Fear NT, Jones M, Murphy D, Hull L, Sundin J, Iversen AC et al. What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. Lancet 375: 1783-1797

Academic Centre for Defence Mental Health, King's College London, London, UK.
The Lancet (Impact Factor: 45.22). 05/2010; 375(9728):1783-97. DOI: 10.1016/S0140-6736(10)60672-1
Source: PubMed


Concerns have been raised about the psychological effect of continued combat exposure and of repeated deployments. We examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009, the effect of multiple deployments, and time since return from deployment.
We reassessed the prevalence of probable mental disorders in participants of our previous study (2003-05). We also studied two new randomly chosen samples: those with recent deployment to Afghanistan, and those who had joined the UK armed forces since April, 2003, to ensure that the final sample continued to be representative of the UK armed forces. Between November, 2007, and September, 2009, participants completed a questionnaire about their deployment experiences and health outcomes.
9990 (56%) participants completed the study questionnaire (8278 regulars, 1712 reservists). The prevalence of probable post-traumatic stress disorder was 4.0% (95% CI 3.5-4.5; n=376), 19.7% (18.7-20.6; n=1908) for symptoms of common mental disorders, and 13.0% (12.2-13.8; n=1323) for alcohol misuse. Deployment to Iraq or Afghanistan was significantly associated with alcohol misuse for regulars (odds ratio 1.22, 95% CI 1.02-1.46) and with probable post-traumatic stress disorder for reservists (2.83, 1.23-6.51). Regular personnel in combat roles were more likely than were those in support roles to report probable post-traumatic stress disorder (1.87, 1.26-2.78). There was no association with number of deployments for any outcome. There was some evidence for a small increase in the reporting of probable post-traumatic stress disorder with time since return from deployment in regulars (1.13, 1.03-1.24).
Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of probable post-traumatic stress disorder was low. These findings show the importance of continued health surveillance of UK military personnel.
UK Ministry of Defence.

Download full-text


Available from: Matthew Hotopf,
37 Reads
  • Source
    • "Based on the assumption that the data are missing at random and that the observed variables modelled to drive nonresponse were correctly identified, the weighted analyses provide valid results. A combined weight was generated by multiplying the sample and response weights (Fear et al., 2010). All analyses were conducted in STATA 11.0 (StataCorp, 2009) and used the survey commands and sampling weights. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Military work, especially operational deployments, may impact the romantic relationships of military personnel. Using a sub-sample (n = 7581) of participants from a cohort study of UK military personnel (data collected between 2007 and 2009), the prevalence of relationship difficulties and associations with socio-demographic, military, and deployment-related characteristics was examined. The majority of participants did not report experiencing relationship difficulties. Adjusted regression analyses indicate that childhood adversity, limited support for and from partners, being in unmarried relationships, financial problems, deploying for more than 13 months in three years, and work being above trade, ability and experience, were key factors associated with relationship difficulties. The likelihood of UK military personnel experiencing relationship difficulties is increased due to personal vulnerabilities which may be exacerbated in the military context.
    Marriage & Family Review 04/2015; 51(3):1-29. DOI:10.1080/01494929.2015.1031425
  • Source
    • "The second, referred to as the 'replenishment' sample, included a random sample of 2665 individuals who joined the UK Armed Forces between April 2003 and April 2007 (response rate 40%). In total, 9990 individuals completed the phase 2 questionnaire (overall response rate 56%) (Fear et al. 2010). Although this cohort included both regulars and reservists, and serving and ex-serving personnel, in the current study the military sample was restricted to regulars who were in service at phase 1 (N = 7786) or phase 2 (N = 6511). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although the military is considered to be a stressful occupation, there are remarkably few studies that compare the prevalence of common mental disorder (CMD) between the military and the general population. This study examined the prevalence of probable CMD in a serving UK military sample compared to a general population sample of employed individuals. Method Data for the general population was from the 2003 and 2008 collections for the Health Survey for England (HSE) and for the serving military from phases 1 (2004���2006) and 2 (2007���2009) of the King's Centre for Military Health Research (KCMHR) cohort study. Probable CMD was assessed by the General Health Questionnaire (GHQ-12). The datasets were appended to calculate the odds of CMD in the military compared to the general population. The odds of probable CMD was approximately double in the military, when comparing phase 1 of the military study to the 2003 HSE [odds ratio (OR) 2.4, 95% confidence interval (CI) 2.1���2.7], and phase 2 to the 2008 HSE (OR 2.3, 95% CI 2.0���2.6) after adjustment for sex, age, social class, education and marital status. Serving military personnel are more likely to endorse symptoms of CMD compared to those selected from a general population study as employed in other occupations, even after accounting for demographic characteristics. This difference may be partly explained by the context of the military study, with evidence from previous research for higher reports of symptoms from the GHQ in occupational compared to population studies, in addition to the role of predisposing characteristics.
    Psychological Medicine 01/2015; 45(09):1-11. DOI:10.1017/S0033291714002980 · 5.94 Impact Factor
  • Source
    • "We have shown that mental health status and multiple symptom status at phase 1 was not associated with participation at phase 2 of the study (Fear et al., 2010). Further details are available elsewhere (Fear et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: We assessed the strength of the association of several mental health problems, childhood difficulties, and combat role with anger, as well as the contribution of these factors to explain anger assessed by population attributable fraction (PAF). A total of 9885 UK service personnel, some of them deployed to Iraq and Afghanistan, participated in the study. There was a strong or intermediate association between cases and subthreshold cases of symptoms of posttraumatic stress disorder, psychological distress, multiple physical symptoms and alcohol misuse, having a combat role, childhood adversity, and childhood antisocial behavior with anger. The PAF for any mental health problem and combat role and childhood difficulties was 0.64 (95% confidence interval [CI], 0.56-0.70) and increased to 0.77 (95% CI, 0.69-0.83) if subthreshold cases were included. Anger is a frequent component of mental disorders; health care professionals need to be aware of the interference of anger in the management of mental illness and that anger infrequently presents as an isolated phenomenon.
    The Journal of nervous and mental disease 12/2014; 203(1). DOI:10.1097/NMD.0000000000000228 · 1.69 Impact Factor
Show more