Self-rated health and subsequent health care use among military personnel returning from international deployments

Individual health status assessment upon completion of U.S military deployments was standardized in 1999 with a brief health assessment questionnaire. This cohort study analyzed health status responses and their relationship to postdeployment health outcomes among 16,142 military personnel who completed a health questionnaire after a deployment ending in 1999. Respondents were Army and Air Force personnel returning from Europe or Southwest Asia. Fourteen percent documented at least one health concern and 1.8% had fair/poor self-rated health. In the 6 months after deployment, 1.4% were hospitalized, 25% made five or more outpatient visits, and 4% separated from military service. Deployers with fair/poor self-rated health were at a significantly increased risk for high use of outpatient services (risk ratio, men 1.8, women 1.7) but not for hospitalization or separation. Self-report of low health status or other health concerns may help identify deployers with higher health care needs after future deployments.     

The health status of Gulf War veterans: lessons learned from the Department of Veterans Affairs Health Registry.

OBJECTIVE: To describe the demographic characteristics and postwar health status of U.S. Gulf War veterans who participated in the Department of Veterans Affairs health examination registry program. DESIGN: Case records of 52,835 veterans who participated in a standardized health examination program were reviewed. SETTING: Participants volunteered for physical examinations at a Department of Veterans Affairs medical treatment facility from August 1992 to September 1996. SUBJECTS: U.S. Gulf War veterans deployed to southwest Asia between August 1990 and 1996. MAIN OUTCOME MEASURE: Demographic, military, symptom, and International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic categories. RESULTS: A wide variety of symptoms and diagnoses were reported without apparent internal variation by military characteristics (branch and service component). The frequency of symptoms (fatigue, skin rash, headache, muscle and joint pain, and memory loss) reported increased over time, whereas the proportion of individuals with physician-diagnosed illnesses remained fairly constant. No single category of disease increased or decreased substantially over time. CONCLUSIONS: Veterans have experienced a wide variety of health problems since their Gulf War service. These problems, in aggregate, are different from what has been seen in other armed conflicts. The Department of Veterans Affairs registry is a very large case series and has failed to identify a single, unique syndrome or new illness after Gulf War service. An epidemiologic study would better define the prevalence of specific symptoms and medical conditions among Gulf War veterans and to what extent any of the conditions identified are associated with Gulf War military service. The knowledge provided by such studies would be important to development of preventive measures and future deployment medical surveillance planning.     

Women in the Gulf War: combat experience,exposures, and subsequent health care use

The expanding role of women in the military raises questions related to the military experiences of women serving in major conflicts. We assess the military experiences and postwar health care use of women who served during the Gulf War. Data from a population-based survey of military personnel serving between August 1990 and July 1991 assessing military preparedness, combat experience, occupational and other service-related exposures, and health care use were analyzed. Deployed women were more often in the Army, single, without children, college educated, and reported fewer vaccinations. Deployed men and women had similar military experiences; however, men more often participated in combat. Deployed women had more outpatient and inpatient health care use 5 years after deployment and more often received Department of Veterans Affairs compensation than men. If these important differences in exposures and health care use are confirmed in other studies, optimal training and deployment preparedness strategies should be reconsidered.     

Predicting costs of Veterans Affairs health care in Gulf War veterans with medically unexplained physical symptoms

Measures of post-traumatic stress disorder (PTSD) and depression were used to predict Veterans Affairs outpatient treatment costs among Persian Gulf War veterans with medically unexplained physical symptoms. Patients (N = 206) enrolled in a Veterans Affairs primary care clinic for Persian Gulf War veterans completed study assessments at the initial appointment or at a proximal follow-up visit. Costs of care for mental health, medical, and pharmacy services for these veterans were computed for the subsequent 6-month period. Depression and PTSD symptoms explained a significant share of variance in costs of mental health care and pharmacy services, after adjustment for covariates. None of the mental status measures was significantly related to costs of medical care. Models using global measures of mental health status were as robust as models using disorder-specific measures of PTSD and depression in predicting mental health care and pharmacy costs. The implications of these findings for anticipating costs of care for Persian Gulf War veterans are discussed.     

