Back to Top Skip to main content Skip to sub-navigation

Brief Report: Prevalence of Screening Positive for Post-Traumatic Stress Disorder Among Service Members Following Combat-Related Injury

Recommended Content:

Medical Surveillance Monthly Report

Background

The post-9/11 conflicts in Iraq and Afghanistan resulted in the most U.S. military casualties since Vietnam.1 Asymmetric warfare dominated the battlefield, commonly in the form of improvised explosive devices and other blast weaponry, which placed infantry and combat support personnel at risk of injury.2 As casualty numbers increased during these conflicts, so too did the survivability rate relative to previous wars, most notably due to advances in personal protective equipment and field medical care.3 This led to a shift in resources towards long-term rehabilitation of wounded service members to ameliorate physical and mental health sequelae.2,4

Post-traumatic stress disorder (PTSD) is frequently reported among military personnel, particularly those with combat-related injury.5,6 Koren et al.5 hypothesized multiple etiologies for the relationship between combat-related injury and PTSD, including increased levels of perceived threat to life and peritraumatic dissociation (i.e., feeling emotionally numb or separated from a traumatic event) among injured relative to non-injured personnel. An increased incidence of PTSD is associated with physical problems and chronic health conditions after combat-related injury.7,8 Moreover, assessment of PTSD following combat-related injury is essential for planning appropriate treatment protocols and improving long-term well-being.4,9

This report describes the prevalence of screening positive for PTSD and the association with injury severity and time since injury among U.S. military personnel injured during combat operations.

Methods

Data were collected from the Wounded Warrior Recovery Project (WWRP), a longitudinal examination of patient-reported outcomes among service members injured on deployment in post-9/11 conflicts.10 Participants in the WWRP are identified from the Expeditionary Medical Encounter Database (EMED), a deployment health repository maintained by the Naval Health Research Center that includes clinical records of service members injured during overseas contingency operations since 2001. Records are collected throughout the continuum of care (i.e., from point of injury through rehabilitation).11 Individuals who sustained an injury during combat operations after 1 September 2001 are eligible for the WWRP and approached via postal mail and email to provide informed consent to complete biannual assessments for 15 years. Recruitment for the WWRP began in November 2012 and is ongoing.

The present study utilized cross-sectional data for 3,847 WWRP participants collected between September 2018 and April 2020. WWRP measures and procedures were updated in late 2018 to remain consistent with current standards of measurement. Specifically, the PTSD screening instrument was updated to the PTSD Checklist for the DSM-5 (PCL-5).12 The PCL-5 shows good psychometric properties and has been used with military samples.13,14 Scores on the PCL-5 were summed to create a total symptom severity score. A standard cutoff of 33 indicated a positive screen for PTSD. Injury dates, Injury Severity Scores (ISS), and demographics for this study were obtained from the EMED. The ISS is a composite measure of overall injury severity that accounts for multiple injuries to different body regions.15 Prevalence of screening positive for PTSD was calculated and stratified by ISS (mild [ISS 1–3], moderate [ISS 4–8], or serious/severe [ISS 9+]) and time between injury and WWRP assessment in quartiles (0.4–7.3, 7.4–10.7, 10.8–13.0, or 13.1–17.8 years). Chi-square tests assessed differences by PTSD screening status. An alpha level of 0.05 was considered statistically significant. Analyses were performed in SAS/STAT software, version 9.4 (SAS Institute, Cary, NC).

Results

The study population consisted mostly of young (<30 years old), non-Hispanic White, and male service members in the Army with mild ISSs (Table). Missing data were observed for sex (n = 4), race/ethnicity group (n = 325), and rank (n = 21). Approximately half completed a WWRP assessment more than 10.8 years after injury, and 38.7% screened positive for PTSD. Service members who screened positive for PTSD were more likely to be non-White (p <.001), non-Army (p <.001), and lower- to midlevel-enlisted (E1–E6; p <.001) with mild or moderate ISSs (p =.001).

