Demographics of and diagnoses in Operation Enduring Freedom and Operation Iraqi Freedom personnel who were psychiatrically evacuated from the theater of operations☆
Introduction
During times of war, some patients are medically evacuated from the theater of military operations for primarily psychiatric reasons [1]. The management of these patients has been a subject of psychiatric study and discussion during and after every war [1], [2], [3]. Between the beginning of Operation Enduring Freedom (OEF; US military operations in Afghanistan) and Operation Iraqi Freedom (OIF; US military operations in Iraq) and July 2004, 12,480 medical, surgical and psychiatric evacuees from the theaters of operation were sent to the Landstuhl Regional Medical Center (LRMC) in Germany. The LRMC received virtually all evacuees leaving OEF and OIF during the reference period [4]. One thousand two hundred sixty-four of those patients (10.1%) were sent to be managed primarily by psychiatry.
While at the LRMC, patients were stabilized and treated for acute problems. Patients who responded to acute treatment returned to duty in OEF or OIF. Patients who needed ongoing care or rehabilitation were sent from the LRMC to military medical facilities in the United States. The LRMC's Mental Health Division maintained clinical records of each OEF and OIF psychiatric patient seen during the reference period. The aim of this study was to characterize the demographic composition, clinical diagnoses and clinical dispositions given to OEF/OIF psychiatric patients seen at this evacuation center.
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Method
The records of 1264 consecutive OEF/OIF patients evaluated by psychiatry personnel at the LRMC between November 4, 2001, and July 30, 2004, were reviewed. A case for the study was defined as a patient who was medically evacuated to the LRMC from the theater of operations for primarily psychiatric reasons. Patients seen by consultation–liaison service personnel were not included in this analysis since their primary reason for evacuation was medical or surgical.
Upon arrival at the LRMC, patients
Results
Table 1 summarizes the demographic information of the study population. When compared with all returned OEF and OIF veterans (N=213,150), psychiatric evacuees were more likely to be female (19% vs. 10%; P<.001), African-American or Hispanic (29% vs. 20%), under the age of 31 years (68% vs. 46%; P<.001), enlisted (96% vs. 86%; P<.001) and National Guard/Reserve, as opposed to active-duty military (34% vs. 26%; P<.001).
Table 2 summarizes the demographic and administrative characteristics of OEF
Discussion
This study is a unique look at a group of patients at an important clinical juncture — immediately after evacuation from a war theater. Since virtually all patients came through this single hospital after evacuation and received evaluations according to a single process, it is a valuable population for study. Prior to evacuation, they were seen in numerous deployed locations with different evaluative procedures; after return to duty or to the United States, they were seen in many different
Conclusion
Almost half of the patients who were psychiatrically evacuated from the OIF/OEF theaters of operations had no psychiatric disorder or adjustment disorder, suggesting that significant clinical improvement occurred during the evacuation process. With robust mental health presence, every effort is made to keep patients in the deployment theater; evacuation occurs only when there is risk to the patient or to others. It is important not to finalize psychiatric diagnoses too early or rigidly based on
References (12)
- et al.
Psychiatric responses to war trauma
A consultation–liaison psychiatry approach to disaster/terrorism victim assessment and management
Bringing up the rear: a memoir
(1979)- et al.
The first OEF patients evacuated to Landstuhl Regional Medical Center
US Army Med Dep J
(2002) Diagnostic and statistical manual of mental disorders
(1994)
Cited by (66)
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The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Army, the Department of Defense, the US Government or any of the institutions with which the author is affiliated.