Neil Greenberg

ICL, Londinium, England, United Kingdom

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Publications (170)681.45 Total impact

  • Elizabeth Banwell · N Greenberg · P Smith · N Jones · M Fertout ·
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    ABSTRACT: Objective: Fear et al identified a small but significant increase in probable post-traumatic stress disorder (PTSD) in UK military personnel from around 3% in first year post deployment to around 6% by year 5. As yet it is not clear what factors are linked to the increase in probable PTSD, and therefore, serial measurement of poor mental health would be helpful. Method: Rates of mental ill health among UK service personnel were compared upon deployment completion and at follow-up and identified factors associated with maladjustment. Results: Poor mental health symptomatology increased from baseline to follow-up, PTSD symptoms and related functional impairment increased significantly. Poor baseline mental health was predictive of transition and family relationship difficulties. Conclusions: The results are discussed in relation to encouraging recognition and reporting of symptoms among personnel and their social networks.
    Journal of the Royal Army Medical Corps 10/2015; DOI:10.1136/jramc-2015-000425 · 0.55 Impact Factor
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    ABSTRACT: Background: When disasters occur, humanitarian relief workers frequently deploy to assist in rescue/recovery efforts. Aims: To conduct a systematic review of factors affecting the psychological wellbeing of disaster relief workers and identify recommendations for interventions. Method: We searched MEDLINE®, Embase, PsycINFO® and Web of Science for relevant studies, supplemented by hand searches. We performed thematic analysis on their results to identify factors predicting wellbeing. Results: Sixty-one publications were included. Key themes were: pre-deployment factors (preparedness/training); peri-deployment factors (deployment length/timing; traumatic exposure; emotional involvement; leadership; inter-agency cooperation; support; role; demands and workload; safety/equipment; self-doubt/guilt; coping strategies) and post-deployment factors (support; media; personal and professional growth). Conclusions: As well as role-specific stressors, many occupational stressors not specific to humanitarian relief (e.g. poor leadership, poor support) present a significant health hazard to relief workers. Humanitarian organisations should prioritise strengthening relationships between team members and supervisors, and dealing effectively with non-role-specific stressors, to improve the psychological resilience of their workforce.
    Journal of Mental Health 10/2015; 24(6):1-29. DOI:10.3109/09638237.2015.1057334 · 1.01 Impact Factor
  • C A M Sage · S K Brooks · N Jones · N Greenberg ·
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    ABSTRACT: Background: TRiM (Trauma Risk Management) has been shown to improve mental health and attitudes towards mental health in high-risk occupational groups; however, there has been no research into how TRiM might work for railway workers. Aims: To assess whether attending a TRiM training course alters mental health and attitudes to mental health-related help-seeking in railway workers. Methods: Workers completed a survey assessing mental health and attitudes towards mental health and help-seeking, before and after a 2-day TRiM course; follow-up questionnaires were administered 4 months post-course. Results: Fifty railway employees completed the questionnaires. Post-course scores for cohesion and mental health peer literacy (i.e. feeling able to recognize and discuss mental health symptoms with colleagues) and some aspects of stigma significantly improved, while there were non-significant improvements in common mental disorder and post-traumatic stress symptoms. The response rate for completing follow-up surveys was small (n = 8) but results from these subjects suggested mental health peer literacy scores remained significantly improved. Conclusions: This study provides a useful insight into attitudes of railway workers regarding stigma and their confidence in discussing trauma-related mental health. Significant improvements in cohesion and mental health peer literacy along with the general improvement in scores post-TRiM course provide some evidence of the potential benefits of TRiM training in railway workers. Follow-up results have limited reliability due to the small number of responders but suggest possible long-term benefits of attending a TRiM course. Further research is required to confirm this finding.
