Neil Greenberg’s research while affiliated with King's College London and other places

Background The twelve item General Health Questionnaire (GHQ-12) is a widely used measure of psychological wellbeing. Because there are seven different sets of response options across the twelve items, there is scope for transcription errors to occur when researchers assemble their study materials. The impact of such errors might be more important if they occur in the first set of response options than if they occur later in the questionnaire, once participants have become aware that options to the right of the GHQ-12 response sets always indicate worse wellbeing. Aims To test the impact of introducing errors into the first and eighth set of response options for the GHQ-12 that render those response sets partially illogical. Methods We used a double-blind randomised controlled trial, pre-registered with Open Science Framework (osf.io/syhwf). Participants were recruited by a market research company from their existing panel of respondents in Great Britain. Participants were randomly allocated to receive one of three versions of the GHQ-12: a correct version (n = 500), a version with a mistake in the first item (n = 502), or a mistake in the eighth item (n = 502). Mistakes replaced ‘better than usual’ (item one) or ‘more so than usual’ (item eight) with ‘not at all.’ Results We found no differences between the versions in terms of number of participants with possible poor psychological wellbeing (χ² = 0.32, df = 2, p = 0.85) or in mean GHQ-12 scores for the three groups (F(2, 1501) = 0.26, p = 0.77). Conclusions Small deviations from the standard GHQ-12 wording do not have a substantive impact on results.

Background Research in recent years has increasingly highlighted the relationship between exposure to potentially morally injurious events (PMIEs) and poor mental health outcomes. Human trafficking survivors often report exposure to many traumatic and PMIEs and given the complexities of trafficking exploitation, survivors may be especially vulnerable to moral injury. Despite this, no research has investigated experiences of PMIEs and moral injury in human trafficking survivors. The objective was to explore survivors’ experiences of PMIEs, the impact of PMIEs on wellbeing and functioning and the factors that may influence outcomes following PMIEs. Method Participants were seven human trafficking survivors from diverse backgrounds who had settled in the UK. In-depth semi-structured interviews were conducted via telephone. Data were analysed using thematic analysis. Results Human trafficking survivors were found to experience multiple PMIEs, including transgressive acts committed by others and betrayal by trusted loved ones or those in positions of authority. Experiencing PMIEs contributed towards considerable psychological distress, including intense feelings of shame, anger and worthlessness, and negatively impacted survivors daily functioning. Formal support, especially practical help (e.g. warm clothing) and social support groups, were experienced as particularly beneficial. Conclusions This study provides some of the first evidence that human trafficking survivors may be vulnerable to moral injury and indicates the impact that exposure to PMIEs can have on functioning. Future work is needed to ensure that statutory organisations consider the potential for causing moral injury when interacting with human trafficking survivors and clinical care teams are equipped to provide tailored guidance and support.

Objective This study investigates perceptions of homeworking in UK Government response-focused employees that contributed to the COVID-19 pandemic response. Method A cross-sectional online survey with open-ended questions was conducted. Free-text responses detailing participants perceptions of barriers, facilitators, advantages, and disadvantages were analysed using content analysis. Results A total of 1,943 free-text responses (from 150 participants) were analysed. There were many conflicting advantages and disadvantages provided by participants, but crudely more positive statements were provided than negative. Flexibility associated with working from home was the most common positive factor, and the isolation and impact on working relationships was the most reported negative factor of working from home. Conclusion We suggest a ‘one size fits all’ approach to supporting staff working from home is not fit for purpose due to individual circumstances and contextual factors.

Robust regulatory scrutiny is an unavoidable and necessary part of professional life for public sector professionals. Inspection and investigation can lead to poor mental health for individuals already working under pressure owing to increased workload and anticipation of poor outcomes. Although good regulation maintains standards and provides accountability to government and the public, regulators must face their obligation to understand the wider impact of their practices on the mental health of those they evaluate. This article discusses how regulation affects public sector culture and the potential risks and negative impact of regulatory practices and highlights how clinicians, working in occupational practice, are well placed to recognise ‘regulatory stress’ among public sector workers and offer vital support, guidance and advocacy.

After disasters, many people seek compensation for physical, psychological or economic damages. However, compensation processes can be perceived as arduous and unfair and potentially create stress for both individuals and communities. This systematic review explored the psychosocial impacts of post-disaster compensation processes, including compensation sought through both litigation and government assistance programmes. We searched seven databases, hand-searched reference lists of included studies, and used thematic analysis to synthesise results of included studies. We screened 6,532 papers, ultimately including 66 in the review. While we found mixed evidence regarding the relationship between individual mental health and the compensation process, many studies suggested the process placed demands on emotional resources and could cause stress. Numerous challenges of the compensation process were described, including complicated paperwork, lengthy processes, inadequate information, confusing eligibility criteria, lack of inter-agency cooperation, poor understanding of communities’ unique needs, insufficient pay-outs, and politicisation of the process. Inequities in compensation distribution introduced additional stress to already traumatised communities, who often experienced resentment, envy and conflict. The mixed nature of the relationship between mental health and the compensation process was evident in research trends where a small number of studies reported positive findings related to relating to gratitude, helpfulness of compensation and strengthened community relationships, while a substantial number of others reported negative impacts including higher mental health problems. Positive and negative impacts were reported for both litigation and non-litigation compensation-seeking. The nuanced dynamics of these findings are described in greater detail within the paper. It is important that compensation regulators consider the potential impacts on individuals and communities and take steps to address compensation inequities. This enhanced understanding of how those affected by disasters can rebuild their lives and furthering understanding of how to support them will enable evidence-based approaches to building resilience and planning for long-term recovery. Significant compensation process improvements could be realised by ensuring clear communication and transparent decision-making. Overall, this review underscores the importance of ensuring that compensation processes are fair and straightforward so they can repair material losses without deteriorating the social norms and relationships of affected communities.

