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Yuan Q, Chen Y, Liu S, Huang Q, Liao M, Zhou J, Li Z, Li Y. UN peacekeeper health and risk factors --- a systematic scoping review. Glob Health Res Policy 2024; 9:13. [PMID: 38600572 PMCID: PMC11005225 DOI: 10.1186/s41256-024-00351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/31/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Conflicts, natural disasters, and complex emergencies present substantial health challenges to United Nations (UN) peacekeepers deployed in mission areas. This scoping review aims at summarizing previous research on the health of UN peacekeepers and identifies issues for further investigation. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews, we systematically searched Web of Science, PubMed, EMBASE, Scopus and China National Knowledge Infrastructure (CNKI) for English and Chinese literature published from April 1997 to November 2023. A data charting form was developed by two reviewers to extract relevant themes and provided narrative descriptions. RESULTS We screened 1079 de-duplicated records and included 143 studies in this scoping review. There were 112 studies on the health status of UN peacekeepers, with more than half on mental health problems such as stress and anxiety. Many studies explored the health status of UN peacekeepers in African countries deployed from mainly U.S., Canada, U.K., China, Australia and Norway. There were 39 studies on the health risk factors of UN peacekeepers, including natural environmental, social environmental, psychological, behavioral lifestyle, biological factors and health service factors. There were 62 articles on the health protection of UN peacekeepers, mainly based on previous deployment experience, with a lack of theoretical guidance from global health perspectives. This scoping review found that health problems of UN peacekeepers are complicated, and whose impacts are cross-border. Social environmental factors were explored the most among health risk factors. Disease prevention measures, medical and health measures, and psychosocial measures were the main health protection for UN peacekeepers. CONCLUSIONS This scoping review highlighted that health problems of UN peacekeepers were typical global health issues with complicated and cross-border health risk factors. Therefore, comprehensive strategies could be taken from global health perspectives, including multi-phases (before-deployment, during-deployment, and post-deployment), multi-disciplines (public health, medicine, politics, health diplomacy, and others), and multi-levels (the UN, host countries, troop-contributing countries, the UN peacekeeping team, and UN peacekeepers).
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Affiliation(s)
- Quan Yuan
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yong Chen
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qingning Huang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Miaomiao Liao
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhaogang Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China.
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Mitchell NA, McCauley M, O’Brien D, Wilson CE. Mental health and resilience in the Irish defense forces during the COVID-19 global pandemic. MILITARY PSYCHOLOGY 2023; 35:383-393. [PMID: 37615557 PMCID: PMC10453996 DOI: 10.1080/08995605.2021.2007728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Nicola A. Mitchell
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Mathew McCauley
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
- Military Clinical Psychology, Office of the DMB, Defence Forces Ireland, Dublin, Ireland
| | - Dorota O’Brien
- Military Clinical Psychology, Office of the DMB, Defence Forces Ireland, Dublin, Ireland
| | - Charlotte E. Wilson
- School of Psychology, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
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Rodrigues-Silveira C, Chambel MJ, Bartone P. Organizational affective commitment effects on militaries’ well-being during a deployment: A study of a peacekeeping mission. MILITARY PSYCHOLOGY 2022; 35:27-37. [PMID: 37130563 DOI: 10.1080/08995605.2022.2060031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Based on the Conservation of Resources Theory, this longitudinal study analyzes the contribution of organizational affective commitment during the preparation phase of a peacekeeping mission (T1) to explain the well-being of soldiers during that mission (T2). A sample of 409 Brazilian army participants in the MINUSTAH (United Nations Stabilization Mission in Haiti) was used in two waves - preparation of the troops in Brazil, and their deployment in Haitian territory. The data analysis was performed using structural equation modeling. The results supported organizational affective commitment during the preparation phase (T1) positively predicting the general well-being (perception of health and general satisfaction with life) of these soldiers during the deployment phase (T2). The workplace well-being (i.e. work engagement) of these peacekeepers was also found to mediate this relationship. Theoretical and practical implications are discussed, and limitations and suggestions for future research are presented.
