The epidemiology of mental disorders in the U.S. Navy: the neuroses.

As part of a series of investigations into the occurrence and outcome of mental disorders in the U.S. Navy, this study was designed to determine first hospitalization incidence rates for neurotic disorders in an initially healthy young adult population and to determine the duration of acute illness, severity, and posthospital outcomes in terms of military performance and premature personnel losses. Data on first hospitalizations for neurotic disorders were extracted from automated medical record data files for all active duty Navy personnel admitted between 1980 and 1988. Incidence rates were calculated for major demographic subgroups, and career history records provided a 4-year follow-up of service-related outcomes. Overall incidence ranged from a low of 3 per 100,000 for obsessive-compulsive disorders to a high of 58 per 100,000 for other neurotic disorders/neurotic disorders not otherwise specified (NOS). The phobia and depressive groups had the poorest prognoses for continued service, and the NOS and anxiety groups had the best prognoses.

Infectious disease rates in the U.S. Navy, 1980 to 1995.

The effect of increasing numbers of women in the U.S. Navy, particularly those aboard Navy ships, on infectious disease risk is unknown. This study examines gender and other demographic differences among all U.S. Navy enlisted personnel in first hospitalizations for infectious diseases from 1980 through 1989 and identifies trends in incidence rates during the extended period from 1980 to 1995. All data were obtained from official personnel and medical records. First hospitalization rates were computed using the Epidemiological Interactive System. Varicella and other viruses and chlamydiae accounted for more than 20,000 hospitalizations among Navy enlisted personnel in the 1980s. In 7 of the 12 categories of common infectious diseases, women's rates were higher than those for men, particularly for viral meningitis, herpes simplex, syphilis, gonococcal disease, and candidiasis. An excess of certain common infectious diseases among women and nonwhite ethnic groups emphasizes the need for continuing education and surveillance in these populations.

Total quality leadership in the U.S. Navy: effective for health promotion activities?

BACKGROUND: Although the U.S. Navy mandated Total Quality Leadership (TQL) as a management strategy throughout its medical department in the early 1990s, it was unknown to what extent it was being used for health promotion activities and, if so, how effectively. METHODS: A brief mail survey of 204 Navy commands supplemented by 97 telephone interviews to TQL-for-health-promotion-using commands and nonusing controls provided worksite information on TQL implementation. Responses from a Navywide health and fitness survey provided perceptions and health behavior attitudes from the individuals at commands. RESULTS: A total of 32% of commands surveyed had used TQL specifically for improving health- and fitness-related processes and outcomes between 1991 and 1995. Participants at commands that had used TQL for health- and fitness-related processes reported a higher importance of good health (P < 0.05) and were more certain that they would reach and or maintain their ideal weight (P < 0.05) than participants at non-TQL commands. However, there were no significant differences in perceptions of command support for health and fitness between TQL and non-TQL commands. CONCLUSIONS: Several factors and organizational arrangements that were pertinent to the development and practice of TQL in the Navy were identified. The use of TQL specifically for health promotion was not consistently related to health-related perceptions or health behavior attitudes.

Demographic differences in body composition of Navy and Marine Corps personnel: findings from the perception of wellness and readiness assessment.

With the recent increase in women's representation in the military, baseline physical measurement data are needed to help set appropriate accession and retention standards and to design useful prevention and intervention programs in the areas of physical fitness and health. This study incorporated several body composition indices to obtain anthropometric data for a representative sample of 1,292 active duty Navy and Marine Corps women and men. It also assessed the extent to which personnel met weight-for-height and body fat standards. The prevalence of overweight was considerably lower among Marine Corps women compared with Navy women and was slightly less for Marine Corps men compared with their Navy counterparts. Between one-fifth and one-third of military personnel exceeded Navy/Marine Corps weight-for-height standards. Navy women tended to meet weight standards more often than Navy men. Fewer Marine Corps women than men were overweight, but more exceeded their weight-for-height standards.

Suicide in the U.S. Marine Corps, 1990 to 1996.

Epidemiologic studies of suicide in the military have not controlled for the higher suicide rates of the unemployed expected in comparative national populations. This study compared the observed number of suicides among U.S. Marine Corps personnel from 1990 to 1996 with the expected number based on rates for the employed general U.S. population. Standardized mortality ratios were calculated to identify demographic groups with higher or lower than expected numbers of suicides. The scan statistic and the Knox technique were used to evaluate potential suicide cluster patterns. Overall, there were fewer suicides in the Marine Corps (n = 213) than expected (n = 225). Hispanic and other ethnic group males and female Marines had greater than expected numbers. Evidence for suicide clustering in time and space was equivocal.

Psychosocial correlates of nicotine dependence among men and women in the U.S. naval services.

