Postcombat outcomes among Marines with preexisting mental diagnoses.

Preexisting mental disorders are not always considered in mental health studies with military populations, even though prior diagnoses may be a risk factor for additional psychiatric harm stemming from combat exposure, as well as postdeployment behavioral problems. The objectives of this study were to investigate postcombat psychiatric and career outcomes among Marines with preexisting mental disorder diagnoses who deployed to combat in Iraq, Afghanistan, or Kuwait from 2002 to 2008. Marines with a preexisting diagnosis were 3.6 times (p < .001) more likely to have at least 1 postdeployment mental health disorder within 6 months postdeployment compared with Marines with no prior psychiatric diagnoses. Marines with a preexisting diagnosis were also 1.8 (p < .001) times more likely to receive a new-onset psychiatric diagnosis within 6 months postdeployment, indicating that postdeployment mental health concerns in this cohort extend beyond continuation of earlier disorders. Additionally, demotions and separation were significantly associated with having any preexisting mental health diagnoses (yielding odds ratios of 2.34 and 2.00, p < .001, respectively. Based on the current findings, it may be advisable to mandate a full medical and psychiatric record review during deployment health screening as part of new initiatives to address whether combat exposure has worsened preexisting conditions or compounded them with new-onset concerns.