Point prevalence survey to evaluate the seropositivity for coronavirus disease 2019 (COVID-19) among high-risk healthcare workers.

Among 1,770 healthcare workers serving in high-risk care areas for coronavirus disease 2019 (COVID-19), 39 (2.2%) were seropositive. Exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the community was associated with being seropositive. Job or unit type and percentage of time working with COVID-19 patients were not associated with positive antibody tests.

Serving Those Who Serve Their Country: Preparing Military Veterans for Nursing Degrees.

BACKGROUND: Challenges remain for integrating Veterans into civilian occupations postservice. This article describes an innovative project affording military service personnel serving in health occupational specialties the opportunity for completion of a Bachelor of Science in Nursing (BSN) degree. METHOD: The Vets2BSN project, launched in July 2014, has achieved several years of enrollment and graduation success using standardized measures and assessment of student modifiers to establish project success. RESULTS: Nearly 80 eligible students holding current or former rank as corpsmen or medics have enrolled in the program with 59 conferrals and an NCLEX pass rate of 98% (48 of 49). Prospective assessment of progress allows real-time intervention and remediation to achieve successful graduation rates. CONCLUSION: Collaboration of university administration and faculty has provided a foundation for reintegration of military health professionals possessing skills allowing for educational credit and acceleration of studies toward earning the BSN and joining the workforce as nursing professionals. [J Nurs Educ. 2019;58(8):444-453.].

Isolating the Association of Sleep, Depressive State, and Other Independent Indicators for Suicide Ideation in United States Teenagers.

According to the Centers for Disease Control and Prevention, suicide is the second leading cause of death in American teenagers, and is a growing public health concern. This study uses multivariable logistic regression to investigate the independent relationship between suicide ideation and sleep duration in teenagers using the 2015 Youth Behavior Risk Surveillance Study, controlling for demographic, behavioral, and other factors found to be associated. Sleep durations of 4-5 hours and 6-7 hours per night were associated with approximately 75-80% and 20-40% increased adjusted odds of suicide ideation, as compared to teens sleeping the recommended 8 hours or more, and should be considered as a potential important indicator for adolescent suicidal ideation in primary-care screens.

When Should "Pre" Carry as Much Weight in the Diabetes Comorbidity Debate? Insights From a Population-Based Survey.

INTRODUCTION: Estimates indicate that 86 million people in the United States fit the clinical definition of prediabetes, which contributes to the epidemic of nearly 2 million new diagnoses of type 2 diabetes mellitus each year. Effort has focused on preventing prediabetes from progressing to clinical diabetes. We investigated the sociodemographic, behavioral, and health factors in people diagnosed with diabetes or prediabetes and associated leading indicators and comorbidities. METHODS: We used Behavioral Risk Factor Surveillance System data from 2011 through 2015 (N = 1,699,754). All respondents aged 18 years or older with complete covariate data were included, differentiating between self-reported diagnosis of diabetes or prediabetes. Weighted univariate and multivariable logistic regression analyses of 28 variables were developed, with adjusted odds of diagnosis, and standardized coefficients were calculated to rank predictors for diabetes and prediabetes. RESULTS: Prevalence of prediabetes increased each year between 2011 and 2014. After adjusting for demographic, lifestyle, and health variables, the most significant predictors in magnitude of importance for prediabetes and diabetes were age and body mass index. Although adjusted odds for cardiovascular disease and kidney disease were higher in respondents with diabetes than in those with prediabetes, respondents with prediabetes had higher adjusted odds of arthritis, depressive disorder, cancer, and chronic obstructive pulmonary disease. CONCLUSIONS: Concurrent chronic diseases occur in people with prediabetes even at normal and overweight classifications. By identifying the conditions that are concomitant with diabetes, people with prediabetes can be provided with more rigorous and individualized treatments that can lead to better population health.

Voluntarily Reported Immunization Registry Data: Reliability and Feasibility to Predict Immunization Rates, San Diego, California, 2013.

