The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study

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Abstract

Background

The mental health of the Armed Forces is an important issue of both academic and public interest. The aims of this study are to: a) assess the prevalence and risk factors for common mental disorders and post traumatic stress disorder (PTSD) symptoms, during the main fighting period of the Iraq War (TELIC 1) and later deployments to Iraq or elsewhere and enlistment status (regular or reserve), and b) compare the prevalence of depression, PTSD symptoms and suicidal ideation in regular and reserve UK Army personnel who deployed to Iraq with their US counterparts.

Methods

Participants were drawn from a large UK military health study using a standard two phase survey technique stratified by deployment status and engagement type. Participants undertook a structured telephone interview including the Patient Health Questionnaire (PHQ) and a short measure of PTSD (Primary Care PTSD, PC-PTSD). The response rate was 76% (821 participants).

Results

The weighted prevalence of common mental disorders and PTSD symptoms was 27.2% and 4.8%, respectively. The most common diagnoses were alcohol abuse (18.0%) and neurotic disorders (13.5%). There was no health effect of deploying for regular personnel, but an increased risk of PTSD for reservists who deployed to Iraq and other recent deployments compared to reservists who did not deploy. The prevalence of depression, PTSD symptoms and subjective poor health were similar between regular US and UK Iraq combatants.

Conclusion

The most common mental disorders in the UK military are alcohol abuse and neurotic disorders. The prevalence of PTSD symptoms remains low in the UK military, but reservists are at greater risk of psychiatric injury than regular personnel.

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Most cited references 30

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Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

Charles W Hoge, Carl A. Castro, Stephen C. Messer … (2004)

The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. Copyright 2004 Massachusetts Medical Society

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Psychometric properties of the PTSD checklist (PCL)

Catlyn Blanchard (1996)

The psychometric properties of the PTSD Checklist (PCL), a new, brief, self-report instrument, were determined on a population of 40 motor vehicle accident victims and sexual assault victims using diagnoses and scores from the CAPS (Clinician Administered PTSD Scale) as the criteria. For the PCL as a whole, the correlation with the CAPS was 0.929 and diagnostic efficiency was 0.900 versus CAPS. Examination of the individual items showed wide ranging values of individual item correlations ranging from 0.386 to 0.788, and with diagnostic efficiencies of 0.700 or better for symptoms. We support the value of the PCL as a brief screening instrument for PTSD.

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Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat.

Charles W Hoge, M. Wright, Julio Oscar Cabrera Rego … (2008)

The purpose of the research was to assess the diagnostic efficiency of the Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD) and the Posttraumatic Stress Disorder Checklist (PCL) as clinical screening tools for active duty soldiers recently returned from a combat deployment. A secondary goal was to examine the item-level characteristics of both the PC-PTSD and the PCL. A validation study conducted with a sample of 352 service members showed that both the PC-PTSD and PCL had good diagnostic efficiency. The overall diagnostic efficiency assessed by the area under the curve (AUC) was virtually the same for both the PC-PTSD and PCL. The most efficient cutoff values for the PC-PTSD were either 2 or 3 "yes" responses with the latter favoring specificity. For the PCL, the most efficient cutoff values were between 30 and 34, mirroring recommended PCL cutoff values from some studies in primary care settings. The examination of item characteristics suggested a 4-item PCL with an AUC virtually identical to that of the full PCL. Item analyses also identified that the most discriminate item in both scales pertained to symptoms of avoidance. Implications and limitations are discussed. PsycINFO Database Record (c) 2008 APA, all rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central

ISSN (Electronic): 1471-244X

Publication date Collection: 2009

Publication date (Electronic): 30 October 2009

Volume: 9

Page: 68

Affiliations

[1 ]King's Centre for Military Health Research, Institute of Psychiatry, Department of Psychological Medicine, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK

[2 ]Academic Centre for Defence Mental Health, Institute of Psychiatry, Department of Psychological Medicine, Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK

[3 ]Health Care and Social Care Advisory Service (HASCAS), 11-13 Cavendish Square, London W1G 0AN, UK

Article

Publisher ID: 1471-244X-9-68

DOI: 10.1186/1471-244X-9-68

PMC ID: 2774683

PubMed ID: 19878538

SO-VID: 823ddecb-1b50-42fa-bbf8-36db4123b7f9

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study

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Most cited references 30

Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

Psychometric properties of the PTSD checklist (PCL)

Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat.

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