Overall, the proportions of service members who screened positive for PTSD increased by time since injury quartile (Figure); 35.9% of participants who completed an assessment 0.4–7.3 years after injury screened positive for PTSD, compared with 41.4% who completed the assessment 13.1–17.8 years after injury. Participants with serious/severe injuries had the lowest prevalence of screening positive for PTSD in all time since injury quartiles (30.8–38.0%), while those with moderate injuries had the highest prevalence in the final 2 quartiles (44.5%).

Editorial Comment

Approximately 39% of WWRP participants screened positive for PTSD, which is higher than the 28% identified in a previous study using the same instrument among military personnel with high combat exposure.14 Another study among Marines and Soldiers returning from deployment identified 12–13% PTSD positive using a 4-item PTSD screening instrument.16 In the present study, all service members had at least 1 potentially traumatic event (i.e., combat-related injury), which could explain the higher prevalence of participants who screened positive for PTSD relative to other studies.

The finding of increasing prevalence by time since injury suggests that PTSD may develop or persist several years after combat-related injury, and underscores the need for continual assessment. The higher prevalence of screening positive for PTSD in participants with mild or moderate combat-related injuries suggests that PTSD symptoms in these individuals may not have been as promptly or readily identified and treated as in those with serious/severe injuries. Further, service members with serious/severe injuries likely received more extensive care for physical ailments and may have been regularly assessed for mental health symptoms leading to earlier identification, treatment, and resolution. Other aspects of serious/severe combat-related injuries, such as medications received during treatment in-theater, could also explain lower PTSD prevalence in this group.17

The results of this study highlight the importance of screening for PTSD after combat-related injury even after long periods of time. Both the Post-Deployment Health Assessment and Periodic Health Assessment should continue to be used to identify and refer individuals at risk for PTSD. Given that service members may be averse to reporting mental health symptoms due to non-anonymity of these assessments,18 programs aimed at reducing the stigma associated with mental health care in the military should be prioritized.19 In addition, medical providers who treat combat-related injuries should routinely screen service members for mental health concerns, as individuals presenting for physical health complaints may be simultaneously experiencing psychological symptoms.20

There are some limitations that should be considered when interpreting the results of this study. This analysis examined time since injury in mutually exclusive groups, rather than repeated measures within individuals, and thus trajectory of PTSD over time could not be elucidated. Similarly, the WWRP does not collect information related to history of PTSD prior to injury. Further, the specific role of injury on the development of PTSD cannot be clarified without a detailed accounting of other factors (e.g., physical health, comorbidities, and life stressors) following combat-related injury.

In conclusion, service members and veterans with combat-related injuries are at risk of screening positive for PTSD even more than a decade after injury. This warrants future research to explore the role of injury severity and factors associated with resiliency, persistence, and recovery. Resources should be prioritized for early intervention and mitigation in this population during active service and post-military discharge.

Author Affiliations: Naval Health Research Center, San Diego, CA (Dr. MacGregor, Ms. Perez, Dr. McCabe, Ms. Dougherty, Dr. Jurick, and Mr. Galarneau); Axiom Resource Management Inc., San Diego, CA (Dr. MacGregor); Leidos, Inc., San Diego, CA (Ms. Perez, Dr. McCabe, Ms. Dougherty, Dr. Jurick)

Disclaimer: The authors are military service members or employees of the U.S. Government. This work was prepared as part of their official duties. Title 17, U.S.C. §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C. §101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person's official duties. This report was supported by the U.S. Navy Bureau of Medicine and Surgery under work unit no. 60808. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. The study protocol was approved by the Naval Health Research Center Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Research data were derived from an approved Naval Health Research Center Institutional Review Board protocol, number NHRC.2009.0014.

References

1. DeBruyne NF, Leland A; Congressional Research Service. American war and military operations casualties: lists and statistics. Accessed 1 June 2021. https://fas.org/sgp/crs/natsec/RL32492.pdf

2. Greer N, Sayer N, Kramer M, Koeller E, Velasquez T. Prevalence and epidemiology of combat blast injuries from the military cohort 2001–2014. Washington, DC: Department of Veterans Affairs; 2016.

