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Misca G, Augustus J, Russell J, Walker J. Meaning(s) of transition(s) from military to civilian life at the intersection with mental health: implications for clinical settings. Front Psychol 2023; 14:1142528. [PMID: 37228334 PMCID: PMC10203708 DOI: 10.3389/fpsyg.2023.1142528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/31/2023] [Indexed: 05/27/2023] Open
Abstract
The experiences of military personnel moving into civilian life can be varied for the individual, families and communities. This paper aims to shed light on the various meanings of the multiple and "nested" transitions of military personnel to civilian life in the context of attending a mental health service in the UK. This was achieved through secondary analysis of semi-structured interviews with veterans who were engaging with a mental health service in the UK and a further interview with the mental health service lead. A thematic analysis was employed based on a descriptive phenomenological approach. Results indicate that an appropriate support infrastructure needs to be put in place for veterans prior to, during and after the transition to civilian life. The support appropriateness includes themes specific to connectedness to others, support service accessibility, mental health professionals' military culture awareness and mental health stigma. Although the findings suggest that community services need an awareness of veterans' specific needs, many of the themes are similar to those of the general population. Therefore, the need for an integrated healthcare system is essential in the transition of military service personnel to civilian life. Drawing on international evidence as well as the current findings, implications for policy and practice are highlighted throughout.
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Affiliation(s)
- Gabriela Misca
- School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Jo Augustus
- Institute of Health, University of Cumbria, Cumbria, United Kingdom
| | - Jade Russell
- School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Janet Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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Osborne AK, Mcgill G, Greaves PJ, Kiernan MD. Developing an Integrated Model of Care for Veterans with Alcohol Problems. Int J Integr Care 2022; 22:15. [PMID: 35282154 PMCID: PMC8855732 DOI: 10.5334/ijic.5500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 01/27/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Veterans often do not present with alcohol problems in isolation, they may have a wide range of social, physical, and psychological needs. The aim of this study was to facilitate the development of a co-designed integrated model of care for veterans with alcohol problems. Methods: Following the development model by the Agency for Clinical Innovation, a planning symposium was held in North East of England to engage health and social care planners, public health leads, clinical commissioning groups and providers. Service users were empowered in discussions to provide insights and look for solutions (N = 43). Results: Using diagramming techniques, three examples of health and social care provision were created demonstrating the current commissioning landscape, one veteran’s experience of accessing services and a proposal for a new integrated model of care for veterans with alcohol problems. Discussion: By engaging stakeholders and service users, the model proposed a potential solution to reducing the number of veterans ‘falling through the gaps’ or disengaging from services. The collaborative approach highlighted the difficulties in navigating the current complex health and social care systems. The co-designed hub and spoke model aims to enable alcohol misuse services to adapt and evolve so that they better fit the needs of veterans.
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Burdett H, Fear NT, Wessely S, Rona RJ. Military and demographic predictors of mental ill-health and socioeconomic hardship among UK veterans. BMC Psychiatry 2021; 21:304. [PMID: 34225685 PMCID: PMC8259380 DOI: 10.1186/s12888-021-03296-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 05/19/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Around 8% of the UK Armed Forces leave in any given year, and must navigate unfamiliar civilian systems to acquire employment, healthcare, and other necessities. This paper determines longer-term prevalences of mental ill health and socioeconomic outcomes in UK Service leavers, and how they are related to demographic factors, military history, and pre-enlistment adversity. METHODS This study utilised data from a longitudinal sample of a cohort study UK Armed Forces personnel since 2003. A range of self-reported military and sociodemographic factors were analysed as predictors of probable Post-Traumatic Stress Disorder, common mental disorders, alcohol misuse, unemployment and financial hardship. Prevalences and odds ratios of associations between predictors and outcomes were estimated for regular veterans in this cohort. RESULTS Veteran hardship was mostly associated with factors linked to socio-economic status: age, education, and childhood adversity. Few military-specific factors predicted mental health or socio-economic hardship, except method of leaving (where those leaving due to medical or unplanned discharge were more likely to encounter most forms of hardship as veterans), and rank which is itself related to socioeconomic status. CONCLUSION Transition and resettlement provisions become increasingly generous with longer service, yet this paper shows the need for those services becomes progressively less necessary as personnel acquire seniority and skills, and instead could be best targeted at unplanned leavers, taking socioeconomic status into consideration. Many will agree that longer service should be more rewarded, but the opposite is true if provision instead reflects need rather than length of service. This is a social, political and ethical dilemma.
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Affiliation(s)
- H Burdett
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK.
| | - N T Fear
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - R J Rona
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
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Bergman BP, Mackay DF, Fear NT, Pell JP. Age at entry to UK military service and long-term mental health. BMJ Mil Health 2021; 169:212-217. [PMID: 33879527 DOI: 10.1136/bmjmilitary-2021-001786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION It has been suggested that 'junior entry' to the UK Armed Forces (prior to age 17.5 years) increases the risk of adverse mental health outcomes. We used data from a large cohort of veterans to examine long-term mental health outcomes in veterans by age at entry to the UK Armed Forces, compared with non-veterans. METHODS Retrospective cohort study of 78 157 veterans in Scotland, born between 1945 and 1995 and and 252 637 matched non-veterans, with up to 37 years follow-up, using Cox proportional hazard models to examine the association between veteran status and cumulative risk of major mental health disorder, stratified by birth cohort, and age at recruitment for the veterans. RESULTS The risk of mental health disorder in the veterans increased with age at entry, ranging from HR 1.12, 95% CI 1.06 to 1.18, p<0.001 for junior entrants to HR 1.37, 95% CI 1.27 to 1.80, p<0.001 for those aged 20-25 years at entry. The pattern was most marked for veterans born before 1960, and age at recruitment had little impact in recent birth cohorts. Post-traumatic stress disorder accounted for most of the observed differences. Younger age at recruitment was associated with longer service, median 7.4 years (IQR 3.0-14.7) compared with 5.6 years (IQR 2.1-11.7) for entrants aged 20-25 years. CONCLUSION We found no evidence that early recruitment is associated with adverse impact on long-term mental health. Paradoxically, it was veterans who entered service at age 20-25 years who demonstrated increased risk, although this attenuated in more recent birth cohorts.
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Affiliation(s)
- Beverly P Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N T Fear
- King's Centre for Military Health Research, King's College London, London, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Armstrong S, Dermont M. Does prevention-focused dental care provision during recruit training reduce adverse dental outcomes in UK Armed Forces personnel? A retrospective cohort analysis. Br Dent J 2021; 230:400-406. [PMID: 33837335 DOI: 10.1038/s41415-021-2741-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/07/2020] [Indexed: 11/09/2022]
Abstract
Background Dental emergencies experienced during military operations may render individuals unable to operate effectively. To minimise this risk, UK Armed Forces (UKAF) recruits receive a prevention-focused dental care intervention during military training (known as 'Project MOLAR') before their entry to the trained strength of the Armed Forces.Aim To evaluate whether Project MOLAR is effective in preventing future dental emergency events and subsequent oral disease in UKAF recruits.Methods This is a retrospective cohort analysis of UKAF recruits who enlisted between 1 January 2011 and 31 December 2011, conducted by analysing electronic primary dental care records. Adverse outcomes were defined as: i) incidence of dental emergency events during the five-year follow-up period; and ii) further oral disease at 18 months measured by an increase in Decayed, Missing and Filled Teeth (DMFT).Results In total, 7,361 recruits met the inclusion criteria. The total follow-up time for the cohort was 31,957 person-years (mean follow-up 4.3 years/recruit). Individuals whose treatment was completed under Project MOLAR were found to experience a 30% reduction in dental emergency incidence (RR: 0.70-95% CI: 0.63-0.76) (p <0.001) and a 64% reduction in the odds of DMFT increase at 18 months (OR: 0.36-95% CI: 0.28-0.47) (p <0.001) compared to individuals whose treatment was incomplete.Conclusions Defence dentistry's focus on delivering prevention-focused dentistry early in a recruit's military career confers a downstream benefit to personnel who complete the intervention, such that dental emergency occurrences and DMFT progression are significantly reduced.
