Citation
Shankle, Shawnice Lee (2024). The Effects of Body Mass Index on Depressive Symptoms Trajectories from Adolescence to Middle Adulthood in Service Members and Veterans Compared to Civilians.
Abstract
Introduction: Despite comprehensive fitness standards for those in the U.S. military, service members (SMs) and veterans have similar rates of high Body Mass Index (BMI) and depressive symptoms as civilians. This dissertation explores the relationship between the two conditions in Gulf War and Post-9/11 SMs and veterans compared to civilian peers by building trajectories for the conditions and their interaction. Literature Review: A literature review was conducted to examine high BMI and depressive symptoms among SMs and veterans of recent wars. The Life Course Health Development Model theoretically guided the review. Sixteen primary research studies met inclusion/exclusion criteria: nine studies uncovered heterogeneous relationships between high BMI and depressive symptoms; seven found no relationship. Wide-ranging definitions, measures, and timelines existed across the studies. Most of the veteran-only studies were program evaluations of the Veterans Health Administration’s MOVE! program. Since there were no longitudinal studies evaluating the complexity within or between high BMI and depressive symptoms, research is needed to clarify how these conditions relate by comparing SM and veteran health across the life course, a secondary analysis study was conducted. Aim 1 tested for differences in BMI trajectories by veteran status. Aim 2 tested for differences in depressive symptoms trajectories by veteran status. Aim 3 assessed BMI’s potential to affect depressive symptoms trajectories differently by veteran status. Methods: This secondary analysis fit multilevel model growth curves to explore BMI and depressive symptoms trajectories. The study sample included the 6,465 non-pregnant participants, 441 SMs and veterans versus 6,024 civilians, present in all waves of the National Longitudinal Study of Adolescent to Adult Health (“Add Health”). Three iterative aims were tested for differences between group (veteran, civilian) trajectories from adolescence to middle adulthood. The study built a full dataset using multiple imputation by chained equations. Tests were conducted for: collinearity amongst predictors; pairwise correlation; and description of the study sample and groups. Results: The veteran group differed demographically from the civilian group and the U.S. veteran population. The proportions with high BMI grew for all waves and demographic groups, but the proportions with reported depressive symptoms remained steady. Aim 1 found BMI trajectory was significantly lower veterans’ than for civilians, with BMI trajectories beginning as normal in wave 1 but approaching obesity by wave 5. Aim 2 found depressive symptoms trajectories did not differ between veterans and civilians: the trajectories were highest at waves 1–2, dipped at wave 3, then trended upward in waves 4–5. Aim 3 found depressive symptoms trajectories were not predicted by lagged BMI trajectories (p=0.55). Discussion: Veterans had statistically lower BMI trajectories but joined their civilian peers in approaching obesity by mid-life [Aim 1]. Depressive symptoms trajectories were not significantly predicted by either veteran status [Aim 2] or lagged BMI trajectories [Aim 3]. Future research should use innovative approaches to explore individual biopsychosocial factors and population health trends to improve scientific understanding of and drive better care for high BMI and depressive symptoms in SMs and veterans.
URL
http://rave.ohiolink.edu/etdc/view?acc_num=osu1712071351736574Keyword(s)
Service Members
Reference Type
Thesis/Dissertation
Book Title
Nursing
Author(s)
Shankle, Shawnice Lee
Series Author(s)
Smith, Laureen
Year Published
2024
Volume Number
Doctor of Philosophy
Publisher
The Ohio State University
Reference ID
10467
