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UK Armed Forces psychiatric morbidity:
Annual Summary 2008
30th September 2009
INTRODUCTION
1.
This report provides statistical information on psychiatric morbidity
among the UK Armed Forces in the period January to December 2008. It
Issued By:
summarises all new referrals of Service personnel to the MOD’s Departments
Defence Analytical
of Community Mental Health (DCMHs) for outpatient care, and new
Services and Advice
admissions to the MOD’s in-patient care contractor. This data has previously
(DASA)
been presented in the quarterly Armed Forces Psychiatric Morbidity Reports;
Ensleigh
however, the accumulation of a year’s worth of data has allowed more
Bath
detailed break downs, in particular by age and Service. In addition, this report
BA1 5AB
provides a summary of the Reserves Mental Health Program (at
Annex A)
and aeromedical evacuations for psychiatric reasons (at
Annex B).
Enquiries:
2.
DCMHs are specialised psychiatric services based on community
Press Office: 020 721 83253 mental health teams, closely located with primary care services at sites in the
Statistical Enquiries:
UK and abroad. Information on patients only seen in the primary care system
Dr Kate Harrison
is not currently available.
Head Health Information
DASA
3. A
rigid
pseudo-anonymisation
process, and other measures
Tel 01225 468615
preserving patient confidentiality, has enabled full verification and validation of
[email address] the DCMH returns, importantly allowing identification of repeat attendances. It
also ensured linkage with deployment databases was possible, so that
potential effects of deployment could be measured.
Internet:
http://www.dasa.mod.uk
4.
The first report
a in the quarterly series provides important background
information on data governance. A summary of this, along with detail of some
minor methodology changes, can be found in the section on
‘Data, definitions
and methods’.
KEY POINTS
5.
During 2008, 3,189
r new cases of mental disorder were identified
within UK Armed Forces personnel, representing a rate of 16.2
r per 1,000
strength.
6. Among
the
3,189
r personnel with a mental disorder, there were
some statistically significant findings:
-
rates for Royal Marines were lower than for other Services;
-
rates for females were higher than for males;
-
rates for other ranks were higher than for Officers;
-
rates for the 20-24 age group were higher than all other age
groups except the under 20s.
7.
Rates of psychoactive substance use, including alcohol, and mood
disorders, including depressive episodes, were lower in those that had
deployed to the Iraq or Afghanistan theatres of operation than in those who
had not deployed there. Rates of neurotic disorder, including adjustment
disorders and PTSD, was higher among those deployed to the Iraq or
Afghanistan theatres of operation compared with those not deployed there.
8.
There were 213 first admissions to the MOD’s inpatient contractor in
2008. The following results were statistically significant:
-
rates for females were higher than for males;
-
rates for other ranks were higher than for Officers;
-
rates for personnel who had deployed to the Iraq and/or
Afghanistan theatres of operation were lower than for those who
had not deployed there.
a UK Armed Forces psychiatric morbidity: Assessment of presenting complaints at MOD DCMHs
and association with deployment on recent operations in the Iraq or Afghanistan theatres of
operation January – March 2007.
RESULTS
Tri-Service
9.
During 2008 a total of 4,465
r UK Service personnel were recorded as having been seen for
assessment as new patients at the MOD’s DCMHs and overseas satellites, representing a rate for the
year of 22.7
r per 1,000 strength. There were 213 first admissions of UK Service personnel to the
MOD’s in-patient contractor.
10.
Table 1 provides details of the key socio-demographic and military characteristics of the
4,465
r new attendances at the MOD’s DCMHs during 2008. This includes 80
r personnel whose
characteristics are not known. The rates presented in table 1 are also shown in
Figures 1 to 4.
Table 1 - New attendances at the MOD’s DCMHs: numbers and rates (per 1,000 strength)
by demographic and military characteristics, 2008
Patients assessed with a m ental disorder
Patients
assessed
w ithout a
All patients
mental
Cha racteristic
Strength3
seen
Num ber
Rate
95% CI
disorder
All
197,000
4,465
r
3,189
r
16.2
r
(15.6 - 16.7)
1,276
r
S ervice
Royal Navy
31,300
602
413
13.2
(11.9 - 14.5)
189
Royal Marines
7,800
84
61
7.8
(5.8 - 9.7)
23
Army
114,100
2,758
r
1,959
r
17.2
(16.4 - 17.9)
799
RAF
43,800
941
706
16.1
(14.9 - 17.3)
235
Gender
Males
179,000
3,573
r
2,511
r
14.0
(13.5 - 14.6)
1,062
Females
18,000
812
628
34.8
(32.1 - 37.6)
184
Rank
Officers
33,400
299
240
7.2
(6.3 - 8.1)
59
Other ranks
163,700
4,086
r
2,899
r
17.7
(17.1 - 18.4)
1,187
Age
<20
15,700
480
r
272
r
17.4
r
(15.3 - 19.4)
r
208
20-24
44,300
1,351
r
910
r
20.6
r
(19.2 - 21.9)
r
441
25-29
42,200
967
r
711
r
16.9
r
(15.6 - 18.1)
256
30-34
28,300
577
r
448
r
15.9
(14.4 - 17.3)
r
129
35-39
33,000
607
r
494
r
14.9
(13.6 - 16.3)
r
113
40-44
18,200
263
r
197
r
10.8
r
(9.3 - 12.3)
r
66
45-49
9,700
97
r
76
r
7.8
r
(6.1 - 9.6)
r
21
50+
5,600
43
r
31
r
5.5
r
(3.6 - 7.5)
r
12
Deployment - Theatres of
operation
Iraq and/or Afghanistan1
112,100
2,354
1,769
15.8
(153.0 - 16.5)
585
of which, Iraq
92,500
1,949
1,463
15.8
(15.0 - 16.6)
486
of which, Afghanistan1
44,000
861
661
15.0
(13.9 - 16.2)
200
Neith er Iraq nor Afghani stan1
85,000
2,031
r
1,370
r
16.1
(15.3 - 17.0)
661
Cha racteristics not known2
80
r
50
r
30
r
1. Does not include personnel deplo yed to Afghanistan during the period January 2003 to October 2005 (see paragraph 49).
2. Records supplied without identifiers (see paragraph 47).
3. Strengths data rounded to the nearest 100. Strengths are a 13-month average (see paragraph 48).
r Data revised due to improvements in data processing
11.
Of the 4,465
r new attendances, 3,189
r (71%) were assessed with a mental disorder,
representing an overall annual rate for new cases of mental disorder of 16.2
r per 1,000 strength.
12.
There were some statistically significant differences in the rates of mental disorder between
various sub-groups of patients.
-
Royal Marines had a lower rate of mental disorder at 7.8 per 1,000 strength (95% CI: 5.8-9.7,
N=61) than Navy personnel at 13.2 per 1,000 strength, who in turn had lower rates than the
Army and RAF personnel at 17.2 and 16.1 per 1,000 strength respectively. This is illustrated
in
Figure 1.
-
Female personnel had a higher rate of mental disorder assessment at 34.8 per 1,000 strength
(95%CI: 32.1-37.6, N=628), which is over double that of male personnel at 14.0 per 1,000
strength (95%CI: 13.5-14.6, N=2,511
r). This is illustrated in
Figure 2.
-
Other ranks had a higher rate of mental disorder at 17.7 per 1,000 strength (95%CI: 17.1-
2
18.4, N=2,899
r), which is over double that of officers at 7.2 per 1,000 strength (95%CI: 6.3-
8.1, N=240). This is illustrated in
Figure 2.
