Do shorter delays to care and mental health system renewal translate into better occupational outcome after mental disorder diagnosis in a cohort of Canadian military personnel who returned from an Afghanistan deployment?
Do shorter delays to care and mental health system renewal translate into better occupational outcome after mental disorder diagnosis in a cohort of Canadian military personnel who returned from an Afghanistan deployment?
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DOI：
10.1136/bmjopen-2015-008591
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发表时间：
2015-12-07
期刊：
影响因子：
2.9
通讯作者：
Zamorski MA
中科院分区：
文献类型：
--
作者：
Boulos D;Zamorski MA
军人的精神障碍导致高流失率。军事组织已加强其心理健康系统，并试图克服护理障碍以取得更好的结果。本研究调查了心理健康服务更新以及护理延迟在被诊断患有精神障碍的加拿大武装部队（CAF）人员中所起的作用。
利用行政数据确定了一个回顾性队列，其中包括30513名为支持阿富汗任务而部署的加拿大武装部队人员。研究参与者包括从该研究队列中选取的2014名个体的加权分层随机样本的加拿大武装部队医疗记录中确定的508名患有精神障碍诊断的个体。在控制了广泛的潜在混杂因素（例如，疾病严重程度、共病情况）之后，加权考克斯比例风险回归评估了诊断时期和护理延迟与结果之间的关联。泰勒级数线性化方法和样本设计权重被应用于生成描述性和回归分析统计数据。
结果是因医疗原因从军队退役，通过对508名患有精神障碍诊断的个体的行政数据进行评估。
在与阿富汗相关的部署之后，该队列中有17.5%（95%置信区间为16.0% - 19.0%）被诊断患有精神障碍，其中在中位随访3.5年期间，有21.3%（95%置信区间为17.2% - 25.5%）因医疗原因退役。与近期诊断的个体相比，2008年4月30日之前被诊断的个体因医疗原因退役的风险升高（调整后的风险比（aHR）=1.77（95%置信区间为1.01 - 3.11）），并且与中等延迟（返回后8 - 21个月，aHR = 2.47（95%置信区间为1.28 - 4.76））的个体相比，护理延迟较长（返回后>21个月）的个体因医疗原因退役的风险也升高。
加拿大武装部队的心理健康服务更新与被诊断患有精神障碍的人员更好的职业结果相关。较长的护理延迟与不太有利的结果相关。
Mental disorders in military personnel result in high rates of attrition. Military organisations have strengthened their mental health systems and attempted to overcome barriers to care in order to see better outcomes. This study investigated the roles of mental health services renewal and delay to care in Canadian Armed Forces (CAF) personnel diagnosed with mental disorders. Administrative data were used to identify a retrospective cohort of 30 513 CAF personnel who deployed in support of the mission in Afghanistan. Study participants included 508 individuals with a mental disorder diagnosis identified from CAF medical records of a weighted, stratified random sample of 2014 individuals selected from the study cohort. Weighted Cox proportional hazards regression assessed the association of diagnosis era and delay to care with the outcome, after controlling for a broad range of potential confounders (eg, disorder severity, comorbidity). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics. The outcome was release from military service for medical reasons, assessed using administrative data for the 508 individuals with a mental disorder diagnosis. 17.5% (95% CI 16.0% to 19.0%) of the cohort had a mental disorder diagnosis after an Afghanistan-related deployment, of which 21.3% (95% CI 17.2% to 25.5%) had a medical release over a median follow-up of 3.5 years. Medical release risk was elevated for individuals diagnosed before 30 April 2008 relative to those with recent diagnoses (adjusted HR (aHR)=1.77 (95% CI 1.01 to 3.11)) and for individuals with a long delay to care (>21 months after return) relative to those with intermediate delays (8–21 months, aHR 2.47=(95% CI 1.28 to 4.76)). Mental health services renewal in the CAF was associated with a better occupational outcome for those diagnosed with mental disorders. Longer delays to care were associated with a less favourable outcome.