Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Predicting mental illness in soldiers before deployment: An exercise in unpredictability..
- Albert ME Coleman (13 November 2006)
|
|
|||
|
Albert ME Coleman, Associate specialist psychiatrist Sussex Partnership NHS trust, Greenarces CMHT, (OPMH), Homefield road. Worthing. W. Sussex BN11 2DH
Send response to journal:
|
Editor, The editorial by Hyman (1), and the research paper by Roberto et al (2), highlights an occupational dilemma of physicians involved in the care of military personnel. As a then medical officer involved in the pre-employment and post-empolyment medical examination of potential military recruits, and troops before deployment for United nations duties in the middle east; and later, full time medical duties with a special forces battalion with unpredictable and unscheduled combat confrontations in a third world sub-Saharan country, I can attest to their observations. Even in a number of third world countries, selection into the military involves rigouros pre-selection medicals including examination by a consultant psychiatrist, (in the case of the combat prone special forces battalion that was under my care). Granted in our case we were going primarily on person contact assessments without use of tested health questionnaires, combatants were examined for pre-existin and existing mental health problems by the consultant psychiatrist. The special forces troops on an on-going basis were being subjected to random face to face screening interviews for vulnerability to mental disorders and emerging mental disorders, because of the unpredictable nature of their day to day assignments, and the then very unstable socio-political climate in the country then. My experience from working with combat prone military personnel, was that apart from peritraumatic acute stress reactions, and post combat traumatic stress disorder, the only retrospective predictive variable in some of these otherwise mentally and physically healthy individuals, was a history of drug use, in this particular group especially cannabis use. This has been observed even in the general population (3). In the case of the combatants I was involved with, considering the diagnosis of post traumatic stress disorder; if one considers their then past frequent unpredictable combat experiences, this could have impacted on the mental health of those with pre-employment undetected vulnerability to mental health problems, as reported by others (4-5). Now, in hindsight with post-graduate training in psychiatry and occupational medicine, I cannot help but agree with the findings of Roberto et al, and the editorial comment of Hyams. Hopefully a more predictable screening tool will come along that will strengthen our clinical acumen in predicting such events, and make hindsight history. 1.Hyams KC Mental health screening before troop deployment. BMJ 2006:333; 979-980 2.Roberto RJ, Hooper R, Jones M, Hull L, Browne T, Horn O et al. Mental health screening in armed forces before war and prevention of subsequent psychological morbidity: follow-up study. BMJ 2006:333; 991-994. 3.Arseneault Louise, Cannon Mary, Witton John, Murray Robin M. Causal association between cannabis and psychosis: examination of the evidence. British Journal of Psychiatry. 2004:184; 119-117. 4.Delahanty DL, Nugent NR.Predicting PTSD prospectively based on prior trauma history and immediate biological response. Ann. N Y. Sci.1071: 27- 40 (2006). doi: 10.1.196/annals. 1364.003. Accessed 12th November 2006. 5.Clancy CP, Graybeal A, Tompson WP, Badgett KS, Feldman ME, Calhoun PS et al Lifetime trauma exposure in veterans with military-related posttraumatic stress disorder: association with current symptomatology. J Clin Psychiatry. 2006 Sep; 76(9): 1346-53. Competing interests: None declared |
|||