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Advances in Environmental Biology, 8(6) Special 2014, Pages: 2869-2874
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Advances in Environmental Biology
ISSN-1995-0756
EISSN-1998-1066
Journal home page: http://www.aensiweb.com/aeb.html
Comparison of Quality of Life and Mental Health among Two Groups of Military
and Non- Military Personnel
1
Reza Nouri, 2Ali Fathi-Ashtiani, 3Khoda Bakhsh Ahmadi, 4Masood Gholam Ali Lavasani
1 PhD Student in Psychology Behavioral Sciences Research Center - University of Baghiyatallah of Medical Science - Tehran - Iran
2 PhD in Psychology Behavioral Sciences Research Center, Baqhiyatallah University of Medical Science. Tehran - Iran
3 PhD in Psychology Behavioral Sciences Research Center, Baqiyatallah University of Medical Science. Tehran - Iran
4 PhD in Psychology Department of Psychology, School of Psychology and Educational Sciences, University of Tehran, Tehran, Iran
ARTICLE INFO
Article history:
Received 15 April 2014
Received in revised form 22 May
2014
Accepted 25 May 2014
Available online 15 June 2014
Key words:
employees, mental health, quality of
life, military.
ABSTRACT
Objective: the present study aimed to compare quality of life and mental health of two
groups of military personnel and non- military in order to offer solutions for improving
mental health of the employees. Methods: sample size included 320 subjects who were
selected using available sampling method. Research tools included Millon Clinical
Multiaxial Inventory (MCMI-III), Short Form of World Health Organization Quality of
Life Questionnaire - (WHOQOL-BREF) and demographic Questionnaire. After the
questionnaires were filled out, collected data was analyzed using SPSS 18 and
statistical methods (frequency distribution, mean, standard deviation and t-test).
Findings: the participants were between 25 and 53 years old. Moreover, 84% of the
subjects were local people while 16% were not local. Furthermore, 82.06% were
married while 11.96% were single. Non- military had lower occupational status
compared to the same level military personnel. There were significant differences in
many areas of mental health and quality of life between two groups of military
personnel and non- military s. In other words, employees had lower mental health and
quality of life. Conclusion: High levels of mental health and quality of life among
military personnel could be due to implementation of training and sports programs and
special privileges given to these individuals compared to non- military . Furthermore, it
may be possible that individual employee rules regulations are either overshadowed or
neglected in the military environment. Therefore, officials should pay attention to this
highly important issue.
© 2014 AENSI Publisher All rights reserved.
To Cite This Article: Reza Nouri, Ali Fathi-Ashtiani, Khoda Bakhsh Ahmadi, Masood Gholam Ali Lavasani, Comparison of Quality of
Life and Mental Health among Two Groups of Military Personnel and Non- military. Adv. Environ. Biol., 8(6), 2869-2874, 2014
INTRODUCTION
We live in a period of time when public mental health is in crisis more than ever in spite of tremendous
progress in various fields of science and technology [1]. The Irish Mental Health Commission reported that
mental health services were developed and provided efficiently in 2012. It also noted that a special emphasis
should be put on public mental health [2]. Various definitions are provided for mental health. Nevertheless,
there is consensus on the issue stating that mental health is beyond what is defined as absence of mental
disorders. Even though many of us do not suffer from a specific diagnosable mental disorder, it is clear that
some of us are healthier than others in terms of mental health [3]. Mental health is defined as “individual
capability to create a harmonious relationship with others and the ability to change and modify our social
environment and properly and reasonably resolving our emotional conflict and meeting our personal desires”
[4]. Allport addressed following traits as characteristics of healthy individuals such as the ability to develop
ourselves, warm and intimate interests, sense of emotional security and self-acceptance, realistic perception of
our talents and abilities, sense of humor, and having a coherent philosophy of life such as religion [5]. Over the
past two decades, evidence has shown that development of military operations is associated with increased
mental disorders and reduced quality of life among military forces [6]. An overview of definition of quality of
life evidently indicates the relationship between dimensions of quality of life and mental health. World Health
Organization defined quality of life as individuals’ perception of their status in life considering cultural context
as well as the value systems where they live in relation to goals, aspirations, and priorities [7]. Research has
Corresponding Author: Reza Nouri, Behavioral Sciences Research Center - University Baghiatolah of Medical Science Tehran – Iran.