3. Cannon JW, Holena DN, Geng Z, et al. Comprehensive analysis of combat casualty outcomes in US service members from the beginning of World War II to the end of Operation Enduring Freedom. J Trauma Acute Care Surg. 2020;89(Suppl 2):S8–S15.

4. Sayer NA, Cifu DX, McNamee S, et al. Rehabilitation needs of combat-injured service members admitted to the VA Polytrauma Rehabilitation Centers: the role of PM&R in the care of wounded warriors. PM R. 2009;1(1):23–28.

5. Koren D, Norman D, Cohen A, Berman J, Klein EM. Increased PTSD risk with combat-related injury: a matched comparison study of injured and uninjured soldiers experiencing the same combat events. Am J Psychiatry. 2005;162(2):276–282.

6. Walker LE, Watrous J, Poltavskiy E, et al. Longitudinal mental health outcomes of combat-injured service members. Brain Behav. 2021;11(5):e02088.

7. Grieger TA, Cozza SJ, Ursano RJ, et al. Posttraumatic stress disorder and depression in battle-injured soldiers. Am J Psychiatry. 2006;163(10):1777–1783.

8. Watrous JR, McCabe CT, Jones G, et al. Low back pain, mental health symptoms, and quality of life among injured service members. Health Psychol. 2020;39(7):549–557.

9. Woodruff SI, Galarneau MR, McCabe CT, Sack DI, Clouser MC. Health-related quality of life among US military personnel injured in combat: findings from the Wounded Warrior Recovery Project. Qual Life Res. 2018;27(5):1393–1402.

10. Watrous JR, Dougherty AL, McCabe CT, Sack DI, Galarneau MR. The Wounded Warrior Recovery Project: a longitudinal examination of patient-reported outcomes among deployment-injured military personnel. Mil Med. 2019;184(3–4):84–89.

11. Galarneau MR, Hancock WC, Konoske P, et al. The Navy-Marine Corps Combat Trauma Registry. Mil Med. 2006;171(8):691–697.

12. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5) – Standard [Measurement instrument]. National Center for PTSD Web site. Accessed 1 June 2021. https://www.ptsd.va.gov/professional/assessment/documents/PCL5_Standard_form.PDF

13. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–498.

14. Hoge CW, Riviere LA, Wilk JE, Herrell RK, Weathers FW. The prevalence of post-traumatic stress disorder (PTSD) in US combat soldiers: a head-to-head comparison of DSM-5 versus DSM-IV-TR symptom criteria with the PTSD checklist. Lancet Psychiatry. 2014;1(4):269–277.

15. Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.

16. Mustillo SA, Kysar-Moon A, Douglas SR, et al. Overview of depression, post-traumatic stress disorder, and alcohol misuse among active duty service members returning from Iraq and Afghanistan, self-report and diagnosis. Mil Med. 2015;180(4):419–27.

17. Holbrook TL, Galarneau MR, Dye JL, Quinn K, Dougherty AL. Morphine use after combat injury in Iraq and post-traumatic stress disorder. N Engl J Med. 2010;362(2):110–117.

18. Warner CH, Appenzeller GN, Grieger T, et al. Importance of anonymity to encourage honest reporting in mental health screening after combat deployment. Arch Gen Psychiatry. 2011;68(10):1065–1071.

19. Ben-Zeev D, Corrigan PW, Britt TW, Langford L. Stigma of mental illness and service use in the military. J Ment Health. 2012;21(3):264–273.

20. MacGregor AJ, Zouris JM, Watrous JR, et al. Multimorbidity and quality of life after blast-related injury among US military personnel: a cluster analysis of retrospective data. BMC Public Health. 2020;20(1):578.

FIGURE. Prevalence of screening positive for post-traumatic stress disorder (PTSD)a by Injury Severity Score (ISS) and time since injury, Wounded Warrior Recovery Project participants, September 2018–April 2020

TABLE. Demographic, military, and injury characteristics of Wounded Warrior Recovery Project participants, by post-traumatic stress disorder (PTSD) screening outcome,a September 2018–April 2020

You also may be interested in...

