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Psychiatric disorders common in Royal Australian Navy.

HOLLYWOOD, CALIF. -- A large study of military recruits has determined that almost half developed a psychiatric disorder after joining military service. In addition, the study suggests that if the serviceman receives mental health and social support during the first year after the onset of symptoms, he is likely to remain in the military.

The study, of 2,215 men who served in the Royal Australian Navy between August 1990 and September 1991 was intended to isolate the factors predicting separation from (or, conversely, retention in) military service. It was presented by Mark Creamer, Ph.D., at the annual meeting of the International Society for Traumatic Stress Studies.

A total of 46% of the sample developed psychiatric disorders while in military service. Most commonly--in 39% of the recruits--it was a substance use disorder, typically involving alcohol.

"I think that's an astonishing figure," said Dr. Creamer, a professor of psychiatry at the University of Melbourne, "but it says something about the culture of the Navy and the drinking culture, that excessive amounts of alcohol use are quite acceptable."

Other common psychiatric disorders were affective disorders (17%), posttraumatic stress disorder (PTSD, 5%), other anxiety disorders (8%), and somatoform disorders (2%). These figures add up to more than 46% because some servicemen had more than one disorder.

Overall, a 19% greater risk of separation was found from the military among men with a psychiatric disorder, compared with those without psychiatric disorders. Men with PTSD had a 45% greater risk of separation per year after diagnosis, those with other anxiety disorders had a 35% greater risk of separation per year, and those with affective disorders had a 25% greater risk of separation per year. On the other hand, men with substance use disorders showed no significantly greater risk of separation. All results were adjusted by age, rank, and length of service.

"What we're saying is that there's a clear association between the development of mental health problems and separation from the military," Dr. Creamer said at the meeting, also sponsored by Boston University. "That in itself is very important information."

Secondly, these results show that the greatest risk is in the first year after symptom onset. "Symptomatic individuals were almost twice as likely to leave the military in that first year," he said. "But separation more than 1 year after symptom onset is comparable [with] that of people with no diagnosis."

Dr. Creamer said that the U.S., Canadian, and Australian military have good screening and early identification programs for people with psychiatric disorders, but that such programs are lacking in most other countries. But the real problem comes after a psychiatric disorder is identified.

"I think this whole idea of support from peers and units in the early stages is crucial," Dr. Creamer said. "If we are to believe the anecdotal reports [from our patients], they're not getting the kind of support at all. In fact, they're being ostracized quite badly. I think it will require a big cultural change, and it's going to take a long while to do.

"[Servicemen] are very good at looking after their mates when they get physically injured, so we need to be educating people about psychological injury and the fact that you need to support your mates through that as well."


San Francisco Bureau
Incidence of Postrecruitment Psychiatric Disorders

Substance use disorder 39%
Affectice disorders 17%
Non-PTSD anxiety disorder 8%
Somatoform disorder 2%

Note: Data from 2,215 men who served in the Royal Australian Navy.
Source: Dr. Creamer

Note: Table made from bar graph.
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Author:Finn, Robert
Publication:Clinical Psychiatry News
Geographic Code:1U9CA
Date:Jan 1, 2007
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