[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] ABSTRACT: Recent epidemiological evidence suggests that military personnel commonly remain psychologically resilient in the face of adversity they face on deployment. However, the processes that promote resilience have not been well assessed within the UK military. For many years, the UK Armed Forces have operated a policy of rest and recuperation (R&R), which refers to the brief period during which troops return home when on an operational tour of duty. While R&R is thought to play an import ant role in promoting recovery and well-being, there is as yet no empirical evidence to support its effectiveness.
Occupational Medicine 09/2014; · 1.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: For years there has been a tremendous gap in our understanding of the mental health effects of deployment and the efforts by military forces at trying to minimize or mitigate these. Many military forces have recently systematized the mental support that is provided to support operational deployments. However, the rationale for doing so and the consequential allocation of resources are felt to vary considerably across North Atlantic Treaty Organisation (NATO) International Security Assistance (ISAF) partners. This review aims to compare the organization and practice of mental support by five partnering countries in the recent deployment in Afghanistan in order to identify and compare the key methods and structures for delivering mental health support, describe bottlenecks and illustrate new developments.
European Journal of Psychotraumatology 08/2014; 5.
[Show abstract][Hide abstract] ABSTRACT: A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals.
European Journal of Psychotraumatology 08/2014; 5.
[Show abstract][Hide abstract] ABSTRACT: Abstract Introduction: mTBI has been termed the 'signature injury' of recent conflicts in Afghanistan and Iraq. Most mTBI research uses retrospective accounts of exposure and point of injury symptoms; mTBI is reportedly less common among UK than US Forces. Methods: This study examined the rate of mTBI exposure and symptoms in 1363 UK military personnel deployed in Afghanistan in 2011 using a self-report questionnaire. Data were collected in the operational location during the 5th month of a 6-month deployment. Personnel reported injuries and symptoms related to six events including fragmentation, blast, bullet, fall, motor vehicle accident and 'other' exposure. Results: Eighty (5.9%) reported at least one potential mTBI exposure during the current deployment and 1.6% (n = 22) reported injury and one or more mTBI symptoms (1 year incidence rate = 3.2%). Higher PTSD symptom scores were significantly associated with reporting potential mTBI (p ≤ 0.001) and mTBI with symptoms (p ≤ 0.001). Conclusion: This study used contemporaneous data gathered in the deployed location which are subject to less memory distortion than studies using post-deployment recall. The incidence of mTBI was substantially lower than those reported in both US and UK post-deployment studies which is consistent with inflated reporting of symptoms when measured post-deployment.
[Show abstract][Hide abstract] ABSTRACT: Beliefs about other people's potential views or reactions may be powerful determinants of mental health help-seeking behaviours. United Kingdom Armed Forces (UK AF) have made considerable efforts to promote appropriate help seeking though it is often suggested that military personnel remain reluctant to seek help. This study evaluated a novel stigma-reduction method, stand-up comedy, in service personnel.
Personnel viewed a regular comedy show or a show containing mental health information. Pre, immediately post-show and 3 months later, military stigmatisation, potential discrimination, mental health knowledge, help-seeking and coping behaviour, talking about mental health, current mental health and alcohol use were measured.
Response rates were 81.3 % pre-show, 67.6 % post-show and 18.9 % at follow-up. Inclusion of mental health material did not appear to detract from show satisfaction. Post-show, intervention group (IG) participants reported significantly less stigmatisation and accurately answered mental health-related questions; in the small numbers followed up, neither difference was maintained, however, IG personnel were statistically significantly more likely to discuss mental health and to advise others about mental health; adjusted analyses suggested that this was related to factors other than the show.
In UK AF personnel, embedding mental health awareness within a comedy show format had a short-term positive effect upon military stigmatisation regarding mental health. The low rate of follow-up limited our ability to assess whether this effect was durable. If the longevity of change can be adequately assessed and demonstrated in further research, comedy could potentially form a component of a comprehensive stigma-reduction strategy.
[Show abstract][Hide abstract] ABSTRACT: This systematic review aimed to assess (1) the level of comorbidity of post-traumatic stress disorder (PTSD) and alcohol misuse reported in research studies since 2007 and (2) any associations found between specific PTSD symptom clusters and alcohol misuse.