-
Personnel in the 20-24 age group had higher rates of mental disorder at 20.6
r per 1,000
strength (95%CI: 19.2-21.9
r, N=910
r), than all other age groups, except for the under 20s.
This is illustrated in
Figure 3.
There was no statistically significant difference between those who had deployed to the Iraq or
Afghanistan theatres of operation and those who had not deployed there.
Figure 1: Rates of new attendances at the MOD’s DCMHs by Service, 2008
20
18
16
14
t
h
eng 12
10
1,000 str
per
8
ate
R
6
4
2
0
Navy
Marines
Army
RAF
Service
Figure 2: Rates of new attendances at the MOD’s DCMHs by Gender and Rank, 2008
40
35
30
ngth
e 25
str
0
00 20
r
1,
pe 15
te
a
R 10
5
0
Male
Female
Officer
Other rank
Gender
Rank
3
Figure 3: Rates of new attendances at the MOD’s DCMHs by age group, 2008
25
20
15
000 strength
10
te per 1,
a
R
5
0
<20
20-24
25-29
30-34
35-39
40-44
45-49
50+
Age group
Figure 4: Rates of new attendances at the MOD’s DCMHs by deployment to the Iraq and/or
Afghanistan 1 theatres of operation, 2008
20
18
16
th 14
reng 12
00 st
0 10
r 1,
e
8
p
t
e
a
6
R
4
2
0
1
Iraq and/or Afghanistan
of which, Iraq
of which, Afghanistan
Neither Iraq nor 1
Afghanistan
Deployment
1. Does not include personnel deployed to Afghanistan during the period January 2003 to October 2005 (see
paragraph 48).
13.
Table 2 provides details of the types of mental disorder by the patients’ past deployment on
recent operations in the Iraq or Afghanistan theatres. The rate ratios presented provide a comparison
of cases seen between personnel identified as having deployed to a theatre and those who have not
been identified as having deployed to either theatre. A rate ratio less than 1 indicates lower rates in
those deployed than those not deployed, whereas a rate ratio greater than 1 indicates higher rates in
those deployed than those not deployed. If the 95% confidence interval does not encompass the
value 1.0, then this difference is statistically significant.
4
Table 2 - Initial mental disorder assessments for all new cases seen at a DCMH: numbers and rate ratios, by deployment and
ICD-10 classification, 2008
Deployment - Theatres of operation
of w hich
1
1
2
Iraq and/or Afghanistan
Iraq
Afghanistan
Neither
Not known
All patients
Patients
Rate
Patients
Rate
Patients
Rate
Patients
ICD-10 description
seen
seen
ratio
95% CI
seen
ratio
9 5% CI
seen
ratio
95% CI
seen Patients seen
r
r
r
All patients se en
4,465
2,354
1,949
861
2,031
80
r
r
r
All patients assessed with a m ental
3,189
1,769
1.0
(0.9 - 1.1)
1,463
1.0
(0.9 - 1.1)
66 1
0.9
(0.8 - 1.0)
1,370
50
disorder
P sychoactive substance use
326
155
0.7
(0.6 - 0.9)
132
0.7
(0.6 - 0.9)
3 5
0.4
(0.3 - 0.6)
166
5
of which disorders due to alcohol
310
150
0.7
(0.6 - 0.9)
127
0.7
(0.6 - 0.9)
3 5
0.4
(0.3 - 0.6)
156
4
Mood disorders
734
366
0.8
(0.7 - 0.9)
314
0.8
(0.7 - 0.9)
12 6
0.7
(0.5 - 0.8)
362
6
of which depressive episode
622
309
0.8
(0.6 - 0.9)
265
0.8
(0.7 - 0.9)
11 2
0.7
(0.6 - 0.9)
309
4
r
r
r
Neurotic disorders
1,863
1,122
1.2
(1.1 - 1.3)
914
1.2
(1.1 - 1.3)
45 9
1.2
(1.1 - 1.4)
714
27
r
r
of which PTSD
156
122
3.2
(2.1 - 4.8)
101
3.2
(2.1 - 4.8)
6 0
4.0
(2.6 - 6.2)
29
5
r
r
of which adjustment di sorders
1,144
695
1.2
(1.1 - 1.4)
560
1.2
(1.1 - 1.4)
29 2
1.3
(1.1 - 1.5)
430
19
O ther mental and behavioural disorders
266
r
126
0.7
(0.6 - 1.0)
103
0.7
(0.6 - 1.0)
4 1
0.6
(0.4 - 0.9)
128
12
r
r
r
No mental disorder
1,276
585
486
20 0
661
30
1. Does not include personnel deployed to Afghanistan during the period January 2003 to October 2005 (see paragraph 49).
2. Records supplied without identifiers (see paragraph 47).
r Data revised due to improvements in data processing
14.
During 2008 there was no difference in the overall rate of mental disorder between those
deployed to the Iraq and Afghanistan theatres of operation and those not identified as having
deployed there. When looking at the rates of major mental disorders, there were some statistically
significant differences between those deployed to the Iraq and Afghanistan theatres of operation and
those not identified as having deployed there;
-
Rates of psychoactive substance use, and the subgroup disorders due to alcohol, and rates of
mood disorders, and the subgroup depressive episodes, were lower in those who had
deployed to the Iraq or Afghanistan theatres of operation than in those who had not deployed
there.
-
Rates of neurotic disorder, and the subgroups adjustment disorder and PTSD, were higher
among those deployed to the Iraq or Afghanistan theatres of operation compared with those
not deployed there.
15.
Figure 5 presents the rate ratios comparing personnel identified as having deployed to the
Iraq and/or Afghanistan theatres of operation and those who have not been identified as having
deployed to either theatre which can also be found in table 2. The rate ratio is represented as a
square block on the graph with the upper and lower 95% confidence limits above and below. The bold
line on the graph is at 1. A confidence interval which lies entirely below this line indicates statistically
significantly lower rates in those deployed than those not deployed, whereas a confidence interval
that lies entirely above the red line indicates statistically significantly higher rates in those deployed
than those not deployed.
5
Figure 5: Initial mental disorder assessments for all new cases seen at a DCMH: rate ratios by
ICD10 groupings, 2008
6
5
4
o
ti
a
r
t
e
3
Ra
2
1
0
Psychoactive
of which
Mood
of which
Neurotic
of which
of which
Other mental
substance use disorders due
disorders
depressive
disorders
PTSD
adjustment
and
to alcohol
episode
disorders
behavioural
disorders
ICD10 Grouping
16.
Table 3 provides details of the types of presenting complaints, by ICD-10 grouping and
Service, for patients seen for the first time during 2008, where information was provided.
17.
Across the Services the most common mental disorders were neurotic disorders. There were
some statistically significant results when comparing the rates of specific mental disorders between
the Services.
-
RAF personnel had a lower rate of psychoactive substance use (0.6 per 1,000 strength) than
Navy or Army personnel. This is also true for the subgroup disorders due to alcohol.
-
Royal Marines had a lower rate of mood disorders (0.9 per 1,000 strength) than the other
Services. This is also true for the subgroup depressive episodes.
-
Royal Marines had a higher rate of PTSD (2.2 per 1,000 strength) than all other Services.
-
Navy personnel and Royal Marines had lower rates of adjustment disorder (3.7 and 2.3 per
1,000 strength respectively) than RAF and Army personnel.
