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Abstract
Objective To investigate the impact of the COVID-19 pandemic on the health and well-being of UK ex-service personnel (veterans) before and during the pandemic, and to assess associations of COVID-19 experiences and stressors with mental health, alcohol use and loneliness.
Design An additional wave of data was collected from a longitudinal cohort study of the UK Armed Forces.
Setting Online survey June–September 2020.
Participants Cohort members were included if they had completed a questionnaire at phase 3 of the King’s Centre for Military Health Research health and well-being study (2014–2016), had left the Armed Forces after regular service, were living in the UK, had consented to follow-up and provided a valid email address. Invitation emails were sent to N=3547 with a 44% response rate (n=1562).
Primary outcome measures Common mental health disorders (CMDs) (measured using the General Health Questionnaire, 12 items—cut-off ≥4), hazardous alcohol use (measured using the Alcohol Use Disorder Identification Test, 10 items—cut off ≥8) and loneliness (University of California, Los Angeles, Loneliness Scale— 3 items-cut-off ≥6).
Results Veterans reported a statistically significant decrease in hazardous drinking of 48.5% to 27.6%, while CMD remained stable (non-statistically significant increase of 24.5% to 26.1%). 27.4% of veterans reported feelings of loneliness. The COVID-19 stressors of reporting difficulties with family/social relationships, boredom and difficulties with health were statistically significantly associated with CMD, hazardous drinking and loneliness, even after adjustment for previous mental health/hazardous alcohol use.
Conclusions Our study suggests a COVID-19 impact on veterans’ mental health, alcohol use and loneliness, particularly for those experiencing difficulties with family relationships. Veterans experienced the pandemic in similar ways to the general population and in some cases may have responded in resilient ways. While stable levels of CMD and reduction in alcohol use are positive, there remains a group of veterans who may need mental health and alcohol treatment services.
- COVID-19
- epidemiology
- mental health
Data availability statement
Data are available upon reasonable request. Data will be processed in accordance with the General Data Protection Regulation (GDPR) and the Data Protection Act 2018. We will not make any record-level data publicly accessible because we need to protect the confidentiality and security of the individual cohort members. You are welcome to contact us with proposals for collaborative research, which the investigators will consider on a case-by-case basis, and which will only occur as part of a legal collaborative agreement and after the collaborator has put in place the relevant research ethics, data protection and data access approvals.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available upon reasonable request. Data will be processed in accordance with the General Data Protection Regulation (GDPR) and the Data Protection Act 2018. We will not make any record-level data publicly accessible because we need to protect the confidentiality and security of the individual cohort members. You are welcome to contact us with proposals for collaborative research, which the investigators will consider on a case-by-case basis, and which will only occur as part of a legal collaborative agreement and after the collaborator has put in place the relevant research ethics, data protection and data access approvals.
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Footnotes
M-LS and DS are joint first authors.
Twitter @MarieLouiseLu
Contributors M-LS, DS, MJ, HB, DP, LH, DP, DM, SW and NTF were involved in the original concept and design of the study. NTF and SW have overseen the conduct of all aspects of the study. M-LS led the formulation of the questionnaire and associated measures, with substantial contributions from all authors in shaping the final questionnaire. DP led the online survey design, format and flow. DS led the ethics submission with substantial contributions from all authors. MJ, HB and LH led the design of participant materials including the participant invite and information sheet with input from all authors. MJ led the data analysis plan and conducted the data analysis with input from all authors. M-LS and DS led the writing of the research paper, with drafting and revision input from all authors. M-LS, DS, MJ, HB, DP, LH, DP, DM, SW and NTF have all seen and approved the final version of this paper and accept accountability for all aspects of the work. SW and NTF secured the funding from OVA for this work.
Funding This work was funded by the Office of Veterans’ Affairs, Cabinet Office, UK Government (Contract Ref: CCZZ20A51).
Competing interests SW is Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid). SW is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King’s College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. NTF is a trustee (unpaid) of The Warrior Programme, an independent advisor to the Independent Group Advising on the Release of Data (IGARD), a member of Independent Scientific Pandemic Insights Group on Behaviours (SPI-B) and their salary is part grant funded by the MoD. DM is a trustee of the Forces in Mind Trust (unpaid) and is employed as the Head of Research for Combat Stress, a UK Veterans Mental Health Charity.
Provenance and peer review Not commissioned; externally peer reviewed.
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