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Williamson C, Croak B, Simms A, Fear NT, Sharp ML, Stevelink SAM. Risk and protective factors for self-harm and suicide behaviours among serving and ex-serving personnel of the UK Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force: A systematic review. PLoS One 2024; 19:e0299239. [PMID: 38669252 PMCID: PMC11051630 DOI: 10.1371/journal.pone.0299239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Self-harm and suicide behaviours are a major public health concern. Several factors are associated with these behaviours among military communities. Identifying these factors may have important implications for policy and clinical services. The aim of this review was to identify the risk and protective factors associated with self-harm and suicide behaviours among serving and ex-serving personnel of the United Kingdom Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force. METHODS A systematic search of seven online databases (PubMed, Web of Science, Embase, Global Health, PsycINFO, PTSDpubs and CINAHL) was conducted alongside cross-referencing, in October 2022. Following an a priori PROSPERO approved protocol (CRD42022348867), papers were independently screened and assessed for quality. Data were synthesised using a narrative approach. RESULTS Overall, 28 papers were included: 13 from Canada, 10 from the United Kingdom, five from Australia and none from New Zealand. Identified risk factors included being single/ex-relationship, early service leavers, shorter length of service (but not necessarily early service leavers), junior ranks, exposure to deployment-related traumatic events, physical and mental health diagnoses, and experience of childhood adversity. Protective factors included being married/in a relationship, higher educational attainment, employment, senior ranks, and higher levels of perceived social support. CONCLUSION Adequate care and support are a necessity for the military community. Prevention and intervention strategies for self-harm and suicide behaviours may be introduced early and may promote social networks as a key source of support. This review found a paucity of peer-reviewed research within some populations. More peer-reviewed research is needed, particularly among these populations where current work is limited, and regarding modifiable risk and protective factors.
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Affiliation(s)
- Charlotte Williamson
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Bethany Croak
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Amos Simms
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
- British Army, London, United Kingdom
| | - Nicola T. Fear
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
| | - Marie-Louise Sharp
- 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
- Department of Psychological Medicine, King’s College London, London, United Kingdom
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Williamson G, Carr E, Fear NT, Dymond S, King K, Simms A, Goodwin L, Murphy D, Leightley D. Digital Therapeutic Intervention for Women in the UK Armed Forces Who Consume Alcohol at a Hazardous or Harmful Level: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e51531. [PMID: 38113103 PMCID: PMC10762616 DOI: 10.2196/51531] [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: 08/02/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Alcohol misuse is common in the United Kingdom Armed Forces (UKAF), with prevalence significantly higher than in the general population. To date, digital health initiatives to support alcohol misuse have focused on male individuals, who represent approximately 89% of the UKAF. However, female veterans drink disproportionally more than female members of the public. OBJECTIVE This 2-arm participant-blinded (single-blinded) confirmatory randomized controlled trial (RCT) aims to assess the efficacy of a brief alcohol intervention (DrinksRation) in reducing weekly self-reported alcohol consumption between baseline and a 3-month follow-up (day 84) among women who have served in the UKAF. METHODS In this 2-arm single-blinded RCT, a smartphone app that includes interactive user-focused features tailored toward the needs of female veterans and designed to enhance participants' motivations to reduce the amount of alcohol they consume is compared with the UK Chief Medical Officer guidance on alcohol consumption. The trial will be conducted among women who have served at least 1 day of paid service in the UKAF. Recruitment, consent, and data collection will be carried out automatically through the DrinksRation app or the BeAlcoholSmart platform. The primary outcome is change in self-reported weekly alcohol consumption between baseline (day 0) and the 3-month follow-up (day 84) measured using the Timeline Follow Back for alcohol consumption. The secondary outcome is the change in the Alcohol Use Disorders Identification Test score measured at baseline and 3-month follow-up between the control and intervention groups. The process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. RESULTS RCT recruitment will begin in January 2024 and last for 5 months. We aim to complete all data collection, including interviews, by May 2024. CONCLUSIONS This study will assess whether a smartphone app tailored to the needs of women who have served in the UKAF is efficacious in reducing self-reported alcohol consumption. If successful, the digital therapeutics platform could be used not only to support women who have served in the UKAF but also for other conditions and disorders. TRIAL REGISTRATION ClinicalTrials.gov NCT05970484; https://www.clinicaltrials.gov/study/NCT05970484. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/51531.
