1. Long operational tours were associated with serious mental health problems.
2. Frequency of deployments was not associated with mental health problems or issues at home.
Evidence Rating Level: 2 (Good)
Study Rundown: The Harmony Guidelines were implemented in order to regulate the duration and frequency of military deployments of UK Armed Forces. The guidelines prevent UK soldiers from serving more than 13 months within a 3-year period. The investigators set out to assess the impact these guidelines have had on the mental health of UK soldiers. In a previous study completed in 2007, the investigators found that 22% of armed forces had been deployed for longer than the guidelines permitted. In this study, soldiers who were deployed in the last 3 years were included in the study and asked to complete a questionnaire. The study outcomes were the following: development of PTSD, psychological distress, multiple physical symptoms, alcohol misuse, and familial or interpersonal issues. Deployments included in the study were primarily to Afghanistan, Iraq, while fewer subjects were stationed in Pakistan, Bosnia, Kosovo, or the Persian Gulf. The investigators found an association between duration of deployment and scoring greater than 40 on the PTSD checklist, presence of psychological distress, and multiple physical symptoms. A similar association was observed in those who were deployed more than 13 months in 3 years. There was no significant association between deployment of more than 13 months and further psychological distress, alcohol misuse, or with scoring above 50 on the PTSD checklist. There was also no association found between number of deployments and the study outcomes. The statistical power of the study was diminished as only 12% of the subjects were deployed for lengths that violated the Harmony Guidelines. Nonetheless, the findings suggest that the Harmony guidelines play a crucial role in preventing the onset of mental health issues in military personnel.
The study was funded by the UK Ministry of Defence.
Click to read the study in The Lancet Psychiatry
Relevant Reading: What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study
In-Depth [retrospective cohort]: The primary objective of this study was to assess the role of duration and frequency of military deployment on the development PTSD, psychological distress, multiple physical symptoms, interpersonal issues, and problems at home in UK military personnel. The investigators had a 57% response rate, with 8278 out of 14467 soldiers completing the questionnaire. The analysis, however, was limited to the 3982 soldiers who had been deployed in the 3 years prior to completing the questionnaire. Deployment of over 13 months had decreased 10% between March 2005 and May 2008 and in this study, only 12% of the subjects’ deployment schedules violated the Harmony guidelines. There was an association between deployment time and scoring above 40 on the PTSD checklist, the presence of psychological distress, and multiple physical symptoms (p = 0.002; 0.018; 0.030 respectively). Serving beyond the Harmony Guidelines limits was associated with those outcomes as well. Violating the guidelines was not associated with additional psychological distress, alcohol misuse, or with scoring above 50 on the PTSD checklist. Number of deployments was not associated with any of the outcomes (p=0.071 for PTSD-checklist cutoff ≥50, p=0.600 for psychological distress, p=0.134 for alcohol misuse). Increased frequency of deployments showed a negative, but non-significant, association with the development of PTSD.
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