Mental health outcomes in US and UK military personnel returning from Iraq

Sundin, Josefin; Herrell, Richard; Hoge, Charles W.; Fear, Nicola T.; Adler, Amy B.; Greenberg, Neil; Riviere, Lyndon A.; Thomas, Jeffrey L.; Wessely, Simon; Bliese, Paul D.

doi:10.1192/bjp.bp.113.129569

Cited by 127 publications

(92 citation statements)

References 48 publications

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“…Reviews confirm that trauma/ combat exposure is the strongest predictor of PTSD among military personnel deployed to Iraq and Afghanistan (Kok et al, 2012;Ramchand, Rudavsky, et al, 2015;Ramchand, Schell, et al, 2010). Deployment trauma exposure also has been associated with depression (Baker et al, 2009;Heron et al, 2013;Jacobson et al, 2012;Luxton, Skopp, and Maguen, 2010;Maguen, Ren, et al, 2010;Mayo et al, 2013;Schell and Tanielian, 2011) and substance misuse (Sundin, Herrell, et al, 2014) among previously deployed troops. In studies that have examined whether deployment increases the risk of PTSD and depression relative to service members who have not deployed, relationships are attenuated once controlling for deployment trauma exposure (Jones et al, 2013;Vanderploeg et al, 2012).…”

Section: Deployment Traumamentioning

confidence: 99%

The Deployment Life Study: Longitudinal Analysis of Military Families Across the Deployment Cycle

Meadows¹,

Tanielian²,

Karney³

et al. 2016

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Section: Deployment Traumamentioning

confidence: 99%

The Deployment Life Study: Longitudinal Analysis of Military Families Across the Deployment Cycle

Meadows¹,

Tanielian²,

Karney³

et al. 2016

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“…Nevertheless, the ≥ 50 cutpoint is a reasonably specific benchmark (nearly everyone who meets this threshold also meets DSM-IV criteria 16 ) and a standard for military research, established at the beginning of the Iraq and Afghanistan wars, 17 ensuring high comparability across studies over what ended up being many war years. [8][9][10]16 Additionally, Wisco et al 1 made a wise choice in selecting the specific stressor version of the PCL (PCL-S), also established as a standard for cross-sectional surveys during these war years. 16,17 The PCL-S format is conducive to any traumatic experience, recent or distant, military or nonmilitary, and was selected as the sole format in the new DSM-5 PCL version.…”

mentioning

confidence: 99%

Estimating PTSD Prevalence in US Veterans: Considering Combat Exposure, PTSD Checklist Cutpoints, and <em>DSM-5</em>

Hoge¹,

Warner²

2014

J. Clin. Psychiatry

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Despite the outstanding methodology, this study will no doubt generate questions and debate, like most veteran studies, concerning sample representativeness and interpretation in the context of other research related to the Iraq and Afghanistan wars, PCL validity, or diagnostic changes between DSM-IV and DSM-5. Questions concerning representativeness stem from the observation that veterans account for > 9% of US adults (2010 census 5 ) but were identified in less than 4% of households in Wisco and colleagues' study sampling frame.1 Nevertheless, this remains one of the only national samples with a high response rate, and the demographic weighting using census figures increases the likelihood that results are nationally representative. Homeless veterans account for < 1% of US veterans and thus their absence from this sample would not significantly influence overall estimates.Current (1-month or 1-year) prevalence is generally more useful for projecting immediate health care requirements than lifetime prevalence, and studies over the last 10 years have been heavily focused on service members returning from Iraq or Afghanistan. However, these studies have produced current PTSD prevalence estimates ranging from < 5% to > 30%, 6,7 not useful for projecting health care needs. Such a wide range has been particularly notable when comparing UK and US personnel after Iraq or Afghanistan deployments, with prevalences in UK personnel consistently at the lowest end of the spectrum, though some US studies, such as the Millennium Cohort, 8 have produced similarly low estimates. Reasons for the striking differences across studies have been extensively debated, to include differences in demographics, exposure to combat, time between deployments, strategies in sampling, case criteria, level of anonymity of questionnaires, proportion of reservists to active members, and even the possibility of cultural differences.6,7 However, one meta-analysis 9 largely resolved this debate by showing that there is much greater consistency across studies than first recognized, provided that studies are suitably grouped. Studies involving stratified random sampling of all deployed personnel, including the large proportion in support roles (eg, UK and Millennium Cohort), yielded a weighted PTSD prevalence of 5.5% (95% CI, 5.4-5.6), comparable to nondeployed personnel, whereas the large body of research focused on combat infantry personnel (mostly US studies) yielded a weighted prevalence of 13.2% (95% CI, 12.8-13.7), 9 numbers nicely framing Wisco and colleagues' overall veteran estimate.

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“…A number of studies have examined suicide in UK military veterans [4][5][6][7], and other studies have looked at suicidal ideation in recently deployed US veterans [8], but to date there has been little research on the longer term risks of non-fatal self-harm in the overall veteran population [9], particularly in the UK where risks are known to differ from the US military population [10]. This represents an important knowledge gap since self-harm is a recognised risk factor for subsequent suicide [11] and may act as a pointer to unmet welfare needs.…”

Section: Introductionmentioning

confidence: 99%

Non-fatal self-harm in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans

Bergman

Mackay

Smith

et al. 2018

Soc Psychiatry Psychiatr Epidemiol

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Purpose Although suicide risk in veterans has been widely studied, there is little information on the risk of non-fatal selfharm in this population. We used data from the Scottish Veterans Health Study to conduct an epidemiological analysis of self-harm in veterans, in comparison with people who have never served. Methods We conducted a retrospective, 30-year cohort study of 56,205 veterans born 1945-1985, and 172,741 people with no record of military service, and used Cox proportional hazard models to examine the association between veteran status and cumulative risk of non-fatal self-harm, overall and stratified by birth cohort, sex and length of service. We also examined mental and physical comorbidities, and association of suicide with prior self-harm. Results There were 1620 (2.90%) first episodes of self-harm in veterans, compared with 4212 (2.45%) in non-veterans. The difference was statistically significant overall (unadjusted HR 1.27, 95% CI 1.21-1.35, p < 0.001). The risk was highest in the oldest veterans, and in the early service leavers who failed to complete initial training (unadjusted HR 1.69, 95% CI 1.50-1.91, p < 0.001). The risk reduced with longer service and in the intermediate birth cohorts but has increased again in the youngest cohort. Conclusions The highest risk of non-fatal self-harm was in veterans with the shortest service, especially those who did not complete training or minimum engagement, and in the oldest birth cohorts, whilst those who had served the longest were at reduced risk. The risk has increased again in the youngest veterans, and further study of this subgroup is indicated.

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Mental health outcomes in US and UK military personnel returning from Iraq

Abstract: Differences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD. Adjusting for self-reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.

Cited by 127 publications

References 48 publications

The Deployment Life Study: Longitudinal Analysis of Military Families Across the Deployment Cycle

The Deployment Life Study: Longitudinal Analysis of Military Families Across the Deployment Cycle

Estimating PTSD Prevalence in US Veterans: Considering Combat Exposure, PTSD Checklist Cutpoints, and <em>DSM-5</em>

Non-fatal self-harm in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans

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