Abstract and Introduction
It is well established that many common skin diseases may result in mild to severe cosmetic disfigurement. Similarly, patients with these conditions have an increased risk for depression, anxiety, feelings of stigmatization, and self-harm ideation. There also is an increased risk for hospitalizations for mental health in patients with acne, rosacea, and hidradenitis suppurativa (HS). Cutaneous body image (CBI) is an individual's mental perception of the condition of their hair, nails, and skin. A positive CBI may be related to increased quality of life, and a negative CBI may be associated with poorer outcomes, such as insomnia, worsened overall morbidity of dermatologic disease, and intentional self-injury. For military service members who face a multitude of operational demands and who must be ready to "fight tonight," a holistic approach that addresses both physical and mental health is critical. Military dermatologists have the tools and expertise available to treat cutaneous disease, which by extension may improve body image, quality of life, and morale in military service members. Herein, we discuss how dermatologic treatments that often are thought of as nonessential cosmetic therapies can positively influence CBI and thus increase military readiness.
According to the US Department of Defense, the term readiness refers to the ability to recruit, train, deploy, and sustain military forces that will be ready to "fight tonight" and succeed in combat. Readiness is a top priority for military medicine, which functions to diagnose, treat, and rehabilitate service members so that they can return to the fight. This central concept drives programs across the military—from operational training events to the establishment of medical and dental standards. Readiness is tracked and scrutinized constantly, and although it is a shared responsibility, efforts to increase and sustain readiness often fall on support staff and military medical providers.
In recent years, there has been a greater awareness of the negative effects of mental illness, low morale, and suicidality on military readiness. In 2013, suicide accounted for 28.1% of all deaths that occurred in the US Armed Forces. Put frankly, suicide was one of the leading causes of death among military members.
The most recent Marine Corps Order regarding the Marine Corps Suicide Prevention Program stated that "suicidal behaviors are a barrier to readiness that have lasting effects on Marines and Service Members attached to Marine Commands…Families, and the Marine Corps." It goes on to say that "[e]ffective suicide prevention requires coordinated efforts within a prevention framework dedicated to promoting mental, physical, spiritual, and social fitness…[and] mitigating stressors that interfere with mission readiness." This statement supports the notion that preventing suicide is not just about treating mental illness; it also involves maximizing physical, spiritual, and social fitness. Although it is well established that various mental health disorders are associated with an increased risk for suicide, it is worth noting that, in one study, only half of individuals who died by suicide had a mental health disorder diagnosed prior to their death. These statistics translate to the military. The 2015 Department of Defense Suicide Event Report noted that only 28% of service members who died by suicide and 22% of members with attempted suicide had been documented as having sought mental health care and disclosed their potential for self-harm prior to the event.[1,4] In 2018, a study published by Ursano et al showed that 36.3% of US soldiers with a documented suicide attempt (N=9650) had no prior mental health diagnoses.
Expanding the scope to include mental health issues in general, only 29% of service members who reported experiencing a mental health problem actually sought mental health care in that same period. Overall, approximately 40% of service members with a reported perceived need for mental health care actually sought care over their entire course of service time, which raises concern for a large population of undiagnosed and undertreated mental illnesses across the military. In response to these statistics, Reger et al posited that it is "essential that suicide prevention efforts move outside the silo of mental health." The authors went on to challenge health care providers across all specialties and civilians alike to take responsibility in understanding, recognizing, and mitigating risk factors for suicide in the general population. Although treating a service member's acne or offering to stand duty for a service member who has been under a great deal of stress in their personal life may appear to be indirect ways of reducing suicide in the US military, they actually may be the most critical means of prevention in a culture that emphasizes resilience and self-reliance, where seeking help for mental health struggles could be perceived as weakness.
In this review article, we discuss the concept of cutaneous body image (CBI) and its associated outcomes on health, satisfaction, and quality of life in military service members. We then examine the intersections between common dermatologic conditions, CBI, and mental health and explore the ability and role of the military dermatologist to serve as a positive influence on military readiness.
Cutis. 2022;109(6):310-313. © 2022 Cutis