Risk, Resilience, and Behavioral Health in the Ohio National Guard, 2008-2012

1. Risk, Resilience, and Behavioral Health in the Ohio National Guard, 2008-2012

2. I. DEMOGRAPHICS: The Who

3. ONG sample demographics (1) % among those in each wave race gender age *Waves 3 and 4 include the dynamic cohorts

4. ONG sample demographics (2) % among those in each wave rank marital status *Waves 3 and 4 include the dynamic cohorts

5. Clinical sub-sample demographics (1) % among those in each wave race gender age *Waves 3 and 4 include the dynamic cohorts

6. Clinical sub-sample demographics (2) % among those in each wave rank marital status *Waves 3 and 4 include the dynamic cohorts

7. II. DEPLOYMENT CYCLES

8. Number of lifetime deployments per person at baseline % % % of soldiers % % % % % Number of lifetime deployments

9. Proportion deployed within past year by wave and location % of soldiers deployed W1 W2 W3 W4 2008 2009 2010 2011 2012 Area of conflict = Iraq or Afghanistan. Non-conflict area = U.S, Saudi Arabia and Kuwait, other

10. Proportion deployed within past year by wave and location Kuwait and domestic hurricane relief Afghanistan surge % of soldiers deployed W1 W2 W3 W4 2008 2009 2010 2011 2012 Area of conflict = Iraq or Afghanistan. Non-conflict area = U.S, Saudi Arabia and Kuwait, other

11. Number of deployments per person within past year through the course of the study

12. III. RISK AND RESILIENCE

13. Three elements of risk

14. Pre-deployment risk factors

15. Sexual assault: most lifetime sexual traumas reported at baseline occurred outside of a deployment setting Not deployment-related Deployment-related Rape Sexual assault (n=114) (n=106) (n=61) (n=14) Women Men (n=388) (n=2228) n=2616

16. Pre-deployment preparation: Most soldiers in the sample agreed that they felt well-prepared Strongly disagree Strongly agree Scale from the Deployment Risk and Resilience Inventory: A Collection of Measures for Studying Deployment-Related Experiences of Military Personnel and Veterans

17. At baseline, soldiers had a comparable lifetime prevalence of civilian-related vs. deployment-related traumatic events Deployment-related events Civilian-related events % Among Total % Among Deployed n deployed at baseline = 1668, n total at baseline = 2616

18. Among both settings, assaultive-type events were more common n = 1839, respondents in baseline who specified their deployment status and did not have events of ambiguous settings or types

19. Peri-deployment risk factors

20. On average, soldiers reported high levels of unit support during their most recent deployment Strongly disagree Strongly agree Scale from the Deployment Risk and Resilience Inventory: A Collection of Measures for Studying Deployment-Related Experiences of Military Personnel and Veterans

21. Although most sexual trauma occurred in a civilian setting, there was an appreciable exposure of deployment-related sexual trauma Women (n = 169) Men (n = 1498) sexual assault only 2% sexual assault only 0.4% both 1% sexual harassment only 13% sexual harassment only 27% none 54% both 17% none 86% *among those deployed

22. % among those deployed • Many soldiers experienced extremely stressful combat-related events during deployment n = 1668

23. Post-deployment risk factors

24. Soldiers in general reported feeling supported post-deployment, but not necessarily understood Strongly disagree Strongly agree Scale from the Deployment Risk and Resilience Inventory: A Collection of Measures for Studying Deployment-Related Experiences of Military Personnel and Veterans

25. Post-deployment unemployment: At each wave, about 18% of soldiers deployed in the past year lost a job, were laid off, or lost a large part of their income in the past year % out of those deployed in past year

26. IV. Psychiatric disorders

27. IV. Psychiatric disorders • -An overview

28. Depression and alcohol use disorders were more prevalent than PTSD across all 4 years % out of those who completed each wave (n = 2616) (n = 1770) (n = 1395) (n = 1172)

29. Prevalence of all condition co-morbidity at baseline Past 30 days Past year Lifetime No disorder One disorder At least two disorders

30. Baseline prevalence of other conditions among those with PTSD within the past year (N=188) 38% has no other condition, 41% had one other condition, and 20% had 2 or more.

31. V. Psychopathology by risk and resilience factors: • How do the “pre-, peri-, and post-” matter?

32. PRE-Deployment risk factors for PTSD

33. Those with prior lifetime sexual trauma exposure had a higher prevalence of past-year PTSD men* women* % with past-year PTSD (n=388) (n=2228) n=2616; *all comparisons significant at p<0.001

34. PERI-Deployment risk factors for PTSD

35. Soldiers with traumas during deployment were more likely than those with non-deployment traumas to experience flashbacks and insomnia Deployment events Non-deployment events flashbacks flashbacks insomnia insomnia

36. However, those with traumas during deployment were less likely than those with non-deployment-related events to report intrusive memoriesand fear/helplessness/horror Deployment events Non-deployment events fear, helplessness, or horror fear, helplessness, or horror intrusive memories intrusive memories

37. POST-Deployment risk factors for PTSD

38. Soldiers with high post-deployment support were significantly less likely to have past-year deployment-related PTSD % with past-year PTSD Among those who had at least one potentially traumatic event during deployment, n = 1266. High post-deployment support = a score of 24 or higher on a scale that sums items ranging from 1 (strongly disagree) to 5 (strongly agree) – see slide 25

39. A combination: Pre-, peri-, and post-deployment factors all matter for PTSD

40. Those with low levels of preparedness, unit support and post-deployment support have the highest prevalence of PTSD Combination of the three factors e.g. HLH = high preparedness, low unit support, high post-deployment support. Among those who have been deployed and experienced a traumatic event during their most recent deployment (n=1294)

41. PRE-Deployment risk factors for depression

42. Those with lifetime sexual trauma exposure had a higher prevalence of past-year depression men* women* % with past-year depression (n=388) (n=2228) n=2616; *all comparisons significant at p<0.001

43. PERI-Deployment risk factors for depression

44. Soldiers who experienced potentially traumatic events during their most recent deployment were more likely to have past-year depression than those who experienced non-deployment-related events % with past-year depression Includes respondents in baseline who specified their deployment status and did not have events of ambiguous settings or types (n = 1839).

45. POST-Deployment risk factors for depression

46. Soldiers with high post-deployment support were significantly less likely to have past-year Depression % with past-year Depression Among those who have been deployed at baseline (N = 1668). High post-deployment support = a score of 24 or higher on a scale that sums items ranging from 1 (strongly disagree) to 5 (strongly agree) – see slide 25

47. A combination of pre- and peri- deployment risk: • What is it about trauma that matters?

48. Although soldiers with deployment-related events in general were more likely to have depression, the type of the event seems to matter more than the setting % with past-year depression Includes respondents in baseline who specified their deployment status and did not have events of ambiguous settings or types

49. V. A look over time:Knowledge requires a longitudinal approach

50. Individuals show different trajectories of stress response after traumatic events Norris FH. Looking for resilience: Understanding the longitudinal trajectories of responses to stress. Social Science & Medicine 2009; 68(12):2190-2198.