Roberto Rona

King's College London | KCL · Department of Psychology

The development of mobile health applications (apps) is growing exponentially. Alcohol reduction apps can break down perceived barriers of seeking help for alcohol misuse, potentially making them more appealing than face-to-face methods. App usability is therefore essential in supporting individuals misusing alcohol. Alcohol misuse is common in the...

Background: Smartphone-based interventions are increasingly being used to facilitate positive behavior change, including reducing alcohol consumption. However, less is known about the effects of notifications to support this change, including intervention engagement and adherence. The aim of this review was to assess the role of notifications in sm...

Whilst most military personnel do not develop Post-Traumatic Stress Disorder (PTSD), ex-serving personnel exhibit higher levels compared to those in service. The heterogeneity of symptom development for serving and ex-serving personnel has not yet been examined in the UK Armed Forces (UK AF). Latent class growth modelling was employed to estimate t...

Background: Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction inter...

Purpose Despite the higher prevalence of problem drinking in the UK military compared to the general population, problem recognition appears to be low, and little is known about which groups are more likely to recognise a problem. This study examined prevalence of problem drinking recognition and its associations. Methods We analysed data from 640...

Background: The use of digital technology within health care service delivery, monitoring, and research is becoming progressively popular, particularly given the ongoing COVID-19 pandemic. Mobile health (m-health) apps, one form of digital technology, are increasingly being used to promote positive health related behavior change. Therefore, it is i...

Background: Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction inte...

BACKGROUND Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction interv...

Background There is a prominent “treatment gap” in relation to at-risk drinking (ARD), whereby a minority of at-risk drinkers ever access treatment. Research suggests that recognition of problem drinking is a necessary precursor for help-seeking and treatment. Objective This systematic review and meta-analysis aimed to estimate the prevalence of A...

Background Around 8% of the UK Armed Forces leave in any given year, and must navigate unfamiliar civilian systems to acquire employment, healthcare, and other necessities. This paper determines longer-term prevalences of mental ill health and socioeconomic outcomes in UK Service leavers, and how they are related to demographic factors, military hi...

Aim: To identify the main trajectories of alcohol misuse among UK military personnel from 12 years after the start of the Iraq war (2003) and the factors associated with each trajectory. Design: Longitudinal cohort study with three phases of data collection (2004-06, 2007-09 and 2014-16). Setting: United Kingdom. Participants: Serving and ex...

Introduction The UK is the only permanent member of the UN Security Council that has a policy of recruiting 16 and 17 year old individuals into its regular Armed Forces. Little is known about the consequences of enlisting as a Junior Entrant (JE), although concerns have been expressed. We compare the mental health, deployment history, and pre-enlis...

Objectives While most UK military personnel transition successfully into civilian life, some experience unemployment and disability, which may be partly attributable to in-service factors. This study aims to determine the degree to which in-service mental health problems impact on postservice benefit claims. Methods Using data from a cohort of 559...

Background: Drinking motivations within the UK military have not been studied despite the high prevalence of alcohol misuse in this group. Aims: We aimed to characterize drinking motivations and their demographic, military and mental health associations in UK serving and ex-serving personnel. Methods: Serving and ex-serving personnel reporting...

Background: Little is known about the economic impact of military mental health screening. Aims: To investigate (a) whether post-deployment screening of military personnel affects use and cost of services and (b) the impact of psychiatric morbidity on costs. Methods: Participants were recruited from UK Royal Marine and Army platoons and randomised...

BACKGROUND Self-reported alcohol misuse remains high in armed forces personnel even after they have left service. More than 50% of ex-serving personnel meet the criteria for hazardous alcohol use; however, many fail to acknowledge that they have a problem. Previous research indicates that interventions delivered via smartphone apps are suitable in...

Introduction: There are higher levels of alcohol misuse in the military compared to the general population. Yet there is a dearth of research in military populations on the longitudinal patterns of alcohol use. This study aims to identify group trajectories of alcohol consumption in the UK military and to identify associations with childhood adver...

Background The effectiveness of post-deployment screening for mental disorders has not been assessed in a randomised controlled trial. We aimed to assess whether post-deployment screening for post-traumatic stress disorder (PTSD), depression, anxiety, or alcohol misuse was effective. We defined screening as the presumptive identification of a previ...

Background US studies have shown an increase of posttraumatic stress disorder (PTSD) and depression, but not alcohol misuse related to time of assessment since returning from deployment. We assessed if similar trends occur in the UK Armed Forces. Methods We selected UK studies based on our data base of King’s Centre for Military Health Research pu...

