The ADVANCE baseline mental health findings are now out!

We are pleased to inform you that the baseline mental health findings from the ADVANCE Study have just been published in the scientific journal Lancet Psychiatry. This is the second ADVANCE scientific publication – and we look forward to sharing many more with you!

You can access the full publication here: Mental health outcomes of male UK military personnel deployed to Afghanistan and the role of combat injury.

We have also recorded a brief video explaining the findings. You can watch the video on the ADVANCE YouTube channel here: [insert link].


The long-term mental health outcomes of UK Armed Forces personnel who sustained serious combat injuries during deployment to Afghanistan are largely unknown. ADVANCE is the first study to look at these outcomes on a relatively large scale and over a long period of time.

The aim of this piece of ADVANCE research was to find out whether the injured group (who have experienced combat-related traumatic injury) and the uninjured comparison group have differences in terms of their mental health outcomes. We looked at depression, anxiety, PTSD and mental health multimorbidity (PTSD with depression and/or anxiety).

What is depression?

Depression can include symptoms of low mood, tiredness, feeling apathetic and not enjoying the things or activities you usually enjoy. Many people experiencing depression also have symptoms of anxiety.

What is anxiety?

Anxiety is a feeling of worry or fear. Feeling a little anxious is normal. However, some people have a hard time controlling their anxiety and it affects their daily life, for example, in forming and maintaining relationships, enjoying their leisure time or achieving their goals and in holding down a job. Anxiety is the main symptom of several other mental health difficulties, including PTSD.

What is PTSD?

PTSD is a mental health condition which can develop after a stressful, frightening or distressing event or a prolonged traumatic experience. Individuals with PTSD may experience vivid flashbacks, intrusive thoughts and nightmares or disturbed sleep. In addition, some people with PTSD feel alert and on edge, irritable, aggressive, or cannot feel their feelings at all. People experiencing PTSD may also experience physical symptoms such as chest pains, headaches, dizziness or stomach aches.

The findings

Our findings showed that the injured group had greater rates of depression, anxiety and PTSD compared to the uninjured group. However, the type of injury seemed to have a significant impact. Participants with amputation-related injuries had very similar rates of mental health problems compared to the uninjured group, whereas those with non-amputation injuries had significantly higher rates of mental health problems.

Here are the findings in more detail:

  • Rates of PTSD, anxiety and depression were higher in the injured vs. uninjured group:
    • Depression: 23.6% in injured vs. 16.8% in uninjured.
    • Anxiety: 20.8% in injured vs. 13.5% in uninjured.
    • PTSD: 16.9% in injured vs. 10.5% uninjured.
  • Rate of mental health multimorbidity was also higher in the injured vs. uninjured group (15.3% vs. 9.8%).
  • Participants with amputations reported very similar rates of mental health issues compared to the uninjured group. However, participants with non-amputation injuries were up to twice as likely to suffer from mental health issues.

What do these findings mean and what next?

The ADVANCE Study has shown that serious physical combat injuries are associated with poorer mental health outcomes, with greater rates of PTSD compared to the general population and an increased psychological burden from multimorbidity. However, the type of injury, in particular amputation, has a significant impact on these outcomes.

One of the main questions that arises from the early mental health findings is around the differences in outcomes between the amputees and the injured non-amputees. We are working on finding out the reasons for these differences.

It is important to stress that these initial findings are from the baseline data only. As ADVANCE progresses, we will collect and analyse further data on mental health as well as physical health. We look forward to seeing what the follow-up data reveals over the 20-year duration of the ADVANCE Study.