New Study Spotlight: The Armed Services Trauma Rehabilitation Study – Combat Injury-Related Challenges to Sexual Intimacy (the ADVANCE-CIRCUIT study).
Welcome to 'New Study Spotlight', where we interview researchers about their new studies to raise awareness and keep you up to date with current research focused on the Armed Forces community. Read on to learn about new research, its importance and relevance, aims, and intended impact and benefit for the Armed Forces community. To learn about all current UK research with the Armed Forces community, you can search Ongoing Research here.
In this issue, we have a PhD Special. We interviewed Anna Verey (King’s Centre for Military Health Research, King’s College London) about her new PhD research, the ADVANCE-CIRCUIT study, investigating combat injury-related challenges to sexual intimacy.
The Armed Services Trauma and Rehabilitation Outcome (ADVANCE) study investigates the long-term physical and psycho-social outcomes of combat casualties. It is a collaboration between the Academic Department of Military Rehabilitation (ADMR, Stanford Hall), Imperial College London, and King’s College London. The ADVANCE-CIRCUIT study is a subsidiary of the main ADVANCE study.
The ADVANCE-CIRCUIT study has one overarching aim: that individuals who sustain occupational injuries which lead to the development of sexual dysfunction are enabled to live the most fulfilling lives possible.
Why is this research important and why now?
Investigations into the prevalence of sexual dysfunction among male military personnel from European countries are limited in number and scale, with no such data stemming from the UK. This study will provide accurate prevalence data on sexual dysfunction, longitudinally, in a cohort of approximately 1200 UK Armed Forces (UKAF) serving and ex-serving personnel who deployed to Afghanistan, approximately half of whom were seriously injured and half of whom were not.
Few civilian men seek assistance for sexual dysfunction, suggesting a high level of unmet need. Reluctance to seek help for sexual dysfunction is exacerbated by cultures of hypermasculinity and military culture has a reputation for being a masculine arena. However, co-designed interventions are suggested to be the cornerstones of accessible and effective treatment for sexual dysfunction, which promote beneficiary engagement.
Through two qualitative work packages, this project will co-design intervention principles in partnership with UKAF personnel (both ADVANCE-CIRCUIT participants and Patient and Public Involvement and Engagement members) and UK healthcare service providers, to inform a population-centred, evidence-based, health systems response.
At a time of heightened global insecurity and conflict, it is important to know how to support those whose sex lives are newly affected by their injuries and those who face unresolved ongoing challenges from prior conflicts.
What is the problem in the world that this aims to address?
The problem is threefold: prevalence data on sexual dysfunction among male military personnel from UK are lacking; UKAF personnel whose sex lives have been negatively impacted by their injuries do not know where to go for support; and UK-based support service providers are not routinely asking their beneficiaries about whether their injuries having impacted their sex lives.
What questions will the research aim to answer?
- What is the prevalence, longitudinally, of sexual dysfunction in male UKAF personnel who sustained a serious combat injury whilst deployed to Afghanistan (and in a comparison group)?
- What are the risk factors and mental health outcomes associated with sexual dysfunction in combat-deployed UKAF personnel?
- What are the experiences, help-seeking behaviours and support needs of UKAF personnel with sexual dysfunction?
- Which intervention principles should shape a population-centred, evidence-based, health systems response?
How will it answer these questions (the research method in lay terms)?
ADVANCE is a 20-year study set up to investigate the long-term physical and psychosocial outcomes of male combat injured UKAF personnel. In ADVANCE, participants are assessed over a 20-year period, at baseline (T0), three (T1), six (T2), ten (T3), 15 (T4) and 20 (T5) years. T0 data were collected between March 2016 and August 2018 (an average of eight years post-injury); T1 data were collected May 2019 and August 2023; T2 data collection started in January 2023 and aims to finish mid-2026. At each time point, participants undergo a series of physical health tests and are administered self-report questionnaires.
The “injured group” (T0, n=579; T1, n=526) sustained their injury in Afghanistan (between 2003-2014) and the “comparison group” (T0, n=565; T1, n=527) were frequency-matched on age, Service branch, rank, deployment phase, and role (29). Details of both groups were provided by the Ministry of Defence, Defence Statistics, UK. Sample size calculations were based on cardiovascular disease and anticipated attrition at the 20-year point.
All participants are male. Women were only allowed to take on front-line combat roles from 2018 by which point combat operations had ended for UKAF personnel in Afghanistan. Full details of ADVANCE, including the study protocol are available here.
The ADVANCE study collects data on sexual dysfunction via the Arizona Sexual Experiences Scale (ASEX). The ASEX is a five-item, self-report questionnaire, measuring key domains of sexual function. The ASEX has been administered to all ADVANCE participants at three time points, since 2016. In ADVANCE, data are also collected on mental health outcomes, injury type, and medication use. ADVANCE data will be analysed to provide accurate prevalence data on sexual dysfunction in male UKAF serving and ex-serving personnel who deployed to Afghanistan and to determine associated risk factors and mental health outcomes.
Approximately 15 qualitative one-to-one interviews will be conducted to understand the experiences, help-seeking behaviours and support needs of UKAF personnel with sexual dysfunction. A focus group, made up of approximately eight UK support service providers, will take place. Data from the focus group will be analysed in conjunction with the qualitative interviews to determine which intervention principles should inform a population-centred, evidence-based health systems response to this issue.
What are the intended outcomes and impact of the research?
Accurate longitudinal, prevalence data on sexual dysfunction in a cohort of UKAF personnel who deployed to Afghanistan, approximately half of whom were seriously injured, will be provided. The physical injuries that are driving these prevalence rates will be determined and the mental health outcomes which result from living with combat injury-related sexual dysfunction will be identified.
Understanding the experiences, help-seeking behaviours and support needs of UKAF personnel whose sex lives have been negatively impacted by their injury(-ies) and the perspectives of UK support service providers working in this field will allow for the generation of a population-centred, evidence-based, health systems response to better meet the needs of those with this issue.
Who is funding the research?
The Colt Foundation
What are the project's key milestones (e.g. recruitment, analysis, results available)?
I will conduct my systematic literature in 2026, quantitative data analysis (prevalence, risk factors and mental health outcomes) in 2027, and qualitative data (interviews and focus group) analysis in 2028. Results from the systematic literature review will become available from the end of 2026. Following that, results from the aforementioned work packages will be released each year.
Many thanks to Anna Verey for authoring this New Study Spotlight.
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