    Occupational Medicine 10/2015; DOI:10.1093/occmed/kqv165 · 1.03 Impact Factor
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    ABSTRACT: Objectives: To compare the prevalence of self-reported risky driving in a sample of UK military personnel at 2 different time points (2004 and 2009), and to identify the incidence of new onset risky driving and possible determinants of becoming a new risky driver. Methods: Data were used from 2 phases of a military cohort study investigating the health and well-being of UK military personnel between 2004 and 2009. Participants were included if they were undertaking regular (rather than reserve) engagements, had completed both surveys and reported being a driver at both surveys. Univariable and multivariable logistic regression analyses were performed to examine the relationship between risky driving status and sociodemographic and military characteristics. Data analysis was conducted in 2011. Results: The prevalence of risky driving reduced from 18% to 14%, over an average of 3.3 years. The incidence of new onset risky driving was 7%. Predictors for becoming a new risky driver were: younger age, not being in a relationship at phase 2 and harmful alcohol use. Those deployed after 2007 were less likely to become risky drivers following deployment, compared with those deployed before 2007 (adjusted OR 0.62 (95% CI 0.40 to 0.95)). Conclusions: The prevalence of becoming a risky driver appears to have reduced over time. This paper suggests a number of explanations for this reduction, including changes in the way that the UK military have dealt with road safety with the introduction of the road safety campaign (in 2007).
    BMJ Open 09/2015; 5(9):e008434. DOI:10.1136/bmjopen-2015-008434 · 2.27 Impact Factor
  • Norman Jones · N Greenberg ·
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    ABSTRACT: Introduction: Clinical assessment is an essential but potentially time-consuming component of mental healthcare provision. The Threshold Assessment Grid (TAG) is a brief structured assessment tool which is applied to written referrals with the aim of identifying the severity of mental illness and suitability for further psychological treatment by assessing perceived risk, safety concerns and clinical factors. Method: The TAG criteria were used to structure a brief TAG-triage face-to-face assessment. As the use of triage has not been evaluated within a military occupational mental health service, differences in clinical and occupational outcomes were compared following either standard face-to-face assessment or receipt of TAG-triage interview among members of the UK Armed Forces who were referred for mental health assessment. During a period of service development, 56.6% of patients referred to a military mental health team received TAG-triage assessment (n=419) and 43.5% were assessed as usual (n=323). Results: There were no significant differences in rank, age, sex and Service background between patients allocated to the two forms of assessment. Patients presenting following acts of deliberate self-harm were as likely to receive TAG-triage as they were to undergo standard assessment, suggesting that clinicians were willing to use TAG-triage for more challenging cases. Patients receiving TAG-triage were as likely to receive further therapy and be allocated a clinical diagnosis as those undergoing standard assessment. Short-term and longer-term occupational outcomes following discharge from care, represented by medical fitness to carry out one's military role, were similar among the TAG-triage and standard assessment groups. Conclusion: TAG-triage appeared to offer a viable alternative to standard face-to-face mental health assessment and could promote more efficient use of clinical time.
    Journal of the Royal Army Medical Corps 09/2015; DOI:10.1136/jramc-2015-000447 · 0.55 Impact Factor
  • Norman Jones · Mary Keeling · Gursimran Thandi · Neil Greenberg ·
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    ABSTRACT: Introduction: The relationship between mental health symptoms, stigmatising beliefs about mental health and help seeking is complex and poorly understood. Method: 1636 UK Armed Forces personnel provided study data immediately after deployment (T1) and approximately 6 months later (T2). Stigmatising beliefs were assessed using an eight-item scale previously used in studies of UK military personnel. Symptoms of probable common mental disorder, probable post-traumatic stress disorder and subjective stressful, emotional, relationship and family problems were evaluated at T1 and T2. Help seeking during deployment was assessed at T1 and post-deployment help seeking at T2. Alcohol use and subjective alcohol problems were assessed at T2 only. Results: Reporting a probable mental health disorder or potentially harmful alcohol use following deployment was both significantly associated with higher levels of stigmatising beliefs. The reported degree of stigma was associated with changes in mental health symptom levels; compared to those who were never classified as a probable mental health disorder case, recovered cases experienced significantly lower levels of stigmatisation, whereas new onset cases reported significantly higher levels. Conclusion: The way that individuals report mental health stigmatisation is not static; rather stigma fluctuates in proportion to the frequency and severity of psychological symptoms. These results suggest that public health stigma-reduction strategies which aim to promote engagement with mental health services should be focused towards people who are experiencing worsening mental health. Our results suggest that willing volunteers who have recovered from a mental-ill-health episode may be well placed to assist in the delivery of such a strategy.
