Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008

Abstract

Objectives: We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans.

Methods: We determined the prevalence and predictors of mental health diagnoses among 289,328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data.

Results: Of 289,328 Iraq and Afghanistan veterans, 106,726 (36.9%) received mental health diagnoses; 62,929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated with higher risk for PTSD.

Conclusions: Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness.

FIGURE 1

Cumulative prevalence of new mental health diagnoses in successive cohorts of Operation Iraqi Freedom and Operation Enduring Freedom veterans entering the Department of Veterans Affairs health care system and followed for increasing lengths of time, from 1 to 4 years.

FIGURE 2

Cohorts of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom veterans entering the Department of Veterans Affairs health care system during successive calendar quarters and followed for 2 years and 2-year period prevalence of (a) mental health diagnoses and problems and (b) specific mental health diagnoses: April 1, 2002, to March 31, 2006. Note. Mental health diagnoses were based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 290.0 to 319.0, which correspond to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised (DSM-IV-R) diagnostic codes for mental illness. Mental health problems were based on V codes indicating psychosocial or behavioral problems: V15.40 to V15.49, V60.0 to V60.2, V60.4, V61.0 to V61.22, V61.80 to V61.83, V61.90, V62.0, V62.2, V62.5, V62.80 to V62.89, V63.0, V63.9, V65.2, V65.5, V69.2 to V69.8, V70.1 to V70.2, V71.0 to V71.01, V71.5, V71.81, V79.0 to V79.1, in addition to ICD-9-CM mental health diagnoses 290.0 to 319.0.