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Original Article
July 2007

Combat and Peacekeeping Operations in Relation to Prevalence of Mental Disorders and Perceived Need for Mental Health Care: Findings From a Large Representative Sample of Military Personnel

Author Affiliations

Author Affiliations: Departments of Psychiatry (Drs Sareen and Cox and Mss Afifi and Belik), Community Health Sciences (Drs Sareen and Cox, Mss Afifi and Belik), and Psychology (Dr Cox), University of Manitoba, Winnipeg; Departments of Psychiatry and Family and Preventive Medicine, University of California San Diego (Dr Stein) and Veterans Affairs San Diego Healthcare System (Dr Stein), San Diego; Department of Psychiatry, University of Melbourne, Melbourne, Australia (Dr Meadows); and Anxiety and Illness Behaviours Laboratory and Traumatic Stress Group, University of Regina, Regina, Saskatchewan (Dr Asmundson).

Arch Gen Psychiatry. 2007;64(7):843-852. doi:10.1001/archpsyc.64.7.843
Abstract

Context  Although military personnel are trained for combat and peacekeeping operations, accumulating evidence indicates that deployment-related exposure to traumatic events is associated with mental health problems and mental health service use.

Objective  To examine the relationships between combat and peacekeeping operations and the prevalence of mental disorders, self-perceived need for mental health care, mental health service use, and suicidality.

Design  Cross-sectional, population-based survey.

Setting  Canadian military.

Participants  A total of 8441 currently active military personnel (aged 16-54 years).

Main Outcome Measures  The DSM-IV mental disorders (major depressive disorder, posttraumatic stress disorder, generalized anxiety disorder, panic disorder, social phobia, and alcohol dependence) were assessed using the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, a fully structured lay-administered psychiatric interview. The survey included validated measures of self-perceived need for mental health treatment, mental health service use, and suicidal ideation. Lifetime exposure to peacekeeping and combat operations and witnessing atrocities or massacres (ie, mutilated bodies or mass killings) were assessed.

Results  The prevalences of any past-year mental disorder assessed in the survey and self-perceived need for care were 14.9% and 23.2%, respectively. Most individuals meeting the criteria for a mental disorder diagnosis did not use any mental health services. Deployment to combat operations and witnessing atrocities were associated with increased prevalence of mental disorders and perceived need for care. After adjusting for the effects of exposure to combat and witnessing atrocities, deployment to peacekeeping operations was not associated with increased prevalence of mental disorders.

Conclusions  This is the first study to use a representative sample of active military personnel to examine the relationship between deployment-related experiences and mental health problems. It provides evidence of a positive association between combat exposure and witnessing atrocities and mental disorders and self-perceived need for treatment.

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