Characteristics of deployed Operation Iraqi Freedom military personnel who seek mental health care

INTRODUCTION: This study reports on the feasibility of using validated mental health screening instruments for deployed Operation Iraqi Freedom military personnel. METHODS: For a 3-month period in 2005, all service members (N=296) who initially presented to the U.S. Military Hospital Kuwait mental health clinic completed an intake questionnaire that gathered demographic information and contained validated instruments to screen for mental disorders and functional impairment. RESULTS: A total of 19% of the sample subjects screened positive for post-traumatic stress disorder-related symptoms, 35% for a major depressive disorder, and 11% for severe misuse of alcohol. Significant levels of distress and functional impairment were reported by 58% of the sample. Women represented a disproportionately high percentage of those presenting for care (27%). CONCLUSIONS: Screening instruments were well accepted and useful in detecting psychopathological conditions and functional impairment. Female service members might represent a high-risk group. These results are useful for those caring for service members during or after deployment.     

Effects of racial/ethnic discrimination on the health status of minority veterans

As the veteran population becomes ethnically diverse, it is important to understand complex interrelationships between racism and health. This study examined the association between perceptions of discrimination and self-reported mental and physical health for Asian/Pacific Islander, African American, and Hispanic veterans. The data for this study come from the 2001 Veteran Identity Program Survey, which measured utilization of outpatient care, discrimination, and health status across three minority veteran groups. Multivariate regression methods were used to model self-reported mental and physical health on perceptions of discrimination controlling for demographic and socioeconomic characteristics. Findings revealed that racial/ethnic discrimination during military service was significantly associated with lower physical, but not mental health. Satisfaction with health care provider's sensitivity toward racial/ethnic background was significantly associated with better mental health. Findings highlight the importance of developing policies that address racial/ethnic discrimination during military service while providing health care services for veterans.     

Stress, mental health, and job performance among active duty military personnel: findings from the 2002 Department of Defense Health-Related Behaviors Survey

This study examined the extent to which high levels of occupational and family stress were associated with mental health problems and productivity loss among active duty military personnel. We analyzed data from the 2002 Department of Defense Survey of Health-Related Behaviors among Military Personnel, which provided extensive population-based information on 12,756 active duty personnel in all branches of the military worldwide. Military personnel reported higher levels of stress at work than in their family life. The personnel reporting the highest levels of occupational stress were those 25 or younger, those who were married with spouses not present, and women. Personnel with high levels of stress had significantly higher rates of mental health problems and productivity loss than those with less stress. We recommend that prevention and intervention efforts geared toward personnel reporting the highest levels of stress be given priority for resources in this population.     

Women in the Persian Gulf: lack of gender differences in long-term health effects of service in United Kingdom Armed Forces in the 1991 Persian Gulf War

A cross-sectional postal survey was conducted to evaluate the health of a random sample of United Kingdom Armed Forces personnel who were deployed to the 1990-1991 Persian Gulf conflict compared with nondeployed controls and controls deployed to Bosnia. The health of service women was examined and compared with that of United Kingdom service men. The main outcome measures were physical symptoms and ailments, functional capacity on the 36-item Short-Form Health Survey, the 12-item General Health Questionnaire, the Centers for Disease Control and Prevention multisymptom criteria for Gulf War illness, and post-traumatic stress reactions. There were 645 (65.3%) valid responses. The women from the Gulf cohort reported each symptom and the majority of health outcomes more frequently than either control group. No gender differences were found for 32 of the 50 symptoms assessed. Of the remaining 18 symptoms, women reported significantly more than men for only 6 of them, and there were no gender differences in 5 of the 6 principal health outcome measures. Women deployed to the Persian Gulf had similar rates of ill health as their male counterparts. Nothing was found to suggest that, other than for gender-specific health effects, any special considerations need to be made on health grounds for service women in any future deployments.     

Predictors of barriers to mental health treatment for Kosovo and Bosnia peacekeepers: a preliminary report

In this study, we assessed basic, physical, and mental health needs of peacekeepers; determined barriers to mental health treatment; and examined predictors of barriers to mental health care. Active duty peacekeepers were surveyed before and after their deployment to Kosovo (n = 203) concerning their stress symptoms and attitudes about seeking mental health care after peacekeeping. Sixty-five peacekeepers were evaluated before and after their peacekeeping deployment to Bosnia. Upon returning from their mission, between 5% and 9% of Kosovo and Bosnia peacekeepers reported needing help for anger or hostility, depression, or deployment-related stress. The most frequently endorsed barrier was concern about the personal cost of mental health care. Among Kosovo peacekeepers, pre- and postdeployment post-traumatic stress disorder symptoms were the most robust predictors of mental health treatment barriers. Peacekeepers report a number of treatment needs and barriers that could prevent them from receiving care. The soldiers most in need of services are also those who report the most barriers to care.     

