Predictors of Worsening Mental Health among OEF/OIF Veterans
BACKGROUND:
It is estimated that one quarter of Veterans who served in Iraq and Afghanistan meet criteria for a mental illness or substance abuse disorder, and PTSD is the most common diagnosis. This observational study sought to identify predictors of worsening mental health, including PTSD and alcohol use, as well as variables that are protective (resilience factors) against worsening mental health in a national sample of OEF/OIF Veterans who had served from 2007-2008. Investigators surveyed 512 OEF/OIF Veterans, including 40% active duty, 30% National Guard, and 30% other Reserve. Women comprised 59% of the total cohort. Participants were surveyed at baseline (Time 1: 3-12 months after returning from deployment) and again six months later (Time 2). Investigators also measured demographics and deployment characteristics (i.e., combat exposure, length of deployment), in addition to mental health status, PTSD, and alcohol abuse. Resilience factors included hardiness, self-efficacy, and social support.
FINDINGS:
- Among this national sample of returning OEF/OIF military personnel, 14–25% showed clinically worse mental health, PTSD, or alcohol use at 6-month follow-up.
- Eleven variables were significantly associated with a decline in overall mental health status from Time 1 to Time 2: Black race, being in the National Guard, more bothersome physical health problems, worse mental health at Time 1, less PTSD symptom severity, lack of psychiatric care between Time 1 and Time 2, more difficult deployment environment, less perceived threat, less sexual harassment, higher levels of hardiness, and lower levels of self-efficacy.
- Nine variables predicted a worsening of PTSD symptom severity: being younger than 26 years old, unemployed, divorced or separated, higher PTSD symptom severity at Time 1, lack of any psychiatric treatment between Time 1 and Time 2, difficult childhood family environment, greater sexual harassment in one's unit, lower levels of deployment preparedness, and higher levels of post-deployment social support.
- Fourteen variables predicted worsening alcohol use, including: being male, under 26 years old, less educated, Hispanic, separated or divorced, and being in the National Guard or Marines.
- National Guard and other Reserve soldiers worsened on both the general mental health and alcohol use measures from Time 1 to Time 2 compared to active duty soldiers, suggesting that these groups may require help with reintegration.
- Higher education, self-efficacy, unit support, and deployment preparedness had a protective effect on both worsening PTSD and alcohol use.
LIMITATIONS:
- Investigators were unable to collect pre-deployment data.
- Only self-reported measures of mental health and substance use were used, which might be subject to bias.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IAC 06-259). All authors are part of HSR&D's Center for Healthcare Organization and Implementation Research located in Bedford/Boston, MA.
Schultz M, Glickman M, and Eisen S. Predictors of Decline in Overall Mental Health, PTSD, and Alcohol Use in OEF/OIF Veterans. Comprehensive Psychiatry. October 2014;55(7):1654-64.
