+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

U.S. military mental health care utilization and attrition prior to the wars in Iraq and Afghanistan



U.S. military mental health care utilization and attrition prior to the wars in Iraq and Afghanistan



Social Psychiatry and Psychiatric Epidemiology 44(6): 473-481



Health care utilization studies of mental disorders focus largely on the ICD-9 category 290-319, and do not generally include analysis of visits for mental health problems identified under V-code categories. Although active duty service members represent a large young adult employed population who use mental health services at similar rates as age-matched civilian populations, V-codes are used in a larger proportion of mental health visits in military mental health care settings than in civilian settings. However, the utilization of these diagnoses has not been systematically studied. The purpose of this study is to characterize outpatient behavioral health visits in military health care facilities prior to Operation Iraqi Freedom, including the use of diagnoses outside of the ICD-9 290-319 range, in order to evaluate the overall burden of mental health care. This study establishes baseline rates of mental health care utilization in military mental health clinics in 2000 and serves as a comparison for future studies of the mental health care burden of the current war. All active duty service members who received care in military outpatient clinics in 2000 (n = 1.35 million) were included. Primary diagnoses were grouped according to mental health relevance in the following categories: mental disorders (ICD-9 290-319), mental health V-code diagnoses (used primarily by behavioral health providers that were indicative of a potential mental health problem), and all other diagnoses. Rates of service utilization within behavioral health clinics were compared with rates in other outpatient clinics for each of the diagnostic groups, reported as individuals or visits per 1,000 person-years. Cox proportional hazard regression was used to produce hazard ratios as measures of association between each of the diagnostic groups and attrition from military service. Time to attrition in months was the difference between the date of military separation and the date of first clinic visit in 2000. Data were obtained from the Defense Medical Surveillance System. The total number of individuals who utilized behavioral health services in 2000 was just over 115 per 1,000 person-years, almost 12% of the military population. Out of every 1,000 person-years, 57.5 individuals received care from behavioral health providers involving an ICD-9 290-319 mental disorder diagnosis, and an additional 26.7 per 1,000 person-years received care in behavioral health clinics only for V-code diagnoses. Attrition from service was correlated with both categories of mental health-related diagnoses. After 1 year, approximately 38% of individuals who received a mental disorder diagnosis left the military, compared with 23% of those who received mental health V-code diagnoses and 14% of those who received health care for any other reason (which included well visits for routine physicals). This study establishes baseline rates of pre-war behavioral healthcare utilization among military service members, and the relationship of mental health care use and attrition from service. The research indicates that in the military population the burden of mental illness in outpatient clinics is significantly greater when V-code diagnoses are included along with conventional mental disorder diagnostic codes.

(PDF emailed within 0-6 h: $19.90)

Accession: 056729495

Download citation: RISBibTeXText

PMID: 19057830

DOI: 10.1007/s00127-008-0461-7


Related references

Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA 295(9): 1023-1032, 2006

Transformation of Mental Health Care for U.S. Soldiers and Families During the Iraq and Afghanistan Wars: Where Science and Politics Intersect. American Journal of Psychiatry 173(4): 334-343, 2016

Predictors of mental health care use among male and female veterans deployed in support of the wars in Afghanistan and Iraq. Psychological Services 10(2): 145-151, 2014

Behavioral Health Service Use by Military Children During Afghanistan and Iraq Wars. Journal of Behavioral Health Services & Research 2019, 2019

Stigma, American military personnel and mental health care: challenges from Iraq and Afghanistan. Journal of Mental Health 24(1): 54-59, 2015

Mental disorders among U.S. military personnel in the 1990s: association with high levels of health care utilization and early military attrition. American Journal of Psychiatry 159(9): 1576-1583, 2002

Prevalence of mental health problems, treatment need, and barriers to care among primary care-seeking spouses of military service members involved in Iraq and Afghanistan deployments. Military Medicine 173(11): 1051-1056, 2008

Mental health utilization of new-to-care Iraq and Afghanistan Veterans following suicidal ideation assessment. Psychiatry Research 217(3): 147-153, 2015

What has been the mental health impact of the wars in Iraq and Afghanistan on UK service personnel, and what can we expect in the future?. Occupational and Environmental Medicine 68(Suppl_1): A27-A28, 2011

Military TBI during the Iraq and Afghanistan wars. Journal of Head Trauma Rehabilitation 21(5): 398-402, 2006

Combat exposure, mental health, and relationship functioning among women veterans of the Afghanistan and Iraq wars. Journal of Family Psychology 43) 30(1): 43-51, 2016

Costs of war: excess health care burdens during the wars in Afghanistan and Iraq (relative to the health care experience pre-war). Msmr 19(11): 2-10, 2013

Utilization of VA mental health and primary care services among Iraq and Afghanistan veterans with depression: the influence of gender and ethnicity status. Military Medicine 179(5): 515-520, 2015

Death by suicide in US military during the Afghanistan and Iraq wars. Lancet. Psychiatry 3(11): 1001-1003, 2016

The Association Between Military Sexual Trauma and Use of VA and Non-VA Health Care Services Among Female Veterans With Military Service in Iraq or Afghanistan. Journal of Interpersonal Violence: -, 2016