Deployment, combat, and risk of multiple physical symptoms in the US military: a prospective cohort study

Phoebe K McCutchan; Xian Liu; Cynthia A LeardMann; Tyler C Smith; Edward J Boyko; Kristie L Gore; Michael C Freed; Charles C Engel

doi:10.1016/j.annepidem.2015.12.001

Deployment, combat, and risk of multiple physical symptoms in the US military: a prospective cohort study

Ann Epidemiol. 2016 Feb;26(2):122-128. doi: 10.1016/j.annepidem.2015.12.001. Epub 2015 Dec 11.

Authors

Phoebe K McCutchan¹, Xian Liu², Cynthia A LeardMann³, Tyler C Smith⁴, Edward J Boyko⁵, Kristie L Gore⁶, Michael C Freed⁷, Charles C Engel⁶

Affiliations

¹ Deployment Health Clinical Center, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD. Electronic address: phoebe.mccutchan@gmail.com.
² Deployment Health Clinical Center, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD.
³ Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Deployment Health Research Department, Naval Health Research Center, San Diego, CA.
⁴ Department of Community Health, School of Health and Human Services, National University, San Diego, CA.
⁵ Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
⁶ Behavioral and Policy Science, RAND Corporation, Arlington, VA.
⁷ Deployment Health Clinical Center, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Silver Spring, MD; Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD.

PMID: 26781443
DOI: 10.1016/j.annepidem.2015.12.001

Abstract

Purpose: Multiple physical symptoms (MPS) have historically been observed after deployment to a combat zone and are often disabling in nature. This study examined longitudinal trends in MPS status and its relationship to deployment in U.S. military service members.

Methods: Using longitudinal data from panel 1 participants in the Millennium Cohort Study (n = 76,924), MPS status was assessed at three time points (2001-2008) using the 15-item Patient Health Questionnaire. Probability of reporting MPS was analyzed using mixed-effects multinomial logit regression, with time and deployment experience as main explanatory variables.

Results: After adjustment for demographic, military, and health characteristics, service members who deployed with combat were significantly more likely to report MPS at each time point compared with those not deployed (odds ratio [OR] and 95% confidence interval [CI] for wave 1 = 1.49 [1.47-1.52], wave 2 = 1.73 [1.69-1.78], wave 3 = 2.08 [2.03-2.12]), and those who deployed without combat (OR and CI for wave 1 = 2.66 [2.59-2.74], wave 2 = 1.81 [1.75-1.87]; wave 3 = 1.68 [1.63-1.74]).

Conclusions: Longitudinal trends indicate that the probability of reporting MPS has increased consistently over time only for those deployed, regardless of combat experience.

Keywords: Cohort studies; Military medicine; Military personnel; Signs and symptoms; Veterans health.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Combat Disorders / epidemiology*
Female
Health Status*
Humans
Longitudinal Studies
Male
Middle Aged
Military Personnel / statistics & numerical data*
Odds Ratio
Prospective Studies
Risk Factors
Warfare*