A literature search was carried out to capture any papers published from 2007 to the end of July 2012. Six hundred and twenty abstracts were identified and reviewed, and 42 papers were included in the final review after applying inclusion and exclusion criteria.
The prevalence of comorbid alcohol misuse in those with PTSD ranged from 9.8 to 61.3 %. The prevalence of comorbid PTSD in those with alcohol misuse ranged from 2.0 to 63.0 %, and the majority of prevalence rates were over 10.0 %. Almost all of the odds ratios representing the strength of association between the conditions across a variety of populations were significant, and those ranged from 1.1 to 4.87. Of the different PTSD symptom clusters, this review found most evidence for associations between alcohol misuse and both avoidance/numbing symptoms and hyperarousal symptoms.
Given that comorbidity appears to be common, the evidence from this systematic review supports the use of routine screening for comorbidity in populations who are known to have PTSD or alcohol misuse.
[Show abstract][Hide abstract] ABSTRACT: The recent conflicts in Iraq and Afghanistan have attracted considerable political and media interest in the mental health of UK military personnel. As a result of the close operational collaboration between US and UK forces, there have inevitably been many comparisons drawn between the mental health status of the two forces. Considerable research activity suggests that the mental health of UK forces appear to have remained relatively resilient in spite of their considerable exposure to traumatic events; one stark exception to this is the high rates of alcohol misuse which seem to be related to deployment. This paper explores the recently published literature relating to UK military forces and attempts to draw conclusions about the reasons for the apparent resilience shown by the majority of the regular forces.
Journal of the Royal Army Medical Corps 02/2014; · 0.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine the factors which facilitate UK military personnel with post-traumatic stress disorder (PTSD) to engage in help-seeking behaviours.
The study recruited active service personnel who were attending mental health services, employed a qualitative design, used semi-structured interview schedules to collect data, and explored these data using interpretative phenomenological analysis (IPA).
Five themes emerged about how participants were able to access help; having to reach a crisis point before accepting the need for help, overcoming feelings of shame, the importance of having an internal locus of control, finding a psychological explanation for their symptoms and having strong social support.
This study reported that for military personnel who accessed mental health services, there were a number of factors that supported them to do so. In particular, factors that combated internal stigma, such as being supported to develop an internal locus of control, appeared to be critical in supporting military personnel to engage in help-seeking behaviour.
European Journal of Psychotraumatology 02/2014; 5.
[Show abstract][Hide abstract] ABSTRACT: Research of military personnel who deployed to the conflicts in Iraq or Afghanistan has suggested that there are differences in mental health outcomes between UK and US military personnel.
To compare the prevalence of post-traumatic stress disorder (PTSD), hazardous alcohol consumption, aggressive behaviour and multiple physical symptoms in US and UK military personnel deployed to Iraq.
Data were from one US (n = 1560) and one UK (n = 313) study of post-deployment military health of army personnel who had deployed to Iraq during 2007-2008. Analyses were stratified by high- and low-combat exposure.
Significant differences in combat exposure and sociodemographics were observed between US and UK personnel; controlling for these variables accounted for the difference in prevalence of PTSD, but not in the total symptom level scores. Levels of hazardous alcohol consumption (low-combat exposure: odds ratio (OR) = 0.13, 95% CI 0.07-0.21; high-combat exposure: OR = 0.23, 95% CI 0.14-0.39) and aggression (low-combat exposure: OR = 0.36, 95% CI 0.19-0.68) were significantly lower in US compared with UK personnel. There was no difference in multiple physical symptoms.
Differences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD. Adjusting for self-reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.
The British journal of psychiatry: the journal of mental science 01/2014; · 6.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To explore the psychological consequences of improvised explosive device (IED) exposure as IEDs have been the greatest threat to UK military personnel in Afghanistan though the mental health consequences of IED exposure are largely unknown.
Deployed UK military personnel completed a survey while deployed in Afghanistan. Combat personnel and those dealing specifically with the IED threat were compared with all other deployed personnel; the relationship between IED exposure, general combat experiences, Post Traumatic Stress Disorder (PTSD) Checklist-Civilian Version (PCL-C) and General Health Questionnaire scores were evaluated.
