Post-traumatic stress disorder in UK and US forces deployed to Iraq

Abstract

Matthew Hotopf and colleagues (May 27, p 1731)1Hotopf M Hull L Fear NT et al.The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study.Lancet. 2006; 367: 1731-1741Summary Full Text Full Text PDF PubMed Scopus (376) Google Scholar present the results of an elegant study of the mental health of UK military personnel who deployed to the 2003 Iraq war. The most notable finding was the strikingly lower rate of post-traumatic stress disorder (PTSD) among UK personnel compared with our report2Hoge CW Castro CA Messer SC McGurk D Cotting DI Koffman RL Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.N Engl J Med. 2004; 351: 13-22Crossref PubMed Scopus (3510) Google Scholar from US military personnel (4% vs 13%, respectively). Although Hotopf and colleagues discuss various possible reasons for this difference, they play down the most important one, which is the frequency and intensity of combat. The degree of combat engagement reported by UK personnel operating mainly in the south of Iraq was far lower than among US personnel operating in the north and central regions. Although it is true that more than half of service members from both the UK and USA reported coming under mortar or artillery attack, this comparison does not reflect the large differences in direct combat experiences reported in these studies. For example, only 17% of UK service members reported discharging their weapon, compared with 77–87% of US service members; 32% of UK service members reported coming under small arms fire, compared with more than 90% of US service members; 15% of UK service members reported body handling experiences, compared with more than 50% of US service members; and 25% of UK service members reported seeing allied persons wounded or killed compared with 65–75% of US service members. Also, it is likely that there were differences in the number of combat events during deployment. In the US study, stratification by the number of firefights resulted in rates of PTSD being very similar for soldiers who deployed to Iraq compared with soldiers who deployed to Afghanistan, where combat intensity (and overall PTSD prevalence) was much more similar to the UK experience.2Hoge CW Castro CA Messer SC McGurk D Cotting DI Koffman RL Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.N Engl J Med. 2004; 351: 13-22Crossref PubMed Scopus (3510) Google Scholar Combat is much more likely to be the most important correlate with PTSD prevalence in these two studies than “cultural and organisational differences” as suggested by Hotopf and colleagues. We declare that we have no conflict of interest. Post-traumatic stress disorder in UK and US forces deployed to Iraq – Author's replyWe agree with Charles Hoge and Carl Castro that the US forces are engaged in serious combat duties in Iraq, and that exposure to combat is a clear risk factor for post-traumatic stress disorder (PTSD). However, if we assume that casualties are the best marker of combat intensity, UK casualty rates would be expected to mirror those of PTSD and be three to five times lower than US rates. Although the absolute number of UK casualties is indeed far lower than for the US forces, we do not have sufficient information on denominators to calculate casualty rates. Full-Text PDF