Prevalence and severity of mental disorders in military personnel: a standardised comparison with civilians.

ABSTRACT

AIMS: Provision and need for mental health services among military personnel are a major concern across nations. Two recent comparisons suggest higher rates of mental disorders in US and UK military personnel compared with civilians. However, these findings may not apply to other nations. Previous studies have focused on the overall effects of military service rather than the separate effects of military service and deployment. This study compared German military personnel with and without a history of deployment to sociodemographically matched civilians regarding prevalence and severity of 12-month DSM-IV mental disorders. METHOD: 1439 deployed soldiers (DS), 779 never deployed soldiers (NS) and 1023 civilians were assessed with an adapted version of the Munich Composite International Diagnostic interview across the same timeframe. Data were weighted using propensity score methodology to assure comparability of the three samples. RESULTS: Compared with adjusted civilians, the prevalence of any 12-month disorder was lower in NS (OR 0.7, 95% CI 0.5-0.99) and did not differ in DS. Significant differences between military personnel and civilians regarding prevalence and severity of individual diagnoses were only apparent for alcohol (DS OR 0.3, 95% CI 0.1-0.6; NS OR 0.2, 95% CI 0.1-0.6) and nicotine dependence (DS OR 0.5, 95% CI 0.3-0.6; NS OR 0.5, 95% CI 0.3-0.7) with lower values in both military samples. Elevated rates of panic/agoraphobia (OR 2.7, 95% CI 1.4-5.3) and posttraumatic stress disorder (OR 3.2, 95% CI 1.3-8.0) were observed in DS with high combat exposure compared with civilians. CONCLUSIONS: Rates and severity of mental disorders in the German military are comparable with civilians for internalising and lower for substance use disorders. A higher risk of some disorders is reduced to DS with high combat exposure. This finding has implications for mental health service provision and the need for targeted interventions. Differences to previous US and UK studies that suggest an overall higher prevalence in military personnel might result from divergent study methods, deployment characteristics, military structures and occupational factors. Some of these factors might yield valuable targets to improve military mental health.