To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Veterans with post-traumatic stress disorder (PTSD) typically report a poorer treatment response than those who have not served in the Armed Forces. A possible explanation is that veterans often present with complex symptoms of PTSD. ICD-11 PTSD and complex PTSD (CPTSD) have not previously been explored in a military sample.
This study aimed to validate the only measure of ICD-11 PTSD and CPTSD, the International Trauma Questionnaire, and assess the rates of the disorder in a sample of treatment-seeking UK veterans.
A sample of help-seeking veterans (N = 177) was recruited from a national charity in the UK that provides clinical services to veterans. Participants completed measures of ICD-11 PTSD and CPTSD as well as childhood and adult traumatic life events. Confirmatory factor analysis was used to assess the latent structure of PTSD and CPTSD symptoms, and rates of the disorders were estimated.
The majority of the participants (70.7%) reported symptoms consistent with a diagnosis of either PTSD or CPTSD. Results indicated the presence of two separate disorders, with CPTSD being more frequently endorsed (56.7%) than PTSD (14.0%). CPTSD was more strongly associated with childhood trauma than PTSD.
The International Trauma Questionnaire can adequately distinguish between PTSD and CPTSD within clinical samples of veterans. There is a need to explore the effectiveness of existing and new treatments for CPTSD in military personnel.
Little is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.
We examined the prevalence of mental disorders and alcohol misuse, whether this differed between serving and ex-serving regular personnel and by deployment status.
This is the third phase of a military cohort study (2014–2016; n = 8093). The sample was based on participants from previous phases (2004–2006 and 2007–2009) and a new randomly selected sample of those who had joined the UK armed forces since 2009.
The prevalence was 6.2% for probable post-traumatic stress disorder, 21.9% for common mental disorders and 10.0% for alcohol misuse. Deployment to Iraq or Afghanistan and a combat role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel.
The findings highlight an increasing prevalence of post-traumatic stress disorder and a lowering prevalence of alcohol misuse compared with our previous findings and stresses the importance of continued surveillance during service and beyond.
Declaration of interest:
All authors are based at King's College London which, for the purpose of this study and other military-related studies, receives funding from the UK Ministry of Defence (MoD). S.A.M.S., M.J., L.H., D.P., S.M. and R.J.R. salaries were totally or partially paid by the UK MoD. The UK MoD provides support to the Academic Department of Military Mental Health, and the salaries of N.J., N.G. and N.T.F. are covered totally or partly by this contribution. D.Mu. is employed by Combat Stress, a national UK charity that provides clinical mental health services to veterans. D.MacM. is the lead consultant for an NHS Veteran Mental Health Service. N.G. is the Royal College of Psychiatrists’ Lead for Military and Veterans’ Health, a trustee of Walking with the Wounded, and an independent director at the Forces in Mind Trust; however, he was not directed by these organisations in any way in relation to his contribution to this paper. N.J. is a full-time member of the armed forces seconded to King's College London. N.T.F. reports grants from the US Department of Defense and the UK MoD, is a trustee (unpaid) of The Warrior Programme and an independent advisor to the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee (unpaid) of Combat Stress and Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid). S.W. is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, the Department of Health, Public Health England or the UK MoD.
Shamans deal with events that involve the threat of death. They help buffer death anxiety because, through their claimed supernatural abilities, they can provide both hope for averting death and evidence for existence of a spirit world offering continuance beyond death. Thus, managing the threat of mortality probably played a major role in the development and maintenance of shamanism.
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.
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.
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.
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.
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.
Most accounts of deployment mental health in UK armed forces personnel
rely on retrospective assessments.
We present data relating to the burden of mental ill health and the
effect of support measures including operational, family, welfare and
medical support obtained on two occasions some 18 months apart.
A total of 2794 personnel completed a survey while deployed to
Afghanistan; 1363 in 2011 and 1431 in 2010. Their responses were compared
The prevalence of self-report mental health disorder was low and not
significantly different between the surveys; the rates of probable
post-traumatic stress disorder (PTSD) were 2.8% in 2010 and 1.8% in 2011;
for common mental health disorders the rates were 17.0% and 16.0%
respectively. Remembering receiving predeployment psychoeducation,
perceptions of good leadership and good family support were all
significantly associated with better mental health. Seeking support from
non-medical sources and reporting sick for medical reasons were both
significantly associated with poorer mental health.
Over a period of 18 months, deployment mental health symptoms in UK armed
forces personnel were fewer than those obtained from a military
population sample despite continuing deployment in a high-threat context
and were associated with perceptions of support.
The 2011 earthquake and tsunami in Japan caused a meltdown at the
Fukushima nuclear power plant.
To quantify emotional responses among British nationals in Japan and to
assess whether perceptions about the incident or accessing information
about it were associated with responses.
A total of 284 participants randomly selected from official records
completed a survey that included instruments to measure emotional
In total, 16% met the criteria for distress, 29.7% reported high anxiety
relating to the incident and 30.4% reported high anger. Perceptions that
strongly predicted these outcomes included feeling uncertain, being
unable to rule out harmful exposure, and believing that exposure would
have severe or hidden health effects or be difficult to detect. Using
information sources was associated with higher emotional outcome,
particularly for sources perceived to have low credibility.
Reducing uncertainty and improving the credibility of information is
essential in reducing the psychological impact of radiological
Most studies of the mental health of UK armed forces focus on
retrospective accounts of deployment and few sample personnel while they
This study reports the results of a survey of deployed personnel,
examining the perceived impact of events at home and military support for
the family on current mental health during the deployment.
