Publication year
2006
Citation Title
Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan.
Journal Name
Journal of the American Medical Association
Journal Volume
295
Issue Number
9
Page Numbers
1023-1032
DOI
10.1001/jama.295.9.1023
Summary
The Post-Deployment Health Assessments (PDHA) of 303,905 Army and Marine Veterans of Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and other recent conflicts were reviewed to examine the association between deployment location and mental health care utilization during the first year after return. Associations between screening results and actual use of mental health services were also studied. Results suggest that mental health problems reported on the assessment were significantly associated with combat experiences, mental health care referral and utilization, and attrition from military service.
Key Findings
A higher percentage of OIF Veterans (19%) screened positive for mental health problems following deployment and combat exposure as compared to Veterans of OEF (11%) and Veterans of other operations (9%).
Approximately one-third of OIF Veterans accessed mental health services in their first year after deployment and 12% received a diagnosis of a mental health problem.
Soldiers and Marines who screened positive for a mental health concern were significantly more likely to leave service for any reason during the first year after deployment; OIF Veterans were significantly more likely to leave military service (17%) than OEF Veterans (14%) or Veterans of other deployments (15%).
Two thirds of Service members who sought mental health care did so within two months of returning home.
Implications for Program Leaders
Offer workshops during reintegration to help families and Service members adjust to the Service member’s return, especially when the deployment has included combat exposure
Disseminate information regarding possible symptoms of mental health problems Service members may face after deployment and where individuals and families can find help for those problems
Engage Service members and their intimate partners in classes that aim to increase communication and conflict-resolution skills prior to and after deployment
Implications for Policy Makers
Support efforts that explore and address barriers to mental health care among returning Service members
Continue to support programs that address the unique challenges faced by deployed Service members who are also parents
Recommend education for service providers around the possible effects of deployment on Service members’ families
Methods
All Service members completed a self-administered Post-Deployment Health Assessment immediately upon returning from deployment, and records from the population-based Defense Medical Surveillance System (DMSS) database completed between May 1, 2003 and April 20, 2004 were used in this study.
Health care utilization and occupational outcomes were measured for one year after deployment or until leaving the Service if this occurred sooner.
Variables of interest were extracted from assessments for mental health screening, referrals, health care utilization, and occupational burden.
Participants
Participants were 303,905 primarily male (89%) Army (82%) and Marine (19%) Veterans between the ages of 18-24 years (42%) who served primarily in the Active Duty component (74%).
The study focused on Army and Marine Veterans returning from Iraq (OIF, 73%), Afghanistan (OEF, 5%), and other locations (21%).
Most participants (49%) were enlisted E1-E4, although many (31%) were E5-6, and some (8%) were E7-9 or officers (12%).
Limitations
All screening data were provided by participants themselves which could have led to a self-report bias.
The measurement of mental health care utilization may have been an underestimate due to the likelihood that some Service members received care outside the military health care system or through primary care settings whereby mental health diagnoses may not have been coded.
Selected participants may differ from nonparticipants in ways that were not measured but affected the outcomes such as average number of previous deployments, ethnicity, or socioeconomic status.
Avenues for Future Research
Examine whether a possible repeat screening program implemented 90 to 180 days after deployment, when the presence of mental health problems is likely to be higher, will result in an increase in mental health care utilization
Gather additional research beyond a year following deployment to determine the long-term burden that military operations will have on the mental health care system
Collect qualitative data from Service members about their healthcare symptoms and utilization
Focus
Multiple Branches
Target Population
Population Focus
Military Component
Abstract
CONTEXT: The US military has conducted population-level screening for mental health problems among all service members returning from deployment to Afghanistan, Iraq, and other locations. To date, no systematic analysis of this program has been conducted, and studies have not assessed the impact of these deployments on mental health care utilization after deployment. OBJECTIVES: To determine the relationship between combat deployment and mental health care use during the first year after return and to assess the lessons learned from the postdeployment mental health screening effort, particularly the correlation between the screening results, actual use of mental health services, and attrition from military service. DESIGN, SETTING, AND PARTICIPANTS: Population-based descriptive study of all Army soldiers and Marines who completed the routine postdeployment health assessment between May 1, 2003, and April 30, 2004, on return from deployment to Operation Enduring Freedom in Afghanistan (n = 16,318), Operation Iraqi Freedom (n = 222,620), and other locations (n = 64,967). Health care utilization and occupational outcomes were measured for 1 year after deployment or until leaving the service if this occurred sooner. MAIN OUTCOME MEASURES: Screening positive for posttraumatic stress disorder, major depression, or other mental health problems; referral for a mental health reason; use of mental health care services after returning from deployment; and attrition from military service. RESULTS: The prevalence of reporting a mental health problem was 19.1% among service members returning from Iraq compared with 11.3% after returning from Afghanistan and 8.5% after returning from other locations (P<.001). Mental health problems reported on the postdeployment assessment were significantly associated with combat experiences, mental health care referral and utilization, and attrition from military service. Thirty-five percent of Iraq war veterans accessed mental health services in the year after returning home; 12% per year were diagnosed with a mental health problem. More than 50% of those referred for a mental health reason were documented to receive follow-up care although less than 10% of all service members who received mental health treatment were referred through the screening program. CONCLUSIONS: Combat duty in Iraq was associated with high utilization of mental health services and attrition from military service after deployment. The deployment mental health screening program provided another indicator of the mental health impact of deployment on a population level but had limited utility in predicting the level of mental health services that were needed after deployment. The high rate of using mental health services among Operation Iraqi Freedom veterans after deployment highlights challenges in ensuring that there are adequate resources to meet the mental health needs of returning veterans.
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