Sex-specific Associations Between Musculoskeletal Injury/pain And Psychosocial Health In Marine Corps Officers In Training

PURPOSE: Females currently comprise 11% of U.S. Marine Corps (USMC) officers, which may have social implications, such as stigmatization or harassment. Additionally, female Marine officers experience a greater incidence of musculoskeletal injury and pain (MSK-I/P) compared to male officers. We hypothesized there may be sex-specific associations between MSK-I/P and psychosocial health in USMC officers graduating from the 6-month Basic Officer Course (BOC). METHODS: Initiation of Marine Physiological Assessment of Combat Training (IMPACT) was a prospective cohort study to assess biopsychosocial characteristics associated with on-time graduation from BOC (2017-2019). Officers completed surveys at the beginning and end (graduation) of training. In this secondary analysis, generalized linear models were used to assess if MSK-I/P during BOC, sex (male/ female), or the interaction of MSK-I/P*sex were associated with psychosocial health [anxiety (GAD-7), depression (PHQ-8), unit support, support from family/friends, and general harassment (DRRI-2), gender-based stigma] at BOC graduation, controlling for age, race, commissioning source, and baseline psychosocial health. RESULTS: Of 900 officers (87% male, 24.8 ± 0.1 yr, 74% White), a greater percentage of females (50%, n = 59) than males (35%, n = 276) reported experiencing MSK-/IP during training (p < 0.01). Compared to males, females reported greater harassment (DRRI-2: 13.2 ± 0.5 vs. 11.7 ± 0.3) (sex main effect p < 0.01). Officers with MSK-I/P reported greater anxiety (GAD-7: 2.8 ± 0.4 vs. 1.6 ± 0.3), depression (PHQ-8: 3.0 ± 0.4 vs. 1.1 ± 0.3), and harassment (DRRI-2: 13.1 ± 0.5 vs. 11.9 ± 0.4) and less unit support (DRRI-2: 41.8 ± 1.1 vs. 44.2 ± 1.1) than those without MSK-I/P (MSK-I/P main effect p < 0.03). Gender-based stigma was greater in females with MSK-I/P (10.8 ± 1.7) compared to females without MSK-I/P (2.8 ± 1.2) and males with (0.1 ± 0.3) and without (0.5 ± 0.3) MSK-IP (MSK-I/P*sex p < 0.001). CONCLUSIONS: Although MSK-I/P impacted psychosocial health in all officers, gender stigmatization was exacerbated in females with MSK-I/P. MSK-I/P treatment strategies should address psychosocial as well as physical health. Addressing health holistically during training is crucial for optimizing readiness in Marines entering the fleet. Supported by: Congressionally Directed Medical Research Program, Joint Programs Committee-5/ Military Operational Medicine Research Program under Grant Number [NH91427516]