KCMHR Health and Wellbeing Study of Serving and Ex-Serving UK Armed Forces Personnel: Phase 4
KCMHR 20-year study finds rises in CMD and PTSD in Serving and ex-Serving personnel who served during the conflicts of Iraq and Afghanistan.
The findings from the fourth phase of the King’s Centre for Military Health Research (KCMHR) Health and Wellbeing study of Serving and ex-Serving UK Armed Forces personnel were launched in September 2024. The full report can be accessed here [1].
Findings revealed rises in probable Post Traumatic Stress Disorder (PTSD) and Common Mental Disorders (CMD) such as depression and anxiety among Serving and ex-Serving personnel of the UK Armed Forces since the last phase of the study in 2014-2016. CMD was the most prevalent in the cohort reported at 28%, followed by probable PTSD at 9% and alcohol misuse at 8% (Figure 1).
Background
The study has been running since 2003 with the aim of investigating the impact of deployment to Iraq (Operation TELIC) and Afghanistan (Operation HERRICK) on the health and wellbeing of Serving and ex-Serving personnel.
Data have been collected over three previous phases - Phase 1 (2004/06), Phase 2 (2007/09), and Phase 3 (2014/16), with the most recent phase taking place over 2022/23 (Phase 4). The cohort includes Regulars and Reservists, men and women, Serving and ex-Serving personnel and all three service branches. In addition to examining key mental health outcomes such as CMD, probable PTSD and alcohol misuse, this phase also collected new data on additional topics relevant to UK Serving and ex-Serving personnel including complex PTSD (C-PTSD; a sub-set of PTSD whereby the individual has been exposed to prolonged or repeated traumatic events), loneliness and caring responsibilities.
For Phase 4 (2022/23), KCMHR followed up participants who took part in the previous phase in 2014/16. 4,104 participants completed the survey. 69% of participants had deployed to Iraq and/or Afghanistan and 72% had now left service.
NB - the term “probable PTSD” is used as the PTSD measures are tools for screening purposes and are not a clinical diagnosis by a healthcare professional.
Enduring impact of combat role in Iraq and Afghanistan on PTSD rates
In the latest phase, KCMHR found that the majority of respondents (67%) did not report adverse mental health problems or alcohol misuse. However, the results also showed:
- The overall rate of probable PTSD has risen from 6% in 2014/16 to 9% in 2022/23.
- The prevalence of probable PTSD was higher in ex-Serving Regular personnel, with a rate of 11% compared to 7% in Regular Serving personnel.
- Having deployed in a combat role to Iraq or Afghanistan was also associated with higher likelihood of reporting probable PTSD in both Serving and ex-Serving Regular personnel with PTSD rising to 13% and 18% respectively in these groups.
What might explain rises in probable PTSD?
- The study finds an enduring impact of combat deployment in Iraq and Afghanistan on rates of probable PTSD for Serving and ex-Serving personnel 20 years on. Whilst there may be other factors that affect PTSD such as childhood adversity and non-military trauma, holding a combat role in Iraq and Afghanistan shows a significant relationship with PTSD that was not apparent when serving personnel were in active combat in the beginning phases of the study.
- Rises in probable PTSD may be due to the higher risk of probable PTSD in ex-Serving personnel compared to Serving personnel, and ex-Serving personnel make up more of the cohort in Phase 4 compared to Phase 3, with 72% having left service at Phase 4, compared to 43% in Phase 3.
- Ex-Serving personnel may have a higher risk of probable PTSD compared to Serving personnel as individuals who aren’t well may leave military service and/or the process of transitioning out of the military and adjusting to civilian life can be challenging for some which could make PTSD symptoms worse.
- However, there were still rises in probable PTSD found in Serving personnel since the last Phase which may be due to military or non-military traumatic exposures experienced since 2014-2016.
The study also observed an increase in the rates of CMD from 22% in 2014/16 to 28% in 2022/23. This may reflect general population trends that see rises in CMD pre- and post-COVID-19. The general decline in alcohol misuse since the beginning of the study has levelled off and stayed relatively stable (from 10% in 2014/16 to 8% in 2022/23) but remains significantly higher compared to the general population.
Most of PTSD reported is complex PTSD
For the first time in this cohort, C-PTSD was examined. C-PTSD is a subset group within PTSD where individuals must meet the criteria for PTSD, and then meet additional criteria for C-PTSD. C-PTSD results from experiencing repeated trauma over a long period of time and can be more difficult to treat with individuals taking longer to seek help and often experiencing other mental health conditions at the same time. The rate of C-PTSD reported in the cohort overall was 5.7%.
Of those who reported PTSD, the study found that 73% of PTSD in the sample met the criteria for C-PTSD, and the rate was higher amongst ex-Serving compared to Serving personnel. Amongst those who deployed in a combat role, the rate of C-PTSD was 7% in Serving personnel and 14% in ex-Serving personnel.
The impact of loneliness and caring responsibilities
In the KCMHR report, other factors that may impact ex-Serving Regulars' mental health were examined. They found that 14% of ex-Serving Regular personnel had unpaid caring responsibilities. Those who reported unpaid caring responsibilities (compared to those with no unpaid caring responsibilities) were more likely to report CMD, probable PTSD, and C-PTSD. One-third of ex-Serving Regulars reported feelings of loneliness (34%). They found that loneliness (compared to not reporting loneliness) was associated with CMD, probable PTSD, C-PTSD, and alcohol misuse.
Take away points
The findings suggest that a substantial minority of personnel who served during the Iraq and Afghanistan era of conflicts experience mental health problems. Those who served in Iraq and Afghanistan should not be a forgotten generation and both research, policies, and support services should continue to focus on addressing the long-term impact of military service.
Key recommendations
- Reiterate the new Phase 4 evidence alongside previous cohort phases that the majority of Serving and ex-Serving personnel do not report adverse mental health outcomes or alcohol misuse.
- Provide continued investment in mental health services for both Serving and ex-Serving personnel.
- Review the current provision of treatment and care for C-PTSD, and invest in research to understand best treatment and support approaches for C-PTSD.
- Review current policy and treatment services available for alcohol misuse.
- Support and conduct further in-depth analyses on loneliness, socio-economic outcomes and other Phase 4 data topics not examined in this report.
- Continue to invest in research to understand the longitudinal health outcomes of UK Armed Forces personnel (Serving and ex-Serving).
To watch a short video on ‘LinkedIn’ about the study findings please follow the link here.
Note
Phase 1-3 of the Health and Wellbeing Cohort Study were previously funded by the Ministry of Defence. Phase 4 was funded by the Office for Veterans’ Affairs. KCMHR are a fully independent academic research group that carried out the research.
References:
[1]. Sharp, M.-L., Franchini, S., Jones, M., Leal, R., Wessely, S., Stevelink, S., & Fear, N. (2024). Health and Wellbeing Study of Serving and Ex-Serving UK Armed Forces Personnel: Phase 4 (Office for Veterans' Affairs Final Report) (Link)
Thank you to Dr Marie-Louise Sharp for writing this Spotlight.
