Trauma exposure and clinical presentation of UK veterans seeking specialist veteran mental health care

Background
Military veterans are at elevated risk of mental health conditions, including Post-Traumatic Stress Disorder (PTSD), Complex-PTSD (C-PTSD), depression and anxiety, among others. To address this need, in April 2023, the National Health Service (NHS) launched Op COURAGE, a specialized mental health service for veterans.

Aims
To describe the demographics, military history, trauma-related factors and clinical presentation, including comorbidities, of UK help-seeking veterans.

Methods
This retrospective study used data collected from a service evaluation involving veterans referred for support at an Op COURAGE service. Clinical data were gathered through self-report measures completed as part of routine clinical practice.

Results
Clinical data were collected from 157 veterans referred to London Op COURAGE between April 2023 and March 2025 (out of a total population of 475). The majority were male (88%), with an average age of 49 years, and 83% served in the Army. A total of 48% experienced four or more adverse childhood experiences, and 55% experienced five or more lifetime traumatic experiences. Concerning mental health, 87% met criteria for depression, 79% for anxiety and 67% for PTSD/C-PTSD. Of the sample, 71% endorsed three or more mental health difficulties.

Conclusions
Our findings indicate that help-seeking veterans present with a complex profile, characterized by high adversity and trauma exposure and significant mental health problems. Such complex mental health presentations can be difficult to treat, and these findings highlight the need for integrated care and tailored interventions. Future research could examine long-term outcomes of veterans with multiple comorbidities and investigate treatment adaptations.