OBJECTIVES: Accurate data on immunization coverage levels are essential to public health program planning. Reliability of coverage estimates derived from immunization information systems (IISs) in states where immunization reporting by medical providers is not mandated by the state may be compromised by low rates of participation. To overcome this problem, data on coverage rates are often acquired through random-digit-dial telephone surveys, which require substantial time and resources. This project tested both the reliability of voluntarily reported IIS data and the feasibility of using these data to estimate regional immunization rates. METHODS: We matched telephone survey records for 553 patients aged 19-35 months obtained in 2013 to 430 records in the San Diego County IIS. We assessed concordance between survey data and IIS data using κ to measure the degree of nonrandom agreement. We used multivariable logistic regression models to investigate differences among demographic variables between the 2 data sets. These models were used to construct weights that enabled us to predict immunization rates in areas where reporting is not mandated. RESULTS: We found moderate agreement between the telephone survey and the IIS for the diphtheria, tetanus, and acellular pertussis (κ = 0.49), pneumococcal conjugate (κ = 0.49), and Haemophilus influenzae type b (κ = 0.46) vaccines; fair agreement for the varicella (κ = 0.39), polio (κ = 0.39), and measles, mumps, and rubella (κ = 0.35) vaccines; and slight agreement for the hepatitis B vaccine (κ = 0.17). CONCLUSIONS: Consistency in factors predicting immunization coverage levels in a telephone survey and IIS data confirmed the feasibility of using voluntarily reported IIS data to assess immunization rates in children aged 19-35 months.

Critical congenital heart defects and abnormal levels of routinely collected first- and second-trimester biomarkers.

We examined the association between maternal characteristics, routinely collected first- and second-trimester biomarkers and the risk of having an infant with a critical congenital heart defect (CCHD). Included were women who participated in the California Prenatal Screening Program who had nuchal translucency (NT) measurement and first- and second-trimester serum screening. All pregnancies ended in a live birth of an infant without aneuploidy or a neural tube defect. Poisson regression analyses were used to estimate the relative risk and 95% confidence interval of a CCHD by maternal characteristics, first- and second-trimester serum biomarkers or NT measurements. The sample included 118,194 mother-infant pairs; 284 infants had a CCHD. Women with preexisting diabetes were three-times as likely to have an infant with a CCHD. After adjusting for preexisting diabetes, women with first-trimester human chorionic gonatotropin (hCG) measurement <10th centile were 1.6-times as likely to have an infant with a CCHD (P = 0.011). Women with a NT measurement ≥95th centile were at two- to threefold higher risk of having an infant with a CCHD (P's = 0.004-0.007). Pregnancies with two risk factors for an infant with a CCHD were 5.6-times more likely to have an infant with a CCHD than women with no identified risk factors (P < 0.001). Despite the increased risk, performance testing demonstrated low sensitivity and specificity for screening use of these risk factors. Of the women with an infant with a CCHD, only 21.8% had an identified risk factor. © 2016 Wiley Periodicals, Inc.

Longitudinal Assessment of Self-Reported Recent Back Pain and Combat Deployment in the Millennium Cohort Study.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: Activities performed during military operations vary in complexity and physical demand. The risk for mental illness following military combat deployment has been well documented. However, information regarding the possible contribution of back pain to decreased mental and functional health is scarce. To our knowledge, this is the first study to prospectively assess deployment and self-reported recent back pain in a population-based U.S. military cohort. SUMMARY OF BACKGROUND DATA: The study consisted of Millennium Cohort participants who were followed for the development of back pain for an average of 3.9 years. METHODS: Descriptive statistics and longitudinal analyses were used to assess the temporal relationship of deployment with self-reported recent back pain at follow-up (N = 53,933). RESULTS: Recent back pain was self-reported by 8379 (15.5%) participants at follow-up. After adjusting for covariates, deployers with combat experiences had higher odds [odds ratio (OR) = 1.38, 95% confidence interval (95% CI): 1.28-1.50] of recent back pain than noncombat deployers. There was no association between recent back pain and nondeployers compared with noncombat deployers. Service support/supply handlers were at an increased odds of reporting recent back pain (OR = 1.11, 95% CI: 1.02-1.21) than functional support/administration occupations. Occupations associated with a physically demanding work environment had a higher risk of back pain. CONCLUSION: Deployers with combat experiences were more likely to report back pain postdeployment. This well-defined group of military personnel may potentially benefit from integrated prevention efforts. LEVEL OF EVIDENCE: 3.

