The Psychological Well-Being of Finnish Peacekeeping Veterans Post-Deployment

An Overview of the Finnish Defence Forces

The Finnish military is collectively known as the Finnish Defence Forces, and its primary purpose is as the military defense of Finland. This includes the land, maritime, and airspace territory of the country, as well as the upholding of lawful order in the Finnish society. The Finnish Defence Forces are responsible for all military training in Finland, the most significant of which is the training of approximately 22,000 conscripts each year. The Finnish Defence Forces also support other authorities in maintaining order and security as well as participating in rescue operations. Internationally, the Finnish Defence Forces participate in multinational regional monitoring and crisis management (Puolustusvoimien henkilöstöstrategia, 2015).

The Finnish Defence Forces comprised of approximately 12,000 permanent job positions in 2015, of which 8,000 were military positions and 4,000 civilian positions. Wartime units are divided into rapid response units and primary units based on their readiness level, as well as into operative, regional, and local forces based on the requirements placed on the units. In total, the wartime strength of the Finnish military is approximately 280,000 soldiers, most of whom are reservists. Every reservist and currently serving employee of the Finnish Defense Forces has been assigned a wartime unit, and the skills required to maintain readiness for those units are regularly trained, for example, via refresher exercises for reservists (Puolustusvoimien henkilöstöstrategia, 2015).

In a military context, “veteran” refers to a person who has participated in a conflict and survived it. “War veteran” is a generally applicable term for these persons. In a colloquial Finnish context, “war veteran” most typically refers to veterans of the Second World War. Crisis management operations refer to activity aimed at maintaining and developing peace. In Finland, any person who has passed military training may apply to crisis management operations. Both reservists and full-time employees of the Finnish Defence Forces participate in crisis management operations globally, organized by NATO, the United Nations, and the European Union. “Crisis management veteran” or “peacekeeping veteran” refers to a person who has participated and survived such an operation (Puolustusvoimat.fi). In this study, the terms “peacekeeping veteran” and “peacekeeping operation” are preferred to maintain a distinction between military and civilian crisis management operations, as well as to maintain congruence with other research literature on the subject.

Mental Health of Peacekeeping Veterans

International peacekeeping operations often take place in environments in which frequent exposure to high levels of stress is likely. Most participants of such operations tolerate the demands of such environments well, and experience no more psychological distress post-deployment than the general population does (Sareen et al., 2010). However, an association between peacekeeping operations and higher risk of psychological symptoms has been established in research literature (e.g., Kaikkonen & Laukkala, 2016; Souza et al., 2011). The most common psychological issues peacekeeping veterans face include posttraumatic stress disorder (PTSD), depression, anxiety, insomnia, and substance abuse. In a study by Forbes et al. (2016), over 30% of peacekeeping veterans reported psychological problems, including a higher risk of suicide and a PTSD incidence 3 times higher than in the general population. Research on the incidence of PTSD in peacekeeping veterans provides mixed results, but it has been proposed that 2–8% of peacekeeping veterans suffer from some degree of posttraumatic symptoms within 3 years of the deployment ending (Pearn, 2000). In general, most psychological symptoms tend to present within a year of returning home (Kaikkonen & Laukkala, 2016), but trauma-related symptoms may take significantly longer to present (Bonanno, 2008), with studies indicating onset of PTSD symptoms sometimes presenting after 18 months (Gray et al., 2004), and heightened overall psychological distress years, even decades after the peacekeeping operation (Forbes et al., 2016; Gjerstad et al., 2020; Hoge et al., 2004; O’Toole et al., 1996; Kulka, 1990).

Research on the topic has also identified events during the deployment that predict psychological symptoms developing later (e.g., Sareen et al., 2007). These potentially traumatic events often involve acute, high-strain situations. For example, a direct attack and being in a combat situation have been associated with significantly higher risk of PTSD and other psychological problems later in life (Hoge et al., 2004). Studies have also indicated a link between the number of peacekeeping operations a person participates in and psychological problems (Sareen et al., 2010). For example, the risk for severe depression increased as the number of peacekeeping operations increased, and the risk had doubled after just two deployments (Forbes et al., 2016). Finally, the process of returning home from a peacekeeping deployment as well as life immediately after deployment are highly stressful, often even more stressful than the deployment itself (Anttila, 2019), which highlights the importance of long-term monitoring.

Methods

Results

Discussion

This study examined the psychological well-being of Finnish peacekeeping veterans post-deployment and assessed possible contributing factors during deployment. A total of 2,317 veterans of peacekeeping operations took the survey within 3 months post-deployment on average. The survey was divided into the following categories: background information, job strain during the operation, potentially traumatic events during deployment, and post-deployment symptoms. Clinical cutoff points were determined for each of the post-deployment symptom measures, which for posttraumatic symptoms were exceeded by 3 respondents, for feelings of stress by 66, for depression by 59, for sense of coherence by 167, and for alcohol risk use by 634 respondents. Of all respondents, 203 reported experiencing a traumatic event related to their deployment, which was associated with increased posttraumatic symptoms and feelings of stress post-deployment. The various forms of job strain reported by the peacekeeping veterans were associated with symptoms of depression, feelings of stress, as well as post-deployment sense of coherence. Sixty-three respondents reported being the victims of bullying during their deployment, which was associated with higher posttraumatic symptoms, feelings of stress and depression, and lower sense of coherence post-deployment. Alcohol use was associated with depression, feelings of stress, and lower sense of coherence. Finally, in the open comments section of the survey, respondents brought up leadership-related issues, problems with logistics, and facing challenges adapting back to everyday life after deployment, but many positive experiences were also described.

On the whole, Finnish peacekeeping veterans generally manage well post-deployment. The levels of depression and posttraumatic symptoms remained below the civilian population of averages (Huttunen, 2018; Käypä Hoito, 2022). The use of alcohol by the peacekeeping veterans in this study was fairly, normally distributed, with the proportion of respondents exceeding the clinical cutoff point for increased risk of alcohol use disorder (29.6%) not differing significantly from the general Finnish working-age population (Finnish Institute of Health and Welfare, 2020). Taking the effect of age into account, the level of sense of coherence among the respondents in this study did not present obvious cause for concern when comparing to the mean levels of sense of coherence among Finnish conscripts (Kronström et al., 2021) or Swedish young adults (Lindmark et al., 2009). For the feelings of stress scale, no civilian population means can be found; however, the findings of this study were in line with findings in earlier studies of peacekeeping veterans in the 21st century (Leskinen, 2011).

Analysis of the feelings of stress measure used in the study raised some concerns: the measure is strongly correlated with the DEPS scale for measuring depression, and factor analysis shows both scales to be unidimensional. This may be explained due to the similar contents of the questions in both scales. For example, the feelings of stress scale contains questions directly pertaining to depression. On the other hand, stress and depression as phenomena have been found to be associated (Hewitt et al., 1992). It is worth noting, however, that another commonly used measure of stress, the Perceived Stress Scale (PSS), consists of two distinct dimensions of strain and coping (Hewitt et al., 1992), while factor analysis showed the feelings of stress scale to unidimensionally focus on the symptoms of stress. It may be that the stress measure used in this study fails to capture all aspects of the phenomenon of stress, and may struggle to justify its future inclusion in the survey alongside the depression scale.

A total of 86.2% of the respondents experienced at least one aspect of adapting to new local environments particularly straining. The most commonly experienced challenges were related to lack of privacy and communication with loved ones at home. These challenges were associated with post-deployment symptoms on multiple scales. In future deployments, offering sufficient chances of communicating with loved ones at home, and possibly being able to allocated private rooms where peacekeepers may at least occasionally spend time alone could be an efficient way to alleviate strain and negative outcomes related to the new, often very different environment that peacekeepers are placed in.

Work community was considered particularly straining by 29.5% of the respondents and was associated with various post-deployment symptoms. One of the most reported issues was related to the unequal treatment of reservists and commissioned staff, which was additionally raised as a theme in the open comment section of the survey. One respondent described unequal disciplinary action for reservists and commissioned staff in cases of alcohol-related misdeeds. It is important to identify the dominant cultural aspects that maintain the dichotomy of reservists and commissioned staff and change the relevant behavior or thought patterns, as experienced injustice at the workplace is associated with various psychological symptoms (Okechukwu et al., 2014; Virtanen et al., 2018). Other straining factors reported were related to intercultural responsibilities and leadership during deployment: the open comment section provided specific examples of unhappiness related to cooperation with some other peacekeeping contingencies. Specific training or interventions aimed at creating an equal, multicultural work culture could be a significant boost to the well-being of peacekeeping personnel. Knowledge and understanding of the cultures and practices surrounding the peacekeeping operation are important both from the perspective of the peacekeepers themselves as well as the local population, as it improves communication and cooperation and reduces intergroup conflicts (Holohan, 2019).

