Papers (Military)
1999
Ismail K, Everitt B, Blatchley N, Hull L, Unwin C, David A, Wessely S. Is there a Gulf war syndrome? Lancet 1999: 353: 179 182
There is a health problem, but no single syndrome
Jones E. War Syndromes: the Psychological Impact of Modern Warfare, A Study of the changing nature of pressure groups and government responses. Research Report, 1999.
Jones E, Wessely S. Chronic fatigue syndrome after the Crimean War and the Indian Mutiny. BMJ 1999: 319:1545-1547
First case reports of “Gulf War Syndrome” long before the Gulf War
Unwin C, Blatchley N, Coker W, Ferry S, Ismail K, Hotopf M, Palmer I, David A, Wessely S. The health of United Kingdom Servicemen who served in the Persian Gulf War. Lancet 1999:353: 169 178
First study to show that service in the 1991 Gulf War had affected the subjective health of part of the UK Armed Forces.
2000
Hotopf M, David A, Hull L, Ismail K, Unwin C, Wessely S. The role of vaccinations as risk factors for ill-health in veterans of the Gulf War:cross sectional study. BMJ 2000:320:1363-1367
Reported a link between the very particular vaccination programme used to protect the Armed Forces against biological warfare and subsequent ill health. Led to important policy changes in UK forces health protection
Ismail K, Blatchley N, Hotopf M, Hull L, Palmer I, Unwin C, David A, Wessely S. Occupational risk factors for ill health in UK Gulf war veterans. J Epi Comm Health 2000; 54:834-838
Outlined main risk factors for ill health – showed could not be DU for example
2001
Chalder T, Hull L, Unwin C, David A, Hotopf M, Wessely S. Prevalence of Gulf war veterans who think they have Gulf War Syndrome Br Med J 2001: 323;473-476
Social networks play a role
Jones E, Wessely S. Psychiatric battle casualties: an intra- and inter-war comparison. Br J Psych 2001: 178: 242-247
Physical and psychological casualties are closely linked – the greater the number of the former, the greater the latter
Reid S, Hotopf M, Hull L, Ismail K, Unwin C, David A, Wessely S. Chronic fatigue syndrome and multiple chemical sensitivity in UK Gulf war veterans. Am J Epidemiology 2001:153:604-609
Increase in several multi symptom conditions
2002
Bartholomew R, Wessely S. The protean nature of mass sociogenic illness: From possessed nuns to chemical and biological terrorism fears. Br J Psychiatry 2002: 180: 300-306
Linked changing illness beliefs to outbreaks of mass hysteria in the age of terrorism
David A, Farrin L, Hull L, Unwin C, Wessely S, Wykes T, Cognitive functioning and disturbances of mood in UK veterans of the Persian Gulf War: a comparative study. Psychological Medicine 2002: 32: 1357-1370
Found no evidence of brain damage
Durodie W, Wessely S. Resilience or panic: the public’s response to a terrorist attack. Lancet 2002: 360: 1901-1902
Editorial on how risk communication can influence public reaction to terrorism
Everitt B, Ismail K, David A, Wessely S. Searching for a Gulf War Syndrome Using Cluster Analysis. Psych Med 2002: 32 1371-137
Different analysis to confirm no unique syndrome
Hyams K, Murphy F, Wessely S. Combating terrorism: recommendations for dealing with the long term consequences of a chemical, biological attack. J Health Politics, Policy & Law 2002:27: 273-291
Short term effects will be well managed, long term problems will be difficult
Ismail K, Kent K, Brugha T, Hotopf M, Hull L, Seed P, Palmer I, Reid S, Unwin C, David A, Wessely S. . The mental health of UK Gulf war veterans: phase 2 of a two-phase cohort study. British Medical Journal 2002: 325: 576-579.
Doubling of psychiatric disorder, but PTSD not main issue. Alcohol and depression more important
Jones E, Hodgins-Vermaas R, McCartney H, Everitt B, Beech C, Poynter D, Palmer I, Hyams K, Wessely S. Post-combat syndromes from the Boer War to the Gulf: a cluster analysis of their nature and attribution. Br Med J 2002: 324: 321-324.
Used war pension records to show that Gulf War Syndrome is not as new as we think it is
Jones E, Palmer I, Wessely S. War Pensions (1900-1945): changing models of psychological understanding. Br J Psychiatry 2002: 180: 374-379.
