The study by Hacker Hughes et al (Reference Hacker Hughes, Cameron and Eldridge2005) is interesting but I wish to raise a few points. The end of pre-deployment mental health briefing was not the best time for assessment because the soldiers were aware that they would soon be going to war and hence their stress levels must have been high. One month after the return from the war, they must have felt relieved and their stress levels must have been reduced. Since the stress levels were high at the time of initial assessment, lack of increased morbidity at the final evaluation might not mean much. It would have been more appropriate to compare stress levels at the final evaluation with those measured during peacetime.

Although the soldiers were told that the commanders would be informed about only the pooled results, they were told that military mental health practitioners would contact them confidentially if results revealed cause for concern. This means that the answers were not anonymous and hence the soldiers may have hidden their psychopathology for fear of being considered weak and the consequences of being under treatment of the military mental health practitioner. These soldiers were in the war theatre for only 4 months and it has not been mentioned how much experience of combat they had but it is known that Basra was the scene of fewer hostilities than other areas. More combat experience may be associated with a higher prevalence of post-traumatic stress disorder (Reference Hoge, Castro and MesserHoge et al, 2004).

The figures do not add up. It is mentioned that 421 soldiers out of the original sample of 899 completed the questionnaires. Later it is mentioned that 35% (n=254) completed both sets of questionnaires. The number 254 is 35% of neither the original sample (n=899) nor the sample that completed the questionnaires at follow-up (n=421). The follow-up rate is very low and hence the advantage of the study being longitudinal is minimised. It is also not mentioned how many soldiers did not volunteer for the study before and after deployment although it is mentioned that participation was voluntary.

The conclusion of the study that ‘participation in war fighting may sometimes not necessarily be as deleterious to psychological well-being as has previously been thought’ is premature. The small sample size compared with studies with positive findings, the high drop-out rate and lack of baseline data do not allow us to draw any conclusions from this study.