The interplay between serious physical combat injuries, leaving military service and suicidal ideation

Findings from ADVANCE study, looked at suicidal ideation within UK military personnel who sustained a serious physical combat injury on deployment in Afghanistan, and compared them to demographically similar individuals who sustained no such injuries. The results are published in the International Journal of Social Psychiatry.

The ADVANCE Study is a collaboration between King's College London, Imperial College London and the Ministry of Defence, and investigates the long term physical and psycho-social outcomes of UK combat casualties from the Afghanistan conflict. Developing an understanding of whether combat injury is associated with higher rates of suicidal ideation will help service providers, policy makers and researchers ensure that appropriate resources and support can be offered to injured serving personnel and veterans to reduce the risk of future suicidal-related behaviors.

Dr. Dan Dyball, first author of the study, explains, "Defence and medical technology progressed at such a significant pace during the Afghanistan conflict, individuals were surviving injuries that they would not have survived at any other point in history. As such, we have very little idea about their long-term outcomes. ADVANCE is set up to help us understand what happens to these individuals, whether in terms of their mental health, their cardiovascular health, their respiratory health—all of it really."

The study found that 15.3% of those who sustained serious physical combat injuries reported suicidal ideation within the past two weeks, compared with 11.9% of the comparison group. Further analysis suggests that the type of injury is an important factor to consider with those who sustained an amputation showing lower rates of suicidal ideation at 8.5% compared to those with non-amputation injuries who reported higher rates at 17.6%.

This is in line with previous research from the ADVANCE study, which found that those with amputation injuries did not differ from the comparison group in rates of anxiety, depression or PTSD, while those with non-amputation injuries had increased rates of these disorders.

The study also explored the impact of leaving service, as veterans in both the injured and comparison group were considerably more likely to report suicidal ideation than their still-serving peers. A surprise finding of the study was that veterans who sustained no serious physical combat injuries reported the highest rates of ideation, at 28.9% compared to veterans who sustained amputation injuries (8.9%) and non-amputation injuries (21.4%).

"We've seen that most individuals in ADVANCE with amputation injuries have remarkable mental health and pain outcomes considering their injuries. But surprisingly, it's those with non-amputation related injuries that appear to be at increased risk of mental health problems, and specifically suicidal ideation in this study.

"Leaving service appears to be strongly associated with suicidal ideation, regardless of whether you sustained an injury or not. This may be because these individuals lose connection to their military support networks, have difficulty in transitioning to civilian life, or lose part of their group identity," says Dr. Dan Dyball, King's Centre for Military Health Research, King's IoPPN.

The ADVANCE Study has 1,145 participants who served in the Afghanistan conflict of 2002-2014. Half of the cohort sustained serious physical combat injuries, and the other half are demographically similar personnel who sustained no such injuries.