Meet the Expert – Professor Nicola T. Fear

Welcome to a special edition of 'Meet the Expert' featuring a member of the FiMT Research Centre team. This series brings you informative interviews with Armed Forces researchers, policy makers and service providers. This edition features Professor Nicola T. Fear, Co-Director of the FiMT Research Centre. Read on to learn about her current work, aspirations for progress and future work, and insights into expert perspectives on key issues impacting ex-Service personnel and their families.

Professor Nicola T. Fear, is Co-Director of the Forces in Mind Trust Research Centre, Director of the King's Centre for Military Health Research (KCMHR), and holds a Chair in Epidemiology at the Academic Department of Military Mental Health (ADMMH) at King’s College London (KCL).

1. Please tell us about your background and how you came to be involved in work relating to the Armed Forces Community?

I trained as an epidemiologist first at the London School of Hygiene and Tropical Medicine before undertaking my doctorate at the University of Oxford. After completing my doctorate, I worked in academia for a couple of years – I was mainly involved in studies exploring the associations between occupational exposures and cancer. After a few years of being a post-doctoral researcher, I joined the Ministry of Defence (MoD) as an epidemiologist within what is now called Defence Statistics (Health). Before joining the MoD, I knew very little about the military – all my military knowledge at that time was based on films and television. A lot was going on within Defence when I joined – including the Deepcut Inquiry and preparation for the 2003 Iraq conflict. So I had a very steep learning curve! During my time at MoD, I got to know the team at King’s College London (KCL), and in 2004 (at 36 weeks pregnant) I moved back into academia as a Senior Lecturer working with Professor Simon Wessely. I have been at KCL ever since and was made a Professor in 2014.       

2. What research projects are you currently working on and how do they fit into the bigger picture of understanding and supporting the Armed Forces Community?

I work across a number of teams (the Academic Department of Military Mental Health, the King’s Centre for Military Health Research, and the FiMT Research Centre) and we always have a lot going on! Key projects at the moment include:

• The fourth phase of the King’s Centre for Military Health Research’s cohort study  (funded by the Office for Veterans’ Affairs). The cohort was established back in 2003 at the start of the Iraq conflict. Over time it has evolved to include those deployed to Afghanistan and new joiners to the Armed Forces. We have recently completed our fourth wave of data collection and have received responses from over 4,000 members of our cohort. Research findings should start being released next year – please keep watching our website and Twitter.

• The ADVANCE study, funded through the ADVANCE Charity¹, is a cohort study of those severely injured in Afghanistan. This includes 579 combat-injured participants (161 with amputation injuries and 418 with non-amputation injuries) and 565 uninjured participants. Baseline and follow up data collection is now complete and follow up results should start being released next year – please keep watching the study website and Twitter. I am particularly keen to understand how the mental health of those with physical combat related injures has changed since we collected and analysed the baseline data.

• Planning and organising our two conferences, the FiMT Research Centre conference on May 13^th 2024 and the Veterans’ Mental Health Conference on May 14^th 2024. It is really exciting to hold these two events back-to-back again, and in 2024 both events will be hosted at Bush House, KCL, London. Tickets are now on sale and both conferences are accepting abstract submissions!

3. What other research or policy areas relating to the Armed Forces Community are you especially passionate about or feel need further attention? Please expand on this and tell us about them, as much as you can.

Families! Families are a more recent addition to our research portfolio, and they are important in their own right, but their needs are often being overlooked. I am keen that we do more to understand their needs and ensure appropriate interventions and services are in place to address those needs. Additionally, the work that has already been done involving families has often focused on the “traditional” family – dad, mum and two kids. Research needs to recognise that families are messy and come in a variety of forms.

4. What are your future aspirations for the impact and utilization of your work/research?

My aspiration is that the evidence we generate as a result of the research we undertake at KCL (via the Academic Department of Military Mental Health, the King’s Centre for Military Health Research and the FiMT Research Centre) will continue to inform policy and practice to support the Armed Forces Community.

5. What do you think are the key challenges impacting current Veterans and their families, and how do you think research and/or policy can be best used to address them?

Currently, the cost-of-living crisis is a key challenge, and the current conflicts in Ukraine and the Middle East are impacting the lives of the Armed Forces Community and could lead to or exacerbate mental health problems.

One challenge I believe we also need to consider is ensuring evidence-based interventions are put in place to support the mental health and wellbeing of Service personnel, Veterans, and their families. If interventions are not evidence-based, it is not possible to know if they are actually helpful, address the issue they were put in place to address, and are an appropriate use of limited resources. We would not introduce a new drug to treat a chronic physical health condition without the relevant supporting evidence, and I don’t believe that interventions to support mental health and wellbeing should be any different.  

6. What do you think will be the leading challenges for the next generation of Veterans and how do you think research and/or policy can be best used to address them?

Recognition of Service by the public may be an issue for the next generation of Veterans. As the size of the UK Armed Forces (Service and ex-Service personnel) decreases, fewer members of the general population will be aware of the sacrifices these individuals have made to the nation. I see part of the role of the research community is to ensure these individuals and their families are not forgotten. We can raise awareness by sharing our research widely, and making sure it is delivered into the hands of those who develop and enact policy.

7. Can you tell us about the methods you tend to use in your research, and why you gravitate towards these kinds of approaches?

I tend to gravitate to quantitative methods, in particular those based on epidemiological techniques. Epidemiology – in the past – has mainly focused on the study of chronic and infectious diseases in populations, investigating how, when, and why they occur. Epidemiological methods have since been used to examine and understand other health and wellbeing outcomes – including (but not limited to) mental health, self-harm, and alcohol (mis)use. 

Epidemiological approaches have a long history of being used within the military community. Their use today underpins many of the results seen emerging from many sources, including academia through peer-reviewed publications, Government Statistics, and charitable reports. 

As an epidemiologist, I love data! However, working with colleagues across KCL and further afield has shown me the value and role of qualitative and mixed methods research in understanding the needs of the Armed Forces Community. I am an epidemiologist at heart but I appreciate the need for other research approaches.

8. Given unlimited funding and time, what would be your dream piece of research to undertake involving the Armed Forces community?

I would love to do a large longitudinal study of military families, starting at the point when recruits join the military. The recruits and their families would be included, and all members of the cohort would be followed up over time. We already know that families change over time so it would be essential to capture changes in family structure (new partners, children, etc). It would also utilise a broad definition of family – including parents and siblings, for example. It would be a logistical nightmare of a study but would have the potential to provide so much information and answer many of our currently unanswered questions! Also, it would help us to identify what, when and how interventions could be delivered to prevent, delay or support the issues families are facing.

Many thanks to Professor Nicola T. Fear for sharing her insights.

Catch us next month for another interesting and informative interview with an expert from the Armed Forces research community.

[1] Key contributors to the ADVANCE charity are the Headley Court Charity (principal funder); HM Treasury (LIBOR grant); Help for Heroes; Nuffield Trust for the Forces of the Crown; Forces in Mind Trust; National Lottery Community Fund; Blesma, The Limbless Veterans; and the UK Ministry of Defence.