Mental health in the Army has been a concern amid rising rates of post-traumatic stress disorder (PTSD) and suicide. But, new research suggests more than 75 percent of soldiers diagnosed with mental health disorders said their conditions started before they enlisted.
JAMA Psychiatry. Eleven percent of Army soldiers likely met criteria for two mental health disorders prior to enlistment.
"Some of the differences in disorder rates are truly remarkable," study author Dr. Ronald Kessler, a health care policy researcher at Harvard Medical School in Boston, said in a statement.
The study, along with two others published in the same journal issue, were part of the Army STARRS (Army Study to Assess Risk and Resilience in Service members). The initiative is a partnership between the U.S. Army and the National Institute of Mental Health.
The survey was sent to more than 5,400 non-deployed soldiers to examine their mental health in an attempt to find out why suicide rates have increased among Army personnel since the Iraq and Afghanistan conflicts.
Of the service members who met criteria for a mental health disorder, nearly 82 percent had "externalizing disorders" including ADHD, intermittent explosive disorder (uncontrolled bursts of anger), and drug and alcohol problems. About 50 percent of those with a mental disorder had "internalizing disorders" including depression, bipolar disorder, generalized anxiety disorder, panic disorders and PTSD.
"The rate of major depression is five times as high among soldiers as civilians, intermittent explosive disorder six times as high, and PTSD nearly 15 times as high," said Kessler.
The Army already screens for mental health disorders, he added in the study, so the implications of this research are unclear. But, interventions for ADHD or anger management for new soldiers might help..
Another study in the same issue, led by psychology professor Dr. Matthew Nock of Harvard, sought to find some reasons why Army suicide rates have increased steadily.
They looked at the same group of 5,400 soldiers, and found about 14 percent thought of suicide, more than 5 percent planned to commit suicide, and almost 2.5 percent actually tried.
Out of those who had attempted suicide, 47 percent to 60 percent reported the suicidal ideation ocurred prior to enlistment.
"It is striking that nearly 50 percent of the soldiers who attempted suicide made their first attempt before joining the Army, as applicants are asked about any history of suicide attempts in recruitment interviews and those who report such a history typically are excluded from service," Nock said in a press release.
The disorders most associated with suicide attempts after enlistment were pre-enlistment panic disorder, pre-enlistment PTSD, post-enlistment depression and both pre- and post-enlistment intermittent explosive disorder.
A suicide prevention strategy, the researchers said, could be restricting access to firearms among high-risk soldiers.
The third study looked at predictors of suicide or accidental deaths among Army soldiers.
A team led by Dr. Michael Schoenbaum, senior advisor for Mental Health Services at the NIMH in Bethesda, Md., reviewed data on 975,057 soldiers who were on active duty between 2004 and 2009. They identified 569 suicide deaths and 1,331 deaths classified as accidents.
Risk factors for suicide they found were being white, a man, having a current or previous deployment, having a junior enlisted rank, and recently being demoted.
"The current articles have already provided a very rich context and raise some important issues that were less apparent previously," wrote Dr. Matthew J. Friedman, a professor of psychiatry at Dartmouth's Geisel School of Medicine in Hanover N.H. in an editorial accompanying the three studies.
He said the findings have major implications for how soldiers are screened and recruited in the Army.
"The baggage people bring with them and often don't disclose in order to get into armed services presumably interacts with the stresses of deployment," Dr. David Brent, a psychiatrist at the University of Pittsburgh who was not involved in the study, told the New York Times.