Do serving and ex-serving personnel of the UK armed forces seek help for perceived stress, emotional or mental health problems?

Figures & data

Figure 1. Flow diagram for the interview study. *These 2017 eligible participants were identified as eligible and identified by August 2016. However, the phase 3 health and wellbeing cohort study, from which these participants were derived, continued data collection until the first week of January 2017. An additional 451 eligible participants were identified after August 2016, but were not selected to take part in the interview study given constraints on the time available for finishing the study.

Table 1. Characteristics of participants who completed the interview study (n = 1448).

	n (%) completed
Overall study sample (N = 1448)
Age (years)
< 30	174 (13.5)
30–39	470 (32.3)
≥ 40	804 (54.2)
Gender
Female	219 (15.1)
Male	1229 (85.0)
Service
Royal Navy or Royal Marines	197 (13.1)
Army	937 (65.9)
Royal Air Force	314 (21.0)
Rank
Officer	380 (25.1)
Non-commissioned officer	879 (60.9)
Junior rank (private soldier or equivalent)	189 (14.0)
Engagement type
Regular	1180 (81.3)
Reservist	268 (18.7)
Serving status
Serving	791 (54.9)
Ex-serving	657 (45.1)
Completed operational deployment (Iraq/Afghanistan)
No	382 (26.6)
Yes	1064 (73.4)
Self-reported stress, emotional, alcohol or mental health problem
Current	819 (57.1)
Past	613 (42.9)
Overall health rating
Excellent/very good	676 (46.6)
Good	529 (36.7)
Fair/poor	243 (16.7)
Functional impairment
No	926 (63.9)
Yes	522 (36.1)
Symptoms of anxiety (GAD-7 score ≥ 10 = case)
Case	260 (18.2)
Symptoms of depression (PHQ-9 score ≥ 15 = case)
Case	110 (7.8)
Probable PTSD (PCL-5 score ≥ 38 = case)
Case	124 (8.7)
Alcohol misuse (AUDIT-C score ≥ 10 = case)
Case	267 (18.6)
Any mental health problem^a
0	1151 (79.3)
1	167 (11.6)
≥ 2	129 (9.1)

AUDIT-C, Alcohol Use Disorders Identification Test; GAD-7, Generalized Anxiety Disorder 7-item; PCL-5, PTSD Checklist for DSM-5; PHQ-9, 9-item Patient Health Questionnaire; PTSD, post-traumatic stress disorder.

Percentages are weighted. ^aAny mental health problem is defined based on participants reporting symptoms of probable PTSD (PCL-5), depression (PHQ-9) or anxiety (GAD-7). Missing: n = 2 for deployment status; n = 16 for self-reported stress, emotional, alcohol or mental health problem; n = 1 for symptoms of anxiety, depression and comorbidity.

Table 2. Recognition of probable mental health disorders and alcohol misuse.

Current symptoms	Symptoms of anxiety (n = 260)	Symptoms of depression (n = 110)	Probable PTSD (n = 124)	Alcohol misuse (n = 266)
Self-reported current problem (n = 819)	229 (88.1)	105 (95.6)	119 (96.0)	178 (67.0)
Self-reported past problem (n = 613)	31 (12.0)	5 (4.4)	5 (4.0)	88 (33.0)

PTSD, post-traumatic stress disorder.

Data are shown as n (%). Percentages are weighted. Missing: n = 16 for self-reported stress, emotional, alcohol or mental health problem; n = 1 for symptoms of anxiety and depression.

Table 3. Sociodemographic and military characteristics of participants who did and did not seek help.

