Long-Term Effects of Peacekeeping Deployment on Mental Health

Christer Lunde Gjerstad

The United Nations has been conducting peacekeeping operations for close to seven decades. Despite this, we still know little about the long-term effects of peacekeeping deployment on mental health (Forbes et al., 2016). For many of us, the name “peacekeeping operations” may be synonymous with the absence of wartime stressors. However, studies have shown that peacekeepers are frequently exposed to a range of potential stressors that may impact their mental health (Loscalzo et al., 2018). It is well documented that participation in peacekeeping missions poses a risk of subsequent problems. Depression, anxiety, alcohol- and drug misuse, insomnia and posttraumatic stress disorder (PTSD) are among the most frequent conditions affecting soldiers returning from peacekeeping missions (Kaikkonen & Laukkala, 2016; Souza et al., 2011). 

The UNIFIL Study – Long-Term Monitoring of Mental Health

The United Nations Interim Force in Lebanon (UNIFIL) is one of the longest standing peacekeeping operations in history. What was originally intended as a short-term intervention to assist the Israeli withdrawal in 1978, would eventually prove to last for several decades. The mission was far more complicated than expected, as acts of war were repeatedly committed by both sides (Strømmen & Leraand, 2005). During the first three decades of UNIFIL, Norway was one of the largest troop contributors with more than 20,000 soldiers. Recently, the Norwegian Armed Forces Joint Medical Services (2016) did a health survey of all its former UNIFIL peacekeepers. With an average follow-up time of almost three decades, this survey provides unique insights into the long-term effects of peacekeeping deployment.

How Are They Doing Three Decades After Deployment?

On the whole, the survey results showed that most peacekeepers (84.9%) reported few symptoms of common mental health problems three decades after deployment (Gjerstad et al., 2020). Considering that this group is frequently portrayed by the media as “damaged goods” and often pathologized by the public, this is an important clarification. Nevertheless, an estimated 15.1% did report symptoms consistent with drug misuse (0.1%), alcohol misuse (3.4%), depression (4.0%), PTSD (6.2%), anxiety (6.4%), and/or insomnia (9.3%). This illustrates that long-term assessment is useful to identify peacekeepers who struggle and to uncover what types of problems they face. Such knowledge may provide grounds for tailoring appropriate interventions and future health care procedures for this population.

Factors Associated with Mental Health Problems

By applying regression analyses to the survey data, Gjerstad and colleagues (2020) identified key risk factors for long-term mental health problems. Perhaps surprising to some, post-deployment stressors showed the strongest link to current problems. Besides post-deployment stressors, current unemployment was also a significant risk factor for mental health problems. Although traumatic exposure during deployment were positively associated with problems, this relationship was weaker. Thus, without downplaying the role of deployment stressors, our results suggest that stressors experienced in one’s civilian life after homecoming are central in the development of long-term mental health problems.

Both civilian- and military education protected against long-term PTSD; higher education equaled less risk of PTSD. Contrary to our expectations, this was not true for the other mental health problems. Highest rank during deployment was, however, protective of all mental health problems. Finally, time since deployment was negatively related to all mental health problems, except PTSD. The more years that had passed since deployment, the less likely a peacekeeper was to report symptoms of anxiety, depression, insomnia or alcohol-/drug misuse.

What Does This Mean for Future Peacekeepers?

Historically, mental preparations for peacekeeping missions have focused on how to prevent or cope with typical stressors experienced during deployment. Although this is undoubtedly important, our findings indicate that post-deployment stressors may play a highly significant role for the long-term mental health of peacekeepers. Consequently, future generations of peacekeepers should to a greater extent be educated and prepared for challenges they may face in the years following homecoming. Moreover, the Armed Forces should facilitate mechanisms that ease the military-civilian transition and increase the likelihood that former peacekeepers remain part of the national workforce. Reducing stigma surrounding peacekeepers’ mental health may be an important step in this direction.

References

Forbes, D., O’Donnell, M., Brand, R. M., Korn, S., Creamer, M., McFarlane, A. C., Sim, M. R., Forbes, A. B., & Hawthorne, G. (2016). The long-term mental health impact of peacekeeping: prevalence and predictors of psychiatric disorder. BJPsych Open, 2, 32-37. https://doi.org/10.1192/bjpo.bp.115.001321

Kaikkonen, N. M., & Laukkala, T. (2016). International military operations and mental health - a review. Nordic Journal of Psychiatry, 70, 10-15. https://doi.org/10.3109/08039488.2015.1048718

Loscalzo, Y., Giannini, M., Gori, A., & Fabio, A. D. (2018). The wellbeing of Italian peacekeeper military: psychological resources, quality of life and internalizing symptoms. Frontiers in Psychology, 9, 103. https://doi.org/10.3389/fpsyg.2018.00103

Norwegian Armed Forces Joint Medical Services. (2016). UNIFIL-undersøkelsen 2016. En etterundersøkelse av norsk militært personell som tjenestegjorde i Libanon i årene 1978-1998. [The UNIFIL study 2016. A survey of Norwegian military personnel who served in Lebanon from 1978-1998]. Institute of Military Psychiatry. https://forsvaret.no/aktuelt_/ForsvaretDocuments/UNIFIL-undersoekelsen%202016.pdf

Souza, F. W., Figueira, V. I., Mendlowicz, M. M., Volchan, C. F. E., Portella, S. F. C., Mendonça-De-Souza, S. F. A., & Coutinho, S. F. E. (2011). Posttraumatic stress disorder in peacekeepers: a meta-analysis. The Journal of Nervous and Mental Disease, 199, 309-312. https://doi.org/10.1097/NMD.0b013e3182175180

Strømmen, W., & Leraand, D. (2005). I kamp for fred. UNIFIL i Libanon - Norge i UNIFIL, 1978-98. [Fighting for peace. UNIFIL in Lebanon - Norway in UNIFIL, 1978-98]. Gazette Bok AS.

Reference Article

Gjerstad, C.L., Bøe, H.J., Falkum, E., Martinsen, E.W., Nordstrand, A.E., Tønnesen, A., Reichelt, J.G. and Lystad, J.U. (2020), Prevalence and Correlates of Mental Health Problems in Norwegian Peacekeepers 18–38 Years Postdeployment. Journal of Traumatic Stress, 33: 762-772. https://doi.org/10.1002/jts.22578

Questions for Discussion

1. Are most peacekeepers struggling with long-term mental health problems following deployment?

2. What is the importance of post-deployment stressors on long-term mental health?

About the Author(s)

Christer Lunde Gjerstad, Clinical Psychologist, is a researcher at the Institute of Military Psychiatry of the Norwegian Armed Forces Joint Medical Services, and a PhD student at the University of Oslo, Norway. His research focuses primarily on the mental health of military personnel. Other research interests include the application of emerging technologies, such as virtual reality (VR), in the treatment of mental health problems.