Update: Exertional Hyponatremia, Active Component, U.S. Armed Forces, 2003–2018

Article
4/1/2019
Drink water the day before and during physical activity or if heat is going to become a factor. (Photo Courtesy: U.S. Air Force)

From 2003 through 2018, there were 1,579 incident diagnoses of exertional hyponatremia among active component service members, for a crude overall incidence rate of 7.2 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, females, those less than 20 years old, and recruit trainees had higher overall incidence rates of exertional hyponatremia diagnoses. The overall incidence rate during the 16-year period was highest in the Marine Corps, intermediate in the Army and Air Force, and lowest in the Navy. Overall rates during the surveillance period were highest among Asian/Pacific Islander and non-Hispanic white service members and lowest among non-Hispanic black service members. Between 2003 and 2018, crude annual incidence rates of exertional hyponatremia peaked in 2010 (12.7 per 100,000 p-yrs) and then decreased to 5.3 cases per 100,000 p-yrs in 2013 before increasing in 2014 and 2015. The crude annual rate in 2018 (6.3 per 100,000 p-yrs) represented a decrease of 26.5% from 2015. Service members and their supervisors must be knowledgeable of the dangers of excessive water consumption and the prescribed limits for water intake during prolonged physical activity (e.g., field training exercises, personal fitness training, and recreational activities) in hot, humid weather.

Recommended Content:

Medical Surveillance Monthly Report

Modeling Lyme Disease Host Animal Habitat Suitability, West Point, New York

Article
4/1/2019
A deer basks in the morning sun at Joint Base San Antonio-Fort Sam Houston, Texas.  (Photo Courtesy: U.S. Air Force)

As the most frequently reported vector-borne disease among active component U.S. service members, with an incidence rate of 16 cases per 100,000 person-years in 2011, Lyme disease poses both a challenge to healthcare providers in the Military Health System and a threat to military readiness. Spread through the bite of an infected blacklegged tick, infection with the bacterial cause of Lyme disease can have lasting effects that may lead to medical discharge from the military. The U.S. Military Academy at West Point is situated in a highly endemic area in New York State. To identify probable areas where West Point cadets as well as active duty service members stationed at West Point and their families might contract Lyme disease, this study used Geographic Information System mapping methods and remote sensing data to replicate an established spatial model to identify the likely habitat of a key host animal—the white-tailed deer.

Recommended Content:

Medical Surveillance Monthly Report

Incidence, Timing, and Seasonal Patterns of Heat Illnesses During U.S. Army Basic Combat Training, 2014–2018

Article
4/1/2019
U.S. Marines participate in morning physical training during a field exercise at Marine Corps Base Camp Pendleton, California. (Photo Courtesy: U.S. Marine Corps)

Risk factors for heat illnesses (HIs) among new soldiers include exercise intensity, environmental conditions at the time of exercise, a high body mass index, and conducting initial entry training during hot and humid weather when recruits are not yet acclimated to physical exertion in heat. This study used data from the Defense Health Agency’s–Weather-Related Injury Repository to calculate rates and to describe the incidence, timing, and geographic distribution of HIs among soldiers during U.S. Army basic combat training (BCT). From 2014 through 2018, HI events occurred in 1,210 trainees during BCT, resulting in an overall rate of 3.6 per 10,000 BCT person-weeks (p-wks) (95% CI: 3.4–3.8). HI rates (cases per 10,000 BCT p-wks) varied among the 4 Army BCT sites: Fort Benning, GA (6.8); Fort Jackson, SC (4.4); Fort Sill, OK (1.8); and Fort Leonard Wood, MO (1.7). Although the highest rates ofHIs occurred at Fort Benning, recruits in all geographic areas were at risk. The highest rates of HI occurred during the peak training months of June through September, and over half of all HI cases affected soldiers during the first 3 weeks of BCT. Prevention of HI among BCT soldiers requires relevant training of both recruits and cadre as well as the implementation of effective preventive measures.