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Affiliation(s)
- Grace Williamson
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Ewan Carr
- Biostatistics & Health Informatics, King's College London, London, United Kingdom
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Academic Department of Military Health, King's College London, London, United Kingdom
| | - Simon Dymond
- School of Psychology, Swansea University, Swansea, United Kingdom
- Department of Psychology, Reykjavík University, Reykjavík, Iceland
| | - Kate King
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Academic Department of Military General Practice, Defence Medical Services, Birmingham, United Kingdom
| | - Amos Simms
- Academic Department of Military Health, King's College London, London, United Kingdom
| | - Laura Goodwin
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Dominic Murphy
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Combat Stress, Leatherhead, United Kingdom
| | - Daniel Leightley
- King's Centre for Military Health Research, King's College London, London, United Kingdom
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Sharp ML, Jones M, Leal R, Hull L, Franchini S, Molloy N, Burdett H, Simms A, Parkes S, Leightley D, Greenberg N, Murphy D, MacManus D, Wessely S, Stevelink S, Fear NT. Health and well-being of serving and ex-serving UK Armed Forces personnel: protocol for the fourth phase of a longitudinal cohort study. BMJ Open 2023; 13:e079016. [PMID: 37813533 PMCID: PMC10565184 DOI: 10.1136/bmjopen-2023-079016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION This is the fourth phase of a longitudinal cohort study (2022-2023) to investigate the health and well-being of UK serving (Regulars and Reservists) and ex-serving personnel (veterans) who served during the era of the Iraq and Afghanistan conflicts. The cohort was established in 2003 and has collected data over three previous phases including Phase 1 (2004-2006), Phase 2 (2007-2009) and Phase 3 (2014-2016). METHODS AND ANALYSIS Participants are eligible to take part if they completed the King's Centre for Military Health Research Health and Wellbeing Cohort Study at Phase 3 (2014-2016) and consented to be recontacted (N=7608). Participants will be recruited through email, post and text message to complete an online or paper questionnaire. Data are being collected between January 2022 and September 2023. Health and well-being measures include measures used in previous phases that assess common mental disorders, post-traumatic stress disorder (PTSD) and alcohol misuse. Other areas of interest assess employment, help-seeking and family relationships. New topics include the impact of the British withdrawal from Afghanistan in 2021, complex PTSD (C-PTSD), illicit drug use, gambling and loneliness. Analyses will describe the effect size between groups deployed to Iraq and/or Afghanistan or not deployed, and those who are currently in service versus ex-service personnel, respectively, reporting prevalences with 95% CIs, and ORs with 95% CI. Multivariable logistic and multiple linear regression analyses will be conducted to assess various health and well-being outcomes and associations with risk and protective factors. ETHICS AND DISSEMINATION Ethical approval has been granted by the Ministry of Defence Research Ethics Committee (Ref: 2061/MODREC/21). Participants are provided with information and agree to a series of consent statements before taking part. Findings will be disseminated to UK Armed Forces stakeholders and international research institutions through stakeholder meetings, project reports and scientific publications.