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Affiliation(s)
- Carolina Rodrigues-Silveira
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
- Centro de Psicologia Aplicada do Exército Brasileiro (CPAEx), Brazilian Army, Rio de Janeiro, Brazil
| | - Maria José Chambel
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - Paul Bartone
- The Institute for National Strategic Studies, National Defense University, Washington, DC
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Cucciare MA, Mengeling MA, Han X, Torner J, Sadler AG. Associations between Augmentee Status, Deployment Stress Preparedness and Depression, Post-Traumatic Stress Disorder, and Binge Drinking in U.S. Servicewomen. Womens Health Issues 2020; 30:207-213. [PMID: 32081595 DOI: 10.1016/j.whi.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Being deployed without one's home unit (individual-augmentee) and low perceived deployment preparedness are risk factors for mental health symptoms and substance use in male service members. However, these relationships have not been examined specifically in U.S. servicewomen. This study sought to fill this gap by examining associations between augmentee status and deployment stress preparedness (independent variables) and depression, probable post-traumatic stress disorder (PTSD), and binge drinking (dependent variables) in a sample of U.S. servicewomen. METHODS A community sample of service women from the Midwest, including both veterans and those serving at the time of data collection (N = 991), completed structured telephone interviews. Logistic regression was used to examine associations between augmentee status, deployment stress preparedness, and the likelihood of reporting depression, probable PTSD, and binge drinking after controlling for covariates. RESULTS Findings showed that U.S. servicewomen in the Reserve/Guard who deployed as individual-augmentees were more likely to screen positive for depression, report probable PTSD, and disclose recent binge drinking than servicewomen in the Reserve/Guard deployed with their home unit. Also, among servicewomen deployed as individual-augmentees, those in the Reserve/Guard were more likely to report binge drinking than servicewomen in the active component. No statistically significant associations between deployment stress preparedness and mental health symptoms or binge drinking were observed. CONCLUSIONS Servicewomen in the Reserve/Guard who deployed as individual-augmentees may be at increased risk for depression, probable PTSD, and hazardous drinking when compared with their active component and Reserve/Guard peers deployed with their home units.
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Affiliation(s)
- Michael A Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas; VA South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas.
| | - Michelle A Mengeling
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa; VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas; VA South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas; Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas
| | - James Torner
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Anne G Sadler
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Ursano RJ, Wang J, Fullerton CS, Ramsawh H, Gifford RK, Russell D, Cohen GH, Sampson L, Galea S. Post-deployment Mental Health in Reserve and National Guard Service Members: Deploying With or Without One's Unit and Deployment Preparedness. Mil Med 2019; 183:e51-e58. [PMID: 29401326 DOI: 10.1093/milmed/usx002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Indexed: 11/14/2022] Open
Abstract
Background Given the greater prevalence of post-deployment mental health concerns among reservists, the higher likelihood of deploying without their regular unit, and potentially lower rates of deployment preparedness, we examined associations between deploying with or without one's regular unit (individual augmentee status, IAS), deployment preparedness, and mental health problems including post-traumatic stress disorder (PTSD), depression (MDD), and binge drinking in a nationally representative sample of Reserve Component (RC) Army and Marine-enlisted males (n = 705). Methods A series of multivariate regressions examined the association of mental health with IAS and deployment preparedness, adjusting for demographics. To examine whether deployment preparedness varied by IAS, an IAS × deployment preparedness interaction was included. Findings In an adjusted model, being an individual augmentee and low deployment preparedness were associated with any mental health problem (screening positive for PTSD, MDD, binge drinking, or any combination of the three). There was a significant IAS × deployment preparedness interaction. Mental health problems did not vary by preparedness among individual augmentees. Participants deploying with regular units with low-medium preparedness had greater risk for mental health problems (odds ratio [OR] = 3.69, 95% confidence interval [CI] = 1.78-7.62 and OR = 2.29, 95% CI = 1.12-4.71), than those with high preparedness. RC-enlisted male personnel who deployed without their regular unit were five times more likely to have a mental health problem, and were 61% more likely to report binge drinking. Additionally, those with lower levels of deployment preparedness were up to three times more likely to have a mental health problem and up to six times more likely to report PTSD. Discussion The current investigation found that both IAS and deployment preparedness were associated with negative mental health outcomes in a large representative sample of previously deployed RC-enlisted male personnel. In particular, low deployment preparedness was associated with an increased likelihood of PTSD, and deploying without one's regular unit was associated with increased rates of binge drinking. There were also significant main and interaction effects of IAS and deployment preparedness on having a mental health problem. It is possible that limiting the number of RC personnel deploying without their regular unit may help to decrease alcohol misuse among U.S. Armed Services reservists during and after future conflicts. Also, to the extent that deployment preparedness is a modifiable risk factor, future studies should examine whether increasing deployment preparedness could mitigate some of the correlates of deployment-related trauma exposure. Finally, future investigation is needed to explain why those who deploy without their regular unit, but who report high deployment preparedness, remain at elevated risk for mental health problems. It is possible that individual augmentees can benefit from a specific preparation for deployment. Those deploying without their regular unit had higher rates of mental health problems regardless of preparedness. These findings have implications for deployment preparedness training for those deploying without their regular unit.
