标题：Canadian Military Personnel's Population Attributable Fractions of Mental Disorders and Mental Health Service Use Associated With Combat and Peacekeeping Operations
摘要：Objectives. We investigated mental disorders, suicidal ideation, self-perceived need for treatment, and mental health service utilization attributable to exposure to peacekeeping and combat operations among Canadian military personnel. Methods. With data from the Canadian Community Health Survey Cycle 1.2 Canadian Forces Supplement, a cross-sectional population-based survey of active Canadian military personnel (N = 8441), we estimated population attributable fractions (PAFs) of adverse mental health outcomes. Results. Exposure to either combat or peacekeeping operations was associated with posttraumatic stress disorder (men: PAF = 46.6%; 95% confidence interval [CI] = 27.3, 62.7; women: PAF = 23.6%; 95% CI = 9.2, 40.1), 1 or more mental disorder assessed in the survey (men: PAF = 9.3%; 95% CI = 0.4, 18.1; women: PAF = 6.1%; 95% CI = 0.0, 13.4), and a perceived need for information (men: PAF = 12.3%; 95% CI = 4.1, 20.6; women: PAF = 7.9%; 95% CI = 1.3, 15.5). Conclusions. A substantial proportion, but not the majority, of mental health–related outcomes were attributable to combat or peacekeeping deployment. Future studies should assess traumatic events and their association with physical injury during deployment, premilitary factors, and postdeployment psychosocial factors that may influence soldiers’ mental health. The current military occupations in Iraq and Afghanistan have created a substantial resurgence of international interest in the mental health consequences of combat. 1 , 2 – 7 Epidemiological studies of soldiers during postdeployment of combat and peacekeeping missions have demonstrated a high prevalence of mental disorders, mental health service use, and somatic complaints. 2 – 4 , 8 – 17 However, it is important to note that several studies have not found an association between peacekeeping or combat operations and mental disorders 5 or suicide. 18 , 19 To the best of our knowledge, there is only 1 study that has examined the population attributable fractions (PAFs) associated with combat, and it was conducted in a nationally representative civilian sample. 20 This study found that 28% of past-year posttraumatic stress disorder (PTSD) and approximately 10% of past-year major depression and substance use problems were attributable to lifetime combat exposure in men. 20 Because none of the women in the study 20 reported exposure to combat, the study was limited to men. To date, there has been no empirical evaluation of PAFs for mental disorders in relation to combat in a representative sample of active military personnel. Also, no data are available on the PAFs for mental disorders associated with peacekeeping operations. There are many studies suggesting that soldiers involved in peacekeeping operations experience stressors different from those of soldiers involved in combat. 21 , 22 Finally, there is no empirical evaluation of PAFs among female soldiers. We studied data from a large population-based survey of active military personnel, the Canadian Community Health Survey Cycle 1.2 Canadian Forces Supplement. 14 This survey is unique because it uses a multistage sampling design in active military personnel and includes the use of standardized state-of-the-art variable assessment of mental disorders, 23 the self-perceived need for treatment, 24 , 25 and mental health service use. 23 Our main objective was to estimate the PAFs for mental disorders, suicidal ideation, and treatment need and use parameters (i.e., self-perceived need for treatment and mental health service utilization) associated with combat or peacekeeping operations.
