I was surprised that Brown did not cite this article from “JAMA Psychiatry” May, 2014 that could have helped him understand something about half (or more) of servicemen: Thirty-Day Prevalence of DSM-IV Mental Disorders Among Nondeployed Soldiers in the US Army. Results From the Army Study to Assess Risk and Resilience in Service members (Army STARRS)
The study found that almost half of soldiers had some mental disorder when they enlisted. The rates of disorders like attention deficit-hyperactivity disorder and intermittent explosive disorder (IED) in the study were similar in the new recruits as well.
This finding in line with our practice experience in Japan that includes servicing a total population of 100,000 military personnel, dependents, and civilian workers. Most of these persons seemed to us to have similar problems before they entered the service, some got worse in the service.
There is a clear path of employment, training, and for long-termers a pension plan, making the military both a good choice for these persons, and these persons a good choice for the military that recruiting is not likely to give up. However, ADD, ADHD, IED, etc are frequently associated with dysphoric mood states and recurrent brief, persistent, or major depression, in addition to drinking, drug abuse, risk taking behavior, and, along with the stresses of being in a war theater the risk of suicide can increase.
The answer to all of this is that, because so many persons enter the military with mental health problems to begin with, any addition of the horror of war to this baseline will continue to make it very challenging to mitigate morbidity and mortality in this population.
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