Restricting duration of UK military tours decreased mental health issues

The introduction of the United Kingdom’s “Harmony Guidelines,” which restrict the duration of military tours of duty, has reduced periods of deployment and also may have decreased mental health problems, according to recent findings.

Researchers at King’s College London evaluated a sample of 3,982 military personnel in the Army, Royal Navy, Royal Air Force and Royal Marines who had been deployed within the previous 3 years. Study participants completed a questionnaire from November 2007 to September 2009 that addressed health issues, including symptoms of posttraumatic stress disorder, psychological distress, intake of alcoholic beverages, and home/family problems. The researchers assessed these outcomes in relation to the Harmony Guidelines that were issued in 2005 and aim to prevent deployment from extending beyond 13 months over 3-year periods.

The researchers found that deployments exceeding 13 months over 3 years correlated with significantly increased risk for PTSD or subthreshold PTSD, somatic symptoms, problems at home, and relationship issues vs. those deployed for shorter durations. Rates of PTSD and subthreshold PTSD were approximately 12% in those deployed beyond 13 months, compared with 6% among those deployed for 5 months or less. The researchers found, however, that violations of the Harmony Guidelines were not significantly linked to increased rates of psychological distress or drinking problems. Moreover, the number of military deployments did not correlate with increased rates of mental health or home/family problems.

Since the introduction of the Harmony Guidelines, the researchers estimated that this may have prevented 138 cases of PTSD, 453 cases of psychological distress, 309 cases of multiple physical symptoms, and 490 cases of alcohol abuse between November 2004 and September 2009.

“The Harmony Guidelines can prevent mental illness in the UK Armed Forces and, since 2006, their introduction has prevented personnel from being deployed for a longer period than recommended in the guidelines,” the researchers wrote. “Monitoring of cumulative length of deployment might reduce mental illness in the UK military.”

In an accompanying commentary, Robert J. Ursano, MD, of the Uniformed Services University School of Medicine, Bethesda, Md., and colleagues, acknowledged the importance of these findings but emphasized the need for further study.

“To examine the subtleties of length of deployment and number of deployments needs a sample powered to examine the interaction of these two variables,” they wrote. “For example, four deployments of 3 months each are different to a continuous 1 year deployment. A deep understanding of dwell time, in addition to length and number of deployment, can help inform policies to better protect the health of service members.”

Disclosure: See the study for a full list of relevant financial disclosures.

For more information:

Rona RJ. Lancet Psychiatry. 2014;doi:10.1016/S2215-0366(14)00062-5.

Ursano RJ. Lancet Psychiatry. 2014;doi:10/1016/S2215-0366(14)00052-2.