BRITISH JOURNAL OF PSYCHIATRY (2005), 186, 536^537 SHORT REPORT

Going to war does not have to hurt: the GHQ–28 was 1.94. Results showed that 2% ((that2% nn¼9) exceeded cut-off criteria preliminary findings from the British on the TSQ (contrasting with 12% reported by HogebyHoge et aletal), with a further two soldiers scoring over 20 on the GHQ–28. All were deployment to contacted individually and offered support. Overall, 35% of the original sample JAMIE HACKER HUGHES, FIONA CAMERON, ROD ELDRIDGE, ((nn¼254) completed both sets of question- MADELEINE DEVON, SIMON WESSELYWESSELYand and NEIL GREENBERG naires. The high turnover of personnel observed between the two occasions was a combined result of postings to new units, redeployment, leave and attendance at Summary We carried out a brief 2004). The brigade commander supported training courses. Also, participation at both longitudinal mental health screen of 254 the project; individuals participated volun- stages was voluntary. In addition, whereas tarily and gave signed consent. The proto- the first set of questionnaires was adminis- members ofthe UK’s Brigade col was approved by the Defence Medical tered during routine pre-deployment before and afterdeploymenttoafter deploymentto Iraqlast Services Clinical Research Committee. training, the follow-up questionnaires were year. Analysis of General Health Questionnaires were circulated at the administered internally on a sub-unit basis, Questionnaire (GHQ^28)(GHQ ^28) scores before end of pre-deployment mental health brief- which may have contributed to the reduced and after deployment revealed a lower ings (standard in UK units’ preparations for follow-up sample size. It is not, however, operational deployments). Soldiers were in- believed that the reasons for the reduced score after deployment (mean formed that military mental health practi- sample size would have affected validity. difference¼0.93, 95% CI 0.35^1.52).This tioners would contact them confidentially Analysis of the GHQ–28 scores before indicated a highly significant relative if results revealed cause for concern. Parti- and after deployment revealed a highly improvement in mental health (PP550.005). cipants were told that commanders would significant (tt¼3.15,3.15, PP550.005) relative be informed only about pooled results. improvement in mental health. This was Moreover, only 9 of a larger sample of 421 The ages of responders ranged from 17 indicated by lower GHQ–28 scores which (2%) exceeded cut-off criteria onthe to 48 years and 71 of the entire sample showed a mean difference of 0.93 (95% Trauma Screening Questionnaire.These (8%) were female. The sample was sur- CI 0.35–1.52). These findings raise the findings suggestthat waris not necessarily veyed before deploymentdeployment using the General question of whether military deployment bad for psychologicalhealth. Health Questionnaire(GHQ–28) (Goldberg is necessarily bad for psychological health. & Hillier, 1979). All those with scores Declaration of interest J.H.H., F.C., exceeding 20 (nn¼16) were contacted and R.E., M.D. and N.G. are employed by offered support. DISCUSSION After war-fighting operations were Defence Medical Services; S.W.is complete, personnel returned to the UK The principal finding of this preliminary Honorary Civilian AdviserinAdviser in Psychiatry having been in theatre for approximately study was a lack of deterioration in the (unpaid) to the Medical 4 months.4months. mental health of British soldiers deployed Services.Services. to Iraq. This is in contrast to the recent well-publicised findings of Hoge et aletal RESULTSRESULTS (2004). Why do our results differ? The In a recent paper, Hoge et aletal (2004)(2004) units studied by Hoge et aletal and ourselves reported that US personnel who were Questionnaires, which included the GHQ– were all front-line units with reputations deployed to Iraq reported poorer mental 28 and the Trauma Screening Question- for military competence. Our measures health after the campaign than before naire (TSQ; Brewin et aletal, 2002), were then were administered 1 month after return (Spurgeon, 2004). Their results were taken sent to participants. One month after whereas those used by Hoge et aletal werewere from cross-sectional surveys before and return, 421 of the original sample of 899 administered 3–4 months after return from after deployment. We performed a brief completed the questionnaires. The sample theatre. However, post-deployment asso- longitudinal mental health screen of mem- size was lower than before deployment (as ciated psychological distress is likely to bers of the UK’s Air Assault Brigade before with Hoge et aletal, 2004) because many reduce over time (Greenberg et aletal, 2003),,2003), and after deployment to Iraq last year. In personnel had been redeployed or were on rather than the converse. It is recognised, this paper we report our preliminary leave. (It is highly unlikely that this loss to however, that we did not at that time have findings.findings. follow-up was attributable to illness as very any baseline prevalence measures using the few diagnoses of post-traumatic stress dis- GHQ with against order were eventually made across all three which these results might be compared. METHOD branches of the British Armed Forces Also, whereas we used different measures following the Iraq deployment.) to HogetoHoge et aletal, we think it implausible that Of a possible 899 soldiers, 733 participated Non-responders did not differ from re- this would account for the considerable dif- in this survey (82% of the available popu- sponders on pre-deployment measures ferences. A final factor might be the differ- lation, compared with 58% for Hoge et aletal,, ((tt¼771.01,1.01, PP¼0.31). The mean score on ent areas of the country in which British

