151
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Farrand P, Jeffs A, Bloomfield T, Greenberg N, Watkins E, Mullan E. Mental health service acceptability for the armed forces veteran community. Occup Med (Lond) 2018; 68:391-398. [DOI: 10.1093/occmed/kqy086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Farrand
- Clinical Education, Development and Research (CEDAR), Psychology, University of Exeter, Washington Singer Laboratories, Exeter, UK
| | - A Jeffs
- Clinical Education, Development and Research (CEDAR), Psychology, University of Exeter, Washington Singer Laboratories, Exeter, UK
| | - T Bloomfield
- Clinical Education, Development and Research (CEDAR), Psychology, University of Exeter, Washington Singer Laboratories, Exeter, UK
| | - N Greenberg
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, London, UK
| | - E Watkins
- SMART Lab, Psychology, University of Exeter, Washington Singer Laboratories, Exeter, UK
| | - E Mullan
- Clinical Education, Development and Research (CEDAR), Psychology, University of Exeter, Washington Singer Laboratories, Exeter, UK
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152
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Dighton G, Roberts E, Hoon AE, Dymond S. Gambling problems and the impact of family in UK armed forces veterans. J Behav Addict 2018; 7:355-365. [PMID: 29739238 PMCID: PMC6174607 DOI: 10.1556/2006.7.2018.25] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background and aims International evidence indicates elevated problem gambling rates in armed forces veterans compared with the general population. Gambling problems adversely impact one's family, and family-related variables may increase vulnerability to gambling-related harm. Little is known, however, about gambling problems in the United Kingdom (UK) veterans or to what extent family variables, such as parenting history and experience of domestic violence, influence veterans' gambling. Methods We compared veterans (n = 257) and sex- and age-matched controls (n = 514) drawn from the 2007 Adult Psychiatric Morbidity Survey on gambling, financial management, domestic violence, childhood parental presence, and experience of stressful life events. Veterans who left the military before or after 4 years of service were compared. Results Problem gambling was significantly more prevalent in veterans (1.4%) than non-veterans (0.2%), and the impact of gambling problems on the family was specific to male veterans, particularly those who had experienced a traumatic event after the age of 16, and those who were more likely to have been physically attacked by their partner. Overall, this study revealed that the UK armed forces veterans report a higher prevalence rate of problem gambling compared with non-veterans, with potential negative impact on family life.
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Affiliation(s)
- Glen Dighton
- Department of Psychology, Swansea University, Swansea, UK
| | - Elystan Roberts
- Department of Psychology, Swansea University, Swansea, UK,Present address: Bristol Medical School, Bristol University, Bristol, UK
| | - Alice E. Hoon
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Simon Dymond
- Department of Psychology, Swansea University, Swansea, UK,Department of Psychology, Reykjavík University, Reykjavík, Iceland,Corresponding author: Simon Dymond; Department of Psychology, Swansea University, Swansea SA2 8PP, UK; Phone: +44 1792 295602; E-mail:
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153
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The Therapeutic Relationship: Enhancing Referrals. Rehabil Nurs 2018; 43:E18-E24. [PMID: 29782478 DOI: 10.1097/rnj.0000000000000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This article focuses on the ways rehabilitation nurses use the therapeutic relationship to lessen barriers some veterans experience when a referral to mental health treatment is recommended. DESIGN Veterans presenting with posttraumatic stress symptoms are discussed, and possible interventions within the therapeutic relationship are proposed. METHOD Veterans' perception of mental health stigma, building a collaborative therapeutic relationship, recommending a referral and assessments of stress responses, posttraumatic stress symptoms, suicide risk, and intervention strategies are proposed. FINDINGS When changes in functioning and suicidality occur in veterans with posttraumatic stress disorder symptoms, it is important to screen and engage veterans at risk. CONCLUSIONS AND CLINICAL RELEVANCE When veterans in the rehabilitation process present with a need for mental health referral, barriers to treatment may include the stigma of mental health treatment. Rehabilitation nurses using the therapeutic relationship act as change agents to assist veterans in overcoming these barriers to treatment. The therapeutic relationship provides nurses with a foundation to provide opportunities for veterans to be supported and to seek treatment.
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154
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Gardiner F, Gardiner EC. Similarities between military and medical service: stigma of seeking mental health assistance. BMJ Mil Health 2018; 166:181-182. [PMID: 29769367 DOI: 10.1136/jramc-2018-000975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 01/02/2023]
Abstract
Studies have identified that there are many barriers to treatment of mental health illnesses in military populations, including the negative-associated stigma. One such barrier includes perceptions of weakness, leading to concerns about leadership and competency and being seen as malingering. Furthermore, similarities can be seen in civilian health professionals, where concerns of negative perceptions can limit reporting and treatment of mental health illnesses. Despite the frequency of stressful events, military and health professionals do not become immune to stress and are often ill prepared to cope with acute stressors that can often build on each other until emotional exhaustion and/or crisis point. Even with targeted internal programmes, the stigma of seeking mental health assistance in the military and medicine is poor and is believed to contribute to poor outcomes, such as the potential of increased suicide prevalence.
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Affiliation(s)
- Fergus Gardiner
- Research and Policy Unit, Royal Flying Doctor Service, Canberra, Australian Capital Territory, Australia
| | - E C Gardiner
- Emergency Department, Calvary Public Hospital, Canberra, Australian Capital Territory, Australia
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155
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Ghahramanlou-Holloway M, LaCroix JM, Koss K, Perera KU, Rowan A, VanSickle MR, Novak LA, Trieu TH. Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E828. [PMID: 29690594 PMCID: PMC5923870 DOI: 10.3390/ijerph15040828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/16/2022]
Abstract
Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines (N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines (N = 40) was matched to a non-treatment-seeking sample of Marines (N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls (p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed.
