To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Social media platforms have long been recognised as major disseminators of health misinformation. Many previous studies have found a negative association between health-protective behaviours and belief in the specific form of misinformation popularly known as ‘conspiracy theory’. Concerns have arisen regarding the spread of COVID-19 conspiracy theories on social media.
Three questionnaire surveys of social media use, conspiracy beliefs and health-protective behaviours with regard to COVID-19 among UK residents were carried out online, one using a self-selecting sample (N = 949) and two using stratified random samples from a recruited panel (N = 2250, N = 2254).
All three studies found a negative relationship between COVID-19 conspiracy beliefs and COVID-19 health-protective behaviours, and a positive relationship between COVID-19 conspiracy beliefs and use of social media as a source of information about COVID-19. Studies 2 and 3 also found a negative relationship between COVID-19 health-protective behaviours and use of social media as a source of information, and Study 3 found a positive relationship between health-protective behaviours and use of broadcast media as a source of information.
When used as an information source, unregulated social media may present a health risk that is partly but not wholly reducible to their role as disseminators of health-related conspiracy beliefs.
Veterans with post-traumatic stress disorder (PTSD) typically report a poorer treatment response than those who have not served in the Armed Forces. A possible explanation is that veterans often present with complex symptoms of PTSD. ICD-11 PTSD and complex PTSD (CPTSD) have not previously been explored in a military sample.
This study aimed to validate the only measure of ICD-11 PTSD and CPTSD, the International Trauma Questionnaire, and assess the rates of the disorder in a sample of treatment-seeking UK veterans.
A sample of help-seeking veterans (N = 177) was recruited from a national charity in the UK that provides clinical services to veterans. Participants completed measures of ICD-11 PTSD and CPTSD as well as childhood and adult traumatic life events. Confirmatory factor analysis was used to assess the latent structure of PTSD and CPTSD symptoms, and rates of the disorders were estimated.
The majority of the participants (70.7%) reported symptoms consistent with a diagnosis of either PTSD or CPTSD. Results indicated the presence of two separate disorders, with CPTSD being more frequently endorsed (56.7%) than PTSD (14.0%). CPTSD was more strongly associated with childhood trauma than PTSD.
The International Trauma Questionnaire can adequately distinguish between PTSD and CPTSD within clinical samples of veterans. There is a need to explore the effectiveness of existing and new treatments for CPTSD in military personnel.
A proportion of ex-military personnel who develop mental health and social problems end up in the Criminal Justice System. A government review called for better understanding of pathways to offending among ex-military personnel to improve services and reduce reoffending. We utilised data linkage with criminal records to examine the patterns of offending among military personnel after they leave service and the associated risk (including mental health and alcohol problems) and socio-economic protective factors.
Questionnaire data from a cohort study of 13 856 randomly selected UK military personnel were linked with national criminal records to examine changes in the rates of offending after leaving service.
All types of offending increased after leaving service, with violent offending being the most prevalent. Offending was predicted by mental health and alcohol problems: probable PTSD, symptoms of common mental disorder and aggressive behaviour (verbal, property and threatened or actual physical aggression). Reduced risk of offending was associated with post-service socio-economic factors: absence of debt, stable housing and relationship satisfaction. These factors were associated with a reduced risk of offending in the presence of mental health risk factors.
Ex-military personnel are more likely to commit violent offences after leaving service than other offence-types. Mental health and alcohol problems are associated with increased risk of post-service offending, and socio-economic stability is associated with reduced risk of offending among military veterans with these problems. Efforts to reduce post-service offending should encompass management of socio-economic risk factors as well as mental health.
Little is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.
We examined the prevalence of mental disorders and alcohol misuse, whether this differed between serving and ex-serving regular personnel and by deployment status.
This is the third phase of a military cohort study (2014–2016; n = 8093). The sample was based on participants from previous phases (2004–2006 and 2007–2009) and a new randomly selected sample of those who had joined the UK armed forces since 2009.
The prevalence was 6.2% for probable post-traumatic stress disorder, 21.9% for common mental disorders and 10.0% for alcohol misuse. Deployment to Iraq or Afghanistan and a combat role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel.
The findings highlight an increasing prevalence of post-traumatic stress disorder and a lowering prevalence of alcohol misuse compared with our previous findings and stresses the importance of continued surveillance during service and beyond.
