What happens to the mental health of UK service personnel after they return home from Afghanistan?

OBJECTIVE: Fear et al identified a small but significant increase in probable post-traumatic stress disorder (PTSD) in UK military personnel from around 3% in first year post deployment to around 6% by year 5. As yet it is not clear what factors are linked to the increase in probable PTSD, and therefore, serial measurement of poor mental health would be helpful. METHOD: Rates of mental ill health among UK service personnel were compared upon deployment completion and at follow-up and identified factors associated with maladjustment. RESULTS: Poor mental health symptomatology increased from baseline to follow-up, PTSD symptoms and related functional impairment increased significantly. Poor baseline mental health was predictive of transition and family relationship difficulties. CONCLUSIONS: The results are discussed in relation to encouraging recognition and reporting of symptoms among personnel and their social networks.

Mental health of UK Armed Forces medical personnel post-deployment.

BACKGROUND: The mental health effects of deployment vary widely, and personnel in both combat and combat support roles, including medical personnel, may be adversely affected. AIMS: To compare the mental health of deployed UK military medical staff in both forward and rear locations and to compare these two groups with other deployed military personnel. METHODS: Participants were medics who had deployed to Iraq or Afghanistan and provided information about their deployed role, experiences during and on return from deployment and demographic and military factors. Health outcomes included common mental health problems (using 12-item General Health Questionnaire), post-traumatic stress disorder (PTSD, using 17-item Post-Traumatic Stress Disorder Checklist-Civilian Version), multiple physical symptoms and alcohol use (using 10-item Alcohol Use Disorders Identification Test). RESULTS: The sample comprised 321 medical personnel. The response rate was 56%. The mental health outcomes for forward located medics (FMs) were no different than those for rear located medics (RLMs). When comparing FMs and RLMs against all other military roles, a small but significant increase in PTSD symptoms in FMs was found. FMs were more likely to rate their work while deployed as being above their skills and experience, report exposure to more combat experiences and report a more challenging homecoming experience than RLMs. CONCLUSIONS: These results suggest that while the overall rates of self-reported mental health disorders were similar in FMs and RLMs, FMs reported more PTSD symptoms than all other roles, which may have been related to working in more hostile environments in more challenging roles while deployed and their experiences on returning home.

Rest and recuperation in the UK Armed Forces.

BACKGROUND: Recent epidemiological evidence suggests that military personnel commonly remain psychologically resilient in the face of adversity they face on deployment. However, the processes that promote resilience have not been well assessed within the UK military. For many years, the UK Armed Forces have operated a policy of rest and recuperation (R&R), which refers to the brief period during which troops return home when on an operational tour of duty. While R&R is thought to play an import ant role in promoting recovery and well-being, there is as yet no empirical evidence to support its effectiveness. AIMS: To explore whether R&R promotes well-being and recovery from the strains of deployment in military personnel. METHODS: Participants completed self-report measures of mental health and exposure to potentially traumatic events (PTEs), as well as an R&R Recovery Questionnaire (R&RRQ). RESULTS: Statistical analysis indicated that the R&RRQ was a reliable measure within the sample of 97 subjects. Participants who reported recovery following R&R reported fewer symptoms of mental health difficulties. However, increased deployment exposure to PTEs was associated with feeling less recovered at the end of R&R. CONCLUSIONS: These preliminary data suggest that R&R can be useful for troops if they can use the time to recover. This study's results are relevant to policymakers and leaders in the military and other groups placed in challenging environments but more work is needed to understand how R&R works and to maximize its capacity to promote well-being among military personnel.

Contrasting beliefs about screening for mental disorders among UK military personnel returning from deployment to Afghanistan.