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Affiliation(s)
- Sarah Armstrong
- Major Royal Army Dental Corps, Dental Public Health Staff Officer, HQ Defence Medical Services, Staffordshire, UK; Lieutenant Colonel Royal Army Dental Corps, SO1 COVID Operations, HQ Defence Primary Healthcare, Staffordshire, UK.
| | - Mark Dermont
- Wing Commander Royal Air Force, Consultant in Dental Public Health, HQ Defence Medical Services, Staffordshire, UK
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Abstract
A child soldier is a person less than 18 years of age who/has been recruited/used by an armed force/armed group in any capacity, including but not limited to children, boys and girls, used as fighters, cooks, porters, messengers, spies, or for sexual purposes. Complex consequences on both physical and mental health are reported among child soldiers. One-third to one-half of these children may have clinically significant symptoms of post-traumatic stress disorder. The United Nations identified more than 25,000 grave violations against children during armed conflicts in 2019. The recruitment and use of children under 18 in armed conflicts must stop.
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Affiliation(s)
- Ruth A Etzel
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Northwest, Washington, DC 20052, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hynes C, Scullion L, Lawler C, Steel R, Boland P. The impact of in-service physical injury or illness on the mental health of military veterans. BMJ Mil Health 2021; 169:e51-e54. [PMID: 33664089 DOI: 10.1136/bmjmilitary-2020-001759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Each year approximately 2000 UK service personnel are medically discharged with physical and/or psychological injury or illness. While there is much research on both psychological injury and physical injury, the challenges of transition relating to the intersection between the two has received less attention. This article reports on the first phase of a 2-year funded study with the aim to understand the lived experiences of veterans who have been discharged from service with a physical injury or illness and the impacts of this on their mental health. METHODS Using a qualitative methodology, 22 veterans who had been discharged from service within the last 8 years were interviewed to identify key aspects of their experience of the transition process. RESULTS The article highlights two key themes: how some veterans adjusted to life with a physical injury or condition; and, the intersections that became apparent between physical injury and mental health. The challenges that veterans faced were shaped by the transition process and by the way in which the medical discharge process was conducted. CONCLUSIONS Consideration of improvements to the medical discharge process could influence better outcomes for those who have left with a physical injury or illness and later find themselves struggling with mental health issues.
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Affiliation(s)
- Celia Hynes
- School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
| | - L Scullion
- Professor of Social Policy, Sustainable Housing & Urban Studies Unit (SHUSU), School of Health & Society, University of Salford, Salford, Greater Manchester, UK
| | - C Lawler
- Salford Social Prescribing Hub, SHUSU, School of Health & Society, University of Salford, Salford, Greater Manchester, UK
| | - R Steel
- School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
| | - P Boland
- School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
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Williamson V, Greenberg N, Murphy D. Predictors of moral injury in UK treatment seeking veterans. Child Abuse Negl 2021; 112:104889. [PMID: 33360537 DOI: 10.1016/j.chiabu.2020.104889] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND Moral injury is known to be associated with mental health difficulties in US military populations, however its impact on wellbeing in a UK Armed Forces (AF) context is less well understood. Additionally, it is not clear whether other factors known to affect service personnel's mental health, such as adverse childhood experiences (ACEs) or military trauma, may influence whether personnel experience moral injury. AIM To examine the relationship between moral injury and ACEs, adverse military events as well as the impact of moral injury on the mental health of UK AF veterans. METHOD A nationally representative sample of UK AF veterans seeking psychological treatment (n = 177) were recruited. Participants completed self-report psychometric measures and expressions of moral injury, ACEs and traumatic in-service events. RESULTS Analyses yielded a significant association between ACEs and veteran expressions of moral injury (p < .001). A significant although weak relationship was found between veteran expressions of moral injury and experiencing adverse events during military service, including physical abuse (AOR 1.04; 95 % CI 1.02-1.06) and emotional abuse (AOR 1.03; 1.01-1.05). Those meeting criteria for mental health disorders, including probable posttraumatic stress disorder (AOR 1.09; 95 % CI 1.05-1.12), were significantly more likely to report expressions of moral injury. CONCLUSIONS These results illustrate the relationship between traumatic life events, including childhood adversity, and experiencing moral injury in UK AF veterans. The findings underscore the need for a validated measurement tool appropriate for the UK AF to better understand the impact of moral injury on wellbeing and to ensure that appropriate treatment can be given to those identified as suffering post-trauma.
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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; Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, OX2 6 GG, 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
| | - Dominic Murphy
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK; Combat Stress, Research Department, Tyrwhitt House, Combat Stress, Leatherhead, Surrey, UK
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Hendrikx LJ, Murphy D. Understanding the Link Between Traumatic Brain Injury Accompanied by Loss of Consciousness and Well-Being: A Sample of UK Military Veterans. J Head Trauma Rehabil 2021; 36:34-43. [PMID: 32769834 DOI: 10.1097/htr.0000000000000599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the association between reported traumatic brain injury plus loss of consciousness (TBI + LOC) and a range of demographic, military, and physical and mental health factors among a sample of UK veterans seeking support for mental health difficulties. DESIGN The present study was a cross-sectional study. PARTICIPANTS Clinical records were used to identify a sample of treatment-seeking UK veterans (N = 3335), of which a total of 403 took part. MAIN MEASURES Information on demographic characteristics, military experiences, and a range of physical and mental health difficulties was collected. RESULTS Almost half of the sample (48%) reported a TBI + LOC, which was most strongly associated with drug use and childhood adversity. More modest associations also emerged with earlier service termination, likelihood of unemployment, as well as chronic pain and poor mobility. CONCLUSION The findings suggested that TBI + LOC may not specifically be associated with symptoms of posttraumatic stress in a sample of treatment-seeking veterans. The demonstrated links between TBI + LOC and adverse childhood, drug use, physical health, and employment may be useful in improving the assessment and rehabilitation of veterans with TBI + LOC.
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Roy D, Ross J, Armour C. Making the transition: How finding a good job is a risky business for military Veterans in Northern Ireland. Mil Psychol 2020; 32:428-441. [PMID: 38536298 PMCID: PMC10013374 DOI: 10.1080/08995605.2020.1785805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
Veterans transitioning from the military to civilian life may encounter difficulties in different domains of functioning. Most research in this area comes from the US and Israel, with Veterans in Northern Ireland (NI) in the United Kingdom, remaining an understudied population. This qualitative study aimed to examine the nature of transition experiences of NI Veterans by analyzing responses (N = 252) to an open-ended question related to the transition process, in a self-report survey. Thematic analysis highlighted both positive and negative experiences across high-level themes. These were related to (1a) how good the military life had been, (1b) the transition had been easy for some Veterans, and (1c) the skills gained in the military have been valuable; (2) it was hard to adjust to civilian life/still adjusting; (3) negative employment experiences; (4) lack of trust; (5) transitioning is hard in NI; and (6) inadequate support, post-service. The findings highlight that NI Veterans share some of the same challenges as other Veterans; however, the challenges in NI are compounded by ongoing security concerns and political tensions, which means living under the radar is a reality for many, making finding meaningful work and community integration difficult. The findings indicate that preparation for civilian life and the acculturation process needs to start many months before discharge. Perhaps more crucially, regiments should work closely with and support civilian employers to equip them to recognize and value the skills ex-Services Veterans can offer, and find a good fit for their skills within their organizations.
