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What explains post-traumatic stress disorder (PTSD) in UK service personnel: deployment or something else?

Published online by Cambridge University Press:  13 November 2012

M. Jones ,
J. Sundin ,
L. Goodwin ,
L. Hull ,
N. T. Fear ,
S. Wessely  and
R. J. Rona
M. Jones*
Affiliation:
King's Centre for Military Health Research, Department of Psychological Medicine, King's College, London, UK
J. Sundin
Affiliation:
Academic Centre for Defence Mental Health, Department of Psychological Medicine, King's CollegeLondon, UK
L. Goodwin
Affiliation:
King's Centre for Military Health Research, Department of Psychological Medicine, King's College, London, UK
L. Hull
Affiliation:
King's Centre for Military Health Research, Department of Psychological Medicine, King's College, London, UK
N. T. Fear
Affiliation:
King's Centre for Military Health Research, Department of Psychological Medicine, King's College, London, UK Academic Centre for Defence Mental Health, Department of Psychological Medicine, King's CollegeLondon, UK
S. Wessely
Affiliation:
King's Centre for Military Health Research, Department of Psychological Medicine, King's College, London, UK Academic Centre for Defence Mental Health, Department of Psychological Medicine, King's CollegeLondon, UK
R. J. Rona
Affiliation:
King's Centre for Military Health Research, Department of Psychological Medicine, King's College, London, UK
*
*Address for correspondence: M. Jones, King's Centre for Military Health Research, Department of Psychological Medicine, King's College, Weston Education Centre, Cutcombe Rd, London SE5 9RJ, UK. (Email: [email protected])
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Abstract

Background

In previous studies an association between deployment to Iraq or Afghanistan and an overall increased risk for post-traumatic stress disorder (PTSD) in UK armed forces has not been found. The lack of a deployment effect might be explained by including, in the comparison group, personnel deployed on other operations or who have experienced traumatic stressors unrelated to deployment.

Methods

The sample comprised 8261 regular UK armed forces personnel who deployed to Iraq, Afghanistan or other operational areas or were not deployed. Participants completed the PTSD CheckList – Civilian Version (PCL-C) and provided information about deployment history, demographic and service factors, serious accidents and childhood experiences.

Results

Deployment to Iraq or Afghanistan [odds ratio (OR) 1.2, 95% confidence interval (CI) 0.6–2.2] or elsewhere (OR 1.1, 95% CI 0.6–2.0) was unrelated to PTSD although holding a combat role was associated with PTSD if deployed to Iraq or Afghanistan (OR 2.7, 95% CI 1.9–3.9). Childhood adversity (OR 3.3, 95% CI 2.1–5.0), having left service (OR 2.7, 95% CI 1.9–4.0) and serious accident (OR 2.1, 95% CI 1.4–3.0) were associated with PTSD whereas higher rank was protective (OR 0.3, 95% CI 0.12–0.76).

Conclusions

For the majority of UK armed forces personnel, deployment whether to Iraq, Afghanistan or elsewhere confers no greater risk for PTSD than service in the armed forces per se but holding a combat role in those deployed to Iraq or Afghanistan is associated with PTSD. Vulnerability factors such as lower rank, childhood adversity and leaving service, and having had a serious accident, may be at least as important as holding a combat role in predicting PTSD in UK armed forces personnel.

Keywords

Deploymentpost-traumatic stress disorderUK Armed Forces
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 8 , August 2013 , pp. 1703 - 1712
Copyright
Copyright © Cambridge University Press 2012 

