Document is current

Article History

Received: 2 October 2025

Accepted: 19 February 2026

First Online: 4 March 2026

Declarations

:

: Approval for this study was granted by the Brandeis University Committee for Protection of Human Subjects, the Colorado Multiple Institutional Review Board, the Department of Veterans Affairs Eastern Colorado Health Care System Institutional Review Board, the Vanderbilt University Institutional Review Board, and the Human Research Protection Program at the Office of the Assistant Secretary of Defense for Health Affairs/ Defense Health Agency. All analyses were performed in accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards. This study used secondary existing data only and did not require written informed consent.

: Clearance for publication was provided by the Defense Health Agency.

: This cohort study was approved by all necessary institutional review boards and deemed exempt under category 4. As the study was retrospective in nature, a waiver of consent was granted. This study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies.

: Dr. Adams reports grants from the National Institutes of Health (NIH) and Henry Jackson Foundation on behalf of the Uniformed Services University (USU)/Department of Defense (DoD). She has an Intergovernmental Personnel Act agreement for work with the VHA Rocky Mountain Mental Illness Research Education and Clinical Center and consults for Denver Research Institute. Dr. Forster reports grants from the Veterans Affairs (VA), DoD and NIH. Dr. Hoffmire reports grants from the VA, DoD, and NIH. Dr. Walsh reports grants from NIH, the US Food and Drug Administration, the Military Suicide Research Consortium, Wellcome Leap, the Selby Stead Fund, Vanderbilt University Medical Center, and the Tennessee Department of Health; receiving personal fees from Southeastern Home Office Underwriters Association and Hannover Re; and holding equity in Sage AI outside the submitted work. Dr. Gradus reports grants from the VA, DoD, and NIH., and receives editorial renumeration from the American Journal of Epidemiology. Dr. Brenner reports grants from the VA, DoD, NIH, and the State of Colorado, editorial renumeration from Wolters Kluwer, and royalties from the American Psychological Association and Oxford University Press. In addition, she consults with sports leagues via her university affiliation.