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Affiliation(s)
- Deborah Roy
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Jana Ross
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Cherie Armour
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
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Bergman BP, Mackay DF, Pell JP. Peripheral arterial disease in Scottish military veterans: a retrospective cohort study of 57 000 veterans and 173 000 matched non-veterans. J Public Health (Oxf) 2020. [PMID: 29534220 DOI: 10.1093/pubmed/fdy046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While traumatic limb loss in military personnel is widely known, the threat posed by peripheral arterial disease (PAD) in those who have served is less well recognized. The aim of our study was to examine the risk of PAD in a Scotland-wide cohort of veterans who served between 1960 and 2012. METHODS Retrospective 30-year cohort study of 56 205 veterans born 1945-85, and 172 741 non-veterans, matched for age, sex and area of residence, using Cox proportional hazard models to examine the association between veteran status, birth cohort, length of service and risk of PAD leading to hospitalization or death. RESULTS Overall, veterans were at increased risk of PAD compared with non-veterans, unadjusted hazard ratio (HR) = 1.46, 95% confidence intervals (CI): 1.33-1.60, P < 0.001. The highest risk was in veterans born between 1950 and 1954, HR = 1.76, 95% CI: 1.50-2.07, P < 0.001, and in those with the shortest service (early service leavers), HR = 1.84, 95% CI: 1.49-2.27, P < 0.001. CONCLUSIONS The findings provide evidence for a hidden burden of life- and limb-threatening PAD in older veterans and are consistent with the higher rates of military smoking which have been reported previously. The study emphasizes the need for vascular preventive measures in this group.
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Affiliation(s)
- B P Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Abstract
BACKGROUND The 'healthy worker effect' predicts that longer employment is positively associated with reduced mortality, but few studies have examined mortality in military veterans irrespective of exposure to conflict. AIMS To examine mortality in a large national cohort of Scottish veterans by length of service. METHODS Retrospective cohort study comparing survival in up to 30-year follow-up among 57 000 veterans and 173 000 people with no record of service, matched for age, sex and area of residence, who were born between 1945 and 1985. We compared antecedent diagnoses in the two groups to provide information on probable risk factors. RESULTS By the end of follow-up, 3520 (6%) veterans had died, compared with 10 947 (6%) non-veterans. Cox proportional hazard analysis confirmed no significant difference overall unadjusted or after adjusting for deprivation. On subgroup analysis, those who left prematurely (early service leavers) were at significantly increased risk of death (hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.09-1.24, P < 0.001), although the increase became non-significant after adjusting for socioeconomic status (HR 1.05, 95% CI 0.99-1.12). Longer-serving veterans were at significantly lower risk of death than non-veterans; the risk decreased both with length of service and in more recent birth cohorts. Smoking-related disease was the greatest contributor to increased mortality in early leavers. CONCLUSIONS Among longer-serving veterans, there was evidence of a HWE partly attributable to selective attrition of early service leavers, but birth cohort analysis suggests improvements over time which may also reflect a causal effect of improved in-service health promotion.
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Affiliation(s)
- B P Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - E B Macdonald
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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15
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Richardson A, Gurung G, Samaranayaka A, Gardner D, deGraaf B, Wyeth EH, Derrett S, Shepherd D, McBride D. Risk and protective factors for post-traumatic stress among New Zealand military personnel: A cross sectional study. PLoS One 2020; 15:e0231460. [PMID: 32303054 PMCID: PMC7164978 DOI: 10.1371/journal.pone.0231460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
Background Post-traumatic stress (PTS) is prevalent among military personnel. Knowledge of the risk and protective factors associated with PTS in this population may assist with identifying personnel who would benefit from increased or targeted support. Aims To examine factors associated with PTS among New Zealand military personnel. Methods For this cross-sectional study, currently serving and retired military personnel were invited to complete a questionnaire. The questionnaire included a measure of PTS (the Military Post-traumatic Stress Disorder Checklist; PCL-M), where scores ≥30 indicate the experience of significant PTS symptoms and scores ≥45 indicate a presumptive clinical diagnosis of post-traumatic stress. Potential risk and protective factors associated with PTS were examined using logistic regression modelling. Results 1817 military personnel completed the questionnaire. PCL-M scores were ≥30 for 549 (30%) participants and ≥45 for 179 (10%) participants. Factors associated with higher PCL-M scores were trauma exposure, older age, male sex, and Māori ethnicity. Factors associated with lower PCL-M scores were greater length of service, psychological flexibility, and better quality sleep. Conclusions PTS was found to be prevalent among New Zealand military personnel. The experience of trauma was strongly associated with PTS. However, factors such as psychological flexibility (the ability to adapt to changes in circumstances) and good sleep were protective, suggesting that these factors could be key targets for interventions designed to reduce PTS among military personnel in New Zealand.
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Affiliation(s)
- Amy Richardson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gagan Gurung
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ari Samaranayaka
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Dianne Gardner
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Brandon deGraaf
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Emma H. Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Daniel Shepherd
- Department of Psychology, Auckland University of Technology, Auckland, New Zealand
| | - David McBride
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- * E-mail:
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Syed Sheriff R, Van Hooff M, Malhi G, Grace B, McFarlane A. Childhood Trauma and Childhood Mental Disorder in Military and Employed Civilian Men. J Nerv Ment Dis 2020; 208:13-20. [PMID: 31834189 DOI: 10.1097/NMD.0000000000001072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We aimed to retrospectively investigate childhood trauma and childhood mental disorder in military and employed civilian men aged 18 to 54 years. Data, derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Australian Bureau of Statistics National Survey of Mental Health and Wellbeing Study, were analyzed and compared using direct age standardization and logistic regression. A greater proportion of ADF reported childhood trauma, multiple trauma types, trauma onset below 12 years of age, and interpersonal trauma than civilian employed men. A greater proportion of ADF reported childhood noninterpersonal trauma, such as accidents, than civilian employed men, with a marked difference in those aged 45 to 54 years. In both populations, childhood disorder was associated with childhood trauma; however, childhood depression was not associated with childhood noninterpersonal trauma in either population. A deeper understanding of the longer-term risk and resilience conferred by different childhood trauma profiles is needed.
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Burdett H, Stevelink SAM, Jones N, Hull L, Wessely S, Rona R. Pre-service Military-related and Mental Disorder Factors Associated with Leaving the UK Armed Forces. Psychiatry 2020; 83:262-277. [PMID: 32125945 DOI: 10.1080/00332747.2020.1729063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The UK Armed Forces (UKAF) have a substantial manning deficit as more personnel leave than join. This article identified pre-service, military, and mental health factors giving rise to leaving the UKAF and estimated the contributions to leaving of those factors which are potentially amenable to modification. Methods: This study utilized data from a three-phase cohort study (2004-2006, 2007-2009 and 2014-2016), commencing while respondents were serving in the UKAF (n = 10,836; 6,046 (55.8%) had left service). Associations between leaving the services and socio-demographics, military career and experiences, and mental health were determined using Cox regression. Contribution to leaving was based on population attributable fractions (PAF) from Cox regression. Analyses were stratified by rank due to the different career structures of Commissioned Officers and enlisted personnel. Results: Leaving the UKAF was associated with joining when older, being a woman with a child/children, Army service, combat role, lower education level, and poor mental health. Factors contributing a significant proportion of leaving among enlisted personnel were joining over the age of 17, history of externalizing behavior, being female, common mental disorders, and alcohol misuse. Among Commissioned Officers only age at joining and sex contributed significant proportions to leaving. Conclusions: The key factors for leaving are education and higher age at recruitment. These are not amenable to intervention, for policy, equity, and legal reasons. Heavy drinking and common mental disorder symptoms may be more amenable to modification and hence reduce rates of leaving the UKAF. Women are more likely to leave due to childbearing.
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Abstract
OBJECTIVE Canadian Armed Forces (CAF) personnel who return from certain international deployments are required to complete post-deployment screening (PDS) 90 to 180 days post-deployment; the primary goal of PDS is early detection of mental health problems that aims for reduced delays to care provision. We investigated service members' compliance with the PDS completion requirement and the factors associated with this compliance; a secondary objective was to investigate completion timing. DESIGN The study used a retrospective cohort of CAF personnel (n=28 460) who had deployments over 01 January 2009 to 31 December 2014; inferences were based on a probabilistic sample (n=3004). PRIMARY OUTCOME The primary outcome was PDS completion. We assessed the timing of PDS completion, comparing non-compliant (early, late or no completion) with compliant completions (90 to 180 days post-deployment) among deployments that required screening. Kaplan-Meier plots summarised time-to-completion and logistic regression assessed the covariate associations with compliant completion. Covariate-adjusted marginal compliance prevalence differences (MPD) were computed. RESULTS 67.3% (95% CI65.0 to 69.6) of deployments that required PDS had one completed; 43.3% (95%CI 40.6 to 46.0) were completed within the compliant period. Compliant completion was higher with lower ranks (MPD=10.6%, relative to officers), combat arms occupations (MPD=8.4%), Afghanistan deployments (MPD=19.2%), longer deployments (MPD=10.1%) and among those without a past mental health problem (MPD=9.7%). CONCLUSIONS Our findings suggest that some selective processes may be occurring where those perceived to be at higher risk for post-deployment mental health problems are more compliant with PDS completion. However, PDS completion and compliant completion were lower than expected and this suggests a need to reinforce instruction on the guidelines and objectives of PDS among service members in the CAF.