Effects of registered nurse staffing level on hospital-acquired conditions in cardiac surgery patients: A propensity score matching analysis.

BACKGROUND: The ramifications of inadequate nurse staffing may have serious consequences due to reimbursement policies. PURPOSE: To determine the effects of registered nurse staffing on hospital-acquired conditions in cardiac surgery patients. METHOD: Data from the 2009 to 2011 Nationwide Inpatient Sample were used to construct a propensity score-matched cohort. Multivariate regressions were performed to compare the probability, length of stay, mortality, and costs of three common hospital-acquired conditions between low- and high-staffing hospitals. RESULTS: A total of 439,365 patients in low-staffing hospitals were 1:1 matched to patients in high-staffing hospitals. High-staffing hospitals had 10% to 25% fewer cases (adjusted odds ratio [AOR] 0.75-0.90, p < .0001), 5% to 20% lower mortality (AOR 0.80-0.95, p < .0001), and 4% to 6% shorter length of stay (coefficient -0.06 to -0.04, p < .0001). The costs for patients with hospital-acquired conditions were 13% to 17% greater in high-staffing hospitals (coefficient 0.13-0.17, p < .0001). CONCLUSIONS: Alternatives to the current staffing and reimbursement policies should be considered to reduce hospital-acquired conditions.

Deployment, combat, and risk of multiple physical symptoms in the US military: a prospective cohort study.

PURPOSE: Multiple physical symptoms (MPS) have historically been observed after deployment to a combat zone and are often disabling in nature. This study examined longitudinal trends in MPS status and its relationship to deployment in U.S. military service members. METHODS: Using longitudinal data from panel 1 participants in the Millennium Cohort Study (n = 76,924), MPS status was assessed at three time points (2001-2008) using the 15-item Patient Health Questionnaire. Probability of reporting MPS was analyzed using mixed-effects multinomial logit regression, with time and deployment experience as main explanatory variables. RESULTS: After adjustment for demographic, military, and health characteristics, service members who deployed with combat were significantly more likely to report MPS at each time point compared with those not deployed (odds ratio [OR] and 95% confidence interval [CI] for wave 1 = 1.49 [1.47-1.52], wave 2 = 1.73 [1.69-1.78], wave 3 = 2.08 [2.03-2.12]), and those who deployed without combat (OR and CI for wave 1 = 2.66 [2.59-2.74], wave 2 = 1.81 [1.75-1.87]; wave 3 = 1.68 [1.63-1.74]). CONCLUSIONS: Longitudinal trends indicate that the probability of reporting MPS has increased consistently over time only for those deployed, regardless of combat experience.

Using Administrative Mental Health Indicators in Heart Failure Outcomes Research: Comparison of Clinical Records and International Classification of Disease Coding.

BACKGROUND: Use of mental indication in health outcomes research is of growing interest to researchers. This study, as part of a larger research program, quantified agreement between administrative International Classification of Disease (ICD-9) coding for, and "gold standard" clinician documentation of, mental health issues (MHIs) in hospitalized heart failure (HF) patients to determine the validity of mental health administrative data for use in HF outcomes research. METHODS: A 13% random sample (n = 504) was selected from all unique patients (n = 3,769) hospitalized with a primary HF diagnosis at 4 San Diego County community hospitals during 2009-2012. MHI was defined as ICD-9 discharge diagnostic coding 290-319. Records were audited for clinician documentation of MHI. RESULTS: A total of 43% (n = 216) had mental health clinician documentation; 33% (n = 164) had ICD-9 coding for MHI. ICD-9 code bundle 290-319 had 0.70 sensitivity, 0.97 specificity, and kappa 0.69 (95% confidence interval 0.61-0.79). More specific ICD-9 MHI code bundles had kappas ranging from 0.44 to 0.82 and sensitivities ranging from 42% to 82%. CONCLUSIONS: Agreement between ICD-9 coding and clinician documentation for a broadly defined MHI is substantial, and can validly "rule in" MHI for hospitalized patients with heart failure. More specific MHI code bundles had fair to almost perfect agreement, with a wide range of sensitivities for identifying patients with an MHI.

