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Author

Josefin Sundin

Other affiliations: University of Cambridge
Bio: Josefin Sundin is an academic researcher from King's College London. The author has contributed to research in topics: Military personnel & Mental health. The author has an hindex of 16, co-authored 25 publications receiving 1523 citations. Previous affiliations of Josefin Sundin include University of Cambridge.

Papers
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Journal ArticleDOI
TL;DR: In this article, the authors examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009, the effect of multiple deployments, and time since return from deployment.

541 citations

Journal ArticleDOI
TL;DR: Prevalence estimates and study characteristics were examined graphically with forest plots, but because of high levels of heterogeneity between studies, overall estimates of PTSD prevalence were not discussed.
Abstract: Background. Post-traumatic stress disorder (PTSD) has been called one of the signature injuries of the Iraq War. In this review prevalence estimates of PTSD are summarized and discrepancies are discussed in relation to methodological differences between studies. Method. We searched for population-based studies with a minimum sample size of 300. Studies based on helpseeking samples were excluded. We identified 60 possible papers, of which 19 fulfilled the inclusion criteria. Prevalence estimates and study characteristics were examined graphically with forest plots, but because of high levels of heterogeneity between studies, overall estimates of PTSD prevalence were not discussed. Results. The prevalence of PTSD in personnel deployed to Iraq varied between 1.4 % and 31 %. Stratifying studies by PTSD measure only slightly reduced the variability in prevalence. Anonymous surveys of line infantry units reported higher levels of PTSD compared to studies that are representative of the entire deployed population. UK studies tend to report lower prevalence of PTSD compared with many US studies ; however, when comparisons are restricted to studies with random samples, prevalences are similar. US studies that have assessed personnel more than once since return from deployment have shown that PTSD prevalence increases over the 12 months following deployment. Conclusions. Differences in methodologies and samples used should be considered when making comparisons of PTSD prevalence between studies. Further studies based on longitudinal samples are needed to understand how the prevalence of PTSD changes over time.

213 citations

Journal ArticleDOI
TL;DR: Differences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD, and Adjusting for self- reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.
Abstract: Background Research of military personnel who deployed to the conflicts in Iraq or Afghanistan has suggested that there are differences in mental health outcomes between UK and US military personnel. Aims To compare the prevalence of post-traumatic stress disorder (PTSD), hazardous alcohol consumption, aggressive behaviour and multiple physical symptoms in US and UK military personnel deployed to Iraq. Method Data were from one US ( n = 1560) and one UK ( n = 313) study of post-deployment military health of army personnel who had deployed to Iraq during 2007-2008. Analyses were stratified by high- and low-combat exposure. Results Significant differences in combat exposure and sociodemographics were observed between US and UK personnel; controlling for these variables accounted for the difference in prevalence of PTSD, but not in the total symptom level scores. Levels of hazardous alcohol consumption (low-combat exposure: odds ratio (OR) = 0.13, 95% CI 0.07-0.21; high-combat exposure: OR = 0.23, 95% CI 0.14-0.39) and aggression (low-combat exposure: OR = 0.36, 95% CI 0.19-0.68) were significantly lower in US compared with UK personnel. There was no difference in multiple physical symptoms. Conclusions Differences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD. Adjusting for self-reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.

