Apr 28, 2021
The Health Related Behaviors Survey (HRBS) is the U.S. Department of Defense's (DoD's) flagship survey for understanding the health, health-related behaviors, and well-being of service members. Fielded periodically for more than 30 years, the HRBS includes content areas that might affect military readiness or the ability to meet the demands of military life. The Defense Health Agency asked the RAND Corporation to revise and field the 2018 HRBS among members of both the active component and the reserve component. This brief discusses findings for the reserve component.
This brief reviews results for deployment experiences and health. Some of the results are also compared with Healthy People 2020 (HP2020) objectives established by the U.S. Department of Health and Human Services for the general U.S. population. Because the military differs notably from the general population (for example, service members are more likely to be young and male than is the general population), these comparisons are offered only as a benchmark of interest.
The 2018 HRBS included several questions asking respondents about their deployment experiences. These included the number of times respondents had been deployed and length of and experiences on deployments.
Across all services, 52.9 percent (confidence interval [CI]: 51.7–54.1) of respondents reported having had at least one previous deployment, including both combat and noncombat deployments. Most personnel who had deployed had done so multiple times, with 18.6 percent (CI: 17.9–19.3) having deployed at least three times (Figure 1).
|Never deployed||Deployed once||Deployed twice||Deployed three or more times|
|Air Force Reserve||41.1%||20.3%||13.1%||25.5%|
|Air National Guard||32.9%||18.4%||14.0%||34.7%|
|Army National Guard||53.8%||21.8%||12.1%||12.2%|
|Marine Corps Reserve||63.1%||15.0%||10.6%||11.2%|
|Coast Guard Reserve||37.5%||19.0%||11.7%||31.9%|
Among those who had deployed, total lifetime duration of deployments varied widely. At one end, 13.5 percent (CI: 12.6–14.5) had deployed for no more than six months; at the other, 6.7 percent (CI: 6.1–7.2) had deployed for more than 48 months. Overall, 60.0 percent (CI: 58.7–61.2) of those who had ever deployed had done so for a total of seven to 24 months (Figure 2). Among those who had deployed, 66.7 percent (CI: 65.4–68.0) had not done so in the past year.
|1 to 6 months||7 to 12 months||13 to 24 months||25 to 48 months||49 months or more|
|Air Force Reserve||27.2%||29.7%||24.3%||14.2%||4.7%|
|Air National Guard||25.8%||26.3%||28.4%||13.9%||5.5%|
|Army National Guard||8.2%||34.1%||29.0%||22.0%||6.7%|
|Marine Corps Reserve||15.5%||37.2%||27.6%||16.5%||3.3%|
|Coast Guard Reserve||22.5%||24.2%||24.5%||17.8%||10.9%|
Those who had deployed also differed in their experience with combat deployments. Among all who had deployed, 80.3 percent (CI: 79.2–81.5) had at least one combat deployment (Figure 3).
|Zero||One||Two||Three or more|
|Air Force Reserve||25.9%||33.0%||18.9%||22.1%|
|Air National Guard||23.8%||34.1%||19.6%||22.5%|
|Army National Guard||14.8%||48.9%||24.3%||12.0%|
|Marine Corps Reserve||27.7%||37.5%||24.6%||10.2%|
|Coast Guard Reserve||67.7%||25.2%||4.4%||2.7%|
Among all who had deployed, 41.2 percent (CI: 39.9–42.5) reported traumatic combat experience, such as working with landmines, witnessing members of their unit or an ally unit being seriously wounded or killed, or being wounded in combat at some point in their deployments. The four most commonly reported traumatic combat experiences were knowing well someone who was killed in combat (25.2 percent, CI: 24.1–26.3), witnessing members of one's own unit or an ally unit being seriously wounded or killed (23.1 percent, CI: 22.0–24.2), witnessing civilians being seriously wounded or killed (23.1 percent, CI: 22.0–24.2), and working with landmines or other unexploded ordnance (11.2 percent, CI: 10.3–12.0).
The HRBS asked respondents about a variety of mental health indicators. It assessed overall mental health status using the Kessler 6 Mental Health Scale (K6), a commonly used measure of nonspecific serious psychological distress. The K6 is designed to distinguish between distress that indicates the presence of a psychiatric disorder that a clinician would recognize and treat and distress that is commonly experienced but not suggestive of a clinical condition. The HRBS also included items to indicate probable posttraumatic stress disorder (PTSD) and items on sleep quality.
Significantly fewer recent deployers (8.0 percent, CI: 6.6–9.3)—that is, those who had deployed in the past 12 months—indicated serious distress in the past 12 months on the K6 than did non–recent deployers (11.3 percent, CI: 10.4–12.3). In addition, significantly fewer recent deployers (4.7 percent, CI: 3.7–5.8) indicated serious distress in the past 30 days on the K6 than did non–recent deployers (6.8 percent, CI: 6.1–7.6). There were no statistically significant differences between recent deployers and non–recent deployers in the proportions reporting no to low distress or moderate distress levels in the past 12 months or the past 30 days.
Significantly fewer recent deployers (10.7 percent, CI: 9.2–12.2) indicated probable PTSD than did non–recent deployers (16.3 percent, CI: 15.3–17.4). Significantly fewer recent deployers (13.5 percent, CI: 11.7–15.2) indicated "very good" sleep in the past 30 days than did non–recent deployers (16.3 percent, CI: 15.3–17.4), though there were no statistically significant differences between recent deployers and non–recent deployers in the proportions indicating "fairly good," "fairly bad," or "very bad" sleep.
The HRBS asked whether respondents had any bodily pain symptoms in the past 30 days, asked whether they had any indicators of traumatic brain injury (TBI) in the past 12 months or postconcussive symptoms in the past 30 days, and asked them to provide self-ratings of health. Significantly more recent deployers indicated that they had bodily pain, mild TBI, and postconcussive symptoms (Table 1). There were no statistically significant differences between deployers and non–recent deployers in self-reported health.
|Deployed in Past 12 Months||Not Deployed in Past 12 Months|
|Any bodily pain (back, arms, legs, or joints), past 30 days||22.6% (CI: 20.5–24.6)||17.7% (CI: 16.8–18.7)|
|Any bodily pain including headache, past 30 days||24.7% (CI: 22.6–26.8)||20.3% (CI: 19.3–21.3)|
|High physical symptom severity, past 30 days||13.1% (CI: 11.4–14.7)||10.5% (CI: 9.8–11.3)|
|Positive screen for mild TBI, past 12 months||5.7% (CI: 4.6–6.7)||4.0% (CI: 3.5–4.6)|
|Postconcussive symptoms, past 30 days||3.6% (CI: 2.8–4.4)||2.5% (CI: 2.1–2.9)|
The HRBS provides insight on how deployment is associated with reserve component service members' physical and mental health outcomes. Understanding this association is important given that service members often deploy more than once in their career and that the negative consequences for health and health behaviors that result from one deployment could impact readiness for future deployments.
Most 2018 HRBS respondents had experienced at least one deployment since joining the military. Exposure to combat trauma was also common. Smaller proportions of recent deployers than non–recent deployers reported serious distress, but greater proportions of recent deployers than non–recent deployers had a positive screen for pain, mild TBI, and postconcussive symptoms.