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Ross D, Mackay DF, Bergman BP. Risk factors for mental ill health in UK Army personnel: an overview. BMJ Mil Health 2021; 168:166-172. [PMID: 33911013 DOI: 10.1136/bmjmilitary-2020-001679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/04/2022]
Abstract
Women in the UK military are more commonly diagnosed with a mental health disorder than men, but the reasons for this difference are not fully understood. This literature review identifies the risk factors for mental ill health in military personnel before serving, during service and as a veteran. The interaction of risk factors is complex and, in some cases, may be synergistic, such as experiencing adverse events in childhood and exposure to combat. Identification of risk factors allows further research to better understand differences between men and women, and the impact of these risk factors on army personnel. In turn this will inform better preventive strategies, which could be targeted at the primary, secondary or tertiary levels.
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Affiliation(s)
- David Ross
- Army Health Unit, Royal Army Medical Corps, Aldershot, Surrey, UK
| | - D F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - B P Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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2
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Thornquist MH, Leonard JE, Fraine MC, Loftis CW, Davison JW. Development of a Tool to Predict Risk of Behavioral Health Evacuation From Combat. J Trauma Stress 2020; 33:267-275. [PMID: 32277805 DOI: 10.1002/jts.22507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 11/08/2022]
Abstract
In the present study, we examined administrative data on 667,437 deployments of at least 30 days duration to Iraq and Afghanistan from 2011 through the end of 2016 to determine risk factors for evacuation from the combat zone for behavioral health reasons. Demographic data, military-specific data, responses on predeployment mental health assessments, and presence of previous treatment for psychiatric conditions were entered into a logistic regression based on expert determination, distinguishing the 2,133 behavioral health evacuations from those deployments that either did not end in evacuation or included evacuations for reasons other than behavioral health. The model, derived from a random half of the sample (training set), was verified on the other half (validation set). Predictor variables used in the model were calendar year; gender; age; rank; marital status; parental status; number of prior war zone deployments; branch of service; screens for symptoms of posttraumatic stress disorder, depression, and hazardous alcohol use on the predeployment mental health assessment; and prior substance- and non-substance-related behavioral health diagnoses. Odds ratios (range: 1.05-3.85) for selected variables that contributed to the model were used to assign risk scores in the Behavioral Health Evacuation Risk Tool, which can aid predicting which service members are more likely to be evacuated from combat for behavioral health reasons, thus indicating where resources can be allocated for behavioral health referrals and war zone care.
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Affiliation(s)
| | | | | | - Christopher W Loftis
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC, USA
| | - John W Davison
- Clinical Communities Policy Support, Medical Affairs/Clinical Support Division, Defense Health Agency, Falls Church, Virginia, USA
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Stoltenberg CDG, Nissen LR, Nielsen ABS, Vedtofte MS, Marott JL, Gyntelberg F, Guldager B. Effect of Predeployment Psychiatric Diagnoses on Postdeployment Long-Term Sickness Absence and Mental Health Problems Among Danish Military Personnel. J Trauma Stress 2020; 33:285-295. [PMID: 32223074 PMCID: PMC7540419 DOI: 10.1002/jts.22498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 12/25/2022]
Abstract
Military personnel may withhold information on mental health problems (MHPs) for fear of not being permitted to deploy. Past or current MHPs may, however, increase the risk of postdeployment MHPs. Using psychiatric diagnoses rather than self-report assessments in predeployment screening may be a more effective screening strategy for determining deployment fitness. This retrospective follow-up study investigated (a) the extent to which predeployment childhood and adult psychiatric diagnoses predicted postdeployment MHPs, measured as psychiatric diagnosis and the purchase of psychiatric drugs, and long-term sickness absence among formerly deployed Danish military personnel and (b) whether perceived combat exposure moderated or mediated the effect of predeployment psychiatric diagnoses. Complete data were available for 7,514 Danish military personnel who answered questions on perceived combat exposure between 6-8 months after returning from their first deployment to the Balkans, Iraq, or Afghanistan. Data on all psychiatric diagnoses given at Danish hospitals, all medicine purchases, and all sickness absences were retrieved from nationwide research registers. Personnel with predeployment psychiatric diagnoses had a statistically significant higher risk for both postdeployment long-term sickness absence, hazard ratio (HR) = 2.06, 95% CI [1.52, 2.80]; and postdeployment MHPs, HR = 2.38, 95% CI [1.73, 3.27], than personnel without a predeployment psychiatric diagnosis. Personnel with a predeployment psychiatric diagnosis demonstrated a higher risk of reporting high levels of perceived combat exposure. Perceived combat exposure was not found to moderate or mediate the effect of a predeployment psychiatric diagnosis on the two outcomes. Additional findings, limitations, and implications are discussed.
