Mental disorders most frequent medical diagnosis among servicemembers just before separation, Pentagon study says
By NANCY MONTGOMERY | STARS AND STRIPES Published: July 23, 2018
They got colds in boot camp. In midcareer they were beset by muscle strains, tears and back problems. But at the end, just before separating from the armed forces, servicemembers’ most common medical diagnosis was mental health disorders, a new Pentagon study has found.
Mental disorders — almost never diagnosed at the beginning of military service — became the top diagnostic category at the end, according to the study by the Defense Health Agency, which surveyed 45,000 troops who served 4-15 years beginning in 2000 and separated in 2014 and 2015.
The study, published in the June edition of the Medical Surveillance Monthly Report, speculated that the increase in mental health diagnoses over time could be attributable partly to the military’s “many unique stressors,” including combat deployments, frequent moves, long hours and time away from family. The fact that the diagnoses of mental disorders surged around the time of separation might also be due to the negative impact such diagnosis is likely to have on a servicemember’s career.
So is serving in the military detrimental to mental health?
“That’s one possible conclusion but probably not the best one,” said Dr. Harold Kudler, a psychiatrist and Duke University professor who recently retired as chief consultant for the Department of Veteran Affairs’ mental health services.
“I think the best conclusion is that we’re selecting healthy young people and then we’re exposing them to significant stressors over time, to the normal wear and tear of being human beings facing the real challenges of military service.”
Kudler told Stars and Stripes that the data reflected a number of phenomena, including a growing acceptance in recent years that mental health ailments are common and that reporting and seeking care for them is no disgrace.
“If you go back not that long ago there was a strong sense that (post-traumatic stress disorder) was something that happened to weak people. That really has changed over the years, from being viewed with strong social stigma to something closer to an occupational hazard, which may affect a sizable proportion of service members,” said Kudler, who was not involved in the study.
Another likely factor is timing and motivation. Troops in early or midcareer face “disincentives for reporting medical conditions or seeking care,” said study authors Capt. Colby Uptegraft, an Air Force physician, and Shauna Stahlman, an epidemiologist at the Armed Forces Health Surveillance Branch. Those included the possibility of adverse personnel actions such as medical evaluation boards and subsequent medical separation, duty location or deployment limitations, and career field denial or termination, particularly in occupations such as aviation and special forces.
But when servicemembers are about to separate, getting medical diagnoses on their records, including for mental health problems, makes them eligible for VA and disability benefits.
“I think one thing we’re looking at is an abrupt change in a motivation for talking about these things as one nears separation from the military,” Kudler said.
The study aimed to track illnesses over time in separating troops — the 83 percent of troops who leave the service before retirement at 20 years or more.
It looked for trends in what went up, down or stayed about the same by examining electronic health records at three career intervals: the first six months of service, the middle six and the final six months before separation.
The majority of the troops in the study — 72 percent — had served four to eight years; 22 percent had served eight to 12 years and 6 percent had served up to 15 years.
Most were male, white troops 25-34 years old. A third were Marines, and more than half were junior enlisted and had never deployed.
At the beginning, the majority of diagnoses were for respiratory infections, which declined afterward. Mental health disorders accounted for 1.3 percent of diagnoses.
In the middle six months of service, musculoskeletal problems accounted for nearly a quarter of all medical diagnoses, and mental health diagnoses had surged to 17 percent.
In the last six months of service, mental health diagnoses were the most frequent of any, accounting for almost 36 percent in men.
The study appears to be one of the first to analyze medical diagnoses over time of people who separated from the services before retirement.
Studies of retirees published in 2010 found a significant increase in the incidence rates of illness and injury-related diagnoses within six months of retirement; 72 percent of retirees were diagnosed with a new medical condition within six months of retirement. But few of them were for mental health conditions, according to the current study.
The potential reasons for this “striking difference” between the two groups could be because troops reaching retirement “are likely among the healthiest overall service members across time,” the study authors wrote. In addition, their study did not distinguish between voluntarily separating service members and those being medically separated. “Many mental health conditions, especially those lasting longer than a year, requiring treatment, and/or impacting duty, do not meet retention standards, and mental health disorders have been found to be the leading category of discharge diagnoses in men and the second leading category in women.”
The current study found that musculoskeletal disorders peaked at 24.3 percent of diagnoses in the middle surveillance period for men but peaked at 23.4 percent in the first six months of service for women.
Kudler said the study reflected “an evolving understanding that mental health problems are very widespread across the general population,” particularly among people under stress.
“Depression and anxiety — these are part of normal human life,” he said. “They’re not always illnesses. If you’re in a room with a tiger and you’re anxious — there’s nothing wrong with that.”