Publication year
2008
Citation Title
Psychiatric diagnoses in historic and contemporary military cohorts: Combat deployment and the healthy warrior effect.
Journal Name
American Journal of Epidemiology
Journal Volume
167
Issue Number
11
Page Numbers
1269-1276
DOI
10.1093/aje/kwn084
Summary
In this study, researchers aimed to determine incidence rates of diagnosed mental disorders in a cohort of Marines deployed to combat during OIF/OEF between 2001 and 2005 and to compare these with mental disorder rates in two historical and two contemporary military control groups from the Navy and Marines.
Key Findings
Of all contemporary deployed Marines, 12% had a diagnosed mental disorder.
Overall, Marines who had recently served in OEF/OIF had lower rates of diagnosed mental disorders than non-combat-deployed Marines and Sailors.
When deployed personnel with precombat mental health diagnoses were excluded from the sample, PTSD was the only psychiatric diagnosis for which the combat-deployed had higher rates.
Almost half of all Marines with a psychiatric disorder were first diagnosed prior to their first combat deployment.
Implications for Program Leaders
Offer workshops for Service members and their families regarding how to deal with post-deployment PTSD symptoms
Offer peer support groups for Service members with a mental health diagnosis in order to increase their social support
Disseminate information regarding the resources and service available to military families coping with mental health issues
Implications for Policy Makers
Continue to support treatment for mental health concerns among Service members
Recommend the development of programs for Service members with post-deployment mental health concerns and their famlies
Encourage collaboration among DoD and community-based programs to provide streamlined care to Service members and their families
Methods
Data were obtained from the Defense Manpower Data Center and the Standard Inpatient Data Record, Standard Ambulatory Data Record, and Health Care Service Record files via TRICARE Management Activity.
Rates of psychiatric disorders were compared among different groups of Service members.
Rates of mental disorders among a cohort of Marines deployed to a combat zone in Iraq or Afghanistan were compared to rates mental disorders among cohorts of Marine and Navy personnel not deployed to a combat zone.
Participants
The primary group of interest consisted of all 41,561 Marines who enlisted between July 2001 and September 2004 and were deployed to an OIF/OEF combat zone prior to September 2005.
The average age was 19.5 years (SD = 2.0); 97% were male and 3% female; 69.6% were White, 16% Latino/Latina, 8% Black, 2% Asian-American, 3% another race, and 2% of participants did not have information regarding race.
In the sample, 39% of participants were 18-24 years old, 30% were 25-29 years old, 28% were 30-39 years old, and 3% were 40 years or older.
Limitations
Rates of certain disorders may be under-reported in this study because Service members may be reluctant to seek assistance for mental health issues because of the effect it might have on their careers.
Without longitudinal data, there is no clear evidence that deployment caused trauma-related symptoms.
Results may not generalize to those serving in other branches of the military.
Avenues for Future Research
Replicate this study among Service members from other branches of the military to examine whether the results can be generalized
Use a longitudinal design to investigate the idea that deployment leads to or exacerbates pre-existing mental health issues
Examine how deployment affects male and female Service members' mental health
Focus
Marines
Target Population
Population Focus
Military Branch
Military Component
Abstract
Research studies have identified heightened psychiatric problems among veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). However, these studies have not compared incidence rates of psychiatric disorders across robust cohorts, nor have they documented psychiatric problems prior to combat exposure. The authors' objectives in this study were to determine incidence rates of diagnosed mental disorders in a cohort of Marines deployed to combat during OIF or OEF in 2001–2005 and to compare these with mental disorder rates in two historical and two contemporary military control groups. After exclusion of persons who had been deployed to a combat zone with a preexisting psychiatric diagnosis, the cumulative rate of post-OIF/-OEF mental disorders was 6.4%. All psychiatric conditions except post-traumatic stress disorder occurred at a lower rate in combat-deployed personnel than in personnel who were not deployed to a combat zone. The findings suggest that psychiatric disorders in Marines are diagnosed most frequently during the initial months of recruit training rather than after combat deployment. The disproportionate loss of psychologically unfit personnel early in training creates a “healthy warrior effect,” because only those persons who have proven their resilience during training remain eligible for combat.
Abstract Document
PRTW Document
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