6
Table 3 - Mental disorder initial assessments for all new cases seen at a DCMH: numbers and rates (per 1,000 strength) , by service and ICD-10
classification, 20081 2
All
Royal Navy
Royal Marines
Army
RAF
95%
95%
95%
95%
95%
Confidence
Confidence
Confidence
Confidence
Confidence
ICD-10 description
Number
Rate
Interval
Number
Rate
Interval
Number
Rate
Interval
Number
Rate
Interval
Number
Rate
Interval
All cases seen by DCMH
4,465 r
22.7 r
(22.0 - 23.3) r
602
19.3 (17.7 - 20.8)
84
10.7 (8.4 - 13.0)
2,758 r
24.2 (23.3 - 25.1)
941
21.5 (20.1 - 22.9)
r
r
Cases of Mental Health disorder
3,189
16.2 r
(15.6 - 16.7)
413
13.2 (11.9 - 14.5)
61
7.8
(5.8 - 9.7)
1,959
17.2 (16.4 - 17.9)
706
16.1 (14.9 - 17.3)
Psychoactive substance use
326
1.7
(1.5 - 1.8)
71
2.3
(1.7 - 2.8)
9
1.1
(0.5 - 2.2)
213
1.9
(1.6 - 2.1)
28
0.6
(0.4 - 0.9)
of which di sorders due to alcohol
310
1.6
(1.4 - 1.7)
70
2.2
(1.7 - 2.8)
9
1.1
(0.5 - 2.2)
200
1.8
(1.5 - 2.0)
27
0.6
(0.4 - 0.9)
Mood disorders
734
3.7
(3.5 - 4.0)
123
3.9
(3.2 - 4.6)
~
0.9
(0.4 - 1.8)
432
3.8
(3.4 - 4.1)
166
3.8
(3.2 - 4.4)
of which Depressive episode
622
3.2
(2.9 - 3.4)
114
3.6
(3.0 - 4.3)
~
0.9
(0.4 - 1.8)
353
3.1
(2.8 - 3.4)
144
3.3
(2.8 - 3.8)
Neurotic disorders
1,863
r
9.5
r
(9.0 - 9.9)
r
191
6.1
(5.2 - 7.0)
42
5.4
(3.7 - 7.0)
1,139
r
10.0
(9.4 - 10.6)
464
10.6
(9.6 - 11.6)
of which P TSD
156
r
0.8
(0.7 - 0.9)
14
0.4
(0.2 - 0.8)
17
2.2
(1.3 - 3.5)
92
0.8
(0.6 - 1.0)
28
0.6
(0.4 - 0.9)
of which A djustment disorders
1,144
r
5.8
(5.5 - 6.1)
115
3.7
(3.0 - 4.4)
18
2.3
(1.4 - 3.6)
726
6.4
(5.9 - 6.8)
266
6.1
(5.3 - 6.8)
Other mental disorders
266
r
1.4
r
(1.2 - 1.5)
28
0.9
(0.6 - 1.3)
~
0.4
(0.1 - 1.1)
175
1.5
(1.3 - 1.8)
48
1.1
(0.8 - 1.4)
No mental disorder
1,276
r
6.5
(6.1 - 6.8)
189
6.0
(5.2 - 6.9)
23
2.9
(1.9 - 4.4)
799
7.0
(6.5 - 7.5)
235
5.4
(4.7 - 6.1)
1. Service breakdowns may not add to the 'All' total as 80 records were supplied without identifiers. These records are absent from the Service breakdowns, as no Service data can be allocated (See paragraph 47).
2. Data presented as "~" has been suppressed in accordance with DASA's rounding policy (see paragraph 52).
r Data re vised due to improvements in data processing
7
In-patient Data
18.
Table 4 provides details of the key socio-demographic and military characteristics of the 213
new attendances at the MOD’s in-patient contractor during 2008, broken down by Service.
Table 4 - New attendances at MOD’s in-patient contractor: numbers and rates (per 1,000 strength) by
demographic and military characteristics, 20081
Patients assessed with a mental disorder
All
Naval Service3
Army
RAF
Cha racteristic
Number
Rate
95% CI
Number Rate
95% CI
Number
Rate
95% CI
Number
Rate
95% CI
First Admissions
213
1.1 (0.9 - 1.2)
49
1.3
(0.9 - 1.6)
119
1.0
(0.9 - 1.2)
45
1.0 (0.7 - 1.3)
Gender
Males
173
1.0 (0.8 - 1.1)
37
1.0 (0.7 - 1.4)
105
1.0 (0.8 - 1.2)
31
0.8 (0.5 - 1.1)
Females
40
2.2 (1.5 - 2.9) 12
3.2
(1.7 - 5.6) 14
1.6
(0.9 - 2.8) 14
2.4
(1.3 - 4.1)
Rank
Officers
18
0.5 (0.3 - 0.9)
~
1.0
(0.5 - 2.1)
~
0.4
(0.2 - 0.9)
~
0.3
(0.1 - 0.9)
Other ranks
195
1.2 (1.0 - 1.4)
~
1.3 (0.9 - 1.7)
~
1.1 (0.9 - 1.4)
~
1.2 (0.9 - 1.6)
Age
<24
77
1.3 (1.0 - 1.6) 15
1.3
(0.7 - 2.2) 51
1.3
(0.9 - 1.6) 11
1.2
(0.6 - 2.2)
25-29
48
1.1 (0.8 - 1.5) 11
1.4
(0.7 - 2.5)
26
1.0
(0.7 - 1.5) 11
1.2
(0.6 - 2.1)
30-34
32
1.1 (0.7 - 1.5)
8
1.5
(0.7 - 3.1)
16
0.9
(0.5 - 1.5)
8
1.3 (0.6 - 2.6)
35-39
34
1.0 (0.7 - 1.4) 10
1.5
(0.7 - 2.7)
17
1.0
(0.6 - 1.5)
7
0.8 (0.3 - 1.7)
40+
22
0.7 (0.4 - 1.0)
5
0.6
(0.2 - 1.5)
9
0.6
(0.3 - 1.2)
8
0.7 (0.3 - 1.4)
Deployment - Theatres of operation
Iraq or Afghanistan2
98
0.9 (0.7 - 1.0)
8
0.5
(0.2 - 1.0)
68
1.0
(0.7 - 1.2) 22
0.9
(0.6 - 1.4)
Of which, Iraq
80
0.9 (0.7 - 1.1)
~
0.5 (0.2 - 1.1)
56
1.0 (0.7 - 1.2)
~
0.8 (0.5 - 1.3)
Of which, Afghanistan2
35
0.8 (0.5 - 1.1)
~
0.2 (0.0 - 0.9)
23
0.8 (0.5 - 1.2)
~
1.1 (0.6 - 2.0)
Neith er Iraq nor Afghani stan2
115
1.4 (1.1 - 1.6)
41
1.8 (1.3 - 2.4)
51
1.2 (0.9 - 1.5)
23
1.2 (0.8 - 1.8)
1. Data presented a s "~" has been suppressed in accordance with DASA's rounding policy (see paragraph 52).
2. Does not include personnel deplo yed to Afghanistan during the period January 2003 to October 2005 (see paragraph 49).
3. Royal Navy and Royal Marines combined to avoid disclosure.
19.
There were 213 first admissions to the MOD’s inpatient contractor in 2008. The following
results were statistically significant.
-
Females had a higher rate of first admission at 2.2 per 1,000 strength (95% CI: 1.5-2.9, N=40)
than males at 1.0 per 1,000 strength (95% CI: 0.8-1.1, N=173).