Becoming the victim of bullying during peacekeeping deployment was a significant predictor of decreased psychological well-being post-deployment. The association between bullying and psychological symptoms was not significantly dependent on the amount of bullying experienced, with even infrequent bullying significantly predicting increased symptoms post-deployment. In research literature, bullying in military environments was been found to associate with higher levels of stress, anxiety and insomnia, as well as lower personnel cohesion and job performance on the organizational level (Stuart & Szeszeran, 2021). The issue is further complicated by a prevalent culture of silence surrounding such cases, both reducing the likelihood of reporting incidents of bullying as well as the likelihood of appropriate action being taken to intervene. Possible ways to decrease bullying may include clear guidelines that individuals in leadership positions strictly adhere to and show example of, as well as increased education and monitoring of possible bullying incidents.

Another interesting finding was that the respondents who described their deployment as a positive experience were more likely to be exposed to potentially traumatic events during their deployment, but did not exhibit significantly higher posttraumatic symptoms, nor did they experience significantly more likely events that they did consider traumatic (as per the description presented in the clinical symptoms scales section). This may indicate that a certain degree of threatening situations during a peacekeeping deployment prevent feelings of boredom and frustration, and perhaps reinforce the peacekeepers’ preconceived notion of what a peacekeeping deployment looks like. This idea is supported by the finding that the respondents who expressly described their deployment as a positive experience were also more likely to have reported “wanting to do something meaningful” as their primary motivation for participating in the operation: being exposed to more threatening situations may reinforce the experience of meaningfulness.

The AUDIT-C failed to reach acceptable levels of reliability in this sample. This finding is surprisingly, as both in Finnish (Castrén et al., 2018) and Swedish (Lundin et al., 2015) populations the reliability of AUDIT-C has reached at least acceptable levels (α > .60), and in studies of military personnel in particular (e.g., Bartone et al., 2017; Currier et al., 2018) the AUDIT-C has reached good reliability levels (α > .75). The low reliability in this study suggests a need to utilize a more extensive screening of alcohol use behavior in future surveys, as alcohol risk use was by far the largest type of post-deployment symptom identified in this study.

Almost three-quarters of the respondents took the survey within 3 months of returning from their peacekeeping deployment. For the Trauma Screening Questionnaire, this may be too short of a timeframe: studies indicate that most mental health problems related to peacekeeping operations manifest within a year of discharge (e.g., Kaikkonen & Laukkala, 2016), many symptoms may not present themselves until even later (Bonanno, 2004). In a study by Gray et al. (2004), a small but significant number of veterans developed clinically significant symptoms of PTSD after 18 months of returning, despite not reporting particularly high levels of stress in earlier follow-ups. Thus, the true number of peacekeeping veterans at high risk of developing PTSD (3 respondents fulfilled the criteria) may not be accurately identified in this sample due to the short time period between returning from the peacekeeping deployment and taking the survey.

This study utilized a modified version of Antonovsky’s (1993) Sense of Coherence scale. Using the clinical cutoff point derived from an earlier peacekeeping study (Leskinen, 2011) a total of 167 respondents showed increased challenges related to sense of coherence in life. While younger age and lower level of education have been identified as predictors of lower sense of coherence (Antonovsky, 1993) on their own without a clear link to clinically significant symptoms, other studies focusing on conscripts or professional soldiers have found associations between sense of coherence and clinical symptoms (e.g., alcohol use, self-harm, psychiatrict disorders, drug abuse). This suggests the scale is clinically meaningful even in the more selective sample used in this study.

In general, the use of clinical cutoff points in this survey was primarily motivated by the ability to refer the respondent to a social curator in case of higher levels of symptoms or risk factors. From this viewpoint, a certain degree of overlap between measures is acceptable and functions as a way to lower the threshold for contacting social services. Another way to lower this threshold and successfully identify and reach the persons in need of professional social support would be to add a direct question to the survey, asking whether the respondent feels that they want to or need to talk to a social curator. This way, each respondent could easily access social support if they feel the need for it regardless of whether they exceed a cutoff point in one of the five measures used. Conversely, the use of clinical cutoff points serves to identify those respondents, who have significant levels of symptoms but have not recognized the need for social support or for another reason have not previously contacted social services.

Competing Interests

The authors have no competing interests to declare.