To the Editor: Dr Hoge and colleagues1 have drawn attention to the potential struggles faced by US military personnel currently returning from war. We are concerned, however, that the data in this article will be erroneously interpreted as evidence for an epidemic of postdeployment psychiatric problems. The findings are actually reassuring with respect to psychiatric morbidity in the US military.
For example, the study reported that 1214 (0.5%) of 222 620 individuals serving in Operation Iraqi Freedom (OIF) were hospitalized for a mental disorder in the first year after deployment. This is a remarkably low prevalence, given that in peacetime approximately 1.4% of newly recruited personnel are hospitalized with a psychiatric diagnosis during their first year of service.2 Although this difference may not be statistically significant, it is possible that the 1-year likelihood of a recruit incurring a psychiatric hospitalization during peacetime is greater than the likelihood of a service member being hospitalized for a war-related psychiatric disorder. Similarly, Hoge et al reported that 17 249 (7.6%) of 222 620 OIF veterans received an outpatient psychiatric diagnosis in the year following combat. This is not much higher than the 6% of military personnel who received an outpatient psychiatric diagnosis annually during the 1990s.3 The difference might actually be due to an increased level of surveillance rather than combat exposure.
Hoge et al also reported that the prevalence of any mental health concern in their sample was 19.1%. Because of the study-specific way in which mental health concerns were assessed, we are not aware of any historically comparable “concern data” in military populations. However, the results do not appear to be unusually high compared with civilian prevalence. For example, results from the National Comorbidity Survey replication4 indicate that approximately 52% of individuals aged 18 to 29 years have experienced symptoms indicative of a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorder in their lifetime.
We do not wish to minimize the long-term effect of combat on military personnel, given the ample evidence that, for many individuals, combat is followed by wrenching struggles to return to well-being and normalcy. It is mistaken, however, to interpret the current clinical data as pointing to an upswing in psychiatric problems in combat veterans.
Financial Disclosures: None reported.
Disclaimer: The views expressed in this letter are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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