Psychiatric Disorders and The Military

Article topic: 
The Hurt Locker

Active military service is well recognised as a risk factor for the development of psychiatric disorder. Perhaps the most commonly discussed condition is post traumatic stress disorder; characterised by re-experiencing of the traumatic event, for example through nightmares or recurrent distressing thoughts of what happened, avoidance of thinking or talking about it, emotional numbing and hyperarousal including increased vigilance, increased startle reaction, irritability and sleeping difficulties.

Recently published research of UK military personnel who had served in Iraq and Afghanistan showed psychiatric morbidity. The study included almost ten thousand military personnel and found a rate of symptoms of common mental disorders of 19.7% (NB this is likely to be an overestimate of the true rate of psychiatric disorder), alcohol misuse 13% and probable post traumatic stress disorder 4%.

The rate of post traumatic stress disorder is much lower than several studies of contemporary United States of America military personnel which have found rates of 10 to 20%. Various explanations for this difference have been postulated including the higher rate of US casualties and fatalities in Iraq, the younger mean age of the US military, greater proportion of US reservists, differences in combat related injury benefit systems and the fact that US military undertake longer tours of duty averaging over 12 months compared to the British military average of around 6 months.

It is clear that the majority of military personnel do not develop formal psychiatric disorders and indeed are extremely resilient to the effects of war. Several risk factors have been associated with the development of post traumatic stress disorder. The most important one across various studies has been shown to be perceived lack of social support following the traumatic event. This was particularly apparent in studies of US veterans following their return from service in Vietnam; it is hoped that the more positive social support provided by society at present will reduce the difficulties experienced by more recently returned military personnel.

During the last three years, a pilot mental health service for veterans of military service, including reservists, was established in South Wales, funded by the Ministry of Defence and the Welsh Assembly Government. This project aimed to assess and offer appropriate management to veterans with mental health difficulties. Research conducted during the pilot project showed it to be a success and an all Wales Veterans’ Health and Wellbeing Service specification based on it has been funded by the Welsh Assembly Government’s Minister of Health and Social Sciences, Mrs Edwina Hart, and is currently being rolled out across Wales. It is hoped that this service will allow the minority of military veterans who need it to receive the appropriate and timely help they deserve and allow them to recover and function at as high a level as possible in their civilian lives.

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