Identifying Non-Fatal Injury & Polypharmacy Indicators of Risk for Accident Death in US Army Enlisted Soldiers

Research Paper Title

Medical-encounter mental health diagnoses, non-fatal injury and polypharmacy indicators of risk for accident death in the US Army enlisted soldiers, 2004-2009.

Background

Accidents are a leading cause of deaths in US active duty personnel. Understanding accident deaths during wartime could facilitate future operational planning and inform risk prevention efforts.

Methods

This study expands prior research, identifying health risk factors associated with US Army accident deaths during the Afghanistan and Iraq war. Military records for 2004-2009 enlisted, active duty, Regular Army soldiers were analysed using logistic regression modeling to identify mental health, injury, and polypharmacy (multiple narcotic and/or psychotropic medications) predictors of accident deaths for current, previously, and never deployed groups.

Results

Deployed soldiers with anxiety diagnoses showed higher risk for accident deaths. Over half had anxiety diagnoses prior to being deployed, suggesting anticipatory anxiety or symptom recurrence may contribute to high risk. For previously deployed soldiers, traumatic brain injury (TBI) indicated higher risk. Two-thirds of these soldiers had first TBI medical-encounter while non-deployed, but mild, combat-related TBIs may have been undetected during deployments. Post-Traumatic Stress Disorder (PTSD) predicted higher risk for never deployed soldiers, as did polypharmacy which may relate to reasons for deployment ineligibility.

Conclusions

Health risk predictors for Army accident deaths are identified and potential practice and policy implications discussed. Further research could test for replicability and expand models to include unobserved factors or modifiable mechanisms related to high risk. PTSD predicted high risk amonthose never deployed, suggesting importance of identification, treatment, and prevention of non-combat traumatic events. Finally, risk predictors overlapped with those identified for suicides, suggesting effective intervention might reduce both types of deaths.

Reference

Lewandowski-Romps, L., Schroeder, H.M., Berglund, P.A., Colpe, L.J., Cox, K., Hauret, K., Hay, J.D., Jones, B., Little, R.J.A., Mitchell, C., Schoenbaum, M., Schulz, P., Stein, M.B., Ursano, R.J., Heeringa, S.G. & Army STARRS Collaborators. (2017) Medical-encounter mental health diagnoses, non-fatal injury and polypharmacy indicators of risk for accident death in the US Army enlisted soldiers, 2004-2009. Preventive Medicine. pii: S0091-7435(17)30457-7. doi: 10.1016/j.ypmed.2017.11.016. [Epub ahead of print].

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