Substance Use and Mental Health Conditions Among US Active Duty Military Personnel: Prevalence and Associated Factors

Abstract

Objective: To assess the relationship between three mental health conditions (post-traumatic stress disorder [PTSD], generalized anxiety disorder [GAD], and depressive symptoms), and cigarette smoking or marijuana use. We also explored this relationship when adding sleep duration (as a mediator variable). Methods: This was a cross-sectional study and secondary data analysis of the 2015 Department of Defense (DoD) Health Related Behaviors Survey (HRBS). Prevalence and 95% Confidence Interval (CI) of PTSD, GAD, and depressive symptoms with the sociodemographic characteristics of the United States (US) active service duty members were measured. Weighted multivariable logistic regression analyses were conducted to estimate the adjusted Odds Ratios (aOR) and 95% CI of the associations between PTSD, GAD, depressive symptoms and cigarette smoking or marijuana use. Mediation analysis was conducted to examine the role of sleep duration in the relationship between the exposures and outcomes mentioned. Results: Our study population includes 3372 service members that had at least one mental health disorder. The data showed that the prevalence of PTSD, GAD and depressive symptoms were higher among individuals who work in the Army (47.07%, 42.45%, 44.43% respectively) followed by the Navy (26.20%, 26.36%, 24.50%), Marines (15.11%, 18.90%, 20.09%), Air Force (10.08%, 10.44%, 9.52%) and lastly the Coast Guard (1.54%, 1.84%, 1.47%). The regression analyses showed that among those who did not receive mental health therapy, the estimated aOR of PTSD is 2.33 times higher for cigarette smokers compared to non-smokers [95% CI= 1.45, 3.74]. Additionally, the estimated aOR of GAD is 1.76 times higher for marijuana users compared to non-users [95% CI= 1.23, 2.51] and 2.26 times higher for cigarette smokers compared to non-smokers [95% CI= 1.60, 3.20]. Regarding depressive symptoms, the estimated aOR were higher for both marijuana users and cigarette smokers compared to non-users and non-smokers respectively. Specifically, the estimated aOR for marijuana users was 1.67 [95% CI= 1.05, 2.63], and for cigarette smokers it was 2.09 [95% CI= 1.35, 3.22]. When the association was investigated among different military branches, we found a statistically significant association between PTSD and both marijuana use and cigarette smoking among the Marines [aOR= 2.20, 95% CI= (1.18, 4.10), and aOR= 3.36, 95% CI= (1.73, 6.53)] respectively, when compared to individuals who did not use marijuana or smoke cigarettes. Among the Air Force, only marijuana use was statistically significantly associated with PTSD [aOR= 1.81, 95% CI= (1.02, 3.23)] when compared to non-users, and finally, cigarette smoking was statistically significantly associated with PTSD among Coast Guard members [aOR= 1.80, 95% CI= (1.22, 2.66)], when compared to non-smokers. For the mediation analysis, sleep duration was found to be a partial mediator in the relationship between smoking or marijuana use and mental health. Conclusion: Our study found that marijuana and cigarette use were associated with higher odds of GAD and depressive symptoms among military personnel who did not receive mental health therapy. Our findings indicated an interplay between mental health conditions, cigarette smoking, marijuana use, and sleep, and that sleep duration partially mediated the relationship, which suggest that improving sleep behavior could potentially improve mental health among individuals who smoke or use marijuana.