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Harwood H, Rhead R, Chui Z, Bakolis I, Connor L, Gazard B, Hall J, MacCrimmon S, Rimes KA, Woodhead C, Hatch SL. Variations by ethnicity in referral and treatment pathways for IAPT service users in South London. Psychol Med 2023; 53:1084-1095. [PMID: 34334151 PMCID: PMC9976018 DOI: 10.1017/s0033291721002518] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Improving Access to Psychological Therapies (IAPT) programme aims to provide equitable access to therapy for common mental disorders. In the UK, inequalities by ethnicity exist in accessing and receiving mental health treatment. However, limited research examines IAPT pathways to understand whether and at which points such inequalities may arise. METHODS This study examined variation by ethnicity in (i) source of referral to IAPT services, (ii) receipt of assessment session, (iii) receipt of at least one treatment session. Routine data were collected on service user characteristics, referral source, assessment and treatment receipt from 85 800 individuals referred to South London and Maudsley NHS Foundation Trust IAPT services between 1st January 2013 and 31st December 2016. Multinomial and logistic regression analysis was used to assess associations between ethnicity and referral source, assessment and treatment receipt. Missing ethnicity data (18.5%) were imputed using census data and reported alongside a complete case analysis. RESULTS Compared to the White British group, Black African, Asian and Mixed ethnic groups were less likely to self-refer to IAPT services. Black Caribbean, Black Other and White Other groups are more likely to be referred through community services. Almost all racial and minority ethnic groups were less likely to receive an assessment compared to the White British group, and of those who were assessed, all racial and ethnic minority groups were less likely to be treated. CONCLUSIONS Racial and ethnic minority service users appear to experience barriers to IAPT care at different pathway stages. Services should address potential cultural, practical and structural barriers.
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Affiliation(s)
- Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Health Service & Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Luke Connor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jheanell Hall
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katharine A. Rimes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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Bakolis I, Hammoud R, Stewart R, Beevers S, Dajnak D, MacCrimmon S, Broadbent M, Pritchard M, Shiode N, Fecht D, Gulliver J, Hotopf M, Hatch SL, Mudway IS. Mental health consequences of urban air pollution: prospective population-based longitudinal survey. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1587-1599. [PMID: 33097984 PMCID: PMC7584487 DOI: 10.1007/s00127-020-01966-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 09/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The World Health Organisation (WHO) recently ranked air pollution as the major environmental cause of premature death. However, the significant potential health and societal costs of poor mental health in relation to air quality are not represented in the WHO report due to limited evidence. We aimed to test the hypothesis that long-term exposure to air pollution is associated with poor mental health. METHODS A prospective longitudinal population-based mental health survey was conducted of 1698 adults living in 1075 households in South East London, from 2008 to 2013. High-resolution quarterly average air pollution concentrations of nitrogen dioxide (NO2) and oxides (NOx), ozone (O3), particulate matter with an aerodynamic diameter < 10 μm (PM10) and < 2.5 μm (PM2.5) were linked to the home addresses of the study participants. Associations with mental health were analysed with the use of multilevel generalised linear models, after adjusting for large number of confounders, including the individuals' socioeconomic position and exposure to road-traffic noise. RESULTS We found robust evidence for interquartile range increases in PM2.5, NOx and NO2 to be associated with 18-39% increased odds of common mental disorders, 19-30% increased odds of poor physical symptoms and 33% of psychotic experiences only for PM10. These longitudinal associations were more pronounced in the subset of non-movers for NO2 and NOx. CONCLUSIONS The findings suggest that traffic-related air pollution is adversely affecting mental health. Whilst causation cannot be proved, this work suggests substantial morbidity from mental disorders could be avoided with improved air quality.
