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Military personnel may withhold information on mental health problems (MHPs) for fear of not being permitted to deploy. Past or current MHPs may, however, increase the risk of postdeployment MHPs. Using psychiatric diagnoses rather than self‐report assessments in predeployment screening may be a more effective screening strategy for determining deployment fitness. This retrospective follow‐up study investigated (a) the extent to which predeployment childhood and adult psychiatric diagnoses predicted postdeployment MHPs, measured as psychiatric diagnosis and the purchase of psychiatric drugs, and long‐term sickness absence among formerly deployed Danish military personnel and (b) whether perceived combat exposure moderated or mediated the effect of predeployment psychiatric diagnoses. Complete data were available for 7,514 Danish military personnel who answered questions on perceived combat exposure between 6–8 months after returning from their first deployment to the Balkans, Iraq, or Afghanistan. Data on all psychiatric diagnoses given at Danish hospitals, all medicine purchases, and all sickness absences were retrieved from nationwide research registers. Personnel with predeployment psychiatric diagnoses had a statistically significant higher risk for both postdeployment long‐term sickness absence, hazard ratio (HR) = 2.06, 95% CI [1.52, 2.80]; and postdeployment MHPs, HR = 2.38, 95% CI [1.73, 3.27], than personnel without a predeployment psychiatric diagnosis. Personnel with a predeployment psychiatric diagnosis demonstrated a higher risk of reporting high levels of perceived combat exposure. Perceived combat exposure was not found to moderate or mediate the effect of a predeployment psychiatric diagnosis on the two outcomes. Additional findings, limitations, and implications are discussed.

Objective: The aim of this study was to estimate the association between self-reported perceived danger during deployment, measured as combat exposure or witnessing the consequences of war, and post-deployment suicide attempts among military personnel. Furthermore, the effect of post-deployment symptoms of posttraumatic stress disorder (PTSD) and/or depression on the risk of suicide attempts was also evaluated.Methods: This observational cohort study included Danish Army military personnel who returned from deployment in international missions from 1998 to 2016 and had completed a post-deployment questionnaire. Perceived exposure to danger was ascertained by self-report. Data on suicide attempt were retrieved from national registers. Adjusted Cox regression analyses were used to evaluate if military personnel indicating high level of combat exposure were more likely to have attempted suicides post-deployment than military personnel with lower levels of combat exposure.Results: Eighty-three suicide attempts were registered after homecoming among 12,218 military personnel. Perceived higher exposure to combat was associated with the risk of suicide attempt (hazard ratio = 1.08; 95% CI, 1.01-1.16). Furthermore, the association between combat exposure and suicide attempt was fully mediated by post-deployment symptoms of PTSD and/or depression. No association was found between witnessing consequences of war and the risk of post-deployment suicide attempt.Conclusions: This nationwide study found that combat exposure was associated with an increased risk of suicide attempt among military personnel. This association was, however, fully mediated by mental disorders (PTSD and/or depression). These findings suggest that better psychological follow-up of military personnel identified as having PTSD and/or depression may be warranted.

