TIHCER June Zoom 2020

These findings fit in with the fact that in Gulf War 1, which was virtually all air combat with only 170 hours of ground combat, there was a remarkably high prevalence of PTSD, but no  prolonged ground combat for the causal explanation.  Given the fact that GW1 was the first time an all-volunteer Army was in the field, I remembered my days as an Army doctor when I repeatedly saw that the Army was a powerful metaphor for a supportive family. The thought then crossed by mind that an all-volunteer Army might have an increased proportion of individuals seeking that support because of adverse childhood experiences. How encouraging to see this evidence; it suggests that further exploration might lead to significant benefits for military and civilian populations by the early recognition via ACE Screening of increased risk for certain outcomes.  

@Joshua S Strait my colleague Jodie Katon also did a cite we cite often (when we try to argue for TIC in VA)  but it did not look at era of service in the same way.  BRFSS data.  Katon JG, Lehavot K, Simpson TL, et al. Adverse Childhood Experiences, Military Service, and Adult Health. Am J Prev Med. 2015;49(4):573-582. doi:10.1016/j.amepre.2015.03.020

"Results: Those with military service had more total ACE than civilians. Higher ACE was associated with poorer HRQOL among women (physical health, military service, relative risk [RR]=1.20, 95% CI=1.09, 1.33; civilians, RR=1.18, 95% CI=1.17, 1.20; mental health, military service, RR=1.21, 95% CI=1.12, 1.32; civilians, RR=1.25, 95% CI=1.23, 1.26). Among men, these associations were somewhat attenuated in those with military service relative to civilians (physical health, military service, RR=1.13, 95% CI=1.09, 1.18; civilians, RR=1.20, 95% CI=1.17, 1.24; mental health, military service, RR=1.21, 95% CI=1.16, 1.27; civilians, RR=1.30, 95% CI=1.27, 1.34).

Conclusions: Relative to civilians, men and women with military service report more ACE, but associations of ACE with adult HRQOL are weaker among men with military service relative to civilians. There is a need to implement and disseminate evidence-based programs to prevent ACE and for research on the long-term health consequences of ACE in military populations."

Thanks for your service and your scholarship @Joshua S Strait

@Megan Gerber MD MPH posted:

Great presentation @Joshua S Strait - In VA we often cite this paper from Blosnich et al 2014: 

"Differences in the prevalence of ACEs were more pronounced

among men by history of military service in the all-volunteer

era than among men by history ofmilitary service in the draft

era (Table 2)."

 

Blosnich JR, Dichter ME, Cerulli C, Batten SV, Bossarte RM. Disparities in Adverse Childhood Experiences Among Individuals With a History of Military Service. JAMA Psychiatry. 2014;71(9):1041–1048. doi:10.1001/jamapsychiatry.2014.724

https://jamanetwork.com/journa.../fullarticle/1890091

This is a very important article! Thanks for sharing! 

Great presentation @Joshua S Strait - In VA we often cite this paper from Blosnich et al 2014: 

"Differences in the prevalence of ACEs were more pronounced

among men by history of military service in the all-volunteer

era than among men by history ofmilitary service in the draft

era (Table 2)."

Blosnich JR, Dichter ME, Cerulli C, Batten SV, Bossarte RM. Disparities in Adverse Childhood Experiences Among Individuals With a History of Military Service. JAMA Psychiatry. 2014;71(9):1041–1048. doi:10.1001/jamapsychiatry.2014.724

https://jamanetwork.com/journa.../fullarticle/1890091

@Vincent J. Felitti, MD posted:

This is a very interesting presentation, and I look forward to reading Dr. Strait's article in The Permanente Journal.  The subject has great relevance for the military because there is highly suggestive evidence that ACE Scores and their generally not-understood sequelae may be more common in a volunteer military that in a draft military.

Attached as Item 3 is an article describing how  routine ACE screening was carried out on a very large scale in one Kaiser Department, and its effects and benefits, which would have great value in the military.  Also attached are the comprehensive medical history questionnaire used that was filled out at home, and the output of the questionnaire from an anonymized actual patient. 

Thank you Dr. Felitti for your kind words and helpful attachments. Your paper is so important, especially in light of the military families I work with. Your words are inspiring and transformative: "We realized that asking, initially via an inert mechanism with later followup in the exam room, coupled with listening and implicitly accepting the person who had just shared his or her dark secrets, is a powerful form of doing." 

This is a very interesting presentation, and I look forward to reading Dr. Strait's article in The Permanente Journal.  The subject has great relevance for the military because there is highly suggestive evidence that ACE Scores and their generally not-understood sequelae may be more common in a volunteer military that in a draft military.

Attached as Item 3 is an article describing how  routine ACE screening was carried out on a very large scale in one Kaiser Department, and its effects and benefits, which would have great value in the military.  Also attached are the comprehensive medical history questionnaire used that was filled out at home, and the output of the questionnaire from an anonymized actual patient.