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Figure 3.1: Lifetime exposure to traumatic events, percentages

05101520253035404550556065707580859095100

Natural disaster

Fire/Explosion

Transport accident

Serious accident

Exposure to toxic substances

Physical assault

Assault with weapon

Sexual assault

Other unwanted sexual experience

Combat/War zone exposure

Captivity

Life threatening illness/injury

Severe human suffering

Sudden violent death

Sudden unexpected death of someone close

Caused serious harm/death to other

Other stressful experience

Experienced it Witnessed

Experienced the traumatic event:

Learned about

% of peacekeepers

Australian peacekeepers: Long-term mental health status, health service use, and quality of life

Technical report

Authors: Graeme Hawthorne, Sam Korn, Mark Creamer*

Australian peacekeepers: Long-term mental health status, health service use, and quality of life

Technical Report

Graeme Hawthorne

Sam Korn

Mark Creamer*

Mental Health Evaluation Unit & the Australian Centre for Posttraumatic Mental Health Department of Psychiatry, The University of Melbourne

August 2013 (Revised August 2014)

* Due to the unforeseen unavailability of the first author to complete this report, the Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, assumed responsibility for the report in May 2013. The final version of the report was revised and edited by Professor Mark Creamer, in consultation with Professor McFarlane, Professor Sim, members of the original research team, and Professor David Forbes and Associate Professor Meaghan ODonnell.

We would like to acknowledge the passing of Associate Professor Graeme Hawthorne and pay tribute to his outstanding leadership of this research project.

Recommended citation:

Hawthorne, G., Korn, S., & Creamer, M. (2014) Australian peacekeepers: Long-term mental health status, health service use, and quality of life Technical Report. Unpublished manuscript, Department of Psychiatry, University of Melbourne, Australia.

For further information about this report please contact:

Associate Professor Meaghan ODonnell

Director of Research

Australian Centre for Posttraumatic Mental Health

Phone: +61 3 9035 5599

Email: mod@unimelb.edu.au

Research team

Chief investigators

A/Prof Graeme Hawthorne

Principal Research Fellow, Mental Health Evaluation Unit

Department of Psychiatry, The University of Melbourne

Professor Malcolm Sim

Director, Monash Centre for Occupational & Environmental Health

Department of Epidemiology & Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences

Monash University

Professor Alexander McFarlane

Director, Centre for Traumatic Stress Studies

University of Adelaide

Research team: Mental Health Evaluation Unit, Department of Psychiatry, The University of Melbourne

Dr Sam Korn

Research Fellow

Mr Andrew Rodsted

Research Assistant

Ms Suzanne Pollard

Research Assistant

Mr David Fallon

Research Assistant

Ms Bianca Anjara

Research Assistant

Professor Mark Creamer

Honorary Professorial Fellow

Department of Psychiatry and the Australian Centre for Posttraumatic Mental Health

Advisory committee

A/Prof Graeme Hawthorne

Principal Research Fellow, Mental Health Evaluation Unit

Department of Psychiatry, The University of Melbourne

Professor Malcolm Sim

Director, Monash Centre for Occupational & Environmental Health

Department of Epidemiology & Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences

Monash University

Professor Alexander McFarlane

Director, Centre for Traumatic Stress Studies

University of Adelaide

Dr Sam Korn

Research Fellow, Mental Health Evaluation Unit

Department of Psychiatry, The University of Melbourne

Ms Sandy Bell

Assistant Secretary Transport, Research and Development Branch, Department of Veterans' Affairs

Ms Kyleigh Heggie

Director

Research, Development and Coordination Section Transport, Research and Development Branch, Department of Veterans' Affairs

Ms Tracey Chant

Assistant Director

Research, Development and Coordination Section Transport, Research and Development Branch, Department of Veterans' Affairs

Mr Tim Cummins

Senior Project Officer

Research, Development and Coordination Section Transport, Research and Development Branch, Department of Veterans' Affairs

