Hostname: page-component-76fb5796d-qxdb6 Total loading time: 0 Render date: 2024-04-27T21:37:26.062Z Has data issue: false hasContentIssue false
  • English
  • Français

Long-term risk for mental health symptoms in Dutch ISAF veterans: the role of perceived social support

Published online by Cambridge University Press:  18 January 2022

Sija J. van der Wal Open the ORCID record for Sija J. van der Wal [Opens in a new window] ,
Elbert Geuze Open the ORCID record for Elbert Geuze [Opens in a new window]  and
Eric Vermetten Open the ORCID record for Eric Vermetten [Opens in a new window]
Sija J. van der Wal*
Affiliation:
Brain Research and Innovation Centre, Ministry of Defence, Utrecht, The Netherlands Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
Elbert Geuze
Affiliation:
Brain Research and Innovation Centre, Ministry of Defence, Utrecht, The Netherlands Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
Eric Vermetten
Affiliation:
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands ARQ National Pyschotrauma Center, Diemen, The Netherlands Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands
*
Author for correspondence: Sija J. van der Wal, E-mail: s.j.vanderwal@umcutrecht.nl
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Military personnel deployed to combat and peacekeeping missions are exposed to high rates of traumatic events. Accumulating evidence suggests an important association between deployment and the development of other mental health symptoms beyond post-traumatic stress disorder.

Methods

This study examined the prevalence of agoraphobia, anxiety, depression, and hostility symptoms in a cohort of Dutch ISAF veterans (N = 978) from pre-deployment up to 10 years after homecoming. The interaction of potential moderating factors with the change in mental health symptoms relative to pre-deployment was investigated at each time point.

Results

The probable prevalence of agoraphobia, anxiety, depression, and hostility symptoms significantly increased over time to respectively 6.5, 2.7, 3.5, and 6.2% at 10 years after deployment. Except for hostility symptoms, the probable prevalence at 10 years after deployment was the highest compared to all previous follow-up assessments. Importantly, less perceived social support after returning from deployment was found as a risk factor for all different mental health symptoms. Unit support was not associated with the development of mental health problems.

Conclusions

This study suggests a probable broad and long-term impact of deployment on the mental health of military service members. Due to the lack of a non-deployed control group, causal effects of deployment could not be demonstrated. Continued effort should nevertheless be made in the diagnosis and treatment of a wide range of mental health symptoms, even a decade after deployment. The findings also underscore the importance of social support after homecoming and its potential for the prevention of long-term mental health problems.