Shows how the awarding of war pensions is socially influenced
Sharief M, Pridden J, Delamont R, Unwin C, Rose M, David A, Wessely S. Neurophysiological evaluation of neuromuscular symptoms in UK Gulf War veterans. A controlled study. Neurology 2002: 59: 1518-1525
No evidence for peripheral neurological damage – and therefore organophosphate pesticides unlike to be playing a role in ill health
Skowera A, Stewart E, Davis E, Cleare A, Hossain G, Unwin C, Hull L, Ismail K, Wessely S, Peakman M. Antinuclear antibodies (ANA) in gulf war related illness and chronic fatigue syndrome (CFS) patients. Clin Exp Immunology 2002:129:354-358
Failed to replicate an earlier claim from USA
Unwin C, Hull L, Hotopf M, Ismail K, David A, Wessely S. Women in the Gulf: Lack of a Gender Difference in Long Term Health Effects in UK Armed Forces. Military Medicine 2002: 167: 406-413
No gender differences – women affected much the same as men
Wessely, S. The Gulf War and its aftermath. Horizons in Medicine 2002: 13: 229-246.
Greenberg N, Iversen A, Hull L, Unwin C, Destrange M, Wessely S. Vaccination records in Gulf War veterans. J Occupational and Environmental Medicine 2003: 45: 219
Ended the “prepped but not deployed” issue – only one valid record was found
Greenberg N, Thomas S, Iversen A, Unwin C, Hull L, Wessely S. Do military peacekeepers want to talk about their experiences? Perceived psychological support of UK military peacekeepers on return from deployment. J Mental Health 2003: 6: 565-573
Supports informal rather than formal interventions
Hotopf, M. David, A. Hull, L, Ismail I. Palmer, I. Unwin, C. Wessely, S. The health effects of peace-keeping in the UK Armed Forces: Bosnia 1992-1996. Predictors of psychological symptoms. Psychological Medicine 2003: 33: 1-8
Peacekeeping can be as difficult as war fighting
Hotopf, M. David, A. Hull, L. Nikalaou, V. Unwin, C. Wessely, S. Gulf War illness – better, worse or just the same? A cohort study. Br Med J. 2003;327:1370
Just the same – not getting worse, not getting better
Hotopf M, Mackness I, Nikolaou V, Collier D, David A, Durrington P, Hull L, Ismail K, Peakman M, Unwin C, Wessely S, Mackness B. Paraoxonase in Persian Gulf War veterans. Journal of Occupational and Environmental Medicine 2003: 45:668-675.
Failed to replicate claim that sick Gulf veterans have a particular variant of the enzyme that deals with organophosphates, but did show that the levels of this enzyme in the blood were lower in Gulf veterans than controls
Jones E, Hodgins Vermaas R, Beech C, Palmer I, Hyams K, Wessely S. Mortality and post-combat disorders: UK veterans of the Boer War and World War One. Military Medicine 2003: 168:414-418
Shell shock, effort syndrome etc not associated with increased mortality, much like gulf war illness
Jones E, Hyams K, Wessely S. Screening for Psychological Vulnerability in the Military: A historical analysis. J Med Screening 2003, 10: 40-46
Don’t do it – was done in World War II and was a disaster
Jones, E., Vermaas, R., McCartney, H. Beech, C., Palmer, I., Hyams, K. Wessely, S. Flashbacks and post-traumatic stress disorder: the genesis of a 20th-century diagnosis. British Journal of Psychiatry 2003, 182, 158-163.
Paper that suggests that PTSD is not a “hard wired” response, but more culturally determined
Jones E, Wessely S. The impact of total war on the practice of psychiatry. In: Shadows of Total War, 1919 1939. (Ed Forster, Chickering). Cambridge Univ Press 2003: 129-148.
It was the Second, not the First World War that changed the practice of psychiatry
Jones E, Wessely S. Forward Psychiatry in the Military: Its Origins and Effectiveness. J Traumatic Stress 2003:16:411-419
Discusses the origins of the standard way in which most Armed Forces treat acute psychiatric casualties, whilst concluding that we will probably never know if this is effective or not
Wessely S, Unwin C, Hotopf M, Hull L, Ismail K, Nicolaou V, David A. Is recall of military hazards stable over time? Evidence from the Gulf War. Br J Psych 2003: 183:314-322
No it isn’t. Self report of exposure to some military hazards unreliable over time
2004
French C, Rona RJ, Jones M, Wessely S. Screening for physical and psychological illness in the British Armed Forces: II Barriers to screening – learning from the opinions of Service personnel. J Medical Screening 2004; 11: 153-157
Problems include stigma, confidence and confidentiality
Hotopf M, David A, Hull L, Nikalaou V, Unwin C, Wessely S. Risk factors for continued illness among gulf war veterans: a cohort study. Psychological Medicine 2004: 34: 1-8
Emphasised that social/psychological factors were important in prognosis
Iversen, A. & Greenberg, N. Food for thought: Participating and managing the psychological aspects of food chain contamination and terrorism. Psychiatric Annals 2004, 34.
Jones E, Woolven, R, Durodié B, Wessely S. Civilian Morale during World War Two: responses to air-raids re-examined. Social History of Medicine 2004: 17: 463-79.