Gulf War veterans (GWVs) have an elevated risk of reporting symptoms of mental disorders as compared with nondeployed military controls. A difficulty in the Gulf War health research is that most health outcomes are self-reported; therefore, it is highly relevant to study objective outcomes in this line of research. The Danish National Prescription Registry provides an opportunity to use the prescription of drugs as an objective evaluation of the impact of mental health disorders at the individual level. In this study, we investigated the prescription of drugs and postdeployment hospitalizations for mental disorders among GWVs compared with a control population of nonveterans (NVs).A prospective registry study including a cohort of 721 GWVs and a control cohort of 3,629 NVs. Main outcome measures were incidence of (1) use of antidepressants, (2) use of anxiolytic/hypnotic medication, and (3) number of postdeployment psychiatric contacts. The association between outcomes and GWVs status was studied by using time-to-event analysis. The index date was the return date from the last deployment to the Gulf. The follow-up period was the time from index date until December 31, 2014.GWVs had an elevated average risk over time for use of both types of medication compared with NV. For use of antidepressants the average hazard rate (HR) was 2.56, with 95% confidence interval (CI) = 2.04-3.21 (p0.0001); for use of anxiolytic/hypnotic medication the corresponding results were HR = 1.78, CI = 1.37-2.31 (p0.0001). The interaction with time was statistically significant with HR increasing with time for both outcomes. Incident use of antidepressants in GWVs after 10 years was two times higher than among NV, after 20 years it was nearly four times higher than among NV. Incident use of anxiolytic/hypnotic medication was one and a half that of NV after 10 years, but nearly three times that of NV after 20 years. There was no difference in rate of postdeployment psychiatric contacts.The findings of increased use of antidepressants and anxiolytic or hypnotic medicine among GWVs compared with NVs were rather surprising since we recently, by using the same study population, found that deployment to the Persian Gulf was not associated with increased sickness absence or reduced labor market attachment. However, our results indicate that the mental health of the Danish GWVs is worse than in NV, and that this unfavorable difference increased with time. A possible explanation is that veterans have a high motivation for being in work, and that the deployment-related mental problems they may have acquired do not impair their ability to work, when treated properly. Furthermore, registry-based research in GWVs could include other outcomes, e.g., the use of pain medication, and other military comparison groups, e.g., veterans deployed to other areas than the Persian Gulf in addition to NV. The method of surveillance of military personnel with register data pertinent to health and monitoring outcomes compared with suitable control populations is highly recommended as a tool in the prevention of deployment-related health problems.

The U.S. Defense Department partnered with the International Initiative for Mental Health Leadership on effective leadership and operational practices for delivery of mental health (MH) as well as addiction services throughout the world for Service Members (SM) and beneficiaries. A Military Issues Work Group (MIWG) was established in 2011 to focus on challenges experienced by military SM and beneficiaries among countries. The MIWG found common concerns related to MH care delivery to rural and remote beneficiaries. Gaps in access to care were identified and prioritized to explore. This led to better collaboration and understanding of telemental health (TMH) practices and technology applications (apps) which increase access to care for rural and remote SMs and beneficiaries. An assessment of the number of SMs and dependents distant from MH care services in the USA was conducted, as well as an environmental scan for psychological health-focused mobile apps and TMH services geared toward SM, veterans, and beneficiaries. The MIWG is developing a compendium of existing military TMH programs and apps that address MH concerns and extant literature on use of technology to extend global access to care for military members and their families across the world.

Selective adsorption of large organic molecules is controlled by switchable azobenzene-based molecules. The azobenzene molecules change their configuration after irradiation with light of 365 nm from the trans to the cis isomer. The light-induced process occurs in the pore-system of the mesoporous silica SBA-15. A new synthetic route is presented allowing a distinct control of the density of functionalization on the inner pore walls of SBA-15. This control may lead to more possible applications of the functionalized mesoporous silica material. Herein we show that the behavior of the silica matrix depends on the density of functionalization. The density of the azobenzene functionalization in SBA-15 enables the selective up-take of different dye molecules. Not only the density is responsible for the selective up-take but also the configuration (cis or trans) of the azobenzene units in the pores. Furthermore dependences concerning the release of the embedded dye molecules are observed.

To examine the assumption that postdeployment incidence of sickness and other absence from work are higher among Gulf War Veterans compared with nonveterans.A prospective registry study including a cohort of 721 Danish Gulf War Veterans and a control cohort of 3,629 nonveterans selected from the general Danish population. Outcome measures were up to 23 years postdeployment incidence of (1) long-term sickness absence and (2) long-term all types of absence from work. Long term with regard to sickness and other absence was defined as exceeding 8 weeks. The association between outcomes and information on deployment history was studied using time-to-event analysis. The index date was the return date from the last deployment to the Gulf. The follow-up period was the time from index date until April 27, 2014.As the main finding, no difference was found between veterans and nonveterans in the incidence rate of long-term sickness absence. After an initial short period (3 months) with elevated incidence rate of long-term absence from work among veterans, there was no difference between the cohorts.Among Danish Gulf War Veterans, no postdeployment increased risk of long-term sickness absence or long-term absence from work was found as compared with nonveterans.

