Content uploaded by Jamie Hacker Hughes
Author content
All content in this area was uploaded by Jamie Hacker Hughes on Jul 18, 2017
Content may be subject to copyright.
SummarySummary We carrie d o ut a briefWe carried out a brief
longitudinal mental health screen of 2 54longitudinal ment al health screen of 2 54
membersofthe UK’s Air Assault Brigademembersofthe UK’s Air Assault Brigade
before and after deployment to Iraqlastbefore and after deployment to Iraq last
year. Analysis of General Healthyear. Analysis of General Health
Ques tionnaire (GHQ ^2 8) score s beforeQuestionnaire (GHQ^28) scores before
and after deployment revealed a lowerand after deployment revealed a lower
score afterdeployment (meanscore afterdeployment (mean
differencedifference¼0.93, 95% CI 0.35^1.52).This0.93, 95% CI 0.35^1.52).This
indicated a highly significant relativeindic ated a highly signif icant relative
improvement in mental health (improvement in mental health (PP550.005).0.005).
Moreover, only 9 of alarger sample of 421Moreover, only 9 of a larger sample of 421
(2 %) exceeded cut-off criteria on the(2 %) exceeded cut-off criteria onthe
Trauma Screening Questionnaire.TheseTrauma Screening Questionnaire.These
findings suggestthat war isnot necessarilyf indings suggestthat war isnot necessarily
bad for psychological health.bad forpsychological health.
Declaration of interestDeclaration of interest J.H.H., F.C. ,J.H.H., F.C. ,
R.E., M.D. and N.G. areemployed byR.E., M.D. and N.G. are employedby
Defence Medical Services; S.W. isDefence Medical Services; S.W. is
Honorary Civilian Adviser in PsychiatryHonorary Civilian Adviser in Psychiatry
(unpaid) to the British Army Medical(unpaid) to the British Army Me dical
Services.Services.
In a recent paper, HogeIn a recent paper, Hoge et alet al (2004)(2004)
reported that US personnel who werereported that US personnel who were
deployed to Iraq reported poorer mentaldeployed to Iraq reported poorer mental
health after the campaign than beforehealth after the campaign than before
(Spurgeon, 2004). Their results were taken(Spurgeon, 2004). Their results were taken
from cross-sectional surveys before andfrom cross-sectional surveys before and
after deployment. We performed a briefafter deployment. We performed a brief
longitudinal mental health screen of mem-longitudinal mental health screen of mem-
bers of the UK’s Air Assault Brigade beforebers of the UK’s Air Assault Brigade before
and after deployment to Iraq last year. Inand after deployment to Iraq last year. In
this paper we report our preliminarythis paper we report our preliminary
findings.findings.
METHODMETHOD
Of a possible 899 soldiers, 733 participatedOf a possible 899 soldiers, 733 participated
in this survey (82% of the available popu-in this survey (82% of the available popu-
lation, compared with 58% for Hogelation, compared with 58% for Hoge et alet al,,
2004). The brigade commander supported2004). The brigade commander supported
the project; individuals participated volun-the project; individuals participated volun-
tarily and gave signed consent. The proto-tarily and gave signed consent. The proto-
col was approved by the Defence Medicalcol was approved by the Defence Medical
Services Clinical Research Committee.Services Clinical Research Committee.
Questionnaires were circulated at theQuestionnaires were circulated at the
end of pre-deployment mental health brief-end of pre-deployment mental health brief-
ings (standard in UK units’ preparations forings (standard in UK units’ preparations for
operational deployments). Soldiers were in-operational deployments). Soldiers were in-
formed that military mental health practi-formed that military mental health practi-
tioners would contact them confidentiallytioners would contact them confidentially
if results revealed cause for concern. Parti-if results revealed cause for concern. Parti-
cipants were told that commanders wouldcipants were told that commanders would
be informed only about pooled results.be informed only about pooled results.
The ages of responders ranged from 17The ages of responders ranged from 17
to 48 years and 71 of the entire sampleto 48 years and 71 of the entire sample
(8%) were female. The sample was sur-(8%) were female. The sample was sur-
veyed before deployveyed before deployment using the Generalment using the General
Health QuestionnaireHealth Questionnaire (GHQ–28) (Goldberg(GHQ–28) (Goldberg
& Hillier, 1979). All those with scores& Hillier, 1979). All those with scores
exceeding 20 (exceeding 20 (nn¼16) were contacted and16) were contacted and
offered support.offered support.