Trends in pediatric spleen management: Do hospital type and ownership still matter?

BACKGROUND: Nonoperative management of traumatic blunt splenic injury is preferred over splenectomy because of improved outcomes and reduced complications. However, variability in treatment is previously reported with respect to hospital profit types and ownership. METHODS: Our study objectives were to investigate the past decade's trends in pediatric splenic injury management and to determine whether previously reported disparities by hospital type have changed. We analyzed data from the Kid's Inpatient Database from Healthcare Cost and Utility Project for Years 2000, 2003, 2006, and 2009. Multivariable logistic regression was used to investigate the likelihood of receiving splenectomy in different hospital profit and ownership types. Patients 18 years and younger admitted with blunt splenic injury (DRG International Classification of Diseases-9th Rev.-Clinical Modification code 865) were included. Treatment was dichotomized into nonoperative management, defined as initial attempt at nonoperative management, and operative management, defined as splenectomy within 1 day of admission. RESULTS: Of 17,044 patient records, 11,893 participants were studied. Not-for-profit hospitals demonstrated a higher rate of nonoperative management than for-profit hospitals in 2000 (83.8% vs. 71.0 %). Both not-for-profit and for-profit hospitals increased the use of nonoperative management, with a narrower disparity observed by 2009 (87.5% vs. 84.6%). The use of splenectomy was reduced significantly between 2000 and 2003 (odds ratio, 0.66; weighted 95% confidence interval, 0.54-0.81). The rate of nonoperative management in children's hospitals remained very high across the study period (98.6% in 2009) and continued to be the benchmark for pediatric spleen injury management. CONCLUSION: Improvement was observed in nonoperative management rates for pediatric spleen injuries in both not-for-profit and for-profit hospitals. However, general hospitals still fail to reach the target of 90% nonoperative management. Further investigations are needed to facilitate optimal management of such children in general hospitals. LEVELS OF EVIDENCE: Epidemiologic and prognostic study, level III.

Understanding the Early Signs of Chronic Disease by Investigating the Overlap of Mental Health Needs and Adolescent Obesity.

OBJECTIVE: Childhood obesity has reached epidemic proportions with two to three-fold increases in prevalence in the past three decades. Sedentary lifestyles and nutrition have been linked to these increases though little is known about mental health illnesses in children and teens which may be precursors to negative modifiable health risk factors. The objective of this study was to investigate for a potentially more clinically practical indicator of depression over a multi-item screen in respect to reporting of overweight and obesity in adolescents. This study further investigated modifiers to this association and stability of association. METHOD: This cross-sectional study aggregated 2007/2009 California Health Interview Survey data (n = 6,917 adolescents). Univariate analyses of population characteristics and modifiable behaviors with obesity/overweight and depression are presented. Multivariable weighted logistic regression was used to compare the adjusted odds of overweight and obesity for those children with reported depression. RESULTS: After controlling for gender, race/ethnicity, age, and modifiable behaviors, there was a statistically significant relationship between reported depression and overweight/obesity (OR = 1.24; 95% CI = 1.04, 1.49). This effect size was consistent in hierarchical models overall and stratified by gender. CONCLUSIONS: Overweight and obesity in adolescents should be understood clinically in the context of depression and other mental health illness. This study highlights a routine primary care or parental screening assessment that could indicate tendencies in adolescent boys and girls which may be precursors to overweight or obesity. Further research should be conducted to identify ways for integrating adolescent mental health screens into primary care.

Changes in Meeting Physical Activity Guidelines After Discharge From the Military.

