Mental Illness Often Ends Soldiers' Careers

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 conditions.

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 or disability.

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 disorder.

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 benefits.

“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>.▪

Am J Psychiatry 2005 3 585