Ursano Robert J, Wang Jing, Fullerton Carol S, Ramsawh Holly, Gifford Robert K, Russell Dale, Cohen Gregory H, Sampson Laura, Galea Sandro
Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
School of Public Health, Boston University, 715 Albany Street-Talbot 301, Boston, MA 02118.
Mil Med. 2018 Jan 1;183(1-2):e51-e58. doi: 10.1093/milmed/usx002.
Given the greater prevalence of post-deployment mental health concerns among reservists, the higher likelihood of deploying without their regular unit, and potentially lower rates of deployment preparedness, we examined associations between deploying with or without one's regular unit (individual augmentee status, IAS), deployment preparedness, and mental health problems including post-traumatic stress disorder (PTSD), depression (MDD), and binge drinking in a nationally representative sample of Reserve Component (RC) Army and Marine-enlisted males (n = 705).
A series of multivariate regressions examined the association of mental health with IAS and deployment preparedness, adjusting for demographics. To examine whether deployment preparedness varied by IAS, an IAS × deployment preparedness interaction was included.
In an adjusted model, being an individual augmentee and low deployment preparedness were associated with any mental health problem (screening positive for PTSD, MDD, binge drinking, or any combination of the three). There was a significant IAS × deployment preparedness interaction. Mental health problems did not vary by preparedness among individual augmentees. Participants deploying with regular units with low-medium preparedness had greater risk for mental health problems (odds ratio [OR] = 3.69, 95% confidence interval [CI] = 1.78-7.62 and OR = 2.29, 95% CI = 1.12-4.71), than those with high preparedness. RC-enlisted male personnel who deployed without their regular unit were five times more likely to have a mental health problem, and were 61% more likely to report binge drinking. Additionally, those with lower levels of deployment preparedness were up to three times more likely to have a mental health problem and up to six times more likely to report PTSD.
The current investigation found that both IAS and deployment preparedness were associated with negative mental health outcomes in a large representative sample of previously deployed RC-enlisted male personnel. In particular, low deployment preparedness was associated with an increased likelihood of PTSD, and deploying without one's regular unit was associated with increased rates of binge drinking. There were also significant main and interaction effects of IAS and deployment preparedness on having a mental health problem. It is possible that limiting the number of RC personnel deploying without their regular unit may help to decrease alcohol misuse among U.S. Armed Services reservists during and after future conflicts. Also, to the extent that deployment preparedness is a modifiable risk factor, future studies should examine whether increasing deployment preparedness could mitigate some of the correlates of deployment-related trauma exposure. Finally, future investigation is needed to explain why those who deploy without their regular unit, but who report high deployment preparedness, remain at elevated risk for mental health problems. It is possible that individual augmentees can benefit from a specific preparation for deployment. Those deploying without their regular unit had higher rates of mental health problems regardless of preparedness. These findings have implications for deployment preparedness training for those deploying without their regular unit.
鉴于后备役军人部署后心理健康问题更为普遍,他们更有可能在未与常规部队一同部署的情况下执行任务,且部署准备率可能较低,我们在一个具有全国代表性的陆军后备役部队(RC)和海军陆战队男性应征入伍人员样本(n = 705)中,研究了与常规部队一同部署或未与常规部队一同部署(个体增员状态,IAS)、部署准备情况以及心理健康问题(包括创伤后应激障碍(PTSD)、抑郁症(MDD)和暴饮)之间的关联。
一系列多变量回归分析了心理健康与IAS和部署准备情况之间的关联,并对人口统计学因素进行了调整。为了研究部署准备情况是否因IAS而异,纳入了IAS×部署准备情况的交互项。
在一个调整后的模型中,作为个体增员人员以及部署准备程度低与任何心理健康问题(PTSD、MDD、暴饮或三者的任何组合筛查呈阳性)相关。存在显著的IAS×部署准备情况交互作用。个体增员人员的心理健康问题不会因准备程度而异。与准备充分的人员相比,与准备程度低至中等的常规部队一同部署的参与者出现心理健康问题的风险更高(优势比[OR] = 3.69,95%置信区间[CI] = 1.78 - 7.62;OR = 2.29,95%CI = 1.12 - 4.71)。未与常规部队一同部署的陆军后备役部队男性人员出现心理健康问题的可能性高出五倍,报告有暴饮情况的可能性高出61%。此外,部署准备程度较低的人员出现心理健康问题的可能性高出三倍,报告患有PTSD的可能性高出六倍。
当前调查发现,在一个具有代表性的大规模先前部署的陆军后备役部队男性应征入伍人员样本中,IAS和部署准备情况均与负面心理健康结果相关。特别是,部署准备程度低与PTSD发生可能性增加相关,而未与常规部队一同部署与暴饮发生率增加相关。IAS和部署准备情况对出现心理健康问题也有显著的主效应和交互效应。限制未与常规部队一同部署的陆军后备役部队人员数量,可能有助于减少美国武装部队后备役军人在未来冲突期间及之后的酒精滥用情况。此外,鉴于部署准备情况是一个可改变的风险因素,未来研究应探讨提高部署准备程度是否可以减轻一些与部署相关的创伤暴露的相关因素。最后,需要未来的调查来解释为什么那些未与常规部队一同部署但报告部署准备程度高的人员,心理健康问题风险仍然较高。个体增员人员可能会从特定的部署准备中受益。无论准备程度如何,未与常规部队一同部署的人员心理健康问题发生率都较高。这些发现对未与常规部队一同部署人员的部署准备培训具有启示意义。