UK veterans' mental health and well-being before and during the COVID-19 pandemic: A longitudinal cohort study

Marie Louise Sharp; Danai Serfioti; Margaret Jones; Howard Burdett; David Pernet; Lisa Hull; Dominic Murphy; Simon Wessely; Nicola T. Fear

doi:10.1136/bmjopen-2021-049815

UK veterans' mental health and well-being before and during the COVID-19 pandemic: A longitudinal cohort study

Marie Louise Sharp^*, Danai Serfioti, Margaret Jones, Howard Burdett, David Pernet, Lisa Hull, Dominic Murphy, Simon Wessely, Nicola T. Fear

^*Corresponding author for this work

Combat Stress

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Abstract

Objective To investigate the impact of the COVID-19 pandemic on the health and well-being of UK ex-service personnel (veterans) before and during the pandemic, and to assess associations of COVID-19 experiences and stressors with mental health, alcohol use and loneliness. Design An additional wave of data was collected from a longitudinal cohort study of the UK Armed Forces. Setting Online survey June-September 2020. Participants Cohort members were included if they had completed a questionnaire at phase 3 of the King's Centre for Military Health Research health and well-being study (2014-2016), had left the Armed Forces after regular service, were living in the UK, had consented to follow-up and provided a valid email address. Invitation emails were sent to N=3547 with a 44% response rate (n=1562). Primary outcome measures Common mental health disorders (CMDs) (measured using the General Health Questionnaire, 12 items - cut-off ≥4), hazardous alcohol use (measured using the Alcohol Use Disorder Identification Test, 10 items - cut off ≥8) and loneliness (University of California, Los Angeles, Loneliness Scale -3 items-cut-off ≥6). Results Veterans reported a statistically significant decrease in hazardous drinking of 48.5% to 27.6%, while CMD remained stable (non-statistically significant increase of 24.5% to 26.1%). 27.4% of veterans reported feelings of loneliness. The COVID-19 stressors of reporting difficulties with family/social relationships, boredom and difficulties with health were statistically significantly associated with CMD, hazardous drinking and loneliness, even after adjustment for previous mental health/hazardous alcohol use. Conclusions Our study suggests a COVID-19 impact on veterans' mental health, alcohol use and loneliness, particularly for those experiencing difficulties with family relationships. Veterans experienced the pandemic in similar ways to the general population and in some cases may have responded in resilient ways. While stable levels of CMD and reduction in alcohol use are positive, there remains a group of veterans who may need mental health and alcohol treatment services.

Original language	English
Article number	e049815
Journal	BMJ Open
Volume	11
Issue number	8
DOIs	https://doi.org/10.1136/bmjopen-2021-049815
Publication status	Published - 27 Aug 2021

Keywords

COVID-19
epidemiology
mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/bmjopen-2021-049815

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@article{ab49494df7344112a4b8d46accd57afa,

title = "UK veterans' mental health and well-being before and during the COVID-19 pandemic: A longitudinal cohort study",

abstract = "Objective To investigate the impact of the COVID-19 pandemic on the health and well-being of UK ex-service personnel (veterans) before and during the pandemic, and to assess associations of COVID-19 experiences and stressors with mental health, alcohol use and loneliness. Design An additional wave of data was collected from a longitudinal cohort study of the UK Armed Forces. Setting Online survey June-September 2020. Participants Cohort members were included if they had completed a questionnaire at phase 3 of the King's Centre for Military Health Research health and well-being study (2014-2016), had left the Armed Forces after regular service, were living in the UK, had consented to follow-up and provided a valid email address. Invitation emails were sent to N=3547 with a 44% response rate (n=1562). Primary outcome measures Common mental health disorders (CMDs) (measured using the General Health Questionnaire, 12 items - cut-off ≥4), hazardous alcohol use (measured using the Alcohol Use Disorder Identification Test, 10 items - cut off ≥8) and loneliness (University of California, Los Angeles, Loneliness Scale -3 items-cut-off ≥6). Results Veterans reported a statistically significant decrease in hazardous drinking of 48.5% to 27.6%, while CMD remained stable (non-statistically significant increase of 24.5% to 26.1%). 27.4% of veterans reported feelings of loneliness. The COVID-19 stressors of reporting difficulties with family/social relationships, boredom and difficulties with health were statistically significantly associated with CMD, hazardous drinking and loneliness, even after adjustment for previous mental health/hazardous alcohol use. Conclusions Our study suggests a COVID-19 impact on veterans' mental health, alcohol use and loneliness, particularly for those experiencing difficulties with family relationships. Veterans experienced the pandemic in similar ways to the general population and in some cases may have responded in resilient ways. While stable levels of CMD and reduction in alcohol use are positive, there remains a group of veterans who may need mental health and alcohol treatment services.",

