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Zhang Y, Xiang D, Alejok N. Coping with COVID-19 in United Nations peacekeeping field hospitals: increased workload and mental stress for military healthcare providers. BMJ Mil Health 2021; 167:229-233. [PMID: 33177148 PMCID: PMC7661351 DOI: 10.1136/bmjmilitary-2020-001642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study aimed to explore the impact of COVID-19 on the United Nations peacekeeping field hospitals where medical supply and manpower are extremely insufficient. METHODS A level II hospital was deployed in Wau, South Sudan, as the regional referral centre of the United Nations Mission in South Sudan (UNMISS). It had a total strength of 63 personnel with 47 medical staff (average age 38.3±8.0 years, 33 men). A new 'appointment-triage-disinfection' work pattern was adopted to cope with the COVID-19 outbreak in the mission. Data on medical service statistics and workload before/after the outbreak were collected and compared. The mental health of staff was analysed from the quarterly psychological survey, including Perceived Stress Scale (PSS)-10, Generalised Anxiety Disorder (GAD)-7 and Patient Health Questionnaire (PHQ)-9. RESULTS The number of outpatients decreased slightly after the COVID-19 outbreak (41.9±11.9 to 37.6±11.8 per week, p=0.49), whereas the weekly hospital length of stay of inpatients increased significantly (0.4±1.0 to 3.1±3.9 days, p=0.02). Total weekly working hours increased from 1884.9±34.1 to 2023.5±67.3 hours (p<0.001). Elevated mental stress (PSS-10: 4.3±2.4 in February to 7.5±3.9 in May, p<0.001; GAD-7: 4.0±2.3 to 9.4±4.0, p<0.001; PHQ-9: 2.1±1.2 to 3.2±2.4, p<0.001) was documented among healthcare providers after the outbreak. The threat of COVID-19 infection, delay in rotation and family-related concerns constituted the main stressors. CONCLUSION COVID-19 imposes a huge pressure on peacekeeping field hospitals. Increased workload and mental stress among frontline healthcare providers deserve the attention of UNMISS officials. Facilitating the rotation of the medical staff might potentially improve the operational readiness of the hospital by bringing in well-trained personnel and sufficient medical supplies.
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Affiliation(s)
- Yongxue Zhang
- Department of Surgery, Handan Medical Center, Bethune International Peace Hospital, Handan, China
- Chinese Level II Hospital, Wau Field Office, Sector West, United Nations Mission in South Sudan (UNMISS), Wau, South Sudan
| | - D Xiang
- Department of Neurology, Handan Medical Center, Bethune International Peace Hospital, Handan, China
| | - N Alejok
- Level I Clinic, Wau Field Office, United Nations Mission in South Sudan (UNMISS), Wau, South Sudan
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Gjerstad CL, Bøe HJ, Falkum E, Martinsen EW, Nordstrand AE, Tønnesen A, Reichelt JG, Lystad JU. Prevalence and Correlates of Mental Health Problems in Norwegian Peacekeepers 18-38 Years Postdeployment. J Trauma Stress 2020; 33:762-772. [PMID: 32810318 DOI: 10.1002/jts.22578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Christer Lunde Gjerstad
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hans Jakob Bøe
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway.,Division of Mental Health and Addiction, Kongsberg DPS, Vestre Viken Hospital Trust, Kongsberg, Norway
| | - Erik Falkum
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Egil Wilhelm Martinsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Andreas Espetvedt Nordstrand
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway.,Department of Psychology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnfinn Tønnesen
- Institute of Military Psychiatry, Norwegian Armed Forces Joint Medical Services, Oslo, Norway
| | | | - June Ullevoldsaeter Lystad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Section of Early Psychosis Treatment, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Tanichi M, Nagamine M, Shigemura J, Yamamoto T, Sawamura T, Takahashi Y, Obara A, Saito T, Toda H, Yoshino A, Shimizu K. General psychological distress among Japan Self-Defense Forces personnel dispatched on United Nations peacekeeping operations and their spouses. Psychiatry Clin Neurosci 2019; 73:77-83. [PMID: 30506835 PMCID: PMC6849727 DOI: 10.1111/pcn.12806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/10/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Masaaki Tanichi
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Masanori Nagamine
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Jun Shigemura
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Taisuke Yamamoto
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Takehito Sawamura
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Yoshitomo Takahashi
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Asuka Obara
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Taku Saito
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Hiroyuki Toda
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Aihide Yoshino
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Kunio Shimizu
- Division of Behavioral Science, National Defense Medical College Research Institute, Tokorozawa, Japan
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