ED ‘warzone’ more stressful than Iraq

By Aoife Connors

Emergency departments may be more stressful for doctors and worse for their mental health than war zones in Iraq are for soldiers, new research has suggested.

UK army troops deployed to Iraq have described their overall health as ‘good, very good or excellent’ rating the negative effects of the war zone lower than doctors working in emergency department (EDs) or other high-stress occupations including police officers and disaster workers.

The British researchers showed that officers rather than service personnel in the army were more likely to report good health than those working in the lower service ranks.

More than 92 per cent of army personnel rated their mental health positively despite the trauma and extremity of the working conditions, unlike doctors working in emergency departments.

If the army officers felt their unit was ‘very cohesive and had supportive leadership’, they reported good health.

In eight different locations across Iraq, 611 armed forces personnel completed a questionnaire about their experiences in the war zone since deployment.

They gave personal accounts of their health status and the effect of deployment on their mental health. Almost 15 per cent of the troops deployed in Iraq were interviewed.

The research was carried out by Prof Neil Greenberg and colleagues from the Academic Centre for Defence Mental Health.

The researchers travelled to Iraq in January and February 2009, to conduct the research. It was the first time a study focused on the mental health of UK troops working in Iraq and the effect such deployment has on one’s mental state.

The effect of army duty, however, does take its toll with more than 20 per cent of the troops showing signs and symptoms of psychological distress and 3.4 per cent diagnosed with post-traumatic stress disorder (PTSD). These rates, according to the study, are similar to those that have been found among service personnel who are not on deployment. They are also lower than in other high-stress occupations such as police officers, doctors in EDs and disaster workers.

At the end of the questionnaire, 11 per cent said they would be interested in receiving help for a stressful, emotional or family problem. These personnel were mostly in the junior ranks.

The most common problem amongst the troops was psychological, particularly amongst those who were young, female, and of junior rank. PTSD was more common among personnel of junior rank and those who felt in danger of being killed, or who had higher combat exposure.

Any of the army officers that had been sick during their deployment often were the troops with symptoms of psychological distress.

Prof Greenberg said that most research on the mental health of UK armed forces personnel has been conducted either before or after deployment and that little was known about their mental health while they were deployed on operations.

“Our study suggested little overall effect of deployment on mental health. Interestingly, those who told us they remembered having a pre-deployment stress briefing reported significantly better mental health than those who did not. Although there is a policy that requires personnel to be given a pre-deployment brief, our study suggested this policy needs to be more rigorously enforced.”

He added “In addition, although most units have some in-unit medical support, the training for medical staff has only recently begun to be standardised to ensure it covers mental health disorders. Improving training, as well as raising awareness among staff of the link between personnel reporting sick and having poorer mental health, may help identify those in most need of psychological help”.

The findings are published in the November issue of the British Journal of Psychiatry, see http://bjp.rcpsych.org/future/197.5.dtl