The Front Line of Military Mental Health

January 1, 2016

First-of-its-kind Department of Defense study advances mental health support and treatment for soldiers

Department of Psychiatry – January 2016 - View Full PDF

Joseph Calabrese, MD

UH Case Medical Center; Bipolar Disorders Research Chair; Professor, Department of Psychiatry; Case Western Reserve University School of Medicine

Since 2008, the Mood Disorders Research Program at University Hospitals Case Medical Center has served as the coordinating center for the Ohio Army National Guard Mental Health Initiative, a $20 million long-term prospective study of the development of post-traumatic stress disorder (PTSD) in active-duty combatants. The nine-year, multisite Department of Defense (DoD) project evaluates risk and resilience factors in the development of PTSD and other mental illnesses among Ohio Army National Guard soldiers.

All of the research conducted within the initiative is built on the base of a single longitudinal study of risk and resiliency in relation to five conditions: PTSD, alcohol abuse, alcohol dependence, depression and anxiety. This comprehensive approach underpins all of the research conducted within the initiative. The study catalogs the lives and military experiences of the soldiers, and tracks multiple mental health indicators over time. Data is collected via annual telephone interviews with a random sample of approximately 3,500 National Guard soldiers. Unlike previous studies of PTSD and other combat related mental disorders, however, this project is careful to capture the full spectrum of experiences in a soldier’s life both inside and outside the military.

The initiative is led by Joseph Calabrese, MD, Director of the Mood Disorders Program, UH Case Medical Center. Dr. Calabrese is a nationally recognized researcher who has served as principal investigator for more than 70 studies on the treatment of bipolar disorder and major depressive disorder.

“The inclusion of pre-, peri-, and post-deployment factors is a first in military PTSD research,” Dr. Calabrese notes. “Already we see a more accurate picture of a soldier’s lifelong mental health, and how events and experiences across the entire lifespan influence the incidence of PTSD and comorbidities such as depression.”

Initial studies, published in Drug and Alcohol Dependence using this robust data set quickly identified higher than expected incidence of depression, alcohol dependence and alcohol abuse. Additionally, as noted in the Journal of Clinical Psychiatry, investigators discovered that soldiers with PTSD and two or more comorbid conditions were seven times more likely to report suicidal ideation than those with PTSD alone. These findings are already influencing clinical psychiatric practices for the Ohio Army National Guard. More recent work in the journal Military Medicine has shown that childhood adversity may serve as a predictor of post-deployment depression. This information will assist with earlier identification of soldiers likely to need support services.

Research teams at the five partner sites, including UH Case Medical Center and the University of Toledo, have free access to the data and participants from the large study through the coordinating center within the Mood Disorders Research Program. As of October 2015, the initiative has yielded 24 peer-reviewed papers, with five more currently under review.

The depth and breadth of the data set also served as a springboard for four additional DoD-sponsored projects. In one such project, researchers at the University of Michigan are using the sample to test an early intervention program for alcohol misuse that can be delivered via smart phone app and text messaging.

This pioneering research has major implications for the training of National Guard soldiers, the care and treatment of adjustment-related illnesses and the provision of post-deployment social support.

Dr. Calabrese concludes, “Our goal is to use these findings to quickly drive training, screening and treatment protocols that more effectively identify and reach the soldiers and their families who need support and intervention the most.”

The $20 million research project was initiated and championed by Rep. Marcy Kaptur of Ohio’s 9th Congressional District, who approached Dr. Calabrese to serve as collaborator and secured initial funding through a Congressional allocation. The project is currently funded by the U. S. Army Medical Research and Material Command, U.S. Army Medical Research Acquisition Activity, and the Office of the Assistant Secretary of Defense for Health Affairs through the Joint Warfighter Medical Research Program. In 2015, the DoD funded another grant for the project, providing an additional $6.5 million to fund the continuation of these landmark studies through 2019.

To learn more about Dr. Calabrese’s research and program, please contact him via email at:  psychiatry@uhhospitals.org

 

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