Seal KH (San Francisco VAMC and University of California, San Francisco), Metzler TJ
(San Francisco VAMC), Gima K
(San Francisco VAMC), Bertenthal D
(San Francisco VAMC), Marmar CR
(San Francisco VAMC and University of California, San Francisco)
To describe cumulative prevalence and 2-year incidence of mental health disorders in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans using VA facilities nationwide, to characterize the relationship of mental health diagnoses to the Iraq War and to identify high-risk subgroups of OEF/OIF veterans.
OEF/OIF veterans seen at VA facilities between 10/1/2001 and 8/31/2007 were included. Mental health ICD-9 codes were abstracted from the VA OEF/OIF Roster and National Patient Care Database. Cumulative prevalence and 2-year incidence rates of mental health disorders were calculated. For each mental health diagnosis, adjusted relative risks (ARR’s) were estimated, stratified by component type [Active Duty (AD) versus National Guard /Reserve (NG/R)] using a fixed effects log-binomial model, including indicator codes for sociodemographics and calendar quarter of first VA visit. Similar log-binomial models were estimated to calculate ARR’s for veterans first seen from 10/1/2001 through 3/31/2003 (pre-Iraq War period) compared to veterans first seen between 1/1/2005-6/30/2005 (Iraq War).
Of 237,867 OEF/OIF veterans seen at VA facilities during the study period, 82,169 (35%) received > 1 mental health diagnoses; the majority (62%) received multiple co-morbid diagnoses. PTSD was the most frequent diagnosis received by 46,498 (20%), increasing in prevalence from 1% to 20% during the study period. Among AD veterans, the incidence of PTSD was highest among the youngest group, 16-24 years (14.2%) compared to veterans > 40 years (4.2%), (ARR=3.36). In contrast, among NG/R veterans, the incidence of PTSD was lowest among veterans < 24 years (7.9%) compared to veterans > 40 years (10.3%) (ARR=0.71) Among AD veterans, the incidence of PTSD was 1.4% during the pre-Iraq War period and increased to 15.0% during the Iraq War (ARR=10.2), while among NG/R veterans, the incidence of PTSD increased from 2% in the pre-Iraq War period to 18% during the Iraq War (ARR=8.6).
There have been large increases in the incidence and prevalence of mental health disorders corresponding to the invasion of Iraq, disproportionately affecting the youngest AD veterans and the oldest NG/R veterans.
Planning targeted mental health services within the VA system is critical to meet the accruing burden of mental disorders.