Private contractors have been deployed extensively around the globe for the past decade and may be exposed to many of the stressors that are known to have physical and mental health implications for military personnel. Results from a RAND survey offer preliminary findings about the mental and physical health of contractors, their deployment experiences, and their access to and use of health care resources.

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Out of the Shadows

The Health and Well-Being of Private Contractors Working in Conflict Environments

by Molly Dunigan, Carrie M. Farmer, Rachel M. Burns, Alison Hawks, Claude Messan Setodji

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Research Questions

  1. What is the prevalence of mental and physical health problems in a sample of private contractors who have deployed at least once to a theater of conflict between 2011 and 2013?
  2. To what extent do private contractors working in conflict environments use mental health care services, and what are the barriers and facilitators to receiving care?
  3. What topics of future research would be most beneficial in building an understanding of the training and preparatory needs and the postdeployment health challenges that private contractors working in conflict environments face?

Over the past decade, private contractors have been deployed extensively around the globe. In addition to supporting U.S. and allied forces in Iraq and Afghanistan, contractors have assisted foreign governments, nongovernmental organizations, and private businesses by providing a wide range of services, including base support and maintenance, logistical support, transportation, intelligence, communications, construction, and security. At the height of the conflicts in Iraq and Afghanistan, contractors outnumbered U.S. troops deployed to both theaters. Although these contractors are not supposed to engage in offensive combat, they may nonetheless be exposed to many of the stressors that are known to have physical and mental health implications for military personnel. RAND conducted an online survey of a sample of contractors who had deployed on contract to a theater of conflict at least once between early 2011 and early 2013. The survey collected demographic and employment information, along with details about respondents' deployment experience (including level of preparation for deployment, combat exposure, and living conditions), mental health (including probable posttraumatic stress disorder, depression, and alcohol misuse), physical health, and access to and use of health care. The goal was to describe the contractors' health and well-being and to explore differences across the sample by such factors as country of citizenship, job specialty, and length and frequency of contract deployment. The findings provide a foundation for future studies of contractor populations and serve to inform policy decisions affecting contractors, including efforts to reduce barriers to mental health treatment for this population.

Key Findings

Contractors' Deployment Experiences Differ with Their Circumstances

  • Differences within the contractor population were most prominent by country of citizenship and job specialty. UK citizens and citizens of countries other than the United States reported better preparation, lower levels of combat exposure, and better living conditions than U.S. citizens, on average, and there was variation by job specialty in preparation, combat exposure, and living conditions.

Contractors Are Affected by Mental and Physical Health Conditions After Deployment

  • Twenty-five percent of the contractors in the RAND survey sample met criteria for probable posttraumatic stress disorder (PTSD), 18 percent screened positive for depression, and 50 percent reported alcohol misuse.
  • Longer deployments and increased combat exposure were each associated with higher rates of probable PTSD and depression, and increased preparedness was associated with lower rates.
  • Although the majority of respondents said that they were in "excellent" or "very good" health, certain subsets of the sample were more likely to report a physical health problem, including U.S. contractors, transportation contractors, those working on contracts funded by the U.S. Department of Defense or U.S. Department of State, and those with more combat exposure.

Not All Contractor Health Needs Are Being Met

  • Although most contractors were insured at the time of the survey, there were differences in coverage by country of citizenship, with U.S. contractors more likely to be uninsured.
  • There is a significant need for care that is not being met, with only 28 percent of those with probable PTSD and 34 percent of those with probable depression receiving mental health treatment in the 12 months prior to the survey. Barriers cited included cost, embarrassment, and concerns about being perceived as weak.

Recommendations

  • Private contracting firms — including but not limited to private military and security firms, risk consultancies, development firms, and construction and engineering companies — as well as contract funders, should work to increase access to stress management and mental health resources. Increased access appears to lower rates of posttraumatic stress disorder and depression among those who deploy on contract.
  • Companies, contract funders, and national governments should implement initiatives to reduce barriers to obtaining mental health treatment, including the stigma associated with seeking help.
  • The research community should extend the findings of the RAND study by examining how prior military experience affects contractors' mental health, how mental health conditions affect occupational functioning among the contractor population, and the specific mental and physical health conditions that result from deployments on contract. Future studies should also extend this analysis to contractors deployed prior to 2011 and aim to identify the prevalence of mental and physical health problems and to develop a better understanding of how training before, during, and after deployments could protect contractors from deployment-related mental health problems.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    The Health Status of Contractors Who Are Deployed to Conflict Environments Is Not Well Understood: A Review of the Literature

  • Chapter Three

    What Are the Deployment Experiences of Contractors?

  • Chapter Four

    What Is the Mental Health Status of Contractors Who Work in Conflict Environments?

  • Chapter Five

    What Other Health Issues Affect Contractors Who Work in Conflict Environments?

  • Chapter Six

    To What Extent Do Contractors Access Health Care, and What Are the Barriers to Receiving Health Care?

  • Chapter Seven

    Conclusions and Policy Recommendations

  • Appendix A

    Additional Data Tables

  • Appendix B

    Sensitivity Analyses

Research conducted by

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