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Affiliation(s)
- Marie-Louise Sharp
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Margaret Jones
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Ray Leal
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Lisa Hull
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Sofia Franchini
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Niamh Molloy
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Howard Burdett
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Amos Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Steven Parkes
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Daniel Leightley
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Dominic Murphy
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
- Research Department, Combat Stress, Leatherhead, UK
| | - Deirdre MacManus
- Department of Forensic and Neurodevelopmental Science, King's College London, London, UK
| | - Simon Wessely
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Sharon Stevelink
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
- Academic Department of Military Mental Health, King's College London, London, UK
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Leightley D, Palmer L, Williamson C, Leal R, Chandran D, Murphy D, Fear NT, Stevelink SAM. Identifying Military Service Status in Electronic Healthcare Records from Psychiatric Secondary Healthcare Services: A Validation Exercise Using the Military Service Identification Tool. Healthcare (Basel) 2023; 11:healthcare11040524. [PMID: 36833058 PMCID: PMC9957026 DOI: 10.3390/healthcare11040524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Electronic healthcare records (EHRs) are a rich source of information with a range of uses in secondary research. In the United Kingdom, there is no pan-national or nationally accepted marker indicating veteran status across all healthcare services. This presents significant obstacles to determining the healthcare needs of veterans using EHRs. To address this issue, we developed the Military Service Identification Tool (MSIT), using an iterative two-staged approach. In the first stage, a Structured Query Language approach was developed to identify veterans using a keyword rule-based approach. This informed the second stage, which was the development of the MSIT using machine learning, which, when tested, obtained an accuracy of 0.97, a positive predictive value of 0.90, a sensitivity of 0.91, and a negative predictive value of 0.98. To further validate the performance of the MSIT, the present study sought to verify the accuracy of the EHRs that trained the MSIT models. To achieve this, we surveyed 902 patients of a local specialist mental healthcare service, with 146 (16.2%) being asked if they had or had not served in the Armed Forces. In total 112 (76.7%) reported that they had not served, and 34 (23.3%) reported that they had served in the Armed Forces (accuracy: 0.84, sensitivity: 0.82, specificity: 0.91). The MSIT has the potential to be used for identifying veterans in the UK from free-text clinical documents and future use should be explored.
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Affiliation(s)
- Daniel Leightley
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
- Correspondence:
| | - Laura Palmer
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Charlotte Williamson
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Ray Leal
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Dave Chandran
- Biomedical Research Centre (BRC), Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE58AB, UK
| | - Dominic Murphy
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
- Combat Stress, Tyrwhitt House, Oaklawn Road, Leatherhead, London KT22 0BX, UK
| | - Nicola T. Fear
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
- Academic Department of Military Mental Health, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Sharon A. M. Stevelink
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE58AB, UK
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Problem drinking recognition among UK military personnel: prevalence and associations. Soc Psychiatry Psychiatr Epidemiol 2023; 58:193-203. [PMID: 35661230 PMCID: PMC9922231 DOI: 10.1007/s00127-022-02306-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
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 6400 regular serving and ex-serving personnel, collected in phase 3 (2014-2016) of the King's Centre for Military Health Research cohort study. MEASUREMENTS Participants provided sociodemographic, military, health and impairment, life experiences, problem drinking, and problem recognition information. Problem drinking was categorised as scores ≥ 16 in the AUDIT questionnaire. Associations with problem recognition were examined with weighted logistic regressions. FINDINGS Among personnel meeting criteria for problem drinking, 49% recognised the problem. Recognition was most strongly associated (ORs ≥ 2.50) with experiencing probable PTSD (AOR = 2.86, 95% CI = 1.64-5.07), social impairment due to physical or mental health problems (AOR = 2.69, 95% CI = 1.51-4.79), adverse life events (AOR = 2.84, 95% CI = 1.70-4.75), ever being arrested (AOR = 2.99, CI = 1.43-6.25) and reporting symptoms of alcohol dependence (AOR = 3.68, 95% CI = 2.33-5.82). To a lesser extent, recognition was also statistically significantly associated with experiencing psychosomatic symptoms, feeling less healthy, probable common mental health disorders, and increased scores on the AUDIT. CONCLUSION Half of UK military personnel experiencing problem drinking does not self-report their drinking behaviour as problematic. Greater problem drinking severity, poorer mental or physical health, and negative life experiences facilitate problem recognition.
