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The Perceived Value of Third-Location Decompression by New Zealand Defence Force Personnel
Abstract
Military personnel who have been involved in combat zones are at greater risk of mental health difficulties, physical health problems, and transitional issues. To alleviate transitional problems, militaries around the world have used a supported process known as decompression. There is limited published literature on decompression programs. This study describes the decompression program used by the New Zealand Defence Force and the perceptions of the decompression program held by military personnel. Results from this study suggest that military personnel believe such decompression programs are a vital component of the transition of personnel from a combat zone.
... Ten studies focus on TLD. All 10 TLD studies describe a number of common factors: TLD is a period of time spent on a location that is neither in theatre nor in the home country; TLD is delivered directly after leaving the operational area, and before returning to the home environment; TLD includes time to rest and relax and contains some form of psychoeducation Currie, Day, & Kelloway, 2011;de Terte, Wray, & O'Sullivan, 2014;Iversen et al., 2008;Jones et al., 2011Jones et al., , 2013Mulligan et al., 2012;Wood et al., 2018;Zamorski, Guest, Bailey, & Garber, 2012). The allowance to drink alcohol is also part of some TLD programmes Jones et al., 2011Jones et al., , 2013de Terte et al., 2014). ...
... All 10 TLD studies describe a number of common factors: TLD is a period of time spent on a location that is neither in theatre nor in the home country; TLD is delivered directly after leaving the operational area, and before returning to the home environment; TLD includes time to rest and relax and contains some form of psychoeducation Currie, Day, & Kelloway, 2011;de Terte, Wray, & O'Sullivan, 2014;Iversen et al., 2008;Jones et al., 2011Jones et al., , 2013Mulligan et al., 2012;Wood et al., 2018;Zamorski, Guest, Bailey, & Garber, 2012). The allowance to drink alcohol is also part of some TLD programmes Jones et al., 2011Jones et al., , 2013de Terte et al., 2014). The actual 'third location' varies between studies, ranging from a military base or camp (de Terte et al., 2014;Schneider et al., 2016) to four-to five-star civilian resort hotels Zamorski et al., 2012), either in a stop-over country Currie et al., 2011;Jones et al., 2011Jones et al., , 2013Mulligan et al., 2012;Zamorski et al., 2012) or at sea (Wood et al., 2018). ...
... The allowance to drink alcohol is also part of some TLD programmes Jones et al., 2011Jones et al., , 2013de Terte et al., 2014). The actual 'third location' varies between studies, ranging from a military base or camp (de Terte et al., 2014;Schneider et al., 2016) to four-to five-star civilian resort hotels Zamorski et al., 2012), either in a stop-over country Currie et al., 2011;Jones et al., 2011Jones et al., , 2013Mulligan et al., 2012;Zamorski et al., 2012) or at sea (Wood et al., 2018). ...
Background: Many countries pay special attention to the transition of their military personnel from deployment to home via post-deployment adaptation programmes (PDAPs). Objective: This systematic review aims to provide a structured analysis of structure, process, and outcomes based on available empirical evidence for PDAPs. Methods: A systematic literature search was performed to identify original peer-reviewed studies on PDAP in six databases (MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, PTSDPubs, and OpenGrey). The overall risk of bias of the articles was assessed using GRADE guidelines. The literature was analysed in its description of PDAP structure, process, and outcomes. In addition, when effects were reported, these were extracted. Results: The search resulted in 1535 unique records that were screened for eligibility; 16 articles were included, of which only three showed low risk of bias according to GRADE. Few studies clearly described and investigated PDAP structure elements (i.e. combat exposure), process elements (i.e. who delivered the intervention), and other outcome elements (i.e. adjustment issues). Most articles included some form of third location decompression (N = 10; psychoeducation and time to rest and relax on a location that is not in the mission theatre or at home) and Battlemind (N = 4; interactive training focusing on how to adapt skills and cognitions after deployment at home). The results suggest positive mental health effects and satisfaction of these two types of PDAP, although the evidence is poor. Conclusions: Empirical, high-quality evidence for PDAP is scarce. In addition, the existing literature reveals a lack of systematic method in describing the goals of PDAP and the ways of achieving these. This leads to incomparability between studies and hinders the building of a knowledge base on PDAPs. A structure is proposed for describing the structure, process, and outcomes of PDAPs with measured effects.
