U.S. military health: The epidemiology of occupational risk factors and long-term health across the life-course
U.S. military service is associated with both health promoting (e.g. physical activity) and health compromising (e.g. psychological trauma) factors that influence health across the life-course. Therefore, understanding how military service may affect the long-term physical, psychological, and social health of service members and veterans is of public health importance. This dissertation (1) investigated the change in persistent post-traumatic stress disorder (PTSD) and post concussive symptoms (PPCS) among patients diagnosed with mild traumatic brain injury seen at a major U.S. military treatment facility from 2008-2013, (2) developed clinical prediction equations of persistent symptom change with predictor variables of interest, and (3) compared the prevalence of metabolic syndrome among veterans and civilians receiving medical evaluations at the Cooper Clinic from 1970-2013. Paired t-tests and mean standardized differences were calculated among 257 patients to evaluate pre- to post-treatment symptom change. Results indicated that the multidisciplinary treatment program was associated with a resolution of global and domain specific persistent PTSD and PPCS. The same sample of 257 patients was used to explore prediction equations of persistent symptom change and clinically meaningful PTSD treatment response. Results from prediction equations indicated that pre-treatment PPCS symptom burden and pre-treatment PTSD diagnosis were the only clinically meaningful predictors identified influencing post-treatment PPCS. Pre-treatment PTSD symptom burden was the only clinically meaningful predictor identified influencing post-treatment PTSD symptom burden or clinically meaningful PTSD treatment response. Among a sample of 64,220 civilians and 1,250 veterans, the prevalence of metabolic syndrome and individual metabolic syndrome risk factors were compared. Prevalence ratios using generalized linear models were reported after adjusting for confounders. Veterans reported a lower prevalence of metabolic syndrome and two of the individual metabolic syndrome risk factors (i.e. low HDL-C and high triglyceride levels). Conversely, veterans reported a higher prevalence of one metabolic risk factor (i.e. large waist circumference). In conclusion, evidence from this research indicates that the multidisciplinary treatment program was associated with resolution of persistent symptoms attributed to mild traumatic brain injury. Furthermore, results support existing research suggesting that a treatment approach addressing comorbidities such as PTSD is important in order to meet the needs of patients with persistent symptoms. Lastly, this research potentially supports a veteran resiliency theory suggesting that a subgroup of veterans view their military experience as a positive influence on their life that was key to instilling health promoting rather than health compromising behaviors associated with a poor metabolic risk profile.
Public health|Military studies|Epidemiology
Janak, Judson Clarke, "U.S. military health: The epidemiology of occupational risk factors and long-term health across the life-course" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3639338.