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Chambliss T, Hsu JL, Chen ML. Post-traumatic Stress Disorder in Veterans: A Concept Analysis. Behav Sci (Basel) 2024; 14:485. [PMID: 38920817 PMCID: PMC11200391 DOI: 10.3390/bs14060485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/06/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) occurs when an individual experiences a traumatic event that exceeds the limits of psychological endurance. Many veterans experience PTSD. PTSD can negatively impact veterans' quality of life, functioning, life satisfaction, and overall well-being. It is important to analyze the concept of PTSD in the veteran population. This concept analysis aimed to investigate the defining attributes, a model case, antecedents, consequences, and empirical referents related to the concept of PTSD among veterans. Walker and Avant's method was used to guide this concept analysis of PTSD. The results showed that three attributes were determined from the analysis: intrusive memories of traumatic events, feelings of isolation and estrangement, and negative cognitions. PTSD is conceptualized as a collection of symptoms that arise from highly traumatic experiences. The military environment predisposes veterans to traumatic events that should be identified or acknowledged. A better understanding of the concept of PTSD can facilitate the development of effective interventions for the veteran population and enhance their mental health.
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Affiliation(s)
- Tormechi Chambliss
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA 30303, USA;
| | - Jung-Lung Hsu
- Department of Neurology, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City 236, Taiwan;
| | - Mei-Lan Chen
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA 30303, USA;
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Adu J, Fordjour Owusu M, Martin-Yeboah E, Gyamfi S. Analyzing Two Decades of Literature on Experiences of Familial Mental Illness Stigma in Four Advanced Countries (2000-2020). Issues Ment Health Nurs 2024; 45:247-263. [PMID: 38270980 DOI: 10.1080/01612840.2023.2301602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND Mental illness-related stigma does not only emanate from the public but also within families of persons with mental illnesses. Familial mental illness stigma implies family members perpetuating stigma against their loved ones with mental illnesses. AIMS The aim of this review was to analyze the empirical literature on experiences of familial mental illness stigma in four countries. METHODS Using seven databases, we reviewed 133 empirical studies with 26 meeting the inclusion criteria. Each of the 26 studies spoke to various forms of familial mental illness stigma that potentially impact the self-esteem and self-worth of the affected person. RESULTS Findings from this review show the existence of familial mental illness stigma in high-income countries, highlighting the need for evidence-based policies to safeguard affected persons at the family level. Close relatives stigmatizing their loved ones due to mental illnesses have contributed to the concealment of mental illness diagnoses within families, which often results in poor prognoses. CONCLUSIONS Family members' understanding of mental illnesses is key in confronting the stigma associated with mental disorders in our communities, but this is contingent on continuous comprehensive familial program and education. Constant social support from community services and family members is essential in the recovery of persons with mental illnesses. This underscores the need for a stigma-free environment at all levels of society to ensure all-inclusiveness which calls for a comprehensive strategy that targets policy changes, public education, and media representations of mental health-related problems.
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Affiliation(s)
- Joseph Adu
- Department of Health and Rehabilitation Sciences, Western University, London, Canada
| | - Mark Fordjour Owusu
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | | | - Sebastian Gyamfi
- Lawson Health Research Institute, London, Canada
- Faculty of Nursing, Windsor University, Windsor, Canada
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Duran F, Woodhams J. Associations between individual cognitive factors, mode of exposure and depression symptoms in practitioners working with aversive crime material. Eur J Psychotraumatol 2023; 14:2264612. [PMID: 37881889 PMCID: PMC10763876 DOI: 10.1080/20008066.2023.2264612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
Abstract
Background: There is extensive literature on front-line officers and investigators exposure to trauma and its negative impact on them. However, there are analytical practitioners in law enforcement who indirectly work with the traumatic experiences of other people daily, but are seldom the focus of academic research.Objective: Our goal was to conduct the first international study with these practitioners to identify the risk of depression symptoms and establish whether potentially modifiable risk factors (belief in a just world, mental imagery and thought suppression) and work-related characteristics (medium of exposure) are associated with depression.Method: 99 analysts and secondary investigators employed in police and law enforcement organizations from the UK, Europe and Canada participated in the study. The online survey was advertised to employees via their employers but hosted without employer access. Multiple regression was used to analyze the data.Results: After controlling for age, gender, ethnicity, previous exposure to trauma, and marital status, four potential risk factors were identified. Analytical practitioners with vivid mental imagery, those exposed to crime material via auditory and visual means, those who suppressed intrusive thoughts, and those who believed in a just world reported more depressive symptoms.Conclusions: The majority of our sample reported clinical levels of depressive symptoms. Four potential risk factors accounted for just under half of the variance in depression scores. We consider strategies that can be used to mitigate the potential negative influence of these factors and suggest that these are established as risk factors for depression symptoms via future longitudinal research.
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Affiliation(s)
- Fazeelat Duran
- School of Psychology, University of Birmingham, Birmingham, UK
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Mills A, Fear NT, Stevelink SA. Awareness of and willingness to access support among UK military personnel who reported a mental health difficulty. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2023. [DOI: 10.3138/jmvfh-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
LAY SUMMARY Being aware of and willing to access mental health services are important first steps in seeking help for a self-reported mental health, stress, or emotional problem. Evidence shows that UK military personnel, in particular ex-serving personnel, are not always aware of or willing to access sources of mental health support. This study explored which sources of mental health support UK military personnel were aware of and willing to use if they self-reported a mental health, stress, or emotional problem. It also explored the possible differences between serving and ex-serving military personnel. All UK military personnel were most aware of and willing to access formal medical services. However, among ex-serving personnel, there was a low awareness of and willingness to use ex-serving-specific support services, such as the Veterans and Reserves Mental Health Programme, National Health Services Veterans Service, and Veterans UK helpline. Future service delivery and policy should focus on improving the variety of sources of support that ex-serving personnel are aware of and willing to use.
