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Mental health and health service use among post-national service veterans: results from the 2007 Adult Psychiatric Morbidity Survey of England

  • C. Woodhead (a1), R. J. Rona (a2), A. Iversen (a2), D. MacManus (a3), M. Hotopf (a2), K. Dean (a3), S. McManus (a4), H. Meltzer (a5), T. Brugha (a5), R. Jenkins (a6), S. Wessely (a2) and N. T. Fear (a1)...

Abstract

Background

There is concern surrounding the psychological health and uptake of treatment services among veterans of the UK Armed Forces.

Method

Data from a cross-sectional, nationally representative sample were used to compare health outcomes and treatment seeking among 257 post-national service veterans aged 16–64 years and 504 age and sex frequency-matched non-veterans living in the community in England. Early leavers (<4 years service) were compared with longer serving veterans.

Results

Male veterans reported more childhood adversity and were more likely to have experienced a major trauma in adulthood than non-veterans. There was no association between any measure of mental health and veteran status in males, except reporting more violent behaviours [adjusted odds ratio (aOR) 1.44, 95% confidence interval (CI) 1.01–2.06]. In females, a significant association was found between veteran status and ever having suicidal thoughts (aOR 2.82, 95% CI 1.13–7.03). No differences in treatment-seeking behaviour were identified between veterans and non-veterans with any mental disorder. Early service leavers were more likely to be heavy drinkers (aOR 4.16, 95% CI 1.08–16.00), to have had suicidal thoughts (aOR 2.37, 95% CI 1.21–4.66) and to have self-harmed (aOR 12.36, 95% CI 1.61–94.68) than longer serving veterans.

Conclusions

The findings of this study do not suggest that being a veteran is associated with adversity in terms of mental health, social disadvantage or reluctance to seek treatment compared with the general population. Some evidence implies that early service leavers may experience more mental health problems than longer-serving veterans.

Copyright

Corresponding author

*Address for correspondence: Dr N. T. Fear, Academic Centre for Defence Mental Health, King's College, London, UK. (Email: Nicola.t.fear@kcl.ac.uk)

