Predictors of barriers to mental health treatment for Kosovo and Bosnia peacekeepers: a preliminary report

In this study, we assessed basic, physical, and mental health needs of peacekeepers; determined barriers to mental health treatment; and examined predictors of barriers to mental health care. Active duty peacekeepers were surveyed before and after their deployment to Kosovo (n = 203) concerning their stress symptoms and attitudes about seeking mental health care after peacekeeping. Sixty-five peacekeepers were evaluated before and after their peacekeeping deployment to Bosnia. Upon returning from their mission, between 5% and 9% of Kosovo and Bosnia peacekeepers reported needing help for anger or hostility, depression, or deployment-related stress. The most frequently endorsed barrier was concern about the personal cost of mental health care. Among Kosovo peacekeepers, pre- and postdeployment post-traumatic stress disorder symptoms were the most robust predictors of mental health treatment barriers. Peacekeepers report a number of treatment needs and barriers that could prevent them from receiving care. The soldiers most in need of services are also those who report the most barriers to care.     

Description of risk and resilience factors among military medical personnel before deployment to Iraq

Military medical personnel preparing for deployment to Iraq (N = 328) participated in a survey concerning predeployment risk and resilience factors. Participants reported exposure to an average of 2.5 potentially traumatic events before deployment and 76% (n = 229) reported at least two current concerns about predeployment stressors. Military personnel also endorsed a series of positive appraisals of the military, the mission, and their unit. Fairly low levels of post-traumatic stress disorder symptoms before deployment were reported and positive affect was significantly higher than reported negative affect. Post-traumatic stress disorder symptoms that were present before deployment were most strongly associated with risk factors, whereas positive affect was most strongly associated with resilience factors. Predeployment negative affect was associated with a combination of risk and resilience factors. These findings have implications for possible interventions and preparation of medical personnel before military deployment. A better understanding of the factors related to risk and resilience in military medical personnel will allow for improved screening, educational, training, and clinical programs aimed at increasing resilience before military deployments.     

Life events in health care providers before and during Persian Gulf War deployment: the USNS Comfort.

Just before the onset of Operation Desert Storm, health care personnel (N = 250) onboard the USNS Comfort reported the occurrence of life events for the preceding year, including before deployment and during the Persian Gulf War. Study participants noted both total and negative life events. The mean number of negative life events during the preceding year was 1.44; a sizable proportion of participants (38%) reported no negative life events during this time. There were no differences in the mean number of total or negative life events by gender, although women checked significantly more life event items related to interpersonal factors and men noted more life events concerning financial issues. Women, nurses, the childless, and lower ranking officers noted significantly greater negative life events during predeployment than deployment. Negative life events were moderately related to anxiety, depression, and post-traumatic stress disorder symptoms. Both research and policy implications are discussed.     

军人军事行动创伤后应激障碍的流行病学调查

目的：了解某部参加军事演习的官兵3个月后创伤后应激障碍（PTSD）的患病率及相关因素。方法2011年4月—2014年7月通过结构式问卷调查和心理量表测评对某部参加军事演习3个月的690名官兵进行相关因素调查。PTSD诊断采用PTSD筛查量表-军人版（PCL-M）进行初筛,再由精神科医师依据美国精神疾病诊断统计手册第四版（DSM-Ⅳ）标准中PTSD的诊断标准,对初筛结果高于划界分者进行一对一晤谈确定诊断,使用SPSSl3．0软件对调查资料进行单因素和Logistic回归分析。结果实际调查690人,收回有效问卷637例,确诊病例30例,占4.71%。个体阳性心理症状与中国男性青年常模相比有统计学意义（包括躯体化、强迫症状、抑郁、焦虑、人际关系、敌对、恐怖、偏执、精神病性因子,P＜0.05）;影响心理健康状况的因素有：独生子女、居住城镇、服役满意度低、遇到困难时不能获取经济帮助、受伤、演习任务过重、不满意上级指示;应激事件对个体短期内的性格因素没有影响（P＞0.05）。结论军事演习官兵3个月后PTSD的患病率较常人高,加强官兵的心理防护和危机干预十分必要。     

Care for the Caregivers: a program for Canadian military chaplains after serving in NATO and United Nations peacekeeping missions in the 1990s

The Mental Health Department of the Canadian Forces Support Unit (Ottawa) developed the Care for the Caregivers program to help participants deal with stressful events experienced directly or vicariously from the NATO and United Nations military missions of the 1990s. The program was developed after complaints of postdeployment stress were received from various military care providers. The objectives were to improve the skills of support personnel and to reduce the distress that some caregivers experienced. Thirty-one chaplains who had been exposed to stressful military operations participated in five workshops. These educational 4-day small-group workshops covered topics such as post-traumatic stress disorder, vicarious traumatization, coping techniques, spirituality, self-care, and family issues. An adult education model was chosen to encourage dialogue. Outcomes included reports of professional and personal benefits, requests for additional programs, local education initiatives, and referrals to mental health professionals. Having met its objectives, the program has become a normal concluding part of stressful deployments.     

