Research progress on intervention strategies for post‐traumatic stress in military personnel exposed to cold environments and radiological threats

In China, cold regions encompass much of Northeast, Northwest and North China and account for 44.5% of the country's total land area. 1 Prolonged deployment in these environments exposes service members to multiple physiological and psychological stressors, including extreme cold, extended winter seasons, elevated ultraviolet radiation, topographically complex terrain, logistical constraints, social isolation, limited access to information, strict military discipline and intensive combat-readiness training.Collectively, these factors may increase vulnerability to post-traumatic stress disorder (PTSD) and associated adverse psychological outcomes, including anxiety, depression, emotional numbing and hypervigilance.2 Although nuclear and radiological accidents share features with other anthropogenic disasters, they also present distinctive challenges.Central to such incidents is exposure to ionising radiation, a physical hazard that cannot be perceived by the senses.Nuclear and radiological events are also strongly associated in the public consciousness with nuclear weapons and explosions, which may amplify psychological apprehension.Military personnel may therefore experience pronounced psychological distress in response to these incidents.3 Prolonged deployment in environments involving a radiological threat may further increase the risk of PTSD.The current global nuclear security landscape-marked by heightened geopolitical tensions, including the continuing Russia-Ukraine conflict-has generated tangible consequences for nuclear safety and security.Notably, operational instability at some nuclear facilities has exposed troops in potential conflict zones to sustained anxiety regarding radiation exposure.4,5 The combination of chronic psychological stress and acute combat-related hazards may further elevate the risk of PTSD.However, research on PTSD interventions in coldregion military settings involving radiological threats remains limited.This paper summarises the mechanisms that may contribute to PTSD in this context and examines potential intervention strategies. Pathogenesis of PTSD and the impact of environmental factorsPTSD is a chronic mental disorder that can develop after exposure to a traumatic event.Its clinical features include intrusive symptoms, avoidance, negative alterations in cognition and mood and heightened arousal.It is often accompanied by secondary negative emotions such as depression and anxiety.6,7 Physiological mechanisms Combined exposure to cold and ionising radiation exerts profound pathophysiological effects across multiple organ systems, particularly the nervous, haematopoietic, cardiovascular and immune systems.Potential effects include neuronal apoptosis, synaptic remodelling, haematopoietic suppression, endothelial dysfunction and altered immune function.Cold and radiation exposure may also disrupt neuroendocrine regulation, including the hypothalamicpituitary-adrenal (HPA) axis, central neural circuits and the brain-gut-microbiota axis.Both cold and radiation-related stress may increase HPA-axis activity and cortisol secretion.Prolonged exposure may also contribute to hippocampal atrophy and prefrontal cortical dysfunction.HPA-axis dysregulation has been associated with adverse emotional states, such as depression and anxiety.8 Critically, these systemic pathophysiological perturbations compromise