Tel.(+98)09198599419
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Reza Nouri et al, 2014
Advances in Environmental Biology, 8(6) Special 2014, Pages: 2869-2874
shown that reduced quality of life was effective in incidence of psychological problems. It has a significant
negative correlation with depression [8].
The results obtained from World Health Organization studies showed that over 450 million people have
psychological problems around the world nowadays [9]. However, women’s mental health problems are often
internalized such as an inner anxiety and depression.
On the other hand, most men’s problems are externalized such as drug use and antisocial behavior [10].
Ministry of Health in UK (1986) reported that approximately 22.8 million working days are lost due to
psychological disorders [11]. Predictably, depression may impose the highest rate of cost on health system after
heart disease in 2020. Meanwhile, both cross-sectional and longitudinal studies have shown that about 20 to 30
percent of people with physical problems suffer from psychological problems. In addition, studies have shown
that mean depression scores are statistically different between the two married and single groups. This showed
that married subjects are more depressed than single ones [12 -13]. Research conducted by the World Health
Organization showed that 20% of Iranian people suffer from mental disorders. In a study conducted in Iran, it
was shown that 21 percent of those people who are higher than 15 years old suffer from mental disorders in total
[14-15]. Paying attention to mental health is considerably important in military positions. Job stress, complex
missions, strict rules, being away from family, likelihood of disability, fear of defeat, imprisonment and even
death are cited as possible problems in military jobs, which are not likely to occur in non-military jobs.
Consequently, military jobs are associated with higher incidence of psychological problems [11]. Hammond
studied psychological effects of war during Civil War in America. He addressed following problems caused by
war such as nostalgia or pain of separation from the beloved one and country. At the same time, Da Costa
identified several symptoms and attributed these symptoms to soldiers’ irritable heart syndrome. This is
undoubtedly a type of mental irritation caused by anxiety and stress of the battle. This syndrome was first
introduced in the World War I. It was called effort syndrome since it was associated with long effort and rallies.
In addition, another disease called explosion shock caused by stress of the battle was studied at the same time
[16-17]. In the World War II, about 102 individuals of every 1000 wounded people were psychiatric patients
and suffered from illnesses. This was called “Battle Exhaustion Term”. Symptoms of this disease include
fatigue, palpitations, diarrhea, headache, impaired concentration, forgetfulness, and sleep disorders. In Vietnam
War, six percent of all the patients were evacuated to the rear due to mental illness. The most common disease
in this war was post-traumatic stress disorder. The main symptoms of this disease include difficulties in
interpersonal relationships, intimacy and sociability, coldness and devoid of emotion, aggression, social
isolation, irritability, sexual problems, problems with parents and parenting, dysfunction, family cohesion,
expressing emotions, reduced disclosure [16-17-18].
Finally, “Persian Gulf Syndrome” was introduced in the Persian Gulf War. Symptoms of this syndrome
include fatigue, headache, joint pain and skin rash [16]. Over the past two decades, evidence has shown that
development of military operations is associated with increased mental disorders and reduced quality of life [8].
In fierce fighting, military power is declined due to combat stress reactions. Glass (1973) reported that levels of
stress reactions to psychological war were between 10% and 48% in America's military casualties who
participated in battles of the World War II. He also stressed that the soldiers who were transferred to the rear due
to psychiatric issues exceeded the number of soldiers who were mobilized in America in 1943 [19-20]. Farsi
[21] and Sechi [22] conducted a number of studies on soldiers and stated that mental disorders are more
prevalent in soldiers compared to public people. Other research suggested that mood disorders and adjustment is
increasingly developing in military society recently [23].
Research conducted on Iranian army forces has shown that 24.4% of military personnel who attempted
suicide or self-mutilation had a history of mental disorder [24]. However, military people with mental disorders
are less likely able to adapt to new conditions. In a military system, a screening process allows identification of
vulnerable people who may not be in suitable military conditions [18].
Therefore, the present study aimed to to compare mental health and quality of life in two groups of military
personnel and non- military in order to offer solutions for improving the health of employees.
Method:
This is a descriptive - cross sectional study conducted in 2013. The statistical population included male staff
of an army force in country. Samples under study were colonized in terms of local and non-local variables, job
categories, work experience and educational level. Sample size was selected using available sampling method
proportional to statistical population. The sample was divided into two groups. Each group consisted of 320
patients (216 military personnel and 104 non- military s). Research tools included Millon Clinical Multiaxial
Inventory (MCMIII) used to assess mental health variables of the subjects, the World Health Organization
Quality of Life Questionnaire - Short Form (WHO Quality of Life – BRIEF), and a demographic questionnaire.
