Simon Wessely
King's College London, Department of Psychological Medicine, Faculty Member
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Modern military operations have incorporated deployed civilians in a variety of roles (e.g. diplomats, private security staff). Many of these roles expose individuals to potentially dangerous or traumatic events. Evidence has shown that... more
Modern military operations have incorporated deployed civilians in a variety of roles (e.g. diplomats, private security staff). Many of these roles expose individuals to potentially dangerous or traumatic events. Evidence has shown that such exposures can cause psychological health problems in military personnel. It is likely that the same would be seen among civilians working in such environments. There is however limited research into the health of civilians deployed to war zones. This study compared health outcomes and related behaviours among UK regular and reserve Army personnel with UK civilian personnel deployed in direct support of the UK military in Iraq. The study sample comprised of 159 Ministry of Defence civilians, 1542 Army regulars and 408 Army reservists, all of whom served in non-combat roles. Data were gathered by questionnaires which asked about deployment experiences, lifestyle factors and health outcomes [i.e. post-traumatic stress disorder (PTSD), general healt...
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In previous studies an association between deployment to Iraq or Afghanistan and an overall increased risk for post-traumatic stress disorder (PTSD) in UK armed forces has not been found. The lack of a deployment effect might be explained... more
In previous studies an association between deployment to Iraq or Afghanistan and an overall increased risk for post-traumatic stress disorder (PTSD) in UK armed forces has not been found. The lack of a deployment effect might be explained by including, in the comparison group, personnel deployed on other operations or who have experienced traumatic stressors unrelated to deployment. The sample comprised 8261 regular UK armed forces personnel who deployed to Iraq, Afghanistan or other operational areas or were not deployed. Participants completed the PTSD CheckList-Civilian Version (PCL-C) and provided information about deployment history, demographic and service factors, serious accidents and childhood experiences. Deployment to Iraq or Afghanistan [odds ratio (OR) 1.2, 95% confidence interval (CI) 0.6-2.2] or elsewhere (OR 1.1, 95% CI 0.6-2.0) was unrelated to PTSD although holding a combat role was associated with PTSD if deployed to Iraq or Afghanistan (OR 2.7, 95% CI 1.9-3.9). C...
Research Interests: Psychology, Psychiatry, Traumatic Stress, Medicine, Psychological Medicine, and 15 moreMilitary Service, Humans, Military Psychiatry, Iraq War, Military Deployment, Female, Male, Young Adult, Great Britain, Adult, Public health systems and services research, Odds ratio, Neurosciences, Software Deployment, and Military Personnel
A large body of research has been produced in recent years investigating posttraumatic stress disorder (PTSD) among military personnel following deployment to Iraq and Afghanistan, resulting in apparent differences in PTSD prevalence. We... more
A large body of research has been produced in recent years investigating posttraumatic stress disorder (PTSD) among military personnel following deployment to Iraq and Afghanistan, resulting in apparent differences in PTSD prevalence. We compare prevalence estimates for current PTSD between military subgroups, providing insight into how groups may be differentially affected by deployment. Systematic literature searches using the terms PTSD, stress disorder, and acute stress, combined with terms relating to military personnel, identified 49 relevant papers. Studies with a sample size of less than 100 and studies based on data for treatment seeking or injured populations were excluded. Studies were categorized according to theatre of deployment (Iraq or Afghanistan), combat and noncombat deployed samples, sex, enlistment type (regular or reserve and [or] National Guard), and service branch (for example, army, navy, and air force). Meta-analysis was used to assess PTSD prevalence acros...
Research Interests: Medicine, Canadian Psychiatry, Military Service, Armed Forces, Humans, and 15 moreMilitary Psychiatry, Iraq War, Posttraumatic stress disorder, Female, Male, Meta Analysis, Navy, Prevalence, Deployment, Adult, Occupations, Military Personnel, Psychology and Cognitive Sciences, active duty, and Medical and Health Sciences
A systematic review and meta-analyses were conducted on studies of the prevalence of aggressive and violent behavior, as well as of violent offenses and convictions, among military personnel following deployment to Iraq and/or... more
A systematic review and meta-analyses were conducted on studies of the prevalence of aggressive and violent behavior, as well as of violent offenses and convictions, among military personnel following deployment to Iraq and/or Afghanistan; the relationship with deployment and combat exposure; and the role that mental health problems, such as post-traumatic stress disorder (PTSD), have on the pathway between deployment and combat to violence. Seventeen studies published between January 1, 2001, and February 12, 2014, in the United States and the United Kingdom met the inclusion criteria. Despite methodological differences across studies, aggressive behavior was found to be prevalent among serving and formerly serving personnel, with pooled estimates of 10% (95% confidence interval (CI): 1, 20) for physical assault and 29% (95% CI: 25, 36) for all types of physical aggression in the last month, and worthy of further exploration. In both countries, rates were increased among combat-exp...
