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Medical downgrading, self-perception of health, and psychological symptoms in the British Armed Forces
  1. R J Rona1,
  2. R Hooper1,
  3. N Greenberg2,
  4. M Jones2,
  5. S Wessely2
  1. 1Department of Public Health Sciences, Guy’s, King’s and St Thomas’ School of Medicine, King’s College London, UK
  2. 2King’s Centre for Military Health Research, Academic Department of Psychological Medicine, Guy’s, King’s and St Thomas’ School of Medicine and Institute of Psychiatry, UK
  1. Correspondence to:
 Professor R J Rona
 Department of Public Health Sciences, King’s College London, Guy’s Campus, 5th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK; roberto.rona{at}


Objective: To investigate the contribution of psychological symptoms to limited employability for medical reasons in the British Armed Forces.

Methods: A sample of 4500 military personnel was randomly selected to receive either a full or an abridged questionnaire. The questionnaires asked whether the participant was medically downgraded and if yes, the reason for it. The full questionnaire included the General Health Questionnaire-12 (GHQ-12), the post-traumatic stress disorder (PTSD) checklist, 15 symptoms to assess somatisation, and selected items of the quality of life SF-36 questionnaire. The abridged questionnaire included the GHQ-4, a 14 item PTSD checklist, five symptoms, and the item on self-perception of health from the SF-36. Subjects above a threshold score for GHQ, PTSD, and symptoms were considered to have psychological symptoms.

Results: 12.4% of the participants were medically downgraded. The majority (70.4%) had social or work limitations. Medically downgraded personnel had higher odds ratios in comparison to non-downgraded personnel for psychological distress 1.84 (95% CI 1.43 to 2.37), PTSD 3.06 (95% CI 1.82 to 5.15), and number of symptoms 2.37 (95% CI 2.37 1.62 to 3.47). GHQ, PTSD, and symptoms scores were mainly, but not exclusively, related to chronic physical injury.

Conclusions: Psychological symptoms are common among medically downgraded personnel. Although the mechanisms involved are unclear, tackling issues of psychological symptoms among these subjects could contribute to faster restitution to full employability in the Armed Forces.

  • AFPAA, Armed Forces Personnel Administration Agency
  • GHQ, General Health Questionnaire
  • MO, Medical Officer
  • PTSD, post-traumatic stress disorder
  • RAF, Royal Air Force
  • RN, Royal Navy
  • TA, Territorial Army
  • medical downgrading
  • medical fitness
  • psychological symptoms
  • perception of health
  • armed forces

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  • Competing interests: none.

  • Ethics approval: the study to develop and validate a questionnaire for screening psychological illness in the UK Armed Forces was approved by the Defence Medical Services Clinical Research Committee (DMSCRC) on the 5 December 2001, reference 505/57. This analysis is based on data collected for such project.