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Pauli FB, Follador FAC, Wendt G, Lucio LC, Pascotto CR, Ferreto LED. Working Conditions and Health of Prison Officers in Paraná (Brazil). REVISTA ESPANOLA DE SANIDAD PENITENCIARIA 2022; 24:79-86. [PMID: 36533785 PMCID: PMC9768564 DOI: 10.18176/resp.00055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This cross-sectional study was carried out to identify the associations between working and health conditions among prison officers at a state prison in Paraná, Brazil. MATERIAL AND METHOD A proportional and stratified random sample of 125 individuals was used. The participants, who were not identified, completed a self-administered questionnaire. RESULTS The results showed a prevalence of minor psychiatric disorders (MPD) of 30.4% (95%CI: 22.4-39.2). A total of 17.9% of the respondents had persistent stress (95%CI: 12.2-25.2), 66.4 had up to five health-related complaints (95%CI: 58.4-75.2) and 9.6% had scores that indicated higher risk for alcohol abuse and/or dependance (95%CI:4.8-16.0). Multivariate analyses showed that with an MPD outcome, health problems (p<0.01), physical environment (p=0.013) and organizational risks (p<0.01) were significant predictors. Persistent stress was predicted by age (p=0.031), health problems (p<0.01) and organizational risks (p=0.023), while health complaints were associated with health problems (p<0.01) and physical environment (p<0.01). There were no significant predictors for higher risk for alcohol abuse and/or dependance. DISCUSSION In general, the results demonstrate the precarious nature of the work of prison officers, and reveal the importance of further studies to evaluate whether this is a specific reality of the unit that was investigated, or whether these results are common in other prison environments.
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Affiliation(s)
- Fernando Braz Pauli
- Enfermero. Estudiante de maestría en Ciencias Aplicadas de la Salud en la Universidade Estadual do Oeste do Paraná. Campus Francisco Beltrão. Paraná. Brasil. Universidade Estadual do Oeste do Paranámaestría en Ciencias Aplicadas de la SaludUniversidade Estadual do Oeste do ParanáCampus Francisco BeltrãoParanáBrazil
| | - Franciele Aní Caovilla Follador
- Doctor en Ingeniería Agrícola y profesor del Programa de Postgrado en Ciencias Aplicadas de la Salud, Universidade Estadual do Oeste do Paraná - UNIOESTE. Campus Francisco Beltrão. Paraná. Brasil. Universidade Estadual do Oeste do ParanáPrograma de Postgrado en Ciencias Aplicadas de la SaludUniversidade Estadual do Oeste do ParanáCampus Francisco BeltrãoParanáBrazil
| | - Guilherme Wendt
- Doctor en Psicología por la Universidad de Londres y profesor del Curso de Medicina, Universidade Estadual do Oeste do Paraná - UNIOESTE. Campus Francisco Beltrão. Paraná. Brasil. Universidade Estadual do Oeste do ParanáCurso de MedicinaUniversidade Estadual do Oeste do ParanáCampus Francisco BeltrãoParanáBrazil
| | - Leia Carolina Lucio
- Doctora en Ciencias por la Universidade Estadual de Maringá. Profesora del Programa de Postgrado en Ciencias Aplicadas de la Salud, Universidade Estadual do Oeste do Paraná - UNIOESTE. Campus Francisco Beltrão. Paraná. Brasil. Universidade Estadual do Oeste do ParanáPrograma de Postgrado en Ciencias Aplicadas de la SaludUniversidade Estadual do Oeste do ParanáCampus Francisco BeltrãoParanáBrazil
| | - Claudicéia Risso Pascotto
- Doctor en Ciencias Biológicas (Biología Celular) y profesor del Programa de Postgrado en Ciencias Aplicadas de la Salud, Universidade Estadual do Oeste do Paraná - UNIOESTE. Campus Francisco Beltrão. Paraná. Brasil. Universidade Estadual do Oeste do ParanáPrograma de Postgrado en Ciencias Aplicadas de la SaludUniversidade Estadual do Oeste do ParanáCampus Francisco BeltrãoParanáBrazil
| | - Lirane Elize Defante Ferreto
- Doctor en Salud Colectiva y profesor del Programa de Postgrado en Ciencias Aplicadas de la Salud, Universidade Estadual do Oeste do Paraná - UNIOESTE. Campus Francisco Beltrão. Paraná. Brasil. Universidade Estadual do Oeste do ParanáPrograma de Postgrado en Ciencias Aplicadas de la SaludUniversidade Estadual do Oeste do ParanáCampus Francisco BeltrãoParanáBrazil
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Osborne AK, Wilson-Menzfeld G, McGill G, Kiernan MD. Military service and alcohol use: a systematic narrative review. Occup Med (Lond) 2022; 72:313-323. [PMID: 35674143 PMCID: PMC9272263 DOI: 10.1093/occmed/kqac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Despite research highlighting the role of alcohol in military life, specifically in relation to mental health and certain combat experiences, there is no synthesised evidence looking at the relationship between military service and alcohol use. Aims To synthesize and examine evidence exploring the relationship between military service and alcohol use. Methods Six databases were examined across a 10-year period. Papers were included if they involved a military population and focused on alcohol use. From 4046 papers identified, 29 papers were included in the review. Results Military characteristics and experience were linked to high levels of alcohol use across military populations. Societal and cultural factors also played a role in alcohol use in military populations. Predatory behaviour of alcohol establishments, pressures to conform, an acceptance of alcohol use, and the role of religious services and military affiliated social networks were all considered. Excessive drinking impacted physical and mental health. Those diagnosed with PTSD and associated symptoms appeared to have greater alcohol use. Conclusions This review identified certain characteristics and experiences of military service that are associated with higher levels of alcohol use. It is important to identify risk factors for alcohol misuse to develop appropriate policy, targeting prevention.
