An exploration and critical analysis of the predisposing factors leading to depression within the British army

Depression is a common mental health (MB) disorder affecting British Army personnel and a significant factor in reducing the fighting capability of the British Armed Forces, yet as a theme it has not been the subject of a detailed empirical investigation. This thesis aimed to redress this imbalance by advancing knowledge and understanding of the predisposing factors that resulted in Army personnel presenting with Depression. Mixed research methods were utilised. Quantitative data was obtained from 2 survey questionnaires, the first providing information from 1,030 military MH hospital admissions and the second was completed by 317 serving soldiers. Qualitative information was obtained through interviews with 19 experienced Army MH clinicians and a Constructivist Grounded Theory provided the theoretical model. The most common reason why soldiers' required a MH hospital admission was for a depressive illness, with the majority presenting with multi-factorial problems displayed in a number of different ways, with the main causes being relationship problems, family issues and occupational stressors irrespective of rank, age and gender. The presentation of Depression was not uniform, or aligned to civilian definitions, and had a unique interpretation within the Army. Results draw attention to previously unpublished issues such as the plight of the unhappy young soldier, where nearly 50% of those who accessed the Army Medical Services (AMS) presented with the one stressor of wanting to leave the Army, and in this sample they were positively correlated with self-harming ideology. The results also challenge held beliefs such as soldiers with MH problems are stigmatised. Female soldiers were significantly more likely to attend for a MH assessment and to be admitted to hospital for a MH disorder, and were more prone to being diagnosed with Depression. It appeared that female soldiers were less affected by stigma, and GPs were more likely to refer a tearful woman than a man who disguised his emotions. The predisposing factors can be absorbed into 4 major clusters; situational stressors, maintaining / precipitating factors, secondary coping mechanisms and help seeking behaviour. There were issues related to the contextual differences of peacetime and operational duties; and the provision provided by the AMS, Departments of Community MH and Unit Command and these aspects could either enable or inhibit access to clinical support. These features are included within a theoretical model detailing the predisposing factors that influence the presentation of military depression and the patient's clinical pathway. This model can be utilised at a practical level within Primary Healthcare, also to support clinical education programmes, and to influence MOD policy. It is anticipated that the findings are transferable to other populations that deal predominately with men's MH, and Armed Forces in other countries