Study Examines Dwell Times, Mental Health Issues

WASHINGTON — 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 explained. 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, they sug­gest, 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.

Air Force Col. Christo­pher Robin­son, 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 added, 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 not­ed, 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 not­ed, 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 not­ed, 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, 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.

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)