The long-term mental health impact of peacekeeping: prevalence and predictors of psychiatric disorder

Post-traumatic stress disorder in peacekeepers: a systematic literature review and meta-analysis

Background: In peacekeeping operations, soldiers are often exposed to the same traumatic factors as in conventional war and may also be subject to physical risks and psychological stressors associated with post-traumatic stress disorder (PTSD). According to the Conservation of Resources Theory (COR), PTSD stems from resource depletion and inadequate restoration.Objectives: To discuss and meta-analyse PTSD-related factors among peacekeepers, based on the COR theory, framing them as resources or loss/threat of loss of resources.Methods: A systematic literature search was performed with relevant keywords, 51 articles were reviewed and 21 of them meta-analysed.Results: Factors mentioned in prior reviews, reinforced by ours, include: family/community and military support as resources; single marital status, female gender, serving in infantry, and longer time since deployment as lack of resources. Factors mentioned in prior reviews, confirmed by our meta-analysis, include: education, rank, and problem-focused coping as resources; negative perceptions about deployment, combat/trauma exposure, deployment stressors, and deployment duration as lack of resources. Factors overlooked in prior reviews include: age as a resource; negative life events, and negative social interactions as lack of resources. Comorbidities include: physical health problems, post-deployment impact on functioning, and post-deployment psychopathology (e.g., depression, substance use).Conclusions: Significantly more individual than contextual factors were identified. While some factors inherent to missions (e.g., combat exposure, deployment stressors) cannot be mitigated, others are crucial to prevent peacekeepers' PTSD (e.g., coping strategies, deployment duration, perceptions about deployment, social interactions, support during deployment) and to inform selection and monitoring by the Armed Forces (e.g., pre-, during and post-deployment psychopathology). However, the findings should be interpreted with caution due to limitations (e.g., publication bias, study heterogeneity) that may have affected the generalizability and strength of the recommendations.

Healthy Warrior Effect With Deployment to United Nations Peacekeeping Operation: A Longitudinal Study Among Japan Ground Self-Defense Forces

INTRODUCTION

The "healthy warrior effect" (HWE), in which deployed military personnel are healthier than those not deployed, is known to be associated with deployment. However, the HWE associated with deployment to United Nations (UN) peacekeeping operations (PKO) has not been examined. This study examined the HWE associated with deployment to UN PKO by examining the impact of pre-deployment mental health on the likelihood of deployment and whether this difference persisted after deployment.

MATERIALS AND METHODS

This retrospective cohort study included 2,712 Japan Ground Self-Defense Forces personnel from four engineering units who consented to participate in annual mental health checks conducted between August and October 2015. The Kessler Psychological Distress Scale (K6) was used to assess general psychological distress before and after deployment. Logistic regression analysis adjusted for age, sex, and rank was conducted with deployment as the dependent variable and the pre-deployment K6 total score as the independent variable. Additionally, a mixed-effects model was performed with K6 total scores as the dependent variable, time and deployment as fixed effect factors, and the individual as the random effect factor.

RESULTS

Of the participants, 254 were in the deployed group, and 2,458 were in the non-deployed group. The pre-deployment K6 total score was significantly lower (t = 5.2, P < .001) for the deployed group (0.67 ± 1.60) than for the non-deployed group (1.26 ± 2.41). Logistic regression analysis showed an odds ratio for the K6 total score before deployment as 0.87 (95% CI = 0.79-0.94). The mixed-effects model exhibited a significant negative main effect of being deployed (t = -5.1, P < .001) and a significant interaction effect between time and being deployed (t = -2.5, P = .012).

CONCLUSIONS

Psychologically healthier personnel were more likely to be deployed for UN PKO and their better mental health status persisted after deployment, reflecting the HWE. However, personnel in good health may develop new mental health issues after their deployment, and more attention to health management will be essential before and after deployment.

Post-traumatic stress disorder among military personnel admitted at the Northwest Command Level Three Military Hospital, Bahir Dar, Ethiopia, 2022: an institution-based cross-sectional study

Background

Post-traumatic stress disorder (PTSD) is one of the most common mental health problems that military personnel encounter. It could be lifelong and affect every aspect of military personnel, including their mental and physical health, family and social interactions, and their work. However, in Ethiopia, the magnitude and its associated factors have not been well investigated.

