Invited commentary: How healthy is the "healthy warrior"?

Abstract

In this issue of the Journal, Larson et al. (Am J Epidemiol 2008;167:1269-1276) report incidence rates of 11.8% for any mental disorder and 1.6% for post-traumatic stress disorder among US Marines deployed during Operation Iraqi Freedom and Operation Enduring Freedom. Various methodological reasons can help explain why these rates are lower than those found in previous wars. One primary reason is varying methods of diagnosis. Other reasons include differences in percentages of active-duty personnel, windows of observation, and methods of calculating rates. In addition, comorbidity for some mental disorders and specific risks for developing certain disorders complicate interpretation of rates. Nevertheless, Larson et al. document evidence for the "healthy warrior" effect - namely that deployed Marines have fewer mental disorders than nondeployed Navy and Marine Corps personnel, with the exception of stress disorders. Suggestions are made for directions of future research into this effect. © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved.