Download 1. Calabrese JR, Prescott M, Tamburrino M, Liberzon I, Slembarski

1. Calabrese JR, Prescott M, Tamburrino M, Liberzon I, Slembarski R, Goldman E, Shirley E,
Fine T, Goto T, Wilson K, Ganocy S, Chan P, Serrano MB, Sizemore J, Galea S: PTSD
comorbidity and suicidal ideation associated with PTSD within the Ohio Army National
Guard. J Clin Psychiatry. 2011 Aug;72(8):1072-8. PMID: 21899816
This study examined (1) the prevalence of other psychopathologies among those with
DSM-IV-diagnosed posttraumatic stress disorder (PTSD) compared to those without PTSD
and (2) the associated between PTSD comorbidity and suicidal ideation (reporting thoughts
of being better off dead or hurting themselves). 61.7% of guard members with PTSD in the
last year had at least one other psychopathology; 20.2% has at least two other co-occurring
conditions. The most common co-occurring psychopathology was depression. While those
with PTSD overall were 5.4 (95% CI 3.8 – 7.5) times more likely to report suicidality than
those without PTSD, those who had at least two additional conditions along with PTSD were
7.5 (95% CI 3.0 – 18.3) times more likely to report suicidal ideation at some point in their
lifetime than those with PTSD alone.
2. Goldmann E, Calabrese JR, Prescott MR, Tamburrino M, Liberzon I, Slembarski R, Shirley
E, Fine T, Goto T, Wilson K, Ganocy S, Chan P, Serrano MB, Sizemore J, Galea S.
Potentially modifiable pre-, peri, and post-deployment characteristics associated with
deployment-related posttraumatic stress disorder among Ohio Army National Guard soldiers.
Ann Epidemiol. 2012 Feb;22(2):71-8. PMID: 22226029
This study assessed preparedness, unit support, and post-deployment support by using
multi-measure scales adapted from the Deployment Risk and Resilience Survey. The
prevalence of deployment-related posttraumatic stress disorder (PTSD) was 9.6%. In
adjusted logistic models, high levels of all three deployment characteristics (compared with
low) were independently associated with lower odds of PTSD. When we evaluated the
influence of combinations of deployment characteristics on the development of PTSD, we
found that post-deployment support was an essential factor in the prevention of PTSD. These
results suggest that the development of suitable post deployment support opportunities may
be centrally important in mitigating the psychological consequences of war.
3. Marshall BD, Prescott MR, Liberzon I, Tamburrino MB, Calabrese JR, Galea S. Coincident
posttraumatic stress disorder and depression predict alcohol abuse during and after
deployment among Army National Guard soldiers. Drug Alcohol Depend. 2012 Aug
1;124(3):193-9. PMID: 22342428
We used logistic regression to determine the correlates of peri-/post-deployment alcohol
abuse. Of 963 participants, 113 (11.7%) screened positive for peri-/post-deployment alcohol
abuse, of whom 35 (34.0%) and 23 (32.9%) also reported peri-/post-deployment depression
and PTSD, respectively. Soldiers with coincident depression (adjusted odds ratio [AOR] =
3.9, 95%CI: 2.0–7.2, p < 0.01) and PTSD (AOR = 2.7, 95%CI: 1.3–5.4, p < 0.01) were
significantly more likely to screen positive for peri-/postdeployment alcohol abuse. This may
suggest an etiologic pathway through which deployment-related exposures increase the risk
of alcohol-related problems.
4. Elhai JD, Contractor A, Tamburrino M, Fine TH, Prescott MR, Shirley E, Chan PK,
Slembarski R, Liberzon I, Galea S, Calabrese JR. The factor structure of major depression
symptoms: A test of four competing models using the Patient Health Questionnaire-9.
Psychiatry Res. 2012 Oct 30;199(3):169-73. PMID:22698261
Our aim was to analyze the symptom structure of major depression using the Patient
Health Questionnaire-9 (PHQ-9). The PHQ-9 was administered to a sample of 2615 Army
National Guard soldiers from Ohio. A one-factor model of depression and three separate twofactor models previously established in the literature were evaluated using confirmatory
factor analysis. Results demonstrated greater support for the two-factor models of depression
than for the one-factor model. The best fitting model was the two-factor model of somatic
and non-somatic symptoms supported previously by Krause et al. (2010) and Richardson and
Richards (2008).
