UK Military Veterans and the Prevalence-Inflation Hypothesis.

Military veterans in the United Kingdom constitute a distinct and important segment of the population. They are individuals who have experienced the unique culture, demands, and stresses of military life and who, upon leaving service, face a series of transitions into civilian society. Over recent decades, increasing attention has been given to the mental health and wellbeing of this group. There has been growing public concern, numerous government initiatives, and an expanding network of charitable and clinical services designed specifically to meet veterans’ psychological needs. Alongside these developments, reported rates of mental health problems among both serving personnel and veterans appear to have risen. This has generated discussion about whether these apparent increases represent genuine rises in mental disorder or whether other factors, such as improved recognition, diagnostic change, and heightened awareness, play a role in shaping the statistics.

One conceptual framework that attempts to explain such phenomena is the “prevalence-inflation hypothesis,” developed by Lucy Foulkes and Jack Andrews in their paper Are Mental Health Awareness Efforts Contributing to the Rise in Reported Mental Health Problems? The authors propose that while awareness campaigns can improve recognition of mental illness and encourage help-seeking, they may also lead to the over-interpretation of normal emotional distress as mental disorder, thereby inflating apparent prevalence rates. This essay explores how that hypothesis can be applied to the context of UK military veterans. It considers the history and nature of veterans’ health concerns, outlines the main features of the prevalence-inflation hypothesis, and critically analyses its potential relevance and limitations when interpreting the mental health landscape of Britain’s veteran community. The aim is to provide a nuanced account of how conceptual, social and cultural dynamics might shape what we perceive as an increase in veterans’ mental ill-health.

The United Kingdom has a long tradition of military service, and veterans form a substantial population numbering in the millions. They are a highly diverse group, spanning generations, branches of service, and social backgrounds. Some have experienced direct combat, others have served in support or peacekeeping roles, and many have transitioned into civilian life successfully. Yet it is equally clear that a significant proportion of veterans experience challenges after leaving the armed forces. The transition to civilian life can involve the loss of comradeship, purpose, and structure; it can expose individuals to unemployment, financial strain, or social isolation and for those who have experienced traumatic events during service, such as combat exposure, moral injury, or witnessing death, these stressors can be compounded by the psychological aftermath of trauma.

In public discussion and in research, certain mental health conditions have become emblematic of the veteran experience, particularly post-traumatic stress disorder (PTSD), depression, anxiety, and alcohol misuse. Over the past two decades, the recognition of such problems has increased dramatically, and there has been a concerted effort to provide specialised clinical services and outreach programmes. The National Health Service now operates veteran-specific mental health pathways, and numerous charities provide psychological support, therapy, and social rehabilitation. Public awareness campaigns and media coverage have amplified these efforts, often portraying veterans as vulnerable and highlighting stories of struggle, suicide, or long-term trauma.

While this growing awareness has undoubtedly been beneficial in reducing stigma and encouraging veterans to seek help, it has also raised complex questions about measurement and interpretation. Reported prevalence rates of mental health problems among veterans have risen over time, but so too have the opportunities for detection, the cultural acceptability of self-reporting, and the conceptual boundaries of what counts as a mental health problem. It is therefore not immediately clear whether the apparent rise in prevalence reflects a true increase in disorder or a shift in social and diagnostic practices. This uncertainty is precisely the domain in which the prevalence-inflation hypothesis becomes relevant.

Lucy Foulkes and Jack Andrews developed the prevalence-inflation hypothesis to explain why reported rates of mental health problems in the general population have increased, especially among young people, in the context of unprecedented public awareness. Their central argument is that awareness campaigns and education about mental health have two opposing effects. On one hand, they yield a positive outcome by improving mental health literacy, reducing stigma, and enabling people who previously suffered in silence to recognise their difficulties and seek help. On the other hand, such efforts may unintentionally encourage individuals to interpret ordinary or transient emotional states, sadness, stress, worry, frustration, as symptoms of mental illness. and when normal fluctuations in mood or behaviour are medicalised, the apparent prevalence of mental health problems rises, even if the underlying level of distress in society remains constant.

