Publication year
2010
Citation Title
Risk of diabetes in U.S. Military service members in relation to combat deployment and mental health.
Journal Name
Diabetes Care
Journal Volume
33
Issue Number
8
Page Numbers
1771-1777
DOI
10.2337/dc10-0296
Summary
Data from 44,754 Millennium Cohort Study participants were used to determine whether military deployment, combat exposures, and mental health conditions were related to the risk of newly reported diabetes over the three-year follow-up period. Those with self-reported diabetes diagnoses at follow-up were significantly older, had greater baseline body mass index (BMI), and were more likely to be Black. Results indicate that, in this military cohort, posttraumatic stress disorder (PTSD) symptoms at baseline, but not other mental health symptoms or military deployment experience, were significantly associated with future risk of diabetes.
Key Findings
Only PTSD symptoms were strongly and significantly related to diabetes occurrence when considering all self-reported psychiatric conditions and characteristics of military service.
Depression was not found to be related to risk of diabetes, contrary to results of previous studies.
Characteristics associated with new onset of diabetes included: two post-baseline deployments, separation from Service, incidence of panic disorders, other anxiety disorders, and PTSD.
Implications for Program Leaders
Provide increased monitoring and assessment specific to Type-2 diabetes for Service members who display or report risk factors for the onset of diabetes
Educate Service members with PTSD and their families about the possible link with Type-2 diabetes development
Develop family-oriented activities that include education about risk factors, and methods for prevention and treatment of diabetes
Implications for Policy Makers
Encourage programs to incorporate additional health screenings and training regarding the development of Type-2 diabetes for Service members diagnosed with PTSD
Promote the development and continuation of programs that can promote resilience in Service members, their partners, and children
Continue to support programs that address the unique challenges faced by Service members who experience PTSD and other anxiety disorders
Methods
Data from the baseline and two follow-up iterations of the Millennium Cohort Study were used for this analysis.
A quantitative study was conducted on the stratified random sample of Service men and women who completed the self-report questionnaires, including questions regarding physical and mental health.
The main outcome variable of interest was the self-reported occurrence of Type-2 diabetes.
Participants
Sample included 44,754 Service members: 44% Reserve/Guard, 56% Active Duty (46% Army, 31% Air Force, 19% Navy/Coast Guard, 4% Marines).
Seventy-three percent were male, and represented the following races/ethnicities: 72% White, 12% Black, 8% Asian-American, 6% Latino/Latina, and 2% Other.
Number of deployments between baseline and follow-up surveys for the sample was zero (85%), one (9%), two (3%), and three (3%).
Limitations
Researchers relied on unvalidated self-reports of various health factors and medical conditions instead of medical encounter data.
Deployment eligibility criteria may have resulted in a bias toward healthy individuals receiving this assessment.
No assessment was done of differences between those who dropped out of the study and those who remained throughout.
No questions were asked regarding level of physical activity at baseline, a potentially important health factor.
Avenues for Future Research
Replicate this study to determine if a prospective association between PTSD and diabetes exists using medical records or direct testing as a measure of diabetes
Explore the association between separation from military service, intake and discharge screenings, and variation in diabetes risk
Examine the association of depression, race/ethnicity, and gender with different risk levels of diabetes
Focus
Multiple Branches
Population Focus
Military Branch
Military Component
Abstract
Few prospective data exist on the risk of diabetes in individuals serving in the U.S. military. The objectives of this study were to determine whether military deployment, combat exposures, and mental health conditions were related to the risk of newly reported diabetes over 3 years. RESEARCH DESIGN AND METHODS Data were from Millennium Cohort Study participants who completed baseline (July 2001–June 2003) and follow-up (June 2004–February 2006) questionnaires (follow-up response rate = 71.4%). After exclusion criteria were applied, adjusted analyses included 44,754 participants (median age 36 years, range 18–68 years). Survey instruments collected demographics, height, weight, lifestyle, military service, clinician-diagnosed diabetes, and other physical and mental health conditions. Deployment was defined by U.S. Department of Defense databases, and combat exposure was assessed by self-report at follow-up. Odds of newly reported diabetes were estimated using logistic regression analysis. RESULTS Occurrence of diabetes during follow-up was 3 per 1,000 person-years. Individuals reporting diabetes at follow-up were significantly older, had greater baseline BMI, and were less likely to be Caucasian. After adjustment for age, sex, BMI, education, race/ethnicity, military service characteristics, and mental health conditions, only baseline posttraumatic stress disorder (PTSD) was significantly associated with risk of diabetes (odds ratio 2.07 [95% CI 1.31–3.29]). Deployments since September 2001 were not significantly related to higher diabetes risk, with or without combat exposure. CONCLUSIONS In this military cohort, PTSD symptoms at baseline but not other mental health symptoms or military deployment experience were significantly associated with future risk of self-reported diabetes.
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