Fears of mass panic/social disintegration were exaggerated before the Blitz
Rona RJ, Hooper R, Jones M, French C, Wessely S. Screening for physical and psychological illness in the British Armed Forces: III The value of a questionnaire to assist a Medical Officer to decide who needs help. J Medical Screening 2004 ; 11: 158-161
Psychological tests not helpful for mental health screening in the context of the UK military
Rona R J, Jones M, French C, Hooper R, Wessely S. Screening for physical and psychological illness in the British Armed Forces: I The acceptability of the programme. J Medical Screening 2004; 11: 148-153
It is not acceptable for many reasons, and will not work until those are sorted
Rose, M. R., Sharief, M. K., Priddin, J., Nikolaou, V., Hull, L., Unwin, C., Ajmal-Ali, R., Sherwood, R. A., Spellman, A., David, A., Wessely, S. Evaluation of Neuromuscular Symptoms in UK Gulf War Veterans. A Controlled Study. Neurology 2004: 63: 1681-1687
Ill gulf veterans found physical exercise more demanding than controls. Found evidence that the mitochondria in muscle cells were working less efficiently, but unable to say if this was cause or effect
Wessely S. The Long Aftermath of the 1991 Gulf War. Annals Int Med 2004: 141: 155-156
Editorial on treatment
Wessely S. When being upset is not a mental health problem. Psychiatry 2004: 67: 153-157
Why it is important to distinguish between normal symptoms of distress and psychiatric disorder
Wessely S, Jones E. Psychiatry and the “Lessons of Vietnam?”: What were they, and are they still relevant? War and Society 2004: 22: 89-103
Paper used in PTSD case to show that UK military could not be blamed for failing to learn the lessons of Vietnam, because no one knew what they were
2005
French, C. Dandeker, C. UK military families and the deployments to Iraq: Preliminary findings from a pre-, during-, and post-deployment study of the British Army. Paper presented at the 2005 Inter-University Seminar on Armed Forces and Society. Chicago, October 2005
Wives are more resilient than their service partners think they are when facing the stresses of separation due to deployment
French, C. Dandeker, C. Birtles, C. & Wessely, S. The family and military as ‘Greedy Institutions’: Negotiating a work-life balance in the British Armed Forces. A report prepared for the Economic and Social Research Council, November 2005.
Analyses tensions between work and family life in the military setting
Hacker Hughes J, Cameron F, Eldridge R, Greenberg N, Wessely S. Going to war does not always have to hurt: preliminary findings from the British deployment to Iraq. Br J Psych 2005: 186: 536-537
Not the best title, but showed that in elite forces (16 AA Bde) Op TELIC 1 was associated with an improvement in mental health
Hooper R, Rona R, French C, Jones M, Wessely S. Unmet expectations in primary care and the agreement between doctor and patient: a questionnaire study. Health Expectations 2005: 8: 26-33
Patients (all of them in the Armed Forces) and doctors have different views on what actions the doctor took during a consultation, and these conflicting perspectives may or may not fulfil patient’s expectations
Hotopf M, Wessely S. Can epidemiology clear the fog of war? Lessons from the first Gulf War. Int J Epidemiology 2005: 34: 791-800
Review of the problems in carrying out this kind of research after deployment
Iversen A, Dyson C, Smith N, Greenberg N, Walwyn R, Unwin C, Hull L, Dandeker C, Ross J, Wessely S. “Goodbye and Good Luck”; the Mental Health Needs and Treatment Experiences of British Ex Service Personnel. Br J Psychiatry 2005: 186: 480-486
Many of those with continuing mental health problems do not access the best treatments once they have left the Armed Forces. Began what would become a continuing theme of our work – that PTSD is not the only, or the commonest, mental health problem affecting veterans
Iversen A, Nicolaou V, Unwin C, Greenberg N, Dandeker C, Ross, J, Wessely S. What happens to UK veterans when they leave the Armed Forces? Eur J Public Health 2005: 15:175-184
Most get jobs and do well, a few don’t
Jones E, Wessely S. From Shellshock to PTSD: Military Psychiatry from 1900 to the Gulf War. Hove: Psychology Press, 2005.
Historical account of the development of military psychiatry
Jones E, Wessely S. War Syndromes: the impact of culture on medically unexplained symptoms, Medical History 2005: 49: 55-78.
Broad review of unexplained syndromes in the military
Rona R, Hyams C, Wessely S. Screening for psychological illness in military personnel. JAMA 2005: 293: 1257-1260
Response to US programme setting out reasons why UK has not followed suit
Skowera A, de Jong E, Schuitemaker J, Wessely S, Griffiths G, Kapsenberg M, Peakman M. Impairment of dendritic cell maturation and effector function by vaccines used for protection against anthrax and plague. J Immunology 2005: 175: 7235-7243.
