The Operational Mental Health Consequences of Deployment to Iraq For UK Forces

The health consequences of civil wars: evidence from Afghanistan

This study examines the effects of long-run civil wars on healthcare, which is an important component of human capital development and their causality nexus in Afghanistan using the MVAR (modified vector autoregressive) approach and the Granger non-causality model covering data period 2002Q3-2020Q4. The primary results support a significant long-run relationship between variables, while the results of the MVAR model indicate the per capita cost of war, per capita GDP, and age dependency ratio have significantly positive impacts on per capita health expenditures, whereas child mortality rate and crude death rate have negative impacts. The results of the Granger non-causality approach demonstrate that there is a statistically significant bidirectional causality nexus between per capita health expenditure, per capita cost of war, per capita GDP, child mortality rate, crude death rate, and age dependency ratio, while it also supports the existence of strong and significant interconnectivity and multidimensionality between per capita cost of war and per capita health expenditure, with a significantly strong feedback response from the control variables. Important policy implications sourced from the key findings are also discussed.

The impact of military service on health and well-being

Background

While it is known that some UK Armed Forces (UK AF) personnel and veterans experience physical and mental health problems, the possible future healthcare needs of military veterans are unknown.

Aims

To estimate the number of military personnel who may experience physical and/or psychological health problems associated with their military service.

Methods

Data were obtained via Freedom of Information requests to several sources, including Defence Statistics. Raw data from research studies were also used where available. Data were analysed using meta-analytic methods to determine the rate of physical, mental or comorbid health problems in AF personnel.

Results

Musculoskeletal problems were the predominant reason for medical discharge from service. In terms of mental health, meta-analyses estimated that veteran reservists (part-time military members) previously deployed to operational areas had the highest proportion of general health problems (35%), previously deployed veteran regulars (those in full time military employment) and veteran reservists had the highest proportion of post-traumatic stress disorder (9%), and regular personnel with a deployment history had the highest proportion of alcohol problems (14%). Overall, our findings suggest that at least 67515 veterans are likely to suffer from mental and/or physical health problems at some point as a result of their service between 2001 and 2014.

Conclusions

The results of this study highlight that the difficulties personnel may face are largely musculoskeletal or mental health-related. These findings may help with planning the provision of future physical and mental health care and support for those who serve in the UK AF.

Human Performance Optimization: Culture Change and Paradigm Shift

The term "Human Performance Optimization" (HPO) emerged across the Department of Defense (DoD) around 2006 when the importance of human performance for military success on the battlefield was acknowledged. Likewise, the term Total Force Fitness (TFF) arose as a conceptual framework within DoD in response to the need for a more holistic approach to the unparalleled operational demands with multiple deployments and strains on the United States Armed Forces. Both HPO and TFF are frameworks for enhancing and sustaining the health, well-being, and performance among our warriors and their families; they are fundamental to accomplishing our nation's mission. A demands-resources model for HPO is presented within the context of TFF to assist in operationalizing actions to enhance performance. In addition, the role leaders can serve is discussed; leaders are uniquely postured in the military chain of command to directly influence a culture of fitness for a ready force, and promote the concept that service members are ultimately responsible for their fitness and performance.

Rest and recuperation in the UK Armed Forces

BACKGROUND

Recent epidemiological evidence suggests that military personnel commonly remain psychologically resilient in the face of adversity they face on deployment. However, the processes that promote resilience have not been well assessed within the UK military. For many years, the UK Armed Forces have operated a policy of rest and recuperation (R&R), which refers to the brief period during which troops return home when on an operational tour of duty. While R&R is thought to play an import ant role in promoting recovery and well-being, there is as yet no empirical evidence to support its effectiveness.

AIMS

To explore whether R&R promotes well-being and recovery from the strains of deployment in military personnel.

METHODS

Participants completed self-report measures of mental health and exposure to potentially traumatic events (PTEs), as well as an R&R Recovery Questionnaire (R&RRQ).

RESULTS

Statistical analysis indicated that the R&RRQ was a reliable measure within the sample of 97 subjects. Participants who reported recovery following R&R reported fewer symptoms of mental health difficulties. However, increased deployment exposure to PTEs was associated with feeling less recovered at the end of R&R.

CONCLUSIONS

These preliminary data suggest that R&R can be useful for troops if they can use the time to recover. This study's results are relevant to policymakers and leaders in the military and other groups placed in challenging environments but more work is needed to understand how R&R works and to maximize its capacity to promote well-being among military personnel.

The Australian Defence Force Mental Health Prevalence and Wellbeing Study: design and methods

BACKGROUND

The Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study (MHPWS) is the first study of mental disorder prevalence in an entire military population.

OBJECTIVE

The MHPWS aims to establish mental disorder prevalence, refine current ADF mental health screening methods, and identify specific occupational factors that influence mental health. This paper describes the design, sampling strategies, and methodology used in this study.

METHOD

At Phase 1, approximately half of all regular Navy, Army, and Air Force personnel (n=24,481) completed self-report questionnaires. At Phase 2, a stratified sub-sample (n=1,798) completed a structured diagnostic interview to detect mental disorder. Based on data from non-responders, data were weighted to represent the entire ADF population (n=50,049).

RESULTS

One in five ADF members met criteria for a 12-month mental disorder (22%). The most common disorder category was anxiety disorders (14.8%), followed by affective (9.5%) and alcohol disorders (5.2%). At risk ADF sub-groups were Army personnel, and those in the lower ranks. Deployment status did not have an impact on mental disorder rates.

CONCLUSION

This study has important implications for mental health service delivery for Australian and international military personnel as well as contemporary veterans.

Military mental health professionals on operational deployment: an exploratory study

This exploratory study aimed to develop greater insight into the occupational and personal nature of the practice of mental healthcare on operational deployments. Twenty-eight British military mental health professionals were identified as having recently returned from deployment, with 35% agreeing to participate in semi-structured qualitative interviews. Results suggest that whilst this population have a range of stressors, their main concern is to work towards the success of the overall mission objectives, mainly through achieving their clinical goals. Such work is impacted by challenges such as ethical difficulties, professional obstacles, bonding with colleagues and personal issues. They do however rely upon a range of intra and inter-personal strategies to overcome these hurdles successfully. A number of suggestions for improved mental healthcare on deployment are also identified. A review of the implications of the findings is offered and recommendations for improved training and support for mental healthcare professionals are explored. Finally, potential avenues for future research are considered.

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.