-
Other ranks had a higher rate of first admission at 1.2 per 1,000 strength (95% CI: 1.0-1.4,
N=195) than Officers at 0.5 per 1,000 strength (95% CI: 0.3-0.9, N=18).
-
Overall, those not identified as being deployed to Iraq and/or Afghanistan theatres of
operation had a higher rate of first admission at 1.4 per 1,000 strength (95%CI: 1.1-1.6,
N=115) then those identified as being deployed there at 0.9 per 1,000 strength (95%CI: 0.7-
1.0, N=98). When broken down by Service, however, this result only remained significant for
Naval Service personnel.
20.
There were no significant differences between the Services and the single Service results
were broadly similar to the overall results. As many of the patient numbers are small, it is important
not to draw any firm conclusions from the Service breakdowns.
8
Royal Navy
21.
During 2008, a total of 602 Royal Navy personnel were recorded as having been seen for
assessment as new patients at the MOD’s DCMHs and overseas satellites, representing a rate for the
year of 19.3 per 1,000 strength.
22.
Table 5 provides details of the key socio-demographic and military characteristics of the 602
new attendances of Royal Navy personnel at the MOD’s DCMHs during 2008.
Table 5 - New attendances of Royal Navy personnel at the MOD’s DCMHs: numbers
and rates (per 1,000 strength) by demographic and military characteristics, 2008
Patients assessed with a mental disorder
Patients
assessed
without a
All patients
mental
Characteristic
Strength2
seen
Number
Rate
95% CI
disorder
All
31,300
602
413
13.2
(11.9 - 14.5)
189
Gender
Males
27,600
430
281
10.2
(9.0 - 11.4)
149
Females
3,600
172
132
36.2
(30.0 - 42.4)
40
Rank
Officers
6,800
71
57
8.4
(6.2 - 10.5)
14
Other ranks
24,400
531
356
14.6
(13.0 - 16.1)
175
Age
<20
1,900
53
r
25
13.3
(8.6 - 19.6)
28
r
20-24
6,500
201
r
124
19.1
(15.8 - 22.5)
77
r
25-29
6,100
119
82
13.5
(10.6 - 16.4)
37
30-34
4,200
80
r
63
r
15.1
r
(11.4 - 18.9)
r
17
r
35-39
5,800
94
r
74
r
12.7
r
(9.8 - 15.6)
r
20
40+
6,800
55
r
45
r
6.6
r
(4.7 - 8.5)
r
10
Deployment - Theatres of
operation
Iraq and/or Afghanistan1
11,500
175
131
11.4
(9.5 - 13.4)
44
Of which, Iraq
10,400
161
119
11.4
(9.3 - 13.4)
42
Of which, Afghanistan1
2,600
32
24
9.2
(5.9 - 13.6)
8
Neither Iraq nor Afghanistan1
19,800
427
282
14.3
(12.6 - 15.9)
145
1. Does not include personnel deployed to Afghanistan during the period January 2003 to October 2005 (see paragraph 49).
2. Strengths data rounded to the nearest 100. Strengths are a 13-month average (see paragraph 48).
r Data revised due to improvements in data processing
23.
Of the 602 new attendances, 413 (69%) were assessed with a mental disorder, representing
an overall rate for new cases of mental disorder of 13.2 per 1,000 strength.
24.
There were some statistically significant differences in the rates of mental disorder between
various sub-groups of Royal Navy patients.
-
Female personnel had a higher rate of mental disorder assessment at 36.2 per 1,000 strength
(95%CI: 30.0-42.4, N=132), which is three and half times that of male personnel at 10.2 per
1,000 strength (95%CI: 9.0-11.4, N=281).
-
Other ranks had a higher rate of mental disorder at 14.6 per 1,000 strength (95%CI: 13.0-
16.1, N=356) than that of Officers at 8.4 per 1,000 strength (95%CI: 6.2-10.5, N=57).
9
25.
Table 6 provides details of the types of mental disorder by the patients’ past deployment on
recent operations in the Iraq or Afghanistan theatres. The rate ratios presented provide a comparison
of cases seen between personnel identified as having deployed to a theatre and those who have not
been identified as having deployed to either theatre. A rate ratio less than 1 indicates lower rates in
those deployed than those not deployed, whereas a rate ratio greater than 1 indicates higher rates in
those deployed than those not deployed. If the 95% confidence interval does not encompass the
value 1.0, then this difference is statistically significant.
Table 6 - Initial mental disorder assessments for all new Royal Navy cases seen at a DCMH: num bers and rate ratios, by
deployment and ICD-10 classification, 20081 2
Deployment - Theatres of operation
of which
Iraq and/or Afghanistan3
Iraq
Afghanistan3
Neither
All
patients
Patients
Rate
Patients
Rate
Patients
Rate
ICD-10 description
seen
seen
ratio
95% CI
seen
ratio
95% CI
seen
ratio
95% CI
Patients seen
All patients se en
602
175
161
32
427
All patients assessed with a m ental
413
131
0.8
(0.7 - 1.0)
119
0.8
(0.6 - 1.0)
24
0.6
(0.4 - 1.0)
2 82
disorder
P sychoactive substance use
71
20
0.7
(0.4 - 1.1)
20
0.7
(0.4 - 1.2)
0
0.0
-
51
of which disorders due to alcohol
70
20
0.7
(0.4 - 1.2)
20
0.8
(0.5 - 1.3)
0
0.0
-
50
Mood disorders
123
33
0.6
(0.4 - 0.9)
30
0.6
(0.4 - 1.0)
7
0.6
(0.3 - 1.3)
90
of which depressive episode
114
32
0.7
(0.4 - 1.0)
30
0.7
(0.5 - 1.1)
~
0.6
(0.2 - 1.3)
82
Neurotic disorders
191
67
0.9
(0.7 - 1.3)
59
0.9
(0.7 - 1.2)
14
0.9
(0.5 - 1.5)
1 24
of which PTSD
14
5
1.0
(0.3 - 2.9)
5
1.1
(0.4 - 3.1)
0
0.0
-
9
of which adjustment di sorders
115
49
1.3
(0.9 - 1.9)
44
1.3
(0.9 - 1.8)
11
1.3
(0.7 - 2.4)
66
O ther mental and behavioural disorders
28
11
1.1
(0.5 - 2.4)
10
1.1
(0.5 - 2.4)
~
1.3
(0.4 - 4.6)
17
No mental disorder
189
44
42
8
1 45
1. Data represented with a "-" symbol is not calculable.
2. Data presented as "~" has been suppressed in accordance with DASA's rounding po licy (see paragraph 52).
3. Does not include personnel deployed to Afghanistan during the period January 2003 to October 2005 (see paragraph 49).
26.
During 2008 the rate of mood disorders was lower in those deployed to the Iraq and/or
Afghanistan theatres of operation than in those who had not deployed there (rate ratio 0.6, 95%CI:
0.4-0.9). There were no cases of psychoactive substance use or PTSD in Royal Navy personnel who
had been deployed to the Afghanistan theatre of operation. It is therefore not possible to calculate a
confidence interval for the rate ratio for these disorders.
10
Royal Marines
27.
During 2008 a total of 84 Royal Marines were recorded as having been seen for assessment
as new patients at the MOD’s DCMHs and overseas satellites, representing a rate for the year of 10.7
per 1,000 strength.
28.
Table 7 provides details of the key socio-demographic and military characteristics of the 84
new attendances of Royal Marines at the MOD’s DCMHs during 2008. Due to the small numbers
involved, gender breakdowns have been removed and broader age categories have been used to
avoid publishing potentially disclosive data.