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Affiliation(s)
- A K Osborne
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - G Wilson-Menzfeld
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - G McGill
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - M D Kiernan
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
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Irizar P, Jones A, Christiansen P, Goodwin L, Gage SH, Roberts C, Knibb G, Cooke R, Rose AK. Longitudinal associations with alcohol consumption during the first COVID-19 lockdown: Associations with mood, drinking motives, context of drinking, and mental health. Drug Alcohol Depend 2021; 226:108913. [PMID: 34315105 PMCID: PMC8567536 DOI: 10.1016/j.drugalcdep.2021.108913] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coronavirus (COVID-19) resulted in lockdown measures in the UK, which has impacted alcohol use. Alcohol is often used as a coping mechanism and there are public health concerns regarding excessive consumption due to the pandemic. We aimed to longitudinally assess drinking behaviors, and associated factors, during the first UK government-mandated lockdown. METHODS An online survey was distributed through social media (8th April 2020, onwards). Fortnightly follow up surveys were emailed to participants. The primary outcome measure was 'weekly unit consumption' and data was collected on a range of potentially related factors: demographics, factors relating to COVID-19 (e.g., health, work status), drinking motives, context of drinking, drinking intentions, mood, depression and anxiety. FINDINGS A total of 539 self-selected participants completed the baseline survey, with 186 completing at least 3 follow up surveys for multilevel modelling analysis. Personal coping motives, anxiety, drinking at home alone, and drinking at home with others were positively associated with alcohol consumption during lockdown. The following baseline measures also predicted increased consumption: male gender, lower education, and higher AUDIT scores (based on behavior prior to lockdown). Findings were consistent when utilizing an inverse probability weight to account for predictors of attrition (female, younger age, higher baseline AUDIT scores). CONCLUSIONS Those already drinking at hazardous levels were more likely to increase their consumption, as were those who were drinking to cope. As we recover from the pandemic, there is a need for widespread alcohol support, and certain groups may need targeted support.
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Affiliation(s)
- Patricia Irizar
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom.
