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Background Internationally, women are about to undertake combat duties alongside their male colleagues. The psychological effect of this policy change is largely unknown. Aims To explore the mental health impact of combat exposure among military women. Methods Self-report, between-subjects survey data were collected in Iraq and Afghanistan on four occasions between 2009 and 2014 (n = 4139). Differences in mental health, stigmatization, deployment experiences, intimate relationship impact, perception of family support levels, unit cohesion, leadership and help-seeking were compared between deployed men and women. Comparisons were repeated with the study sample stratified by level of combat exposure. Outcomes were examined using logistic regression adjusted for socio-demographic, mental health and military factors. Results Overall, 4.1% of women and 4.3% of men reported post-traumatic stress disorder (PTSD) (odds ratio (OR) 1.31, 95% confidence interval (95% CI) 0.70–2.46); 22% of women and 16% of men reported symptoms of common mental disorder (CMD) (OR 1.52, 95% CI 1.11–2.08). Women were less likely to report mental health-related stigmatization (OR 0.68, 95% CI 0.53–0.87), negative relationship impact from deployment (OR 0.69, 95% CI 0.49–0.98) and subjective unit cohesion (OR 0.69, 95% CI 0.53–0.90). Help-seeking for emotional problems was similar by gender (OR 1.22, 95% CI 0.84–1.77). Overall, outcomes were minimally impacted by level of combat exposure. Conclusions Although women experienced more CMD symptoms, PTSD symptoms were similar by gender. Subject to confirmation of the study findings, women may not require enhanced mental healthcare during deployment for exposure-based conditions such as PTSD when undertaking the ground close combat role. [ABSTRACT FROM AUTHOR]

Background Recently, proposals have been made to improve mental health care for UK military veterans. Combat Stress (CS), a veteran’s charity, has provided mental health services for veterans since 1919. Since 2003, service users have included veterans from the Iraq and Afghanistan conflicts; however, their pattern of help-seeking has not been evaluated. Aims To describe the characteristics of the veteran population of the recent Iraq or Afghanistan conflicts who sought help from CS between 2003 and May 2011. Methods CS Iraq and Afghanistan veteran clinical and welfare records were evaluated. Results Nine hundred and eighty-eight records were evaluated. The median time for veterans of recent conflicts to seek help from CS since discharge from military service was ~2 years, considerably shorter than the mean time of 14 years previously estimated by CS. Approximately, three-quarters of the veterans receiving a full clinical assessment (n = 114), received a diagnosis of post traumatic stress disorder (PTSD) (n = 87). Approximately half of the clinically assessed veterans self-referred to CS (51%); their most frequent diagnosis was PTSD. Conclusions Veterans who have served in Iraq and Afghanistan are presenting to Combat Stress sooner, and at a younger age, than veterans of previous conflicts and operations. [ABSTRACT FROM AUTHOR]

Background Military personnel exposed to potentially traumatic events whilst deployed on operational duties may develop psychological problems. The Royal Marines have made extensive use of Trauma Risk Management (TRiM), a peer-support system that operates through practitioners embedded within operational units. TRiM aims to promote recognition of psychological illness and to facilitate social support.Aims To evaluate the effects of TRiM in two units at different stages of implementation.Methods Royal Marines and Army personnel were surveyed prior to, during and upon return from an operational deployment to Afghanistan. Participants completed measures of general mental health (GHQ12) and traumatic stress [PCL(C)].Results We received responses from 180 pre-deployment, 105 during deployment and 137 post-deployment. Personnel within units with experience of TRiM reported lower levels of psychological distress than personnel in the unit who were using TRiM for the first time. Both groups reported higher psychological distress scores before and during deployment, compared with post-deployment. However, we found personnel who reported having more access to social support during deployment reported less psychological distress.Conclusions The use of TRiM may assist in increasing the psychological resilience of military personnel through the facilitation of social support; this may have particular utility during operational deployments. [ABSTRACT FROM AUTHOR]