Declaration of interest:
All authors are based at King's College London which, for the purpose of this study and other military-related studies, receives funding from the UK Ministry of Defence (MoD). S.A.M.S., M.J., L.H., D.P., S.M. and R.J.R. salaries were totally or partially paid by the UK MoD. The UK MoD provides support to the Academic Department of Military Mental Health, and the salaries of N.J., N.G. and N.T.F. are covered totally or partly by this contribution. D.Mu. is employed by Combat Stress, a national UK charity that provides clinical mental health services to veterans. D.MacM. is the lead consultant for an NHS Veteran Mental Health Service. N.G. is the Royal College of Psychiatrists’ Lead for Military and Veterans’ Health, a trustee of Walking with the Wounded, and an independent director at the Forces in Mind Trust; however, he was not directed by these organisations in any way in relation to his contribution to this paper. N.J. is a full-time member of the armed forces seconded to King's College London. N.T.F. reports grants from the US Department of Defense and the UK MoD, is a trustee (unpaid) of The Warrior Programme and an independent advisor to the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee (unpaid) of Combat Stress and Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid). S.W. is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, the Department of Health, Public Health England or the UK MoD.
Little is known about the social and emotional well-being of children whose fathers have been deployed to the conflicts in Iraq/Afghanistan or who have post-traumatic stress disorder (PTSD).
To examine the emotional and behavioural well-being of children whose fathers are or have been in the UK armed forces, in particular the effects of paternal deployment to the conflicts in Iraq or Afghanistan and paternal PTSD.
Fathers who had taken part in a large tri-service cohort and had children aged 3–16 years were asked about the emotional and behavioural well-being of their child(ren) and assessed for symptoms of PTSD via online questionnaires and telephone interview.
In total, 621 (67%) fathers participated, providing data on 1044 children. Paternal deployment to Iraq or Afghanistan was not associated with childhood emotional and behavioural difficulties. Paternal probable PTSD were associated with child hyperactivity. This finding was limited to boys and those under 11 years of age.
This study showed that adverse childhood emotional and behavioural well-being was not associated with paternal deployment but was associated with paternal probable PTSD.
Declaration of interest
N.T.F. is a trustee of the Warrior Programme, a charity supporting ex-service personnel and their families. She is also a member of the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee of Combat Stress, a charity supporting ex-service personnel and their families, and President of the Royal Society of Medicine. S.W. is partially funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England (PHE), in collaboration with the University of East Anglia and Newcastle University.
Research into violence among military personnel has not differentiated between stranger- and family-directed violence. While military factors (combat exposure and post-deployment mental health problems) are risk factors for general violence, there has been limited research on their impact on violence within the family environment. This study aims to compare the prevalence of family-directed and stranger-directed violence among a deployed sample of UK military personnel and to explore risk factors associated with both family- and stranger-directed violence.
This study utilised data from a large cohort study which collected information by questionnaire from a representative sample of randomly selected deployed UK military personnel (n = 6711).
The prevalence of family violence immediately following return from deployment was 3.6% and 7.8% for stranger violence. Family violence was significantly associated with having left service, while stranger violence was associated with younger age, male gender, being single, having a history of antisocial behaviour as well as having left service. Deployment in a combat role was significantly associated with both family and stranger violence after adjustment for confounders [adjusted odds ratio (aOR) = 1.92 (1.25–2.94), p = 0.003 and aOR = 1.77 (1.31–2.40), p < 0.001, respectively], as was the presence of symptoms of post-traumatic stress disorder, common mental disorders and aggression.
Exposure to combat and post-deployment mental health problems are risk factors for violence both inside and outside the family environment and should be considered in violence reduction programmes for military personnel. Further research using a validated measurement tool for family violence would improve comparability with other research.
The Broadening the Foundation Programme report has led to an expansion in the number of psychiatry foundation placements. This change will have far-reaching benefits for foundation doctors doing psychiatry, no matter what their future career intentions. Doctors will develop a better understanding of mental illness, they will improve their communication skills and they will gain experience of working within multidisciplinary teams. Recruitment into psychiatry is also likely to improve. The Royal College of Psychiatrists is putting in place a number of measures to ensure that placements are of a high quality so that foundation doctors have a good experience of psychiatry.