Recommended Content:

Medical Surveillance Monthly Report

Vasectomy and Vasectomy Reversals, Active Component, U.S. Armed Forces, 2000–2017

Article
3/1/2019
Sperm is the male reproductive cell  Photo: iStock

During 2000–2017, a total of 170,878 active component service members underwent a first-occurring vasectomy, for a crude overall incidence rate of 8.6 cases per 1,000 person-years (p-yrs). Among the men who underwent incident vasectomy, 2.2% had another vasectomy performed during the surveillance period. Compared to their respective counterparts, the overall rates of vasectomy were highest among service men aged 30–39 years, non-Hispanic whites, married men, and those in pilot/air crew occupations. Male Air Force members had the highest overall incidence of vasectomy and men in the Marine Corps, the lowest. Crude annual vasectomy rates among service men increased slightly between 2000 and 2017. The largest increases in rates over the 18-year period occurred among service men aged 35–49 years and among men working as pilots/air crew. Among those who underwent vasectomy, 1.8% also had at least 1 vasectomy reversal during the surveillance period. The likelihood of vasectomy reversal decreased with advancing age. Non-Hispanic black and Hispanic service men were more likely than those of other race/ethnicity groups to undergo vasectomy reversals.

Recommended Content:

Medical Surveillance Monthly Report

Brief Report: Male Infertility, Active Component, U.S. Armed Forces, 2013–2017

Article
3/1/2019
Sperm is the male reproductive cell  Photo: iStock

Infertility, defined as the inability to achieve a successful pregnancy after 1 year or more of unprotected sexual intercourse or therapeutic donor insemination, affects approximately 15% of all couples. Male infertility is diagnosed when, after testing both partners, reproductive problems have been found in the male. A male factor contributes in part or whole to about 50% of cases of infertility. However, determining the true prevalence of male infertility remains elusive, as most estimates are derived from couples seeking assistive reproductive technology in tertiary care or referral centers, population-based surveys, or high-risk occupational cohorts, all of which are likely to underestimate the prevalence of the condition in the general U.S. population.

Recommended Content:

Medical Surveillance Monthly Report

Sexually Transmitted Infections, Active Component, U.S. Armed Forces, 2010–2018

Article
3/1/2019
Anopheles merus

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2010–2018. Infections with chlamydia were the most common, followed in decreasing order of frequency by infections with genital human papillomavirus (HPV), gonorrhea, genital herpes simplex virus (HSV), and syphilis. Compared to men, women had higher rates of all STIs except for syphilis. In general, compared to their respective counterparts, younger service members, non-Hispanic blacks, soldiers, and enlisted members had higher incidence rates of STIs. During the latter half of the surveillance period, the incidence of chlamydia and gonorrhea increased among both male and female service members. Rates of syphilis increased for male service members but remained relatively stable among female service members. In contrast, the incidence of genital HPV and HSV decreased among both male and female service members. Similarities to and differences from the findings of the last MSMR update on STIs are discussed.

Recommended Content:

Medical Surveillance Monthly Report

Testosterone Replacement Therapy Use Among Active Component Service Men, 2017

Article
3/1/2019
Image of Marines carrying a wooden log for physical fitness. Click to open a larger version of the image.

This analysis summarizes the prevalence of testosterone replacement therapy (TRT) during 2017 among active component service men by demographic and military characteristics. This analysis also determines the percentage of those receiving TRT in 2017 who had an indication for receiving TRT using the 2018 American Urological Association (AUA) clinical practice guidelines. In 2017, 5,093 of 1,076,633 active component service men filled a prescription for TRT, for a period prevalence of 4.7 per 1,000 male service members. After adjustment for covariates, the prevalence of TRT use remained highest among Army members, senior enlisted members, warrant officers, non-Hispanic whites, American Indians/Alaska Natives, those in combat arms occupations, healthcare workers, those who were married, and those with other/unknown marital status. Among active component male service members who received TRT in 2017, only 44.5% met the 2018 AUA clinical practice guidelines for receiving TRT.