BACKGROUND: Understanding physical activity (PA) after discharge from the military can inform theory on the role of habit and reinforcement in behavior maintenance and has implications for this population's future health. METHODS: Using data from 28,866 Millennium Cohort Study participants (n = 3782 of whom were discharged during the years between assessments), we 1) investigated changes in meeting federal PA guidelines for moderate-to-vigorous activity (MVPA) following military discharge and 2) determined predictors of meeting these guidelines after discharge. RESULTS: MVPA declined more in those who were discharged than in those who were not (-17.8 percentage points vs. -2.7 percentage points), with greater declines in former active-duty personnel, those who had deployed with combat exposures, had 14 to 25 years of service, and had been discharged more recently (>2 years prior). In those who were discharged, being normal or overweight (vs. obese), and a nonsmoker or former smoker (vs. current smoker) were positively associated with meeting MVPA Guidelines at follow-up, while meeting MVPA Guidelines at baseline and depression were inversely associated. CONCLUSIONS: Reductions in MVPA were substantial and unexpected. Increased understanding of transitional periods that may benefit from interventions to mitigate declines in PA will help prevent excess weight gain and physical inactivity-associated health consequences.

Chronic multisymptom illness: a comparison of Iraq and Afghanistan deployers with veterans of the 1991 Gulf War.

Symptoms and illnesses reported by veterans of the 1991 Gulf War era are a cause of potential concern for those military members who have deployed to the Gulf region in support of more recent contingency operations in Iraq and Afghanistan. In the present study, we quantified self-reported symptoms from participants in the Millennium Cohort Study, a prospective study representing all US service branches, including both active duty and Reserve/National Guard components (2001-2008). Self-reported symptoms were uniquely compared with those in a cohort of subjects from the 1991 Gulf War to gain context for the present report. Symptoms were then aggregated to identify cases of chronic multisymptom illness (CMI) based on the case definition from the Centers for Disease Control and Prevention. The prevalence of self-reported CMI symptoms was compared with that collected in 1997-1999 from a study population of US Seabees from the 1991 Gulf War, as well as from deployed and nondeployed subgroups. Although overall symptom reporting was much less in the Millennium Cohort than in the 1991 Gulf War cohort, a higher prevalence of reported CMI was noted among deployed compared with nondeployed contemporary cohort members. An increased understanding of coping skills and resilience and development of well-designed screening instruments, along with appropriate clinical and psychological follow-up for returning veterans, might help to focus resources on early identification of potential long-term chronic disease manifestations.

Building an evidence base for the co-occurrence of chronic disease and psychiatric distress and impairment.

INTRODUCTION: Mental disorders and chronic diseases have been reported to independently affect half of the US population. The objective of this study was to evaluate the comorbid nature of these conditions. METHODS: We analyzed data from 39,954 participants from the 2009 California Health Interview Survey who reported both psychological distress and impairment, on the basis of the Kessler 6 and the Sheehan Disability Scale, and 1 or more of 4 chronic diseases (type 2 diabetes, high blood pressure, asthma, heart disease). Weighted and nonweighted multivariable logistic regression were used to investigate the association between psychological distress and impairment and chronic disease, after adjusting for sex, age, race, current smoking, binge drinking in the previous year, moderate physical activity, and body mass index. RESULTS: After controlling for covariates in the model, we found a significant dose-response relationship between reported chronic diseases and psychiatric distress and impairment that ranged from 1.50 for 1 reported chronic disease to 4.68 for 4 reported chronic diseases. CONCLUSION: The growing chronic disease burden should be understood clinically in the context of mental health conditions. Further research is needed to identify ways to integrate mental health and chronic disease prevention in primary care.

Diabetes in US women on the rise independent of increasing BMI and other risk factors; a trend investigation of serial cross-sections.

