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. 2016 Sep 15:202:171-7.
doi: 10.1016/j.jad.2016.05.025. Epub 2016 May 18.

Retrospective age-of-onset and projected lifetime prevalence of psychiatric disorders among U.S. Army National Guard soldiers

David S Fink  1 , Joseph R Calabrese  2 , Israel Liberzon  3 , Marijo B Tamburrino  4 , Philip Chan  4 , Greg H Cohen  5 , Laura Sampson  6 , Philip L Reed  7 , Edwin Shirley  2 , Toyomi Goto  2 , Nicole D'Arcangelo  2 , Thomas Fine  4 , Sandro Galea  8
Affiliations

Retrospective age-of-onset and projected lifetime prevalence of psychiatric disorders among U.S. Army National Guard soldiers

David S Fink et al. J Affect Disord. .

Abstract

Background: The study of military-related mental health has been disproportionately focused on current symptomology rather than potentially more informative life course mental health. Indeed, no study has assessed age-of-onset and projected lifetime prevalence of disorders among reservists.

Methods: Age-of-onset and projected lifetime DSM-IV anxiety, mood, and substance use disorders were assessed in 671 Ohio Army National Guard soldiers aged 17-60 years. Between 2008 and 2012, face-to-face clinical assessments and surveys were conducted using the Structured Clinical Interview for DSM-IV and Clinician-Administered PTSD Scale.

Results: Lifetime prevalence of psychiatric disorders was 61%. Alcohol abuse/dependence (44%) and major depressive disorder (23%) were the most common disorders. The majority (64%) of participants reported disorders antedating enlistment. Median age-of-onset varied with anxiety disorders - particularly phobias and OCD - having the earliest (median=15 years) and mood disorders the latest median age-of-onset (median=21 years).

Limitations: The study was limited by both the retrospective investigation of age-of-onset and the location of our sample. As our sample may not represent the general military population, our findings need to be confirmed in additional samples.

Conclusions: Each psychiatric disorder exhibited a distinct age-of-onset pattern, such that phobias and OCD onset earliest, substance use disorders onset during a short interval from late-adolescence to early-adulthood, and mood disorders onset the latest. Our finding that the majority of participants reported disorders antedating enlistment suggests that an assessment of lifetime psychopathology is essential to understanding the mental health burden of both current and former military personnel.

Keywords: Age-of-onset; Military medicine; Military personnel; Psychiatric disorder.

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Figures

Fig. 1
Fig. 1
Proportion of diagnosed psychiatric disorders that had first onsets prior to military service in a representative study of the Ohio Army National Guard, 2008–2012. PTSD, posttraumatic stress disorder; OCD, obsessive-compulsive disorder; MDD, major depressive disorder.
Fig. 2
Fig. 2
Cumulative onset probability distributions of common psychiatric disorders within a representative sample of the Ohio Army National Guard service members (N = 671). The estimated cumulative onset probabilities were determined using the actuarial (life table) method. Note y-axis for anxiety disorder (lower-left quadrant) is 0.0–0.2; all other y-axis range from 0.0–0.6. Abbreviations: PTSD, posttraumatic stress disorder; OCD, obsessive-compulsive disorder; MDD, major depressive disorder.
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