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首页> 外文学位 >Mental health in the military: Pre-Iraq war behavioral health utilization rates, and anonymous survey linkage and combat exposure recall in Operation Iraqi Freedom veterans.
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Mental health in the military: Pre-Iraq war behavioral health utilization rates, and anonymous survey linkage and combat exposure recall in Operation Iraqi Freedom veterans.

机译：军队中的心理健康：伊拉克前战争退伍军人中伊拉克战争前的行为健康利用率，匿名调查联系和战斗暴露召回。

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摘要

Objective. This three-part dissertation studies mental health in United States Active Duty Service Members. The purpose of the first part of this study is to characterize outpatient behavioral health visits in military health care facilities prior to Operation Iraqi Freedom (OIF), including the use of diagnoses outside of the ICD-9 290-319 range, in order to evaluate the overall burden of mental health care. This part of the research establishes baseline rates of mental health care utilization in military mental health clinics in 2000 and serves as a comparison for future studies of the mental health care burden of the current war.;The second part of this study provides a unique application of a procedure to link anonymous survey records as a means to assess mental health problems among soldiers at different time points during the first year after return from deployment to Iraq. The research purpose of the second part is to validate the use of a linkage method on anonymous survey data for longitudinal analysis.;The third part of this study evaluates changes in recall of combat exposures at different time points over the first year after return from deployment. The research purpose of this final part is to utilize the linked datasets to assess whether recall of combat exposures is consistent at different time points; and if not, what demographic and/or PTSD symptom risk factors exist for any directional instability.;Results. The total number of individuals who utilized behavioral health services in 2000 was just over 115 per 1,000 person-years, almost 12% of the military population. Out of every 1,000 person-years, 57.5 individuals received care from behavioral health providers involving an ICD-9 290-319 mental disorder diagnosis, and an additional 26.7 per 1,000 person-years received care in behavioral health clinics only for V-code diagnoses. Attrition from service was correlated with both categories of mental health related diagnoses. After one year, approximately 38% of individuals who received an ICD-9 290-319 mental disorder diagnosis left the military, compared with 23% of those who received mental health V-code diagnoses, and 14% of those who received health care for any other reason (which included well visits for routine physicals).;The second part found final match rates of the surveys to be comparable to rates obtained in preliminary analyses using different methods. The matched records showed very high agreement in variables not included in the matching procedure, and were similar to the unmatched records with regard to demographics and the prevalence of PTSD.;The results of the third part showed a high degree of agreement in combat exposure reporting between the time points, averaging 80-90%. Of the 36 different combat exposure questions, about three-quarters of the respondents had three or fewer changes between the two time points. On average, all three linked datasets showed a similar number of newly endorsed as no longer endorsed exposures. All exposures had weighted kappa statistics between 0.2 and 0.8, with the majority above 0.4.;Conclusions. The first part of the study establishes baseline rates of pre-war behavioral healthcare utilization among military service members, and the relationship of mental health care use and attrition from service. This research indicates that in the military population the burden of mental illness in outpatient clinics is significantly greater when V-code diagnoses are included along with conventional mental disorder diagnostic codes.;The second part of the research demonstrates that use of self-generated codes protects anonymity while the method utilized and validated in this study allows for longitudinal data analysis. The results show that matched surveys were similar to unmatched surveys in terms of demographics and PTSD prevalence.;Finally, the results of the third part demonstrate that over the first year after return from deployment to Iraq, recall of combat experiences remained stable, and that PTSD was slightly associated with increased reporting of combat exposures over time. (Abstract shortened by UMI.).
机译：目的。本论文分为三部分，研究美国现役军人的心理健康状况。本研究第一部分的目的是表征伊拉克自由行动（OIF）之前在军事医疗机构进行的门诊行为健康就诊，包括使用ICD-9 290-319范围以外的诊断，以评估精神保健的总体负担。这部分研究建立了2000年军事精神卫生诊所中精神卫生使用率的基准率，并与未来对当前战争中精神卫生负担的研究作了比较。第二部分提供了独特的应用链接匿名调查记录的程序，以评估从部署返回伊拉克后的第一年中不同时间点士兵的心理健康问题。第二部分的研究目的是验证对匿名调查数据使用链接方法进行纵向分析的有效性。本研究的第三部分评估从部署返回后第一年不同时间点的战斗暴露召回率的变化。最后一部分的研究目的是利用链接的数据集评估战斗暴露的召回在不同时间点是否一致。如果没有，那么对于任何方向性不稳定，存在哪些人口统计学和/或PTSD症状风险因素。 2000年，使用行为健康服务的总人数刚刚超过每千人年115个人，几乎占军事人口的12％。在每1,000人年中，有57.5个人从行为健康提供者那里获得了ICD-9 290-319精神障碍诊断的护理，另外每千人年26.7在行为健康诊所接受了仅针对V码诊断的护理。服务人员流失与精神健康相关的两种诊断都相关。一年后，接受ICD-9 290-319精神障碍诊断的人中约有38％离开了军队，而接受精神卫生V编码诊断的人中有23％，接受过医疗保健的14％任何其他原因（包括对常规身体检查进行的拜访）。第二部分发现调查的最终匹配率与使用不同方法进行的初步分析所获得的匹配率可比。匹配的记录在匹配过程中未包含的变量中显示出很高的一致性，并且在人口统计和PTSD的发生率方面与未匹配的记录相似;第三部分的结果表明，在作战暴露报告中具有高度的一致性在两个时间点之间，平均为80-90％。在36个不同的战斗曝光问题中，大约四分之三的受访者在两个时间点之间的变化少于或少于三个。平均而言，所有三个链接的数据集显示的新认可数量与不再认可的暴露数量相似。所有暴露的加权Kappa统计值在0.2到0.8之间，大多数在0.4以上。该研究的第一部分确定了战前服役人员使用战前行为医疗的基准率，以及心理医疗的使用与服役人员流失之间的关系。这项研究表明，在军事人群中，如果将V代码诊断与常规的精神障碍诊断代码一起包括在内，则门诊诊所的精神疾病负担会大大增加。;第二部分研究表明，使用自我生成的代码可以保护匿名性，而本研究中使用和验证的方法允许进行纵向数据分析。结果表明，就人口统计和PTSD患病率而言，匹配的调查与不匹配的调查相似;最后，第三部分的结果表明，从部署回伊拉克后的第一年中，战斗经历的回忆保持稳定，并且随着时间的推移，PTSD与战斗曝光报告的增加略相关。 （摘要由UMI缩短。）。

著录项

  • 作者

    Garvey Wilson, Abigail Lynn.;

  • 作者单位

    The George Washington University.;

  • 授予单位 The George Washington University.;
  • 学科 Health Sciences Epidemiology.;Military Studies.
  • 学位 Ph.D.
  • 年度 2008
  • 页码 172 p.
  • 总页数 172
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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