Kate Harrison

Suicide after leaving the UK armed forces--a cohort study.

Background Few studies have examined suicide risk in individuals once they have left the military. We aimed to investigate the rate, timing, and risk factors for suicide in all those who had left the UK Armed Forces (1996–2005). Methods and Findings We carried out a cohort study of ex-Armed Forces personnel by linking national databases of discharged personnel and suicide deaths (which included deaths receiving either a suicide or undetermined verdict). Comparisons were made with both general and serving populations. During the study period 233,803 individuals left the Armed Forces and 224 died by suicide. Although the overall rate of suicide was not greater than that in the general population, the risk of suicide in men aged 24 y and younger who had left the Armed Forces was approximately two to three times higher than the risk for the same age groups in the general and serving populations (age-specific rate ratios ranging from 170 to 290). The risk of suicide for men aged 30–49 y was lower than that in the general population. The risk was persistent but may have been at its highest in the first 2 y following discharge. The risk of suicide was greatest in males, those who had served in the Army, those with a short length of service, and those of lower rank. The rate of contact with specialist mental health was lowest in the age groups at greatest risk of suicide (14% for those aged under 20 y, 20% for those aged 20–24 y). Conclusions Young men who leave the UK Armed Forces were at increased risk of suicide. This may reflect preservice vulnerabilities rather than factors related to service experiences or discharge. Preventive strategies might include practical and psychological preparation for discharge and encouraging appropriate help-seeking behaviour once individuals have left the services.

Suicide among male regular UK Armed Forces personnel, 1984-2007.

Objective: To examine the number of suicide and open verdict deaths in the regular UK Armed Forces and to make comparisons with the UK general population. Methods: Age and calendar year-adjusted standardised mortality ratios (SMRs) and 95% CI were calculated to compare the number of suicides among the UK Armed Forces with the general population of the UK. Results: Between 1984 and 2007, there were 694 suicide and open verdict deaths among male UK Armed Forces personnel. The UK Armed Forces had statistically significantly fewer suicides than expected compared with the UK general population (SMRu200a=u200a58, 95% CI 54 to 63, based on 694 deaths). This was evident for each of the three Services (Naval Service, Army and Royal Air Force). For each age group, the number of suicides in each Service was lower than the number expected based on UK general population rates, except for Army males under 20 years of age, where there were 1.5 times more deaths than expected (SMRu200a=u200a150, 95% CI 118 to 190, based on 68 deaths). Conclusion: The UK Armed Forces are subject to a number of unique occupational stressors, so it is reassuring that they experience lower than expected numbers of suicides in comparison with the UK general population. This is true for each Service and all age groups except young Army males.

What are the effects of having an illness or injury whilst deployed on post deployment mental health? A population based record linkage study of UK army personnel who have served in Iraq or Afghanistan.

BackgroundThe negative impact of sustaining an injury on a military deployment on subsequent mental health is well-documented, however, the relationship between having an illness on a military operation and subsequent mental health is unknown.MethodsPopulation based study, linking routinely collected data of attendances at emergency departments in military hospitals in Iraq and Afghanistan [Operational Emergency Department Attendance Register (OpEDAR)], with data on 3896 UK Army personnel who participated in a military health study between 2007 and 2009 and deployed to Iraq or Afghanistan between 2003 to 2009.ResultsIn total, 13.8% (531/3896) of participants had an event recorded on OpEDAR during deployment; 2.3% (89/3884) were medically evacuated. As expected, those medically evacuated for an injury were at increased risk of post deployment probable PTSD (odds ratio 4.27, 95% confidence interval 1.80-10.12). Less expected was that being medically evacuated for an illness was also associated with a similarly increased risk of probable PTSD (4.39, 1.60-12.07) and common mental disorders (2.79, 1.41-5.51). There was no association between having an OpEDAR event and alcohol misuse. Having an injury caused by hostile action was associated with increased risk of probable PTSD compared to those with a non-hostile injury (3.88, 1.15 to 13.06).ConclusionsPersonnel sustaining illnesses on deployment are just as, if not more, at risk of having subsequent mental health problems as personnel who have sustained an injury. Monitoring of mental health problems should consider those with illnesses as well as physical injuries.

Self-harm in UK armed forces personnel: descriptive and case-control study of general hospital presentations

BACKGROUNDnLittle is known about self-harm in the armed forces.nnnAIMSnTo investigate the characteristics of armed forces personnel presenting to a general hospital following self-harm and compare these with matched controls who had self-harmed.nnnMETHODnInvestigation of armed forces personnel presenting to hospital between 1989 and 2003 following self-harm and case-control comparison with people in the general population who had self-harmed.nnnRESULTSnOne hundred and sixty-six armed forces personnel presented with self-harm during the study period, of whom 72.3% (120) were male. Nearly two-thirds (62.7%) were aged under 25 years. Relationship problems (62.0%), employment problems (43.9%) and alcohol misuse (40.5%) were common. Fewer armed forces personnel than controls had evidence of current or past psychiatric disorders or treatment or a prior history of self-harm, and their suicidal intent was lower (males only). Of 64 people in the armed forces who presented during the first 9 years of the study period, 1 had died (from natural causes) by the end of 2000, compared with 9 (5.1%) of the controls, 6 by probable suicide.nnnCONCLUSIONSnSelf-harm by armed forces personnel may often be a response to interpersonal and employment problems complicated by alcohol misuse, with relatively low suicide intent.

