Epidemiology of psychiatric disorders sustained by a U.S. Army brigade combat team during the Iraq War☆
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
References (28)
- et al.
Changes in the distribution of Navy and Marine Corps casualties from World War I through the Vietnam conflict
Mil Med
(1981) - et al.
Army psychiatry in the Korean War: the experience of 1 Commonwealth Division
Mil Med
(2000) - et al.
Physical and mental health costs of traumatic war experiences among Civil War veterans
Arch Gen Psychiatry
(2006) - et al.
Comparisons of disease and nonbattle injury incidence across various military operations
Mil Med
(1995) - et al.
A disease and non-battle injury model based on Persian Gulf War admission rates
Am J Ind Med
(2004) - et al.
Diagnoses and factors associated with medical evacuation and return to duty for service members participating in Operation Iraqi Freedom or Operation Enduring Freedom: a prospective cohort study
Lancet
(2010) - et al.
Aeromedical evacuations from Operation Iraqi Freedom: a descriptive study
Mil Med
(2005) - et al.
Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care
N Engl J Med
(2004) - et al.
Effects of repeated deployment to Iraq and Afghanistan on the health of New Jersey Army National Guard troops: implications for military readiness
Am J Public Health
(2010) - et al.
Psychiatric diagnoses in historic and contemporary military cohorts: combat deployment and the healthy warrior effect
Am J Epidemiol
(2008)
Demographics of and diagnoses in Operation Enduring Freedom and Operation Iraqi Freedom personnel who were psychiatrically evacuated from the theater of operations
Gen Hosp Psychiatry
Army disease and nonbattle injury model, refined in Afghanistan and Iraq
Mil Med
Injury and illness casualty distributions among U.S. Army and Marine Corps personnel during Operation Iraqi Freedom
Mil Med
Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war
JAMA
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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.