    Social Psychiatry 09/2015; 50(12). DOI:10.1007/s00127-015-1118-y · 2.54 Impact Factor
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    ABSTRACT: Objectives: We assessed changes in Alcohol Use Disorders Identification Test (AUDIT) scores over time. We investigated the impact of life events and changes in mental health status on AUDIT scores over time in UK military personnel. Methods: A random representative sample of regular UK military personnel who had been serving in 2003 were surveyed in 2004-2006 (phase 1) and again in 2007-2009 (phase 2). The impact of changes in symptoms of psychological distress, probable post-traumatic stress disorder (PTSD), marital status, serving status, rank, deployment to Iraq/Afghanistan and smoking was assessed between phases. Results: We found a statistically significant but small decrease in AUDIT scores between phases 1 and 2 (mean change=-1.01, 95% confidence interval=-1.14, -0.88). Participants reported a decrease in AUDIT scores if they experienced remission in psychological distress (adjusted mean -2.21, 95% CI -2.58, -1.84) and probable PTSD (adjusted mean -3.59, 95% CI -4.41, -2.78), if they stopped smoking (adjusted mean -1.41, 95% CI -1.83, -0.98) and were in a new relationship (adjusted mean -2.77, 95% CI -3.15, -2.38). On the other hand, reporting new onset or persistent symptoms of probable PTSD (adjusted mean 1.34, 95% CI 0.71, 1.98) or a relationship breakdown (adjusted mean 0.53, 95% CI 0.07, 0.99) at phase 2 were associated with an increase in AUDIT scores. Conclusions: The overall level of hazardous alcohol consumption remains high in the UK military. Changes in AUDIT scores were linked to mental health and life events but not with deployment to Iraq or Afghanistan.
    Drug and Alcohol Dependence 09/2015; DOI:10.1016/j.drugalcdep.2015.08.033 · 3.42 Impact Factor
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    ABSTRACT: To establish the level of psychological symptoms and the risk factors for possible decreased mental health among deployed UK maritime forces. A survey was completed by deployed Royal Navy (RN) personnel which measured the prevalence of common mental disorder (CMD), post-traumatic stress disorder (PTSD) and potential alcohol misuse. Military and operational characteristics were also measured including exposure to potentially traumatic events, problems occurring at home during the deployment, unit cohesion, leadership and morale. Associations between variables of interest were identified using binary logistic regression to generate ORs and 95% CIs adjusted for a range of potential confounding variables. In total, 41.2% (n=572/1387) of respondents reported probable CMD, 7.8% (n=109/1389) probable PTSD and 17.4% (n=242/1387) potentially harmful alcohol use. Lower morale, cohesion, leadership and problems at home were associated with CMD; lower morale, leadership, problems at home and exposure to potentially traumatic events were associated with probable PTSD; working in ships with a smaller crew size was associated with potentially harmful alcohol use. CMD and PTSD were more frequently reported in the maritime environment than during recent land-based deployments. Rates of potentially harmful alcohol use have reduced but remain higher than the wider military. Experiencing problems at home and exposure to potentially traumatic events were associated with experiencing poorer mental health; higher morale, cohesion and better leadership with fewer psychological symptoms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Occupational and Environmental Medicine 08/2015; DOI:10.1136/oemed-2015-102961 · 3.27 Impact Factor
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    Deirdre Macmanus · N Jones · S Wessely · N T Fear · E Jones · N Greenberg ·

  • R Dunn · V Kemp · D Patel · R Williams · N Greenberg ·
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    ABSTRACT: Diplomatic organizations routinely send staff to high-threat postings (HTPs) and consequentially have moral and legal obligations to protect their health as far as is reasonably practicable. To carry out an international survey of diplomatic organizations that send personnel to HTPs to establish how they deal practically with their obligations to protect the mental health of their staff. An online anonymous survey about their organizations' policies relating to HTPs completed by international diplomatic organizations. Fourteen of 30 organizations approached completed the questionnaire, with a response rate of 47%. Deployment length varied: no minimum (15%), a minimum of 2 years (39%) and a maximum of 2 (31%), 3 (15%) or 4 years (31%); one organization did not state any maximum. HTP and low-threat postings had the same policies in 46% of organizations. Additional care and support (66%), additional preparation (50%), enhanced leave (33%) and additional physical and mental health assessments were informally adopted to address psychosocial risks of deployment to HTPs. There was little consensus on policies and practice for HTP deployment. We suggest that formal, consistently written guidelines, based on available quality evidence, and associated training and quality assurance should be formulated to make international practice more consistent and equitable. © Crown copyright 2015.