Highlights:
High -quality evidence for post-deployment adaptation programmes is scarce.Programme structure, process, and aims with measured effects are not delineated.Positive mental health effects are reported for Battlemind and third location decompression.
The present quasi-experimental study examined the psychological health of one group of U.S. Marines returning home by 12-day sea voyage to another comparable group returning within 24 hours by air following a six-month combat deployment to Iraq. Few significant group differences were seen in the 11 assessed self-report outcomes at three (n = 631) or at six months post-deployment (n = 437). The few significant differences were largely small and somewhat inconsistent. For example, the prevalence of PTSD in Marines returning by sea was higher at 3 months (13% vs 7%) but lower at 6 months (12% vs. 18%), though only the former difference was statistically significant. We conclude that decompression done at sea or at home after return by air have ultimately similar enough outcomes that either approach is appropriate. Future research is needed to explore the potential for time-dependent impacts of various approaches to decompression and to possible heterogeneity of affects across relevant outcomes.
Mental disorders are prevalent on deployed operations, but only a small fraction of those with problems access care due to a range of barriers. A survey measuring need for care, perceived barriers, and care-seeking propensity was administered to Canadian Forces personnel during deployment in Afghanistan. Complex characteristics of barriers to care on deployment were found: stigma had no association with care-seeking propensity; perceived structural barriers were associated with greater care-seeking propensity; and perceived structural barriers were greater in more isolated locations. Only negative attitudes toward care had the expected negative association with care-seeking propensity. Research and practical considerations are discussed.
Deployments increase risk for adjustment problems in service members. To mitigate this increased risk, mental health training programs have been developed and implemented in several nations. As part of a coordinated effort, three nations adapted a U.S. mental health training program that had been validated by a series of group randomized trials demonstrating improvement in postdeployment adjustment. Implementation of evidence-based programs in a new context is challenging: How much of the original program needs to remain intact in order to retain its utility? User satisfaction rates can provide essential data to assess how well a program is accepted. This article summarizes service member ratings of postdeployment mental health training and compares ratings from service members across four nations. The participating nations (Canada, New Zealand, United Kingdom, and the United States) administered mental health training to active duty military personnel in their respective nations. Following the training, military personnel completed an evaluation of the training. Overall, across the four nations, more than 70% of military personnel agreed or strongly agreed that they were satisfied with the mental health training. Although some differences in evaluations were observed across nations, components of training that were most important to overall satisfaction with the training were strikingly similar across nations. Fundamentally, it appears feasible that despite cultural and organizational differences, a mental health training program developed in one nation can be successfully adapted for use in other nations. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Background
High rates of mental health disorders have been reported in veterans returning from deployment to Afghanistan (Operation Enduring Freedom: OEF) and Iraq (Operation Iraqi Freedom: OIF); however, less is known about physical health functioning and its temporal course post-deployment. Therefore, our goal is to study physical health functioning in OEF/OIF veterans after deployment.
Methods
We analyzed self-reported physical health functioning as physical component summary (PCS) scores on the Veterans version of the Short Form 36 health survey in 679 OEF/OIF veterans clinically evaluated at a post-deployment health clinic. Veterans were stratified into four groups based on time post-deployment: (1Yr) 0 – 365 days; (2Yr) 366 – 730 days; (3Yr) 731 – 1095 days; and (4Yr+) > 1095 days. To assess the possibility that our effect was specific to a treatment-seeking sample, we also analyzed PCS scores from a separate military community sample of 768 OEF/OIF veterans evaluated pre-deployment and up to one-year post-deployment.
