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Original Investigation |

Thirty-Day Prevalence of DSM-IV Mental Disorders Among Nondeployed Soldiers in the US Army:  Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

Ronald C. Kessler, PhD1; Steven G. Heeringa, PhD3; Murray B. Stein, MD, MPH5; Lisa J. Colpe, PhD, MPH2; Carol S. Fullerton, PhD6; Irving Hwang, MA1; James A. Naifeh, PhD6; Matthew K. Nock, PhD4; Maria Petukhova, PhD1; Nancy A. Sampson, BA1; Michael Schoenbaum, PhD2; Alan M. Zaslavsky, PhD1; Robert J. Ursano, MD6; for the Army STARRS Collaborators
[+] Author Affiliations
1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
2National Institute of Mental Health, Bethesda, Maryland
3University of Michigan, Institute for Social Research, Ann Arbor
4Department of Psychology, Harvard College, Cambridge, Massachusetts
5Departments of Psychiatry and Family and Preventive Medicine, University of California–San Diego, La Jolla, and VA San Diego Healthcare System, San Diego, California
6Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland
JAMA Psychiatry. 2014;71(5):504-513. doi:10.1001/jamapsychiatry.2014.28.
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Importance  Although high rates of current mental disorder are known to exist in the US Army, little is known about the proportions of these disorders that had onsets prior to enlistment.

Objective  To estimate the proportions of 30-day DSM-IV mental disorders among nondeployed US Army personnel with first onsets prior to enlistment and the extent which role impairments associated with 30-day disorders differ depending on whether the disorders had pre- vs post-enlistment onsets.

Design, Setting, and Participants  A representative sample of 5428 soldiers participating in the Army Study to Assess Risk and Resilience in Servicemembers completed self-administered questionnaires and consented to linkage of questionnaire responses with administrative records.

Main Outcomes and Measures  Thirty-day DSM-IV internalizing (major depressive, bipolar, generalized anxiety, panic, and posttraumatic stress) and externalizing (attention-deficit/hyperactivity, intermittent explosive, alcohol/drug) disorders were assessed with validated self-report scales. Age at onset was assessed retrospectively. Role impairment was assessed with a modified Sheehan Disability Scale.

Results  A total of 25.1% of respondents met criteria for any 30-day disorder (15.0% internalizing; 18.4% externalizing) and 11.1% for multiple disorders. A total of 76.6% of cases reported pre-enlistment age at onset of at least one 30-day disorder (49.6% internalizing; 81.7% externalizing). Also, 12.8% of respondents reported severe role impairment. Controlling for sociodemographic and Army career correlates, which were broadly consistent with other studies, 30-day disorders with pre-enlistment (χ28 = 131.8, P < .001) and post-enlistment (χ27 = 123.8, P < .001) ages at onset both significantly predicted severe role impairment, although pre-enlistment disorders were more consistent powerful predictors (7 of 8 disorders significant; odds ratios, 1.6-11.4) than post-enlistment disorders (5 of 7 disorders significant; odds ratios, 1.5-7.7). Population-attributable risk proportions of severe role impairment were 21.7% for pre-enlistment disorders, 24.3% for post-enlistment disorders, and 43.4% for all disorders.

Conclusions and Relevance  Interventions to limit accession or increase resilience of new soldiers with pre-enlistment mental disorders might reduce prevalence and impairments of mental disorders in the US Army.

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