Research Interests: Violence, Environmental Health, Injury Prevention, Suicide prevention, Medicine, and 13 moreHumans, Iraq War, Aggression, United States, Occupational Safety and Health, Risk factors, Prevalence, Great Britain, Odds ratio, Risk Factors, Poison Control, Military Personnel, and Medical and Health Sciences
Research Interests: Military Medicine, Mental Health, Evidence Based Medicine, Public Health, Medicine, and 12 moreMilitary, Military Psychology, Humans, Decompression illness, Great Britain, Rest, Peer reviewed, Public health systems and services research, Discretion, Decompression Sickness, Decompression, and Military Personnel
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To determine the current state of knowledge regarding the effects of deployment length and a ‘mismatch’ between the expected and actual length of deployments on the health and well-being of military personnel in order to draw relevant... more
To determine the current state of knowledge regarding the effects of deployment length and a ‘mismatch’ between the expected and actual length of deployments on the health and well-being of military personnel in order to draw relevant conclusions for all organisations that deploy personnel to conflict zones. A systematic review was conducted of studies measuring deployment length to theatres of operations and the issue of ‘mismatch’ between expected and actual tour lengths. The nine studies included were rated for quality. Of the nine studies reviewed, six were rated as high quality, two as moderate quality and one as low quality. Seven of these studies found adverse effects of longer deployments on health and well-being. The two studies that measured ‘mismatch’ found adverse effects on mental health and well-being when deployments lasted longer than personnel expected. There are a limited number of studies which have assessed the effects of deployment length and very few that have ...
Research Interests: Research Design, Mental Health, Gastroenterology, Medicine, Military, and 15 moreMarriage, Humans, Internal Medicine, Female, Male, Mental Disorders, Clinical Sciences, Occupational, Family Health, Occupational Diseases, Residence Time, Health Effect, Military Personnel, Adverse effect, and Apatinib
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Research Interests: Psychiatry, Adolescent, Medicine, Biological Psychiatry, Humans, and 15 moreIraq War, Female, Male, Great Britain, Middle Aged, Longitudinal Studies, Adult, Risk Factors, Psychiatric, Likelihood Functions, Military Personnel, Predictive value of tests, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Mental Health, Leadership, Medicine, European Public Health Policies, Mental Illness, and 15 moreDistress, Military, Post traumatic stress disorder, Humans, Iraq War, Alcoholism, Female, Male, Preparedness, Great Britain, Adult, Health Care Utilization, Military Personnel, Health Outcome, and Health Personnel
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U.K. Reserve Forces, principally the Territorial Army (TA), have been increasingly used since the end of the cold war, but there have been some concerns about their mental health problems and also possible unwillingness to remain in... more
U.K. Reserve Forces, principally the Territorial Army (TA), have been increasingly used since the end of the cold war, but there have been some concerns about their mental health problems and also possible unwillingness to remain in service. This article reports on the retention issues of 191 TA personnel who deployed to Iraq from 2003 to 2006. Qualitative data were thematically analyzed from three complementary studies. The authors found that, in 2003, negative aspects of Army organizational culture were reported as the prime reasons for TA personnel wishing to leave the military. In particular, Reservists reported their being unaccepted and underutilized. In contrast, by 2006, TA personnel were generally reporting being satisfied with their work as a Reservist and felt integrated with Regular colleagues. Those who stated they wanted to leave the military now reported it was primarily because of poor military family welfare support. These results suggest that although the British A...
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An important feature of civil-military relations is the way in which states recognize the sacrifices that the men and women of the armed forces give to their country and provide care and support for them and their families once they leave... more
An important feature of civil-military relations is the way in which states recognize the sacrifices that the men and women of the armed forces give to their country and provide care and support for them and their families once they leave the military as veterans. Yet states differ not only in the levels and kinds of support provided for ex-service personnel but also in their very definition of what a veteran is. This article examines the case of the United Kingdom from an international perspective. It explains how and why the United Kingdom has developed a particular—and inclusive—definition of veteran and, in conjunction with veterans interest groups, a strategy for allocating scarce resources to this group. The article analyzes attempts to mitigate the effects of social exclusion suffered by some subgroups within the veteran population, although the great majority does well at least in terms of short-term employment prospects. It concludes with an analysis of the dilemmas that ar...