Objectives The objectives of this study were to examine post COVID-19 syndrome (PCS) among healthcare workers (HCWs) in England and explore risk factors for the condition. Methods Data were collected by National Health Service (NHS) CHECK, a longitudinal study exploring HCWs’ mental and physical well-being during and after the COVID-19 pandemic. NHS CHECK collected data at four timepoints: the baseline survey between April 2020 and January 2021, and then three follow-up surveys at approximately 6, 12 and 32 months post baseline. PCS data were collected at 12 and 32 months, while risk factor data were from baseline. HCWs were asked what COVID-19 symptoms they experienced and for how long and were classified as having PCS if they had any symptom for ≥12 weeks. Multilevel regressions were used to examine risk factors for PCS. Results This study included 5248 HCWs. While 33.6% (n=1730) reported prolonged COVID-19 symptoms consistent with PCS, only 7.4% (n=385) reported a formal diagnosis of PCS. Fatigue, difficult concentrating, insomnia and anxiety or depression were the most common PCS symptoms. Baseline risk factors for reporting PCS included screening for common mental disorders, direct contact with COVID-19 patients, pre-existing respiratory illnesses, female sex and older age. Conclusions While a third of HCWs reported prolonged COVID-19 symptoms consistent with PCS, a smaller percentage reported a formal diagnosis of the condition. We replicate findings that direct contact with COVID-19 patients, older age, female sex, pre-existing respiratory illness and symptoms of common mental disorders are associated with increased risk of PCS.

The role of women in the UK Armed Forces has changed considerably in the last decade. With drives to increase the number of women serving in the military, research must consider the impact of both service and transition into civilian life on the health and wellbeing of service and ex-servicewomen (female veterans). This paper adds to the field by providing the perspective of service providers supporting ex-service personnel with their mental health, employment, housing and other needs in addition to those working in policy affecting ex-servicewomen. This study aimed to explore their understanding of what constitutes a successful transition into civilian life, the barriers and facilitators to achieving this and how transition might be impacted by the gender of the individual transitioning. Interviews and roundtable discussions were held with stakeholders (n=28) and analysed using framework analysis. Four overarching themes were identified: Successful transition is individual and all-encompassing, The conflicting identities of servicewomen, Sexism: women don't belong in service and The needs of servicewomen. The first theme describes how the process and result of successful transition is individual to each ex-servicewoman, whilst the remaining themes outline common challenges faced by ex-servicewomen on this journey. There was no singular definition of successful transition, but stakeholders described barriers to a successful transition. They identified prominent gender-specific barriers rooted in misogyny and inequality during military service that permeated into civilian life and impacted support use and workplace experiences. Ex-servicewomen were often required to juggle multiple responsibilities, mother and partner, and identities, women and warrior, simultaneously. Policies should look to address elements of military culture that may reinforce gender inequality and ensure veteran services are inclusive and welcoming to women and cater for gender-specific needs such as gynaecological health. Whilst in-service and veteran-focused interventions are needed, entrenched sexism in general society should not be ignored.

Introduction Working on the frontline during the COVID-19 pandemic has been associated with increased risk to mental health and wellbeing in multiple occupations and contexts. The current study aimed to provide an insight into the rate of probable mental health problems amongst United Kingdom (UK) Government employees who contributed to the COVID-19 response whilst working from home, and to ascertain what factors and constructs, if any, influence mental health and wellbeing in the sample population. Method This paper reports on the findings from two studies completed by UK Government employees. Study 1: A cross-sectional online survey, containing standardised and validated measures of common mental health disorders of staff who actively contributed to the COVID-19 response from their own homes. Binary logistic regression was used to assess factors associated with mental health outcomes. Study 2: A secondary data analysis of cross-sectional survey data collected across three timepoints (May, June, and August) in 2020 focusing on the wellbeing of employees who worked from home during the COVID-19 pandemic. Results Study 1: 17.9% of participants met the threshold criteria for a probable moderate anxiety disorder, moderate depression, or post-traumatic stress disorder. Younger, less resilient, less productive individuals, with lower personal wellbeing and less enjoyment of working from home, were more likely to present with poorer mental health. Study 2: Found lower wellbeing was consistently associated with having less opportunities to look after one’s physical and mental health, and having unsupportive line managers and colleagues. Conclusion It is important to ensure UK Government employees’ psychological needs are met whilst working from home and responding to enhanced incidents. It is recommended that workplaces should be seeking to continually build and improve employee resilience (e.g., through opportunities to increase social ties and support networks), essentially ensuring employees have necessary resources and skills to support themselves and others.