Mental health status in veterans residing in rural versus non-rural areas:results from the veterans'health study

Background:The majority of Veterans Affair(VA)hospitals are in urban areas.We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status.Methods:Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview.Mental health status,including posttraumatic stress disorder(PTSD),major depression,alcohol abuse and mental health global severity,were assessed using structured interviews.Psychiatric service use was based on self-reported utilization in the past 12 months.Results were compared between veterans residing in rural and non-rural areas.Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors.Results:A total of 1730 subjects(55％of the eligible veterans)responded to the survey and 1692 of them had complete geocode information.Those that did not have this information(n=38),were excluded from some analyses.Veterans residing in rural areas were older,more often of the white race,married,and experienced fewer stressful events.In comparison to those residing in non-rural areas,veterans residing in rural areas had lower global mental health severity scores;they also had fewer mental health visits.In multivariate logistic regression,rural residence was associated with lower service use,but not with PTSD,major depression,alcohol abuse,and global mental health severity score after adjusting confounding factors(e.g.,age,gender,marital status and education).Conclusions:Rural residence is associated with lower mental health service use,but not with poor mental health in veterans with former warzone deployment,suggesting rural residence is possibly protective.     

Mental health and quality of mental health care

Mental health is an intrinsic part of health. Its prevailing position as secondary to physical health and its consequent neglect are based on inaccurate assumptions about mental health. Nowhere in the world, in either the developed or the developing countries, has mental health work been given priority as part of social policy, health policy or public policy. Yet all countries readily admit the major impact of mental health disturbances on the national economy and public health. The mentally sick are at the bottom of the list in service systems the world over, and the common attitude towards them tends to be highly negative. Meanwhile there is convincing evidence of the global and growing need for mental health services. The international debate on mental health policy has its origins in two arenas: in human rights issues and in service reform issues. The debate on human rights concerns legislation on mental health, compulsory treatment and coercive measures. As to the service reform process, the universal focus has been on the financing of health care, on cuts and downsizing, where no priority has been given to the quality of care. The social consequences of mental illnesses may be far more seriously marginalising for the patient than is the illness itself. They are caused by the inexperience and the exclusion mechanisms of the social community. They are evident also in non-institutional services, causing isolation and rejection. The state of mental health patients will not improve without the strong involvement of health policy planners, quality assurance developers and the medical and scientific community. We need far more studies and research in the field. We need also the empowerment of the patients themselves and their relatives.     

Priorities for psychiatric research in the U.S. military: an epidemiological approach

Among the 1.4 million active duty U.S. military service members, 6% receive outpatient treatment for a mental disorder each year. Over 25% of these service members leave military service within 6 months, a rate that is more than two times higher than the rate following treatment for any other illness category. There is clearly a need to define psychiatric research priorities and an unprecedented opportunity to enhance the field of psychiatric research in general using the well-characterized military population. The first priority is to better define the burden of mental disorders in terms of incidence, prevalence, severity, risk factors, and health care use. The impact of mental disorders on occupational functioning, particularly among new recruits, needs to be better characterized. Suicide research should include efforts to validate mortality data, define the normal level of rate variability, and establish surveillance for clusters. The highly structured occupational environment of the military lends itself to studies of preventive interventions designed to reduce disability or occupational attrition resulting from mental/behavioral problems.     

西沙某岛420名官兵心理健康调查分析

目的 了解海岛官兵心理健康状况及相关因素,提出防治对策.方法 采取症状自评量表(SCL-90)对西沙某岛420名官兵和内地海军某部450名官兵进行心理测试,比较2组人员心理健康状况.结果 西沙官兵一定程度上存在心理健康问题,且常见心理异常症状的发生率高于内地组,尤其以情绪低落、焦虑、恐惧、失眠、纳差等更为显著(P＜0.01).结论 影响心理健康状况的因素包括人员身份、文化程度、城乡来源和驻岛时间等.因此要加大对西沙官兵心理健康教育力度,严格新兵入伍心理检测,提高基层医务人员诊疗心理疾病水平,改善生活条件,丰富精神文化生活,以缓解小岛官兵心理问题,提高部队战斗力.     

