Christopher Dandeker

The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study.

BACKGROUND Concerns have been raised about the mental and physical health of UK military personnel who deployed to the 2003 war in Iraq and subsequent tours of duty in the country. METHODS We compared health outcomes in a random sample of UK armed forces personnel who were deployed to the 2003 Iraq war with those in personnel who were not deployed. Participants completed a questionnaire covering the nature of the deployment and health outcomes, which included symptoms of post-traumatic stress disorder, common mental disorders, general wellbeing, alcohol consumption, physical symptoms, and fatigue. FINDINGS The participation rate was 62.3% (n=4722) in the deployed sample, and 56.3% (n=5550) in the non-deployed sample. Differences in health outcomes between groups were slight. There was a modest increase in the number of individuals with multiple physical symptoms (odds ratio 1.33; 95% CI 1.15-1.54). No other differences between groups were noted. The effect of deployment was different for reservists compared with regulars. In regulars, only presence of multiple physical symptoms was weakly associated with deployment (1.32; 1.14-1.53), whereas for reservists deployment was associated with common mental disorders (2.47, 1.35-4.52) and fatigue (1.78; 1.09-2.91). There was no evidence that later deployments, which were associated with escalating insurgency and UK casualties, were associated with poorer mental health outcomes. INTERPRETATION For regular personnel in the UK armed forces, deployment to the Iraq war has not, so far, been associated with significantly worse health outcomes, apart from a modest effect on multiple physical symptoms. There is evidence of a clinically and statistically significant effect on health in reservists.

What's in a name? Defining and caring for "veterans" - The United Kingdom in international perspective

An important feature of civil-military relations is the way in which states recognize the sacrifices that the men and women of the armed forces give to their country and provide care and support for them and their families once they leave the military as veterans. Yet states differ not only in the levels and kinds of support provided for ex-service personnel but also in their very definition of what a veteran is. This article examines the case of the United Kingdom from an international perspective. It explains how and why the United Kingdom has developed a particular—and inclusive—definition of veteran and, in conjunction with veterans interest groups, a strategy for allocating scarce resources to this group. The article analyzes attempts to mitigate the effects of social exclusion suffered by some subgroups within the veteran population, although the great majority does well at least in terms of short-term employment prospects. It concludes with an analysis of the dilemmas that are likely to confront those responsible for developing policy on veterans issues in the future, especially where to target scarce resources in such an inclusively defined group of the population.

Coming Home: Social Functioning and the Mental Health of UK Reservists on Return From Deployment to Iraq or Afghanistan

PURPOSE There is speculation that high rates of mental illness among Reservists returning from deployment to Iraq and Afghanistan may be due to the challenge of reintegrating into civilian life. We aimed to examine the postdeployment social functioning of Reservists and to explore the relationship between adverse postdeployment experiences and subsequent mental ill health. METHODS A sample of 4,991 UK military personnel who had deployed to either Iraq or Afghanistan were asked about their postdeployment experiences with a particular focus on their levels of social integration, perceived support from the military, and civilian employment. All participants were asked to complete a series of validated measures of mental health. RESULTS Compared with Regular personnel, Reservists were more likely to feel unsupported by the military and to have difficulties with social functioning in the postdeployment period. Perceived lack of support from the military was associated with increased reporting of probable posttraumatic stress disorder (PTSD) and alcohol misuse. Low levels of non-military postdeployment social support and participation were associated with increased reporting of common mental disorder, probable PTSD, and alcohol misuse. CONCLUSIONS Many Reservists find the transition from military deployment to civilian life difficult. Differences in postdeployment experiences may explain some of the increased rates of mental ill health among Reservists.

Life in and after the Armed Forces: social networks and mental health in the UK military

This study focuses on the influence of structural aspects of social integration (social networks and social participation outside work) on mental health (common mental disorders (CMD), that is, depression and anxiety symptoms, post-traumatic stress disorder (PTSD) symptoms and alcohol misuse). This study examines differences in levels of social integration and associations between social integration and mental health among service leavers and personnel still in service. Data were collected from regular serving personnel (n=6,511) and regular service leavers (n=1,753), from a representative cohort study of the Armed Forces in the UK. We found that service leavers reported less social participation outside work and a general disengagement with military social contacts in comparison to serving personnel. Service leavers were more likely to report CMD and PTSD symptoms. The increased risk of CMD but not PTSD symptoms, was partially accounted for by the reduced levels of social integration among the service leavers. Maintaining social networks in which most members are still in the military is associated with alcohol misuse for both groups, but it is related to CMD and PTSD symptoms for service leavers only.

