title: An exploration of gender differences in risk factors for mental ill health &amp; functional capability in UK army personnel – A through life approach
Creators: name: Ross, David A.
Publisher: name: University of Glasgow
Year: 2024

description: Introduction 
Since 2019 all roles in the UK Armed Forces have been equally open to men and women. Prior to this women had not been able to serve in combat roles. However, historic data has shown that serving women had approximately twice the rate of mental ill health as men in the Army. There was therefore concern from senior leaders in Defence and the Army that employment in combat roles may further exacerbate this, resulting in even higher rates of mental illness in women in the Army. This thesis takes a through life course in exploring the risk factors for mental ill health in the UK Army, university students and veterans.

Methods 
A sequential mixed methods approach was taken, with priority given to the qualitative part of the study. The COVID-19 pandemic and lockdown started soon after ethical approval, resulting in the study being undertaken over a prolonged period. A quantitative survey using a bespoke questionnaire of 7000 serving Army personnel was distributed in July 2020 but could not be analysed until a year later. The aim of the survey was to gather data on the perceived importance of the risk factors for mental ill health in order to develop questions for the qualitative interviews. Twenty-one Army personnel were subsequently interviewed between January and June 2022. Qualitative data were analysed using thematic analysis. The COVID-19 pandemic led to additional quantitative research on soldiers’ social isolation and mental ill health and wellbeing, and qualitative service improvement work on veterans at the Royal Hospital Chelsea. Both form part of the thesis. Finally, a second survey, using the same questionnaire, of young Army Officer university cadets was undertaken in March 2023 in order to validate any specific findings on health and wellbeing that had been identified by the previous arms of the research.

Findings 
Five hundred and sixty-eight (16.2%) women and 310 (8.9%) men responded to the survey, which was a representative sample in terms of diversity of the Army, but older age, higher educational attainment and senior rank were slightly over- represented. Key findings were that men were more likely to fear that their life was at risk when deployed (p&lt; 0.001); women were more likely to face harassment when deployed (p&lt; 0.001); women were more likely to report that a parent suffered from mental ill health (p=0.036) and also that their mother figure was difficult to please (p&lt; 0.001); women were more likely to have been sexually abused as a child (p&lt; 0.001); binge drinking of alcohol was more common in men (p=0.039); female respondents were more likely to be in a partnership with another military person (p&lt; 0.001); and women, at the time of the survey, were more likely to feel “sad” or “blue” (p=0.003).
Five main themes were identified from the qualitative research on Army personnel, who were recruited through volunteering at the time of completing the survey questionnaire. These themes were (i) Generations, (ii) Pre-Service Life Experiences, (iii) Interpersonal Behaviours, (iv) Deployment Issues and (v) COVID19. A total of thirteen sub themes were also identified that were risk factors for mental ill health in Army personnel.

Interpretation &amp; Conclusion 
Mitigating the risks of developing mental illness is complex and requires integrative development of policy, preventive health, and provision of appropriate mental health services. This research demonstrated that the focus in the future should be through a generational, rather than a gender based, approach to prevent mental ill health and improve wellbeing. Moreover, a “one size fits all” mental health preventive policy is unlikely to be effective. For older men, principally Generation X and millennials, the focus should be on encouraging earlier engagement with primary care and mental health services. For Generation Z men and women, and future generations, there will need to be a greater understanding of their (mental) health and wellbeing needs before adapting preventive and healthcare services to try to meet these needs.
The research identified several other risks for developing mental illness whilst serving as a soldier. It further confirmed that military sexual trauma remains a significant area of concern in the UK Army, and more initiatives to eradicate this unacceptable behaviour are required. Deploying as a parent of a very young child could have mental health implications for all soldiers irrespective of gender and may be even more important in younger generations. Young soldiers, particularly men are emotionally immature. Many of their behaviours are erroneously labelled as clinical mental illnesses. Better emotional support of these young soldiers through the availability of a uniformed psychology service may also free up resources in over stretched clinical mental health services.
The through life course starts with recruiting the right individual and employing them in a role that is appropriate to their skills and interests. Whilst employed in the Army, mitigating the risk of mental ill health through a better understanding of the multiple risk factors that may impinge on an individual’s mental health and wellbeing will be key. Finally, whilst UK military veterans, other than early service leavers, appear to be more resilient than their civilian peers currently, this may not always be the case. The as yet, unexplained increase in rates of mental health disorders in Generation Z in society as a whole may then translate into less resilience in the veteran community. Therefore, further qualitative research into the mental health and wellbeing of current and future cohorts of veterans will be vital.