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Affiliation(s)
- Christian D. G. Stoltenberg
- Centre for Social MedicineBispebjerg and Frederiksberg HospitalFrederiksbergDenmark,Research and Knowledge CentreThe Danish Veteran CentreRingstedDenmark
| | - Lars R. Nissen
- Centre for Social MedicineBispebjerg and Frederiksberg HospitalFrederiksbergDenmark,Research and Knowledge CentreThe Danish Veteran CentreRingstedDenmark
| | | | - Mia S. Vedtofte
- Research and Knowledge CentreThe Danish Veteran CentreRingstedDenmark
| | - Jacob L. Marott
- Copenhagen City Heart StudyBispebjerg and Frederiksberg HospitalFrederiksbergDenmark
| | - Finn Gyntelberg
- Department of Occupational and Environmental MedicineBispebjerg HospitalKøbenhavnDenmark
| | - Bernadette Guldager
- Centre for Social MedicineBispebjerg and Frederiksberg HospitalFrederiksbergDenmark
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Varga CM, Haibach MA, Rowan AB, Haibach JP. Psychiatric History, Deployments, and Potential Impacts of Mental Health Care in a Combat Theater. Mil Med 2018; 183:e77-e82. [PMID: 29401345 DOI: 10.1093/milmed/usx012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 10/20/2017] [Indexed: 11/12/2022] Open
Abstract
Introduction Increasing numbers of U.S. service members access mental health care while deployed and at home station. Multiple deployments carry with them a higher risk of exposure to combat as well as the impact of cumulative stressors associated with separation from family, hostile environments, and high operations tempo. However, mental health care resources continue to be underutilized, potentially because of higher levels of stigma regarding mental health care and concerns about career impact among service members. Some studies indicate that service members who have previously sought mental health care are likely to continue to do so proactively as needed. This study examined the associations between prior deployments, prior mental health treatment, and subsequent career-impacting recommendations (e.g., duty limitations and medical evacuation) among deployed service members seeking mental health care. Materials and. Methods This study is a retrospective review of clinical records from three U.S. military Combat and Operational Stress Control units in Afghanistan. Data were drawn from the mental health records of 1,639 Army service members presenting for outpatient mental health services while deployed in Afghanistan from years 2006 to 2008. Results In an unadjusted logistic regression model, service members with at least one prior deployment had a 38% greater odds (odds ratio [OR] = 1.38, 95% confidence interval [95% CI] 1.06, 1.80; p < 0.05) of receiving career-impacting recommendations than those without a prior deployment. However, after adjusting for demographics (age, gender, marital status, rank, and military status), there was no association between prior deployments and career-impacting recommendations (OR = 1.06, 95% CI 0.78, 1.43; p = 0.716). In the second unadjusted model, service members with prior mental health treatment had a 57% lower odds (OR = 0.43, 95% CI 0.34, 0.56; p < 0.001) of receiving career-impacting recommendations than those without prior mental health treatment. After adjusting for demographics and number of prior deployments, service members with prior mental health treatment had a 58% lower odds (OR = 0.42, 95% CI 0.33, 0.56; p < 0.001) of receiving career-impacting recommendations than those without prior mental health treatment. Conclusion Among service members who had a clinical mental health encounter, prior deployment was not associated with career-impacting recommendations and prior mental health treatment appeared to be protective against career-impacting recommendations. These results are in line with research indicating that service members who have previous experience with mental health care tend to seek help sooner than those without prior treatment. Those service members who had previously sought care were more likely to express decreased stigma and seek mental health care while deployed. Consequently, service members who have prior mental health treatment may seek care before their concerns become marked enough to warrant duty-limiting recommendations to command. These findings have important implications for campaigns to reduce stigma and promote early help-seeking among service members. Efforts should continue to study and respectively make known the rates of career impact with the goal of increased early service utilization and increased ability to sustain service members' military readiness and personal functioning.
