Understanding the Needs of Veterans Seeking Support for Mental Health Difficulties

Research Paper Title

Understanding the needs of veterans seeking support for mental health difficulties.

Background

Since the late 1990s, studies have been conducted in the UK to monitor the health and well-being of military personnel. The bulk of this work has been conducted by researchers at King’s College London, first after the 1991 Gulf War and then later by setting up a cohort study in the wake of the 2003 Iraq War.

This was later expanded to be representative of the wider military and so far has included three waves of data collection, the most recent of which
reported results in late 2018.

The third wave of data collection observed increases in the prevalence rates of post-traumatic stress disorder (PTSD) from 4% to 6% for the entire population (including serving and ex-serving individuals). However, this only told half the story, when the sample was restricted to veterans only, the prevalence rate for PTSD was 7.4%. For the first time, this suggested that veterans were at increased risk of PTSD compared with the general public in the UK.

Further, when the sample was restricted to only veterans who had deployed within a combat role (approximately a third of all veterans), the observed rates of PTSD increased to 17.1%. These rates are worrying as until recently, evidence suggested that rates of PTSD in UK veterans from Iraq and Afghanistan were lower than their US, Canadian and Australian counterparts.

However, this data suggests that for the most at risk groups of UK veterans the PTSD prevalence rates are comparable. In addition to PTSD, population studies of military populations typically report high rates of anxiety, depression, anger and alcohol problems.

Data suggests that veterans with PTSD profit less from therapy than their civilian counterparts and that the cost to society for veterans with PTSD is higher than for veterans with other mental health difficulties. The reasons for this disparity are unclear. Studies exploring treatment efficacy in veterans with PTSD suggest that individuals with higher rates of psychiatric comorbidity are at risk of poor treatment responses.

Further, it has been suggested that veterans often take many years to seek help, by which time there is an erosion of resources around them that increases the risk of either dropping out of treatment or only making modest gains.

Latent Class analyses have allowed researchers to model heterogeneity in PTSD treatment responses. These analyses show that comorbid depression, guilt associated with the traumatic event and combat exposure are related to treatment non-response. These studies suggest the importance of moving away from a one-size fits all treatment response for veterans to one that takes into account the idiosyncratic presentations of individuals.

In long-term follow-up studies, it has been demonstrated that Vietnam veterans report a higher prevalence of long-term health conditions compared with the general population. Studies have observed associations between mental health difficulties in veterans and a range of physical health problems such as chronic pain, cardiovascular disease, autoimmune diseases and gastrointestinal disorders.

PTSD appears to be particularly problematic, with strong associations noted between PTSD and serious reductions in daily functioning. In US samples, veterans seeking support for PTSD were found to be at increased risk for both a range of physical health complaints and also earlier onset of physical health problems compared with veterans without PTSD.

You can read the full paper below:

Reference

Murphy, D. & Busuttil, W. (2019) Understanding the needs of veterans seeking support for mental health difficulties. Journal of the Royal Army Medical Corps. pii: jramc-2019-001204. doi: 10.1136/jramc-2019-001204. [Epub ahead of print].

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