General summary Research Home Front Care
A proactive health policy following peace-keeping missions should be based on (1) insight in the nature and severity of health problems that can be associated with peace-keeping missions and (2) knowledge of the factors that influence and/or prolong these health problems. Previous research (see chapter 2) shows that (1) PTSS ( and PTSS symptoms ) are strongly connected to somatic, psychic and relational health problems and that (2) PTSS ( symptoms ) are connected to shocking mission experiences ( combat stress) and problems within the unit ( unit-cohesion) ,after the mission social backing and a good partner relationship have been known to contribute to the prevention or reduction of PTSS (symptoms) ( see chapter 3 ).
Supposedly there are effective treatments for PTSS, but various studies show that only 29% – 40% of the soldiers or veterans who have been diagnosed with serious problems, actually seeks aid. Moreover it is so that many terminate their treatment prematurely ( see chapter 3 ). This means that the direct social environment (partner, family, colleagues and friends) could be the most important source of follow up care. In spite of the large amount of research, including Dutch soldiers and veterans, there are a few black spots in the knowledge that is required for a pro-active health policy after peace-keeping missions.
The research in question is aimed at the following black spots: (1) to what extent are PTSS symptoms indicative for the presence of other (somatic(biological)), psychological and social/relational) problems? If PTSS symptoms are indeed indicative for various health problems, then the problems that are associated with peace-keeping missions can primarily be understood as PTSS symptoms and the severity of these problems can be measured by mapping the entire spectrum of health problems. (2) Are combat-stress and unit-cohesion not only associated with PTSS but also with other health issues following the mission? And the same goes for the often mentioned (but seldom researched) protective factor for the creation of PTSS, a strong mission-moral (i.e. A positive mission evaluation)? For the content of the care provided it is important to know whether or not these three mission factors can be associated with specific problems. (3) What connections are there concerning the soldiers PTSS symptoms on the one side and the quality of the partner relationship and other aspects of the bio-psychological health of the partner on the other?
This knowledge is necessary for aimed, effective support for the partner as part of a pro-active health policy. In a survey group of 69 soldiers ( mostly middle age officers and NCO's who have participated in several missions) that were invited by the union to take part in this survey, it was found that:
1. PTSS symptoms are closely linked to physical, psychological, social and relational dysfunctions and therefore are indicative for various health problems.
2. PTSS symptoms and other health problems are closely linked to (a) one or more negative experience within the unit (limited unit cohesion), (b) negative mission evaluation (mission moral) , ( c ) previous life experience and ( d ) the presence of domestic problems that complicate being sent on a mission, but hardly if at all with dramatic experiences during the mission ( combat stress ). These findings suggest that a peace- keeping mission can be a dramatic life experience ( comparable to bankruptcy or loss of a friendship), but only in exceptional cases can it be a traumatic experience. Guidance and support therefore seem to be key ingredients for aftercare.
3. In the group of 29 partners which participated in the survey 20% had asked for help with health problems and the percentage of clearly evident health problems (15% – 20% ) was twice as high as with the participating soldiers.
4. Being content with the partner relationship and especially the combination of the social support experienced by the partner and an active and self assured ( extravert) social behaviour style, are linked to less PTSS symptoms and better health for the soldier.
Based on these findings it seems that groups of fellow sufferers partners ( if primarily aimed at getting social support and the stimulation of social contacts), and the involvement of the partner in the health care plan for soldiers, are effective ingredients for a pro-active health policy. It has to be kept in mind that all of these findings and recommendations are based on information from a survey group consisting mainly of middle age officers and NCO's who have participated in several missions also there was a survey group that consisted of their partners.
It is not unimaginable that younger soldiers/corporals will display other links between health, mission experiences and their partners health. Therefore it is advisable to repeat this survey in conjunction with a larger, more diverse group. Finally is has to be said that ( due to the relatively small size of the survey groups) “extreme” scores have been neutralised by limiting the scoring possibilities to three categories ( low, medium and high ). Because of this all correlations have been calculated in a conservative manner. Therefore it is not likely that the established links will not be found in a larger survey group.
It is actually more likely that the intensiveness of some of the links has been underestimated because of the conservative approach.
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