Background

The long-term psychosocial outcomes of UK armed forces personnel who sustained serious combat injuries during deployment to Afghanistan are largely unknown. We aimed to assess rates of probable post-traumatic stress disorder (PTSD), depression, anxiety, and mental health-associated multimorbidity in a representative sample of serving and ex-serving UK military personnel with combat injuries, compared with rates in a matched sample of uninjured personnel.

Methods

This analysis used baseline data from the ADVANCE cohort study, in which injured individuals were recruited from a sample of UK armed forces personnel who were deployed to Afghanistan and had physical combat injuries, according to records provided by the UK Ministry of Defence. Participants from the uninjured group were frequency-matched by age, rank, regiment, deployment, and role on deployment. Participants were recruited through postal, email, and telephone invitations. Participants completed a comprehensive health assessment, including physical health assessment and self-reported mental health measures (PTSD Checklist, Patient Health Questionnaire-9, and Generalised Anxiety Disorder-7). The mental health outcomes were rates of PTSD, depression, anxiety, and mental health-associated multimorbidity in the injured and uninjured groups. The ADVANCE study is ongoing and is registered with the ISRCTN registry, ISRCTN57285353.

Findings

579 combat-injured participants (161 with amputation injuries and 418 with non-amputation injuries) and 565 uninjured participants were included in the analysis. Participants had a median age of 33 years (IQR 30–37 years) at the time of assessment. 90·3% identified as White and 9·7% were from all other ethnic groups. The rates of PTSD (16·9% [n=89] vs 10·5% [n=53]; adjusted odds ratio [AOR] 1·67 [95% CI 1·16–2·41], depression (23·6% [n=129] vs 16·8% [n=87]; AOR 1·46 [1·08–2·03]), anxiety (20·8% [n=111] vs 13·5% [n=71]; AOR 1·56 [1·13–2·24]) and mental health-associated multimorbidity (15·3% [n=81] vs 9·8% [n=49]; AOR 1·62 [1·12–2·49]) were greater in the injured group than the uninjured group. Minimal differences in odds of reporting any poor mental health outcome were noted between the amputation injury subgroup and the uninjured group (AOR range 0·77–0·97), whereas up to double the odds were noted for the non-amputation injury subgroup compared with the uninjured group (AOR range 1·74–2·02).

Interpretation

Serious physical combat injuries were associated with poor mental health outcomes. However, the type of injury sustained influenced this relationship. Regardless of injury, this cohort represents a group who present with greater rates of PTSD than the general population, as well as increased psychological burden from multimorbidity.

Funding

The ADVANCE Charity.

中文翻译：

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部署到阿富汗的英国男性军事人员的心理健康结果和战斗伤害的作用：来自 ADVANCE 队列研究的基线数据分析

背景

在部署到阿富汗期间遭受严重战斗伤害的英国武装部队人员的长期心理社会结果在很大程度上是未知的。我们的目的是评估可能的创伤后应激障碍 (PTSD)、抑郁症、焦虑症和与心理健康相关的多重疾病的发生率，并与匹配样本中的比率进行比较的未受伤人员。

方法

根据英国国防部提供的记录，该分析使用了 ADVANCE 队列研究的基线数据，其中受伤人员是从被部署到阿富汗并遭受身体战斗伤害的英国武装部队人员样本中招募的。来自未受伤组的参与者按年龄、军衔、团、部署和部署角色进行频率匹配。参与者通过邮寄、电子邮件和电话邀请进行招募。参与者完成了全面的健康评估，包括身体健康评估和自我报告的心理健康措施（PTSD 检查表、患者健康问卷 9 和广泛性焦虑症 7）。心理健康结果是受伤和未受伤组的 PTSD、抑郁、焦虑和心理健康相关的多发病率。

发现

579 名战斗受伤的参与者（161 名截肢伤和 418 名非截肢伤）和 565 名未受伤的参与者被纳入分析。参与者在评估时的中位年龄为 33 岁（IQR 30-37 岁）。90·3% 被认定为白人，9·7% 来自所有其他种族。PTSD 发生率（16·9% [n=89] vs 10·5% [n=53]；调整优势比 [AOR] 1·67 [95% CI 1·16–2·41]，抑郁症（23 ·6% [n=129] vs 16·8% [n=87]；AOR 1·46 [1·08–2·03])，焦虑 (20·8% [n=111] vs 13·5% [n=71]；AOR 1·56 [1·13–2·24]）和心理健康相关的多发病（15·3% [n=81] vs9·8% [n=49]；受伤组的 AOR 1·62 [1·12–2·49]) 高于未受伤组。截肢损伤亚组和未受伤组之间报告任何不良心理健康结果的几率差异很小（AOR 范围 0·77-0·97），而非截肢损伤亚组的几率高达两倍与未受伤组（AOR 范围 1·74–2·02）。

解释

严重的身体战斗伤害与不良的心理健康结果有关。然而，受伤的类型影响了这种关系。无论受伤情况如何，该队列代表的 PTSD 发病率高于普通人群，并且多病的心理负担增加。

资金

ADVANCE 慈善机构。