Van Staden L, French C, Iversen A, Dandeker C, Wessely S. Post discharge mentoring for vulnerable service leavers. Unpublished Research Report, MOD 2005.
Wessely S. What should mental health professionals do, and not do. In: Neria Y, Gross R, Marshall R, Susser E, eds. 9/11: Mental Health in the Wake of a Terrorist Attack. New York: Cambridge University Press, 2005.
Wessely S. Don’t Panic!: Short and Long Term Psychological Reactions to the New Terrorism: The Role of Information and the Authorities. J Mental Health 2005: 14: 1-6
Developing themes of civilian resilience and communication
Wessely S. Victimhood and Resilience. New England Journal of Medicine 2005: 353: 548-550
Wessely S. War Stories. Br J Psychiatry 2005: 186: 473-475
Importance of understanding recall bias – memory is a human function, and soldiers can sometimes forget things that happened to them, or remember things that didn’t .
Wessely S. Risk, psychiatry and the military. Br J Psychiatry 2005: 186: 459-466
Reflections on risk and the Armed Forces
Wessely S, Hotopf M. Something Old, Something New, Something Borrowed, Something Blue: The Story of “Gulf War Syndrome”. In: Medical and Psychiatric Comorbidity over the Course of Life. Ed Easton W. APPI, Washington.
One more review
Wessely S, Krasnov V (eds). Psychological Aspects of the New Terrorism: A NATO Russia Dialogue. IOS Press, 2005.
French C, Dandeker C, van Staden L, Wessely S. Deployment of British Army Reserves on Op TELIC 5: Expectations, experiences and impact on retention. Unpublished Research Report. MOD, 2006.
Reservists and Regulars differ less on what they experience on deployment and more on how they are treated when they come home
French, C. Dandeker, C & Wessely, S. Deployment of British Army reservists on Op TELIC 5: Deployment related stressors and the overall affect on retention. Submitted to 9th International Military Mental Health Conference on “The Unhappy Soldier: The Management of Disenchanted Service Personnel”, RMAS 2006.
Horn O, Hull L, Jones M, Murphy D, Browne T, Fear NT, Hotopf M, Rona R, Wessely S. Is there an “Iraq War Syndrome”? Comparison of the health of UK service personnel after the Gulf and Iraq wars. Lancet 2006: 367: 1742-1746
History has not repeated itself. Raises interesting questions about why not
Hotopf M, Hull L, Fear N, Browne T, Horn O, Iversen A, Jones M, Murphy D, Bland D, Earnshaw M, Greenberg N, Hacker-Hughes J, Tate R, Dandeker C, Rona R, Wessely S. The health of UK military personnel who deployed to the 2003 Iraq War. Lancet 2006: 367: 1731-1741
Key paper showing that between 2003 and 2006 there was no increase in psychiatric problems in Regular personnel who had served in Iraq from the initial invasion to the shift to counter insurgency. This contrasted with the US experience. However, there was a significant increase in psychiatric disorders in Reservists associated with service in Iraq
Iversen A, Liddell K, Fear N, Hotopf M, Wessely S. Consent, Confidentiality and the Data Protection Act: Epidemiological Research and hard-to-engage Cohorts. Br Med J 2006: 332: 165-169
Uses data from our Gulf and Iraq studies to show that the main obstacle to using personal medical information in key research is faulty understanding of the Data Protection Act, and not as is often claimed the law itself
Jones E, Hyams K, Wessely S. Iconic Images. The Historian 2006: 92,6-11.
Jones E, Woolven R, Durodie W, Wessely S. Public Panic and Morale: World War Two civilian responses re-examined in the light of the current anti-terrorist campaign. Journal of Risk Research 2006: 9, 57-73.
Links population reactions to terror over 50 years
McGeorge T, Hacker Hughes H, Wessely S. The MOD PTSD Class Action – A Psychiatric Perspective. Occupational Health Review 2006: 122: 21-28
Summary of the large class action brought unsuccessfully by veterans against MOD in 2003. What is the duty of care re stress/PTSD? What must MOD do in future? What does it not need to do?
