Deployments & Mental Health: Those With Longer Dwell Times May Be More At Risk

Service members who spend more time at home between deployments may have a greater chance of being diagnosed with a mental health disorder than those with briefer dwell times, a Defense Department  analysis has revealed, but officials urge further research.
 
The study, conducted by the Armed Forces Health Surveillance Center, revealed that the percentage of service members diagnosed with mental health disorders after repeat deployments — their second through fifth — increased as dwell times prior to the deployments lengthened, surveillance center officials said.
 
The report, they noted, reflects only data for service members who sought help and received a medically diagnosed mental health condition from credentialed providers.
 
These results, published in the Medical Surveillance Monthly Report, are based on data from the Defense Medical Surveillance System spanning an eight-year period. The study encompassed more than 1 million male and more than 150,000 female active-duty service members who deployed at least once in support of operations Enduring Freedom, Iraqi Freedom or New Dawn.
 
The report’s authors offered some possible reasons behind the dwell time findings. Longer dwell times may offer service members the opportunity to completely readjust to being home, they suggested. It then may be more difficult to transition back to a warrior mindset on the next deployment. In contrast, service members who are home for a brief time may not fully adjust and, as a result, are better able to psychologically handle subsequent deployments.
 
Another possibility for the finding, is that some service members may temporarily be unable to deploy again or may be delayed due to a medical condition, such as a mental health disorder, which can result in a longer dwell time. In these cases, an increase in mental health disorders correlates with a longer dwell time, they noted, but one doesn’t necessarily cause the other.
 
Col. Christopher Robinson, the deputy director of psychological health for the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, offered his own interpretation of the data. He suggested that the longer service members are home, the more likely they are to seek services or that a spouse or friend will encourage them to seek help.
 
Service members who have relatively short dwell times tend to keep their guard up, he explained, and may cover up symptoms or slough off suggestions to seek help knowing they’re soon to deploy. But, the “longer they’re home and connect with people, the greater the chance someone will tell them they’re drinking too much or they seem depressed, if that is indeed the case,” he said.
 
“Rather than thinking that longer dwell times causes more mental health diagnoses, I’d rather think that longer dwell times give service members time to seek help appropriately,” Robinson said. This fits in with the data, he said, since it only reflects service members who received medical diagnoses of a mental health condition from a credentialed provider.
 
“I still stand by the notion that longer dwell times are helpful for the health of our service members,” the doctor said, citing results from the 2009 and 2011 Mental Health Assessment Tools. MHAT teams surveyed behavioral health personnel in theater, who concurred that longer dwell times could result in less mental health problems and better morale.
 
The study also showed an increase in the number of service members with diagnosed mental health conditions after the first deployment and through the third, and then a general decline in the number of service members with mental health disorders on subsequent deployments. This finding is interesting, the report’s authors said, since people often have the impression that deployments have a cumulative effect, meaning the more service members deploy, the more problems they’re likely to have.
 
Robinson said this may be due to what he calls the “resilience effect.” The more service members deploy, he explained, the more they know what to expect and are better able to weather adversity.
 
The data also may be reflecting the fact that people who stay in the service and take on repeat deployments already have the resilience to weather challenges. Others may choose to leave the service or are held back from repeat deployments due to diagnosed mental health conditions.
 
Other results included higher percentages of service members in health care careers being diagnosed with post-traumatic stress disorder. The proportion of health care workers with PTSD increased more sharply than those in combat occupations, the report revealed. In some cases, officials suggested, medical workers may be exposed to death and injury on more constant basis than those in combat occupations, and, as a result, are more susceptible to mental health issues.
 
Additionally, younger service members and female service members were diagnosed with a mental health condition more frequently than their older counterparts.
 
This may be due to the fact that, as people age, they have better coping mechanisms, Robinson said. “As we age and mature, there is more of a chance that bad things can happen,” he explained, and as a result people build resilience by making it through these challenging events. “That’s what resilience is — facing adversity with courage and fortitude.”
 
As for the gender-related finding, women in general are more likely to seek mental health care than men, the report said. This doesn’t mean they’re less resilient, Robinson said, but that females tend to seek care more often.
 
Overall, the findings bear a closer look, Robinson said. The fact that some of the results were unexpected, such as the dwell time issue, only underscores that need. Other findings, such as the increasing rates of mental health issues among health care providers, can help the Defense Department better tailor programs and address a growing need.
 
The analysis, Robinson said, also points to the importance of seeking mental health care without fear of repercussion.
 
Perhaps one of the reasons the data is showing an increase in mental health disorders, he suggested, is that more people are seeking help without fear of career repercussion. Officials will continue to work to combat the stigma of seeking help, he added, through education and awareness.
 
“We know that combat exposure is a risk factor for some of these problems,” Robinson said. “We need to recognize that and make sure to provide services for these service members and these families, and put out a consistent message of the importance of seeking help.
 
“The earlier we get help the better,” he added. “The longer we wait the worse things typically become.”
 
Service members and their family members who need mental health care can access many online resources to help identify and address issues, Robinson said, such as Afterdeployment.org, and the Real Warriors Campaign. They also can contact a chaplain, health care provider or a supervisor.
 
“Suffering in silence is not the way to go,” he said.
 
(By Elaine Sanchez, as printed for American Forces Press Service)