Hostname: page-component-7479d7b7d-767nl Total loading time: 0 Render date: 2024-07-15T11:22:00.132Z Has data issue: false hasContentIssue false

Mental health disorders and alcohol misuse among UK military veterans and the general population: a comparison study

Published online by Cambridge University Press:  10 August 2020

Rebecca Rhead*
Affiliation:
Department of Forensic and Neurodevelopmental Science, King's College London, London, UK King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
Deirdre MacManus
Affiliation:
Department of Forensic and Neurodevelopmental Science, King's College London, London, UK King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
Margaret Jones
Affiliation:
King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
Neil Greenberg
Affiliation:
King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
Nicola T Fear
Affiliation:
King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
Laura Goodwin
Affiliation:
King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK Department of Psychological Sciences, University of Liverpool, Liverpool, UK
*
Author for correspondence: Rebecca Rhead, E-mail: rebecca.rhead@kcl.ac.uk

Abstract

Background

For a small minority of personnel, military service can have a negative impact on their mental health. Yet no studies have assessed how the mental health of UK veterans (who served during the recent operations in Afghanistan or Iraq) compares to non-veterans, to determine if they are at a disadvantage. We examine the prevalence of mental disorders and alcohol misuse in UK veterans compared to non-veterans.

Methods

Veteran data were taken from the third phase of the King's Centre for Military Health Research cohort study (n = 2917). These data were compared with data on non-veterans taken from two large general population surveys: 2014 Adult Psychiatric Morbidity Survey (n = 5871) and wave 6 of the UK Household Longitudinal Study (UKHLS, n = 22 760).

Results

We found that, overall, UK veterans who served at the time of recent military operations were more likely to report a significantly higher prevalence of common mental disorders (CMD) (23% v. 16%), post-traumatic stress disorder (PTSD) (8% v. 5%) and alcohol misuse (11% v. 6%) than non-veterans. Stratifying by gender showed that the negative impact of being a veteran on mental health and alcohol misuse was restricted to male veterans. Being ill or disabled was associated with a higher prevalence of CMD and PTSD for both veterans and non-veterans.

Conclusion

Whilst the same sociodemographic groups within the veteran and non-veteran populations seemed to have an increased risk of mental health problems (e.g. those who were unemployed), male veterans, in particular, appear to be at a distinct disadvantage compared to those who have never served.