After war-fighting operations wereAfter war-fighting operations were
complete, personnel returned to the UKcomplete, personnel returned to the UK
having been in theatre for approximatelyhaving been in theatre for approximately
4 months.4 months.
RESULTSRESULTS
Questionnaires, which included the GHQ–Questionnaires, which included the GHQ–
28 and the Trauma Screening Question-28 and the Trauma Screening Question-
naire (TSQ; Brewinnaire (TSQ; Brewin et alet al, 2002), were then, 2002), were then
sent to participants. One month aftersent to participants. One month after
return, 421 of the original sample of 899return, 421 of the original sample of 899
completed the questionnaires. The samplecompleted the questionnaires. The sample
size was lower than before deployment (assize was lower than before deployment (as
with Hogewith Hoge et alet al, 2004) because many, 2004) because many
personnel had been redeployed or were onpersonnel had been redeployed or were on
leave. (It is highly unlikely that this loss toleave. (It is highly unlikely that this loss to
follow-up was attributable to illness as veryfollow-up was attributable to illness as very
few diagnoses of post-traumatic stress dis-few diagnoses of post-traumatic stress dis-
order were eventually made across all threeorder were eventually made across all three
branches of the British Armed Forcesbranches of the British Armed Forces
following the Iraq deployment.)following the Iraq deployment.)
Non-responders did not differ from re-Non-responders did not differ from re-
sponders on pre-deployment measuressponders on pre-deployment measures
((tt¼771.01,1.01, PP¼0.31). The mean score on0.31). The mean score on
the GHQ–28 was 1.94. Results showedthe GHQ–28 was 1.94. Results showed
that 2% (that 2% (nn¼9) exceeded cut-off criteria9) exceeded cut-off criteria
on the TSQ (contrasting with 12% reportedon the TSQ (contrasting with 12% reported
by Hogeby Hoge et alet al), with a further two soldiers), with a further two soldiers
scoring over 20 on the GHQ–28. All werescoring over 20 on the GHQ–28. All were
contacted individually and offered support.contacted individually and offered support.
Overall, 35% of the original sampleOverall, 35% of the original sample
((nn¼254) completed both sets of question-254) completed both sets of question-
naires. The high turnover of personnelnaires. The high turnover of personnel
observed between the two occasions was aobserved between the two occasions was a
combined result of postings to new units,combined result of postings to new units,
redeployment, leave and attendance atredeployment, leave and attendance at
training courses. Also, participation at bothtraining courses. Also, participation at both
stages was voluntary. In addition, whereasstages was voluntary. In addition, whereas
the first set of questionnaires was adminis-the first set of questionnaires was adminis-
tered during routine pre-deploymenttered during routine pre-deployment
training, the follow-up questionnaires weretraining, the follow-up questionnaires were
administered internally on a sub-unit basis,administered internally on a sub-unit basis,
which may have contributed to the reducedwhich may have contributed to the reduced
follow-up sample size. It is not, however,follow-up sample size. It is not, however,
believed that the reasons for the reducedbelieved that the reasons for the reduced
sample size would have affected validity.sample size would have affected validity.
Analysis of the GHQ–28 scores beforeAnalysis of the GHQ–28 scores before
and after deployment revealed a highlyand after deployment revealed a highly
significant (significant (tt¼3.15,3.15, PP550.005) relative0.005) relative
improvement in mental health. This wasimprovement in mental health. This was
indicated by lower GHQ–28 scores whichindicated by lower GHQ–28 scores which
showed a mean difference of 0.93 (95%showed a mean difference of 0.93 (95%
CI 0.35–1.52). These findings raise theCI 0.35–1.52). These findings raise the
question of whether military deploymentquestion of whether military deployment
is necessarily bad for psychological health.is necessarily bad for psychological health.
