1
|
McKenzie A, Burdett H, Croak B, Rafferty L, Greenberg N, Stevelink SAM. Adjustment disorder in the Armed Forces: a systematic review. J Ment Health 2023; 32:962-984. [PMID: 36330797 DOI: 10.1080/09638237.2022.2140792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the UK military, adjustment disorder (AjD) is reported as one of the most diagnosed mental disorders, alongside depression, in personnel presenting to mental health services. Despite this, little is understood about what may predict AjD, common treatment or outcomes for this population. AIM The systematic review aimed to summarise existing research for AjD in Armed Forces (AF) populations, including prevalence and risk factors, and to outline clinical and occupational outcomes. METHOD A literature search was conducted in December 2020 to identify research that investigated AjD within an AF population (serving or veteran) following the PRISMA guidelines. RESULTS Eighty-three studies were included in the review. The AjD prevalence estimates in AF populations with a mental disorder was considerably higher for serving AF personnel (34.9%) compared to veterans (12.8%). Childhood adversities were identified as a risk factor for AjD. AjD was found to increase the risk of suicidal ideation, with one study reporting a risk ratio of 4.70 (95% Confidence Interval: 3.50-6.20). Talking therapies were the most common treatment for AjD, however none reported on treatment effectiveness. CONCLUSION This review found that AjD was commonly reported across international AF. Despite heterogeneity in the results, the review identifies several literature gaps.
Collapse
Affiliation(s)
- Amber McKenzie
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Howard Burdett
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Bethany Croak
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Laura Rafferty
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
2
|
Bajjani-Gebara J, Wilcox SL, Williams JW, Kosinski AS, Allard RJ, Wilson C, Landoll R. Adjustment Disorders in U.S. Active Duty Military Women: A Scoping Review for the Years 2000 to 2018. Womens Health Issues 2021; 31 Suppl 1:S33-S42. [PMID: 34454702 DOI: 10.1016/j.whi.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjustment disorder (AD) is the most common mental health diagnosis in the U.S. military and is more than twice as likely to be diagnosed in active duty servicewomen as compared with male servicemembers. The literature on ADs, particularly in female servicemembers, has not been reviewed yet. We conducted a scoping review of the literature to explore the degree of research activity and summarize current literature gaps. METHODS We created a PRISMA-ScR checklist and prospectively registered it in Open Science Framework. The literature search included articles (including studies and reports) published between 2000 and 2018 in either the grey literature or the following databases: Ovid Medline, CINAHL, Embase, PsycINFO, Web of Science, and Ovid Cochrane. We used DistillerSR to conduct title and abstracts screening, full-text screening, and data charting. The social ecological model for military women's health framework was used to organize the results. RESULTS After screening 1,304 records, 29 were included for data charting. Most frequently, studies were descriptive (cross-sectional) (25%), with no randomized controlled studies. The studies primarily focused on ADs' risk factors in servicewomen (76%), followed by military readiness (38%). Only 14% addressed recommendations for treatments based on expert opinion, although they did not directly test interventions, and 7% focused on health outcomes. CONCLUSIONS ADs affect the health of U.S. military women and military readiness, yet little is known about their successful treatment or health outcomes. Additional research in those areas is warranted.
Collapse
Affiliation(s)
- Jouhayna Bajjani-Gebara
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland.
