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Chui Z, Leightley D, Jones M, Landau S, McCrone P, Hayes RD, Wessely S, Fear NT, Goodwin L. Mental health problems and admissions to hospital for accidents and injuries in the UK military: A data linkage study. PLoS One 2023; 18:e0280938. [PMID: 36693079 PMCID: PMC9873160 DOI: 10.1371/journal.pone.0280938] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Accidents are the most common cause of death among UK military personnel. It is a common misconception in the general public that accidental injuries are always the result of random events, however research suggests that mental health problems and the increased levels of risky behaviour in military personnel may play a role. The objective of this study was to further our understanding of injuries and deaths not related to deployment by examining the associations of mental health, alcohol misuse and smoking with inpatient admission to hospital for accidents and injuries, and attendance to accident and emergency (A&E) departments. METHODS Data on all hospital admissions for accidents and injuries and A&E attendance at NHS hospitals in England, Scotland and Wales were linked to data on self-reported mental health problems, alcohol misuse and smoking from a large, representative UK military cohort of serving and ex-serving personnel (n = 8,602). Logistic regression was used to examine the associations between having a hospital admission for an accident or injury with self-reported mental health problems, alcohol misuse and smoking. Cox proportional-hazards regression was then conducted to assess the associations of mental health problems, alcohol misuse and smoking with time to hospital admission for an accident or injury. Finally, negative binomial regression was used to examine associations between the number of A&E attendances with mental health problems, alcohol misuse and smoking. RESULTS Personnel reporting symptoms of common mental disorder (CMD) or probable post-traumatic stress disorder (PTSD) were more likely to have an admission to hospital for an accident or injury (fully adjusted odds ratio 1.39, 95% confidence interval [CI] 1.05-1.84), than those who did not report these symptoms, and also had more attendances to A&E (fully adjusted incidence rate ratio [IRR] 1.32, 95% CI 1.16-1.51). A&E attendances were also more common in personnel who were smokers (fully adjusted IRR 1.21, 95% CI 1.09-1.35) following adjustment for demographic, military and health characteristics. CONCLUSIONS The findings suggest that accidents and injuries among military personnel are not always random events and that there are health and behavioural factors, including poor mental health and smoking, which are associated (with small effect sizes) with an increased risk of being involved in an accident. Clinicians treating individuals attending hospital after an accident should consider their healthcare needs holistically, including issues related to mental health and health damaging behaviours.
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Affiliation(s)
- Zoe Chui
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Daniel Leightley
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Margaret Jones
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sabine Landau
- Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Paul McCrone
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Richard D. Hayes
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Simon Wessely
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Nicola T. Fear
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Laura Goodwin
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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Gambling problems and associated harms in United Kingdom Royal Air Force personnel. Addict Behav 2022; 126:107200. [PMID: 34906882 DOI: 10.1016/j.addbeh.2021.107200] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022]
Abstract
International evidence indicates that currently serving and former military personnel may be at heightened vulnerability to problem gambling. The aim of the present study was to undertake the first survey of gambling experience and potential problems among serving United Kingdom Royal Air Force (RAF) personnel. Our objectives were to survey the frequency of gambling problems, types of gambling activities, examine mental health, alcohol use, and COVID-19-related associations with gambling, and identify potential risk factors for problem gambling among RAF personnel. A cross-sectional online survey was distributed to all serving RAF personnel in January 2021 and the final dataset consisted of n = 2119 responses. The Problem Gambling Severity Index (PGSI) identified gambling severity, the Patient Health Questionnaire (PHQ-9) assessed depression, the Generalized Anxiety Disorder assessment (GAD-7) measured anxiety, and alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT). Questions relating to COVID-19 asked whether the pandemic had impacted one's gambling, mental health, and alcohol use. Findings indicated that 12.5% of personnel reported gambling problems, which included 8.0% with PGSI scores indicating low-risk gambling (1-2), 2.9% with moderate-risk gambling scores (3-4), and 1.6% with scores indicating problem gambling (≥8). Most personnel had no symptoms of depression or anxiety, and most experienced lower risk drinking levels. The likelihood of any gambling problem (PGSI ≥ 1) in RAF personnel was associated with age (18-24 years old), male gender, and Non-Commissioned ranks. Most participants reported a deterioration in their mental health due to COVID-19 and increased risky gambling. These findings indicate that gambling problems and associated harms are significant concerns for serving RAF personnel.
