Study Suggests Post-deployment Health Outcomes Associated with Multiple Deployment-Related Factors
BACKGROUND:
Recent efforts to attribute an array of post-deployment symptoms (i.e., fatigue, bodily aches and pains, concentration difficulty) to either mental health factors (e.g., PTSD) or physical injury (e.g., mild TBI) neglect the long history of these unexplained symptoms after most major wars. This epidemiologic study examined the unique contributions of various deployment-related exposures and injuries to current post-deployment physical, psychological, and general health outcomes in more than 3,000 Florida National Guard members. From 2009 to 2010, investigators conducted an anonymous online survey of 1,443 National Guard members who had been deployed to Iraq or Afghanistan and 1,655 National Guard members who had not been deployed. Exposure to deployment-related traumatic combat experiences in this cohort was common (58%), as was exposure to blasts (52%). The survey assessed three domains of possible predictors of health outcomes: 1) demographics; 2) pre-deployment psychologically traumatic events or history of prior TBI; and 3) OEF/OIF deployment and related experiences, including combat exposure and exposure to potentially physically injurious and psychologically traumatic events (i.e., mild TBI and blast exposure). Using the survey questionnaire, investigators evaluated study participants' current symptoms of major depressive disorder, general anxiety, and PTSD, as well as post-deployment physical health outcomes. Surveys were completed an average of 31.8 months after deployment.
FINDINGS:
- Various deployment-related experiences increased the risk for post-deployment adverse mental and physical health outcomes, individually and in combination. Most adverse outcomes had associations with multiple deployment-related factors.
- Deployment-related mild TBI was associated with post-deployment depression, anxiety, PTSD, and post-concussive symptoms such as headaches and dizziness.
- Combat exposures with and without physical injury were associated not only with PTSD, but also with numerous post-concussive and non-post-concussive symptoms (e.g., chest pain, indigestion).
- Associations between blast exposure and abdominal pain, pain on deep breathing, shortness of breath, hearing loss, and tinnitus suggested residual barotrauma.
- The experience of seeing others wounded or killed, or experiencing the death of a buddy or leader, was associated with indigestion and headaches, but not with depression, anxiety, or PTSD.
- Findings indicate that an integrated interdisciplinary healthcare approach would be beneficial for Veterans with multiple deployment-related health issues. Such a system of care is currently being used within the VA Polytrauma programs.
LIMITATIONS:
- Findings are based on self-report. Causality can only be inferred, and bias is possible
- No information was collected regarding events since deployment that might have had an impact on the current findings, e.g., subsequent TBIs.
AUTHOR/FUNDING INFORMATION: This study was funded by HSR&D (CNN 06-164). Drs. Vanderploeg, Belanger, Spehar, Powell-Cope, Luther, and Scott are part of the HSR&D/RR&D Maximizing Rehabilitation Outcomes Center in Tampa, FL.
Vanderploeg R, Belanger H, Horner R, Spehar A, Powell-Cope G, Luther S, and Scott S. Health Outcomes Associated with Military Deployment: Mild Traumatic Brain Injury, Blast, Trauma, and Combat Associations in the Florida National Guard. Archives of Physical Medicine and Rehabilitation November 2012;93(11):1887-95.