Type of help-seeking Characteristics	No help sought (n = 103, 7.2%)	Any form of help-seeking (n = 1328, 92.8%)	MOR (95% CI)	AMOR (95% CI)
Age (years)
< 30	7 (7.9)	166 (14.0)	2.12 (0.95–4.70)	1.41 (0.57–3.51)
30–39	29 (28.2)	433 (32.4)	1.37 (0.87–2.16)	1.09 (0.66–1.80)
≥ 40	67 (64.0)	729 (53.6)	1	1
Gender
Female	5 (4.9)	214 (16.0)	3.68 (1.47–9.19)	3.45 (1.33–8.95)
Male	98 (95.1)	1114 (84.0)	1	1
Service
Royal Navy or Royal Marines	13 (11.9)	182 (13.2)	1.28 (0.70–2.36)	1.29 (0.70–2.37)
Army	77 (75.9)	850 (65.2)	1	1
Royal Air Force	13 (12.2)	296 (21.6)	2.06 (1.12–3.76)	1.97 (1.08–3.60)
Rank
Officer	26 (24.2)	352 (25.3)	1.16 (0.73–1.86)	1.07 (0.67–1.72)
Non-commissioned officer	68 (66.8)	798 (60.3)	1	1
Junior rank (private soldier or equivalent)	9 (9.0)	178 (14.4)	1.77 (0.86–3.62)	1.71 (0.76–3.84)
Engagement
Regular	82 (79.5)	1084 (81.5)	1	1
Reservist	21 (20.6)	244 (18.5)	0.88 (0.53–1.45)	0.85 (0.51–1.42)
Serving status
Serving	46 (44.8)	736 (55.8)	1	1
Ex-service	57 (55.2)	592 (44.3)	0.64 (0.43–0.96)	0.70 (0.44–1.11)
Completed operational deployment (Iraq/Afghanistan)
No	17 (16.5)	360 (27.3)	1	1
Yes	86 (83.5)	966 (72.7)	0.52 (0.31–0.90)	0.51 (0.30–0.88)
Overall health rating
Excellent/very good	54 (52.5)	609 (45.7)	1	1
Good	34 (33.0)	492 (37.2)	1.29 (0.83–2.02)	1.36 (0.87–2.15)
Fair/poor	15 (14.6)	227 (17.0)	1.34 (0.74–2.43)	1.50 (0.82–2.74)
Functional impairment
No	75 (72.6)	837 (63.0)	1	1
Yes	28 (27.4)	491 (37.0)	1.56 (0.99–2.44)	1.69 (1.07–2.70)
Any mental health problems
0	83 (80.2)	1051 (79.0)	1	1
1	16 (15.7)	151 (11.4)	0.74 (0.42–1.30)	0.70 (0.39–1.24)
≥ 2	4 (4.1)	125 (9.6)	2.39 (0.86–6.65)	2.44 (0.86–6.95)
Social support, mean (95% CI)	29.55 (28.53–30.56)	32.47 (32.11–32.63)	1.09 (1.06–1.13)	1.09 (1.06–1.13)

AMOR, Adjusted multinomial odds ratio; CI, confidence interval; MOR, multinomial odds ratio.

Percentages and means are weighted. AMOR is adjusted for age (as a continuous variable), gender, rank, serving status and engagement type. Missing: n = 2 for deployment status; n = 16 did not disclose a past or current stress, emotional, alcohol or mental health problem; n = 1 failed to answer help-seeking section; n = 1 for any mental health problems.

The confidence interval in bold indicates that the difference was significant.

Table 4. Levels of help-seeking by probable mental health disorder, alcohol misuse and current or past self-reported problem.

Current symptoms of a mental disorder	No help sought^b n (%; 95% CI)	Informal support n (%; 95% CI)	Formal non-medical support n (%; 95% CI)	Formal medical support n (%; 95% CI)
Whole sample^a	103 (7.2; 5.97–8.66)	1230 (85.9; 83.98–87.60)	664 (46.4; 43.82–49.00)	785 (54.5; 51.92–57.10)
Symptoms of anxiety	17 (6.6; 4.13–10.42)	218 (83.7; 78.58–87.72)	135 (51.9; 45.72–57.92)	182 (69.8; 63.92–75.16)
Symptoms of depression	3 (2.7; 0.85–8.13)	97 (88.0; 80.28–92.97)	66 (60.3; 50.71–69.11)	88 (79.8; 71.07–86.42)
Probable PTSD	7 (5.7; 2.72–11.63)	105 (84.6; 76.97–90.02)	70 (56.4; 47.45–65.00)	97 (78.0; 69.67–84.53)
Alcohol misuse	29 (10.9; 7.64–15.26)	215 (80.8; (75.57–85.13)	98 (36.8; 31.21–42.86)	140 (52.5; 46.47–58.52)
Self-reported current problem	65 (8.0; 6.33–10.11)	690 (84.1; 81.45–86.49)	399 (48.8; 45.39–52.26)	519 (63.1; 59.75–66.39)
Self-reported past problem	38 (6.1; 4.47–8.29)	540 (88.2; 85.42–90.54)	265 (43.2; 39.29–47.16)	266 (43.1; 39.17–47.02)