BACKGROUND: The epidemic of diabetes continues leaving an enormous and growing burden of chronic disease to public health. This study investigates this growing burden of diabetes independent of increasing BMI in a large population based female sample, 2006-2010. METHODS: Serial cross-sectional data using the Behavioral Risk Factor Surveillance System (BRFSS) 2006-2010 surveys from 1,168,418 women. Diabetes was assessed by self-report of a physician diagnosis, and body mass index (BMI) was calculated based on self-reported height and weight. RESULTS: Almost 60% of women responders had a BMI > 25 (defined as overweight or obese). Diabetes was reported in 16% of respondents whose BMI > 25, and in 4% of respondents with reported BMI ≤ 25. Overall, 11% of the women in this sample reported being diagnosed with diabetes, of whom 83% had a BMI > 25. BMI, physical activity, age, and race were each independently associated with diabetes (p-value < 0.05). The odds of reported diabetes increased each year independent of BMI, physical activity, age, and race. CONCLUSIONS: After adjusting for age, race, physical activity, and year of survey response, results indicate a threefold increase in diabetes among respondents with a BMI > 25 (OR = 3.57; 95% CI = 3.52-3.63). Potentially more alarming was a notable increase in odds of diabetes across the years of study among women, implying a near 30 percent projected increase in odds of diabetes diagnoses by 2020. This is likely due to advances in diagnosis and treatment but also highlights a burden of disease that will have a growing and sustained impact on public health and healthcare systems.

Longitudinal assessment of mental disorders, smoking, and hazardous drinking among a population-based cohort of US service members.

OBJECTIVES: Combat exposure is known to increase the risk for mental disorders; however, less is known about the temporal relationship between mental disorders and alcohol misuse or smoking. To better understand these interrelationships, this study investigated mental disorders in association with hazardous drinking and cigarette smoking. METHODS: Using data from a large population-based military cohort, standardized instruments were used to screen for posttraumatic stress disorder, depression, panic, and other anxiety syndromes. Self-reported use of cigarettes and hazardous drinking was also assessed. Subjects were classified as having "new-onset," "persistent," or "resolved" mental disorders and health risk behaviors on the basis of screening results from baseline to follow-up (n = 50,028). Multivariable logistic regression models were used to investigate temporal patterns between the development of mental disorders and the uptake of smoking or hazardous drinking. RESULTS: The strongest associations of new-onset mental disorders were among those who newly reported smoking or hazardous drinking (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.28-2.59 and OR, 2.49; 95% CI, 2.15-2.89, respectively), even after adjustment for combat deployment experience. In addition, persistent smokers and hazardous drinkers had elevated odds for developing a mental disorder at follow-up. CONCLUSIONS: This study demonstrates a positive association between the onset of mental disorders with the uptake of smoking and hazardous drinking and the likelihood that multiple temporal sequence patterns exist to explain the relationship between mental disorders and hazardous drinking and smoking. Clinical approaches to mitigate deployment-related mental disorders should include alcohol and tobacco-related assessments and interventions.

Impact of combat deployment and posttraumatic stress disorder on newly reported coronary heart disease among US active duty and reserve forces.

BACKGROUND: The recent conflicts in Iraq and Afghanistan have exposed thousands of service members to intense stress, and as a result, many have developed posttraumatic stress disorder (PTSD). The role of military deployment experiences and PTSD in coronary heart disease (CHD) is not well defined, especially in young US service members with recent combat exposure. METHODS AND RESULTS: We conducted a prospective cohort study to investigate the relationships between wartime experiences, PTSD, and CHD. Current and former US military personnel from all service branches participating in the Millennium Cohort Study during 2001 to 2008 (n=60 025) were evaluated for newly self-reported CHD. Electronic medical record review for International Classification of Diseases, Ninth Revision, Clinical Modification codes for CHD was conducted among a subpopulation of active duty members (n=23 794). Logistic regression models examined the associations between combat experiences and PTSD with CHD with adjustment for established CHD risk factors. A total of 627 participants (1.0%) newly reported CHD over an average of 5.6 years of follow-up. Deployers with combat experiences had an increased odds of newly reporting CHD (odds ratio, 1.63; 95% confidence interval, 1.11-2.40) and having a diagnosis code for new-onset CHD (odds ratio, 1.93; 95% confidence interval, 1.31-2.84) compared with noncombat deployers. Screening positive for PTSD symptoms was associated with self-reported CHD before but not after adjustment for depression and anxiety and was not associated with a new diagnosis code for CHD. CONCLUSIONS: Combat deployments are associated with new-onset CHD among young US service members and veterans. Experiences of intense stress may increase the risk for CHD over a relatively short period among young adults.

