Mental health advisory teams: a proactive examination of mental health during combat deployments

Mental health advisory teams (MHATs) conduct comprehensive mental health surveillance of US service members in combat environments. Since 2003, six teams have deployed to Iraq and four have deployed to Afghanistan, and results have played a key role influencing behavioural health policy. The repeated deployments of the teams have provided opportunities for processes to be refined, and this refinement has led to a scientifically rigorous and replicable approach. In this article we focus on two themes. The first theme is how changes in sampling have influenced the nature of the inferences drawn from the survey-based surveillance data. The second theme is how the ability to utilize different forms of data has served to strengthen the programme. Focusing on these two themes provides a way to discuss key findings, recommendations and limitations while also interspersing practical observations intended to help inform the design of broad-scale, in-theatre mental health surveillance efforts. We believe that future surveillance efforts should build on the lessons of the MHATs and attempt to replicate the more rigorous sampling methods; nonetheless, we also strive to convey that large surveillance efforts are valuable even if they cannot be executed with random sampling.

Family resilience and the fortunes of war

Military families have been a subject of concern due to increasing divorce rates and child maltreatment that have been directly linked to the number and length of combat deployments. In contrast many military families show positive resilience in the wake of multiple deployments. This article looks at several special situations where military families are faced with serious challenges after deployment: soldiers returning with post-traumatic stress disorder, soldiers receiving serious injuries, and those killed in action. McCubbin's Family Resilience Model is applied as a theoretical tool for understanding not only the stressors military families face, but other factors that buffer stress and assist in problem solving and coping.

Mental health of UK military personnel while on deployment in Iraq

BACKGROUND

Most research on the mental health of UK armed forces personnel has been conducted either before or after deployment; there is scant evidence concerning personnel while they are on deployment.

AIMS

To assess the mental health of UK armed forces personnel deployed in Iraq and identify gaps in the provision of support on operations.

METHOD

Personnel completed a questionnaire about their deployment experiences and health status. Primary outcomes were psychological distress (General Health Questionnaire-12, GHQ-12), symptoms of post-traumatic stress disorder (PTSD) and self-rating of overall health.

RESULTS

Of 611 participants, 20.5% scored above the cut-off on the GHQ-12 and 3.4% scored as having probable PTSD. Higher risk of psychological distress was associated with younger age, female gender, weaker unit cohesion, poorer perceived leadership and non-receipt of a pre-deployment stress brief. Perceived threat to life, poorer perceived leadership and non-receipt of a stress brief were risk factors for symptoms of PTSD. Better self-rated overall health was associated with being a commissioned officer, stronger unit cohesion and having taken a period of rest and recuperation. Personnel who reported sick for any reason during deployment were more likely to report psychological symptoms. Around 11% reported currently being interested in receiving help for a psychological problem.

CONCLUSIONS

In an established operational theatre the prevalence of common psychopathology was similar to rates found in non-deployed military samples. However, there remains scope for further improving in-theatre support mechanisms, raising awareness of the link between reporting sick and mental health and ensuring implementation of current policy to deliver pre-deployment stress briefs.

Mental health among commando, airborne and other UK infantry personnel

BACKGROUND

Despite having high levels of combat exposure, commando and airborne forces may be at less risk of mental ill-health than other troops.

AIMS

To examine differences in mental health outcomes and occupational risk factors between Royal Marines Commandos (RMCs), paratroopers (PARAs) and other army infantry (INF).

METHODS

Three groups of personnel (275 RMCs, 202 PARAs and 572 INF) were generated from a UK military cohort study of personnel serving at the time of the 2003 Iraq war. Participants completed a questionnaire about their mental health and experiences on deployment. Differences in mental health outcomes between the groups were examined with logistic regression and negative binomial regression analyses.

RESULTS

Both RMCs and PARAs were less likely to have multiple physical symptoms or to be fatigued, and RMCs also had lower levels of general mental health problems and lower scores on the Post-traumatic Checklist than INF personnel. Differences were not explained by the level of unit cohesion.

CONCLUSIONS

The effect of warfare on troops' well-being is not universal across occupational groups. A possible explanation for this difference is that the high level of preparedness in RMCs and PARAs may lessen the psychological impact of war-zone deployment experiences.

PTSD after deployment to Iraq: conflicting rates, conflicting claims

BACKGROUND

Post-traumatic stress disorder (PTSD) has been called one of the signature injuries of the Iraq War. In this review prevalence estimates of PTSD are summarized and discrepancies are discussed in relation to methodological differences between studies.

METHOD

We searched for population-based studies with a minimum sample size of 300. Studies based on help-seeking samples were excluded. We identified 60 possible papers, of which 19 fulfilled the inclusion criteria. Prevalence estimates and study characteristics were examined graphically with forest plots, but because of high levels of heterogeneity between studies, overall estimates of PTSD prevalence were not discussed.

RESULTS

The prevalence of PTSD in personnel deployed to Iraq varied between 1.4% and 31%. Stratifying studies by PTSD measure only slightly reduced the variability in prevalence. Anonymous surveys of line infantry units reported higher levels of PTSD compared to studies that are representative of the entire deployed population. UK studies tend to report lower prevalence of PTSD compared with many US studies; however, when comparisons are restricted to studies with random samples, prevalences are similar. US studies that have assessed personnel more than once since return from deployment have shown that PTSD prevalence increases over the 12 months following deployment.

CONCLUSIONS

Differences in methodologies and samples used should be considered when making comparisons of PTSD prevalence between studies. Further studies based on longitudinal samples are needed to understand how the prevalence of PTSD changes over time.