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Research Interests: Mental Health, Medicine, Humans, Iraq War, Mathematical Sciences, and 15 moreMilitary Deployment, Female, Divorce, Male, Mental Disorders, Cohort, Health Status, Great Britain, Middle Aged, Adult, Military Personnel, Logistic Models, Case Control Studies, active duty, and Medical and Health Sciences
ABSTRACTAims To examine patterns of drinking in the UK Armed Forces, how they vary according to gender and other demographics, and to make comparisons with the general population.Design Large cross‐sectional postal questionnaire study... more
ABSTRACTAims To examine patterns of drinking in the UK Armed Forces, how they vary according to gender and other demographics, and to make comparisons with the general population.Design Large cross‐sectional postal questionnaire study (response rate 60%).Setting United Kingdom.Participants A random representative sample of the regular UK Armed Forces who were in service in March 2003 (n = 8686; 7937 men, 749 women). Comparisons were made with the general population of Great Britain.Measurements Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT).Findings Sixty‐seven per cent of men and 49% of women in the UK Armed Forces had an AUDIT score of 8+ (defined as hazardous drinking), compared to 38% of men and 16% of women in the general population. In both sexes, for all ages, the military have a higher prevalence of hazardous drinking. Binge drinking was associated with being younger, being in the Army, being single, being a smoker and bein...
Research Interests: Demography, Addiction, Environmental Health, Medicine, Military Service, and 15 morePopulation, Humans, Female, Alcohol Drinking, Male, Alcohol Consumption, Great Britain, Middle Aged, Adult, Binge drinking, Cross Section, Military Personnel, General Population, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Mental Health, Iraq, Medicine, Post traumatic stress disorder, Humans, and 15 moreMilitary Deployment, Cohort Study, Occupational Safety and Health, Mental Disorders, Common Mental Disorders, Alcohol Consumption, Health Status, Lancet, Great Britain, Questionnaires, Random sampling, Military Personnel, Health Outcome, Cohort Studies, and Medical and Health Sciences
Research Interests: Cognitive Science, Military Medicine, Psychiatry, Mental Health, Political Science, and 14 moreIntergroup Conflict (Psychology), Medicine, Humans, Iraq War, Military Deployment, Alcoholism, Mental health services, Risk factors, Clinical Sciences, Great Britain, Risk Factors, Software Deployment, Military Personnel, and Conflict Psychology
Different countries have varying definitions of the word “veteran,” which in turn influence the benefits that ex-Service personnel receive. However, public opinion does not necessarily reflect official definitions. This article seeks to... more
Different countries have varying definitions of the word “veteran,” which in turn influence the benefits that ex-Service personnel receive. However, public opinion does not necessarily reflect official definitions. This article seeks to identify whether characteristics by which UK ex-Service personnel self-identify as veterans are aligned with official policy/public opinion, and which factors are associated with self-identification as a veteran. This article utilizes data from a structured telephone interview survey of UK Armed Forces personnel. All those who had left the military by the time of interview ( n = 202) were asked whether they considered themselves to be a veteran. Their responses were recorded and analyzed. Only half of the sample considered themselves to be veterans. Definitions used by UK ex-Service personnel do not align with the official UK government definition or public perceptions of “veterans,” which tend to focus on older veterans and/or those who served in bo...
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Little is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.AimsWe examined the prevalence of mental disorders and alcohol misuse, whether this... more
Little is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.AimsWe examined the prevalence of mental disorders and alcohol misuse, whether this differed between serving and ex-serving regular personnel and by deployment status. This is the third phase of a military cohort study (2014-2016; n = 8093). The sample was based on participants from previous phases (2004-2006 and 2007-2009) and a new randomly selected sample of those who had joined the UK armed forces since 2009. The prevalence was 6.2% for probable post-traumatic stress disorder, 21.9% for common mental disorders and 10.0% for alcohol misuse. Deployment to Iraq or Afghanistan and a combat role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel. The findings highlight an increasing prevalence of post-tra...