The response rate was 98% (n=2794). Half reported IED-related concerns, a third experienced exploding IEDs and a quarter gave medical aid to IED casualties. Combat and counter-IED threat personnel had higher levels of IED exposure than other deployed personnel. 18.8% of personnel who witnessed exploding IEDs scored positive for common mental disorder (General Health Questionnaire-12 scores ≥4) and 7.6% scored positive for probable PTSD symptoms (PTSD Checklist-Civilian Version scores ≥44). After adjusting for general combat exposure and other observed confounders, PTSD symptoms were associated with IED exposure whereas common mental disorder symptoms were not. IED exposure, IED-related concerns and functional impairment accumulated during deployment but functional impairment was related to factors other than IED exposure alone.
In Afghanistan, a substantial proportion of personnel were exposed to exploding IEDs however, the majority of exposed personnel were psychologically healthy. Psychological effects were similar for combat personnel and those dealing specifically with the IED threat but both groups were at greater psychological risk than other deployed personnel.
Occupational and environmental medicine 01/2014; · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Most accounts of deployment mental health in UK armed forces personnel rely on retrospective assessments.
We present data relating to the burden of mental ill health and the effect of support measures including operational, family, welfare and medical support obtained on two occasions some 18 months apart.
A total of 2794 personnel completed a survey while deployed to Afghanistan; 1363 in 2011 and 1431 in 2010. Their responses were compared and contrasted.
The prevalence of self-report mental health disorder was low and not significantly different between the surveys; the rates of probable post-traumatic stress disorder (PTSD) were 2.8% in 2010 and 1.8% in 2011; for common mental health disorders the rates were 17.0% and 16.0% respectively. Remembering receiving predeployment psychoeducation, perceptions of good leadership and good family support were all significantly associated with better mental health. Seeking support from non-medical sources and reporting sick for medical reasons were both significantly associated with poorer mental health.
Over a period of 18 months, deployment mental health symptoms in UK armed forces personnel were fewer than those obtained from a military population sample despite continuing deployment in a high-threat context and were associated with perceptions of support.
The British journal of psychiatry: the journal of mental science 11/2013; · 6.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BackgroundA major incident involving multiple fatalities occurred in Cumbria, England on 2 June 2010. The Cumbrian Constabulary deployed an organizational peer support response for personnel involved known as trauma risk management (TRiM).AimsTo examine data routinely gathered during the TRiM process to evaluate the relationship of the intervention to sickness absence.Methods
Using incident databases, details were gathered regarding exposure to the murders and type of TRiM intervention, including an assessment of the psychological risk to the individual of developing a trauma-related mental health problem. Sociodemographic information was collated by the occupational health department. Cumulative sickness absence data in the 2 months following the murders were used as a proxy for mental health status.ResultsA total of 717 police officers and civilian support staff were identified. High levels of traumatic exposure were associated with subsequent receipt of a TRiM intervention. The majority of psychological risk indices reduced between the initial and subsequent evaluation. Greater traumatic exposure was associated with longer sickness absence lengths. Engagement in the TRiM process was associated with a reduction in sickness absence especially in more junior ranks.Conclusions
In this study, we found that TRiM deployed within a police force responding to a major event offered a way of structuring a response for those involved. Our data suggest that TRiM may offer a way of assessing psychological risk so that officers can be offered early supportive interventions. Our data suggest that TRiM may help to ameliorate some of the negative effects of high trauma exposure.
Occupational Medicine 10/2013; · 1.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare attitudes to mental illness in the U.K. military and in the general population in England.
Using data from a cross-sectional survey of 821 U.K. military personnel and a separate cross-sectional survey of 1,729 members of the general population in England, levels of agreement with five statements about mental illness were compared in the military and the general population.
The majority of respondents from both populations showed positive attitudes toward mental illness. The general population showed slightly more positive attitudes toward integrating people with mental illness into the community (68.0% [65.7%-70.1%] agreed that "People with mental illness have the same rights to a job as everyone else," vs. 56.7% [51.5%-61.7%] of the military). However, the general population showed more negative attitudes about the causes of mental illness (62.4% [60.1%-64.6%] disagreed that "One of the main causes of mental illness is a lack of self-discipline and willpower," vs. 81.3% [77.0%-84.9%] of the military).