Suicide rate among former Swedish peacekeeping personnel

Increased suicide rates for military personnel suffering from post-traumatic stress disorders have been reported in various countries. Although it is known that some peacekeepers are exposed to potentially traumatic events and are thus at risk of suffering from post-traumatic stress reactions, only a few studies have examined suicide rates in this group. Therefore, the aim of this study was to investigate the suicide rate among former Swedish peacekeeping personnel. We compared 39,768 former Swedish peacekeepers to the general population in the National General Population Registry and the Cause-of-Death Registry. A lower number of suicides was found among former Swedish peacekeepers than in the general population. In conclusion, Swedish personnel serving in international peace-keeping operations do not show a higher suicide rate than the general population. Unique problems associated with this research area are discussed.     

Ethnic-related stressors in the war zone: case studies of Asian American Vietnam veterans

Empirical research has shown that exposure to race-related stressors in the military by Asian American Pacific Islander Vietnam veterans, now reliably measurable, contributes uniquely and significantly to post-traumatic stress disorder (PTSD) symptoms and generalized psychiatric distress; moreover, studies reveal that adverse race-related events can meet Diagnostic and Statistical Manual of Mental Disorders-IV criteria for a PTSD diagnosis. Competence in treating PTSD or general psychiatric distress requires understanding the types of, and effects of, adverse race-related events experienced by ethnic minority veterans. Case studies highlight two types of race-related stressors-"bicultural identification and conflict" and "racial stigmatization"-which placed the veteran at greater risk of death and reduced cohesion with fellow service members. The studies demonstrate the presence of race-related stressors in one or more of the four major types of war zone stressors: traditional combat, atrocities-abusive violence, perceived threat, and malevolent environment. These case studies supplement the empirical findings on race-related stressors and PTSD, enlarging the clinician's understanding of this unique type of mental health risk factor.     

The role of post-traumatic stress disorder symptoms in fatigued Cambodia veterans

Post-traumatic stress disorder (PTSD) is sometimes put forward as an explanation for unexplained somatic symptoms in military personnel who have been deployed in war or peace missions. Using a cross-sectional postal survey, we investigated whether PTSD symptoms can account for fatigue in Dutch (ex-)servicemen who returned from the peace operation United Nations Transitional Authority for Cambodia and what features distinguish veterans with and without presumptive PTSD diagnoses. Increased PTSD scores were found in 1.3% of 1,698 veterans. There was no concordance between increased PTSD scores and fatigue, as defined in previous studies. Respondents with presumptive PTSD had more often left service, had more often been exposed to severe and potentially traumatic events, and more often reported a greater impact of the mission. Furthermore, they reported more mental problems that they perceived to be service related and they held a stronger causal attribution to post-traumatic stress. In conclusion, presumptive PTSD cannot offer an explanation for fatigue in Cambodia veterans.     

Military hardiness as a buffer of psychological health on return from deployment

Military hardiness, the context-specific adaptation of psychological hardiness, is explored as it relates to military occupational stressors. It was hypothesized that military hardiness would moderate the effects of deployment stressors on soldier health. In a survey study of 629 U.S. soldiers, deployment stressors, military hardiness, and psychological and physical health were assessed during a peacekeeping deployment. Health was measured again after deployment. Results of moderated regression analyses partially supported the hypotheses; military hardiness moderated the impact of deployment stressors on depression after deployment, after controlling for depression during deployment. Implications for training military hardiness and applications to other occupational settings are discussed.     

Job stress, depression, work performance, and perceptions of supervisors in military personnel

OBJECTIVE: Recent studies have identified high levels of job stress in military personnel. This study examined the relationship among job stress, depression, work performance, types of stressors, and perceptions about supervisors in military personnel. METHODS: Eight hundred nine military personnel answered a 43-item survey on work stress, physical and emotional health, work performance, perceptions about leadership, job stressors, and demographics. RESULTS: More than one- quarter (27.4%) of this military population reported suffering from significant job stress. Both the report of work stress and depression were significantly related to impaired work performance, more days of missed work, poorer physical health, and negative perceptions about the abilities of supervisors and commanders. Depression and job stress were significantly and positively related to each other. CONCLUSIONS: These results support accumulating data indicating that work stress is a significant occupational health hazard in the routine military work environment. Targeting and eliminating sources of job stress should be a priority for the U.S. military to preserve and protect the mental health of military personnel.     

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.     

三大核事故应急人员心理健康后果的系统综述

目的:系统性评价三哩岛、切尔诺贝利、福岛三大核事故对应急人员心理健康状况的影响。方法:采用主题词与自由词组合检索的方式，检索PubMed、Web of Science、APA PsycINFO数据库中关于三哩岛、切尔诺贝利、福岛三大核事故应急人员心理健康后果研究的相关文献，进行系统综述。结果:共纳入37项研究。核事故后应急人员普遍存在一般心理困扰、抑郁、焦虑、创伤后应激障碍等心理问题。切尔诺贝利核事故的心理影响最为严重，引起清理人员器质性精神障碍、人格障碍等严重精神障碍。不同核事故应急人员的心理健康状况与灾难相关的应急处置工作经历、核事故伴发的社会因素相关。结论:核事故后应急人员普遍存在一般心理困扰、焦虑、抑郁、创伤后应激障碍、严重精神障碍等长期心理健康问题，应急人员的基线心理健康状况和心理干预措施有待进一步研究。     