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Affiliation(s)
- Peter J H Beliveau
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - David Boulos
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - Dylan Johnson
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
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Bakker LP, Småstuen MC, Reichelt JG, Gjerstad CL, Tønnessen A, Weisæth L, Herlofsen PH, Grov EK. The trajectory of symptom burden in exposed and unexposed survivors of a major avalanche disaster: a 30 year long-term follow-up study. BMC Psychiatry 2019; 19:175. [PMID: 31182052 PMCID: PMC6558916 DOI: 10.1186/s12888-019-2159-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/23/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Limited research exists concerning the long-term effects of avalanches on survivors' mental health beyond the first years after the accident. The aims of this study were to describe and evaluate possible differences in long-term mental health symptoms after a major avalanche disaster between exposed and unexposed soldiers using a longitudinal design. METHOD Present mental health symptoms were examined among avalanche exposed (n = 12) and unexposed (n = 9) soldiers by PTSS-10, IES-15 and STAI-12 in four waves (1986-1987 and 2016). RESULTS Binary logistic regression revealed that the odds to score above the cut-off were significantly lower for both groups after one year compared to baseline for PTSS-10 (p = 0.018) and significantly lower after 30 days compared to baseline for IES-15 (p = 0.005). Data did not reveal significant differences between the exposed and unexposed groups regarding adjusted PTSS-10, IES-15 or STAI-12 mean scores compared. Linear mixed model-analyses revealed significant effects of time. The adjusted mean scores declined over time for both groups: PTSS-10 (p = 0.001), IES-15 (p = 0.026) and STAI-12 (p = 0.001), and the time trajectories for PTSS-10 were significantly different between the groups (p = 0.013). Although not significant (all p > 0.05), results indicated that a larger proportion of soldiers in the exposed group experienced posttraumatic stress symptoms (5/12) (PTSS-10 score ≥ 4) and distress symptoms (6/12) (IES-15 score ≥ 26) above cut-off points, 30 years post-disaster. CONCLUSIONS The course of mental health symptoms may persist, and even increase, in selected and trained military personnel 30 years after exposure to a natural disaster. These findings may be of great importance for health authorities planning appropriate follow-up.
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Affiliation(s)
- Lars-Petter Bakker
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, PO Box 1550, Sentrum, N-0015, Oslo, Norway.
| | - Milada Cvancarova Småstuen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs plass, N-0130 Oslo, Norway
| | - Jon Gerhard Reichelt
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, PO Box 1550, Sentrum, N-0015 Oslo, Norway
| | - Christer Lunde Gjerstad
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, PO Box 1550, Sentrum, N-0015 Oslo, Norway
| | - Arnfinn Tønnessen
- Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry, PO Box 1550, Sentrum, N-0015 Oslo, Norway
| | - Lars Weisæth
- 0000 0004 1936 8921grid.5510.1Institute of Clinical Medicine, Division of Mental Health and Addiction, University of Oslo, Gaustad sykehus. Bygg 4, PO Box 1039, N-0315 Oslo, Blindern Norway
| | | | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs plass, N-0130 Oslo, Norway
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MORAN DOMINIQUE, TURNER JENNIFER, ARNOLD HELEN. Soldiering On? The Prison‐Military Complex and Ex‐Military Personnel as Prison Officers: Transition, Rehabilitation and Prison Reform. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/hojo.12316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- DOMINIQUE MORAN
- Dominique Moran is Professor in Carceral GeographyUniversity of Birmingham
| | - JENNIFER TURNER
- Jennifer Turner is Lecturer in Human GeographyUniversity of Liverpool
| | - HELEN ARNOLD
- Helen Arnold is Senior Lecturer in CriminologyUniversity of Suffolk
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Engelbrecht A, Burdett H, Silva MJ, Bhui K, Jones E. The symptomatology of psychological trauma in the aftermath of war (1945-1980): UK army veterans, civilians and emergency responders. Psychol Med 2019; 49:811-818. [PMID: 29925460 DOI: 10.1017/s0033291718001460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND UK veterans suffering from a psychological or psychiatric illness as a consequence of service in the Second World War were entitled to a war pension. Their case files, which include regular medical assessments, are a valuable resource to investigate the nature, distribution and duration of symptoms. METHODS A standardised form was used to collect data from pension records of a random sample of 500 UK army veterans from the first presentation in the 1940s until 1980. Data were also gathered from 50 civilians and 54 emergency responders with a pension for post-traumatic illness following air-raids. RESULTS The 10 most common symptoms reported by veterans were anxiety, depression, sleep problems, headache, irritability/anger, tremor/shaking, difficulty completing tasks, poor concentration, repeated fears and avoidance of social contact. Nine of the 10 were widely distributed across the veteran population when symptoms were ranked by the number of subjects who reported them. Nine symptoms persisted significantly longer in the veteran sample than in emergency responders. These included seven of the most common symptoms, together with two others: muscle pain and restlessness. The persistence of these symptoms in the veteran group suggests a post-traumatic illness linked to lengthy overseas service in combat units. CONCLUSIONS The nature and duration of symptoms exhibited by veterans may be associated with their experience of heightened risks. Exposure to severe or prolonged trauma seems to be associated with chronic multi-symptom illness, symptoms of post-traumatic stress and somatic expressions of pain that may delay or complicate the recovery process.
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Affiliation(s)
- Alberta Engelbrecht
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - Howard Burdett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
| | - Maria João Silva
- Centre for Psychiatry at the Wolfson Institute of Preventive Medicine, Barts & The London, Queen Mary University of London,London,UK
| | - Kamaldeep Bhui
- Centre for Psychiatry at the Wolfson Institute of Preventive Medicine, Barts & The London, Queen Mary University of London,London,UK
| | - Edgar Jones
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London,UK
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Aldridge V, Scott H, Paskell R. Investigating the Relationship Between Guilt and Shame Proneness and Moral Injury in Veterans That Have Experienced Active Deployment. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/21635781.2019.1580641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Vicky Aldridge
- Staffordshire University, Stoke-on-Trent, Staffordshire, United Kingdom of Great Britain and Northern Ireland
| | - Helen Scott
- Staffordshire University, Stoke-on-Trent, Staffordshire, United Kingdom of Great Britain and Northern Ireland
| | - Rachel Paskell
- Avon and Wiltshire Partnership Trust, NHS, Bath, England
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Abstract
The challenge of transition from service to civilian life is explored through the experiences of a sample of 225 UK army veterans between 1945 and 2000. All subjects had a war pension for a psychological disorder, and most had served overseas in combat roles. Statements about issues of adjustment and health were analyzed by the constant comparison method. Although 20 themes were identified, three ('anxiety, nerves and depression', 'enduring illness attributed to combat exposure', and 'illness interferes with the ability to find or keep employment') accounted for 46% of the total and were reported by between 53% and 86% of subjects. Consistency was observed in the ranking of themes over time. In content, they replicate those reported by veterans of recent conflicts, suggesting that the core issues of transition have an enduring quality. Most statements (66%) date from the 1940s, a time when the application process for a pension required the veteran to provide an explanation for his illness. A rise in the number of statements during the 1980s and 1990s reflected wider cultural acceptance of post-traumatic illness and veteran population entering retirement with time to reflect on defining experiences.
