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Simms A, Leightley D, Lamb D. Caring for the carers: an evaluation of the recovery, readjustment and reintegration programme (R3P). BMJ Mil Health 2024; 170:384-389. [PMID: 37487658 DOI: 10.1136/military-2023-002359] [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: 01/23/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The challenges faced by healthcare workers, not least during the response to the COVID-19 pandemic, have been extensively studied, and concerns continue to be highlighted in relation to their long-term mental health. Identifying the need to support their personnel, a leader-led structured programme of reflection: the recovery, readjustment and reintegration programme (R3P) was designed by the UK Defence Medical Services to mitigate the potential stressors associated with this outbreak and enhance the resilience of the workforce. METHODS 128 military personnel completed an evaluation of R3P. A survey included measures of anxiety before and after the intervention, perceptions of the discussion themes and whether these brought a sense of closure to areas of distress, and attitudes to help-seeking. RESULTS Most respondents (86%-92%) rated the five discussion themes either 'helpful' or 'very helpful', 51% of respondents reported a sense of closure about an issue that had been causing distress and 72% of respondents felt better able to seek help should it be necessary. Evaluating the effect R3P had on anxiety, a Wilcoxon signed rank test elicited a statistically significant difference in anxiety pre-R3P and post-R3P; Z=-3.54, p<0.001. The median anxiety rating was 3.5 (IQR 4.75, 95% CI 1.25 to 6.00) before undertaking R3P, which decreased to 3 (IQR 4.75, 95% CI 1.00 to 5.75) after undertaking R3P. 39.1% of participants reported decreased anxiety, 18.8% reported increased anxiety and 42.2% reported no change. CONCLUSION This evaluation has identified several positive aspects to R3P with many personnel reporting a reduction in anxiety, a sense of closure and increased likelihood of help-seeking. Several participants did report an increase in anxiety and the long-term impact of R3P on mental health and well-being is unclear. Further mixed-methods evaluation incorporating a longer follow-up is required.
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Affiliation(s)
- Amos Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - D Leightley
- King's Centre for Military Health Research, King's College London, London, UK
| | - D Lamb
- RCDM (Research and Academia), MOD, Birmingham, UK
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Bennett N, Lawrence-Wood E, McFarlane A. Is inflammatory change associated with psychological risk and resilience in high-risk military personnel? BMJ Mil Health 2024; 170:396-401. [PMID: 39043474 DOI: 10.1136/military-2024-002725] [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: 03/15/2024] [Accepted: 05/30/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION In military populations, the potential for under-reporting of Post-traumatic Stress Disorder (PTSD) symptoms and challenges in recognising early changes can make it difficult to detect an emerging disorder. However, early identification of PTSD symptoms would improve opportunities for intervention, and potentially reduce the likelihood of chronic mental health problems. METHOD This study explored if changes in levels of inflammation, measured by C reactive protein (CRP) and interleukin 6 (IL-6), were associated with the onset of psychological symptoms associated with PTSD. It also examined if changes in inflammation over time contributed to psychological risk and resilience, which was defined by psychological reactivity to deployment-related combat exposures. Participants were special forces personnel who completed psychological self-report questionnaires and had measures of CRP and IL-6 taken pre and post deployment. Regression analysis was used to examine how psychological symptoms predicted change in inflammation, and Analysis of Variance (ANOVA) were used to examine differences between identified subgroups. RESULTS Results identify this population as having high levels of combat and trauma exposures, with low-level psychological symptoms. The results also identified a decrease in CRP and an increase in IL-6 over time. A significant difference in inflammation was identified between subgroups (p<0.05). An association between inflammatory markers and subthreshold symptoms related to anger (p<0.01) and sleep (p<0.05) was also identified. CONCLUSION These preliminary findings suggest inflammatory markers may help to identify adaptive responses post deployment. In addition, low-level increases in inflammatory markers may be associated with subthreshold PTSD symptoms. These findings offer potential insights for prevention, early identification and treatment in military and veteran populations.