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Champion H, Pritchard A, Dighton G, Dymond S. Gambling problems and help-seeking in serving United Kingdom military personnel: A qualitative study. Front Psychiatry 2022; 13:1003457. [PMID: 36620678 PMCID: PMC9816802 DOI: 10.3389/fpsyt.2022.1003457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION In military personnel are vulnerable to gambling problems, yet many are reluctant to seek help. The aim of the current study was to explore the lived experience of problem gambling and help-seeking among serving members of the United Kingdom Armed Forces. METHODS Seventeen individuals from a larger, cross-sectional survey of gambling and wellbeing in the Royal Air Force (RAF) completed semi-structured interviews. Interview questions focused on personal experiences, the context of the RAF and its influence, knowledge and experiences of treatment and support services, and the impact of COVID-19. RESULTS Reflexive thematic analysis revealed four themes: (1) harmful and protective occupational factors; (2) socio-cultural and personal influences; (3) organizational attitudes toward mental health and help-seeking, and (4) current support pathways and provision. DISCUSSION Findings also indicated that gambling and alcohol use are common within the RAF, and that personnel are actively coping with mental health challenges.
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Affiliation(s)
- Hannah Champion
- School of Psychology, Swansea University, Swansea, United Kingdom
| | - Amy Pritchard
- School of Psychology, Swansea University, Swansea, United Kingdom.,Department of Mental Health and Social Work, Middlesex University, Hendon, United Kingdom
| | - Glen Dighton
- School of Psychology, Swansea University, Swansea, United Kingdom.,King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Simon Dymond
- School of Psychology, Swansea University, Swansea, United Kingdom.,Department of Psychology, Reykjavík University, Reykjavík, Iceland
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Thandi G, Fear NT. Factors associated with smoking behaviour change in UK military personnel. Occup Med (Lond) 2019; 67:712-714. [PMID: 29040747 DOI: 10.1093/occmed/kqx149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Research in the UK civilian population suggests that poor mental health outcomes are associated with smoking behaviour. In the UK military population, smoking cessation is associated with deployment in the reserve forces. However, little is known about the links between mental health outcomes and smoking initiation and cessation in the UK military. Aims The aim of this longitudinal study was to examine change in mental health and military factors associated with smoking initiation and cessation in a representative sample of UK military personnel. Methods Data were collected between 2003 and 2009; 5138 regular and reserve military personnel were included in the analyses. Results The results showed that smoking initiation was associated with symptoms of psychological distress, symptoms of probable post-traumatic stress disorder (PTSD), relationship breakdown and deployment. Conclusions These findings are consistent with existing research in civilian populations showing links between poor mental health and smoking behaviour. Furthermore, our finding that deployment is associated with smoking initiation is also in line with research from the US military and UK reserves.
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Affiliation(s)
- G Thandi
- Academic Department of Military Mental Health, King's College London, 10 Cutcombe Road, Weston Education Centre, London, UK
| | - N T Fear
- Academic Department of Military Mental Health, King's College London, 10 Cutcombe Road, Weston Education Centre, London, UK
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Dighton G, Roberts E, Hoon AE, Dymond S. Gambling problems and the impact of family in UK armed forces veterans. J Behav Addict 2018; 7:355-365. [PMID: 29739238 PMCID: PMC6174607 DOI: 10.1556/2006.7.2018.25] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background and aims International evidence indicates elevated problem gambling rates in armed forces veterans compared with the general population. Gambling problems adversely impact one's family, and family-related variables may increase vulnerability to gambling-related harm. Little is known, however, about gambling problems in the United Kingdom (UK) veterans or to what extent family variables, such as parenting history and experience of domestic violence, influence veterans' gambling. Methods We compared veterans (n = 257) and sex- and age-matched controls (n = 514) drawn from the 2007 Adult Psychiatric Morbidity Survey on gambling, financial management, domestic violence, childhood parental presence, and experience of stressful life events. Veterans who left the military before or after 4 years of service were compared. Results Problem gambling was significantly more prevalent in veterans (1.4%) than non-veterans (0.2%), and the impact of gambling problems on the family was specific to male veterans, particularly those who had experienced a traumatic event after the age of 16, and those who were more likely to have been physically attacked by their partner. Overall, this study revealed that the UK armed forces veterans report a higher prevalence rate of problem gambling compared with non-veterans, with potential negative impact on family life.
