The Weight of Mental Disorders
> 2/23/2006 12:46:47 PM

The military, like the civilian working population, struggles with medical problems and hospitalizations. Productivity and financial losses can be steep in either sphere. Often, however, the effects of mental disorders on the overall health and functioning of the military are overlooked. In a study published in The American Journal of Psychiatry’s March of 2005 issue Dr. Charles Hoge, et al. set out to assess the damage done, in terms of military service separations, from mental health disorders.

Previous studies had already illustrated that mental disorders were the leading cause of hospitalization among active-duty military personnel. These hospitalizations, it had also been previously shown, led to an astronomically high attrition rate. Dr. Hoge had found in a 2002 study that nearly 50% of soldiers hospitalized for a mental disorder left military service within six months. Only 12% of those who were hospitalized for other illnesses did the same.

In their new study, Hoge and crew set out to find the actual reasons for these discharges. Using information from the Total Army Injury and Health Outcomes Database, they confirmed earlier findings. After controlling for possible separation factors such as age, gender, rank, duration of service, marital status, education and race or ethnicity, it was clear that there was a “strong association between separation from service and mental disorder relative to no mental disorder diagnosis.”

The reasons for separation of service paint an important picture in terms of the devastating effects that mental health problems can have on soldiers. In their study, the most common reason for separation for a service man or woman hospitalized for non-mental health reasons was voluntary in nature. This included completion of enlistment and retirement. For those hospitalized for mental disorders, involuntary discharges were far more common. This was the case for those hospitalized for both mental disorders that originated during service, as well as those that predated enlistment.

Among the reasons for involuntary separation of service for those with mental disorders “adjustment disorder” was the most common at 40%. This was followed by alcohol and drug use problems, which accounted for 26% of separations, mood/anxiety disorders (22%), personality disorders (4%), psychotic disorders (3%) and other miscellaneous mental disorders (4%).

Analysis of the outcomes of these patients illustrated the man different problems fostered by the persistence of mental health disorders in the military. Misconduct and/or legal problems accounted for 17% of all soldiers discharged involuntarily after a mental health hospitalization. Absenteeism, failure to meet weight or other physical requirements and drug and alcohol abuse were all prevalent reasons for discharge following mental health hospitalization.

The costs of mental health disorders on the military are clearly laid out by Hoge:
”Overall, 8% of soldiers hospitalized for mental disorders received a medical separation compared with 4% of those hospitalized for other medical conditions, and the level of disability awarded was significantly higher among those with mental disorders compared with persons treated for other conditions. In the military, 30% disability has particular significance because this generally entitles a service member with less than 20 years of service to retirement benefits. In aggregate, these findings add to the growing literature documenting the disabling, chronic, and costly nature of mental disorders compared with other medical conditions.”

One other important note that the group hits in its conclusion is the association between mental disorders and medical separations for conditions that predated enlistment.
“These [types of medical separations] can occur when a medical condition that would normally disqualify someone from service is not detected during the entry medical evaluation but is discovered sometime during the first 6 months of service. The fact that these separations were significantly higher among those with mental disorders (8%) than among those with other conditions (<1%) speaks to the many problems inherent in screening applicants for mental disorders prior to coming into service.”

With this information in hand, it is clear that more can be done to better serve the mental health needs of our troops. More thorough entry screenings will help to reduce the service separations from preexisting disorders. Meanwhile, a more preventative approach toward mental health within the general ranks could help to seriously reduce the costs of mental disorders on the armed services. If we can identify possible problems before they reach the point of requiring hospitalization, treatment can begin sooner and more favorable outcomes can be achieved. As armed conflict persists and even in future times of peace, these are important issues that we must remain vigilant on if we are to control health care costs, both financial and interpersonal.

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