Loneliness among veterans in the Netherlands

BACKGROUND

Loneliness among military veterans may have unique features because of deployment-related experiences. Consequently, loneliness is increasingly recognized as an issue that may affect the health of veterans, even years after military deployment.

AIMS

To examine the prevalence of loneliness in Dutch veterans and to assess the extent to which their loneliness is associated with deployment-related factors.

METHODS

We invited 6000 veterans who have left the Armed Forces to fill out a questionnaire. Hierarchical regression analysis was used to assess the association between loneliness and deployment-related factors in addition to demographic information, social support and needs of care.

RESULTS

We received the responses of 2643 veterans (44%). Of them, 27% experienced at least some loneliness and 13% experienced severe loneliness. Social support, perceived comradeship during deployment and a perceived positive effect of one's deployment on life at present are negatively related to loneliness. Younger age, living alone (with or without children), unemployment or work disability, needs of care in general or deployment-related, perceived frustration related to the deployment and longing back to the time of the deployment were positively associated with loneliness.

CONCLUSIONS

Feelings of loneliness are prevalent among Dutch veterans who have left the Armed Forces. Veterans' loneliness is associated with several deployment-related factors. To reduce veterans' loneliness, attention for deployment-related experiences and its consequences is recommended.

Cohort profile: the Prospective Research In Stress-Related Military Operations (PRISMO) study in the Dutch Armed Forces

PURPOSE

The Prospective Research in Stress-Related Military Operations (PRISMO) study was initiated to gain a better understanding of the long-term impact of military deployment on mental health, and to map the different biological and psychological factors that contribute to the development of stress-related mental health symptoms.

PARTICIPANTS

The PRISMO cohort consists of a convenience sample of Dutch military personnel deployed to Afghanistan between 2005 and 2008. Baseline data collection resulted in the recruitment of 1032 military men and women. Combat troops as well as non-combat support troops were recruited to increase the representativeness of the sample to the population as a whole.

FINDINGS TO DATE

The prevalence of various mental health symptoms increases after deployment in PRISMO cohort members, but symptom progression over time appears to be specific for various mental health symptoms. For post-traumatic stress disorder, we found a short-term symptom increase within 6 months after deployment (8.2%), and a long-term symptom increase at 5 years after deployment (12.9%). Several biological vulnerability factors associated with the development of stress-related conditions after deployment were identified, including predeployment glucocorticoid receptor sensitivity and predeployment testosterone level. Thus far, 34 publications have resulted from the cohort.

FUTURE PLANS

Various analyses are planned that will include the prevalence of mental health symptoms at 10 years postdeployment, as well as trajectory analyses that capture the longitudinal development of symptoms. Furthermore, we will use a machine learning approach to develop predictive and network models for several mental health symptoms, incorporating biological, psychological and social factors.

Development of Self-Directedness and Cooperativeness in Relation to Post-Traumatic Stress Disorder Symptom Trajectories After Military Deployment

Background

Personality traits, such as the character traits self-directedness and cooperativeness, might play a role in the risk of developing post-traumatic stress disorder (PTSD) after deployment to a combat zone. However, it is unclear whether these traits are preexisting risk factors or if event-related changes might also be associated with PTSD symptoms over time. Therefore, the current aim was to assess if military deployment is associated with changes in cooperativeness and self-directedness and to study how these traits are related to PTSD symptom trajectories.

Methods

In a large cohort of military personnel (N = 1007), measurements were performed before, at one and six months, and two and five years after deployment to Afghanistan. Linear mixed-effect models were used to assess the individual change in the traits over time and to study the relation with potential predictors.

Results

Cooperativeness was found to remain stable, whereas self-directedness was found to slightly decrease over time. This decrease was related to the development of PTSD symptoms over time. Furthermore, lower levels of self-directedness were associated with the symptomatic trajectories of PTSD symptoms. Lower levels of cooperativeness were only associated with the recovered PTSD trajectory.

Conclusions

So, not only do the findings confirm that lower levels of these character traits are associated with the development of PTSD symptoms, it was also shown that there are differences in the relation between these traits and the course of PTSD symptoms. Studying methods to promote the levels of these character traits might help to improve the resiliency of military personnel.

Individual variation in plasma oxytocin and vasopressin levels in relation to the development of combat-related PTSD in a large military cohort

In an attempt to decrease the risk of developing mental health problems after military deployment, it is important to find biological markers to identify those at risk. Oxytocin (OT) and arginine vasopressin (AVP) are potential biomarkers for the development of posttraumatic stress disorder (PTSD) because they are involved in the regulation of stress and anxiety. Therefore, the aim was to examine whether plasma OT (pOT) and AVP (pAVP) levels before and after deployment are biomarkers for the development of posttraumatic stress symptoms over time in addition to other known risk factors. This study is part of a large prospective cohort study on candidate markers for stress-related mental health symptoms and resiliency after deployment to a combat zone; Prospective Research in Stress-related Military Operations (PRISMO; N = 907). Data was collected prior to deployment and follow-ups were performed at 1 and 6 months, and 1, 2, and 5 years post-deployment. Blood samples were collected in the first three assessments. The levels of pOT and pAVP were not significantly related to the development of PTSD symptoms over time. The results confirm that age, the experience of early life trauma, combat-related stressors and the presence of depressive symptoms are predictive for the development of PTSD symptoms over time. These findings showed that peripherally measured OT and AVP currently do not qualify as useful susceptibility biomarkers for the development of PTSD symptoms over time in military men after combat.

