The stressors and demands of peacekeeping in Kosovo: predictors of mental health response

U.S. soldiers' appraisal and experience of the Kosovo peacekeeping mission is described. Using a prospective design, we evaluated the prevalence, severity, and predictors of several mental health outcomes at redeployment. We found that peacekeepers frequently were exposed to potentially traumatizing and other stressful events while in Kosovo, but on average, their appraisal of those events was moderate. Postdeployment psychopathology was also low--soldiers endorsed more severe mental health difficulties at predeployment, which suggests anticipatory negative affect. After controlling for the impact of predeployment stressors, we examined the contribution of potentially traumatizing events, general overseas military duty stressors, negative aspects of peacekeeping roles, and generic positive military experiences, including morale, to explain variance in four outcomes: post-traumatic stress disorder, depression, hostility and aggression problems, and problems with alcohol abuse. Findings indicate that hostility and drinking may be more chronic problems that emerge during stressful times, whereas depression and post-traumatic stress disorder symptoms may be more apt to fluctuate and are associated with potentially traumatizing experiences during peacekeeping. The implications and limitations of the study are discussed.     

A historical overview of combat stress control units of the U.S. Army

Combat stress control units have been deployed to the Gulf War, Somalia, Haiti, Guantanamo Bay, Bosnia, and Kosovo. They have been very flexible and useful mental health tools for commanders in both combat and peacekeeping operations for the past decade. In their operational role they have been effective, but their garrison mission remains unclear. This article summarizes the uses, missions, and lessons learned from the various combat stress control missions around the world.     

Serving in Bosnia made me appreciate living in Bristol: stressful experiences, attitudes, and psychological needs of members of the United Kingdom Armed Forces

Peacekeeping operations form an increasing part of the role of the U.K. Armed Forces. This study identified perceived needs for training before such operations, experiences of stress during deployments, beliefs and attitudes regarding psychological support and debriefing on return, general attitudes toward peacekeeping duties, and positive aspects of the peacekeeping role. Although nearly all peacekeepers were exposed to a variety of experiences, most perceived stress came from professional difficulties and frustrations with the occupational role of being a peacekeeper, rather than from dangerous situations. The exception was a significant fear of land mines. For many, peacekeeping had a positive impact on soldiers' lives, most commonly an appreciation of "things back home." Respondents' opinions about the peacekeeping experience vary greatly. Additional training addressing and exploring potential conflicts between the traditional role of the soldier and the role of the peacekeeper may be useful.     

Psychophysiological assessment of stress and screening of health risk in peacekeeping operations

Medical surveillance for military personnel participating in peacekeeping missions (PKMs) is required to define the effect of stress on health status. The aim of this study was to determine the effect of stress on the autonomic cardiovascular control and health risk of 72 Bulgarian peacekeepers participating in a PKM in Kosovo. The assessment of psychophysiological stress and determination of stress characteristics were implemented with analysis of heart rate variability and personal interviews. As a response to the cumulative exposure to the effect of stress on cognitive function, we observed reductions in parasympathetic function and baroreceptor modulation of heart rhythm. The alteration in cardiovascular control was registered as decreases in short-term variability and spectral powers of cardiointervals in the respiratory sinus arrhythmia and Traube-Hering-Mayer bands. The advantage of psychophysiological stress assessment and screening of health risk in PKMs is that results indicate the mechanisms of the effects of stress on cognitive function and health status.     

亚洲维和官兵人格特征与心理健康状况的关系研究

目的 探讨亚洲三国维和官兵人格特征与心理健康状况的关系,为我国维和官兵的心理干预提供参考.方法 随机抽取2007年印度、巴基斯坦和孟加拉国赴利比里亚维和官兵380名作为研究对象,于到达维和任务区第7天和第120天采用《中国军人心理健康量表》(CMMHS)和《艾森克人格问卷》(EPQ)对其进行测评.结果 除焦虑因子分外,第120天时维和官兵CMMHS量表的总分及其他各因子分均显著低于第7天(P＜0.05或0.01).单因素直线相关分析显示,维和官兵CMMHS总分及精神病性、神经衰弱因子分前后两次的差值与神经质分量表得分呈正相关(P＜0.05或0.01),抑郁因子分前后两次的差值与内外向分量表呈负相关(P＜0.01).多元逐步回归分析显示,内外向、神经质分别进入以抑郁、精神病性、神经衰弱及CMMHS总分差值为因变量的回归方程(P＜0.05或0.01).结论 亚洲维和官兵的人格特征与心理健康状况关系密切,人格特征能明显影响个体的心理健康状况.     

