Varuni Asanka de Silva

Publications (3)5.66 Total impact

• Article: Smoking among troops deployed in combat areas and its association with combat exposure among navy personnel in Sri Lanka.

  Varuni Asanka de Silva, Nicholas Elw Jayasekera, Raveen Hanwella
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  ABSTRACT: Among 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. This 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). Sample 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)]. There 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.
  Substance Abuse Treatment Prevention and Policy 07/2012; 7:27. · 1.16 Impact Factor
• Source

  Available from: PubMed Central

  Article: Alcohol use in a military population deployed in combat areas: a cross sectional study.

  Raveen Hanwella, Varuni Asanka de Silva, Nicholas E L W Jayasekera
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  ABSTRACT: Alcohol 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. Cross 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. Sample 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. High 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.
  Substance Abuse Treatment Prevention and Policy 06/2012; 7:24. · 1.16 Impact Factor
• Article: Efficacy and tolerability of venlafaxine versus specific serotonin reuptake inhibitors in treatment of major depressive disorder: a meta-analysis of published studies.

  Varuni Asanka de Silva, Raveen Hanwella
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  ABSTRACT: Specific serotonin reuptake inhibitors (SSRIs) are considered as first-line treatment in major depressive disorder (MDD). There is evidence that venlafaxine may be more effective than several antidepressants in the treatment of MDD. This meta-analysis includes all published, randomized, double-blind, head-to-head trials, which compared venlafaxine and an SSRI in the treatment of MDD in adults. Twenty-six trials comparing venlafaxine with an SSRI were included (total participants: 5858). Meta-analysis using a random effect model showed that venlafaxine was superior to SSRIs in achieving remission [odds ratio (OR)=1.13, 95% confidence interval (CI)=1.0-1.28, P=0.05] and response (OR=1.17, 95% CI=1.03-1.34, P=0.02). Subgroup analysis found that venlafaxine had a significantly better response rate than fluoxetine (OR=1.28, 95% CI=1.05-1.55, P=0.01). There were no significant differences in response or remission between venlafaxine and other individual SSRIs. There was no significant difference in all cause discontinuation between venlafaxine and SSRIs (OR=1.10, 95% CI=0.97-1.25, P=0.15). Venlafaxine had significantly higher discontinuation due to adverse events compared with SSRIs (OR=1.41, 95% CI=1.10-1.79, P=0.006). The superior efficacy of venlafaxine over SSRIs is of clinical importance. However, higher rates of discontinuation due to adverse events for venlafaxine compared with SSRIs are a disadvantage. Findings of this meta-analysis that included only published studies were similar to those from meta-analysis that included unpublished data.
  International clinical psychopharmacology 01/2012; 27(1):8-16. · 3.35 Impact Factor