Post-traumatic stress symptoms 5 years after military deployment to Afghanistan: an observational cohort study

BACKGROUND

Deployment can put soldiers at risk of developing post-traumatic stress symptoms. Despite several longitudinal studies, little is known about the timing of an increase in post-traumatic stress symptoms relative to pre-deployment. Longitudinal studies starting pre-deployment, in which participants are repeatedly measured over time, are warranted to assess the timing of an increase in symptoms to ultimately assess the timing of an increase in treatment demand after deployment.

METHODS

In this large observational cohort study, Dutch military personnel who were deployed to Afghanistan as part of the International Security Assistance Forces between March, 2005, and September, 2008, were assessed for post-traumatic stress symptoms with the Self-Rating Inventory for Post-traumatic Stress Disorder (SRIP) questionnaire. Participants were assessed 1 month before deployment and followed up at 1 month, 6 months, 12 months, 2 years, and 5 years after deployment, with changes in SRIP scores compared with pre-deployment using a mixed model analysis. The primary outcome was the total score of post-traumatic stress symptoms measured with SRIP at pre-deployment and the five follow-up assessments, with a score of 38 used as the cutoff to indicate substantial post-traumatic stress symptoms.

FINDINGS

Between March, 2005, and September, 2008, 1007 participants were recruited to this study. The results show two important effects of deployment on post-traumatic stress symptoms. A short-term symptom increase within the first 6 months after deployment (symptom increase coefficient for SRIP score vs pre-deployment [β] 0·99, 95% CI 0·50-1·48); and a long-term symptom increase at 5 years after deployment (β 1·67, 1·14-2·20).

INTERPRETATION

This study underlines the importance of long-term monitoring of the psychological health of soldiers after deployment because early detection of symptoms is essential to early treatment, which is related to improved psychological health.

FUNDING

Dutch Ministry of Defense.

The effect of deployment to a combat zone on testosterone levels and the association with the development of posttraumatic stress symptoms: A longitudinal prospective Dutch military cohort study

OBJECTIVE

There is limited evidence on the association of the activity of HPG-axis with stress and symptoms of stress-related disorders. The aim of the current study was to assess the effect of deployment to a combat zone on plasma testosterone levels, and the possible association with the development of symptoms of posttraumatic stress disorder (PTSD).

METHODS

A total of 918 males were included in the study before deployment to a combat zone in Afghanistan. The effect of deployment on testosterone was longitudinally assessed; starting prior to deployment and follow-up assessments were preformed at 1 and 6 months after return. Furthermore, the association with PTSD symptoms reported at 1 and 2 years post-deployment was assessed.

RESULTS

Plasma testosterone levels were significantly increased after deployment compared with pre-deployment levels. Although no difference was found between individuals reporting high or low levels of PTSD symptoms, pre-deployment testosterone levels predicted the development of PTSD symptoms at 1 and 2 years post-deployment.

CONCLUSION

This study provides evidence that not the alterations in testosterone levels shortly after deployment, but the pre-deployment testosterone levels are associated with PTSD symptoms, which is of value in the identification of biological vulnerability factors for the development of PTSD.

['Multi-moment non-invasive neurostimulation' - a controlled study of a new treatment for depression]

BACKGROUND

Depressive symptoms occur frequently in Dutch society. Recently a new method for treating depressive symptoms was introduced in the Netherlands. The method, known as 'multi-moment non-invasive neurostimulation' (MNNS), involves presenting patients with a series of photographs, each picture having a positive valence. The purpose of this method is to improve the mood of patients. So far, however, the method has not been thoroughly tested.

AIM

To conduct a pilot study designed to compare the effectiveness of MNNS pictures with pictures from the International Affective Pictures System (IAPS) by means of a double-blind randomised controlled trial.

METHOD

Thirty-three patients with depressive symptoms were randomly assigned to two groups, one representing the experimental condition (MNNS) and the other the control condition (IAPS). Patients were treated for six weeks in one mood-inductive session per week. The severity of the patients' depressive symptoms was assessed before the mood-induction treatment began and again at one week and at three months after the final session.

RESULTS

Each group showed a significant reduction in depressive symptoms. There were no significant differences between the MNNS condition and the control condition with regard to the reduction of depressive symptoms over time.

CONCLUSION

There was a marked reduction in the depressive symptoms of the patients of both groups which had received short-term treatments involving the viewing of pictures with a positive valence. This reduction was still apparent three months after the treatment. The positive pictures presented in the MNNS method were found to be just as effective in reducing depressive symptoms as the positive pictures presented by the IAPS.