Civilian Stress Compounds Service-Related Stress

The stresses of civilian life—job problems, divorce, money—can add to the burden when a service member is already under strain from deployment-related traumatic events, such as being wounded or sexually harassed. Those extramilitary stressors may make it more likely for reserve soldiers to abuse alcohol, say researchers from Columbia University in New York City; University of Michigan in Ann Arbor; Case Western Reserve University in Cleveland, and University of Toledo, both in Ohio.

The researchers surveyed 1,095 members of the Ohio Army National Guard who served mostly in Afghanistan and Iraq from June 2008 to February 2009. They wanted to find out the relative influence of both deployment-related trauma and civilian stress, including the influence of both or either on alcohol abuse.

Almost 60% of soldiers surveyed reported experiencing combat-related traumatic events; 13% of that group was abusing alcohol. Of the 17% who reported being sexually harassed, about 5% were abusing alcohol. Of the nearly 36% of respondents who also experienced civilian stressors, 7.1% were abusing alcohol. In a final model, only civilian stressors were associated with subsequent alcohol use disorder (AUD), independent of deployment-related traumatic events.

Of the respondents, 106 had experienced mental illness personally or in someone close to them, 156 had been through a divorce or breakup, and 105 had been unemployed for ≥ 3 months. While serving, 364 had encountered land mines, water mines, or booby traps; 573 had received hostile incoming fire; and 471 had been attacked by terrorists, insurgents, or civilians.

The civilian stressors found to be most closely associated with AUD were having a family member with a serious drug or alcohol problem (adjusted odds ratio [OR] 1.36; 95% CI, 0.96-1.94), being robbed or having the house broken into (adjusted OR, 1.48; 95% CI, 1.02-2.21), and having problems in getting access to adequate health care (adjusted OR, 1.97; 95% CI, 1.07-3.63). Having experienced sexual harassment was the most closely associated combat trauma.

It was clear to the researchers that the combination of deployment-related trauma and civilian stressors were associated with new onset of AUD. That could mean that adult-onset AUD constitutes a different phenotype from recurrent AUDs, the researchers say. They cite previous research that identified 2 “types” of people who abuse alcohol. One type has a later onset, has “greater malleability to the social environment,” uses alcohol to soothe anxiety, and has less severe alcohol dependence symptoms. The other type turns to alcohol earlier, may be genetically predisposed to alcohol abuse, uses alcohol for its euphoric effect, and has a chronic treatment history.

A consideration when evaluating the findings, the researchers say, is that the soldiers who were interviewed shortly after their deployment may have been misclassified because psychiatric symptoms tend to appear 3 to 4 months after deployment.

Source
Cerdá M, Richards C, Cohen GH, et al. Am J Prev Med. 2014;47(4):461-466.
doi: 10.1016/j.amepre.2014.06.015.