BMJ  2006;333:1123 (25 November), doi:10.1136/bmj.39037.702211.3A

Letters

Predicting mental illness in soldiers

Pre-deployment screening for vulnerability to post- traumatic stress disorder

Rona et al have conducted an important study of UK military personnel with a large, statistically powerful cohort.¹ Hyams points out the confounding "healthy warrior" effect.² This, together with the marked differences between conscripted and volunteer groups, makes it difficult to extrapolate findings from the first and second world wars to the modern era. Nevertheless, there is a powerful message that post-traumatic stress disorder (and other mental disorders) are difficult to predict, with the implication that ex-service personnel are likely to present to civilian mental health services with such conditions. As a substance misuse service, we have seen post-traumatic stress disorder with drug and alcohol misuse as the index symptom in several such people and have found Combat Stress (based in Leatherhead, Surrey) a very useful organisation, not least because of the ability to tap into the "healthy warrior" effect through group and individual therapies, allowing us to treat the addictive behaviours in context.

Post-trauma debriefing is possibly harmful,³ so service personnel need vigilant monitoring for mental disorder after the fact. This is particularly important when they leave the protective group environment provided by military life. More attention should be paid to the transitional and demobilised phases to allow early detection of post-traumatic stress disorder emerging from a dormant phase. Often, on discharge, ex-service personnel feel abandoned, adding to the sense of anomie experienced by those with post-traumatic stress disorder. There is a case for all mental health services to receive training in helping them accept generic treatment and access more specialised input, where indicated.

¹ St George's, University of London, London SW17 0RE

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Competing interests: None declared.

References

1. Rona RJ, Hooper R, Jones M, Hull L, Browne T, Horn O, Mental health screening in armed forces before the Iraq war and prevention of subsequent psychological morbidity: follow-up study. BMJ 2006;333:991-4. (11 November.)[Abstract/Free Full Text]
2. Hyams KC. Mental health screening before troop deployment. BMJ 2006;333:979-80. (11 November.)[Free Full Text]
3. Rose S, Bisson J, Churchill R, Wessely S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Systematic Review 2002.

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