Murphy D, Dandeker C, Horn O, Hotopf M, Hull L, Jones M, Marteau T, Rona R, Wessely S. UK Armed Forces response to an informed consent policy for anthrax vaccination: A paradoxical effect? Vaccine 2006: 24: 3109-3114
Changing to informed consent for anthrax vaccine in Armed Forces has caused confusion and not increased confidence
Murphy D, Hooper C, French C, Jones M, Rona R, Wessely S. Is increased reporting of symptomatic ill health in Gulf War veterans related to how one asks the question? J Psychosom Res 2006: 61: 181-186
No it isn’t – important confirmation that the Gulf Health effect is not an artefact of knowing you went to the Gulf
Rona R, Hooper R, French C, Jones M, Wessely S. The meaning of self perception of health in the UK Armed Forces. Br J Health Psychology 2006: 11: 703-715
Points out that the Armed Forces often score highly on questionnaire self reports of ill health, but this does not mean that their health is impaired
Rona R, Hooper R, Greenberg N, Jones M, Wessely S. Medical downgrading, self-perception of health and psychological symptoms in the British Armed Forces. Occupational and Environmental Medicine 2006: 63: 250-254
Those who are downgraded for longer periods of time with physical problems often have psychological distress as well
Rona R, Hooper R, Jones M, Hull L, Browne T, Horn O, Murphy D, Hotopf M, Wessely S. Would mental health screening of the UK Armed Forces before the Iraq War have prevented subsequent psychological morbidity? Br Med J 2006: 333: 991-994
Using before/after data we show that mental health screening would not have prevented mental health problems after Iraq
Shephard B, Rubin J, Wardman J, Wessely S. Terrorism and dispelling the myth of a panic prone public. Journal of Public Health Policy 2006: 27:219-245
Extends the arguments and evidence from the Blitz to the present day
Wessely S. Twentieth century theories on combat motivation and breakdown. J Contemp Hist 2006: 41: 268-286
A historical paper outlining how the military and the psychiatrists used to think in a similar fashion about why men fight, and why they cease to fight, but since the coming of PTSD these views have diverged
Wessely S. The Life and Death of Private Harry Farr. J Royal Soc Medicine 2006: 99:440-443 and RUSI Journal
Harry Farr was one of those executed for military offences during the First World War. This paper looks at why things happened the way they did, and raises questions about the dangers of rewriting history through our modern sensibilities
Wessely S, Freedman L. Reflections on Gulf Illness. Philosophical Transactions of the Royal Society 2006: 361: 721-730
A brief summing up of what we know, and what we don’t know
Wessely S, Thomas S, Dandeker C, Greenberg N, Kelly V. “Serving in Bosnia made me appreciate living in Bristol”: Stressful Experiences, Attitudes, and Psychological Needs of Members of the United Kingdom Armed Forces. Mil Medicine 2006: 171: 376-380
Paper highlighting both the positive and negative aspects of peace keeping, and adds to the evidence that peacekeeping is associated with different psychological challenges than traditional war fighting
Browne T, Hull L, Horn O, Jones M, Murphy D, Fear N, Greenberg N, French C, Rona R, Wessely S, Hotopf M. Explanations for the increase in mental health problems in UK Reserve Forces who have served in Iraq. Br J Psychiatry 2007: 190: 484-489
Showed how problems at home and problems adjusting to homecoming played an important role in the increase in PTSD symptoms that we found as a result of deployment in UK Reservists
Fear N, Iversen A, Meltzer H, Workman L, Hull L, Greenberg N, Earnshaw M, Rona R, Hotopf M, Wessely S. Do the UK Armed Forces drink more than the general population? Patterns of drinking in the military and comparisons with the general population? Addictions 2007: 102: 1749-1759
The answer to the question is yes they do, and the differences between the military and the general population are most marked in young women. This is partly explained by selection – the Services recruit young people, some of whom already are prone to heavier drinking. However, other factors also play a part, such as culture, price and availability
Iversen A, Chalder T, Wessely S. “Gulf War Syndrome”: Lessons from Medically Unexplained Symptoms. Clinical Psychology Review 2007: 27: 842-854
A review paper proposing that we need now to look at Gulf War illness in a similar fashion to the way we think about illnesses such as chronic fatigue syndrome, irritable bowel syndrome and other unexplained syndromes to think more about why veterans are either staying ill or not getting better, and put to one side the vexed question of what started the problem in the first place
Iversen A, Fear N, Simonoff E, Hull L, Horn O, Greenberg N, Hotopf M, Rona R, Wessely S. Pre enlistment vulnerability factors and their influence on health outcomes in UK Military personnel. Br J Psychiatry 2007: 191: 506-511.
Jones E, Fear N, Wessely S. Shell Shock and Mild Traumatic Brain Injury: A Historical Review. Am J Psychiatry 2007: 164,1641-1645
A historical paper outlining the early history of “shell shock” during the First World War, emphasising shifting perspectives, beginning with the belief this was a form of head injury, before more psychological and/or social paradigms took over. One hopes the reader will notice the analogies with the current debate over mTBI
Jones E, Wessely S. Post traumatic stress disorder: a paradigm shift in the conceptualization of psychiatric disorder. J Anxiety Disorders 2007: 21: 164-175
What did we think about trauma and psychiatry before we had PTSD?
