Article

Combat and Peacekeeping Operations in Relation to Prevalence of Mental Disorders and Perceived Need for Mental Health Care: Findings From a Large Representative Sample of Military Personnel

Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB PZ430, Canada R3E 3N4.
Archives of General Psychiatry (Impact Factor: 14.48). 08/2007; 64(7):843-52. DOI: 10.1001/archpsyc.64.7.843
Source: PubMed

ABSTRACT

Although military personnel are trained for combat and peacekeeping operations, accumulating evidence indicates that deployment-related exposure to traumatic events is associated with mental health problems and mental health service use.
To examine the relationships between combat and peacekeeping operations and the prevalence of mental disorders, self-perceived need for mental health care, mental health service use, and suicidality.
Cross-sectional, population-based survey.
Canadian military.
A total of 8441 currently active military personnel (aged 16-54 years).
The DSM-IV mental disorders (major depressive disorder, posttraumatic stress disorder, generalized anxiety disorder, panic disorder, social phobia, and alcohol dependence) were assessed using the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, a fully structured lay-administered psychiatric interview. The survey included validated measures of self-perceived need for mental health treatment, mental health service use, and suicidal ideation. Lifetime exposure to peacekeeping and combat operations and witnessing atrocities or massacres (ie, mutilated bodies or mass killings) were assessed.
The prevalences of any past-year mental disorder assessed in the survey and self-perceived need for care were 14.9% and 23.2%, respectively. Most individuals meeting the criteria for a mental disorder diagnosis did not use any mental health services. Deployment to combat operations and witnessing atrocities were associated with increased prevalence of mental disorders and perceived need for care. After adjusting for the effects of exposure to combat and witnessing atrocities, deployment to peacekeeping operations was not associated with increased prevalence of mental disorders.
This is the first study to use a representative sample of active military personnel to examine the relationship between deployment-related experiences and mental health problems. It provides evidence of a positive association between combat exposure and witnessing atrocities and mental disorders and self-perceived need for treatment.

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    • "Recent attention has been brought to the connection between combat experiences and suicidality; for example, one study found that witnessing wartime atrocities is associated with current suicidal ideation (SI; Sareen et al., 2007). In a study of veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), Pietrzak et al. (2010) found that respondents who endorsed SI were more likely to score higher on measures of combat exposure. "
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    • "Firearms may, therefore, provide a means of avoidance-based coping and serve to promote a sense of emotional safety. Past research also suggests that PTSD symptom severity and specific types of experiences in combat, such as killing others and exposure to atrocities, are more highly associated with acute suicide risk compared to the frequency of combat exposure or number of deployments (Bryan et al., 2013; Fontana and Rosenheck, 1994; Griffith, 2012; Kang et al., 2015; Maguen et al., 2012; Nelson et al., 2011; Sareen et al., 2007). These findings lead us to consider that firearm access and familiarity may be better conceptualized as a distal risk factor or vulnerability that, when coupled with distress associated with PTSD, is more likely to result in suicide. "

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    • "Firearms may, therefore, provide a means of avoidance-based coping and serve to promote a sense of emotional safety. Past research also suggests that PTSD symptom severity and specific types of experiences in combat, such as killing others and exposure to atrocities, are more highly associated with acute suicide risk compared to the frequency of combat exposure or number of deployments (Bryan et al., 2013; Fontana and Rosenheck, 1994; Griffith, 2012; Kang et al., 2015; Maguen et al., 2012; Nelson et al., 2011; Sareen et al., 2007). These findings lead us to consider that firearm access and familiarity may be better conceptualized as a distal risk factor or vulnerability that, when coupled with distress associated with PTSD, is more likely to result in suicide. "
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