Medically 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.
This 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.
Prevalence 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.
Prevalence 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.
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[Show abstract][Hide abstract] 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.
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).
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 [adjusted OR 9.85 (95% CI 5.42-17.9)]. Fatigue was significantly associated with functional impairment.
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.
Preview · Article · Jun 2014 · Ceylon Medical Journal
[Show abstract][Hide abstract] ABSTRACT: The main aim of this study was to assess the mental health status of the Navy Special Forces and regular forces three and a half years after the end of combat operations in mid 2009, and compare it with the findings in 2009. This cross sectional study was carried out in the Sri Lanka Navy (SLN), three and a half years after the end of combat operations. Representative samples of SLN Special Forces and regular forces deployed in combat areas were selected using simple random sampling. Only personnel who had served continuously in combat areas during the one year period prior to the end of combat operations were included in the study. The sample consisted of 220 Special Forces and 275 regular forces personnel. Compared to regular forces a significantly higher number of Special Forces personnel had experienced potentially traumatic events. Compared to the period immediately after end of combat operations, in the Special Forces, prevalence of psychological distress and fatigue showed a marginal increase while hazardous drinking and multiple physical symptoms showed a marginal decrease. In the regular forces, the prevalence of psychological distress, fatigue and multiple somatic symptoms declined and prevalence of hazardous drinking increased from 16.5% to 25.7%. During the same period prevalence of smoking doubled in both Special Forces and regular forces. Prevalence of PTSD reduced from 1.9% in Special Forces to 0.9% and in the regular forces from 2.07% to 1.1%. Three and a half years after the end of combat operations mental health problems have declined among SLN regular forces while there was no significant change among Special Forces. Hazardous drinking among regular forces and smoking among both Special Forces and regular forces have increased.
[Show abstract][Hide abstract] ABSTRACT: Sri Lanka has recently emerged from nearly three decades of protracted conflict, which came to an end five years ago in 2009. A number of researchers have explored the devastating effect the conflict has had on public health, and its impact on Sri Lanka’s health system - hailed as a success story in the South Asian region. Remarkably, no attempt has been made to synthesize the findings of such studies in order to build an evidence-informed research platform. This review aims to map the ‘research landscape’ on the impact of conflict on health in Sri Lanka. Findings highlight health status in select groups within affected communities and unmet needs of health systems in post-conflict regions. We contend that Sri Lanka’s post-conflict research landscape requires exploration of individual, community and health system resilience, to provide better evidence for health programs and interventions after 26 years of conflict.
Full-text · Article · Nov 2014 · Conflict and Health