Rona R, Fear N, Hull L, Greenberg N, Earnshaw M, Hotopf M, Wessely S. The mental health consequences of “overstretch” in the UK Armed Forces. BMJ 2007: 335: 603-607
No link between number or length of deployments and mental health, provided the “Harmony Guidelines” are observed. If they are not, and in particular if tour length is unexpectedly increased, then there are increases in both PTSD and alcohol
Rona R, Fear N, Hull L, Wessely S. Women in novel occupational roles: mental health trends in the UK Armed Forces. International Journal of Epidemiology 2007; 36: 319-327
Women have higher prevalence rates of mental illness than men with the exception of alcohol misuse. However, the effects of deployment are similar for both sexes
Rubin G, Brewin C, Greenberg N, Hacker Hughes J, Simpson J, Wessely S. Enduring consequences of terrorism: 7 month follow up survey of reactions to the bombings in London on 7 July 2005, Br J Psych 2007: 190: 350-356
Demonstrated emotional and behavioural reactions in ordinary Londoners ten days after July 7th attacks
Cohn S, Dyson C, Wessely S. Early accounts of Gulf War illness and the construction of narratives in UK service personnel. Social Science and Medicine 2008; 67: 1641-1649
An anthropological perspective using free text accounts given by study respondents to our first Gulf study, showing how uncertainty, rumours and information gaps played a role in how veterans started to make sense of their symptoms
Hacker Hughes J, Earnshaw M, Greenberg N, Eldridge R, Fear N, French C, Deahl M, Wessely S. The use of psychological decompression in military operational environments. Mil Medicine 2008: 173: 534-538
Why decompression might be useful, why it is popular, and why there is scant evidence to suggest that it actually is beneficial
Hooper R, Rona R, Jones M, Fear N, Hull L, Wessely S. Cigarette and alcohol use in the UK Armed Forces, and their association with combat exposure; a prospective study. Addictive Behaviors 2008: 33: 1067-1071
Alcohol consumption and binge drinking has increased over time. The increase of consumption is greater in those who have been deployed, but the increase was strongest in those most recently deployed. Smoking is declining.
Iversen A, Fear N, Ehlers A, Hacker Hughes J, Hull L, Earnshaw, M, Greenberg N, Rona R, Wessely S, Hotopf M. Risk Factors for Post traumatic stress disorder in United Kingdom Armed Forces. Psych Med 2008: 38: 511-522
As expected PTSD was associated with traumatic events in theatre, most particularly believing one’s life was in danger. But it was also associated with early adversity, such as poor school record and childhood adversity. Low morale and poor social support within the unit also played a role
Jones M, Fear N, Greenberg N, Jones N, Hull L, Hotopf M, Wessely S. Rona R. Do medical personnel deployed to Iraq have worse mental health than other personnel? Eur J Public Health 2008: 18; 422-427
Unfortunately yes they do, although this had improved by 2009
Murphy D, Hotopf M, Marteau T, Wessely S. Multiple vaccinations, health and recall bias in UK Armed Forces deployed to Iraq. BMJ 2008: 337: a220
Using data from the Iraq deployment, showed no link between multiple vaccines and ill health, except when using self report. Suggested that our previous findings of such a link after the Gulf War may despite all efforts still have been influenced by recall bias
Murphy D, Marteau T, Hotopf M, Rona R, Wessely S. Why do UK military personnel refuse the anthrax vaccination? Biosecurity and Bioterrorism 2008: 6: 237-242
Because they no longer believe there is a realistic threat
Page L, Rubin J, Amlot R, Simpson J, Wessely S. Are Londoners prepared for an emergency? A longitudinal study following the London bombs. Bioterrorism and Biosecurity. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 2008, 6: 309-320.
Do we need to say? No they are not.
Stuart J, Ursano R, Fullerton C, Wessely S. Belief in exposure to chemical and biological agents in Persian Gulf War soldiers. J Nerv Mental Diseases 2008: 196: 122-127
Shows how those who believe that they were exposed to CBW agents as a result of their Gulf service are substantially more likely to have long term symptomatic ill health. Given that the evidence of any exposure is far from compelling, shows both the dangers of recall bias and also the influence of illness beliefs on health
Wilson J, Jones M, Hull L, Hotopf M, Wessely S, Rona R. Does prior psychological health influence recall of military experiences? A prospective study. J Traumatic Stress 2008: 21: 385-393
Is that more vulnerable people simply recall more traumatic exposures? A little, but not sufficient to suggest that predeployment psychological status would be useful for correcting for recall bias
The symptoms of mTBI (or post concussional syndrome as the UK prefers to call it) are linked with self reported exposure to blast injuries, as one would predict, but also with several other traumas/exposures that have nothing to do with concussion.
Fear N, Ward VR, Harrison K, Davison L, Williamson S, Blatchley NF. Suicide among male regular UK Armed Forces personnel, 1984-2007. Occupational & Environmental Medicine 2009: 66: 438-441
Overall the Armed Forces have a lower suicide rate than the general population, the exception being young men in the Army
Greenberg N, Langston V, Fear NT, Jones M, Wessely S. An evaluation of stress education in the Royal Navy. Occupational Medicine 2009; 59: 20-24.
