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标题：Trends and Risk Factors for Mental Health Diagnoses Among Iraq and Afghanistan Veterans Using Department of Veterans Affairs Health Care, 2002–2008
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作者：Karen H. Seal ; Thomas J. Metzler ; Kristian S. Gima 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2009
卷号：99
期号：9
页码：1651-1658
DOI：10.2105/AJPH.2008.150284
语种：English
出版社：American Public Health Association
摘要：Objectives. We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans. Methods. We determined the prevalence and predictors of mental health diagnoses among 289 328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data. Results. Of 289 328 Iraq and Afghanistan veterans, 106 726 (36.9%) received mental health diagnoses; 62 929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated with higher risk for PTSD. Conclusions. Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness. The United States invaded Afghanistan on October 7, 2001, and Iraq on March 20, 2003. To date, over 1.6 million veterans have served in those 2 theaters of war. High rates of military service-related mental disorders among military service personnel and veterans of Operation Enduring Freedom (OEF; principally taking place in Afghanistan) and Operation Iraqi Freedom (OIF; principally in Iraq) have been described and publicized.^{1 – 7} Among 100 000 OEF and OIF veterans first seen at Department of Veterans Affairs (VA) health care facilities between 2001 and 2005, 25% received mental health diagnoses.⁴ Since that study, however, there has not been a published description of the accruing prevalence of mental health disorders and specific risk factors for these disorders among OEF and OIF veterans entering VA health care. Until recently, in January 2008, when Congress extended the combat veteran health care benefit to 5 years postdischarge,⁸ the VA provided OEF and OIF veterans 2 years of free military service–related health care dating from service separation. After this period of free care, OIF and OEF veterans are eligible to continue to use VA health care services without charge or must pay a nominal co-payment scaled to income.⁹ OIF and OEF veterans who have health insurance through employment or school, for example, may also seek non-VA health care services in their communities.^{10 – 12} Nevertheless, 41% of all 837 458 separated OIF and OEF veterans eligible for VA health care have enrolled in the VA since 2002.⁵ This is historically high for VA. Only 10% of Vietnam veterans enrolled in the VA,¹³ and enrollment has been increasing ever since, making VA the single largest health care provider for OIF and OEF veterans. Thus, longitudinal trends in the prevalence of mental disorders among OIF and OEF veterans using VA health care may reflect the overall public health obligation to treatment-seeking OIF and OEF veterans within the United States. Further, identification of high-risk subgroups of OIF and OEF veterans will facilitate development of targeted mental health services within the VA and other health care systems in an effort to stem an epidemic of chronic mental illness, as occurred with Vietnam-era veterans.¹³