keywords = "COVID-19, epidemiology, mental health",

author = "Sharp, {Marie Louise} and Danai Serfioti and Margaret Jones and Howard Burdett and David Pernet and Lisa Hull and Dominic Murphy and Simon Wessely and Fear, {Nicola T.}",

note = "Funding Information: Funding This work was funded by the Office of Veterans{\textquoteright} Affairs, Cabinet Office, UK Government (Contract Ref: CCZZ20A51). Funding Information: Contributors M-LS, DS, MJ, HB, DP, LH, DP, DM, SW and NTF were involved in the original concept and design of the study. NTF and SW have overseen the conduct of all aspects of the study. M-LS led the formulation of the questionnaire and associated measures, with substantial contributions from all authors in shaping the final questionnaire. DP led the online survey design, format and flow. DS led the ethics submission with substantial contributions from all authors. MJ, HB and LH led the design of participant materials including the participant invite and information sheet with input from all authors. MJ led the data analysis plan and conducted the data analysis with input from all authors. M-LS and DS led the writing of the research paper, with drafting and revision input from all authors. M-LS, DS, MJ, HB, DP, LH, DP, DM, SW and NTF have all seen and approved the final version of this paper and accept accountability for all aspects of the work. SW and NTF secured the funding from OVA for this work. Publisher Copyright: {\textcopyright} 2021 BMJ Publishing Group. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = aug,

day = "27",

doi = "10.1136/bmjopen-2021-049815",

language = "English",

volume = "11",

journal = "BMJ Open",

issn = "2044-6055",

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number = "8",

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TY - JOUR

T1 - UK veterans' mental health and well-being before and during the COVID-19 pandemic

T2 - A longitudinal cohort study

AU - Sharp, Marie Louise

AU - Serfioti, Danai

AU - Jones, Margaret

AU - Burdett, Howard

AU - Pernet, David

AU - Hull, Lisa

AU - Murphy, Dominic

AU - Wessely, Simon

AU - Fear, Nicola T.

N1 - Funding Information: Funding This work was funded by the Office of Veterans’ Affairs, Cabinet Office, UK Government (Contract Ref: CCZZ20A51). Funding Information: Contributors M-LS, DS, MJ, HB, DP, LH, DP, DM, SW and NTF were involved in the original concept and design of the study. NTF and SW have overseen the conduct of all aspects of the study. M-LS led the formulation of the questionnaire and associated measures, with substantial contributions from all authors in shaping the final questionnaire. DP led the online survey design, format and flow. DS led the ethics submission with substantial contributions from all authors. MJ, HB and LH led the design of participant materials including the participant invite and information sheet with input from all authors. MJ led the data analysis plan and conducted the data analysis with input from all authors. M-LS and DS led the writing of the research paper, with drafting and revision input from all authors. M-LS, DS, MJ, HB, DP, LH, DP, DM, SW and NTF have all seen and approved the final version of this paper and accept accountability for all aspects of the work. SW and NTF secured the funding from OVA for this work. Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/8/27

