MINISTERIAL SUBMISSION

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1 Ref: CJHLTH/OUT/20 10lAF Requested Australian Government Department of Defence MINISTERIAL SUBMISSION To: Mr Snowdon CC: Senator Feeney Copies to: Secretary, CDF, FASMSPA, CN, CA, CAF. Timing: Required by: Reason: Routine Multiple operational deployments - Effects on Australian Defence Force members That you: note that the impact of multiple deployments on mental health of Australian Defence Force members and other nations is not clear and that further research is underway. NOTED / PLEASE DISCUSS Key Points: 1. Your office has requested information on the impact of multiple deployments on Australian Defence Force members. Specifically, information was requested on. the incidence of multiple deployments for Australian Defence Force personnel, a review of existing literature on the topic, and options for enhancing understanding in this area. Background information is provided at. 2. Based on preliminary data from the Military Health Outcomes Program (a major health and mental health prevalence study being coordinated by Joint Health Command) the incidence of multiple deployments in the Australian Defence Forces is estimated to be 22%, while 61% of personnel have not deployed and 17% have deployed only once. 3. Army has the highest incidents of multiple deployments 32%, followed by Navy 23% and Air Force the lowest 8%, however Navy had the highest proportion of personnel reporting 6 or more deployments at 6%. 4. A literature review of other nations shows inconsistent research findings. United Kingdom Armed Forces studies report little or no relationship between multiple deployments and mental health, problems at home or retention. United States Army studies have reported detrimental effects of multiple deployments for combat operations and no negative effects of multiple deployments for peace keeping deployments. 5. Existing research within the Australian Defence Force has shown a positive relationship between the number of multiple deployments and mental health and organisational indicators. Personnel report an increase in morale, and decrease in rates of psychological distress and post traumatic stress symptoms. Page 1

2 Ref: CJHLTWOUT/201 OlAF The Military Health Outcomes Program will provide a detailed understanding of the impact of multiple deployments on both physical and mental health. As at 1 October 2010, 33% of personnel have completed the questionnaire with data collection continuing until December While the current response rate exceeds most international studies there are not enough junior ranks represented in the study. Joint Health Command is working with the single Services to increase the participation rate of junior personnel. Sensitivity: 7. Nil. Resources: 8. ]VIA. Consultation: 9. 1 st Psychology Unit. Attachments: A. Background information on multiple deployments and mental health. P. V. Alexander CJHLTH / SGADF... WARREN SNOWDON 1 1 Page 2

3 BACKGROUND INFORMATION ON MULTIPLE DEPLOYMENTS AND MENTAL HEALTH 1. Over the past decade the Australian Defence Force has experienced a surge in involvement in overseas military operations. These include multinational peacekeeping missions, humanitarian assistance missions and combat operations. The current operational tempo has resulted in military personnel spending an increased amount of time away from home including for some multiple deployments. Incidence of multiple deployments in the Australian Defence Force 2. The incidence of multiple deployments have been obtained from the Military Health Outcomes Program (MilHOP; a major health and mental health prevalence study being coordinated by Joint Health Command) data. The figures are based on a preliminary sample of members who deployed between 1997 and 2010, with data continuing to be collected. Table 1, shows almost two thirds of members have not been on a deployment, and another 17% have only been on one deployment. This leaves, 22.2% of the population who have been on multiple deployments. Table 1. Number and percent of multiple deployments in MilHOP sample.i Number of I I I deployments 0 Frequency 5658 Percent I 6 or more I Table 2, shows the Air Force have the smallest proportion of members on multiple deployments, with 82.7% reporting no deployment experience. Army members are more likely to report multiple deployments compared to the other two Services, with 32.4% reporting more than one deployment (Navy = 22.6%, Air Force = 7.5%). The Navy show the highest proportion of members reporting six or more deployments, at 6.2%.

4 Table 2. Number of multiple deployments by service Total or more % International literature 4. International literature on the impact of multiple deployments on mental health has proven to be inconsistent. Findings from a 2005 study on United States soldiers into the impact of length and frequency of non-combat deployments on mental health, found having been on a previous deployment reduced incidence of depression and posttraumatic stress. This supported the notion of stress inoculation, whereby training and exposure to stressors can enhance performance when re-exposed to similar environments and stressors (Adler, Huffman, Bliese, Castro, 2005). 5. Findings from the United States Army Surgeon General's Mental Health Advisory Team report suggest that soldiers on their second or thirdfourth deployment to Iraq (2008) and Afghanistan (2009) are more likely to report significantly more mental health problems (in terms of depression, anxiety or acute stress symptoms) than soldiers on their first deployment. The study also found that those soldiers on their second or thirdfourth deployments had significantly lower morale and more marital issues than soldiers on their first deployment. Similar results were published by Kline et a1 (2010) who found previously deployed New Jersey soldiers were three times more likely to screen positive to Post Traumatic Stress Disorder. The discrepancy across the above United States studies may be a result of the type of deployment in each study (combat vs non-combat) or the method of analysis (i.e. previous deployment vs no previous deployment; or the number of previous deployments). 6. A United Kingdom study based on the first phase of a cohort study of armed forces personnel deployed to Iraq in early 2003 found no association between number of deployments and problems at home or intention to stay in the armed forces (Rona, et al., 2007). Some evidence was found for an association between number of deployments and caseness on the posttraumatic stress disorder checklist and multiple physical symptoms, but the associations were non-significant (Rona, et al., 2007). A more recent United Kingdom study examining multiple