Keywords

Deploymentlongitudinalmental healthmilitarysocial support
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 8 , June 2023 , pp. 3355 - 3365
Check for updates
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anderson, L., Campbell-Sills, L., Ursano, R. J., Kessler, R. C., Sun, X., Heeringa, S. G., … Stein, M. B. (2019). Prospective associations of perceived unit cohesion with post-deployment mental health outcomes. Depression and Anxiety, 36(6), 511–521. doi:10.1002/da.22884CrossRefGoogle Scholar
Arrindell, W. A., & Ettema, J. H. M. (2003). SCL-90: Revised manual for a multidimensional indicator of psychopathology [Herziene handleiding bij een multidimensionale psychopathologie indicator]. Lisse, The Netherlands: Swets & Zeitlinger.Google Scholar
Bonanno, G. A., Mancini, A. D., Horton, J. L., Powell, T. M., LeardMann, C. A., Boyko, E. J., … Smith, T. C. (2012). Trajectories of trauma symptoms and resilience in deployed US military service members: Prospective cohort study. British Journal of Psychiatry, 200(4), 317–323. doi:10.1192/bjp.bp.111.096552CrossRefGoogle ScholarPubMed
Bremner, J. D., Bolus, R., & Mayer, E. A. (2007). Psychometric properties of the early trauma inventory-self report. The Journal of Nervous and Mental Disease, 195(3), 211–218. doi:10.1097/01.nmd.0000243824.84651.6cCrossRefGoogle ScholarPubMed
Cai, W. P., Pan, Y., Zhang, S. M., Wei, C., Dong, W., & Deng, G. H. (2017). Relationship between cognitive emotion regulation, social support, resilience and acute stress responses in Chinese soldiers: Exploring multiple mediation model. Psychiatry Research, 256, 71–78. doi:10.1016/j.psychres.2017.06.018CrossRefGoogle ScholarPubMed
Campbell-Sills, L., Flynn, P. J., Choi, K. W., Ng, T. H. H., Aliaga, P. A., Broshek, C., … Bliese, P. D. (2020). Unit cohesion during deployment and post-deployment mental health: Is cohesion an individual- or unit-level buffer for combat-exposed soldiers? Psychological Medicine, 52(1), 1–11. doi:10.1017/S0033291720001786Google ScholarPubMed
Carrozzino, D., Vassend, O., Bjørndal, F., Pignolo, C., Olsen, L. R., & Bech, P. (2016). A clinimetric analysis of the Hopkins Symptom Checklist (SCL-90-R) in general population studies (Denmark, Norway, and Italy). Nordic Journal of Psychiatry, 70(5), 374–379. doi:10.3109/08039488.2016.1155235CrossRefGoogle ScholarPubMed
Choi, K. W., Chen, C. Y., Ursano, R .J., Sun, X., Jain, S., Kessler, R. C., … Smoller, J. W. (2020). Prospective study of polygenic risk, protective factors, and incident depression following combat deployment in US army soldiers. Psychological Medicine, 50(5), 737–745. doi:10.1017/S0033291719000527CrossRefGoogle ScholarPubMed
Ciarleglio, M. M., Aslan, M., Proctor, S. P., Concato, J., Ko, J., Kaiser, A. P., & Vasterling, J. J. (2018). Associations of stress exposures and social support with long-term mental health outcomes among U.S. Iraq war veterans. Behavior Therapy, 49(5), 653–667. doi:10.1016/j.beth.2018.01.002CrossRefGoogle ScholarPubMed
De Graaf, R., Ten Have, M., Van Gool, C., & Van Dorsselaer, S. (2012). Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands mental health survey and incidence study-2. Social Psychiatry and Psychiatric Epidemiology, 47(2), 203–213. doi:10.1007/s00127-010-0334-8CrossRefGoogle ScholarPubMed
Derogatis, L. R. (1993). Brief symptom inventory (BSI): Administration, scoring, and procedures manual. Minneapolis: National Computer Systems.Google Scholar
Derogatis, L. R. (1994). SCL-90-R. Administration, scoring and procedures manual. Minneapolis: National Computer Systems.Google Scholar