Type
Original Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G., & World Health Organization (2001). AUDIT: The alcohol use disorders identification test: Guidelines for use in primary health care.Google Scholar
Defence Select Committee (2018). Mental health and the Armed Forces, Part One: The Scale of mental health issues: Government Response to the Committee's Eleventh Report. (HC 813).Google Scholar
Elovainio, M., Hakulinen, C., Pulkki-Råback, L., Virtanen, M., Josefsson, K., Jokela, M., … Kivimäki, M. (2017). Contribution of risk factors to excess mortality in isolated and lonely individuals: An analysis of data from the UK Biobank cohort study. The Lancet Public Health, 2(6), e260e266. doi:10.1016/S2468-2667(17)30075-0.CrossRefGoogle ScholarPubMed
Erol, A., & Karpyak, V. M. (2015). Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations. Drug and Alcohol Dependence, 156, 113. doi:10.1016/j.drugalcdep.2015.08.023.CrossRefGoogle ScholarPubMed
Fear, N. T., Iversen, A., Meltzer, H., Workman, L., Hull, L., Greenberg, N., … Wessely, S. (2007). Patterns of drinking in the UK Armed Forces. Addiction, 102(11), 17491759. doi:10.1111/j.1360-0443.2007.01978.x.CrossRefGoogle ScholarPubMed
Fear, N. T., Jones, M., Murphy, D., Hull, L., Iversen, A. C., Coker, B., … Wessely, S. (2010). What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. The Lancet, 375(9728), 17831797. doi:10.1016/S0140-6736(10)60672-1.CrossRefGoogle ScholarPubMed
Goldberg, D. P., Gater, R., Sartorius, N., Ustun, T. B., Piccinelli, M., Gureje, O., & Rutter, C. (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27(1), 191197.CrossRefGoogle ScholarPubMed
Goodwin, L., Norton, S., Fear, N. T., Jones, M., Hull, L., Wessely, S., & Rona, R. J. (2017). Trajectories of alcohol use in the UK military and associations with mental health. Addictive Behaviors, 75, 130137. doi:10.1016/j.addbeh.2017.07.010.CrossRefGoogle ScholarPubMed
Goodwin, L., Wessely, S., Hotopf, M., Jones, M., Greenberg, N., Rona, R. J., … Fear, N. T. (2015). Are common mental disorders more prevalent in the UK serving military compared to the general working population? Psychological Medicine, 45(9), 18811891. doi:10.1017/S0033291714002980.CrossRefGoogle Scholar
Gribble, R., Goodwin, L., & Fear, N. T. (2019). Mental health outcomes and alcohol consumption among UK military spouses/partners: A comparison with women in the general population. European Journal of Psychotraumatology, 10(1). https://doi.org/10.1080/20008198.2019.1654781.CrossRefGoogle ScholarPubMed
Hainmueller, J. (2012). Entropy balancing for causal effects: A multivariate reweighting method to produce balanced samples in observational studies. Political Analysis, 20(1), 2546.CrossRefGoogle Scholar
Hamilton, A. B., Williams, L., & Washington, D. L. (2015). Military and mental health correlates of unemployment in a national sample of women veterans. Medical Care, 53, S32. doi:10.1097/MLR.0000000000000297.CrossRefGoogle Scholar
Harden, L., & Murphy, D. (2018). Risk factors of suicidal ideation in a population of UK military veterans seeking support for mental health difficulties. Journal of the Royal Army Medical Corps, 164(5), 352356. doi:10.1136/jramc-2018-000921.CrossRefGoogle Scholar
Haskell, S. G., Gordon, K. S., Mattocks, K., Duggal, M., Erdos, J., Justice, A., & Brandt, C. A. (2010). Gender differences in rates of depression, PTSD, pain, obesity, and military sexual trauma among Connecticut War Veterans of Iraq and Afghanistan. Journal of Women's Health (2002), 19(2), 267271. doi:10.1089/jwh.2008.1262.CrossRefGoogle ScholarPubMed
Hatch, S. L., Harvey, S. B., Dandeker, C., Burdett, H., Greenberg, N., Fear, N. T., & Wessely, S. (2013). Life in and after the Armed Forces: Social networks and mental health in the UK military. Sociology of Health & Illness, 35(7), 10451064. doi:10.1111/1467-9566.12022.CrossRefGoogle ScholarPubMed