Objective

This study aimed to determine the prevalence of PTSD and its associated factors among military personnel, who were admitted at the Northwest Command Level Three Military Hospital, Bahir Dar, Northwest, Ethiopia, 2022.

Methods

An institution-based cross-sectional study was conducted from 21 June to 21 July 2022, at the Northwest Command Level Three Military Hospital. A computer-generated simple random sampling technique was used to select a total of 627 participants. The 17-item Military Version Checklist was utilized to measure PTSD. The Patient Health Questionnaire, Brief Resilience Coping, and Critical War Zone Experience scale were utilized to measure depression, resilience, and combat exposure, respectively. Descriptive, bivariate, and multivariate binary logistic regressions with odds ratios and a 95% confidence interval were used. The level of significance of the association was determined at a p-value < 0.05.

Results

A total of 612 respondents participated, with a response rate of 97.6%. The prevalence of PTSD in this study was 21.9% (95% CI: 18.6, 25.2). In multivariable regression, female sex [adjusted odds ratio (AOR) = 2.3, 95% CI; 1.3, 3.87], combat personnel (AOR = 2.75, 95% CI; 1.44, 6.36), handling dead bodies (AOR = 2.5, 95% CI,1.24, 5.02), having 4-5 deployments (AOR = 2.94, 95% CI, 1.63, 5.32), having ≥6 deployments (AOR = 3.4, 95% CI, 1.95, 6.17), low resilience coping (AOR = 2.02, 95% CI; 1.16, 3.53), poor social support (AOR = 2.46, 95% CI, 1.39, 4.35), very high combat exposures (AOR = 4.8, 95% CI, 2.03, 11.93), and depression (AOR = 2.8, 95% CI, 1.68, 4.67) were significantly associated with PTSD.

Conclusion

PTSD is markedly prevalent among the Ethiopian military population, with key risk factors identified as being female, poor social support, low resilience coping skills, handling dead bodies, multiple deployments (four or more), high combat experiences, and depression. Healthcare professionals must prioritize the early diagnosis and intervention of PTSD in vulnerable groups of military personnel.

Suicide and suicidality in Australian Defence Force veterans: A systematic scoping review

OBJECTIVE

Increased suicidality and suicide deaths among veterans of the Australian Defence Force have gained recent prominence. A systematic scoping review was conducted to identify, summarise and synthesise the existing literature relating to Australian veteran suicide and suicidality, with the objective of identifying future research priorities.

METHODS

We conducted a PRISMA-compliant systematic search on PubMed/MEDLINE, Embase and CINAHL databases for all manuscripts reporting primary data on suicide and suicidality in Australian veterans. The search was supplemented by grey literature and a search of reference lists. Manuscripts of any study type, published in the English language since the Vietnam era, were eligible for inclusion.

RESULTS

A total of 26 articles and reports, utilising a variety of mostly quantitative approaches, were included in the review. Findings, especially in larger and more recent studies, indicate increased suicidality in the veteran population. Suicide deaths appeared to increase with transition out of the military. Mental illness was identified as an important risk factor for suicide and suicidality. Current service was identified as a protective factor against suicide. There was mixed evidence regarding the impact of operational deployment on suicide and suicidality.

CONCLUSIONS

Gaps were identified in relation to the relative contributions to risk from transition, the various psychosocial correlates (for example, relationships, finances, employment), pre-service factors and the extent to which these are causal or mediating in nature. A better understanding of health service utilisation would also aid in targeting preventive efforts. Future research in these areas is warranted.

Symptoms of Posttraumatic Stress Disorder Among Japanese Peacekeepers Deployed in South Sudan

Importance

Peacekeepers in United Nations missions experience potentially traumatic events, resulting in increased risk for posttraumatic stress disorder (PTSD). Understanding the course and risk factors of PTSD symptom severity is crucial to ensure personnel safety.

Objective

To investigate the incidence of PTSD, symptom severity trajectories, and potential risk factors associated with adverse trajectories among Japanese peacekeepers deployed in South Sudan.

Design, Setting, and Participants

Data for this 6-year prospective cohort study were collected from December 2011 to December 2018 from Japan Ground Self-Defense Force personnel deployed at the United Nations Mission in South Sudan, corresponding to before and up to 78 months after deployment. Of 3799 potential participants, 80 were excluded because of multiple deployments and 757 because of missing data, incomplete responses, or not providing informed consent. Therefore, 2962 participants were included in the analysis. Data analysis was performed from February 2022 to February 2024.

