Combat Stress

I’m enjoying working with Combat Stress although not able to give nearly as much time as I had expected (In April I promised them 100 hours … they’re still collecting). A couple of weeks ago they had a visit from the PM himself:

Mr Cameron said: “It is a priority to do more to help the mental health issues that veterans in our country have.

“The fact is, for many people the mental scars that they have from the time they have served can be as serious or sometimes even worse than the physical scars and we need to take it much more seriously as a country.”

Touring the centre, which cares for 30 patients at any one time, Mr Cameron spoke to those still suffering flashbacks and depression resulting from their time fighting in places such as Afghanistan and Northern Ireland.

Experts are forecasting that the instances of PTSD among veterans are set to get worse because of the numbers of soldiers deployed in Iraq and Afghanistan.

So far 180,000 British troops have fought in Iraq and Afghanistan since 2003. General Dannatt, the former Chief of the General Staff, has warned that as many as 8,500 former servicemen of these will develop mental health problems.  

Dr Chai Patel, chairman of the appeal, said: “Combat Stress knows that it is vital for Government and military charities to work together to ensure veterans can access services effectively and engage with the treatment provided.

“We know that veterans wait on average 14 years before seeking Combat Stress’s help.

“That’s why we launched The Enemy Within Appeal earlier this year, which I hope will continue to be supported both by the public and politicians alike in order to ensure that Veterans get the support that they need, when and where they need it.”

Sourced from the Daily Telegraph

It’s that forecast that the instances of PTSD will get worse that hooked me on their cause. If it takes 14 years post-demob, on average, before a veteran seeks help and perhaps only 5% seek help … then what happens if the 14 years compresses to, say, 7 years (because the stresses are greater, the combat more intense, injury rates are going up, we’re making use of a higher number of reservists than previously and because PTSD’s profile is higher) and what happens if the 5% becomes 10%? That requires taking care of double the number of veterans in half the current time that they approach anyone for help… it would mean there’s a big shock coming within a very short numbers of years.

For instance:

1) PTSD in National Guard Soldiers shows higher instances in reservistsr

The researchers assessed 18,305 soldiers from four Active Component and two National Guard infantry brigade combat teams, all of whom had combat exposure. The soldiers completed mental health surveys between 2004 and 2007, at three and 12 months following their deployment. Overall, the researchers found that rates of PTSD and depression ranged from 9% to 31%, depending on the level of functional impairment reported. Generally, National Guard soldiers had significant increases in depression and PTSD symptoms between the three and 12-month time points, while depression symptoms remained stable for Active Component soldiers. This group also had increases in PTSD symptoms, but not as great as those among the National Guard members. “Symptoms of PTSD increased significantly in both groups but with much larger increases observed in National Guard participants,” they wrote. For instance, the DSM-IV-diagnosed rates of PTSD with serious functional impairment in the Active Component was 7.7% at three months and 8.9% after a year. For the National Guard, those numbers were 6.7% and 12.4%, respectively.

2) A Study from 1988 already showing potentially higher instances

The relationship between combat stress, DSM-III-defined post-traumatic stress disorder (PTSD), and a variety of behavioral factors was examined in a large nonclinical population. A total of 2858 randomly selected American Legion members who had served in Southeast Asia completed a questionnaire which elicited information on military service, personal health, and a variety of mental health outcomes. The data confirm the utility of the PTSD diagnosis as a distinct clinical entity. The frequency of PTSD and the extent of symptoms developed varied with the severity of criteria used for determining the extent of traumatic exposure. The PTSD rate ranged from 1.8 to 15.0% of the total sample, depending on whether “exposure” to combat was defined relatively narrowly or broadly. A distinct linear dose-response relationship between combat stress and a quantitative measure of PTSD intensity was observed. The frequency of PTSD diagnosis was not affected by the presence of either physical or mental health problems which predated military service. A strong, stable relationship was found between combat stress and PTSD intensity for cohorts with differing intervals since the experience of combat trauma, which persisted up to 20 years after discharge from the military. The data thus support a broader approach to defining traumatic events which recognizes individual differences in response to combat, as well as the existence of other behavioral outcomes as residual effects of combat. Implications of these findings and the importance of treating veterans with varying presentations of PTSD are discussed.

3) Worryingly high instances in young soliders (and oddly, those who have stable, romantic relationships)

Since the beginning of war on terror, over 5,000 US troops have lost their lives and many more wounded or injured. Nearly one-third of US troops develop serious mental health problems such as PTSD within 3 to 4 months of returning home from Iraq. Using data from the latest wave of Add Health, we examine how diverse experiences lead to differential risks for PTSD among young people who are serving or have served in the military. We found that that men and women who served in the combat units, such as the Army and the Marines, are more likely to develop PTSD. On the other hand, respondents with college education or enlisted high school friends are less likely to suffer from PTSD. Using measurements developed by Elder and Clipp (1988), this study investigated the influence of exposure to combat on the likelihood of acquiring PTSD. Similar to previous findings, both the amount of time spent in a combat zone and the frequency of engaging the enemy in a firefight dramatically increase the risk of PTSD among the respondents. However, the effect of combat on young people’s mental health is largely mediated through their being wounded/injuried and exposure to death, both triple the odds of respondents being diagnosed with PTSD. In addition, this study found that respondents who have stable romantic relationships are more likely to experience PTSD. Finally, respondents with higher agreeableness, characterized by a positive view of human nature, are less likely to develop PTSD.

Much of the data collected, and the detail of the conclusions is hidden away behind academic firewalls … It would be good to get at the data and do a meta-survey so that we could see what was really happening.