Foulkes and Andrews suggest that this process involves not only shifts in perception but also deeper identity and behavioural changes. Once a person identifies with a diagnostic label, such as depression, anxiety, or PTSD, that label can influence how they interpret future experiences, how they behave, and how others respond to them. This may have therapeutic benefits; for others, it can entrench a sense of vulnerability or illness that perpetuates distress. Over time, such self-labelling, combined with expanded diagnostic boundaries and greater willingness to report, can produce what appears to be an increase in prevalence. This is not to deny that real increases in mental ill-health may occur due to social or economic stressors, but to highlight that measurement and interpretation are shaped by cultural context as much as by pathology.

The hypothesis thus offers a dual-mechanism model: improved recognition of previously hidden disorders and simultaneous over-interpretation of non-disordered distress. In societies with expanding mental health literacy, both forces operate in tandem. The net effect may be an apparent epidemic of mental illness that partly reflects genuine need but also a shift in how we define and experience mental health itself.

When applied to the context of UK military veterans, the prevalence-inflation hypothesis acquires distinctive features. Veterans occupy a social space in which mental health awareness, trauma narratives, and collective identity intersect in particularly powerful ways. In recent years, public and institutional recognition of veterans’ mental health has grown exponentially. Campaigns have sought to destigmatise help-seeking, and the media frequently highlight the psychological costs of service and within the veteran community itself, discussions of trauma, PTSD, and transition difficulties have become increasingly prominent. This changing discourse has clear benefits: it acknowledges suffering that was once ignored and legitimises psychological help as part of the veteran experience. Yet it may also contribute to processes that resemble those described by Foulkes and Andrews.

The first mechanism of the hypothesis, improved recognition, is readily apparent. Historically, many veterans with psychological injuries went unrecognised or untreated. Terms such as “shell shock” or “battle fatigue” once carried stigma and misunderstanding, and formal treatment was rare. Today, awareness and services have expanded to ensure that those with genuine trauma-related disorders are identified and supported. This is a positive and necessary development. It explains part of the increase in diagnosed mental health conditions among veterans: people who once would have suffered invisibly are now counted.

The second mechanism, over-interpretation of distress, is more complex but equally plausible in the veteran context. Leaving the armed forces often entails a profound identity shift. Veterans may experience loneliness, a loss of purpose, or difficulty adapting to civilian norms. These are natural responses to life transition, yet in a culture saturated with mental health messaging, such feelings may be quickly interpreted through a clinical lens. A veteran who struggles to adjust might self-diagnose depression or PTSD, not necessarily because of underlying pathology but because these categories provide an accessible framework for understanding distress. The diagnostic language offers both explanation and legitimacy, but it may also encourage individuals to view themselves as permanently damaged or ill, even when their difficulties are situational and potentially transient.

Furthermore, veteran-specific services and charities, while invaluable, can unintentionally reinforce this dynamic. Many outreach programmes are built around narratives of trauma and recovery. Their publicity materials often emphasise the high risk of PTSD or suicide among veterans in order to secure funding and attract those in need. This is understandable, but it can create an impression that psychological injury is an almost inevitable consequence of military service. Sadly, some veterans internalise these messages and interpret ordinary struggles of adjustment as symptoms of mental disorder, thereby increasing self-reported prevalence rates.

The veteran community also has strong social cohesion and shared cultural narratives. Storytelling about service experiences, trauma, and recovery can foster belonging but may simultaneously normalise the idea that veterans are “damaged” or “broken.” In group settings, adopting such identities can become a way of maintaining membership or solidarity and from the perspective of the prevalence-inflation hypothesis, this illustrates how awareness and social dynamics can shape the boundaries between distress and disorder.

Another factor relevant to the hypothesis is the evolving diagnostic landscape. The criteria for PTSD and related conditions have broadened over successive editions of diagnostic manuals, and new categories such as “complex PTSD” or “moral injury” have emerged. These refinements have improved sensitivity to different forms of trauma but also lowered the threshold for diagnosis. Consequently, more veterans may fit the criteria, even if the intensity or functional impact of symptoms remains similar to past cohorts. Increased research, screening, and clinical outreach further enhance detection, contributing to apparent prevalence growth without necessarily reflecting a rise in true incidence.

To understand the relationship between veterans and the prevalence-inflation hypothesis, it is important to distinguish between real prevalence (the actual proportion of individuals suffering from clinically significant disorder) and reported prevalence (the proportion who identify or are identified as having a mental health problem). The two are related but not identical. Real prevalence may rise due to genuine increases in exposure to trauma, socioeconomic stress, or social dislocation. Reported prevalence can rise even if real prevalence remains constant, through improved awareness, lower diagnostic thresholds, or self-labelling.