Soldier attitudes toward mental health screening and seeking care upon return from combat

OBJECTIVE: This study examined soldier attitudes about postdeployment mental health screening, treatment, barriers to care, strategies for overcoming barriers, and settings, personnel and timing for conducting postdeployment mental health screening. METHODS: Deploying soldiers participated in a voluntary anonymous survey. RESULTS: Of 3,294 soldiers, 2,678 (81.3%) responded to the survey. When the three most endorsed perceived barriers to mental health care (negative perception by unit members, negative perception by leaders, and being viewed as weak) were examined, approximately 15% fewer soldiers endorsed the perceptions, compared with a previous study conducted at the beginning of the war. Receipt of training focused on managing psychological problems associated with increased agreement to seek treatment. Participants endorsed surveys, interviews, and unit providers as preferred instruments and providers for postdeployment screening. Soldiers endorsed encouragement from family members and friends as the preferred approach to reducing barriers to mental health care. CONCLUSION: Extensive educational programs seemed to have reduced the stigma related to receiving mental health care. Programs that focus on friend and family member encouragement of soldiers to seek mental health assistance should continue. Postdeployment screening should be conducted under conditions in which soldiers are most likely to report problems honestly.     

第二、八批赴苏丹瓦乌维和官兵初期心理健康状况的对照分析

目的对比分析中国第二、八批赴苏丹瓦乌地区维和的官兵心理状况及原因,为部队合理选拔维和队员及针对性地进行心理教育提供依据。方法使用症状自评量表(SCL-90)对160名维和官兵进行集中测试。结果 (1)第八批维和官兵在执行任务初期SCL-90躯体化因子分高于军人常模,其他各因子分均低于中国军人常模,差异有显著统计学意义(P<0.01)。(2)第二批维和官兵人际关系、抑郁和精神病性因子分也高于军人常模,差异有统计学意义(P<0.05);躯体化、焦虑因子分显著高于军人常模,差异有显著统计学意义(P<0.01)。(3)第二批与第八批比较,躯体化和强迫因子分显著高于第八批,差异有统计学意义(P<0.05),其他各因子分显著高于第八批,差异有显著统计学意义(P<0.01)。结论第八批赴苏丹瓦乌地区初期,维和官兵心理健康状况良好,与进行针对性教育、训练及有维和经历的人员参加有关。     

Post-traumatic stress disorder and depression in health care providers returning from deployment to Iraq and Afghanistan

OBJECTIVE: This study examines risk factors for post-traumatic stress disorder (PTSD), depression, and mental health care use among health care workers deployed to combat settings. METHODS: Anonymous surveys were administered to previously deployed workers at a military hospital. PTSD and depression were assessed by using the PTSD Checklist and the Patient Health Questionnaire depression scale, respectively. Deployment exposures and perceived threats during deployment were also assessed. RESULTS: There were 102 respondents (36% response rate). Nine percent (n=9) met the criteria for PTSD and 5% (n=5) met the criteria for depression. Direct and perceived threats of personal harm were risk factors for PTSD; exposure to wounded or dead patients did not increase risk. Those who met the criteria for PTSD were more likely to seek mental health care after but not before their deployment. CONCLUSIONS: For health care workers returning from a warfare environment, threat of personal harm may be the most predictive factor in determining those with subsequent PTSD.     

The millennium Cohort Study: a 21-year prospective cohort study of 140,000 military personnel

Does military service, in particular operational deployment, result in a higher risk of chronic illness among military personnel and veterans? The Millennium Cohort Study, the largest Department of Defense prospective cohort study ever conducted, will attempt to answer this question. The probability-based sample of 140,000 military personnel will be surveyed every 3 years during a 21-year period. The first questionnaire, scheduled for release in summer 2001, will be sent to 30,000 veterans who have been deployed to southwest Asia, Bosnia, or Kosovo since August 1997 and 70,000 veterans who have not been deployed to these conflict areas. Twenty thousand new participants will be added to the group in each of the years 2004 and 2007 to complete the study population of 140,000. The participants will have the option of completing the study questionnaire either on the paper copy received in the mail or through the World Wide Web-based version, which is available at www.MillenniumCohort.org. This will be one of the first prospective studies ever to offer such an option. The initial survey instrument will collect data regarding demographic characteristics, self-reported medical conditions and symptoms, and health-related behaviors. Validated instruments will be incorporated to capture self-assessed physical and mental functional status (Short Form for Veterans), psychosocial assessment (Patient Health Questionnaire), and post-traumatic stress disorder (Patient Checklist-17). Information obtained from the survey responses will be linked with other military databases, including data on deployment, occupation, vaccinations, health care utilization, and disability. In addition to revealing changes in veterans' health status over time, the Millennium Cohort Study will serve as a data repository, providing a solid foundation upon which additional epidemiological studies may be constructed.     

