Association Between Mental Health Conditions Diagnosed During Initial Eligibility for Military Health Care Benefits and Subsequent Deployment, Attrition, and Death by Suicide Among Active Duty Service Members

Abstract

Objective: To examine incidence of mental health diagnoses during initial service of U.S. active duty military members and identify associations with deployment, attrition, and suicide. Methods: A retrospective cohort of 576,502 service members (SMs) newly enlisted between 2003 and 2006 was identified. Data included medical encounter, deployment and attrition, and suicide. Multivariable logistic regression models examine the association between mental health diagnoses coded within the SMs' first 6 months of eligibility for health care benefits and deployment. Multivariable Cox proportional hazards models quantify the association between mental health diagnoses and attrition and suicide. Results: The cumulative incidence of mental health diagnoses was approximately 9% at 6 months of service. Adjustment, depressive, and anxiety disorders were most common. Those with any mental health diagnosis during initial eligibility had increased risk of early attrition and were 77% less likely to deploy.

Suicidal ideation among young Afghanistan/Iraq War Veterans and civilians: Individual, social, and environmental risk factors and perception of unmet mental healthcare needs, United States, 2013

“…Major depression and/or psychological distress were risk factors for suicidal ideation in both groups, which also has been found in other military, Veteran, and civilian studies (Ilgen et al, 2010a; Logan et al, 2011b; Hyman et al, 2012, 2012; Ireland et al, 2012; Kessler et al, 2014; Nock et al, 2014). However, our finding that perception of unmet mental health care needs was a much stronger risk factor for suicidal ideation among Veterans versus civilians was novel.…”

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?

“…2 For those in high-threat locations, rates approached 30% after 7 years. 2 Mental health problems have a pronounced impact on military occupational fitness, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] which in turn can lead to attrition when personnel fail to meet stringent military occupational fitness requirements. Attrition is the largest single mental health-related cost for employers, 18 and it has particular salience for military organisations, given their extensive and specialised training requirements.…”

“…5-8 10 17 19-24 In addition to mental health problems, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] factors include age, 5-8 10 19-21 24 gender, 5-7 10 17 19-22 race/ethnicity, 6 8 19 rank, 5 19 years of service, 10 17 23 24 marital status, 10 22 24 element (Army, Navy or Air Force) 5 21 and education. 10 Research on factors influencing outcome among those with mental disorders is sparse.…”

Medically Documented Suicide Ideation Among U.S. Army Soldiers

“…Lastly, it is important to note that the observed differences across time in service and deployment status are not evidence of within-person changes in risk over time, as the composition of these groups is affected by the non-random nature of Army attrition and deployment. (Hoge, Auchterlonie, & Milliken, 2006; Ireland, Kress, & Frost, 2012; Warner et al, 2011)…”