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Affiliation(s)
- Ioannis Bakolis
- Health Services and Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Ryan Hammoud
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK, London, UK
| | - Sean Beevers
- MRC Centre for Environment and Health, School of Public Health, Environmental Research Group, Imperial College London, London, UK
| | - David Dajnak
- MRC Centre for Environment and Health, School of Public Health, Environmental Research Group, Imperial College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Broadbent
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK, London, UK
| | - Megan Pritchard
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK, London, UK
| | | | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - John Gulliver
- Centre for Environmental Health and Sustainability, School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, UK, London, UK
| | - Ian S Mudway
- MRC Centre for Environment and Health, School of Public Health, Environmental Research Group, Imperial College London, London, UK
- National Institute for Health Research, Health Protection Research Unit on Environmental Exposures and Health, Imperial College London, London, UK
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Chui Z, Gazard B, MacCrimmon S, Harwood H, Downs J, Bakolis I, Polling C, Rhead R, Hatch SL. Inequalities in referral pathways for young people accessing secondary mental health services in south east London. Eur Child Adolesc Psychiatry 2021; 30:1113-1128. [PMID: 32683491 PMCID: PMC8295086 DOI: 10.1007/s00787-020-01603-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
Differences in health service use between ethnic groups have been well documented, but little research has been conducted on inequalities in access to mental health services among young people. This study examines inequalities in pathways into care by ethnicity and migration status in 12-29 years old accessing health services in south east London. This study analyses anonymized electronic patient record data for patients aged 12-29 referred to a south east London mental health trust between 2008 and 2016 for an anxiety or non-psychotic depressive disorder (n = 18,931). Multinomial regression was used to examine associations between ethnicity, migration status, and both referral source and destination, stratified by age group. Young people in the Black African ethnic group were more likely to be referred from secondary health or social/criminal justice services compared to those in the White British ethnic group; the effect was most pronounced for those aged 16-17 years. Young people in the Black African ethnic group were also significantly more likely to be referred to inpatient and emergency services compared to those in the White British ethnic group. Black individuals living in south east London, particularly those who identify as Black African, are referred to mental health services via more adverse pathways than White individuals. Our findings suggest that inequalities in referral destination may be perpetuated by inequalities generated at the point of access.
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Affiliation(s)
- Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Catherine Polling
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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Rhead RD, Chui Z, Bakolis I, Gazard B, Harwood H, MacCrimmon S, Woodhead C, Hatch SL. Impact of workplace discrimination and harassment among National Health Service staff working in London trusts: results from the TIDES study. BJPsych Open 2020; 7:e10. [PMID: 33323151 PMCID: PMC7791556 DOI: 10.1192/bjo.2020.137] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 12/05/2022] Open
Abstract
BACKGROUND Harassment and discrimination in the National Health Service (NHS) has steadily increased over the past 5 years with London being the worst performing region. There is a lack of data and research on the impact this is having on staff health and job satisfaction. Such data are necessary to inform the development of effective workplace interventions to mitigate the effects these experiences have on staff. AIMS Examine the impact of harassment and discrimination on NHS staff working in London trusts, utilising data from the 2019 TIDES cross-sectional survey. METHOD In total, 931 London-based healthcare practitioners participated in the TIDES survey. Regression analysis was used to examine associations between the sociodemographic characteristics of participants, exposure to discrimination and harassment, and how such exposures are associated with physical and mental health, job satisfaction and sickness absence. RESULTS Women, Black ethnic minority staff, migrants, nurses and healthcare assistants were most at risk of discrimination and/or harassment. Experiencing either of the main exposures was associated with probable anxiety or depression. Experiencing harassment was also associated with moderate-to-severe somatic symptoms. Finally, both witnessing and experiencing the main exposures were associated with low job satisfaction and long periods of sickness absence. CONCLUSIONS NHS staff, particularly those working in London trusts, are exposed to unprecedented levels of discrimination and harassment from their colleagues. Within the context of an already stretched and under-resourced NHS, in order to combat poor job satisfaction and high turnover rates, the value of all healthcare practitioners must be visibly and continuously reinforced by all management and senior leaders.
