Active-duty soldiers in the Army who are hospitalized because of a
psychiatric disorder are far more likely to leave the military involuntarily
within six months of that hospital stay than are soldiers with other medical
These involuntary separations usually stemmed from the soldiers' inability
to perform their work duties and were attributed to "behaviors not
considered conducive to further service," according to a study reported
in the March American Journal of Psychiatry.
Col. Charles Hoge, M.C., chief of the psychiatry department at Walter Reed
Army Institute of Research in Bethesda, Md., and colleagues at several other
military facilities evaluated the medical and discharge records of about
14,000 active-duty soldiers who were hospitalized in 1998, before post-2001
U.S. operations in Afghanistan and the current Iraq war.
About 1,900 of the soldiers studied were diagnosed with a primary or
secondary psychiatric disorder, and about 12,000 soldiers were hospitalized
for other types of disorders.
The researchers followed up by reexamining the soldiers' records between
one and two years after the 1998 hospitalizations to try to determine what
factors were associated with separations from the military in soldiers with
mental illness compared with those diagnosed with other categories of illness
Hoge and his colleagues found that the rate of attrition, both voluntary
and involuntary, within six months of the hospitalization was 45 percent for
soldiers hospitalized with primary psychiatric diagnoses, 27 percent for
soldiers hospitalized with secondary psychiatric diagnoses, and 11 percent for
soldiers hospitalized for other medical conditions.
By two years after hospitalization, 67 percent of those with a primary
mental illness diagnosis had left the military, while 52 percent of those with
a secondary mental illness diagnosis had, and only 28 percent of soldiers with
other illnesses had.
"We had established in a previous study that mental disorders were
the main cause of hospitalization for men in the military and the second
leading cause of hospitalization for women" after pregnancy and
childbirth, Hoge and his colleagues said. "We also knew mental disorders
were highly correlated with separation from the military."
While the most common reason for separation from the military in the
subjects with nonpsychiatric diagnoses was voluntary retirement or completion
of enlistment, the most common reasons for separation of soldiers with
psychiatric disorders were involuntary. The most often cited cluster of
reasons for the latter group's discharge consisted of misconduct,
court-martial, discharge in lieu of a trial, and imprisonment. Seventeen
percent of those with a psychiatric disorder were discharged for reasons in
this category compared with 1.9 percent of those with a nonpsychiatric
Other reasons for involuntary separations from the military for soldiers
with mental disorders were personality disorders, alcohol and drug
rehabilitation failure, unauthorized absences from work, failure to meet
physical fitness or weight requirements, and unsatisfactory performance during
entry-level training, Hoge and his colleagues found.
Overall, soldiers with mental disorders were twice as likely as soldiers
with other medical conditions to receive a medical discharge due to
service-related conditions, which entitled many of them to a higher level of
retirement benefits than would have been the case if their discharge was for
behavioral or other nonmedical reasons.
These service-related medical discharges were most common among soldiers
with psychotic, mood, and anxiety disorders, Hoge and his colleagues reported.
In contrast, soldiers with substance abuse, adjustment, or personality
disorders were more likely to be involuntarily separated without retirement
"The study adds to the existing literature on the considerable
occupational impact and spectrum of mental health problems," Hoge told
Psychiatric News. "They will inform further research efforts
designed to reduce the burden of mental disorders on the military and society
as a whole."
The study, "The Occupational Burden of Mental Disorders in the
U.S. Military: Psychiatric Hospitalizations, Involuntary Separations, and
Disability," is posted online at<http://ajp.psychiatryonline.org/cgi/content/full/162/3/585>.▪