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Affiliation(s)
- Amy Mills
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Nicola T. Fear
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Sharon A.M. Stevelink
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
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Fikretoglu D, Sharp ML, Adler AB, Bélanger S, Benassi H, Bennett C, Bryant R, Busuttil W, Cramm H, Fear N, Greenberg N, Heber A, Hosseiny F, Hoge CW, Jetly R, McFarlane A, Morganstein J, Murphy D, O'Donnell M, Phelps A, Richardson DJ, Sadler N, Schnurr PP, Smith P, Ursano R, Hooff MV, Wessely S, Forbes D, Pedlar D. Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective. Clin Psychol Rev 2021; 91:102100. [PMID: 34871868 DOI: 10.1016/j.cpr.2021.102100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022]
Abstract
Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the past six years to update and broaden the discussion on pathways to mental healthcare in military populations. We find that at a broad population level, there is improvement in several indicators of mental health care access, with greater gains in initial engagement, time to first treatment contact, and subjective satisfaction with care, and smaller gains in objective indicators of adequacy of care. Among individual-level barriers to care-seeking, there is progress in improving recognition of need for care and reducing stigma concerns. Among organizational-level barriers, there are advances in availability of services and cultural acceptance of care-seeking. Other barriers, such as concerns around confidentiality, career impact, and deployability persist, however, and may account for some remaining unmet need. To address these barriers, new initiatives that are more evidence-based, theoretically-driven, and culturally-sensitive, are therefore needed, and must be rigorously evaluated to ensure they bring about additional improvements in pathways to care.
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Affiliation(s)
- Deniz Fikretoglu
- Defence Research and Development Canada, 1133 Sheppard Ave. West, Toronto, ON, Canada.
| | | | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | | | | | | | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | | | | | | | - Fardous Hosseiny
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rakesh Jetly
- Department of National Defence, Ottawa, ON, Canada
| | | | | | - Dominic Murphy
- Combat Stress, Leatherhead, Surrey, UK; King's College London, London, UK
| | - Meaghan O'Donnell
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Andrea Phelps
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Don J Richardson
- Parkwood Institute- St. Joseph's Health Care London, London, ON, Canada
| | - Nicole Sadler
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | | | - Patrick Smith
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | | | - Miranda Van Hooff
- Military and Emergency Services Health Australia (MESHA), Woodville, SA, Australia
| | | | - David Forbes
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - David Pedlar
- Canadian Institute for Military and Veteran Health Research, Queen's University, Kingston, ON, Canada
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Geuzinge R, Visse M, Duyndam J, Vermetten E. Social Embeddedness of Firefighters, Paramedics, Specialized Nurses, Police Officers, and Military Personnel: Systematic Review in Relation to the Risk of Traumatization. Front Psychiatry 2020; 11:496663. [PMID: 33408646 PMCID: PMC7779596 DOI: 10.3389/fpsyt.2020.496663] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Firefighters, paramedics, specialized nurses working in Intensive Care Units (ICUs), Operating Rooms (OR), and Emergency Rooms (ER), police officers and military personnel are more frequently exposed to potentially traumatic events than the general population; they are considered high-risk professionals. To reduce the risk of traumatization it is of great importance to be embedded in a social environment with supportive relationships. Methods: We performed a systematic review (based on the PRISMA-Guidelines) looking for social connections within the environment in which high-risk professionals are embedded (work, home, community), to obtain evidence on the impact of these connections on the risk of traumatization. Additionally, we aim to identify relevant supportive relationships in the professionals' environments. We identified the relevant scientific literature by searching, without time, and language restriction, five electronic bibliographic databases: MEDLINE, PsycINFO, Sociological Abstracts, CINAHL, and Web of Science. These databases were last searched in January 2019. Results: A qualitative analysis of the 89 eligible (out of 9,047 screened) studies shows that for firefighters, paramedics, and emergency nurses social connections in their work environment are predominantly supportive relationships and may protect them against traumatization. In other occupations (OR-nurses, ICU-nurses, police officers), however, social connections at work are not only a source of support but are also a source of stress. For military personnel study results are inconclusive as to whether their social connections at work or at home support them against traumatization. In so far as connections are supportive, their sources vary greatly from one occupational group to another; they differ between work vs. home as well as within work between peers vs. supervisor. Conclusions: Being embedded in a social environment, i.e., having social connections, is important but not always sufficient to protect high-risk professionals against traumatization. For, while these connections may be the antecedents of supportive relationships, they can also be the antecedents of damaging relationships. Additionally, the sources of supportive relationships differ among groups. This suggests that knowledge of how the social structures of the occupational groups differ may increase our understanding of the impact of social connections and relationships, including socialization, on the risk of traumatization of high-risk professionals.
