The relationship between trauma, mental health, alcohol and help-seeking, for military veterans residing in Northern Ireland

However, LCA of mental health/alcohol outcomes found 40% experienced two to six co-occurring mental health/alcohol difficulties at moderate to high levels, with 20% experiencing four to six at high levels. Having a moderate risk of problematic drinking was unassociated with poor mental health. UDR service, military-specific trauma and trauma class membership were key predictors of mental health/alcohol comorbidity class membership, particularly the combat/conflict trauma class, suggesting that the Troubles’ trauma greatly affected mental health.

Still, UDR service did not predict help-seeking. Predictors of help-seeking, defined as therapy engagement and medication use, were diverse. Mental health and alcohol class membership had the greatest effect on medication use, particularly for ‘high comorbidity’ class members.

Therapy engagement had few, smaller predictors, with the main predictor being poor transition. Self-marginalisation likely led to choosing medication over therapy. The qualitative phenomenological study identified themes describing veterans as having low mental health and alcohol literacy, low expectations of any official support and experiencing poor displays of appreciation.

Themes also described high engagement with local-level support and being embedded in a heavy rule-based environment. Heavy alcohol use was just another form of ‘rule-following’. Participants had experienced repeated ‘extreme’ environmental shifts, which may have affected their mental health/alcohol outcomes.

They also described help-seeking, despite preferring to stay hidden. This thesis adopted an Ecological Systems perspective, and the findings suggest that specific ‘systems’ could be targeted for future research/interventions. More adequate/efficient NI-specific exosystem services are needed, perhaps to operate alongside support the veterans can access within their own local communities and/or homes.

To address NI veterans’ issues adequately they ought to be included as stakeholders in ongoing research, intervention creation and policy development; this may help to build trust between the veterans and other ‘systems’. <br><i><br>Thesis embargoed until 31st December 2027</i>