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Affiliation(s)
- Rebecca D Rhead
- Department of Psychological Medicine, King's College London, UK
| | - Zoe Chui
- Department of Psychological Medicine, King's College London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department and Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Billy Gazard
- Department of Psychological Medicine, King's College London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, King's College London, UK
| | | | - Charlotte Woodhead
- Department of Psychological Medicine, King's College London; and ESRC Centre for Society and Mental Health, King's College London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, King's College London; and ESRC Centre for Society and Mental Health, King's College London, UK
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Stevelink SAM, Jones M, Hull L, Pernet D, MacCrimmon S, Goodwin L, MacManus D, Murphy D, Jones N, Greenberg N, Rona RJ, Fear NT, Wessely S. Mental health outcomes at the end of the British involvement in the Iraq and Afghanistan conflicts: a cohort study - CORRIGENDUM. Br J Psychiatry 2019; 214:175. [PMID: 30343676 PMCID: PMC6429244 DOI: 10.1192/bjp.2018.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Stevelink SAM, Jones N, Jones M, Dyball D, Khera CK, Pernet D, MacCrimmon S, Murphy D, Hull L, Greenberg N, MacManus D, Goodwin L, Sharp ML, Wessely S, Rona RJ, Fear NT. Do serving and ex-serving personnel of the UK armed forces seek help for perceived stress, emotional or mental health problems? Eur J Psychotraumatol 2019; 10:1556552. [PMID: 30693074 PMCID: PMC6338286 DOI: 10.1080/20008198.2018.1556552] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [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: 07/06/2018] [Revised: 11/16/2018] [Accepted: 11/26/2018] [Indexed: 10/25/2022] Open
Abstract
Background: UK armed forces personnel are at risk of occupational psychological injury; they are often reluctant to seek help for such problems. Objective: We aimed to examine and describe sources of support, prevalence and associates of help-seeking among UK serving and ex-serving personnel. Method: A total of 1450 participants who self-reported a stress, emotional or mental health problem in the past 3 years were sampled from a health and wellbeing study and subsequently completed a telephone interview comprising measures of mental disorder symptoms, alcohol misuse and help-seeking behaviour. Results: Seven per cent of participants had not sought any help, 55% had accessed medical sources of support (general practitioner or mental health specialist), 46% had received formal non-medical (welfare) support and 86% had used informal support. Gender, age, perceived health, functional impairment, social support, deployment, alcohol and comorbidity impacted upon the choice of help source. Conclusions: This study found that the majority of those with perceived mental health problems sought some form of help, with over half using formal medical sources of support.
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Affiliation(s)
- Sharon A. M. Stevelink
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Norman Jones
- Academic Department of Military Mental Health, Department of Psychological Medicine, King’s College London, London, UK
| | - Margaret Jones
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Daniel Dyball
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charandeep K. Khera
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - David Pernet
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Shirlee MacCrimmon
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Dominic Murphy
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Combat Stress, Leatherhead, UK
| | - Lisa Hull
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Neil Greenberg
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Deirdre MacManus
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Laura Goodwin
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Marie-Louise Sharp
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Simon Wessely
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Roberto J. Rona
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nicola T. Fear
- King’s Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Academic Department of Military Mental Health, Department of Psychological Medicine, King’s College London, London, UK
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Gazard B, Chui Z, Harber-Aschan L, MacCrimmon S, Bakolis I, Rimes K, Hotopf M, Hatch SL. Barrier or stressor? The role of discrimination experiences in health service use. BMC Public Health 2018; 18:1354. [PMID: 30526564 PMCID: PMC6286602 DOI: 10.1186/s12889-018-6267-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 05/04/2018] [Accepted: 11/26/2018] [Indexed: 01/01/2023] Open
Abstract
Background Discrimination is a well-established stressor that is substantially associated with poor health and a known contributor to health inequalities. However, the role of discrimination in health service use is less explored. This study will take an intersectional approach to investigate differences in health service use and examine the role of discrimination experiences. Methods Data on health service use were assessed in a diverse inner London sample of 1052 participants in the South East London Community Health (SELCoH) Study. Latent class analysis (LCA) was used to define classes of intersectional social status using multiple indicators of socioeconomic status (SES), ethnicity and migration status. Adjusted associations between intersectional social status and discrimination experiences with health service use indicators are presented. Results Using latent class analysis allowed us to identify an intersectional social status characterized by multiple disadvantage that was associated with decreased secondary physical health service use and a class characterized by both privilege and disadvantage that was associated with increased health service use for mental disorder after controlling for age, gender and health status. Anticipated discrimination was also associated with increased service use for mental disorder in adjusted models. There was no evidence to suggest that discrimination experiences were acting as a barrier to health service use. Conclusions This study highlights the complex ways in which discrimination experiences may increase the need for health services whilst also highlighting differences in health service use at the intersection of ethnicity, migration status and SES. Findings from this study illustrate the importance of measuring multiple levels of discrimination and taking an intersectional approach for health service use research.
