title: Traumatic experiences and posttraumatic stress disorder in soldiers following deployment abroad: how big is the hidden problem?
abstract: BACKGROUND
  Little is known about the frequency of traumatic event exposure and the development of post-traumatic stress disorder (PTSD) among German soldiers serving in Afghanistan.
  
  
  METHODS
  We studied a random sample consisting of 1599 soldiers who had served in the 2009/2010 ISAF mission in Afghanistan, stratified by deployment location and unit. Twelve months after their return to Germany, the soldiers were assessed with a Composite International Diagnostic Interview (CIDI) to establish the diagnoses of mental disorders and PTSD according to the DSM-IV. 889 similar soldiers who had not been deployed abroad were assessed in the same way.
  
  
  RESULTS
  49.2% (95% confidence interval [CI]: 46.4 to 52.1) of the deployed soldiers experienced at least one traumatic event during their deployment, and 13% experienced more than three. The 12-month prevalence of PTSD among returning soldiers was 2.9% (95% CI: 2.1 to 4.1), while the service-related incidence after deployment was 0.9% (95% CI: 0.5 to 1.6). These figures imply a two- to fourfold elevation of the risk of PTSD. The risk of PTSD was highest among soldiers who had served in Kunduz (Afghanistan) and in combat units. Only half of all soldiers with PTSD sought professional help.
  
  
  CONCLUSIONS
  Deployment abroad is associated with a high frequency of traumatic experiences and a two- to fourfold elevation of the risk of PTSD. Each year, about 300 cases of PTSD develop for every 10 000 soldiers who return to Germany; thus, the cumulative number of returnees with PTSD from the beginning of German deployment abroad may currently run into the thousands. 45% of all PTSD cases, or about one in two, are neither diagnosed nor treated. Deployment abroad also substantially increases the risk of developing a number of other mental disorders.
authors.affiliation: Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany. wittchen@psychologie.tu-dresden.de
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
authors.forename: Sabine
authors.initials: S
authors.lastname: Schönfeld
authors.forename: Clemens
authors.initials: C
authors.lastname: Kirschbaum
authors.forename: Christin
authors.initials: C
authors.lastname: Thurau
authors.forename: Sebastian
authors.initials: S
authors.lastname: Trautmann
authors.forename: Susann
authors.initials: S
authors.lastname: Steudte
authors.forename: Jens
authors.initials: J
authors.lastname: Klotsche
authors.forename: Michael
authors.initials: M
authors.lastname: Höfler
authors.forename: Robin
authors.initials: R
authors.lastname: Hauffa
authors.forename: Peter
authors.initials: P
authors.lastname: Zimmermann
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D003130:Combat Disorders / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D009784:Occupational Diseases / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000628:therapy; D014195:Travel / Q000706:statistics & numerical data*; D055815:Young Adult