• adult psychiatry
• trauma management
• limb reconstruction

The developments in combat trauma care during the Afghanistan campaign have led to unprecedented survivability from severe injuries. However, the longer term physical and mental health outcomes for combat-injured UK Armed Forces personnel remain unknown. To answer these questions, the Armed Services Trauma and Rehabilitation Outcome (ADVANCE) prospective cohort study has been established to conduct long-term interval follow-up of injured, and matched but non-injured, personnel who deployed to the conflict.1 The cohort has already demonstrated an association between combat-related injury and subsequently higher levels of both metabolic syndrome and arterial stiffness, indicators of increased cardiovascular risk.2 Many more new insights will surely follow.

The ADVANCE study has recently published the first analysis of mental health outcomes and the role of combat injury in Lancet Psychiatry.3 The authors compared 579 combat-injured participants to 565 matched non-injured personnel, achieving response rates of 59.6% and 56.3%, respectively, with a median time elapsed from Afghanistan deployment to baseline assessment of 8 years. On self-reported measures, the rates of all assessed outcomes were all higher in the injured group: post-traumatic stress disorder (PTSD, 16.9% vs 10.5%), depression (23.6% vs 16.8%) and anxiety (20.8% v 13.5%), with adjusted ORs of 1.67, 1.46 and 1.56.

US research has previously established that being wounded or injured on deployment is associated …