Overall, attitudes toward mental illness are comparable in the general population in England and the U.K. military. Differences included the military holding more positive attitudes about the causes of mental illness, but more negatives attitudes about job rights of those with mental illness. Strategies aiming to improve attitudes toward mental illness could focus particularly on personnel's concerns around mental illness impacting on their career.
[Show abstract][Hide abstract] ABSTRACT: Stigmatizing beliefs about seeking help for mental health conditions and perceived barriers to care (BTC) may influence the decision to seek support and treatment in U.K. military personnel. Many coalition partners, including the U.K. Armed Forces (UKAF), have made considerable efforts to reduce stigma/BTC although the impact of these efforts over time has not been assessed. We surveyed a total of 23,101 UKAF personnel who deployed to Afghanistan and Iraq between 2008 and 2011 and examined whether stigma/BTC levels changed during this time. The results suggested that stigma, including the fear of being treated differently by commanders and loss of trust among peers, was greater than perceived BTC. The likelihood of reporting stigma/BTC, although significantly greater during deployment than postdeployment, reduced significantly over the survey period. A similar reduction was less apparent during postdeployment phase. These findings support the notion that UKAF's anti-stigma campaigns may have had some positive effects, particularly among deployed personnel. However, we suggest that stigma still plays a part in inhibiting help-seeking, particularly during deployment when stigma rates are higher, and that a careful balance must be struck between encouraging help-seeking and maintaining the operational effectiveness of deployed personnel.
[Show abstract][Hide abstract] ABSTRACT: Background
The Department of Community Mental Health (DCMH) at RAF Brize Norton runs a regular anxiety management day (AMD) which is a group intervention for regular military personnel who have been diagnosed with anxiety-related disorders. The AMD is a 1 day course for up to 20 participants run by two community mental health nurses based at the DCMH. It contains a combination of psycho-education and generic anxiety management techniques.AimsTo establish whether the AMD is acceptable to full time regular military personnel who have been referred to the DCMH.Methods
The acceptability of the AMD was assessed using a standardized feedback form, which asked about the patient's perception of the quality of the AMD and the course content. Feedback data were collected over a 12 month period between September 2010 and August 2011.ResultsClinical and sociodemographic data were available for 91 of the 97 (94%) participants who participated in the AMD over the period from September 2010 to August 2011. Ninety-two per cent (89/97) of participants completed a post course survey immediately after they completed the AMD. Respectively, 95 and 93% considered the format and content of the AMD to be of good quality.Conclusions
The AMD fits well with the stepped care approach of the Improving Access to Psychological Therapies programme and resulted in a good level of patient satisfaction.
Occupational Medicine 07/2013; · 1.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
Rest and Recuperation (R & R) is a period of home leave taken during an operational deployment; we sought to examine the relationship between taking R & R and mental health.DesignA survey-based post-intervention evaluation.SettingUKParticipants232 members of the UK Armed Forces; 42 of which completed pre and post R & R surveys.Main Outcome MeasuresAlcohol use, Post Traumatic Stress Disorder, Common Mental Disorder Symptoms and R & R experiences.Results12.1% of respondents (n=27) reported symptoms of common mental disorder and 3.7% (n=8) reported probable PTSD. 50% (n=110) reported hazardous use of alcohol during R & R. In the pre- and post-assessed sample, mental health status and alcohol use levels were similar at both survey points. Using principal component analysis, five components of R & R were identified; mentally switching off from deployment, travel experience, physical recovery, relaxation, rest and social support. R & R was extremely popular and although it did not improve mental health overall, the ability to engage with or derive satisfaction from aspects of the five components was significantly associated with better mental health and less alcohol use at the end of R & R.Conclusion
Operational commanders should advise personnel about the best way to actively engage with R & R before they leave theatre and be aware of the significant detrimental impact of disrupted travel arrangements upon the ability to benefit from R & R.
Journal of the Royal Society of Medicine 07/2013; · 2.02 Impact Factor