Elsevier

The Lancet

Volume 367, Issue 9524, 27 May–2 June 2006, Pages 1731-1741
The Lancet

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The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study

https://doi.org/10.1016/S0140-6736(06)68662-5Get rights and content

Summary

Background

Concerns have been raised about the mental and physical health of UK military personnel who deployed to the 2003 war in Iraq and subsequent tours of duty in the country.

Methods

We compared health outcomes in a random sample of UK armed forces personnel who were deployed to the 2003 Iraq war with those in personnel who were not deployed. Participants completed a questionnaire covering the nature of the deployment and health outcomes, which included symptoms of post-traumatic stress disorder, common mental disorders, general wellbeing, alcohol consumption, physical symptoms, and fatigue.

Findings

The participation rate was 62·3% (n=4722) in the deployed sample, and 56·3% (n=5550) in the non-deployed sample. Differences in health outcomes between groups were slight. There was a modest increase in the number of individuals with multiple physical symptoms (odds ratio 1·33; 95% CI 1·15–1·54). No other differences between groups were noted. The effect of deployment was different for reservists compared with regulars. In regulars, only presence of multiple physical symptoms was weakly associated with deployment (1·32; 1·14–1·53), whereas for reservists deployment was associated with common mental disorders (2·47, 1·35–4·52) and fatigue (1·78; 1·09–2·91). There was no evidence that later deployments, which were associated with escalating insurgency and UK casualties, were associated with poorer mental health outcomes.

Interpretation

For regular personnel in the UK armed forces, deployment to the Iraq war has not, so far, been associated with significantly worse health outcomes, apart from a modest effect on multiple physical symptoms. There is evidence of a clinically and statistically significant effect on health in reservists.

Introduction

There is no doubt that service personnel returning from military deployments are at risk of both mental and physical illness. Increased rates of several physical symptoms, and psychiatric disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD), have been reported in many controlled epidemiological studies after deployments dating back as far as the American Civil War, and have been prominent in recent conflicts.1, 2, 3, 4, 5, 6 Despite these recognised associations, systematic epidemiological research has not been done until many years after deployments have ended. This delay has led to a range of methodological difficulties, including selection biases (due to low participation rates and exclusion of participants who have left the military), recall biases,7 and difficulties in determining causal pathways between deployment-related hazards and later health outcomes.8 Although some broad similarities might exist in the stresses experienced during different deployments, each has its own particular range of hazards. High-quality information on health outcomes after deployment is necessary to plan health services for serving and ex-serving personnel.

In the present study, we assessed the mental and physical health of UK veterans of the 2003 Iraq war. Our immediate focus was on Operation TELIC 1, which represented the build up and completion of major combat operations from Jan 18 to June 28, 2003. During this time about 46 000 UK service personnel were deployed. Since June, 2003, UK forces have continued to be deployed in southeastern Iraq and neighbouring areas, and by the end of 2005, 100 000 UK military personnel had served in the Joint Operational consecutive roulements of Operation TELIC. By February, 2006, 103 UK service personnel had died. There has been great concern in the UK media about the psychological effects of this deployment for UK service personnel.9, 10 Evidence from a large epidemiological study showed that US service personnel who deployed to Iraq in combat units had substantially higher rates of anxiety, depression, and PTSD symptoms than similar samples who were surveyed before deployment.11 Routine screening for PTSD and depression has also indicated higher than expected rates in US service personnel.12

We aimed to compare the mental and physical health of UK armed forces personnel who had served in Operation TELIC 1 with that of a military group who had not, with two primary outcomes: common mental disorders and symptoms of PTSD.

Section snippets

Study design and participants

This was the first stage of data collection of a planned cohort study in which we compared mental and physical health outcomes in two groups: individuals who had deployed on Operation TELIC 1, and individuals who were in the military at that time, but who were not deployed on Operation TELIC 1.

The first phase of deployment where major combat duties took place was designated TELIC 1 and took place from Jan 18, 2003, to June 28, 2003. Subsequent deployments, each lasting about 6 months, have been

Procedures

We devised and piloted a 28-page questionnaire booklet, which included the information that participation in the survey was entirely voluntary, and that the researchers were independent of the Ministry Of Defence. The questionnaire consisted of seven sections: (1) demographics; (2) service information (including information on those no longer serving, current or last rank, and details of previous deployments); (3) experiences before deployment (including expectations and receipt of

Results

We attempted contact with 17 499 individuals, of whom 10 272 (58·7%) completed the questionnaire and 160 (0·9%) refused to participate. Table 1 shows the response received according to the method of contact we used. For each contact a proportion of questionnaires were returned (return to sender); this proportion varied over the life of the study. The final number of individuals who we can be confident would never have received a questionnaire due to inadequate address information was 657. When

Discussion

This large epidemiological study of UK veterans of the 2003 Iraq war had two principal findings. First, as a whole, individuals who were deployed to Iraq had similar rates of mental and physical illness to a similar military control group who were not deployed to Iraq, the only exception being a slight increase in physical symptoms in those deployed. Second, for most health outcomes we noted significant interaction between deployment and reservist status. Although deployment has not, to date,

References (29)

  • C Unwin et al.

    Health of UK servicemen who served in the Persian Gulf War

    Lancet

    (1999)
  • EB Blanchard et al.

    Psychometric properties of the PTSD checklist (PCL)

    Behav Res Ther

    (1996)
  • WDS Killgore et al.

    The effects of prior combat experience on the expression of somatic and affective symptoms in deploying soldiers

    J Psychosom Res

    (2006)
  • J Pizarro et al.

    Physical and mental health costs of traumatic war experiences among civil war veterans

    Arch Gen Psychiatry

    (2006)
  • E Jones et al.

    Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution

    BMJ

    (2002)
  • BK Jordan et al.

    Lifetime and current prevalence of specific psychiatric disorders among Vietnam veterans and controls

    Arch Gen Psychiatry

    (1991)
  • Health status of Vietnam veterans. I. Psychosocial characteristics. The Centers for Disease Control Vietnam Experience Study

    JAMA

    (1988)
  • HK Kang et al.

    Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30 000 veterans

    Am J Epidemiol

    (2003)
  • S Wessely et al.

    Stability of recall of military hazards over time: Evidence from the Persian Gulf War of 1991

    Br J Psychiatry

    (2003)
  • M Hotopf et al.

    Epidemiology and the fog of war: lessons from the 1990–1991 Gulf War

    Int J Epidemiology

    (2005)
  • RA Greene

    UK troops face trauma after Iraq

  • J Burke

    Relatives fear for forgotten war wounded

    (Nov 28, 2004)
  • CW Hoge et al.

    Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care

    N Engl J Med

    (2004)
  • CW Hoge et al.

    Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan

    JAMA

    (2006)
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