title: Risk of diabetes in U.S. military service members in relation to combat deployment and mental health.
abstract: OBJECTIVE
  Few prospective data exist on the risk of diabetes in individuals serving in the U.S. military. The objectives of this study were to determine whether military deployment, combat exposures, and mental health conditions were related to the risk of newly reported diabetes over 3 years.
  
  
  METHODS
  Data were from Millennium Cohort Study participants who completed baseline (July 2001-June 2003) and follow-up (June 2004-February 2006) questionnaires (follow-up response rate = 71.4%). After exclusion criteria were applied, adjusted analyses included 44,754 participants (median age 36 years, range 18-68 years). Survey instruments collected demographics, height, weight, lifestyle, military service, clinician-diagnosed diabetes, and other physical and mental health conditions. Deployment was defined by U.S. Department of Defense databases, and combat exposure was assessed by self-report at follow-up. Odds of newly reported diabetes were estimated using logistic regression analysis.
  
  
  RESULTS
  Occurrence of diabetes during follow-up was 3 per 1,000 person-years. Individuals reporting diabetes at follow-up were significantly older, had greater baseline BMI, and were less likely to be Caucasian. After adjustment for age, sex, BMI, education, race/ethnicity, military service characteristics, and mental health conditions, only baseline posttraumatic stress disorder (PTSD) was significantly associated with risk of diabetes (odds ratio 2.07 [95% CI 1.31-3.29]). Deployments since September 2001 were not significantly related to higher diabetes risk, with or without combat exposure.
  
  
  CONCLUSIONS
  In this military cohort, PTSD symptoms at baseline but not other mental health symptoms or military deployment experience were significantly associated with future risk of self-reported diabetes.
authors.affiliation: Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA. eboyko@uw.edu
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Isabel G
authors.initials: IG
authors.lastname: Jacobson
authors.forename: Besa
authors.initials: B
authors.lastname: Smith
authors.forename: Margaret A K
authors.initials: MA
authors.lastname: Ryan
authors.forename: Tomoko I
authors.initials: TI
authors.lastname: Hooper
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Amoroso
authors.forename: Gary D
authors.initials: GD
authors.lastname: Gackstetter
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: Tyler C
authors.initials: TC
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003130:Combat Disorders / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D055815:Young Adult