Mental Ill Health- The Effects of Primary, Secondary and Tertiary Prevention Across the Military Deployment Cycle

Student thesis: Doctoral ThesisDoctor of Philosophy


Primary, secondary and tertiary prevention of mental ill-health among UK military personnel was evaluated pre-, during and post-operational deployment. Primary prevention studies examined whether rest and recuperation taken during deployment promoted better mental health (n=536). R&R was highly satisfying but did not promote better mental health. Psychological benefits occurred only when R&R was used to mentally disengage from operations and to access social support. Mental health outcomes were compared in a sample of personnel attending a brief structured post-deployment rest period (Third Location Decompression or TLD) (n=1407) and non-attendees (n=1664). TLD attendance benefited mental and physical health, reduced alcohol misuse following deployment, but had no demonstrable effect upon transition from operations to the peacetime environment. Psychological effects were related to levels of combat where greater combat exposure was associated with reduced TLD benefits. Primary and secondary prevention activity was assessed during deployment (n=2794). Receipt of predeployment psycho-education, experiencing good leadership and satisfactory support for families were associated with substantially better deployment mental health. Medical consultation for a physical condition was associated with poorer mental health, suggesting that mental ill-health detection might take place during medical consultations. Secondary prevention was assessed pre-deployment (n=484) and post-deployment (n=1636). Greater mental health stigmatisation was associated with reduced help-seeking. Changes in psychological symptom levels were associated with synchronous fluctuations in stigma levels. New mental disorder caseness and remission from caseness were both associated with significant increases and decreases in stigmatisation respectively. For tertiary prevention, mental healthcare delivered during operations (n=611) returned around 75% of personnel to full operational duties. Over a four year follow-up period, around a third of study participants were consistently unfit for deployment. Pre-deployment clinical care (n=2979) returned around 75% of personnel to full duties; during prolonged follow-up, around 33% of personnel experienced reduced occupational fitness. Recommendations for improving current mental ill-health prevention practices and avenues for future research are described.
Date of Award2015
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorNicola Fear (Supervisor)

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