Retrospective age-of-onset and projected lifetime prevalence of psychiatric disorders among U.S. Army National Guard soldiers

Abstract

Background The study of military-related mental health has been disproportionately focused on current symptomology rather than potentially more informative life course mental health. Indeed, no study has assessed age-of-onset and projected lifetime prevalence of disorders among reservists. Methods Age-of-onset and projected lifetime DSM-IV anxiety, mood, and substance use disorders were assessed in 671 Ohio Army National Guard soldiers aged 17–60 years. Between 2008 and 2012, face-to-face clinical assessments and surveys were conducted using the Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale. Results Lifetime prevalence of psychiatric disorders was 61%. Alcohol abuse/dependence (44%) and major depressive disorder (23%) were the most common disorders. The majority (64%) of participants reported disorders antedating enlistment. Median age-of-onset varied with anxiety disorders – particularly phobias and OCD – having the earliest (median = 15 years) and mood disorders the latest median age-of-onset (median = 21 years). Limitations The study was limited by both the retrospective investigation of age-of-onset and the location of our sample. As our sample may not represent the general military population, our findings need to be confirmed in additional samples. Conclusions Each psychiatric disorder exhibited a distinct age-of-onset pattern, such that phobias and OCD onset earliest, substance use disorders onset during a short interval from late-adolescence to early-adulthood, and mood disorders onset the latest. Our finding that the majority of participants reported disorders antedating enlistment suggests that an assessment of lifetime psychopathology is essential to understanding the mental health burden of both current and former military personnel.

Minding the treatment gap: results of the Singapore Mental Health Study

“…To address the treatment gap among the employed, it would also be necessary to advocate and work with employers to change hiring practices and put in place a mental health support framework in the workplace for employees. Schools and institutions of higher learning should be cognizant of the importance of the need for mental health education and awareness as most mental disorders have an early age of onset with the majority emerging during adolescence and early adulthood [42][43][44]. Helpseeking, however, remains low in this population leading to treatment delay and adverse outcomes [45].…”

Alcohol Misuse and Co‐Occurring Mental Disorders Among New Soldiers in the U.S. Army

“…Substantially higher prevalence of lifetime AUD is observed in surveys that include more experienced military personnel and veterans. AUDs were the most prevalent lifetime disorders among Ohio National Guard members (44%)(Fink et al, 2016a) and Canadian Regular Force members (32%)(Pearson et al, 2014). A contemporary survey of U.S. military veterans revealed that 42% had lifetime AUD and 15% had past-year AUD (Fuehrlein et al, 2016).…”

“…Population-based health behavior surveys of active duty personnel administered by the US Department of Defense (DoD) revealed significant increases in binge drinking (35% to 47%) and heavy drinking (15% to 20%) from 1998-2008 that were highest among those with combat exposure (Bray et al, 2013). A study of mental disorders in a representative sample of 671 Ohio Army National Guard members found that AUD was the most common lifetime disorder, with a prevalence of 44% (Fink et al, 2016a). U.S. military veterans also have a high prevalence (42%) of lifetime AUD (Fuehrlein et al, 2016).…”

“…An analysis from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) found that approximately 38% of soldiers with 30-day Substance Use Disorder (SUD; due to alcohol and/or drug misuse) reported onset prior to their enlistment in the US Army (Kessler et al, 2014). More than 40% of Ohio National Guard members with lifetime AUD reported onset of the disorder prior to enlistment (Fink et al, 2016a). These studies established pre-enlistment onset via retrospective self-report.…”

Prospective risk factors for post-deployment heavy drinking and alcohol or substance use disorder among US Army soldiers

“…Available evidence suggests the large majority of AUD/SUD in this sample was in fact AUD; only 10% of respondents with AUD/SUD at either post-deployment assessment endorsed regular use of any non-alcohol drug. Prior work also indicates that AUD is more common than drug abuse/dependence among servicemembers (Fink et al , 2016). Chronicity (persistence at T3) of two-thirds of AUD/SUD with post-deployment onset argues against characterization of these new disorders as transient reactions; and may reflect more enduring stress/adjustment demands associated with deployment to a combat zone and subsequent re-deployment to the U.S.…”