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Affiliation(s)
| | | | | | - Jeffrey P Haibach
- U.S. Department of Veterans Affairs, 810 Vermont Avenue NW (10P9H), Washington, DC 20420
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Is the Military’s Century-Old Frontline Psychiatry Policy Harmful to Veterans and Their Families? Part Three of a Systematic Review. PSYCHOLOGICAL INJURY & LAW 2017. [DOI: 10.1007/s12207-016-9280-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Boulos D, Zamorski MA. Military Occupational Outcomes in Canadian Armed Forces Personnel with and without Deployment-Related Mental Disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:348-57. [PMID: 27254844 PMCID: PMC4872242 DOI: 10.1177/0706743716643742] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Mental disorders are common in military organizations, and these frequently lead to functional impairments that can interfere with duties and lead to costly attrition. In Canada, the military mental health system has received heavy investment to improve occupational outcomes. We investigated military occupational outcomes of diagnosed mental disorders in a cohort of 30,513 personnel who deployed on the Afghanistan mission. METHODS Cohort members were military personnel who deployed on the Afghanistan mission from 2001 to 2008. Mental disorder diagnoses and their attribution to the Afghanistan mission were ascertained via medical records in a stratified random sample (n = 2014). Career-limiting medical conditions (that is, condition-associated restrictions that reliably lead to medically related attrition) were determined using administrative data. Outcomes were assessed from first Afghanistan-related deployment return. RESULTS At 5 years of follow-up, the Kaplan-Meier estimated cumulative fraction with career-limiting medical conditions was 40.9% (95% confidence interval [CI] 35.5 to 46.4) among individuals with Afghanistan service-related mental disorders (ARMD), 23.6% (CI 15.5 to 31.8) with other mental disorders, and 11.1% (CI 8.9 to 13.3) without mental disorders. The adjusted Cox regression hazard ratios for career-limiting medical condition risk were 4.89 (CI 3.85 to 6.23) among individuals with ARMD and 2.31 (CI 1.48 to 3.60) with other mental disorders, relative to those without mental disorders. CONCLUSIONS Notwithstanding the Canadian military's mental health system investments, mental disorders (particularly ARMD) still led to a high risk of adverse military occupational outcomes. Such investments have intrinsic value but may not translate into reduced medically related attrition without improvements in prevention and treatment effectiveness.