Dr Eileen Wilson, Ms Megan McDonald and Ms Kerrie Martain

Former Department of Veterans' Affairs members of the Advisory Committee

Mr Paul Copeland

Immediate Past President

Australian Peacekeeper & Peacemaker Veterans Association

Mr Michael Annett

Chief Executive Officer, Victorian Branch

Returned and Services League of Australia

Acknowledgements

We would like to thank the Australian Department of Veterans Affairs for funding this project, with particular acknowledgement to Dr Eileen Wilson, Director Research, Development and Coordination Section, Transport, Research and Development Branch as well as Ms Megan McDonald and Kerrie Martain, Senior Research Officers, Research, Development and Coordination Section, Transport, Research and Development Branch, Department of Veterans' Affairs, Commonwealth of Australia.

Our thanks are extended to Mr Paul Copeland, Immediate National President, Australian Peacekeeper & Peacemaker Veterans Association, and Mr Michael Annett, Chief Executive Officer, RSL Victorian Branch.

We would like to thank the research assistants who interviewed peacekeepers and maintained the study database: Mr Andrew Rodsted, Ms Suzanne Pollard, Mr David Fallon and Ms Bianca Anjara.

Our thanks are also extended to all the peacekeepers who participated in this study. Without their generosity in giving up their time this study would not have been possible.

Table of contents

iiiResearch team

ivAdvisory committee

viAcknowledgements

xList of tables

xiList of figures

xiiAbbreviations

xivGlossary of terms

1Executive summary

11.Background

12.Study aims

13.Study design, data collection, and analysis

24.Study findings

45.Study strengths and limitations

46.Implications

71.0Background and study aims

71.1The nature of peacekeeping

71.2Australias involvement

91.3The nature of mental health problems

91.3.1Psychiatric diagnoses

101.3.2Other mental health and related constructs

111.4The mental health sequelae of peacekeeping operations

121.5Rationale for the current study

121.6Appropriate comparisons for the current study

141.7Aims of the current study

172.0Method

172.1Study design

172.1.1Study deployments

182.1.2High versus low stress deployments

182.2Participants: Sample and selection

182.2.1Sample size

192.2.2Participant selection

202.3Procedures for data collection

202.3.1 Initial recruitment into the study

232.3.2 Data collection

242.4Comparator samples

252.4.1National Survey of Mental Health and Wellbeing (NSMHWB)

262.4.2CMVH East Timor and Bougainville samples

272.4.3 Australian Gulf War Veterans Health Study (AGWVHS)

272.4.4 (ADF) Mental Health Prevalence and Wellbeing Study sample

282.5Measures

292.5.1Composite International Diagnostic Interview (CIDI)

302.5.2Background information

312.5.3Standardised self-report measures mental and physical health

332.5.4Standardised self-report measures associated problems

362.5.5 Standardised self-report measures potential risk and protective factors

372.6Data analysis

372.6.1Data verification and missing data

382.6.2Participation bias

392.6.3Response bias

392.6.4Significance levels and statistical analyses

412.6.5Predictor variables

422.7Ethics

422.7.1Adverse events

433.0Participants

433.1Participation rate

443.2Study generalisability

443.2.1Non-response and partial completion

453.2.2Bias response by questionnaire length

463.2.3Questionnaire response bias

483.2.4Missing data

483.3Demographic details of participants

483.3.1General demographic profile of study participants

513.4Service and deployment history

523.5Trauma exposure

523.5.1Traumatic life events exposure

543.5.2Trauma exposure on deployment: TSES-R2 findings

563.6Summary

584.0Mental health

584.1Pre-deployment mental health

604.2The prevalence of mental health conditions

644.2.1Posttraumatic stress disorder (PTSD)

654.2.2Generalised Anxiety Disorder (GAD)

664.2.3Major Depressive Episode (MDE)

664.2.4Alcohol and other drug abuse and dependence

674.3Predictors and correlates of mental health conditions

674.3.1Univariate associations

704.3.2Multivariate analyses

734.4Associated constructs of mental health and wellbeing

744.4.1PCL

754.4.2General Health Questionnaire (GHQ-12 bimodal)

764.4.3K10

784.4.4Suicidal ideation and