title: Early Service leavers: a study of the factors associated with premature separation from the UK Armed Forces and the mental health of those that leave early.
abstract: BACKGROUND
  Approximately 18,000 personnel leave the UK Armed Forces annually. Those leaving before completing the minimum term of their contracts are called early Service leavers (ESLs). This study aims to identify characteristics associated with being an ESL, and compare the post-discharge mental health of ESLs and other Service leavers (non-ESLs).
  
  
  METHODS
  A cross-sectional study used data on ex-Serving UK Armed Forces personnel. ESLs were personnel leaving before completing their 3-4.5 years minimum Service contracts and were compared with non-ESLs. Multivariable logistic regression was used to estimate odds ratios and 95% confidence intervals for the associations between Service leaving status with socio-demographics, military characteristics and mental health outcomes.
  
  
  RESULTS
  Of 845 Service leavers, 80 (9.5%) were ESLs. Being an ESL was associated with younger age, female sex, not being in a relationship, lower rank, serving in the Army and with a trend of reporting higher levels of childhood adversity, but not with deployment to Iraq. ESLs were at an increased risk of probable post-traumatic stress disorder (PTSD), common mental disorders, fatigue and multiple physical symptoms, but not alcohol misuse.
  
  
  CONCLUSIONS
  The study suggests that operational Service is not a factor causing personnel to become an ESL. Current mental health problems were more commonly reported among ESLs than other Service leavers. There may be a need to target interventions to ESLs on leaving Service to smooth their transition to civilian life and prevent the negative mental health outcomes experienced by ESLs further down the line.
authors.affiliation: King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK.
authors.forename: Joshua E J
authors.initials: JE
authors.lastname: Buckman
authors.forename: Harriet J
authors.initials: HJ
authors.lastname: Forbes
authors.forename: Tim
authors.initials: T
authors.lastname: Clayton
authors.forename: Margaret
authors.initials: M
authors.lastname: Jones
authors.forename: Norman
authors.initials: N
authors.lastname: Jones
authors.forename: Neil
authors.initials: N
authors.lastname: Greenberg
authors.forename: Josefin
authors.initials: J
authors.lastname: Sundin
authors.forename: Lisa
authors.initials: L
authors.lastname: Hull
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
authors.forename: Nicola T
authors.initials: NT
authors.lastname: Fear
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D008889:Military Personnel / Q000145:classification / Q000523:psychology* / Q000706:statistics & numerical data; D016017:Odds Ratio; D032024:Personnel Delegation; D010558:Personnel Loyalty; D010563:Personnel Turnover / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology