Institute of Clinical Psychology and Psychotherapy,Technische Universität Dresden,Dresden,Germany.
Department of Psychological Medicine,King's Centre for Military Health Research,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK.
Epidemiol Psychiatr Sci. 2017 Apr;26(2):199-208. doi: 10.1017/S204579601600024X. Epub 2016 Apr 18.
Provision and need for mental health services among military personnel are a major concern across nations. Two recent comparisons suggest higher rates of mental disorders in US and UK military personnel compared with civilians. However, these findings may not apply to other nations. Previous studies have focused on the overall effects of military service rather than the separate effects of military service and deployment. This study compared German military personnel with and without a history of deployment to sociodemographically matched civilians regarding prevalence and severity of 12-month DSM-IV mental disorders.
1439 deployed soldiers (DS), 779 never deployed soldiers (NS) and 1023 civilians were assessed with an adapted version of the Munich Composite International Diagnostic interview across the same timeframe. Data were weighted using propensity score methodology to assure comparability of the three samples.
Compared with adjusted civilians, the prevalence of any 12-month disorder was lower in NS (OR: 0.7, 95% CI: 0.5-0.99) and did not differ in DS. Significant differences between military personnel and civilians regarding prevalence and severity of individual diagnoses were only apparent for alcohol (DS: OR: 0.3, 95% CI: 0.1-0.6; NS: OR: 0.2, 95% CI: 0.1-0.6) and nicotine dependence (DS: OR: 0.5, 95% CI: 0.3-0.6; NS: OR: 0.5, 95% CI: 0.3-0.7) with lower values in both military samples. Elevated rates of panic/agoraphobia (OR: 2.7, 95% CI: 1.4-5.3) and posttraumatic stress disorder (OR: 3.2, 95% CI: 1.3-8.0) were observed in DS with high combat exposure compared with civilians.
Rates and severity of mental disorders in the German military are comparable with civilians for internalising and lower for substance use disorders. A higher risk of some disorders is reduced to DS with high combat exposure. This finding has implications for mental health service provision and the need for targeted interventions. Differences to previous US and UK studies that suggest an overall higher prevalence in military personnel might result from divergent study methods, deployment characteristics, military structures and occupational factors. Some of these factors might yield valuable targets to improve military mental health.
军人的精神健康服务的提供和需求是各国关注的主要问题。最近的两项比较研究表明，美国和英国军人的精神障碍发病率高于平民。然而，这些发现可能不适用于其他国家。以前的研究侧重于军事服务的总体影响，而不是军事服务和部署的单独影响。本研究比较了有和没有部署历史的德国军人与社会人口统计学匹配的平民在 12 个月 DSM-IV 精神障碍的发生率和严重程度。
在同一时间框架内，使用改良的慕尼黑综合国际诊断访谈对 1439 名现役士兵（DS）、779 名从未部署过的士兵（NS）和 1023 名平民进行评估。使用倾向评分方法对数据进行加权，以确保三个样本的可比性。
与调整后的平民相比，NS 组的任何 12 个月障碍的患病率较低（OR：0.7，95%CI：0.5-0.99），而 DS 组则没有差异。只有在酒精（DS：OR：0.3，95%CI：0.1-0.6；NS：OR：0.2，95%CI：0.1-0.6）和尼古丁依赖（DS：OR：0.5，95%CI：0.3-0.6；NS：OR：0.5，95%CI：0.3-0.7）方面，军人和平民之间的个体诊断的患病率和严重程度存在显著差异，两个军事样本的值均较低。在高战斗暴露的 DS 中，惊恐/广场恐怖症（OR：2.7，95%CI：1.4-5.3）和创伤后应激障碍（OR：3.2，95%CI：1.3-8.0）的发生率较高。
德国军人的精神障碍发生率和严重程度与平民相比，内化障碍的发生率较高，而物质使用障碍的发生率较低。高战斗暴露的 DS 中一些疾病的风险较高。这一发现对精神卫生服务的提供和有针对性干预的必要性具有重要意义。与以前的美国和英国研究相比，这些研究表明军人的总体患病率较高，可能是由于研究方法、部署特征、军事结构和职业因素的不同。其中一些因素可能成为改善军人心理健康的有价值的目标。
