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'Goodbye and Good Luck': the Mental Health Needs and Treatment

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'Goodbye and Good Luck': the Mental Health Needs and Treatment BRITISH JOURNAL OF PSYCHIATRY (2005), 186, 480^486 ‘Goodbye and good luck’: the mental health needs sample consisted of three randomly selected groups of service personnel: those who and treatment experiences of British ex-service served in the Persian Gulf War in 1990– 1991 (1991(nn¼4250), those who served in Bosnia between 1992 and 1997 (nn¼4250) and an personnelpersonnel ‘Era’ group who served but were not deployed (deployed(nn¼4246). About a quarter of AMY IVERSEN, CLAIRE DYSON, NAOMI SMITH, NEIL GREENBERG, the cohort (nn¼3322) were contacted again REBECCA WALW YN, CATHERINE UNWIN, LISA HULL, MATTHEW HOTOPF, in 2001 (Hotopf et aletal, 2003). Almost all CHRISTOPHER DANDEKER, JOHN ROSS and SIMON WESSELY of those who took part in the 2001 survey (stage 3 of the investigation of this cohort) gave consent for further follow-up by Background Little is known aboutaboutthe the The war in Iraq has heightened recognition telephone.telephone. psychologicalhealth or treatment that active military service can adversely Our case group consisted of 701 in- affect the mental health of some who serve. dividuals for whom we had already collected experiences of those who have leftthe Despite this, little is known about the two waves of data, at baseline (1997) and at British armed forces. health of ex-service personnel in the UK. follow-up (2001). Inclusion criteria were After the Falklands War in 1982, several scores of 3 or more on the 12-item General Aims Todescribe the frequency and small, selective studies demonstrated poor Health Questionnaire (GHQ; Goldberg & associations of common mental disorders mental health among some returnees Williams, 1988) at stages 1 and 3 of our and help-seeking behavioursin a (O’Brien & Hughes, 1991; Orner et al,etal, original investigation (nn¼636), and all those representative sample of UKveterans 1993), but little has been published on the who were unemployed at stage 3, having left at high risk of mental health problems. subject since then. The majority of the the services by stage 1 (nn¼107). Individuals available research comes from the USA fulfilling ‘GHQ caseness’ at stages 1 and 3 MethodMethod A cross-sectional telephone and focuses on those who served in were selected on the basis of an assumption Vietnam, its emphasis being on the sequelae ofadegreeofchronicityofmentalhealth survey of 496 ‘vulnerable’ex-service of combat rather than military service perper problems, as opposed to transient distress. personnel selected from an existing sese, and specifically post-traumatic stress As the unemployed individuals were still epidemiologicalepidemiologicalmilitarycohort. military cohort. disorder (Card, 1987; Kulka et aletal, 1990).,1990). not working 4–5 years after leaving the Our own studies of veterans of the 1991 armed forces, chronicity of employment dif- ResultsResults Theresponseratewas64%; Gulf War, however, suggest that although ficulties was assumed. Inevitably, there was 44% ofofthese these had a psychiatric diagnosis, mental health problems are indeed asso- overlap between these two groups: 42 of most commonly depression.Those with a ciated with ill health in the military (Iversen 107 individuals who were unemployed also diagnosis were more likely to be of lower et aletal, 2005), post-traumatic stress fulfilled GHQ criteria. Members of the sam- disorder – despite receiving most atten- ple who were still serving in the armed forces rank and divorced or separated.Justoverseparated.Just over tion – is not the most important diagnosis at the point of last follow-up (nn¼205) werewere205) half ofthose with self-reported mental (Ismail(Ismail et aletal, 2002). The aim of this study excluded from this study, leaving a sample health problems were currently seeking was to look in depth at a representative group of 496. The advantages of using the help, most from their general sample of UK veterans at high risk of existing cohort were that participants were mental health problems, and describe the originally randomly selected, and were there- practitioners.Most help-seekers received frequency and associations of common fore not seeking treatment or compensation, treatment, usually medication; 28% were mental disorders and help-seeking behav- and that vulnerable individuals could be intouch with a service charity and 4% iours in a sample of veterans who had left selected from the cohort on the basis of their were receiving cognitive ^ behavioural the military and who we believed to be at previous questionnaire responses. therapy. heightened risk of developing mental health problems.problems. Conclusions DepressionDepressionis is more Procedure commoncommonthan than post-traumatic stress METHOD All potential participants who had given consent to follow-up at last contact were disorder in UKex-service personnel.Only Participants contacted by letter at the start of the study. about