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Affiliation(s)
- Robert J Ursano
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Jing Wang
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Carol S Fullerton
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Holly Ramsawh
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Robert K Gifford
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Dale Russell
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Gregory H Cohen
- School of Public Health, Boston University, 715 Albany Street-Talbot 301, Boston, MA 02118
| | - Laura Sampson
- School of Public Health, Boston University, 715 Albany Street-Talbot 301, Boston, MA 02118
| | - Sandro Galea
- School of Public Health, Boston University, 715 Albany Street-Talbot 301, Boston, MA 02118
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Abstract
The mental health of military veterans has been, and continues to be, a topic of heated political and journalistic debate. There is a well-documented impact of conflict upon the mental health of service personnel, and most nations have aimed to provide effective care for individuals who have fought for their country. However, as the three thematic papers in this issue demonstrate, the realities of service-related mental health are rather more complex than they initially appear.
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Banwell E, Greenberg N, Smith P, Jones N, Fertout M. What happens to the mental health of UK service personnel after they return home from Afghanistan? J ROY ARMY MED CORPS 2015; 162:115-9. [PMID: 26508773 DOI: 10.1136/jramc-2015-000425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 09/14/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Fear et al identified a small but significant increase in probable post-traumatic stress disorder (PTSD) in UK military personnel from around 3% in first year post deployment to around 6% by year 5. As yet it is not clear what factors are linked to the increase in probable PTSD, and therefore, serial measurement of poor mental health would be helpful. METHOD Rates of mental ill health among UK service personnel were compared upon deployment completion and at follow-up and identified factors associated with maladjustment. RESULTS Poor mental health symptomatology increased from baseline to follow-up, PTSD symptoms and related functional impairment increased significantly. Poor baseline mental health was predictive of transition and family relationship difficulties. CONCLUSIONS The results are discussed in relation to encouraging recognition and reporting of symptoms among personnel and their social networks.
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Affiliation(s)
| | - N Greenberg
- Academic Centre for Defence Mental Health, King's College London, London, UK
| | - P Smith
- Institute of Psychiatry, King's College London, London, UK
| | - N Jones
- Academic Centre for Defence Mental Health, King's College London, London, UK
| | - M Fertout
- Academic Centre for Defence Mental Health, King's College London, London, UK
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Greenberg N. What's so special about military veterans? Int Psychiatry 2014; 11:81-83. [PMID: 31507772 PMCID: PMC6735137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The mental health of military veterans has been, and continues to be, a topic of heated political and journalistic debate. There is a well-documented impact of conflict upon the mental health of service personnel, and most nations have aimed to provide effective care for individuals who have fought for their country. However, as the three thematic papers in this issue demonstrate, the realities of service-related mental health are rather more complex than they initially appear.
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Affiliation(s)
- Neil Greenberg
- Professor of Defence Mental Health, Psychological Medicine, King’s Centre for Military Health Research, King’s College London, London, UK, email
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Dunn R, Williams R, Kemp V, Patel D, Greenberg N. Systematic review: deployment length and the mental health of diplomats. Occup Med (Lond) 2014; 65:32-8. [DOI: 10.1093/occmed/kqu142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Parsloe L, Jones N, Fertout M, Luzon O, Greenberg N. Rest and recuperation in the UK Armed Forces. Occup Med (Lond) 2014; 64:616-21. [PMID: 25190713 DOI: 10.1093/occmed/kqu119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- L Parsloe
- Royal Holloway, University of London, Egham, TW20 0EX Surrey, UK,
| | - N Jones
- Academic Department of Military Mental Health, Institute of Psychiatry, King's College London, SE5 9RJ London, UK
| | - M Fertout
- Academic Department of Military Mental Health, Institute of Psychiatry, King's College London, SE5 9RJ London, UK
| | - O Luzon
- Royal Holloway, University of London, Egham, TW20 0EX Surrey, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Institute of Psychiatry, King's College London, SE5 9RJ London, UK
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Hunt EJF, Wessely S, Jones N, Rona RJ, Greenberg N. The mental health of the UK Armed Forces: where facts meet fiction. Eur J Psychotraumatol 2014; 5:23617. [PMID: 25206948 PMCID: PMC4138705 DOI: 10.3402/ejpt.v5.23617] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 04/05/2014] [Accepted: 05/21/2014] [Indexed: 11/14/2022] Open
Abstract
A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals.
