Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-23T17:17:53.410Z Has data issue: false hasContentIssue false
  • English
  • Français

The symptomatology of psychological trauma in the aftermath of war (1945–1980): UK army veterans, civilians and emergency responders

Published online by Cambridge University Press:  21 June 2018

Alberta Engelbrecht ,
Howard Burdett Open the ORCID record for Howard Burdett [Opens in a new window] ,
Maria João Silva ,
Kamaldeep Bhui  and
Edgar Jones
Alberta Engelbrecht
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Howard Burdett
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Maria João Silva
Affiliation:
Centre for Psychiatry at the Wolfson Institute of Preventive Medicine, Barts & The London, Queen Mary University of London, London, UK
Kamaldeep Bhui
Affiliation:
Centre for Psychiatry at the Wolfson Institute of Preventive Medicine, Barts & The London, Queen Mary University of London, London, UK
Edgar Jones*
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
*
Author for correspondence: Edgar Jones, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

UK veterans suffering from a psychological or psychiatric illness as a consequence of service in the Second World War were entitled to a war pension. Their case files, which include regular medical assessments, are a valuable resource to investigate the nature, distribution and duration of symptoms.

Methods

A standardised form was used to collect data from pension records of a random sample of 500 UK army veterans from the first presentation in the 1940s until 1980. Data were also gathered from 50 civilians and 54 emergency responders with a pension for post-traumatic illness following air-raids.

Results

The 10 most common symptoms reported by veterans were anxiety, depression, sleep problems, headache, irritability/anger, tremor/shaking, difficulty completing tasks, poor concentration, repeated fears and avoidance of social contact. Nine of the 10 were widely distributed across the veteran population when symptoms were ranked by the number of subjects who reported them. Nine symptoms persisted significantly longer in the veteran sample than in emergency responders. These included seven of the most common symptoms, together with two others: muscle pain and restlessness. The persistence of these symptoms in the veteran group suggests a post-traumatic illness linked to lengthy overseas service in combat units.

Conclusions

The nature and duration of symptoms exhibited by veterans may be associated with their experience of heightened risks. Exposure to severe or prolonged trauma seems to be associated with chronic multi-symptom illness, symptoms of post-traumatic stress and somatic expressions of pain that may delay or complicate the recovery process.

