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Do Junior Entrants to the UK Armed Forces have worse outcomes than Standard Entrants?
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  • Published on: 22 May 2023
    Enlistment of under-18s: Abiding concerns – Authors’ response
    • Margaret Jones, Research Associate King's College, London
    • Other Contributors:
      • Howard Burdett, Post doctoral research associate
      • Beverly Bergman, Honorary Clinical Associate Professor
      • Nicola T. Fear, Professor of Epidemiology, Co-director KCMHR
      • Simon Wessely, Regius Professor of Psychiatry, Director KCMHR
      • Roberto J Rona, Professor Public Health

    Dear Editor
    We read with interest the comments made by Cooper et al to our paper comparing experiences and mental health of personnel who joined service as junior entrants compared to adult entrants. Participants in the King's Centre for Military Health Research (KCMHR) cohort study were sampled from the trained and, consequently, deployable strength of the UK Armed Forces (UKAF) since the primary purpose of the cohort study was to measure the health consequences of deployment to Iraq and Afghanistan[1]. The participants were not sampled from personnel at recruitment but on the basis of their deployment to Iraq or Afghanistan. We had no data about individuals who joined service at the same time but who did not remain in service until the time of sampling and this is a fully acknowledged limitation in the paper. We have no evidence that there may have been differential attrition on the basis of mental health between the comparison groups. Those who joined before 2003 could represent a sub sample of particularly successful personnel (both those who joined as Junior Entrants and those who joined as adults). That is why we carried out a subgroup analysis of the smaller number of participants who had joined the trained strength after 2003 (the replenishment samples). In that analysis there were some significant associations that are of concern, but PTSD and common mental disorders were not, as suggested, among them as they were far from being statistically significan...

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    Conflict of Interest:
    King’s College London receives funds from the UK Ministry of Defence for the purpose of this study.
    Professor N.T.Fear is a trustee (unpaid) of The Warrior Programme and an independent advisor to the Independent Group Advising on the Release of Data (IGARD).
    Professor S.Wessely is 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.
    Professor Beverly Bergman is a retired Army doctor and Honorary Civilian Consultant Advisor (Army) for Veterans’ Health & Epidemiology.
  • Published on: 22 May 2023
    Enlistment of under-18s: Abiding concerns
    • Charlotte Cooper, Researcher Child Rights International Network
    • Other Contributors:
      • David Gee, Researcher
      • David McCoy, Professor of Global Public Health

    Dear Editor

    Margaret Jones and colleagues’ study of armed forces personnel concluded that, for the study cohort as a whole, those who had joined up under the age of 17.5 years (‘junior entrants’) were no more likely than those who enlisted at older ages to report symptoms of mental health disorders. However, the study also found that junior entrants who had enlisted since 2003 showed significantly higher rates of alcohol misuse, somatic symptoms, and a lifetime history of self-harm, relative to older recruits. The study’s data further suggests that PTSD and common mental disorders may also be more prevalent among younger enlistees since 2003, although this is not statistically significant.

    In recent decades, protections for armed forces recruits who are legally children have improved, including a legal prohibition on deployment to zones since 2002. Despite these developments, this study’s findings indicate continuing reason to be concerned about the impact of early enlistment on long-term mental health. It could be relevant that, as this study has shown, once junior entrants turn 18 and may be deployed, they are more likely to be in a combat role such as the frontline infantry.

    Furthermore, the study sample may not reflect the relevant population accurately. Comparing Table 1 with UK armed forces quarterly personnel statistics,(1) higher-ranked personnel appear to be over-represented in the study sample, while those with the lowest ranks are under-repr...

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    Conflict of Interest:
    None declared.