Response

To explore the long-term impact of exposure to trauma, 156 journalists who report wars were recruited from five US media organisations to provide psychometric data on their mental health. Of these 99 were also interviewed. ^{Reference Feinstein, Mead, Newman, Shapiro, Bennett and Fainaru1} Almost half of the participants had spent more than three years in war zones. Lifetime prevalences of post-traumatic stress disorder (PTSD) (27%), major depression (34%) and alcohol use disorder (34%) suggested an enduring adverse effect for a subgroup. The rates were significantly higher than found for the US population but similar to those for US veterans of the Iraq and Afghanistan conflicts. The study found that time spent in war zones correlated with risk severity for PTSD. No significant statistical differences in outcomes were found for men and women. That conflict journalism is a hazardous profession with implications for mental health is well understood. ^{Reference Feinstein, Owen and Blair2} However, little is known about the long-term impact of this reporting and less still about risk and protective factors; Feinstein et al’s ^{Reference Feinstein, Mead, Newman, Shapiro, Bennett and Fainaru1} study sought to answer these questions.

Journalists who cover war are subject to a range of stressors. They include the need to establish contacts and acquire local knowledge in an uncertain environment. To get reliable information in a conflict zone, they often have to act in irregular ways and negotiate with officials or soldiers to gain access to people or places while trying to remain safe. ^{Reference Armoudian3} Arguably the work attracts resourceful individuals with a capacity for risk and adventure. Indeed, some may seek the career to avoid the routine of a stable family life. They are largely a self-selecting profession and form close bonds with colleagues through shared, life-threatening experiences. Mortality rates reveal the hazards journalists face: in 2001 alone, 100 reporters were killed. ^{Reference Bolton4} In the past, it may have been thought that war correspondents were naturally resilient without need of counselling and protected against psychological trauma. The study found that only 40% of participants had been provided with counselling by their news organisation during their employment, though 69% had sought therapy in the aftermath of traumatic assignments.

Although the majority of reporters were able to cope in the long term, Feinstein et al ^{Reference Feinstein, Mead, Newman, Shapiro, Bennett and Fainaru1} found that even the resourceful and resilient may eventually experience PTSD or depression or seek to cope through misuse of alcohol. However, few in the study reported the symptoms of complex PTSD. A higher rate might have been expected given the accumulation of trauma, loss of comrades and repeated deployments away from home. Although earlier research had identified a history of emotional challenges pre-dating journalism as a risk factor for PTSD, ^{Reference Feinstein and Osmann5} this study found little evidence of adverse childhood experiences in the sample. The low rate of complex PTSD contrasts with infantry soldiers recruited from areas of socioeconomic deprivation. ^{Reference Sharp, Franchini, Jones, Leal, Wessely and Stevelink6} A possible explanation includes a wider range of protective factors such as higher education, greater agency and a positive sense of purpose without the necessity to inflict violence on others.

Why, then, is it important that journalists who cover war be studied, and what marks them apart from other members of the media? The simple answer is the trauma to which they are exposed over many years and in different environments. Although a fellowship exists among war journalists, they are in competition to get a headline story and may take excessive risks to meet an editor’s demands. The photojournalist must be on the battlefield or at the atrocity site to get the front-page picture. Colleagues and friends in the media are killed or seriously wounded. Like soldiers, some cope by misusing alcohol, increasing the risk of breakdown. Lee Miller survived the Normandy landings and witnessed German atrocities only to suffer from severe depression during the post-1945 period. ^{Reference Roberts7}

In an increasingly unstable world where the level of inter-state conflict is slowly rising, the role of the war correspondent remains imperative to afford citizens and institutions a source of reliable information. Challenging the Orwellian political command to ‘reject the evidence of your eyes and ears’, ^{Reference Orwell8} Martha Gellhorn, who reported on conflict from the Spanish Civil War through to Vietnam, emphasised the importance of evidence gathered first-hand. ^{Reference Gellhorn9} Reporting from Dachau concentration camp at the end of the Second World War, she argued that personal testimony was needed to convince a doubting public of the scale and depth of the genocide. The study by Feinstein et al ^{Reference Feinstein, Mead, Newman, Shapiro, Bennett and Fainaru1} reveals the price that around a quarter of journalists pay for witnessing conflict and the requirement for media organisations to provide them with mental health support during assignments.