References

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Aldwin, CM, Levenson, MR, Spiro, A III (1994). Vulnerability and resilience to combat exposure: can stress have lifelong effects? Psychology and Aging 9, 3444.
Babor, TF, Higgins-Biddle, JC, Saunders, JB, Monteiro, M (2001). AUDIT: The Alcohol Use Disorders Identification Test (2nd edn.) World Health Organization: Geneva.
Bowling, A (2005). Mode of questionnaire administration can have serious effects on data quality. Journal of Public Health 27, 281291.
Brewin, CR, Rose, S, Andrews, B, Green, J, Tata, P, McEvedy, C, Turner, SW, Foa, E (2002). A brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry 181, 158162.
British Army (2009). (www.army.mod.uk). Accessed 15 March 2009.
Brugha, TS, Morgan, Z, Bebbington, P, Jenkins, R, Lewis, G, Farrell, M, Meltzer, H (2003). Social support networks and type of neurotic symptom among adults in British households. Psychological Medicine 33, 307318.
Defence Analytical Services and Advice (2009). (http://www.dasa.mod.uk/). Accessed 18 March 2009.
Di Blasi, Z, Harkness, E, Ernst, E, Georgiou, A, Kleijnen, J (2001). Influence of context effects on health outcomes: a systematic review. Lancet 357, 757762.
Dohrenwend, BP, Turner, JB, Turse, NA, Adams, BG, Koenen, KC, Marshall, R (2006). The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods. Science 313, 979982.
Engelhard, IM, van den Hout, MA, Weerts, J, Arntz, A, Hox, JJ, McNally, RJ (2007). Deployment-related stress and trauma in Dutch soldiers returning from Iraq. Prospective study. British Journal of Psychiatry 191, 140145.
Fear, NT, Iversen, I, Meltzer, H, Workman, L, Hull, L, Geenberg, N, Barker, C, Browne, T, Earnshaw, M, Horn, O, Jones, M, Murphy, D, Rona, R, Hotopf, M, Wessely, S (2007). Patterns of drinking in the UK Armed Forces. Addiction 102, 17491759.
Foa, EB, Riggs, DS, Dancu, CV, Rothbaum, BO (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress 6, 459473.
Fontana, A, Rosenheck, R (1994). Traumatic war stressors and psychiatric symptoms among World War II, Korean, and Vietnam War veterans. Psychology and Aging 9, 2733.
Groves, RM (2006). Nonresponse rates and nonresponse bias in household surveys. Public Opinion Quarterly 70, 646675.
Helzer, JE, Robins, LN, McEvoy, L (1987). Post-traumatic stress disorder in the general population. Findings of the Epidemiologic Catchment Area survey. New England Journal of Medicine 317, 16301634.
Hoge, CW, Castro, CA, Messer, SC, McGurk, D, Cotting, DI, Koffman, R (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351, 1322.
Hotopf, M, Hull, L, Fear, N, Browne, T, Horn, O, Iversen, A, Jones, M, Murphy, D, Bland, D, Earnshaw, M, Greenberg, N, Hacker-Hughes, J, Tate, R, Dandeker, C, Rona, R, Wessely, S (2006). The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet 367, 17311734.
Ikin, JF, Sim, MR, McKenzie, DP, Horsley, KA, Wilson, EJ, Moore, MR, Jelfs, P, Harrex, WK, Henderson, S (2007). Anxiety, post-traumatic stress disorder and depression in Korean War veterans 50 years after the war. British Journal of Psychiatry 190, 475483.
Iversen, A, Dyson, C, Smith, N, Greenberg, N, Walwyn, R, Unwin, C, Hull, L, Hotopf, M, Dandeker, C, Ross, J, Wessely, S (2005 a). ‘Goodbye and good luck’: the mental health needs and treatment experiences of British ex-service personnel. British Journal of Psychiatry 186, 480486.
Iversen, A, Fear, NT, Simonoff, E, Hull, L, Horn, O, Greenberg, N, Hotopf, M, Rona, RJ, Wessely, S (2007). Pre-enlistment vulnerability factors and their influence on health outcomes in UK Military personnel. British Journal of Psychiatry 191, 506511.
Iversen, A, Nicolaou, V, Unwin, C, Greenberg, N, Dandeker, C, Ross, J, Wessely, S (2005 b). What happens to British veterans when they leave the armed forces? European Journal of Public Health 15, 175184.
Jones, N, Fear, NT, Greenberg, N, Hull, L, Wessely, S (2009). Occupational outcomes in soldiers hospitalized with mental health problems. Occupational Medicine 59, 459465. doi:10.1093/occmed/kqp115, published online 10 August 2009.
Kang, HK, Natelson, BH, Mahan, CM, Lee, KY, Murphy, F (2003). Post-Traumatic Stress Disorder and Chronic Fatigue Syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. American Journal of Epidemiology 157, 141148.