Results
In veterans evaluated at our clinic, we observed significantly lower PCS scores as time post-deployment increased (p = 0.018) after adjusting for probable post-traumatic stress disorder (PTSD). We similarly observed in our community sample that PCS scores were lower both immediately after and one year after return from deployment (p < 0.001) relative to pre-deployment PCS. Further, PCS scores obtained 1-year post-deployment were significantly lower than scores obtained immediately post-deployment (p = 0.02).
Conclusion
In our clinical sample, the longer the duration between return from deployment and their visit to our clinic, the worse the Veteran’s physical health even after adjusting for PTSD. Additionally, a decline is also present in a military community sample of OEF/OIF veterans. These data suggest that, as time since deployment length increases, physical health may deteriorate for some veterans.
Five electronic databases were searched using the key words Employee Assistance, research, and evaluation for articles published from 2000 to 2009 along with a manual search of the two prominent journals in the Employee Assistance field. Forty-two evaluations were found that were categorized using Macdonald's structure into four groups: needs assessments (n = 2), program development (case study) (n = 21), outcome (n = 10), and process (n = 9). Although the majority of evaluations were conducted in the United States (n = 29), there was a distinct international component with studies from Australia (n = 1), Canada (n = 5), Israel (n = 1), Japan (n = 1), South Africa (n = 2), South Korea (n = 1), and the United Kingdom (n = 2) also being published during the first 10 years of the new millennium. Evaluations were conducted upon programs delivered across the entire helping continuum: by peers, professionals working for the organization, and external providers as well as joint internal-external service delivery models. A broad range of methodologies were employed that demonstrated in general that the Employee Assistance Programs (EAPs) that were reviewed produced positive outcomes including saving organizations money as well as in producing positive change in those who sought counseling through their auspices. However, as well as describing new initiatives, program evolution, and offering insights into how specific programs could be further enhanced, broader themes were also examined such as who is and is not availing themselves of EAP services and the stigma that some still feel in seeking help through EAPs.
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).
To examine the subjective utility of TLD for personnel deployed as individual augmentees (IAs) by comparing their experience with FU personnel.
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).
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.
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.
Combat exposure can increase the risk of subsequent psychological ill-health in armed forces (AF) personnel. A U.S. postdeployment psycho-educational intervention, Battlemind, showed a beneficial effect on mental health in U.S. military personnel exposed to high combat levels. We evaluated the effectiveness of an anglicized version of postdeployment Battlemind.
Battlemind was adapted for the United Kingdom. The main amendments were to sections about carrying weapons, driving, and alcohol misuse. The anglicized Battlemind was compared with the U.K. standard postdeployment brief in a cluster randomized controlled trial. At baseline, 2,443 U.K. AF personnel returning from Afghanistan via Cyprus completed questionnaires about their combat experiences and mental health. Of these, 1,616 (66%) completed 6-month follow-up questionnaires. We used the Posttraumatic Stress Disorder Checklist (PCL-C) to measure probable posttraumatic stress disorder and the General Health Questionnaire (GHQ-12) to measure common mental disorders. Secondary outcomes included alcohol misuse, assessed with the Alcohol Use Disorders Identification Test (AUDIT), and binge drinking. Mixed-effects models were used to account for possible cluster effects.
We did not find a difference in mental health or overall AUDIT score. Those who received Battlemind versus the standard brief were less likely to report binge drinking, although the effect size was small (adjusted odds ratio = 0.73, 95% CI [0.58, 0.92]).
The anglicized Battlemind did not improve mental health but had a modest impact on the reporting of binge drinking. Alcohol misuse is problematic in military populations; therefore, an intervention that reduces binge drinking may be helpful.
We sought to estimate the pooled current prevalence of posttraumatic stress disorder (PTSD) among rescue workers and to determine the variables implicated in the heterogeneity observed among the prevalences of individual studies.
