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Mental disorders derived from Afghanistan deployments
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Researchers reported that 13.5% of Canadian Forces personnel who served in Afghanistan had a mental disorder apparently related to their deployment, and serving in higher-threat locations in that country increased the risk for mental illness.
David Boulos, MSc, and Mark A. Zamorski, MD, MHSA, of the Canadian Forces Health Services, studied the prevalence of mental disorders in 30,513 Canadian Forces personnel who were deployed to Afghanistan before January 2009. The researchers reviewed medical records of a random sample of 2,014 personnel to determine whether there was a mental disorder diagnosis — based on DSM-IV criteria — and any clinical indication of where the disorder had originated.
The results, published today in the Canadian Medical Association Journal, indicated that posttraumatic stress disorder was the most common diagnosis among the study population (8%) followed by depression (6.3%). Among those with depression, 22.8% had comorbid PTSD. Boulos and Zamorski found that 29.6% of the cohort had used Canadian Forces mental health services during follow-up.
Serving in more dangerous locations resulted in a greater risk for developing a mental disorder. For example, the HR for deployment in Kandahar province was 5.6 (95% CI, 2.6-12.5) compared with serving in the United Arab Emirates. Service in the Canadian Army and lower rank were independent risk factors, as well. However, sex, multiple deployments, length of deployment and Reserve Force status did not predict a diagnosis.
"This study provided a precise and methodologically rigorous estimate of the impact of the mission on the risk of mental disorders during continued military service," the researchers concluded. "These findings will have implications in terms of service delivery and veterans' benefits. Future research with this cohort will explore the process and outcomes of the mental health care delivered to personnel with mental disorders related to the Afghanistan mission."
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Elspeth Cameron Ritchie, MD, MPH
Looking at other countries always helps understand your own better. This interesting paper focuses on deployment-related stress disorders among Canadian Forces — 13.5% had a mental disorder attributed to the deployment; 8% had PTSD.
How does that contrast with US armed forces? That depends which study you look at, but most find that between 10% and 20% of US previously deployed troops have PTSD.
The article states that “Deployment to higher-threat locations, service in the Canadian Army and lower rank were independent risk factors associated with an Afghanistan-related mental disorder.” This is also consistent with the data we have from the US Mental Health Advisory Teams and other sources.
Less intuitive is that there was “no independent association was seen with sex, Reserve Force status, multiple deployments or deployment length.” People often assume that women will have higher rates of PTSD than men because that is what is seen in the civilian world. However, in the (admittedly) limited data we have on military woman, their PTSD rate is essentially the same as men. Ditto for the reserves.
What about multiple deployments? Intuitively one would think that extra exposure would also add up to more PTSD. But there is a facto known as the “healthy worker” effect that may be at play here. At least in the US — where the rates go up some with multiple deployments, but not enormously — soldiers who struggle with deployment get out of the Army. The ones that stay in often like the experience, which is why they go back.
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