Effects of Repeated Deployment on the Health of Army National Guard Troops
Effects of Repeated Deployment on the Health of Army National Guard Troops
Objectives. We assessed the effects of prior military service in Iraq or Afghanistan on the health of New Jersey Army National Guard members preparing for deployment to Iraq.
Methods. We analyzed anonymous, self-administered predeployment surveys from 2543 National Guard members deployed to Iraq in 2008. We used bivariate and multivariate analyses to measure the effects of prior service in Afghanistan (Operation Enduring Freedom [OEF]) or Iraq (Operation Iraqi Freedom [OIF]) on mental and physical health.
Results. Nearly 25% of respondents reported at least 1 previous OEF or OIF deployment. Previously deployed soldiers were more than 3 times as likely as soldiers with no previous deployments to screen positive for posttraumatic stress disorder (adjusted odds ratio [AOR]=3.69; 95% confidence interval [CI]=2.59, 5.24) and major depression (AOR=3.07; 95% CI=1.81, 5.19), more than twice as likely to report chronic pain (AOR=2.20; 95% CI=1.78, 2.72) and more than 90% more likely to score below the general population norm on physical functioning (AOR=1.94; 95% CI=1.51, 2.48).
Conclusions. Repeated OEF and OIF deployments may adversely affect the military readiness of New Jersey National Guard combat soldiers.
The mental and physical health consequences of service in Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]) have been well documented. Studies report rates of posttraumatic stress disorder (PTSD) among returning soldiers ranging from 4% to 31% and rates of depression ranging from 3% to 25%, with rates varying by diagnostic criteria, military population, deployment location, and time since deployment. Traumatic brain injury has been identified in 19% of returning troops. Those experiencing multiple deployments are most at risk, with the Office of the US Army Surgeon General reporting mental health problems in 11.9%of those with1deployment,18.5% with 2 deployments, and 27.2% with 3 or 4 deployments. National Guard and Reserve troops are more vulnerable than active-duty troops, with 35.5% of Guard and Reserve troops at mental health risk 6 months after deployment compared with 27.1%of active-duty soldiers. With respect to physical health, the OEF and OIF conflicts have produced the highest ratio of wounded to killed of any previous military operation (approximately 7:1), with over 33170 wounded in action as of October 2008. Orthopedic injuries are the most common class of injury and pain one of the most frequently reported symptoms.
Although the adverse health consequences of service in OEF and OIF have focused public attention on the medical needs of returning veterans, concern has also centered on the military readiness of our fighting force, given the unprecedented pattern of repeat deployments unique to this particular conflict. Of all soldiers deployed to Iraq since 2003, approximately 38% have been deployed more than once and 10% have been deployed 3 times or more. The Department of Defense and state National Guard authorities conduct extensive pre- and postdeployment screenings to ensure that only "healthy and medically prepared" soldiers are deployed to combat. However, becausemost studies of veterans of OEF and OIF to date have focused on postdeployment populations, we have little information about the effectiveness of military programs in screening seriously impaired soldiers out of the eligibility pool for future deployment. Postdeployment studies, moreover, are likely to include many medically compromised soldiers who were subsequently disqualified from, or voluntarily left, active military service before being recalled to duty. In the absence of large-scale predeployment health studies, we have no information on the effect of multiple deployments on the fitness of soldiers returning to combat. The 1 published study identified by the authors to date that examined predeployment health status included a small sample of combat veterans (n=173) with mixed histories of previous service: some had served in Afghanistan, some in conflicts other than OEF and OIF, but none in Iraq, even though, until recently, Iraq war veterans experienced substantially greater combat stress than veterans from Afghanistan.
We explored the effects of multiple deployments on the mental and physical health of New Jersey Army National Guard troops preparing for deployment to Iraq. Specifically, we (1) compared the health status of soldiers with previous OEF and OIF deployments with that of soldiers experiencing their first deployment, (2) examined associations between deployment status and health after controlling for possible confounding factors, and (3) compared the present survey with New Jersey's predeployment health assessment on identification rates of key mental health problems.