    Occupational Medicine 07/2015; 65(7). DOI:10.1093/occmed/kqv095 · 1.03 Impact Factor
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    ABSTRACT: Background: Deploying in a combat role negatively impacts risk-taking behaviours, such as drinking, smoking and risky driving in regular UK military personnel. Little is known about the impact of deployment on the risk-taking behaviours of reservists. Aims: To explore the impact of deployment on risk-taking behaviours among reservists. Methods: This was a cross-sectional study. Hazardous drinking, risky driving, physical violence, smoking and attendance at accident and emergency (A&E) departments as a result of risk-taking behaviours were assessed by self-reported questionnaire. Results: There were 1710 participants in the study; response rate 51%. The overall prevalence of risk-taking behaviours was: hazardous drinking 46%, smoking 18%, risky driving 11%, attending A&E due to risky behaviours 13% and reporting physical violence 3%. Deployment was significantly associated with risky driving [odds ratio (OR) 1.88, 95% confidence interval (CI) 1.25–2.81], smoking (OR 2.02, 95% CI 1.46–2.78) and physical violence (OR 3.63, 95% CI 1.88–7.02). Conclusions: It is important to consider the impact of deployment and military factors on the prevalence of risk-taking behaviours in reservists as greater numbers than ever before will face the prospect of deployment to overseas conflicts.
    Occupational Medicine 07/2015; 65(5):413-416. DOI:10.1093/occmed/kqv057 · 1.03 Impact Factor
  • Neil Greenberg · Samantha Brooks · Rebecca Dunn ·
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    ABSTRACT: Most people will experience a traumatic event during their lives. However, not all will develop Post-Traumatic Stress Disorder (PTSD). There have been recent changes in diagnostic criteria for PTSD and there are a number of treatment options available. This review is based on published literature in the field of PTSD, its management and the recently published DSM-V. The most influential risk factors relate to the post-incident environment rather than pre-incident or the incident itself. There are two established and effective psychological therapies; trauma-focussed cognitive behavioural therapy and eye movement desensitization and reprocessing. It is unclear what actually constitutes a traumatic event. Psychological debriefing or counselling interventions, shortly after trauma-exposure are found to be ineffective and may cause harm. Medication, whilst common practice, is not recommended as first line management. Future psychotherapies for PTSD may be just as effective if delivered in carefully considered group settings or through remote means. Research into the most effective ways to prevent individuals at risk of developing PTSD is still at an early stage and development of effective early interventions could substantially reduce the morbidity associated with PTSD. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:
    British Medical Bulletin 04/2015; 114(1). DOI:10.1093/bmb/ldv014 · 3.66 Impact Factor
  • D. Whybrow · N. Jones · N. Greenberg ·
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    ABSTRACT: Trauma Risk Management (TRiM) is a peer support system developed within the British Armed Forces. It aims to ensure that trauma-exposed personnel are properly supported and encouraged to seek timely help should they develop mental health problems that fail to resolve spontaneously. To summarize current knowledge about TRiM and make recommendations for further research. A search of PsychINFO, CINAHL and PubMed identified 13 published papers. TRiM outcomes were represented in different ways within the relevant studies suggesting that TRiM may have effects additional to those that it seeks to achieve. For example, a randomized controlled trial demonstrated that TRiM had a specific positive occupational effect and did no harm; a qualitative study suggested that TRiM enhanced liaison between mental health workers and line managers and a service evaluation suggested that it reduced sickness absence. In general, the process appears to enhance trauma-exposed personnel's reliance on peer support and TRiM was reportedly acceptable and sustainable. Evidence suggests that TRiM's utility has moved beyond the military to other organizations where personnel risk occupational traumatic exposure. Further research would help to understand how TRiM is perceived by line managers and how it functions within the trauma-prone populations. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email:
    Occupational Medicine 04/2015; 65(4). DOI:10.1093/occmed/kqv024 · 1.03 Impact Factor
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    ABSTRACT: This study aimed to examine currently serving United Kingdom (UK) military Medical and Welfare Officers views on the potential introduction of post-deployment screening for mental ill health. Semi-structured interviews were conducted with 21 Medical and Welfare Officers. Interview transcripts were analysed using data-driven thematic analysis. Four themes were identified: positive views of screening; reliability of responses; impact on workload; and suggestions for implementation. Interviewees viewed the introduction of screening post-deployment as likely to increase awareness of mental health problems whilst also reporting that service personnel were likely to conceal their true mental health status by providing misleading responses to any screening tool. Concern over reliability of responses may provide one explanation for the reluctance of service personnel to seek help for problems, as they could feel they will not be taken seriously. Welfare Officers felt they would not have the knowledge or experience to respond to help-seeking. Although participants were concerned about potential impact on their personal workload, they indicated a desire to positively engage with the screening programme if research showed it was an effective tool to improve mental health care. Welfare and healthcare providers are well disposed towards a screening programme for mental health but highlight a few concerns in its implementation. In particular Welfare Officers appear to require more training in how to respond to mental ill health. Concerns about available funding and resources to respond to increased workload will need to be addressed should post-deployment screening for mental health be introduced in the UK military.
    BMC Public Health 04/2015; 15(1):338. DOI:10.1186/s12889-015-1695-4 · 2.26 Impact Factor
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    P Cawkill · M Jones · N T Fear · N Jones · M Fertout · S Wessely · N Greenberg ·
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    ABSTRACT: Background: The mental health effects of deployment vary widely, and personnel in both combat and combat support roles, including medical personnel, may be adversely affected. Aims: To compare the mental health of deployed UK military medical staff in both forward and rear locations and to compare these two groups with other deployed military personnel. Methods: Participants were medics who had deployed to Iraq or Afghanistan and provided information about their deployed role, experiences during and on return from deployment and demographic and military factors. Health outcomes included common mental health problems (using 12-item General Health Questionnaire), post-traumatic stress disorder (PTSD, using 17-item Post-Traumatic Stress Disorder Checklist-Civilian Version), multiple physical symptoms and alcohol use (using 10-item Alcohol Use Disorders Identification Test). Results: The sample comprised 321 medical personnel. The response rate was 56%. The mental health outcomes for forward located medics (FMs) were no different than those for rear located medics (RLMs). When comparing FMs and RLMs against all other military roles, a small but significant increase in PTSD symptoms in FMs was found. FMs were more likely to rate their work while deployed as being above their skills and experience, report exposure to more combat experiences and report a more challenging homecoming experience than RLMs. Conclusions: These results suggest that while the overall rates of self-reported mental health disorders were similar in FMs and RLMs, FMs reported more PTSD symptoms than all other roles, which may have been related to working in more hostile environments in more challenging roles while deployed and their experiences on returning home.