Suicide among Falkland war veterans

Responses should be based on sound statistics not misleading sound bites

Risky driving among UK regular armed forces personnel: changes over time

Objectives To compare the prevalence of self-reported risky driving in a sample of UK military personnel at 2 different time points (2004 and 2009), and to identify the incidence of new onset risky driving and possible determinants of becoming a new risky driver. Methods Data were used from 2 phases of a military cohort study investigating the health and well-being of UK military personnel between 2004 and 2009. Participants were included if they were undertaking regular (rather than reserve) engagements, had completed both surveys and reported being a driver at both surveys. Univariable and multivariable logistic regression analyses were performed to examine the relationship between risky driving status and sociodemographic and military characteristics. Data analysis was conducted in 2011. Results The prevalence of risky driving reduced from 18% to 14%, over an average of 3.3u2005years. The incidence of new onset risky driving was 7%. Predictors for becoming a new risky driver were: younger age, not being in a relationship at phase 2 and harmful alcohol use. Those deployed after 2007 were less likely to become risky drivers following deployment, compared with those deployed before 2007 (adjusted OR 0.62 (95% CI 0.40 to 0.95)). Conclusions The prevalence of becoming a risky driver appears to have reduced over time. This paper suggests a number of explanations for this reduction, including changes in the way that the UK military have dealt with road safety with the introduction of the road safety campaign (in 2007).

Impact of operational tours on mental health referrals for military patients, including time to referral and rates of PTSD

Objectives Determine impact of operational tours on referral rates to MOD Departments of Community Mental Health (DCMH); Identify military populations at risk for mental health problems; Assess impact of length of time from deployment to referral and Is there evidence for ‘bow-wave’ of PTSD resulting from operational deployments? Methods This is a cohort study based on administrative data for period 2007–2010. Records for Service personnel who attended an MOD Department of Community Mental Health (DCMH) facility were linked to the MOD personnel administration system to identify all those who had deployed prior to their mental health referral. Results More than 4000 Service personnel attended a DCMH following deployment to either Iraq or Afghanistan; 51% were assessed with a neurotic disorder. Population groups at risk included Army personnel, females and lower ranks. First 12 months showed increase in referrals for neurotic disorders (of which 61% adjustment disorders; 11% PTSD), after 24 months referral rates return to baseline. Significant impact of PTSD post deployment, rate ratio 15.5 (95% CI 4.8 to 49.8) for those deployed to Afghanistan and 9.9 (95% CI 3.1 to 32.3) for those deployed to Iraq compared to those not deployed on operations. Conclusions Groups at risk include females, Army personnel and other ranks. Rates of referral are highest in 12 months post deployment, adjustment disorder greatest impact on DCMH activity. No evidence for a bow-wave but evidence for increasing impact of PTSD in those who have deployed on operations.

Does attending an emergency department whilst deployed in Iraq or Afghanistan impact on the mental health of UK Army personnel

Objectives Attendances at emergency departments in deployed field hospitals by UK military personnel are frequent. Whilst combat-related injuries are known to impact on post-deployment mental health, less is known about the role other injuries or illnesses sustained on deployment have on subsequent mental health. The impact of attending emergency departments for an injury or illness in Iraq or Afghanistan on post-deployment mental health is examined. Methods Routinely collected data of emergency department attendances in Iraq and Afghanistan linked with cross-sectional survey-data containing outcomes: probable post-traumatic stress disorder (PTSD), common mental disorders and alcohol misuse. Results Data from 3896 UK Army personnel were included. 13.8% attended the emergency department. 2.3% were air-evacuated from Iraq or Afghanistan for further treatment. Compared to individuals without an attendance, those air-evacuated for an injury were at increased risk of post-deployment probable PTSD (OR 5.00, 95% CI 2.24 to 11.2). Those air-evacuated for an illness were at increased risk of probable PTSD (OR 4.43 95% CI 1.61 to 12.16) and common mental disorders (OR 2.82, 95% CI 1.43 to 5.56). There was no association between attending an emergency department and alcohol misuse. There was increased risk of probable PTSD among those with a hostile, compared to a non-hostile, injury (OR 3.88 95% CI 1.15-13.06). Conclusions Being air-evacuated from Iraq or Afghanistan increases the risk of post-deployment mental health problems, particularly probable PTSD. The mental health of individuals air-evacuated from theatre should be monitored. Attending an emergency department whilst deployed had no effect on post-deployment reporting of alcohol misuse.