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Affiliation(s)
- Renate Geuzinge
- Humanism and Social Resilience, University of Humanistic Studies, Utrecht, Netherlands
| | - Merel Visse
- Care Ethics, University of Humanistic Studies, Utrecht, Netherlands
| | - Joachim Duyndam
- Humanism and Social Resilience, University of Humanistic Studies, Utrecht, Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
- Ministry of Defense, Military Mental Health Research Center, Utrecht, Netherlands
- ARQ National Psychotrauma Center, Diemen, Netherlands
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Stevelink SAM, Opie E, Pernet D, Gao H, Elliott P, Wessely S, Fear NT, Hotopf M, Greenberg N. Probable PTSD, depression and anxiety in 40,299 UK police officers and staff: Prevalence, risk factors and associations with blood pressure. PLoS One 2020; 15:e0240902. [PMID: 33180769 PMCID: PMC7660485 DOI: 10.1371/journal.pone.0240902] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/06/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Police employees undertake challenging duties which may adversely impact their health. This study explored the prevalence of and risk factors for probable mental disorders amongst a representative sample of UK police employees. The association between mental illness and alterations in blood pressure was also explored. METHODS Data were used from the Airwave Health Monitoring Study which was established to monitor the possible physical health impacts of a new communication system on police employees. Data included sociodemographic characteristics, lifestyle habits, depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms and blood pressure. Descriptive statistics were used to explore the prevalence of probable mental disorders and associated factors. Stepwise linear regression was conducted, controlling for confounding variables, to examine associations between mental disorders and blood pressure. RESULTS The sample included 40,299 police staff, police constable/sergeants and inspectors or above. Probable depression was most frequently reported (9.8%), followed by anxiety (8.5%) and PTSD (3.9%). Groups at risk for probable mental disorders included police staff, and police employees who reported drinking heavily. Police employees exposed to traumatic incidents in the past six months had a doubling in rates of anxiety or depression and a six-fold increase in PTSD compared to those with no recent trauma exposure. Adjusted logistic regression models did not reveal any significant association between probable mental disorders and systolic blood pressure but significantly elevated diastolic blood pressure (≈1mmHg) was found across mental disorders. CONCLUSIONS These results show lower rates of probable mental disorders, especially PTSD, than reported in other studies focusing on police employees. Although mental ill health was associated with increased diastolic blood pressure, this was unlikely to be clinically significant. These findings highlight the importance of continued health monitoring of members of the UK police forces, focusing on employees recently exposed to traumatic incidents, heavy drinkers and police staff.
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Affiliation(s)
- Sharon A. M. Stevelink
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
- Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - Elena Opie
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - David Pernet
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - He Gao
- MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Paul Elliott
- MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- NIHR Imperial College Biomedical Research Centre, Imperial College London, London, United Kingdom
- UK Dementia Research Institute at Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
- Health Data Research UK London at Imperial College London, Faculty of Medicine, St Mary’s Campus, London, United Kingdom
| | - Simon Wessely
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - Nicola T. Fear
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
| | - Matthew Hotopf
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Neil Greenberg
- King’s Centre for Military Health Research, Department of Psychological Medicine, King’s College London, London, United Kingdom
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Stevelink SAM, Pernet D, Dregan A, Davis K, Walker-Bone K, Fear NT, Hotopf M. The mental health of emergency services personnel in the UK Biobank: a comparison with the working population. Eur J Psychotraumatol 2020; 11:1799477. [PMID: 33062207 PMCID: PMC7534319 DOI: 10.1080/20008198.2020.1799477] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There is evidence that mental disorders are more frequently reported among emergency services personnel due to the stressful nature of the job in combination with a high exposure to traumatic events. However, most of this research is based on occupational surveys that may lead to a contextual bias in the prevalence estimates or lack an adequate comparison group. Objectives: To investigate mental health outcomes and associations with individual, job and trauma related characteristics among emergency services personnel compared to other workers. Method: Participants were identified from the UK Biobank, a large study that collected a variety of genetic, physical and health data on individuals from across the UK. UK Biobank participants were aged between 40-69 years at recruitment. Those employed in the emergency services were identified based on job titles. A comparison sample of other workers was selected and matched to the gender composition of emergency services personnel. Results: 5052 participants were included, and 842 were currently working in the emergency services. The majority were male (77.4%) and the mean age at Biobank enrolment was 52.5 years. Alcohol misuse was reported in 32.8% of emergency services personnel compared to 29.2% in non-emergency services personnel, followed by PTSD (9.2% vs 6.0%), depression (6.8% vs 5.1%) and anxiety (3.9% vs 3.6%). An increased risk of PTSD was found among emergency services personnel compared to other workers (odds ratio 1.58, 95% confidence interval 1.21-2.06), but this association was no longer significant after adjustment for exposure to traumatic events and job characteristics. Conclusions: The substantial levels of alcohol misuse and increased risk of PTSD, possibly as a result of traumatic exposures in the line of duty in combination with job stressors such as shift work, call for continued monitoring of the health and wellbeing of emergency services personnel.
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Affiliation(s)
- Sharon A. M. Stevelink
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - David Pernet
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Alexandru Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Katrina Davis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Karen Walker-Bone
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, Hampshire, UK
- Arthritis Research UK/MRC Centre for Musculoskeletal Work and Health, Southampton General Hospital, Southampton, Hampshire, UK
| | - Nicola T. Fear
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Academic Department of Military Mental Health, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Gu RP, Liu XR, Ye XF. Attitudes and perceived barriers to mental healthcare in the People's Liberation Army Navy: study from a navy base. BMJ Mil Health 2020; 168:331-336. [PMID: 32430460 PMCID: PMC9554070 DOI: 10.1136/bmjmilitary-2019-001396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022]
Abstract
Introduction The People’s Liberation Army (PLA, China) Navy is increasingly conducting military operations other than war overseas. Factors such as confrontations with pirates, special environments and long sailing times have resulted in mental health problems. However, the navy’s actual utilisation of mental health services is low. This study examined members’ rate of willingness to seek help and the factors that act as barriers to willingness to seek mental health services in the PLA Navy. Methods This cross-sectional study was conducted at the Zhoushan Base, operated by the East Sea Fleet, between March 2019 and April 2019. We distributed a 12-item questionnaire to examine participants’ attitudes and perceived barriers to mental healthcare. We recruited 676 navy personnel. Participants’ willingness to seek help if they had mental health problems was also assessed. Results The response rate was 99%. A total of 88.44% of the sample reported being willing to seek help. Univariate analysis suggested that those not willing to seek help were more likely to agree with the items, ‘Mental healthcare does not work’ and ‘My unit leadership might treat me differently’ and all organisational barriers, and they were more likely to have concerns about ‘embarrassment’ and ‘being weak’ than those willing to seek help. After controlling for demographic characteristics, binary logistic regression analyses confirmed that a lack of knowledge regarding the location of mental health clinics and being perceived as weak were the main factors preventing participants’ willingness from seeking help. Conclusions Extensive efforts to decrease organisational barriers and stigma towards mental healthcare should be a priority for researchers and policymakers to improve the usage of mental health services. Psychoeducation aimed at de-stigmatising mental health problems should be delivered and the accessibility and availability of mental health services should be increased.
