title: The subjective utility of early psychosocial interventions following combat deployment.
abstract: BACKGROUND
  Third Location Decompression (TLD) is the process through which personnel, returning from combat operations, begin to psychologically 'unwind'. Decompression comprises welfare activities, such as contacting home, beach events, social events, psycho-educational briefings and controlled re-introduction to alcohol.
  
  
  OBJECTIVE
  To assess the subjective utility of decompression by surveying all British troops transiting the TLD facility in Cyprus, during 2008.
  
  
  METHODS
  Analysis of distributed surveys completed by personnel who had deployed either to Iraq or Afghanistan. The main outcome was the subjective utility of the decompression process, with operational exposures, stigma, early post-traumatic stress (PTS) symptoms and adjustment concerns also measured.
  
  
  RESULTS
  Response rate was 87% (11,304 returned surveys). Eighty per cent of respondents reported being ambivalent or not wanting to go through TLD before decompression; however, on completion, 91% reported finding it useful. The desire to participate was the strongest predictor of perceived helpfulness. Troops who found the TLD less helpful included those who had been through the process before, combat troops and non-commissioned officers. Twelve per cent reported substantial concerns about re-establishing relationships or settling down to 'normal life'; those reporting more adjustment concerns were more likely to perceive TLD as helpful. Six per cent reported significant PTS symptoms and 27% of troops reported substantial levels of stigma related to mental health and barriers to care.
  
  
  CONCLUSIONS
  TLD was well received by troops following combat deployment. However, TLD does not appear to be equally acceptable to all and alterations to the TLD programme for certain subgroups might be required.
authors.affiliation: Academic Centre for Defence Mental Health, Department of Psychological Medicine, Institute of Psychiatry, King's College London, 10 Cutcombe Road, London SE5 9RJ, UK. norman.jones@kcl.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Jones
authors.forename: H
authors.initials: H
authors.lastname: Burdett
authors.forename: S
authors.initials: S
authors.lastname: Wessely
authors.forename: N
authors.initials: N
authors.lastname: Greenberg
mesh_terms: D055826:Afghan Campaign 2001-; D000346:Afghanistan; D000428:Alcohol Drinking; D003130:Combat Disorders / Q000517:prevention & control / Q000523:psychology*; D003376:Counseling; D003535:Cyprus; D005260:Female; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D008605:Mental Health Services; D008889:Military Personnel / Q000523:psychology*; D009784:Occupational Diseases / Q000517:prevention & control / Q000523:psychology*; D011592:Psychology, Military / Q000379:methods; D011998:Recreation; D013313:Stress Disorders, Post-Traumatic / Q000517:prevention & control / Q000523:psychology*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000208:ethnology