Exposure

The participants were deployed to United Nations Mission in South Sudan for 6 months.

Main Outcomes and Measures

The 22-item Impact of Event Scale-Revised was used to assess PTSD symptoms, with 25 or more points indicating probable PTSD (p-PTSD). Sociodemographic data were collected, and the 30-item General Health Questionnaire was administered before deployment to identify risk factors for PTSD symptom severity.

Results

In the 2962 participants studied (2901 [97.9%] male; mean [SD] age, 33.9 [7.2] years), the incidence of p-PTSD was 3.95%. Latent growth mixture models identified 4 symptom severity trajectories: resilient (2143 [72.3%]), recovery (479 [16.2%]), protracted (182 [6.1%]), and delayed (158 [5.3%]). Multinomial logistic regression showed that sleep disturbance was a common risk factor for the 2 most severe trajectories (protracted: odds ratio [OR], 1.29; 95% CI, 1.08-1.54; delayed: OR, 1.26; 95% CI, 1.03-1.53), whereas older age (OR, 1.25; 95% CI, 1.06-1.48), anxiety and dysphoria (OR, 1.45; 95% CI, 1.20-1.75), and general illness (OR, 1.30; 95% CI, 1.06-1.59) were associated with the protracted trajectory.

Conclusions and Relevance

This cohort study found that approximately 4% of the participants developed p-PTSD and identified 4 distinct PTSD symptom trajectories. The findings suggest that addressing sleep disturbance and general health issues could effectively prevent PTSD symptoms among peacekeepers.

A Retrospective Cohort Analysis of Mental Health-Related Emergency Department Visits Among Veterans and Non-Veterans Residing in Ontario, Canada: Une analyse de cohorte rétrospective des visites au service d'urgence liées à la santé mentale parmi les vétérans et non-vétérans résidant en Ontario, Canada

OBJECTIVES

Emergency departments (EDs) are a vital part of healthcare systems, at times acting as a gateway to community-based mental health (MH) services. This may be particularly true for veterans of the Royal Canadian Mounted Police who were released prior to 2013 and the Canadian Armed Forces, as these individuals transition from federal to provincial healthcare coverage on release and may use EDs because of delays in obtaining a primary care provider. We aimed to estimate the hazard ratio (HR) of MH-related ED visits between veterans and non-veterans residing in Ontario, Canada: (1) overall; and by (2) sex; and (3) length of service.

METHODS

This retrospective cohort study used administrative healthcare data from 18,837 veterans and 75,348 age-, sex-, geography-, and income-matched non-veterans residing in Ontario, Canada between April 1, 2002, and March 31, 2020. Anderson-Gill regression models were used to estimate the HR of recurrent MH-related ED visits during the period of follow-up. Sex and length of service were used as stratification variables in the models.

RESULTS

Veterans had a higher adjusted HR (aHR) of MH-related ED visits than non-veterans (aHR, 1.97, 95% CI, 1.70 to 2.29). A stronger effect was observed among females (aHR, 3.29; 95% CI, 1.96 to 5.53) than males (aHR, 1.78; 95% CI, 1.57 to 2.01). Veterans who served for 5-9 years had a higher rate of use than non-veterans (aHR, 3.76; 95% CI, 2.34 to 6.02) while veterans who served for 30+ years had a lower rate compared to non-veterans (aHR, 0.60; 95% CI, 0.42 à 0.84).

CONCLUSIONS

Rates of MH-related ED visits are higher among veterans overall compared to members of the Ontario general population, but usage is influenced by sex and length of service. These findings indicate that certain subpopulations of veterans, including females and those with fewer years of service, may have greater acute mental healthcare needs and/or reduced access to primary mental healthcare.

