Higher incidence rates of diagnoses of PTSD and TBI were found in service members during the wars in Afghanistan and Iraq because of the risks associated with service in those war zones, and also because of overall enhanced efforts to detect and diagnose cases, according to the report in the February issue of the Medical Surveillance Monthly Report published by the Armed Forces Health Surveillance Center (AFHSC).
“Service members are at risk of TBI and PTSD even when the U.S. is not at war,’’ said Navy Captain Kevin Russell, director of the AFHSC. “Yes, the risk of those conditions rises greatly during war. However, enhanced efforts by the Department of Defense to detect, diagnose, and treat produced dramatic results even among service members without exposures to war zones. Continuation of those efforts in the post-war period will mean more comprehensive care for all service members compared to the pre-war period.”
The analysis first examined the incidence of TBI and PTSD in service members who returned from overseas assignments in Korea and Japan during the pre-war period (1 January 1, 2000 through August 31, 2001). Incidence rates of the conditions in this population were used to estimate the background incidence (not related to war) and the background capabilities of the Military Health System (MHS) to detect and diagnose cases.
The study then examined the incidence of TBI and PTSD in service members who returned from overseas assignments in Korea and Japan during the war period (April 2003 through March 2013). Incidence rates of the conditions in this population were used to estimate the impact of enhanced capabilities of detect and diagnose cases as the Department of Defense implemented widespread policies and programs to reduce stigmas associated with, and to eliminate barriers to seeking or receiving, mental health care. Changes over time in the incidence of TBI and PTSD in this population, who had not served in a war zone, were attributed to changing capabilities to detect and diagnose cases during the period of war. Enhancements to the MHS included greatly increased resources for mental disorder and TBI-related awareness, education, screening, diagnosis, treatment, and research.
The analysis used the estimates of the background incidence of TBI and PTSD and of the impact of enhanced ascertainment and then applied those estimates to diagnoses of the conditions among service members following their return from deployment to the war zones in Afghanistan and Iraq. Although service in the war zones was associated with a much higher risk of TBI and PTSD than that for those who had served in Korea and Japan, the most noteworthy finding was the increasing proportions of diagnoses that could be attributed to enhanced case ascertainment efforts. The implication of the finding is that, when the war-associated risks of TBI and PTSD have ceased, the incidence of diagnoses of these conditions in the post-war period will greatly exceed the incidence in the pre-war period because of the redoubled efforts to detect and diagnose cases in recent years.
The proportions of PTSD disorder diagnoses among service members attributed to deployment in war zones decreased from about 80 percent to nearly 50 percent during a 10-year surveillance period between 2003 and 2013, while the proportions of PTSD diagnoses attributed to increased detection efforts by the Department of Defense increased from less than 10 percent to nearly 50 percent for the same period, the report said.
In addition, the proportions of diagnoses of TBI among service members attributed to deployment in war zones more than tripled from 2003 to 2009 during the 10-year surveillance period, while the proportions attributed to Department of Defense enhancement efforts markedly increased from nearly nine percent of diagnoses in 2003-2005 to 48 percent in 2012-2013, the report said.
Click here to read entire study. The MSMR is the flagship publication for the AFHSC, featuring articles on evidence-based estimates of the incidence, distribution, impact and trends of illness in service members and associated populations.
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