5. Biehn TL, Contractor A, Elhai JD, Tamburrino M, Fine TH, Prescott MR, Shirley E, Chan
PK, Slembarski R, Liberzon I, Calabrese JR, Galea S. Relations between the underlying
dimensions of PTSD and major depression using an epidemiological survey of deployed
Ohio national guard Soldiers. J Affect Disord. 2013 Jan 10;144(1-2):106-11.
PMID:22974471
A sample of soldiers with a history of overseas deployment participated and were
administered the PTSD Checklist (assessing PTSD) and Patient Health Questionnaire-9
(assessing depression). Using confirmatory factor analysis, results demonstrated that both
PTSD’s dysphoria and hyperarousal factors were more related to depression’s somatic than
non-somatic factor. Furthermore, depression’s somatic factor was more related to PTSD’s
dysphoria than hyperarousal factor. Results indicate that PTSD’s dysphoria factor is related
to depression specifically by way of depression’s somatic construct. Given PTSD’s
substantial dysphoria/distress component, these results have implications for understanding
the nature of PTSD’s high comorbidity with depression.
6. Marshall BD, Prescott MR, Liberzon I, Tamburrino MB, Calabrese JR, Galea S.
Posttraumatic stress disorder, depression, and HIV risk behavior among Army National
Guard Soldiers. J of Traumatic Stress. 2013 Feb;26(1):64-70. PMID: 23417876
We examined the relationship between posttraumatic stress disorder (PTSD), major
depressive disorder (MDD), and human immunodeficiency virus (HIV) risk behavior among
the Ohio Army National Guard (OHARNG). Logistic regression was used to examine the
independent and combined effects of PTSD and MDD on past-year HIV risk behavior. Of
2,259 participants, 142 (6.3%) reported at least 1 past-year HIV risk behavior. To assess HIV
risk behaviors, participants were asked whether they had engaged in any of the following in
the past year: (a) used intravenous drugs, (b) been treated for a sexually transmitted or
venereal disease, (c) given or received money or drugs in exchange for sex, and (d) had anal
sex without a condom. In adjusted models, relative to soldiers with neither disorder,
screening positive for MDD only was associated with HIV risk behavior (adjusted odds ratio
[AOR] = 2.33, 95% CI = [1.15, 4.71]), whereas PTSD was not significant (AOR = 1.60, 95%
CI = [0.80, 3.20]). Participants with both PTSD and depression were most likely to report
HIV risk behavior (AOR = 2.75, 95% CI = [1.06, 7.11]). Soldiers with PTSD and MDD may
be at greater risk for HIV infection due to increased engagement in HIV risk behavior.
Integrated interventions to address mental health problems and reduce HIV risk behavior are
in need of development and evaluation.
7. Goodwin RD, Prescott MR, Tamburrino M, Calabrese JR, Liberzon I, Galea S. Cigarette
smoking and subsequent risk of suicidal ideation among National Guard soldiers. J Affect
Dis. 2013 Feb 15;145(1):111-114. PMID: 23141668
A representative sample of Ohio Army National Guard soldiers were followed
prospectively and information was gathered on smoking, suicidal ideation and depression at
baseline and one year later. Smoking at baseline was associated with significantly increased
likelihood of suicidal ideation at follow-up (OR=2.0 (1.3, 3.2)). This association persisted
after adjusting for demographics and history of depression at baseline, but was no longer
statistically significant after adjusting for depression at follow-up. Army National Guard
soldiers who smoke have a greater risk of subsequent suicidal ideation. Depression
concurrent with suicidal ideation appears to explain this relationship. If these results are
replicated, screening of soldiers who smoke may be recommended as a proactive step
towards mitigating the high risk of suicide in military personnel.