DISCUSSIONDISCUSSION
The principal finding of this preliminaryThe principal finding of this preliminary
study was a lack of deterioration in thestudy was a lack of deterioration in the
mental health of British soldiers deployedmental health of British soldiers deployed
to Iraq. This is in contrast to the recentto Iraq. This is in contrast to the recent
well-publicised findings of Hogewell-publicised findings of Hoge et alet al
(2004). Why do our results differ? The(2004). Why do our results differ? The
units studied by Hogeunits studied by Hoge et alet al and ourselvesand ourselves
were all front-line units with reputationswere all front-line units with reputations
for military competence. Our measuresfor military competence. Our measures
were administered 1 month after returnwere administered 1 month after return
whereas those used by Hogewhereas those used by Hoge et alet al werewere
administered 3–4 months after return fromadministered 3–4 months after return from
theatre. However, post-deployment asso-theatre. However, post-deployment asso-
ciated psychological distress is likely tociated psychological distress is likely to
reduce over time (Greenbergreduce over time (Greenberg et alet al, 2003),, 2003),
rather than the converse. It is recognised,rather than the converse. It is recognised,
however, that we did not at that time havehowever, that we did not at that time have
any baseline prevalence measures using theany baseline prevalence measures using the
GHQ with British Armed Forces againstGHQ with British Armed Forces against
which these results might be compared.which these results might be compared.
Also, whereas we used different measuresAlso, whereas we used different measures
to Hogeto Hoge et alet al, we think it implausible that, we think it implausible that
this would account for the considerable dif-this would account for the considerable dif-
ferences. A final factor might be the differ-ferences. A final factor might be the differ-
ent areas of the country in which Britishent areas of the country in which British
536536
BRITISH JOURNAL OF P SYCHIATRYBRITISH JOURNAL OF P SYCHIATRY (2 005), 186, 536^ 537(2005), 186 , 536 ^537 SHORT REPORTSHORT REP ORT
Going to war does not have to hurt:Going to war does not have to hurt:
preliminary findings from the Britishpreliminary findings from the British
deployment to Iraqdeployment to Iraq
JAMIE HACKER HUGHES, FIONA CAMERON, ROD ELDRIDGE,JAMIE HACKER HUGHES, FIONA CAMERON, ROD ELDRIDGE,
MADEL EINE DEVON, SIMON W ESSELY and NEIL GREENB ERGMADE LEINE D EVON, SIMON WE SSELY and NEIL GREENBERG
MENTAL HEALTH AFT ER IRAQMENTAL HEALTH AFTE R IRAQ
and US troops were deployed and theand US troops were deployed and the
differences in fighting in which they weredifferences in fighting in which they were
involved, reflected in the higher numberinvolved, reflected in the higher number
of US casualties, both physical andof US casualties, both physical and
psychological.psychological.
Our results show that it is premature toOur results show that it is premature to
conclude that the Iraq war has already hadconclude that the Iraq war has already had
a serious adverse effect on the mentala serious adverse effect on the mental
health of the armed forces, or that we arehealth of the armed forces, or that we are
inevitably facing a repeat of the Vietnaminevitably facing a repeat of the Vietnam
story (Wessely & Jones, 2004). This studystory (Wessely & Jones, 2004). This study
also reminds us that where there are highlyalso reminds us that where there are highly
selected forces with high morale involved inselected forces with high morale involved in
focused operations with positive outcomes,focused operations with positive outcomes,
whatever the immediate political context,whatever the immediate political context,
participation in war fighting may some-participation in war fighting may some-
times not necessarily be as deleterious totimes not necessarily be as deleterious to
psychological well-being as has previouslypsychological well-being as has previously
been thought.been thought.
ACKNOWLEDGEMENTSACKNOWLED GE MENTS
We thank Stewart Neale, RMN, CommunityWe th ank Stewar t Neale, RMN, Community
PsychiatricNurse,andMichaelSrinivasan,PsychiatricNurse,andMichaelSrinivasan,
MRCPsych, Consultant Psychiatrist, Department ofMRCPsych, Consultant Psychiatrist, Department of
Community Mental Health, 16 Air A ssault BrigadeCommunity Mental Health, 16 Air Assault Brigade
and Colchester Garrison.and Colchester Garrison.
REFERENCESREFERENCES
Brewin, C. R., Rose, S., Andrews, B.,Brewin, C. R., Ro se, S. , Andre ws, B. , et alet al (200 2)(200 2)
Brief screening instrument for post-traumatic stressBrief screening instrument for post-traumatic stress
disorder.disorder. British Journal of PsychiatryBritish Journal of Psychiatry,, 181181, 158^162.,158^162.
