The Foundation-funded Gambling problems among Australian military personnel after deployment: analyses of the Middle East Area of Operations Prospective Health Study is believed to be the first research study into gambling among Australian Defence Force (ADF) personnel.
Led by Senior Research Fellow Dr Sean Cowlishaw from Melbourne University’s Phoenix Australia Centre for Posttraumatic Mental Health, a not-for-profit centre based in the Department of Psychiatry, the study highlights the extent, risk factors, and implications of gambling problems among current members of the ADF.
Research study context
The study considered a spectrum of gambling harm and problem severity, which was broader than just a psychiatric diagnosis of gambling disorder. This covers gambling harm and problems ranging from clinically significant conditions to at-risk behaviour that may be targeted in early intervention programs.
‘Gambling behaviours and problems can fall along a spectrum of severity,’ says Dr Cowlishaw. ‘It’s critical that our attempts to reduce harm include a focus on prevention, along with early identification and intervention, as well as responses to clinically significant conditions. The latter may also need to consider complex co-occurring mental health problems that occur in the context of trauma.’
Threat to life and trauma exposure may be part of the job ...’ Dr Sean Cowlishaw
He gave a figure of 58 per cent for gambling comorbidity with mental health issues and substance use disorders in the general population, while gambling harms are present in around 23 per cent of people in substance use treatment within addiction services.
An important context for the study was the military culture: a hierarchical organisation with regimented training that regularly takes people (primarily men) and places them in high-risk operations. Coupled with frequent relocations, personnel can at times experience disconnection from broader society.
‘Threat to life and trauma exposure may be part of the job and create individual risks for gambling harm,’ says Dr Cowlishaw.
… personnel can at times experience disconnection from broader society.
At a base level, most current serving personnel have lower rates of mental ill-health than the general population, potentially explained by such conditions prohibiting people from ever joining the military.
But higher risks occur during transition periods such as coming home from deployment and moving out of the service, with common issues including post-traumatic stress disorder (PTSD), anger, and alcohol misuse. In the Australian context, serving personnel are also returning to one of the most highly accessible and hazardous gambling environments in the world.
While most data about gambling harm and members of the military comes from US studies, ‘Australian data from the early 2000s in hospital-based PTSD programs indicated that 29 per cent of veterans in PTSD treatment reported gambling harm,’ reports Dr Cowlishaw.
‘But despite Australia having the highest levels of gambling expenditure per capita in the world – which means we have a very different risk environment from the British and Americans – we have had almost no data on those deployed to Afghanistan and Iraq, referred to collectively as the Middle East Area of Operations.’
The research drilled into the ‘Middle East Area of Operations Prospective Health Study’ which involved 3074 ADF personnel who deployed between 2010 and 2012. It analysed data captured via surveys issued at pre-deployment (60.9 per cent response rate) and post-deployment (43.1 per cent response rate).
The Problem Gambling Severity Index was also administered both before and after deployment.
While, perhaps unsurprisingly, PTSD was the highest reported mental health issue, approximately eight per cent of recently returned personnel reported issues across a spectrum of gambling harm.
‘It’s salient that this was reported at a higher rate than other mental health issues such as harmful drinking, which came in at five per cent,’ says Dr Cowlishaw.
Gambling may function as a coping strategy.
Groups identified as more vulnerable to gambling harm included men in the 18 to 24 years age range at 13.4 per cent, and Army personnel, relative to Navy and Air Force, at 9.7 per cent.
Gambling harm also appeared to exacerbate post-deployment adjustment difficulties such as not wanting to talk to family and friends, more frequent arguments with a partner, and difficulties resuming normal social activities. It was also speculated that gambling may function as a coping strategy and way of dealing with adjustment difficulties, which may then cause further harm and negative consequences.
‘Fundamentally, gambling issues are of significant concern to some ADF personnel post-deployment,’ continues Dr Cowlishaw. ‘They return to Australia, where gambling is normalised, gambling advertising is rampant, and remote gambling access is total.
‘… there was a relationship between gambling problems and other mental health issues …’ Dr Sean Cowlishaw
‘Another key finding was that there was a relationship between gambling problems and other mental health issues, with 41 per cent of personnel who reported more severe gambling harm also experiencing PTSD. The overall rates were comparable to other mental health issues such as alcohol-use problems, and services need to recognise this and embed responses within military-specific services.’
The researchers conclude that developing services to identify personnel at risk, but not yet in the grip of gambling harm presents a compelling opportunity for early intervention and pathways to treatment and support.