A systematic review covering studies reporting on the PTSD prevalence in rescue teams was conducted following four sequential steps: (1) research in specialized online databases, (2) review of abstracts and selection of studies, (3) review of reference list, and (4) contact with authors and experts. Prevalence data from all studies were pooled using random effects model. Multivariate meta-regression models were fitted to identify variables related to the prevalences heterogeneity.
A total of 28 studies, reporting on 40 samples with 20,424 rescuers, were selected. The worldwide pooled current prevalence was 10%. Meta-regression modeling in studies carried out in the Asian continent had, on average, higher estimated prevalences than those from Europe, but not higher than the North American estimates. Studies of ambulance personnel also showed higher estimated PTSD prevalence than studies with firefighters and police officers.
Rescue workers in general have a pooled current prevalence of PTSD that is much higher than that of the general population. Ambulance personnel and rescuers from Asia may be more susceptible to PTSD. These results indicate the need for improving pre-employment strategies to select the most resilient individuals for rescue work, to implement continuous preventive measures for personnel, and to promote educational campaigns about PTSD and its therapeutic possibilities.
Third Location Decompression (TLD) is the process through which personnel, returning from combat operations, begin to psychologically 'unwind'. Decompression comprises welfare activities, such as contacting home, beach events, social events, psycho-educational briefings and controlled re-introduction to alcohol.
To assess the subjective utility of decompression by surveying all British troops transiting the TLD facility in Cyprus, during 2008.
Analysis of distributed surveys completed by personnel who had deployed either to Iraq or Afghanistan. The main outcome was the subjective utility of the decompression process, with operational exposures, stigma, early post-traumatic stress (PTS) symptoms and adjustment concerns also measured.
Response rate was 87% (11,304 returned surveys). Eighty per cent of respondents reported being ambivalent or not wanting to go through TLD before decompression; however, on completion, 91% reported finding it useful. The desire to participate was the strongest predictor of perceived helpfulness. Troops who found the TLD less helpful included those who had been through the process before, combat troops and non-commissioned officers. Twelve per cent reported substantial concerns about re-establishing relationships or settling down to 'normal life'; those reporting more adjustment concerns were more likely to perceive TLD as helpful. Six per cent reported significant PTS symptoms and 27% of troops reported substantial levels of stigma related to mental health and barriers to care.
TLD was well received by troops following combat deployment. However, TLD does not appear to be equally acceptable to all and alterations to the TLD programme for certain subgroups might be required.
Psychological debriefing for preventing post traumatic stress disorder (PTSD)
This review concerns the efficacy of single session psychological "debriefing" in reducing psychological distress and preventing the development of post traumatic stress disorder (PTSD) after traumatic events. Psychological debriefing is either equivalent to, or worse than, control or educational interventions in preventing or reducing the severity of PTSD, depression, anxiety and general psychological morbidity. There is some suggestion that it may increase the risk of PTSD and depression. The routine use of single session debriefing given to non selected trauma victims is not supported. No evidence has been found that this procedure is effective.
Researchers have found that there is an increase in mental heath problems as a result of military-related traumatic events, and such problems increase in the months following return from combat. Nevertheless, researchers have not assessed the impact of early intervention efforts with this at-risk population. In the present study, the authors compared different early interventions with 2,297 U.S. soldiers following a year-long deployment to Iraq. Platoons were randomly assigned to standard postdeployment stress education, Battlemind debriefing, and small and large group Battlemind training. Results from a 4-month follow-up with 1,060 participants showed those with high levels of combat exposure who received Battlemind debriefing reported fewer posttraumatic stress symptoms, depression symptoms, and sleep problems than those in stress education. Small group Battlemind training participants with high combat exposure reported fewer posttraumatic stress symptoms and sleep problems than stress education participants. Compared to stress education participants, large group Battlemind training participants with high combat exposure reported fewer posttraumatic stress symptoms and lower levels of stigma and, regardless of combat exposure, reported fewer depression symptoms. Findings demonstrate that brief early interventions have the potential to be effective with at-risk occupational groups.
