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

  • Catherine Hitch

Student thesis: Doctoral ThesisDoctor of Philosophy


Research suggests that higher rates of poor mental health and low support services across Northern Ireland (NI) may account for an increased risk of mental health difficulties in NI veterans, especially as they tend to self-marginalise. To help support them this thesis set out to understand the relationship between trauma, mental health, alcohol and help-seeking for NI veterans. Two systematic reviews found help-seeking predictors, enablers and barriers predominantly related to mental health functional impairment, cultural beliefs, social support, attitudes towards mental health, alcohol and help-seeking. Alcohol was an initial help-seeking barrier. Four empirical studies, based on Northern Ireland Veteran Health and Wellbeing Survey data taken from 609 participants, found there were both high rates of lifetime co-occurring trauma and co-occurring mental health/alcohol issues: with self-reported symptoms reaching clinically relevant levels. Latent class analysis (LCA) of 16 traumatic experiences found most participants experienced conflict-related trauma but with little impact on mental health outcomes for 60% of participants. 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’.

Thesis embargoed until 31st December 2027
Date of AwardDec 2022
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SponsorsRoyal British Legion
SupervisorCherie Armour (Supervisor) & Paul Toner (Supervisor)


  • Trauma
  • mental health
  • alcohol
  • help-seeking
  • military
  • veterans
  • hidden
  • Northern Ireland

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