{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:13:23Z","timestamp":1790831603664,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,7,19]],"date-time":"2019-07-19T00:00:00Z","timestamp":1563494400000},"content-version":"am","delay-in-days":365,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#am"},{"start":{"date-parts":[[2018,7,19]],"date-time":"2018-07-19T00:00:00Z","timestamp":1531958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000182","name":"Medical Research and Materiel Command","doi-asserted-by":"publisher","award":["W81XWH\u201012\u20102\u20100095"],"award-info":[{"award-number":["W81XWH\u201012\u20102\u20100095"]}],"id":[{"id":"10.13039\/100000182","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Traumatic Stress"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Understanding mental health disorder diagnosis and treatment seeking among active\u2010duty military personnel is a topic with both clinical and policy implications. It has been well documented in military populations that individual\u2010level military experience, including deployment history and combat exposure, influences mental health outcomes, but the impact of unit\u2010level factors is less well understood. In the current study, we used administrative longitudinal data to examine a comprehensive set of unit\u2010 and individual\u2010level predictors of posttraumatic stress disorder (PTSD), non\u2010PTSD anxiety disorders, depressive disorders, and overall mental health diagnoses among Army and Marines Corps personnel. Using Cox survival models for time\u2010dependent variables, we analyzed time from military accession (between January 1, 2001 and December 31, 2011) until first mental health diagnosis for 773,359 soldiers and 332,093 Marines. Prior diagnosis of a substance abuse disorder during one's military career, hazard ratios (HRs) = 1.68\u20133.10, and cumulative time spent deployed,<jats:italic>HR<\/jats:italic>s = 1.11\u20132.04, were the most predictive risk factors for all outcomes. Male sex,<jats:italic>HR<\/jats:italic>s = 0.35\u20130.57, and officer rank,<jats:italic>HR<\/jats:italic>s = 0.13\u20130.23, were the most protective factors. Unit\u2010level rate of high deployment stress was a small but significant predictor of all outcomes after controlling for individual\u2010level deployment history and other predictors,<jats:italic>HR<\/jats:italic>s = 1.01\u20131.05. Findings suggest both unit\u2010 and individual\u2010level risk and protective factors of mental health diagnoses associated with treatment seeking. Clinical, including mental health assessment and management, and policy implications related to the military environment and the individual as it relates to mental health disorders are discussed.<\/jats:p>","DOI":"10.1002\/jts.22316","type":"journal-article","created":{"date-parts":[[2018,7,19]],"date-time":"2018-07-19T16:45:07Z","timestamp":1532018707000},"page":"568-578","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Predictors of Posttraumatic Stress Disorder, Anxiety Disorders, Depressive Disorders, and Any Mental Health Condition Among U.S. Soldiers and Marines, 2001\u20132011"],"prefix":"10.1002","volume":"31","author":[{"given":"Alison","family":"Levin\u2010Rector","sequence":"first","affiliation":[{"name":"RTI International Research Triangle Park North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurel L.","family":"Hourani","sequence":"additional","affiliation":[{"name":"RTI International Research Triangle Park North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Van Dorn","sequence":"additional","affiliation":[{"name":"RTI International Research Triangle Park North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Bray","sequence":"additional","affiliation":[{"name":"RTI International Research Triangle Park North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie A.","family":"Stander","sequence":"additional","affiliation":[{"name":"Naval Health Research Center San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel K.","family":"Cartwright","sequence":"additional","affiliation":[{"name":"RTI International Research Triangle Park North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica K.","family":"Morgan","sequence":"additional","affiliation":[{"name":"RTI International Research Triangle Park North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Trudeau","sequence":"additional","affiliation":[{"name":"RTI International Research Triangle Park North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela K.","family":"Lattimore","sequence":"additional","affiliation":[{"name":"RTI International Research Triangle Park North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,19]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1037\/1076-8998.10.2.121"},{"key":"e_1_2_5_3_1","volume-title":"Survival analysis using SAS: A practical guide","author":"Allison P. 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