childhood family violence and 34% of recruits attrited within 4 years after enlistment. Considered separately, each form of childhood violence was significantly associated with attrition. When considered simultaneously, all three types of childhood violence were associated with attrition in men, but only CSA was associated with attrition in women. Men and women who experienced all three types of childhood violence were 303% and 139%, respectively, more likely to attrite than recruits who reported no childhood violence. In analyses examining the timing of attrition, CSA was associated with early attrition, whereas child physical abuse and domestic violence were unrelated to timing of attrition.
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http://dx.doi.org/10.7205/milmed.169.6.465DOI Listing
June 2004

Self-definition as a survivor of childhood sexual abuse among navy recruits.

J Consult Clin Psychol 2002 Apr;70(2):369-77

Naval Health Research Center, San Diego, California 92186-5122, USA.

This study explored how specific childhood sexual experiences (CSEs) might be related to self-identification as a victim of sexual abuse and to gender differences in self-defined victimization. Hierarchical logistic regression was used to estimate the relationship of demographic and CSE characteristics with self-definitions. The characteristics most strongly associated were threats-force, incest, and younger age at the time of the experience. Men were less likely than were women to acknowledge abuse and to report CSE characteristics indicative of abuse. Women were more likely to identify themselves as victims the more CSEs they reported involving sexual penetration. Finally, in an analysis of familial abuse, men were more likely to define themselves as victims if the perpetrator was also male.
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http://dx.doi.org/10.1037//0022-006x.70.2.369DOI Listing
April 2002
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