Describing the profile of a population of UK veterans seeking support for mental health difficulties
Abstract:Â Background: Evidence suggests that veterans with mental health issues have poorer treatment outcomes than civilian counterparts. Understanding the difficulties faced by veterans could help focus treatments and improve outcomes. Aims: To survey a representative sample of treatment-seeking veterans to explore their mental health needs. Methods: A random sample of UK veterans who had engaged with a national mental health charity in the UK was drawn. Individuals completed questionnaires about their health, military experiences and pre-enlistment vulnerabilities. Results: Four hundred and three out of six hundred (67.2%) participants returned completed questionnaires. PTSD was the most commonly endorsed mental health difficulty (82%), followed by problems with anger (74%), common mental health difficulties (72%) and alcohol misuse (43%). Comorbidity was frequent; with 32% of those with PTSD meeting criteria for three other health outcomes versus only 5% with PTSD alone. Conclusions: Results indicate the complexity of presentations within treatment seeking veterans. These difficulties may partly explain the poorer treatment outcomes reported in veterans in comparison to the general public. As such, it would be prudent for interventions targeted at veterans with mental health difficulties to attempt to address the range of issues faced by this population rather than focus on a particular presenting problem.
Abstract: Background: Exposure to potentially morally injurious events (PMIEs) during military service can lead to moral injury (MI) outcomes and posttraumatic stress symptoms (PTSS). This longitudinal study examined the relationships between PMIE exposure, MI outcomes, and PTSS among Israeli combat veterans, and the potential protective role of dispositional forgiveness in these associations. Method: Participants were 169 Israeli combat veterans who participated in a six-year longitudinal study with four measurement points (T1: 12 months before enlistment, T2: Six months following enlistment- pre-deployment, T3: 18 months following enlistment- post-deployment, and T4: 28 months following discharge). Participants’ characteristics were assessed via semi-structured interviews (T1) and validated self-report measures (T2-T4) between 2019-2024. Results: Approximately 36% of participants reported exposure to PMIEs during service, with 13% exceeding the clinical threshold for probable PTSD at T4. PMIE-Betrayal at T3 was positively associated with MI outcomes of shame and trust violation at T4. The indirect effect of PMIEs on PTSS through MI outcome-Shame depended on forgiveness levels. Among veterans with low forgiveness, higher exposure to PMIE-Betrayal was associated with increased MI shame, which was linked to more severe PTSS. Conversely, for those with high forgiveness, exposure to PMIE-Self and Other was associated with decreased MI shame and subsequently reduced PTSS. Conclusion: Dispositional forgiveness moderates the relationship between PMIE exposure and MI outcomes, particularly shame, which mediates the development of PTSS. These findings highlight forgiveness as a potential target for intervention in treating moral injury and preventing PTSS among combat veterans.