Self-Rated Health and Subsequent Health Care Use among Military Personnel Returning from International Deployments

Military Medicine, Feb 2004 by Trump, David H, Brady, P Jeffrey, Olsen, Cara H

Individual health status assessment upon completion of U.S. military deployments was standardized in 1999 with a brief health assessment questionnaire. This cohort study analyzed health status responses and their relationship to postdeployment health outcomes among 16,142 military personnel who completed a health questionnaire after a deployment ending in 1999. Respondents were Army and Air Force personnel returning from Europe or Southwest Asia. Fourteen percent documented at least one health concern and 1.8% had fair/poor self-rated health. In the 6 months after deployment, 1.4% were hospitalized, 25% made five or more outpatient visits, and 4% separated from military service. Deployers with fair/poor self-rated health were at a significantly increased risk for high use of outpatient services (risk ratio, men 1.8, women 1.7) but not for hospitalization or separation. Self-report of low health status or other health concerns may help identify deployers with higher health care needs after future deployments.

Introduction

The health of military veterans, especially during and after major military deployments, has received increased attention since the Gulf War. Veterans of that war have self-reported increased rates of nearly all symptoms and illnesses, although they have not experienced increased rates of hospitalization or death.1-6 More recently, military members who deployed to Bosnia-Herzegovina between 1995 and 1997 have had an increased risk of hospitalization after deployment relative to before deployment.7,8 While military deployment missions may be for war or low-intensity conflict, many ongoing military deployments are for military exercises and training, humanitarian assistance, and peacekeeping.

By Department of Defense (DoD) policy, members of the U.S. military are to fill out a postdeployment health questionnaire as part of their health evaluation at the end of a deployment.9 A postdeployment questionnaire is required if the deployment is 30 days or longer in duration, involves operations ashore, and is in a location without an established DoD military medical treatment facility. The Assistant Secretary of Defense for Health Affairs approved a Predeployment Health Assessment and a Postdeployment Health Assessment (DoD forms 2795 and 2796, respectively) in 1998.9 A copy of the form is placed in the individual's medical record. Another copy is sent to the Army Medical Surveillance Activity, U.S. Army Center for Health Promotion and Preventive Medicine for entry into the Defense Medical Surveillance System.10,11

Although various postdeployment questionnaires have been used since 1996,12,13 there has been little evaluation of these assessments in their different roles as tools for individual clinical assessment, medical documentation, or evaluation of the current and future health of deployed populations.14 The President, the U.S. Congress, and the Institute of Medicine have endorsed the improvement of health assessments and health surveillance of military members,15-18 although the Institute of Medicine has also questioned the value of the current deployment health assessments.17,18

The aim of this pilot study was to describe the self-rated health of military members who completed postdeployment questionnaires upon return from deployments in 1999 and to examine the associations between self-rated health and subsequent health care use and health outcomes in the 6-month period after return from deployment.

Materials and Methods

The Defense Medical Surveillance System, which is operated by the Army Medical Surveillance Activity, is an executive health information system for the DoD. The Army Medical Surveillance Activity provided the principal investigator with study datasets that included: (1) demographic characteristics, (2) responses on the postdeployment questionnaire, (3) history of any hospitalization while in military service before the deployment, (4) date of separation from military service, and (5) health outcomes occurring within 6 months of departure from theater of operation. Health outcome data were from the standard inpatient data record and standard ambulatory data record. Personal identifying information was redacted for this study. This research was conducted in compliance with all applicable federal regulations governing the protection of human subjects in research.

The postdeployment questionnaire has one self-rated general health question: Would you say your health in general is "excellent, very good, good, fair, or poor?" In addition, five questions ask for "yes" or "no" responses (Table I).

The eligible study population was active duty military members who completed a postdeployment questionnaire on or before December 31, 1999 and had been deployed more than 30 days to a foreign area of military operation. For this pilot study, the analyses were restricted to Army and Air Force service members who had completed a deployment of 30 to 365 days duration to Southwest Asia or Europe that had ended between January 1 and December 31, 1999. In addition, a postdeployment questionnaire had to have been completed between 45 days before to 90 days after the end date of the deployment and have responses to all of the health status questions.