Mental health of most UK troops serving in Afghanistan, Iraq is 'resilient'

February 26, 2014

Science Daily/BMJ-British Medical Journal

Despite prolonged combat missions to Iraq and Afghanistan, there has been no overall increase in mental health problems among United Kingdom soldiers, finds a review of the available evidence.

But certain groups of soldiers do seem to be more vulnerable to mental ill health on their return home, while alcohol problems continue to give cause for concern among regulars. The researchers focused on Iraq and Afghanistan because of the lengthy and challenging nature of the conflict experienced by British soldiers in these two countries, including protracted counter insurgency and repeated exposure to improvised explosive devices (IEDs), snipers, and suicide bombers.

Their analysis, which draws on 34 studies, shows that, overall, most UK regulars returning from deployment have remained psychologically resilient, despite the adversities they faced.

Rates of post-traumatic stress disorder, or PTSD, among most UK regulars returning from deployment range between 1.3% and 4.8%, the evidence suggests; the prevalence of PTSD among the UK general population is 3%, say the authors.

Depression and anxiety are the most frequently reported common mental health disorders among soldiers who have served in Iraq and Afghanistan. But overall rates are no higher than among soldiers who have not been deployed to these regions -- or indeed the general population, the research indicates.

Harmful drinking, however, continues to give cause for concern, affecting up to one in five regular soldiers, while aggressive and violent behaviour is also more likely among those returning from deployment, particularly soldiers in combat roles who are experiencing mental health issues.

But despite the unique stressors soldiers face, rates of suicide and self-harm are lower than they are among the general population, except for army recruits under the age of 20.

And the evidence suggests that levels of social support during childhood and after leaving the Army have a greater impact on suicide rates than deployment.

Overall, UK troops fare better than their US peers in terms of their mental health, possibly because UK Army recruits tend to be older, have shorter tours of duty, and have better access to healthcare, say the authors. But UK troops are more likely to report harmful levels of drinking than their US peers.

There is also some evidence to suggest that good training, leadership and unit cohesion may help to stave off mental health problems, in addition to which the Army has invested heavily in initiatives to mitigate the effects of trauma and ease soldiers' return home.

These include 'third location decompression'(TLD) -- 36 hours of social, supportive, and educational intervention after prolonged operational deployment before returning home -- and the Trauma Risk Management Programme (TRiM) -- peer support designed to pick up vulnerability to mental health problems in the wake of a traumatic incident.

"The evidence presented [here] shows that, in the main, UK military personnel have remained resilient in spite of having suffered significant numbers of fatalities and casualties in Iraq and Afghanistan," write the authors.

They acknowledge that there will be "a small but important group of veterans" who will need specialist mental healthcare services in the years ahead, and that it is too early to tell what the longer term psychological impacts of service in Iraq and Afghanistan might be.

But they conclude: "There appears to be some evidence that the considerable efforts the UK Armed Forces have made to ensure that deployed personnel are well trained, well led, cohesive, have access to high quality mental health services and a number of evidence based mitigation measures, such as TLD and TRiM, are important."

http://www.sciencedaily.com/releases/2014/02/140226211235.htm

Combat Veterans Suffering from PTSD, 'Fear Circuitry' in the Brain Never Rests

May 18, 2013 —

Science Daily/NYU Langone Medical Center

Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or under-react in response to stressful tasks, such as recalling a traumatic event or reacting to a photo of a threatening face. Now, researchers at NYU School of Medicine have explored for the first time what happens in the brains of combat veterans with PTSD in the absence of external triggers.

Their results, published in Neuroscience Letters, and presented today at the annual meeting of the American Psychiatry Association in San Francisco, show that the effects of trauma persist in certain brain regions even when combat veterans are not engaged in cognitive or emotional tasks, and face no immediate external threats. The findings shed light on which areas of the brain provoke traumatic symptoms and represent a critical step toward better diagnostics and treatments for PTSD.

A chronic condition that develops after trauma, PTSD can plague victims with disturbing memories, flashbacks, nightmares and emotional instability. Among the 1.7 million men and women who have served in the wars in Iraq and Afghanistan, an estimated 20% have PTSD. Research shows that suicide risk is higher in veterans with PTSD. Tragically, more soldiers committed suicide in 2012 than the number of soldiers who were killed in combat in Afghanistan that year.

"It is critical to have an objective test to confirm PTSD diagnosis as self reports can be unreliable," says co-author Charles Marmar, MD, the Lucius N. Littauer Professor of Psychiatry and chair of NYU Langone's Department of Psychiatry. Dr. Marmar, a nationally recognized expert on trauma and stress among veterans, heads The Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center.

The study, led by Xiaodan Yan, a research fellow at NYU School of Medicine, examined "spontaneous" or "resting" brain activity in 104 veterans of combat from the Iraq and Afghanistan wars using functional MRI, which measures blood-oxygen levels in the brain. The researchers found that spontaneous brain activity in the amygdala, a key structure in the brain's "fear circuitry" that processes fearful and anxious emotions, was significantly higher in the 52 combat veterans with PTSD than in the 52 combat veterans without PTSD. The PTSD group also showed elevated brain activity in the anterior insula, a brain region that regulates sensitivity to pain and negative emotions.

Moreover, the PTSD group had lower activity in the precuneus, a structure tucked between the brain's two hemispheres that helps integrate information from the past and future, especially when the mind is wandering or disengaged from active thought. Decreased activity in the precuneus correlates with more severe "re-experiencing" symptoms -- that is, when victims re-experience trauma over and over again through flashbacks, nightmares and frightening thoughts.

http://www.sciencedaily.com/releases/2013/05/130518153257.htm