This research has been published in BMJ Military Health; and was led by Swansea University, in collaboration with Queen's University Belfast, Anglia Ruskin University, Bangor University, Veterans' NHS Wales, Cardiff University, The Recovery Course and Reykjavik University.

Gambling is a growing public health concern, and online survey data collected from the UK Armed Forces Veterans' Health and Gambling Study notes military veterans are at heightened risk of more than ten times.

Financial difficulties

While some 10 per cent of UK military veterans get into financial difficulties after leaving the forces, routine mental health assessments after deployment don't currently include gambling.

With funding from the Forces in Mind Trust, this new study examined differences in healthcare use and social service provision between a sample of former UK soldiers and a comparison group of civilians who hadn't served in the military but matched in age and sex.

A total of 5,147 responses were received, with 2,185 people, 1,037 of whom were military veterans, and included in the final analysis. 

Respondents answered a series of questions about their mental health, health-related quality of life, and health services use. They were also asked about their ethnicity, marital status, educational attainment, hours worked, debt levels, welfare benefits, accommodation, and household size. Veterans provided additional details about the length and type of their military service. 

Researchers found that 43.1 per cent of the veterans had scores indicative of problem gambling, while among the non-veterans, the figure was 6.5 per cent.

The researchers compared costs and outcomes for the veterans according to their gambling severity score. For the preceding three months, resource use was grouped by service type, while unit costs were obtained from previously published sources.

Total costs were then calculated for health service use and social care plus societal costs, adjusting for potentially influential factors, such as ethnicity, country of residence, qualifications, and relationship status.

Veterans generally reported higher use of healthcare services, including hospital stays, visits to GPs, and contact with social workers than non-veterans. They made more use of gambling support, substance and alcohol misuse treatment services.

They also had more brushes with the police, lost more working hours, received more benefits and amassed larger debts than non-veterans (£1,375 vs £806). 

Cost analysis

The cost analysis revealed that veterans incurred substantially higher health, social care, and societal costs than non-veterans of around £600 per person. While veterans' average costs were lower if they were gamblers, their use of services rose as problem gambling severity scores increased, resulting in higher societal costs. 

These differences are likely to be driven by the impact of military service, which is associated with greater physical and mental health needs, suggest the researchers.

This is an observational study, and as such, it can't establish cause. The researchers also acknowledge that the economic analysis has some limitations. The study covers all of the UK but numbers recruited from NI were small - 28 veterans.

Data was collected at a single point in time, and greater healthcare costs for veterans are likely to indicate greater physical and mental health problems for this group unrelated to gambling.

Professor Cherie Armour from Queen’s University Belfast was involved in the project. She comments: “It was a pleasure to partner on the UK Armed Forces health and Gambling Study, led by colleagues at Swansea University. Together we aimed to understand gambling participation and severity among UK veterans relative to the general UK population.

“We wanted to better understand the physical and mental health behaviours and economic healthcare costs associated with gambling-related harm. We found high rates of problematic gambling in veterans which was associated with PTSD and in turn likely motivated by an attempt to escape from or avoid distress."

“Overall, veterans reporting problematic gambling had greater associated healthcare costs, related to both gambling and a range of gambling related harms. The situation for veterans residing in Northern Ireland is different from those in the rest of the UK with previous work suggesting increased rates of difficulties across an array of mental ill health and adverse behavioural outcomes. However, we do not know if this is true for gambling specifically as that study has not be done.”

Professor Armour adds: “We recommend that screening for problematic gambling at the end of service for UK Armed Forces veterans may offset both gambling related harms and thus related healthcare costs.” 

Project lead Professor Simon Dymond from Swansea University's School of Psychology comments: "Our findings support an economic case for screening for gambling-related harm among UK Armed Forces veterans. 

"The costs of routine post-deployment and end of service screening are relatively low. However, while costs may increase for those identified with mental health conditions, there is an obvious trade-off in the costs saved from future healthcare resource use as well as criminal justice contact and accrued debt."

Professor Cherie Armour

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