Cumulative incidence of mental disorders in military personnel after 20 years of war in Afghanistan and 10 years in Mali – a comparison

<b>Background:</b> This study compares the mental health effects of deployment on soldiers that have been deployed to Afghanistan and Mali. The psychiatric disorders among Mali veterans represent a previously unstudied area, particularly when compared to the larger and more thoroughly researched group of Afghanistan veterans. This comparison will help shed light on the unique challenges faced by soldiers deployed in Mali.<b>Aims:</b> To gain better insight, all German armed forces personnel who were deployed to Mali before 2023 are compared with the total sample that was deployed to Afghanistan. Because there were more critical incidents per deployed soldier, the cumulative incidence rates of all mental disorders are expected to be higher among Afghanistan veterans.<b>Methods:</b> All <i>N </i>= 111,157 German soldiers who were deployed to Afghanistan (<i>n </i>= 93,000; 2001-2021) or Mali (<i>n </i>= 18,157; 2013-2022) were included. According to the Central Registry, which records all soldiers with documented deployment-related mental disorders, the number for these two missions was <i>n </i>= 2,652 (Afghanistan: <i>n </i>= 2,458; Mali: <i>n </i>= 194; female: <i>n </i>= 183; 6.9%). The cumulative incidence between the two deployments was compared using χ² tests. In addition, the frequency of diagnosis among affected soldiers was compared.<b>Results:</b> The cumulative incidence of all deployment-related mental disorders was higher among Afghanistan veterans (2.6% to 1.1%; OR = 2.51, 95% CI: [2.17, 2.91]). Afghanistan veterans had a higher cumulative incidence of PTSD, anxiety disorders, affective disorders and substance abuse, with ORs ranging from 1.6 to 4.1. PTSD was more common among Afghanistan veterans, while anxiety disorders were most common among Mali veterans.<b>Conclusion:</b> Mali veterans had significantly lower cumulative incidence rates for all mental disorders, but showed a shift in frequency towards more anxiety disorders. These findings have implications for optimising mental health training before and after deployments in Mali and similar areas.