Hoerster, K. D., Lehavot, K., Simpson, T., McFall, M., Reiber, G., & Nelson, K. M. (2012). Health and health behavior differences: U.S. Military, Veteran, and Civilian Men. American Journal of Preventive Medicine, 43(5), 483489. doi:10.1016/j.amepre.2012.07.029.CrossRefGoogle ScholarPubMed
Hooff, M. V., McFarlane, A. C., Davies, C. E., Searle, A. K., Fairweather-Schmidt, A. K., Verhagen, A., … Hodson, S. E. (2014). The Australian defence force mental health prevalence and wellbeing study: Design and methods. European Journal of Psychotraumatology, 5(1), 23950. doi:10.3402/ejpt.v5.23950.CrossRefGoogle ScholarPubMed
Hotopf, M., Hull, L., Fear, N. T., Browne, T., Horn, O., Iversen, A., … Wessely, S. (2006). The health of UK military personnel who deployed to the 2003 Iraq war: A cohort study. Lancet (London, England), 367(9524), 17311741. doi:10.1016/S0140-6736(06)68662-5.CrossRefGoogle Scholar
Iversen, A. C., Fear, N. T., Simonoff, E., Hull, L., Horn, O., Greenberg, N., … Wessely, S. (2007). Influence of childhood adversity on health among male UK military personnel. The British Journal of Psychiatry, 191(6), 506511. doi:10.1192/bjp.bp.107.039818.CrossRefGoogle ScholarPubMed
Iversen, A. C., & Greenberg, N. (2009). Mental health of regular and reserve military veterans. Advances in Psychiatric Treatment, 15(2), 100106. doi:10.1192/apt.bp.107.004713.CrossRefGoogle Scholar
Lee, J. E., Sudom, K. A., & Zamorski, M. A. (2013). Longitudinal analysis of psychological resilience and mental health in Canadian military personnel returning from overseas deployment. Journal of Occupational Health Psychology, 18(3), 327.CrossRefGoogle ScholarPubMed
Leightley, D., Puddephatt, J.-A., Goodwin, L., Rona, R., & Fear, N. T. (2018). InDEx: Open source iOS and android software for self-reporting and monitoring of alcohol consumption. Journal of Open Research Software, 6, 1324. doi:10.5334/jors.207CrossRefGoogle ScholarPubMed
Lynn, P. (2006). Quality profile: BHPS version 2.0: Waves 1 to 13 1991–2003. Essex, UK: University of Essex. Institute for Social Research.Google Scholar
McManus, S., Bebbington, P., Jenkins, R., & Brugha, T. (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014. Leed, UK: NHS Digital.Google Scholar
Murphy, D., Palmer, E., Westwood, G., Busuttil, W., & Greenberg, N. (2016). Do alcohol misuse, service utilisation, and demographic characteristics differ between UK veterans and members of the general public attending an NHS general hospital? Journal of Clinical Medicine, 5(11), 95107. doi:10.3390/jcm5110095CrossRefGoogle ScholarPubMed
Office for National Statistics (n.d.). NS-SEC. The National Statistics Socio-Economic- Classification (NS-SEC) - Office for National Statistics. Retrieved 6 March 2018, from https://www.ons.gov.uk/methodology/classificationsandstandards/otherclassifications/thenationalstatisticssocioeconomicclassificationnssecrebasedonsoc2010.Google Scholar
Oster, C., Morello, A., Venning, A., Redpath, P., & Lawn, S. (2017). The health and wellbeing needs of veterans: A rapid review. BMC Psychiatry, 17(1), 411428. doi:10.1186/s12888-017-1547-0CrossRefGoogle ScholarPubMed
Ostler, K., Thompson, C., Kinmonth, A.-L. K., Peveler, R. C., Stevens, L., & Stevens, A. (2001). Influence of socio-economic deprivation on the prevalence and outcome of depression in primary care: The Hampshire Depression Project. The British Journal of Psychiatry, 178(1), 1217. doi:10.1192/bjp.178.1.12.CrossRefGoogle ScholarPubMed
Pole, N., Best, S. R., Weiss, D. S., Metzler, T., Liberman, A. M., Fagan, J., & Marmar, C. R. (2001). Effects of gender and ethnicity on duty-related posttraumatic stress symptoms among urban police officers. The Journal of Nervous and Mental Disease, 189(7), 442448.CrossRefGoogle ScholarPubMed