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and US troops were deployed and the JAMIE HACKER HUGHES, PsychD, FIONA CAMERON, RMN, ROD ELDRIDGE, RMN, MADELEINE DEVON, differences in fighting in which they were MSc, Defence Medical Services, Department of Community Mental Health,Colchester, SIMON WESSELY, involved, reflected in the higher number FRCPsych, NEILNEILGREENBERG, GREENBERG, MRCPsych,MRCPsych,King’s King’s Centre for Military Health Research, London,London,UK UK of US casualties, both physical and psychological. Correspondence: Dr Jamie Hacker Hughes, Senior Lecturer,Academic Centre for Defence Mental Our results show that it is premature to Health,King’s Centre for Military Health Research,Institute of Psychiatry,King’s College London,Weston conclude that the has already had Education Centre,Cutcombe Road,London,Road, London, SE5 9RJ,UK.9RJ,UK.E-mail: E-mail: j.hacker-hughesj.hacker-hughes@@iop.kcl.ac.uk a serious adverse effect on the mental (First received 14 September 2004, final revision 25 February 2005, accepted 3 March 2005) health of the armed forces, or that we are inevitably facing a repeat of the Vietnam story (Wessely & Jones, 2004). This study also reminds us that where there are highly MRCPsych, Consultant Psychiatrist, Department of peacekeepers on return from deployment. Journal ofofJournal selected forces with high morale involved in Community Mental Health, 16 Air Assault Brigade Mental Health,, 66, 565^573. focused operations with positive outcomes, and . whatever the immediate political context, Hoge, C.W., Castro, C. A., Messer, S. C., et aletal (2004)(2004) Combat duty in Iraq and , mental health participation in war fighting may some- REFERENCES problems and barriers to care. New England Journal of times not necessarily be as deleterious to MedicineMedicine,, 351351,13^22. psychological well-being as has previously Brewin,C.Brewin, C. R., Rose, S., Andrews, B., et aletal (2002) Brief screening instrument for post-traumatic stress been thought. disorder.disorder. British Journal of Psychiatry,, 181181,158^162.,158^162. Spurgeon, D. (2004) Fear of stigma deters US soldiers from seeking help for mental health. British Medical Goldberg, D. & Hillier,V. (1979) A scaled version of the JournalJournal,, 329329,12. ACKNOWLEDGEMENTS General Health Questionnaire. Psychological Medicine,, 99,, 139 ^ 14 5. Wassely, S. & Jones, E. (2004) Psychiatry and the We thank Stewart Neale, RMN, Community Greenberg, N., Maingay, B., Iversen, A., et aletal (2003) ‘lessons of Vietnam’: what were they and are they still PsychiatricNurse,andMichaelSrinivasan, Perceived psychological support of UKUKmilitary military relevant? War and Society,, 22, 89^103.,89^103.

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