{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T07:09:30Z","timestamp":1770966570190,"version":"3.50.1"},"reference-count":26,"publisher":"BMJ","issue":"9","funder":[{"DOI":"10.13039\/100012345","name":"Forces in Mind Trust","doi-asserted-by":"publisher","award":["FiMT16\/0204K."],"award-info":[{"award-number":["FiMT16\/0204K."]}],"id":[{"id":"10.13039\/100012345","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Occup Environ Med"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mental illness occurring in-service predicted both unemployment and disability claims, partly mediated by postservice health (23%\u201352%\u2009total 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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1136\/oemed-2020-107050","type":"journal-article","created":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T21:29:17Z","timestamp":1611350957000},"page":"643-647","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Contribution of mental ill health during military service to postservice benefit claims in the UK"],"prefix":"10.1136","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8127-8981","authenticated-orcid":false,"given":"Howard","family":"Burdett","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5792-2925","authenticated-orcid":false,"given":"Nicola T","family":"Fear","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6743-9929","authenticated-orcid":false,"given":"Simon","family":"Wessely","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Greenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto J","family":"Rona","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,22]]},"reference":[{"key":"2021081710150900000_78.9.643.1","unstructured":"Ministry of Defence . Uk armed forces Quarterly service personnel statistics 1 April 2009. London, 2019."},{"key":"2021081710150900000_78.9.643.2","unstructured":"National Audit Office . Leaving the services. London, 2007."},{"key":"2021081710150900000_78.9.643.3","unstructured":"Forces in Mind Trust . The transition mapping study: understanding the transition process for service personnel returning to civilian life 2013."},{"key":"2021081710150900000_78.9.643.4","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2019-105737"},{"key":"2021081710150900000_78.9.643.5","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2018.175"},{"key":"2021081710150900000_78.9.643.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-017-1547-0","article-title":"The health and wellbeing needs of veterans: a rapid review","volume":"17","author":"Oster","year":"2017","journal-title":"BMC Psychiatry"},{"key":"2021081710150900000_78.9.643.7","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.jpsychires.2018.11.023","article-title":"Fourteen-Year trajectories of posttraumatic stress disorder (PTSD) symptoms in UK military personnel, and associated risk factors","volume":"109","author":"Palmer","year":"2019","journal-title":"J Psychiatr Res"},{"key":"2021081710150900000_78.9.643.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68662-5"},{"key":"2021081710150900000_78.9.643.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60672-1"},{"key":"2021081710150900000_78.9.643.10","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2018.175"},{"key":"2021081710150900000_78.9.643.11","doi-asserted-by":"crossref","unstructured":"Weathers FW , Litz B , Huska JA . PTSD Checklist - Civilian version. Boston: National Center for PTSD, Behavioral Science Division, 1994.","DOI":"10.1037\/t02622-000"},{"key":"2021081710150900000_78.9.643.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2008.09.006"},{"key":"2021081710150900000_78.9.643.13","unstructured":"Goldberg DP , Huxley P . Common mental disorders: a bio-social model: Tavistock\/Routledge 1992."},{"key":"2021081710150900000_78.9.643.14","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291796004242"},{"key":"2021081710150900000_78.9.643.15","unstructured":"Babor TF , Higgins-Biddle JC , Saunders JB . Audit. The alcohol use disorders identification test. Geneva: Department of Mental Health and Substance Dependence, World Health Organization, 2001."},{"key":"2021081710150900000_78.9.643.16","doi-asserted-by":"crossref","first-page":"956","DOI":"10.7205\/MILMED.172.9.956","article-title":"Factors associated with heavy alcohol consumption in the U.K. armed forces: data from a health survey of Gulf, Bosnia, and era veterans","volume":"172","author":"Iversen","year":"2007","journal-title":"Mil Med"},{"key":"2021081710150900000_78.9.643.17","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291711002327"},{"key":"2021081710150900000_78.9.643.18","doi-asserted-by":"crossref","unstructured":"Therneau TM , Grambsch PM . Modeling survival data: extending the COX model. 1 edn. Springer Verlag, 2000.","DOI":"10.1007\/978-1-4757-3294-8_1"},{"key":"2021081710150900000_78.9.643.19","unstructured":"StataCorp . Stata statistical software: release 14. College Station, TX: StataCorp LP, 2015."},{"key":"2021081710150900000_78.9.643.20","doi-asserted-by":"publisher","DOI":"10.2307\/2532206"},{"key":"2021081710150900000_78.9.643.21","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.51.6.1173"},{"key":"2021081710150900000_78.9.643.22","doi-asserted-by":"publisher","DOI":"10.1037\/a0020761"},{"key":"2021081710150900000_78.9.643.23","doi-asserted-by":"crossref","unstructured":"Hicks R , Tingley D . Mediation: Stata module for causal mediation analysis and sensitivity analysis: Boston College department of economics 2011.","DOI":"10.1177\/1536867X1201100407"},{"key":"2021081710150900000_78.9.643.24","doi-asserted-by":"publisher","DOI":"10.1007\/s11020-005-3780-2"},{"key":"2021081710150900000_78.9.643.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2003.08.009"},{"key":"2021081710150900000_78.9.643.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2009.11.014"}],"container-title":["Occupational and Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/oemed-2020-107050","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T17:45:23Z","timestamp":1629222323000},"score":1,"resource":{"primary":{"URL":"https:\/\/oem.bmj.com\/lookup\/doi\/10.1136\/oemed-2020-107050"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,22]]},"references-count":26,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,8,17]]},"published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1136\/oemed-2020-107050"],"URL":"https:\/\/doi.org\/10.1136\/oemed-2020-107050","relation":{},"ISSN":["1351-0711","1470-7926"],"issn-type":[{"value":"1351-0711","type":"print"},{"value":"1470-7926","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,22]]}}}