8. Goodwin RD, Prescott M, Tamburrino M, Calabrese JR, Liberzon I, Galea S. Smoking is a
predictor of depression onset among National Guard soldiers. Psychiatric Res. 2013 Apr
30;206(2-3):321-3. PMID: 23291043
This paper aimed to investigate the relationship between smoking and depression in a
sample of American soldiers. In bivariable cross-sectional associations, smoking status at
baseline was associated with depression at baseline. History of smoking (but not current)
(AOR=1.2 (0.7, 2.1)), sporadic/inconsistent smoking (AOR=2.2 (0.9, 5.2)) and incident
smoking (AOR=2.7 (0.6, 12.4)) at baseline were not associated with increased risk of
depression at follow-up but chronic smoking was associated with significantly increased risk
of incident depression at follow-up (AOR=2.0 (1.2, 3.4)). This association remained
statistically significant after adjusting for demographic differences. As such, the importance
of making smoking cessation programs available to soldiers—as prevention of subsequent
mental health problems, as well as a means to stop smoking— cannot be overestimated.
9. Fine TH, Contractor AA, Tamburrino M, Elhai JD, Prescott MR, Cohen GH, Shirley E,
Chan PK, Goto T, Slembarski R, Liberzon I, Galea S, Calabrese JR. Validation of the
telephone-administered PHQ-9 against the in-person administered SCID-I major depression
module. J Affect Disord. 2013 Sep 25;150(3):1001-1007. PMID:23747208
We assessed item-to-item correspondence between the Patient Health Questionnaire-9
(PHQ-9) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) major
depression episode portion of the major depressive module. Data were analyzed using chisquare analyses, logistic regression, receiver operating characteristic (ROC) curve analyses
and diagnostic efficiency statistics. To screen for depression effectively, results indicate use
of the cardinal first two items, items representing fatigue, appetite and sleep changes with an
item level cut-off point of two, and the item representing suicidal ideation with item level
cut-off point of one. Further, total PHQ-9 scores significantly predicted SCID-I major
depressive episode (MDE) and diagnosis (MDD) with moderate accuracy. Lastly, the cut-off
total score of 10 had the optimal balance of sensitivity and specificity compared to other
PHQ-9 scoring options. This validation study provides guidelines for the use of the
telephone-administered PHQ-9 in assessing the lifetime prevalence of a major depressive
episode and diagnosis in non-clinical populations, with implications for clinical use.
10. Prescott MR, Tamburrino M, Calabrese JR, Liberzon I, Slembarski R, Shirley E, Fine T,
Goto T, Wilson K, Ganocy S, Chan P, Derus A, Serrano MB, Sizemore J, Kauffman J, Galea
S. Validation of lay-administered mental health assessments in a large National Guard cohort.
Int J Methods Psychiatr Res. 2014 Mar;23(1):109-19. PMID: 24615746
The purpose of this analysis was to report the reliability and validity of key mental health
assessments in an ongoing study of the Ohio Army National Guard (OHARNG). OHARNG
soldiers received hour-long structured telephone surveys including the post-traumatic stress
disorder (PTSD) checklist (PCV-C) and Patient Health Questionnaire – 9 (PHQ-9). A subset
(N=500) participated in two hour clinical reappraisals, using the Clinician-Administered
PTSD Scale (CAPS) and the Structured Clinical Interview for DSM (SCID). The telephone
survey assessment for PTSD and for any depressive disorder were both highly specific [92%
(standard error, SE 0.01), 83% (SE 0.02)] with moderate sensitivity [54% (SE 0.09), 51%
(SE 0.05)]. Other psychopathologies assessed included alcohol abuse [sensitivity, 40%, (SE
0.04) and specificity 80% (SE 0.02)] and alcohol dependence [sensitivity, 60% (SE 0.05) and
specificity 81% (SE 0.02)].The baseline prevalence estimates from the telephone study
suggest alcohol abuse and dependence may be higher in this sample than the general
population. Validity and reliability statistics suggest specific, but moderately sensitive
instruments.
11. Orr MG, Prescott MR, Cohen GH, Calabrese JR, Tamburrino MB, Liberzon I, Galea S.
Potentially modifiable deployment characteristics and new-onset alcohol abuse or
dependence in the US National Guard. Drug Alcohol Depend. 2014 Sep 1;142:325-32.
