Publication year
2010
Citation Title
Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq.
Journal Name
Archives of General Psychiatry
Journal Volume
67
Issue Number
6
Page Numbers
614-623
DOI
10.1001/archgenpsychiatry.2010.54
Summary
Researchers examined the prevalence rates of depression and posttraumatic stress disorder (PTSD), determined the comorbidity of alcohol misuse or aggressive behaviors with depression or PTSD, and compared prevalence rates between Active Component and National Guard Soldiers (N = 13,226). Participants were surveyed at 3- and 12-months postdeployment to Iraq (OIF). In this sample, PTSD prevalence ranged from 6% to 11% and depression prevalence from 5% to 9%.
Key Findings
Using the most stringent criteria, PTSD prevalence ranged from 6% to 11%, depression prevalence from 5% to 9%, and either PTSD or depression prevalence from 9% to 14%.
Approximately 50% of Soldiers who screened positive for PTSD or depression also met criteria for alcohol misuse or aggressive behavior.
Between the 3- and 12-month time points, PTSD and depression symptoms increased significantly among National Guard participants. PTSD symptoms increased and depression symptoms remained stable in the Active Duty group.
Between the 3- to 12-month time points, there was a significant increase in aggressive behaviors among National Guard Soldiers, but not among Active Duty Soldiers.
Implications for Program Leaders
Provide comprehensive post-deployment screening of and referrals for mental health issues, alcohol misuse, and aggression
Establish collaborations with military and community-based oragnizations to help Service members, particularly National Guard and Reserve, and their families during reintegration
Offer training for service providers on evidence-based practices to reduce the symptoms of PTSD, depression, alcohol misuse, and aggression among Service members
Implications for Policy Makers
Continue to support programs for identification and prevention of substance abuse in military families
Recommend integrating mental health education into existing service delivery systems for military families
Recommend education of professionals (e.g. child caregivers, mental health, and education professionals) on the possible effects of parents’ emotion regulation and parenting during deployment and post-deployment
Methods
Between 2004 and 2007, researchers collected anonymous self-report surveys from members of four Active Component and two National Guard infantry brigade combat teams (response rate: 45%).
Current PTSD, depression, functional impairment, alcohol misuse, and aggressive behaviors were measured.
Statistical analyses were conducted to examine prevalence rates of mental health disorders and substance abuse.
Participants
A sample of 13,226 Veterans of OIF participated.
The sample was 96% male and 4% female. The participants' ages were between 18–24 years (45%), between 25–29 years (28%), between 30–39 years (23%), and 8% were 40 years and older.
The sample's race/ethnicity was 64% White, 20% Black, 9% Latino/Latina, and 6% Other. Most were Active Duty (68%), while 32% were National Guard.
Limitations
This study focused on Service members from the Army. Hence, findings may not generalize to Service members in other branches of the military.
Participants may differ from non-participants in meaningful ways (e.g., those who responded may be functioning differently than those who did not respond) that were not accounted for in the analyses.
This study relied on self-report rather than diagnostic measures of mental health, which means the data were more susceptible to social desirability and response biases.
Data were cross-sectional; hence, causation cannot be inferred.
Avenues for Future Research
Assess whether increased dwell time between deployments is associated with improved mental health among returning Service members
Explore specific factors (e.g., heavy training schedules, less access to mental health facilities) that might predict increases in mental health issues among National Guard Soldiers after deployment
Investigate the effects of self-perceived serious impairment due to mental health issues in a variety of settings such as military occupational performance, work, family, and social relationships
Focus
Army
Target Population
Population Focus
Military Branch
Military Component
Abstract
Context: A growing body of literature has demonstrated the association of combat in Iraq and Afghanistan with postdeployment mental health problems, particularly posttraumatic stress disorder (PTSD) and depression. However, studies have shown varying prevalence rates of these disorders based on different case definitions and have not assessed functional impairment, alcohol misuse, or aggressive behavior as comorbid factors occurring with PTSD and depression. Objectives To (1) examine the prevalence rates of depression and PTSD using several case definitions including functional impairment, (2) determine the comorbidity of alcohol misuse or aggressive behaviors with depression or PTSD, and (3) compare rates between Active Component and National Guard soldiers at the 3- and 12-month time points following their deployment to Iraq. Design: Population-based, cross-sectional study. Setting: United States Army posts and National Guard armories. Participants: A total of 18 305 US Army soldiers from 4 Active Component and 2 National Guard infantry brigade combat teams. Interventions: Between 2004 and 2007, anonymous mental health surveys were collected at 3 and 12 months following deployment. Main Outcome Measures: Current PTSD, depression, functional impairment, alcohol misuse, and aggressive behavior. Results: Prevalence rates for PTSD or depression with serious functional impairment ranged between 8.5% and 14.0%, with some impairment between 23.2% and 31.1%. Alcohol misuse or aggressive behavior comorbidity was present in approximately half of the cases. Rates remained stable for the Active Component soldiers but increased across all case definitions from the 3- to 12-month time point for National Guard soldiers. Conclusions: The prevalence rates of PTSD and depression after returning from combat ranged from 9% to 31% depending on the level of functional impairment reported. The high comorbidity with alcohol misuse and aggression highlights the need for comprehensive postdeployment screening. Persistent or increased prevalence rates at 12 months compared with 3 months postdeployment illustrate the persistent effects of war zone service and provide important data to guide postdeployment care.
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