Theater Mental Health Encounter Data (TMHED): Overview of Study Design and Methods

Abstract

Research has documented higher risks for mental health problems among service members deployed to war zones, yet a research limitation has been that assessment has generally occurred often years after combat exposure. The Operational Stress Control and Readiness program integrated mental health practitioners with 1st Marine Division units serving in Iraq. This team documented mental health visits between January 2006 and January 2007 and developed the Theater Mental Health Encounter Database (TMHED). This report describes the TMHED study design, measures, and cases. Of 1336 patients (3180 patient visits), 10% were women, 75% were high school educated, 55% were mid-paygrade enlisted, and 63% were on their first combat deployment. Compared with the overall deployed population, patient percentages included higher percentages of Marines and Navy personnel but lower percentages of Army and Air Force personnel, more junior enlisted but fewer officers, and fewer college graduates. TMHED provides an unprecedented opportunity to study early psychiatric intervention in a combat zone and prospectively examines postdeployment health and career outcomes.

Treatment of Mental or Physical Health Problems in a Combat Zone: Comparisons of Postdeployment Mental Health and Early Separation From Service

“…Also, although treatment of TMHED cases did follow Department of Veterans Affairs and Department of Defense clinical practice guidelines to the extent feasible, operational context in a combat zone may have required modifications or affected compliance with treatment regimens. For example, half of the TMHED patients were seen only once (Conway et al., ; Schmitz et al., ), limiting opportunities to monitor compliance with treatment recommendations. This point is important because compliance with medical regimens is difficult to achieve (DiMatteo, ) and is a common issue in psychiatric care (McDonald, Garg, & Haynes, ).…”

“…Until recently, available information has been limited to case studies (Cigrang, Peterson, & Schobitz, ; Hung, ; McLay, McBrien, Wiederhold, & Wiederhold, ; Moore & Krakow, ; Peterson, Baker, & McCarthy, ), which provide a limited basis for constructing a general picture of the consequences of in‐theater mental disorders. The Theater Mental Health Encounter Database (TMHED), which formally documented encounters with mental health providers in the Iraqi combat theater, provides the opportunity to explore the topic in a larger, more representative sample than previously available in case studies (Conway et al., ). Other TMHED studies have described the types of mental health problems and the treatment of those problems in theater (Conway et al., ; Larson et al., ; Schmitz et al., ).…”

“…The Theater Mental Health Encounter Database (TMHED), which formally documented encounters with mental health providers in the Iraqi combat theater, provides the opportunity to explore the topic in a larger, more representative sample than previously available in case studies (Conway et al., ). Other TMHED studies have described the types of mental health problems and the treatment of those problems in theater (Conway et al., ; Larson et al., ; Schmitz et al., ). Anxiety, adjustment, and mood‐related disorders represented the major types of mental diagnoses in TMHED patients while in theater.…”