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BackgroundMost previous attempts to determine the psychological cost of military deployment have been limited by reliance on convenience samples, lack of pre-deployment data or confidentiality and cross-sectional designs.AimsThis study addressed these limitations using a population-based, prospective cohort of US military personnel deployed in support of the operations in Iraq and Afghanistan.MethodThe sample consisted of US military service members in all branches including active duty, reserve and national guard who deployed once (n= 3393) or multiple times (n= 4394). Self-reported symptoms of post-traumatic stress were obtained prior to deployment and at two follow-ups spaced 3 years apart. Data were examined for longitudinal trajectories using latent growth mixture modelling.ResultsEach analysis revealed remarkably similar post-traumatic stress trajectories across time. The most common pattern was low–stable post-traumatic stress or resilience (83.1% single deployers, 84.9% multiple deployers), moderate–improving (8.0%, 8.5%), then worsening–chronic posttraumatic stress (6.7%, 4.5%), high–stable (2.2% single deployers only) and high–improving (2.2% multiple deployers only). Covariates associated with each trajectory were identified.ConclusionsThe final models exhibited similar types of trajectories for single and multiple deployers; most notably, the stable trajectory of low post-traumatic stress pre- to post-deployment, or resilience, was exceptionally high. Several factors predicting trajectories were identified, which we hope will assist in future research aimed at decreasing the risk of post-traumatic stress disorder among deployers.

Objective. We investigated relations between deployment and new-onset depression among US service members recently deployed to the wars in Iraq and Afghanistan. Methods. We included 40 219 Millennium Cohort Study participants who completed baseline and follow-up questionnaires and met inclusion criteria. Participants were identified with depression if they met the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire criteria for depression at follow-up, but not at baseline. Results. Deployed men and women with combat exposures had the highest onset of depression, followed by those not deployed and those deployed without combat exposures. Combat-deployed men and women were at increased risk for new-onset depression compared with nondeployed men and women (men: adjusted odds ratio [AOR] = 1.32; 95% confidence interval [CI] = 1.13, 1.54; women: AOR = 2.13; 95% CI = 1.70, 2.65). Conversely, deployment without combat exposures led to decreased risk for new-onset depression compared with those who did not deploy (men: AOR = 0.66; 95% CI = 0.53, 0.83; women: AOR = 0.65; 95% CI = 0.47, 0.89). Conclusions. Deployment with combat exposures is a risk factor for new-onset depression among US service members. Post-deployment screening may be beneficial for US service members exposed to combat.

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In rats, the onset of the sexually dimorphic pattern of growth hormone (GH) secretion and increased hepatic GH-binding capacity at puberty are temporally correlated with the sex-dependent expression of some hepatic cytochrome P450 enzymes involved in steroid metabolism. There are indications that the expression of the GH receptor gene itself is dependent on the sexually differentiated pattern of GH secretion. However, the molecular mechanisms by which a given pattern of GH secretion turns on a specific set of genes in the hepatocyte are not yet understood. Studies of the cytochrome P450 2C gene subfamily in hypophysectomized rats and isolated hepatocytes suggest that one major mechanism of GH action in the liver occurs through modulation of gene transcriptional initiation. The occurrence, in dwarf rats and in rats treated neonatally with monosodium glutamate, of sex differences in GH secretion and liver steroid metabolism typical of normal rats, in spite of a 95% reduction in pituitary GH levels, is compatible with the notion that extremely low levels of circulating GH are sufficient to regulate the expression of liver steroid-metabolizing enzymes. This, together with the fact that single daily subcutaneous injections of GH are sufficient to masculinize the liver of a hypophysectomized rat, indicates that neither the amplitude nor the frequency of the GH pulse is recognized as male or female by the hepatocyte, but rather the complete and prolonged suppression (in males) or the persistence (in females) of circulating GH during the trough period after a GH surge.

Objective To determine if baseline functional health status, as measured by SF-36 (veterans), predicts new onset symptoms or diagnosis of post-traumatic stress disorder among deployed US military personnel with combat exposure.Design Prospective cohort analysis.Setting Millennium Cohort.Participants Combat deployed members who completed baseline (2001-3) and follow-up (2004-6) questionnaires. Self reported and electronic data used to examine the relation between functional health and post-traumatic stress disorder.Main outcome measures New onset post-traumatic stress disorder as measured by either meeting the DSM-IV criteria with the 17 item post-traumatic stress disorder checklist-civilian version or self report of a physician diagnosis at follow-up with the absence of both at baseline.Results Of the 5410 eligible participants, 395 (7.3%) had new onset symptoms or diagnosis of post-traumatic stress disorder at the time of follow-up. Individuals whose baseline mental or physical component summary scores were below the 15th centile had two to three times the risk of symptoms or a diagnosis of post-traumatic stress disorder by follow-up compared with those in the 15th to 85th centile. Of those with new onset symptoms or diagnosis of post-traumatic stress disorder, over half (58%) of cases occurred among participants with scores below the 15th centile at baseline.Conclusions Low mental or physical health status before combat exposure significantly increases the risk of symptoms or diagnosis of post-traumatic stress disorder after deployment. More vulnerable members of a population could be identified and benefit from interventions targeted to prevent new onset post-traumatic stress disorder.

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