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References

Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA (1996). Psychometric properties of the PTSD checklist (PCL). Behaviour Research and Therapy 34, 669–673.CrossRefGoogle ScholarPubMed
Bremner, JD, Southwick, SM, Darnell, A, Charney, DS (1996). Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse. American Journal of Psychiatry 153, 369–375.Google ScholarPubMed
Brewin, CR, Andrews, B, Valentine, JD (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology 68, 748–766.CrossRefGoogle ScholarPubMed
Cabrera, OA, Hoge, CW, Bliese, PD, Castro, CA, Messer, SC (2007). Childhood adversity and combat as predictors of depression and post-traumatic stress in deployed troops. American Journal of Preventive Medicine 33, 77–82.CrossRefGoogle ScholarPubMed
Creamer, M, Carboon, I, Forbes, AB, McKenzie, DP, McFarlane, AC, Kelsall, HL, Sim, MR (2006). Psychiatric disorder and separation from military service: a 10-year retrospective study. American Journal of Psychiatry 163, 733–734.CrossRefGoogle Scholar
Darves-Bornoz, J-M, Alonso, J, de Girolamo, G, de Graaf, R, Haro, J-M, Kovess-Masfety, V, Lepine, J-P, Nachbaur, G, Negre-Pages, L, Vilagut, G, Gasquet, I (2008). Main traumatic events in Europe: PTSD in the European Study of the Epidemiology of Mental Disorders Survey. Journal of Traumatic Stress 21, 455–462.CrossRefGoogle ScholarPubMed
Fear, NT, Iversen, AC, Chatterjee, A, Jones, M, Greenberg, N, Hull, L, Rona, RJ, Hotopf, M, Wessely, S (2008). Risky driving among regular armed forces personnel from the United Kingdom. American Journal of Preventive Medicine 35, 230–236.CrossRefGoogle ScholarPubMed
Fear, NT, Jones, M, Murphy, D, Hull, L, Iversen, AC, Coker, B, Machell, L, Sundin, J, Woodhead, C, Jones, N, Greenberg, N, Landau, S, Dandeker, C, Rona, RJ, Hotopf, M, Wessely, S (2010). What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. Lancet 375, 1783–1797.CrossRefGoogle ScholarPubMed
Greenberg, N, Iversen, A, Hull, L, Bland, D, Wessely, S (2008). Getting a peace of the action: measures of post traumatic stress in UK military peacekeepers. Journal of the Royal Society of Medicine 101, 78–84.CrossRefGoogle ScholarPubMed
Hoge, CW, Auchterlonie, JL, Milliken, CS (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association 295, 1023–1032.CrossRefGoogle ScholarPubMed
Hoge, CW, Castro, CA, Messer, SC, McGurk, D, Cotting, DI, Koffman, RL (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351, 13–22.CrossRefGoogle ScholarPubMed
Hoge, CW, Lesikar, SE, Guevara, R, Lange, J, Brundage, JF, Engel, CC, Messer, SC, Orman, DT (2002). Mental disorders among US military personnel in the 1990s: association with high levels of health care utilization and early military attrition. American Journal of Psychiatry 159, 1576–1583.CrossRefGoogle ScholarPubMed
Hotopf, M, Hull, L, Fear, NT, Browne, T, Horn, O, Iversen, A, Jones, M, Murphy, D, Bland, D, Earnshaw, M, Greenberg, N, Hughes, JH, Tate, AR, Dandeker, C, Rona, R, Wessely, S (2006). The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet 367, 1731–1741.CrossRefGoogle Scholar
HPA&E (2006). 2003–2004 Active Duty Health Study. Health Program Analysis & Evaluation: Falls Church, VA.Google Scholar
Iversen, AC, Fear, NT, Ehlers, A, Hughes, JH, Hull, L, Earnshaw, M, Greenberg, N, Rona, R, Wessely, S, Hotopf, M (2008). Risk factors for post-traumatic stress disorder among UK Armed Forces personnel. Psychological Medicine 38, 511–522.CrossRefGoogle ScholarPubMed
Iversen, AC, Fear, NT, Simonoff, E, Hull, L, Horn, O, Greenberg, N, Hotopf, M, Rona, R, Wessely, S (2007). Influence of childhood adversity on health among male UK military personnel. British Journal of Psychiatry 191, 506–511.CrossRefGoogle ScholarPubMed
Iversen, AC, van Staden, L, Hughes, JH, Greenberg, N, Hotopf, M, Rona, RJ, Thornicroft, G, Wessely, S, Fear, NT (2011). The stigma of mental health problems and other barriers to care in the UK Armed Forces. BMC Health Services Research 11, 31.CrossRefGoogle ScholarPubMed
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 1048–1060.CrossRefGoogle ScholarPubMed
Koenen, KC, Moffitt, TE, Poulton, R, Martin, J, Caspi, A (2007). Early childhood factors associated with the development of post-traumatic stress disorder: results from a longitudinal birth cohort. Psychological Medicine 37, 181–192.CrossRefGoogle ScholarPubMed