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Affiliation(s)
- Edgar Jones
- a Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience , King's College London , London , UK
| | - Kamaldeep Bhui
- b Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London , Queen Mary University of London , London , UK
| | - Alberta Engelbrecht
- a Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience , King's College London , London , UK
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Affiliation(s)
| | - Guddi Singh
- Integrated Child Health QI Fellow and Paediatric Registrar, London, UK
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Bergman BP, Mackay DF, Smith DJ, Pell JP. Non-fatal self-harm in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans. Soc Psychiatry Psychiatr Epidemiol 2019; 54:81-87. [PMID: 30145625 PMCID: PMC6336751 DOI: 10.1007/s00127-018-1588-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Although suicide risk in veterans has been widely studied, there is little information on the risk of non-fatal self-harm in this population. We used data from the Scottish Veterans Health Study to conduct an epidemiological analysis of self-harm in veterans, in comparison with people who have never served. METHODS We conducted a retrospective, 30-year cohort study of 56,205 veterans born 1945-1985, and 172,741 people with no record of military service, and used Cox proportional hazard models to examine the association between veteran status and cumulative risk of non-fatal self-harm, overall and stratified by birth cohort, sex and length of service. We also examined mental and physical comorbidities, and association of suicide with prior self-harm. RESULTS There were 1620 (2.90%) first episodes of self-harm in veterans, compared with 4212 (2.45%) in non-veterans. The difference was statistically significant overall (unadjusted HR 1.27, 95% CI 1.21-1.35, p < 0.001). The risk was highest in the oldest veterans, and in the early service leavers who failed to complete initial training (unadjusted HR 1.69, 95% CI 1.50-1.91, p < 0.001). The risk reduced with longer service and in the intermediate birth cohorts but has increased again in the youngest cohort. CONCLUSIONS The highest risk of non-fatal self-harm was in veterans with the shortest service, especially those who did not complete training or minimum engagement, and in the oldest birth cohorts, whilst those who had served the longest were at reduced risk. The risk has increased again in the youngest veterans, and further study of this subgroup is indicated.
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Affiliation(s)
- Beverly P. Bergman
- Institute of Health and Wellbeing, Public Health and Health Policy, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
| | - Daniel F. Mackay
- Institute of Health and Wellbeing, Public Health and Health Policy, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
| | - Daniel J. Smith
- Institute of Health and Wellbeing, Public Health and Health Policy, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
| | - Jill P. Pell
- Institute of Health and Wellbeing, Public Health and Health Policy, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
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Senior SL. Health needs of ex-military personnel in the UK: a systematic review and qualitative synthesis. J ROY ARMY MED CORPS 2018; 165:410-415. [DOI: 10.1136/jramc-2018-001101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 12/31/2022]
Abstract
BackgroundDespite all local authorities in England signing up to the Armed Forces Covenant, only a small proportion of Joint Strategic Needs Assessments (JSNAs) include detailed consideration of the health of the local ex-military population. This article supports improvements to JSNAs by systematically reviewing published research for evidence of differences in health between the ex-military population and the general public.MethodsSystematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology for qualitative synthesis of mixed study designs. SCOPUS, PubMed and Google Scholar were searched for published research on health outcomes among UK ex-military populations. All study designs were included.Results43 studies met the inclusion criteria. Rates of mental illness and hearing loss are higher among ex-military populations compared with the general public, while rates of cancer among ex-military personnel born after 1960 are lower. Despite high rates of hazardous drinking among serving personnel, rates of alcohol-related harm among ex-military populations are no higher than the general public. There is a subpopulation at increased risk of a range of adverse outcomes. This group is variously identified as younger, male, less educated, more likely to have served in a combat role and/or left service early.ConclusionsThis review found evidence of areas of increased and reduced disease burden among ex-military populations. More detailed information on the make-up of the local ex-service population would support more meaningful needs assessments. The Ministry of Defence and local authorities and service providers should work together to support early identification and targeted support for those at the highest risk of adverse outcomes.
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Harden L, Murphy D. Risk factors of suicidal ideation in a population of UK military veterans seeking support for mental health difficulties. J ROY ARMY MED CORPS 2018; 164:352-356. [DOI: 10.1136/jramc-2018-000921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 11/03/2022]
Abstract
BackgroundLittle has been reported regarding the risk factors of suicidal ideation in individuals once they have left the military in the UK. The aim of this paper was to explore the risk factors associated with suicidal ideation in a sample of treatment-seeking veterans.MethodsUsing a cross-sectional design, participants included veterans (n=144) seeking treatment from a national mental health charity in the UK. Individuals completed questionnaires regarding their military experiences, pre-enlistment factors and health. Data were then linked to risk assessments extracted from clinical records.ResultsAfter controlling for relevant variables, suicidal ideation was significantly higher in veterans who were unemployed (OR 8.01; 95% CI 1.79 to 35.80), were early service leavers (OR 8.46; 95% CI 2.21 to 32.35) and those with a history of childhood adversity (OR 6.92; 95% CI 2.10 to 22.82). In addition, taking longer than 5 years to seek help was associated with a reduced risk of suicidal ideation (OR 0.10; 95% CI 0.06 to 0.87). There was no association between health outcomes and suicidal ideation.ConclusionsRisk factors associated with suicidal ideation in this sample of veterans included: being unemployed, an early service leaver, taking less than 5 years to seek help and experiencing preservice adversity.
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Mahar AL, Aiken AB, Cramm H, Whitehead M, Groome P, Kurdyak P. Mental Health Services Use Trends in Canadian Veterans: A Population-Based Retrospective Cohort Study in Ontario. Can J Psychiatry 2018; 63:378-386. [PMID: 28903578 PMCID: PMC5971406 DOI: 10.1177/0706743717730826] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A substantial evidence base in the peer-reviewed literature exists investigating mental illness in the military, but relatively less is documented about mental illness in veterans. This study uses provincial, administrative data to study the use of mental health services by Canadian veterans in Ontario. METHOD This was a retrospective cohort study of Canadian Armed Forces and Royal Canadian Mounted Police veterans who were released between 1990 and 2013 and resided in Ontario. Mental health-related primary care physician, psychiatrist, emergency department (ED) visits, and psychiatric hospitalisations were counted. Repeated measures were presented in 5-year intervals, stratified by age at release. RESULTS The cohort included 23,818 veterans. In the first 5 years following entry into the health care system, 28.9% of veterans had ≥1 mental health-related primary care physician visit, 5.8% visited a psychiatrist at least once, and 2.4% received acute mental health services at an ED. The use of mental health services was consistent over time. Almost 8% of veterans aged 30 to 39 years saw a psychiatrist in the first 5 years after release, compared to 3.5% of veterans aged ≥50 years at release. The youngest veterans at release (<30 years) were the most frequent users of ED services for a mental health-related reason (5.1% had at least 1 ED visit). CONCLUSION Understanding how veterans use the health care system for mental health problems is an important step to ensuring needs are met during the transition to civilian life.