    Occupational Medicine 03/2015; 65(2):157-64. DOI:10.1093/occmed/kqu200 · 1.03 Impact Factor
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    ABSTRACT: To evaluate the possible mental health impact of resistance training on UK Armed Forces personnel undergoing training and the psychological effects of delivering such training. British Military personnel (n = 42) completed a battery of self-report measures on anxiety, general mental health, post-traumatic stress disorder, resiliency and training outcomes 1 month before, on the first and last day of the course and at 1-month follow-up. Resistance Instructors (RIs) (n = 40) completed a battery of self-report measures on anxiety, depression, post-traumatic stress disorder, alcohol use, sleep, burnout, leadership, and morale. Although student self-ratings of resiliency did not change, they reported significant improvements in their ability to use strategies to cope with captivity. There was no significant increase in anxiety between precourse and follow-up. Post-traumatic stress intrusive symptoms were elevated at 1-month postcourse but remained low. Prevalence rates of psychological distress among RIs were elevated compared to U.K. military personnel but views of professional efficacy, unit leadership and morale were broadly positive. Resistance training demonstrates some benefit to students but was associated with increase in traumatic stress symptoms at follow-up, whereas the mental health of RI appears modestly worse than the rest of the Armed Forces population. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.
    Military medicine 02/2015; 180(2):168-177. DOI:10.7205/MILMED-D-14-00285 · 0.77 Impact Factor
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    L Goodwin · S Wessely · M Hotopf · M Jones · N Greenberg · R J Rona · L Hull · N T Fear ·
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    ABSTRACT: Although the military is considered to be a stressful occupation, there are remarkably few studies that compare the prevalence of common mental disorder (CMD) between the military and the general population. This study examined the prevalence of probable CMD in a serving UK military sample compared to a general population sample of employed individuals. Method Data for the general population was from the 2003 and 2008 collections for the Health Survey for England (HSE) and for the serving military from phases 1 (2004���2006) and 2 (2007���2009) of the King's Centre for Military Health Research (KCMHR) cohort study. Probable CMD was assessed by the General Health Questionnaire (GHQ-12). The datasets were appended to calculate the odds of CMD in the military compared to the general population. The odds of probable CMD was approximately double in the military, when comparing phase 1 of the military study to the 2003 HSE [odds ratio (OR) 2.4, 95% confidence interval (CI) 2.1���2.7], and phase 2 to the 2008 HSE (OR 2.3, 95% CI 2.0���2.6) after adjustment for sex, age, social class, education and marital status. Serving military personnel are more likely to endorse symptoms of CMD compared to those selected from a general population study as employed in other occupations, even after accounting for demographic characteristics. This difference may be partly explained by the context of the military study, with evidence from previous research for higher reports of symptoms from the GHQ in occupational compared to population studies, in addition to the role of predisposing characteristics.
    Psychological Medicine 01/2015; 45(09):1-11. DOI:10.1017/S0033291714002980 · 5.94 Impact Factor
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    ABSTRACT: Approximately 60% of military personnel who experience mental health problems do not seek help, yet many of them could benefit from professional treatment. Across military studies, one of the most frequently reported barriers to help-seeking for mental health problems is concerns about stigma. It is, however, less clear how stigma influences mental health service utilization. This review will synthesize existing research on stigma, focusing on those in the military with mental health problems. We conducted a systematic review and meta-analysis of studies between 2001 and 2014 to examine the prevalence of stigma for seeking help for a mental health problem and its association with help-seeking intentions/mental health service utilization. Twenty papers met the search criteria. Weighted prevalence estimates for the 2 most endorsed stigma concerns were 44.2% (95% confidence interval: 37.1, 51.4) for "My unit leadership might treat me differently" and 42.9% (95% confidence interval: 36.8, 49.0) for "I would be seen as weak." Nine studies found no association between anticipated stigma and help-seeking intentions/mental health service use and 4 studies found a positive association. One study found a negative association between self-stigma and intentions to seek help. Counterintuitively, those that endorsed high anticipated stigma still utilized mental health services or were interested in seeking help. We propose that these findings may be related to intention-behavior gaps or methodological issues in the measurement of stigma. Positive associations may be influenced by modified labeling theory. Additionally, other factors such as self-stigma and negative attitudes toward mental health care may be worth further attention in future investigation. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail:
