Posttraumatic Stress Disorder and Health-Related Quality of Life among a Sample of Treatment- and Pension-Seeking Deployed Canadian Forces Peacekeeping Veterans

Article excerpt

Objectives: To examine the health-related quality of life (HRQOL) in deployed Canadian Forces peacekeeping veterans, addressing associations with posttraumatic stress disorder (PTSD), and depression severity.

Methods: Participants (n = 125) were consecutive male veterans who were referred for a psychiatric assessment. Instruments administered included the Clinician-Administered PTSD Scale, Hamilton Depression Scale, Short-Form-36 Health Survey, and sociodemographic characteristics.

Results: Mental HRQOL was significantly lower for peacekeepers with, than without, PTSD. Using univariate analyses, PTSD and depression severity were each significantly negatively related to mental HRQOL. In sequential regression analyses controlling for age, we found that PTSD and depression severity significantly predicted both mental and physical HRQOL.

Conclusions: Veterans with PTSD have significant impairments in mental and physical HRQOL. This information is useful for clinicians and Veterans Affairs administrators working with the newer generation of veterans, as it stresses the importance of including measures of quality of life in the psychiatric evaluation of veterans to better address their rehabilitation needs.

Can J Psychiatry 2008;53(9):594-600

Clinical Implications

* Veterans with significant symptoms of PTSD and depression present with significant physical and mental impairment.

* Understanding the functional impairment in veterans wim PTSD can assist with rehabilitation.

* It is important to include measures of quality of life in the comprehensive evaluation of veterans to better address their health care needs.

Limitations

* A male sample of veterans with a service-related disability limits generalizability.

* HRQOL was based on the Short-Form-36 Health Survey.

* Inherent to a cross-sectional study, at best we can establish an association but not causality.

Key words: quality of life, peacekeepers, posttraumatic stress disorder

Abbreviations used in this article

CAPS Clinician-Administered PTSD Scale

HDRS Hamilton Depression Rating Scale

HRQOL health-related quality of life

MCS Mental Component Summary Score

PCS Physical Component Summary Score

PTSD posttraumatic stress disorder

SF-36 Short-Form-36 Health Survey

Since the 1990s, with the end of the Cold War, there has been increased instability on the international stage with a rise in intra-state conflict, ethnic cleansing, and global terrorism. Recent United Nations peacekeeping missions in areas such as Rwanda, Somalia, and the former Yugoslavia expose peacekeepers to considerable stress and traumatic events, such as witnessing atrocities that they are helpless to prevent, especially the death of children.1-5 The United Nations rules of engagement, in which soldiers must show restraint and neutrality, often prohibit the use of force. This may increase a soldier's sense of helplessness and exacerbate an already stressful situation. Of particular importance to peacekeeping, the feeling of being unable to control a situation at the time of trauma is an important risk factor for developing PTSD.6,7

Over the past 2 decades, many studies have demonstrated the negative psychiatric impact of peacekeeping operations.8-12 The relations among PTSD, physical health, and mental health impairment is a large and well-developed area in combat veterans,13-19 but less studied is the impact of psychiatric illness on quality of life among the deployed peacekeeping veteran population.

Physical and mental health functioning are among the principal domains of HRQOL,20 and a growing amount of literature has examined the association between mental illness and HRQOL. However, its association with anxiety disorders, such as PTSD and HRQOL, has not been adequately studied, especially among combat and peacekeeping veterans. …