American Journal of Epidemiology Advance Access published online on April 23, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn084
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Original Contribution |
Psychiatric Diagnoses in Historic and Contemporary Military Cohorts: Combat Deployment and the Healthy Warrior Effect
1 Behavioral Science and Epidemiology Department, Naval Health Research Center, San Diego, CA
2 Science Applications International Corporation, San Diego, CA
Correspondence to Robyn M. Highfill-McRoy, Behavioral Science and Epidemiology Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106 (e-mail: Robyn.Highfill{at}med.navy.mil).
Received for publication August 17, 2007. Accepted for publication January 10, 2008.
Research studies have identified heightened psychiatric problems among veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). However, these studies have not compared incidence rates of psychiatric disorders across robust cohorts, nor have they documented psychiatric problems prior to combat exposure. The authors' objectives in this study were to determine incidence rates of diagnosed mental disorders in a cohort of Marines deployed to combat during OIF or OEF in 2001–2005 and to compare these with mental disorder rates in two historical and two contemporary military control groups. After exclusion of persons who had been deployed to a combat zone with a preexisting psychiatric diagnosis, the cumulative rate of post-OIF/-OEF mental disorders was 6.4%. All psychiatric conditions except post-traumatic stress disorder occurred at a lower rate in combat-deployed personnel than in personnel who were not deployed to a combat zone. The findings suggest that psychiatric disorders in Marines are diagnosed most frequently during the initial months of recruit training rather than after combat deployment. The disproportionate loss of psychologically unfit personnel early in training creates a "healthy warrior effect," because only those persons who have proven their resilience during training remain eligible for combat.
cohort studies; incidence; mental disorders; military personnel
Abbreviations: ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; OEF, Operation Enduring Freedom; OIF, Operation Iraqi Freedom; PTSD, post-traumatic stress disorder
Editor's note: An invited commentary on this article appears on page 000.
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