How do you see me? The impact of perceived societal recognition on PTSD symptoms amongst Norwegian peacekeepers

Background: The peacekeeper role is different to that of traditional combat, however, peacekeepers, like combat soldiers, may also be exposed to high levels of dangerous and/or potentially morally injurious events (PMIEs).Objective: It was hypothesized that given the centrality of societal approval for the peacekeeping mission, in addition to the known relevance of perceived social support, perceived societal recognition would influence PTSD symptoms (PTSS) and depression. It was hypothesized that perceived societal recognition would moderate the effect of exposure to potentially traumatic events and PMIEs on psychological outcomes.Method: 8341, predominantly male, former UNIFIL peacekeepers, almost three decades following deployment, answered a survey to determine the impact of perceived social support and perceived societal recognition, on PTSS and depression symptoms. Hierarchical regression analyses were performed for PTSS and depression separately and moderation analysis was performed for perceived societal recognition.Results: Exposure to potentially traumatic events showed the greatest predictive value for PTSS and exposure to PMIEs and potentially traumatic events were equally predictive of depression symptoms. While perceived social support presented the strongest buffer for PTSS and depression symptoms following UNIFIL deployment, perceived societal recognition also significantly contributed to the prediction of both PTSS and depression symptoms. There was a weak moderation effect of perceived societal recognition on trauma type in the development of PTSS.Conclusions: Even decades following peacekeeping deployment, military experiences have a significant impact on psychological functioning. This impact is both from the types of events experienced and from the perception of social and societal support upon return home.

Mental healthcare utilisation among Danish formerly deployed military personnel and their civilian counterparts: a cohort study

Background: Prior studies comparing the mental healthcare utilisation (MHU) of Danish formerly deployed military personnel (FDP) with the general population have not included data on psychotherapy through the Defence or talking therapy with the general practitioner. This study included these and several other data sources in a comprehensive comparison of MHU between Danish FDP and civilians.Methods: First-time deployed military personnel (N = 10,971) who had returned from a mission to Kosovo, Afghanistan, Iraq or Lebanon between January 2005 and July 2017 were included. A sex and birth-year-matched civilian reference group was randomly drawn from the entire Danish non-deployed population (N = 253,714). Furthermore, a sub-cohort, including male FDP and civilians deemed eligible for military service, was defined. These cohorts were followed up in military medical records and registers covering the primary and secondary civilian health sectors from 2005 to 2018, and the rates of MHU were compared.Results: Approximately half of the initial help-seeking for FDP took place through the Defence (49.4%), and the remainder through the civilian healthcare system. When help-seeking through the Defence was not included, MHU was significantly lower among FDP in the main cohort during the first two years (IRR = 0.84, 95% CI: [0.77, 0.92]) compared to civilians. When help-seeking through the Defence was included, MHU was significantly higher among FDP compared to civilians both in the first two years of follow-up (IRR = 2.01, 95% CI: [1.89, 2.13]) and thereafter (IRR = 1.18, 95% CI: [1.13, 1.23]). In the sub-cohort, these differences were even more pronounced both in the first two years of follow-up and thereafter.Conclusions: MHU was higher among Danish FDP compared to civilians only when data from the Defence was included. The inclusion of data on both civilian and military healthcare services is necessary to evaluate the full impact of deployment on MHU among Danish FDP.

Mental health and resilience in the Irish defense forces during the COVID-19 global pandemic

The Irish Defense Forces (DF) responded to the COVID-19 pandemic and national public health crisis by deploying personnel to aid domestic civil authorities in medical and care settings, contact tracing, logistics, and operations. Current research on COVID-19 reveals increased psychological distress among frontline workers and the general public. Resilience has previously been associated with lower levels of psychological distress. This study sets out to test these associations, and to examine mental health differences between DF personnel deployed in Ireland on pandemic-related duties (DIPD) and non-DIPD. Participants were 231 DF members who completed the: Connor-Davidson Resilience Scale-10, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Coronavirus Threat Questionnaire, Brief Trauma Questionnaire, Post-traumatic Stress Disorder Checklist-5, and Alcohol Use Disorder Identification Test. Independent t-tests revealed no differences between DIPD and non-DIPD on measures of psychological distress or on self-rated mental health prior to COVID-19 (PC19) and during COVID-19 (DC19). Results of multiple hierarchical regression analyses revealed that depression predicted lower levels of resilience, while multiple traumatic events predicted higher levels of resilience. The total adjusted variance explained by the model was 25%. Clinical and policy implications for improving access to psychological support within the DF and military populations are discussed.

A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice

INTRODUCTION

Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters.

OBJECTIVE

There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition.

METHODS

A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported.