Eekhout, I., Reijnen, A., Vermetten, E., & Geuze, E. (2016). Post-traumatic stress symptoms 5 years after military deployment to Afghanistan: An observational cohort study. The Lancet Psychiatry, 3(1), 58–64. doi:10.1016/S2215-0366(15)00368-5CrossRefGoogle ScholarPubMed
Engelhard, I. M., van den Hout, M. A., Weerts, J., Arntz, A., Hox, J. J. C. M., & McNally, R. J. (2007). Deployment-related stress and trauma in Dutch soldiers returning from Iraq: Prospective study. British Journal of Psychiatry, 191, 140–145. doi:10.1192/bjp.bp.106.034884CrossRefGoogle ScholarPubMed
Fear, N. T., Jones, M., Murphy, D., Hull, L., Iversen, A. C., Coker, B., … Wessely, S. (2010). What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. The Lancet, 375(9728), 1783–1797. doi:10.1016/S0140-6736(10)60672-1CrossRefGoogle ScholarPubMed
Forbes, D., Alkemade, N., Nickerson, A., Bryant, R. A., Creamer, M., Silove, D., … ODonnell, M. (2016). Prediction of late-onset psychiatric disorder in survivors of severe injury: Findings of a latent transition analysis. Journal of Clinical Psychiatry, 77(6), 807–812. doi:10.4088/JCP.15m09854CrossRefGoogle ScholarPubMed
Frueh, B. C., Hamner, M. B., Cahill, S. P., Gold, P. B., & Hamlin, K. L. (2000). Apparent symptom overreporting in combat veterans evaluated for PTSD. Clinical Psychology Review, 20(7), 853–885. doi:10.1016/S0272-7358(99)00015-XCrossRefGoogle ScholarPubMed
Han, S. C., Castro, F., Lee, L. O., Charney, M. E., Marx, B. P., Brailey, K., … Vasterling, J. J. (2014). Military unit support, post-deployment social support, and PTSD symptoms among active duty and national guard soldiers deployed to Iraq. Journal of Anxiety Disorders, 28(5), 446–453. doi:10.1016/j.janxdis.2014.04.004CrossRefGoogle Scholar
Heinrichs, M., Baumgartner, T., Kirschbaum, C., & Ehlert, U. (2003). Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biological Psychiatry, 54(12), 1389–1398. doi:10.1016/S0006-3223(03)00465-7CrossRefGoogle ScholarPubMed
Holi, M. M., Sammallahti, P. R., & Aalberg, V. A. (1998). A Finnish validation study of the SCL-90. Acta Psychiatrica Scandinavica, 97(1), 42–46. doi:10.1111/j.1600-0447.1998.tb09961.xCrossRefGoogle ScholarPubMed
Hoopsick, R. A., Homish, D. L., Collins, R. L., Nochajski, T. H., Read, J. P., Bartone, P. T., … Homish, G. G. (2020). Resilience to mental health problems and the role of deployment status among U.S. Army reserve and national guard soldiers. Social Psychiatry and Psychiatric Epidemiology, 56(7), 1299–1310. doi:10.1007/s00127-020-01899-5Google ScholarPubMed
Iob, E., Kirschbaum, C., & Steptoe, A. (2018). Positive and negative social support and HPA-axis hyperactivity: Evidence from glucocorticoids in human hair. Psychoneuroendocrinology, 96, 100–108. doi:10.1016/j.psyneuen.2018.06.008CrossRefGoogle ScholarPubMed
Jokela, M., Batty, G. D., & Kivimäki, M. (2013). Ageing and the prevalence and treatment of mental health problems. Psychological Medicine, 43(10), 2037–2045. doi:10.1017/S0033291712003042CrossRefGoogle ScholarPubMed
Kamphuis, W., Delahaij, R., Duel, J., Geuze, E., & Vermetten, E. (2021). The relationship between resilience resources and long-term deployment-related PTSD symptoms: A longitudinal study in dutch veterans. Military Behavioral Health, 9(3), 1–8. doi:10.1080/21635781.2020.1864528CrossRefGoogle Scholar
King, L. A., King, D. W., Vogt, D. S., Knight, J., & Samper, R. E. (2006). Deployment risk and resilience inventory: A collection of measures for studying deployment-related experiences of military personnel and veterans. Military Psychology, 18(2), 89–120. doi:10.1207/s15327876mp1802_1CrossRefGoogle Scholar
LaRocca, M. A., & Scogin, F. R. (2015). The effect of social support on quality of life in older adults receiving cognitive behavioral therapy. Clinical Gerontologist, 38(2), 131–148. doi:10.1080/07317115.2014.990598CrossRefGoogle ScholarPubMed
