Health outcomes associated with military deployment: mild traumatic brain injury, blast, trauma, and combat associations in the Florida National Guard
Vanderploeg RD, Belanger HG, Horner RD, Spehard AM, Powell-Cope G, Luther SL, Scott SG.
Arch Phys Med Rehabil. 2012 Jun 13. [Epub ahead of print]
OBJECTIVE: To determine the association between specific military deployment experiences and immediate and longer- term physical and mental health effects, as well as examine the effects of multiple deployment-related traumatic brain injuries on health outcomes. These relationships have important implications for post-deployment monitoring and treatment, but have yet to be fully delineated. DESIGN: Online survey of cross-sectional cohort. Odds ratios were calculated to assess the association between deployment-related factors (i.e., physical injuries, exposure to potentially traumatic deployment experiences, combat, blast exposure, and mild traumatic brain injury) and current health status, controlling for potential confounders, demographics and pre-deployment experiences. SETTING: Non-clinical. PARTICIPANTS: A total of 3098 members of the Florida National Guard (1443 deployed, 1655 not deployed). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Presence of current psychiatric diagnoses and health outcomes, including postconcussive and non-postconcussive symptoms. RESULTS: Surveys were completed an average of 31.8 months (SD = 24.4, Range = 0 to 95) following deployment. Strong, statistically significant associations were found between self-reported military deployment-related factors and current adverse health status. Deployment-related mild traumatic brain injury (TBI) was associated with depression, anxiety, PTSD, and postconcussive symptoms collectively and individually. Statistically significant increases in frequency of depression, anxiety, PTSD, and a postconcussive symptom complex were seen comparing single to multiple TBIs. However, a pre-deployment TBI did not increase the likelihood of sustaining another TBI in a blast exposure. Associations between blast exposure and abdominal pain, pain on deep breathing, shortness of breath, hearing loss, and tinnitus suggested residual barotrauma. Combat exposure with and without physical injury were each associated with PTSD, but also with numerous postconcussive and non-postconcussive symptoms. The experience of seeing others wounded or killed or experiencing the death of a buddy or leader was associated with indigestion and headaches, but not with depression, anxiety, or posttraumatic stress disorder (PTSD). CONCLUSIONS: Complex relationships exist between multiple deployment-related factors and numerous overlapping and co-occurring current adverse physical and psychological health outcomes. Various deployment-related experiences increased the risk for post-deployment adverse mental and physical health outcomes, individually and in combination. These findings suggest that an integrated physical and mental healthcare approach would be beneficial to post-deployment care.