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Affiliation(s)
- Marjan Ghahramanlou-Holloway
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Jessica M LaCroix
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Kari Koss
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Kanchana U Perera
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Anderson Rowan
- School of Psychology and Counseling, Regent University, Virginia Beach, VA 23464, USA.
| | - Marcus R VanSickle
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Laura A Novak
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Theresa H Trieu
- Department of Medical & Clinical Psychology, Suicide Care, Prevention, and Research Initiative, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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156
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Bowes MA, Ferreira N, Henderson M. The influence of psychosocial factors in veteran adjustment to civilian life. Clin Psychol Psychother 2018; 25:583-600. [PMID: 29575290 DOI: 10.1002/cpp.2182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 11/09/2022]
Abstract
AIM Although most veterans have a successful transition to civilian life when they leave the military, some struggle to cope and adjust to the demands and challenges of civilian life. This study explores how a variety of psychosocial factors influence veteran adjustment to civilian life in Scotland, UK, and which of these factors predict a poor adjustment. METHODS One hundred and fifty-four veterans across Scotland completed a set of questionnaires that measured veteran adjustment difficulty, quality of life, mental health, stigma, self-stigma, attitude towards help-seeking, likelihood of help-seeking, experiential avoidance, reappraisal and suppression. RESULTS Veteran adjustment difficulty and quality of life were significantly correlated to a number of psychosocial factors. Mental health, experiential avoidance and cognitive reappraisal were found to be predictors of veteran adjustment difficulty, and experiential avoidance and cognitive reappraisal partially mediated the relationship between mental health and veteran adjustment, with experiential avoidance being the stronger mediator. DISCUSSION Our findings suggest that early assessment of experiential avoidance and cognitive reappraisal and the provision of relevant emotion regulation skills training could potentially reduce the veteran's need for more complex (and costly) psychological interventions in the future. Implications for veterans, as well as the services and professionals involved with veteran transition and health care are discussed.
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Affiliation(s)
| | - Nuno Ferreira
- Department of Clinical and Health Psychology, University of Nicosia, Nicosia, Cyprus
- Department of Clinical and Health Psychology, University of Edinburgh, Edinburgh, UK
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157
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Britt TW, Black KJ, Cheung JH, Pury CLS, Zinzow HM. Unit training to increase support for military personnel with mental health problems. WORK AND STRESS 2018. [DOI: 10.1080/02678373.2018.1445671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Thomas W. Britt
- Department of Psychology, Clemson University, Clemson, SC, USA
| | | | | | | | - Heidi M. Zinzow
- Department of Psychology, Clemson University, Clemson, SC, USA
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158
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Jones N, Whybrow D, Coetzee R. UK military doctors; stigma, mental health and help-seeking: a comparative cohort study. J ROY ARMY MED CORPS 2018. [PMID: 29523754 DOI: 10.1136/jramc-2018-000928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Studies suggest that medical doctors can suffer from substantial levels of mental ill-health. Little is known about military doctors' mental health and well-being; we therefore assessed attitudes to mental health, self-stigma, psychological distress and help-seeking among UK Armed Forces doctors. METHODS Six hundred and seventy-eight military doctors (response rate 59%) completed an anonymous online survey. Comparisons were made with serving and ex-military personnel (n=1448, response rate 84.5%) participating in a mental health-related help-seeking survey. Basic sociodemographic data were gathered, and participants completed measures of mental health-related stigmatisation, perceived barriers to care and the 12-Item General Health Questionnaire. All participants were asked if in the last three years they had experienced stress, emotional, mental health, alcohol, family or relationship problems, and whether they had sought help from formal sources. RESULTS Military doctors reported fewer mental disorder symptoms than the comparison groups. They endorsed higher levels of stigmatising beliefs, negative attitudes to mental healthcare, desire to self-manage and self-stigmatisation than each of the comparison groups. They were most concerned about potential negative effects of and peer perceptions about receiving a mental disorder diagnosis. Military doctors reporting historical and current relationship, and alcohol or mental health problems were significantly and substantially less likely to seek help than the comparison groups. CONCLUSIONS Although there are a number of study limitations, outcomes suggest that UK military doctors report lower levels of mental disorder symptoms, higher levels of stigmatising beliefs and a lower propensity to seek formal support than other military reference groups.
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Affiliation(s)
- Norman Jones
- Academic Department of Military Mental Health, Ministry of Defence, Weston Education Centre, London, UK
| | - D Whybrow
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - R Coetzee
- HQ Defence Primary Healthcare, Ministry of Defence, Lichfield, UK
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159
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Cerully JL, Acosta JD, Sloan J. Mental Health Stigma and Its Effects on Treatment-Related Outcomes: A Narrative Review. Mil Med 2018. [DOI: 10.1093/milmed/usx219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Joie D Acosta
- RAND Corporation, 1200 South Hayes Street, Arlington, VA
| | - Jennifer Sloan
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA
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160
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Jones N, Coetzee R. What drives UK military personnel to seek mental healthcare, work strain or something else? J ROY ARMY MED CORPS 2018; 164:248-252. [PMID: 29378786 DOI: 10.1136/jramc-2017-000861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND The numbers of UK military personnel referred to military departments of community mental health (DCMH) have increased annually over recent years; the reasons for such an increase are unclear. METHOD Data for this study were derived from 549 DCMH attendees and 3682 serving regular military personnel. DCMH attendees completed a checklist of potential reasons for help-seeking. Cohort members provided data on perceived mental health problems and help-seeking from specialist mental health services. Both samples provided work strain and basic sociodemographic data. Work strain levels were compared among cohort and DCMH help seekers and non-help seekers using adjusted logistic regression analyses. RESULTS Perceiving that mental health-related stigmatisation had reduced and being prompted to seek help by attending a health promotion event were among the least frequent reasons for seeking help in DCMH attendees. Realising that help was needed and being urged to seek help by one's partner, friends or family were the most common. Working very hard and experiencing excessive work were the most common work strain factors. Overall, the greatest levels of work strain were found among DCMH attendees. In all subsamples, work strain was significantly associated with experiencing a perceived mental health problem irrespective of whether help was sought or not. CONCLUSION Work strain was significantly associated with experiencing a stressful, emotional, mental health or alcohol problem and was the highest among current DCMH help seekers. Recognising that help was required and being prompted by a significant other were the main drivers for help-seeking among DCMH attendees.
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Affiliation(s)
- Norman Jones
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - R Coetzee
- DPHC-HQ, DMS Whittington, Lichfield, UK
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161
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Naifeh JA, Colpe LJ, Aliaga PA, Sampson NA, Heeringa SG, Stein MB, Ursano RJ, Fullerton CS, Nock MK, Schoenbaum M, Zaslavsky AM, Kessler RC. Barriers to Initiating and Continuing Mental Health Treatment Among Soldiers in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Mil Med 2018; 181:1021-32. [PMID: 27612348 DOI: 10.7205/milmed-d-15-00211] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
U.S. Army soldiers with mental disorders report a variety of barriers to initiating and continuing treatment. Improved understanding of these barriers can help direct mental health services to soldiers in need. A representative sample of 5,428 nondeployed Regular Army soldiers participating in the Army Study to Assess Risk and Resilience in Servicemembers completed a self-administered questionnaire and consented to linking self-administered questionnaire data with administrative records. We examined reported treatment barriers (perceived need, structural reasons, attitudinal reasons) among respondents with current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, mental disorders who either did not seek treatment in the past year (n = 744) or discontinued treatment (n = 145). About 82.4% of soldiers who did not initiate treatment and 69.5% of those who discontinued treatment endorsed at least two barriers; 69.8% of never-treated soldiers reported no perceived need. Attitudinal reasons were cited more frequently than structural reasons among never-treated soldiers with perceived need (80.7% vs. 62.7%) and those who discontinued treatment (71.0% vs. 37.8%). Multivariate associations with sociodemographic, Army career, and mental health predictors varied across barrier categories. These findings suggest most soldiers with mental disorders do not believe they need treatment and those who do typically face multiple attitudinal and, to a lesser extent, structural barriers.
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Affiliation(s)
- James A Naifeh
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Lisa J Colpe
- Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Boulevard, Room 7137, MSC 9635, Bethesda, MD 20892
| | - Pablo A Aliaga
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48106-1248
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, 8939 Villa La Jolla Drive, Suite 200, La Jolla, CA 92037
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Carol S Fullerton
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Matthew K Nock
- Department of Psychology, Harvard University, William James Hall 1220, 33 Kirkland Street, Cambridge, MA 02138
| | - Michael Schoenbaum
- Office of Clinical and Population Epidemiology Research, Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Boulevard, Room 7137, MSC 9635, Bethesda, MD 20892
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115
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162
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Rüsch N, Rose C, Holzhausen F, Mulfinger N, Krumm S, Corrigan PW, Willmund GD, Zimmermann P. Attitudes towards disclosing a mental illness among German soldiers and their comrades. Psychiatry Res 2017; 258:200-206. [PMID: 28864120 DOI: 10.1016/j.psychres.2017.08.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/12/2017] [Indexed: 11/17/2022]
Abstract
Many soldiers with mental illness (SWMIs) struggle with the decision whether to disclose their condition in or outside the military. This study therefore explored views on (self-)labeling as 'mentally ill', experiences of discrimination and coping, risks and benefits of (non-)disclosure, service use, disclosure decisions and consequences of disclosing. Active-duty SWMIs as well as soldiers without mental illness (commanding officers; enlisted ranks) and military social workers participated in focus groups. Transcripts were analyzed using qualitative content analysis. SWMIs perceived negative stereotypes about their group (weakness, incompetence, blame, malingering) and saw stigma as a barrier to help-seeking. Being labeled 'mentally ill' was seen as harmful for one's career. Self-labeling led to poor self-esteem, greater need for help and feelings of weakness. Many SWMIs had experienced discrimination, such as gossip or inappropriate comments. Social isolation was a disadvantage of secrecy. Most SWMIs preferred selective disclosure and many did not disclose to their family. Military staff without mental illness expressed partly different views and described organizational challenges posed by SWMIs. Our findings suggest that disclosure decisions are personal and difficult and that stigma remains a barrier to re-integration and recovery of SWMIs in the military. Implications for interventions to support SWMIs are discussed.
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Affiliation(s)
- Nicolas Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany.
| | - Carolyn Rose
- Center for Military Mental Health, Berlin, Germany
| | - Fabian Holzhausen
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
| | - Nadine Mulfinger
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
| | - Silvia Krumm
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany
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163
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Haugen PT, McCrillis AM, Smid GE, Nijdam MJ. Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis. J Psychiatr Res 2017; 94:218-229. [PMID: 28800529 DOI: 10.1016/j.jpsychires.2017.08.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/11/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE It is unclear how many first responders experience barriers to care and stigma regarding mental health care, and how this influences their help-seeking. A systematic review and meta-analysis was conducted on barriers to care and mental health stigma in first responders and their empirical relationship with psychosocial and psychiatric variables. METHODS The databases Medline, Embase PsycINFO, CINAHL, PILOTS, LILACS, Sociological Abstracts, SocINDEX, and Social Citation Index were searched to identify relevant studies. A quality assessment and meta-analysis was performed. RESULTS Fourteen articles met inclusion criteria, from which data from 12 samples were extracted for meta-analyses. All studies measured stigma regarding mental health care and 33.1% of first responders (95% CI 26.7-40.1; 12 individual samples) endorsed stigma items. The systematic review revealed that the most frequently endorsed items were fears regarding confidentiality and negative career impact. Five of 14 studies measured barriers to mental health care and 9.3% of first responders (95% CI 7.0-12.3; 4 individual samples) endorsed barriers to care items. The most frequently endorsed barriers were scheduling concerns and not knowing where to get help. Indications were found for more stigma and barriers in individuals with mental health problems. CONCLUSIONS Stigma and barriers to care are experienced by a significant proportion of firs responders, which can potentially lead to delayed presentation in mental health care and therefore, increased risk of chronicity of post-trauma psychopathology for these groups. The current systematic review draws attention to the paucity of research in this area, particularly in non-Western samples.
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Affiliation(s)
- Peter T Haugen
- NYU School of Medicine, NYU School of Medicine WTC Health Program Clinical Center of Excellence, 530 First Avenue, New York, NY, 10016, USA.
