A cohort of U.S. Army soldiers first psychiatrically hospitalized in 1998 was followed up for two years (Hoge et al., 2005). The attrition rate within six months following a hospitalization for mental disorder was 45 percent compared with 11 percent for other medical illnesses. A secondary mental health diagnosis also increased the risk of attrition to 27 percent at six months.

Mental health–related separations for Air Force basic military trainees were assessed for the year 2001:4.2 percent of separations were attributable to mental health disorders, with adjustment disorders and depressive disorders being the top diagnostic categories (Englert, Hunter, and Sweeney, 2003).

In the 2000 annual report, AMSARA described a five-year, retrospective cohort study of the relationship between waivers for mental health and attrition during the first two years of service. This study compared 502 first-time enlistees across the Services who were granted waivers for depression with a matched group of 1,501 recruits who were qualified on all physical, medical, and mental criteria. The overall results show that recruits with mental health waivers are significantly less likely to remain in military service than those in the comparison group; the probability of retention was .62 versus .72 at the two-year mark. Specific analyses by Service and gender were also performed. For men in the Marine Corps, the retention rate for those with waivers was significant lower; for men in the Navy, it was marginally lower; and for men in the Army, there were no significant differences between the two groups. For woman in the Army, the retention rate was significantly lower for those with waivers, whereas for women in the Navy, no significant differences were found.

The mental health effects of exposure to combat duty in Iraq or Afghanistan for U.S. combat infantry units (three Army units and one Marine Corps unit) were investigated by Hoge et al. (2004). In these groups, exposure to combat was significantly greater among those deployed to Iraq than those deployed to Afghanistan. After duty in Iraq, 15.6 to 17 percent of the military personnel met screening criteria for major depression, generalized anxiety, or posttraumatic stress disorder compared with 9.3 percent before deployment to Iraq. After duty in Afghanistan, 11.2 percent met criteria for these disorders. Posttraumatic stress disorder accounted for the largest difference in the pre- and postdeployment rates. Importantly, only 23 to 40 percent of these military personnel sought mental health care. Concern about stigmatization as well as other barriers (e.g., difficulty scheduling an appointment, difficulty getting time off from work, transportation problems) were cited by military personal as reasons for not seeking mental health care.

These data are less complete than those for the general adolescent population described above, so there is considerably greater difficulty in



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