Background We investigated the net changes in prevalence of symptoms of asthma and rhinitis over 10 years in a cohort of young by baseline sensitization status. Methods One thousand one hundred ninety three Chilean adults subjects aged 22–28 living in a semi-rural area of central Chile answered a lifestyle and the European Community Respiratory Hea...

Objectives: To assess whether the association between birth weight and blood pressure (BP) increases with age using three different statistical methods. Methods: A representative sample of 1232 study participants born between 1974-1978 in Limache, Chile were assessed in 2000-2002, of whom 796 were reassessed in 2010-2012. An 'amplification effec...

Two-phase mental health screening methods, in which an abridged mental health measure is used to establish who should receive a more comprehensive assessment, may be more efficient and acceptable to respondents than a stand-alone complete questionnaire. Such two-phase methods are in use in US armed forces post-deployment mental health screening. Th...

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...

Dietary antioxidants may protect against poor ventilatory function. We assessed the relation between ventilatory function and antioxidant components of diet in young Chileans. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and the ratio FEV1/FVC were measured in 1232 adults aged 22-28 years, using a Vitalograph device. Dietary...

A systematic review and meta-analyses were conducted on studies of the prevalence of aggressive and violent behavior, as well as of violent offenses and convictions, among military personnel following deployment to Iraq and/or Afghanistan; the relationship with deployment and combat exposure; and the role that mental health problems, such as post-t...

Background: Concerns have been raised about the effect of tour length on the mental health of the UK armed forces. In 2007, we reported that cumulative length of deployment was associated with mental illness in military personnel. Our findings provided empirical evidence to support the UK advisory policy for tour length, known as the Harmony Guide...

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 d...

The Limache cohort was set up to assess the programming and life course events hypotheses in relation to cardiovascular risk factors and chronic respiratory conditions, especially asthma, in the context of an unprecedented economic growth in Chile. The cohort was a representative sample of 1232 participants born between 1974 and 1978 in the hospita...

Post-traumatic stress disorder (PTSD) was formally recognised as a psychiatric disorder in 1980, largely in response to America's attempts to make sense of the costs of the Vietnam war [Wessely, S., & Jones, E. (2004). Psychiatry and the 'lessons of Vietnam': What were they, and are they still relevant? War & Society, 22(1), 89-103.]. Interestingly...

Objective: This study assessed the prevalence of general medical problems, stress or emotional problems, and alcohol problems reported by members of the armed forces of the United Kingdom after deployment in Iraq or Afghanistan. The study also identified types of help seeking and factors associated with help seeking. Methods: A total of 4,725 mi...

Purpose: Diarrhoea and vomiting (D & V) was common in military personnel during deployment to the initial phases of the Iraq war. D & V is an established risk factor for irritable bowel syndrome (IBS). This study examined the prevalence of IBS in a military sample with a history of deployment to Iraq and the association between D & V and common me...

To assess the importance of service demographic, mental disorders, and deployment factors on headache severity and prevalence, and to assess the impact of headache on functional impairment. There is no information on prevalence and risk factors of headache in the UK military. Recent US reports suggest that deployment, especially a combat role, is a...

Background: Violent offending by veterans of the Iraq and Afghanistan conflicts is a cause for concern and there is much public debate about the proportion of ex-military personnel in the criminal justice system for violent offences. Although the psychological effects of conflict are well documented, the potential legacy of violent offending has y...

Background Violent offending by veterans of the Iraq and Afghanistan confl icts is a cause for concern and there is much public debate about the proportion of ex-military personnel in the criminal justice system for violent off ences. Although the psychological eff ects of confl ict are well documented, the potential legacy of violent off ending ha...

Background: In previous studies an association between deployment to Iraq or Afghanistan and an overall increased risk for post-traumatic stress disorder (PTSD) in UK armed forces has not been found. The lack of a deployment effect might be explained by including, in the comparison group, personnel deployed on other operations or who have experien...

Objective: The objective of the study was to elicit beliefs and experiences of the value of a screening programme for mental illness among UK military personnel. Method: Three months after returning from Afghanistan 21 army personnel participated in a qualitative study about mental health screening. One-to-one interviews were conducted and recor...

Background There is considerable media, political and public interest on both sides of the Atlantic in an alleged rise in violence among military personnel returned from conflicts in Iraq and Afghanistan. This study explores violence among a large sample of UK military personnel, a proportion of whom had been deployed to Iraq/Afghanistan. The aims...

It has been reported that waist circumference (WC) is a better predictor of cardiovascular risk factors than body mass index (BMI), although the findings have not been consistent. The aim of this study was to assess which measurement, BMI or WC, is more strongly associated with blood pressure, homeostatic model assessment (HOMA) and blood lipids in...

