The health of UK civilians deployed to Iraq.

Background: Modern military operations have incorporated deployed civilians in a variety of roles (e.g. diplomats, private security staff). Many of these roles expose individuals to potentially dangerous or traumatic events. Evidence has shown that such exposures can cause psychological health problems in military personnel. It is likely that the same would be seen among civilians working in such environments. There is however limited research into the health of civilians deployed to war zones. This study compared health outcomes and related behaviours among UK regular and reserve Army personnel with UK civilian personnel deployed in direct support of the UK military in Iraq. Methods: The study sample comprised of 159 Ministry of Defence civilians, 1542 Army regulars and 408 Army reservists, all of whom served in non-combat roles. Data were gathered by questionnaires which asked about deployment experiences, lifestyle factors and health outcomes [i.e. post-traumatic stress disorder (PTSD), general health, multiple physical symptoms and alcohol use]. Results: Fewer deployed UK civilians smoked than regular Army personnel (adjusted OR 0.83 95% CI 0.70-0.98). UK civilians had better overall health and were less likely to report multiple physical symptoms compared with reservists (adjusted ORs 0.64 95% CI 0.44-0.93 and 0.60 95% CI 0.39-0.93, respectively). Conclusions: Overall, the psychological health of deployed civilians appears to be better than that of Army personnel deployed in non-combat roles. Civilians are also less likely to engage in some risky behaviours.

The experiences of security industry contractors working in Iraq: an interpretative phenomenological analysis.

OBJECTIVE: To explore the occupational experiences of private security contractors working in a war zone and how it impacts on their mental health. METHODS: Semistructured interviews were conducted with seven contractors employed by a large UK-based private security company. Interpretative phenomenological analysis was used to analyze the interview transcripts. Participants also completed the 12-item General Health Questionnaire and the Posttraumatic Stress Disorder Checklist. RESULTS: Four overarching themes emerged: the appeal of the job; vulnerability; keep going; and seeking help for stress in the workplace. No clinically significant levels of distress were reported. CONCLUSIONS: Contractors are frequently exposed to stressors known to increase risk of psychiatric difficulty in military personnel. A number of potential protective factors were identified. Only a minority of participants were open to seeking help for mental health difficulties.

International military leaders' survey on operational stress.

Despite the importance of military leaders in moderating the impact of deployment stressors on unit members, little attention has focused on the training leaders receive in managing unit stress. As part of a NATO Research Panel (Human Factors and Medicine (HFM)-081/Research and Technology Organization Task Group (RTG)), 16 nations participated in a needs assessment survey of military leaders who had returned from an operation within the previous 2 years. Findings from 172 leaders emphasized the lack of training specifically geared for leaders to address operational stress issues for unit members and their families and the need for integrated mental health support across the deployment cycle. In general, most leaders regarded stress-related mental health problems as normal and were supportive of help-seeking. The information obtained here was used to develop a Human Factors and Medicine -081/RTG Leader's Guide on operational stress.

Posttraumatic stress disorder (PTSD) in the Armed Forces: health economic considerations.

This paper addresses the use of health economics in relation to posttraumatic stress disorder (PTSD) in the Armed Forces, with a view to assessing the feasibility of carrying out future evaluative studies. Although psychological and pharmacological interventions can be used to treat PTSD, no economic evaluations are known to exist. There is an economic burden associated with PTSD, and treatments require the use of scarce resources. Health economics provides tools (including cost-effectiveness, cost-benefit, and cost-utility analyses) to ascertain the relative efficiency of different treatment options. The paper concludes that the quality of life and resource consequences of PTSD require a better understanding of the economics of the disorder and the alternative ways to treat it.