Luciano, M. T., & McDevitt-Murphy, M. E. (2017). Posttraumatic stress and physical health functioning: Moderating effects of deployment and post-deployment social support in OEF/OIF/OND veterans. The Journal of Nervous and Mental Disease, 205(2), 93–98. doi:10.1097/NMD.0000000000000571CrossRefGoogle Scholar
Matsushita, H., Latt, H. M., Koga, Y., Nishiki, T., & Matsui, H. (2019). Oxytocin and stress: Neural mechanisms, stress-related disorders, and therapeutic approaches. Neuroscience, 417, 1–10. doi:10.1016/j.neuroscience.2019.07.046CrossRefGoogle ScholarPubMed
Milliken, C. S., Auchterlonie, J. L., & Hoge, C. W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. Journal of the American Medical Association, 298(18), 2141–2148. doi:10.1001/jama.298.18.2141CrossRefGoogle ScholarPubMed
Moore, T. M., Risbrough, V. B., Baker, D. G., Larson, G. E., Glenn, D. E., Nievergelt, C. M., … Gur, R. C. (2017). Effects of military service and deployment on clinical symptomatology: The role of trauma exposure and social support. Journal of Psychiatric Research, 95, 121–128. doi:10.1016/j.jpsychires.2017.08.013CrossRefGoogle ScholarPubMed
Nordmo, M., Hystad, S. W., Sanden, S., & Johnsen, B. H. (2020). Mental health during naval deployment: The protective role of family support. Military Medicine, 185(5–6), 703–710. doi:10.1093/milmed/usz436CrossRefGoogle ScholarPubMed
Ozbay, F., Johnson, D. C., Dimoulas, E., Morgan, C. A., Charney, D., & Southwick, S. (2007). Social support and resilience to stress: From neurobiology to clinical practice. Psychiatry, 4(5), 35–40.Google ScholarPubMed
Palmer, L., Thandi, G., Norton, S., Jones, M., Fear, N. T., Wessely, S., & Rona, R. J. (2019). Fourteen-year trajectories of posttraumatic stress disorder (PTSD) symptoms in UK military personnel, and associated risk factors. Journal of Psychiatric Research, 109, 156–163. doi:10.1016/j.jpsychires.2018.11.023CrossRefGoogle ScholarPubMed
Pietrzak, R. H., Johnson, D. C., Goldstein, M. B., Malley, J. C., Rivers, A. J., Morgan, C. A., & Southwick, S. M. (2010). Psychosocial buffers of traumatic stress, depressive symptoms, and psychosocial difficulties in veterans of operations enduring freedom and Iraqi freedom: The role of resilience, unit support, and post-deployment social support. Journal of Affective Disorders, 120(1–3), 188–192. doi:10.1016/j.jad.2009.04.015CrossRefGoogle Scholar
Pink, F. (1973). Us and Them. The Dark Side of the Moon. Los Angeles: Harvest Records.Google Scholar
Polusny, M. A., Erbes, C. R., Kramer, M. D., Thuras, P., DeGarmo, D., Koffel, E., … Arbisi, P. A. (2017). Resilience and posttraumatic stress disorder symptoms in national guard soldiers deployed to Iraq: A prospective study of latent class trajectories and their predictors. Journal of Traumatic Stress, 30(4), 351–361. doi:10.1002/jts.22199CrossRefGoogle ScholarPubMed
Price, M., Gros, D. F., Strachan, M., Ruggiero, K. J., & Acierno, R. (2013). The role of social support in exposure therapy for operation Iraqi freedom/operation enduring freedom veterans: A preliminary investigation. Psychological Trauma: Theory, Research, Practice, and Policy, 5(1), 93–100. doi:10.1037/a0026244CrossRefGoogle ScholarPubMed
Ramchand, R., Rudavsky, R., Grant, S., Tanielian, T., & Jaycox, L. (2015). Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan. Current Psychiatry Reports, 17(5), 35. doi:10.1007/s11920-015-0575-zCrossRefGoogle ScholarPubMed
Reijnen, A., Rademaker, A. R., Vermetten, E., & Geuze, E. (2015). Prevalence of mental health symptoms in Dutch military personnel returning from deployment to Afghanistan: A 2-year longitudinal analysis. European Psychiatry, 30(2), 341–346. doi:10.1016/j.eurpsy.2014.05.003CrossRefGoogle ScholarPubMed