PMID: 25064024
Soldiers were assessed for alcohol abuse/dependence, depression, post-traumatic stress
disorder (PTSD), deployment related factors (e.g., exposure to warzone stressors) and three
deployment characteristics (pre-deployment preparedness, unit support during deployment,
and post-deployment social support). Associations between the three deployment
characteristics and incident alcohol abuse/dependence (defined as abuse or dependence at
any point during or after deployment) were estimated using logistic regression. Only predeployment preparedness was associated with incident alcohol abuse/dependence (a nonlinear inverted-u shaped relation) when controlling for demographics, deployment related
factors (e.g., exposure to warzone stressors), and the presence of psychopathology that
exhibited peri-/postdeployment. The association between pre-deployment preparedness and
alcohol abuse/dependence may be characterized as an inverted-U shaped function.
Suggestions for how and whether to modify predeployment preparedness in an effort to
reduce peri-/post-deployment alcohol abuse or dependence should await further research.
12. Cerda M, Richards C, Cohen G, Calabrese J, Liberzon I, Tamburrino M, Galea S, Koenen
KC. Civilian stressors associated with alcohol use disorders in the national guard. Am J Prev
Med. 2014 Oct;47(4):461–466. PMID: 25089013
A cohort of Ohio National Guard soldiers was interviewed three times over 3 years. The
analytic sample included Ohio National Guard soldiers who had been deployed by 2008–
2009, had participated in at least one follow-up wave, had reported consuming at least one
alcoholic drink in their lifetime, and had non-missing data on alcohol use disorders
(n=1,095). In a model including measures of civilian stressors and deployment-related
traumatic events, only civilian stressors (OR=2.07, 95% CI=1.46, 2.94) were associated with
subsequent alcohol use disorder. The effects of civilian stressors were only present among
people with no history of alcohol use disorder. Independent of deployment-related exposures,
post-deployment civilian stressors are associated with the onset of alcohol use disorder
among reserve-component soldiers. Concerted investment to address daily civilian
difficulties associated with reintegration into civilian life may be needed to prevent new
cases of alcohol use disorders among returning military personnel.
13. Liberzon I, King AP, Ressler KJ, Almli LM, Zhang P, Ma ST, Cohen GH, Tamburrino MB,
Calabrese JR, Galea S. Interaction of the ADRB2 gene polymorphism with childhood trauma
in predicting adult symptoms of posttraumatic stress disorder. JAMA Psychiatry. 2014
Oct;71(10):1174-82. PMID: 25162199
This is a genetic association study in an Ohio National Guard longitudinal cohort (n =
810) of predominantly male soldiers of European ancestry, with replication in an independent
Grady Trauma Project (Atlanta, Georgia) cohort (n = 2083) of predominantly female African
American civilians. Controlling for the level of lifetime adult trauma exposure, we identified
the novel association of a single-nucleotide polymorphism within the promoter region of the
ADRB2 (Online Mendelian Inheritance in Man 109690) gene with PTSD symptoms in
interaction with childhood trauma (rs2400707, P = 1.02 × 10−5, significant after correction
for multiple comparisons). The rs2400707 A allele was associated with relative resilience to
childhood adversity. An rs2400707 × childhood trauma interaction predicting adult PTSD
symptoms was replicated in the independent predominantly female African American cohort.
The rs2400707 polymorphism has been linked to function of the adrenergic system, but, to
our knowledge, this is the first study to date linking the ADRB2 gene to PTSD or any
psychiatric disorders. These findings have important implications for PTSD etiology, chronic
pain, and stress-related comorbidity, as well as for both primary prevention and treatment
strategies.
14. Goodwin RD, Cohen GH, Tamburrino M, Calabrese JR, Liberzon I, Galea S. Mental health
service use in a representative sample of national guard soldiers. Psychiatr Serv. 2014 Nov
1;65(11):1347-53. PMID: 25081739
A representative sample of Ohio Army National Guard participants was enrolled.
