Mental health outcomes in US and UK military personnel returning from Iraq

Josefin Sundin , Richard K. Herrell , Charles W. Hoge , Nicola T. Fear , Amy B. Adler , Neil Greenberg , Lyndon A. Riviere , Jeffrey L. Thomas , Simon Wessely , Paul D. Bliese
  • Declaration of interest

    J.S., N.T.F., N.G. and S.W. are based at King’s College London which, for the purpose of this study and other military-related studies, receives funding from the UK Ministry of Defence; N.G. is employed by the UK armed forces. R.K.H., C.W.H., A.B.A., L.A.R., J.L.T. and P.D.B. are based at the Walter Reed Army Institute of Research, which is a US Department of Defense research laboratory. The views expressed here are those of the authors and do not necessarily represent the official policy or position of the US Army Medical Command or the Department of Defense.



Research of military personnel who deployed to the conflicts in Iraq or Afghanistan has suggested that there are differences in mental health outcomes between UK and US military personnel.


To compare the prevalence of post-traumatic stress disorder (PTSD), hazardous alcohol consumption, aggressive behaviour and multiple physical symptoms in US and UK military personnel deployed to Iraq.


Data were from one US (n = 1560) and one UK (n = 313) study of post-deployment military health of army personnel who had deployed to Iraq during 2007-2008. Analyses were stratified by high- and low-combat exposure.


Significant differences in combat exposure and sociodemographics were observed between US and UK personnel; controlling for these variables accounted for the difference in prevalence of PTSD, but not in the total symptom level scores. Levels of hazardous alcohol consumption (low-combat exposure: odds ratio (OR) = 0.13, 95% CI 0.07-0.21; high-combat exposure: OR = 0.23, 95% CI 0.14-0.39) and aggression (low-combat exposure: OR = 0.36, 95% CI 0.19-0.68) were significantly lower in US compared with UK personnel. There was no difference in multiple physical symptoms.


Differences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD. Adjusting for self-reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.


  • Funding

    J.S., N.T.F., N.G. and S.W. are based at King’s College London, which receives funding from the UK Ministry of Defence. US funding for this work comes from the US Army’s Military Operational Medicine Research Program.

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