Cohen Gregory H, Fink David S, Sampson Laura, Galea Sandro
Epidemiol Rev. 2015;37(1):7-22. doi: 10.1093/epirev/mxu007. Epub 2015 Jan 16.
Since 2001, the US military has increasingly relied on National Guard and reserve component forces to meet operational demands. Differences in preparation and military engagement experiences between active component and reserve component forces have long suggested that the psychiatric consequences of military engagement differ by component. We conducted a systematic review of prevalence and new onset of psychiatric disorders among reserve component forces and a meta-analysis of prevalence estimates comparing reserve component and active component forces, and we documented stage-sequential drivers of psychiatric burden among reserve component forces. We identified 27 reports from 19 unique samples published between 1985 and 2012: 9 studies reporting on the reserve component alone and 10 reporting on both the reserve component and the active component. The pooled prevalence for alcohol use disorders of 14.5% (95% confidence interval: 12.7, 15.2) among the reserve component was higher than that of 11.7% (95% confidence interval: 10.9, 12.6) among the active component, while there were no component differences for depression or post-traumatic stress disorder. We observed substantial heterogeneity in prevalence estimates reported by the reserve component. Published studies suggest that stage-sequential risk factors throughout the deployment cycle predicted alcohol use disorders, post-traumatic stress disorder and, to a lesser degree, depression. Improved and more standardized documentation of the mental health burden, as well as study of explanatory factors within a life-course framework, is necessary to inform mitigating strategies and to reduce psychiatric burden among reserve component forces.
自2001年以来，美国军队越来越依赖国民警卫队和后备役部队来满足作战需求。现役部队和后备役部队在准备情况和军事参与经历方面的差异长期以来表明，军事参与对精神的影响因部队类型而异。我们对后备役部队中精神障碍的患病率和新发情况进行了系统综述，并对后备役部队和现役部队的患病率估计进行了荟萃分析，还记录了后备役部队中精神负担的阶段性驱动因素。我们从1985年至2012年间发表的19个独特样本中识别出27份报告：9项研究仅报告了后备役部队情况，10项研究同时报告了后备役部队和现役部队情况。后备役部队中酒精使用障碍的合并患病率为14.5%（95%置信区间：12.7，15.2），高于现役部队的11.7%（95%置信区间：10.9，12.6），而抑郁症或创伤后应激障碍在不同部队类型间无差异。我们观察到后备役部队报告的患病率估计存在很大异质性。已发表的研究表明，整个部署周期中的阶段性风险因素可预测酒精使用障碍、创伤后应激障碍，以及在较小程度上可预测抑郁症。有必要改进并更规范地记录心理健康负担，并在生命历程框架内研究解释性因素，以为缓解策略提供依据并减轻后备役部队的精神负担。
