Stress in The Indian Armed Forces: How True and What To Do?: Editorial
Stress in The Indian Armed Forces: How True and What To Do?: Editorial
Stress in The Indian Armed Forces: How True and What To Do?: Editorial
Stress in the Indian Armed Forces: how true and what to do?
Surg Cmde VSSR Ryali*, Col PS Bhat+, Kalpana Srivastava#
MJAFI 2011;67:209–211
Correspondence: Surg Cmde VSSR Ryali, Professor and HOD, Department Combat stress manifests as acute stress reaction, adjustment
of Psychiatry, AFMC, Pune – 40. disorder and post traumatic stress disorder (PTSD). The conse-
E-mail: ryalisubbarao@yahoo.co.in
quences of chronic stress can be in the form of physical and
doi: 10.1016/S0377-1237(11)60041-5 psychological symptoms like headaches, bodyaches, tiredness,
reduced sleep or appetite, and lethargy. Chronic stress may also above cut-off in 23.3% children on the child behaviour check list,
manifest as psychosomatic disorders or psychiatric illnesses. they did not find any significant increase in the behavioural prob-
Evaluation of 601 polytrauma patients at one of the service lems among children of personal posted in field areas. This can be
hospitals revealed incidence of PTSD as 24.3%.7 However, no attributed to the successful implementation of the rotation policy
standardised scale for PTSD was used in this study. A series of between field and peace, which the Indian Army adopts for its
140 limb fracture patients at a service hospital reported signifi- soldiers. All the above discussed studies were cross-sectional. A
cantly higher scores on general health questionnaire, Michigan longitudinal follow up of Army personal engaged in CI Ops with
alcoholism screening test, Carroll rating scale for depression, a self made personal questionnaire, multidimensional fatigue
impact of events scale, and fatigue scale.8 The limb fracture pa- inventory, perceived stress questionnaire, PEN inventory, AFMC
tients also had a high prevalence of alcohol dependence/abuse life events questionnaire, general health questionnaire, state-trait
and depressive disorders. The above were hospital based cross- anxiety inventory, Carroll rating scale for depression, Michigan
sectional studies done on in patients and cannot be generalised alcoholism screening test and Impact of events scale for two
to soldiers in the field. In a second set of studies, a researcher years with all scales being administered at six monthly intervals,
reported that troops deployed in counter insurgency operations found significant increases in general and fatigue and certain
(CI Ops) showed higher and significant signs of stress indicators other parameters during the period of service in CI Ops.14
such as use of alcohol, unfavourable response to tasks, dimin- Data from annual health reports does not show any significant
ished efficiency, frustration, maladjustment, tension, isolation increase in the decadal trends of three psychosomatic and life
and depression.9 Standardised scales were not used in this study. style disorders, namely ischemic heart disease (IHD), essential
Another study in this set assessed stress and job satisfaction of hypertension (EHT), and obesity during the previous decade.
soldiers in CI Ops using the Taylor’s manifest anxiety scale and There is no significant increasing trend discernible in the invalid-
security/insecurity inventory developed earlier.10 Use of stan- ment rates due to mental disorders and injuries during the same
dardised scales in a study showed high psychiatric morbidity, period either.15
depression and alcoholism in soldiers in low intensity conflict
(LIC), but the study lacked a control group.11 A third set of studies
reported the effects of soldiering and terrorism on children of COPING WITH STRESS
Armed Forces personal. One such study on 16 children injured
in a terrorist attack, found that five suffered acute stress reaction Soldiering is stressful and evidence exists regarding the stress
of which three recovered with crisis intervention while two suf- consequences on Indian soldiers. However there is no evidence
fered persistent scholastic backwardness on review after one to suggest a stress epidemic in the Indian Armed Forces nor is
year.12 A study published in this issue assessed behavioural there any evidence of increasing stress related illnesses over the
problems of 150 children of service personal in a field area and last decade. Reports in lay press on suicides and fratricides tend
compared them with equal number of children from a peace to be sensationalised and fail to report the relative low rates of
area.13 Interesting findings in this study were that the soldiers suicide in the Armed Forces compared with matching samples of
from the field and peace areas did not differ significantly in life civilian population. How are the Armed forces managing stress at
events past year (LEP) and life events life time (LELT) on the the organisational level? A flurry of welfare measures (Table)
AFMC life events scale. Though the authors reported scores unveiled in the last decade seem to have had an effect in
Table Measures in the Indian Armed Forces to deal with combat stress.
