title: The mental health of UK ex-servicemen with a combat-related or a non-combat-related visual impairment: does the cause of visual impairment matter?
abstract: OBJECTIVE
  Since the start of the conflicts in Iraq and Afghanistan, the numbers of young service personnel who have sustained a combat-related visual impairment have increased. This cross-sectional study examined the mental well-being of ex-servicemen (aged 22-55 years) with a visual impairment and determined if the mental health of those with a combat-related visual impairment differed from those whose visual impairment is not combat-related.
  
  
  METHODS
  Male ex-service personnel with a visual impairment completed a telephone interview assessing the presence of depressive symptomatology, probable anxiety disorder, post-traumatic stress disorder (PTSD) symptomatology and alcohol misuse. Data were analysed using descriptive statistics.
  
  
  RESULTS
  77 participants were included in the study, reflecting a response rate of 76.2%. Of those with complete data (n=74), 20 ex-servicemen had a combat-related visual impairment. Among ex-service personnel with a combat-related visual impairment, 10.0% (95% CI 0 to 23.2) screened positive for a probable depression, 25.0% (95% CI 6.0 to 44.0) for probable anxiety and 10.0% (95% CI 0 to 23.2) for probable PTSD. The prevalence of probable depression and probable PTSD differed among those with a non-combat-related visual impairment, namely 18.5% (95% CI 8.1 to 28.9) and 16.7% (95% CI 6.8 to 26.7), respectively. Probable anxiety was 18.5% (95% CI 8.1 to 28.9) among non-combat-related visually impaired ex-service personnel. 45.0% (95% CI 23.2 to 66.8) of combat-related visually impaired personnel reported hazardous drinking, compared with 20.4% (95% CI 9.7 to 31.2) of those with a non-combat-related visual impairment.
  
  
  CONCLUSIONS
  Mental health problems were prevalent among visually impaired younger ex-servicemen. No statistically significant differences were found in the prevalence of mental health problems among ex-servicemen with a combat-related visual impairment compared with those with a non-combat-related visual impairment.
authors.affiliation: Department of Psychological Medicine, King's Centre for Military Health Research (KCMHR), King's College London, London, UK.
authors.forename: Sharon A M
authors.initials: SA
authors.lastname: Stevelink
authors.affiliation: Department of Psychological Medicine, King's Centre for Military Health Research (KCMHR), King's College London, London, UK.
authors.forename: Estelle M
authors.initials: EM
authors.lastname: Malcolm
authors.affiliation: King's College School of Medicine, King's College London, London, UK.
authors.forename: Pashyca C
authors.initials: PC
authors.lastname: Gill
authors.affiliation: Department of Psychological Medicine, King's Centre for Military Health Research (KCMHR), King's College London, London, UK Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK.
authors.forename: Nicola T
authors.initials: NT
authors.lastname: Fear
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D003130:Combat Disorders / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D008887:Military Medicine; D008889:Military Personnel / Q000706:statistics & numerical data*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D006113:United Kingdom / Q000453:epidemiology; D014786:Vision Disorders / Q000453:epidemiology*; D014792:Visual Acuity / Q000502:physiology; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*
keywords: Epidemiology; Public health; Trauma; Vision