Demographic characteristics, mental health problems, and deployment status in 2009-2010
and mental health service use during the subsequent one-year period (2010-2011) were
assessed. Approximately 16% of National Guard members used mental health services
during the one-year period. Among those with depression, posttraumatic stress disorder,
anxiety, alcohol use disorders, or suicidal ideation, a little over one-third (37%) reported
using services in the subsequent 12 months. Among all National Guard soldiers, being
female, black, Hispanic, and insured and having comorbid general medical and mental health
problems predicted mental health service use. Among those with mental health problems,
only black race predicted mental health service use. Results suggest that there is a substantial
level of unmet need for mental health treatment among National Guard soldiers. Efforts to
identify National Guard soldiers with a need for mental health services and improving access
to care might be warranted.
15. Walsh K, Galea S, Cerda M, Richards C, Liberzon I, Tamburrino MB, Calabrese J, Koenen
KC. Unit support protects against sexual harassment and assault among national guard
soldiers. Womens Health Issues. 2014 Nov-Dec;24(6):600-4. PMID: 25442705
This study examined whether unit support, which reflects the quality of service members’
relationships within their unit, protects against sexual harassment and assault during
deployment. Participants were 1,674 Ohio Army National Guard service members who
reported at least one deployment during a telephone survey conducted in 2008 and 2009.
Participants completed measures of sexual harassment/assault, unit support, and psychosocial
support. Logistic regression was used to model odds of sexual harassment/assault.
Approximately 13.2% of men (n = 198) and 43.5% of women (n = 74) reported sexual
harassment, and 1.1% of men (n = 17) and 18.8% of women (n = 32) reported sexual assault
during their most recent deployment. Greater unit support was associated with decreased
odds of sexual harassment and assault. Programming designed to improve unit cohesion has
the potential to reduce sexual harassment and assault.
16. Hoggatt KJ, Prescott M, Goldmann E, Tamburrino M, Calabrese JR, Liberzon I, Galea S. The
prevalence and correlates of risky driving behavior among National Guard soldiers. Traffic
Inj Prev. 2015;16(1):17-23. PMID: 25260973
The goal of this analysis was to assess the prevalence of risky driving and its
demographic, mental health, and deployment-related correlates among members of the Ohio
Army National Guard (OHARNG). We fit multiple logistic regression models and derived
the adjusted prevalence of risky driving behavior for soldiers with mental health conditions,
deployment experience, exposure to combat or trauma, and psychosocial stressors or
supports. The prevalence of risky driving, including drinking and driving, passing on the right,
and ignoring speed limits, were positively associated with a history of psychiatric disorders,
deployment, deployment-related traumatic events, and combat or post-combat stressors. In
contrast, the prevalence of risky driving was lower for soldiers who reported high levels of
psychosocial support. Efforts to mitigate risky driving in military populations may be more
effective if they incorporate both targeted messages to remediate dangerous learned driving
behaviors and psychosocial interventions to build resilience and address underlying stressors
and mental health symptoms.
17. Tamburrino MB, Chan P, Prescott M, Calabrese J, Liberzon I, Slembarski R, Shirley E, Fine
T, Goto T, Wilson K, Derus A, Ganocy S, Beth Serrano M, Galea S. Baseline prevalence of
Axis I diagnosis in the Ohio Army National Guard. Psychiatr Res. 2015 Mar 30;226(1):1428. PMID: 25623021
The goal of this study is to determine the pre-existing lifetime and current prevalence of
DSM-IV Axis I disorders within the Ohio Army National Guard (OHARNG). Data was
analyzed from the clinical subsample of the Ohio Army National Guard Mental Health
Initiative (OHARNG MHI). Five hundred participants were provided with an in-depth
clinical assessment using the Clinician-Administered PTSD Scale (CAPS) and the Structured
Clinical Interview for DSM-IV-TR (SCID). Logistic regression examined the relationship
between Axis I disorders and the number of deployments and gender. Prevalence of at least
one DSM-IV lifetime disorder was 66.2%; substance use disorders were 52.2%, followed by
mood disorders (30.0%) and anxiety disorders (22.0%). Prevalence of at least one current
disorder was 24.8%; anxiety disorders (13.2%), mood disorders (7.6%), and substance use
disorders (7.0%) were most frequent. Number of deployments was associated with PTSD
(OR=8.27, 95% CI 2.10–32.59, p=0.003), alcohol use disorder (OR=1.77, 95% CI 1.07–
2.92, p=0.025), and any substance use disorder (OR=1.85, 95% CI 1.12–3.05, p=0.016).