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Affiliation(s)
- Ren-Ping Gu
- Faculty of Military Health Service, Second Military Medical University, Shanghai, China
| | - X R Liu
- Faculty of Military Health Service, Second Military Medical University, Shanghai, China
| | - X F Ye
- Faculty of Military Health Service, Second Military Medical University, Shanghai, China
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Phillips R. The Stigmatized Hero? A Review of UK Opinion Polls and Surveys on Perceptions of British Veterans in UK Society. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i1.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Jones N, Greenberg N, Phillips A, Simms A, Wessely S. British military women: combat exposure, deployment and mental health. Occup Med (Lond) 2019; 69:549-558. [PMID: 31404463 DOI: 10.1093/occmed/kqz103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Internationally, women are about to undertake combat duties alongside their male colleagues. The psychological effect of this policy change is largely unknown. AIMS To explore the mental health impact of combat exposure among military women. METHODS Self-report, between-subjects survey data were collected in Iraq and Afghanistan on four occasions between 2009 and 2014 (n = 4139). Differences in mental health, stigmatization, deployment experiences, intimate relationship impact, perception of family support levels, unit cohesion, leadership and help-seeking were compared between deployed men and women. Comparisons were repeated with the study sample stratified by level of combat exposure. Outcomes were examined using logistic regression adjusted for socio-demographic, mental health and military factors. RESULTS Overall, 4.1% of women and 4.3% of men reported post-traumatic stress disorder (PTSD) (odds ratio (OR) 1.31, 95% confidence interval (95% CI) 0.70-2.46); 22% of women and 16% of men reported symptoms of common mental disorder (CMD) (OR 1.52, 95% CI 1.11-2.08). Women were less likely to report mental health-related stigmatization (OR 0.68, 95% CI 0.53-0.87), negative relationship impact from deployment (OR 0.69, 95% CI 0.49-0.98) and subjective unit cohesion (OR 0.69, 95% CI 0.53-0.90). Help-seeking for emotional problems was similar by gender (OR 1.22, 95% CI 0.84-1.77). Overall, outcomes were minimally impacted by level of combat exposure. CONCLUSIONS Although women experienced more CMD symptoms, PTSD symptoms were similar by gender. Subject to confirmation of the study findings, women may not require enhanced mental healthcare during deployment for exposure-based conditions such as PTSD when undertaking the ground close combat role.
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Affiliation(s)
- N Jones
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK.,King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
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12
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Williamson V, Greenberg N, Stevelink SAM. Perceived stigma and barriers to care in UK Armed Forces personnel and veterans with and without probable mental disorders. BMC Psychol 2019; 7:75. [PMID: 31775853 PMCID: PMC6881983 DOI: 10.1186/s40359-019-0351-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/11/2019] [Indexed: 12/04/2022] Open
Abstract
Background Previous studies have found that perceptions of mental health related stigma can negatively impact help-seeking, particularly in military samples. Moreover, perceptions of stigma and barriers to care can vary between individuals with different psychiatric disorders. The aim of this study was to examine whether perceptions of stigma and barriers to care differed in a UK military sample between those with and without a current likely mental health diagnosis. Method Structured telephone interviews were carried out with 1432 service personnel and veterans who reported recent subjective mental ill health in the last 3 years. Participants completed self-reported measures relating to perceived stigma, barriers to care and psychological wellbeing. Results Those meeting criteria for probable common mental disorders (CMD) and PTSD were significantly more likely to report concerns relating to perceived and internalised stigma and barriers to care compared to participants without a likely mental disorder. Compared to individuals with likely CMD and alcohol misuse, those with probable PTSD reported higher levels of stigma-related concerns and barriers to care – although this difference was not significantly different. Conclusions These results indicate that perceptions of stigma continue to exist in UK serving personnel and military veterans with current probable mental disorders. Efforts to address particular concerns (e.g. being seen as weak; difficulty accessing appointments) may be worthwhile and, ultimately, lead to improvements in military personnel and veteran wellbeing.
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Affiliation(s)
- Victoria Williamson
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK.
| | - Neil Greenberg
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK.,Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 16 DeCrespigny Park, London, SE5 8AF, UK
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Stevelink SAM, Jones N, Jones M, Dyball D, Khera CK, Pernet D, MacCrimmon S, Murphy D, Hull L, Greenberg N, MacManus D, Goodwin L, Sharp ML, Wessely S, Rona RJ, Fear NT. Do serving and ex-serving personnel of the UK armed forces seek help for perceived stress, emotional or mental health problems? Eur J Psychotraumatol 2019; 10:1556552. [PMID: 30693074 PMCID: PMC6338286 DOI: 10.1080/20008198.2018.1556552] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/16/2018] [Accepted: 11/26/2018] [Indexed: 10/25/2022] Open
Abstract
Background: UK armed forces personnel are at risk of occupational psychological injury; they are often reluctant to seek help for such problems. Objective: We aimed to examine and describe sources of support, prevalence and associates of help-seeking among UK serving and ex-serving personnel. Method: A total of 1450 participants who self-reported a stress, emotional or mental health problem in the past 3 years were sampled from a health and wellbeing study and subsequently completed a telephone interview comprising measures of mental disorder symptoms, alcohol misuse and help-seeking behaviour. Results: Seven per cent of participants had not sought any help, 55% had accessed medical sources of support (general practitioner or mental health specialist), 46% had received formal non-medical (welfare) support and 86% had used informal support. Gender, age, perceived health, functional impairment, social support, deployment, alcohol and comorbidity impacted upon the choice of help source. Conclusions: This study found that the majority of those with perceived mental health problems sought some form of help, with over half using formal medical sources of support.