Scientific criteria for identifying allergenic foods of public health importance (Björkstén, B., Crevel, R., Hischenhuber, C., Løvik, M., Samuels, F., Strobel, S., Taylor, S.L., Wal, J.-M., Ward, R., 2008. Criteria for identifying allergenic foods of public health importance. Regulatory Toxicology and Pharmacology 51(1), 42-52) have been further re...

Delayed-onset posttraumatic stress disorder (PTSD) is defined as onset at least 6 months after a traumatic event. This study investigates the prevalence of delayed-onset PTSD in 1397 participants from a two-phase prospective cohort study of UK military personnel. Delayed-onset PTSD was categorized as participants who did not meet the criteria for p...

It is not known whether smoking by mothers during pregnancy is associated with headache in their offspring. Two prospective cohorts of 869 children aged 10-11 years from Ribeirão Preto (RP) and 805 children aged 7-9 years from São Luís (SL) were studied. Data on maternal smoking were collected at birth. Primary headache was defined as a reporting o...

: To assess (a) the prevalence of mild traumatic brain injury (mTBI) in UK military personnel deployed to Iraq and/or Afghanistan, (b) the risk factors associated with mTBI, and (c) the association between mTBI and subsequent postconcussion symptoms (PCS). : A total of 4620 personnel deployed to Iraq and/or Afghanistan who completed a questionnaire...

: Rates of mild traumatic brain injury (mTBI) differ considerably between US and UK forces, despite similar methodology and similar exposure risks. We assessed, in the UK forces, if the differences in rates based on last deployment can be explained by differences in deployment length, given that US forces deploy for approximately twice as long as U...

Objective: Current tobacco smoking has been associated with headache. However it is not known if maternal smoking during pregnancy is associated with headache in their offspring. The aim of this research was evaluated the association between maternal smoking during pregnancy with headache in schol-aged children.

Identification of allergenic foods of public health importance should be based on well-defined criteria. Björkstén et al. (2008) proposed that the criteria should assess the evidence for an IgE mechanism, the reaction, the potency and the severity of the effect of the food and its prevalence. This study evaluated the application of the proposed cri...

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 servi...

Although studies have shown association of birth weight (BW) and adult body mass index (BMI) with insulin sensitivity in adults, there is limited evidence that BW is associated with insulin secretion. We assessed the associations between BW and current BMI with insulin sensitivity and secretion in young Latin American adults. Two birth cohorts, one...

Body Mass Index (BMI) does not distinguish between fat-free mass and fat mass, yet this distinction is important as a clinical tool, especially in the military and occupations for which physical fitness is important. This study assessed the level of agreement between BMI, sum of skin-folds and waist circumference in UK Army personnel. Three hundred...

To assess the risk factors of obesity in terms of body mass index (BMI) and waist circumference in the UK Armed Forces. A quota sample from all UK services, of 2,448 men and 311 women aged 17-55 years. The risk ratios for those with a BMI 227.5 kg/m2 and waist circumference 294 cm in men were 0.21 (95% confidence interval [CI], 0.13-0.34) for non-w...

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-vet...

As with the general population, a proportion of military personnel with mental health problems do not seek help. As the military is a profession at high risk of occupational psychiatric injury, understanding barriers to help-seeking is a priority. Participants were drawn from a large UK military health study. Participants undertook a telephone inte...

To assess the prevalence of obesity in the United Kingdom military and general population and the extent to which self-reported data underestimates obesity. Height and weight data from military personnel (measured data: 2,073 men, 308 women; self-reported data: 6,374 men, 609 women) and from the general population (measured data: 1,121 men, 1,396 w...

Despite having high levels of combat exposure, commando and airborne forces may be at less risk of mental ill-health than other troops. To examine differences in mental health outcomes and occupational risk factors between Royal Marines Commandos (RMCs), paratroopers (PARAs) and other army infantry (INF). Three groups of personnel (275 RMCs, 202 PA...

Research into how individuals perceive their deployment experiences is important for understanding the association between stressful events and subsequent positive or negative effects. This study examines perceptions among UK military personnel with regard to rewarding and unrewarding aspects of deployment in Iraq. Analyses were carried out on 5,57...

For armed forces personnel, data on help-seeking behaviour and receipt of treatment for mental disorders are important for both research and policy. To examine mental healthcare service use and receipt of treatment in a sample of the UK military. Participants were drawn from an existing UK military health cohort. The sample was stratified by reserv...

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 pr...

The relationship between birth weight and plasma lipoproteins is inconsistent. To assess the association between birth weight and (1) body mass index (BMI) at birth and (2) lipoproteins in young adults, and also to explore the possible effect of current obesity as a possible effect modifier. Two prospective studies based on representative samples o...

