War is not necessarily the cause of post-traumatic stress disorder

A large-scale survey of the mental condition of military personnel before, during and after their posting to Afghanistan has proved thought-provoking. In total, 746 Danish soldiers took part in the survey. The soldiers completed a questionnaire five times in all -- before their posting, during their time in Afghanistan and three times after their return to Denmark.

Professor Dorthe Berntsen of the Center on Autobiographical Memory Research -- CON AMORE, Department of Psychology, Aarhus University, Business and Social Sciences, is responsible for the study, together with military psychologists at the Danish Centre for Defence Veterans and researchers from Duke University in North Carolina. The survey has produced some surprising results.

"Typically, it is not the experience of war that triggers the symptoms of post-traumatic stress disorder (PSTD)," explains Dorthe Berntsen.

"In the case of soldiers in Afghanistan, we might well expect that it was their experiences of war there that triggered PSTD. However, the situation is not so simple. We need to look at the soldiers' experiences in a lifetime perspective. The study has provided new information, because the survey includes data on the soldiers' state of health before their departure, during their tour of duty and several times after their return. It shows that many of the soldiers had already experienced trauma before they went to Afghanistan, and that this has affected the way they reacted during their posting.

"It has long been generally thought that PTSD occurs after violent experiences. Our survey thus provides new knowledge," says Dorthe Berntsen.

"War in itself is not the crucial factor in making soldiers ill. It can be a contributing factor, but it is not the decisive factor."

Research can help

Dorthe Berntsen explains that PTSD sufferers experience among other symptoms involuntary intrusive recollections. These are very negative memories that force themselves into the consciousness, and they can be very disabling for the individual concerned. They may, for example, take the form of unpleasant flash-backs from the war that can cause mood changes, and can lead some individuals to lose confidence in themselves to a greater or lesser degree and to begin to dwell too much on their situation.

"Our research into involuntary recall shows that this type of recollection and the way it normally occurs can help us to understand the dysfunctional involuntary recollections that occur in disorders like PTSD."

Research conducted at the basic research centre CON AMORE, where Dorthe Berntsen is the director, shows that people have many pleasant involuntary recall experiences every day; the knowledge that the researchers have concerning ordinary involuntary recall can be used in understanding the dysfunctional, intrusive recollections that some soldiers experience when they return from war.

Differences among soldiers

The experiences of war do not cause negative effects in all soldiers. The majority of military personnel are resistant, and do not experience their combat-zone posting as a great problem. Soldiers can be grouped into three categories.

A small proportion of the soldiers in the survey felt better as a result of their posting. They had a high level of PSTD before their tour of duty, and this level decreased during or immediately after their posting to Afghanistan, after which it rose again. This group of soldiers were less well educated than the others, with many of them having only attended lower secondary school, explains Dorthe Berntsen.

"Being sent abroad in the military services can be an attractive opportunity for this group of young people to escape from their everyday lives in Denmark. We presume that they are attracted by the camaraderie and by working with others."

According to Dorthe Berntsen, by far the largest proportion of soldiers in the survey fell into the category termed robust. They are a resistant group, and do not allow themselves to be affected by their everyday situation either before their posting, during their tour in Afghanistan or after returning home.

Around five percent of the soldiers in the survey proved to be different to those in the two groups above, and not in a positive sense. They were like the robust soldiers before going to the war zone, but their mental state deteriorated while they were there, and did not recover after their return home, says Dorthe Berntsen.

- We cannot rule out the possibility that they were exposed to different experiences than the robust group of soldiers in Afghanistan. But this is probably not the case. According to Dorthe Berntsen, this group of soldiers differ from the robust group in that there were more childhood traumas in their backgrounds.

What do the soldiers think?

It is Dorthe Berntsen's impression that the soldiers who participated in the study were generally pleased to have done so.

"The troops were pleased that the Defence Command was interested in their welfare and wellbeing before, during and after their posting to Afghanistan. The survey participants were guaranteed anonymity throughout the survey process,'" concludes Dorthe Berntsen.

In brief

• Professor Dorthe Berntsen is a professor at the Department of Psychology, Aarhus University, Business and Social Sciences and is director of the Center on Autobiographical Memory Research -- CON AMORE
• CON AMORE is a basic research centre established under the auspices of the Danish National Research Foundation and is located in the Department of Psychology, Aarhus University, Business and Social Sciences.
• 746 military personnel participated in the study.
• The survey was carried out in cooperation with the Danish Defence Command.
• The results of the study have been accepted for publication in the academic journal Psychological Science.