Recommended Content:

Medical Surveillance Monthly Report

Update: Malaria, U.S. Armed Forces, 2018

Article
2/1/2019
Anopheles merus

Malaria infection remains an important health threat to U.S. service mem­bers who are located in endemic areas because of long-term duty assign­ments, participation in shorter-term contingency operations, or personal travel. In 2018, a total of 58 service members were diagnosed with or reported to have malaria. This represents a 65.7% increase from the 35 cases identi­fied in 2017. The relatively low numbers of cases during 2012–2018 mainly reflect decreases in cases acquired in Afghanistan, a reduction due largely to the progressive withdrawal of U.S. forces from that country. The percentage of cases of malaria caused by unspecified agents (63.8%; n=37) in 2018 was the highest during any given year of the surveillance period. The percent­age of cases identified as having been caused by Plasmodium vivax (10.3%; n=6) in 2018 was the lowest observed during the 10-year surveillance period. The percentage of malaria cases attributed to P. falciparum (25.9 %) in 2018 was similar to that observed in 2017 (25.7%), although the number of cases increased. Malaria was diagnosed at or reported from 31 different medical facilities in the U.S., Afghanistan, Italy, Germany, Djibouti, and Korea. Pro­viders of medical care to military members should be knowledgeable of and vigilant for clinical manifestations of malaria outside of endemic areas.

Recommended Content:

Medical Surveillance Monthly Report

Outbreak of Acute Respiratory Illness Associated with Adenovirus Type 4 at the U.S. Naval Academy, 2016

Article
2/1/2019
Malaria case definition

Human adenoviruses (HAdVs) are known to cause respiratory illness outbreaks at basic military training (BMT) sites. HAdV type-4 and -7 vaccines are routinely administered at enlisted BMT sites, but not at military academies. During August–September 2016, U.S. Naval Academy clinical staff noted an increase in students presenting with acute respiratory illness (ARI). An investigation was conducted to determine the extent and cause of the outbreak. During 22 August–11 September 2016, 652 clinic visits for ARI were identified using electronic health records. HAdV-4 was confirmed by real-time polymerase chain reaction assay in 18 out of 33 patient specimens collected and 1 additional HAdV case was detected from hospital records. Two HAdV-4 positive patients were treated for pneumonia including 1 hospitalized patient. Molecular analysis of 4 HAdV-4 isolates identified genome type 4a1, which is considered vaccine-preventable. Understanding the impact of HAdV in congregate settings other than enlisted BMT sites is necessary to inform discussions regarding future HAdV vaccine strategy.

Recommended Content:

Medical Surveillance Monthly Report

Update: Incidence of Glaucoma Diagnoses, Active Component, U.S. Armed Forces, 2013–2017

Article
2/1/2019
Glaucoma

Glaucoma is an eye disease that involves progressive optic nerve damage and vision loss, leading to blindness if undetected or untreated. This report describes an analysis using the Defense Medical Surveillance System to identify all active component service members with an incident diagnosis of glaucoma during the period between 2013 and 2017. The analysis identified 37,718 incident cases of glaucoma and an overall incidence rate of 5.9 cases per 1,000 person-years (p-yrs). The majority of cases (97.6%) were diagnosed at an early stage as borderline glaucoma; of these borderline cases, 2.2% progressed to open-angle glaucoma during the study period. No incident cases of absolute glaucoma, or total blindness, were identified. Rates of glaucoma were higher among non-Hispanic black (11.0 per 1,000 p-yrs), Asian/Pacific Islander (9.5), and Hispanic (6.9) service members, compared with non-Hispanic white (4.0) service members. Rates among female service members (6.6 per 1,000 p-yrs) were higher than those among male service members (5.8). Between 2013 and 2017, incidence rates of glaucoma diagnoses increased by 75.4% among all service members.

Recommended Content:

Medical Surveillance Monthly Report

Re-evaluation of the MSMR Case Definition for Incident Cases of Malaria

Article
2/1/2019
Anopheles merus

The MSMR has been publishing the results of surveillance studies of malaria since 1995. The standard MSMR case definition uses Medical Event Reports and records of hospitalizations in counting cases of malaria. This report summarizes the performance of the standard MSMR case definition in estimating incident cases of malaria from 2015 through 2017. Also explored was the potential surveillance value of including outpatient encounters with diagnoses of malaria or positive laboratory tests for malaria in the case definition. The study corroborated the relative accuracy of the MSMR case definition in estimating malaria incidence and provided the basis for updating the case definition in 2019 to include positive laboratory tests for malaria antigen within 30 days of an outpatient diagnosis.