Kessler, R (2000). Posttraumatic stress disorder: the burden to the individual and to society. Journal of Clinical Psychiatry 61, 4–12.
Kulka, RA, Schlenger, WE, Fairbank, JA, Hough, RL, Jordan, BK, Marmar, CR, Weiss, DS, Grady, D (1990). Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. Brunner Mazel Publishers: New York.
Lewis, G, Pelosi, AJ, Araya, R, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine 22, 465486.
Lidz, CW, Mulvey, E, Gardner, W (1993). The accuracy of predictions of violence to others. Journal of the American Medical Association 269, 10071011.
McManus, S, Meltzer, H, Brugha, T, Bebbington, P, Jenkins, R (2009). Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. (http://www.ic.nhs.uk/pubs/psychiatricmorbidity07). Accessed 18 March 2009.
Murphy, D, Hooper, R, French, C, Jones, M, Rona, RJ, Wessely, S (2006). Is the increased reporting of symptomatic ill health in Gulf War veterans related to how one asks the question? Journal of Psychosomatic Research 61, 181186.
Norquist, GS, Hough, RL, Golding, JM, Escobar, JI (1990). Psychiatric disorder in male veterans and nonveterans. Journal of Nervous and Mental Disease 178, 328335.
O'Brien, L, Hughes, S (1991). Symptoms of post-traumatic stress disorder in Falklands War veterans five years after the conflict. British Journal of Psychiatry 59, 135141.
Office for National Statistics (2009). NS-SEC classes and collapses. (http://www.ons.gov.uk/about-statistics/classifications/current/ns-sec/cats-and-classes/ns-sec-classes-and-collapses/index.html). Accessed 18 March 2009.
Orner, RJ, Lynch, T, Seed, P (1992). Long-term traumatic stress reactions in British Falklands War veterans. British Journal of Clinical Psychology 32, 457459.
Piccinelli, M, Tessari, E, Bortolomasi, M, Piasere, O, Semenzin, M, Garzotto, N, Tansella, M (1997). Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study. British Medical Journal 314, 420424.
Rona, RJ, Fear, NT, Hull, L, Greenberg, N, Earnshaw, M, Hotopf, M, Wessely, S (2007). Mental health consequences of overstretch in the UK armed forces: first phase of a cohort study. British Medical Journal 33, 603610.
Schell, TF, Marshall, G (2008). Survey of individuals previously deployed for OEF/OIF. In Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (ed. Tanielian, T. and Jaycox, L. H.), pp. 217244. RAND Center for Military Health Policy Research: Santa Monica, CA (http://www.rand.org/pubs/monographs/2008/RAND_MG720.pdf). Accessed 21 April 2009.
Seltzer, C, Jablon, S (1974). Effects of selection on mortality. American Journal of Epidemiology 100, 367372.
Solomon, Z, Neria, Y, Ohry, A, Waysman, M, Ginzburg, K (1994). PTSD among Israeli former prisoners of war and soldiers with combat stress reaction: a longitudinal study. American Journal of Psychiatry 151, 554559.
Solomon, Z, Waysman, M, Belkin, R, Levy, G, Mikulincer, M, Enoch, D (1992). Marital relations and combat stress reaction: the wives' perspective. Journal of Marriage & the Family 54, 316326.
Stockwell, T, Murphy, D, Hogson, R (1983). The severity of alcohol dependence questionnaire: its use, reliability and validity. British Journal of Addiction 78, 145155.
Sundin, J, Fear, NT, Iversen, A, Rona, RJ, Wessely, S (2009). PTSD after deployment to Iraq: conflicting rates, conflicting claims. Psychological Medicine 40, 367382.
Taft, CT, Schumm, JA, Panuzio, J, Proctor, S (2008). An examination of family adjustment among Operation Desert Storm veterans. Journal of Consulting & Clinical Psychology 76, 648656.
Thornicroft, G (2006). Shunned: Discrimination Against People with Mental Illness. Oxford University Press: Oxford.
Wessely, S, Jones, E (2004). Psychiatry and the ‘lessons of Vietnam?’: what were they, and are they still relevant? War and Society 22, 89–103.
Zaidi, L, Foy, D (1994). Childhood abuse experiences and combat-related PTSD. Journal of Traumatic Stress 7, 3342.

Keywords

Mental health and health service use among post-national service veterans: results from the 2007 Adult Psychiatric Morbidity Survey of England

  • C. Woodhead (a1), R. J. Rona (a2), A. Iversen (a2), D. MacManus (a3), M. Hotopf (a2), K. Dean (a3), S. McManus (a4), H. Meltzer (a5), T. Brugha (a5), R. Jenkins (a6), S. Wessely (a2) and N. T. Fear (a1)...

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