Abstract: Functional Impairment at 3 and 12 Months Post-Combat

Vol. 67 No. 6, June 2010


Abstract: Prevalence of Mental Health Problems and Functional Impairment Among Active Component and National Guard Soldiers 3 and 12 Months Following Combat in Iraq

Jeffrey L. Thomas, PhD; Joshua E. Wilk, PhD; Lyndon A. Riviere, PhD; Dennis McGurk, PhD; Carl A. Castro, PhD; Charles W. Hoge, MD

Arch Gen Psychiatry. 2010;67(6):614-623.

Context A growing body of literature has demonstrated the association of combat in Iraq and Afghanistan with postdeployment mental health problems, particularly posttraumatic stress disorder (PTSD) and depression. However, studies have shown varying prevalence rates of these disorders based on different case definitions and have not assessed functional impairment, alcohol misuse, or aggressive behavior as comorbid factors occurring with PTSD and depression.

Objectives To (1) examine the prevalence rates of depression and PTSD using several case definitions including functional impairment, (2) determine the comorbidity of alcohol misuse or aggressive behaviors with depression or PTSD, and (3) compare rates between Active Component and National Guard soldiers at the 3- and 12-month time points following their deployment to Iraq.

Design Population-based, cross-sectional study.

Setting United States Army posts and National Guard armories.

Participants A total of 18 305 US Army soldiers from 4 Active Component and 2 National Guard infantry brigade combat teams.

Interventions Between 2004 and 2007, anonymous mental health surveys were collected at 3 and 12 months following deployment.

Main Outcome Measures Current PTSD, depression, functional impairment, alcohol misuse, and aggressive behavior.

Results Prevalence rates for PTSD or depression with serious functional impairment ranged between 8.5% and 14.0%, with some impairment between 23.2% and 31.1%. Alcohol misuse or aggressive behavior comorbidity was present in approximately half of the cases. Rates remained stable for the Active Component soldiers but increased across all case definitions from the 3- to 12-month time point for National Guard soldiers.

Conclusions The prevalence rates of PTSD and depression after returning from combat ranged from 9% to 31% depending on the level of functional impairment reported. The high comorbidity with alcohol misuse and aggression highlights the need for comprehensive postdeployment screening. Persistent or increased prevalence rates at 12 months compared with 3 months postdeployment illustrate the persistent effects of war zone service and provide important data to guide postdeployment care.


Author Affiliations: Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research, US Army Medical Research and Materiel Command, Silver Spring, Maryland (Drs Thomas, Wilk, Riviere, and Hoge); US Army Medical Research Unit-Europe, Walter Reed Army Institute of Research, US Army Medical Research and Materiel Command, Heidelberg, Germany (Dr McGurk); Military Operational Medicine Research Program, US Army Medical Research and Materiel Command, Fort Detrick, Maryland (Dr Castro).