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Affiliation(s)
- Sharon A. M. Stevelink
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Norman Jones
- Academic Department of Military Mental Health, Department of Psychological Medicine, King’s College London, London, UK
| | - Margaret Jones
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Daniel Dyball
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charandeep K. Khera
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - David Pernet
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Shirlee MacCrimmon
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Dominic Murphy
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Combat Stress, Leatherhead, UK
| | - Lisa Hull
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Neil Greenberg
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Deirdre MacManus
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Laura Goodwin
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Marie-Louise Sharp
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Simon Wessely
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Roberto J. Rona
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nicola T. Fear
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Academic Department of Military Mental Health, Department of Psychological Medicine, King’s College London, London, UK
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Jones N, Greenberg N, Phillips A, Simms A, Wessely S. Mental Health, Help-Seeking Behaviour and Social Support in the UK Armed Forces by Gender. Psychiatry 2019; 82:256-271. [PMID: 31385751 DOI: 10.1080/00332747.2019.1626200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Little is known about gender differences in mental health, related help-seeking behavior and social support in UK military personnel. Methods: 1714 UK military serving personnel and ex-service veterans were randomly selected if, in a cohort study, they endorsed experiencing a subjective stress, emotional, alcohol or mental health problem in the previous three years. Following exclusions, the final sample size was 1448 (participation rate 84.5%; women n = 219). Structured telephone interviews assessed anxiety, depression, PTSD symptoms, alcohol use, help-seeking and social support occurring both currently and in the past three years. Outcomes were assessed using weighted unadjusted and adjusted logistic regression analyses. Results: Mental health problems assessed at interview were broadly similar for men and women; for both genders, levels of social support were high. One-fifth of respondents screened positive for probable mental disorder or alcohol misuse; although rates of mental disorder symptoms did not differ by gender, women were significantly less likely than men to report alcohol misuse. Women were significantly more likely to have sought help from formal medical sources but significantly less likely to access informal support such as friends, family or unit welfare sources; reasons for seeking formal medical support were similar for men and women except for problem recognition and acting on advice from others, which were both significantly more common among women. Conclusion: For military personnel with a history of mental ill-health, women should make greater use of informal support networks while for men, engagement with formal medical help sources should be encouraged.
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Frank C, Zamorski MA, Colman I. Stigma doesn't discriminate: physical and mental health and stigma in Canadian military personnel and Canadian civilians. BMC Psychol 2018; 6:61. [PMID: 30567607 PMCID: PMC6300033 DOI: 10.1186/s40359-018-0273-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Illness-related stigma has been identified as an important public health concern. Past research suggests there is a disproportionate risk of mental-health stigma in the military, but this same finding has not yet been established for physical-health stigma. The current study aimed to assess the independent contribution of mental and physical health on both enacted stigma (discriminatory behaviour) and felt stigma (feelings of embarrassment) and to determine whether these associations were stronger for military personnel than civilians. Methods Data were obtained from the 2002 Canadian Community Health Survey - Mental Health and Well-being and its corresponding Canadian Forces Supplement. Logistic regressions were used to examine a potential interaction between population (military [N = 1900] versus civilian [N = 2960]), mental health, and physical health in predicting both enacted and felt stigma, with adjustments made for socio-demographic information, mental health characteristics, and disability. Results Mental health did not predict enacted or felt stigma as a main effect nor in an interaction. There was a strong link between physical health and enacted and felt stigma, where worse physical health was associated with an increased likelihood of experiencing both facets of stigma. The link between physical health and enacted stigma was significantly stronger for military personnel than for civilians. Conclusions Physical health stigma appears to be present for both civilians and military personnel, but more so for military personnel. Elements of military culture (e.g., the way care is sought, culture of toughness, strict fitness requirements) as well as the physical demands of the job could be potential predictors of group differences.
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Affiliation(s)
- Christine Frank
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada. .,Department of National Defence, Ottawa, ON, Canada.