This study assessed the prevalence and psychosocial correlates of clinical criteria-based diagnoses of nicotine dependence in men and women in the U.S. naval services. Analyses were based on data from the 1995 Perceptions of Wellness and Readiness Assessment, a population-based self-report survey of 9,856 active-duty Navy and Marine Corps members worldwide, specifically focusing on a subsample of those who completed the telephone version of the Quick Diagnostic Interview Schedule (n = 782). Twenty-five percent of all telephone interview volunteers met diagnostic criteria for lifetime nicotine dependence, and 15% met criteria for nicotine dependence in the last year. There was no difference in nicotine dependence by job classification (traditional vs. nontraditional) among women. Women who were abused prior to entering the military were almost three times as likely to be nicotine dependent as those not abused. Men who had been exposed to combat or violence were twice as likely to be nicotine dependent as those not exposed.

The mental health status of women in the Navy and Marine Corps: preliminary findings from the Perceptions of Wellness and Readiness Assessment.

The 1995 Perceptions of Wellness and Readiness Assessment was designed to provide baseline health and risk-factor information on the physical and mental health status of women in the U.S. Navy and Marine Corps and to make comparisons both within military subpopulations and with civilian populations. A population-based, multi-stage, cluster sample of 782 active duty Navy and Marine Corps women and men were administered a structured computerized telephone interview to make Diagnostic and Statistical Manual-III-R psychiatric diagnoses. Estimates were 40 and 21% for overall lifetime and 1-year prevalence of psychiatric disorders, respectively. Women had about five times the risk of experiencing post-traumatic stress disorder than men and about twice the risk of a major depressive episode. Of all personnel meeting diagnostic criteria for an active mental disorder, only 19% sought mental health care in the last year. Women generally sought treatment more readily than men.

A demographic analysis of suicide among U.S. Navy personnel.

Age-, sex-, race-, and employment-adjusted standardized mortality ratios (SMRs) were calculated for sailors committing suicide between 1990 and 1996 and compared with adjusted SMRs for civilians. Cluster analyses were conducted on annual rates from 1983 through 1995 to examine differences between comparison groups across time and location. Results showed fewer than expected suicides for Caucasian and African American males and a somewhat higher than expected suicide rate among other ethnic group males and among Caucasian women. The suicide rate showed an increase during the study period, with some evidence toward a clustering effect in time and space.

Aircraft type and diagnosed back disorders in U.S. Navy pilots and aircrew.

BACKGROUND: Back disorders have long been recognized as a serious problem within the military aviation community and a possible threat to mission accomplishment. The purpose of the present study was to determine the extent to which the type of aircraft flown is associated with diagnosed back problems, and to examine differences in the prevalence of back disorders between pilots and aircrew. METHODS: A case-control study was conducted in which U.S. Navy pilots and aircrew members with a diagnosed back disorder on their most recent physical exam between 1991 and 1993 were compared with pilots and aircrew without such diagnoses. Data were obtained from the automated physical examination records maintained by the Naval Operational Medicine Institute for all Naval aviation personnel. RESULTS: Results showed that aircrew members have a higher risk of diagnosed back problems than pilots for both helicopters and fixed-wing aircraft. The study revealed that flight engineers have a higher risk of diagnosed back problems than other aircrew members. Among pilots, no association was found between type of aircraft and diagnosed back problems.

Predictors of gender differences in sunscreen use and screening outcome among skin cancer screening participants.

This study identified predictors of sunscreen use in males and females and examined the extent to which gender differences in sunscreen use were associated with skin cancer screening outcomes. Subjects were 351 adult Southern California residents who participated in one of five free skin cancer screenings. Logistic regression models showed that sunscreen use was significantly associated with sex, personal and family history of skin cancer, and a sun sensitivity index. The latter three factors were found to be confounders of the sex-sunscreen use relationship. Whereas female use of sunscreen was best predicted by her sun sensitivity, male use of sunscreen was best predicted by a family history of skin cancer. Screening outcomes also varied by sex, suggesting that the interrelationships among gender, family history of skin cancer, and sun sensitivity have important implications for sunscreen use, which may in turn impact clinical outcomes.

Determinants of perceived mental health status and help-seeking behavior: preliminary testing of a conceptual model.

This paper presents a preliminary test of the conceptual model of cognitive determinants of the perception of mental health status. Path analysis was used to examine the causal relationships between education, awareness of higher level needs, one's definition of mental health, and self-rating of mental health status. Discriminant analyses was used to evaluate these variables and others as predictors of help-seeking behavior. Results indicate the importance of cognitive factors in the perception of mental health status and support a direct causal interpretation of model variables. Symptom checklist scores and path variables were found to be the best predictors of help-seeking behavior.

A population-based survey of loss and psychological distress during war.

Research on the psychological effects of war has been conducted on a limited number of population groups and has generally failed to study the experience of particular losses while warfare was still in progress. This paper presents the results of a household surveillance study of 5788 displaced and non-displaced civilians conducted during the summer 1982 war in Lebanon. In order to determine demographic differences in the psychological response to war and help identify population groups possibly at-risk for mental disorder, an interview checklist of symptoms of psychological distress was developed and administered to a key informant in each household. The occurrence of psychological distress symptoms varied significantly by age, sex, nationality, socio-economic status, loss of physical health and economic loss. A more detailed analysis of the psychological effect of displacement or loss of one's home during war is presented. Displacement group differentials suggest that psychological distress may be more frequently perceived post-war and that both social integration and social isolation may play important roles in mediating the perception of psychological distress during war.