Prospective investigation of the interrelation of new and persistent mental health symptoms and coping behaviors in a large military cohort

Combat exposure is known to increase the risk for mental health outcomes, however, little is known about the temporal relationship of mental health symptoms and coping mechanisms. The objective of this study was to prospectively investigate new and persistent mental health symptoms in association with newly reported alcohol misuse and cigarette smoking while differentiating by deployment experience.

The Millennium Cohort Study began in 2001, before the current military conflicts, and obtained follow-up data from over 55,000 participants approximately 3 years later. Posttraumatic stress disorder was assessed using the PTSD Checklist, and major depressive, panic and other anxiety syndromes were assessed using the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire. Self-reported use of cigarettes and alcohol misuse were measured at baseline and follow-up. Mental disorders were aggregated to investigate relationships with smoking and drinking behaviors, using logistic regression models to adjust for demographic, military and behavioral characteristics. At both baseline and follow-up, approximately 7% of participants screened positive for a mental health disorder. Service members who screened positive were proportionately more likely to report a new alcohol-related problem or smoking uptake at follow-up. At both time periods, the percentage of those who reported smoking and alcohol-related problems was approximately two-fold among those with mental health disorders compared to those without a disorder. Differentiating between deployers and non-deployers and including all services and active duty and Reserve/National Guard, this study quantifies the mental health comorbidities and associated smoking and problem drinking in a large Military Cohort.