OBJECTIVE: The objective of the study was to elicit beliefs and experiences of the value of a screening programme for mental illness among UK military personnel. METHOD: Three months after returning from Afghanistan 21 army personnel participated in a qualitative study about mental health screening. One-to-one interviews were conducted and recorded. Data-driven thematic analysis was used. Researchers identified master themes represented by extracts of text from the 21 complete transcripts. RESULTS: Participants made positive remarks on the advantages of screening. Noted barriers to seeking help included: unwillingness to receive advice, a wish to deal with any problems themselves and a belief that military personnel should be strong enough to cope with any difficulties. Participants believed that overcoming barriers to participating in screening and seeking help would be best achieved by making screening compulsory. CONCLUSIONS: Although respondents were positive about a screening programme for mental illness, the barriers to seeking help for mental illness appear deep rooted and reinforced by the value ascribed to hardiness.

Third location decompression for individual augmentees after a military deployment.

BACKGROUND: Third location decompression (TLD) refers to the initial process, undertaken by military personnel at the end of an operational deployment, whereby adjustment from military operations commences. TLD has been shown to be useful for personnel in formed units (FU). AIMS: To examine the subjective utility of TLD for personnel deployed as individual augmentees (IAs) by comparing their experience with FU personnel. METHODS: One hundred and twenty-nine IAs and 121 FU personnel completed a short survey at the end of the decompression period asking about operational exposures, perceived usefulness, stigma, concerns about readjustment and post-traumatic stress symptoms (PTSS). RESULTS: The strongest predictor of perceived utility was the desire to participate prior to arrival at the facility. FU personnel were more likely to want to participate in TLD than IAs (60% versus 30%); however, on completion, IAs reported high usefulness ratings with 78% of IAs and 84% of FU personnel finding it useful or a little useful. More FU personnel reported substantial PTSS, reporting that high numbers of PTSS were associated with finding the briefings that dealt with traumatic stress useful. Personnel reporting substantial operational exposures also reported greater levels of PTSS. CONCLUSIONS: IAs found TLD to be as useful as FU personnel; therefore, exclusion from the TLD process is not warranted. Military commanders should consider restricting TLD to both IA and FU personnel deemed to be at increased risk of a difficult adjustment due to greater operational exposure. Our data suggest that smaller numbers of IA personnel would fall into this group.

The use of exercise and dietary supplements among British soldiers in Afghanistan.

BACKGROUND AND OBJECTIVES: Recently published case reports, coupled with a large observational study of 1017 deployed servicemen to Iraq (January 2009), has highlighted the issue and potential concerns regarding the unregulated use of dietary and exercise supplements within the British military. Consequently, an exploratory pilot study was undertaken to assess whether the findings of the previous Iraq study were applicable to current deployed British servicemen in Afghanistan. METHODS: This was a voluntary questionnaire-based study targeted at individuals attending a health promotion fair in Camp Bastion, Afghanistan in June 2010. RESULTS: From 150 questionnaires handed out there were 87 completed questionnaires (58% return). The mean age was 28.0 (SD 7.1; range of 18-50 years) with 89.7% being male. From the total of 87 persons 46.0% were self-declared current smokers with 37.9% admitting to drinking >6 caffeinated drinks per day. Forty nine persons (56.3%) admitted to a history of supplement use with 35 (40.2% compared with 32.0% in 2009 in Iraq) declaring current use. The average duration of supplement use among current users was 3.0 (2.0-9.0) months. The main sources of supplement supply were via local NAAFI purchase (57.1%), internet purchase (40.0%) and via their local chemist (2.9%). The main types of supplement used were proteins/amino acids (85.7%), creatine (34.3%), chromium (31.4%), stimulants (17.1%), hydroxycut (5.7%), and testosterone boosters (1.2%) with no persons admitting to the use of ephedra or anabolic steroids. CONCLUSIONS: A significant proportion of the British servicemen employed on operations in Afghanistan who were sampled, admitted to current dietary and exercise supplement use whilst on deployment. The results of this small study suggest that their use on operations may be increasing. Smoking rates and caffeine consumption, on deployment, remain high in the British military. A larger detailed study with greater representation among soldiers deployed to forward operating bases would be helpful to fully appreciate the scale of supplement use.