Effectiveness of mandatory postdeployment programs questioned
medwireNews: The Third Location Decompression (TLD) program, currently a mandatory activity for UK military personnel following an overseas deployment, may not always be effective in helping personnel readjust, researchers report.
However, TLD has not been shown to cause harm, and may be useful in reducing alcohol abuse, post-traumatic stress disorder (PTSD), and physical problems in some people.
"Personnel who have experienced high levels of combat need greater support to address their mental health and readjustment needs, whereas those reporting lower levels of combat seemed to benefit from the standard TLD approach," write Norman Jones (Weston Education Centre, London, UK) and colleagues in Occupational & Environmental Medicine.
Jones et al reviewed data from a large cohort study of UK military personnel who had been deployed in Iraq or Afghanistan. Of the 3071 personnel included in the current analysis, 1407 attended TLD sessions; 1664 did not participate in TLD (eg, it was not mandatory at the time; member of Royal Navy or Royal Air Force) and were considered the control group.
There were no significant differences in the amount of postdeployment readjustment problems between the TLD and control groups. However, 3.0% of the TLD group reported PTSD versus 4.5% of the control group, and there was a smaller rate of harmful alcohol abuse among TLD attendees (16.8 vs 19.5%).
The positive effects of TLD were most apparent in personnel with medium combat exposure, particularly with regards to PTSD and physical symptoms. Those who had the least amount of combat exposure were less likely to report any common mental disorders.
As the investigators note, "personnel with more PTSD symptoms in the high-exposure group may be limited in their ability to engage with the TLD process; this may relate to intrusive PTSD symptoms, difficulties with concentration and, therefore, a reduced ability to engage with the psychoeducation elements."
They conclude that while TLD appears to have beneficial effects on mental health, no evidence was found to support the claim that TLD can assist in postdeployment readjustment. "We suggest that further prospective research be undertaken to ensure that future policy regarding TLD is based upon a robust evaluation, and that this should take the form of a RCT [randomized controlled trial]."
By Stephanie Leveene, medwireNews Reporter