title: Psychiatric disorders among United States Marines wounded in action in Vietnam.
abstract: Although the posttraumatic stress disorders of Vietnam veterans have been well documented, the psychological and environmental factors that gave rise to these and other psychiatric disorders remain to be clearly identified. The object of this study is to determine if United States Marines who were wounded in action in Vietnam were also at risk for an impatient admission with a psychiatric disorder. We also wish to examine the effect of the practice of returning psychiatric patients to duty upon completion of treatment on the relationship between combat exposure and psychiatric distress. Records of all hospital admissions for active-duty Marines for the period 1965 to 1972 were examined and personnel having a combat-related wound or injury and/or a psychiatric hospitalization were identified. Rates of first hospitalization were calculated and standardized incidence ratios were used to obtain measures of risk. Results indicated that, compared with Marines not wounded in Vietnam, Marines wounded in Vietnam were at significant risk for having a psychiatric hospitalization. Most of the psychiatric first hospitalizations occurred before being wounded in action, however, and psychiatric patients who were treated and then returned to duty had a significantly greater than expected risk of being subsequently wounded. This risk differed with respect to psychiatric diagnosis due to variations in the practice of returning psychiatric patients to duty on the basis of primary diagnosis. Variations in the probability of being returned to duty also accounted for variations in the relative risk of psychiatric first hospitalizations among wounded Marines by diagnostic category. These results cell into question the validity of using ratios of psychiatric casualties to numbers of wounded personnel as measures of the relationship between combat exposure and psychological distress.
mesh_terms: D000293:Adolescent; D000328:Adult; D006753:Hospital Records; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008890:Military Psychiatry; D010043:Outcome and Process Assessment, Health Care; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology; D014744:Vietnam; D014857:Warfare; D014947:Wounds and Injuries / Q000150:complications* / Q000453:epidemiology