| | - Mark A Zamorski
- Canadian Forces Health Services Group, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ian Colman
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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16
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Hamilton FL, Hornby J, Sheringham J, Linke S, Ashton C, Moore K, Stevenson F, Murray E. DIAMOND (DIgital Alcohol Management ON Demand): a feasibility RCT and embedded process evaluation of a digital health intervention to reduce hazardous and harmful alcohol use recruiting in hospital emergency departments and online. Pilot Feasibility Stud 2018; 4:114. [PMID: 29946479 PMCID: PMC6003139 DOI: 10.1186/s40814-018-0303-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/25/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions and leads to over 3 million deaths every year worldwide. Relatively few problem alcohol users access treatment due to stigma and lack of services. Alcohol-specific digital health interventions (DHI) may help them, but trial data comparing DHI with face-to-face treatment are lacking. METHODS We conducted a feasibility RCT of an alcohol DHI, testing recruitment, online data-collection and randomisation processes, with an embedded process evaluation. Recruitment ran from October 2015 for 12 months. Participants were adults, drinking at hazardous and harmful levels, recruited from hospital emergency departments (ED) in London or recruited online. Participants were randomised to HeLP-Alcohol, a six module DHI with weekly reminder prompts (phone, email or text message), or to face-to-face treatment as usual (TAU). Participants were invited to take part in qualitative interviews after the trial. RESULTS The trial website was accessed 1074 times: 420 people completed online eligibility questionnaires; 350 did not meet eligibility criteria, 51 declined to participate, and 19 were recruited and randomised. Follow-up data were collected from three participants (retention 3/19), and four agreed to be interviewed for the process evaluation. The main themes of the interviews were:Participants were not at equipoise. They wanted to try the website and were disappointed to be randomised to face-to-face, so they were less engaged and dropped out.Other reasons for drop out included not accepting that they had a drink problem; problem drinking interfering with their ability to take part in a trial or forgetting appointments; having a busy life and being randomised to TAU made it difficult to attend appointments. CONCLUSIONS This feasibility RCT aimed to test recruitment, randomisation, retention, and data collection methods, but recruited only 19 participants. This illustrates the importance of undertaking feasibility studies prior to fully powered RCTs. From the qualitative interviews we found that potential recruits were not at equipoise for recruitment. An alternative methodology, for example a preference RCT recruiting from multiple locations, needs to be explored in future trials. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number: ISRCTN31789096.
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Affiliation(s)
- Fiona L. Hamilton
- eHealth Unit, Department of Primary Care & Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Jo Hornby
- eHealth Unit, Department of Primary Care & Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | | | - Stuart Linke
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Kevin Moore
- Institute for Liver and Digestive Health, UCL, London, UK
| | - Fiona Stevenson
- eHealth Unit, Department of Primary Care & Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Elizabeth Murray
- eHealth Unit, Department of Primary Care & Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
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17
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Bowes MA, Ferreira N, Henderson M. The influence of psychosocial factors in veteran adjustment to civilian life. Clin Psychol Psychother 2018; 25:583-600. [PMID: 29575290 DOI: 10.1002/cpp.2182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 11/09/2022]
Abstract
AIM Although most veterans have a successful transition to civilian life when they leave the military, some struggle to cope and adjust to the demands and challenges of civilian life. This study explores how a variety of psychosocial factors influence veteran adjustment to civilian life in Scotland, UK, and which of these factors predict a poor adjustment. METHODS One hundred and fifty-four veterans across Scotland completed a set of questionnaires that measured veteran adjustment difficulty, quality of life, mental health, stigma, self-stigma, attitude towards help-seeking, likelihood of help-seeking, experiential avoidance, reappraisal and suppression. RESULTS Veteran adjustment difficulty and quality of life were significantly correlated to a number of psychosocial factors. Mental health, experiential avoidance and cognitive reappraisal were found to be predictors of veteran adjustment difficulty, and experiential avoidance and cognitive reappraisal partially mediated the relationship between mental health and veteran adjustment, with experiential avoidance being the stronger mediator. DISCUSSION Our findings suggest that early assessment of experiential avoidance and cognitive reappraisal and the provision of relevant emotion regulation skills training could potentially reduce the veteran's need for more complex (and costly) psychological interventions in the future. Implications for veterans, as well as the services and professionals involved with veteran transition and health care are discussed.
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Affiliation(s)
| | - Nuno Ferreira
- Department of Clinical and Health Psychology, University of Nicosia, Nicosia, Cyprus
- Department of Clinical and Health Psychology, University of Edinburgh, Edinburgh, UK
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18
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Jones N, Coetzee R. What drives UK military personnel to seek mental healthcare, work strain or something else? J ROY ARMY MED CORPS 2018; 164:248-252. [PMID: 29378786 DOI: 10.1136/jramc-2017-000861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND The numbers of UK military personnel referred to military departments of community mental health (DCMH) have increased annually over recent years; the reasons for such an increase are unclear. METHOD Data for this study were derived from 549 DCMH attendees and 3682 serving regular military personnel. DCMH attendees completed a checklist of potential reasons for help-seeking. Cohort members provided data on perceived mental health problems and help-seeking from specialist mental health services. Both samples provided work strain and basic sociodemographic data. Work strain levels were compared among cohort and DCMH help seekers and non-help seekers using adjusted logistic regression analyses. RESULTS Perceiving that mental health-related stigmatisation had reduced and being prompted to seek help by attending a health promotion event were among the least frequent reasons for seeking help in DCMH attendees. Realising that help was needed and being urged to seek help by one's partner, friends or family were the most common. Working very hard and experiencing excessive work were the most common work strain factors. Overall, the greatest levels of work strain were found among DCMH attendees. In all subsamples, work strain was significantly associated with experiencing a perceived mental health problem irrespective of whether help was sought or not. CONCLUSION Work strain was significantly associated with experiencing a stressful, emotional, mental health or alcohol problem and was the highest among current DCMH help seekers. Recognising that help was required and being prompted by a significant other were the main drivers for help-seeking among DCMH attendees.
