NEW POLICY BRIEF: A Mixed Methods Investigation of Self-Harm and Suicidal Behaviours in the UK Armed Forces

Content warning: self-harm and suicidal behaviours

A new policy brief from the King's Centre for Military Health Research (KCMHR) at King's College London summarises the findings and recommendations resulting from a mixed methods PhD investigation which explored self-harm and suicidal behaviours in the UK Armed Forces.

About the PhD

Over three years (2022-2025), this mixed methods PhD investigated self-harm and suicidal behaviours in the UK Armed Forces across three sub-studies:

1. A systematic review on the risk and protective factors associated with self-harm, suicidal thoughts, suicide attempts and death by suicide among serving and ex-serving personnel of the UK Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force (28 papers).
2. A secondary data analysis using data from Phase 3 (2014-2016) and Phase 4 (2022-2023) of the KCMHR health and wellbeing cohort study to explore the rates of, factors associated with, and timing of, lifetime self-harm, lifetime suicidal thoughts and lifetime suicide attempts among serving and ex-serving personnel (approximately 4,000 participants).
3. Qualitative semi-structured interviews with a subsample of UK ex-serving personnel who endorsed self-harm, suicidal thoughts, and/or suicide attempts in Phase 4 of the cohort study to explore their experiences of seeking help for these behaviours (15 participants).

Summary of findings and recommendations

This work found that among a sample of approximately 4,000 UK serving and ex-serving personnel:

• A minority reported lifetime self-harm (8%) and lifetime suicide attempts (6%).
• A moderate proportion reported lifetime suicidal thoughts (36%).
• Mental health comorbidities (such as post-traumatic stress disorder [PTSD], common mental disorders [e.g., anxiety and depression], and loneliness) increased risk of self-harm and suicidal behaviours (ranging from two to seven times more likely).
• Higher levels of perceived social support reduced the risk of self-harm and suicidal behaviours by approximately half. 

Additional qualitative work with 15 ex-serving personnel suggested:

• There are unique barriers to help-seeking for self-harm and suicidal behaviours, including embarrassment and shame, and the societal hierarchy of health conditions (i.e., the way certain health conditions are prioritised, stigmatised, or viewed as more or less legitimate and deserving of support).

To reduce the incidence and impact of these behaviours among serving and ex-serving personnel, there is a need for co-ordinated action across multiple domains including Defence, policy and healthcare.

Recommendations include to:

1. Continue targeted mental health and suicide prevention strategies for serving and ex-serving personnel.
2. Develop an equivalent suicide prevention strategy and action plan for ex-serving personnel.
3. Promote step-change in organisational culture within the military to reduce stigma. 
4.  Improve access to, and awareness of, support available to serving and ex-serving personnel. 
5. Enhance military cultural competency among clinicians supporting serving and ex-serving personnel.

Want to know more?

You can read the research articles resulting from this PhD here:

Who conducted the research?

This work was completed by Dr Charlotte Williamson at the King’s Centre for Military Health Research (KCMHR), King’s College London. This work was supervised by Professor Sharon Stevelink and Dr Marie-Louise Sharp.

After completing an undergraduate degree in Psychology and a master’s degree Mental Health, Ethics and Law, Charlotte worked as a Research Assistant in the field of military mental health for several years prior to starting her PhD at KCMHR. Whilst remaining involved in military health research, Charlotte is now a Research Associate in the Department of Population Health Sciences, King's College London, working primarily on a project aiming to use artificial intelligence to produce evidence-based summaries to support policy makers with decision-making. Charlotte's research interests include self-harm and suicidality, military mental health, and digital health technology (including AI).

Who funded the research?

This PhD was funded by the Office for Veterans’ Affairs, UK Government, via Phase 4 of the KCMHR cohort study, and conducted by KCMHR which is a fully independent research group.

Need to access help and support?

Please see our Signposting Booklet detailing national and local support for the Armed Forces veteran community.