Goldberg, D. & Hillier,V. (197 9)Goldb erg, D. & Hillier,V. (197 9) A sc aled version of th eA scaled versionof the
General Health Questionnaire.General Health Questionnaire.Psych ological M edicinePsych ological Medicine,, 99,,
139^ 14 5.139 ^ 14 5 .
Greenberg, N., Maingay, B., Iversen, A. ,Greenberg, N., Maingay, B., Iversen, A. , et alet al (20 03)(20 03)
Perceived psychological support of UK militaryPerceive d psycholo gical supp ort of UK military
peacekeepers on return from deployment.peacekeepers on return from deployment. Journal ofJournal of
Me ntal He althMental Health,, 66, 565^573., 565^573.
Hoge, C.W.,Castro, C. A., Messer, S. C.,Hoge, C.W.,Castro, C. A., Messer, S. C., et alet al (20 04)(20 04)
Combat dutyin Iraq and Afghanistan, mentalhealthCombat dutyin Iraq and Afghanistan, mentalhealth
problems and barriers to care.problems and barriers to care. New England Journal ofNew England Journal of
MedicineMedicine,, 351351,13^22.,13^22.
Spurgeon, D. ( 20 04)Spurgeon, D. (20 04) Fear of stigma deters US soldier sFear of stigma deters US soldiers
from se eking help for mental health.from se eking help for mental health. British MedicalBritish Medical
JournalJournal,, 32 9329,12.,12.
Was sel y, S. & J one s, E . (2 00 4)Was sel y, S. & J one s, E . ( 20 04) Psychiatry and thePsychiatry and the
‘lessons of Vietnam’: what were they and are they still‘lessons of Vietnam’: what were they and are they still
relevant?relevant? Warand SocietyWar and Society,, 2222, 89^103., 89^103.
537537
JAMIE HACKER HUGHES, PsychD, FIONA CAMERON, RMN, ROD ELDRIDGE, RMN, MADELEINE DEVON,JAMIE HACKER HUGHES, PsychD, FIONA C AMERON, RMN, ROD ELDRIDGE, RMN, MADELEINE DEVON,
MSc,Defence Medical Services, Department of Community Mental Health,Colchester,SIMONWESSELY,MSc,Defence Medical Services,Departmentof Community Mental Health,Colchester,SIMONWESSELY,
FRCPsych, NEIL GREENBERG, MRCPsych,King’s Centre for Military Health Research, London, UKFRCPsych, NEIL GREENBERG, MRCPsych, King’s Centre f or Military He alth Res earch, Londo n,UK
Correspondence:Dr Jamie Hacker Hughes,Senior Lecturer,Academic Centre for Defence MentalCorrespondence:Dr Jamie Hacker Hughes,Senior Lecturer, Academic Centrefor Defence Mental
Health,King’s Centre for Military Health Research,Instituteof Psychiatry,King’s College London,WestonHealth,King’s Centre for Military Health Research,Instituteof Psychiatry,King’s College London,Weston
Education Centre,Cutcombe Road, London, SE5 9RJ,UK.E-mail: j.hacker-hughesEducation Centre,Cutcombe Road, London, SE 5 9RJ,UK. E-mail: j.ha cker-hughe s@@iop.kcl.ac. ukiop.kcl.ac.uk
(First received14 September 2004, finalrevision 25 February 2005, accepted 3 March 20 05)(First received14 September 2004, finalrevision 25 February 2005, accepted 3 March 2005)
10.1192/bjp.186.6.536Access the most recent version at DOI:
2005, 186:536-537.BJP
WESSELY and NEIL GREENBERG
JAMIE HACKER HUGHES, FIONA CAMERON, ROD ELDRIDGE, MADELEINE DEVON, SIMON
British deployment to Iraq
Going to war does not have to hurt: preliminary findings from the
References http://bjp.rcpsych.org/content/186/6/536#BIBL
This article cites 6 articles, 2 of which you can access for free at:
permissions
Reprints/ permissions@rcpsych.ac.ukwrite to
To obtain reprints or permission to reproduce material from this paper, please
to this article at
You can respond /letters/submit/bjprcpsych;186/6/536
from
Downloaded The Royal College of PsychiatristsPublished by on July 18, 2017http://bjp.rcpsych.org/
http://bjp.rcpsych.org/site/subscriptions/ go to: The British Journal of PsychiatryTo subscribe to
