Behavioral health status after globe removal in United States service members

Abstract: PURPOSE: To describe the incidence of new behavioral health (BH) diagnoses in patients who underwent globe removal (GR) in the Military Health System (MHS). DESIGN: Retrospective cohort study. PARTICIPANTS: Active-duty service members (SMs) who underwent GR or were diagnosed with a BH diagnosis between 2017 and 2022 in the MHS system. METHODS: This retrospective study queried the MHS Mart (M2) database for patients who underwent GR secondary to trauma between 2017 and 2022. A multivariate Poisson regression model, adjusted for age and sex, was used to calculate the relative risk (RR) of new BH diagnoses in patients who underwent GR compared with those who did not. Patients with a BH diagnosis before GR were excluded from this analysis. MAIN OUTCOME MEASURES: Probability of developing a new BH condition after GR compared with non-GR individuals. RESULTS: There were 901 595 SM patients with a BH diagnosis between 2017 and 2022, and 103 patients had a history of GR secondary to globe trauma. Among the GR group, 29 patients had a prior BH diagnosis and 27 patients had a new BH diagnosis post-GR. Compared with the population who did not receive GR, the estimated RR (95% confidence interval) for patients with a new BH diagnosis post-GR were as follows: suicide or suicidal ideation 47.2 (7.9-145.8), alcohol use disorder 17.3 (7.5-33.5), anxiety 12.8 (6.86-21.5), adjustment disorder 10.5 (5.9-17.0), substance use disorder 5.29 (1.64-12.3), and depression 8.0 (3.2-16.1). The number of lag days was shorter for patients who were diagnosed with a new BH condition after GR (median = 49 days) compared with those who were diagnosed with a BH condition before GR (median = 351 days). Because of the rare events of GR, there were substantial limitations in the calculation of estimated RR. CONCLUSIONS: This study suggests that patients undergoing GR are at an increased risk for developing a new BH diagnosis, with higher rates of suicide or suicidal ideation, substance disorders, and other mental health conditions compared with the non-GR population. Early BH screening is crucial for these patients.