This article reviews the use of psychological decompression as applied to troops returning from active service in operational theaters. Definitions of the term are considered and a brief history is given. Current policies and practices are described and the question of mandatory decompression is considered. Finally, the evidence base for the efficacy of decompression is examined and some conclusions are drawn. This article highlights variations in the definition and practice of decompression and its use. Although there is, as yet, no evidence that decompression works, there is also no evidence to the contrary. Given the lack of knowledge as to the balance of risks and benefits of decompression and the absence of any definitive evidence that decompression is associated with improved mental health outcomes or that lack of decompression is associated with the reverse, it is argued that the use of decompression should remain a matter for discretion.
Parasympathetic and heart rate (HR) reactivity to memories of traumatic and pleasant events were investigated in trauma-exposed individuals (n = 40). Vagal tone and HR were recorded before, during, and following recall of traumatic and pleasant events. Posttraumatic stress (PTS) was related to blunted parasympathetic reactivity among trauma-exposed individuals. Specifically, PTS severity was related to lower parasympathetic activation and lower recovery following trauma recall, and to lower parasympathetic activation (but not recovery) in response to a pleasant event recall. No association was observed between PTS severity and initial parasympathetic tone. However, PTS severity was associated with initial HR. Assessment of parasympathetic reactivity may enhance our understanding of the normative and pathological reactions to trauma and stress.
The drivers of the perceived value of third-location decompression (TLD) programs are unclear. For this study, 14,253 Canadian personnel completed evaluations at the end of a TLD program. Results showed that sociodemographic and military characteristics were weak predictors of the perceived value of TLD. Instead, satisfaction with 10 out of 13 aspects of the program was predictive of the perceived value of TLD. The strongest predictors were support for the general concept of TLD and satisfaction with the educational and rest-and-relaxation components of the program. It was concluded that support for the concept and satisfaction with key program components drive the perceived value of TLD.
Objectives
Abuse of children is a concerning issue in South Africa, particularly the percentage of sexual offences committed by children and youth. Fight with Insight (FWI), which forms part of a 12-week diversion programme, combines boxing and cognitive-behavioural therapy (CBT), and is intended for child and youth sexual offenders. The aim of this evaluation was to qualitatively evaluate the FWI programme. The evaluation was intended to achieve the following outcomes: 1) a description of FWI (including outcomes and mechanisms); 2) understanding of perceptions of FWI's effectiveness; and 3) insight into factors influencing programme effectiveness.DesignA case-study approach was used to conduct this qualitative evaluation.Methods
Focus groups were conducted with FWI participants (n = 17), parents of FWI participants (n = 7), and a comparison group of youth offenders who had only participated in CBT sessions (n = 10). Key informants interviews were conducted with programme staff (n = 6).ResultsThe main outcome was identified as a reduction in recidivism, along with other intra- and inter-personal outcomes. Participants were generally positive about FWI and it's effectiveness, and these views were reinforced by key informant and parents' perceptions. FWI (compared to comparison) participants tended to be more specific about changes and learning they experienced as a result of the programme. A conceptual model highlights that it is the interplay between the boxing and the themes addressed within the CBT that contributes to FWI's effectiveness.Conclusions
This study has provided insight into FWI's outcomes and mechanisms, factors influencing its effectiveness, and the kind of change that it helps to bring about in its participants.
Objective:
Third Location Decompression (TLD) is an activity undertaken by UK Armed Forces (UK AF) personnel at the end of an operational deployment which aims to smooth the transition between operations and returning home. We assessed whether TLD impacted upon both mental health and postdeployment readjustment.
Method:
Data collected during a large cohort study was examined to identify personnel who either engaged in TLD or returned home directly following deployment. Propensity scores were generated and used to calculate inverse probability of treatment weights in adjusted regression analyses to compare mental health outcomes and postdeployment readjustment problems.