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Affiliation(s)
- Elizabeth J F Hunt
- Academic Centre for Defence Mental Health (ACDMH), King's College London, Western Education Centre, London, UK
| | - Simon Wessely
- King's Centre for Military Health Research (KCMHR), King's College London, Western Education Centre, London, UK
| | - Norman Jones
- Academic Centre for Defence Mental Health (ACDMH), King's College London, Western Education Centre, London, UK
| | - Roberto J Rona
- King's Centre for Military Health Research (KCMHR), King's College London, Western Education Centre, London, UK
| | - Neil Greenberg
- Academic Centre for Defence Mental Health (ACDMH), King's College London, Western Education Centre, London, UK
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Jones M, Sundin J, Goodwin L, Hull L, Fear NT, Wessely S, Rona RJ. What explains post-traumatic stress disorder (PTSD) in UK service personnel: deployment or something else? Psychol Med 2013; 43:1703-1712. [PMID: 23199850 DOI: 10.1017/s0033291712002619] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In previous studies an association between deployment to Iraq or Afghanistan and an overall increased risk for post-traumatic stress disorder (PTSD) in UK armed forces has not been found. The lack of a deployment effect might be explained by including, in the comparison group, personnel deployed on other operations or who have experienced traumatic stressors unrelated to deployment. METHODS The sample comprised 8261 regular UK armed forces personnel who deployed to Iraq, Afghanistan or other operational areas or were not deployed. Participants completed the PTSD CheckList-Civilian Version (PCL-C) and provided information about deployment history, demographic and service factors, serious accidents and childhood experiences. RESULTS Deployment to Iraq or Afghanistan [odds ratio (OR) 1.2, 95% confidence interval (CI) 0.6-2.2] or elsewhere (OR 1.1, 95% CI 0.6-2.0) was unrelated to PTSD although holding a combat role was associated with PTSD if deployed to Iraq or Afghanistan (OR 2.7, 95% CI 1.9-3.9). Childhood adversity (OR 3.3, 95% CI 2.1-5.0), having left service (OR 2.7, 95% CI 1.9-4.0) and serious accident (OR 2.1, 95% CI 1.4-3.0) were associated with PTSD whereas higher rank was protective (OR 0.3, 95% CI 0.12-0.76). CONCLUSIONS For the majority of UK armed forces personnel, deployment whether to Iraq, Afghanistan or elsewhere confers no greater risk for PTSD than service in the armed forces per se but holding a combat role in those deployed to Iraq or Afghanistan is associated with PTSD. Vulnerability factors such as lower rank, childhood adversity and leaving service, and having had a serious accident, may be at least as important as holding a combat role in predicting PTSD in UK armed forces personnel.
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Affiliation(s)
- M Jones
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College, London, UK.
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Connorton E, Perry MJ, Hemenway D, Miller M. Humanitarian relief workers and trauma-related mental illness. Epidemiol Rev 2011; 34:145-55. [PMID: 22180469 DOI: 10.1093/epirev/mxr026] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Humanitarian relief work is a growing field characterized by ongoing exposure to primary and secondary trauma, which has implications for workers' occupational mental health. This paper reviews and summarizes research to date on mental health effects of relief work. Twelve studies on relief workers and 5 studies on organizations that employ relief workers are examined to determine whether relief work is a risk factor for trauma-related mental illness. Although studies are inconsistent regarding methods and outcomes documenting trauma-related mental illness among relief workers, it appears that relief workers, compared with the general population, experience elevated trauma rates and suffer from more posttraumatic stress disorder, depression, and anxiety. Organizations that employ relief workers have varying approaches to train for these risks, and more support in the field is needed.
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Affiliation(s)
- Ellen Connorton
- Department of Health Policy and Management, Harvard School of Public Health and Dana-Farber Cancer Institute, Boston, MA 02215, USA.
