title: Grief and physical health outcomes in U.S. soldiers returning from combat.
abstract: BACKGROUND
  Few studies have measured the burden of physical health problems after Iraq/Afghanistan deployment, except in association with post-traumatic stress disorder (PTSD) or mild traumatic brain injury (mTBI). Grief, a correlate of health problems in the general population, has not been systematically examined. We aimed to identify the prevalence of post-deployment physical health problems and their association with difficulty coping with grief.
  
  
  METHODS
  Infantry soldiers (n=1522) completed anonymous surveys using validated instruments six months following deployment in November-December 2008. Multiple logistic regression was used to assess the association of difficulty coping with grief and physical health.
  
  
  RESULTS
  The most frequent physical health symptoms reported were: sleep problems (32.8%), musculoskeletal pain (32.7%), fatigue (32.3%), and back pain (28.1%). Difficulty coping with grief over the death of someone close affected 21.3%. There was a dose-response relationship between level of difficulty coping with grief and principal physical health outcomes (ps<.002). Controlling for demographics, combat experiences, injuries, PTSD, depression, and other factors, grief significantly and uniquely contributed to a high somatic symptom score (adjusted odds ratio (AOR)=3.6), poor general health (AOR=2.0), missed work (AOR=1.7), medical utilization (AOR=1.5), difficulty carrying a heavy load (AOR=1.7), and difficulty performing physical training (AOR=1.6; all 95% confidence intervals>1).
  
  
  CONCLUSIONS
  Data are cross-sectional and grief was measured with one item.
  
  
  CONCLUSIONS
  Over 20% of soldiers reported difficulty coping with grief. This difficulty was significantly associated with physical health outcomes and occupational impairment. Clinicians should be aware of the unique role grief plays in post-deployment physical health when treating patients.
authors.affiliation: Military Psychiatry Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA. robin.l.toblin@us.army.mil
authors.forename: Robin L
authors.initials: RL
authors.lastname: Toblin
authors.forename: Lyndon A
authors.initials: LA
authors.lastname: Riviere
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Thomas
authors.forename: Amy B
authors.initials: AB
authors.lastname: Adler
authors.forename: Brian C
authors.initials: BC
authors.lastname: Kok
authors.forename: Charles W
authors.initials: CW
authors.lastname: Hoge
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D003430:Cross-Sectional Studies; D004194:Disease / Q000523:psychology*; D005260:Female; D006117:Grief; D006304:Health Status; D006801:Humans; D054542:Iraq War, 2003-2011; D016015:Logistic Models; D008297:Male; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D015995:Prevalence; D055815:Young Adult