LeardMann et al. BMC Public Health 2010, 10:437 http://www.biomedcentral.com/1471-2458/10/437 Table 2 Adverse childhood experiences of Recruit Assessment Program male responders deployed between September 1, 2001 and June 30, 2004 Adverse Childhood Experiences Study Postdeployment Sample PTSDa N = 8391 N = 226 % % Physical neglectb,c No Yes Physical abuse No Yes Emotional neglectb,c No Yes Emotional abusec No Yes Domestic violence No Yes Sexual abuse No Yes Family history of mental illness or alcohol abuse No Yes Overall ACEc None ACE in 1 category ACE in 2 or more categories 88.5 11.0 96.8 3.0 93.3 6.2 92.4 7.1 92.2 7.5 98.4 1.2 82.7 15.2 66.5 19.6 11.6 81.0 19.0 96.0 3.1 88.9 10.6 89.4 10.2 89.8 9.7 97.4 1.8 83.6 15.0 61.1 20.8 16.4 Abbreviations: ACE = adverse childhood experiences; PTSD = posttraumatic stress disorder. As a result of missing data, percentages may not sum to 100%. aDiagnosed with PTSD after returning from first deployment in support of the operations in Iraq and Afghanistan and within 2 years of last deployment. Responders with a PTSD diagnosis prior to first deployment are excluded from this model. bSignificant (p < .05) association with PTSD diagnosis. cSignificant (p < .05) association with mental health diagnosis. The findings of this prospective evaluation found that Marines who reported ACE in 2 or more cate- gories were at increased risk for PTSD after military deployment compared with those who reported no ACE exposure. The results of this report also indicate that men who reported physical neglect in childhood in particular were significantly more likely to be diag- nosed with PTSD. Reports of other types of ACE, including sexual or physical abuse, emotional neglect or abuse, domestic violence or family history of mental health illness or alcohol abuse, were not independently associated with an increased risk for PTSD. Previous research has found no direct link between domestic violence, problematic family history, and PTSD [15, 34]. Other ACE research, however, has reported Table 3 Adjusted risk of posttraumatic stress disorder among deployed male Marines by adverse childhood experiences Postdeployment PTSDa Prevalence HR (95% CI)b per 100 Characteristic Physical neglect No Yes Physical abuse No Yes Emotional neglect No Yes Emotional abuse No Yes Domestic violence No Yes Sexual abuse No Yes Family history of mental illness or alcohol abuse No Yes Marital status at time of deployment Not married Married AFQT score < 42 (below 25th percentile) 42-54 (25-49th percentile) 55-70 (50-74th percentile) > 70 (above 74th percentile) Number of deployments 1 2-3 Diagnosed with mental health disorder prior to deployment No Yes 2.48 4.58 2.70 2.88 2.57 4.80 2.61 3.97 2.63 3.59 2.69 4.26 2.72 2.61 2.50 3.83 4.29 2.54 2.60 1.62 2.51 6.31 2.63 6.58 Page 5 of 8 1.00 1.74 (1.17, 2.59) 1.00 0.58 (0.25, 1.32) 1.00 1.30 (0.78, 2.15) 1.00 1.30 (0.78, 2.16) 1.00 1.19 (0.75, 1.90) 1.00 1.13 (0.40, 3.16) 1.00 0.88 (0.60, 1.29) 1.00 1.48 (1.08, 2.04) 1.00 0.60 (0.42, 0.85) 0.63 (0.44, 0.89) 0.40 (0.27, 0.60) 1.00 2.33 (1.54, 3.52) 1.00 2.52 (1.33, 4.77) Abbreviations: AFQT = Armed Forces Qualification Test; CI = confidence interval; HR = hazard ratio; PTSD = posttraumatic stress disorder. aDiagnosed with PTSD after returning from first deployment in support of the operations in Iraq and Afghanistan and within 2 years of last deployment. Responders with a PTSD diagnosis prior to first deployment are excluded from this model. bHR and 95% CI are adjusted for AFQT score, number of deployments, mental health diagnosis prior to deployment, marital status, and ACE categories. associations between PTSD and physical and sexual abuse [14,15,32,33]. The concept that prior trauma, ACE or otherwise, confers increased vulnerability, rather than resilience, to post-combat PTSD is consistent with other recent, large, prospective studies in the US military. The Millennium