Y1 - 2021/8/27

N2 - Objective To investigate the impact of the COVID-19 pandemic on the health and well-being of UK ex-service personnel (veterans) before and during the pandemic, and to assess associations of COVID-19 experiences and stressors with mental health, alcohol use and loneliness. Design An additional wave of data was collected from a longitudinal cohort study of the UK Armed Forces. Setting Online survey June-September 2020. Participants Cohort members were included if they had completed a questionnaire at phase 3 of the King's Centre for Military Health Research health and well-being study (2014-2016), had left the Armed Forces after regular service, were living in the UK, had consented to follow-up and provided a valid email address. Invitation emails were sent to N=3547 with a 44% response rate (n=1562). Primary outcome measures Common mental health disorders (CMDs) (measured using the General Health Questionnaire, 12 items - cut-off ≥4), hazardous alcohol use (measured using the Alcohol Use Disorder Identification Test, 10 items - cut off ≥8) and loneliness (University of California, Los Angeles, Loneliness Scale -3 items-cut-off ≥6). Results Veterans reported a statistically significant decrease in hazardous drinking of 48.5% to 27.6%, while CMD remained stable (non-statistically significant increase of 24.5% to 26.1%). 27.4% of veterans reported feelings of loneliness. The COVID-19 stressors of reporting difficulties with family/social relationships, boredom and difficulties with health were statistically significantly associated with CMD, hazardous drinking and loneliness, even after adjustment for previous mental health/hazardous alcohol use. Conclusions Our study suggests a COVID-19 impact on veterans' mental health, alcohol use and loneliness, particularly for those experiencing difficulties with family relationships. Veterans experienced the pandemic in similar ways to the general population and in some cases may have responded in resilient ways. While stable levels of CMD and reduction in alcohol use are positive, there remains a group of veterans who may need mental health and alcohol treatment services.

AB - Objective To investigate the impact of the COVID-19 pandemic on the health and well-being of UK ex-service personnel (veterans) before and during the pandemic, and to assess associations of COVID-19 experiences and stressors with mental health, alcohol use and loneliness. Design An additional wave of data was collected from a longitudinal cohort study of the UK Armed Forces. Setting Online survey June-September 2020. Participants Cohort members were included if they had completed a questionnaire at phase 3 of the King's Centre for Military Health Research health and well-being study (2014-2016), had left the Armed Forces after regular service, were living in the UK, had consented to follow-up and provided a valid email address. Invitation emails were sent to N=3547 with a 44% response rate (n=1562). Primary outcome measures Common mental health disorders (CMDs) (measured using the General Health Questionnaire, 12 items - cut-off ≥4), hazardous alcohol use (measured using the Alcohol Use Disorder Identification Test, 10 items - cut off ≥8) and loneliness (University of California, Los Angeles, Loneliness Scale -3 items-cut-off ≥6). Results Veterans reported a statistically significant decrease in hazardous drinking of 48.5% to 27.6%, while CMD remained stable (non-statistically significant increase of 24.5% to 26.1%). 27.4% of veterans reported feelings of loneliness. The COVID-19 stressors of reporting difficulties with family/social relationships, boredom and difficulties with health were statistically significantly associated with CMD, hazardous drinking and loneliness, even after adjustment for previous mental health/hazardous alcohol use. Conclusions Our study suggests a COVID-19 impact on veterans' mental health, alcohol use and loneliness, particularly for those experiencing difficulties with family relationships. Veterans experienced the pandemic in similar ways to the general population and in some cases may have responded in resilient ways. While stable levels of CMD and reduction in alcohol use are positive, there remains a group of veterans who may need mental health and alcohol treatment services.

KW - COVID-19

KW - epidemiology

KW - mental health

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U2 - 10.1136/bmjopen-2021-049815

DO - 10.1136/bmjopen-2021-049815

M3 - Article

AN - SCOPUS:85114351718

SN - 2044-6055

VL - 11

JO - BMJ Open

JF - BMJ Open

IS - 8

M1 - e049815

ER -

UK veterans' mental health and well-being before and during the COVID-19 pandemic: A longitudinal cohort study

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Keywords

UN SDGs

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