Although stress education is now almost impossible to avoid, most military personnel do not recall ever have received any. Those who did remember and also found it helpful reported better mental health – no differences were found if briefings were perceived as being unhelpful.
Jones N, Fear N, Greenberg N, Hull L, Wessely S. Occupational outcomes in soldiers admitted to hospital for treatment of mental health problems. Occupational Medicine 2009: 59: 459-465
Generally poor, especially in those with short employment histories and/or substance misuse problems
Rona R, Jones M,Iversen A, Hull L, Greenberg N, Hotopf M, Wessely S. The impact of post traumatic stress disorder on impairment in the UK military at the time of the Iraq war. J Psychiatric Research 2009: 43: 649-655
Social and work impairment is a serious problem for those with PTSD and even for those who only have partial PTSD
Wessely S, Greenberg N, Woodhead C, Fear N. Gulf war illnesses. Lancet 2009; 373:462.
Wilson J, Jones M, Fear N, Rona R, Hull L, Hotopf M, Wessely S, Rona R. Was previous psychological health associated with the likelihood of being sent to Iraq for the UK Military? Investigating the “healthy warrior” effect. Am J Epidemiology 2009: 169: 1362-1369
A small “healthy warrior” effect was demonstrated
Woodhead C, Sloggett A, Bray I, Bradbury J, McManus S, Meltzer H, Brugha T, Jenkins R, Greenberg N, Wessely S, Fear N. An estimate of the veteran population in England: based on data from the 2007 Adult Psychiatric Morbidity Survey. Population Trends 2009: 138:50-54
Using this population based study, to which we had added a couple of questions on military service, we estimated that the total number of ex service personnel in England in 2007 was 3,770,000, close to the previous estimate made by the Royal British Legion.
Fear NT, Jones M, Murphy D, Hull L, Iversen A, Coker B, Machell L, Sundin J, Woodhead C, Jones N, Greenberg N, Landau S, Dandeker C, Rona R, Hotopf M, Wessely S. What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK Armed Forces? A cohort study. Lancet 2010: 375: 1783- 1797.
Main results of the follow up study. Overall mental health of Armed Forces remains robust. No overall increase in PTSD following deployment to either Iraq or Afghanistan in Regulars, but increases in combat troops and Reservists. Situation stable from 2003 to 2009. Impact of deployment on alcohol misuse. No impact of number of deployments. Only a very small increase in PTSD over time since return – i.e. no “tidal wave”.
Fear N, Van Staden L, Iversen A, Hall J, Wessely S. “50 ways to trace your veteran”: increasing response rates can be cheap and effective. European Journal of Psychotraumatology 2010, 1: 5516 – DOI: 10.3402/ejpt.v1i0.5516
Reminder to people thinking of doing this kind of research – it’s very difficult!
Greenberg N, Langston V, Everitt B, Iversen A, Fear N, Jones N, Wessely S. A cluster randomised controlled trial to determine the efficacy of TRIM (Trauma Risk Management) in a military population. Journal of Traumatic Stress 2010: 23: 430-436
Results of the cluster randomised controlled trial. No differences in primary outcomes between the ships that did or not receive TRIM, but overall there were very few traumatic incidents anyway during the year in question
Horn O, Sloggett A, Ploubidis G, Hull L, Hotopf M, Wessely S, Rona R. Upward trends in symptom reporting in the UK Armed Forces. Eur J Epidemiology 2010: 25-87-94
There is a general increase in symptom reporting across the Armed Forces over a 7 year period, which is independent of deployment
Iversen A, van Staden L, Birtles C, Hacker Hughes J, Browne T, Langston V, Greenberg N, Hotopf M, Rona R, Wessely S,Thornicroft G, Fear N. Help seeking and receipt of treatment in United Kingdom Service Personnel. Br J Psychiatry 2010: 197: 149-155
Padres are more popular than psychiatrists. Informal sources of help are first port of call for service personnel with mental health problems and only the minority are seen in specialist services.
Jones, N. Fear, N.T., Greenberg, N. & Wessely, S. Long Term Occupational Outcomes in Soldiers Who Become Mental Health Casualties When Deployed on Operations. 2010. Psychiatry 2010: 73: 352-364.
Confirms that most of those treated in theatre by the Field Mental Health Teams do well, but less so if they are evacuated back to UK
Mulligan K, Jones N, Woodhead C, Davies M, Wessely S, Greenberg N. Mental Health of UK Military Personnel while on Deployment in Iraq. Br J Psych 2010; 197: 405-410
First ever UK assessment of the mental health of a large group of service personnel in a theatre of war. Showed surprisingly few differences in the prevalence of mental health disorders before, during and after
Rona R, Jones M, Fear N, Hull L, Hotopf M, Wessely S. Alcohol misuse and functional impairment in the UK Armed Forces. Drug and Alcohol Dependence 2010: 108, 37-42
Social and work impairment is acknowledged by those with alcohol dependence, alcohol induced harm or severe alcohol misuse. Those with lower scores of alcohol misuse, but still excessive drinking do not acknowledge impairment.