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Research into violence among military personnel has not differentiated between stranger- and family-directed violence. While military factors (combat exposure and post-deployment mental health problems) are risk factors for general... more
Research into violence among military personnel has not differentiated between stranger- and family-directed violence. While military factors (combat exposure and post-deployment mental health problems) are risk factors for general violence, there has been limited research on their impact on violence within the family environment. This study aims to compare the prevalence of family-directed and stranger-directed violence among a deployed sample of UK military personnel and to explore risk factors associated with both family- and stranger-directed violence. This study utilised data from a large cohort study which collected information by questionnaire from a representative sample of randomly selected deployed UK military personnel (n = 6711). The prevalence of family violence immediately following return from deployment was 3.6% and 7.8% for stranger violence. Family violence was significantly associated with having left service, while stranger violence was associated with younger ag...
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Electronic Healthcare Records (EHRs) are created to capture summaries of care and contact made to healthcare services. EHRs offer a means to analyse admissions to hospitals for epidemiological research. In the United Kingdom (UK),... more
Electronic Healthcare Records (EHRs) are created to capture summaries of care and contact made to healthcare services. EHRs offer a means to analyse admissions to hospitals for epidemiological research. In the United Kingdom (UK), England, Scotland and Wales maintain separate data stores, which are administered and managed exclusively by devolved Government. This independence results in harmonisation challenges, not least lack of uniformity, making it difficult to evaluate care, diagnoses and treatment across the UK. To overcome this lack of uniformity, it is important to develop methods to integrate EHRs to provide a multi-nation dataset of health. To develop and describe a method which integrates the EHRs of Armed Forces personnel in England, Scotland and Wales based on variable commonality to produce a multi-nation dataset of secondary health care. An Armed Forces cohort was used to extract and integrate three EHR datasets, using commonality as the linkage point. This was achieve...
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Little is known about the social and emotional well-being of children whose fathers have been deployed to the conflicts in Iraq/Afghanistan or who have post-traumatic stress disorder (PTSD).AimsTo examine the emotional and behavioural... more
Little is known about the social and emotional well-being of children whose fathers have been deployed to the conflicts in Iraq/Afghanistan or who have post-traumatic stress disorder (PTSD).AimsTo examine the emotional and behavioural well-being of children whose fathers are or have been in the UK armed forces, in particular the effects of paternal deployment to the conflicts in Iraq or Afghanistan and paternal PTSD. Fathers who had taken part in a large tri-service cohort and had children aged 3-16 years were asked about the emotional and behavioural well-being of their child(ren) and assessed for symptoms of PTSD via online questionnaires and telephone interview. In total, 621 (67%) fathers participated, providing data on 1044 children. Paternal deployment to Iraq or Afghanistan was not associated with childhood emotional and behavioural difficulties. Paternal probable PTSD were associated with child hyperactivity. This finding was limited to boys and those under 11 years of age. ...
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The purpose of the present study was to address 1) whether exercise provides protection against new-onset depression and anxiety and 2) if so, the intensity and amount of exercise required to gain protection and, lastly, 3) the mechanisms... more
The purpose of the present study was to address 1) whether exercise provides protection against new-onset depression and anxiety and 2) if so, the intensity and amount of exercise required to gain protection and, lastly, 3) the mechanisms that underlie any association. A "healthy" cohort of 33,908 adults, selected on the basis of having no symptoms of common mental disorder or limiting physical health conditions, was prospectively followed for 11 years. Validated measures of exercise, depression, anxiety, and a range of potential confounding and mediating factors were collected. Undertaking regular leisure-time exercise was associated with reduced incidence of future depression but not anxiety. The majority of this protective effect occurred at low levels of exercise and was observed regardless of intensity. After adjustment for confounders, the population attributable fraction suggests that, assuming the relationship is causal, 12% of future cases of depression could have...
