ArticlesWhat are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study
Introduction
We have previously shown that deployment to Iraq has not adversely affected the mental health of regular UK military personnel; however, deployment did affect the mental health of reservists (individuals paid by the military only when they are undertaking military duties; reservists typically have civilian jobs when not working for the military).1 Our results contrasted with data from the USA that show increased prevalences of probable mental disorders, particularly post-traumatic stress disorder, in military personnel returning from deployment.2, 3, 4, 5, 6, 7, 8, 9, 10, 11
Much has changed since the publication of our initial report in 2006.1 The war in Iraq continued and UK armed forces experienced an increase in hostilities in the south of Iraq. At the same time, the campaign in Afghanistan intensified, with UK armed forces deployed in large numbers to Helmand Province in southern Afghanistan, close to the Pakistan border (at present there are 9500 UK armed forces personnel in Afghanistan).12 Fighting continues to be intense, and casualties, often resulting from improvised explosive devices, have been frequent.
Further, as the military operations in Iraq and Afghanistan continued, rates of post-traumatic stress disorder in the USA have increased with time since return from deployment.5 If replicated in the UK, this increase in prevalence over time would have implications for the long-term effect of deployment, with some predicting a so-called tidal wave of mental disorders in years to come.13 Additionally, some speculate that experiencing multiple deployments will lead to an increase in the frequency of mental disorders.14, 15
To address these issues we assessed the effect of deployment to Iraq and Afghanistan from 2003 to the end of data collection (September, 2009). We have re-assessed the mental health of those who participated in phase 1 of our cohort study1 and included two additional groups of UK armed forces personnel to represent the present military structure (those who have joined the military since 2003) and present operational deployments (those deployed to Afghanistan, between April, 2006, and April, 2007).
We examined: (1) the effect of deployment to Iraq and Afghanistan from 2003 to the end of data collection (September, 2009); (2) the effect of multiple deployments of UK personnel to both Iraq and Afghanistan; and (3) whether any effects of deployment on mental disorders increase or decrease with time since return from deployment.
Section snippets
Study design and participants
The first phase of our cohort study compared a range of health outcomes between two randomly selected groups.1 The first group consisted of roughly 10% of the fighting force that was deployed during the 2003 Iraq war (codename Operation TELIC 1). Our TELIC sample comprised individuals deployed between Jan 18, 2003, and April 28, 2003. The second group comprised individuals who were in the military at the same time but were not deployed on Operation TELIC 1 (termed ERA). The sample included
Results
9990 participants completed our study questionnaire (response rate 56%). The response rate was higher for the follow-up sample (6429 [68%]) than for the replenishment (896 [40%]) and HERRICK samples (2665 [50%]). Table 1 shows the characteristics of responders compared with non-responders. Response was associated with older age, being female, being an officer, and being of regular engagement type (table 1). For the follow-up sample, we examined whether response was associated with phase 1
Discussion
Our main finding is that, overall, the prevalence of mental disorders in the UK armed forces remained stable between 2003 and 2009. For regular personnel, we did not detect an effect of deployment to Iraq or Afghanistan on two of the three outcomes (probable post-traumatic stress disorder and common mental disorders) but we did record a modest effect of deployment on alcohol consumption. As we first noted in our 2006 report,1 covering the period of the UK military operation in Iraq from 2003 to
References (55)
- et al.
The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study
Lancet
(2006) - et al.
Childhood adversity and combat as predictors of depression and post-traumatic stress in deployed troops
Am J Prev Med
(2007) - et al.
Development of a fatigue scale
J Psychosom Res
(1993) - et al.
Cigarette and alcohol use in the UK Armed Forces, and their association with combat exposures: a prospective study
Addict Behav
(2008) - et al.
Relationship of combat experiences to alcohol misuse among U.S. soldiers returning from the Iraq war
Drug Alcohol Depend
(2010) - et al.
Health of UK servicemen who served in Persian Gulf War
Lancet
(1999) - et al.
Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care
N Engl J Med
(2004) - Health Program Analysis & Evaluation. 2003–2004 active duty health study. Revised by Health Program Analysis &...
- et al.
Survey of individuals previously deployed for OEF/OIF
- et al.
PTSD after deployment to Iraq: conflicting rates, conflicting claims
Psychol Med
(2010)
Timing of postcombat mental health assessments
Psychol Serv
Longitudinal mental health screening results among postdeployed U.S. soldiers preparing to deploy again
J Trauma Stress
Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans
Am J Psychiatry
Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war
J Am Med Assoc
PTSD symptom increases in Iraq-deployed soldiers: comparison with nondeployed soldiers and associations with baseline symptoms, deployment experiences, and postdeployment stress
J Trauma Stress
Operations in Afghanistan
Scores of troops traumatised by Afghan war
The Sunday Times
Association between number of deployments to Iraq and mental health screening outcomes in US Army soldiers
J Clin Psychiatry
Mental Health Advisory Team (MHAT) 6. Operation Enduring Freedom 2009 Afghanistan
How many mailouts?
BMC Med Res Methodol
UK Defence Statistics 2009
TSP 7—UK Reserves and Cadets Strengths
The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection
Med Care
The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs
Med Care
The validity of two versions of the GHQ in the WHO study of mental illness in general health care
Psychol Med
The PTSD checklist—civilian version (PCL-C)
AUDIT. The Alcohol Use Disorders Identification Test
Cited by (463)
Predictors of PTSD and Psychological Distress Symptoms of Ukraine Civilians during war
2023, Disaster Medicine and Public Health PreparednessLong-term risk for mental health symptoms in Dutch ISAF veterans: The role of perceived social support
2023, Psychological MedicineEffects of prior deployments and perceived resilience on anger trajectories of combat-deployed soldiers
2023, Psychological MedicineEating Disorder Risk and Common Mental Disorders in British Servicewomen: A Cross-Sectional Observational Study
2024, Medicine and Science in Sports and Exercise
- ‡
Joint last author