title: Lower health related quality of life in U.S. military personnel is associated with service-related disorders and inflammation.
abstract: Military personnel who have combat exposures are at increased risk for the service-related disorders of post-traumatic stress disorder (PTSD), depression, sleep disturbances and decreased health related quality of life (HRQOL). Those with a traumatic brain injury (TBI) are at even greater risk. Inflammation is associated with these disorders and may underlie the risk for health declines. We evaluated 110 recently deployed, military personnel presenting with sleep disturbances for service-related disorders (TBI, PTSD, and depression) as well as HRQOL. ANOVA models were used to examine differences among military personnel with two or more service-related disorders (high comorbid group), or one or no disorders (low comorbid group). Logistic regression models were used to determine associations among interleukin-6 (IL-6) to HRQOL and service-related disorders. Approximately one-third of the sample had two or more service-related disorders. HRQOL was lower and IL-6 concentrations were higher in military personnel with PTSD or depression, with the most profound differences in those with more service-related disorders, regardless of sleep disorder. Having symptoms of depression and PTSD resulted in a 3.5-fold risk to be in the lower quartile of HRQOL and the highest quartile of IL-6. In a linear regression model, 41% of the relationship between HRQOL and IL-6 concentrations was mediated by PTSD and depression. Military personnel with PTSD and depression are at high risk for lower HRQOL, and higher IL-6 concentrations. Comprehensive treatment is required to address co-occurring service-related disorders in military personnel to promote health and well-being.
authors.affiliation: National Institutes of Health National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA. Electronic address: gillj@mail.nih.gov.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gill
authors.affiliation: National Institutes of Health National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA.
authors.forename: Hyunhwa
authors.initials: H
authors.lastname: Lee
authors.affiliation: West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506, USA.
authors.forename: Taura
authors.initials: T
authors.lastname: Barr
authors.affiliation: Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431, USA.
authors.forename: Tristin
authors.initials: T
authors.lastname: Baxter
authors.affiliation: National Institutes of Health National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Heinzelmann
authors.affiliation: National Institutes of Health National Institutes of Nursing Research, 10 Center Drive, Bethesda, MD 20892, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Rak
authors.affiliation: Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431, USA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mysliwiec
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D015850:Interleukin-6 / Q000097:blood; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D011788:Quality of Life; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D015850:Interleukin-6
keywords: Depression; IL-6; Post-traumatic stress disorder; Traumatic brain injury