BackgroundAlcohol misuse is more prevalent among military populations. Association between PTSD and heavy drinking have been reported in many studies. Most of the studies on alcohol use among military personnel are from US and UK. Aim of this study is to describe alcohol consumption patterns among military personnel in Sri Lanka, a country where the alcohol consumption among the general population are very different to that in US and UK.MethodsCross sectional study consisting of representative samples of Sri Lanka Navy Special Forces and regular forces deployed in combat areas continuously during a one year period was carried out. Data was collected using a self report questionnaire. Alcohol Use Disorder Identification Test (AUDIT) was used to assess alcohol consumption.ResultsSample consisted of 259 Special Forces and 412 regular navy personnel. The median AUDIT score was 2.0 (interquartile range 6.0). Prevalence of current drinking was 71.2 %. Of the current users 54.81 % were infrequent users (frequency ≤ once a month) while 37.87 % of users consumed 2–4 times a month. Prevalence of hazardous drinking (AUDIT ≥ 8) was 16.69 % and binge drinking 14.01 %. Five (0.75 %) had AUDIT total ≥20. There was no significant difference between Special Forces and regular forces in hazardous drinking or binge drinking. Total AUDIT score ≥16 were associated with difficulty performing work.ConclusionsHigh rates of hazardous drinking and binge drinking described among military personnel in US and UK were not seen among SLN personnel deployed in combat areas. This finding contrasts with previously reported association between combat exposure and hazardous alcohol use among military personnel. Alcohol use among military personnel may be significantly influenced by alcohol consumption patterns among the general population, access to alcohol and attitudes about alcohol use. Similar to findings from other countries, heavy alcohol use was associated with poorer psychological health and functional impairment.

BackgroundAmong military personnel alcohol consumption and binge-drinking have increased but cigarette smoking has declined in the recent past. Although there is a strong association between smoking and PTSD the association between combat exposure and smoking is not clear.MethodsThis cross sectional study was carried out among representative samples of SLN Special Forces and regular forces deployed in combat areas. Both Special Forces and regular forces were selected using simple random sampling. Only personnel who had served continuously in combat areas during the one year period prior to end of combat operations were included in the study. Females were not included in the sample. The study assessed several mental health outcomes as well as alcohol use, smoking and cannabis use. Sample was classified according to smoking habits as never smokers, past smokers (those who had smoked in the past but not within the past year) and current smokers (those smoking at least one cigarette within the past 12 months).ResultsSample consisted of 259 Special Forces and 412 regular navy personnel. Prevalence of current smoking was 17.9% (95% CI 14.9-20.8). Of the sample 58.4% had never smoked and 23.7% were past smokers. Prevalence of current smoking was significantly higher among Special Forces personnel compared to regular forces. (OR 1.90 (95% CI 1.20-3.02). Personnel aged ≥35 years had the lowest prevalence of smoking (14.0%). Commissioned officers had a lower prevalence (12.1%) than non commissioned officers or other ranks. After adjustment for demographic variables and service type there was significant association between smoking and combat experiences of seeing dead or wounded [OR 1.79 (95%CI 1.08-2.9)], handling dead bodies [OR 2.47(95%CI 1.6-3.81)], coming under small arms fire [OR 2.01(95%CI 1.28-3.15)] and coming under mortar, missile and artillery fire [OR 2.02(95%CI 1.29-3.17)]. There was significant association between the number of risk events and current smoking [OR 1.22 (95%CI1.11-1.35)].ConclusionsThere was significant association between current smoking and combat experiences. Current smoking was strongly associated with current alcohol use. Prevalence of current smoking was less among military personnel than in the general population. Prevalence of smoking was significantly higher among Special Forces personnel.

BackgroundMedically unexplained symptoms have been reported among both civilians and military personnel exposed to combat. A large number of military personnel deployed to the Gulf War in 1991 reported non-specific symptoms. These symptoms did not constitute a clearly defined syndrome. Post-traumatic stress disorder (PTSD) and to a lesser degree exposure to combat are associated with physical symptoms.MethodsThis is a cross-sectional study of representative samples of Sri Lanka Navy Special Forces and regular forces deployed in combat areas continuously during a 1-year period. Multiple physical symptoms were elicited using a checklist of 53 symptoms. Cases were defined as individuals with ten or more symptoms. Symptoms of common mental disorder were identified using the General Health Questionnaire 12 (GHQ-12). PTSD was diagnosed using the 17-item National Centre for PTSD checklist civilian version.ResultsPrevalence of multiple physical symptoms was 10.4% (95% CI 8.11–12.75). Prevalence was significantly less in the Special Forces (5.79%) than in the regular forces (13.35%). The mean number of symptoms reported by those who met the criteria for PTSD was 12.19 (SD 10.58), GHQ caseness 7.87 (SD 7.57) and those without these conditions 2.84 (SD 3.63). After adjusting for socio-demographic and service variables, ‘thought I might be killed’ , ‘coming under small arms fire’ , and ‘coming under mortar, missile and artillery fire’ remained significant. Multiple physical symptoms were associated with functional impairment and poor perceived general health.ConclusionsPrevalence of multiple physical symptoms was significantly lower in the Special Forces despite high exposure to potentially traumatic events. More multiple physical symptoms were reported by personnel with PTSD and common mental disorders. Multiple physical symptoms were associated with functional impairment.