CI, confidence interval; PTSD, post-traumatic stress disorder.

Percentages are weighted. ^aIncludes those who did not meet the criteria for alcohol misuse or a probable mental disorder. ^bNumbers do not add up to 100% as participants can be included in more than one help-seeking category. Missing: n = 16 did not disclose a past or current stress, emotional, alcohol or mental health problem; n = 1 failed to answer help-seeking section.

Table 5. Reasons given for accessing formal medical support.

Reason for accessing formal medical support (n = 785)	n (%)
I realized that I had a problem	557 (71.0)
I was concerned that the problem was getting worse	448 (57.1)
I realized that I could not solve the problem myself	407 (51.7)
On the advice of or referral from a healthcare professional	397 (50.8)
On the advice of a family member, friend or colleague	386 (49.4)
The problem had started to affect my work	354 (45.1)
A change in life circumstances or a major life event	195 (24.7)
On the advice of my employer or chain of command	113 (14.5)
The problem was causing disciplinary problems	69 (9.0)
Due to physical symptoms or a physical health condition	56 (7.1)
Miscellaneous reasons	45 (5.6)
Advice from or referral by a non-healthcare professional	43 (5.6)
I found a service through word of mouth, advert or online	36 (4.7)
As part of the healthcare process	33 (4.2)
Due to mental health symptoms	17 (2.2)
The problem was starting to affect family and/or friends	5 (0.6)

Percentages are weighted. Participants often gave more than one reason for accessing a source of formal medical support.

Table 6. Sociodemographic, health and military factors associated with help-seeking behaviour (n = 1328).