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Affiliation(s)
- David Boulos
- Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
| | - Mark A Zamorski
- Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada Department of Family Medicine, University of Ottawa, Ontario, Canada
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Conway TL, Schmied EA, Larson GE, Galarneau MR, Hammer PS, Quinn KH, Schmitz KJ, Webb-Murphy JA, Boucher WC, Edwards NK, Ly HL. Treatment of Mental or Physical Health Problems in a Combat Zone: Comparisons of Postdeployment Mental Health and Early Separation From Service. J Trauma Stress 2016; 29:149-57. [PMID: 26990003 DOI: 10.1002/jts.22091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The primary aim of this study was to evaluate whether being treated for mental health or nonbattle physical injury during military combat deployment was associated with higher risk for postdeployment mental disorders and poorer career outcomes than seen in the general combat-deployed population. Service members treated in theater for mental health (n = 964) or noncombat injury (n = 853) were compared with randomly sampled personnel (n = 7,220) from the general deployed population on diagnosed mental disorders and early separation from service. Deployment, medical, and career information were obtained from Department of Defense archival databases. Over half of the personnel who received mental health treatment while deployed were diagnosed with 1 or more mental disorders postdeployment and/or were separated from service before completing their full-term enlistment. This was significantly higher than expected compared to the general deployed group, adjusting for demographic/military characteristics and mental health history (adjusted odds ratios [ORs] ranging 1.62 to 2.96). Frequencies of problems also were higher in the mental health-treated group than in the group treated for nonbattle physical injuries (significant adjusted ORs ranging 1.65 to 2.58). The documented higher risks for postdeployment adjustment problems suggested that especially those treated in theater by mental health providers might benefit from postdeployment risk-reduction programs.
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Affiliation(s)
- Terry L Conway
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Emily A Schmied
- Behavioral Sciences and Epidemiology Department, Naval Health Research Center, San Diego, California, USA
| | - Gerald E Larson
- Behavioral Sciences and Epidemiology Department, Naval Health Research Center, San Diego, California, USA
| | - Michael R Galarneau
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Paul S Hammer
- Navy Medicine Information Systems Support Activity, San Antonio, Texas, USA
| | - Kimberly H Quinn
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Kimberly J Schmitz
- Naval Center for Combat and Operational Stress Control, San Diego, California, USA
| | | | - Wayne C Boucher
- Mental Health Directorate, Naval Hospital Camp Pendleton, Marine Corps Base Camp Pendleton, California, USA
| | - Nathan K Edwards
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
| | - Hoa L Ly
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
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Boulos D, Zamorski MA. Do shorter delays to care and mental health system renewal translate into better occupational outcome after mental disorder diagnosis in a cohort of Canadian military personnel who returned from an Afghanistan deployment? BMJ Open 2015; 5:e008591. [PMID: 26644121 PMCID: PMC4679995 DOI: 10.1136/bmjopen-2015-008591] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Mental disorders in military personnel result in high rates of attrition. Military organisations have strengthened their mental health systems and attempted to overcome barriers to care in order to see better outcomes. This study investigated the roles of mental health services renewal and delay to care in Canadian Armed Forces (CAF) personnel diagnosed with mental disorders. DESIGN Administrative data were used to identify a retrospective cohort of 30,513 CAF personnel who deployed in support of the mission in Afghanistan. Study participants included 508 individuals with a mental disorder diagnosis identified from CAF medical records of a weighted, stratified random sample of 2014 individuals selected from the study cohort. Weighted Cox proportional hazards regression assessed the association of diagnosis era and delay to care with the outcome, after controlling for a broad range of potential confounders (eg, disorder severity, comorbidity). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics. PRIMARY OUTCOME The outcome was release from military service for medical reasons, assessed using administrative data for the 508 individuals with a mental disorder diagnosis. RESULTS 17.5% (95% CI 16.0% to 19.0%) of the cohort had a mental disorder diagnosis after an Afghanistan-related deployment, of which 21.3% (95% CI 17.2% to 25.5%) had a medical release over a median follow-up of 3.5 years. Medical release risk was elevated for individuals diagnosed before 30 April 2008 relative to those with recent diagnoses (adjusted HR (aHR)=1.77 (95% CI 1.01 to 3.11)) and for individuals with a long delay to care (>21 months after return) relative to those with intermediate delays (8-21 months, aHR 2.47=(95% CI 1.28 to 4.76)). CONCLUSIONS Mental health services renewal in the CAF was associated with a better occupational outcome for those diagnosed with mental disorders. Longer delays to care were associated with a less favourable outcome.
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Affiliation(s)
- David Boulos
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
| | - Mark A Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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