Depression is more common than post-traumatic stress disorder (PTSD) among UK ex-service personnel. Only about a half of those who have a diagnosis of depression are seeking help currently, and few see specialists.
The war in Iraq has heightened recognition that active military service can have an adverse effect on the mental health of some military service personnel. Despite this, little is known about the psychological health or treatment experiences of those who have left the British armed forces.
The aims of this study, published in the June issue of the British Journal of Psychiatry, were to describe the frequency and associations of common mental disorders and help-seeking in a representative sample of UK veterans at high risk of mental health problems.
The group studied by the researchers consisted of 701 ex-service personnel on whom they had already collected two sets of information about psychological problems - at baseline (1997) and at follow-up (2001). A telephone survey was carried out of 496 'vulnerable' individuals.
The response rate was 64%. The final sample consisted of 315 individuals, all of whom had left the military and 98% of whom had been full-time employees; 12% were women.
Of the people studied, 44% had a psychiatric diagnosis, most commonly depression (53%). 18% had an anxiety disorder, 16% PTSD and 12% probable alcohol dependence. Those with a psychiatric diagnosis were more likely to be of lower rank and divorced or separated.
Just over half of those with self-reported mental health problems were currently seeking help, most from their general practitioners. The majority of help-seekers received treatment, usually medication.
28% were in touch with a service charity, and only 4% were receiving cognitive-behavioural therapy.
The authors of the study comment that the findings confirm that the most important diagnoses in ex-service personnel are classic psychiatric disorders rather than specific service-related psychiatric injury.
There are two major policy implications. First, ex-service personnel are reluctant to seek help, both while in service and after leaving. The military should therefore continue to encourage a culture in which consulting a medical practitioner about psychological symptoms is acceptable.
Second, it is now established that untreated mental health problems are associated with considerable functional and social disability and suffering for the individual, as well as increased use of medical services, and higher costs borne by individuals and healthcare institutions alike.
Therefore those who do consult should have access to high-quality, effective treatments delivered as swiftly as possible. It is a question of policy as to whether military service, with all its risks, entitles veterans to better access to specialist services than those who have not served in the military. At present, however, the treatment needs of this group are not being met.