Lesson of the week: Post-traumatic stress disorder following military combat or peace keeping

Health Status and Clinical Diagnoses of 3000 UK Gulf War Veterans

Up to June 2001, 3000 British veterans of the Gulf War had sought advice from a special medical assessment programme established because of an alleged Gulf War syndrome. After assessment those attending were classified as completely well, well with symptoms, well with incidental diagnoses treated or controlled, or unwell (physically or mentally). Mental illness was confirmed by a psychiatrist. The first 2000 attenders have been reported previously. The present paper summarizes findings in all 3000.

2252 (75%) of those attending were judged ‘well’, of whom 303 were symptom-free. Medical diagnoses were those to be expected in such an age-group (mean age 34 years, range 21–63). No novel or unusual condition was found. In 604 of the 748 unwell veterans, a substantial element of the illness was psychiatric, the most common condition being post-traumatic stress disorder.

The healthcare requirements of the Gulf veterans seen in this programme can therefore be met by standard National Health Service provision.

A literature review of medical aspects of post-cold war UN peacekeeping operations: trends, lessons learnt, courses of action and recommendations

OBJECTIVE

Post-Cold War United Nations Peace Keeping Operations (UN PKOs) have been increasingly involved in dangerous areas with ill-defined boundaries, harsh and remote geographies, simmering internecine armed conflict and disregard on the part of some local parties for peacekeepers' security and role. In the interest of 'force protection' and optimising operations, a key component of UN PKOs is healthcare and medical treatment. The expectation is that UN PKO medical support will conform to the general intent and structure of UN PKOs. To do so requires effective policies and planning informed by a review of medical aspects crucial to UN PKOs. The intent of this article is to report on a review of principal medical aspects practical to post-Cold War UN PKOs.

METHODS

This review was assembled through a comprehensive, grounded, systematic iterative inquiry of open-source articles.

RESULTS

This inquiry revealed that the principal medical aspects in post-Cold War UN missions were the following: (1) the changed nature of UN PKOs, (2) new challenges in terms of proximity and distance to medical care, (3) expanded need for preventive medicine and disease contagion prevention and (4) increased propensity for psychological morbidity and need for intervention.

CONCLUSIONS

Post Cold War, the dramatically changed nature of UN PKOs has resulted in new challenges mainly in terms of medical logistics, preventive medicine and psychiatry. The changed nature of post-Cold War UN PKOs altered the character of medical support most notably regarding (1) a need for emphasis on immediate response proximate to medical events and rapid transport over long distances and traversing barriers to higher levels of care, (2) proactive contagion and hazard identification and prevention and (3) interventions designed to reduce psychological morbidity. Recommendations are offered about possible courses of action in terms of addressing trends found in identified medical aspects of PKOs.

Mental and physical health status and alcohol and drug use following return from deployment to Iraq or Afghanistan

OBJECTIVES

We examined (1) mental and physical health symptoms and functioning in US veterans within 1 year of returning from deployment, and (2) differences by gender, service component (Active, National Guard, other Reserve), service branch (Army, Navy, Air Force, Marines), and deployment operation (Operation Enduring Freedom/Operation Iraqi Freedom [OEF/OIF]).

METHODS

We surveyed a national sample of 596 OEF/OIF veterans, oversampling women to make up 50% of the total, and National Guard and Reserve components to each make up 25%. Weights were applied to account for stratification and nonresponse bias.

RESULTS

Mental health functioning was significantly worse compared with the general population; 13.9% screened positive for probable posttraumatic stress disorder, 39% for probable alcohol abuse, and 3% for probable drug abuse. Men reported more alcohol and drug use than did women, but there were no gender differences in posttraumatic stress disorder or other mental health domains. OIF veterans reported more depression or functioning problems and alcohol and drug use than did OEF veterans. Army and Marine veterans reported worse mental and physical health than did Air Force or Navy veterans.

CONCLUSIONS

Continuing identification of veterans at risk for mental health and substance use problems is important for evidence-based interventions intended to increase resilience and enhance treatment.

Quality of life in Croatian Homeland war (1991-1995) veterans who suffer from post-traumatic stress disorder and chronic pain

BACKGROUND

The aim of this study was to investigate the quality of life in Croatian homeland war veterans who suffer from post-traumatic stress disorder and chronic low back pain (LBP).

METHODS

A total of 369 participants were included, classified in four study groups: those with post-traumatic stress disorder (PTSD; N = 59), those with both PTSD and lower back pain (PTSD+LBP; N = 80), those with isolated LBP (N = 95) and controls (N = 135). WHOQOL-BREF survey was used in the estimation of quality of life. The data were analysed using statistical methods and hierarchical clustering.

