What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study

Fear, Nicola T.; Jones, Margaret; Murphy, Dominic; Hull, Lisa; Iversen, Amy; Coker, Bolaji; Machell, Louise; Sundin, Josefin; Woodhead, Charlotte; Jones, Norman; Greenberg, Neil; Landau, Sabine; Dandeker, Christopher; Rona, Roberto J.; Hotopf, Matthew; Wessely, Simon

doi:10.1016/s0140-6736(10)60672-1

Cited by 494 publications

(583 citation statements)

References 37 publications

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“…Much debate is present in the military and veteran literature about gender differences in PTSD with opinions supporting and opposing the presence of a gender difference [10,13,14,27,33]. Our results do not support that PTSD is more common in women but results in more substantial disability than experienced by their men counterparts, and the rates identified are consistent with previous reports.…”

Section: Discussioncontrasting

confidence: 58%

Disability After Deployment Injury: Are Women and Men Service Members Different?

Rivera

Hylden

Johnson

2015

Clinical Orthopaedics &Amp; Related Research

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Background Civilian trauma literature suggests sexual dimorphism in outcomes after trauma. Because women represent an increasing demographic among veterans, the question remains if war trauma outcomes, like civilian trauma outcomes, differ between genders. Questions/purposes (1) Do women service members develop different conditions resulting in long-term disability compared with men service members after injuries sustained during deployment? (2) Do women service members have more or less severe disability after deployment injury compared with men service members? (3) Are men or women more likely to return to duty after combat injury?Methods The Department of Defense Trauma Registry was queried for women injured during deployment from 2001 to 2011. The subjects were then queried in the Physical Evaluation Board database to determine each subject's return-to-duty status and what disabling conditions and disability percentages were assigned to those who did not return to duty. Frequency of disabling conditions, disability percentages, and return-to-duty rates for 368 women were compared with a previously published cohort of 450 men service members, 378 of whom had orthopaedic injuries.Results Women who were unable to return to duty had a higher frequency of arthritic conditions (58% 378] of men, p = 0.0410; RR, 0.169; 95% CI, 0.023-1.224). Women had more severely rated posttraumatic stress disorder (PTSD) compared with men (38% ± 23% versus 19% ± 17%). Forty-eight percent (64 of 133) of battle-injured women were unable to return to active duty, resulting in a lower return-to-duty rate compared with men (34% [450 of 1333]; p = 0.003). Conclusions After deployment-related injury, women have higher rates of arthritis, lower rates of pain disorders, and more severely rated PTSD compared with men. Women are unable to return to duty more often than men injured in combat. These results suggest some difference between men's and women's outcomes after deployment injury, important information for military and Veterans Administration providers seeking to minimize postdeployment disability.

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Section: Discussioncontrasting

confidence: 58%

Disability After Deployment Injury: Are Women and Men Service Members Different?

Rivera

Hylden

Johnson

2015

Clinical Orthopaedics &Amp; Related Research

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“…Although higher rates were observed in those in direct combat roles, the prevalence of PTSD, psychological distress and alcohol misuse among regular UK personnel deployed to Iraq and Afghanistan was four percent, 20% and 16% respectively, 5 not dissimilar to rates found among those who did not deploy to Iraq and/or Afghanistan. 5,6 But even though the rates are not as high as some anticipated, the absolute numbers are still substantial. Mental health screening is one way to address these problems.…”

Section: Methodsmentioning

confidence: 88%

“…This was more common in younger groups and among lower ranks, both of which are risk factors for mental disorders. 5 However, only 15% among those with a score indicative of a mental disorder declined to see the tailored advice, with the exception of alcohol misuse (25%). The lack of interest in viewing the tailored advice shown by some UK service personnel occurred despite the vast majority receiving a homecoming briefing upon leaving the operational area; the briefing detailed symptom recognition in oneself and others, and how to access potential sources of mental health support if required.…”

Section: Discussionmentioning

confidence: 99%

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Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial

et al. 2017

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“…Studies have shown that the intensity and frequency of combat exposure are often proportional to post-deployment severity of posttraumatic stress disorder (PTSD) (Fear et al, 2010; Xue et al, 2015). However, life in a war zone often includes stressful experiences not related directly to combat and not posing a direct threat, e.g.…”

Section: Introductionmentioning

confidence: 99%

Perceived danger during deployment: a Rasch validation of an instrument assessing perceived combat exposure and the witnessing of combat consequences in a war zone

Karstoft

Nielsen

2018

European Journal of Psychotraumatology

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The potential stressors associated with military deployment are related to an increased risk of adverse mental health outcomes. Perceived exposure to combat has been found to be proportional to the severity of post-deployment posttraumatic stress disorder (PTSD). However, other perceived adversities during deployment, such as witnessing danger, distress, and hardship in the war zone, have been less systematically studied, but might play an equally substantial role for post-deployment mental health. The development and validation of scales that assess these related constructs are needed to distinguish their contribution to post-deployment risk of PTSD. We evaluated the validity of 10 items measuring perceived danger distributed to all deployed personnel with the Danish Defense since 1998. We hypothesize two scales: Exposure to Danger and Combat (EDC) and Witnessing Consequences of War (WCW). Two military cohorts deployed to Afghanistan in 2009 (Cohort 1, N = 276) and 2013 (Cohort 2, N = 273) were included. Questionnaire data was collected six months after homecoming, including deployment experiences and post-deployment reactions. We tested the construct validity of the 10 items of perceived danger with Rasch models (RM), focusing specifically on presence of subscales, and differential item functioning (DIF) across cohorts. We confirmed the existence of two separate subscales, EDCS and WCWS, both with adequate reliability. None of the subscales fitted a pure RM, but adequate fit was found for graphical log-linear RMs with evidence of DIF for the ECDS. However, adjusting the score to account for DIF had practically no effect, suggesting that the total non-adjusted mean score can be used in future cohort comparisons. Perceived exposure to combat and danger and witnessing consequences of war are related, but essentially distinct, concepts, each providing unique information about deployment adversities. Future studies should evaluate their shared and unique contribution to the risk of post-deployment PTSD.

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What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study

Cited by 494 publications

References 37 publications

Disability After Deployment Injury: Are Women and Men Service Members Different?

Disability After Deployment Injury: Are Women and Men Service Members Different?

Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial

Perceived danger during deployment: a Rasch validation of an instrument assessing perceived combat exposure and the witnessing of combat consequences in a war zone

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