军人罪犯人格特征及心理状态调查分析

目的　了解军人罪犯的心理健康状况及个性特征。方法　采用精神症状自评量表 (SCL 90 )、艾森克人格问卷进行评估。结果　SCL 90量表提示军人罪犯较常见的症状为躯体化不适为 2 0 9分 ,强迫为 2 14分 ,抑郁为 2 0 8分 ,焦虑为 1 81分 ,精神病性症状为 1 76分。EPQ提示个性内外向 ,中间占 5 0 0 %、倾内向占 16 7%、内向占 12 5 %、倾外向占 12 5 %、外向占 8 3 %,情绪稳定度是中间、稳定、倾向稳定、倾向不稳定、不稳定者分别为 45 8%,16 7%,4 2 %,2 5 0 %,8 4%。结论　军人罪犯常见的心理问题为躯体化不适、强迫、抑郁、焦虑、精神病性症状 ,不良人格对其犯罪行为具有重要作用     

Collaborative intervention: a model for coordinated treatment of mental health issues within a ground combat unit

Involvement in combat imposes a psychological burden that affects all combatants, not only those who are vulnerable to emotional disorders or those who sustain physical wound distress. This burden of combat is also carried by the families of those who go to war. Although most ground combat units have a medical officer as well as a chaplain assigned to them, they do not have a mental health counselor or psychologist. Traditionally, the medical officer focuses on the treatment of physical symptoms, diseases, and physical injuries, whereas the chaplain treats spiritual and adjustment issues that may affect how well an individual service member functions personally and/or professionally. Located between these two points is a void, the treatment of psychological or emotional issues. By using the collaborative intervention model presented here, unit medical officers and chaplains can work together to treat these issues, thus reducing the number of service members needing referral to mental health agencies, decreasing the number of mental health-related medical separations, and increasing overall mission readiness. This article presents a model whereby medical officers and chaplains can enter this void together, treating these emotional issues collaboratively.     

The Department of Defense's Persian Gulf War registry year 2000: an examination of veterans' health status

This study examined the health status of 46,633 Persian Gulf War theater veterans who received full clinical evaluations in the Department of Defense's Gulf War Comprehensive Clinical Evaluation Program (CCEP) as of spring 2000. Clinical data analyzed included demographic information, 15 health symptoms, 19 wartime exposures, and primary and secondary physician-determined medical diagnoses based on International Classification of Diseases, 9th Revision, Clinical Modification, criteria. Findings and discussions are arrayed, by gender, with comparative 1996 data from the Department of Veterans Affairs Health Examination Registry Program. Many veterans reported fewer physical symptoms now than during the time of the Gulf War. Many endorsed symptoms of joint pain, fatigue, weight change, and sleep disturbances. Most reported exposure to diesel fuel and the nerve agent antidote pyridostigmine bromide; far fewer female veterans reported combat involvement. The most frequent primary or secondary diagnosed medical conditions were musculoskeletal/connective tissue diseases, ill-defined conditions, and mental disorders. Female veterans were diagnosed more frequently with mental disorders. Symptom endorsement and diagnosis rates between the CCEP and the Department of Veterans Affairs registry were not dissimilar. Overall, the self-reported general health of veterans with symptoms was much poorer (females had higher rates of "fair to poor" health than males) than that of veterans with no reported symptoms.     

Screening soldiers in outpatient care for mental health concerns

Significant recent effort has been directed toward screening and describing military populations in relation to deployment. Missing from these recent efforts is information describing screened mental health symptoms for the population of active duty military that are seen for mental health services. This article presents mental health screening data for 2,882 soldiers seeking services at a military facility outpatient behavioral health clinic. Screening positive for multiple symptom domains was common, with >60% of the sample screening positive for more than one clinical symptom domain. Post-traumatic stress disorder and depression were among the most commonly identified disorders, followed by alcohol abuse. This screening data, gathered using measures similar to those used in published deployment-related screening efforts, suggest differences that exist between the clinical population and the overall military population, providing some insights into the rates of clinical symptomatology within the military health system and providing a point of comparison for population- screening efforts. Clinical implications include the importance of provider awareness to the high rates of comorbidity across symptom domains.     

Effects of a holistic health program on women''s physical activity and mental and spiritual health

Intervention studies aimed at promoting increased physical activity have been trialled in many different settings including primary care, worksites and the community. Churches are also potential settings for physical activity promotion. However, little is known about the effectiveness of this setting for promoting physical activity, particularly in Australia. The purpose of this study was to evaluate the effectiveness of a mind, body and spiritually based health promotion program in increasing physical activity and promoting mental and spiritual health. Nineteen women completed the 8-week intervention, and 30 women in a non-health related 8-week program at the same church comprised a comparison group. Pre- and post-program surveys assessed outcome measures. Between-group differences over time were examined using one-way MANOVA's. Physical activity was higher in the intervention group than the comparison group. In contrast to the comparison group, both mental health (depression symptoms) and spiritual health improved significantly more among intervention participants. The data highlight the potential for a church-based setting and holistic approach to health promotion as a successful means of increasing physical activity and promoting mental and spiritual health among Australian women.