| | - Aileen M McCrillis
- NYU School of Medicine, Medical Library, 577 First Ave, New York, NY, 10016, USA
| | - Geert E Smid
- Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands
| | - Mirjam J Nijdam
- Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands; Center for Psychological Trauma, Academic Medical Center at the University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
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164
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Meshberg-Cohen S, Kachadourian L, Black AC, Rosen MI. Relationship between substance use and attitudes towards seeking professional psychological help among veterans filing PTSD claims. Addict Behav 2017; 74:9-12. [PMID: 28558337 DOI: 10.1016/j.addbeh.2017.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/05/2017] [Accepted: 05/22/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Veterans in distress often do not seek mental health treatment, even when such services are available. Substance use may further undermine treatment-seeking, given its association with negative treatment views. This study examined attitudes towards seeking psychological help in a sample of veterans diagnosed with posttraumatic stress disorder (PTSD), with and without co-occurring substance use disorders (SUD). METHODS Altogether, 143 male OEF/OIF veterans filing service-connected benefits claims for PTSD completed the Attitudes Towards Seeking Professional Psychological Help-Short Form (ATSPPH-SF) and other baseline assessments. Treatment attitudes were compared among veterans with (n=34) and without (n=109) SUD using ANCOVA, controlling for demographic covariates. Post-hoc ANCOVA compared means on the two ATSPPH-SF subscales: Openness to Seeking Treatment, and Value/Need in Seeking Treatment. RESULTS Overall, ATSPPH-SF scores were similar to those reported in other samples of young men. Controlling for demographic covariates, veterans with co-occurring SUD held significantly less favorable attitudes towards seeking help than veterans without comorbid SUD. In subscale analyses, valuation of treatment was significantly lower among veterans with SUDs, but openness towards treatment was not. CONCLUSIONS Substance-using veterans' lower valuation of treatment may reflect opinions that problems resolve on their own, psychotherapy is ineffective, or concerns that SUDs complicate treatment. Thus an approach towards engaging these veterans in treatment that addresses a general skepticism towards the value of psychological help is warranted.
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Affiliation(s)
- Sarah Meshberg-Cohen
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States.
| | - Lorig Kachadourian
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States
| | - Anne C Black
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States
| | - Marc I Rosen
- VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology Service/Department of Psychiatry, 116A West Haven, CT 06516, United States; Yale University School of Medicine, Department of Psychiatry, United States
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165
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Mellotte H, Murphy D, Rafferty L, Greenberg N. Pathways into mental health care for UK veterans: a qualitative study. Eur J Psychotraumatol 2017; 8:1389207. [PMID: 29163864 PMCID: PMC5687804 DOI: 10.1080/20008198.2017.1389207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/25/2017] [Indexed: 12/04/2022] Open
Abstract
Background: It is well established that veterans suffering from mental health difficulties under use mental health services. Objective: This study aimed to understand more about the barriers that prevent veterans from seeking professional help and the enablers that assist veterans in seeking professional help. It also aimed to explore potential mechanisms to improve veterans' help-seeking and pathways to care. Method: The study employed a qualitative design whereby 17 veterans who had recently attended specialist veteran mental health services took part in semi-structured interviews. The resultant data were analysed using grounded theory. Results: Participants described two distinct stages to their help-seeking: initial help-seeking and pathways through treatment. Specific barriers and enablers to help-seeking were identified at each stage. Initial barriers included recognizing that there is a problem, self-stigma and anticipated public stigma. Initial enablers included being in crisis, social support, motivation and the media. Treatment pathway barriers included practical factors and negative beliefs about health services and professionals. Treatment pathway enablers included having a diagnosis, being seen in a veteran-specific service and establishing a good therapeutic relationship. Participants provided some suggestions for interventions to improve veterans' help-seeking in future; these focussed on enhancing both veterans and health professionals' knowledge regarding mental health difficulties. Conclusions: This study identified a number of barriers and enablers that may impact a veteran's journey in seeking help from professional services for mental health difficulties. Enablers such as reaching a crisis point, social support, the media, having a diagnosis of PTSD and veteran-specific mental health services appeared to be important in opposing stigma-related beliefs and in supporting veterans to engage in help-seeking behaviours.
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Affiliation(s)
- Harriet Mellotte
- Doctorate in Clinical Psychology, Addiction Sciences Building, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Dominic Murphy
- King’s Centre for Military Health Research, Weston Education Centre, King’s College London, London, UK
- Combat Stress, Tyrwhitt House, Leatherhead, Surrey, UK
| | - Laura Rafferty
- King’s Centre for Military Health Research, Weston Education Centre, King’s College London, London, UK
| | - Neil Greenberg
- King’s Centre for Military Health Research, Weston Education Centre, King’s College London, London, UK
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166
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Coleman SJ, Stevelink SAM, Hatch SL, Denny JA, Greenberg N. Stigma-related barriers and facilitators to help seeking for mental health issues in the armed forces: a systematic review and thematic synthesis of qualitative literature. Psychol Med 2017; 47:1880-1892. [PMID: 28290262 DOI: 10.1017/s0033291717000356] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A recent quantitative review in the area of stigma and help seeking in the armed forces has questioned the association between these factors (Sharp et al. 2015). To date, the contribution of qualitative literature in this area has largely been ignored, despite the value this research brings to the understanding of complex social constructs such as stigma. The aim of the current systematic review of qualitative studies was to identify appropriate literature, assess the quality and synthesize findings across studies regarding evidence of stigma-related barriers and facilitators to help seeking for mental health issues within the armed forces. A multi-database text word search incorporating searches of PsycINFO, MEDLINE, Social Policy and Practice, Social Work Abstracts, EMBASE, ERIC and EBM Review databases between 1980 and April 2015 was conducted. Literature was quality assessed using the Critical Appraisal Skills Programme tool. Thematic synthesis was conducted across the literature. The review identified eight studies with 1012 participants meeting the inclusion criteria. Five overarching themes were identified across the literature: (1) non-disclosure; (2) individual beliefs about mental health; (3) anticipated and personal experience of stigma; (4) career concerns; and (5) factors influencing stigma. The findings from the current systematic review found that unlike inconsistent findings in the quantitative literature, there was substantial evidence of a negative relationship between stigma and help seeking for mental health difficulties within the armed forces. The study advocates for refinement of measures to accurately capture the complexity of stigma and help seeking in future quantitative studies.
