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Risk of First Adjustment Disorder in U.S. Army Soldiers.

Holly B Herberman Mash1,2, James A Naifeh1,2, Rachel Shor1,2

  • 1Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.

Military Medicine
|June 23, 2026
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Summary
This summary is machine-generated.

Adjustment disorder (AD) risk is highest for U.S. Army soldiers in early career (1-4 years) and late career (17-20 years). Risk factors differ between these groups, necessitating tailored interventions for adjustment disorder prevention.

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Area of Science:

  • Military mental health
  • Psychological adjustment
  • Epidemiology of mental disorders

Background:

  • Adjustment disorder (AD) is a prevalent mental health diagnosis within the U.S. military and globally.
  • Limited research exists on the specific patterns and predictors of AD in military populations.
  • Understanding risk factors is crucial for developing targeted prevention and intervention strategies.

Purpose of the Study:

  • To identify career phases and soldier characteristics associated with an increased risk of a first-time adjustment disorder diagnosis.
  • To inform the development of targeted prevention and intervention efforts for U.S. Army soldiers.

Main Methods:

  • Longitudinal, retrospective cohort study utilizing data from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS).
  • Analysis included administrative medical and personnel records of active duty Regular Army enlisted soldiers from 2015-2019.
  • Compared person-months with a first AD diagnosis (n=118,735) to a control sample (n=316,275), examining risk as a function of time in service, stratified by sex and occupation.

Main Results:

  • The risk of a first AD diagnosis exhibited a bimodal pattern, with elevated risk during early-career (1-4 years) and late-career (17-20 years) phases.
  • Multiple risk factors were associated with AD, with significant differences observed between early- and late-career soldiers.
  • Key risk factors included female sex, deployment status, recent mental health diagnoses, reported stressors/marital problems, and postconcussive syndrome.

Conclusions:

  • First-time adjustment disorder diagnoses are most common at the beginning and near the end of soldiers' Army careers.
  • Distinct risk factors across career stages underscore the need for tailored interventions considering unique military and life stressors.
  • Targeted prevention and intervention strategies are essential for mitigating AD risk in soldiers.