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    ABSTRACT: Most studies of the mental health of UK armed forces focus on retrospective accounts of deployment and few sample personnel while they are deployed. This study reports the results of a survey of deployed personnel, examining the perceived impact of events at home and military support for the family on current mental health during the deployment. Surveys were conducted with 2042 British forces personnel serving in Iraq and Afghanistan. Prevalence of common mental disorders was assessed with the 12-item General Health Questionnaire (GHQ-12) and post-traumatic stress disorder (PTSD) was assessed with the PTSD Checklist - Civilian version (PCL-C). The prevalence of common mental disorders was 17.8% and of probable PTSD was 2.8%. Perceived home difficulties significantly influenced the mental health of deployed personnel; the greater the perception of negative events in the home environment, the greater the reporting of adverse mental health effects. This finding was independent of combat exposure and was only partially mitigated by being well led and reporting subjectively good unit cohesion; however, the effect of the totality of home-front events was not improved by the latter. Poor perceived military support for the family had a detrimental impact on deployment mental health. The armed forces offer many support services to the partners and families of deployed personnel and ensuring that the efforts being made on their behalf are well communicated might improve the mental health of deployed personnel.
    The British journal of psychiatry: the journal of mental science 04/2012; 201:193-8.
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    ABSTRACT: Combat exposure can increase the risk of subsequent psychological ill-health in armed forces (AF) personnel. A U.S. postdeployment psycho-educational intervention, Battlemind, showed a beneficial effect on mental health in U.S. military personnel exposed to high combat levels. We evaluated the effectiveness of an anglicized version of postdeployment Battlemind. Battlemind was adapted for the United Kingdom. The main amendments were to sections about carrying weapons, driving, and alcohol misuse. The anglicized Battlemind was compared with the U.K. standard postdeployment brief in a cluster randomized controlled trial. At baseline, 2,443 U.K. AF personnel returning from Afghanistan via Cyprus completed questionnaires about their combat experiences and mental health. Of these, 1,616 (66%) completed 6-month follow-up questionnaires. We used the Posttraumatic Stress Disorder Checklist (PCL-C) to measure probable posttraumatic stress disorder and the General Health Questionnaire (GHQ-12) to measure common mental disorders. Secondary outcomes included alcohol misuse, assessed with the Alcohol Use Disorders Identification Test (AUDIT), and binge drinking. Mixed-effects models were used to account for possible cluster effects. We did not find a difference in mental health or overall AUDIT score. Those who received Battlemind versus the standard brief were less likely to report binge drinking, although the effect size was small (adjusted odds ratio = 0.73, 95% CI [0.58, 0.92]). The anglicized Battlemind did not improve mental health but had a modest impact on the reporting of binge drinking. Alcohol misuse is problematic in military populations; therefore, an intervention that reduces binge drinking may be helpful.
    Journal of Consulting and Clinical Psychology 03/2012; 80(3):331-41.
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    ABSTRACT: UK Armed Forces (AF) personnel deployed to Afghanistan are frequently exposed to intense combat and yet little is known about the short-term mental health consequences of this exposure and the potential mitigating effects of military factors such as cohesion, morale, and leadership. To assess the possible modulating influence of cohesion, morale, and leadership on post-traumatic stress disorder (PTSD) symptoms and common mental disorders resulting from combat exposure among UK AF personnel deployed to Afghanistan, UK AF personnel, during their deployment to Afghanistan in 2010, completed a self-report survey about aspects of their current deployment, including perceived levels of cohesion, morale, leadership, combat exposure, and their mental health status. Outcomes were symptoms of common mental disorder and symptoms of PTSD. Combat exposure was associated with both PTSD symptoms and symptoms of common mental disorder. Of the 1,431 participants, 17.1% reported caseness levels of common mental disorder, and 2.7% were classified as probable PTSD cases. Greater self-reported levels of unit cohesion, morale, and perceived good leadership were all associated with lower levels of common mental disorder and PTSD. Greater levels of unit cohesion, morale, and good leadership may help to modulate the effects of combat exposure and the subsequent development of mental health problems among UK Armed Forces personnel deployed to Afghanistan.
    Psychiatry Interpersonal & Biological Processes 01/2012; 75(1):49-59.
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    ABSTRACT: In the context of increasing concerns for the health of UK armed forces veterans, this study aims to compare the prevalence of current mental, physical and behavioural difficulties in conscripted national service veterans with population controls, and to assess the impact of length of service in the military. The compulsory nature of national service sets these veterans apart from younger veterans. Data are drawn from a nationally representative community-dwelling sample of England. We compared 484 male national service veterans to 301 male non-veterans aged 65+ years. There were no differences in mental, behavioural or physical outcomes, except that veterans were less likely to have "any mental disorder" than non-veterans (age adjusted OR = 0.56, 95% CI 0.31, 0.99). Longer serving veterans were older but were not different in terms of mental, behavioural or physical outcomes. Community-dwelling national service veterans are at no greater risk of current adverse mental, physical or behavioural health than population controls.
    Social Psychiatry 07/2011; 46(7):559-66.
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    ABSTRACT: Concerns about the mental health of military personnel deployed to Iraq and Afghanistan has led to a new generation of research. This review is an examination of the UK literature on the mental health consequences of deployment of armed forces personnel to Iraq and Afghanistan. As yet, deployment to Iraq or Afghanistan has not been associated with a general increase in mental health problems for the UK Armed Forces. However, research has highlighted certain problems that continue to need to be addressed. Whilst, the rate of post-traumatic stress disorder (PTSD) is low in the UK Armed Forces (1.6-6%), deployment to Iraq or Afghanistan is associated with an increased risk of PTSD for reserve personnel. In contrast to PTSD, the rate of alcohol misuse is high in the UK Armed Forces (between 16-20%), and has been associated with deployment to Iraq or Afghanistan for regular personnel. As the UK military engagement in Afghanistan continues and more personnel are deployed, the demand for help from military health services, the NHS and the service charities will increase.