In the case of UK veterans, there are credible reasons to believe that both processes are operating. The wars in Iraq and Afghanistan exposed many service members to intense combat environments and moral challenges that undoubtedly increased the risk of trauma-related disorders. Simultaneously, society’s awareness of PTSD and other conditions expanded dramatically, making veterans more likely to recognise and report symptoms. This dual process mirrors the dual mechanism of the prevalence-inflation hypothesis: genuine discovery of hidden cases combined with inflationary reporting driven by cultural change.

It is also worth considering that prevalence inflation may not always be harmful, simply because, awareness leads people to seek help earlier, even for mild distress, it can prevent more serious deterioration. The problem arises only if over-interpretation leads to unnecessary medicalisation or self-identification with illness in ways that impede recovery and for some veterans, adopting a clinical label provides validation and access to support; for others, it may entrench dependency or hinder adaptation. The balance between these outcomes is delicate and requires careful management by clinicians, policymakers and charities.

One of the most distinctive features of the veteran context, and one that intersects closely with the prevalence-inflation hypothesis, is the role of identity. Military service instils a powerful collective identity based on discipline, loyalty and shared experience. Upon leaving service, that identity often becomes a source of pride but also a potential vulnerability. Its well documented that without the structure of the armed forces, some veterans experience a loss of purpose and belonging. In recent years, public narratives have increasingly defined the veteran identity through the lens of mental health and trauma and while this can foster empathy and solidarity, it may also narrow the social script available to veterans, suggesting that suffering and psychological injury are defining features of post-service life.

In this cultural context, adopting a mental health label may offer continuity with the collective identity: “I was a soldier; now I am a veteran with PTSD.” It provides a new but related sense of belonging. The prevalence-inflation hypothesis helps explain how such identity processes can translate into elevated reported prevalence. Labels not only describe experience but also shape it. When a label becomes central to self-understanding, symptoms may persist or intensify because they are woven into identity. Conversely, when identity is anchored in resilience, service values, or post-military purpose, distress may diminish even without clinical intervention.

Thus, the hypothesis does not imply that veterans fabricate symptoms but that social meanings attached to diagnosis influence how symptoms are experienced, reported, and maintained. In this way, awareness campaigns and cultural narratives can simultaneously alleviate stigma and alter the phenomenology of distress itself. For researchers and practitioners, recognising this interplay between culture, identity and reporting is essential to interpreting prevalence data responsibly.

If elements of the prevalence-inflation hypothesis apply to UK veterans, several implications follow for policy and practice. First, prevalence statistics must be interpreted with caution. Rising rates of diagnosed or self-reported mental health problems should not automatically be equated with deteriorating psychological wellbeing across the veteran population because some increases may represent successful identification of previously hidden need; others may reflect shifting boundaries of what counts as disorder. Policymakers should therefore base resource allocation not only on prevalence numbers but also on measures of functional impairment, quality of life, and service demand.

Second, clinical services should maintain clear diagnostic thresholds while offering graded responses to distress. A stepped-care approach that distinguishes between normal adjustment difficulties and clinically significant disorders can ensure that resources are directed where they are most needed, while still providing support for those experiencing mild but genuine distress. Peer support programmes, social reintegration initiatives, and vocational schemes may be more appropriate for some veterans than intensive psychological therapy or medication.

Third, awareness campaigns themselves need to be carefully designed. The goal should be to promote understanding and reduce stigma without inadvertently implying that all distress is pathological. Campaigns that emphasise resilience, recovery and post-traumatic growth can balance the narrative of vulnerability. Similarly, encouraging veterans to view help-seeking as a strength rather than a marker of illness may also mitigate the identity effects described earlier.

Finally, researchers studying veterans should incorporate measures that capture changing awareness and reporting behaviour. Longitudinal studies that track both symptoms and attitudes toward mental health can help disentangle real increases in disorder from prevalence inflation. Qualitative research exploring how veterans interpret and label their experiences would add depth to our understanding of these processes. Applying the prevalence-inflation hypothesis to veterans offers valuable insights but also faces important limitations. The first is methodological: it is extremely difficult to disentangle the contribution of awareness and diagnostic change from that of genuine increases in morbidity. Mental health data rely heavily on self-report questionnaires and diagnostic interviews that are sensitive to cultural norms and language. Even clinical diagnosis is influenced by changing professional standards and expectations. As such, any attempt to quantify the exact degree of prevalence inflation is fraught with uncertainty.