To assess whether alcohol misuse was associated with functional impairment in the military, and whether an association between any of the measures of alcohol misuse and impairment would be explained by psychiatric comorbidity. Large cross-sectional study. 8585 responders of a random sample of the regular United Kingdom Armed Forces who completed a...

Low birth weight and preterm birth, and social disadvantage may negatively affect mental health of children, but findings have been inconsistent. To assess the influence of perinatal and social factors on mental health problems in children aged 7-9 years. A random sample of 805 births in São Luís, Brazil was studied in 1997/1998 and again in 2005/2...

We assessed socio-demographic and military factors associated with smoking among males in the UK Armed Forces; made comparisons with the general population; and, tested the hypothesis that smoking has declined in the Armed Forces. Using data from two cross-sectional studies (conducted in 1998 and 2004), we examined the patterns of smoking among reg...

Several reports have shown increases in the prevalence of non-specific symptoms in the general population. Research in the military tends to focus on comparisons between deployed and non-deployed personnel and does not examine trends over time. 4,257 and 4,295 male participants of the Gulf war and Iraq war studies not deployed to either of these wa...

The mental health of the Armed Forces is an important issue of both academic and public interest. The aims of this study are to: a) assess the prevalence and risk factors for common mental disorders and post traumatic stress disorder (PTSD) symptoms, during the main fighting period of the Iraq War (TELIC 1) and later deployments to Iraq or elsewher...

Supplementary table 1 (S1) and Supplementary table 2 (S2). Table S1: Sampling weights used to generate weighted prevalences, number and percentage (%) within each 2 × 2 table: The data provided presents the weighted prevalences. Weighting was based on the inverse of the sampling weight for the three characteristics that were over-sampled in the stu...

Post-traumatic stress disorder (PTSD) has been called one of the signature injuries of the Iraq War. In this review prevalence estimates of PTSD are summarized and discrepancies are discussed in relation to methodological differences between studies. We searched for population-based studies with a minimum sample size of 300. Studies based on help-s...

Definitions of overweight and obesity for children were published in 2000, derived by averaging the centiles of six countries equivalent to body mass index (BMI) at age 18 years of 25 and 30. For use in the UK it is unclear whether these present an advantage over equivalent definitions based on UK data. To compare the recently published internation...

The study assessed the impact of body mass index (BMI) at birth, infancy, and adulthood, and waist circumference on lung function. Using a longitudinal design 1221 Chilean young adults were studied. A standardized respiratory questionnaire was used. Forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), height, weight and waist circ...

We assessed whether job demand and job control have independent effects on psychological symptoms or whether job control modifies effect of job demand; we also assessed whether rank modified associations between job strain and psychological symptoms. We used the Post Traumatic Stress Disorder (PTSD) Checklist (PCL-C), General Health Questionnaire-1...

Using survey data, the authors assessed whether military personnel's prior mental health status would influence their likelihood of being deployed. None of the previous studies that assessed a possible "healthy warrior effect," in which persons selected for deployment have better predeployment health, were based on surveys. A sample of 2,820 United...

Enhanced oxidative stress has been described in adults who suffer from symptoms of asthma and poor lung function. This study assessed the relation between markers of oxidative stress and antioxidant status and lung function, symptoms of asthma, atopy and bronchial hyperresponsiveness (BHR) in young adults. A sub-sample of 589 individuals aged 22-28...

This study assessed the contribution of baseline psychological symptoms, combat exposure, and unit support in the etiology of posttraumatic stress disorder (PTSD), and psychological distress. From 2004-2006, 67% of a random sample of 2,820 participants who had been assessed for psychological symptoms in 2002 were reassessed. Baseline psychological...

The National Study of Health and Growth (NSHG) was a surveillance system of growth in primary school children of England and Scotland from 1972 to 1994. The system included a representative sample and an inner city sample. The study was valuable for assessing the possible impact of food welfare policy and social factors on nutritional status, mainl...

The aims of this study were to assess: (1) the relationship between PTSD and impairment, (2) whether there is a threshold in the association of PTSD score and impairment, and (3) whether any of the PTSD criteria are more strongly associated with impairment. We studied 10,069 service personnel from a representative sample of the British Armed Forces...

The pattern of associations and the attributable fractions (AF) of atopic conditions due to specific sensitizations vary between countries. To assess the level of associations and AF between sensitization to five allergens and atopic conditions in two settings. We studied 2063 Brazilians and 1231 Chileans of both sexes using representative samples...

The purpose of this study was to understand the reasons why some UK military personnel refused the anthrax vaccination. Data were collected from 5,302 members of the UK Armed Forces who had been deployed to Iraq since 2003 and had been offered the anthrax vaccination. As part of a larger questionnaire, information was collected on acceptance or ref...