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Affiliation(s)
- Alyson L Mahar
- 1 Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario.,2 Canadian Institute for Military & Veteran Health Research, Kingston, Ontario
| | - Alice B Aiken
- 2 Canadian Institute for Military & Veteran Health Research, Kingston, Ontario.,3 Faculty of Health, Dalhousie University, Halifax Nova Scotia
| | - Heidi Cramm
- 2 Canadian Institute for Military & Veteran Health Research, Kingston, Ontario.,4 School of Rehabilitation Therapy, Queen's University, Kingston, Ontario
| | - Marlo Whitehead
- 5 Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Patti Groome
- 5 Institute for Clinical Evaluative Sciences, Toronto, Ontario.,6 Department of Public Health Sciences, Queen's University, Kingston, Ontario
| | - Paul Kurdyak
- 5 Institute for Clinical Evaluative Sciences, Toronto, Ontario.,7 Centre for Addictions & Mental Health, Toronto, Ontario
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Bergman BP, Mackay DF, Pell JP. Road traffic accidents in Scottish military veterans. Accid Anal Prev 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Buckman JEJ, Naismith I, Saunders R, Morrison T, Linke S, Leibowitz J, Pilling S. The Impact of Alcohol Use on Drop-out and Psychological Treatment Outcomes in Improving Access to Psychological Therapies Services: an Audit. Behav Cogn Psychother 2018; 46:513-27. [PMID: 29480157 DOI: 10.1017/S1352465817000819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of alcohol use disorders (AUD) on psychological treatments for depression or anxiety in primary care psychological treatment services is unknown. AIMS To establish levels of alcohol misuse in an Improving Access to Psychological Therapies (IAPT) service, examine the impact of higher risk drinking on IAPT treatment outcomes and drop-out, and to inform good practice in working with alcohol misuse in IAPT services. METHOD 3643 patients completed a brief questionnaire on alcohol use pre-treatment in addition to measures of depression, anxiety and functioning. Symptom and functioning measures were re-administered at all treatment sessions. RESULTS Severity of alcohol misuse was not associated with treatment outcomes, although those scoring eight or more on the AUDIT-C were more likely to drop out from treatment. CONCLUSIONS IAPT services may be well placed to offer psychological therapies to patients with common mental disorders and comorbid AUD. Patients with AUD can have equivalent treatment outcomes to those without AUD, but some higher risk drinkers may find accessing IAPT treatment more difficult as they are more likely to drop out. Alcohol misuse on its own should not be used as an exclusion criterion from IAPT services. Recommendations are given as to how clinicians can: adjust their assessments to consider the appropriateness of IAPT treatment for patients that misuse alcohol, consider the potential impact of alcohol misuse on treatment, and improve engagement in treatment for higher risk drinkers.
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O'Shea L, Watkins E, Farrand P. Psychological interventions for the treatment of depression, anxiety, alcohol misuse or anger in armed forces veterans and their families: systematic review and meta-analysis protocol. Syst Rev 2017; 6:112. [PMID: 28619078 PMCID: PMC5472945 DOI: 10.1186/s13643-017-0513-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 06/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence highlights a high prevalence of common mental health disorders in armed forces veterans and their families, with depression, anxiety, alcohol misuse and anger being more common than PTSD. This paper presents a protocol for a systematic review and meta-analysis to identify existing randomised controlled trial (RCT) research testing the effectiveness of psychological interventions for these difficulties in armed forces veterans and their family members. METHODS Electronic databases (CENTRAL, PsycInfo, MEDLINE, CINAHL, The Cochrane Register of Clinical Trials, EMBASE and ASSIA) will be searched to identify suitable studies for inclusion in the review supplemented by forward and backward reference checking, grey literature searches and contact with subject authors. Research including armed forces veterans and their family members will be included in the review with research including serving personnel or individuals under the age of 18 being excluded. Few RCTs examining the treatment of depression, anxiety, alcohol misuse or anger exist in armed forces veterans to date. The primary outcome will be symptomatic change following intervention for these difficulties. The secondary outcomes will include methodological aspects of interest such as discharge type and recruitment setting if data permits. In the event that the number of studies identified is too low to undertake a meta-analysis, a narrative review will be conducted. Quality assessment will be undertaken using the Cochrane Collaboration Tool and Cochran's Q statistic calculated to test for heterogeneity as suggested by the Cochrane handbook. DISCUSSION The review will examine the findings of existing intervention research for depression, anxiety, alcohol misuse or anger in armed forces veterans and their families, along with any effect sizes that may exist. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016036676.
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Affiliation(s)
- Luke O'Shea
- Mood Disorders Centre, School of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
| | - Ed Watkins
- Clinical Education Development and Research (CEDAR), Psychology: College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Paul Farrand
- Mood Disorders Centre, School of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
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Bergman BP, Mackay DF, Pell JP. Chronic obstructive pulmonary disease in Scottish military veterans. J ROY ARMY MED CORPS 2017; 164:25-29. [DOI: 10.1136/jramc-2016-000729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/16/2017] [Accepted: 03/26/2017] [Indexed: 11/04/2022]
Abstract
IntroductionSmoking is a major risk factor for chronic obstructive pulmonary disease (COPD). Serving military personnel have previously been shown to be more likely to smoke, and to smoke more heavily, than civilians, but there is no clear consensus as to whether in later life, as veterans, they experience a higher prevalence and mortality from COPD than do non-veterans. We examined the risk of COPD in Scottish veterans and assessed the impact of changes in military smoking.MethodsRetrospective 30-year cohort study of 56 205 veterans born 1945–1985, and 172 741 people with no record of military service, matched for age, sex and area of residence, using Cox proportional hazard models to examine the association between veteran status, birth cohort, length of service and risk of COPD resulting in hospitalisation or death.ResultsThere were 1966 (3.52%) cases of COPD meeting the definition in veterans, compared with 5434 (3.19%) in non-veterans. The difference was statistically significant (p=0.001) in the unadjusted model although it became non-significant after adjusting for deprivation. The highest risk was seen in the oldest (1945–1949) birth cohort and in veterans with the shortest service (Early Service Leavers). The risk was significantly reduced in veterans born from 1960, and in those with over 12 years' service.ConclusionsOur findings are consistent with falling rates of military smoking since the 1960s, and with the reduction in smoking with longer service. The oldest veterans, and those with the shortest service, are least likely to have benefited from this, as reflected in their higher risk for COPD.
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Russell MC, Figley CR. Do the Military’s Frontline Psychiatry/Combat Operational Stress Control Programs Benefit Veterans? Part Two: Systematic Review of the Evidence. Psychol Inj and Law 2017; 10:24-71. [DOI: 10.1007/s12207-016-9279-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hougsnæs S, Bøe HJ, Dahl AA, Reichelt JG. Norwegian male military veterans show low levels of mental health problems four years after deployment in Afghanistan. Nord J Psychiatry 2017; 71:26-32. [PMID: 27356042 DOI: 10.1080/08039488.2016.1201529] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Deployment of soldiers is associated with considerable rates of mental disorders after redeployment. AIMS The aim of this study was to identity prevalence of probable mental disorders and associated factors among male Norwegian soldiers at a mean of 4 years following deployment to Afghanistan in 2001-2011. METHODS The retrospective questionnaire-based study invited all Norwegian veterans deployed to Afghanistan from 2001-2011 to participate. The response rate was 59%, but only the 3403 men (47.5%) who completed all items of the four different screening instruments were used to define cases with mental health problems were included. Independent variables covered deployment and post-deployment issues. RESULTS The prevalence of subjects with mental health problems was 5.1% (95% CI = 4.4-5.9%) of the sample. Among deployment-related factors, physical and mental problems during deployment were most strongly associated with mental health problems after deployment. Among post-deployment factors high neuroticism and limitations in work, social, and family functions showed the strongest associations. In multivariable analysis, younger age at first deployment (OR = 0.95), neuroticism (OR = 6.40), increased current alcohol intake (OR = 3.08), impaired family function (OR = 1.91), more sleep problems (OR =1.13), and increased negative civilian life events (OR = 1.39) remained significantly associated with probable mental disorders. CONCLUSIONS Among male Norwegian veterans from Afghanistan, the prevalence of mental health problems was low, and mainly associated with post-deployment factors. Veterans complaining of mental symptoms should be diagnosed, treated, and examined for other problems of life.