RESULTS

The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort.

CONCLUSION

This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.

Caring for Coronavirus Healthcare Workers: Lessons Learned From Long-Term Monitoring of Military Peacekeepers

BACKGROUND

The current outbreak of the coronavirus disease (COVID-19) is of unprecedented proportions in several regards. Recent reports suggest that many frontline healthcare workers (HCWs) suffer from mental health problems, including posttraumatic stress symptoms (PTSS). Previous studies have identified several key factors associated with short-term PTSS in pandemic HCWs, yet limited data is available on factors associated with long-term PTSS. Understanding the psychological impact of the pandemic on HCWs is important in planning for future outbreaks of emerging infectious diseases. In the current study, we look to findings from a highly relevant subsection of the trauma field, the military domain.

OBJECTIVE

Pandemic HCWs and military peacekeepers may experience similar stressors in the line of duty. This study investigated whether factors linked to short-term PTSS in pandemic HCWs were also associated with long-term PTSS in military peacekeepers.

MATERIALS AND METHODS

Peacekeepers who reported pandemic-relevant stressors during deployment to a UN peacekeeping mission were included in the study (N = 1,627). PTSS was self-reported using the Posttraumatic Stress Disorder Checklist - Military Version. Descriptive instruments were used to assess possible factors associated with PTSS. A multiple linear regression analysis was performed to explore associations between these factors and PTSS.

RESULTS

Our model accounted for 50% of the variance in PTSS, F(1503,11) = 139.00, p < 0.001. Age, relationship and employment status, preparedness, working environment, social support after deployment, barriers to disclose, recognition, and loneliness were all significantly associated with PTSS on average 30 years after deployment. The most important risk factors of long-term PTSS were personal barriers to disclose one's experiences and current unemployment.

CONCLUSION

Several factors linked to short-term PTSS in pandemic HCWs were associated with long-term PTSS in peacekeepers. We discuss how these findings may be used to prevent long-term PTSS in HCWs involved in the current COVID-19 outbreak.

Prevalence and Correlates of Mental Health Problems in Norwegian Peacekeepers 18-38 Years Postdeployment

Peacekeeping missions involve experiences that may impact the mental health of participating soldiers. However, research on the long-term mental health consequences of peacekeeping is sparse. The present study aimed to find the prevalence of mental health problems (MHPs), possible MHP predictors, and associations between predictors and MHPs in Norwegian peacekeepers 18-38 years after deployment to a United Nations peacekeeping mission. We used data from a cross-sectional, postdeployment survey of Norwegian peacekeepers who served in Lebanon between 1978 and 1998 (N = 10,605). Participants were assessed for posttraumatic stress disorder (PTSD); anxiety; depression; insomnia; alcohol misuse; drug misuse; and exposure to pre-, peri-, and postdeployment stressors. Logistic regressions were executed to explore key variables associated with MHPs. Total MHP prevalence was 15.1%, 95% CI [14.4, 15.8]. The estimates for specific disorders were 0.1% for drug misuse, 3.4% for alcohol misuse, 4.0% for depression, 6.2% for PTSD, 6.4% for anxiety, and 9.3% for insomnia. Postdeployment stressors, OR = 1.91, 95% CI [1.79, 2.04]; employment status, OR = 1.41, 95% CI [1.33, 1.48]; and traumatic exposure during deployment, OR = 1.11, 95% CI [1.09, 1.12], were positively related to PTSD, χ2(17, N = 8,568) = 1,791.299, p < .001. Similar patterns were found for the other MHPs. Considering that most participants (84.9%) reported low symptom levels, our findings challenge the widespread public perception that most peacekeepers have MHPs. Moreover, our results indicate that future peacekeepers should be prepared for challenges they may face not only during deployment but also in the years following their homecoming.

Mental health disorders and utilization of mental healthcare services in United Nations personnel

BACKGROUND

United Nations (UN) personnel address a diverse range of political, social, and cultural crises throughout the world. Compared with other occupations routinely exposed to traumatic stress, there remains a paucity of research on mental health disorders and access to mental healthcare in this population. To fill this gap, personnel from UN agencies were surveyed for mental health disorders and mental healthcare utilization.