Million Clinical Multiaxial Inventory (MCMI):
This is a standardized self-assessment questionnaire. This was designed for18 years old adults and older
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than that who have at least an eighth-grade level of reading ability. The original version of this test was prepared
and designed by Theodore Millon in 1977. This was revised twice since then. Over six hundred articles were
either published about this questionnaire or used this inventory since the first print version.
It is one of the most widely used test in clinical practice. The current version of this inventory, i.e. IIIMCMI, includes 175 items. In total, this inventory includes 24 clinical scales and 4 validity indices. Among
these 24 scales, 14 scales assess personality disorders according to the second axis, i.e. DSM-IV, while 10 other
scales assess clinical syndrome based on the first axis. Internal consistency method was used to assess validity
of the test. This showed that the validity of the test is equal to 0.78. In addition, validity of this test was
compared to MMPI test using common measurable parameters. The correlation coefficient between these two
tests was reported higher than 0.75 [25].
Quality of Life Questionnaire - Short Form:
This questionnaire is used to assess quality of life. The World Health Organization in collaboration with 15
International Centre developed this questionnaire in 1989. It generally includes 26 questions in four areas in
which the first two questions do not belong to any of the above-mentioned areas and generally assess health
status and quality of life. Quality of life questionnaire has four subscales including physical health, mental
health, social health, safety of living environment. Each item is scores in a range between 1 and 5. The lowest
score denotes the worst status while the highest score shows the best status. The developers of this questionnaire
reported that Cronbach's alpha coefficient is between 0.73 and 0.89 for the four subscales and the total scale. In
Iran, Nasiri used three methods including retest with three weeks intervals, splitting and Cronbach's alpha to
evaluate reliability of the scale. The reliability coefficients were respectively as 0.67, 0.87 and 0.84 [26].
Preliminary tasks were done and consents of relevant officials were obtained for the sake of their
cooperation. For this purpose, the specified locations were visited in predetermined periods. The subjects were
divided in groups consisting of 50 individuals and necessary explanations were given to them. Then, the
questionnaires were distributed among them.
When questionnaires were filling out, the ambiguities were resolved as well. At the end, the filled out
questionnaires were collected. Obtained data was analyzed using SPSS 18 and statistical methods (frequency
distribution, mean, standard deviation and test-t).
Findings:
According to contents of Table 1, the participants were between 25 and 53 years old. The highest frequency
of education (51.1%) referred to higher than diploma degree while the lowest one (3.91%) referred to lower than
diploma degree. Moreover, 88.4% of the subjects were married while 11.96% were single. Furthermore, 84% of
the participants were local while 16% were non-local. Non- military had lower occupational status compared to
the same level military personnel.
Table 1: Frequency and percentage of demographic characteristics.
Row
Variable name
1
Age group
22-30
31-40
40-53
2
Education
High school
Diploma
Higher than diploma
and bachelor
Master and higher than
that
3
Marriage status
Married
Single
4
Service location
Local
Non-local
Frequency
334
356
230
36
470
284
Percentage
36.3
38.7
25
3.91
51.1
30.37
130
14.13
810
110
772
148
88.04
11.96
84
16
Quality of life
questionnaire
Table 2: Comparison of quality of life between the subjects in two groups of military personnel (group 1) and non- military (group 2).
Variable
Groups
Mean
Standard deviation
t
Level of significance
Physical health
1
15.21
5.03
0.85
0.518
2
15.75
4.86
Mental health
1
15.58
4.83
7.04
0.000
2
8.15
2.82
Social health
1
10.23
3.47
4.57
0.001
2
7.06
1.66
Environmental health
1
16.65
5.03
9.02
0.001
2
10.51
2.08
Comparison of quality of life between military group and employee group indicated that mean quality of
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life in three domains of mental health, social health and environmental health is higher in the military group
compared to employees group. This difference was statistically significantly. In the area of physical health,
employees had higher mean scores compared to military group; however, this difference was not significant
(Table 2).
