One obvious issue facing military personnel is that of physical injury incurred whilst serving and the recovery and rehabilitation process that the individual has to undergo. While some make a recovery that allows them to continue to serve some do not make this recovery and the injuries sustained will cause them to be medically discharged from the services. The psychological impact of encountering this kind of trauma, either as a victim of the event or as a witness to it can also lead the individual to suffer from mental health conditions. The House of Commons briefing paper, Mental Health Statistics for England (Baker 2018) gives a breakdown of the prevalence of mental health conditions into regions, gender, occupation and ethnicity but does not mention veterans as a community. NHS (2016) states that ‘one in four adults experience at least one diagnosable mental health problem in any given year, this equals 25% of the population, including veterans.
One such condition is post-traumatic stress (PTS) and according to APA (2022), it is categorised under Traumatic and Stressor Related Disorders in The Diagnostic Statistical Manual of Mental Disorders (DSM). According to Yehuda et al. (2015), PTS is a condition that can develop following exposure to extremely traumatic events such as interpersonal violence, combat, life-threatening incidents or natural disasters. It can also develop from indirect exposure to the grotesque effects of war as first responders to serious injury or death and military personnel collecting human remains (APA, 2022). Its core features are the persistence of intense, distressing, and fearfully avoided reactions to reminders of the triggering event, alteration of mood and cognition, a pervasive sense of imminent threat, disturbed sleep and hypervigilance (Shalev, 2017). Yehuda et al. (2015) describe the symptoms as intrusive distressing memories, nightmares of the trauma, enhanced threat sensitivity and preoccupation with the potential for danger, difficulty sleeping, poor concentration and emotional withdrawal.
To be diagnosed with PTS, the sufferer must show symptoms that occur for at least a month and result in functional impairment or clinically significant distress (Adler & Hoge, 2008). PTS can be categorised into two types, it is termed ‘acute’ if symptoms last for less than three months and termed ‘chronic’ if persisting for more than three months (Javidi & Yadollahie, 2012). Shalev (2017) explains that the symptoms of PTS frequently present shortly after the traumatic event but a delayed onset seen in military personnel accounts for 25% of chronic cases. Delayed onset occurs at least six months after the traumatic event (Javidi & Yadollahie, 2012). For a diagnosis of PTS to be given an individual must present with multiple symptoms from a range of seven symptom clusters given in DSM. The DSM is now in its fifth edition (DSM-V) since its creation and according to Shalev (2017), there is only a 55% overlap between those identified as having PTS in the previous DSM – IV version. This indicates that 45% of those that were diagnosed with PTS following the DSM – IV guidelines would not have been diagnosed under DSM – V. Many studies that show statistics of the prevalence of PTS were conducted before DSM – V.
Various sources claim different statistics for the prevalence of PTS in the armed forces, according to (Shalev, 2017) 78% of those who experience combat will not develop PTS but the intensity of the event and the number of traumatic events that someone is exposed to will increase the likelihood of PTS developing. The APA (2022) however states that the rates of PTS are higher among veterans. The highest rates range from one-third to more than half are found in rape survivors, military combat and captivity and ethnically or politically motivated genocide (p 308). Many veterans support charities such as Combatstress (2019) use the figures from the Stevelink et al. (2018) study stating that the prevalence of PTS was lower in serving personnel at 4.8% compared to the 7.4% in UK veterans, this leaves the overall PTS rates for the military community at 6.2%. Zoteyeva et al. (2016) agree, citing Iverson et. al. (2009) that the rate of probable PTS from recent conflicts was 6.2% which is elevated compared to 4% of the general population.
Aside from PTS alcohol misuse and common mental disorders (CMD) continue to be the most common mental health problems the military and veteran community face with rates of alcohol misuse at 10%, and 21% suffering from CMD (Stevelink et al., 2018). The symptoms that the varied range of conditions present include anxiety, depression, negative thoughts, low self-esteem, anger, irritability, mood problems, and insomnia, these result in sufferers withdrawing socially and avoiding social situations. These can affect family and work relationships and an unwillingness to socialise. Hunt et al. (2014) conclude that ‘UK studies of military personnel suggest that their rates of common mental disorder are comparable to or higher than the UK general population, that military exposures do not seem to influence rates of common mental disorders and that certain groups of the military are far more likely to suffer from psychological distress rather than PTS, with a suggestion that general aspects of daily work seem to have a greater impact on common mental disorders that any specific exposure (p7).’ NHS (2016) rates of mental health problems amongst serving personnel and recent veterans appear to be broadly similar to the UK population but, working-age veterans are more likely to report suffering from depression.
Zoteyeva et al. (2016) observed that despite the high prevalence of mental illness in the population, not all veterans seek professional treatment (p308). It is acknowledged that mental health issues in the defence forces often exist within a culture of stigmatisation with servicemen often reluctant to admit to having a problem (Balfour 2018). This reluctance of veterans to come forward and seek help could be one factor that complicates the statistics. In the survey conducted for NHS (2016) 77.1% agreed to the question ‘I felt no one would understand my armed forces’ experience.’ With one comment that’ Non-military civilians do not understand military life and conditions and therefore veterans will always be wary of dealing with such people.’ 78.3% of veterans surveyed agreed to the question ‘I found it hard to ask for help for my mental health condition.’ One commented, ‘Servicemen are always trained not to show weakness,’ while another stated, ‘I knew there was help available, but a mix of pride and fear stopped me from asking for help.’ These attitudes often delay individuals’ from seeking help. Delayed onset PTS is 33% more common in veterans than compared to the civilian population (Andrews et al., 2009), and the finding by the charity Combat Stress is that the average delay between symptom onset and presentation to support services is 13 years (Iversen & Greenberg, 2009). This delay in symptoms and the unwillingness of veterans to come forward to ask for help with their problems may be leaving many veterans with undiagnosed conditions.
One personal way to cope with these issues that veterans face is to the mindfulness approach of the five steps to wellbeing 1) connect with other people, 2) be active, 3) learn new skills, 4) give to others and 5) take notice and pay attention to the present moment.