| | - Sherrie L Wilcox
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Department of Preventive Medicine and Biostatistics, Bethesda, Maryland
| | - John W Williams
- Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina
| | - Andrzej S Kosinski
- Duke University School of Medicine, Department of Biostatistics and Bioinformatics, Durham, North Carolina
| | - Rhonda J Allard
- Uniformed Services University of the Health Sciences, James A. Zimble Learning Resource Center, Bethesda, Maryland
| | - Candy Wilson
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland
| | - Ryan Landoll
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland
| |
Collapse
|
3
|
Wall PH, Convoy SP, Braybrook CJ. Military Service–Related Post-traumatic Stress Disorder: Finding a Way Home. Nurs Clin North Am 2019; 54:503-515. [DOI: 10.1016/j.cnur.2019.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
4
|
Jongsma HE, Turner C, Kirkbride JB, Jones PB. International incidence of psychotic disorders, 2002-17: a systematic review and meta-analysis. Lancet Public Health 2019; 4:e229-e244. [PMID: 31054641 PMCID: PMC6693560 DOI: 10.1016/s2468-2667(19)30056-8] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/18/2019] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The last comprehensive systematic review of the incidence of psychotic disorders was published in 2004. New epidemiological data from different settings now permit a broader understanding of global variation. We examined the variation in psychosis by demographic characteristics and study method. METHODS For this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, PsycINFO, and bibliographies, and directly contacted first authors. We sought to obtain citations of original research published between Jan 1, 2002, and Dec 31, 2017, on incidence of non-organic adult-onset psychotic disorder. We included papers that were published or in grey literature and had no language restrictions. Data were extracted from published reports, where possible, by sex, age, and ethnic group. Quality of yield was assessed. Data were assessed using univariable random-effects meta-analysis and meta-regression. We registered our systematic review on PROSPERO, number CRD42018086800. FINDINGS From 56 721 records identified, 177 met inclusion criteria. The pooled incidence of all psychotic disorders was 26·6 per 100 000 person-years (95% CI 22·0-31·7). Heterogeneity was high (I2≥98·5%). Men were at higher risk of all psychotic disorders (incidence rate ratio 1·44 [1·27-1·62]) and non-affective disorders (1·60 [1·44-1·77]) than women, but not affective psychotic disorders (0·87 [0·75-1·00]). Ethnic minorities were also at excess risk of all psychotic disorders (1·75 [1·53-2·00]), including non-affective disorders (1·71 [1·40-2·09]). Meta-regression revealed that population registers reported higher rates of non-affective disorders (9·64 [2·72-31·82]), schizophrenia (2·51 [1·24-5·21]), and bipolar disorder (4·53 [2·41-8·51]) than first contact study designs. INTERPRETATION We found marked variation in incidence of psychotic disorders by personal characteristics and place. Some geographical variation could be partially explained by differences in case ascertainment methods. FUNDING None.
Collapse
Affiliation(s)
- Hannah E Jongsma
- Department of Psychiatry, University of Cambridge, Cambridge, UK; PsyLife Group, Division of Psychiatry, University College London, London, UK.
| | - Caitlin Turner
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - James B Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK; CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
5
|
Chaudhary MA, Schoenfeld AJ, Harlow AF, Ranjit A, Scully R, Chowdhury R, Sharma M, Nitzschke S, Koehlmoos T, Haider AH. Incidence and Predictors of Opioid Prescription at Discharge After Traumatic Injury. JAMA Surg 2017. [PMID: 28636707 DOI: 10.1001/jamasurg.2017.1685] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance In the current health care environment with increased scrutiny and growing concern regarding opioid use and abuse, there has been a push toward greater regulation over prescriptions of opioids. Trauma patients represent a population that may be affected by this regulation, as the incidence of pain at hospital discharge is greater than 95%, and opioids are considered the first line of treatment for pain management. However, the use of opioid prescriptions in trauma patients at hospital discharge has not been explored. Objective To study the incidence and predictors of opioid prescription in trauma patients at discharge in a large national cohort. Design, Setting, and Participants Analysis of adult (18-64 years), opioid-naive trauma patients who were beneficiaries of Military Health Insurance (military personnel and their dependents) treated at both military health care facilities and civilian trauma centers and hospitals between January 1, 2006, and December 31, 2013, was conducted. Patients with burns, foreign body injury, toxic effects, or late complications of trauma were excluded. Prior diagnosis of trauma within 1 year and in-hospital death were also grounds for exclusion. Injury mechanism and severity, comorbid conditions, mental health disorders, and demographic factors were considered covariates. The Drug Enforcement Administration's list of scheduled narcotics was used to query opioid use. Unadjusted and adjusted logistic regression models were used to determine the predictors of opioid prescription. Data analysis was performed from June 7 to August 21, 2016. Exposures Injury mechanism and severity, comorbid conditions, mental health disorders, and demographic factors. Main Outcomes and Measures Prescription of opioid analgesics at discharge. Results Among the 33 762 patients included in the study (26 997 [80.0%] men; mean [SD] age, 32.9 [13.3] years), 18 338 (54.3%) received an opioid prescription at discharge. In risk-adjusted models, older age (45-64 vs 18-24 years: odds ratio [OR], 1.28; 95% CI, 1.13-1.44), marriage (OR, 1.26; 95% CI, 1.20-1.34), and higher Injury Severity Score (≥9 vs <9: OR, 1.40; 95% CI, 1.32-1.48) were associated with a higher likelihood of opioid prescription at discharge. Male sex (OR, 0.76; 95% CI, 0.69-0.83) and anxiety (OR, 0.82; 95% CI, 0.73-0.93) were associated with a decreased likelihood of opioid prescription at discharge. Conclusions and Relevance The incidence of opioid prescription at discharge (54.3%) closely matches the incidence of moderate to severe pain in trauma patients, indicating appropriate prescribing practices. We advocate that injury severity and level of pain-not arbitrary regulations-should inform the decision to prescribe opioids.