Keywords

Emergency respondersfunctional physical symptomspost-traumatic stress disorderpsychological traumaveterans
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 5 , April 2019 , pp. 811 - 818
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addison, P (1985) Now the war is Over, A Social History of Britain 1945–51. London: Jonathan Cape.Google Scholar
Afari, N, Ahumada, SM, Johnson Wright, L, Mostoufi, MS, Golnari, G, Reis, V and Cuneo, JG (2014) Psychological trauma and functional somatic syndromes: a systematic reviews and meta-analysis. Psychosomatic Medicine 76, 2–11.Google Scholar
Allport, A (2009) Demobbed, Coming Home After the Second World War. New Haven: Yale University Press.Google Scholar
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th Edn. Washington, DC: American Psychiatric Association.Google Scholar
Andrews, B, Brewin, CR, Stewart, L, Philpott, R and Hejenberg, J (2009) Comparison of immediate-onset and delayed-onset post-traumatic stress disorder in military veterans. Journal of Abnormal Psychology 118, 767–777.Google Scholar
Bowland, EW (1947) Psychogenic rheumatism: the musculoskeletal expression of psychoneurosis. Annals of Rheumatic Diseases 6, 195–203.Google Scholar
Brewin, CR, Andrews, B and Hejenberg, J (2012) Recognition and treatment of psychological disorders during military service in the UK armed forces: a study of war pensioners. Social Psychiatry and Psychiatric Epidemiology 47, 1891–1897.Google Scholar
Brewin, CR, Garnett, R and Andrews, B (2011) Trauma, identity and mental health in UK military veterans. Psychological Medicine 41, 733–740.Google Scholar
Buckman, JEJ, Forbes, HJ, Clayton, T, Jones, M, Jones, N, Greenberg, N, Sundin, J, Hull, H, Wessely, S and Fear, NT (2013) Early service leavers: a study of the factors associated with premature separation from the UK armed forces and the mental health of those that leave early. European Journal of Public Health 23, 410–415.Google Scholar
Coughlin, SS, McNeil, RB, Provenzale, DT, Dursa, EK and Thomas, CM (2013) Method issues in epidemiological studies of medically unexplained symptom-based conditions in veterans. Journal of Military Veterans’ Health 21, 4–10.Google Scholar
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 and Wessely, S (2010) What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces. Lancet 375, 1783–1797.Google Scholar
Frankfurt, S and Frazier, P (2016) A review of research on moral injury in combat veterans. Military Psychology 28, 318–330.Google Scholar
Friedman, MJ, Resick, PA, Bryant, RA and Brewin, CR (2011) Considering PTSD for DSM-5. Depression & Anxiety 28, 750–769.Google Scholar
Guttman, E and Baker, AA (1945) Neuroses in Firemen. Journal of Mental Science 91, 454–457.Google Scholar
Henderson, DK and Batchelor, IRC (1962) Henderson & Gillespie's Textbook of Psychiatry. London: Oxford University Press.Google Scholar
Hofman, SG, Litz, BT and Weathers, FW (2003) Social anxiety, depression, and PTSD in Vietnam veterans. Journal of Anxiety Disorders 17, 573–582.Google Scholar
Hoge, CW, Castro, CA, Messer, SC, McGurk, D, Cotting, DI and Koffman, RL (2004) Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351, 13–22.Google Scholar
Hoge, CW, Terhakopian, A, Castro, CA, Messer, SC and Engel, CC (2007) Association of PTSD with somatic symptoms, health care visits and absenteeism among Iraq War veterans. American Journal of Psychiatry 164, 150–153.Google Scholar
Iversen, A, van Staden, L, Hughes, J, Greenberg, N, Hotopf, M, Rona, R, Thornicroft, G, Wessely, S and 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.Google Scholar
Iversen, AC, van Staden, L, Hughes, JH, Browne, T, Greenberg, N, Hotopf, M, Rona, RJ, Wessely, S, Thornicroft, G and Fear, NT (2010) Help-seeking and receipt of treatment among UK service personnel. The British Journal of Psychiatry 197, 149–155.Google Scholar
Jones, E, Hodgins-Vermaas, R, McCartney, H, Everitt, B, Beech, C, Poynter, D, Palmer, I, Hyams, K and Wessely, S (2002 a) Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution. BMJ 324, 321–324.Google Scholar
Jones, E, Palmer, I and Wessely, S (2002 b) War pensions (1900–1945): changing models of psychological understanding. British Journal of Psychiatry 180, 374–379.Google Scholar
Kang, HK, Li, B, Mahan, CM, Eisen, SA and Engel, CC (2009) Health of US veterans of 1991 Gulf War: a follow-up survey in 10 years. Journal of Occupational and Environmental Medicine 51, 401–410.Google Scholar
Kelsall, HL, McKenzie, DP, Sim, MR, Leder, K, Forbes, AB and Dwyer, T (2009) Physical, psychological, and functional comorbidities of multisymptom illness in Australian male veterans of the 1991 Gulf War. American Journal of Epidemiology 170, 1048–1056.Google Scholar
King, GS (1958) The Ministry of Pensions and National Insurance. London: George Allen and Unwin.Google Scholar
Kulka, RA, Schlenger, WE, Fairbank, JA, Hough, RL, Jordan, BK and Marmar, CR (1990) Trauma and the Vietnam War Generation: Report of Findings From the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.Google Scholar
McAndrew, LM, Helmer, DA, Phillips, LA, Chandler, HK, Ray, K and Quigley, KS (2016) Iraq and Afghanistan veterans report symptoms consistent with chronic multi-symptom illness one year after deployment. Journal of Rehabilitation Research and Development 53, 59–70.Google Scholar
Ministry of Pensions (1943) New War Disability Code (1943). London: Her Majesty's Stationery Office.Google Scholar
Ministry of Pensions (1953) Twenty-Eighth Annual Report for the Period 1 April 1952 to 31 March 1953. London: Her Majesty's Stationery Office.Google Scholar
Murphy, D, Hodgman, G, Carson, C, Spencer-Harper, L, Hinton, M, Wessely, S and Busuttil, W (2015) Mental health and functional impairment outcomes following 6-week intensive treatment programme for UK military veterans with PTSD. BMJ Open 5(3), e007051.Google Scholar
O'Brien, LS (1998) Traumatic Events and Mental Health. Cambridge: Cambridge University Press.Google Scholar
Shephard, B (1999) ‘Pitiless Psychology’: the role of prevention in British military psychiatry in the Second World War. History of Psychiatry 10, 491–542.Google Scholar
StataCorp (2015) Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.Google Scholar
Steenkamp, MM, Litz, BT, Hoge, CW and Marmar, CR (2015) Psychotherapy for military-related PTSD: a review of randomized clinical trials. JAMA 314, 489–500.Google Scholar
Xue, C, Ge, Y, Tang, B, Liu, Y, Kang, P, Wang, M and Zhang, L (2015) A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PLoS ONE 10(3), e0120270.Google Scholar
Yehuda, R and Hoge, CW (2016) The meaning of evidence-based treatments for veterans with posttraumatic stress disorder. JAMA Psychiatry 73, 433–434.Google Scholar