Table 7 - New attendances of Royal Marine personnel at the MOD’s DCMHs: num bers and
rates (per 1,000 strength) by demographic and m ilitary characteristics, 2008
Patients assessed with a mental disorder
Patients
assessed
without a
All patients
mental
Cha racteristic
Strength2
seen
Num ber
Rate
95% CI
disorde r
All
7,800
84
61
7.8
(5.8 - 9.7)
23
Rank
Officers
800
5
5
6.0
(1.9 - 14.0)
0
Other ranks
7,000
79
56
8.0
(5.9 - 10.1)
23
Age
<24
2,800
31
25
8.8
(5.7 - 13.0)
6
25-34
2,900
40
29
9.9
(6.6 - 14.2)
11
r
r
r
r
r
35+
5,000
13
7
1.4
(0.6 - 2.9)
6
Deployment - Theatres of
operation
Iraq and/or Afghanistan1
4,900
56
41
8.4
(5.8 - 10.9)
15
Of which, Iraq
2,900
33
25
8.6
(5.6 - 12.7)
8
Of which, Afghanistan1
3,600
43
31
8.7
(5.6 - 11.7)
12
Neith er Iraq nor Afghani stan1
2,900
28
20
6.8
(4.2 - 10.5)
8
1. Does not include personnel deplo yed to Afghanistan during the period January 2003 to October 2005 (see paragraph 49).
2. Strengths data rounded to the nearest 100. Strengths are a 13-month average (see paragraph 48).
r. Data revised d ue to improvements in data processing
29.
Of the 84 new attendances, 61 (73%) were assessed with a mental disorder, representing an
overall rate for new cases of mental disorder in Royal Marine personnel of 7.8 per 1,000 strength.
30.
There were no statistically significant differences in the rates of mental disorder between
various sub-groups of Royal Marine patients. Confidence intervals for some of the sub groups are,
however, very wide due to the small numbers involved.
11
31.
Table 8 provides details of the types of mental disorder by the patients’ past deployment on
recent operations in the Iraq or Afghanistan theatres. The rate ratios presented provide a comparison
of cases seen between personnel identified as having deployed to a theatre and those who have not
been identified as having deployed to either theatre. A rate ratio less than 1 indicates lower rates in
those deployed than those not deployed, whereas a rate ratio greater than 1 indicates higher rates in
those deployed than those not deployed. If the 95% confidence interval does not encompass the
value 1.0, then this difference is statistically significant.
Table 8 - Initial mental disorder assessments for all new Royal Marine cases seen at a DCMH: num bers and rate ratios,
by deployment and ICD-10 classification, 20081 2
Deployment - Theatres of operation
of which
Iraq and/or Afghanistan3
Iraq
Afghanistan3
Neither
All
patients
Patients
Rate
Patients
Rate
Patients
Rate
ICD-10 description
seen
seen
ratio
95% CI
seen
ratio
95% CI
seen
ratio
95% CI
Patients seen
All patients se en
84
56
33
43
28
All patients assessed with a m ental
61
41
1.2
(0.7 - 2.1)
25
1.3
(0.7 - 2.3)
31
1.3
(0.7 - 2.2)
20
disorder
P sychoactive substance use
9
~
1.2
(0.3 - 4.8)
5
1.7
(0.4 - 7.1)
~
0.8
(0.2 - 4.1)
~
of which disorders due to alcohol
9
~
1.2
(0.3 - 4.8)
5
1.7
(0.4 - 7.1)
~
0.8
(0.2 - 4.1)
~
Mood disorders
~
~
0.8
(0.2 - 3.6)
~
1.4
(0.3 - 6.0)
~
0.3
(0.0 - 2.6)
~
of which depressive episode
~
~
0.8
(0.2 - 3.6)
~
1.4
(0.3 - 6.0)
~
0.3
(0.0 - 2.6)
~
Neurotic disorders
42
31
1.7
(0.8 - 3.4)
16
1.5
(0.7 - 3.2)
27
2.0
(1.0 - 4.1)
11
of which PTSD
17
~
4.5
(1.0 - 19.6)
9
4.6
(1.0 - 21.1)
14
5.8
(1.3 - 25.3)
~
of which adjustment di sorders
18
9
0.6
(0.2 - 1.5)
~
0.3
(0.1 - 1.2)
8
0.7
(0.3 - 1.9)
9
O ther mental and behavioural disorders
~
0
0.0
-
0
0.0
-
0
0.0
-
~
No mental disorder
23
15
8
12
8
1. Data represented with a "-" symbol is not calculable.
2. Data presented as "~" has been suppressed in accordance with DASA's rounding po licy (see paragraph 52).
3. Does not include personnel deployed to Afghanistan during the period January 2003 to October 2005 (see paragraph 49).
32.
In 2008 the rate of PTSD in Royal Marine personnel was statistically significantly higher
among those deployed to the Afghanistan theatre of operation compared with those not identified as
having deployed there (rate ratio 5.8, 95% CI: 1.3-25.3). There were no cases of ‘other mental and
behavioural disorders’ in Royal Marines who had been deployed to the Iraq or Afghanistan theatres of
operation. It is therefore not possible to calculate a rate ratio for these disorders. There were no other
statistically significant differences between those who had and had not been deployed to the Iraq or
Afghanistan theatres of operation.
12
Army
33.
During 2008 a total of 2,758
r Army personnel were recorded as having been seen for
assessment as new patients at the MOD’s DCMHs and overseas satellites, representing a rate for the
year of 24.2 per 1,000 strength.
34.
Table 9 provides details of the key socio-demographic and military characteristics of the
2,757 new attendances of Army personnel at the MOD’s DCMHs during 2008.
Table 9 - New attendances of Army personnel at the MOD’s DCMHs: numbers and
rates (per 1,000 strength) by demographic and military characteristics, 2008
Patients assessed with a mental disorder
Patients
assessed
without a
All patients
mental
Characteristic
Strength2
seen
Number
Rate
95% CI
disorder
All
114,100
2,758
r
1,959
r
17.2
(16.4 - 17.9)
799
Gender
Males
105,600
2,389
r
1,679
r
15.9
(15.1 - 16.7)
710
Females
8,500
369
280
32.9
(29.0 - 36.7)
89
Rank
Officers
15,900
130
103
6.5
(5.2 - 7.7)
27
Other ranks
98,200
2,628
r
1,856
r
18.9
(18.0 - 19.7)
772
Age
<20
11,800
377
r
221
r
18.7
r
(16.2 - 21.1)
r
156
r
20-24
28,100
917
r
629
r
22.4
r
(20.6 - 24.1)
r
288
r
25-29
24,900
621
r
455
r
18.3
r
(16.6 - 19.9)
r
166
r
30-34
17,000
340
r
261
r
15.4
r
(13.5 - 17.2)
r
79
r
35-39
17,800
313
r
252
14.2
(12.4 - 15.9)
61
r
40-44
8,000
133
100
12.5
(10.0 - 14.9)
33
45-49
3,800
36
r
26
r
6.9
r
(4.5 - 10.1)
r
10
50+
2,700
21
r
15
r
5.5
r
(3.1 - 9.0)
r
6
Deployment - Theatres of
operation
Iraq and/or Afghanistan1
71,100
1,644
1,222
17.2
(16.2 - 18.1)
422
Of which, Iraq
57,800
1,341
991
17.2
(16.1 - 18.2)
350
Of which, Afghanistan1
28,100
608
468
16.6
(15.1 - 18.2)
140
Neither Iraq nor Afghanistan1
43,000
1,114 r
737 r
17.1
(15.9 - 18.4)
377
1. Does not include personnel deployed to Afghanistan during the period January 2003 to October 2005.
2. Strengths data rounded to the nearest 100. Strengths are a 13-month average.
r Data revised due to improvements in data processing
35.