Abstract and Introduction
Abstract
Objectives. We assessed the effects of prior military service in Iraq or Afghanistan on the health of New Jersey Army National Guard members preparing for deployment to Iraq.
Methods. We analyzed anonymous, self-administered predeployment surveys from 2543 National Guard members deployed to Iraq in 2008. We used bivariate and multivariate analyses to measure the effects of prior service in Afghanistan (Operation Enduring Freedom [OEF]) or Iraq (Operation Iraqi Freedom [OIF]) on mental and physical health.
Results. Nearly 25% of respondents reported at least 1 previous OEF or OIF deployment. Previously deployed soldiers were more than 3 times as likely as soldiers with no previous deployments to screen positive for posttraumatic stress disorder (adjusted odds ratio [AOR]=3.69; 95% confidence interval [CI]=2.59, 5.24) and major depression (AOR=3.07; 95% CI=1.81, 5.19), more than twice as likely to report chronic pain (AOR=2.20; 95% CI=1.78, 2.72) and more than 90% more likely to score below the general population norm on physical functioning (AOR=1.94; 95% CI=1.51, 2.48).
Conclusions. Repeated OEF and OIF deployments may adversely affect the military readiness of New Jersey National Guard combat soldiers.
Introduction
The mental and physical health consequences of service in Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]) have been well documented. Studies report rates of posttraumatic stress disorder (PTSD) among returning soldiers ranging from 4% to 31% and rates of depression ranging from 3% to 25%, with rates varying by diagnostic criteria, military population, deployment location, and time since deployment. Traumatic brain injury has been identified in 19% of returning troops. Those experiencing multiple deployments are most at risk, with the Office of the US Army Surgeon General reporting mental health problems in 11.9%of those with1deployment,18.5% with 2 deployments, and 27.2% with 3 or 4 deployments. National Guard and Reserve troops are more vulnerable than active-duty troops, with 35.5% of Guard and Reserve troops at mental health risk 6 months after deployment compared with 27.1%of active-duty soldiers. With respect to physical health, the OEF and OIF conflicts have produced the highest ratio of wounded to killed of any previous military operation (approximately 7:1), with over 33170 wounded in action as of October 2008. Orthopedic injuries are the most common class of injury and pain one of the most frequently reported symptoms.
Although the adverse health consequences of service in OEF and OIF have focused public attention on the medical needs of returning veterans, concern has also centered on the military readiness of our fighting force, given the unprecedented pattern of repeat deployments unique to this particular conflict. Of all soldiers deployed to Iraq since 2003, approximately 38% have been deployed more than once and 10% have been deployed 3 times or more. The Department of Defense and state National Guard authorities conduct extensive pre- and postdeployment screenings to ensure that only "healthy and medically prepared" soldiers are deployed to combat. However, becausemost studies of veterans of OEF and OIF to date have focused on postdeployment populations, we have little information about the effectiveness of military programs in screening seriously impaired soldiers out of the eligibility pool for future deployment. Postdeployment studies, moreover, are likely to include many medically compromised soldiers who were subsequently disqualified from, or voluntarily left, active military service before being recalled to duty. In the absence of large-scale predeployment health studies, we have no information on the effect of multiple deployments on the fitness of soldiers returning to combat. The 1 published study identified by the authors to date that examined predeployment health status included a small sample of combat veterans (n=173) with mixed histories of previous service: some had served in Afghanistan, some in conflicts other than OEF and OIF, but none in Iraq, even though, until recently, Iraq war veterans experienced substantially greater combat stress than veterans from Afghanistan.
We explored the effects of multiple deployments on the mental and physical health of New Jersey Army National Guard troops preparing for deployment to Iraq. Specifically, we (1) compared the health status of soldiers with previous OEF and OIF deployments with that of soldiers experiencing their first deployment, (2) examined associations between deployment status and health after controlling for possible confounding factors, and (3) compared the present survey with New Jersey's predeployment health assessment on identification rates of key mental health problems.
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