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Comment & Response |

Adverse Childhood Experiences and Military Service—Reply

John R. Blosnich, PhD, MPH1
[+] Author Affiliations
1Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
JAMA Psychiatry. 2015;72(3):296-297. doi:10.1001/jamapsychiatry.2014.2508.
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In Reply We appreciate Ivany and Hoge’s comments on our article about adverse childhood experiences (ACEs) among persons with military service history1; however, we believe the critiques go beyond the scope of our report and reiterate limitations we stated in the article.

Their first critique about the problematic nature of dividing the sample by Vietnam war era vs all-volunteer (ie, post-Vietnam) era seems contradicted by the authors. Ivany and Hoge noted numerous differences between the 2 eras that would support stratification by era. Their claim that there are other possible differences between the eras—besides compulsory vs voluntary service—is as viable a hypothesis as the one we put forward in our report. However, the specific differences on which they focus are accession requirements and attrition before completion of service. Our hypothesis involved enlistment as a potential form of escape, not successful completion of military service on enlistment. The authors cited attrition figures; however, these figures are predicated on the fact that those who prematurely separated from service had to be enlisted for service in the first place, which would support our hypothesis. While we agree that the successful completion of service among persons who survive ACEs is an important and interesting issue, it is goes beyond the scope of the data and our report, which addressed the enlistment hypothesis.

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March 1, 2015
Christopher G. Ivany, MD; Charles W. Hoge, MD
1Behavioral Health Division, Office of the Army Surgeon General, Falls Church, Virginia
1Behavioral Health Division, Office of the Army Surgeon General, Falls Church, Virginia2Center for Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
JAMA Psychiatry. 2015;72(3):296. doi:10.1001/jamapsychiatry.2014.2474.
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