    International Review of Psychiatry 04/2011; 23(2):153-9.
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    ABSTRACT: There is concern surrounding the psychological health and uptake of treatment services among veterans of the UK Armed Forces. Data from a cross-sectional, nationally representative sample were used to compare health outcomes and treatment seeking among 257 post-national service veterans aged 16-64 years and 504 age and sex frequency-matched non-veterans living in the community in England. Early leavers (<4 years service) were compared with longer serving veterans. Male veterans reported more childhood adversity and were more likely to have experienced a major trauma in adulthood than non-veterans. There was no association between any measure of mental health and veteran status in males, except reporting more violent behaviours [adjusted odds ratio (aOR) 1.44, 95% confidence interval (CI) 1.01-2.06]. In females, a significant association was found between veteran status and ever having suicidal thoughts (aOR 2.82, 95% CI 1.13-7.03). No differences in treatment-seeking behaviour were identified between veterans and non-veterans with any mental disorder. Early service leavers were more likely to be heavy drinkers (aOR 4.16, 95% CI 1.08-16.00), to have had suicidal thoughts (aOR 2.37, 95% CI 1.21-4.66) and to have self-harmed (aOR 12.36, 95% CI 1.61-94.68) than longer serving veterans. The findings of this study do not suggest that being a veteran is associated with adversity in terms of mental health, social disadvantage or reluctance to seek treatment compared with the general population. Some evidence implies that early service leavers may experience more mental health problems than longer-serving veterans.
    Psychological Medicine 02/2011; 41(2):363-72.
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    ABSTRACT: Culture plays a crucial role in the military, helping the armed forces achieve their goals. However, cultural issues can negatively affect personnel's well-being and effectiveness, especially when there is a "clash" between military and other cultures. The literature suggests there should be more training and education on individual service cultures, as well as other countries' military cultures to improve cooperation and coordination during joint operations and working in multinational forces. A greater knowledge of local cultures may help avoid offending noncombatants. When deployment ends, service personnel need more support when they transition back to civilian culture.
    Military medicine 12/2010; 175(12):958-63.
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    ABSTRACT: Communication with home can be beneficial to deployed service members' mental health, morale, and occupational effectiveness. Conversely a lack of communication with home increases the risk of developing mental health problems. Therefore it is important to ensure that communications media is both affordable and accessible while on deployment. However, contact with families can sometimes have negative effects, particularly when problems arise at either end. It can also be difficult for military personnel and their families if the level of contact is lower than they expected. Conversely, too much contact with home may have a negative impact on occupational effectiveness. More research is required to determine the optimal level of communication with home. Additional research is required to determine which types of communications media are most beneficial and whether the benefits of communication with home differ depending on the context of the deployment and the family status of the service member.
    Military medicine 10/2010; 175(10):745-9.
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    ABSTRACT: Trauma Risk Management is a peer-support program that aims to promote help-seeking in the aftermath of traumatic events. Prior to its implementation, the British military conducted a randomized controlled trial of Trauma Risk Management against standard care in 12 warships; 6 were randomized to use Trauma Risk Management after collecting baseline measurements. Follow up after 12-18 months found no significant change in psychological health or stigma scores in either group; however, the studied vessels only encountered low numbers of critical incidents. Additionally, measurements of organizational functioning were modestly better in the Trauma Risk Management ships. The authors conclude that within organizations using Trauma Risk Management may be beneficial and may, in time, lead to a valuable cultural shift.
    Journal of Traumatic Stress 08/2010; 23(4):430-6.
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    ABSTRACT: Concerns have been raised about the psychological effect of continued combat exposure and of repeated deployments. We examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009, the effect of multiple deployments, and time since return from deployment. We reassessed the prevalence of probable mental disorders in participants of our previous study (2003-05). We also studied two new randomly chosen samples: those with recent deployment to Afghanistan, and those who had joined the UK armed forces since April, 2003, to ensure that the final sample continued to be representative of the UK armed forces. Between November, 2007, and September, 2009, participants completed a questionnaire about their deployment experiences and health outcomes. 9990 (56%) participants completed the study questionnaire (8278 regulars, 1712 reservists). The prevalence of probable post-traumatic stress disorder was 4.0% (95% CI 3.5-4.5; n=376), 19.7% (18.7-20.6; n=1908) for symptoms of common mental disorders, and 13.0% (12.2-13.8; n=1323) for alcohol misuse. Deployment to Iraq or Afghanistan was significantly associated with alcohol misuse for regulars (odds ratio 1.22, 95% CI 1.02-1.46) and with probable post-traumatic stress disorder for reservists (2.83, 1.23-6.51). Regular personnel in combat roles were more likely than were those in support roles to report probable post-traumatic stress disorder (1.87, 1.26-2.78). There was no association with number of deployments for any outcome. There was some evidence for a small increase in the reporting of probable post-traumatic stress disorder with time since return from deployment in regulars (1.13, 1.03-1.24). Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of probable post-traumatic stress disorder was low. These findings show the importance of continued health surveillance of UK military personnel. UK Ministry of Defence.
    The Lancet 05/2010; 375(9728):1783-97.
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