U.S. Army Mortuary Affairs Soldiers: Predeployment Traumatic Exposures, Mental Health, and Substance Use

U.S. Army Mortuary Affairs (MA) soldiers collect, identify, and evacuate the remains of deceased personnel from the theater of war. They are exposed to violent death, human remains, information about the deceased, combat, and other dangerous environments, and deployment-related stressors. Understanding the predeployment health and history of trauma exposures is important to planning deployment and postdeployment health. This study examined predeployment traumatic exposures, mental health, and substance use in MA soldiers, including population characteristics, exposure to dead bodies and combat, posttraumatic stress disorder (PTSD), depression, suicidal ideation (SI), and alcohol and tobacco use.

Participants were 968 MA soldiers preparing for deployment to the Middle East (mean age: 26.3, 69.9% male, 51.0% E4-E5 rank, 83.2% had not previously deployed to the Middle East). Data were collected from 2005 to 2019 from self-report questionnaires administered 1-2 weeks before deployment. Measures included the Combat Experiences Scale, PCL-17, PHQ-9, and the CAGE. Analyses included descriptive statistics, frequency distributions, and parametric and non-parametric tests to identify differences between not deployed and previously deployed soldiers. The study was approved by the Institutional Review Board of the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Before deployment, 36.9% of MA soldiers reported one or more dead body exposures, and 28.0% had one or more combat exposures. A total of 7.8% had past-month PTSD, 6.7% had past-2-week major depression, and 7.2% endorsed past-2-week SI. Rates of PTSD and depression declined across time when examined in 5-year groups (2005-2009, 2010-2014, 2015-2019; PTSD: 10.8%, 6.7%, 4.3%, respectively; F(2, 910) = 4.83, P = .008; depression: 10.2%, 4.8%, 3.1%, respectively; F(2, 928) = 7.60, P < .001). Frequent alcohol use was reported by 5.7%, 12.6% had possible problematic alcohol use, and 13.5% reported high daily cigarette use. Previously deployed soldiers (vs. those not previously deployed) were more likely to report previous dead body exposures (deployed: 89.0%, not deployed 26.3%, χ2 = 228.35, P < .001), combat exposures (deployed: 84.7%, not deployed 16.5%, χ2 = 312.23, P < .001), and higher rates of PTSD (deployed: 12.4%, not deployed: 6.8%, χ2 = 5.52, P = .019), depression (deployed: 10.9%, not deployed: 5.8%, χ2 = 5.41, P = .020), SI (deployed: 12.9%, not deployed: 6.1%, χ2 = 9.00, P = .003), frequent alcohol use (deployed: 11.4%, not deployed: 4.6%, χ2 = 11.19, P < .001), possible problematic alcohol use (deployed: 18.1%, not deployed: 11.5%, χ2 = 5.00, P = .025), and high daily cigarette use (deployed: 20.4%, not deployed: 12.1%, χ2 = 7.72, P = .006).

This study examined predeployment traumatic exposures, mental health, and substance use of MA soldiers during a 15-year period of war. The results provide a baseline of the characteristics of MA soldiers before deployment. The higher body and combat exposures, PTSD, depression, SI, and alcohol and tobacco use before deployment are possible risk factors for deployment and postdeployment mental health problems. Potentially targeted predeployment screening and offering of care to MA soldiers can address the needs of soldiers who have psychiatric issues before deployment. Future studies of MA soldiers should examine outcomes postdeployment considering these predeployment factors.