The second limitation is ethical. Emphasising prevalence inflation risks being interpreted as questioning the legitimacy of veterans’ suffering. This is not the intention of the hypothesis, which recognises the real and often severe psychological injuries that can result from service. Rather, it calls for a more nuanced understanding of how cultural and systemic factors influence reported data. Nevertheless, care must be taken in communication to avoid reinforcing stigma or suggesting that veterans’ mental health concerns are exaggerated.

A further consideration is that awareness and labelling may function differently across subgroups of veterans. Older veterans, for example, may remain reluctant to report mental health problems due to lingering stigma, while younger cohorts raised in an era of mental health openness may be more forthcoming. Thus, awareness may simultaneously reduce under-reporting in one group and increase self-labelling in another. The net effect on aggregate prevalence is therefore complex and not uniformly inflationary.

Finally, the hypothesis does not fully account for socioeconomic and structural determinants of mental health. Veterans often face housing difficulties, unemployment, or chronic physical injuries. These material stressors contribute to genuine psychological distress that cannot be explained by awareness or labelling. Any comprehensive understanding of veteran mental health must therefore integrate the prevalence-inflation hypothesis with broader social models of wellbeing.

The most productive way to apply the prevalence-inflation hypothesis to UK veterans is not as a challenge to the existence of mental health problems but as a framework for balance. It reminds researchers, clinicians and policymakers that apparent increases in prevalence are multifactorial. They reflect real suffering, improved detection, shifting cultural norms, and the evolving meanings of distress. Recognising this complexity allows for a more sophisticated approach to veteran mental health.

From this perspective, the rise in reported mental health problems among veterans is neither entirely real nor entirely artefactual. It is the result of interaction between lived experience and cultural interpretation. Awareness campaigns have empowered many veterans to seek help who would once have remained silent. Yet, at the same time, the very success of those campaigns may expand the boundaries of what counts as a mental health problem. The challenge is to harness the positive aspects of awareness reduced stigma, earlier intervention, increased empathy while minimising the risks of over-pathologisation.

This balance requires ongoing dialogue between veterans, clinicians, researchers, and policymakers. Veterans themselves must be active participants in defining what wellbeing and recovery mean for their community. Rather than focusing solely on symptom reduction, support systems should promote social reintegration, purpose, and identity reconstruction. In doing so, they address the underlying determinants of distress without necessarily relying on diagnostic labelling. Such an approach would align with the spirit of the prevalence-inflation hypothesis by acknowledging the power of cultural narratives while remaining committed to genuine care.

The mental health of UK military veterans is a complex and evolving issue. Over recent decades, rising awareness, improved services, and shifting cultural attitudes have transformed how veteran wellbeing is understood and addressed. The prevalence-inflation hypothesis, as articulated by Lucy Foulkes and Jack Andrews, provides a valuable conceptual tool for interpreting these developments. It suggests that increased awareness can simultaneously reveal hidden suffering and inflate apparent prevalence by encouraging the medicalisation of normal distress.

When applied to UK veterans, this hypothesis highlights both the successes and challenges of contemporary mental health culture. Veterans benefit from greater recognition and support, yet they also navigate a social landscape in which distress and diagnosis are closely intertwined. Some of the observed rise in reported mental health problems likely reflects real need stemming from trauma and transition stress. Some may also reflect changing perceptions, identity processes, and cultural expectations so distinguishing between the two is difficult but essential if policy and practice are to remain effective and proportionate.

Ultimately, the goal is not to minimise or inflate the scale of veterans’ mental health problems but to understand them more accurately. Awareness, when guided by evidence and nuance, remains a vital force for good. The prevalence-inflation hypothesis reminds us, however, that even beneficial cultural shifts have complex consequences and it will be by integrating this understanding into research, clinical work and public discourse, that the UK will be able to support its veterans in ways that honour their service, respect their individuality, and promote genuine psychological wellbeing rather than inadvertently pathologising the human process of adjustment and recovery.

Tony Wright