Combat Related PTSD among Sri Lankan Combatants and Psychological Management

Objective: To study the impact of combat related stress and psychological management of combatants
Design: Assessment of Military Hospital Psychiatric Unit attendees using a structured questionnaire.
Materials & Methods: Soldiers coming for treatment at the Psychiatric Unit Military Hospital Colombo in August 2002 to March 2005 were chosen to be studied. The study groups included 824 soldiers and obtained informed consent and the methods used ensured participants' anonymity. The study was conducted under the direct supervision of the Consultant Psychiatrist of the Sri Lanka Army. These Soldiers were administered the PTSD Check List based on DSM 4 with a structured interview. This schedule designed from similar trauma questionnaires used elsewhere in the world to detect PTSD. (one or more re-experiencing symptoms; three or more avoidance/numbing symptoms; two or more hyper-arousal symptoms) and that they coexist for at least 1 month after the trauma and are associated with significant distress or functional impairment)The presence or absence of PTSD was evaluated with the use of the PTSD Checklist. Results were scored as positive if subjects reported at least one intrusion symptom, three avoidance symptoms, and two hyperarousal symptoms that were categorized as at the moderate level, according to the PTSD checklist. In addition to these measures, on the survey participants were asked whether they were currently experiencing stress, emotional problems, problems related to the use of alcohol, or family problems.
Results Exposure to combat was significantly greater among those who were deployed in the North and East of Sri Lanka. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after serving in the above mentioned areas. PTSD was identified in 62 combatants (56 with full blown symptoms and 6 with partial PTSD)
Conclusions: This study provides an initial look at the mental health of members of the Army who were involved in combat operations. There was a strong reported relation between combat experiences, such as being shot at, handling dead bodies, knowing someone who was killed, or killing the enemy, and the prevalence of PTSD. Findings indicate that among the study groups there was a significant risk of mental health problems especially regarding combat related PTSD. Longitudinal study of the effect of combat on the mental health of the soldiers reveals that the systematic treatment and close monitoring is needed following the possibility of late reactions urge screening and treating the combat stress during war time and in times of peace as well.

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