In response to Dr Jhingan's letter we should first point out that the rates of morbidity obtained pre-deployment were entirely compatible with those from other studies (Rona et al, 2004). Furthermore, it is illogical to argue that rates of pre-deployment stress must have been high in this group because of anticipatory anxiety. Not only is there no evidence for this assertion in this population but the converse probably applies. Troops in this elite formation would have probably been looking forward to the deployment, confident in the strong belief that they were going to win (Hacker Hughes et al, 2006).
The argument that post-deployment stress levels would be low because of relief to be home does not allow for the influence of any adverse events in theatre. In fact, 1 month after return is the earliest time to assess for possible post-traumatic stress using the screening questionnaire (Brewin et al, 2002).
For a brigade such as 16 Air Assault Brigade, there is no such thing as true ‘peacetime’. This brigade has, to the best of our knowledge, been deployed more often than any other in the British Army since its formation and is constantly training for, or recovering from, deployments when not on operations.
With regard to responses not being anonymised, in fact the converse applies. Soldiers may use the questionnaires as a confidential means of signalling to command, via the mental health chain, that there is a problem. In addition, there are also data from the USA to suggest that when asked questions it is only information on banned activities (such as drug use) that is significantly affected by anonymity, rather than simple distress (Adler & Thomas, 2005).
With regard to the figures, they add up perfectly. There was a population of 899 with 733 initial responses (giving a response rate of 82%); 421 completed the follow-up questionnaires and, in total, 254 of the initial 733 (35%) completed both sets.
On this basis, it is totally reasonable to have stated that, for highly trained professional soldiers involved in brief, focused operations with positive outcomes, participation in active war fighting may not be necessarily bad for mental health, at least in the short term.
Declaration of interest
J.G.H.H., F.C., R.E., M.D. and N.G. are or were employed by Defence Medical Services. S.W. is honorary Civilian Adviser in Psychiatry (unpaid) to the British Army Medical Services.