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Risk factors for post-traumatic stress disorder among UK Armed Forces personnel

Published online by Cambridge University Press:  29 January 2008

A. C. Iversen ,
N. T. Fear ,
A. Ehlers ,
J. Hacker Hughes ,
L. Hull ,
M. Earnshaw ,
N. Greenberg ,
R. Rona ,
S. Wessely  and
M. Hotopf
A. C. Iversen*
Affiliation:
King's Centre for Military Health Research, King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK
N. T. Fear
Affiliation:
Academic Centre for Defence Mental Health, King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK
A. Ehlers
Affiliation:
Department of Psychology, Institute of Psychiatry, King's College London, UK
J. Hacker Hughes
Affiliation:
Academic Centre for Defence Mental Health, King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK
L. Hull
Affiliation:
King's Centre for Military Health Research, King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK
M. Earnshaw
Affiliation:
Academic Centre for Defence Mental Health, King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK
N. Greenberg
Affiliation:
King's Centre for Military Health Research, King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK
R. Rona
Affiliation:
King's Centre for Military Health Research, King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK
S. Wessely
Affiliation:
King's Centre for Military Health Research, King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK
M. Hotopf
Affiliation:
King's Centre for Military Health Research, King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK
*
*Address for correspondence: A. C. Iversen, MRCP, MRCPsych, Department of Psychological Medicine, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK. (Email: A.Iversen@iop.kcl.ac.uk)
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Abstract

Background

There is considerable interest in understanding further the factors that increase the risk of post-traumatic stress disorder (PTSD) for military personnel. This study aimed to investigate the relative contribution of demographic variables; childhood adversity; the nature of exposure to traumatic events during deployment; appraisal of these experiences; and home-coming experiences in relation to the prevalence of PTSD ‘caseness’ as measured by a score of ⩾50 on the PTSD Checklist (PCL) in UK Armed Forces personnel who have been deployed in Iraq since 2003.

Method

Data were drawn from the first stage of a retrospective cohort study comparing UK military personnel who were deployed to the 2003 Iraq War with personnel serving in the UK Armed Forces on 31 March 2003 but who were not deployed to the initial phase of war fighting. Participants were randomly selected and invited to participate. The response rate was 61%. We have limited these analyses to 4762 regular service individuals who responded to the survey and who have been deployed in Iraq since 2003.

Results

Post-traumatic stress symptoms were associated with lower rank, being unmarried, having low educational attainment and a history of childhood adversity. Exposure to potentially traumatizing events, in particular being deployed to a ‘forward’ area in close contact with the enemy, was associated with post-traumatic stress symptoms. Appraisals of the experience as involving threat to one's own life and a perception that work in theatre was above an individual's trade and experience were strongly associated with post-traumatic stress symptoms. Low morale and poor social support within the unit and non-receipt of a home-coming brief (psycho-education) were associated with greater risk of post-traumatic stress symptoms.

Conclusions

Personal appraisal of threat to life during the trauma emerged as the most important predictor of post-traumatic stress symptoms. These results also raise the possibility that there are important modifiable occupational factors such as unit morale, leadership, preparing combatants for their role in theatre which may influence an individual's risk of post-traumatic stress symptoms. Therefore interventions focused on systematic preparation of personnel for the extreme stress of combat may help to lessen the psychological impact of deployment.

Keywords

Armed Forcescombatmilitarypost-traumatic stress disorder
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 4 , April 2008 , pp. 511 - 522
Copyright
Copyright © Cambridge University Press 2008

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