People exposed to stressful events on deployment are more likely to report subsequent mental health problems, in particular symptoms of Post Traumatic Stress Disorder (PTSD) or alcohol misuse [1
]. This finding has been well documented in studies focused on combat exposures during deployments to Vietnam, Iraq and Afghanistan. Less is known about the level of traumatic exposure experienced on peacekeeping deployments and the effects of this type of exposure on subsequent health [5
Many of the recent studies of peacekeeping deployments have focused on operations in Somalia and Bosnia. A 12
% absolute increase in psychiatric morbidity was found in a small study of Australian troops who deployed to Somalia [6
], and higher levels of anxiety, depression and psychological distress were found in a study of New Zealand peacekeepers [7
] deployed predominantly to Cambodia. A study of UK personnel showed a twofold increase in heavy drinking in those who had deployed to Bosnia [8
], but this study and others of deployments to this region have not shown an increase in psychiatric morbidity or PTSD in deployed troops [9
]. However, the differing locations and exposures associated with the operations studied make it difficult to generalise these results to other peacekeeping deployments [5
A number of stressors have been associated with peacekeeping operations, including environmental adaptation and homesickness [11
], pre-deployment anxiety [7
], and witnessing atrocities [6
]. Each of these stressors has the potential to affect the physical and mental health of those deployed. Personnel deployed on peacekeeping missions may also be exposed to warlike stressors and potentially dangerous situations. One of the most common stressors (65
%) reported by UK and US troops deployed to Bosnia and Kosovo was danger of minefields [9
]. Being shot at or coming under small arms fire (35
%) and witnessing human remains (40
] were also commonly reported. Likewise US peacekeepers deployed to Somalia frequently experienced dangerous patrols and having rocks thrown at their unit [14
]. In the face of these exposures peacekeepers have noted uncertainty over their role and frustration in complying with the rules of engagement [6
Previous research has shown increased rates of PTSD among those reporting events such as sustaining wounds or witnessing injuries or death [2
], however, other studies have reported that fear of events on deployment are also strong predictors of PTSD [2
]. Those who have experienced more traumatic exposures may have worse psychological health because repeated exposures may have ‘sensitized’ them to reactions to trauma related cues [19
], however, repeated exposures may have ‘immunized’ others to such a reaction [13
]. Non-traumatic deployment stressors have also been shown to be associated with worse health outcomes [1
Recent years have seen a marked increase in Australia’s operational commitments abroad. Between 1980 and 1989 the Australian Defence Force (ADF) had 16 operational deployments involving a total of approximately 1,000 personnel. In contrast, nearly 17,000 were deployed between 1990 and 1999. Further, large deployments to East Timor (19,705 personnel deployed between June 1999 and May 2005) and Iraq and Afghanistan (26,915 personnel deployed between 2001 and December 2009) have occurred since then. These deployments are a significant commitment for the ADF, which employs approximately 50,000 permanent full-time active duty personnel. The ADF defines non-warlike operations as those where there is risk associated with the assigned tasks, where the application of force is limited to self-defence, and where casualties could occur but are not expected [20
]. The deployment to Bougainville was classified as ‘non-warlike’ whereas the East Timor deployment included both ‘warlike’ and ‘non-warlike’ operations.
Against the backdrop of increasing operational tempo, the Deployment Health Surveillance Program was established to provide a systematic, prospective and ongoing means of assessing and understanding the health effects of operational deployment on ADF personnel. As part of this program, studies of the post deployment health of those deployed to Bougainville and East Timor and comparison groups have been undertaken.
A recent literature review of peacekeeping deployments highlighted the need for a comparison of soldiers undergoing deployment on combat operations and peacekeeping operations to delineate whether the stressors of peacekeeping deployments differ meaningfully from those in combat operations [5
]. In this paper we assess how frequently peacekeepers report traumatic and non-traumatic stressors compared to those on a deployment including warlike and non-warlike operations.
For each deployment group we assess the association between the number of traumatic events experienced on deployment and self reported psychological and physical health outcomes. We also consider objective and subjective traumatic exposures separately to determine which are most strongly related to physical and psychological health outcomes. Finally, we will assess the relationship between non-traumatic deployment stressors and physical and mental health.