Objectives While most UK military personnel transition successfully into civilian life, some experience unemployment and disability, which may be partly attributable to in-service factors. This study aims to determine the degree to which in-service mental health problems impact on postservice benefit claims.
Methods Using data from a cohort of 5598 recent leavers from regular service in the UK Armed Forces linked with data from the Department for Work and Pensions, we assessed associations between in-service mental health and postservice benefit claims, and the population attributable fraction (PAF) of benefit claims related to in-service mental health. An analysis with postservice mental ill health as mediator was performed to determine the degree to which the observed effects were a consequence of persistent illness, as opposed to remitted.
Results Mental illness occurring in-service predicted both unemployment and disability claims, partly mediated by postservice health (23%–52% total effects mediated), but alcohol misuse did not. Common mental disorder (CMD) (PAF 0.07, 95% CI: 0.02 to 0.11) and probable post-traumatic stress disorder (PTSD) (PAF 0.05, 95% CI 0.01 to 0.09) contributed to unemployment claims. Probable PTSD was the largest contributor to disability claims (PAF 0.25, 95% CI 0.13 to 0.36), with a smaller contribution from CMD (PAF 0.16, 95% CI 0.03 to 0.27).
Conclusions In-service mental ill health gives rise to benefit claims. These effects are only partly mediated by postservice mental health, implying that in-service (or pre-service) mental issues have carry-over effects into civilian life even if remitted. Better prevention and treatment of in-service PTSD symptoms may well reduce postservice disability claims.
- mental health
- military personnel
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Contributors HB wrote the manuscript. NG oversaw the data linkage with the department of work and pensions. NTF, SW, RJR and NG contributed to the writing and revision of the paper. HB performed the analyses and all authors discussed the analysis and interpretation of the data.
Funding This project was funded by Forces in Mind Trust, award number FiMT16/0204K.
Competing interests RJR and HB report grants from ministry of defence and grants from Forces in Mind Trust during the conduct of the study. NG reports personal fees from King’s College London, during the conduct of the study, and is the Royal College of Psychiatrists Lead for Military and Veterans Health and also a trustee for two military charities. He was not required to act in any particular way by these organisations in relation to the paper. NTF and SW have nothing to disclose.
Patient consent for publication Not required.
Ethics approval The ministry of defence research ethics committee (reference 448/MODREC/13), and the King’s College London Psychiatry Nursing and Midwifery Research Ethics Subcommittee (reference PNM/12/13-169) granted approval for the King’s Centre for Mental Health Research cohort study. Ethical approval was not required for administratively collected department of work and pensions data.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available. The datasets generated and analysed during the study are not publicly available due to the sensitive nature of data referring to members of the Armed Forces.