Mental healthcare utilisation among Danish formerly deployed military personnel and their civilian counterparts: a cohort study

<b>Background:</b> Prior studies comparing the mental healthcare utilisation (MHU) of Danish formerly deployed military personnel (FDP) with the general population have not included data on psychotherapy through the Defence or talking therapy with the general practitioner. This study included these and several other data sources in a comprehensive comparison of MHU between Danish FDP and civilians. <b>Methods:</b> First-time deployed military personnel (<i>N</i> = 10,971) who had returned from a mission to Kosovo, Afghanistan, Iraq or Lebanon between January 2005 and July 2017 were included. A sex and birth-year-matched civilian reference group was randomly drawn from the entire Danish non-deployed population (<i>N</i> = 253,714). Furthermore, a sub-cohort, including male FDP and civilians deemed eligible for military service, was defined. These cohorts were followed up in military medical records and registers covering the primary and secondary civilian health sectors from 2005 to 2018, and the rates of MHU were compared. <b>Results:</b> Approximately half of the initial help-seeking for FDP took place through the Defence (49.4%), and the remainder through the civilian healthcare system. When help-seeking through the Defence was not included, MHU was significantly lower among FDP in the main cohort during the first two years (IRR = 0.84, 95% CI: [0.77, 0.92]) compared to civilians. When help-seeking through the Defence was included, MHU was significantly higher among FDP compared to civilians both in the first two years of follow-up (IRR = 2.01, 95% CI: [1.89, 2.13]) and thereafter (IRR = 1.18, 95% CI: [1.13, 1.23]). In the sub-cohort, these differences were even more pronounced both in the first two years of follow-up and thereafter. <b>Conclusions:</b> MHU was higher among Danish FDP compared to civilians only when data from the Defence was included. The inclusion of data on both civilian and military healthcare services is necessary to evaluate the full impact of deployment on MHU among Danish FDP. This study compared mental healthcare utilisation among Danish deployed military personnel and civilians.Most personnel sought help first through the Defence.When all data sources were included, mental healthcare utilisation was significantly higher among military personnel. This study compared mental healthcare utilisation among Danish deployed military personnel and civilians. Most personnel sought help first through the Defence. When all data sources were included, mental healthcare utilisation was significantly higher among military personnel.

**背景：** 既往针对丹麦曾部署军事人员（Formerly Deployed Personnel, FDP）与普通人群的精神医疗服务利用（mental healthcare utilisation, MHU）的比较研究，均未纳入通过国防部提供的心理治疗或全科医生谈话治疗的数据。本研究纳入上述两类数据及其他多项数据源，对丹麦FDP与普通民众的精神医疗服务利用情况开展全面对比分析。
**方法：** 本研究纳入2005年1月至2017年7月间赴科索沃、阿富汗、伊拉克或黎巴嫩执行任务后归国的首次部署军事人员（N=10971）。从丹麦全部未部署人群中随机抽取与研究对象按性别、出生年份匹配的平民对照队列（N=253714）。此外，本研究还定义了一个亚队列，纳入符合兵役资格的男性FDP及平民。所有队列均通过军队医疗记录及覆盖2005至2018年基层与二级民用医疗领域的登记系统进行随访，并对比两组的精神医疗服务利用率。
**结果：** 丹麦FDP中约半数（49.4%）的初始精神医疗求助通过国防部渠道完成，剩余部分则通过民用医疗系统寻求帮助。若不纳入国防部渠道的求助数据，主队列中FDP在随访前两年的精神医疗服务利用率显著低于平民（发病率比IRR=0.84，95%置信区间CI：[0.77, 0.92]）。若纳入国防部渠道的求助数据，则FDP在随访前两年（IRR=2.01，95%CI：[1.89, 2.13]）及后续随访时段（IRR=1.18，95%CI：[1.13, 1.23]）的精神医疗服务利用率均显著高于平民。在亚队列中，上述差异在随访前两年及后续时段均更为显著。
**结论：** 仅当纳入国防部的医疗数据时，丹麦FDP的精神医疗服务利用率才显著高于平民。要全面评估部署任务对丹麦FDP精神医疗服务利用的整体影响，必须同时纳入民用与军队医疗服务的数据。
本研究对比了丹麦部署军事人员与平民的精神医疗服务利用情况。多数人员首先通过国防部渠道寻求帮助。当纳入所有数据源后，军事人员的精神医疗服务利用率显著更高。本研究对比了丹麦部署军事人员与平民的精神医疗服务利用情况。多数人员首先通过国防部渠道寻求帮助。当纳入所有数据源后，军事人员的精神医疗服务利用率显著更高。