King's Centre for Military Health Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
King's Centre for Military Health Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK.
Occup Environ Med. 2021 Sep;78(9):643-647. doi: 10.1136/oemed-2020-107050. Epub 2021 Jan 22.
While most UK military personnel transition successfully into civilian life, some experience unemployment and disability, which may be partly attributable to in-service factors. This study aims to determine the degree to which in-service mental health problems impact on postservice benefit claims.
Using data from a cohort of 5598 recent leavers from regular service in the UK Armed Forces linked with data from the Department for Work and Pensions, we assessed associations between in-service mental health and postservice benefit claims, and the population attributable fraction (PAF) of benefit claims related to in-service mental health. An analysis with postservice mental ill health as mediator was performed to determine the degree to which the observed effects were a consequence of persistent illness, as opposed to remitted.
Mental illness occurring in-service predicted both unemployment and disability claims, partly mediated by postservice health (23%-52% total effects mediated), but alcohol misuse did not. Common mental disorder (CMD) (PAF 0.07, 95% CI: 0.02 to 0.11) and probable post-traumatic stress disorder (PTSD) (PAF 0.05, 95% CI 0.01 to 0.09) contributed to unemployment claims. Probable PTSD was the largest contributor to disability claims (PAF 0.25, 95% CI 0.13 to 0.36), with a smaller contribution from CMD (PAF 0.16, 95% CI 0.03 to 0.27).
In-service mental ill health gives rise to benefit claims. These effects are only partly mediated by postservice mental health, implying that in-service (or pre-service) mental issues have carry-over effects into civilian life even if remitted. Better prevention and treatment of in-service PTSD symptoms may well reduce postservice disability claims.
尽管大多数英国军人都能成功过渡到平民生活，但仍有一些人会失业和残疾，这在一定程度上可能与服役期间的因素有关。本研究旨在确定服役期间的心理健康问题对退役后福利申请的影响程度。
利用英国武装部队最近的 5598 名定期服役退伍人员的队列数据，与来自工作和养老金部的数据相链接，我们评估了服役期间的心理健康状况与退役后福利申请之间的关联，以及与服役期间心理健康相关的福利申请的人群归因分数（PAF）。进行了一项有退役后精神健康障碍作为中介的分析，以确定观察到的影响有多大程度是由于持续性疾病，而不是缓解性疾病。
服役期间发生的精神疾病既预测了失业，也预测了残疾申请，部分由退役后的健康状况介导（总效应的 23%-52%为中介），但酒精滥用没有。常见精神障碍（CMD）（PAF 为 0.07，95%CI：0.02 至 0.11）和可能的创伤后应激障碍（PTSD）（PAF 为 0.05，95%CI 为 0.01 至 0.09）导致了失业申请。可能的 PTSD 是导致残疾申请的最大因素（PAF 为 0.25，95%CI 为 0.13 至 0.36），而 CMD 的贡献较小（PAF 为 0.16，95%CI 为 0.03 至 0.27）。
服役期间的精神健康问题导致了福利申请。这些影响只有部分通过退役后的心理健康状况来介导，这意味着即使缓解，服役期间（或服役前）的精神问题仍会对平民生活产生延续影响。更好地预防和治疗服役期间的 PTSD 症状可能会降低退役后的残疾申请。