METHODS

UN personnel (N = 17 363) from 11 UN entities completed online measures of generalized anxiety disorder (GAD), major depressive disorder (MDD), posttraumatic stress disorder (PTSD), trauma exposure, mental healthcare usage, and socio-demographic information.

RESULTS

Exposure to one or more traumatic events was reported by 36.2% of survey responders. Additionally, 17.9% screened positive for GAD, 22.8% for MDD, and 19.9% for PTSD. Employing multivariable logistic regressions, low job satisfaction, younger age (<35 years of age), greater length of employment, and trauma exposure on or off-duty was significantly associated with all the three disorders. Among individuals screening positive for a mental health disorder, 2.05% sought mental health treatment within and 10.01% outside the UN in the past year.

CONCLUSIONS

UN personnel appear to be at high risk for trauma exposure and screening positive for a mental health disorder, yet a small percentage screening positive for mental health disorders sought treatment. Despite the mental health gaps observed in this study, additional research is needed, as these data reflect a large sample of convenience and it cannot be determined if the findings are representative of the UN.

General psychological distress among Japan Self-Defense Forces personnel dispatched on United Nations peacekeeping operations and their spouses

AIM

The importance of family care during international deployment is emphasized within military organizations, but mental health interactions between deployed personnel and their spouses have not yet been assessed. This study addressed this gap by examining couples' mental health throughout a deployment period.

METHODS

The mental health of 324 spousal dyads of Japan Self-Defense Forces personnel dispatched for a half-year United Nations Disengagement Observer Force mission was examined, using longitudinal data derived from a survey at four time points: one-month pre-deployment, initial deployment, middle deployment, and immediately after homecoming. The 30-item General Health Questionnaire was used to evaluate general psychological distress, with high scores (≥7) indicating adverse mental health.

RESULTS

The spouses' general psychological distress was significantly higher compared with the deployed personnel (P < 0.001). The high general psychological distress of personnel was significantly related to that of their spouses (odds ratio = 2.24; 95% confidence interval, 1.32-3.80), and vice versa (odds ratio = 2.38; 95% confidence interval 1.39-4.08).

CONCLUSION

Mental health care will be beneficial for not only deployed personnel but also their spouses.

Physical comorbidities of post-traumatic stress disorder in Australian Vietnam War veterans

OBJECTIVE

To determine whether the prevalence of physical comorbidities in Australian Vietnam War veterans with post-traumatic stress disorder (PTSD) is higher than in trauma-exposed veterans without PTSD.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional analysis of the health status (based on self-reported and objective clinical assessments) of 298 Australian Vietnam War veterans enrolled by the Gallipoli Medical Research Institute (Brisbane) during February 2014 - July 2015, of whom 108 were confirmed as having had PTSD and 106 served as trauma-exposed control participants.Main outcomes and measures: Diagnostic psychiatric interview and psychological assessments determined PTSD status, trauma exposure, and comorbid psychological symptoms. Demographic data, and medical and sleep history were collected; comprehensive clinical examination, electrocardiography, spirometry, liver transient elastography, and selected pathology assessments and diagnostic imaging were performed. Outcomes associated with PTSD were identified; regression analysis excluded the effects of potentially confounding demographic and risk factors and comorbid symptoms of depression and anxiety.

RESULTS

The mean total number of comorbidities was higher among those with PTSD (17.7; SD, 6.1) than in trauma-exposed controls (14.1; SD, 5.2; P < 0.001). For 24 of 171 assessed clinical outcomes, morbidity was greater in the PTSD group, including for conditions of the gastrointestinal, hepatic, cardiovascular, and respiratory systems, sleep disorders, and laboratory pathology measures. In regression analyses including demographic factors, PTSD remained positively associated with 17 adverse outcomes; after adjusting for the severity of depressive symptoms, it remained significantly associated with ten.

CONCLUSION

PTSD in Australian Vietnam veterans is associated with comorbidities in several organ systems, independent of trauma exposure. A comprehensive approach to the health care of veterans with PTSD is needed.

Peacekeepers deserve more mental health research and care

SUMMARY

United Nations peacekeeping personnel face numerous stressors due to their challenging deployments. Past studies have had inconsistent results regarding whether or not their deployment experience affects their mental health outcomes. Further studies are required to ascertain the associations between their outcomes and factors before, during and after their peacekeeping missions.

DECLARATIONS OF INTEREST

None.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.