BackgroundPrevalence of cannabis use among military populations vary. There is evidence that drug use is associated with combat exposure and PTSD. The objective of the study was to assess the prevalence of cannabis use among Sri Lanka Navy (SLN) personnel and to identify any relationship with cannabis use and combat exposure.MethodsThis cross sectional study was carried out among representative samples of SLN Special Forces (Special Boat Squadron) and regular forces deployed in combat areas. Both Special Forces and regular forces were selected using simple random sampling. Personnel who had served continuously in combat areas during the 1 year period prior to end of combat operations were included in the study. Cannabis use was defined as smoking cannabis at least once during the past 12 months.ResultsThe sample consisted of 259 Special Forces and 412 regular navy personnel. Prevalence of cannabis use was 5.22 % (95 % CI 3.53–6.9). There was no significant difference in prevalence of cannabis use among Special Forces personnel compared to regular forces. Cannabis use was significantly higher in the age group 18–24 years [OR 4.42 (95 % CI 2.18–8.97)], personnel who were never married [OR 2.02 (95 % CI 0.99–4.12)], or had an educational level less than GCE O’Level [OR 4.02 (95 % CI 1.17–13.78)]. There was significant association between cannabis use and hazardous alcohol use [adjusted OR 5.47 (95 % CI 2.65–11.28)], PTSD [adjusted OR 4.20 (95 % CI 1.08–16.38)], GHQ caseness [adjusted OR 2.83 (95 % CI 1.18–6.79)] and multiple somatic complaints [adjusted OR 3.61 (95 % CI 1.5–8.7)]. Cannabis use was not associated with smoking. Risk of cannabis use was less in those who had seen dead or wounded [adjusted OR 0.42 (95 % CI 0.20–0.85)]. Experiencing hostility from civilians was the only combat exposure that significantly increased the risk of cannabis use [adjusted OR 4.06 (95 % CI 1.06–15.56)].ConclusionsAmong Sri Lanka Navy personnel exposed to combat cannabis use was significantly associated with hazardous alcohol use but not smoking. PTSD and other adverse mental health outcomes were associated with an increased risk of cannabis use. Exposure to combat was not associated with increased risk of cannabis use.

The main aim of this study was to assess the mental health status of the Navy Special Forces and regular forces three and a half years after the end of combat operations in mid 2009, and compare it with the findings in 2009. This cross sectional study was carried out in the Sri Lanka Navy (SLN), three and a half years after the end of combat operations. Representative samples of SLN Special Forces and regular forces deployed in combat areas were selected using simple random sampling. Only personnel who had served continuously in combat areas during the one year period prior to the end of combat operations were included in the study. The sample consisted of 220 Special Forces and 275 regular forces personnel. Compared to regular forces a significantly higher number of Special Forces personnel had experienced potentially traumatic events. Compared to the period immediately after end of combat operations, in the Special Forces, prevalence of psychological distress and fatigue showed a marginal increase while hazardous drinking and multiple physical symptoms showed a marginal decrease. In the regular forces, the prevalence of psychological distress, fatigue and multiple somatic symptoms declined and prevalence of hazardous drinking increased from 16.5% to 25.7%. During the same period prevalence of smoking doubled in both Special Forces and regular forces. Prevalence of PTSD reduced from 1.9% in Special Forces to 0.9% and in the regular forces from 2.07% to 1.1%. Three and a half years after the end of combat operations mental health problems have declined among SLN regular forces while there was no significant change among Special Forces. Hazardous drinking among regular forces and smoking among both Special Forces and regular forces have increased.

Objectives The objective was to study the prevalence of fatigue symptoms among Special Forces and regular forces military personnel deployed in combat areas and to explore factors associated with fatigue symptoms.Methods This is a cross sectional study of representative samples of Sri Lanka Navy Special Forces and regular forces deployed in combat areas continuously for at least one year. Fatigue was measured using a 12 item fatigue scale. Symptoms of common mental disorder were identified using the General Health questionnaire 12 (GHQ-12). Multiple physical symptoms were elicited using a checklist of symptoms. PTSD was diagnosed using the 17-item National Centre for PTSD checklist civilian version (PCL-C).Results Sample consisted of 259 Special Forces and 412 regular navy personnel. Prevalence of fatigue over the last month was 13.41% (95% CI 10.83-16.00). Prevalence was significantly less in the Special Forces (5.4%) than in the regular forces (18.4%) [OR 0.38 (95% CI 0.17-0.82)]. Only two types of combat exposure "thought I might be killed" and "coming under mortar, missile and artillery fire" were significantly associated with fatigue symptoms. Fatigue was strongly associated with symptoms of common mental illness [adjusted OR 12.82 (95% CI 7.10-23.12)], PTSD [adjusted OR 9.08 (95% CI 2.84-29.0)] and multiple somatic symptoms ]. Fatigue was significantly associated with functional impairment.Conclusions Prevalence of fatigue was significantly lower in the Special Forces despite high combat exposure. Fatigue was associated only with indicators of intense combat exposure. Fatigue caused significant functional impairment even after adjusting for psychological morbidity.