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Affiliation(s)
- Glen Dighton
- Department of Psychology, Swansea University, Swansea, UK
| | - Elystan Roberts
- Department of Psychology, Swansea University, Swansea, UK,Present address: Bristol Medical School, Bristol University, Bristol, UK
| | - Alice E. Hoon
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Simon Dymond
- Department of Psychology, Swansea University, Swansea, UK,Department of Psychology, Reykjavík University, Reykjavík, Iceland,Corresponding author: Simon Dymond; Department of Psychology, Swansea University, Swansea SA2 8PP, UK; Phone: +44 1792 295602; E-mail:
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Bergman BP, Mackay DF, Pell JP. Road traffic accidents in Scottish military veterans. ACCIDENT; ANALYSIS AND PREVENTION 2018; 113:287-291. [PMID: 29455117 DOI: 10.1016/j.aap.2018.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/02/2018] [Accepted: 02/09/2018] [Indexed: 06/08/2023]
Abstract
Road traffic accidents (RTA) are recognised to be an important cause of death and injury in serving military personnel but little is known about the risk in veterans. We used data from the Scottish Veterans Health Study to examine the risk of RTA in a large national cohort of veterans, in comparison with people who had never served. We conducted a retrospective cohort study of 57,000 veterans and 173,000 non-veterans, followed up for up to 30 years, using survival analysis to compare risk of RTA injury. Subgroup analysis was used to explore trends by birth cohort and length of service. Overall, veterans had a higher risk of RTA (Cox proportional hazard ratio (HR) 1.17, 95% confidence intervals (CI) 1.14-1.20). The risk was highest in the veterans with the shortest service (early service leavers), including those who did not complete initial military training (HR 1.31, 95% CI 1.23-1.40). The mean age at first RTA was 34 years, irrespective of age at leaving service, and the greatest increase in risk was in veterans born in the 1960s, but veterans born after 1970 showed no increase in risk. We have therefore demonstrated that the increased risk of RTA observed in serving military personnel persists in veterans through the fourth decade of life. The high risk in early service leavers is likely to be related to risk factors other than military service, including previous childhood adversity. Recent Ministry of Defence road safety programmes may now be reducing the long-term risk of RTA injury.
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Affiliation(s)
- Beverly P Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK.