Stress appraisals,emotions, and coping among international adolescent golfers

The aims of this study were to (a) explore the emotions generated during or as a consequence of stress appraisals, after coping, and after the event outcome, (b) explore whether multiple emotions were generated from the initial stress appraisal through to event outcome, and (c) to explore whether outcomes that were perceived as favorable resulted in positive emotions and outcomes that were perceived as unfavorable or neither favorable nor unfavorable resulted in negatively toned emotions. Participants were 10 male English international adolescent golfers (mean±SD; age 16.7±1.6 years), who were interviewed regarding their experiences of stress appraisals, emotions, and coping during competitive golf. Results revealed that emotions were generated within or as a consequence of stress appraisals, after coping, and after the event outcome. Additionally, multiple emotions were generated from the stressful appraisal to the event outcome. Positively toned emotions were cited more frequently than negatively toned emotions after favorable events, whereas negatively toned emotions were reported more frequently than positively toned emotions after unfavorable events. Coping appears important in generating positively toned emotions.     

Approaches to the primary prevention of posttraumatic stress disorder in the military: a review of the stress control literature

Numerous studies are underway, using data collected from clinical studies and data collected from surveys of combat troops, to determine the most efficacious treatment options for those diagnosed with posttraumatic stress disorder (PTSD). In contrast, little is known about the effectiveness of predeployment training in preventing or mitigating the impact of combat-related stressors on the development of PTSD. We conducted a comprehensive review of literature pertaining to primary prevention efforts to stem the advent of PTSD and other combat and operational stress injuries in military populations using databases from the peer-reviewed literature as well as online searches and colleague referrals. Results show that, as with treatment for PTSD, the most promising preventive approaches appear to utilize exposure strategies, especially those in conjunction with education and stress reduction skills training.     

Functioning and psychiatric symptoms among military men and women exposed to sexual stressors

OBJECTIVE: The goal was to describe military men's and women's functioning and psychiatric symptoms according to their military sexual stressor exposure. METHOD: A cross-sectional survey of 204 Army soldiers and 611 other active duty troops (487 men and 327 women) was performed. RESULTS: Forty-five percent of men and 80% of women reported at least one sexual stressor type (i.e., sexual identity challenges, sexual harassment, or sexual assault). After adjustment, subjects reporting more types of sexual stressors had poorer physical, work, role, and social functioning; more-severe post-traumatic stress disorder, depression, and anxiety symptoms; and more somatic concerns, compared with subjects reporting fewer or no sexual stressor types (all p < or = 0.004). Interactions by gender were insignificant (all p > 0.11). Within sexual stressor category, men and women reported similar mean adjusted functioning and psychiatric symptoms. CONCLUSIONS: For both men and women, impaired functioning and more severe psychiatric symptoms were more common among those reporting more types of sexual stressors.     

Impact on mental health of deploying as an individual augmentee in the U.K. Armed Forces

Armed Forces personnel who deploy as individual augmentees (IAs), with a unit other than their formed unit, often fill shortages or provide specialized knowledge or skill sets. This article examined the effect of deploying as an IA on mental health outcomes and unit cohesion. A U.K. military cohort study was used to compare IAs (n = 1352) with personnel who had deployed with a formed unit (n = 2980). Differences between the groups in questionnaire assessed symptoms of post-traumatic stress disorder (PTSD Checklist-Civilian Version), common mental disorders (General Health Questionnaire-12) and alcohol misuse (Alcohol Use Disorders Identification Test) were examined with logistic and negative-binomial regression analyses. There was no difference between IAs and those who deployed with a formed unit in level of unit cohesion, symptoms of post-traumatic stress disorder or common mental disorder. Deployment as an IA was associated with less alcohol misuse (Odds Ratio 0.77, 95% Confidence Interval 0.63-0.94). IAs appeared able to integrate with the group they deployed with as levels of unit cohesion were similar to personnel who deployed with a formed unit. IAs were also at a lower risk of alcohol misuse compared to personnel who deployed with a formed unit.     

Prevalence and characteristics of trauma and post-traumatic stress symptoms in operational members of the South African National Defence Force

The prevalence of traumatic event exposure and post-traumatic stress disorder (PTSD) were surveyed in a cohort of 198 full-time operational members of the South African National Defence Force stationed in their "home" unit between deployments. Approximately 90% of members reported having experienced or witnessed trauma in their lifetime (mean number of traumatic events = 4.3 +/- 3.2), whereas 51% reported having inflicted trauma. Twenty-six percent met diagnostic criteria for PTSD on self-report with approximately 29% with PTSD also meeting diagnostic criteria for depression. Few members, however, sought help. PTSD symptom severity was best predicted by trauma type (exposure to physical assault and infliction of life-threatening injury). These findings highlight the high rates of exposure to multiple, noncombat-related trauma in military personnel, the potentially high rates of PTSD, and the role of inflicted trauma as an additional risk factor for PTSD.     

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.