Results:
TLD had a positive impact upon mental health outcomes (post-traumatic stress disorder (PTSD) and multiple physical symptoms) and levels of harmful alcohol use. However, when the samples were stratified by combat exposure, although postdeployment readjustment was similar for all exposure levels, personnel experiencing low and moderate levels of combat exposure experienced the greatest positive mental health effects.
Conclusions:
We found no evidence to suggest that TLD promotes better postdeployment readjustment; however, we found a positive impact upon alcohol use and mental health with an interaction with degree of combat exposure. This study suggests that TLD is a useful postdeployment transitional activity that may help to improve PTSD symptoms and alcohol use in UK AF personnel.
Objective:
The deployed environment poses special challenges to the delivery of effective in-theatre mental health care. Our study sought to identify the prevalence and impact of symptoms of mental health problems in Canadian Forces (CF) personnel serving in Task Force Afghanistan; and, to determine the use of, and perceived need for, mental health services in CF personnel while deployed.
Methods:
Our study consisted of a cross-sectional survey of all 2779 CF personnel deployed to the province of Kandahar, Afghanistan, from February 15, 2010, to March 15, 2010.
Results:
An important minority (8.5%) of the 1572 respondents (response rate = 57%) exceeded civilian criteria for symptoms of acute traumatic stress, major depression, or generalized anxiety. Prevalence of these 3 mental health problems increased with higher combat exposure and location in more isolated posts. A much larger fraction (31%) reported suffering a stress, emotional, alcohol, or family problem during the deployment. Only a minority of respondents with a mental health problem (26%) were currently interested in getting help. Almost one-half of respondents with a mental health problem perceived occupational dysfunction as a result, though two-thirds of respondents with occupational dysfunction were in the group without the 3 mental health problems assessed.
Conclusions:
The needs base for psychosocial support extends beyond personnel who meet conventional questionnaire criteria for traumatic stress, depression, or generalized anxiety. Future research is needed to understand what precise problems are driving this larger needs base and what precise supports (clinical or nonclinical) would be most appropriate.
Social workers provide a variety of stress management interventions to police officers and their families. Educational groups can be useful for providing information regarding stress management interventions. The purpose of this article is to describe a framework for facilitating stress management educational groups for police officers. The framework was developed and implemented to inform officers about sources and types of work and life stress, as well as the cognitive-behavioral coping strategies that have been found to be useful in creating and maintaining a sense of well-being among police officers.
Military personnel report significant and increasing mental health problems in the months following return from combat. Nevertheless, studies have not assessed the impact of mental health training with this at-risk population. The present study evaluated the efficacy of a prototype mental health training module designed for U.S. soldiers 3-6 months after returning from combat; the module was a component of the Battlemind Training system. Soldiers (N = 1,645) were randomly assigned by platoon to 1 hour of training or a survey-only control group. Baseline surveys were conducted immediately before training; a training satisfaction survey was administered immediately after training, and a follow-up survey was administered 6 months later. Immediate postsession surveys were conducted with 681 subjects, and follow-up surveys were conducted with 542 soldiers. The Battlemind Training module received positive ratings from participants, and those who received it reported significantly better adjustment in terms of posttraumatic stress disorder symptoms, depression, and life satisfaction at follow-up compared to those in the survey-only control group. Changes in attitudes about the stigma of seeking mental health care were found immediately posttraining, but not at follow-up. The findings demonstrate that brief mental health training can be effective in reducing mental health systems with at-risk occupational groups.
Service members returning from combat can experience difficulty adapting to home life. To help ease this transition, the Canadian Forces provides a Third-location Decompression (TLD) program in Cyprus to members returning from deployment to Afghanistan.
The 5-day program consists of individual free time, structured recreational activities, and educational programming. Its perceived value and impact were measured immediately afterward and 4 to 6 months later.
