title: Association between mental health conditions diagnosed during initial eligibility for military health care benefits and subsequent deployment, attrition, and death by suicide among active duty service members.
abstract: OBJECTIVE
  To examine incidence of mental health diagnoses during initial service of U.S. active duty military members and identify associations with deployment, attrition, and suicide.
  
  
  METHODS
  A retrospective cohort of 576,502 service members (SMs) newly enlisted between 2003 and 2006 was identified. Data included medical encounter, deployment and attrition, and suicide. Multivariable logistic regression models examine the association between mental health diagnoses coded within the SMs' first 6 months of eligibility for health care benefits and deployment. Multivariable Cox proportional hazards models quantify the association between mental health diagnoses and attrition and suicide.
  
  
  RESULTS
  The cumulative incidence of mental health diagnoses was approximately 9% at 6 months of service. Adjustment, depressive, and anxiety disorders were most common. Those with any mental health diagnosis during initial eligibility had increased risk of early attrition and were 77% less likely to deploy. Early mental health diagnoses were not statistically significantly associated with death by suicide.
  
  
  CONCLUSIONS
  Mental health diagnoses during initial eligibility are common and associated with reduced odds of deployment and increased risk of early attrition. Policies designed to either retain or discharge SMs with a mental health diagnosis identified during initial training merit close examination in light of these findings.
authors.affiliation: Office of the Assistant Secretary of Defense (Health Affairs)/Clinical and Program Policy, 5111 Leesburg Pike, Skyline 5, Suite 601, Falls Church, VA 22041, USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Ireland
authors.forename: Amii M
authors.initials: AM
authors.lastname: Kress
authors.forename: Lucinda Z
authors.initials: LZ
authors.lastname: Frost
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D007342:Insurance Benefits; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D008887:Military Medicine; D008889:Military Personnel; D010560:Personnel Selection; D016016:Proportional Hazards Models; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult