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19 January 2021

More support needed for Armed Forces personnel with PTSD

A major new study has been published today exploring how PTSD (Post-Traumatic Stress Disorder) affects UK Armed Forces personnel - particularly those who served in Iraq and Afghanistan. This adds to a recent body of research which calls for more support for serving and ex-serving personnel with PTSD.

Man in military uniform holding his hands to his face

The report, 'The evolution of PTSD in the UK Armed Forces: Traumatic exposures in Iraq & Afghanistan and responses of distress (TRIAD Study)', from King’s College London and funded by Forces in Mind Trust (FiMT), examines how PTSD evolves over time and the factors that can protect against or make personnel more vulnerable to PTSD symptoms.

The report highlights that most (70 per cent) of UK Armed Forces personnel did not experience any PTSD symptoms over a twelve-year period (2004-2016) spanning the Iraq and Afghanistan conflicts. In total, 12 per cent of participants experienced probable PTSD at some point within the twelve-year period (five per cent of whom improved, five per cent worsened and two per cent had ongoing symptoms), and a further 18 per cent experienced consistently elevated symptoms, described by the researchers as mild distress.

Our research found most Armed Forces personnel fare well during and beyond Service, however some may develop symptoms of PTSD. Our study showed that the military may provide robust support structures to those serving, but the trauma some in-service experience - combined with loss of supports upon leaving - may make some particularly vulnerable.

Dr Sharon Stevelink, King’s Centre for Military Health Research

She added, “That PTSD is not necessarily apparent immediately after a traumatic event is not a new finding, but the fact that military personnel may be able to compartmentalize experiences over very long periods suggests a stronger focus is needed upon the availability of longer-term care, particularly at the point of transition and well into post-service life.”

Factors found to be associated with PTSD symptoms included experiencing stress or violence during childhood, serving in the Army and misusing alcohol. This supports other recent studies which have shown associations between probable PTSD and alcohol misuse, including 'Help-seeking for alcohol problems in serving and ex-serving personnel' from King’s College London and the University of Liverpool (published in 2020).

The researchers found that ex-serving personnel had higher rates of probable PTSD than serving personnel (13 per cent v 10 per cent), had worse long-term outcomes and were less likely to improve than personnel still in service. Most ex-serving personnel described not experiencing probable PTSD immediately after their first deployments and that traumatic experiences were compartmentalized. Symptoms therefore emerged over time, but intensified most after personnel had left service. This highlights a unique consideration for ex-serving personnel with PTSD symptoms, as such compartmentalization is a crucial skill during deployments, but this may lead to suppression over the longer term.

There is much we can learn from this world-leading study. It is important to acknowledge that, as the report confirms, most Armed Forces personnel do not experience PTSD. But we must support those who do have this debilitating mental health condition.

Ray Lock CBE, Chief Executive of FiMT

He continued, “Based on the TRIAD Study and other research from FiMT’s Mental Health Research Programme, we now have strong evidence to suggest that more support is needed – and more importantly, we have a clear set of recommendations to follow. Evidently, transition from military to civilian life is key, so it must be a particular focus for change. This report highlights in particular the importance of promoting continuity and diversifying support structures. The recommendations from recent reports are consistent, and action must now be taken to better support serving and ex-Service personnel with PTSD.”

The report found that joining the military offered a range of practical and cultural support structures that may buffer the emergence of early PTSD symptoms, such as camaraderie and contexts where traumatic exposures are normal and shared. When leaving the military, the loss or change of support structures appeared to be an important factor in the development, or in the worsening, of PTSD symptoms. Those who did not develop symptoms reported more stable structures as they transitioned from the military into civilian life. As a result, the researchers emphasize the need for continuity in support as personnel leave service and helping to find effective alternatives to in-service support, in order to prevent the burden being carried primarily by the family.

It is important that continuous support is provided, especially during transition to civilian life and beyond, to ensure that veterans are able to access any support they need when they need it.

Professor Nicola Fear, Co-Director of King’s Centre for Military Health Research

The TRIAD Study supports a growing evidence base, built by Forces in Mind Trust, as part of their Mental Health Research Programme. A report published in 2020 from King’s College London and the University of Liverpool found that veterans are more likely to exhibit probable PTSD than non-veterans of the same age and gender. Previous research from King’s College London also found that veterans are more likely to report probable PTSD than serving personnel (7.4 per cent v 4.8 per cent), whilst PTSD rates for serving personnel have remained relatively stable since 2004.

‘The evolution of PTSD in the UK Armed Forces: Traumatic exposures in Iraq & Afghanistan and responses of distress (TRIAD Study)’ by Dr Laura Palmer, Professor Roberto J. Rona, Professor Nicola T. Fear and Dr Sharon A.M. Stevelink from King’s Centre for Military Health Research King’s College London can be accessed here and is funded by The Forces In Mind Trust.

In this story

Nicola Fear

Professor of Epidemiology

Sharon Stevelink

Reader in Epidemiology