Elsevier

General Hospital Psychiatry

Volume 33, Issue 1, January–February 2011, Pages 51-57
General Hospital Psychiatry

Epidemiology of psychiatric disorders sustained by a U.S. Army brigade combat team during the Iraq War

https://doi.org/10.1016/j.genhosppsych.2010.10.007Get rights and content

Abstract

Objective

This study was designed to describe the epidemiology of psychiatric illnesses experienced by soldiers in a combat environment, which has been previously underreported.

Methods

A U.S. Army brigade combat team deployed to Iraq during the Iraq War “Troop Surge" was followed by reviewing unit casualty rosters and electronic medical records for psychiatric diagnoses made by treating providers. The main outcome was the incidence rates of psychiatric disease and nonbattle injury (DNBI).

Results

Of the 4122 soldiers deployed, there were 308 psychiatric DNBI casualties (59.8 per 1000 soldier combat-years), which represented 23% of all DNBIs and was second only to musculoskeletal injuries (50% of all DNBI). Most psychiatric DNBI (88%) were treated in theater and returned to duty, 11% were medically evacuated and 1% died. Junior enlisted soldiers, compared with junior officers, and women, compared with men, were at a significantly increased risk for becoming a psychiatric DNBI casualty (77.3 vs. 32.2 per 1000 combat-years, P<.002 and 110.8 vs. 55.4 per 1000 combat-years P<.05, respectively).

Conclusions

Psychiatric diagnoses are second only to musculoskeletal injuries as a cause for DNBIs sustained in the current combat environment. Most can be treated in theater and permit soldiers to return to duty.

Introduction

Psychiatric disorders have been a major cause of personnel loss from the combat zone during military deployments since antiquity. This has been delineated in great detail in studies of the American Civil War, World War I, World War II, Korean War, Vietnam War and the Persian Gulf War [1], [2], [3], [4], [5]. Many recent studies have analyzed the medical aspects of the current Operation Iraqi Freedom and Operation Enduring Freedom Conflicts [6], [7], [8], [9], [10], [11], [12], [13]. Several of these studies described the medical evacuation (MEDEVAC) rates out of the combat theater and in-theater hospitalizations, with the finding that a psychiatric disorder was the primary cause in 6% to 8% of all evacuations and hospitalizations, ranking as the fourth to seventh most common etiology for disease and nonbattle injury (DNBI) [6], [7], [12], [13].

While psychiatric disorders requiring MEDEVAC out of theater and those necessitating hospitalization in theater are certainly important, these typically only represent a fraction of psychiatric disorders in a population. One study of outpatient visits found that 6.4% of a cohort of U.S. Marines (97% men) were diagnosed with a mental disorder after returning from deployment [10]. Using screening instruments, another study revealed that U.S. Army soldiers and Marines returning from deployment had a combined prevalence for depression, anxiety and posttraumatic stress disorder (PTSD) of 11% to 17% [8]. Other studies have also focused on the postdeployment period [14], [15].

The findings of a significant proportion of service members being evacuated for a psychiatric disorder as well as frequent diagnoses for psychiatric disorders after deployment would suggest that these disorders are quite common in a combat-deployed population. The U.S. Army's Mental Health Advisory Team has reported on selected psychiatric disorders, using anonymous surveys, for soldiers currently serving in Iraq [16]. However, the sampling strategy used (to be feasible in the combat environment) and the lack of record review limit the generalizability of the findings [16]. To our knowledge, there has never been a published study describing the prevalence and burden of psychiatric disorders in an entire large combat-deployed maneuver unit. This study was designed to describe the prevalence, epidemiological characteristics and burden of psychiatric DNBI sustained by a brigade combat team (BCT) during “The Surge” portion of Operation Iraqi Freedom.

Section snippets

Methods

With approval of our Institutional Review Board and using only deidentified patient data, a cross-sectional study of a U.S. Army BCT deployed to Iraq for 15 months (1.25 years) during the Iraq War “Troop Surge" was performed. Unit rosters were obtained, and a comprehensive database was created by querying each soldier's electronic medical record and the unit's casualty rosters. There are multiple levels of care from which information is obtained, starting at the point of entry, progressing

Results

The study population consisted of 4122 (3797 men and 325 women) BCT soldiers deployed in support of Operation Iraqi Freedom during the specified period. The average age was 27.0 years (range 18–52 years). The median military rank was enlisted grade E4 (SPC). In 4122 deployed soldiers (5152 soldier combat-years at risk), there were 500 combat wounds in 390 combat casualties and 1324 DNBI casualties. Therefore, the majority of casualties sustained by the BCT were a result of DNBI (77.2%). Of the

Discussion

Our study found that psychiatric casualties accounted for nearly one quarter of all DNBI casualties during a 15-month deployment by a BCT in support of Operation Iraqi Freedom, with a rate of 59.8 psychiatric causalities per 1000 combat-years. As 88% of these casualties were RTD, they would not have been accounted for by previous research methods that solely rely upon hospital admissions rates, MEDEVAC data and death certificates. The most common psychiatric disorders included sleep

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    Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or U.S. government. The authors are employees of the U.S. government.

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