Infant abusive head trauma in a military cohort.

OBJECTIVE: Evaluate the rate of, and risk factors for, abusive head trauma (AHT) among infants born to military families and compare with civilian population rates. METHODS: Electronic International Classification of Diseases data from the US Department of Defense (DoD) Birth and Infant Health Registry were used to identify infants born to military families from 1998 through 2005 (N = 676 827) who met the study definition for AHT. DoD Family Advocacy Program data were used to identify infants with substantiated reports of abuse. Rates within the military were compared with civilian population rates by applying an alternate AHT case definition used in a civilian study. RESULTS: Applying the study definition, the estimated rate of substantiated military AHT was 34.0 cases in the first year of life per 100 000 live births. Using the alternate case definition, the estimated AHT rate was 25.6 cases per 100 000 live births. Infant risk factors for AHT included male sex, premature birth, and a diagnosed major birth defect. Parental risk factors included young maternal age (<21 years), lower sponsor rank or pay grade, and current maternal military service. CONCLUSIONS: This is the first large database study of AHT with the ability to link investigative results to cases. Overall rates of AHT were consistent with civilian populations when using the same case definition codes. Infants most at risk, warranting special attention from military family support programs, include infants with parents in lower military pay grades, infants with military mothers, and infants born premature or with birth defects.

Risk factors associated with suicide in current and former US military personnel.

IMPORTANCE: Beginning in 2005, the incidence of suicide deaths in the US military began to sharply increase. Unique stressors, such as combat deployments, have been assumed to underlie the increasing incidence. Previous military suicide studies, however, have relied on case series and cross-sectional investigations and have not linked data during service with postservice periods. OBJECTIVE: To prospectively identify and quantify risk factors associated with suicide in current and former US military personnel including demographic, military, mental health, behavioral, and deployment characteristics. DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal study with accrual and assessment of participants in 2001, 2004, and 2007. Questionnaire data were linked with the National Death Index and the Department of Defense Medical Mortality Registry through December 31, 2008. Participants were current and former US military personnel from all service branches, including active and Reserve/National Guard, who were included in the Millennium Cohort Study (N = 151,560). MAIN OUTCOMES AND MEASURES: Death by suicide captured by the National Death Index and the Department of Defense Medical Mortality Registry. RESULTS: Through the end of 2008, findings were 83 suicides in 707,493 person-years of follow-up (11.73/100,000 person-years [95% CI, 9.21-14.26]). In Cox models adjusted for age and sex, factors significantly associated with increased risk of suicide included male sex, depression, manic-depressive disorder, heavy or binge drinking, and alcohol-related problems. None of the deployment-related factors (combat experience, cumulative days deployed, or number of deployments) were associated with increased suicide risk in any of the models. In multivariable Cox models, individuals with increased risk for suicide were men (hazard ratio [HR], 2.14; 95% CI, 1.17-3.92; P = .01; attributable risk [AR], 3.5 cases/10,000 persons), and those with depression (HR, 1.96; 95% CI, 1.05-3.64; P = .03; AR, 6.9/10,000 persons), manic-depressive disorder (HR, 4.35; 95% CI, 1.56-12.09; P = .005; AR, 35.6/10,000 persons), or alcohol-related problems (HR, 2.56; 95% CI, 1.56-4.18; P <.001; AR, 7.7/10,000 persons). A nested, matched case-control analysis using 20:1 control participants per case confirmed these findings. CONCLUSIONS AND RELEVANCE: In this sample of current and former military personnel observed July 1, 2001-December 31, 2008, suicide risk was independently associated with male sex and mental disorders but not with military-specific variables. These findings may inform approaches to mitigating suicide risk in this population.