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Affiliation(s)
- Neanne Bennett
- The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- Department of Defence, Defence People Group, Canberra, Australian Capital Territory, Australia
| | - E Lawrence-Wood
- Phoenix Australia Centre for Post-traumatic Mental Health, Carlton, Victoria, Australia
| | - A McFarlane
- The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
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Hitch C, Toner P, Champion H, Armour C. Lifetime trauma, mental well-being, alcohol and help-seeking; the phenomenological experience of veterans residing in Northern Ireland. BMC Psychol 2024; 12:479. [PMID: 39256824 PMCID: PMC11386114 DOI: 10.1186/s40359-024-01978-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 09/03/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Veteran residents in Northern Ireland (NI) are an under-researched population. Little is known about their experiences of trauma and mental health management. The overall mental well-being of veterans living in NI may be poorer than other veteran populations, due to the challenges presented by the unique landscape. Understanding their experiences is crucial for providing appropriate, targeted support. METHOD Six male veterans, who had received a mental health diagnosis, living in NI and all aged > 40 years participated. Semi-structured interviews, using open-ended questions, were conducted over the telephone. Interpretative phenomenological analysis was used to explore their experiences. RESULTS Two experiential themes were identified each containing three experiential statements. Statements for 'an extreme lack of' included: lack of mental health literacy/awareness; lack of expectations of official support; lack of a sense of perceived appreciation. Statements for 'an extreme abundance of' included: exacerbated exposure to a range of extreme environments; high levels of ruled-based living; high levels of engaging with informal/local level support. CONCLUSIONS Several experiential statements aligned with existing literature, including having poor mental health literacy and problem recognition, and heavily utilising social support versus formal help-seeking. Some novel findings included bouncing between extreme positive and negative environments which could be as detrimental to mental health as experiencing conflict trauma. Heavy alcohol use was just another rule soldiers followed. Positive help-seeking experiences failed to improve poor opinions of support organisations. Finally, poor self-perceptions connected to military status are pertinent in NI, which seems to fuel self-marginalisation and distrust. A combination of factors likely contributes to many veterans living in NI having poorer mental well-being. Novel findings would benefit from further exploration as understanding how NI veterans interpret their experiences is key to providing adequate healthcare.
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Affiliation(s)
- Catherine Hitch
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, Northern Ireland.
- School of Psychology, Arden University, Arden House, Middlemarch Park, Coventry, CV3, UK.
| | - Paul Toner
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, Northern Ireland
| | - Hannah Champion
- 4FJSchool of Psychology, Swansea University, Singleton Park Campus, Swansea, SA2 8PP, UK
| | - Cherie Armour
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, Northern Ireland
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Provan M, Ahmed Z, Stevens AR, Sardeli AV. Are equine-assisted services beneficial for military veterans with post-traumatic stress disorder? A systematic review and meta-analysis. BMC Psychiatry 2024; 24:544. [PMID: 39085783 PMCID: PMC11293092 DOI: 10.1186/s12888-024-05984-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Equine-assisted services (EAS) involves the use of horses within therapy, learning or horsemanship sessions and has been used with military veterans suffering from post-traumatic stress disorder (PTSD). This study systematically reviewed existing research on the use of EAS in the treatment of PTSD in military veterans and evaluated its effectiveness. METHODS A systematic review was performed, in May 2023, with searches and data extraction carried out from three separate databases (PubMed, JSTOR and Science Direct) related to testing the effect of EAS on PTSD outcomes in veterans. A risk of bias assessment of included studies was conducted and meta-analysis of outcomes performed when two or more studies reported the same outcomes. Other effects of EAS on veterans' health were also discussed. RESULTS A total of 13 studies were identified based on our inclusion and exclusion criteria with 11 originating from the US and the remaining two from Australia and Israel. There were 344 participants amongst all of the studies with a mean age of 47 years and a male:female ratio of 19:6. Eight out of the 13 studies reported PTSD scores, as measured by either PTSD Checklist for DSM-5 (PCL-5) or PCL-Veteran/-Military versions (PCL-V/-M), and results suggested a reduction in PTSD score after EAS treatment of 22.6%. A meta-analysis confirmed that EAS favored a significantly lower PTSD score after treatment, with a mean difference of 12.46, 95% CI [9.03,15.88], p < 0.00001. However, only one study had low risk of bias whilst all the rest of the studies had some concerns to high risk of bias. CONCLUSIONS EAS appeared to have a positive influence on PTSD symptoms in military veterans, significantly reducing PTSD severity scores. Other benefits of EAS may be peer support, social integration, learning new skills and bonding. However, the results of this systematic review must be interpreted with caution as almost all of the studies were of low quality. Therefore, further rigorous research is required with larger participants to be able to draw conclusions about the benefits of EAS on PTSD severity.
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Affiliation(s)
- Maisy Provan
- Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Zubair Ahmed
- Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Andrew R Stevens
- Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Amanda V Sardeli
- Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Franco Z, Ruffalo L, Curry B, Gollin-Graves M, Ahamed SI, Winstead O, Hooyer K, Pazdera M, Rein L, Lizarraga Mazaba J, Hossain MF, Stoffel V, Flower M, Madiraju P, Melka S, Berte K, Whittle J. Impact of veteran-led peer mentorship on posttraumatic stress disorder. J Trauma Stress 2024; 37:617-630. [PMID: 38635149 DOI: 10.1002/jts.23038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/05/2024] [Accepted: 03/23/2024] [Indexed: 04/19/2024]
Abstract
Peer mentorship shows promise as a strategy to support veteran mental health. A community-academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at baseline, midpoint, and 12-week discharge using the PTSD Checklist for DSM-5 (PCL-5), Deployment Risk and Resilience Inventory-2, Social Adaptation Self-evaluation Scale, and Values in Action Survey. Brief weekly check-in surveys reinforced mentor contact and assessed retention. The sample included 307 veterans who were served by 17 veteran peer mentors. Mixed-effects linear models found a modest effect for PTSD symptom change, with a mean PCL-5 score reduction of 4.04 points, 95% CI [-6.44, -1.64], d = 0.44. More symptomatic veterans showed a larger effect, with average reductions of 9.03 points, 95% CI [-12.11, -5.95], d = 0.77. There were no significant findings for other outcome variables. Compared to younger veterans, those aged 32-57 years were less likely to drop out by 6 weeks, aORs = 0.32-0.26. Week-by-week hazard of drop-out was lower with mentors ≥ 35 years old, aHR = 0.62, 95% CI [0.37, 1.05]. Unadjusted survival differed by mentor military branch, p = .028, but the small mentor sample reduced interpretability. Like many community research efforts, this study lacked a control group, limiting the inferences that can be drawn. Continued study of veteran peer mentorship is important as this modality is often viewed as more tolerable than therapy.
