Psychological distress in the active duty military spine patient

Disorders of the spine are a substantial burden to the military health care system that degrades readiness in the overall force. Because treatment outcomes are affected by psychosocial factors, assessment of psychological distress is important for patients with spine complaints. The incidence of psychological distress in the unique military population is not well described. The purpose of this retrospective case-control study was to determine the rate of psychological distress and identify associated patient characteristics among many variables collected in the military health system. A consecutive cohort of active duty service members presenting to a spine specialty clinic was assessed as Normal, At Risk, or Distressed using the Distress and Risk Assessment Method. Of 74 active duty patients (63 male, 11 female), 43 (58%) had some level of psychological distress: 29 (39%) At Risk, 12 (16%) Distressed-Depressive, and 2 (3%) Distressed-Somatic. Multivariate regression analysis identified female gender (odds ratio [OR] 7.90), higher disability as measured by Oswestry Disability Index/Neck Disability Index (OR 8.0 per 13.8 point increase), and assignment to a Warrior Transition Unit or Medical Evaluation Board (OR 7.35) as statistically significant variables. The results indicate that active duty patients are subject to similarly high levels of psychological distress as their civilian counterparts.