Mental Health Issues Accounted for One-Third of Military Medevacs from Middle East in 2020

U.S. Air Force combat aeromedical evacuation mission.
U.S. Air Force Capt. John Ininns, 379th Expeditionary Aeromedical Evacuation Squadron medical crew director, tends to a patient during a combat aeromedical evacuation mission while in flight over U.S. Central Command’s area of responsibility, Aug. 28, 2020. (U.S. Air Force/Senior Airman Ashley Perdue)

Mental health disorders, injuries and COVID-19 were listed as the top reasons that U.S. service members were evacuated from the U.S. Central Command area of operations in 2020, according to a new report from the Defense Health Agency.

Last year, 1,207 troops out of an estimated 60,000 to 80,000 stationed in the region were flown to hospitals in the U.S. or Europe for medical reasons, including 59 with combat injuries, according to the May Medical Surveillance Monthly Report published by the Defense Department.

Among the evacuations, 27%, or 328, were for mental health conditions, and 19% were for non-battlefield injuries such as broken bones or sprains. At least 10%, or 121, were thought to be the result of COVID-19, although medical records listed most as "other" or "encounter for administrative examination;" just 23 officially were evacuated over the coronavirus.

"Taking into account these administrative examinations would make COVID-19 the third leading cause of medical evacuation out of CENTCOM AOR in 2020. However, not all of these evacuations may have been medically necessary and may have instead been driven by guidance, policies, and procedures in-theater," noted the authors.

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Over the past five years, mental health disorders were the most frequent reason for medical evacuations, followed by non-battlefield injuries, ill defined conditions, musculoskeletal disorders and digestive system conditions.

As with the general U.S. population, mental health diagnoses have been on the rise in the military over the past decade. However, the overall rate of mental health diagnoses in the American military remains significantly lower than the rate in the U.S. According to the National Association for Mental Illness, one in five adults in the U.S., or 20%, experience a mental illness in a given year, while the lifetime prevalence for mental illness is 50% among all Americans. In 2018, the overall DoD rate was 8.3%. More than a quarter, or 25.2%, of all women on active duty in 2018 had a history of a mental health condition, while 16.2% of men had received a diagnosis during their lifetime.

In 2020, the pattern changed slightly as the result of COVID-19, with male service members having higher percentages of evacuation for non-battlefield injuries and the coronavirus compared to women.

The majority -- more than 80% -- of those evacuated returned to normal duty status after they received medical care outside the area of operations. And 63% of those evacuated for battle injuries also returned to duty immediately after they were treated.

According to the report, battlefield injuries were relatively stable over the past five years, peaking in 2017 at 71. In 2020, there was a spike in January of roughly 26 battle injuries, which the writers surmised was related to the Iranian ballistic missile attack on Iraq's Al Asad Airbase.

For men, the top reasons for evacuation were severe stress or adjustment disorders, COVID-19, wrist or hand fractures, back pain, leg fractures or an episode of major depressive disorder.

Women's reasons for evacuation included severe stress or adjustment disorders, an episode of major depressive disorder, recurrent major depression, other anxiety disorders, COVID-19 and leg fractures.

The authors noted that some conditions that prompted medical evacuations in 2020 may be preventable, noting that even though access to mental health services in deployed settings has improved over the years, there is still spotty access in some places.

"In addition, although the number of mental health care providers in Afghanistan increased from 2005 through 2010, this number decreased after 2013 as part of the overall drawdown of U.S. troops from the region," they wrote.

The findings, they concluded, "highlight the continued need to tailor force health protection, policies, supplies, equipment, and practices based on characteristics of the deployed force, as well as the nature of military operations."

As of Monday, the Pentagon had tallied 199,420 cases of COVID-19 among U.S. service members, including 1,726 hospitalizations. Twenty-six have died.

-- Patricia Kime can be reached at Follow her on Twitter @patriciakime.

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