We often hear about the high rates of mental health disorders among service members; however, these rates typically reflect only those diagnoses received or the disorders treated while in-garrison. The mental health burden experienced while in-theater has been frequently underreported. This represents an important gap in our understanding of the behavioral health care needs of service members while deployed as well as the training needs of deploying providers. This led our team to partner with the Psychological Health Center of Excellence to investigate the case rates of mental health diagnoses while deployed.
We examined differences in rates by diagnostic category and across sex and race/ethnicity using the medical records of Soldiers deployed during Calendar Years 2008 to 2013. A list of ICD-9 diagnostic codes was generated, and diagnoses with low frequency among active duty service members (e.g., autism spectrum disorder) were removed. The resulting list was grouped into 12 diagnostic categories, informed by the categorization of diagnoses in the DSM-5. These categories included: alcohol and drug-related disorders; anxiety disorders; ADHD/ADD; bipolar and mania; depressive disorders; feeding and eating disorders; personality disorders; PTSD; schizophrenic disorders, psychosis, and paranoia; sleep disorders; somatic system disorders; and stress reactions and adjustment disorders.
Overall, we found a case rate of approximately 11 diagnoses per 100 deployed person-years. The most frequent diagnoses were (in order) stress reactions and adjustment disorders, depressive disorders, anxiety disorders, sleep disorders, PTSD, and ADHD/ADD.
Much to our surprise, female Soldiers had higher rates of all diagnostic categories than their male counterparts for all 12 diagnostic categories examined. This is in contrast to prior studies of civilian and military samples that have shown greater rates among males for disorders such as alcohol and substance use disorders or ADHD/ADD.
Most diagnostic categories had higher rates among non-Hispanic white Soldiers. However, the rates of schizophrenic disorders, psychosis, and paranoia were higher among Hispanic Soldiers and non-Hispanic Black/African American Soldiers. Other disorders including somatic and stressor-related/adjustment disorders had no to negligible differences across race/ethnicities.
Using archival medical record data has some inherent limitations. Diagnoses can only be given if a Soldier first comes in to be seen. Once seen, a diagnosis must be made and entered into the system. However, it is not possible to validate the accuracy of the diagnosis or to ensure that all diagnoses were properly entered into TMDS. Additionally, the use of archival medical record data prevents consideration of additional factors, such as social support or stress, that may contribute to these rates.
These results help us to understand the rates of specific mental health diagnoses among deployed Soldiers and how these diagnoses are differentially observed by sex and race/ethnicity. This information may prove useful in understanding the deployment of mental health providers and support assets as well as the training needed to better prepare them for caring for deployed service members. Based on these results, we recommend deploying providers be trained and competent in the assessment and delivery of effective, short-term treatments for stress, anxiety, depression, and sleep disturbances.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Maegan Paxton Willing is a Research Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
Paxton Willing, M. M., Tate, L. L., O’Gallagher, K. G., Evatt, D. P., & Riggs, D. S. (2022). In-theater mental health disorders among U.S. soldiers deployed between 2008 and 2013. Medical Surveillance Monthly Report (MSMR). https://www.health.mil/Reference-Center/Reports/2022/11/01/Medical-Surveillance-Monthly-Report-Volume-29-Number-11