    Epidemiologic Reviews 01/2015; 37(1). DOI:10.1093/epirev/mxu012 · 6.67 Impact Factor
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    Neil Greenberg · Simon Wessely · Til Wykes ·
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    ABSTRACT: Whilst many organisations are working around the clock to provide humanitarian and medical support to a number of West African countries as they battle with Ebola, the psychological health needs of the staff carrying out this important work should not be forgotten. To date, there has understandably been a focus on ensuring that staff have the right personnel protective equipment and know how to use it, and that the physical health needs of deployed staff have been fully considered. It may now be appropriate to ensure that any long-term psychological impact of this important work is minimised both for those deploying to West Africa but also for the "home teams" who also have had to deal with a range of highly challenging and potentially traumatic material. We suggest that trauma-exposed organisations would do well to follow an evidence-based preventative medicine approach to this issue as highlighted in this editorial. Evaluations of new methods of support are now sorely needed as the evidence is sparse and often focussed on troop deployment. One novel support system is now provided by the South London and Maudsley NHS Foundation Trust following discussions with healthcare workers in Sierra Leone. The NHS Trust's clinical psychologists have set up a volunteer support system that provides a listening ear for individuals who are deployed before, during and after their deployment through face-to-face contacts, email, phone and skype. This provides more support than is currently provided in the trauma world particularly during deployment, but mirrors some of the suggestions in the TRiM programme for peer support. The programme aims to support resilience, prevent motivational decreases which may result in errors during deployment, and to sustain team leadership and cohesion which is a clear predictor of trauma effects. Whether this is too much or too little support will only be apparent after independent evaluation. We hope this happens soon so that we can pass on good practice not only to the Ebola health workers, but also to deployments to combat future health epidemics.
    Journal of Mental Health 01/2015; 24(1). DOI:10.3109/09638237.2014.1000676 · 1.40 Impact Factor
  • Dunn R · Williams R · Kemp V · Patel D · Greenberg N ·
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    ABSTRACT: Background: While there has been considerable research into the psychosocial consequences of tour length for military personnel, this subject has not been studied in other occupational groups who also deploy staff to high-threat areas. Aims: To carry out a comprehensive review of relevant published literature to inform diplomatic organizations that deploy staff in high-threat postings (HTPs). Methods: We searched appropriate scientific databases for studies relevant to deployment length, mental health and well-being for diplomats. A systematic review related to military personnel was found and used as the foundation for the literature review. Other relevant papers identified by the search have also been included. Results: The majority of identified papers had examined military personnel. Results suggested that longer deployments were associated with poorer mental health including post-traumatic stress disorder, depression and alcohol problems and this was most likely to be a function of increased exposure to potentially traumatic events. Exceeding a threshold of 6-12 months within a 3 year period, for military personnel, appeared to elevate the risk of psychosocial problems. Furthermore, diplomats deploying on their first HTP, and those whose tour length is altered after deployment, could be especially vulnerable. Conclusions: While further research of this topic is required, this review provides an evidence-based insight into the increased risks of developing mental health problems when deployed to HTPs. This information is relevant to generating policies, which may reduce the impacts of adverse psychosocial effects on diplomatic staff and their families.
    Occupational medicine 10/2014; Advance Access(1). DOI:10.1093/occmed/kqu · 1.12 Impact Factor

Publication Stats

3k Citations
681.45 Total Impact Points


  • 2008-2015
    • ICL
      Londinium, England, United Kingdom
  • 2003-2015
    • King's College London
      • • Department of Psychological Medicine
      • • King's Centre for Military Health Research
      • • Academic Centre for Defence Mental Health
      • • Institute of Psychiatry
      • • Department of War Studies
      Londinium, England, United Kingdom
    • The Kings College
      Бесемер, Alabama, United States
  • 2011
    • Centre for IT Education
      Bhubaneswar, Odisha, India
  • 2007
    • University of Leicester
      • Department of Health Sciences
      Leicester, ENG, United Kingdom