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Affiliation(s)
- Billy Gazard
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.
| | - Zoe Chui
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
| | - Lisa Harber-Aschan
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Shirlee MacCrimmon
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department, Psychology and Neuroscience, Institute of Psychiatry, King's College London, London, UK.,Department of Biostatistics and Health Informatics, Psychology and Neuroscience, Institute of Psychiatry, King's College London, London, UK
| | - Katharine Rimes
- Psychology and Neuroscience, King's College London, Psychology, Institute of Psychiatry, London, UK
| | - Matthew Hotopf
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
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Stevelink SAM, Jones M, Hull L, Pernet D, MacCrimmon S, Goodwin L, MacManus D, Murphy D, Jones N, Greenberg N, Rona RJ, Fear NT, Wessely S. Mental health outcomes at the end of the British involvement in the Iraq and Afghanistan conflicts: a cohort study. Br J Psychiatry 2018; 213:690-697. [PMID: 30295216 PMCID: PMC6429255 DOI: 10.1192/bjp.2018.175] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [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: 11/25/2022]
Abstract
BACKGROUND Little is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.AimsWe examined the prevalence of mental disorders and alcohol misuse, whether this differed between serving and ex-serving regular personnel and by deployment status. METHOD This is the third phase of a military cohort study (2014-2016; n = 8093). The sample was based on participants from previous phases (2004-2006 and 2007-2009) and a new randomly selected sample of those who had joined the UK armed forces since 2009. RESULTS The prevalence was 6.2% for probable post-traumatic stress disorder, 21.9% for common mental disorders and 10.0% for alcohol misuse. Deployment to Iraq or Afghanistan and a combat role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel. CONCLUSIONS The findings highlight an increasing prevalence of post-traumatic stress disorder and a lowering prevalence of alcohol misuse compared with our previous findings and stresses the importance of continued surveillance during service and beyond. DECLARATION OF INTEREST All authors are based at King's College London which, for the purpose of this study and other military-related studies, receives funding from the UK Ministry of Defence (MoD). S.A.M.S., M.J., L.H., D.P., S.M. and R.J.R. salaries were totally or partially paid by the UK MoD. The UK MoD provides support to the Academic Department of Military Mental Health, and the salaries of N.J., N.G. and N.T.F. are covered totally or partly by this contribution. D.Mu. is employed by Combat Stress, a national UK charity that provides clinical mental health services to veterans. D.MacM. is the lead consultant for an NHS Veteran Mental Health Service. N.G. is the Royal College of Psychiatrists' Lead for Military and Veterans' Health, a trustee of Walking with the Wounded, and an independent director at the Forces in Mind Trust; however, he was not directed by these organisations in any way in relation to his contribution to this paper. N.J. is a full-time member of the armed forces seconded to King's College London. N.T.F. reports grants from the US Department of Defense and the UK MoD, is a trustee (unpaid) of The Warrior Programme and an independent advisor to the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee (unpaid) of Combat Stress and Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid). S.W. is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, the Department of Health, Public Health England or the UK MoD.
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Affiliation(s)
- Sharon A. M. Stevelink
- Lecturer in Epidemiology, King's Centre for Military Health Research, UK,Correspondence: Sharon Stevelink, King's Centre for Military Health Research, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
| | | | - Lisa Hull
- Project Manager, King's College London, UK
| | - David Pernet
- Database Administrator, King's College London, UK
| | | | - Laura Goodwin
- Lecturer in Epidemiology, University of Liverpool, UK
| | | | | | - Norman Jones
- Military Senior Lecturer, King's College London, UK
| | - Neil Greenberg
- Professor of Defence Mental Health, King's College London, UK
| | - Roberto J. Rona
- Professor of Public Health Medicine, King's College London, UK
| | | | - Simon Wessely
- Professor of Psychological Medicine, King's College London, UK
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Affiliation(s)
- Cerisse Gunasinghe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK and
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK and
| | - Lisa Aschan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK and
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK and
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK and
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK and
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