2018 Health Related Behaviors Survey

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.

Frequency and Duration of Deployments

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
Total	47.1%	21.3%	13.0%	18.6%
Air Force Reserve	41.1%	20.3%	13.1%	25.5%
Air National Guard	32.9%	18.4%	14.0%	34.7%
Army Reserve	47.8%	23.9%	13.3%	15.1%
Army National Guard	53.8%	21.8%	12.1%	12.2%
Marine Corps Reserve	63.1%	15.0%	10.6%	11.2%
Navy Reserve	29.2%	20.1%	17.1%	33.6%
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
Total	13.5%	31.3%	28.7%	19.8%	6.7%
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 Reserve	7.8%	33.6%	28.2%	22.8%	7.6%
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%
Navy Reserve	11.6%	23.7%	34.2%	21.5%	9.1%
Coast Guard Reserve	22.5%	24.2%	24.5%	17.8%	10.9%

Combat Deployments

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
Total	19.7%	42.3%	22.7%	15.3%
Air Force Reserve	25.9%	33.0%	18.9%	22.1%
Air National Guard	23.8%	34.1%	19.6%	22.5%
Army Reserve	15.5%	46.3%	25.3%	12.9%
Army National Guard	14.8%	48.9%	24.3%	12.0%
Marine Corps Reserve	27.7%	37.5%	24.6%	10.2%
Navy Reserve	27.4%	34.3%	20.2%	18.0%
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).

Deployment and Mental and Emotional Health

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.

Deployment and Physical Health

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.

Conclusions

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.

Note

• [1] CIs provide a range in which the true population value is expected to fall. They account for sampling variability when calculating point estimates but do not account for problems with question wording, response bias, or other methodological issues that, if present in the HRBS, might bias point estimates.