Royal British Legion (2014). A UK household survey of the ex-service community.Google Scholar
Stansfeld, S. A., Rasul, F. R., Head, J., & Singleton, N. (2011). Occupation and mental health in a national UK survey. Social Psychiatry and Psychiatric Epidemiology, 46(2), 101110. doi:10.1007/s00127-009-0173-7.CrossRefGoogle Scholar
Stevelink, S., Jones, M., Hull, L., Pernet, D., MacCrimmon, S., Goodwin, L., … Wessely, S. (2018). Mental health outcomes at the end of the British involvement in the Iraq and Afghanistan conflicts: A cohort study. The British Journal of Psychiatry: The Journal of Mental Science, 213(6), 690697. doi:10.1192/bjp.2018.175CrossRefGoogle ScholarPubMed
Stevelink, S., Malcolm, E. M., Mason, C., Jenkins, S., Sundin, J., & Fear, N. T. (2015). The prevalence of mental health disorders in (ex-)military personnel with a physical impairment: A systematic review. Occupational and Environmental Medicine, 72(4), 243251. doi:10.1136/oemed-2014-102207.CrossRefGoogle ScholarPubMed
Sundin, J., Herrell, R. K., Hoge, C. W., Fear, N. T., Adler, A. B., Greenberg, N., … Bliese, P. D. (2014). Mental health outcomes in US and UK military personnel returning from Iraq. The British Journal of Psychiatry, 204(3), 200207. doi:10.1192/bjp.bp.113.129569.CrossRefGoogle ScholarPubMed
Sutker, P. B., Davis, J. M., Uddo, M., & Ditta, S. R. (1995). Assessment of psychological distress in Persian gulf troops: Ethnicity and gender comparisons. Journal of Personality Assessment, 64(3), 415427. doi:10.1207/s15327752jpa6403_2.CrossRefGoogle ScholarPubMed
Taylor, C. (2011). Armed forces covenant. Standard note SN/IA/5979. London: Government Publication.Google Scholar
Taylor, S., Koch, W. J., Kuch, K., Crockett, D. J., & Passey, G. (1998). The structure of posttraumatic stress symptoms. Journal of Abnormal Psychology, 107(1), 154160. Scopus. doi:0.1037/0021-843X.107.1.154.CrossRefGoogle ScholarPubMed
Thandi, G., Sundin, J., Ng-Knight, T., Jones, M., Hull, L., Jones, N., … Fear, N. T. (2015). Alcohol misuse in the United Kingdom Armed Forces: A longitudinal study. Drug and Alcohol Dependence, 156, 7883. doi:10.1016/j.drugalcdep.2015.08.033.CrossRefGoogle ScholarPubMed
Vasterling, J. J., Proctor, S. P., Friedman, M. J., Hoge, C. W., Heeren, T., King, L. A., & King, D. W. (2010). PTSD Symptom increases in Iraq-deployed soldiers: Comparison with nondeployed soldiers and associations with baseline symptoms, deployment experiences, and postdeployment stress. Journal of Traumatic Stress, 23(1), 4151. doi:10.1002/jts.20487.CrossRefGoogle ScholarPubMed
Weathers, F. W., Litz, B. T., Herman, D., Huska, J., & Keane, T. (1994). The PTSD checklist-civilian version (PCL-C). Boston, MA: National Center for PTSD.Google Scholar
Wilkins, K. C., Lang, A. J., & Norman, S. B. (2011). Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28(7), 596606. doi:10.1002/da.20837.CrossRefGoogle ScholarPubMed
Woodhead, C., Rona, R. J., Iversen, A., MacManus, D., Hotopf, M., Dean, K., … Fear, N. T. (2011 b). Mental health and health service use among post-national service veterans: Results from the 2007 Adult Psychiatric Morbidity Survey of England. Psychological Medicine, 41(2), 363372. doi:10.1017/S0033291710000759.CrossRefGoogle ScholarPubMed
Woodhead, C., Rona, R. J., Iversen, A. C., MacManus, D., Hotopf, M., Dean, K., … Fear, N. T. (2011 a). Health of national service veterans: An analysis of a community-based sample using data from the 2007 Adult Psychiatric Morbidity Survey of England. Social Psychiatry and Psychiatric Epidemiology, 46(7), 559566. doi:10.1007/s00127-010-0232-0.CrossRefGoogle ScholarPubMed
Supplementary material: File

Rhead et al. supplementary material

Table S1

Download Rhead et al. supplementary material(File)
File 19.1 KB