Traumatic experiences and psychological reactions among women in Bosnia during the war

Internally displaced women (N = 77) in Bosnia were interviewed before and after participating in group psychotherapy during the war in 1994 and 1995 to gain background information and assess stress exposure and stress reactions. Nearly all the women had experienced loss of family members, many acts of violence and mental health impairment. The participants had high scores on a symptom scale, in terms of intrusive, avoidance and arousal symptoms and somewhat lower on depression/powerlessness items. After participating in short‐term group therapy they reported significant reduction in symptoms. The women who had experienced most traumatic events and had most symptoms, reported greatest reduction in symptomatology. Some of the implications of the findings are discussed and it is concluded that group therapy may be helpful in war conditions, even though traditional preconditions for psychotherapy are not present.     

Traumatic experiences and psychological reactions among women in Bosnia during the war

Internally displaced women (N = 77) in Bosnia were interviewed before and after participating in group psychotherapy during the war in 1994 and 1995 to gain background information and assess stress exposure and stress reactions. Nearly all the women had experienced loss of family members, many acts of violence and mental health impairment. The participants had high scores on a symptom scale, in terms of intrusive, avoidance and arousal symptoms and somewhat lower on depression/powerlessness items. After participating in short-term group therapy they reported significant reduction in symptoms. The women who had experienced most traumatic events and had most symptoms, reported greatest reduction in symptomatology. Some of the implications of the findings are discussed and it is concluded that group therapy may be helpful in war conditions, even though traditional preconditions for psychotherapy are not present.     

Trauma-induced coagulopathy and treatment in Kosovo

The 67th Combat Support Hospital at Camp Bondsteel, Kosovo, treated victims of trauma on an almost daily basis at the beginning of U.S. peacekeeping efforts in the region. Military health care personnel must respond quickly and efficiently when confronted with patient wounds resulting in massive blood losses. The limited medical resources of a field hospital often complicate efforts to treat the most severe injuries. One such case involved a young farmer riddled with gunshot wounds. Early volume/blood resuscitation before, during, and after surgery led to a massive blood coagulopathy. This case study describes the actions the physicians and nurses initiated to save this victim of violence. The subsequent discussion delineates methods to reduce intraoperative blood losses, blood transfusion alternatives, and technological advances in trauma resuscitation.     

Health care utilization by United Nations peacekeeping veterans with co-occurring, self-reported, post-traumatic stress disorder and depression symptoms versus those without

It remains to be determined whether patients with comorbid post-traumatic stress disorder (PTSD) and depression use more health care resources than do those without. United Nations peacekeeping veterans from Canada were divided into four groups, i.e., PTSD alone (n = 23), depression alone (n = 167), comorbid PTSD and depression (n = 119), and neither (n = 164), and compared with respect to total number of visits to any health care professional in the past year. Analysis of variance revealed that the groups significantly differed in total visits. Post hoc analyses indicated that veterans with co-occurring PTSD and depression symptoms had more visits than did those in the other groups and that veterans with PTSD symptoms alone and depression symptoms alone had more visits than did those with neither PTSD nor depression. Additional analyses revealed that veterans with co-occurring PTSD and depression symptoms made more visits to general practitioners, specialists, pharmacists, and mental health professionals than did the others. Future research directions and implications for treatment planning are discussed.     

Factors influencing psychological stress levels of Italian peacekeepers in Bosnia

OBJECTIVE: The present study evaluated the factors that contribute to stress and the psychological difficulties of the Italian military component of the United Nations Mission in Bosnia and Herzegovina. This group was compared with a homogeneous group stationed in Italy. METHODS: A cross-sectional study was performed in two groups of career military personnel: 452 subjects who were stationed in Bosnia as peacekeepers and 166 who were stationed in Italy. All subjects completed two multiple-choice questionnaires (a stress self-evaluation test and a socioeconomic questionnaire) during various periods of duty. RESULTS: The responses to the stress self-evaluation test indicated that the peacekeepers did not show a statistically significant increase in stress. Those who were affected by stress, though, indicated that the level was high. The principal variables that were associated with a greater level of stress were length of the mission, lack of recreational or athletic activities during the mission, more than three family members, and unemployment before enrollment. CONCLUSIONS: Peacekeepers come from an economically poor environment, have large families, and usually have a history of unemployment. Along with these preenrollment risk factors, the effective time spent in recreational activities and the length of the mission also influence stress levels. Individual and group techniques for stress management should be implemented.     