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Affiliation(s)
- S J Coleman
- King's College London, Clinical Psychology, Institute of Psychology, Psychiatry and Neuroscience,Addiction Sciences Building,4 Windsor Walk,London SE5 8AF,UK
| | - S A M Stevelink
- King's Centre for Military Health Research, King's College London, Weston Education Centre,Cutcombe Road,London SE5 9RJ,UK
| | - S L Hatch
- King's College London, Psychological Medicine, Institute of Psychiatry,10 Cutcombe Road,London SE5 9RJ,UK
| | - J A Denny
- Queen's University Belfast,University Road,Belfast BT7 1NN,UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, Weston Education Centre,Cutcombe Road,London SE5 9RJ,UK
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167
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Hernandez SHA, Morgan BJ, Parshall MB. A Concept Analysis of Stigma Perceived by Military Service Members Who Seek Mental Health Services. Nurs Forum 2017; 52:188-195. [PMID: 27958653 DOI: 10.1111/nuf.12187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/26/2016] [Accepted: 06/27/2016] [Indexed: 06/06/2023]
Abstract
PROBLEM The aim of this concept analysis is to clarify military service members' stigma associated with seeking mental health services (MHS). Since 2001, over 2 million military service members have been deployed for or assigned to support military operations. Many service members develop a mental health concern during or after a deployment. Although researchers have assessed perceptions of stigma associated with accessing MHS, defining stigma is difficult, and conceptual clarity regarding stigma is lagging behind studies focused on its effects. METHODS Stigma was explored using Walker and Avant's method of concept analysis. Thirty articles were found in the PsycARTICLES, PsycINFO, and PubMed databases and selected for inclusion and synthesis. FINDINGS Military service member stigma is a set of beliefs, based on the member's military and prior civilian enculturation, that seeking MHS would be discrediting or embarrassing, cause harm to career progression, or cause peers or superiors to have decreased confidence in the member's ability to perform assigned duties. CONCLUSIONS Nurses are ideally suited and situated to play an important role in decreasing stigma inhibiting service members from seeking MHS. Healthcare providers and civilian and uniformed leaders must communicate the value of seeking MHS to ensure service members' health, unit readiness, and overall force preparedness.
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Affiliation(s)
| | - Brenda J Morgan
- Director, 59th Medical Wing Nursing Research Division, Lackland, TX
| | - Mark B Parshall
- Professor, College of Nursing, University of New Mexico, Albuquerque, NM
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168
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Schnyder N, Panczak R, Groth N, Schultze-Lutter F. Association between mental health-related stigma and active help-seeking: systematic review and meta-analysis. Br J Psychiatry 2017; 210:261-268. [PMID: 28153928 DOI: 10.1192/bjp.bp.116.189464] [Citation(s) in RCA: 309] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/22/2016] [Accepted: 09/06/2016] [Indexed: 11/23/2022]
Abstract
BackgroundMental disorders create high individual and societal costs and burden, partly because help-seeking is often delayed or completely avoided. Stigma related to mental disorders or mental health services is regarded as a main reason for insufficient help-seeking.AimsTo estimate the impact of four stigma types (help-seeking attitudes and personal, self and perceived public stigma) on active help-seeking in the general population.MethodA systematic review of three electronic databases was followed by random effect meta-analyses according to the stigma types.ResultsTwenty-seven studies fulfilled eligibility criteria. Participants' own negative attitudes towards mental health help-seeking (OR = 0.80, 95% CI 0.73-0.88) and their stigmatising attitudes towards people with a mental illness (OR = 0.82, 95% CI 0.69-0.98) were associated with less active help-seeking. Self-stigma showed insignificant association (OR = 0.88, 95% CI 0.76-1.03), whereas perceived public stigma was not associated.ConclusionsPersonal attitudes towards mental illness or help-seeking are associated with active help-seeking for mental problems. Campaigns promoting help-seeking by means of fighting mental illness-related stigma should target these personal attitudes rather than broad public opinions.
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Affiliation(s)
- Nina Schnyder
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Radoslaw Panczak
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Nicola Groth
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Frauke Schultze-Lutter
- Nina Schnyder, MSc, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern; Radoslaw Panczak, PhD, Institute of Social and Preventive Medicine, University of Bern; Nicola Groth, Dipl Psych, Frauke Schultze-Lutter, PhD, University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
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Keeling M, Bull S, Thandi G, Brooks S, Greenberg N. U.K. Army Medical and Unit Welfare Officers' Perceptions of Mental Health Stigma and Its Impact on Army Personnel's Mental Health Help Seeking. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/21635781.2017.1310682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mary Keeling
- University of Southern California, Los Angeles, California
| | - Samantha Bull
- University of Manchester, Manchester, United Kingdom
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Wesemann U, Kahn C, Zimmermann PL, Willmund GD, Schomerus G. Self-stigma in military personnel with alcohol dependence: comparison with a civilian sample before qualified withdrawal treatment. DRUGS AND ALCOHOL TODAY 2017. [DOI: 10.1108/dat-08-2016-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to highlight the differences in self-stigma between a military and a civilian sample in order to infer military-specific aspects of the stigmatization process.
Design/methodology/approach
Before undergoing a three-week course of qualified withdrawal treatment, 55 German military personnel were examined in terms of self-stigma, abstinence self-efficacy, duration of alcohol abuse, severity of alcohol dependence, and current mental disorders. Afterwards, the participants were compared with a non-military sample of 173 subjects with alcohol dependence in a civilian psychiatric clinic that had not yet undergone qualified withdrawal treatment.
Findings
While awareness of stigmatization is significantly greater among military personnel than in the civilian comparison group (t(171)=3.83, p<0.01), there is far less agreement with such stigmatization (t(170)=−3.20, p<0.01). More severe mental disorders and low abstinence self-efficacy have a significant influence on self-esteem decrement for the entire group.
Research limitations/implications
Both samples only consisted of male participants who wanted to receive treatment.
Originality/value
Since most studies refer to civilian patients, a comparative study of the influence of stigmatization of alcohol use disorders in the armed forces is of particular interest. The study indicates that military personnel are more aware of stigmatization by colleagues and superiors than is the case among civilian patients. This could be a significant obstacle when it comes to seeking professional help. Prevention programs need to give greater priority to this subject.
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171
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Hom MA, Stanley IH, Schneider ME, Joiner TE. A systematic review of help-seeking and mental health service utilization among military service members. Clin Psychol Rev 2017; 53:59-78. [PMID: 28214634 DOI: 10.1016/j.cpr.2017.01.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 11/10/2016] [Accepted: 01/24/2017] [Indexed: 11/20/2022]
Abstract
Research has demonstrated that military service members are at elevated risk for a range of psychiatric problems, and mental health services use is a conduit to symptom reduction and remission. Nonetheless, there is a notable underutilization of mental health services in this population. This systematic review aimed to identify and critically examine: (1) rates of service use; (2) barriers and facilitators to care; and (3) programs and interventions designed to enhance willingness to seek care and increase help-seeking behaviors among current military personnel (e.g., active duty, National Guard, Reserve). Overall, 111 peer-reviewed articles were identified for inclusion. Across studies, the rate of past-year service use among service members with mental health problems during the same time frame was 29.3% based on weighted averages. Studies identified common barriers to care (e.g., concerns regarding stigma, career impact) and facilitators to care (e.g., positive attitudes toward treatment, family/friend support, military leadership support) among this population. Although programs (e.g., screening, gatekeeper training) have been developed to reduce these barriers, leverage facilitators, and encourage service use, further research is needed to empirically test the effectiveness of these interventions in increasing rates of service utilization. Critical areas for future research on treatment engagement among this high-risk population are discussed.