Respondents overwhelmingly supported the TLD concept, with 95% agreeing that "some form of TLD is a good idea." Eighty-one percent of participants found the program valuable, and 83% recommended it for future deployments to Afghanistan. Perceived value persisted 4 to 6 months after return, and 74% felt that it helped to make reintegration easier for them.
Canadian Forces members saw value in the TLD program, and most members believed that the program had its intended effect of making the reintegration process easier for them.
Colonial influences have generally failed to respect indigenous knowledge, languages, and cultures. Determination to reclaim First Nations identity is visible in many jurisdictions. First Nations Peoples continue to call on governments to facilitate changes needed to revitalize their economic, social, cultural, and spiritual well-being. This article is a reflective article generated from our response to the situation of Mäori, the indigenous peoples of New Zealand. It provides a background on the historical attempts to weaken Mäori leadership and the resilience of Mäori in their resistance to such undermining. Using a description of a physical space, the Marae (the meetinghouse), the authors provide a glimpse into a distinctive Mäori psychology connected to Marae encounters and into Mäori ways of thinking, feeling, and behaving. Three examples of organizational practice at the incorporation of such values are provided. Four implications for management education are posited as relevant not only to the education of managers in Aotearoa but wherever engagement with indigenous people occurs.
Concerns have been raised about the psychological effect of continued combat exposure and of repeated deployments. We examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009, the effect of multiple deployments, and time since return from deployment.
We reassessed the prevalence of probable mental disorders in participants of our previous study (2003-05). We also studied two new randomly chosen samples: those with recent deployment to Afghanistan, and those who had joined the UK armed forces since April, 2003, to ensure that the final sample continued to be representative of the UK armed forces. Between November, 2007, and September, 2009, participants completed a questionnaire about their deployment experiences and health outcomes.
9990 (56%) participants completed the study questionnaire (8278 regulars, 1712 reservists). The prevalence of probable post-traumatic stress disorder was 4.0% (95% CI 3.5-4.5; n=376), 19.7% (18.7-20.6; n=1908) for symptoms of common mental disorders, and 13.0% (12.2-13.8; n=1323) for alcohol misuse. Deployment to Iraq or Afghanistan was significantly associated with alcohol misuse for regulars (odds ratio 1.22, 95% CI 1.02-1.46) and with probable post-traumatic stress disorder for reservists (2.83, 1.23-6.51). Regular personnel in combat roles were more likely than were those in support roles to report probable post-traumatic stress disorder (1.87, 1.26-2.78). There was no association with number of deployments for any outcome. There was some evidence for a small increase in the reporting of probable post-traumatic stress disorder with time since return from deployment in regulars (1.13, 1.03-1.24).
Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of probable post-traumatic stress disorder was low. These findings show the importance of continued health surveillance of UK military personnel.
UK Ministry of Defence.
Few studies have investigated stressors to which fire fighters are subjected and the potential psychological consequences. One hundred and forty-five fire fighters were studied to enumerate potential occupational stressors, assess psychological distress and problems with alcohol use, and determine whether a relationship exists between these measures and self-reported stressors. Hearing that children are in a burning building was the highest ranked stressor. According to three self-report instruments, between 33 and 41% of the fire fighters were experiencing significant psychological distress, and 29% had possible or probable problems with alcohol use. These figures are significantly higher than would be expected in a typical community or working population. In a logistic regression analysis, no relationship was found between measures of psychological distress and alcohol use and the 10 most highly ranked work stressors.
This review concerns the efficacy of single session psychological "debriefing" in reducing psychological distress and preventing the development of post traumatic stress disorder (PTSD) after traumatic events. Psychological debriefing is either equivalent to, or worse than, control or educational interventions in preventing or reducing the severity of PTSD, depression, anxiety and general psychological morbidity. There is some suggestion that it may increase the risk of PTSD and depression. The routine use of single session debriefing given to non selected trauma victims is not supported. No evidence has been found that this procedure is effective.
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