Surveys were conducted with 2042 British forces personnel serving in Iraq
and Afghanistan. Prevalence of common mental disorders was assessed with
the 12-item General Health Questionnaire (GHQ-12) and post-traumatic
stress disorder (PTSD) was assessed with the PTSD Checklist – Civilian
The prevalence of common mental disorders was 17.8% and of probable PTSD
was 2.8%. Perceived home difficulties significantly influenced the mental
health of deployed personnel; the greater the perception of negative
events in the home environment, the greater the reporting of adverse
mental health effects. This finding was independent of combat exposure
and was only partially mitigated by being well led and reporting
subjectively good unit cohesion; however, the effect of the totality of
home-front events was not improved by the latter. Poor perceived military
support for the family had a detrimental impact on deployment mental
The armed forces offer many support services to the partners and families
of deployed personnel and ensuring that the efforts being made on their
behalf are well communicated might improve the mental health of deployed
This chapter concerns the procedure governing the conduct of an arbitration. Its temporal scope commences from the claimant's initiation of the arbitration and extends up to the closure of the arbitral proceedings.
Parties opting for international commercial arbitration are given considerable freedom to choose and individually tailor the procedure of the arbitration. Arbitral procedure may be conducted in flexible, cost-efficient and innovative ways that are attractive to the business community. Through this free choice of the parties, arbitral procedure has evolved to be significantly distinct from the rigid procedures traditionally adopted by courts. In a study on the views of in-house counsel at leading multinational corporations published in 2006, flexibility of procedure emerged as the most widely recognised advantage of international commercial arbitration. Another relevant finding in that study was that ‘active participation of the parties in determining and shaping the procedure inspires confidence in the process’.
Section 2 of this chapter explores the important role of party autonomy in arbitral procedure. Rules, procedural law and guidelines are discussed in Section 3. Section 4 focuses particularly on core arbitral procedural rights and duties. Section 5 deals with the way international arbitration balances traditional differences between the common and civil law systems on matters of procedure. Section 6 considers a number of procedural stages involved in an arbitration. Issues relating to evidence are discussed in Section 7. This is followed by an overview of procedural aspects of arbitration hearings in Section 8.
This chapter examines how, why and on what basis the process of international commercial arbitration is legally permitted. It also covers the main practical functions of the seat of arbitration.
The seat (or place) of arbitration is the jurisdiction in which an arbitration takes place legally. This must be distinguished from the location of any physical hearings or meetings that are held as part of the arbitration proceedings. The hearings or meetings do not necessarily have to be held at the seat of arbitration.
It is essential to appreciate the connection between arbitration proceedings and the laws of the seat of arbitration. The different theories relating to this connection arise from the delicate interplay between a state's powers (particularly state judicial powers), an arbitral tribunal's powers and the freedom of parties to choose how their disputes are determined. At times these interests may conflict and there is potential for the law and/or the courts of the seat of arbitration to constrain the flexible and pragmatic qualities of arbitration. To gain a deeper understanding of these conflicting circumstances, recourse to theory and legal doctrine is unavoidable.
In Section 2 we discuss whether to use the term ‘seat’ or ‘place’ referring to the jurisdiction to which the arbitration is legally attached. In this book we mainly use ‘seat.’ In Section 3 we distinguish between the seat of arbitration and the place or venue of hearings. Section 4 examines the different laws and rules which regulate international arbitration proceedings.
This chapter concerns the identification of the law that applies in an international arbitration. Various laws may apply to different aspects of the dispute.
After providing an overview of the types of choice of law issues that arise in international arbitration (Section 2), the remainder of this chapter focuses on the law applicable to the merits or substance of the parties' dispute. It first examines how an arbitral tribunal should determine the applicable law (Section 3). It then considers other issues such as mandatory laws, which apply regardless of the otherwise applicable substantive law (Section 4), how an arbitral tribunal should determine the content of the applicable law (Section 5), the compulsory application of the terms of the contract and trade usages (Section 6), the possibility of applying national rules of law or the lex mercatoria (Section 7), and finally the possibility for international arbitrators to decide cases based on principles of fairness and justice without reference to law (Section 8).
The treatment of applicable law issues in investment arbitrations under the ICSID Convention is completely different from international commercial arbitration. It is addressed in Chapter 10, Section 4.5.
Types of conflict of law issues in international arbitration
Determining the applicable law in an international litigation matter (i.e. before a state court) can be very complex, yet seductively interesting from an academic perspective.
The features and requirements of arbitration agreements were examined in Chapter 4. This chapter addresses procedural and other issues that can arise when a party wishes to contest an arbitral tribunal's jurisdiction. It also considers the link between an arbitral tribunal's authority to rule on its own jurisdiction and the control of that authority by domestic courts.
An arbitral tribunal's jurisdiction is far from automatic. It derives from the disputing parties' free will, i.e. their agreement to arbitrate. The consensual nature of arbitral jurisdiction must be contrasted with the jurisdiction of domestic courts, which is established by the domestic law of the forum and any applicable treaties dealing with international judicial competence.
The consensual basis of arbitration means that a respondent party can attempt to contest or deny arbitral jurisdiction. The objecting party might never have agreed to arbitrate or, even if it previously agreed, may now prefer to litigate the dispute in a domestic court. In the latter case the objecting party may seek to escape its obligation to arbitrate by denying its previous agreement. Alternatively, that party might raise jurisdictional objections in an attempt to delay and frustrate the resolution of the dispute.
After introducing and summarising the procedure of jurisdictional objections (Section 2), we examine preliminary issues concerning arbitral jurisdiction (Section 3), before dealing with the competence-competence rule and prima facie jurisdictional decisions by courts (Section 4), prima facie jurisdictional decisions by arbitral institutions (Section 5), and finally the effects of a court, institution or arbitral tribunal's jurisdictional decision (Section 6).