Gender (OR=2.02, 95% CI 1.10–3.73, p=0.024) was associated with any mood disorder. The
results provide baseline information on the most prevalent mental disorders within the
OHARNG.
18. Elhai JD, Contractor AA, Tamburrino, M, Fine TH, Cohen G, Shirley E, Chan PK, Liberzon
I, Calabrese, JR, Galea S. Structural relations between DSM-5 PTSD and major depression
symptoms in military soldiers. J Affect Disord. 2015 Apr 1;175:373-8. PMID: 25665497
Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are
frequently comorbid. One explanation for this comorbidity is that PTSD has a constellation
of “dysphoria” symptoms resembling depression. Using confirmatory factor analysis we
tested the role of DSM-5 PTSD‫׳‬s dysphoria factor in relation to MDD symptom dimensions
of somatic and non-somatic psychopathology. 672 Ohio National Guard soldiers completed
DSM-5 measures of PTSD and MDD symptoms in an epidemiological study. Results
indicated that in contrast to other PTSD factors, PTSD‫׳‬s dysphoria factor was more related to
MDD’s somatic and non-somatic factors.
19. Fink DS, Sampson L, Tamburrino M, Liberzon I, Slembarski R, Chan P, Cohen GH, Shirley
E, Goto T, D'Arcangelo N, Fine T. Reed P, Galea S, Calabrese JR. Lifetime and 12-month use
of mental health services among US Army National Guard Soldiers in Ohio. Psychiatr Serv.
2015 May 1;66(5):514-20. PMID: 25639992
This study aimed to document, by psychiatric disorder category, the annualized rate of
Guard members who obtained psychiatric services and the factors associated with service
utilization. Face-to-face clinical assessments were conducted to assess lifetime and current
psychiatric disorders and recent psychiatric service use among 528 Ohio Army National
Guard soldiers. An annualized rate of 31% of persons per year accessed psychiatric services
between 2010 and 2012. Persons with substance use disorders had the lowest annualized rate
of service use, and these were the only disorders not predictive of accessing services. Current
mood disorder, current anxiety disorder, and lifetime history of service use were the strongest
predictors of recent service use. There were no socioeconomic or other group predictors of
psychiatric service use. Efforts to encourage broader adoption of treatment seeking,
particularly among persons with substance use disorders, are necessary to mitigate
psychiatric health burden in this population.
20. Rudenstine S, Liberzon I, Galea S, Cohen G, Prescott M, Tamburrino M, Sampson L,
Calabrese J. Adverse childhood events and the risk for new onset depression and
posttraumatic stress disorder among US National Guard soldiers. Military Medicine. In Press.
This study looked at how having a history of childhood maltreatment serves as a risk
factor for mental illness among deployed National Guard soldiers with no history of
depression or post-traumatic stress disorder (PTSD). The main health indicator of interest in
this investigation was the risk of new-onset PTSD or new-onset depression first developed
during or after the respondents’ most-recent deployment. Overall, 6.6% of soldiers
developed new-onset PTSD during or after deployment and 10.5% of soldiers developed
new-onset depression either during or after deployment. Experiencing sexual abuse as a
child was associated with new-onset PTSD (odds ratio (OR): 8.5; 95% confidence interval
(CI): 1.9, 38.9). Experiencing any child abuse (OR: 1.9; 95% CI: 1.1, 3.2) or 2 or more types
of child abuse was associated with new onset depression (OR: 2.5; 95% CI: 1.3,4.5), as was
emotional abuse (OR: 2.4; 95% CI: 1.3,4.2) and physical abuse (OR: 1.9; 95% CI: 1.1,3.5).
Female gender was associated with new-onset PTSD (OR: 3.4; 95% CI: 1.7,6.8) and newonset depression (OR: 2.0; 95% CI: 1.0, 3.9). These findings suggest that among soldiers
with no lifetime PTSD or depression, a history of childhood abuse is a contributor to a
soldier’s risk of developing depression during or following deployment, independent of the
soldier’s traumatic event exposure history.