Objective The aim of this study was to examine depression as a potential negative health effect of long work hours, anticipating an exposure–response relationship. Method A nationwide prospective cohort study of 2790 Danish senior medical consultants was conducted (61.7% response rate). With the consent of Danish Data Protection Agency, data from a questionnaire survey was linked with data from a Medical Products Agency Register. Long work hours were defined based on a self-reported average of weekly work hours >40, while redemption of anti-depressive (AD) drug prescriptions defined depression. Proportional hazards Cox regression analyses were conducted adjusting for gender, age, marital status, medical specialty, decision authority at work, work social support, quantitative work demands, and AD drugs prescribed before baseline. Results Long weekly work hours did not increase the risk of redeeming AD drug prescriptions at all times during follow-up compared to the reference of 37–40 work hours [41–44 hours: hazard ratio (HR) 0.95, 95% confidence interval (95% CI) 0.5–1.8; 45–49 hours: HR 0.88, 95% CI 0.4–1.8; 50–54 hours: HR 0.83, 95% CI 0.3–2.1; 55–59 hours: HR 0.67, 95% CI 0.2–2.9; ≥60 hours: HR 0.48, 95% CI 0.1–3.7]. The same result emerged when work hours was applied in a continuous form (from 25–36 hours to 37–40 hours to 41–44 hours and so on) (HR 0.93, 95% CI 0.76–1.13) and when robust analyses were conducted (data not shown). Conclusions This study does not support the anticipation that long work hours increase the risk of depression. If anything, long work hours vaguely appear to decrease the risk of redeeming AD drug prescriptions.

We develop a novel argument why better public information can help countries to insure against idiosyncratic risk. Representative agents of developing and industrial countries receive public and private signals on their future income realization and engage in risk-sharing contracts with limited enforceability. Better public information has two opposite effects. First, it has a detrimental effect on risk sharing by limiting risk-sharing possibilities as emphasized by Hirshleifer (1971). Second, it mitigates the adverse selection problem resulting from private information which improves risk sharing. We find that better public information in developing countries ameliorates risk sharing in both developing and industrial countries.

In this paper we propose a novel methodology to analyze optimal policies under model uncertainty in micro-founded macroeconomic models. As an application we assess the relevant sources of uncertainty for the optimal conduct of monetary policy within (parameter uncertainty) and across models (specification uncertainty) using EU 13 data. Parameter uncertainty matters only if the zero bound on interest rates is explicitly taken into account. In any case, optimal monetary policy is highly sensitive with respect to specification uncertainty implying substantial welfare gains of a robustly-optimal rule that incorporates this risk.

This paper examines whether the existence and the timing of real balance effects contribute to the determination of the absolute price level, as suggested by Patinkin (1949,1965), and if they affect conditions for local equilibrium uniqueness and stability. I show that there exists a unique price level sequence that is consistent with an equilibrium under interest rate policy, only if beginning-of-period money yields transaction services. Predetermined real money balances can then serve as a state variable, implying that interest rate setting must be passive - a violation of the Taylor-principle - for unique, stable, and non-oscillatory equilibrium sequences. On the contrary, when the end-of-period money stock facilitates transactions, the equilibrium displays nominal indeterminacy and equilibrium uniqueness requires an interest rate setting consistent with the Taylor-principle.

Objectives To examine depression as a potential negative health effect of long work hours. An exposure-response relationship was anticipated. Methods A prospective cohort study of 4520 Danish senior medical consultants was conducted. Average weekly work hours >40 defined long work hours. Redemption of antidepressive drug prescriptions defined depression. Control variables were gender, age, marital status, medical specialty, decision authority at work, work social support, quantitative work demands and previous redemption of antidepressive drug prescriptions. By means of Proportional Hazards Cox Regression Analyses adjusted hazard ratios (HR) were computed. Results Among Danish senior medical consultants long weekly work hours were associated with a reduced adjusted risk of redeeming antidepressive drug prescriptions at all times during follow-up compared to reference work hours of 37–40 (41–44 h: HR 0.95, CI 0.5 to 1.8; 45–49 h: HR 0.88, CI 0.4 to 1.8; 50–54 h: HR 0.83, CI 0.3 to 2.1; 55–59 h: HR 0.67, CI 0.2 to 2.9; >60 h: HR 0.48, CI 0.1 to 3.7). Conclusions Long work hours decrease the risk of developing depression when measured as redemption of antidepressive drug prescriptions among Danish senior medical consultants. Whether this is explained by the healthy worker effect, an unexpected protective effect of long work hours or chance remains to be explored. Study strengths and limitations should be taken into account.