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Affiliation(s)
- Norman Jones
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - R Coetzee
- DPHC-HQ, DMS Whittington, Lichfield, UK
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19
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Rüsch N, Rose C, Holzhausen F, Mulfinger N, Krumm S, Corrigan PW, Willmund GD, Zimmermann P. Attitudes towards disclosing a mental illness among German soldiers and their comrades. Psychiatry Res 2017; 258:200-206. [PMID: 28864120 DOI: 10.1016/j.psychres.2017.08.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/12/2017] [Indexed: 11/17/2022]
Abstract
Many soldiers with mental illness (SWMIs) struggle with the decision whether to disclose their condition in or outside the military. This study therefore explored views on (self-)labeling as 'mentally ill', experiences of discrimination and coping, risks and benefits of (non-)disclosure, service use, disclosure decisions and consequences of disclosing. Active-duty SWMIs as well as soldiers without mental illness (commanding officers; enlisted ranks) and military social workers participated in focus groups. Transcripts were analyzed using qualitative content analysis. SWMIs perceived negative stereotypes about their group (weakness, incompetence, blame, malingering) and saw stigma as a barrier to help-seeking. Being labeled 'mentally ill' was seen as harmful for one's career. Self-labeling led to poor self-esteem, greater need for help and feelings of weakness. Many SWMIs had experienced discrimination, such as gossip or inappropriate comments. Social isolation was a disadvantage of secrecy. Most SWMIs preferred selective disclosure and many did not disclose to their family. Military staff without mental illness expressed partly different views and described organizational challenges posed by SWMIs. Our findings suggest that disclosure decisions are personal and difficult and that stigma remains a barrier to re-integration and recovery of SWMIs in the military. Implications for interventions to support SWMIs are discussed.
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Affiliation(s)
- Nicolas Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany.
| | - Carolyn Rose
- Center for Military Mental Health, Berlin, Germany
| | - Fabian Holzhausen
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
| | - Nadine Mulfinger
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
| | - Silvia Krumm
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
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20
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Hamilton FL, Hornby J, Sheringham J, Linke S, Ashton C, Moore K, Stevenson F, Murray E. DIAMOND (DIgital Alcohol Management ON Demand): a mixed methods feasibility RCT and embedded process evaluation of a digital health intervention to reduce hazardous and harmful alcohol use. Pilot Feasibility Stud 2017; 3:34. [PMID: 28879021 PMCID: PMC5583751 DOI: 10.1186/s40814-017-0177-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022] Open
Abstract
Background Alcohol is a major risk factor for preventable illness, with huge cost to healthcare economies. There is a role for alcohol-specific digital health interventions (DHI), but there have been few randomised controlled trials (RCT) comparing DHI with face-to-face treatment. Such trials are complex and face obstacles in recruitment and retention. Methods Mixed-methods feasibility RCT of an alcohol DHI, testing recruitment, online data-collection and randomisation processes, with an embedded process evaluation. Recruitment ran from October 2014 for 9 months. Participants were adults drinking at hazardous and harmful levels, attending four community drug and alcohol services (CDAS) in London. Participants completed baseline demographic, alcohol-related and other psychological questionnaires online and were randomised to HeLP-Alcohol, a six-module DHI with weekly reminder prompts (phone, email or text message), which mirrors face-to-face treatment, or to face-to-face treatment at CDAS. Alcohol counsellors took part in qualitative interviews at the end of the study. Results Alcohol counsellors screened 1253 patients. One thousand one hundred eighty-nine did not meet inclusion criteria so were excluded: 579 were dependent drinkers, 548 had health conditions that made them ineligible to take part and 62 were ineligible for other reasons including homelessness. Of the 64 patients who were eligible to take part, 54 declined to participate, with 36 stating a preference for face-to-face treatment, 13 gave no reason, and 5 gave other reasons including not wanting to use a computer. Ten consented but then 3 changed their minds, so we were able to randomise 7 participants to the study (11% of eligible). Five alcohol counsellors agreed to be interviewed for the process evaluation and provided the following feedback: Although most of their colleagues were enthusiastic about the trial, some were not at equipoise in recruiting; potential participants also declared strong preference to intervention arm from the outset. These factors affected recruitment. Counsellors also lacked time to undertake the data inputting and follow-up of participants in addition to their everyday work. Conclusions This feasibility study aimed to test recruitment, randomisation, retention and data collection methods but recruited only 7 participants so these aims were not fully achieved. This illustrates to all researchers of complex interventions the importance of conducting feasibility studies and is generalisable to areas other than alcohol research. CDAS were seeing larger numbers of non-dependent drinkers with complex additional problems than alcohol commissioners expected. CDAS clients and some counsellors were not at equipoise for recruitment. Alternative settings for recruitment need to be explored in future trials. Trial registration International Standard Randomized Controlled Trial Number: ISRCTN31789096, DOI 10.1186/ISRCTN31789096
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Affiliation(s)
- Fiona L Hamilton
- eHealth Unit, Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Jo Hornby
- eHealth Unit, Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | | | - Stuart Linke
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Kevin Moore
- Institute for Liver and Digestive Health, UCL, London, UK
| | - Fiona Stevenson
- eHealth Unit, Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Elizabeth Murray
- eHealth Unit, Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
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21
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Baines LS, Mitchell L, Long K, Abbot C, Clarke N, Tyler D, Ireton D, Khan F. Post-deployment screening for mental disorders and help-seeking in the UK military. Lancet 2017; 390:553-554. [PMID: 28792391 DOI: 10.1016/s0140-6736(17)31627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Lyndsay S Baines
- Lead MSc Global Military Veterans and Families Studies, Faculty of Health Social Care and Education, Department of Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK.