The Long-Term Consequences of Military Deployment: A 5-Year Cohort Study of United Kingdom Reservists Deployed to Iraq in 2003

Reserve and National Guard forces have been mobilized to an unprecedented degree in recent overseas conflicts. There is concern that rates of psychological problems may continue to rise for many years after deployment. The authors conducted a cohort study of 552 United Kingdom Reservists who deployed to Iraq in 2003 and 391 nondeployed Reservists. Measures of mental health and social functioning were collected a mean of 16 months and 4.8 years after return from possible deployment. At the first follow-up, deployment was associated with increased common mental disorder, post-traumatic stress disorder (PTSD), and poor general health. By the second follow-up, those who had deployed were no longer at increased risk for common mental disorder or poor general health and had good levels of social functioning. However, those who deployed continued to have over twice the odds of PTSD (odds ratio = 2.42, 95% confidence interval: 1.04, 5.62) and were more likely to report actual or serious consideration of separation from their partner. In conclusion, the authors found that the majority of mental health and social problems following deployment are transient. However, Reservists who deployed in the Iraq War remain at increased risk of PTSD and relationship problems 5 years after their tour of duty.

Gender Integration in Armed Forces: Recent Policy Developments in the United Kingdom

This article reports on recent developments in policy on gender integration in the United Kingdoms armed forces, whereby womens employment opportunities have widened significantly since the early 1980s. These changes include increases in womens representation and the number of positions they are allowed to occupy; abolition of the Womens Royal Army Corps (WRAC) and Womens Royal Naval Service (WRNS); assigning women to combat ships, and training women as jet fighter pilots. Drawing on official reports and statistics and formal interviews with military and civilian defense officials, we analyze the main factors that have led the United Kingdom to make these policy changes. These factors are: demographic pressures, sociocultural changes in gender definitions, legal constraints (particularly from the European Union), and changing views of policy makers on whether women can and should serve in combat roles. The article highlights a number of implications of the policy changes.

Rights and Fights: Sexual Orientation and Military Effectiveness

ing civil rights. Our contention is that Kier fails to grapple with the central issue of the heterosexist and masculine culture of the U. S. military. Her commitment to the civil rights of gays and lesbians, which we share, must not be allowed to obscure the real obstacles standing in the way of that commitment; civil rights are not advanced by oawed policy analysis. Kier’s thesis is undermined by three problems. First, she pays insufacient attention to the historical and social structural context within which military personnel policy evolves. She fails to appreciate that given the functional imperative of managing violence, even modern high-technology militaries must retain a degree of distinctiveness from civilian society and nonmilitary institutions for purposes of combat effectiveness. Although she draws on a wide variety of data to support her arguments, much of it concerns group formation in civilian settings or is drawn from noncombat elements of the armed forces. This leads to a second problem: her analysis of the relationship between cohesion and homosexuality. Kier does not give sufacient attention to the special nature of cohesion in the combat arms, particularly in ground combat forces, and to the ways in which militaries must produce soldiers from the civilian social context in which they are embedded. The context she focuses on—the U.S. case—however regrettable, is not generally supportive of the open integration of gays and lesbians

''Are You a Veteran?'' Understanding of the Term ''Veteran'' among UK Ex-Service Personnel A Research Note

Different countries have varying definitions of the word “veteran,” which in turn influence the benefits that ex-Service personnel receive. However, public opinion does not necessarily reflect official definitions. This article seeks to identify whether characteristics by which UK ex-Service personnel self-identify as veterans are aligned with official policy/public opinion, and which factors are associated with self-identification as a veteran. This article utilizes data from a structured telephone interview survey of UK Armed Forces personnel. All those who had left the military by the time of interview (n = 202) were asked whether they considered themselves to be a veteran. Their responses were recorded and analyzed. Only half of the sample considered themselves to be veterans. Definitions used by UK ex-Service personnel do not align with the official UK government definition or public perceptions of “veterans,” which tend to focus on older veterans and/or those who served in both World Wars.

Cultural Stress: How Interactions With and Among Foreign Populations Affect Military Personnel

The purpose of this article is to expand civil—military and military health research’s concepts of stress with the addition of a theoretical construct of the concept known as “cultural stress.” Military research often discusses combat and operational stress and its effect on soldiers but does not address unique culturally induced stressors created by the modern military’s interaction with indigenous populations. Civilian research discusses stress as it relates to “culture shock” but does not account for unique pressures facing servicemen in both peacetime and wartime environments. This article synthesizes these concepts to produce a new conceptual basis of “cultural stress” from which further empirical research can be conducted.

The British armed services and the participation of minority ethnic communities : from equal opportunities to diversity?

This paper examines the commitments enshrined in the Strategic Defence Review White Paper to make the armed forces more genuinely representative of the British population, notably with respect to ethnicity. It identifies some conceptual problems associated with the way in which those commitments are presented and with the arguments usually deployed in support of their pursuit. It suggests that a fundamental re-assessment is required of the concept of representativeness, which is at the heart of current policy commitments, if their planned practical outcomes are to be achieved. The paper asks whether a shift in focus from equal opportunities to diversity offers the prospect of resolving some of the dilemmas and obstacles identified. It concludes by suggesting that the concept of diversity is itself not unproblematic – particularly in a military context – and that it could offer a solution only if it were embraced hand in hand with a much more explicit acceptance of the diversity of the political community. This would mean nothing less than a reassessment of what it means to be British in the twenty first century and a more sophisticated grasp of what would be entailed in being representative of such a nation.