Research of military personnel who deployed to the conflicts in Iraq or
Afghanistan has suggested that there are differences in mental health
outcomes between UK and US military personnel.
To compare the prevalence of post-traumatic stress disorder (PTSD),
hazardous alcohol consumption, aggressive behaviour and multiple physical
symptoms in US and UK military personnel deployed to Iraq.
Data were from one US (n = 1560) and one UK
(n = 313) study of post-deployment military health of
army personnel who had deployed to Iraq during 2007–2008. Analyses were
stratified by high- and low-combat exposure.
Significant differences in combat exposure and sociodemographics were
observed between US and UK personnel; controlling for these variables
accounted for the difference in prevalence of PTSD, but not in the total
symptom level scores. Levels of hazardous alcohol consumption (low-combat
exposure: odds ratio (OR) = 0.13, 95% CI 0.07–0.21; high-combat exposure:
OR = 0.23, 95% CI 0.14–0.39) and aggression (low-combat exposure: OR =
0.36, 95% CI 0.19–0.68) were significantly lower in US compared with UK
personnel. There was no difference in multiple physical symptoms.
Differences in self-reported combat exposures explain most of the
differences in reported prevalence of PTSD. Adjusting for self-reported
combat exposures and sociodemographics did not explain differences in
hazardous alcohol consumption or aggression.
Most accounts of deployment mental health in UK armed forces personnel
rely on retrospective assessments.
We present data relating to the burden of mental ill health and the
effect of support measures including operational, family, welfare and
medical support obtained on two occasions some 18 months apart.
A total of 2794 personnel completed a survey while deployed to
Afghanistan; 1363 in 2011 and 1431 in 2010. Their responses were compared
The prevalence of self-report mental health disorder was low and not
significantly different between the surveys; the rates of probable
post-traumatic stress disorder (PTSD) were 2.8% in 2010 and 1.8% in 2011;
for common mental health disorders the rates were 17.0% and 16.0%
respectively. Remembering receiving predeployment psychoeducation,
perceptions of good leadership and good family support were all
significantly associated with better mental health. Seeking support from
non-medical sources and reporting sick for medical reasons were both
significantly associated with poorer mental health.
Over a period of 18 months, deployment mental health symptoms in UK armed
forces personnel were fewer than those obtained from a military
population sample despite continuing deployment in a high-threat context
and were associated with perceptions of support.
Psychiatry recruitment in the UK is in crisis. In this paper we review reasons and solutions for the current predicament, focusing on the UK situation. We assert that there are specific national issues over and above more general and well-established ones, such as stigma and bad-mouthing, which need to be considered. These include factors that are an unintended consequence of recent changes in postgraduate training, as well as the organisation of the National Health Service. We conclude with some suggestions for psychiatrists, whether trainee or consultant, to help address the situation.
The aim of this study was to enhance public health preparedness for incidents that involve the large-scale release of a hazardous substance by examining factors likely to influence public responses to official guidance on how to limit their exposure.
An online demographically representative survey was conducted in the United Kingdom (n = 601) and Poland (n = 602) to test the strength of association of trust in authorities, anxiety, threat, and coping appraisals with the intention to comply with advice to shelter in place following a hypothetical chemical spill. The impact of ease of compliance and style of message presentation were also examined.
Participants were more likely to comply if at home when the incident happened, but message presentation had little impact. Coping appraisals and trust were key predictors of compliance, but threat appraisals were associated with noncompliance. Anxiety was seen to promote behavioral change. UK participants were more likely to comply than Polish participants.
Successful crisis communications during an emergency should aim to influence perceptions regarding the efficacy of recommended behaviors, the difficulties people may have in following advice, and perceptions about the cost of following recommended behaviors. Generic principles of crisis communication may need adaptation for national contexts. (Disaster Med Public Health Preparedness. 2013;7:65-74)
The 2011 earthquake and tsunami in Japan caused a meltdown at the
Fukushima nuclear power plant.
To quantify emotional responses among British nationals in Japan and to
assess whether perceptions about the incident or accessing information
about it were associated with responses.