| | - Lee Mitchell
- Lead MSc Global Military Veterans and Families Studies, Faculty of Health Social Care and Education, Department of Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Kevin Long
- Lead MSc Global Military Veterans and Families Studies, Faculty of Health Social Care and Education, Department of Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Caroline Abbot
- Lead MSc Global Military Veterans and Families Studies, Faculty of Health Social Care and Education, Department of Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Nicky Clarke
- Lead MSc Global Military Veterans and Families Studies, Faculty of Health Social Care and Education, Department of Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Domon Tyler
- Lead MSc Global Military Veterans and Families Studies, Faculty of Health Social Care and Education, Department of Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Daniel Ireton
- Lead MSc Global Military Veterans and Families Studies, Faculty of Health Social Care and Education, Department of Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Faria Khan
- Lead MSc Global Military Veterans and Families Studies, Faculty of Health Social Care and Education, Department of Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
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Combat experience and problem drinking in veterans: Exploring the roles of PTSD, coping motives, and perceived stigma. Addict Behav 2017; 66:90-95. [PMID: 27902943 DOI: 10.1016/j.addbeh.2016.11.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/25/2016] [Accepted: 11/13/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE The current investigation sought to illustrate the etiology of adverse alcohol consequences in young adult veterans using a path analytic framework. METHODS A total of 312 veterans aged 19-34 were enrolled in a larger intervention study on alcohol use. At baseline, participants completed measures of combat severity, PTSD symptom severity, and drinking motives to cope. At one month follow-up, participants completed measures of perceived stigma of behavioral health treatment seeking and past 30-day alcohol consequences. RESULTS After entering the covariates of age, gender, race/ethnicity, and past year behavioral health treatment utilization, a path analytic model demonstrated a good fit to the data predicting alcohol consequences in this population. Further, a separate exploratory analysis confirmed that both drinking motives to cope and perceived stigma of behavioral health treatment seeking mediated the link between PTSD symptom severity and alcohol consequences. CONCLUSIONS The current model expands upon prior research showing the relationship between combat severity and alcohol use behavior in young adult veterans. Results support the notion that veterans with PTSD symptoms may drink to cope and that perceived stigma surrounding help seeking may further contribute to alcohol related problems.
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23
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Sinclair JMA, E. Chambers S, C. Manson C. Internet Support for Dealing with Problematic Alcohol Use: A Survey of the Soberistas Online Community. Alcohol Alcohol 2017; 52:220-226. [PMID: 28182197 PMCID: PMC5859982 DOI: 10.1093/alcalc/agw078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/26/2016] [Accepted: 10/04/2016] [Indexed: 12/02/2022] Open
Abstract
Aims Advances in technology have led to an increased range of possibilities for forms of mutual aid in addictions, and patient empowerment in the management of long-term conditions. However, the effective processes involved may be different online than for those that meet in person. Soberistas is a ‘social network site for people who are trying to resolve their problematic drinking patterns’. We aim to describe the population, component parts and processes that define this online community, and consider potential mechanisms of action for future research. Methods Cross-sectional online survey through an advert embedded within the Soberistas website. Participants were asked questions about themselves, their alcohol use and use of the website. Results Four hundred and thirty-eight people completed the survey, primarily women, 50% of whom lived with their children. Over 60% described having problematic alcohol use for over 10 years and 46.5% had not tried any form of previous support. Participants accessed the site at different stages of change; over half still drinking alcohol, cutting down or recently stopped. Over 18% reported abstinence of over 1 year. Anonymity, the ability to be honest, being a source of trusted information, and ongoing support were all cited as reasons for continued membership. Conclusion Soberistas offers a form of mutual aid primarily for women who have often not engaged with other treatment or support. This preliminary study suggests that the online, flexible, platform affords members an accessible and anonymous community to address their difficulties and encourages a positive ‘alcohol free’ identity. Short Summary Soberistas is ‘an online community of people who are trying to resolve their problematic drinking patterns’. Preliminary data suggest that it offers a flexible platform for mutual aid primarily for women who have often not engaged with other treatment or support, by encouraging a positive ‘alcohol free’ identity.
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Affiliation(s)
- Julia M. A. Sinclair
- Faculty of Medicine, University of Southampton, Southampton SO14 3DT, UK
- Corresponding author: Department of Psychiatry, University of Southampton, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, UK. Tel.:+44 2380 718 520; Fax:+44 2380 718 532; E-mail:
| | - Sophia E. Chambers
- Faculty of Medicine, University of Southampton, Southampton SO14 3DT, UK
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Himmerich H, Willmund GD, Wesemann U, Jones N, Fear NT. European military mental health research: benefits of collaboration. J ROY ARMY MED CORPS 2016; 163:155-157. [PMID: 27903838 DOI: 10.1136/jramc-2016-000676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/07/2016] [Accepted: 11/06/2016] [Indexed: 11/03/2022]
Abstract
Despite joint participation in international military operations, few collaborative military mental health research projects have been undertaken by European countries. From a common perspective of military mental health researchers from Germany and the UK, the lack of shared research might be related not only to the use of different languages but also the different ways in which the two militaries provide mental health and medical support to operations and differences in military institutions. One area that is suitable for military health research collaboration within UK and German forces is mental health and well-being among military personnel. This could include the study of resilience factors, the prevention of mental disorder, mental health awareness, stigma reduction and the treatment of mental disorder. Military mental health research topics, interests and the studies that have been conducted to date in the UK and Germany have considerable overlap and commonality of purpose. To undertake the investigation of the long-term consequences of operational deployment, the specific burdens placed on military families and to further the understanding of the role of factors such as biomarkers for use in military mental health research, it seems advisable to forge international research alliances across European nations, which would allow for researchers to draw transcultural and generalisable conclusions from their work. Such an enterprise is probably worthwhile given the shared research interests of Germany and the UK and the common perspectives on military mental health in particular.
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Affiliation(s)
- Hubertus Himmerich
- Centre for Psychiatry and Psychotraumatology, German Armed Forces Hospital, Berlin, Germany.,Department of Psychological Medicine, King's College London, London, UK
| | - G D Willmund
- Centre for Psychiatry and Psychotraumatology, German Armed Forces Hospital, Berlin, Germany
| | - U Wesemann
- Centre for Psychiatry and Psychotraumatology, German Armed Forces Hospital, Berlin, Germany
| | - N Jones
- Department of Psychological Medicine, King's College London, London, UK.,King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - N T Fear
- Department of Psychological Medicine, King's College London, London, UK.,King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
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