| | - Andrew Jones
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Paul Christiansen
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Laura Goodwin
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom,Liverpool Centre for Alcohol Research, United Kingdom
| | - Suzanne H Gage
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom,Liverpool Centre for Alcohol Research, United Kingdom
| | - Carl Roberts
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Graeme Knibb
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Richard Cooke
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom,Liverpool Centre for Alcohol Research, United Kingdom
| | - Abigail K Rose
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom,Liverpool Centre for Alcohol Research, United Kingdom
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9
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Sharp ML, Serfioti D, Jones M, Burdett H, Pernet D, Hull L, Murphy D, Wessely S, Fear NT. UK veterans' mental health and well-being before and during the COVID-19 pandemic: a longitudinal cohort study. BMJ Open 2021; 11:e049815. [PMID: 34452965 PMCID: PMC8406464 DOI: 10.1136/bmjopen-2021-049815] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To investigate the impact of the COVID-19 pandemic on the health and well-being of UK ex-service personnel (veterans) before and during the pandemic, and to assess associations of COVID-19 experiences and stressors with mental health, alcohol use and loneliness. DESIGN An additional wave of data was collected from a longitudinal cohort study of the UK Armed Forces. SETTING Online survey June-September 2020. PARTICIPANTS Cohort members were included if they had completed a questionnaire at phase 3 of the King's Centre for Military Health Research health and well-being study (2014-2016), had left the Armed Forces after regular service, were living in the UK, had consented to follow-up and provided a valid email address. Invitation emails were sent to N=3547 with a 44% response rate (n=1562). PRIMARY OUTCOME MEASURES Common mental health disorders (CMDs) (measured using the General Health Questionnaire, 12 items-cut-off ≥4), hazardous alcohol use (measured using the Alcohol Use Disorder Identification Test, 10 items-cut off ≥8) and loneliness (University of California, Los Angeles, Loneliness Scale- 3 items-cut-off ≥6). RESULTS Veterans reported a statistically significant decrease in hazardous drinking of 48.5% to 27.6%, while CMD remained stable (non-statistically significant increase of 24.5% to 26.1%). 27.4% of veterans reported feelings of loneliness. The COVID-19 stressors of reporting difficulties with family/social relationships, boredom and difficulties with health were statistically significantly associated with CMD, hazardous drinking and loneliness, even after adjustment for previous mental health/hazardous alcohol use. CONCLUSIONS Our study suggests a COVID-19 impact on veterans' mental health, alcohol use and loneliness, particularly for those experiencing difficulties with family relationships. Veterans experienced the pandemic in similar ways to the general population and in some cases may have responded in resilient ways. While stable levels of CMD and reduction in alcohol use are positive, there remains a group of veterans who may need mental health and alcohol treatment services.
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Affiliation(s)
- Marie-Louise Sharp
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Danai Serfioti
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Margaret Jones
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Howard Burdett
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - David Pernet
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Lisa Hull
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Dominic Murphy
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
- Research Department, Combat Stress, Leatherhead, UK
| | - Simon Wessely
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
- Academic Department of Military Mental Health, Psychological Medicine, King's College London, London, UK
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10
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Irizar P, Stevelink SAM, Pernet D, Gage SH, Greenberg N, Wessely S, Goodwin L, Fear NT. Probable post-traumatic stress disorder and harmful alcohol use among male members of the British Police Forces and the British Armed Forces: a comparative study. Eur J Psychotraumatol 2021; 12:1891734. [PMID: 33968324 PMCID: PMC8079084 DOI: 10.1080/20008198.2021.1891734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: British Armed Forces' and Police Forces' personnel are trained to operate in potentially traumatic conditions. Consequently, they may experience post-traumatic stress disorder (PTSD), which is often comorbid with harmful alcohol use. Objective: We aimed to assess the proportions, and associations, of probable PTSD and harmful alcohol use among a covariate-balanced sample of male military personnel and police employees. Methods: Proportions of probable PTSD, harmful alcohol use, and daily binge drinking, were explored using data from the police Airwave Health Monitoring Study (2007-2015) (N = 23,826) and the military Health and Wellbeing Cohort Study (phase 2: 2007-2009, phase 3: 2014-2016) (N = 7,399). Entropy balancing weights were applied to the larger police sample to make them comparable to the military sample on a range of pre-specified variables (i.e. year of data collection, age and education attainment). Multinomial and logistic regression analyses determined sample differences in outcome variables, and associated factors (stratified by sample). Results: Proportions of probable PTSD were similar in military personnel and police employees (3.67% vs 3.95%), although the large sample size made these borderline significant (Adjusted Odds Ratio (AOR): 0.84; 95% Confidence Intervals (CI): 0.72 to 0.99). Clear differences were found in harmful alcohol use among military personnel, compared to police employees (9.59% vs 2.87%; AOR: 2.79; 95% CI: 2.42 to 3.21). Current smoking, which was more prevalent in military personnel, was associated with harmful drinking and binge drinking in both samples but was associated with PTSD in military personnel only. Conclusions: It is generally assumed that both groups have high rates of PTSD from traumatic exposures, however, low proportions of PTSD were observed in both samples, possibly reflecting protective effects of unit cohesion or resilience. The higher level of harmful drinking in military personnel may relate to more prominent drinking cultures or unique operational experiences.
