The psychological effects of conflict in wartime have attracted much interest,1,2 but today's army is more commonly employed to maintain internal security and as international peacekeeping forces. Such duties can result in psychological sequelae, including distress, nightmares, and tension.3,4 However, previous research has not included baseline morbidity and nor has it considered working on security duties in Northern Ireland, in which most of the army is employed. We prospectively explored how service in Northern Ireland affects the mental health of military personnel.
Participants, methods, and results
We selected a stratified sample of 200 servicemen from an infantry battalion of 566 according to rank (20 officers, 30 from the senior ranks of sergeant to warrant officer, and 150 from the junior ranks of corporal and below). We excluded six women, because there were few, and 44 men deemed unfit for service in Northern Ireland or for administrative reasons. Three servicemen withdrew before departure, leaving a sample of 197.
We sent an explanatory letter and an anonymous baseline postal questionnaire to the barracks two weeks before deployment to Northern Ireland. We distributed the follow up questionnaire in Northern Ireland two weeks before the end of a six months tour.
The servicemen recorded their age, rank, length of service, and marital status. They also completed the general health questionnaire 28 at baseline and follow up which assessed somatic symptoms, anxiety, social impairment, and depression.5 We scored this questionnaire using 0 or 1 for each item to create subtotals of 0 to 7 for each subscale and using the recognised cut-off point of 5 for “caseness” for the total score (0-28). We analysed data with Wilcoxon matched pairs rank sum tests to compare scores from the subscales at baseline and follow up, and we used odds ratios to examine changes in caseness.
Baseline response rate was 85.8% (169/197). Follow up response rate was 86.8% (171). A total of 150 (76.1%) servicemen completed both sets of measures. We received completed questionnaires from 14 (9.4%) officers, 26 (17.3%) senior ranks, and 110 (73.3%) junior ranks. Servicemen who responded were demographically similar to those who did not.
The average age was 25.71 (standard deviation 6.0). Ninety (60%) were single; 1 (0.7%) was widowed, separated, or divorced; and 59 (39.9%) were married. Fifty four (36%) had served for 0-3 years, 55 (36.7%) had served for 4-9 years, and 41 (27.3%) had served for 10 or more years. Although the tour was between 1993 and 1994 and before the cease fire, only 12 (8%) servicemen stated that they had witnessed any traumatic event.
Soldiers reported high baseline levels of psychological morbidity, and caseness was three times as great after an operational tour in Northern Ireland (table). We found significant increases in somatic symptoms (P < 0.0001), anxiety (P < 0.0001), and social isolation (P < 0.0001), but ratings for depression did not change (P = 0.93).
Table 1.
Scores from the general health questionnaire at baseline and at six months and change in caseness for 150 servicemen on security duties in Northern Ireland
| Median (range) baseline score | Median (range) follow up score | Z score (95% CI) | P value | |
|---|---|---|---|---|
|
General health questionnaire subscale
| ||||
| Somatic symptoms | 0 (0-7) | 1 (0-7) | −4.26 | 0.0001 |
| Anxiety | 0 (0-7) | 1 (0-7) | −3.71 | 0.0001 |
| Social isolation | 0 (0-6) | 1 (0-6) | −3.62 | 0.0001 |
| Depression | 0 (0-7) | 0 (0-7) | −0.087 | 0.93 |
| Change in caseness (t1-t2) | ||||
| Follow up (t2) | ||||
| NO | YES | |||
| Baseline (t1) | NO | 82 | 32 | Odds ratio 2.9 (1.4 to 6.4) |
| YES | 11 | 25 | ||
Comment
Although research has emphasised the detrimental effects of fighting war, tours to maintain security may also be damaging to soldiers' mental health. On tour, soldiers live in cramped conditions and are separated from their home life, in common with many people who work and live away from home. Soldiers also experience long periods of inactivity interspersed with sporadic episodes of exposure to potentially dangerous situations. Future research should explore what aspects of a soldier's existence contribute to changes in psychological morbidity if remedial steps are to be taken to maximise a soldier's professional potential.
This project was completed as part assessment of the MSc in General Practice at Guy's, King's, and St Thomas's, King's College London for GL supervised by JO. We thank Matthew Hankins for statistical advice.
Contributors: GL conceived the idea and collected the data. Both authors designed the study, analysed the data, and wrote the paper. GL is guarantor.
Funding: None.
Competing interests: None declared.
Ethical approval: Army medical services research executive committee.
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