Adverse Mental Health Outcomes and Alcohol Misuse Among UK Armed Forces Personnel: A 20-Year Cohort Study of Military Personnel Who Served During the Iraq and Afghanistan Conflicts

Abstract

Background: Twenty years since the start of UK Armed Forces participation in the Iraq and Afghanistan conflicts post-2001, the extent to which these deployments continue to impact mental health outcomes and alcohol misuse in UK military personnel is unknown.

Methods: This is the fourth phase of a longitudinal cohort study that has assessed the health and wellbeing of UK serving and ex-serving personnel since 2004. Participants were eligible for the most recent phase (2022–2023) if they took part previously (2014–2016) and consented to recontact. Primary outcome measures included symptoms of Common Mental Disorders (CMD), probable Post Traumatic Stress Disorder (PTSD), Complex-PTSD (C-PTSD) and alcohol misuse.

Findings: In the overall sample (n=4104, response rate = 54·6%), CMD were the most prevalent outcome (27·8%), followed by probable PTSD (9·4%) and alcohol misuse (8·4%). The majority of PTSD experienced met the criteria for C-PTSD. Ex-serving Regulars compared to serving Regulars reported higher rates of PTSD and C-PTSD; higher rates of both disorders were also reported in serving/ex-serving Regulars whose last deployment to Iraq or Afghanistan was in a combat role. Since the previous phase, rates of CMD and PTSD have increased, and alcohol misuse has remained high but relatively stable.

Interpretation: Although the majority of those who deployed to Iraq and/or Afghanistan remain well, there is an enduring impact of combat deployment on the rates of PTSD. Attention should continue to be directed towards the prevention and treatment of adverse mental health outcomes and alcohol misuse in this cohort.

Funding: Office for Veterans’ Affairs, Cabinet Office, UK Government.

Declaration of Interest: MLS, MJ, SF, HB salaries are fully, or part funded through a grant by the Office for Veterans’ Affairs (OVA). AS and JS are serving Regular members of the British Army. DL is a Reservist in the UK Armed Forces, this work has been undertaken as part of his civilian employment. SW and NG are 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. NG is a trustee with the Faculty and Society of Occupational Medicine. DMu is a trustee of the Forces in Mind Trust (unpaid) and is employed as the Head of Research for Combat Stress, a UK veterans mental health charity. DMa is employed as joint head of service of the London NHS Veterans Mental Health and Wellbeing Service (Op Courage). SAMS is supported by the NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and funded by the National Institute for Health and Care Research, NIHR Advanced Fellowship, Dr Sharon Stevelink, NIHR300592. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. SW is Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid), a Vice President of Combat Stress and a Non-Executive Director of NHS England. NTF is a trustee of Help for Heroes, a charity supporting the wellbeing of veterans and their families, and their salary is part grant funded by the MoD.

Ethical Approval: Ethical approval was granted by the UK Ministry of Defence Research Ethics Committee (Ref: 2061/MODREC/21).

Keywords: Mental health, CMD, PTSD, alcohol misuse, C-PTSD, Military, Veteran, cohort, Iraq, Afghanistan.