Fatigue symptoms in Sri Lanka Navy personnel deployed in combat areas

Abstract

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.

Exploring the effects of the past civil war in terms of the prevalence and associating factors of PTSD

“…Consisting with our findings, the naval study of Sri Lanka too saw a significant association between fatigue and PTSD and emphasized the importance of training and maintenance of good physical and mental health before combat duties (31). Trauma studies corroborate the significance of the relationship between PTSD and fatigue, attributing it to the altered emotional state and the stress-response system in general, and the hypothalamic-pituitary-adrenal (HPA) axis in particular following the exposure to trauma (32)(33)(34).…”

“…Nevertheless, the former Army study revealed that PTSD was significantly higher in those with less education and younger age at first battle exposure (6). Strikingly, the Navy study demonstrated that personnel in the elite units compared with their counterparts in the regular units were less affected by the age at first battle exposure, and attributed to the higher degree of unit cohesion (23). International literature illuminates that, liability to PTSD increases with younger age, lower educational attainment and being unmarried, owing to the inability to cope with trauma and the vulnerability to trauma exposure (9) (24)(25)(26).…”

Construct validity and reliability of the Sinhala version of the Chalder fatigue questionnaire in a cohort following dengue infection in Sri Lanka

“…At the planning stage, there were no Sri Lankan studies that had assessed PIF following dengue infection. There were only two local studies that had assessed fatigue among twins (general population) and Navy officers (Ball et al, 2011;Hanwella et al, 2014). A survey among Sri Lankan physicians revealed that 77 % were reported as post-viral fatigue (Kularatne, 2005).…”