Schmitz, N., Hartkamp, N., Kiuse, J., Franke, G. H., Reister, G., & Tress, W. (2000). The symptom check-list-90-R (SCL-90-R): A German validation study. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 9(2), 185–193. doi:10.1023/a:1008931926181CrossRefGoogle ScholarPubMed
Sheriff, R. S., Van Hooff, M., Malhi, G., Grace, B., & McFarlane, A. (2020). Childhood trauma and the impact of deployment on the development of mental disorder in military males. Psychological Medicine, 50(5), 818–826. doi:10.1017/S0033291719000655CrossRefGoogle Scholar
Stevelink, S. A. M., Jones, M., Hull, L., Pernet, D., Maccrimmon, S., Goodwin, L., … Wessely, S. (2018). Mental health outcomes at the end of the British involvement in the Iraq and Afghanistan conflicts: A cohort study. British Journal of Psychiatry, 213(6), 690–697. doi:10.1192/bjp.2018.175CrossRefGoogle ScholarPubMed
Thomas, J. L., Wilk, J. E., Riviere, L. A., McGurk, D., Castro, C. A., & Hoge, C. W. (2010). Prevalence of mental health problems and functional impairment among active component and national guard soldiers 3 and 12 months following combat in Iraq. Archives of General Psychiatry, 67(6), 614–623. doi:10.1001/archgenpsychiatry.2010.54CrossRefGoogle ScholarPubMed
Twisk, J., De Boer, M., De Vente, W., & Heymans, M. (2013). Multiple imputation of missing values was not necessary before performing a longitudinal mixed-model analysis. Journal of Clinical Epidemiology, 66(9), 1022–1028. doi:10.1016/j.jclinepi.2013.03.017CrossRefGoogle Scholar
van der Wal, S. J., Gorter, R., Reijnen, A., Geuze, E., & Vermetten, E. (2019). Cohort profile: The prospective research in stress-related military operations (PRISMO) study in the Dutch armed forces. BMJ Open, 9(3), 1–10. doi:10.1136/bmjopen-2018-026670CrossRefGoogle ScholarPubMed
van der Wal, S. J., Vermetten, E., & Geuze, E. (2020). Long-term development of post-traumatic stress symptoms and associated risk factors in military service members deployed to Afghanistan: Results from the PRISMO 10-year follow-up. European Psychiatry, 64(1), 1–9. doi:10.1192/j.eurpsy.2020.113Google ScholarPubMed
Vest, B. M., Cercone Heavey, S., Homish, D. L., & Homish, G. G. (2017). Marital satisfaction, family support, and pre-deployment resiliency factors related to mental health outcomes for reserve and national guard soldiers. Military Behavioral Health, 5(4), 313–323. doi:10.1080/21635781.2017.1343694CrossRefGoogle ScholarPubMed
Wells, T. S., Leardmann, C. A., Fortuna, S. O., Smith, B., Smith, T. C., Ryan, M. A. K., … Blazer, D. (2010). A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan. American Journal of Public Health, 100(1), 90–99. doi:10.2105/AJPH.2008.155432CrossRefGoogle ScholarPubMed
Zang, Y., Gallagher, T., McLean, C. P., Tannahill, H. S., Yarvis, J. S., & Foa, E. B. (2017). The impact of social support, unit cohesion, and trait resilience on PTSD in treatment-seeking military personnel with PTSD: The role of posttraumatic cognitions. Journal of Psychiatric Research, 86, 18–25. doi:10.1016/j.jpsychires.2016.11.005CrossRefGoogle ScholarPubMed
Zuromski, K. L., Bernecker, S. L., Chu, C., Wilks, C. R., Gutierrez, P. M., Joiner, T. E., … Kessler, R. C. (2020). Pre-deployment predictors of suicide attempt during and after combat deployment: Results from the army study to assess risk and resilience in servicemembers. Journal of Psychiatric Research, 121, 214–221. doi:10.1016/j.jpsychires.2019.12.003CrossRefGoogle ScholarPubMed
Supplementary material: File

van der Wal et al. supplementary material

van der Wal et al. supplementary material

Download van der Wal et al. supplementary material(File)
File 119.9 KB