The mental health of the UK Armed Forces: where facts meet fiction

A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals.

A systematic review of the experience of treatment burden of digital health for military personnel in primary healthcare

Background

Digital Health (DH) integrates digital technologies into healthcare to increase efficiency and improve patient experiences, benefiting both primary care and military healthcare systems. However, it raises concerns about the potential shift of healthcare responsibilities onto patients, creating workloads or treatment burdens that affect care, adherence, equity, and resource allocation. It is critical to assess this in the military context to enhance patient-centred care and outcomes.

Objective

To understand military personnel's experience of treatment burden of DH in primary care, to understand the barriers and facilitators of the use of DH, and to map barriers identified to the Burden of Treatment Theory (BOTT).

Design

A systematic literature review. MEDLINE, Psych INFO, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Google Scholar will be searched. Two independent reviewers will screen papers using inclusion and exclusion criteria, with conflicts decided by a third reviewer. Any retrieved study that meets the inclusion and exclusion criteria will be quality appraised using the appropriate Critical Appraisal Skills Programme (CASP) checklist. The findings will be analysed using thematic synthesis and evaluated in the context of the Burden of Treatment Theory. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA) guidelines have been adhered to in the production of this protocol.

Conclusions

Understanding the experience of treatment burden whilst using DH in the military has the potential to influence health policy, the commissioning of services and interventions, and most importantly, improve patient experience and health outcomes. PROSPERO registration number: CRD42023494297.

Quantification of stressful life events in service personnel

The role of stressful life events in the etiology of various disorders has been of interest to investigators attempting to establish a link between stressful life events and disorders. None of the available scales are relevant to service personnel. In the present study an attempt was made to construct a scale to measure stressful life events in service personnel. In the first stage of study open-ended questions along with items generated by the expert group by consensus method were administered to 50 soldiers. During the second stage the scale comprising of 59 items was administered in group setting to 165 service personnel. Weightage was assigned on 0-100 range Frequency of occurrence of life events within past one year and lifetime was also noted. Findings revealed that service personnel experience more number of life events within a year as well as in lifetime. Some general items, which are common to civilians are having consistency of weightage being assigned. There is a pattern of uniformity with the civilian counterparts along with differences in the items specific to service personnel.