A total of 284 participants randomly selected from official records
completed a survey that included instruments to measure emotional
In total, 16% met the criteria for distress, 29.7% reported high anxiety
relating to the incident and 30.4% reported high anger. Perceptions that
strongly predicted these outcomes included feeling uncertain, being
unable to rule out harmful exposure, and believing that exposure would
have severe or hidden health effects or be difficult to detect. Using
information sources was associated with higher emotional outcome,
particularly for sources perceived to have low credibility.
Reducing uncertainty and improving the credibility of information is
essential in reducing the psychological impact of radiological
Most studies of the mental health of UK armed forces focus on
retrospective accounts of deployment and few sample personnel while they
This study reports the results of a survey of deployed personnel,
examining the perceived impact of events at home and military support for
the family on current mental health during the deployment.
Surveys were conducted with 2042 British forces personnel serving in Iraq
and Afghanistan. Prevalence of common mental disorders was assessed with
the 12-item General Health Questionnaire (GHQ-12) and post-traumatic
stress disorder (PTSD) was assessed with the PTSD Checklist – Civilian
The prevalence of common mental disorders was 17.8% and of probable PTSD
was 2.8%. Perceived home difficulties significantly influenced the mental
health of deployed personnel; the greater the perception of negative
events in the home environment, the greater the reporting of adverse
mental health effects. This finding was independent of combat exposure
and was only partially mitigated by being well led and reporting
subjectively good unit cohesion; however, the effect of the totality of
home-front events was not improved by the latter. Poor perceived military
support for the family had a detrimental impact on deployment mental
The armed forces offer many support services to the partners and families
of deployed personnel and ensuring that the efforts being made on their
behalf are well communicated might improve the mental health of deployed
Most research on the mental health of UK armed forces personnel has been conducted either before or after deployment; there is scant evidence concerning personnel while they are on deployment.
To assess the mental health of UK armed forces personnel deployed in Iraq and identify gaps in the provision of support on operations.
Personnel completed a questionnaire about their deployment experiences and health status. Primary outcomes were psychological distress (General Health Questionnaire–12, GHQ–12), symptoms of post-traumatic stress disorder (PTSD) and self-rating of overall health.
Of 611 participants, 20.5% scored above the cut-off on the GHQ–12 and 3.4% scored as having probable PTSD. Higher risk of psychological distress was associated with younger age, female gender, weaker unit cohesion, poorer perceived leadership and non-receipt of a pre-deployment stress brief. Perceived threat to life, poorer perceived leadership and non-receipt of a stress brief were risk factors for symptoms of PTSD. Better self-rated overall health was associated with being a commissioned officer, stronger unit cohesion and having taken a period of rest and recuperation. Personnel who reported sick for any reason during deployment were more likely to report psychological symptoms. Around 11% reported currently being interested in receiving help for a psychological problem.
In an established operational theatre the prevalence of common psychopathology was similar to rates found in non-deployed military samples. However, there remains scope for further improving in-theatre support mechanisms, raising awareness of the link between reporting sick and mental health and ensuring implementation of current policy to deliver pre-deployment stress briefs.
For armed forces personnel, data on help-seeking behaviour and receipt of treatment for mental disorders are important for both research and policy.
To examine mental healthcare service use and receipt of treatment in a sample of the UK military.
Participants were drawn from an existing UK military health cohort. The sample was stratified by reserve status and by participation in the main war-fighting period of the Iraq War. Participants completed a telephone-based structured diagnostic interview comprising the Patient Health Questionnaire and Primary Care Post-Traumatic Stress Disorder Screen (PC–PTSD), and a series of questions about service utilisation and treatment receipt.
Only 23% of those with common mental disorders and still serving in the military were receiving any form of medical professional help. Non-medical sources of help such as chaplains were more widely used. Among regular personnel in receipt of professional help, most were seen in primary care (79%) and the most common treatment was medication or counselling/psychotherapy. Few regular personnel were receiving cognitive–behavioural therapy (CBT). These findings are comparable with those reported for the general population.
In the UK armed forces, the majority of those with mental disorders are not currently seeking medical help for their symptoms. Further work to understand barriers to care is important and timely given that this is a group at risk of occupational psychiatric injury.
Conversion disorder presents a problem for the revisions of DSM–IV and ICD–10, for reasons that are informative about the difficulties of psychiatric classification more generally. Giving up criteria based on psychological aetiology may be a painful sacrifice but it is still the right thing to do.