Associations between Mental Health Disorders and Body Mass Index among Military Personnel Tracey J. Smith, PhD, RD; Alan White, PhD; Louise Hadden, MS; Andrew J. Young. PhD; Bernadette P. Marriott, PhD Objective: To determine if overweight or obesity is associated with mental health disorder (MHD) symptoms among military personnel Methods: Secondary analysis using the 2005 Department of Defense Health Related Behaviors Survey (N = 15,195). Standard Body Mass Index (BMI) categories were used to classify participants’ body composition. Results: For women, obesity was associated with symptoms of serious psychological distress (SPD), post-traumatic stress disorder, and depression. For men, obe-
T
he prevalence and cost of mental health disorders (MHD) in the United States (US) are high and increasing. Current estimates indicate that 3.2% of adults experienced serious psychological distress (SPD) in the past 30 days, and in the past year, 3.1% of the US adults were symptomatic for generalized anxiety disorder (GAD) whereas 6.7% were symptomatic for major depressive disorder.1,2 According to the US Substance Abuse and Mental Health Services Administration, approximately $113 million was spent on mental health related issues in 2005, compared to approximately $61 million in 1995.3 Military personnel are not included in these national estimates, but military personnel are at high risk of MHD after deployment.4-6 Understanding the relationships between overweight and obesity with MHD is important because more than 65% of US civilian adults are considered overweight or obese.7 Associations among body weight/body fat, as represented by body
Tracey J. Smith, Research Dietitian, Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA. Alan White, Principal Associate, Abt Associates, Inc., Durham, NC. Louise Hadden, Lead Programmer Analyst, Abt Associates, Inc., Cambridge, MA. Andrew J. Young, Chief, Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA. Bernadette P. Marriott, Professor, Division of Gastroenterology, Department of Medicine, Medical University of South Carolina, Charleston, SC. Correspondence; Dr Smith, [email protected]
Am J Health Behav.™ 2014;38(4):529-540
sity and overweight was associated with symptoms of generalized anxiety disorder and SPD, respectively. Self-reported high personal stress was the strongest predictor of MHD symptoms and suicide attempts. Conclusion: Self-reported stress was a stronger predictor of MHD symptoms than BMI. There is potential value in screening personnel for personal stress as a MHD risk factor. Key words: BMI, mental health Am J Health Behav. 2014;38(4):529-540 DOI: http://dx.doi.org/10.5993/AJHB.38.4.6
mass index (BMI: weight [kg] / height [m]2), with depression, and other MHD including posttraumatic stress disorder (PTSD) have been reported among civilian8-12 and military populations.13-18 The potential association between depression and BMI has been studied extensively with several reports suggesting a u-shaped association between BMI categories (underweight, normal, overweight, and obesity) and depression.12,19,20 Longitudinal studies of depression and categorical body weight among adult civilians found that obesity increased the risk of depression and that depression was predictive of developing obesity.21 Regression analysis of cross-sectional data found a similar relationship between BMI and depression whether BMI was treated as a continuous or categorical variable.12 A community-based, prospective, longitudinal study of 3021 civilian adults found that PTSD was a significant predictor of obesity among women but not among men.11 Clinical studies also have found a higher rate of obesity among military veterans with PTSD in both men and women.14,16-18 Few studies among civilians have addressed the relationship of other mental health symptoms or diagnoses of anxiety, psychological distress, suicide ideation, or suicide attempts and obesity.8,20,22 For example, large epidemiologic studies have reported an association of anxiety with overweight and/or obesity compared with normal weight.8 Further, results from a national telephone interview survey found that civilian men, categorized as obese and underweight by BMI, were significantly
529
Associations between Mental Health Disorders and Body Mass Index among Military Personnel
Table 1 Sample and Distribution of Selected Characteristics Total DOD: 2005 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnela
Characteristic Total Sample (N) Weighted N % ± SE
Total DOD
Total DOD
2005b
2005
15,195 (946,008)
Underweight
Normal Weight
Overweight
Obese
(BMI25.0 would be associated with symptoms for GAD, depression, SPD, suicide ideation, and PTSD, as well as self-reported attempted suicide, when considering select demographic and lifestyle factors among active duty military personnel. Secondly, we sought to assess the degree of association between select demographic and lifestyle factors and a variety of MHD symptoms to identify their importance in relation to BMI. METHODS Study Population The 2005 HRBS was conducted by RTI International under sponsorship of the Office of the Assistant Secretary of Defense (Health Affairs) and TMA, Health Program Analysis and Evaluation Directorate.23 For this analysis, the authors obtained a de-identified data file from TMA through a data use agreement. The target population included
