Great to see a new paper published in BMJ Military Health, led by Amos Simms, alongside Neil Greenberg, Nicola T. Fear and me.
Mental health and well-being among military remotely piloted aircraft systems personnel: a systematic reviewbrings together the available evidence on the mental health and well-being of military personnel working with remotely piloted aircraft systems (RPAS).
Remote warfare does not mean an absence of stress
RPAS personnel occupy a somewhat unusual position in modern military operations. They can be geographically distant from the battlefield while remaining closely involved in operational activity, sometimes over prolonged periods.
This creates a potentially distinctive combination of operational, organisational and moral stressors.
Our review identified 14 studies examining mental health and well-being among military RPAS personnel. Across these studies, rates of probable post-traumatic stress disorder were broadly comparable with those seen in other military populations.
That is an important finding, but it is only part of the story.
The evidence suggests that the challenges facing RPAS personnel may be driven as much by how the work is organised as by exposure to combat itself.
A recurring theme across the literature was occupational strain. Long working hours, unstable shift patterns, understaffing, role conflict and disrupted sleep were all associated with poorer outcomes. Emotional exhaustion, psychological distress, sleep problems and functional impairment were also evident within the literature.
Looking beyond exposure to combat
I think one of the more interesting aspects of this work is that it challenges a relatively simple assumption about military mental health: that proximity to combat is necessarily the main determinant of psychological impact.
For RPAS personnel, the picture appears more complicated.
The organisational environment in which people operate, including workload, staffing, leadership, team cohesion and opportunities for adequate sleep and recovery, may be particularly important. Conversely, supportive leadership, strong teams, adequate sleep and positive attitudes towards seeking help emerged as potential protective factors.
This matters because many of these factors are potentially modifiable. They are not simply unavoidable consequences of military operations.
Where next?
The evidence base remains relatively small. Much of the existing research is cross-sectional, making it difficult to understand how the experiences and mental health of RPAS personnel change over time.
There is a clear need for more longitudinal research, appropriate comparison groups and, importantly, studies evaluating interventions aimed at the occupational and organisational factors identified in this review.
As remotely piloted and increasingly autonomous systems become an even more significant part of military operations, understanding the people operating alongside these technologies will remain important.
Congratulations in particular to Amos, who led this work as part of his wider research examining remote warfare and its impact on military personnel.
Read the paper
Amos Simms, Neil Greenberg, Daniel Leightley & Nicola T. Fear.
Mental health and well-being among military remotely piloted aircraft systems personnel: a systematic review.
BMJ Military Health, 2026.
https://militaryhealth.bmj.com/content/early/2026/09/03/military-2026-003419
DOI: 10.1136/military-2026-003419