Recommended Content:

Medical Surveillance Monthly Report

Adrenal Gland Disorders, Active Component, U.S. Armed Forces, 2002–2017

Article
12/1/2018

During 2002–2017, the most common incident adrenal gland disorder among male and female service members was adrenal insufficiency and the least common was adrenomedullary hyperfunction. Adrenal insufficiency was diagnosed among 267 females (crude overall incidence rate: 8.2 cases per 100,000 person-years [p-yrs]) and 729 males (3.9 per 100,000 p-yrs). In both sexes, overall rates of other disorders of adrenal gland and Cushing’s syndrome were lower than for adrenal insufficiency but higher than for hyperaldosteronism, adrenogenital disorders, and adrenomedullary hyperfunction. Crude overall rates of adrenal gland disorders among females tended to be higher than those of males, with female:male rate ratios ranging from 2.1 for adrenal insufficiency to 5.5 for androgenital disorders and Cushing’s syndrome. The highest overall rates of adrenal insufficiency for males and females were among non-Hispanic white service members. Among females, rates of Cushing’s syndrome and other disorders of adrenal gland were 31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

Recommended Content:

Medical Surveillance Monthly Report

Incidence and Prevalence of the Metabolic Syndrome Using ICD-9 and ICD-10 Diagnostic Codes, Active Component, U.S. Armed Forces, 2002–2017

Article
12/1/2018

This report uses ICD-9 and ICD-10 codes (277.7 and E88.81, respectively) for the metabolic syndrome (MetS) to summarize trends in the incidence and prevalence of this condition among active component members of the U.S. Armed Forces between 2002 and 2017. During this period, the crude overall incidence rate of MetS was 7.5 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, overall incidence rates were highest among Asian/Pacific Islanders, Air Force members, and warrant officers and were lowest among those of other/unknown race/ethnicity, Marine Corps members, and junior enlisted personnel and officers. During 2002–2017, the annual incidence rates of MetS peaked in 2009 at 11.6 cases per 100,000 p-yrs and decreased to 5.9 cases per 100,000 p-yrs in 2017. Annual prevalence rates of MetS increased steadily during the first 11 years of the surveillance period reaching a high of 38.9 per 100,000 active component service members in 2012, after which rates declined slightly to 31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

Recommended Content:

Medical Surveillance Monthly Report

Thyroid Disorders, Active Component, U.S. Armed Forces, 2008–2017

Article
12/1/2018

This analysis describes the incidence and prevalence of five thyroid disorders (goiter, thyrotoxicosis, primary/not otherwise specified [NOS] hypothyroidism, thyroiditis, and other disorders of the thyroid) among active component service members between 2008 and 2017. During the 10-year surveillance period, the most common incident thyroid disorder among male and female service members was primary/NOS hypothyroidism and the least common were thyroiditis and other disorders of thyroid. Primary/NOS hypothyroidism was diagnosed among 8,641 females (incidence rate: 43.7 per 10,000 person-years [p-yrs]) and 11,656 males (incidence rate: 10.2 per 10,000 p-yrs). Overall incidence rates of all thyroid disorders were 3 to 5 times higher among females compared to males. Among both males and females, incidence of primary/NOS hypothyroidism was higher among non-Hispanic white service members compared with service members in other race/ethnicity groups. The incidence of most thyroid disorders remained stable or decreased during the surveillance period. Overall, the prevalence of most thyroid disorders increased during the first part of the surveillance period and then either decreased or leveled off.31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

Recommended Content:

Medical Surveillance Monthly Report
<< < ... 11 > >> 
Showing results 151 - 164 Page 11 of 11
Refine your search
Last Updated: October 29, 2021

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.