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Affiliation(s)
- Melanie A Hom
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States.
| | - Ian H Stanley
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States
| | - Matthew E Schneider
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL 32306, United States
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172
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Jones N, Burdett H, Green K, Greenberg N. Trauma Risk Management (TRiM): Promoting Help Seeking for Mental Health Problems Among Combat-Exposed U.K. Military Personnel. Psychiatry 2017; 80:236-251. [PMID: 29087252 DOI: 10.1080/00332747.2017.1286894] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Trauma Risk Management (TRiM) is a peer-led, occupational mental health support process that aims to identify and assist U.K. military personnel with persistent mental ill health related to potentially traumatic events (PTEs). This study compared help seeking, mental disorder symptoms, and alcohol use between TRiM recipients and personnel experiencing similar combat events who did not receive TRiM; an unexposed group provided context. METHODS Records of TRiM activity during a U.K. military deployment in Afghanistan were linked to contemporaneous survey data assessing mental health and combat experiences. The resulting deployment data set was amalgamated with mental health, alcohol use, and help-seeking data collected within 12 weeks of homecoming and again one to two years later. Mental health and help-seeking outcomes were compared between a nonexposed, non-TRiM sample (n = 161), an exposed, non-TRiM sample (n = 149), and an exposed, TRiM-recipient sample (n = 328) using logistic regression analyses. RESULTS At follow-up, TRiM recipients were significantly more likely to seek help from mental health services than exposed, non-TRiM personnel. At baseline, TRiM recipients had significantly greater adjusted odds of reporting possible posttraumatic stress disorder (PTSD) symptoms than exposed non-TRiM personnel; the difference was not significant at follow-up. TRiM recipients were significantly more likely to report persistent mental disorder and alcohol misuse caseness over the follow-up period. CONCLUSIONS TRiM recipients were significantly more likely to seek help from mental health services than a similar PTE-exposed group that did not receive TRiM; however, TRiM recipients experienced more persistent mental ill-health symptoms and hazardous alcohol use over the period of follow-up despite seeking help.
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173
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Sparrow K, Kwan J, Howard L, Fear N, MacManus D. Systematic review of mental health disorders and intimate partner violence victimisation among military populations. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1059-1080. [PMID: 28748307 PMCID: PMC5581819 DOI: 10.1007/s00127-017-1423-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/14/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE There is growing awareness of the problem of intimate partner violence (IPV) among military populations. IPV victimisation has been shown to be associated with mental disorder. A better understanding of the link between IPV and mental disorder is needed to inform service development to meet the needs of military families. We aimed to systematically review the literature on the association between IPV victimisation and mental health disorders among military personnel. METHODS Searches of four electronic databases (Embase, Medline, PsycINFO, and Web of Science) were supplemented by reference list screening. Heterogeneity among studies precluded a meta-analysis. RESULTS Thirteen studies were included. There was stronger evidence for an association between IPV and depression/alcohol problems than between IPV and PTSD. An association between IPV and mental health problems was more frequently found among veterans compared to active duty personnel. However, the link between IPV and alcohol misuse was more consistently found among active duty samples. Finally, among active duty personnel psychological IPV was more consistently associated with depression/alcohol problems than physical/sexual IPV. The review highlighted the lack of research on male IPV victimisation in the military. CONCLUSIONS There is evidence that the burden of mental health need may be significant among military personnel who are victims of IPV. The influence of attitudes towards gender in the military on research in this area is discussed. Further research is needed to inform development of services and policy to reduce IPV victimisation and the mental health consequences among military personnel.
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Affiliation(s)
- Katherine Sparrow
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry Psychology and Neuroscience, King’s College London, PO23, 16 De Crespigny Park, London, SE5 8AF UK
| | - Jamie Kwan
- Department of Psychological Medicine, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
| | - Louise Howard
- David Goldberg Centre, Institute of Psychiatry Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Nicola Fear
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
| | - Deirdre MacManus
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry Psychology and Neuroscience, King's College London, PO23, 16 De Crespigny Park, London, SE5 8AF, UK.
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174
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Abstract
The purpose of this article is to illustrate prescient issues relating to current and ex-military communities in the United Kingdom who have featured heavily within the policy arena over the past decade in relation to several key areas of importance. It will be illustrated how this population becomes visible within the public imagination (via military losses), how discourses relating to the harms they experience are structured and articulated within political and policy domains (particularly in relation to mental health) via “state talk” (qua Sim), and what the potential social consequences are for politically rendering an unproblematized populist view of current and ex-military communities (i.e., pending crises). This argument is made with the express intention of reengaging critical recognition of the distancing of the military institution from the physical and psychological vulnerability of those who have participated in war and military environments. This is an argument returned to pertinence from the recent publication of the Chilcot Inquiry into British involvement in the Iraq war.
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175
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Chan MPS, Cheng C. Explaining personality and contextual differences in beneficial role of online versus offline social support: A moderated mediation model. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.05.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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177
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Kim TK, Lee SG, Han KT, Choi Y, Lee SY, Park EC. The association between perceived unmet medical need and mental health among the Republic of Korea Armed Forces. J ROY ARMY MED CORPS 2016; 163:184-192. [PMID: 27660285 DOI: 10.1136/jramc-2016-000625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/17/2016] [Accepted: 08/07/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We investigated the effect of unmet medical need on the mental health of Republic of Korea (ROK) Armed Forces personnel, as most of the service members work in remote areas and often experience such unmet needs. METHODS This study used secondary data from the 2014 Military Health Survey (MHS), conducted by the ROK School of Military Medicine and designed to collect military health determinants. Descriptive statistics showed the general characteristics of the study populations by variable. We specifically compared the population after stratifying participants by suicide ideation. An analysis of variance was also carried out to compare Kessler Psychological Distress Scale 10 Scores. Additionally, dependent spouses and children of both active-duty service members and retirees are included among those entitled to Military Health System healthcare. RESULTS Among the 4967 military personnel, 681 (13.7%) individuals reported an experience of unmet medical need within the past 12 months and gave reasons of 'no time (5.15%)', 'long office wait (2.6%)', 'no money (0.22%)', 'long distance from base (1.19%)', 'illness but not very serious (1.65%)', 'mistrust in doctors (1.95%)' and 'pressure due to performance appraisal (0.95%)'. Regression analysis revealed that unmet medical need was significantly associated with negative mental health (β=1.753, p<0.0001) and increased suicide ideation (OR=2.649, 95% CI 1.84 to 3.82). Also, soldiers reporting unmet medical need due to 'no money', 'no time' or 'pressure due to performance appraisal' were significantly more likely to experience similar negative mental health effects. CONCLUSIONS Our study indicates that unmet medical need is significantly associated with soldiers' mental health decline and suicide ideation, highlighting the importance of providing military personnel with timely, affordable and sufficient medical care.