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Affiliation(s)
- Sverre Hougsnæs
- a Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry , Oslo , Norway
| | - Hans Jacob Bøe
- a Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry , Oslo , Norway
| | - Alv A Dahl
- b National Resource Center for Late Effects after Cancer Treatment, Oslo University Hospital, Radiumhospitalet , Oslo , Norway.,c University of Oslo , Oslo , Norway
| | - Jon G Reichelt
- a Norwegian Armed Forces Joint Medical Services, Institute of Military Psychiatry , Oslo , Norway
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Cooper L, Andrew S, Fossey M. Educating nurses to care for military veterans in civilian hospitals: An integrated literature review. Nurse Educ Today 2016; 47:68-73. [PMID: 27288266 DOI: 10.1016/j.nedt.2016.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 02/18/2016] [Accepted: 05/21/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND In the UK, military veterans will receive care by civilian nurses in civilian hospitals. We propose that the nurses providing this care require an understanding of the unique experiences and specific health needs of veterans to deliver evidence-based care. AIM To conduct an integrative review of published literature to explore how nursing programmes prepare nurses to care for the military veteran population in civilian hospitals. REVIEW METHODS A systematic search was undertaken of a range of electronic databases, Google Scholar and hand searching of Military and Veteran health journals. Papers that focused on education of civilian nurses about veteran health and included primary research or description of practice-based innovations were included in the review. RESULTS The search generated sixteen papers that were focused on nurse education in higher education institutions. Several papers focused on simulation as a teaching method for veteran-specific health issues or curriculum developments with educational innovations such as online courses. Six papers focusing in continuing professional education of nurses in the clinical setting were included as supplementary information. All papers reviewed were US focused and dated between January 2011 and September 2015. Our search concluded that there is a gap in knowledge in this subject area within a UK context, therefore our review includes UK background information to support the US findings. CONCLUSION Civilian nurses need educational preparation to understand the specific needs of veterans. Educational institutions in the US have responded to nationwide initiatives to undertake that preparation. More empirical studies need to be undertaken to develop, test and evaluate educational innovations for preparing students and nurses delivering care to military veteran in civilian healthcare settings.
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Affiliation(s)
- Linda Cooper
- Veterans and Families Institute, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford CMI 1SQ, UK.
| | - Sharon Andrew
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford CMI 1SQ, UK.
| | - Matt Fossey
- Veterans and Families Institute, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford CMI 1SQ, UK.
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Clarkson P, Giebel CM, Challis D, Duthie P, Barrett A, Lambert H. Outcomes from a pilot psychological therapies service for UK military veterans. Nurs Open 2016; 3:227-235. [PMID: 27708834 PMCID: PMC5050547 DOI: 10.1002/nop2.57] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 05/23/2016] [Indexed: 12/01/2022] Open
Abstract
Aim To evaluate the outcomes of participants attending a psychological therapies service for military veterans. Background The UK Military Veterans’ Improving Access to Psychological Therapies Service (North West) (MV IAPT) provided a clinical psychological therapies service for military veterans. Outcomes of depression, anxiety and social adjustment were assessed after treatment in the service's pilot phase. Design An observational, prospective cohort study examined changes in depression, anxiety and social adjustment during receipt of the service. Methods Changes in depression (PHQ‐9), anxiety (GAD‐7) and social adjustment (WSAS) were examined in 952 veterans referred over 20 months from September 2011. Data were collected using the IAPT clinical information system plus additional fields. Changes for patients who completed treatment, remained in treatment and dropped out were compared. Results Seven hundred and seven veterans received an initial assessment, from which 505 received two or more appointments. Of these, 156 completed treatments, 179 remained in treatment and 170 dropped out. The majority of veterans had been operationally deployed and were similar in risk characteristics to those in other military cohort studies. There were highly significant improvements on all measures (p<.01), with completers improving more and having higher rates of recovery from depression and anxiety than those remaining and drop outs. Recovery rates compared favourably with evaluations of general IAPT services and also exceeded reported natural recovery rates.
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Affiliation(s)
- Paul Clarkson
- Personal Social Services Research Unit (PSSRU) University of Manchester Manchester UK
| | - Clarissa M Giebel
- Personal Social Services Research Unit (PSSRU) University of Manchester Manchester UK
| | - David Challis
- Personal Social Services Research Unit (PSSRU) University of Manchester Manchester UK
| | - Paul Duthie
- Pennine Care NHS Foundation Trust Lancashire UK
| | - Alan Barrett
- Military Veterans' IAPT Service (North West) Pennine Care NHS Foundation Trust Bury UK
| | - Helen Lambert
- Military Veterans' IAPT Service (North West) Pennine Care NHS Foundation Trust Bury UK
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Boulos D, Zamorski MA. Military Occupational Outcomes in Canadian Armed Forces Personnel with and without Deployment-Related Mental Disorders. Can J Psychiatry 2016; 61:348-57. [PMID: 27254844 PMCID: PMC4872242 DOI: 10.1177/0706743716643742] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Mental disorders are common in military organizations, and these frequently lead to functional impairments that can interfere with duties and lead to costly attrition. In Canada, the military mental health system has received heavy investment to improve occupational outcomes. We investigated military occupational outcomes of diagnosed mental disorders in a cohort of 30,513 personnel who deployed on the Afghanistan mission. METHODS Cohort members were military personnel who deployed on the Afghanistan mission from 2001 to 2008. Mental disorder diagnoses and their attribution to the Afghanistan mission were ascertained via medical records in a stratified random sample (n = 2014). Career-limiting medical conditions (that is, condition-associated restrictions that reliably lead to medically related attrition) were determined using administrative data. Outcomes were assessed from first Afghanistan-related deployment return. RESULTS At 5 years of follow-up, the Kaplan-Meier estimated cumulative fraction with career-limiting medical conditions was 40.9% (95% confidence interval [CI] 35.5 to 46.4) among individuals with Afghanistan service-related mental disorders (ARMD), 23.6% (CI 15.5 to 31.8) with other mental disorders, and 11.1% (CI 8.9 to 13.3) without mental disorders. The adjusted Cox regression hazard ratios for career-limiting medical condition risk were 4.89 (CI 3.85 to 6.23) among individuals with ARMD and 2.31 (CI 1.48 to 3.60) with other mental disorders, relative to those without mental disorders. CONCLUSIONS Notwithstanding the Canadian military's mental health system investments, mental disorders (particularly ARMD) still led to a high risk of adverse military occupational outcomes. Such investments have intrinsic value but may not translate into reduced medically related attrition without improvements in prevention and treatment effectiveness.
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Affiliation(s)
- David Boulos
- Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
| | - Mark A Zamorski
- Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada Department of Family Medicine, University of Ottawa, Ontario, Canada
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Bergman BP, Mackay DF, Morrison D, Pell JP. Smoking-related cancer in military veterans: retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans. BMC Cancer 2016; 16:311. [PMID: 27178424 PMCID: PMC4868009 DOI: 10.1186/s12885-016-2347-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 05/11/2016] [Indexed: 11/15/2022] Open
Abstract
Background Serving military personnel are more likely to smoke, and to smoke more heavily, than civilians. The aim of our study was to examine whether veterans have an increased risk of a range of smoking-related cancers compared with non-veterans, using a large, national cohort of veterans. Methods We conducted a retrospective cohort study of 57,000 veterans resident in Scotland and 173,000 age, sex and area of residence matched civilians. We used Cox proportional hazard models to compare the risk of any cancer, lung cancer and other smoking-related cancers overall, by sex and by birth cohort, adjusting for the potential confounding effect of socioeconomic deprivation. Results Over a mean of 29 years follow-up, 445 (0.79 %) veterans developed lung cancer compared with 1106 (0.64 %) non-veterans (adjusted hazard ratio 1.16, 95 % confidence intervals 1.04–1.30, p = 0.008). Other smoking-related cancers occurred in 737 (1.31 %) veterans compared with 1883 (1.09 %) non-veterans (adjusted hazard ratio 1.18, 95 % confidence intervals 1.08–1.29, p < 0.001). A significantly increased risk was observed among veterans born 1950–1954 for lung cancer and 1945–1954 for other smoking-related cancers. The risk of lung cancer was decreased among veterans born 1960 onwards. In comparison, there was no difference in the risk of any cancer overall (adjusted hazard ratio 0.98, 95 % confidence intervals 0.94–1.01, p = 0.171), whilst younger veterans were at reduced risk of any cancer (adjusted hazard ratio 0.88, 95 % confidence intervals 0.81–0.97, p = 0.006). Conclusions Military veterans living in Scotland who were born before 1955 are at increased risk of smoking-related cancer compared with non-veterans, but younger veterans are not. The differences may reflect changing patterns of smoking behaviour over time in military personnel which may, in turn, be linked to developments in military health promotion policy and a changing military operational environment, as well as to wider societal factors.