123 citations

Journal ArticleDOI
TL;DR: Comparison of prevalence estimates for current PTSD between military subgroups provides insight into how groups may be differentially affected by deployment, and identifies differences among subgroups that provide further support for factors underlying the development of PTSD.
Abstract: A large body of research has been produced in recent years investigating posttraumatic stress disorder (PTSD) among military personnel following deployment to Iraq and Afghanistan, resulting in apparent differences in PTSD prevalence. We compare prevalence estimates for current PTSD between military subgroups, providing insight into how groups may be differentially affected by deployment. Systematic literature searches using the terms PTSD, stress disorder, and acute stress, combined with terms relating to military personnel, identified 49 relevant papers. Studies with a sample size of less than 100 and studies based on data for treatment seeking or injured populations were excluded. Studies were categorized according to theatre of deployment (Iraq or Afghanistan), combat and noncombat deployed samples, sex, enlistment type (regular or reserve and [or] National Guard), and service branch (for example, army, navy, and air force). Meta-analysis was used to assess PTSD prevalence across subgroups. There was large variability in PTSD prevalence between studies, but, regardless of heterogeneity, prevalence rates of PTSD were higher among studies of Iraq-deployed personnel (12.9%; 95% CI 11.3% to 14.4%), compared with personnel deployed to Afghanistan (7.1%; 95% CI 4.6% to 9.6%), combat deployed personnel, and personnel serving in the Canadian, US, or UK army or the navy or marines (12.4%; 95% CI 10.9% to 13.4%), compared with the other services (4.9%; 95% CI 1.4% to 8.4%). Contrary to findings from within-study comparisons, we did not find a difference in PTSD prevalence for regular active-duty and reserve or National Guard personnel. Categorizing studies according to deployment location and branch of service identified differences among subgroups that provide further support for factors underlying the development of PTSD.

107 citations

Journal ArticleDOI
TL;DR: It is suggested that, as deployment length increases, the potential for personnel to suffer adverse health effects also increases, and better preparation for the potentially harmful effects that deployments can have on employees' health and well-being is needed.
Abstract: To determine the current state of knowledge regarding the effects of deployment length and a 'mismatch' between the expected and actual length of deployments on the health and well-being of military personnel in order to draw relevant conclusions for all organisations that deploy personnel to conflict zones. A systematic review was conducted of studies measuring deployment length to theatres of operations and the issue of 'mismatch' between expected and actual tour lengths. The nine studies included were rated for quality. Of the nine studies reviewed, six were rated as high quality, two as moderate quality and one as low quality. Seven of these studies found adverse effects of longer deployments on health and well-being. The two studies that measured 'mismatch' found adverse effects on mental health and well-being when deployments lasted longer than personnel expected. There are a limited number of studies which have assessed the effects of deployment length and very few that have assessed the effects of 'mismatch' on health and well-being. However, this review suggests that, as deployment length increases, the potential for personnel to suffer adverse health effects also increases. Further research is required to investigate the effects of spending prolonged periods of time away from family and friends, especially when deployment lasts longer than expected by personnel. These results are important not only for the Armed Forces, but also for other organisations that place employees in similar working conditions. Taking account of these findings may allow better preparation for the potentially harmful effects that deployments can have on employees' health and well-being.

90 citations


Cited by
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Journal ArticleDOI
TL;DR: In this article, the authors examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009, the effect of multiple deployments, and time since return from deployment.

541 citations

Journal ArticleDOI
TL;DR: This meta-analysis examined 33 studies published between 2007 and 2013 involving OEF/OIF veterans, and PTSD prevalence was estimated at 23%.

518 citations

Journal ArticleDOI
20 Mar 2015-PLOS ONE
TL;DR: Evidence of risk factors for combat-related PTSD in military personnel and veterans is provided and more research is needed to determine how these variables interact and how to best protect against susceptibility to PTSD.
Abstract: Post-traumatic stress disorder (PTSD), a complex and chronic disorder caused by exposure to a traumatic event, is a common psychological result of current military operations. It causes substantial distress and interferes with personal and social functioning. Consequently, identifying the risk factors that make military personnel and veterans more likely to experience PTSD is of academic, clinical, and social importance. Four electronic databases (PubMed, Embase, Web of Science, and PsycINFO) were used to search for observational studies (cross-sectional, retrospective, and cohort studies) about PTSD after deployment to combat areas. The literature search, study selection, and data extraction were conducted by two of the authors independently. Thirty-two articles were included in this study. Summary estimates were obtained using random-effects models. Subgroup analyses, sensitivity analyses, and publication bias tests were performed. The prevalence of combat-related PTSD ranged from 1.09% to 34.84%. A total of 18 significant predictors of PTSD among military personnel and veterans were found. Risk factors stemming from before the trauma include female gender, ethnic minority status, low education, non-officer ranks, army service, combat specialization, high numbers of deployments, longer cumulative length of deployments, more adverse life events, prior trauma exposure, and prior psychological problems. Various aspects of the trauma period also constituted risk factors. These include increased combat exposure, discharging a weapon, witnessing someone being wounded or killed, severe trauma, and deployment-related stressors. Lastly, lack of post-deployment support during the post-trauma period also increased the risk of PTSD. The current analysis provides evidence of risk factors for combat-related PTSD in military personnel and veterans. More research is needed to determine how these variables interact and how to best protect against susceptibility to PTSD.

