Of current and former members of the British military, rates of post-traumatic stress disorder are highest among combat veterans who recently left the service, a new study finds.
The research also found a rise in the number of current and former military members showing symptoms of the disorder, known as PTSD, between 2004 and 2014.
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Among veterans whose last mission included a combat role in the Iraq or Afghanistan Wars, 17.1% reported symptoms of probable PTSD when given questionnaires focused on the condition.
Those deployed in support roles, such as medical or logistics, in the same locations reported a 6% rate of PTSD -- more than 11 percentage points lower -- according to the study, published Monday in the British Journal of Psychiatry. Veterans who had not been deployed to Iraq or Afghanistan saw rates of 5%.
The new study is "the closest thing we have to a true picture" of service members' mental health, said Simon Wessely, professor of psychological medicine at King's College London and author of the study.
Sharon Stevelink, a lecturer in epidemiology at King's College who led the study, added, "For the first time, we have identified that the risk of PTSD for veterans deployed in conflicts was substantially higher than the risk for those still serving."
The overall rate of probable PTSD among both current and former British military personnel rose over a 10-year period, from 4% in 2004-06 to 6% in 2014-16.
"If you have left the services and have been in combat, the rates [of developing PTSD] have gone up to 1 in 6 or 1 in 5, which is higher than what it was before," Wessely said.
PTSD is an anxiety disorder that manifests after a traumatic experience and can cause sleeplessness, irritability and traumatic nightmares. Four percent of the British civilian population and an estimated 5% of the US population struggles with it.
The study is the latest from major research by the King's Centre for Military Health Research, with more than 8,000 participants, 62% of whom had been deployed to Iraq or Afghanistan. The newest numbers look at surveys completed from 2014 to 2016.
The study highlights that veterans were 2½ times more likely to develop PTSD when they were deployed in a combat role than a combat support role, Stevelink said.
However, "while the increase among veterans is a concern, not every veteran has been deployed, and in general, only about 1 in 3 would have been deployed in a combat role," she noted.
Rates of common mental disorders such as depression and anxiety are also significantly higher for veterans, with 1 in 3 being affected, Stevelink added. These were high across all groups in the study, with 21.9% of participants affected.
Transitioning from the field
The transition from military service, with its strong social bonds, into civilian life is a stressful experience that can lead to an onset of mental health issues, Wessely said.
"As people leave, their vulnerability increases because they are losing the powerful support in they experienced in the forces," he said.
To ease the transition, veterans in the UK receive benefits such as free travel, tax reductions, school and child care allowances, and pension plans. For veterans returning in the United States, benefits include compensation payments, educational programs and health care options.
Britons and Americans are also deployed for different periods, with British troops spending an average of six months in the field but longer deployment for American troops, Wessely added.
American veterans report a higher rate of PTSD, with 24.7% of Army personnel meeting the definition eight years after being involved in Iraq, according to research.
'A common story'
Glyn Lewis, professor of psychiatry at University College London and consultant psychiatrist, noted that PTSD symptoms often manifest later in life. "This is a common story," said Lewis, who was not involved in the new study.
"You will find that people who had a bad experience in life will develop the classic [PTSD] symptoms years after the experience," he said, adding that this often can be triggered by similar things.
Another possible factor in the high numbers: Veterans may seek help only outside the military due to fear of stigma, study says.
Mental health awareness and declines in the stigma surrounding such issues also play a role, Wessely believes. In the 2014 to 2016 period, 31% of military personnel accessed mental health services, and only 7% opted to not seek help, according to the new research.
Together with alcohol misuse, common mental health disorders continue to be the most reported problems in British service members, the study says.
But alcohol abuse has been steadily declining since the start of the 15-year research, most recently recording a 6% fall for 2014 to 2016, compared with 2007 to 2009.
That decline can be explained by a declining drinking rate in the general population and by the participants' average age of 40, Lewis said.
"There is this issue about what should we be doing to try to help," he said. "Perhaps the need and particular experiences of people who have been deployed merit some separate health care provisions. We still don't really know what to do to prevent these things from happening."