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American Journal of Epidemiology Advance Access originally published online on April 22, 2008
American Journal of Epidemiology 2008 167(11):1277-1280; doi:10.1093/aje/kwn083
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Invited Commentary: How Healthy is the "Healthy Warrior"?

Rosemary Toomey1,2,3

1 Department of Psychology, Boston University, Boston, MA
2 Massachusetts Mental Health Center Public Academic Psychiatry Division of the Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, MA
3 Research Service, Boston Veterans Affairs Healthcare System, Brockton, MA

Correspondence to Dr. Rosemary Toomey, Department of Psychology, Boston University, 648 Beacon Street, 6th Floor, Boston, MA 02215 (e-mail: rosemary_toomey{at}hms.harvard.edu).

Received for publication February 19, 2008. Accepted for publication February 29, 2008.

In this issue of the Journal, Larson et al. (Am J Epidemiol 2008;167:1269–1276) report incidence rates of 11.8% for any mental disorder and 1.6% for post-traumatic stress disorder among US Marines deployed during Operation Iraqi Freedom and Operation Enduring Freedom. Various methodological reasons can help explain why these rates are lower than those found in previous wars. One primary reason is varying methods of diagnosis. Other reasons include differences in percentages of active-duty personnel, windows of observation, and methods of calculating rates. In addition, comorbidity for some mental disorders and specific risks for developing certain disorders complicate interpretation of rates. Nevertheless, Larson et al. document evidence for the "healthy warrior" effect—namely that deployed Marines have fewer mental disorders than nondeployed Navy and Marine Corps personnel, with the exception of stress disorders. Suggestions are made for directions of future research into this effect.

cohort studies; incidence; mental disorders; military personnel

Abbreviations: CAPS, Clinician-Administered PTSD Scale; OEF, Operation Enduring Freedom; OIF, Operation Iraqi Freedom; PTSD, post-traumatic stress disorder; SCID, Structured Clinical Interview for DSM Disorders


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