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Depression is more common than post-traumatic stress disorder in UK ex-service personnel. Only about half of those who have a diagnosis are seeking help currently, and few see specialists.

Objectives To explore the relation between ill health after the Gulf war and vaccines received before or during the conflict. To test the hypothesis that such ill health is limited to military personnel who received multiple vaccines during deployment and that pesticide use modifies any effect. Design Cross sectional study of Gulf war veterans followed for six to eight years after deployment. Setting UK armed forces. Participants Military personnel who served in the Gulf and who still had their vaccine records. Main outcome measures Multisymptom illness as classified by the Centers for Disease Control and Prevention; fatigue; psychological distress; post-traumatic stress reaction; health perception; and physical functioning. Results The response rate for the original survey was 70.4% (n = 3284). Of these, 28% (923) had vaccine records. Receipt of multiple vaccines before deployment was associated with only one of the six health outcomes (post-traumatic stress reaction). By contrast five of the six outcomes (all but post-traumatic stress reaction) were associated with multiple vaccines received during deployment. The strongest association was for the multisymptom illness (odds ratio 5.0; 95% confidence interval 2.5 to 9.8). Conclusion Among veterans of the Gulf war there is a specific relation between multiple vaccinations given during deployment and later ill health. Multiple vaccinations in themselves do not seem to be harmful but combined with the "stress" of deployment they may be associated with adverse health outcomes. These results imply that every effort should be made to maintain routine vaccines during peacetime.

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Background: Little is known about what support the United Kingdom (UK) armed forces require when they return from operations. Aims: To investigate the perceived psychological support requirements for service personnel on peacekeeping deployments when they return home from operations and examine their views on the requirement for formal psychological debriefings. Methods: A retrospective cohort study examined the perceived psychological needs of 1202 UK peacekeepers on return from deployment. Participants were sent a questionnaire asking about their perceived needs relating to peacekeeping deployments from April 1991 to October 2000. Results:Results indicate that about two-thirds of peacekeepers spoke about their experiences. Most turned to informal networks, such as peers and family members, for support. Those who were highly distressed reported talking to medical and welfare services. Overall, speaking about experiences was associated with less psychological distress. Additionally, two thirds of the sample was in favour of a formalised psychological debriefing on return to the UK. Conclusions: This study suggests that most peacekeepers do not require formalised interventions on homecoming and that more distressed personnel are already accessing formalised support mechanisms. Additionally social support from peers and family appears useful and the UK military should foster all appropriate possibilities for such support.

Objectives Firstly, to describe changes in the health

People with depression report frequent cognitive failures, but objective measures of cognition show mixed results. Some studies show impairment on effortful tasks. The relationship between subjective and objective cognitive failures was studied in 102 "depressed" or "nondepressed" UK servicemen, grouped by Beck Depression Inventory scores with a cutoff score of 10. Participants were administered cognitive tests including the Sustained Attention to Response Task (SART), a laboratory measure of vigilance that has revealed increased attentional lapses in traumatic brain injury patients. The depressed men made more errors on SART than the nondepressed men (P=0.012) but reported much higher incidences of cognitive failures on a standardized questionnaire (P=0.0001). The depressed men's SART reaction times slowed following an error, a pattern different from that of brain-injured subjects. Nonclinical depressed subjects may respond "catastrophically" to errors, heightening the subjective sense of failure and contributing to the strong relationship between subjectively reported cognitive failures and depression.

Most disabled Gulf veterans do not have a formal psychiatric disorder. Post-traumatic stress disorder is not higher in Gulf veterans than in other veterans. Psychiatric disorders do not fully explain self reported ill health in Gulf veterans; alternative explanations for persistent ill health in Gulf veterans are needed.