DuPreez J, Sundin J, Wessely S, Fear NT. Unit cohesion and mental health in UK Armed Forces Personnel.Occ Med 2011: 10: 1-7 Contrary to expectations, soldiers who had trauma related symptoms following their experiences inm Bosnia, neither avoied nor were disturbed by a very powerful dramatic reconstruction of their experiences.
Ismail K, Fear N, Flanagan M, Doebbeling B, Wessely, S. Comparison of Symptom Reports, Medical Conditions and Environmental Exposures between US and UK Veterans of the Persian Gulf War 1990-9. Occupational Medicine 2011: 61: 483 – 489
MacManus D, Dean K, Al-Bakir M, Iversen A, Hull L, Wessely S, Fear N. Violent behavior by UK military personnel on returning home after deployment. Psych Med 2011: 10: 1-11
Violent behaviour on homecoming from deployment was associated with premilitary antisocial behaviour as expected, but it was also linked to exposure to combat and traumatic experiences while deployed, even taking into account the earlier link.
MacManus D, Wessely S. Why do some ex-armed forces personnel end up in prison? BMJ 2011: 342: d3898
Woodhead C, Rona R, Iversen A, MacManus D, Hotopf M, Dean K, McManus S, Meltzer H, Brugha T, Jenkins R, Wessely S, Fear N. Mental health and service use amongst post-National Service veterans: results from the 2007 Adult Psychiatric Morbidity Survey of England. Psychological Medicine 2011: 41: 363-372
First study to use a population base to compare veterans and non veterans, and in which mental health was ascertained independently of knowledge of service status. No association was found between any mental health outcome, including PTSD, and military service, with the exception of violent behaviour. Females who had served had more suicidal ideation. Early service leavers drank more, and were more likely to have self harmed than longer serving veterans. There was no difference in treatment seeking behaviour between veterans and non veterans
MacManus D, Dean K, Iversen A, Hull L, Wessely S, Fear N. Impact of pre-enlistement antisocial behavious on behavioural outcomes among UK military personnel. Sub Social Psych Psych Epi 2012: 47: 1353-1358.
Pre-enlistment conduct problems were associated with negative military behavioural outcomes like alcohol misuse, interpersonal violence, risky driving and irritability and anger.
Mulligan K. Fear N, Jones N, Alvarez H, Hull L, Naumann U, Wessely S, Greenberg N. Post-deployment Battlemind training for the UK Armed Forces: A cluster-randomised controlled trial.
No impact on mental health, and thus failed to replicate the US study, but did find an impact on alcohol. Journal of Consulting and Clinical Psychology. 2012: 80: 331-341
Rona RJ, Jones M, Fear NT, Hull L, Murphy D, Machell L, Coker B, Iversen AC, Jones N, David AS, Greenberg N, Hotopf M, Wessely S. Mild Traumatic Brain Injury (mTBI) in the UK military personnel returning from Afghanistan and Iraq. Cohort and cross-sectional analyses. J Head Injury Trauma Rehabilitation 2012: 27:33-44
The overall prevalence of mTBI was 4%,less than reported by US Forces fighting the same war. The symptoms of what we call post concussional syndrome was largely unrelated to mTBI, suggesting that they are different things.
Rona RJ, Jones M, Fear NT, Sundin J, Hull L, Wessely S. Frequency of mild Traumatic Brain Injury (mTBI) in Iraq and Afghanistan: Are we measuring incidence or prevalence? J Head Injury Trauma Rehab 2012: 27: 75-82
Some, but not all, of the differences between the US and UK is explained by the differences in tour length.
Hinds L, Jawahar K, Wessely S, Fear N. Self harm in the UK military. Occ Med 2013: 63: 354-35
2014
Roberto J Rona, Margaret Jones, Mary Keeling, Lisa Hull, Simon Wessely, Nicola T Fear Mental health consequences of overstretch in the UK Armed
Forces, 2007–09: a population-based cohort study. Lancet Psychiatry 2014: 1: 531-538
2015
2016
2017
Rona R, Burdett H, Khondoker M, Chesnikov M, Green K, Pernet D, Jones N, Greenberg N, Wessely S, Fear N. The effectiveness of post deployment screening for mental disorder and the impact of tailored advice about help seeking in the UK military: a cluster randomized controlled trial. Lancet published Online February 16, 2017 http://dx.doi.org/10.1016/ S0140-6736(16)32398-4
2018
2019 and In Press
For other publications relating to military health refer to this website: KCMHR and ADMMH publications