RESULTS

The results indicated a general pattern of lowering quality of life in participants with both psychological (PTSD) and physical (LBP) burden. The average overall quality of life was 2.82 ± 1.14 for the PTSD+LBP group, 3.29 ± 1.28 for the PTSD group, 4.04 ± 1.25 for the LBP group and 4.48 ± 0.80 for the controls (notably, all the pair-wise comparisons were significantly different at the level of P < 0.001, except for the pair LBP-controls, which was insignificant). This result indicated that quality of life was reduced for 9.9% in patients with LBP, 26.6% in patients with PTSD and 37.1% in PTSD+LBP, suggesting strong synergistic effect of PTSD and LBP. The analysis also identified several clusters of participants with different pattern of quality of life related outcomes, reflecting the complex nature of this indicator.

CONCLUSIONS

The results of this study reiterate strong impact of PTSD on quality of life, which is additionally reduced if the patient also suffers from LBP. PTSD remains a substantial problem in Croatia, nearly two decades after the beginning of the 1991-1996 Homeland war.

Posttraumatic stress disorder in peacekeepers: a meta-analysis

A meta-analysis was conducted to estimate the prevalence of posttraumatic stress disorder (PTSD) among peacekeepers. A systematic review was carried out using Medline, Institute for Scientific Information/Web of Science and Published International Literature on Traumatic Stress databases, leading to a total of 12 studies reporting PTSD estimates. Pooled current PTSD prevalence was 5.3%, ranging from 0.05% to 25.8%, and a metaregression was used to investigate the variables that could account for the lack of homogeneity. However, none of the extracted information was capable of explaining the heterogeneity of the estimates. Peacekeeping studies presented different methodologies such as several screening instruments and different times from the deployment to the moment of PTSD assessment. The wide difference found among those estimates highlights the importance of the creation of standards for PTSD evaluation among peacekeepers.

Assessing the mental health consequences of military combat in Iraq and Afghanistan: a literature review

The aim of this paper was to explore how a military career may affect the mental health of serving and ex-service personnel, to identify the accessibility and helpfulness of support (both during and after military service) and to make recommendations for change. A literature search was undertaken using the MetaFind meta search engine with keywords: mental health, psychological health, emotional health, soldier, British army, army, ex-army, military, military personnel, armed forces, resettlement, impact, family relationship, divorce, health, support services. The search was applied to the following databases: EBSCO Host, CINAHL, Cochrane Library, Ingenta Connect, Medline, PsyArticles, PubMed, Web of Knowledge, together with the specific journals American Journal of Psychiatry, British Journal of Psychiatry and ProQuest Nursing journals. 110 relevant publications were identified and from these 61 papers were retrieved for further analysis. Poor mental health is associated with increased risk of social exclusion on leaving the services, which further exacerbates mental health problems. An increasing number of ex-service personnel are expected to develop stress-related mental health problems in the future.

Forever changed: posttraumatic stress disorder in female military veterans, a case report

PURPOSE. This paper examines the experience of posttraumatic stress disorder (PTSD) in a female veteran of Operation Iraqi Freedom, including the barriers to treatment she encountered in an outpatient psychiatry clinic. DESIGN AND METHODS. Case report data were obtained through review of records and interviews with a veteran combat nurse diagnosed with chronic PTSD. CONCLUSIONS. Sex differences in PTSD are controversial, but PTSD in female military veterans is a significant problem. Gender may complicate diagnosis and treatment. This case report discusses these issues and invites further research. PRACTICE IMPLICATIONS. Advanced practice psychiatric nurses increasingly will see female veterans with PTSD in their practices.

Health status and clinical diagnoses of 3000 UK Gulf War veterans

Up to June 2001, 3000 British veterans of the Gulf War had sought advice from a special medical assessment programme established because of an alleged Gulf War syndrome. After assessment those attending were classified as completely well, well with symptoms, well with incidental diagnoses treated or controlled, or unwell (physically or mentally). Mental illness was confirmed by a psychiatrist. The first 2000 attenders have been reported previously. The present paper summarizes findings in all 3000. 2252 (75%) of those attending were judged "well", of whom 303 were symptom-free. Medical diagnoses were those to be expected in such an age-group (mean age 34 years, range 21-63). No novel or unusual condition was found. In 604 of the 748 unwell veterans, a substantial element of the illness was psychiatric, the most common condition being post-traumatic stress disorder. The healthcare requirements of the Gulf veterans seen in this programme can therefore be met by standard National Health Service provision.