Physical, psychological and demographic factors associated with military discharge: a systematic review

Fidelis, Gabriel Luis Moreira; Miranda, Maria Elisa Koppke; Bunn, Priscila dos Santos

doi:10.1590/S1980-65742021004820

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Motriz: Revista de Educação Física

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Sumário

Mini-Review or Systematic Review • Motriz: rev. educ. fis. 27 • 2021 • https://doi.org/10.1590/S1980-65742021004820 copy

Physical, psychological and demographic factors associated with military discharge: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Aims:

The present study is a review focused on analyzing the physical, psychological, and demographic factors that lead recruits to be dismissed or to request their dismissal during basic military training periods.

Methods:

This study is a systematic review of cohort studies. The following databases were searched in June 2019 and updated in July 2020: Embase, LILACS, CINAHL, Cochrane, MEDLINE, SCOPUS, SPORTDiscus, Web of Science, and Science Direct databases. The MeSH descriptors military personnel, risk factors, and discharge were used to elaborate the search equations. Reference lists were explored to find studies that examined the association between physical, psychological, and demographic factors that lead recruits to be discharged. The following data were extracted from the studies: profile of the participants, sample size, type of risk factors, the duration of follow-up, and the results of the statistical analysis carried out in the studies included. The risk of bias was analyzed with the Newcastle-Ottawa Scale for cohort studies.

Results:

A total of 531 titles were retrieved from the databases, and eight articles met the eligibility criteria. The results showed the factors associated with discharge, in descending order: musculoskeletal injuries and other medical questions, depressive and behavioural disorders, performance in physical fitness tests, and others. Factors such as educational level, alcohol use, history of suicide attempt, and imprisonments were not associated with an increased risk of being discharged.

Conclusion:

Musculoskeletal injuries, depression, running performance, previous physical exercise practice, and demographic factors were associated with an increased risk of being discharged.

Keywords
military personnel; risk factors; discharge

Database	Search phrase
MEDLINE	(((((((((((((risk factor)[Title/Abstract] OR risk factors)[Title/Abstract] OR population at risk)[Title/Abstract] OR risk, population at)[Title/Abstract] OR populations at risk)[Title/Abstract] OR risk, populations at)[Title/Abstract] OR factors, risk)[Title/Abstract] OR factors risk))[Title/Abstract] OR factor)[Title/Abstract] OR factors[Title/Abstract])) AND ((((marines)[Title/Abstract] OR soldier)[Title/Abstract] OR soldiers)[Title/Abstract] OR marine[Title/Abstract])) AND ((attrition)[Title/Abstract] OR discharge[Title/Abstract])
LILACS	marine or marines or soldier or soldiers [Palavras] and attrition or discharge [Palavras]
Science Direct	(marine or soldier) AND (Attrition or discharge) AND factor
SCOPUS	(TITLE-ABS-KEY (“Risk factor” OR “Factor, Risk” OR “Factors, Risk” OR “Population at Risk”)) AND (TITLE-ABS-KEY (“attrition” OR “discharge”)) AND (TITLE-ABS-KEY (“Marines” OR “Soldier” OR “Soldiers”))
Cochrane	marine or marines or soldier or soldiers in Title Abstract Keyword AND attrition or discharge in Title Abstract Keyword - (Word variations have been searched)
SPORTDiscus	AB (“risk factor” OR “risk factors” OR “population at risk” OR “populations at risk” OR “factors risk” OR factor OR factors”) AND AB (marines OR soldier OR soldiers OR marine) AND AB (attrition OR discharge)
CINAHL	AB (“risk factor” OR “risk factors” OR “population at risk” OR “populations at risk” OR “factors risk” OR factor OR factors”) AND AB (marines OR soldier OR soldiers OR marine OR military) AND AB (attrition OR discharge)
Web of Science	TíTULO: (“risk factor” OR “risk factors” OR “population at risk” OR “populations at risk” OR “factors risk” OR factor OR factors) AND TíTULO: (marines OR soldier OR soldiers OR marine OR military OR “military personnel”) AND TíTULO: (attrition OR discharge) Tempo estipulado: Todos os anos. índices: SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI.
Embase	(‘risk factor’:ab,ti OR ‘risk factors’:ab,ti OR ‘population at risk’:ab,ti OR ‘populations at risk’:ab,ti OR ‘factors risk’:ab,ti) AND (marines:ab,ti OR soldier:ab,ti OR soldiers:ab,ti OR marine:ab,ti) AND (attrition:ab,ti OR discharge:ab,ti)