5 deployments in personnel deployed to Iraq and Afghanistan between 2003 and 2009 concluded no significant relationship between multiple deployments and mental health concerns (Fear, et al., 2010). Existing multiple deployment research in the Australian Defence Force A Joint Health Command technical brief investigated data from 2 1,744 Australian Defence Force personnel deployed to the Middle East Area of Operation from 2002 to 2007 to understand the impact of multiple deployments on mental health and morale of our deployed forces (Curtis, 2008). The study showed that negative mental health outcomes, measured when members were returning home, actually decreased slightly as the number of deployments increased. The difference between those who had deployed once, and those who had deployed multiple times was statistically significant, although of very small effect size suggesting it is of very limited practical difference. 8. Similarly, the study showed a slight improvement in morale and an increase in personnel reporting a desire to serve out a long term service career, as the number of their deployments increased. This difference was not statistically significant. 9. In an unpublished Australian Defence Force study exploring results from the Profile of Unit Leadership, Satisfaction and Effectiveness survey, Goyne (in press) found no difference in reported anxietyldepression symptomatology between the non-deployed and multipledeployment Army groups. Individuals who had been deployed once or more reported significantly higher work motivation than individuals who had never been deployed. Similarly, individuals with one deployment reported feeling more valued by their unit than the nondeployed group, although there was no difference between the multiple deployed members and all other groups. The results suggested that job satisfaction, as defined by a range of positive factors, including how much an individual enjoys the work they do and feeling valued by one's unit, are potentially protective factors for Army personnel who experience one or a number of deployments. Continued research 10. The Australian Defence Force has recognised a need for further research into the effects of multiple deployments on the mental health of its troops, and with the Military Health Outcomes Program study currently underway, this need has been actioned. 11. The Military Health Outcomes Program officially commenced on 23 April 2010 and two of its studies are the Middle East Area of Operations Study and the Health and Wellbeing Study (or Mental Health Prevalence Study). These two studies will determine the effects of deployment and multiple deployments on the health of Australian Defence Force personnel. 12. Data collected through the Military Health Outcomes Program will provide invaluable information on the effects of multiple deployments on the mental health of Australian Defence Force personnel. This is particularly important given the increasing operational tempo and subsequent likelihood of multiple deployments. The information collected through these studies will not only inform policy and the establishment of health priorities and early intervention programs, but will also ensure the adverse effects of multiple deployments are minimised to maintain the capability, deployability and overall quality of life of current Australian Defence Force members. Conclusion 13. The effects of multiple deployments on Australian Defence Force personnel remains largely unclear, although preliminary investigations suggest there are few, if any, negative mental health outcomes. Experience from previous deployments may actually prove to be beneficial for re-deploying members. Emerging research is beginning to suggest the amount of respite

6 period between deployments may be more important than the length or frequency of deployments. Data from the Military Health Outcomes Program study will further the Australian Defence Force's understanding of how multiple deployments may impact the health of our deployed personnel. References: Adler, A.B., Huffman, A.H., Bliese, P.D., & Castro, C.A. (2005). The impact of deployment length and deployment experience on the well-being of male and female military personnel. Journal of Occupational Health Psychology, 10, (2), Curtis, A. (2008). The impact of multiple deployments on mental health, morale and career intentions: ADF personnel deployed to the middle east area of operations PTRG Technical Brief 21/2008. Canberra: Department of Defence. Fear, N., Jones, M., Murphy, D., Hull, L., Clversen, A., Coker, B...Wessely, S. (2010). What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. The Lancet. 375(22). Goyne, A. (in press). Impact of multiple deployments: Results of the combined Army PULSE. PRTG Technical'BrieJ: Canberra: Department of Defence. Kline, A., Falca-Dodson, M., Sussner, B., Ciccone, D., Chandler, H., Callahan, L., and Losonczy, M. (2010). Effects of repeated deployment to Iraq and Afghanistan on the health of New Jersey Army National Guard Troops: Implications for military readiness. American Journal of Public Health. 1 OO(2). Mental Health Advisory Team (MHAT) V. Operation Iraqi Freedom 06-08, chartered by the Office of the Surgeon General Multi-National Forces-Iraq and Office of the Surgeon General United States Army Medical Command, 14 February 2008, available on Mental Health Advisory Team (MHAT) VI. Operation Enduring Freedom 2009, chartered by the Office of the Command Surgeon US Forces Afghanistan and Office of the Surgeon General united States Army Medical Command, 6 November 2009, available on Rona, J., Fear, N., Hull, L., Greenberg, N., Eamshaw, M., Hotopf, M., and Wessely, S. (2007). Mental health consequences of overstretch in the UK armed forces: first phase of a cohort study. BMJ, 335(7620):603.

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