War causes mental illness in soldiers
One in every two cases of post-traumatic stress disorder (PTSD) in soldiers remains undiagnosed. This is the conclusion reached by a working group led by Hans-Ulrich Wittchen et al. They report their study in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2012; 109(35): 559), which is a special issue focusing on the prevalence of psychological stress in German army soldiers. In a second original article, results reported by Jens T Kowalski and colleagues show that more female soldiers contact the psychosocial support services provided by Germany’s armed forces than their male colleagues (Dtsch Arztbl Int 2012; 109 (35): 559).
Wittchen et al. draw attention to the fact that thus far no information has been available on how commonly soldiers have traumatic experiences during deployments to Afghanistan and develop PSTD. In their study, 85% of all soldiers deployed overseas reported at least one distressing event, but usually several such events. Overseas deployment is associated with twice or four times the risk of PTSD for soldiers. In international comparison, the prevalence of PTSD is notably lower in German soldiers, at 2.9%, than in soldiers from other countries who are deployed in the same regions. However, the estimated proportion of undiagnosed and untreated cases of PTSD is 45%.
Kowalski et al. explain that it is not only Afghanistan from where soldiers return in a traumatized state but also Kosovo.
The number of Kosovo returnees with mental problems in their study increased significantly compared to the number of traumatized soldiers returning from Afghanistan. The study is based on hospital data of all German army psychiatric wards; these data evaluated the psychiatric morbidities between January 2010 through June 2011. The most common diagnoses were adjustment disorders, PSTD, and mild and moderate depressive episodes.
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E. Bartholomäus
49-223-470-11133
Deutsches Aerzteblatt International
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Traumatic Experiences and Posttraumatic
Stress Disorder in Soldiers Following
Deployment Abroad
SUMMARY
Background: Little is known about the frequency of traumatic event exposure
and the development of post-traumatic stress disorder (PTSD) among German
soldiers serving in Afghanistan.
Methods: We studied a random sample consisting of 1599 soldiers who had
served in the 2009/2010 ISAF mission in Afghanistan, stratified by deployment
location and unit. Twelve months after their return to Germany, the soldiers
were assessed with a Composite International Diagnostic Interview (CIDI) to
establish the diagnoses of mental disorders and PTSD according to the DSM-IV.
889 similar soldiers who had not been deployed abroad were assessed in the
same way.
Results: 49.2% (95% confidence interval [CI]: 46.4 to 52.1) of the deployed
soldiers experienced at least one traumatic event during their deployment, and
13% experienced more than three. The 12-month prevalence of PTSD among
returning soldiers was 2.9% (95% CI: 2.1 to 4.1), while the service-related inci-
dence after deployment was 0.9% (95% CI: 0.5 to 1.6). These figures imply a
two- to fourfold elevation of the risk of PTSD. The risk of PTSD was highest
among soldiers who had served in Kunduz (Afghanistan) and in combat units.
Only half of all soldiers with PTSD sought professional help.
Conclusion: Deployment abroad is associated with a high frequency of trau-
matic experiences and a two- to fourfold elevation of the risk of PTSD. Each
year, about 300 cases of PTSD develop for every 10 000 soldiers who return to
Germany; thus, the cumulative number of returnees with PTSD from the begin-
ning of German deployment abroad may currently run into the thousands. 45%
of all PTSD cases, or about one in two, are neither diagnosed nor treated. De-
ployment abroad also substantially increases the risk of developing a number
of other mental disorders.
Cite this as:
Wittchen HU, Schönfeld S, Kirschbaum C, et al.: Traumatic experiences and
posttraumatic stress disorder in soldiers following deployment abroad: how
big is the hidden problem? Dtsch Arztebl Int 2012; 109(3536): 55968.
DOI: 10.3238/arztebl.2012.0559