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Difficult childhoods predict later psychological problems in UK military men

NOVEMBER 30, 2007

The majority of UK soldiers do not develop combat-related psychiatric illness, despite enduring traumatic experiences on the battlefield. Experiencing adversity in childhood may explain why only a minority of soldiers exposed to trauma develop psychological problems.

This study, published in the December 2007 issue of the British Journal of Psychiatry, set out to examine the association between self-reported childhood vulnerability and later health outcomes in a large randomly selected group of male soldiers in service at the time of the Iraq war in March 2003. They were compared with non-deployed UK military personnel.

10,272 men were invited to complete a questionnaire on their childhood experiences, deployment experiences and health outcomes. After 3 mailings and active follow-up there was a 61% response rate. The final sample size available for analysis was 7937 men.

It was found that as many as 76% of respondents reported at least 2 or more vulnerability markers whilst growing up. 37.5% had been in trouble with the police; 29.8% got shouted at a lot at home; 25.5% had been in fights at school; and 3.3% had spent time in local authority care.

Higher vulnerability was associated with younger age, being in the Army, being a non-commissioned officer or other rank, having low educational attainment and being divorced, separated or widowed.

Pre-enlistment vulnerability was associated with a variety of negative health outcomes, including general psychological ill-health, post-traumatic stress disorder (PTSD), self-harming behaviour, and heavy drinking and smoking.

2 main factors emerged as important predictors of ill-health: a 'family relationships' factor, which reflects the home environment during childhood, and an 'externalising behaviours' factor, which reflects a variety of markers of behavioural disturbance during childhood and adolescence.

The family relationships factor was associated with increased exposure to trauma, which may contribute to the link between this factor and increased risk of PTSD.

The researchers comment that, historically, the UK armed forces have recruited from inner-city areas with high levels of socio-economic deprivation and social problems. It has been suggested that such young people often 'join up' to escape from adversity at home, such as physical abuse or discord between parents.

Previous work has suggested that early adversity may predispose a person to PTSD by a 'double hit'. Not only are they more likely to develop PTSD with any given exposure to trauma, but they are also more likely to be exposed to trauma in combat.

This study replicates these findings. They may be explained by the fact that adversity in childhood and adolescence is associated with risk-taking, impulsiveness, poor self-regulation and sensation-seeking in adult life; and such personality traits predispose a person to be exposed to combat.

The researchers do not suggest that these results should lead to a principle of excluding recruits from vulnerable backgrounds. Instead, they argue that it is important to recognise that some people have pre-enlistment histories that make them more vulnerable to psychological problems.

It should therefore remain a priority for the military as an employer to continue to develop appropriate support systems for all personnel during their service. 

For a full copy of the paper please refer to the December issue of the British Journal of Psychiatry, paper reference: Iversen AC, Fear NT, Simonoff E, Hull L, Horn O, Greenberg N, Hotopf M, Rona R and Wessely S (2007). Influence of childhood adversity on health among male UK military personnel. British Journal of Psychiatry, 191, 506-511.
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