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American Journal of Epidemiology Advance Access originally published online on April 10, 2009
American Journal of Epidemiology 2009 169(11):1362-1369; doi:10.1093/aje/kwp044
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Is Previous Psychological Health Associated With the Likelihood of Iraq War Deployment? An Investigation of the "Healthy Warrior Effect"

Jennifer Wilson, Margaret Jones, Nicola T. Fear, Lisa Hull, Matthew Hotopf, Simon Wessely and Roberto J. Rona

Correspondence to Prof. Roberto Rona, King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, United Kingdom (e-mail: roberto.rona{at}iop.kcl.ac.uk).

Received for publication September 24, 2008. Accepted for publication February 6, 2009.

Using survey data, the authors assessed whether military personnel's prior mental health status would influence their likelihood of being deployed. None of the previous studies that assessed a possible "healthy warrior effect," in which persons selected for deployment have better predeployment health, were based on surveys. A sample of 2,820 United Kingdom military personnel studied in 2002, before the Iraq War, was contacted again between 2004 and 2006. The baseline questionnaire included a measure of psychological distress (the General Health Questionnaire), the PTSD [posttraumatic stress disorder] Checklist (PCL), physical symptoms, and level of medical fitness. A total of 1,885 (67%) participants completed a follow-up questionnaire. General Health Questionnaire caseness in 2002 was associated with a reduction in risk of deployment later on (risk ratio = 0.81, 95% confidence interval: 0.67, 0.99). Scoring high on the PCL intrusiveness and avoidance domains also reduced the risk of deployment. These associations were slightly stronger when the comparison was made between persons who were deployed to Iraq and those who were not. Although risk ratios were well below 1.00, PCL categories were not significantly associated with being deployed. This study demonstrated a small "healthy warrior effect"; persons with better psychological health had a higher chance of being deployed, even after adjustment for predeployment medical fitness.

bias (epidemiology); follow-up studies; mental health; military personnel; stress disorders, post-traumatic

Abbreviations: GHQ, General Health Questionnaire; PCL, PTSD Checklist; PTSD, posttraumatic stress disorder


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