The findings obtained from III-Millon questionnaire showed that the comparison between mean scores of
two groups of non- military and military personnel considering 11 sub-scales were significantly different. In
other words, military personnel had higher mental health than non- military in nine subscales of avoidant,
depressed, dependent, dramatic, negative-oriented, self-injury, schizotypal, borderline, anxiety disorder and
dysthymic personality characteristics. The non- military had higher mental health than military personnel in two
sub-scales of quasi-physical and post-traumatic stress. In III-Millon questionnaire, lower scores represent higher
mental health (Table 3).
Table 3: Mean comparison of III-Millon Questionnaire in two groups of military personnel (group I) and non- military (group II)
Variable
Groups 1
Group II
t
Level of significance
Mean
Standard deviation
Mean
Standard deviation
Schizoid
30.06
18.383
33.93
22.018
1.75
0.080
personality
Avoidant
31.74
13.86
38.26
9.19
5.036
0.010
personality
Depressed
35.05
17.15
44.134
12.41
7.52
0.000
personality
Dependent
28.71
16.84
36.23
19.85
8.573
0.000
personality
Dramatic
33.31
24.94
44.91
21.63
3.12
0.001
personality
Narcissist
33.28
20.785
33.03
18.704
0.38
0.701
personality
Anti-social
27.68
27.37
28.01
25.435
0.88
0.300
personality
Sadistic
29.24
25.237
28.75
24.686
0.694
0.070
personality
Obsessive
48.54
35.50
40.91
39.36
0.729
0.086
personality
Negative45.08
30.53
31.866
25.68
5.959
0.040
oriented
personality
Self-injury
23.33
18.35
49.36
17.88
8.51
0.001
personality
Schizotypal
39.85
33.292
44.55
22.111
3.017
0.020
personality
Borderline
49.04
27.877
57.91
24.219
10.454
0.001
personality
Paranoid
54.11
20.838
53.61
20.038
0.848
0.100
personality
Anxiety disorder
23.09
24.17
41.66
22.79
3.31
0.001
Quasi-physical
29.51
25.08
28.12
26.91
2.781
0.006
Maniac
24.81
17.03
25.50
18.69
0.869
0.070
Dysthymic
24.49
24.33
47.07
28.20
12.45
0.001
Alcohol
15.01
8.11
16.45
8.47
0.68
0.213
dependence
Drug
16.44
9.01
17.01
10.02
0.56
0.080
dependence
Post-traumatic
41.33
20.12
32.66
14.23
7.33
0.040
stress
Thought disorder
35.74
21.95
36.06
22.55
0.87
0.080
Fundamental
23.91
24.27
37.12
24.17
8.69
0.005
depression
Delusional
21.33
12.56
26.45
15.19
7.77
0.040
disorder
Discussion:
The findings revealed that military personnel have higher mental health than non- military s. These findings
are in line with those obtained by Fathi [8]. The latter showed that military university personnel have higher
mental health compared non-military university personnel. Moreover, Yan et al quoted Fathi [8] in their study
and stated that mental health of Chinese Army Forces is higher than public people.
The high level of mental health of military personnel could be due to following factors. Individuals
recruited for military positions undergone close and discriminate examination in terms of mental and physical
health. They should also pass regular physical and mental health promotion and prevention programs in service.
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Military personnel have higher occupational status compared to the same level non- military in service. This can
be effective in maintaining and promoting individual mental health. However, several employee rules and
regulations may be eclipsed by military environment. In addition, special privileges not given to non- military s,
such as occupational status, can be directly related to their lower mental health compared to military personnel.
Comparison of quality of life between two groups of military personnel and non- military indicated that
quality of life in the military group is better than employees group. Quality of life can be affected by mental
health problems. Therefore, given that the group of employees had more mental health problems in this study,
they consequently may have lower quality of life. These findings are consistent with other research. Hamuleh
[27] stated that many areas of quality of life have significant correlation with mental health. Emamipoor [28]
also stated that the individuals with mental problems have lower quality of life. According to Abdullahi [29-30],
patients still suffer from lower quality of life even after complete treatment of their diseases.
Conclusion:
According to study results, level of quality of life and mental health of military personnel is higher than
non- military s. The high level of mental health and quality of life of military personnel can be due to
implementation of educational and sports programs as well as special occupational privileges given to these
people compared to non- military s. On the other hand, staff rules may be overshadowed or neglected in military
environment. Therefore, officials should considerably pay attention to this issue.
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