RESUMEN
Introduction: The primary objective of this study was to describe the demographic, clinical, and attrition characteristics of active duty U.S. military service members who were aeromedically evacuated from Iraq and Afghanistan theaters with a psychiatric condition as the primary diagnosis. The study links the U.S. Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) data with the Defense Manpower Data Center (DMDC) to conduct an examination of the long-term occupational impact of psychiatric aeromedical evacuations on military separations and discharges. Materials and Methods: Retrospective analyses were conducted on the demographic, clinical, and attrition information of active duty service members (N = 7,023) who received a psychiatric aeromedical evacuation from Iraq or Afghanistan between 2001 and 2013 using TRAC2ES data. Additionally, TRAC2ES database was compared with DMDC data to analyze personal and service demographics, aeromedical evacuation information, and reasons for military separation with the entire 2013 active duty force. Chi-square tests of independence and standardized residuals were used to identify cells with observed frequencies or proportions significantly different than expected by chance. Additionally, OR were calculated to provide context about the nature of any significant relationships. Results: Compared with the active duty comparison sample, those with a psychiatric aeromedical evacuation tended to be younger, female, white, divorced or widowed, and less educated. They were also more likely to be junior enlisted service members in the Army serving in a Combat Arms military occupational specialty. The primary psychiatric conditions related to the aeromedical evacuation were depressive disorders (25%), adjustment disorders (18%), post-traumatic stress disorder (9%), bipolar disorders (6%), and anxiety disorders (6%). Approximately, 3% were evacuated for suicidal ideation and associated behaviors. Individuals who received a psychiatric aeromedical evacuation were almost four times as likely (53%) to have been subsequently separated from active duty at the time of the data analysis compared with other active duty service members (14%). The current study also found that peaks in the number of aeromedical evacuations coincided with significant combat operational events. These peaks almost always preceded or followed a significant operational event. An unexpected finding of the present study was that movement classification code was not predictive of subsequent reasons for separation from the military. Thus, the degree of clinical supervision and restraint of a service member during psychiatric aeromedical evacuation from deployment proved to be unrelated to subsequent service outcome. Conclusions: Psychiatric conditions are one of the leading reasons for the aeromedical evacuation of active duty military personnel from the military combat theater. For many active duty military personnel, a psychiatric aeromedical evacuation from a combat theater is the start of a military career-ending event that results in separation from active duty. This finding has important clinical and operational implications for the evaluation and treatment of psychiatric conditions during military deployments. Whenever possible, deployed military behavioral health providers should attempt to treat psychiatric patients in theater to help them remain in theater to complete their operational deployments. Improved understanding of the factors related to psychiatric aeromedical evacuations will provide important clinical and policy implications for future conflicts.
Asunto(s)
Medicina Aeroespacial/estadística & datos numéricos , Trastornos Mentales/terapia , Personal Militar/estadística & datos numéricos , Guerra , Trastornos de Adaptación/epidemiología , Trastornos de Adaptación/terapia , Adulto , Medicina Aeroespacial/métodos , Campaña Afgana 2001- , Ambulancias Aéreas/estadística & datos numéricos , Trastorno Bipolar/epidemiología , Trastorno Bipolar/terapia , Distribución de Chi-Cuadrado , Depresión/epidemiología , Depresión/terapia , Femenino , Humanos , Clasificación Internacional de Enfermedades/tendencias , Guerra de Irak 2003-2011 , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Personal Militar/psicología , Sistemas de Identificación de Pacientes/métodos , Sistemas de Identificación de Pacientes/estadística & datos numéricos , Enfermería Psiquiátrica/métodos , Enfermería Psiquiátrica/estadística & datos numéricos , Estudios Retrospectivos , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/terapia , Viaje/estadística & datos numéricos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To determine whether depression in the elderly in institutionalized settings could be identified using the mood indicators in the Minimum Data Set (MDS) 2.0 (Section E1, Items A-P). DESIGN: Descriptive study. SETTING: Three nursing homes in the southeastern part of the country. PARTICIPANTS: Residents aged 65 and above. MEASUREMENTS: The items in "Indicators of Depression, Anxiety and Sad Mood" on the MDS 2.0 were used to identify observable features of depression in the elderly. The Cornell Scale for Depression in Dementia (CSDD) was used to validate the MDS indicators. Consensus analysis, which controls raters' bias, raters' ability, and item difficulty, was used to analyze data. RESULTS: No depressive patterns were detected using the MDS indicators. On the CSDD, distinct depressive features were identified: anxiety, sadness, lack of reaction to pleasant events, irritability, agitation, multiple physical complaints, loss of interest, appetite loss, and lack of energy. CONCLUSION: The incongruent findings on the MDS indicators the CSDD may be reflective of the assessment process used with the MDS rather than its ability to identify features of elderly depression. The practice of allowing nondirect caregivers to complete the MDS may have serious implications for the accuracy of the data collected.