Predictors of Posttraumatic Stress Disorder, Anxiety Disorders, Depressive Disorders, and Any Mental Health Condition Among U.S. Soldiers and Marines, 2001–2011

Understanding mental health disorder diagnosis and treatment seeking among active‐duty military personnel is a topic with both clinical and policy implications. It has been well documented in military populations that individual‐level military experience, including deployment history and combat exposure, influences mental health outcomes, but the impact of unit‐level factors is less well understood. In the current study, we used administrative longitudinal data to examine a comprehensive set of unit‐ and individual‐level predictors of posttraumatic stress disorder (PTSD), non‐PTSD anxiety disorders, depressive disorders, and overall mental health diagnoses among Army and Marines Corps personnel. Using Cox survival models for time‐dependent variables, we analyzed time from military accession (between January 1, 2001 and December 31, 2011) until first mental health diagnosis for 773,359 soldiers and 332,093 Marines. Prior diagnosis of a substance abuse disorder during one's military career, hazard ratios (HRs) = 1.68–3.10, and cumulative time spent deployed, HRs = 1.11–2.04, were the most predictive risk factors for all outcomes. Male sex, HRs = 0.35–0.57, and officer rank, HRs = 0.13–0.23, were the most protective factors. Unit‐level rate of high deployment stress was a small but significant predictor of all outcomes after controlling for individual‐level deployment history and other predictors, HRs = 1.01–1.05. Findings suggest both unit‐ and individual‐level risk and protective factors of mental health diagnoses associated with treatment seeking. Clinical, including mental health assessment and management, and policy implications related to the military environment and the individual as it relates to mental health disorders are discussed. Resumen Spanish s by Asociación Chilena de Estrés Traumático (ACET) Predictores de Trastorno de Estrés Postraumático, Trastornos de Ansiedad, Trastornos Depresivos y cualquier Condición de Salud Mental entre los Soldados e Infantería de Marina de EE. UU., 2001–2011 TRASTORNO DE LA SALUD MENTAL EN LOS MILITARES DE EE. UU Comprender el diagnóstico de trastornos de salud mental y la búsqueda de tratamiento entre el personal militar activo es un tópico con implicaciones clínicas y políticas. Se ha documentado bien en poblaciones militares que la experiencia militar a nivel individual, incluyendo el historial de despliegue y la exposición al combate, influyen en los resultados de salud mental, pero el impacto de los factores