title: Multiple physical symptoms in a military population: a cross-sectional study.
abstract: BACKGROUND
  Medically unexplained symptoms have been reported among both civilians and military personnel exposed to combat. A large number of military personnel deployed to the Gulf War in 1991 reported non-specific symptoms. These symptoms did not constitute a clearly defined syndrome. Post-traumatic stress disorder (PTSD) and to a lesser degree exposure to combat are associated with physical symptoms.
  
  
  METHODS
  This is a cross-sectional study of representative samples of Sri Lanka Navy Special Forces and regular forces deployed in combat areas continuously during a 1-year period. Multiple physical symptoms were elicited using a checklist of 53 symptoms. Cases were defined as individuals with ten or more symptoms. Symptoms of common mental disorder were identified using the General Health Questionnaire 12 (GHQ-12). PTSD was diagnosed using the 17-item National Centre for PTSD checklist civilian version.
  
  
  RESULTS
  Prevalence of multiple physical symptoms was 10.4% (95% CI 8.11-12.75). Prevalence was significantly less in the Special Forces (5.79%) than in the regular forces (13.35%). The mean number of symptoms reported by those who met the criteria for PTSD was 12.19 (SD 10.58), GHQ caseness 7.87 (SD 7.57) and those without these conditions 2.84 (SD 3.63). After adjusting for socio-demographic and service variables, 'thought I might be killed' , 'coming under small arms fire' , and 'coming under mortar, missile and artillery fire' remained significant. Multiple physical symptoms were associated with functional impairment and poor perceived general health.
  
  
  CONCLUSIONS
  Prevalence of multiple physical symptoms was significantly lower in the Special Forces despite high exposure to potentially traumatic events. More multiple physical symptoms were reported by personnel with PTSD and common mental disorders. Multiple physical symptoms were associated with functional impairment.
authors.affiliation: Department of Psychological Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka.
authors.forename: Varuni A
authors.initials: VA
authors.lastname: de Silva
authors.affiliation: Directorate of Health Services, Sri Lanka Navy, Colombo, Sri Lanka.
authors.forename: Nicholas Elw
authors.initials: NE
authors.lastname: Jayasekera
authors.affiliation: Department of Psychological Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka.
authors.forename: Raveen
authors.initials: R
authors.lastname: Hanwella