Of the 2,758
r new attendances, 1,959
r (71%) were assessed with a mental disorder,
representing an overall rate for new cases of mental disorder of 17.2 per 1,000 strength.
36.
There were some statistically significant differences in the rates of mental disorder between
various sub-groups of Army patients.
-
Female personnel had a higher rate of mental disorder assessment at 32.9 per 1,000 strength
(95%CI: 29.0-36.7, N=280), which is double that of male personnel at 15.9 per 1,000 strength
(95%CI: 15.1-16.7, N=1,679
r).
-
Other ranks had a higher rate of mental disorder at 18.9 per 1,000 strength (95%CI: 18.0-
19.7, N=1,856
r), which is almost three times that of officers at 6.5 per 1,000 strength (95%CI:
5.2-7.7, N=103).
-
When broken down by age, the 20-24 age group had a higher rate of mental disorder at 22.4
r per 1,000 strength, than all except the under 20 age group.
13
37.
Table 10 provides details of the types of mental disorder by the patients’ past deployment on
recent operations in the Iraq or Afghanistan theatres. The rate ratios presented provide a comparison
of cases seen between personnel identified as having deployed to a theatre and those who have not
been identified as having deployed to either theatre. A rate ratio less than 1 indicates lower rates in
those deployed than those not deployed, whereas a rate ratio greater than 1 indicates higher rates in
those deployed than those not deployed. If the 95% confidence interval does not encompass the
value 1.0, then this difference is statistically significant.
Table 10 - Initial mental disorder assessments for all new Army cases seen at a DCMH: numbers and rate ratios, by
deployment and ICD-10 classification, 2008
Deployment - Theatres of operation
of which
1
1
Iraq and/or Afghanistan
Iraq
Afghanistan
Neither
All patients
Patients
Rate
Patients
Rate
Patients
Rate
ICD-10 description
seen
seen
ratio
95% CI
seen
ratio
95% CI
seen
ratio
95% CI
Patients seen
r
r
All patients se en
2,758
1,644
1,341
608
1,114
r
r
All patients assessed with a m ental
1,959
1,222
1.0
(0.9 - 1.1)
991
1.0
(0.9 - 1.1)
468
1.0
(0.9 - 1.1)
737
disorder
P sychoactive substance use
213
118
0.8
(0.6 - 1.0)
97
0.8
(0.6 - 1.0)
31
0.5
(0.3 - 0.7)
95
of which disorders due to alcohol
200
113
0.8
(0.6 - 1.0)
92
0.8
(0.6 - 1.1)
31
0.5
(0.4 - 0.8)
87
Mood disorders
432
252
0.8
(0.7 - 1.0)
216
0.9
(0.7 - 1.1)
85
0.7
(0.6 - 0.9)
180
of which depressive episode
241
205
3.4
(2.4 - 4.9)
175
3.6
(2.5 - 5.2)
74
3.1
(2.1 - 4.7)
36
Neurotic disorders
1,139
r
758
1.2
(1.1 - 1.4)
605
1.2
(1.0 - 1.3)
319
1.3
(1.1 - 1.5)
381
r
of which PTSD
92
76
2.9
(1.7 - 4.9)
64
3.0
(1.7 - 5.1)
34
3.2
(1.8 - 5.9)
16
of which adjustment disorders
726
475
1.1
(1.0 - 1.3)
365
1.1
(0.9 - 1.3)
218
1.3
(1.1 - 1.6)
251
O ther mental and behavioural
175
94
0.7
(0.5 - 0.9)
73
0.7
(0.5 - 0.9)
33
0.6
(0.4 - 0.9)
81
di sorders
No mental disorder
799
422
350
140
377
1. Does not include personnel deployed to Afghanistan during the period January 2003 to October 2005 (see paragraph 49).
38.
In 2008, there were many statistically significant differences for Army personnel deployed to
the Iraq or Afghanistan theatres of operation compared to those not identified as having deployed
there:
-
The rates of depressive episodes (rate ratio 3.4, 95% CI: 2.4-4.9) and PTSD (rate ratio 2.9,
95% CI: 1.7-4.9) were higher among those deployed to the Iraq and/or Afghanistan theatres
of operation than those not identified as having deployed there.
-
Rates of overall mood disorder were lower in those deployed to the Afghanistan theatre of
operation than those not identified as having deployed to the Iraq and/or Afghanistan theatres
of operation (rate ratio 0.7, 95% CI: 0.6-0.9).
-
Rates of neurotic disorders (rate ratio 1.3 95% CI: 1.1-1.5), including PTSD (rate ratio 3.2
95% CI: 1.8-5.9) and adjustment disorders (rate ratio 1.3 95% CI: 1.1-1.6), were higher in
those deployed to the Afghanistan theatre of operation than those not identified as having
deployed to the Iraq and/or Afghanistan theatres of operation.
-
With a rate ratio of 0.5, psychoactive substance use, including disorders due to alcohol, was
lower in those deployed to the Afghanistan theatre of operation than those not identified as
having deployed to the Iraq and/or Afghanistan theatres of operation.
-
Other mental and behavioural disorders were lower in those deployed to the Iraq and/or
Afghanistan theatres of operation than those not identified as having deployed there (rate
ratio 0.7, 95% CI: 0.5-0.9).
14
RAF
39.
During 2008 a total of 941 RAF personnel were recorded as having been seen for
assessment as new patients at the MOD’s DCMHs and overseas satellites, representing a rate for the
year of 21.5 per 1,000 strength.
40.
Table 11 provides details of the key socio-demographic and military characteristics of the 941
new attendances of Royal Air Force personnel at the MOD’s DCMHs during 2008.
Table 11 - New attendances of RAF Personnel at the MOD’s DCMHs in 2008:
demographic and military characteristics, numbers and rates (per 1,000 strength)
Patients assessed with a mental disorder
Patients
assessed
without a
All patients
mental
Characteristic
Strength2
seen
Number
Rate
95% CI
disorder
All
43,800
941
706
16.1
(14.9 - 17.3)
235
Gender
Males
38,000
672
492
12.9
(11.8 - 14.1)
180
Females
5,800
269
214
37.1
(32.1 - 42.1)
55
Rank
Officers
9,800
93
75
7.6
(5.9 - 9.4)
18
Other ranks
34,000
848
631
18.6
(17.1 - 20.0)
217
Age
<20
1,400
46
r
24
17.4
(11.1 - 25.8)
22
r
20-24
7,400
206
134
r
18.1
r
(15.0 - 21.1)
r
72
r
25-29
9,200
202
157
17.0
(14.3 - 19.6)
45
30-34
6,100
142
r
112
r
18.3
r
(14.9 - 21.7)
r
30
35-39
8,500
192
r
163
r
19.3
r
(16.3 - 22.2)
r
29
40-44
5,800
92
69
11.9
(9.1 - 14.7)
23
45-49
3,400
41
33
9.6
(6.4 - 12.9)
8
50+
2,000
20
14
7.1
(3.9 - 11.9)
6
Deployment - Theatres of
operation
Iraq and/or Afghanistan1
24,500
479
375
15.3
(13.7 - 16.8)
104
Of which, Iraq
21,400
414
328
15.3
(13.6 - 17.0)
86
Of which, Afghanistan1
9,700
178
138
14.2
(11.9 - 16.6)
40
Neither Iraq nor Afghanistan1
19,300
462
331
17.2
(15.3 - 19.0)
131
1. Does not include personnel deployed to Afghanistan during the period January 2003 to October 2005.
2. Strengths data rounded to the nearest 100. Strengths are a 13-month average.
r Data revised due to improvements in data processing
41.
