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Lessons for Canada: UK study links tour length, not number of tours, to mental i


Army.ca Legend
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A UK study, looking at the results of their "harmony guidelines," has found that constrained tour lengths and increased time between tours results in fewer mental injuries.  Seems the secret is not more that 13 months in a four year cycle, with at least three years between deployments ... But that is a somewhat simplified recounting of: http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00062-5/fulltext

More summary here:
Shorter overseas troop deployments tied to better mental health in U.K. study
More deployments not necessarily associated with worse mental illness

CBC News
11 nov 2014

Shorter overseas deployments of U.K. armed forces can help prevent mental illness, say researchers who looked at risks of developing post-traumatic stress disorder, harmful drinking and family problems.

Under the U.K.’s "Harmony Guidelines," the maximum recommended time for operational tours is set at 13 months within a three-year time period. In Tuesday’s online issue of The Lancet Psychiatry, researchers from King’s College estimated how limiting deployments could help prevent mental health problems.

"Extrapolating from our results, a decrease from 22 per cent to 12 per cent in personnel deployed for longer than recommended by the Harmony Guidelines might have prevented 138 cases of PTSD, 453 cases of psychological distress, 309 cases of multiple physical symptoms, and 490 cases of alcohol misuse between November 2004 and September 2009," concluded Roberto Rona, a professor of Public Health Medicine, and the co-authors.

As part of the study, researchers assessed a random sample of 3,982 regular military personnel who had been on overseas tours and asked them to fill in a questionnaire about symptoms of PTSD and other problems. The response rate was 57 per cent, which the authors said is rarely achieved in military studies.

Breaches of the guidelines decreased from 22 per cent in 2005 to 12 per cent in 2008.

The length of deployment is an indicator of the degree of exposure to stressful and traumatic events and points to the amount of non-deployed time available for recovery, professors Robert Ursano, David Benedek and Gary Wynn from the Uniformed Services University School of Medicine in Bethesda, Md., said in a journal commentary published with the study.

"Importantly, number of deployments was not associated with worse mental illness status or problems at home," the commentators said.

But individuals deployed several times are not the same population as those deployed only once, they said, pointing to experience, greater training or involvement in special operations and older age and greater likelihood of being married with children.

Dwell time, or the time between deployments for recovery, is an important variable to consider, they said, pointing to a U.S. army finding that suggests units need as much as three years of dwell time to return to baseline rates of mental health.

They added that individuals who respond to public health emergencies, including humanitarian aid and disaster relief, such as after a tsunami or to stop the spread of Ebola, also face stress from deployments.

In the study, deployments were mainly to Afghanistan, Iraq or both, and for a small proportion of the sample, Pakistan, Bosnia, Kosovo or the Persian Gulf.

Last year, a study published in the Canadian Medical Association Journal on Canadian Forces deployment in support of the mission in Afghanistan from 2001 to 2008 concluded that "an important minority," 14 per cent, of personnel had a mental disorder such as PTSD attributed to the deployment.

The U.K. Ministry of Defence funded the study.

And more clearly discussed here:
The Lancet Psychiatry: Guidelines limiting duration of overseas deployment prevent mental health problems in UK troops
10 Nov 2014

Prolonged periods of deployment among the UK's armed forces have fallen since the introduction of the "Harmony Guidelines" to limit tours of overseas duty--which might have led to a reduction in mental health problems, new research published in The Lancet Psychiatry journal suggests.

Researchers from King's College London estimate that this drop in the number of troops experiencing prolonged tours of duty might have prevented 138 cases of post-traumatic stress disorder (PTSD), 453 cases of psychological distress, 309 cases of multiple physical symptoms, and 490 cases of alcohol misuse between November 2004 and September 2009.

In 2007, research by the King's College London Centre for Military Health Research showed that long operational tours--more than 13 months within a 3-year time period (the maximum recommended time limit set by the UK Government and known as the Harmony Guidelines)--were linked to serious mental health problems, alcohol problems, and family difficulties.

In this study, Roberto Rona, Professor of Public Health Medicine at King's College London and colleagues re-examined whether length of deployment above these guidelines and frequency of deployment over 3 years had an effect on mental health. They assessed a random sample of 3982 regular military personnel (Army, Royal Navy, Royal Air Force, and Royal Marines) who had been on overseas tours during the 3 years prior to completing a questionnaire between November 2007 and September 2009, asking about their health including symptoms of post-traumatic stress disorder (PTSD), psychological distress, alcohol consumption, and problems at home.

The researchers found that breaching the Harmony Guidelines by deploying for 13 months or more over a 3-year period almost halved from 22% in March 2005 to 12% in May 2008*.

Being deployed for more than 13 months over 3 years was associated with a significantly increased risk of developing PTSD or subthreshold PTSD, multiple physical symptoms, problems at home, and relationships and family problems compared to those deployed for shorter time periods, but not with psychological distress or harmful drinking. For example, rates of PTSD including subthreshold PTSD were around 12% in those deployed above the 13 month limit, compared with 6% among those who spent less than 5 months in conflict (see table 2 page 4).

Importantly, the number of deployments was not associated with worse mental health or problems at home.

According to Professor Rona, "The Harmony Guidelines can prevent mental illness in the UK Armed Forces and, since 2006, their introduction has prevented deployment of more personnel for longer than recommended in the guidelines. Monitoring of cumulative length of deployment could prevent an increase in levels of stress and mental illness in the UK military."

Writing in a linked Comment, Professors Robert Ursano, David Benedek, and Gary Wynn from the Uniformed Services University School of Medicine, Bethesda, Maryland, USA, say, "Further work is needed, now and certainly for any future conflicts. To examine the subtleties of length of deployment and number of deployments needs a sample powered to examine the interaction of these two variables. For example, four deployments of 3 months each are different to a continuous 1 year deployment... A deep understanding of dwell time [time between deployments for recovery], in addition to length and number of deployment, can help inform policies to better protect the health of service members."


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There's probably something to that..... Roulement tours in Northern Ireland were 4 1/2 months, with a 5 day R&R (to mainland UK only, two days travel!).

We were on ops in the hardest areas 24/7, and 'got blowed up real good' occasionally, but I can't recall anyone who was anything more than the usual amount of crazy as a result.

Humphrey Bogart

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Common sense would dictate that rotating your soldiers in and out of a theatre of operations would probably be better for their mental health then leaving them there for 15 months at time like our American brethren to the South seem to favour doing.

I don't even see this as purely a PTSD problem, it would most likely also help the following:

1.  Help with family problems.

2.  Keep soldiers interested in the operation.

3.  Preserve the overall force for follow-on operations. 



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We did 13 month tours. I think they were a tad long....should be in the 9-10 month range.

It takes about 4-6 weeks climatization and orientation initially, but the last 4-6 weeks were generally less productive unless you were coming right back on a 6 month extension. I don't know how that would translate in a shorter tour....

The intervening time was more productive in the sense that you had a complete SA and knew you duties/area, etc......