International military leaders' survey on operational stress

Despite the importance of military leaders in moderating the impact of deployment stressors on unit members, little attention has focused on the training leaders receive in managing unit stress. As part of a NATO Research Panel (Human Factors and Medicine (HFM)-081/Research and Technology Organization Task Group (RTG)), 16 nations participated in a needs assessment survey of military leaders who had returned from an operation within the previous 2 years. Findings from 172 leaders emphasized the lack of training specifically geared for leaders to address operational stress issues for unit members and their families and the need for integrated mental health support across the deployment cycle. In general, most leaders regarded stress-related mental health problems as normal and were supportive of help-seeking. The information obtained here was used to develop a Human Factors and Medicine -081/RTG Leader's Guide on operational stress.     

赴苏丹瓦乌维和官兵人格特征和心理健康状况相关分析

目的分析中国第八批赴苏丹瓦乌地区,运输、医疗两个分队的维和官兵初期心理健康状况及人格特征的相关性,为针对性的心理教育提供依据。方法使用症状自评量表(SCL-90)和艾森克个性问卷(EPQ)对运输分队和医疗分队共160名维和官兵进行集中测试。结果 (1)维和官兵在执行任务初期SCL-90除躯体化因子高于军人常模(P<0.01)外,其他各因子分均低于中国军人常模(P<0.01)。(2)维和官兵心理健康状况与人格特征相关。EPQ内外向维度与SCL-90强迫、抑郁、恐怖、偏执、精神病性因子呈负相关(P<0.05,P<0.01),与人际关系、焦虑、敌对因子呈正相关(P<0.05,P<0.01);神经质维度与SCL-90各因子呈正相关(P<0.05,P<0.01),除躯体化、强迫因子外,精神质维度与SCL-90其余各因子呈正相关(P<0.05,P<0.01);掩饰性维度与抑郁、焦虑因子呈正相关(P<0.05,P<0.01)。(3)运输分队的强迫、抑郁、焦虑及恐怖因子分显著高于医疗分队(P<0.05)。结论赴苏丹瓦乌地区初期,维和官兵心理健康状况良好;维和官兵心理健康状况与自身的人格特征相关;医疗分队相对运输分队心理健康状况要好。     

Factors associated with depression on a hospital ship deployed during the Persian Gulf War

Investigators surveyed health care providers (N = 250) deployed to the Persian Gulf on the USNS Comfort hospital ship days before the beginning of the Persian Gulf War in 1990. In this article, we identify factors associated with the development of depression during deployment. Age, gender, negative life events, stress from trauma-related work demands, and occupational experience with the dying and the dead were significant predictors of depression. Military training, although not associated with the experience of depression, was negatively correlated with concern about injury.     

Access to Mental Health Services at Veterans Affairs community-based outpatient clinics

Access to care and treatment of mental disorders within the Veterans Health Administration (VHA) has seen dramatic changes in recent years. The VHA has been transformed from a hospital-based provider to one that relies on more outpatient care, although some are concerned this has compromised specialty services such as mental health care. The VHA is increasing the number of community-based outpatient clinics, which has improved access to primary care, and some are suggesting providing more mental health services at these clinics. The objective of this survey was to determine which clinics are currently providing mental health care and to identify clinics that provide little or no mental health care and their reasons for not doing so. A questionnaire was developed to answer these questions, and clinics were contacted by telephone to complete the survey. The results indicate that more clinics are providing basic mental health services than has been reported previously. The results also suggest that, before making changes in the delivery of mental health care within the VHA, a comprehensive study needs to be performed to identify current needs and establish a clear goal of how and where to provide quality mental health care for veterans.     

Risk factors for fatal accidents and suicides in peacekeepers: is there an overlap?

OBJECTIVE: Previous research has indicated that there is an increased risk of fatal accidents in veterans of military operations and that such accidental deaths may be related to mental health problems. This study was conducted to investigate fatal accidents in Norwegian former peacekeepers. METHODS: A subgroup of alcohol-related fatal accidents was identified. Interview data with next of kin, military data and police report data from 17 cases of alcohol-related fatal accidents were compared with data from 28 cases of other accidents and 43 cases of suicide among Norwegian veterans of peacekeeping service. RESULTS: The alcohol-related fatal accidents were found to share many common features with the suicide group, such as depression, alcohol and substance abuse, and various social problems, and were also found to differ significantly from the other fatal accidents. CONCLUSIONS: The findings indicate a need for preventive measures directed at reducing the risk of premature death not only from suicide, but also from accidental death.