Up-to-date comorbid anxiety and depressive syndromes among servicemen participating in combat operations

Abstract

Purpose: to study the prevalence of comorbid anxiety and depressive syndromes among the military personnel participating in combat operations who underwent military medical examination. Materials and methods. The prevalence of anxiety and depressive syndromes among the military personnel participating in combat operations was studied by questionnaire survey. The study group included 250 combatants aged 21 to 59 years (mean age – 42,5±2,9 years) who were referred to the outpatient clinic of the National Military Medical Clinical Centre «Main Military Clinical Hospital» for the purpose of undergoing a preliminary medical examination to determine the degree of fitness for military service. The control group consisted of 40 practically healthy servicemen who did not take part in combat operations, but did not differ in age and gender from the main group. Methods of the study: systematic approach and analysis, bibliographic, questionnaire survey (screening methodology: PHQ-2 Hospital Anxiety and Depression Scale (HADS), Hamilton Depression Rating Scale (HDRS)), medical and statistical. Results. According to the results of the study, using the screening methodology of the Hospital Anxiety and Depression Scale, it was found that the frequency of anxiety manifestations in the participating servicemen was 27% and 18% in the control group (p<0,05). The prevalence of depressive disorders among the servicemen participating in combat operations is 44%, which is significantly higher than the corresponding indicators of the control group ‒15% (p<0,05) and significantly higher than population indicators (8-10%). According to the results of the study using the Hamilton Scale, depressive manifestations were detected in 43% of servicemen who participated in combat operations, which is significantly higher than the corresponding indicators of the control group – 24%. The results of the diagnosis of depressive disorders using the Hospital Anxiety and Depression Scale and the Hamilton Depression Scale did not differ significantly. The frequency of depressive manifestations was the highest among the servicemen with an expert decision «Limitedly fit» – 52%, which significantly exceeds the frequency of depressive manifestations in servicemen who were given a decision «Fit for military service». The highest level of anxiety was found among the servicemen with the expert decision «Unfit for military service with exclusion from military registration» / «Unfit for military service with re-examination in 6-12 months» – 33%, but the difference is not statistically significant (p≥0,05). Anxiety and depression manifestations were detected in 40% of servicemen with up to 12 months of participation in combat operations, 42% – with 12-24 months of service, and 56% – among the servicemen who participated in combat operations for more than 24 months (without a statistically significant difference between the groups, p≥0,05). Middle-aged servicemen participating in combat operations were significantly (p≤0,05) more likely to have depressive disorders than younger servicemen (under 35) (36% and 50%, respectively). Conclusions. The screening revealed a high prevalence of depressive syndromes among the military personnel participating in combat operations, mostly of mild and subclinical level. The introduction of screening methods for the presence of depressive and anxiety syndromes in combatants is important for their timely diagnosis and correction, which justifies the need to raise awareness of doctors about this problem.

Keywords

• anxiety, depression, comorbidity, military personnel, combatants, patient health questionnaire, Hospital Anxiety and Depression Scale, Hamilton Scale.