Research Interests: Health Behavior, Depression, Anxiety, Norway, Humans, and 15 moreFemale, Male, Exercise, Health Status, Middle Aged, Psychological Tests, Adult, Protective factors, ANXIETY, Leisure Activities, Cohort Studies, Socioeconomic Factors, Psychology and Cognitive Sciences, Outcome assessment (Health care), and Medical and Health Sciences
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Fitness to undertake operational deployment is a key requirement of military service. To assess individual deployment fitness at a single point from one month to eight years following discharge from mental healthcare. Survival analyses... more
Fitness to undertake operational deployment is a key requirement of military service. To assess individual deployment fitness at a single point from one month to eight years following discharge from mental healthcare. Survival analyses assessed levels of deployability; the predictive effects of key covariates upon time to being classified as non-deployable were examined using univariate and multivariate Cox proportional hazards regression procedures. A total of 1405 individuals provided study data. 437 individuals (31.1%) were non-deployable or discharged from service during follow-up. 17.2% were non-deployable in the first year following mental healthcare; the proportion did not rise above this level until year seven when it was 19.1% and then 30.6% in year eight. Risk factors for being classified as non-deployable were female sex, receipt of intermediate duration therapy, management by the multidisciplinary team and previous referral to mental health services. Previous deployment ...
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The association of post-traumatic stress disorder (PTSD) symptom clusters with combat and other operational experiences among United Kingdom Armed Forces (UK AF) personnel who deployed to Afghanistan in 2009 were examined. Previous... more
The association of post-traumatic stress disorder (PTSD) symptom clusters with combat and other operational experiences among United Kingdom Armed Forces (UK AF) personnel who deployed to Afghanistan in 2009 were examined. Previous studies suggest that the risk of developing PTSD rises as combat exposure levels increase. To date, no UK research has investigated how specific classes of combat and operational experiences relate to PTSD symptom clusters. The current study was a secondary analysis of data derived from a two-arm cluster, randomized-controlled trial of a postdeployment operational stress-reduction intervention in deployed UK AF personnel. 2510 UK AF personnel provided combat exposure data and completed the PTSD checklist (civilian version) immediately post-deployment while 1635 of the original cohort completed further followed-up measures four to six months later. A 14-item combat experience scale was explored using principle component analysis, which yielded three main c...
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The effectiveness of post-deployment screening for mental disorders has not been assessed in a randomised controlled trial. We aimed to assess whether post-deployment screening for post-traumatic stress disorder (PTSD), depression,... more
The effectiveness of post-deployment screening for mental disorders has not been assessed in a randomised controlled trial. We aimed to assess whether post-deployment screening for post-traumatic stress disorder (PTSD), depression, anxiety, or alcohol misuse was effective. We defined screening as the presumptive identification of a previously unrecognised disorder using tests to distinguish those who probably had the disorder from those who probably did not so that those people with a probable disorder could be referred appropriately, and assessed effectiveness and consequences for help-seeking by the odds ratio at follow-up between those receiving tailored help-seeking advice and those who received general mental health advice. We did a cluster randomised controlled trial among Royal Marines and Army personnel in the UK military after deployment to Afghanistan. Platoons were randomly assigned (1:1 initially, then 2:1) by stratified block randomisation with randomly varying block si...
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Social values and concepts have played a central role in the history of mental health care. They have driven major reforms and guided the development of various treatment models. Although social values and concepts have been important for... more
Social values and concepts have played a central role in the history of mental health care. They have driven major reforms and guided the development of various treatment models. Although social values and concepts have been important for mental health care in the past, this Personal View addresses what their role might be in the future. We (DG, PH, and SP) did a survey of professional stakeholders and then used a scenario planning technique in an international expert workshop to address this question. The workshop developed four distinct but not mutually exclusive scenarios in which the social aspect is central: mental health care will be patient controlled; it will target people's social context to improve their mental health; it will become virtual; and access to care will be regulated on the basis of social disadvantage. These scenarios are not intended as fixed depictions of what will happen. They could, however, be useful in guiding further debate, research, and innovation.
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Mortality associated with chronic fatigue syndrome is uncertain. We investigated mortality in individuals diagnosed with chronic fatigue syndrome in secondary and tertiary care using data from the South London and Maudsley NHS Foundation... more
Mortality associated with chronic fatigue syndrome is uncertain. We investigated mortality in individuals diagnosed with chronic fatigue syndrome in secondary and tertiary care using data from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) register. We calculated standardised mortality ratios (SMRs) for all-cause, suicide-specific, and cancer-specific mortality for a 7-year observation period using the number of deaths observed in SLaM records compared with age-specific and sex-specific mortality statistics for England and Wales. Study participants were included if they had had contact with the chronic fatigue service (referral, discharge, or case note entry) and received a diagnosis of chronic fatigue syndrome. We identified 2147 cases of chronic fatigue syndrome from CRIS and 17 deaths from Jan 1, 2007, to Dec 31, 2013. 1533 patients were women of whom 11 died, and 614 were men of whom six died. Th...