The mental health of Veterans - Ticking Time-bomb or Business as Usual?

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The mental health of Veterans - Ticking Time-bomb
or Business as Usual?

• Professor Neil Greenberg
• Professor of Defence Mental Health at Kings
  College London
• Royal College of Psychiatrists Lead on Military
  and Veterans Health

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Question

• What proportion of Veterans suffer from Physical
  , Emotional or Mental Health problem related to
  their service?

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The UK Armed Forces

• Who are they as of 01 Apr 2013
• Full time trained strength - 170,710
• Intake 14,370 in the last 12 months
• Outflow 23,520 in the 12 months
• RN 34,000 Army 100,000 RAF 37,000
• Varied backgrounds 10 female, Reservists too
  (more later)

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Inflow/outflow and ESLs
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The mental health of UK military personnel and
Veterans since 2003
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KCMHR Military Cohort Studies

• Phase 1 - Random selection of
• TELIC 1 personnel
• non-deployed serving personnel
• Tri-service, all arms except Special Forces
• Data collection period 2004-2006
• Sample size 10,272
• Phase 2
• Follow up of Phase 1
• HERRICK sample
• New-joiners
• Data collection 2007-2009
• Sample size 9990
• Phase 3
• About to start

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Overall prevalence of outcomes
Outcome Overall, (95 confidence interval)
Probable PTSD 4.0 (3.5-4.5)
Common Mental Disorder 19.7 (18.7-20.6)
Alcohol Misuse 13.0 (12.2-13.8)
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Role of combat
Outcome Combat (25.0) Combat support (12.0) Combat service support (63.1)
Probable PTSD 6.9 2.1 3.6
Common mental disorders 20.6 18.3 19.7
Alcohol misuse 22.5 10.8 14.2
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Alcohol (mis)use in the military
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UK Armed Forces vs. the general population
Males (67 vs. 38)
Fear et al, Addictions 2007
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UK Armed Forces vs. the general population
Females (49 vs. 16)
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Comparisons with the UK General Population
of population
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What about the number of deployments
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Number of deployments currently serving Army
regulars
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Deploying above Harmony Guidelines impacts on PTSD
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Mild Traumatic Brain Injury (mTBI)

• Said to occur as a result of blast or head injury
• Describes the initial symptoms but used to infer
  longer term problems
• Not clear why concussion was not used as a term
  (mTBI a US signature injury!)

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Prevalence of mTBI
Author, year of publication Prevalence
Hoge et al.,2008 15.2
Tanielian T et al., 2008 19.5
Terrio et al., 2009 22.8
Pietrzak et al., 2009 18.8
Rona et al, 2012 3.6
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Reserves
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Types of Reserve

• Volunteer (RNR, RMR, TA (AR), RAAF etc)
• Full Time Reserve Service (FTRS)
• Regular Reserve
• Reserve Liability

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Mobilisation

• In TELIC 1 this was ordered now intelligent
• Usually for 9 months to a year
• Treated as regulars when mobilised for
  healthcare, support etc

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Prevalence of outcomes reserves (2007-2009)
Outcome Non-deployed (59.9) Deployed (40.1) Odds ratio (95 CI)
Probable PTSD 1.8 5.0 2.83 (1.23-6.51)
Common mental disorders 18.1 19.9 1.16 (0.85-1.59)
Alcohol misuse 6.8 9.5 1.38 (0.89-2.13)
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After Service
Veterans care
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Veterans

• Anyone who has served a day or more in the AF
  (and their families)
• Up to 4 million qualify
• Mental Healthcare provided by NHS and voluntary
  sector

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How personnel leave

• 1,711 ex-Service personnel from the KCMHR cohort
• 43 end of service term
• 47 leave voluntarily before end of term
• 11 unplanned leaving
• Made up of medical discharge, administrative
  discharge, temperamental unsuitability,
  compulsory redundancy, disciplinary discharge

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All leavers Prevalence of mental health outcomes
(phase 2 data)

• Common mental disorders
• Serving 19
• Left 22
• Probable PTSD
• Serving 3
• Left 6.5
• Alcohol misuse
• Serving 13
• Left 13

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What Happens Probable PTSD Rates Over Time in
relation to deployment?
Veterans?
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Early Service Leavers

• Female
• Single
• Lower rank
• Experienced more childhood adversity

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ESLs vs. other leavers
Outcome ESLs Other leavers
Common mental disorders 46 27
PTSD symptoms 20 7
Multiple physical symptoms 26 15
Alcohol misuse 31 15
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But
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Stigma and Barriers to Care
Gould et al, 2010, JRSM
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Self Stigma UK military
Seen as weak by managers
Langston et al, 2010, JMH
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Help seeking for PTSD (APMS)
Most Veterans with PTSD do not get treatmentbut
nor do non Veterans
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Suicide
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Standardised mortality ratios by Service, males,
1984-2011SMR (number of observed
deaths/number of expected deaths)100
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SMRs by age Service, males, 1984-2011
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More Falklands veterans have taken their own
life than were killed in the conflict
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Presentation Summary

• Prevalence and nature of disorder
• Regular (combat or not) and Reservists
• Definition of a Veteran
• Alcohol use and misuse
• Early Service Leavers
• Suicide
• The role and impact of myth

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The end Any Questions?- Fire Away!
Neil neil.greenberg_at_kcl.ac.uk