title: The long-term burden of military deployment on the health care system.
abstract: Health care providers need to be aware that stress complaints that result from deployment can emerge even after many years. This has important implications for health care policies. The main aim of this study is to investigate the relation between the development of posttraumatic stress and other mental health complaints and the burden on (mental) health care after a deployment. For this study we used data from a large prospective cohort study on stress-factors related to deployment in 1007 Dutch soldiers, who were deployed to Afghanistan. Participants were assessed at six follow up times up until five years after deployment. In a Generalized Estimated Equations model we estimated the relation between mental health complaints and the utilization of psychological treatment and a general practitioner, respectively. Moreover, we studied the relation between mental health complaints and health care costs using bootstrap techniques. The results showed that higher scores for PTSD, depression and fatigue relate to increased use of a psychologist. And lower PTSD scores and higher depression, anxiety and somatization scores relate to increased odds to visit a GP. Furthermore, mental health complaints relate to higher costs. In conclusion, monitoring soldiers is important in order to be informed on the current demand for (mental) health care to satisfy the health care need of veterans. Early treatment, which is enabled by lowering barriers to care, relates to positive results and therefore, lower health care costs.
authors.affiliation: Research Center - Military Mental Health, Ministry of Defense, Utrecht, The Netherlands; Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; Netherlands Organization for Applied Scientific Research (TNO), Leiden, The Netherlands. Electronic address: i.eekhout@vumc.nl.
authors.forename: Iris
authors.initials: I
authors.lastname: Eekhout
authors.affiliation: Research Center - Military Mental Health, Ministry of Defense, Utrecht, The Netherlands; Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Elbert
authors.initials: E
authors.lastname: Geuze
authors.affiliation: Research Center - Military Mental Health, Ministry of Defense, Utrecht, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Arq, Psychotrauma Expert Group, Diemen, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Vermetten
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D003863:Depression / Q000191:economics / Q000209:etiology / Q000628:therapy; D004522:Educational Status; D005221:Fatigue / Q000191:economics / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008603:Mental Health / Q000191:economics; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D008889:Military Personnel / Q000706:statistics & numerical data; D009426:Netherlands; D011446:Prospective Studies; D012907:Smoking / Q000191:economics; D013313:Stress Disorders, Post-Traumatic / Q000191:economics / Q000209:etiology / Q000628:therapy; D013315:Stress, Psychological / Q000191:economics / Q000209:etiology / Q000628:therapy; D011795:Surveys and Questionnaires; D000067453:War Exposure / Q000191:economics* / Q000706:statistics & numerical data
keywords: Health care costs; Mental health; Military deployment; Posttraumatic-stress disorder