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Connorton E, Perry MJ, Hemenway D, Miller M. Occupational trauma and mental illness--combat, peacekeeping, or relief work and the national co-morbidity survey replication. J Occup Environ Med 2011; 53:1360-3. [PMID: 22173283 PMCID: PMC3243957 DOI: 10.1097/jom.0b013e318234e2ec] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Peacekeepers, relief workers, and military members experience multiple traumas, and trauma is believed to increase risk for psychiatric distress. We examined whether combat and/or peacekeeping or relief work was associated with subsequent mental illness. METHODS Using data from the US National Co-morbidity Survey Replication (n = 2383), we estimated whether combat, peacekeeping, or relief work was associated with increased prevalence of mental illness through bivariate cross-tabulations and multivariate logistic regression. RESULTS Combat was associated with increased subsequent posttraumatic stress disorder (PTSD) and alcohol or drug issues more than peacekeeping or relief work. CONCLUSIONS Combat, alone or combined with peacekeeping/relief work, appears to be a risk factor for subsequent PTSD and issues with drugs and alcohol. Peacekeeping/relief work without combat does not appear to be associated with these diagnoses. CLINICAL SIGNIFICANCE We found an association between combat and subsequent PTSD and drug and alcohol issues. Absent combat, peacekeeping, or relief work were not associated with mental illness. Previous diagnoses and trauma exposure may increase potential for subsequent mental health problems.
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Affiliation(s)
- Ellen Connorton
- Department of Health Policy and Management, Harvard School of Public Health, The George Washington University, USA.
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Fernando A, Hull L, Greenberg N, Fear NT, Hotopf M, Wessely S. "Warriors": impact of a powerful television drama on the psychological health of U.K. Bosnia peacekeepers. Ann Epidemiol 2011; 21:660-5. [PMID: 21684177 DOI: 10.1016/j.annepidem.2011.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 03/14/2011] [Accepted: 03/18/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE The impact of secondary trauma, such as watching powerful images on television, on the etiology of posttraumatic stress disorder in adults remains controversial. We explored the impact of a powerful TV drama ("Warriors") on the psychological health of U.K. peacekeeping troops compared with other military personnel who also saw the program but did not deploy on the same mission. METHODS Psychological health (health perception, fatigue, posttraumatic stress reactions and common mental disorders) was assessed via questionnaire in a group of 1463 U.K. Armed Forces personnel before and after the televising of an award-winning dramatic reconstruction ("Warriors") of events in Former Yugoslavia, a deployment in which some of the respondents had participated (Bosnia group) and some who had not (Era group). Information was also collected on whether participants had seen Warriors. RESULTS Those who had deployed to Bosnia were more likely to have watched the drama, and viewers were more likely to be posttraumatic stress reactions and common mental disorders cases before transmission of the program. There were few health differences between viewers and nonviewers, and Bosnia viewers and Era viewers, posttransmission. Viewing status and group status (Bosnia/Era) restricted to viewers only did not predict posttransmission health outcomes, with one exception. Group status (viewers only) was a significant predictor of posttransmission fatigue, with Bosnia viewers more likely to be cases. Additional analyses, however, revealed the same finding for nonviewers. CONCLUSIONS We found no evidence that those with symptoms of traumatic distress avoided watching a drama relevant to their experiences and no evidence of adverse effects on mental health.
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Affiliation(s)
- Asanga Fernando
- Institute of Psychiatry, King's College London & South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Greenberg N, Jones E, Jones N, Fear NT, Wessely S. The injured mind in the UK Armed Forces. Philos Trans R Soc Lond B Biol Sci 2011; 366:261-7. [PMID: 21149361 DOI: 10.1098/rstb.2010.0210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The mental health of the UK Armed Forces is a topic much debated by healthcare professionals, politicians and the media. While the current operations in Afghanistan, and the recent conflict in Iraq, are relevant to this debate, much of what is known about the effects of war upon the psyche still derives from the two World Wars. This paper will examine the historical and contemporary evidence about why it is that some Service personnel suffer psychological injuries during their military service and others do not. The paper will also consider some of the strategies that today's Armed Forces have put in place to mitigate the effects of sending military personnel into danger.
