Explosive ordnance disposal personnel in the U.S. military have higher risk of insomnia and post-traumatic stress disorder: a large retrospective cohort study

Ann Epidemiol. 2021 May:57:40-45. doi: 10.1016/j.annepidem.2021.02.001. Epub 2021 Feb 11.


Purpose: We examined the risk of post-traumatic stress disorder (PTSD), affective disorders, alcohol/substance-related disorders, traumatic brain injury (TBI) and insomnia, among explosive ordnance disposal (EOD) technicians compared to the general population of active-duty non-EOD personnel in the U.S. military.

Methods: We conducted a retrospective cohort study using administrative and healthcare utilization data from fiscal year 2004 (FY2004) to FY2015 for this comparison. We used propensity score matching to balance baseline covariates, and discrete-time hazard models to compare the odds of occurrence of the outcomes.

Results: EOD personnel had higher odds of having a new diagnosis of insomnia (odds ratio [OR] = 1.33; 95% confidence interval [CI]:1.22-1.45) and PTSD (OR = 1.23; 95% CI:1.08-1.41) than did non-EOD personnel. EOD technicians had lower odds of having a new diagnosis of affective disorders (OR = 0.83; 95% CI:0.79-0.87) and alcohol/substance-related disorders (OR = 0.59; 95% CI:0.54-0.64) than did non-EOD personnel. There was little evidence of a difference in the odds of a TBI diagnosis (OR = 1.07; 95% CI:0.99-1.16).

Conclusions: As reliance on EOD forces continues, ongoing vigilance of the stressors, health sequelae and disincentives to access mental health care among this military occupation should be monitored and mitigated wherever possible.

Keywords: Explosive ordnance disposal; Insomnia; Military; Post-traumatic stress disorder; Traumatic brain injury.

MeSH terms

  • Explosive Agents*
  • Humans
  • Military Personnel*
  • Occupations
  • Retrospective Studies
  • Sleep Initiation and Maintenance Disorders* / epidemiology
  • Stress Disorders, Post-Traumatic* / epidemiology


  • Explosive Agents