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Affiliation(s)
- Tae Kyung Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - S G Lee
- Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - K-T Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Y Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - S Y Lee
- Department of Nursing, Seoul National University Hospital, Seoul, Republic of Korea
| | - E-C Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
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178
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Hunt EJF, Greenberg N, Jones N. Poor sleep after military deployment: associations with mental health difficulties. Occup Med (Lond) 2016; 66:669-675. [DOI: 10.1093/occmed/kqw116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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179
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Michalopoulou LE, Welsh JA, Perkins DF, Ormsby L. Stigma and Mental Health Service Utilization in Military Personnel: A Review of the Literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/21635781.2016.1200504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lito E. Michalopoulou
- Clearinghouse for Military Family Readiness at Penn State, University Park, Pennsylvania
| | - Janet A. Welsh
- Clearinghouse for Military Family Readiness at Penn State, University Park, Pennsylvania
| | - Daniel F. Perkins
- Clearinghouse for Military Family Readiness at Penn State, University Park, Pennsylvania
| | - LaJuana Ormsby
- U.S. Air Force, Family Advocacy Program, San Antonio, Texas
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180
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Bass SB, Muñiz J, Gordon TF, Maurer L, Patterson F. Understanding help-seeking intentions in male military cadets: An application of perceptual mapping. BMC Public Health 2016; 16:413. [PMID: 27184052 PMCID: PMC4869204 DOI: 10.1186/s12889-016-3092-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 05/10/2016] [Indexed: 12/04/2022] Open
Abstract
Background Research suggests that men are less likely to seek help for depression, substance abuse, and stressful life events due to negative perceptions of asking for and receiving help. This may be exacerbated in male military cadets who exhibit higher levels of gender role conflict because of military culture. Methods This exploratory study examined the perceptions of 78 male military cadets toward help-seeking behaviors. Cadets completed the 31-item Barriers to Help Seeking Scale (BHSS) and a component factor analysis was used to generate five composite variables and compare to validated factors. Perceptual mapping and vector modeling, which produce 3-dimensional models of a group’s perceptions, were then used to model how they conceptualize help-seeking. Results Factor analysis showed slightly different groupings than the BHSS, perhaps attributed to different characteristics of respondents, who are situated in a military school compared to general university males. Perceptual maps show that cadets perceive trust of doctors closest to them and help-seeking farthest, supporting the concept that these males have rigid beliefs about having control and its relationship to health seeking. Differences were seen when comparing maps of White and non-White cadets. White cadets positioned themselves far away from all variables, while non-White cadets were closest to “emotional control”. Conclusion To move these cadets toward help-seeking, vector modeling suggests that interventions should focus on their general trust of doctors, accepting lack of control, and decreasing feelings of weakness when asking for help. For non-White cadets a focus on self-reliance may also need to be emphasized. Use of these unique methods resulted in articulation of specific barriers that if addressed early, may have lasting effects on help-seeking behavior as these young men become adults. Future studies are needed to develop and test specific interventions to promote help-seeking among military cadets.
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Affiliation(s)
- Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University, College of Public Health, 1301 Cecil B. Moore Ave., Room 951, Philadelphia, PA, 19122, USA.
| | - Javier Muñiz
- Department of Social and Behavioral Sciences, Temple University, College of Public Health, 1301 Cecil B. Moore Ave., Room 951, Philadelphia, PA, 19122, USA
| | - Thomas F Gordon
- Department of Psychology, University of Massachusetts-Lowell, 113 Wilder St., Lowell, MA, 01854-3059, USA
| | - Laurie Maurer
- Department of Social and Behavioral Sciences, Temple University, College of Public Health, 1301 Cecil B. Moore Ave., Room 951, Philadelphia, PA, 19122, USA
| | - Freda Patterson
- Department of Behavioral Health and Nutrition, University of Delaware, 026 North College Ave., Carpenter Sports Building, Newark, DE, 19711, USA
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Bowen GL, Jensen TM, Martin JA, Mancini JA. The Willingness of Military Members to Seek Help: The Role of Social Involvement and Social Responsibility. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2016; 57:203-215. [PMID: 27217323 DOI: 10.1002/ajcp.12030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Anchored in the social organization theory of action and change, we use data from a large sample of active-duty Air Force members to examine the direct and indirect influence of social involvement and social responsibility on willingness to seek help in times of need via trust in formal systems and informal supports. Group comparisons are conducted between junior male, junior female, senior male, and senior female service members. The key mediational path in the model for all groups is the connection between social involvement and willingness to seek help via trust in formal systems. These results can inform both unit- and community-level interventions intended to increase the likelihood that active-duty AF members will seek help in times of need.
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Affiliation(s)
- Gary L Bowen
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Todd M Jensen
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chu C, Stanley IH, Hom MA, Lim IC, Joiner TE. Deployment, Mental Health Problems, Suicidality, and Use of Mental Health Services Among Military Personnel. MILITARY BEHAVIORAL HEALTH 2016; 4:243-250. [PMID: 28959502 DOI: 10.1080/21635781.2016.1153533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Following deployment, soldiers may struggle to cope with the after-effects of combat service and experience increased suicidality. Therefore, connection to mental health services is vital. Research regarding the relationship between deployment, suicidality, and mental health connections has been equivocal, with some studies finding a link between deployment history and mental health outcomes, and others not. The purpose of this study was to examine the effects of military deployment on mental health and service utilization outcomes using a longitudinal design. Deployment history, mental health visits, symptoms of suicidality, and various mental health outcomes were assessed in a sample of 1,566 Army recruiters at study entry and 18-months follow-up. Deployment history was positively associated with mental health visits, number of major depressive episodes, and acquired capability for suicide at baseline; however, no significant relationship between deployment, mental health visits, and any other suicide or mental health-related outcomes emerged at baseline or follow-up. Findings suggest a disconnection from mental health services among military personnel. Implications for treatment and suicide prevention efforts among military personnel are discussed.