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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
| | - David Morrison
- 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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Thompson JM, VanTil LD, Zamorski MA, Garber B, Dursun S, Fikretoglu D, Ross D, Richardson JD, Sareen J, Sudom K, Courchesne C, Pedlar DJ. Mental health of Canadian Armed Forces Veterans: review of population studies. Journal of Military, Veteran and Family Health 2016. [DOI: 10.3138/jmvfh.3258] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction. The mental health of Canadian Armed Forces (CAF) populations emerged as an important concern in the wake of difficult CAF deployments in the 1990s. This article is the first comprehensive summary of findings from subsequent surveys of mental health and well-being in CAF Veterans, undertaken to inform mental health service renewals by CAF Health Services and Veterans Affairs Canada (VAC). Methods. Epidemiological findings in journal publications and government reports were summarized from four cross-sectional national surveys: a survey of Veterans participating in VAC programs in 1999 and three surveys of health and well-being representative of whole populations of Veterans in 2003, 2010, and 2013. Results. Although most Veterans had good mental health, many had mental health problems that affected functioning, well-being, and service utilization. Recent Veterans had a higher prevalence of mental health problems than the general Canadian population, earlier-era Veterans, and possibly the serving population. There were associations between mental health conditions and difficult adjustment to civilian life, physical health, and multiple socio-demographic factors. Mental health problems were key drivers of disability. Comparisons with other studies were complicated by methodological, era, and cultural differences. Discussion. The survey findings support ongoing multifactorial approaches to optimizing mental health and well-being in CAF Veterans, including strong military-to-civilian transition support and access to effective mental and physical health services. Studies underway of transitioning members and families in the peri-release period of the military-to-civilian transition and longitudinal studies of mental health in Veterans will address important knowledge gaps.
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Affiliation(s)
- James M. Thompson
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Linda D. VanTil
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Mark A. Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - Bryan Garber
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - Sanela Dursun
- Director General Military Personnel Research and Analysis (DGMPRA), Ottawa, Ontario, Canada
| | - Deniz Fikretoglu
- Defense Research and Development Canada, Toronto, Ontario, Canada
| | - David Ross
- National Centre for Operational Stress Injuries, Veterans Affairs Canada, Sainte-Anne-de-Bellevue, QC
| | | | - Jitender Sareen
- Departments of Psychiatry, Psychology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kerry Sudom
- Director General Military Personnel Research and Analysis (DGMPRA), Ottawa, Ontario, Canada
| | - Cyd Courchesne
- Health Professionals, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - David J. Pedlar
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
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Boulos D, Zamorski MA. Do shorter delays to care and mental health system renewal translate into better occupational outcome after mental disorder diagnosis in a cohort of Canadian military personnel who returned from an Afghanistan deployment? BMJ Open 2015; 5:e008591. [PMID: 26644121 PMCID: PMC4679995 DOI: 10.1136/bmjopen-2015-008591] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Mental disorders in military personnel result in high rates of attrition. Military organisations have strengthened their mental health systems and attempted to overcome barriers to care in order to see better outcomes. This study investigated the roles of mental health services renewal and delay to care in Canadian Armed Forces (CAF) personnel diagnosed with mental disorders. DESIGN Administrative data were used to identify a retrospective cohort of 30,513 CAF personnel who deployed in support of the mission in Afghanistan. Study participants included 508 individuals with a mental disorder diagnosis identified from CAF medical records of a weighted, stratified random sample of 2014 individuals selected from the study cohort. Weighted Cox proportional hazards regression assessed the association of diagnosis era and delay to care with the outcome, after controlling for a broad range of potential confounders (eg, disorder severity, comorbidity). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics. PRIMARY OUTCOME The outcome was release from military service for medical reasons, assessed using administrative data for the 508 individuals with a mental disorder diagnosis. RESULTS 17.5% (95% CI 16.0% to 19.0%) of the cohort had a mental disorder diagnosis after an Afghanistan-related deployment, of which 21.3% (95% CI 17.2% to 25.5%) had a medical release over a median follow-up of 3.5 years. Medical release risk was elevated for individuals diagnosed before 30 April 2008 relative to those with recent diagnoses (adjusted HR (aHR)=1.77 (95% CI 1.01 to 3.11)) and for individuals with a long delay to care (>21 months after return) relative to those with intermediate delays (8-21 months, aHR 2.47=(95% CI 1.28 to 4.76)). CONCLUSIONS Mental health services renewal in the CAF was associated with a better occupational outcome for those diagnosed with mental disorders. Longer delays to care were associated with a less favourable outcome.
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Affiliation(s)
- David Boulos
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
| | - Mark A Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Thandi G, Sundin J, Ng-Knight T, Jones M, Hull L, Jones N, Greenberg N, Rona RJ, Wessely S, Fear NT. Alcohol misuse in the United Kingdom Armed Forces: A longitudinal study. Drug Alcohol Depend 2015; 156:78-83. [PMID: 26409753 DOI: 10.1016/j.drugalcdep.2015.08.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/22/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We assessed changes in Alcohol Use Disorders Identification Test (AUDIT) scores over time. We investigated the impact of life events and changes in mental health status on AUDIT scores over time in UK military personnel. METHODS A random representative sample of regular UK military personnel who had been serving in 2003 were surveyed in 2004-2006 (phase 1) and again in 2007-2009 (phase 2). The impact of changes in symptoms of psychological distress, probable post-traumatic stress disorder (PTSD), marital status, serving status, rank, deployment to Iraq/Afghanistan and smoking was assessed between phases. RESULTS We found a statistically significant but small decrease in AUDIT scores between phases 1 and 2 (mean change=-1.01, 95% confidence interval=-1.14, -0.88). Participants reported a decrease in AUDIT scores if they experienced remission in psychological distress (adjusted mean -2.21, 95% CI -2.58, -1.84) and probable PTSD (adjusted mean -3.59, 95% CI -4.41, -2.78), if they stopped smoking (adjusted mean -1.41, 95% CI -1.83, -0.98) and were in a new relationship (adjusted mean -2.77, 95% CI -3.15, -2.38). On the other hand, reporting new onset or persistent symptoms of probable PTSD (adjusted mean 1.34, 95% CI 0.71, 1.98) or a relationship breakdown (adjusted mean 0.53, 95% CI 0.07, 0.99) at phase 2 were associated with an increase in AUDIT scores. CONCLUSIONS The overall level of hazardous alcohol consumption remains high in the UK military. Changes in AUDIT scores were linked to mental health and life events but not with deployment to Iraq or Afghanistan.
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Affiliation(s)
- Gursimran Thandi
- Academic Department of Military Mental Health, King's College London, London, UK; King's Centre for Military Health Research, King's College London, London, UK.
| | - Josefin Sundin
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Terry Ng-Knight
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Margaret Jones
- King's Centre for Military Health Research, King's College London, London, UK
| | - Lisa Hull
- King's Centre for Military Health Research, King's College London, London, UK
| | - Norman Jones
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Neil Greenberg
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Roberto J Rona
- King's Centre for Military Health Research, King's College London, London, UK
| | - Simon Wessely
- King's Centre for Military Health Research, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, UK
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Giebel CM, Clarkson P, Challis D. Demographic and clinical characteristics of UK military veterans attending a psychological therapies service. Psychiatr Bull (2014) 2014; 38:270-5. [PMID: 25505626 PMCID: PMC4248162 DOI: 10.1192/pb.bp.113.046474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/07/2014] [Accepted: 03/31/2014] [Indexed: 11/26/2022]
Abstract
Aims and method To investigate the demographic and clinical characteristics of subgroups of UK veterans attending a dedicated psychological therapies service following the Improving Access to Psychological Therapies (IAPT) treatment model. Veterans accessing a newly established service in the north-west were categorised into three groups: early service leavers, those with a physical disability, and substance and/or alcohol misusers. Anxiety, depression and social functioning were measured pre- and post-treatment. Results Veterans vary in their demographic and clinical characteristics as well as in treatment efficacy, as measured by the post-treatment scores on probable depression and anxiety. Therapy appears to be most effective in early service leavers, whereas veterans with a physical disability or a substance or alcohol misuse problem tend not to do as well in terms of symptoms of depression or anxiety. Clinical implications This study highlights the importance of targeting different veteran subgroups for dedicated psychological therapy.
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