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Thirty-Day Prevalence of DSM-IV Mental Disorders Among Nondeployed Soldiers in the US Army: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

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Kessler, Ronald C., Heeringa, Steven G., Stein, Murray B., Colpe, Lisa J., Fullerton, Carol S., Hwang, Irving, Naifeh, James A., Nock, Matthew K., Petukhova, Maria, Sampson, Nancy A., Schoenbaum, Michael, Zaslavsky, Alan M., Ursano, Robert J.·2014·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2014.28PMC PMC4057988
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Abstract

IMPORTANCE: Although high rates of current mental disorder are known to exist in the US Army, little is known about the proportions of these disorders that had onsets prior to enlistment. OBJECTIVE: To estimate the proportions of 30-day DSM-IV mental disorders among nondeployed US Army personnel with first onsets prior to enlistment and the extent which role impairments associated with 30-day disorders differ depending on whether the disorders had pre- vs post-enlistment onsets. DESIGN, SETTING, AND PARTICIPANTS: A representative sample of 5428 soldiers participating in the Army Study to Assess Risk and Resilience in Servicemembers completed self-administered questionnaires and consented to linkage of questionnaire responses with administrative records. MAIN OUTCOMES AND MEASURES: Thirty-day DSM-IV internalizing (major depressive, bipolar, generalized anxiety, panic, and posttraumatic stress) and externalizing (attention-deficit/hyperactivity, intermittent explosive, alcohol/drug) disorders were assessed with validated self-report scales. Age at onset was assessed retrospectively. Role impairment was assessed with a modified Sheehan Disability Scale. RESULTS: A total of 25.1% of respondents met criteria for any 30-day disorder (15.0% internalizing; 18.4% externalizing) and 11.1% for multiple disorders. A total of 76.6% of cases reported pre-enlistment age at onset of at least one 30-day disorder (49.6% internalizing; 81.7% externalizing). Also, 12.8% of respondents reported severe role impairment. Controlling for sociodemographic and Army career correlates, which were broadly consistent with other studies, 30-day disorders with pre-enlistment (χ₈² = 131.8, P < .001) and post-enlistment (χ₇² = 123.8, P < .001) ages at onset both significantly predicted severe role impairment, although pre-enlistment disorders were more consistent powerful predictors (7 of 8 disorders significant; odds ratios, 1.6-11.4) than post-enlistment disorders (5 of 7 disorders significant; odds ratios, 1.5-7.7). Population-attributable risk proportions of severe role impairment were 21.7% for pre-enlistment disorders, 24.3% for post-enlistment disorders, and 43.4% for all disorders. CONCLUSIONS AND RELEVANCE: Interventions to limit accession or increase resilience of new soldiers with pre-enlistment mental disorders might reduce prevalence and impairments of mental disorders in the US Army.

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  1. [25]First MB Spitzer RL Gibbon M Williams JBW Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP) 2002 Biometrics Research, New York State Psychiatric Institute New York, NY
  2. [32]Rothman K Greenland S Modern Epidemiology 1998 Lippincott Williams & Wilkins Philadelphia, PA 2nd ed

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Metadata

Authors
Kessler, R. C., Heeringa, S. G., Stein, M. B., Colpe, L. J., Fullerton, C. S., Hwang, I., Naifeh, J. A., Nock, M. K., Petukhova, M., Sampson, N. A., Schoenbaum, M., Zaslavsky, A. M., & Ursano, R. J.
Affiliations
  • Harvard University (US)
  • University of Michigan (US)
  • University of California San Diego (US)
  • National Institute of Mental Health (US)
  • Uniformed Services University of the Health Sciences (US)
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2014-05-01
Volume
71
Issue
5
Pages
504
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2014.28
PMC
PMC4057988
OpenAlex
W2066062750
Cited by
212
References
74
Citations by year
2026: 6 · 2025: 10 · 2024: 13 · 2023: 10 · 2022: 16 · 2021: 12 · 2020: 23 · 2019: 16 · 2018: 28 · 2017: 18 · 2016: 28 · 2015: 16 · 2014: 16
FWCI
38.58
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
National Institute of Mental Health (U01MH087981)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Performance
Keywords
mental illness, United States Army, role impairment, internalizing disorders, externalizing disorders, major depressive disorder, post-traumatic stress disorder, generalized anxiety disorder, attention deficit hyperactivity disorder, intermittent explosive disorder, population attributable risk, military personnel, Sheehan Disability Scale, DSM-IV
MeSH terms
Adult, Mental Disorders, Cross-Sectional Studies, Disability Evaluation, Female, Health Surveys, Humans, Internal-External Control, Male, Military Personnel, Surveys and Questionnaires, Risk Factors, Socioeconomic Factors, United States, Age of Onset, Risk Assessment, Diagnostic and Statistical Manual of Mental Disorders, Iraq War, 2003-2011, Resilience, Psychological, Young Adult, Afghan Campaign 2001-

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