Multiple physical symptoms in a military population: a cross-sectional study

Abstract

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.

Fatigue symptoms in Sri Lanka Navy personnel deployed in combat areas

“…This is in keeping with the previous findings in this sample of better mental health outcomes among Special Forces indicated by lower rates of hazardous drinking, smoking, GHQ caseness and multiple physical symptoms, despite higher rates of combat exposure [20,[25][26][27]. UK military reservists and US National Guard also experienced more mental health problems than regular personnel [14,28,29].…”

The Associations Between Physical and Psychological Symptoms and Traumatic Military Deployment Exposures

“…Each symptom was further dichotomized as no (response of never) or yes (responses of mild, moderate, or severe) as per previous military studies (Kelsall et al, 2004;Unwin et al, 1999). We assigned physical distress caseness as an endorsement of 16 or more physical symptoms; this represented the top 12.4% of our sample, which was comparable to cutoffs established in previous military research (de Silva et al, 2013;Hoge, Terhakopian, Castro, Messer, & Engel, 2007;Hotopf et al, 2006;McCutchan et al, 2016). The HSC had high internal consistency in our sample, Cronbach's α = .92.…”

“…"); and Human Death or Degradation, which included six items (e.g., "Did you handle dead bodies? "; de Silva et al, 2013;Nissen et al, 2011;Waller et al, 2012). Each subscale score was a count of the number of subscale items to which participants were exposed.…”

“…Several military studies suggest that certain TDEs may be associated with negative physical and psychological outcomes (Killgore, Stetz, Castro, & Hoge, 2006;Kroenke, Koslowe, & Roy, 1998;Searle et al, 2017). Subjective threat-to-self exposures and witnessing human atrocities have been found to be predictors of both physical and psychological symptoms, whereas objective combat exposures appear to have less impact (de Silva, Jayasekera, & Hanwella, 2013;Nissen et al, 2011;Waller et al, 2012). Other studies have found that deployment rather than combat is associated with physical symptoms (de Silva et al, 2013;Hotopf et al, 2006;McCutchan et al, 2016).…”

“…Subjective threat-to-self exposures and witnessing human atrocities have been found to be predictors of both physical and psychological symptoms, whereas objective combat exposures appear to have less impact (de Silva, Jayasekera, & Hanwella, 2013;Nissen et al, 2011;Waller et al, 2012). Other studies have found that deployment rather than combat is associated with physical symptoms (de Silva et al, 2013;Hotopf et al, 2006;McCutchan et al, 2016). This variability in findings may be due to the wide range of tools used to measure physical symptoms.…”