There were some statistically significant differences in the rates of mental disorder between
various sub-groups of RAF patients.
-
Female personnel had a higher rate of mental disorder assessment at 37.1 per 1,000 strength
(95%CI: 32.1-42.1, N=214), which is almost three times that of male personnel at 12.9 per
1,000 strength (95%CI: 11.8-14.1, N=492).
-
Other ranks had a higher rate of mental disorder at 18.6 per 1,000 strength (95%CI: 17.1-
20.0, N=631), which is over double that of officers at 7.6 per 1,000 strength (95%CI: 5.9-9.4,
N=75).
42.
Table 12 provides details of the types of mental disorder by the patients’ past deployment
15
link to page 16
on recent operations in the Iraq or Afghanistan theatres. The rate ratios presented provide a
comparison of cases seen between personnel identified as having deployed to a theatre and those
who have not been identified as having deployed to either theatre. A rate ratio less than 1 indicates
lower rates in those deployed than those not deployed, whereas a rate ratio greater than 1 indicates
higher rates in those deployed than those not deployed. If the 95% confidence interval does not
encompass the value 1.0, then this difference is statistically significant.
Table 12 - Initial mental disorder assessments for all new RAF cases seen at a DCMH: numbers and rate ratios, by
deployment and ICD-10 classification, 20081
Deployment - Theatres of operation
of w hich
Iraq and/or Afghanistan2
Iraq
Afghanistan2
Neither
All
patients
Patients
Rate
Patients
Rate
Patients
Rate
Patients
ICD-10 description
seen
seen
ratio
95% CI
seen
ratio
95% CI
seen
ratio
95% CI
seen
All patients se en
941
479
414
178
462
All patients assessed with a m ental
706
375
0.9
(0.8 - 1.0)
328
0.9
(0.8 - 1.0)
138
0.8
(0.7 - 1.0)
33 1
disorder
P sychoactive substance use
28
11
0.5
(0.2 - 1.1)
10
0.5
(0.2 - 1.2)
~
0.1
(0.0 - 0.9)
1 7
of which disorders due to alcohol
27
~
0.5
(0.3 - 1.2)
10
0.6
(0.3 - 1.2)
~
0.1
(0.0 - 0.9)
~
Mood disorders
166
77
0.7
(0.5 - 0.9)
64
0.6
(0.5 - 0.9)
33
0.7
(0.5 - 1.1)
8 9
of which depressive episode
144
68
0.7
(0.5 - 1.0)
56
0.7
(0.5 - 0.9)
31
0.8
(0.5 - 1.2)
7 6
Neurotic disorders
464
266
1.1
(0.9 - 1.3)
234
1.1
(0.9 - 1.3)
99
1.0
(0.8 - 1.3)
19 8
of which PTSD
28
~
10.2
(2.4
-
43) 23
10.3
(2.4
-
43.8) 12
11.9
(2.7
-
53.3)
~
of which adjustment disorders
266
162
1.2
(1.0 - 1.6)
148
1.3
(1.0 - 1.6)
55
1.1
(0.8 - 1.5)
10 4
O ther mental and behavioural disorders
48
21
0.6
(0.3 - 1.1)
20
0.7
(0.4 - 1.2)
~
0.4
(0.1 - 1.0)
2 7
No mental disorder
235
104
86
40
13 1
1. Data presented as "~" has been suppressed in accordance with DASA's rounding po licy (see paragraph 52).
2. Does not include personnel deployed to Afghanistan during the period January 2003 to October 2005 (see paragraph 49).
43.
During 2008 there were some statistically significant differences between those deployed to
the Iraq and Afghanistan theatres of operation and those not identified as having deployed there.
-
Rates of mood disorders, and the subgroup depressive episodes, were lower in those who
had deployed to the Iraq theatre of operation than in those who had not deployed to the Iraq
and/or Afghanistan theatres of operation.
-
Rates of psychoactive substance use, and the subgroup disorders due to alcohol, were lower
in those who had deployed to the Afghanistan theatre of operation than in those who had not
deployed to the Iraq and/or Afghanistan theatres of operation.
-
The rate of PTSD was higher among those deployed to the Iraq or Afghanistan theatres of
operation compared with those not deployed there (rate ratio 10.2, 95% CI: 2.4-43.0).
However, it is important to note that at 28, the number of cases of PTSD was small.
POINTS TO NOTE
44.
Interpretation of the findings in this report continues to require caution. They do not cover the
full picture of all mental disorders in the UK Armed Forces. Personnel may have been seen in Primary
care, who did not require, or who did not wish, onward referral to the DCMHs. It is also possible that
the support through a strong culture of comradeship within the Armed Forces, may have served to
minimise the number and severity of symptoms experienced by some cases. It is important therefore
to view the results presented here alongside independent academic research, such as that conducted
by the Kings Centre for Military Health Research, who collect subjective information on self-reported
mental health, through the use of confidential surveys
b.
DATA, DEFINITIONS AND METHODS 45.
DCMH staff record the initial psychiatric assessment during a patient’s first appointment,
based on presenting complaints. The information is provisional and final diagnoses may differ as
some patients do not present the full range of symptoms, signs or clinical history during their first
appointment. The psychiatric assessment data were categorised into three standard groupings of
common mental disorders used by the World Health Organisation’s International Statistical
Classification of Diseases and Health-Related Disorders 10th edition (ICD-10).
46.
A number of patients present to DCMHs with symptoms that require the treatment skills of
b Their findings are published in the peer-reviewed medical literature and are freely available in the public domain at
URL:http://www.kcl.ac.uk/kcmhr/information/publications/publications.html.
16
link to page 17
DCMH staff, whilst not necessarily having a specific and identifiable mental disorder. In the
Results section, these cases are referred to as “assessed without a mental disorder”.
47.
As for the Quarterly reports, a range of validation and verification quality assurance
procedures were applied to the data DASA received from the DCMHs. Records submitted were
excluded from the main analysis if they were duplicates or repeat attendances in the same episode of
care, and civilian or non-UK military personnel not covered by this report. In 2008, 80 cases were
included in the analysis, but since they were supplied in fully anonymous format, could not be verified
or linked to demographic or deployment data.
48.
In order to calculate the rates in this report, an estimate of person time at risk is required for
the denominator value. The estimate was calculated using a 13-month average of strengths figures
(e.g. the strength at the first of every month between January 2008 and January 2009 divided by 13
for 2008 strengths). This estimate is in line with the method used for the 2007 annual report.
Strengths figures include regulars (including Gurkhas and Military Provost Guard Staff), mobilised
reservists, Full Time Reserve Service personnel and Non-regular Permanent Staff as all of these
individuals are eligible for assessment at a DCMH.
49.
Deployment data, used for deployment breakdowns and to calculate denominators, cover
several operational deployments between November 2001 and December 2008, although person
level deployment data for Afghanistan between 1 January 2003 and 14 October 2005 were not
available. About 4% of the deployment records were not successfully validated against the “gold
standard” personnel records held by the Service Personnel and Veterans Agency
c.
50.
