Posttraumatic Stress Disorder Associated With Combat Service in Iraq or Afghanistan

Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
The Journal of nervous and mental disease (Impact Factor: 1.69). 05/2012; 200(5):444-50. DOI: 10.1097/NMD.0b013e3182532312
Source: PubMed


Studies of posttraumatic stress disorder (PTSD) prevalence associated with deployment to Iraq or Afghanistan report wide variability, making interpretation and projection for research and public health purposes difficult. This article placed this literature within a military context. Studies were categorized according to deployment time-frame, screening case definition, and study group (operational infantry units exposed to direct combat versus population samples with a high proportion of support personnel). Precision weighted averages were calculated using a fixed-effects meta-analysis. Using a specific case definition, the weighted postdeployment PTSD prevalence was 5.5% (95% CI, 5.4-5.6) in population samples and 13.2% (12.8-13.7) in operational infantry units. Both population-level and unit-specific studies provided valuable and unique information for public health purposes; understanding the military context is essential for interpreting prevalence studies.

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    • "Several systematic reviews have highlighted the wide variation in PTSD prevalence estimates and examined methodological factors contributing these disparate findings (Griffith, 2010; Kok, Herrell, Thomas, & Hoge, 2012; Ramchand et al., 2010). Three meta-analyses have examined differences in PTSD prevalence estimates between active duty and NG/R components (Cohen, Fink, Sampson, & Galea, 2015; Hines, Sundin, Rona, Wessely, & Fear, 2014; Sundin, Fear, Iversen, Rona, & Wessely, 2010). "
    Comprehensive Guide to Post-Traumatic Stress Disorder, Edited by C Martin, V Preedy, V Patel, 12/2015; Springer.
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    • "British studies are confidential but not anonymous, in order to enable records to be linked and followed up. By contrast the core US Land Combat Studies of Hoge and colleagues are genuinely anonymous (Kok, Herrell, Thomas, & Hoge, 2012). Sundin et al. performed a meta-analysis of 19 population-based studies of PTSD after deployment to Iraq (Sundin, Fear, Iversen, et al., 2010). "
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    ABSTRACT: A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals.
    European Journal of Psychotraumatology 08/2014; 5. DOI:10.3402/ejpt.v5.23617 · 2.40 Impact Factor
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    • "The results can manifest in terms of behavioral/physical and mental health (MH) problems, as has been spelled out in various studies in relation to the most recent deployments (Creamer, Burgess, & McFarlane, 2001; Engelhard et al., 2007; Fear et al., 2010; Hoge, Auchterlonie, & Milliken, 2006; Hoge et al., 2008; Killgore et al., 2008; Vasterling et al., 2010; Wittchen et al., 2012). The prevalence of persistent disrupted sleep, headaches, fatigue, or symptoms associated with other stresses and combat-related disorders such as posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, or ill-defined health conditions may vary across nations (Iversen et al., 2009; Kelsall et al., 2009; Kok, Herrell, Thomas, & Hoge, 2012; Luxton et al., 2011; Sareen et al., 2007; Smith et al., 2009; Theeler, Mercer, & Erickson, 2008; Thomas et al., 2010) but are not uncommon in any of them. "
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    ABSTRACT: Background For years there has been a tremendous gap in our understanding of the mental health effects of deployment and the efforts by military forces at trying to minimize or mitigate these. Many military forces have recently systematized the mental support that is provided to support operational deployments. However, the rationale for doing so and the consequential allocation of resources are felt to vary considerably across North Atlantic Treaty Organisation (NATO) International Security Assistance (ISAF) partners. This review aims to compare the organization and practice of mental support by five partnering countries in the recent deployment in Afghanistan in order to identify and compare the key methods and structures for delivering mental health support, describe bottlenecks and illustrate new developments. Method Information was collected through document analysis and semi-structured interviews with key military mental healthcare stakeholders. The review resulted from close collaboration between key military mental healthcare professionals within the Australian Defense Forces (ADF), Canadian Armed Forces (CAF), United Kingdom Armed Forces (UK), Netherlands Armed Forces (NLD), and the United States Army (US). Key stakeholders were interviewed about the mental health support provided during a serviceperson's military career. The main items discussed were training, prevention, early identification, intervention, and aftercare in the field of mental health. Results All forces reported that much attention was paid to mental health during the individual's military career, including deployment. In doing so there was much overlap between the rationale and applied methods. The main method of providing support was through training and education. The educative focus was to strengthen the mental resilience of individual soldiers while providing a range of mental healthcare services. All forces had abandoned standard psychological debriefing after critical incidents. Instead, by default, mental healthcare professionals acted to support the leader and peer led “after action” reviews. All countries provided professional mental support close to the front line, aimed at early detection and early return to normal activities within the unit. All countries deployed a mental health support team that consisted of a range of mental health staff including psychiatrists, psychologists, social workers, mental health nurses, and chaplains. There was no overall consensus in the allocation of mental health disciplines in theatre. All countries (except the US) provided troops with a third location decompression (TLD) stop after deployment, which aimed to recognize what the deployed units had been through and to prepare them for transition home. The US conducted in-garrison ‘decompression’, or ‘reintegration training’ in the US, with a similiar focus to TLD. All had a reasonably comparable infrastructure in the field of mental healthcare. Shared bottlenecks across countries included perceived stigma and barriers to care around mental health problems as well as the need for improving the awareness and recognition of mental health problems among service members. Conclusion This analysis demonstrated that in all five partners state-of-the-art preventative mental healthcare was included in the last deployment in Afghanistan, including a positive approach towards strengthening the mental resilience, a focus on self-regulatory skills and self-empowerment, and several initiatives that were well-integrated in a military context. These initiatives were partly/completely implemented by the military/colleagues/supervisors and applicable during several phases of the deployment cycle. Important new developments in operational mental health support are recognition of the role of social leadership and enhancement of operational peer support. This requires awareness of mental problems that will contribute to reduction of the barriers to care in case of problems. Finally, comparing mental health support services across countries can contribute to optimal preparation for the challenges of military deployment.
    European Journal of Psychotraumatology 08/2014; 5. DOI:10.3402/ejpt.v5.23732 · 2.40 Impact Factor
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