Non-fatal self-harm in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans (Scotland)
Abstract: Purpose: Although suicide risk in veterans has been widely studied, there is little information on the risk of non-fatal self-harm in this population. We used data from the Scottish Veterans Health Study to conduct an epidemiological analysis of self-harm in veterans, in comparison with people who have never served. Methods: We conducted a retrospective, 30-year cohort study of 56,205 veterans born 1945–1985, and 172,741 people with no record of military service, and used Cox proportional hazard models to examine the association between veteran status and cumulative risk of non-fatal self-harm, overall and stratified by birth cohort, sex and length of service. We also examined mental and physical comorbidities, and association of suicide with prior self-harm. Results: There were 1620 (2.90%) first episodes of self-harm in veterans, compared with 4212 (2.45%) in non-veterans. The difference was statistically significant overall (unadjusted HR 1.27, 95% CI 1.21–1.35, p < 0.001). The risk was highest in the oldest veterans, and in the early service leavers who failed to complete initial training (unadjusted HR 1.69, 95% CI 1.50–1.91, p < 0.001). The risk reduced with longer service and in the intermediate birth cohorts but has increased again in the youngest cohort. Conclusions: The highest risk of non-fatal self-harm was in veterans with the shortest service, especially those who did not complete training or minimum engagement, and in the oldest birth cohorts, whilst those who had served the longest were at reduced risk. The risk has increased again in the youngest veterans, and further study of this subgroup is indicated.
Abstract: Objective: The present study is a retrospective quasi-experimental study to evaluate the effectiveness of the Warrior PATHH (WP) program at improving posttraumatic growth (PTG) outcomes and reducing PTSD symptoms compared to a waitlist control among a sample of Veterans. Method: Participants (n = 164) were U.S. military Veterans with a history of trauma. Participants were either undergoing the Warrior PATHH program or a waitlist. Primary outcome measures were administered at baseline and at 90-day follow-up and consisted of the Posttraumatic Growth Inventory – Expanded (PTGI-X) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Secondary outcome measures assessed psychosocial functioning and included measures of depression and anxiety symptoms, sleep, wellbeing, and social support. Results: Significant differences were observed between groups on the PTGI-X (F(1, 205) = 23.667, p < .001, partial η2 = 0.103), and the PCL-5 (F(1, 205) = 262.460, p < .001, partial η2 = 0.561) with the WP group showing significant positive psychological change following a traumatic event as measured by the PTGI-X and decreased PTSD symptoms as measured by the PCL-5 compared to those in the waitlist condition. Those in the treatment arm also demonstrated gains to psychosocial functioning. Conclusions: Consistent with previous research, participants in the Warrior PATHH program exhibited significant increases in PTG outcomes, decreased PTSD symptoms, and broad improvements to psychosocial functioning. These findings suggest it is an effective training program to foster PTG outcomes among Veterans. This study is unique as it is the first to compare the effects of WP programming with a sample of waitlisted Veterans.