title: Trauma, identity and mental health in UK military veterans.
abstract: BACKGROUND
  Military service can lead to profound changes in identity, both in servicemen's perception of themselves and in their relationship to the world, but the significance of these changes for psychopathology is unclear. We investigated whether the extent and valence of identity change was related to the degree of military trauma exposure or to post-traumatic stress disorder (PTSD) and suicide attempts. We further sought to describe the nature of such changes using qualitative analysis.
  
  
  METHODS
  A total of 153 veterans in receipt of a war pension for PTSD or physical disability were identified. Interviews established retrospectively DSM-IV diagnoses of PTSD and reports of suicidal ideation or behaviour since enlistment were examined.
  
  
  RESULTS
  Trauma exposure alone was unrelated to any measure of identity change. By contrast, PTSD was associated with a relationship to the world that had changed in a negative direction. It was also associated with a changed perception of self, which could be either positive or negative. After controlling for trauma exposure and PTSD, suicidal behaviours were associated with more negative perceptions of the world. These perceptions of the world included disillusionment about human nature and a more specific rejection of civilian life.
  
  
  CONCLUSIONS
  PTSD and suicidal behaviours in veterans seem not to be associated with significantly more negative views of the self but rather with more alienation from civilian life. This has serious consequences for engaging veterans in National Health Service (NHS) mental health services and for the provision of effective treatment.
authors.affiliation: Clinical, Educational and Health Psychology, University College London, London, UK. c.brewin@ucl.ac.uk
authors.forename: C R
authors.initials: CR
authors.lastname: Brewin
authors.forename: R
authors.initials: R
authors.lastname: Garnett
authors.forename: B
authors.initials: B
authors.lastname: Andrews
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D012649:Self Concept; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology; D006113:United Kingdom; D014728:Veterans / Q000523:psychology*; D014947:Wounds and Injuries / Q000209:etiology / Q000523:psychology*