Adjustment disorder in the UK Armed Forces: prevalence, stressors and risk factors among serving personnel and veterans

Background

We all go through stressful life events or ‘stressors’ at one point or another like a breakup, financial trouble, or even getting sick. Whilst many people will experience some short-term distress as a result of the stressor, most will find ways to cope with the stressful event and adjust to the situation whilst getting on with our lives.

However, an important minority will feel overwhelmed and be unable to find ways to cope. As a result, they may experience a range of distressing emotions such as anxiety or despair whilst becoming fixated on the stressor. Often these unpleasant symptoms are associated with unhelpful behaviours such as risk-taking, overuse of alcohol or other substances or possibly uncharacteristic aggression.

Thankfully, once the stressful event comes to an end, the distress ordinarily resolves. These emotional, cognitive, behavioural and physical reactions, when tied directly to a specific stressful event, are known as an adjustment disorder. This is a recognised mental health condition that can affect anyone, especially during major life transitions.

But what about those in the Armed Forces?

Adjustment disorder is one of the most common mental health disorders diagnosed in the UK Armed Forces by military mental health services. But despite this, we still know very little about how it actually affects those who serve.

This lack of knowledge is surprising since military life is predictably filled with high-stress moments such as operational deployments, relocations, long periods away from loved ones, and challenging transitions back to civilian life.

Why did we do this study?
Although military mental health gets a lot of attention, not much is known about how adjustment disorder affects UK military personnel. So, as part of a PhD project at the King’s Centre for Military Health Research (KCMHR), we explored this topic. We wanted to find out:

• How common is adjustment disorder in the UK Armed Forces?
• What kinds of stressors are most likely to trigger it?
• And are there any specific factors that make someone in the Armed Forces community more at risk?

What did we do?

We made use of the King’s Centre for Military Health Research (KCMHR) cohort study which began in 2003. The KCMHR cohort study investigates the health and wellbeing outcomes among UK military personnel deployed to Iraq and/or Afghanistan across a number of phases.

We used data from a large group of over 4,600 people who had served in Iraq and/or Afghanistan—roughly half of them were still in the Armed Forces (n = 1999) with the rest having already left (n = 2657). We used the results of several mental health measures at phase three of the cohort study (2014-2016) to identify probable adjustment disorder symptoms in KCMHR Health and Wellbeing study responders.

We compared those showing signs of adjustment disorder with those who did not, looking closely at their backgrounds, experiences, and recent life stressors.

What have we found?

How common was it?

We identified that around 6.0% of serving personnel and 7.1% of veterans showed symptoms suggestive of an adjustment disorder diagnosis.

That means about 1 in 15 people in both groups were struggling to adjust after a stressful life event.

Stressors:
Some life events were more strongly linked to adjustment disorder symptoms

• Financial problems (7x more likely to report symptoms)
• Relationship dissatisfaction (6x more likely)
• Severe illness (3x more likely)
• Being assaulted (3x more likely for serving personnel and 5x more likely for veterans)
• Going through a breakup (3x more likely for serving personnel and 4x for veterans)
• Seeing a loved one go through something traumatic (2x more likely for serving personnel and 3x more likely for veterans)

Interestingly, we found that being arrested was strongly linked to adjustment disorder symptoms (5x more likely), but only for those still serving. Additionally, ex-service personnel who perceived that they had manageable workloads were less likely to report adjustment disorder symptoms.

Leaving the military itself was not linked to higher rates of adjustment disorder. That might come as a surprise, but it could suggest that the transition back to civilian life is not always as emotionally disruptive as we might think. In fact, for some, it might even ease certain pressures associated with being in uniform.

Risk factors:

Risk factors differed depending on whether responders were still serving or had left military services.

• Serving personnel: Being single, in a combat role, or having a history of difficult childhood experiences made reporting probably adjustment disorder more likely. But a more senior rank helped protect against it.
• Ex-serving personnel: Having been in a combat role and being aged 30–39 were linked to a higher risk of probable adjustment disorder.

Why does this matter?

This is the first study to provide a clear picture of adjustment disorder in the UK military community. Also, for the first time, adjustment disorder rates have been reported for veterans, which were comparable to serving personnel.

The key takeaway? Many of the same stressors affecting civilians also impact serving personnel and veterans, but it appears that the military environment may amplify them.

Despite the structured and supportive environment the military often provides, common civilian stressors like financial strain, relationship issues, and personal illness still play a major role in triggering adjustment disorder symptoms.

For example, financial difficulties were a common stressor associated with adjustment disorder, even though serving personnel often have more financial security than civilians. The financial security of the military may mean that unexpected money issues are even more stressful when they do arise.

This implies that mental health strategies for military personnel should not only focus on military stressors for an adjustment disorder such as deployment or combat stress but should also focus on the impact of everyday life challenges.

We also found that being single was linked to a higher chance of adjustment disorder, particularly for those still serving. This is relevant as military life may make it harder to form and maintain enduring relationships. As a result, not having someone to lean on during tough times may make stressful events harder to cope with.

To the best of our knowledge, this is the first study to examine risk factors and stressors for an adjustment disorder in the UK military population.

Yet, further research is needed to examine military-specific stressors and stressors which may be niche to each of the service branches (Royal Navy, Army, and Royal Air Force).

Understanding who is most at risk and why helps mental health professionals better support those who serve and those who have served. Our study sets the groundwork for future research into military-specific stressors and highlights the need to tailor support based on serving status.

Funders: This PhD project was funded by The Colt Foundation.

Image: UK MOD © Crown copyright.