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
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de Granda-Orive JI, de Granda-Beltrán AM, López-Aguilar JC. Is there a need for specific smoking cessation programs for the military? Occup Med (Lond) 2018; 68:146. [DOI: 10.1093/occmed/kqy009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bergman BP, Mackay DF, Smith DJ, Pell JP. Suicide in Scottish military veterans: a 30-year retrospective cohort study. Occup Med (Lond) 2017; 67:350-355. [DOI: 10.1093/occmed/kqx047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kwan J, Jones M, Hull L, Wessely S, Fear N, MacManus D. Violent behavior among military reservists. Aggress Behav 2017; 43:273-280. [PMID: 27775160 DOI: 10.1002/ab.21687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/26/2016] [Accepted: 09/07/2016] [Indexed: 11/06/2022]
Abstract
Large numbers of British and American Reservists have been deployed to operations in Iraq and Afghanistan. Little is known about the impact of deployment and combat exposure on violent behavior in Reservists. The purpose of this study was to determine the prevalence of self-reported violent behavior among a representative sample of United Kingdom Reservists, the risk factors associated with violence and the impact of deployment and combat exposure on violence. This study used data from a large cohort study of randomly selected UK military personnel and included Reservists who were in service at the time of sampling (n = 1710). Data were collected by questionnaires that asked about socio-demographic and military characteristics, pre-enlistment antisocial behavior, deployment experiences, post-deployment mental health, and self-reported interpersonal violent behavior. The prevalence of violence among Reservists was 3.5%. Deployment was found to be a risk factor for violent behavior even after adjustment for confounders. The association with violence was similar for those deployed in either a combat role or non-combat role. Violence was also strongly associated with mental health risk factors (PTSD, common mental disorders, and alcohol misuse). This study demonstrated higher levels of self-reported post-deployment violence in UK Reservists who had served in either Iraq or Afghanistan. Deployment, irrespective of the role was associated with higher levels of violent behavior among Reservists. The results also emphasize the risk of violent behavior associated with post-deployment mental health problems. Aggr. Behav. 43:273-280, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jamie Kwan
- Department of Psychological Medicine; King's College London, Weston Education Centre; London United Kingdom
| | - Margaret Jones
- King's Centre for Military Health Research; King's College London; London United Kingdom
| | - Lisa Hull
- King's Centre for Military Health Research; King's College London; London United Kingdom
| | - Simon Wessely
- King's Centre for Military Health Research; King's College London; London United Kingdom
| | - Nicola Fear
- King's Centre for Military Health Research; King's College London; London United Kingdom
| | - Deirdre MacManus
- Department of Forensic and Neurodevelopmental Sciences; Institute of Psychiatry, King's College London; London United Kingdom
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Laukkala T, Parkkola K, Henriksson M, Pirkola S, Kaikkonen N, Pukkala E, Jousilahti P. Total and cause-specific mortality of Finnish military personnel following service in international peacekeeping operations 1990-2010: a comprehensive register-based cohort study. BMJ Open 2016; 6:e012146. [PMID: 27799241 PMCID: PMC5093393 DOI: 10.1136/bmjopen-2016-012146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/23/2016] [Accepted: 09/30/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate total and cause-specific mortality after international peacekeeping deployments among the Finnish military peacekeeping personnel in comparison to the general population of similar age and sex. DESIGN A register-based study of a cohort of military peacekeeping personnel in 1990-2010 followed for mortality until the end of 2013. Causes of death were obtained from the national Causes of Death Register. The standardised mortality ratio (SMR) for total and cause-specific mortality was calculated as the ratio of observed and expected number of deaths. SETTING Finland (peacekeeping operations in different countries in Africa, Asia and in an area of former Yugoslavia in Europe). PARTICIPANTS 14 584 men and 418 women who had participated in international military peacekeeping operations ending between 1990 and 2010. INTERVENTIONS Participation in military peacekeeping operations. MAIN OUTCOME Total and cause-specific mortality. RESULTS 209 men and 3 women died after their peacekeeping service. The SMR for all-cause mortality was 0.55 (95% CI 0.48 to 0.62). For the male peacekeeping personnel, the SMR for all diseases was 0.44 (95% CI 0.35 to 0.53) and for accidental and violent deaths 0.69 (95% CI 0.57 to 0.82). The SMR for suicides was 0.71 (95% CI 0.53 to 0.92). CONCLUSIONS Even though military peacekeeping personnel are working in unique and often stressful conditions, their mortality after their service is lower compared with the general population. Military peacekeeping personnel appear to be a selected population group with low general mortality and no excess risk of any cause of death after peacekeeping service.
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Affiliation(s)
- T Laukkala
- Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - K Parkkola
- School of Medicine, University of Tampere, Tampere, Finland
| | - M Henriksson
- National Supervisory Authority for Welfare and Health, Helsinki, Finland
- Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - S Pirkola
- School of Health Sciences, University of Tampere, and Tampere University Hospital, Tampere, Finland
| | - N Kaikkonen
- Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - E Pukkala
- School of Health Sciences, University of Tampere, Tampere Finland and the Finnish Cancer Registry, Helsinki, Finland
| | - P Jousilahti
- National Institute for Health and Welfare, Helsinki, Finland
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