Deployment markers were assigned using the criteria that an individual was recorded as
being deployed to the Iraq and/or Afghanistan theatres of operation if they had deployed to these
theatres prior to their appointment date.
To be accurate, this report compares those who had
been deployed before their first appointment with those who have not been identified as
having deployed before their first appointment. 51.
This report includes an additional breakdown by age. The age used is the patient’s age on
the date of their first appointment.
52.
In line with DASA’s latest rounding policy (May 2009) all numbers less than five
have been
suppressed. Where there is only 1 cell in a row or column that is less than 5, the next smallest
number has also been suppressed so that numbers cannot simply be derived from totals. Where there
are tied values both numbers have been suppressed.
REFERENCES
1
Hyams KC, Wignall FS, Roswell R. War syndromes and their evaluation: from the U.S. Civil
War to the Persian Gulf War.
Annals of Internal Medicine;
125: 398-405.
2
Jones E, Hodgins-Vermaas R, McCartney H et al. Post-combat syndromes from the Boer War
to the Gulf: a cluster analysis of their nature and attribution.
British Medical Journal 2002;
324: 321-324.
3
Hoge CW, Castro CA, Messer SC et al. Combat duty in Iraq and Afghanistan, mental health
problems, and barriers to care.
New England Journal of Medicine 2004;
351: 13-22.
4
Hotopf M, Fear NT, Browne T et al. The health of UK military personnel who deployed to the
2003 Iraq war: a cohort study. The Lancet; 367: 1731-1741.
5
Pearson ES, Hartley HO, 1954. Biometrika tables for statisticians volume I. Cambridge:
Cambridge University Press.
c It is reassuring that the research carried out by the Kings Centre for Military Health Research on a large tri-Service sample of
personnel deployed during the first phase of Op TELIC in 2003, who were identified from DASA’s deployment database,
reported a cohort error rate of less than 0.5 per cent.4
17
Annex A: Reserves Mental Health Programme
53.
The Reserves Mental Health Programme (RMHP) is open to any current or former member
of the UK Volunteer and Regular Reserves who has been demobilised since 1 January 2003 following
an overseas operational deployment as a reservist, and who believes that the deployment may have
adversely affected their mental health.
54.
Under the RMHP, Defence Medical Services (DMS) liaise with the individual’s GP and offer
a mental health assessment at the Reserves Training and Mobilisation Centre. If diagnosed with a
combat-related mental health condition, out-patient treatment is offered via one of the MOD’s 15
Departments of Community Mental Health (DCMHs). If more acute cases present, the DMS will
assist access to NHS in-patient care.
55.
An individual who believes they are eligible, and who would like an assessment, should ask
their GP for a referral. This is the preferred method of contact, to ensure that both the GP and the
RMHP assessors are kept aware of all the factors affecting the individual’s health. Referrals from
civilian psychiatric services (such as Combat Stress) are also accepted but the patient’s GP is to be
kept informed. Individuals can contact the assessment centre directly, but no patient will be accepted
for treatment without GP registration.
Table 13 provides a summary of the method of contact made to
the RMHP since the scheme began on 6th November 2006.
Table 13 - Calls received by the Reserves Mental Health Programme, 6th November
2006 to 26th December 2008
06Nov06 - 29Dec06
30Dec06 - 28Dec07
29Dec07 - 26Dec08
Number Percentage of Number Percentage of Number Percentage of
of calls
calls received
of calls
calls received
of calls
calls received
Total calls received
16
100
159
100
51
100
Self Referral
7
44
86
54
42
82
GP referral
1
6
10
6
6
12
3rd Party Referral
8
50
63
40
3
6
Invalid Calls
12
42
0
56.
Despite publicised details that primary referral should be through a GP, this accounted for
only 12% of calls between 29th December 2007 and 26th December 2008.
57.
Table 14 provides a summary of appointments made through the RMHP since the scheme
began on 6th November 2006.
Table 14 - Appointments through the Reserves Mental Health Programme, 6th November 2006 to 28th
December 20081
06Nov06 - 29Dec06
30Dec06 - 28Dec07
29Dec07 - 26Dec08
Percentage of
Percentage of
Percentage of
Number cases assessed Number
cases assessed Number
cases assessed
Cases assessed
0
45
100
36
100
No mental disorder
0
12
27
8
22
Mental disorder not combat-related
0
2
4
2
6
Mental disorder combat-related
0
31
69
26
72
Cases waiting to be seen at end date
7
4
4
Appointments cancelled
0
5
11
Did not attend
0
1
0
1. Individuals will not necessarily be seen in the same time period in which they place a call, so totals in Tables 13 and 14 will not be comparable.
58.
Of the cases assessed between 29 December 2007 and 26 December 2009, 72% were
assessed as having a combat-related mental disorder and were offered mental health treatment.
59.
It is important to note that whilst mobilised, Reserve personnel receive the same healthcare
provision as their Regular counterparts. Any Reserve personnel identified as having a mental health
condition during deployment and the pre-demobilisation period will continue to receive medical
treatment from the Defence Medical Services post-deployment and should be captured in the DCMH
figures earlier in this report.
60.
The figures in
Tables 13 and
14 were provided in aggregated form by the RMHP practice
manager and have not been validated by DASA.
18
Annex B: Aeromedical Evacuations
61.
Personnel are aeromedically evacuated from theatre for a range of medical conditions.
Table
15 details the number of UK Military personnel aeromedically evacuated from theatre for psychiatric
reasons in 2007 and 2008.
Table 15 - Number of UK Military personnel Aeromedically Evacuated1 for Psychiatric
reasons from the Iraq and Afghanistan theatres of operation, 2007 and 2008 2 3
2007
2008
Afghanistan
Iraq
Afghanistan
Iraq
Total number of evacuations
22
35
15
26
1A - Severe Psychiatric Patient
0
0
0
~
1B - Psychiatric Patients of Intermediate Severity
5
7
~
~
1C - Mildly Disturbed Psychiatric Patients
17
28
~
16
Psychiatric Evacuation - Unknown Severity
0
0
0
~
1. Patients flown home to the UK either by the aeromed evacuation team or other flights.
2. The numbers reported here reflect the reason for evacuation as recorded. There may be patients who are evacuated for other
medical reasons who are also suffering from a mental disorder.
3. Data presented as "~" has been suppressed in accordance with DASA's rounding policy (see paragraph 52).
62.
These figures have been compiled using data from Brize Norton Aeromedical Evacuation
Control Centre (AECC) and the Defence Patient Tracking System (DPTS). It is possible that some
individuals have returned to the UK for psychiatric reasons without being recorded on the AECC or
DPTS as psychiatry, and their details will not have been recorded centrally.
63.
Table 16 shows the first location of medical care following aeromedical evacuation from the
Iraq or Afghanistan theatres of operation.
Evacuated for Psychiatric reasons from the Iraq and Afghanistan theatres of
operation, 20081 2
2008
Afghanistan
Iraq
Total number of evacuations
15
26
DCMH or in-patient care contractor
6
10
Unit/Unit Primary Healthcare
9
16
of which subsequently seen at a DCMH or in-patient care contractor
5
6
1. The DPTS is a live system and is constantly being updated retrospectively as such the data are provisional and subject to change.
2. These figures include Naval Service Personnel, Army Personnel including those from the Gibraltar Regiment, RAF
Personnel and Reservists. These exclude Other Nations Service Personnel.
64.
Of the 41 individuals aeromedically evacuated for psychiatric reasons in 2008, 66% were
seen at a DCMH or by the MOD’s in-patient care contractor during the care pathway that followed
their evacuation.
19
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