Collapse
Affiliation(s)
- Muhammad Ali Chaudhary
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Schoenfeld
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alyssa F Harlow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anju Ranjit
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rebecca Scully
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ritam Chowdhury
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meesha Sharma
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Nitzschke
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Trauma Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tracey Koehlmoos
- Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Deputy Editor
| |
Collapse
|
6
|
Ramchand R, Rudavsky R, Grant S, Tanielian T, Jaycox L. Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan. Curr Psychiatry Rep 2015; 17:37. [PMID: 25876141 DOI: 10.1007/s11920-015-0575-z] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review summarizes the epidemiology of posttraumatic stress disorder (PTSD) and related mental health problems among persons who served in the armed forces during the Iraq and Afghanistan conflicts, as reflected in the literature published between 2009 and 2014. One-hundred and sixteen research studies are reviewed, most of which are among non-treatment-seeking US service members or treatment-seeking US veterans. Evidence is provided for demographic, military, and deployment-related risk factors for PTSD, though most derive from cross-sectional studies and few control for combat exposure, which is a primary risk factor for mental health problems in this cohort. Evidence is also provided linking PTSD with outcomes in the following domains: physical health, suicide, housing and homelessness, employment and economic well-being, social well-being, and aggression, violence, and criminality. Also included is evidence about the prevalence of mental health service use in this cohort. In many instances, the current suite of studies replicates findings observed in civilian samples, but new findings emerge of relevance to both military and civilian populations, such as the link between PTSD and suicide. Future research should make effort to control for combat exposure and use longitudinal study designs; promising areas for investigation are in non-treatment-seeking samples of US veterans and the role of social support in preventing or mitigating mental health problems in this group.
Collapse
Affiliation(s)
- Rajeev Ramchand
- RAND Corporation, 1100 South Hayes Street, Arlington, VA, 22202-5050, USA,
| | | | | | | | | |
Collapse
|
7
|
Booth-Kewley S, Schmied EA, Highfill-McRoy RM, Larson GE, Garland CF, Ziajko LA. Predictors of psychiatric disorders in combat veterans. BMC Psychiatry 2013; 13:130. [PMID: 23651663 PMCID: PMC3651311 DOI: 10.1186/1471-244x-13-130] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 04/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most previous research that has examined mental health among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combatants has relied on self-report measures to assess mental health outcomes; few studies have examined predictors of actual mental health diagnoses. The objective of this longitudinal investigation was to identify predictors of psychiatric disorders among Marines who deployed to combat in Iraq and Afghanistan. METHODS The study sample consisted of 1113 Marines who had deployed to Iraq or Afghanistan. Demographic and psychosocial predictor variables from a survey that all Marines in the sample had completed were studied in relation to subsequent psychiatric diagnoses. Univariate and multivariate logistic regression were used to determine the influence of the predictors on the occurrence of psychiatric disorders. RESULTS In a sample of Marines with no previous psychiatric disorder diagnoses, 18% were diagnosed with a new-onset psychiatric disorder. Adjusting for other variables, the strongest predictors of overall psychiatric disorders were female gender, mild traumatic brain injury symptoms, and satisfaction with leadership. Service members who expressed greater satisfaction with leadership were about half as likely to develop a mental disorder as those who were not satisfied. Unique predictors of specific types of mental disorders were also identified. CONCLUSIONS Overall, the study's most relevant result was that two potentially modifiable factors, low satisfaction with leadership and low organizational commitment, predicted mental disorder diagnoses in a military sample. Additional research should aim to clarify the nature and impact of these factors on combatant mental health.
Collapse
Affiliation(s)
- Stephanie Booth-Kewley
- Behavioral Science and Epidemiology Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521, USA.
| | - Emily A Schmied
- Behavioral Science and Epidemiology Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521, USA
| | - Robyn M Highfill-McRoy
- Behavioral Science and Epidemiology Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521, USA
| | - Gerald E Larson
- Behavioral Science and Epidemiology Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521, USA
| | - Cedric F Garland
- Behavioral Science and Epidemiology Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521, USA,Department of Family and Preventive Medicine and Moores UCSD Cancer Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093-0631, USA
| | - Lauretta A Ziajko
- Naval Medical Center, San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| |
Collapse
|