351 citations

BookDOI
01 Jan 2010
Abstract: As of December 2012, Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq have resulted in the deployment of about 22 million troops; there have been 2,222 US fatalities in OEF and Operation New Dawn (OND)1 and 4,422 in OIF The numbers of wounded US troops exceed 16,000 in Afghanistan and 32,000 in Iraq In addition to deaths and morbidity, the operations have unforeseen consequences that are yet to be fully understoodIn contrast with previous conflicts, the all-volunteer military has experienced numerous deployments of individual service members; has seen increased deployments of women, parents of young children, and reserve and National Guard troops; and in some cases has been subject to longer deployments and shorter times at home between deployments Numerous reports in the popular press have made the public aware of issues that have pointed to the difficulty of military personnel in readjusting after returning from Iraq and Afghanistan Many of those who have served in OEF and OIF readjust with few difficulties, but others have problems in readjusting to home, reconnecting with family members, finding employment, and returning to schoolIn response to the return of large numbers of veterans from Iraq and Afghanistan with physical-health and mental-health problems and to the growing readjustment needs of active duty service members, veterans, and their family members, Congress included Section 1661 of the National Defense Authorization Act for fiscal year 2008 That section required the secretary of defense, in consultation with the secretary of veterans affairs, to enter into an agreement with the National Academies for a study of the physical-health, mental-health, and other readjustment needs of members and former members of the armed forces who were deployed in OIF or OEF, their families, and their communities as a result of such deploymentThe study consisted of two phases The Phase 1 task was to conduct a preliminary assessment The Phase 2 task was to provide a comprehensive assessment of the physical, psychologic, social, and economic effects of deployment on and identification of gaps in care for members and former members, their families, and their communities The Phase 1 report was completed in March 2010 and delivered to the Department of Defense (DOD), the Department of Veterans Affairs (VA), and the relevant committees of the House of Representatives and the Senate The secretaries of DOD and VA responded to the Phase 1 report in September 2010 Returning Home from Iraq and Afghanistan: Assessment of Readjustment Needs of Veterans, Service Members, and Their Families fulfills the requirement for Phase 2

348 citations

Journal ArticleDOI
TL;DR: The final models exhibited similar types of trajectories for single and multiple deployers; most notably, the stable trajectory of low post-traumatic stress preto post-deployment, or resilience, was exceptionally high.
Abstract: Background Most previous attempts to determine the psychological cost of military deployment have been limited by reliance on convenience samples, lack of pre-deployment data or confidentiality and cross-sectional designs. Aims This study addressed these limitations using a population-based, prospective cohort of US military personnel deployed in support of the operations in Iraq and Afghanistan. Method The sample consisted of US military service members in all branches including active duty, reserve and national guard who deployed once ( n = 3393) or multiple times ( n = 4394). Self-reported symptoms of post-traumatic stress were obtained prior to deployment and at two follow-ups spaced 3 years apart. Data were examined for longitudinal trajectories using latent growth mixture modelling. Results Each analysis revealed remarkably similar post-traumatic stress trajectories across time. The most common pattern was low-stable post-traumatic stress or resilience (83.1% single deployers, 84.9% multiple deployers), moderate-improving (8.0%, 8.5%), then worsening-chronic post-traumatic stress (6.7%, 4.5%), high-stable (2.2% single deployers only) and high-improving (2.2% multiple deployers only). Covariates associated with each trajectory were identified. Conclusions The final models exhibited similar types of trajectories for single and multiple deployers; most notably, the stable trajectory of low post-traumatic stress preto post-deployment, or resilience, was exceptionally high. Several factors predicting trajectories were identified, which we hope will assist in future research aimed at decreasing the risk of post-traumatic stress disorder among deployers.

340 citations