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Affiliation(s)
- Patricia Irizar
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - David Pernet
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Suzanne H Gage
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Simon Wessely
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Laura Goodwin
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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11
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Leightley D, Rona RJ, Shearer J, Williamson C, Gunasinghe C, Simms A, Fear NT, Goodwin L, Murphy D. Evaluating the Efficacy of a Mobile App (Drinks:Ration) and Personalized Text and Push Messaging to Reduce Alcohol Consumption in a Veteran Population: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19720. [PMID: 33006569 PMCID: PMC7568221 DOI: 10.2196/19720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 01/30/2023] Open
Abstract
Background Alcohol misuse is higher in the UK Armed Forces than in the general population. Previous research has shown that interventions delivered via smartphones are efficacious in promoting self-monitoring of alcohol use, have utility in reducing alcohol consumption, and have a broad reach. Objective This single-blinded randomized controlled trial (RCT) aims to assess the efficacy of a 28-day brief alcohol intervention delivered via a smartphone app (Drinks:Ration) in reducing weekly self-reported alcohol consumption between baseline and 3-month follow-up among veterans who drink at a hazardous or harmful level and receive or have received support for mental health symptoms in a clinical setting. Methods In this two-arm, single-blinded RCT, a smartphone app that includes interactive features designed to enhance participants’ motivation and personalized messaging is compared with a smartphone app that provides only government guidance on alcohol consumption. The trial will be conducted in a veteran population that has sought help through Combat Stress, a UK veteran’s mental health charity. Recruitment, consent, and data collection will be carried out automatically through the Drinks:Ration platform. The primary outcome is the change in self-reported weekly alcohol consumption between baseline (day 0) and 3-month follow-up (day 84) as measured using the Time-Line Follow back for Alcohol Consumption. Secondary outcome measures include (1) change in the baseline to 3-month follow-up (day 84) Alcohol Use Disorder Identification Test score and (2) change in the baseline to 3-month follow-up (day 84) World Health Organization Quality of Life-BREF score to assess the quality of adjusted life years. Process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. The primary and secondary outcomes will also be reassessed at the 6-month follow-up (day 168) to assess the longer-term benefits of the intervention, which will be reported as a secondary outcome. Results The study will begin recruitment in October 2020 and is expected to require 12 months to complete. The study results will be published in 2022. Conclusions This study assesses whether a smartphone app is efficacious in reducing self-reported alcohol consumption in a veteran population that has sought help through Combat Stress using personalized messaging and interactive features. This innovative approach, if successful, may provide a means to deliver a low-cost health promotion program that has the potential to reach large groups, in particular those who are geographically dispersed, such as military personnel. Trial Registration ClinicalTrials.gov NCT04494594; https://clinicaltrials.gov/ct2/show/NCT04494594 International Registered Report Identifier (IRRID) PRR1-10.2196/19720
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Affiliation(s)
- Daniel Leightley
- King's College London, King's Centre for Military Health Research, London, United Kingdom
| | - Roberto J Rona
- King's College London, King's Centre for Military Health Research, London, United Kingdom
| | - James Shearer
- King's College London, King's Health Economics, London, United Kingdom
| | | | - Cerisse Gunasinghe
- King's College London, Department of Psychological Medicine, London, United Kingdom
| | - Amos Simms
- Academic Department of Military Mental Health, King's College London, London, United Kingdom.,British Army, London, United Kingdom
| | - Nicola T Fear
- King's College London, King's Centre for Military Health Research, London, United Kingdom.,Academic Department of Military Mental Health, King's College London, London, United Kingdom
| | - Laura Goodwin
- University of Liverpool, Department of Psychological Sciences, Liverpool, United Kingdom
| | - Dominic Murphy
- King's College London, King's Centre for Military Health Research, London, United Kingdom.,Combat Stress, Leatherhead, United Kingdom
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12
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Zhou AY. In this issue of Occupational Medicine. Occup Med (Lond) 2020. [DOI: 10.1093/occmed/kqaa102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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