Author	Sample	Risk factor	Results	Follow-up
Reis et al. (2007)	n = 2,137 recruits the body of US Marines	Physical characteristics, socio data - demographic, history of physical exercise and injuries	Stress fracture during training, age> 23 years, not a Hispanic race, poor self-reported physical fitness without competitive exercise history, and previous injury in the lower limbs were associated with a higher risk of discharge (P <0.05).	12 weeks
Chang et al. (2008)	n = 1,912 recruits Taiwanese	Mental disorders	Depressive disorders such as major depression, mental failure, type II bipolar depression, and personality disorders were associated with a greater number of lower (P <0.05).	12 months
Pope et al. (1999)	n = 1,317 Australian recruits	2 miles run performance or injury.	A multivariate analysis was performed. Age was not associated with a greater number of casualties. Recruits who have suffered an injury and the worst-performing Yo-Yo test were considered at high risk of attrition.	12 weeks
Swedler et al. (2011)	n = 4,005 Recruits US Army	Psychosocial and historical factors of physical activity.	Women had a higher risk than men with HR = 2.76 (95%CI = 2.04-3.74) of attrition. There were factors associated with both sexes (divorced marital status or separated, and failure on bar fitness test), for females (age, Caucasian ethnicity, and BMI between 25 and 29 kg/m²2. Knapik JJ, Canham-Chervak M, Hauret K, Hoedebecke E, Laurin MJ, Cuthie J. Discharges during U.S. Army basic training: Injury rates and risk factors. Mil Med [Internet]. 2001;166(7):641-7.) and males (lower injuries and poor historical of exercise).	2 months
Larsson et al. (2009)	n = 469 Army military Swedish	Injuries and psychosocial factors	Recruits who reported injuries early in the course were more associated with discharge. 56% of which were lower were considered physically inactive in the period prior to enrollment. The habit of smoking significantly was more present in the case of discharge.	12 months
Talcott et al. (1999)	n = 32,144 recruits of the US Air Force.	Medical and psychological reasons	The most associated with discharge factors were, in descending order: medical reasons, followed by psychological or behavioral, administrative or legal reasons, and last underperforming.	12 months
Elbogen et al. (2018)	n = 1,172 Iraq/Afghanistan-era veterans were evaluated between 2005 and 2016	Demographic, military, historic, clinical, and situational characteristics from veterans discharged under honorable conditions	Factors associated with discharge: Older age - reduced odds of discharge (0.95; P=0,046); Higher level of education - reduced odds of discharge (OR=0.95; P=0,053); Family history of depression (OR=2.18; P=0,03) or drug abuse (OR=2.16; P=0,034), living status and community function (OR = 0.99, P=0,042), unmarried status (0.43; P=0,032) and report of past incarceration (OR=4.25 e P= 0,0001). Sleep problems (OR=0.46; P=0,019). Factors without association with discharge: factors in the domains of trauma and military history, gender, race, education, alcohol, attempt of suicide, prison, and other health/psychiatric problems.	–
Wunderlin et al. (2015)	n = 230 male recruits in a Swiss Anny fusilier company	Global trunk muscle strength (TMS) and sit-up tests	AUC = 0.60 and P=0.11 (TMS) and AUC = 0.50 and P=1.00 (sit-up)	13 weeks

Author	1	2	3	4	5	6	7	8	9	Score	Risk
Reis et al. (30)	*	*	*	*	*	*		*	*	8	Low
Chang et al. (7)	*		*	*	*	*		*	*	7	Low
Pope et al. (11)	*	*	*	*	*			*	*	7	Low
Swedler et al. (34)	*	*	*	*	*	*			*	7	Low
Larsson et al. (21)	*	*	*	*	*	*		*	*	8	Low
Talcott et al. (8)	*	*		*	*	*		*	*	7	Low
Elbogen et al. (10)	*	*	*	*	*	*	*		*	8	Low
Wunderlin et al. (27)		*		*			*	*	*	5	Uncertain

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[1] Associate Editor: Romulo A Fernandes, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Presidente Prudente, SP, Brazil.