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Medical correlates of first-term attrition in US Navy personnel
  1. Trevor Alan Elkins1,2,
  2. A MacGregor1,
  3. A Dougherty1,2 and
  4. A Olson1
  1. 1Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, California, USA
  2. 2Leidos, San Diego, California, USA
  1. Correspondence to Mr Trevor Alan Elkins, Naval Health Research Center, San Diego, CA 92152, USA; trevor.elkins2{at}gmail.com

Abstract

Introduction First-term attrition (FTA), or failure of a military service member to complete their initial service contract, is a major financial burden and source of lost manpower in the US Navy. The objective of the present study was to examine medical correlates of FTA using healthcare and disability rating data.

Methods In this retrospective cohort study, all US Navy-enlisted personnel between the years 2003 and 2018 with FTA (n=58 777) and regular discharge (n=203 084) were identified for analysis from accession dates in the Career History Archival Medical and Personnel System. Medical diagnoses from outpatient and inpatient records were abstracted from the Military Health System Data Repository. For a subgroup of the study population discharged with a disability rating (n=12 880), diagnoses were identified from the Integrated Disability Evaluation System. The FTA and regular discharge groups were compared using relative risks (RRs) and 95% CIs, and per cent differences for the disability subgroup analysis.

Results Compared with regular discharges, those with FTA were more likely to have outpatient and inpatient diagnoses for mental health disorders. Personality disorder yielded the strongest association with FTA in both outpatient (RR=10.45, 95% CI 9.79 to 11.16) and inpatient settings (RR=18.97, 95% CI 14.16 to 25.42). Other disorders associated with FTA included schizophrenia, substance-related disorders, poisoning by psychotropic agents and adjustment disorders. In the disability analysis, the FTA group relative to regular discharges had the largest per cent differences for ‘arthritis, degenerative (hypertrophic or osteoarthritis)’ (10.8% vs 2.5%) and ‘tibia and fibula, impairment’ (3.0% vs 0.4%).

Conclusions This study provides evidence that FTA is associated with both mental and physical health conditions. Mental and physical factors related to FTA require further examination, particularly whether pre-enlistment screening or early career intervention could lead to mitigation strategies. Future research should extend this analysis to other services and population subgroups.

  • EPIDEMIOLOGY
  • MENTAL HEALTH
  • Musculoskeletal disorders
  • Personality disorders
  • Substance misuse

Data availability statement

Data are available upon reasonable request. The data sets generated and/or analysed during the current study are not publicly available due to personally identifiable information regulations, but may be made available by the corresponding author on reasonable request and approval by the Naval Health Research Center Institutional Review Board.

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Data availability statement

Data are available upon reasonable request. The data sets generated and/or analysed during the current study are not publicly available due to personally identifiable information regulations, but may be made available by the corresponding author on reasonable request and approval by the Naval Health Research Center Institutional Review Board.

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Footnotes

  • Contributors TAE and AM designed the study, analysed the data and drafted the manuscript. All authors interpreted the data. AD and AO critically revised the manuscript for important intellectual content. All authors approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. TAE acts as guarantor for the overall content.

  • Funding This work was supported by the US Navy Bureau of Medicine and Surgery under work unit number N1214.

  • Disclaimer I am a military service member or employee of the US Government. This work was prepared as part of my official duties. Title 17, USC §105 provides that copyright protection under this title is not available for any work of the US Government. Title 17, USC §101 defines a US Government work as work prepared by a military service member or employee of the US Government as part of that person’s official duties. Report No 21-70 was supported by the US Navy Bureau of Medicine and Surgery under work unit number N1214. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.