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The psychiatric consequences of physical injury in military personnel: predicting and managing the risk
  1. Alexander C McFarlane
  1. Correspondence to Professor Alexander C McFarlane, Centre for Traumatic Stress Studies, University of Adelaide, Level 2/122 Frome Street, Adelaide, SA 5000, Australia; alexander.mcfarlane{at}adelaide.edu.au

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Stevelink et al's1 review of the comorbidity between physical injury and mental disorders is a timely reminder of the challenges involved in rehabilitating injured military personnel. It is critical that there is ongoing systematic screening for psychiatric disorders in combat injured service personal because of the role that depression, post-traumatic stress disorder (PTSD) and anxiety have in further increasing the disability in individuals who are already facing significant challenges in their rehabilitation.

The high rates of psychiatric disorder reported by Stevelink et al1 are not surprising, given the proximity and risk of death that must accompany many of the injuries described, particularly traumatic amputations. The physical injury further adds a reality to the confrontation with death that has become imprinted on the individual's mind and then is replayed in the traumatic memories that represent a major driver to psychopathology.

As the authors highlighted, the timing of the assessment is an important issue to consider in studies of comorbid physical and psychiatric injury. Psychological morbidity can have a delayed onset2 and as such the assessment time frame might account for the variable prevalence of disorder in the studies of this review. For example, Grieger et al …

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