Background: Violent offending by veterans of the Iraq and Afghanistan conflicts is a cause for concern and there is much public debate about the proportion of ex-military personnel in the criminal justice system for violent offences. Although the psychological effects of conflict are well documented, the potential legacy of violent offending has yet to be ascertained. We describe our use of criminal records to investigate the effect of deployment, combat, and post-deployment mental health problems on violent offending among military personnel relative to pre-existing risk factors., Methods: In this cohort study, we linked data from 13,856 randomly selected, serving and ex-serving UK military personnel with national criminal records stored on the Ministry of Justice Police National Computer database. We describe offending during the lifetime of the participants and assess the risk factors for violent offending., Findings: 2,139 (weighted 17.0%) of 12,359 male UK military personnel had a criminal record for any offence during their lifetime. Violent offenders (1,369 [11.0%]) were the most prevalent offender types; prevalence was highest in men aged 30 years or younger (521 [20.6%] of 2,728) and fell with age (164 [4.7%] of 3027 at age >45 years). Deployment was not independently associated with increased risk of violent offending, but serving in a combat role conferred an additional risk, even after adjustment for confounders (violent offending in 137 [6.3%] of 2178 men deployed in a combat role vs 140 (2.4%) of 5,797 deployed in a non-combat role; adjusted hazard ratio 1.53, 95% CI 1.15-2.03; p=0.003). Increased exposure to traumatic events during deployment also increased risk of violent offending (violent offending in 104 [4.1%] of 2753 men with exposure to two to four traumatic events vs 56 [1.6%] of 2944 with zero to one traumatic event, 1.77, 1.21-2.58, p=0.003; and violent offending in 122 [5.1%] of 2582 men with exposure to five to 16 traumatic events, 1.65, 1.12-2.40, p=0.01; test for trend, p=0.032). Violent offending was strongly associated with post-deployment alcohol misuse (violent offending in 120 [9.0%] of 1363 men with alcohol misuse vs 155 [2.3%] of 6768 with no alcohol misuse; 2.16, 1.62-2.90; p<0.0001), post-traumatic stress disorder (violent offending in 25 [8.6%] of 344 men with post-traumatic stress disorder vs 221 [3.0%] of 7256 with no symptoms of post-traumatic stress disorder; 2.20, 1.36-3.55; p=0.001), and high levels of self-reported aggressive behaviour (violent offending in 56 [6.7%] of 856 men with an aggression score of six to 16 vs 22 [1.2%] of 1685 with an aggression score of zero; 2.47, 1.37-4.46; p=0.003). Of the post-traumatic stress disorder symptoms, the hyperarousal cluster was most strongly associated with violent offending (2.01, 1.50-2.70; p<0.0001)., Interpretation: Alcohol misuse and aggressive behaviour might be appropriate targets for interventions, but any action must be evidence based. Post-traumatic stress disorder, though less prevalent, is also a risk factor for violence, especially hyperarousal symptoms, so if diagnosed it should be appropriately treated and associated risk monitored., Funding: Medical Research Council and the UK Ministry of Defence., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Third Location Decompression (TLD) is the process through which personnel, returning from combat operations, begin to psychologically 'unwind'. Decompression comprises welfare activities, such as contacting home, beach events, social events, psycho-educational briefings and controlled re-introduction to alcohol., Aims: To assess the subjective utility of decompression by surveying all British troops transiting the TLD facility in Cyprus, during 2008., Methods: Analysis of distributed surveys completed by personnel who had deployed either to Iraq or Afghanistan. The main outcome was the subjective utility of the decompression process, with operational exposures, stigma, early post-traumatic stress (PTS) symptoms and adjustment concerns also measured., Results: Response rate was 87% (11,304 returned surveys). Eighty per cent of respondents reported being ambivalent or not wanting to go through TLD before decompression; however, on completion, 91% reported finding it useful. The desire to participate was the strongest predictor of perceived helpfulness. Troops who found the TLD less helpful included those who had been through the process before, combat troops and non-commissioned officers. Twelve per cent reported substantial concerns about re-establishing relationships or settling down to 'normal life'; those reporting more adjustment concerns were more likely to perceive TLD as helpful. Six per cent reported significant PTS symptoms and 27% of troops reported substantial levels of stigma related to mental health and barriers to care., Conclusions: TLD was well received by troops following combat deployment. However, TLD does not appear to be equally acceptable to all and alterations to the TLD programme for certain subgroups might be required.