Type of help-seeking Characteristics	Informal support (n = 349)	Formal non-medical support (n = 194)	MOR (95% CI)	AMOR (95% CI)	Formal medical support (n = 785)	MOR (95% CI)	AMOR (95% CI)
Age (years)
< 30	51 (16.4)	40 (22.8)	1.90 (1.16–3.11)	1.64 (0.90–2.99)	75 (10.7)	0.62 (0.42–0.92)	0.49 (0.30–0.80)
30–39	104 (29.5)	74 (37.7)	1.75 (1.18–2.60)	1.48 (0.97–2.24)	255 (32.4)	1.05 (0.79–1.39)	0.92 (0.68–1.26)
≥ 40	194 (54.1)	80 (39.5)	1	1	455 (56.9)	1
Gender
Female	35 (9.9)	25 (12.7)	1.32 (0.76–2.29)	1.18 (0.67–2.07)	154 (19.6)	2.21 (1.49–3.27)	2.49 (1.66–3.74)
Male	314 (90.1)	169 (87.3)	1	1	631 (80.4)	1	1
Service
Royal Navy or Royal Marines	41 (11.3)	29 (14.1)	1.37 (0.81–2.32)	1.38 (0.81–2.37)	112 (13.8)	1.38 (0.93–2.03)	1.36 (0.92–2.03)
Army	243 (70.7)	122 (64.5)	1	1	485 (62.9)	1	1
Royal Air Force	65 (18.0)	43 (21.4)	1.30 (0.83–2.03)	1.33 (0.84–2.11)	188 (23.3)	1.45 (1.05–2.01)	1.33 (0.95–1.87)
Rank
Officer	92 (25.2)	57 (27.8)	1.12 (0.75–1.67)	1.09 (0.72–1.65)	203 (24.8)	1.00 (0.69–1.47)	0.87 (0.64–1.19)
Non-commissioned officer	210 (60.3)	114 (59.4)	1	1	474 (60.5)	1	1
Junior rank (private soldier or equivalent)	47 (14.6)	23 (12.9)	0.90 (0.52–1.56)	0.83 (0.46–1.53)	108 (14.7)	0.98 (0.73–1.32)	1.22 (0.81–1.84)
Engagement
Regular	282 (80.6)	165 (85.1)	1	1	637 (81.0)	1	1
Reservist	67 (19.4)	29 (14.9)	0.73 (0.45–1.17)	0.82 (0.50–1.34)	148 (19.1)	0.98 (0.71–1.35)	0.81 (0.58–1.14)
Serving status
Serving	190 (54.9)	146 (75.6)	1	1	400 (51.2)	1	1
Ex-service	159 (45.1)	48 (24.5)	0.39 (0.27–0.58)	0.44 (0.29–0.68)	385 (48.8)	1.16 (0.90–1.50)	1.05 (0.79–1.39)
Completed operational deployment (Iraq/Afghanistan)
No	94 (27.0)	33 (17.3)	1	1	233 (29.9)	1	1
Yes	255 (73.0)	160 (82.7)	1.77 (1.13–2.76)	1.61 (1.02–2.55)	551 (70.1)	0.87 (0.65–1.15)	0.98 (0.73–1.31)
Overall health rating
Excellent/very good	190 (54.0)	106 (54.6)	1	1	313 (39.8)	1	1
Good	116 (33.5)	73 (38.0)	1.12 (0.77–1.64)	1.24 (0.85–1.82)	303 (38.7)	1.57 (1.19–2.08)	1.58 (1.18–2.10)
Fair/poor	43 (12.5)	15 (7.5)	0.59 (0.31–1.12)	0.70 (0.37–1.34)	169 (21.5)	2.33 (1.59–3.42)	2.32 (1.57–3.43)
Functional impairment
No	248 (70.7)	135 (70.0)	1	1	454 (57.8)	1	1
Yes	101 (29.3)	59 (30.0)	1.03 (0.70–1.52)	1.18 (0.80–1.75)	331 (42.2)	1.76 (1.34–2.31)	1.71 (1.29–2.26)
Any mental health problems
0	302 (86.2)	170 (88.2)	1	1	579 (73.4)	1
1	29 (8.5)	18 (9.2)	1.06 (0.57–1.96)	1.09 (0.57–2.06)	104 (13.3)	1.83 (1.19–2.84)	1.75 (1.13–2.69)
≥ 2	18 (5.3)	5 (25.7)	0.48 (0.17–1.31)	0.54 (0.19–1.49)	102 (13.3)	2.96 (1.76–4.99)	3.07 (1.82–5.18)
Alcohol misuse (AUDIT-C score ≥ 10 = case)
Non-case	277 (79.2)	169 (87.3)	1	1	645 (82.0)	1	1
Case	72 (20.8)	25 (12.7)	0.55 (0.34–0.91)	0.59 (0.36–0.98)	140 (18.0)	0.84 (0.61–1.15)	0.90 (0.65–1.24)
Social support, mean (95% CI)	32.85 (32.39–33.28)	33.01 (32.36–33.66)	1.01 (0.97–1.05)	1.00 (0.95–1.04)	31.99 (31.63–32.35)	0.96 (0.94–0.99)	0.96 (0.94–0.99)

The confidence interval in bold indicates that the difference was significant.

AMOR, adjusted multinomial odds ratio; AUDIT-C, Alcohol Use Disorders Identification Test; CI, confidence interval; GAD-7, Generalized Anxiety Disorder 7 item; PCL-5, PTSD Checklist for DSM-5; PHQ-9, 9-item Patient Health Questionnaire.

Reference group: only informal support. Percentages and means are weighted. The numbers and percentages in the help-seeking categories are different from those in Table 3 as a hierarchical help-seeking variable was created for analysis purposes. Missing: n = 2 deployment status; n = 16 did not disclose a past or current stress, emotional, alcohol or mental health problem; n = 1 failed to answer help-seeking section; n = 1 for any mental health problems. AMOR is adjusted for age (as a continuous variable), gender, rank, serving status and engagement type.