half ofthose who have a diagnosis The study aimed to assess mental health For all letters returned to the unit un- are seeking help currently,currently,and and few see needs and treatment experiences of a repre- delivered, electoral register searches were specialists. sentative sample of UK veterans, selected used in order to clarify a change of address. from a previously studied cohort as those After a period of 4 weeks, telephone Declaration of interest S.W. isisS.W. most at risk of long-term psychological interviews conducted by two research Honorary Civilian AdvisorinAdvisor in Psychiatry and/or social problems. The participants associates commenced. The research were drawn from the original military associates were masked to any previous (unpaid) to the British Army Medical cohort set up at King’s College London in information collected about the individuals Services.Funding detailedin 1995 (see Unwin et aletal, 1999; Ismail et aletal,, contacted, other than that they fulfilled Acknowledgements. 2002; Hotopf et aletal, 2003). The original criteria to participate. A list of 480480 Downloaded from https://www.cambridge.org/core. 26 Sep 2021 at 15:49:56, subject to the Cambridge Core terms of use. MENTAL HEALTH OF EX-SERVICE PERSONNEL non-responders who had agreed to take RREESUSULLTTSS found that non-responders had slightly part when last contacted but were untrace- higher mean GHQ scores, higher post- able was drawn up, and the Department for Response rate traumatic stress reaction (PTSR) scores Work and Pensions sent letters to these The response rate was 63.5% (315/496). and worse self-perceived health, but none individuals on our behalf (using up-to-date Non-responders fell into two groups: those of these differences reached statistical addresses) asking them to make contact to whom we were unable to trace despite significance. Non-responders were likely provide their new address details. Two multiple attempts (25.2%) and those who to be younger and of lower rank than members of the cohort were in prison, refused to participate once contact was responders and were less likely to be and we managed to interview one of them established (11.3%). These groups were married. They were more likely to have using a modified postal questionnaire. combined for the purpose of a non- been unemployed when last followed up, responder analysis (Table 1). Using data but this difference did not reach signifi- collected on these individuals in 2001, we cance. Gender, pre-enlistment educational MMeeasasuurreses The final questionnaire used a combination TaTablbel1e1 Comparison of responders and non-responders, based on data from previous cohort survey of existing measures and new questions (Hotopfet,200,23)003) al arising out of our interviews with veterans and veteran organisations. Additional in- formation included details of individuals Variable11 Responders Non-responders Significance testOR (95% CI) (age, marital status) as well as details of ((nn¼315315)) ((nn¼181) their military experience: length of service, time elapsed since leaving, method of Gender, nn (%) leaving, whether participants had been Male 227755(8(877..9)9) 115599(90(90..9)9) ww22¼1.1, d.f.¼1,1, 1.0 given a diagnosis of post-traumatic stress FeFemmaallee 38 (12.1) 1166(9(9..11)) PP¼0.4 1.3 (0.72^2.4) disorder (PTSD) at any time and who Missing data 262 6 had made that diagnosis. We also explored Age, years: mean (s.d.)39.9 (7.9) 37.6 (7.0) tt¼3.2, d.f.¼487, participants’ experiences of primary ((nn¼314) ((nn¼171755)) PP¼0.02 healthcare, what treatments they had Marital status, nn (%) received and what role specialist services Married 230 (73.7) 110606 (60(60..9)9) ww22¼8.6, d.f.¼1,1, 1.0 played.played. OtOthheerr 8282 (26(26..33)) 6868(3(399..11)) PP¼0.04 0.56 (0.37^0.83) A modified version of the Primary Care Rank, nn (%(%)) Evaluation of Mental Disorders (PRIME– OfOfffiicceerr 3388(1(13.3.1)1) 8(4.7) ww22¼14.6, d.f.¼2, 1.0 MD; Spitzer etetalal, 1994) was administered to detect the presence or absense of psychi- NCNCOO 181888((6655..11)) 110044(60(60..8)8) PP¼0.001 0.38 (0.17^0.85) atric disorders, according to prearranged PPrriivvatatee 6633(2(211..8)8) 59 (34.5) 0.23 (0.10^0.52) algorithms (excluding sections on eating Employment status, nn (%) disorders and somatoform disorders). InIn Employed 224444(80(80.5.5)) 125 (73.1) ww22¼3.5, d.f.¼1,1, 1.0 addition, a short screening scale designed Unemployed 59 (19.5) 4646 (26(26..9)9) PP¼0.07 0.66 (0.42^1.0) to detect the presence of PTSD in Serving arm, nn (%) inindividualsdividuals who self-reported exposure to Army22 222299(80(80..11)) 131355(8(855.4.4)) ww22¼2.3, d.f.¼2, 1.0 trauma was administered (Breslau etetalal,, Navy 21 (7.3) 7(4.4) PP¼0.3 1.77 (0.73^4.3) 1999). The scale is based on the DSM–IV RARAFF 36 (12.6) 16 (10.1) 1.3 (0.71^2.48) diagnostic criteria for PTSD (American Deployment group, nn (%(%)) Psychiatric Association, 1994) and con- Gulf 118282 ((5858..0)0) 85 (48.6) ww22¼5.5.77,,d.d.ff..¼3,3, 1.0 sists of a seven-item structured telephone interview schedule.
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