Elsevier

The Lancet

Volume 375, Issue 9728, 22–28 May 2010, Pages 1783-1797
The Lancet

Articles
What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study

https://doi.org/10.1016/S0140-6736(10)60672-1Get rights and content

Summary

Background

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.

Methods

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.

Findings

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).

Interpretation

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.

Funding

UK Ministry of Defence.

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

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