Kok, BC, Herrell, RK, Thomas, JL, Hoge, CW (2012). Posttraumatic stress disorder associated with combat service in Iraq or Afghanistan: reconciling prevalence differences between studies. Journal of Nervous and Mental Disease 200, 444–450.CrossRefGoogle ScholarPubMed
Landis, JR, Koch, GG (1977). Measurement of observer agreement for categorical data. Biometrics 33, 159–174.CrossRefGoogle ScholarPubMed
Litz, BT, Orsillo, SM, Friedman, M, Ehlich, P, Batres, A (1997). Posttraumatic stress disorder associated with peacekeeping duty in Somalia for US military personnel. American Journal of Psychiatry 154, 178–184.Google Scholar
MacManus, D, Dean, K, Iversen, A, Hull, L, Jones, N, Fahy, T, Wessely, S, Fear, N (2012). Impact of pre-enlistment antisocial behaviour on behavioural outcomes among U.K. military personnel. Social Psychiatry and Psychiatric Epidemiology 47, 1353–1358.CrossRefGoogle ScholarPubMed
McManus, S, Meltzer, H, Wessely, S (2009). Posttraumatic stress disorder. In Adult Psychiatric Morbidity in England, 2007. Results of a Household Survey (ed. McManus, S., Meltzer, H., Brugha, T., Bebbington, P. and Jenkins, R.), pp. 53–70. The NHS Information Centre for Health and Social Care: London.Google Scholar
Oakley Browne, MA, Wells, JE, Scott, KM (eds) (2006). Te Rau Hinengaro: The New Zealand Mental Health Survey. Ministry of Health: Wellington.Google ScholarPubMed
Ozer, EJ, Best, SR, Lipsey, TL, Weiss, DS (2003). Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychological Bulletin 129, 52–73.CrossRefGoogle ScholarPubMed
Perkonigg, A, Kessler, RC, Storz, S, Wittchen, HU (2000). Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica 101, 46–59.CrossRefGoogle ScholarPubMed
Ramchand, R, Schell, TL, Karney, BR, Osilla, KC, Burns, RM, Caldarone, LB (2010). Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: possible explanations. Journal of Traumatic Stress 23, 59–68.CrossRefGoogle ScholarPubMed
Richardson, LK, Frueh, BC, Acierno, R (2010). Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Australian and New Zealand Journal of Psychiatry 44, 4–19.CrossRefGoogle ScholarPubMed
Rona, RJ, Fear, NT, Hull, L, Wessely, S (2007). Women in novel occupational roles: mental health trends in the UK Armed Forces. International Journal of Epidemiology 36, 319–326.CrossRefGoogle ScholarPubMed
Rona, RJ, Hooper, R, Jones, M, Hull, L, Browne, T, Horn, O, Murphy, D, Hotopf, M, Wessely, S (2006). Mental health screening in armed forces before the Iraq war and prevention of subsequent psychological morbidity: follow-up study. British Medical Journal 333, 991.CrossRefGoogle ScholarPubMed
Rona, RJ, Hooper, R, Jones, M, Iversen, AC, Hull, L, Murphy, D, Hotopf, M, Wessely, S (2009). The contribution of prior psychological symptoms and combat exposure to post Iraq deployment mental health in the UK military. Journal of Traumatic Stress 22, 11–19.CrossRefGoogle ScholarPubMed
Schell, TL, Marshall, GN (2008). Survey of individuals previously deployed for OEF/OIF. In Invisible Wounds of War. Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (ed. Tanielian, T. and Jaycox, L. H.), pp. 87–115. RAND: Santa Monica.Google Scholar
Smith, TC, Ryan, MAK, Wingard, DL, Slymen, DJ, Sallis, JF, Kritz-Silverstein, D; Millennium Cohort Study Team (2008). New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study. British Medical Journal 336, 366–371.CrossRefGoogle ScholarPubMed
Storr, CL, Ialongo, NS, Anthony, JC, Breslau, N (2007). Childhood antecedents of exposure to traumatic events and posttraumatic stress disorder. American Journal of Psychiatry 164, 119–125.CrossRefGoogle ScholarPubMed
Sundin, J, Fear, NT, Iversen, A, Rona, RJ, Wessely, S (2010). PTSD after deployment to Iraq: conflicting rates, conflicting claims. Psychological Medicine 40, 367–382.CrossRefGoogle ScholarPubMed
van Ameringen, M, Mancini, C, Patterson, B, Boyle, MH (2008). Post-traumatic stress disorder in Canada. CNS Neuroscience and Therapeutics 14, 171–181.CrossRefGoogle ScholarPubMed
Vasterling, JJ, Proctor, SP, Friedman, MJ, Hoge, CW, Heeren, T, King, LA, King, DW (2010). PTSD symptom increases in Iraq-deployed soldiers: comparison with nondeployed soldiers and associations with baseline symptoms, deployment experiences, and postdeployment stress. Journal of Traumatic Stress 23, 41–51.CrossRefGoogle ScholarPubMed