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Affiliation(s)
- N Greenberg
- Academic Centre for Defence Mental Health, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
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Frappell-Cooke W, Gulina M, Green K, Hacker Hughes J, Greenberg N. Does trauma risk management reduce psychological distress in deployed troops? Occup Med (Lond) 2010; 60:645-50. [PMID: 20889815 DOI: 10.1093/occmed/kqq149] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Military personnel exposed to potentially traumatic events whilst deployed on operational duties may develop psychological problems. The Royal Marines have made extensive use of Trauma Risk Management (TRiM), a peer-support system that operates through practitioners embedded within operational units. TRiM aims to promote recognition of psychological illness and to facilitate social support. AIMS To evaluate the effects of TRiM in two units at different stages of implementation. METHODS Royal Marines and Army personnel were surveyed prior to, during and upon return from an operational deployment to Afghanistan. Participants completed measures of general mental health (GHQ12) and traumatic stress [PCL(C)]. RESULTS We received responses from 180 pre-deployment, 105 during deployment and 137 post-deployment. Personnel within units with experience of TRiM reported lower levels of psychological distress than personnel in the unit who were using TRiM for the first time. Both groups reported higher psychological distress scores before and during deployment, compared with post-deployment. However, we found personnel who reported having more access to social support during deployment reported less psychological distress. CONCLUSIONS The use of TRiM may assist in increasing the psychological resilience of military personnel through the facilitation of social support; this may have particular utility during operational deployments.
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Affiliation(s)
- W Frappell-Cooke
- Defence Clinical Psychology Service, HQ Surgeon General, DMS Whittington, Lichfield, Staffordshire WS14 9PY, UK
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Greenberg N, Langston V, Everitt B, Iversen A, Fear NT, Jones N, Wessely S. A cluster randomized controlled trial to determine the efficacy of Trauma Risk Management (TRiM) in a military population. J Trauma Stress 2010; 23:430-6. [PMID: 20690168 DOI: 10.1002/jts.20538] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Trauma Risk Management is a peer-support program that aims to promote help-seeking in the aftermath of traumatic events. Prior to its implementation, the British military conducted a randomized controlled trial of Trauma Risk Management against standard care in 12 warships; 6 were randomized to use Trauma Risk Management after collecting baseline measurements. Follow up after 12-18 months found no significant change in psychological health or stigma scores in either group; however, the studied vessels only encountered low numbers of critical incidents. Additionally, measurements of organizational functioning were modestly better in the Trauma Risk Management ships. The authors conclude that within organizations using Trauma Risk Management may be beneficial and may, in time, lead to a valuable cultural shift.
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Affiliation(s)
- Neil Greenberg
- Academic Centre for Defence Mental Health, King's College London and Institute of Psychiatry, London, UK
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Sareen J, Stein MB, Thoresen S, Belik SL, Zamorski M, Asmundson GJ. Is peacekeeping peaceful? A systematic review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:464-72. [PMID: 20704774 DOI: 10.1177/070674371005500710] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review the literature on the association between deployment to a peacekeeping mission and distress, mental disorders, and suicide. METHODS Peer-reviewed English publications were found through key word searches in MEDLINE, PsycINFO, Scopus, and Embase, and by contacting authors in the field. Sixty-eight articles were included in this review. RESULTS Some studies have found higher levels of postdeployment distress and posttraumatic stress disorder (PTSD) symptoms. Most studies have not shown an increased risk of suicide in former peacekeepers. Correlates of distress and PTSD symptoms included level of exposure to traumatic events during deployment, number of deployments, predeployment personality traits or disorder, and postdeployment stressors. Perceived meaningfulness of the mission, postdeployment social supports, and positive perception of homecoming were associated with lower likelihood of distress. CONCLUSIONS Most peacekeepers do not develop high levels of distress or symptoms of PTSD. As postdeployment distress is consistently shown to be associated with high levels of exposure to combat during deployment, targeted interventions for peacekeepers who have been exposed to high levels of combat should be considered.
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Affiliation(s)
- Jitender Sareen
- Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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McCormack L. Civilian Women at War: Psychological Impact Decades After the Vietnam War. JOURNAL OF LOSS & TRAUMA 2009. [DOI: 10.1080/15325020902925209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Alexander DA, Klein S. Combat-Related Disorders: A Persistent Chimera. J ROY ARMY MED CORPS 2008; 154:96-101. [DOI: 10.1136/jramc-154-02-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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