• Liberalised leave policy including provision to avail full casual leave at one go.
• Increased provision of free warrants to home town from field areas to twice a year.
• Thrust on provision of maximum government family accommodation in peace areas by completion of married accommodation projects (MAP).
• Enhanced officer–soldier interaction.
• Establishment of Rest and Recoup Centres in operational areas.
• Improved financial condition following last pay revision.
• Significant enhancement of hardship related allowances.
• Establishment of educational institutions for the wards of the soldier under Army Welfare Education Society.
• Recognition of various technical trades by collaboration with various Universities.
• Establishment of placement cells at regimental centres for better post retirement prospects.
• Modification of pay distribution method by direct collaboration with banks.
• Establishment of effective and faster grievance redressal by establishing Armed Forces Tribunals.
• Establishment of railway booking centres even at forward areas.
• Measures to make online train reservation at unit level obviating the use of warrants/concession forms.
• Creation of pool of trained counsellors at unit level by ongoing training programmes for RT JCOs and NCOs at psychiatric centres.
containing the exceptionally high level of stress faced by the 5. Singh G, Kaur D, Kaur H. Presumptive stressful life events scale (PSLE).
Indian soldier due to ongoing counter insurgency. Is this enough a new stressful life events scale for use in India. Ind J Psychiatry
and is everything perfect? Indian studies in this field have been 1984;26:107–114.
sporadic and scanty when compared to the large number of 6. Raju MSVK, Srivastava K, Chaudhury S, Saluja SK. Quantification of
studies from Vietnam, Somalia, Kosovo and the ongoing opera- stressful life events in service personal. Ind J Psychiatry 2001;
tions in Iraq and Afghanistan, which are freely available in in- 43:213–218.
dexed psychiatric and combat journals or as service published 7. Saldanha D, Goel DS, Kapoor S, Garg A, Kochhar HK. Post-traumatic
monographs. Service psychiatry in the Indian Armed Forces is stress disorder in polytrauma cases. MJAFI 1996;49:7–10.
largely hospital based and this is reflected in the large number 8. Chaudhury S, John TR, Kumar A, Singh H. Psychiatric evaluation of
of studies on patient populations which cannot be generalised limb fracture patients. MJAFI 2002;58:107–110.
to the soldier in the field. Most combat psychiatric research 9. Puri SK, Sharma PC, Naik CRK, Banerjee A. Ecology of combat fatigue
work from the USA and Europe is done by psychiatrists posted among troops engaged in counterinsurgency operations. MJAFI
in field units. It is perhaps time to experiment with a few field 1999;55:315–318.
psychiatric units in the operational commands of the Indian 10. Asnani V, Pandey UD, Chaudhary PN, Singhal SNP, Tripathi RK, Boro
Army. This experiment with field psychiatric units can be com- SR. Stress and job satisfaction among soldiers operating in counter-
bined with centrally directed integrated research projects to insurgency areas. DIPR Note No. 562. 2001:3–33.
improve yield in combat psychiatry. 11. Chaudhury S, Chakraborty PK, Pande V, John TR, Saini R, Rathee SP.
Impact of low intensity conflict operations on service personnel.
Ind Psychiatry J 2005;14:69–75.
REFERENCES 12. Harjai MM, Chandrashekhar N, Raju U, Arora P. Terrorism, Trauma
and Children. MJAFI 2005;61:330–332.
1. Selye H. Stress and psychiatry. Am J Psychiatry 1956;111:276. 13. Prabhu HRA, Prakash J, Bhat PS, Gambhir J. Study of events in serving
2. Holmes TH, Rahe RH. The social readjustment rating scale. personnel and its association with psychopathology in their children:
J Psychosomatic Res 1967;11:213–218. a multicentric study. MJAFI 2011;67:225–229.
3. Paykel ES. Scaling of life events. Arch Gen Psychiatry 1971;25: 14. Bhat PS, Mehta VK, Chaudhury S. Evaluation of psychological effects
340–347. of service in counter insurgency operations on soldiers. AFMRC
4. Dube S. Scaling life events-some issues in research on stress and ill- Project No. 3164/2003.
ness. Paper Presented at the Seminar on Stress, Anxiety and Mental 15. Annual Health Report for the Armed Forces India. Published by the
Health 1983; Allahabad: University of Allahabad. Director General Armed Forces, 2009.