Smith et al
Table 1 (contined) Sample and Distribution of Selected Characteristics Total DOD: 2005 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnela
Characteristic Total Sample (N) Weighted N % ± SE
Total DOD
Total DOD
2005b
2005
15,195 (946,008)
Underweight
Normal Weight
Overweight
Obese
(BMI
T
he prevalence and cost of mental health disorders (MHD) in the United States (US) are high and increasing. Current estimates indicate that 3.2% of adults experienced serious psychological distress (SPD) in the past 30 days, and in the past year, 3.1% of the US adults were symptomatic for generalized anxiety disorder (GAD) whereas 6.7% were symptomatic for major depressive disorder.1,2 According to the US Substance Abuse and Mental Health Services Administration, approximately $113 million was spent on mental health related issues in 2005, compared to approximately $61 million in 1995.3 Military personnel are not included in these national estimates, but military personnel are at high risk of MHD after deployment.4-6 Understanding the relationships between overweight and obesity with MHD is important because more than 65% of US civilian adults are considered overweight or obese.7 Associations among body weight/body fat, as represented by body
Tracey J. Smith, Research Dietitian, Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA. Alan White, Principal Associate, Abt Associates, Inc., Durham, NC. Louise Hadden, Lead Programmer Analyst, Abt Associates, Inc., Cambridge, MA. Andrew J. Young, Chief, Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA. Bernadette P. Marriott, Professor, Division of Gastroenterology, Department of Medicine, Medical University of South Carolina, Charleston, SC. Correspondence; Dr Smith, [email protected]
Am J Health Behav.™ 2014;38(4):529-540
sity and overweight was associated with symptoms of generalized anxiety disorder and SPD, respectively. Self-reported high personal stress was the strongest predictor of MHD symptoms and suicide attempts. Conclusion: Self-reported stress was a stronger predictor of MHD symptoms than BMI. There is potential value in screening personnel for personal stress as a MHD risk factor. Key words: BMI, mental health Am J Health Behav. 2014;38(4):529-540 DOI: http://dx.doi.org/10.5993/AJHB.38.4.6
mass index (BMI: weight [kg] / height [m]2), with depression, and other MHD including posttraumatic stress disorder (PTSD) have been reported among civilian8-12 and military populations.13-18 The potential association between depression and BMI has been studied extensively with several reports suggesting a u-shaped association between BMI categories (underweight, normal, overweight, and obesity) and depression.12,19,20 Longitudinal studies of depression and categorical body weight among adult civilians found that obesity increased the risk of depression and that depression was predictive of developing obesity.21 Regression analysis of cross-sectional data found a similar relationship between BMI and depression whether BMI was treated as a continuous or categorical variable.12 A community-based, prospective, longitudinal study of 3021 civilian adults found that PTSD was a significant predictor of obesity among women but not among men.11 Clinical studies also have found a higher rate of obesity among military veterans with PTSD in both men and women.14,16-18 Few studies among civilians have addressed the relationship of other mental health symptoms or diagnoses of anxiety, psychological distress, suicide ideation, or suicide attempts and obesity.8,20,22 For example, large epidemiologic studies have reported an association of anxiety with overweight and/or obesity compared with normal weight.8 Further, results from a national telephone interview survey found that civilian men, categorized as obese and underweight by BMI, were significantly
529
Associations between Mental Health Disorders and Body Mass Index among Military Personnel
Table 1 Sample and Distribution of Selected Characteristics Total DOD: 2005 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnela
Characteristic Total Sample (N) Weighted N % ± SE
Total DOD
Total DOD
2005b
2005
15,195 (946,008)
Underweight
Normal Weight
Overweight
Obese
(BMI25.0 would be associated with symptoms for GAD, depression, SPD, suicide ideation, and PTSD, as well as self-reported attempted suicide, when considering select demographic and lifestyle factors among active duty military personnel. Secondly, we sought to assess the degree of association between select demographic and lifestyle factors and a variety of MHD symptoms to identify their importance in relation to BMI. METHODS Study Population The 2005 HRBS was conducted by RTI International under sponsorship of the Office of the Assistant Secretary of Defense (Health Affairs) and TMA, Health Program Analysis and Evaluation Directorate.23 For this analysis, the authors obtained a de-identified data file from TMA through a data use agreement. The target population included
Smith et al
Table 1 (contined) Sample and Distribution of Selected Characteristics Total DOD: 2005 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnela
Characteristic Total Sample (N) Weighted N % ± SE
Total DOD
Total DOD
2005b
2005
15,195 (946,008)
Underweight
Normal Weight
Overweight
Obese
(BMI