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Affiliation(s)
- Carol Chu
- Florida State University, Department of Psychology, 1107 West Call Street, Tallahassee, FL 32306
| | - Ian H Stanley
- Florida State University, Department of Psychology, 1107 West Call Street, Tallahassee, FL 32306
| | - Melanie A Hom
- Florida State University, Department of Psychology, 1107 West Call Street, Tallahassee, FL 32306
| | - Ingrid C Lim
- Office of the Surgeon General, Defense Health Headquarters, 7700 Arlington Blvd, Falls Church, VA 22042
| | - Thomas E Joiner
- Florida State University, Department of Psychology, 1107 West Call Street, Tallahassee, FL 32306
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183
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Hurtado SL, Simon-Arndt CM, McAnany J, Crain JA. Acceptability of mental health stigma-reduction training and initial effects on awareness among military personnel. SPRINGERPLUS 2015; 4:606. [PMID: 26543741 PMCID: PMC4628072 DOI: 10.1186/s40064-015-1402-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/06/2015] [Indexed: 11/23/2022]
Abstract
The purpose of this paper is to report on the development of a mental health stigma reduction toolkit and training, and the acceptability and level of stigma awareness following the stigma-reduction training for military personnel. The overall aims of the training were to provide discussion tools highlighting the experiences of Marines seeking help for stress concerns, improve communication between leaders and their Marines around the issue of help seeking, and familiarize Marines with behavioral health treatment. Senior enlisted leaders and officers (N = 52) from a Marine Corps battalion participated in a pretest, 2-h stigma-reduction training and immediate posttest. Acceptability of the training was measured by querying participants about the usefulness and helpfulness of the training among other factors, and stigma awareness was measured with 10 items about mental health stigma. The stigma-reduction training and materials were well accepted by participants. In addition, there was a significant improvement in four of ten stigma-reduction awareness concepts measured before and immediately after the training, which included an increase in agreement that mental health treatments are usually effective in reducing stress reactions [t(51) = −3.35, p = 0.002], and an increase in disagreement that seeking counseling after a deployment will jeopardize future deployments [t(51) = −3.05, p = 0.004]. Level of agreement with several statements including those regarding perceptions of invincibility, and malingering, among others, did not change significantly after the training. The stigma-reduction training containing educational and contact strategies was highly acceptable to the leaders and may have promise for initially dispelling myths associated with seeking help for stress concerns among military service members; however, results indicate that there is clearly more work to be done in combatting stigma.
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Affiliation(s)
- Suzanne L Hurtado
- Health and Behavioral Sciences, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521 USA
| | - Cynthia M Simon-Arndt
- Health and Behavioral Sciences, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521 USA
| | - Jennifer McAnany
- Health and Behavioral Sciences, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521 USA
| | - Jenny A Crain
- Health and Behavioral Sciences, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521 USA
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184
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Rice SM, Aucote HM, Parker AG, Alvarez-Jimenez M, Filia KM, Amminger GP. Men’s perceived barriers to help seeking for depression: Longitudinal findings relative to symptom onset and duration. J Health Psychol 2015; 22:529-536. [DOI: 10.1177/1359105315605655] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Simon M Rice
- Orygen – The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia
- School of Psychology, Australian Catholic University, Australia
| | - Helen M Aucote
- School of Psychology, Australian Catholic University, Australia
| | - Alexandra G Parker
- Orygen – The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen – The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia
| | - Kate M Filia
- Orygen – The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia
| | - G Paul Amminger
- Orygen – The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria
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185
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ALBERTSON KATHERINE, IRVING JAMIE, BEST DAVID. A Social Capital Approach to Assisting Veterans Through Recovery and Desistance Transitions in Civilian Life. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/hojo.12138] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - JAMIE IRVING
- Criminology; Department of Law and Criminology, Sheffield Hallam University
| | - DAVID BEST
- Criminology; Department of Law and Criminology, Sheffield Hallam University
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186
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Galea S. Editorial: Veterans' health. Am J Epidemiol 2015; 181:223-4. [PMID: 25678565 DOI: 10.1093/aje/kwu337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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187
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Nasioudis D, Palaiodimos L, Dagiasis M, Katsarou A, Ntouros E. Depression in military medicine cadets: a cross-sectional study. Mil Med Res 2015; 2:28. [PMID: 26557991 PMCID: PMC4640107 DOI: 10.1186/s40779-015-0058-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 10/20/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Military medicine cadets undergo strenuous military training alongside demanding medical studies. This stressful and complex educational environment can lead to the emergence of depressive symptoms. We investigated the prevalence of depressive symptoms in a cohort of military medicine cadets. METHODS We conducted a descriptive questionnaire-based cross-sectional study among Greek military medicine cadets in the undergraduate program of the Hellenic Military School of Combat Support Officers. The Greek translation of the Zung self-rating depression scale questionnaire was used to screen for the presence of depressive symptoms. In addition, demographic, academic and dietary information was collected. The Shapiro-Wilk test of normality, Pearson correlation test, Chi-square test, t-test and Mann Whitney U test were employed for statistical analysis. RESULTS We enrolled 55 female and 91 male military medicine cadets with a mean age of 19.84 years (SD = 0.99). The mean Zung crude score was 43.32 (SD = 4.55): 42.8 (SD = 4.43) for female cadets and 43.64 (SD = 4.6) for male cadets. Cadets were further subdivided into low and high risk groups for the presence of depressive symptoms. We identified 57 (39 %) cadets with a total Zung crude score of 45 or above: 21 females and 36 males. Statistical analysis did not reveal any significant differences between the two groups based on gender, year of training, academic performance, alcohol consumption, smoking status, vitamin supplementation, dietary habits or BMI. CONCLUSIONS We report a high prevalence of depressive symptoms in a cohort of military medicine cadets that underscores the need for effective screening and appropriate and timely interventions. We did not identify any related risk factors. Military medicine cadets are exposed to a challenging military and medical training environment, and thus represent a group at risk for development of depression.
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Affiliation(s)
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, USA
| | | | | | - Evangelos Ntouros
- Hellenic Military School of Combat Support Officers (SSAS), Thessaloniki, Greece
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