Mental healthcare utilisation among Danish formerly deployed military personnel and their civilian counterparts: a cohort study

Background: Prior studies comparing the mental healthcare utilisation (MHU) of Danish formerly deployed military personnel (FDP) with the general population have not included data on psychotherapy through the Defence or talking therapy with the general practitioner. This study included these and several other data sources in a comprehensive comparison of MHU between Danish FDP and civilians.Methods: First-time deployed military personnel (N = 10,971) who had returned from a mission to Kosovo, Afghanistan, Iraq or Lebanon between January 2005 and July 2017 were included. A sex and birth-year-matched civilian reference group was randomly drawn from the entire Danish non-deployed population (N = 253,714). Furthermore, a sub-cohort, including male FDP and civilians deemed eligible for military service, was defined. These cohorts were followed up in military medical records and registers covering the primary and secondary civilian health sectors from 2005 to 2018, and the rates of MHU were compared.Results: Approximately half of the initial help-seeking for FDP took place through the Defence (49.4%), and the remainder through the civilian healthcare system. When help-seeking through the Defence was not included, MHU was significantly lower among FDP in the main cohort during the first two years (IRR = 0.84, 95% CI: [0.77, 0.92]) compared to civilians. When help-seeking through the Defence was included, MHU was significantly higher among FDP compared to civilians both in the first two years of follow-up (IRR = 2.01, 95% CI: [1.89, 2.13]) and thereafter (IRR = 1.18, 95% CI: [1.13, 1.23]). In the sub-cohort, these differences were even more pronounced both in the first two years of follow-up and thereafter.Conclusions: MHU was higher among Danish FDP compared to civilians only when data from the Defence was included. The inclusion of data on both civilian and military healthcare services is necessary to evaluate the full impact of deployment on MHU among Danish FDP. This study compared mental healthcare utilisation among Danish deployed military personnel and civilians.Most personnel sought help first through the Defence.When all data sources were included, mental healthcare utilisation was significantly higher among military personnel. Antecedentes: Estudios anteriores que compararon la utilizacion de la atencion de salud mental (UASM) del personal militar danes anteriormente desplegado (PAD) con la poblacion general no han incluido datos sobre psicoterapia (en contexto de atencion, NdelT) a traves de la Defensa o terapia de conversacion con el medico general. Este estudio incluyo estas y varias otras fuentes de datos en una comparacion exhaustiva de UASM entre el PAD danes y civiles.Metodos: Se incluyo al personal militar desplegado por primera vez (N = 10.971) que habia regresado de una mision a Kosovo, Afganistan, Irak o El Libano entre enero de 2005 y julio de 2017. Se selecciono aleatoriamente un grupo de referencia civil emparejado por sexo y ano de nacimiento de toda la poblacion danesa no desplegada (N = 253.714). Ademas, se definio una subcohorte que incluia hombres del PAD y civiles considerados elegibles para el servicio militar. Estas cohortes fueron seguidas en registros medicos militares y registros que cubren los sectores de salud civil primario y secundario de 2005 a 2018, y se compararon las tasas de UASM.Resultados: Aproximadamente la mitad de las solicitudes iniciales de ayuda del PAD se realizaron a traves de la Defensa (49,4%) y el resto a traves del sistema sanitario civil. Cuando no se incluyo la busqueda de ayuda a traves de la Defensa, la UASM fue significativamente menor entre el PAD en la cohorte principal durante los primeros dos anos (IRR = 0,84, CI del 95%: [0,77, 0,92]) en comparacion con los civiles. Cuando se incluyo la busqueda de ayuda a traves de la Defensa, la UASM fue significativamente mayor entre el PAD en comparacion con los civiles tanto en los primeros dos anos de seguimiento (IRR = 2,01, CI del 95%: [1,89, 2,13]) como posteriormente (IRR = 1,18, CI del 95%: [1,13, 1,23]). En la subcohorte estas diferencias fueron aun mas pronunciadas tanto en los dos primeros anos de seguimiento como posteriormente.Conclusiones: La UASM fue mayor entre el PAD danes en comparacion con los civiles solo cuando se incluyeron datos de la Defensa. La inclusion de datos sobre los servicios de salud tanto civiles como militares es necesaria para evaluar el impacto total del despliegue en UASM entre el PAD danes.