Mental and Physical Health Conditions in US Combat Veterans: Results From the National Health and Resilience in Veterans Study.
Mental and Physical Health Conditions in US Combat Veterans: Results From the National Health and Resilience in Veterans Study.
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DOI：
10.4088/pcc.17m02118
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发表时间：
2017-06-22
影响因子：
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通讯作者：
Pietrzak, Robert H
中科院分区：
文献类型：
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作者：
Thomas, Melissa M;Harpaz-Rotem, Ilan;Pietrzak, Robert H
目的：确定美国战斗暴露和非战斗暴露退伍军人的社会人口学和军事特征，并比较这些人群的精神和身体健康状况。方法：数据分析来自国家退伍军人健康和恢复力研究（NHRVS），这是一项当代的，具有全国代表性的对1480名美国退伍军人进行的调查，于2013年9月至10月进行。分层后的权重应用于分析，以使结果能够推广到美国退伍军人人群。测量的结果包括终生和当前的精神疾病和身体健康状况。结果：总共有38%的美国退伍军人报告曾经历过战斗。与非战斗退伍军人相比，战斗退伍军人更年轻，家庭收入更高，在军队服役的时间更长；男性、曾在海军陆战队服役、以退伍军人事务医疗保健系统（Veterans Affairs Healthcare System）作为主要医疗保健来源的比例更高；并且报告了更多的潜在创伤事件。在对这些社会人口统计学和军事差异进行调整后，战斗退伍军人对终身创伤后应激障碍（PTSD）筛查呈阳性的可能性是非战斗退伍军人的3倍多，对当前PTSD筛查呈阳性的可能性是非战斗退伍军人的2倍多，对当前广泛性焦虑症筛查呈阳性的可能性高出82%。在额外控制了创伤后应激障碍和抑郁症、酒精或药物使用障碍以及尼古丁依赖的终身诊断后，战斗退伍军人自杀未遂的几率高出68%，被诊断为中风和慢性疼痛的几率分别高出85%和38%。年轻的战斗退伍军人比年长的战斗退伍军人更有可能筛查出终生（30.6%对10.1%）和当前的创伤后应激障碍（19.2%对4.9%）和自杀意念（18.6%对6.9%），并被诊断患有偏头痛（12.8%对2.1%），而年长的战斗退伍军人比年轻的战斗退伍军人更有可能报告被诊断患有心脏病（19.2%对2.6%）和心脏病发作（13.9%对2.5%）。结论：与美国的非战斗退伍军人相比，战斗退伍军人的创伤后应激障碍、自杀未遂、中风和慢性疼痛发生率升高，与其他社会人口统计学、军事和心理健康因素无关。年轻的退伍军人患创伤后应激障碍、自杀意念和偏头痛的几率更高，而年长的退伍军人患心脏病和心脏病的几率更高。这些结果表征了战斗退伍军人以人口为基础的精神和身体健康状况负担。他们进一步强调了在这一人群中进行年龄和病情敏感筛查、监测和治疗工作的重要性。
OBJECTIVE: To identify sociodemographic and military characteristics of combat-exposed and non-combat-exposed veterans in the United States and to compare rates of mental and physical health conditions in these populations.METHODS: Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a contemporary, nationally representative survey of 1,480 US veterans conducted September-October 2013. Poststratification weights were applied to analyses to permit generalizability of results to the US veteran population. Outcomes measured included lifetime and current psychiatric disorders and physical health conditions.RESULTS: A total 38% of US veterans reported being exposed to combat. Compared to noncombat veterans, combat veterans were younger, had greater household income, and served a greater number of years in the military; were more likely to be male, to have served in the Marine Corps, and to use the Veterans Affairs Healthcare System as their main source of health care; and reported a greater number of lifetime potentially traumatic events. After adjustment for these sociodemographic and military differences, combat veterans were more than 3 times as likely as noncombat veterans to screen positive for lifetime posttraumatic stress disorder (PTSD) and more than twice as likely for current PTSD and had 82% greater odds of screening positive for current generalized anxiety disorder. After additionally controlling for lifetime diagnoses of PTSD and depression, alcohol or drug use disorder, and nicotine dependence, combat veterans had 68% greater odds of having attempted suicide and 85% and 38% greater odds of being diagnosed with a stroke and chronic pain, respectively. Younger combat veterans were more likely than older combat veterans to screen positive for lifetime (30.6% vs 10.1%) and current PTSD (19.2% vs 4.9%) and suicidal ideation (18.6% vs 6.9%) and to have been diagnosed with migraine headaches (12.8% vs 2.1%), while older combat veterans were more likely than younger combat veterans to report having been diagnosed with heart disease (19.2% vs 2.6%) and heart attack (13.9% vs 2.5%).CONCLUSIONS: Compared to noncombat veterans in the United States, combat veterans have elevated rates of PTSD, suicide attempt, stroke, and chronic pain independent of other sociodemographic, military, and mental health factors. Younger combat veterans have elevated rates of PTSD, suicidal ideation, and migraine headaches, while older combat veterans have elevated rates of heart disease and heart attack. These results characterize the population-based burden of mental and physical health conditions in combat veterans. They further underscore the importance of age- and condition-sensitive screening, monitoring, and treatment efforts in this population.