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Affiliation(s)
- Zeno Franco
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leslie Ruffalo
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bob Curry
- Great Lakes Dryhootch, Milwaukee, Wisconsin, USA
| | | | - Sheikh Iqbal Ahamed
- Department of Computer Science, Marquette University, Milwaukee, Wisconsin, USA
| | | | - Katinka Hooyer
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Myah Pazdera
- Office of Community Engagement, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lisa Rein
- Institute for Health & Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jose Lizarraga Mazaba
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Md Fitrat Hossain
- Department of Computer Science, Marquette University, Milwaukee, Wisconsin, USA
| | - Virginia Stoffel
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Mark Flower
- Mental Health America of Wisconsin, Milwaukee, Wisconsin, USA
| | - Praveen Madiraju
- Department of Computer Science, Marquette University, Milwaukee, Wisconsin, USA
| | - Stephen Melka
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Karen Berte
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | - Jeffrey Whittle
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
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Ravyts SG, Eshera YM, Griffin SC, Halverson T, Grove JL, Beckham JC, Pugh MJ, Kimbrel NA, Calhoun PS. Sleep Apnea Among Gulf War Veterans: An Examination of VA Utilization Rates, Treatment Initiation, and Health Outcomes. Behav Sleep Med 2024; 22:446-456. [PMID: 38156829 PMCID: PMC11166522 DOI: 10.1080/15402002.2023.2299675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) among veterans is frequently underdiagnosed and undertreated. The present study sought to: 1) characterize the prevalence and rate of treatment of OSA among VA users and non-users and 2) examine the associations between diagnosed or probable OSA and key physical and mental health outcomes. METHODS Gulf-War I-era Veterans were recruited as part of a national survey assessing mental and physical health concerns, healthcare needs, and healthcare utilization. OSA diagnoses were self-reported while sleep apnea risk was assessed via the STOP-Bang. Veterans also completed questionnaires assessing overall health, pain, depression, PTSD, and psychosocial functioning. RESULTS 1,153 veterans were included in the present analyses (Mean age = 58.81; 21.84% female). Compared to non-VA healthcare users, veterans receiving care at the VA were more likely to have been diagnosed with OSA (p < .001) and report receiving treatment for OSA (p = .005). Compared to veterans at low risk for OSA, veterans at elevated risk reported higher levels of pain (p = .001), depression (p = .02), and poorer psychosocial functioning (p < .001). CONCLUSIONS OSA diagnoses appear to be more common among VA healthcare users. Findings suggest that OSA remains underdiagnosed and associated with important physical and mental health consequences. Additional screening for OSA, especially among non-VA clinics, is warranted.
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Affiliation(s)
- Scott G. Ravyts
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yasmine M. Eshera
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sarah C. Griffin
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA
| | - Tate Halverson
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA
| | - Jeremy L. Grove
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jean C. Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA
| | - Mary J. Pugh
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nathan A. Kimbrel
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S. Calhoun
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA
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7
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Fischer IC, Nichter B, Trachik B, Bryan CJ, Pietrzak RH. Suicide-Specific Cognitions and Suicidal Behavior in U.S. Military Veterans. Psychiatry 2024; 87:241-250. [PMID: 38832675 DOI: 10.1080/00332747.2024.2352883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND U.S. military veterans may be reluctant to disclose suicidal thoughts and behaviors. Suicide-specific cognitions, which generally avoid direct mention of suicide, may be reliable indicators of risk among those reluctant to disclose such thoughts and behaviors. METHODS Data from a population-based, cross-sectional study of 2,430 U.S. military veterans were analyzed to examine the associations between the Brief Suicide Cognitions Scale (B-SCS), suicidal ideation, and suicide planning. RESULTS After adjusting for age, sex, number of adverse childhood experiences, cumulative trauma burden, depressive symptom severity, and lifetime history of suicide attempt, total scores on the B-SCS (excluding the item mentioning suicide) were uniquely associated with suicidal ideation (odds ratio [OR] = 1.23, 95% confidence interval [CI] = 1.15-1.32) and suicide planning (OR = 1.27, 95%CI = 1.18-1.37). Exploratory post-hoc analyses revealed that difficulties with solving and coping with one's problems were uniquely linked to these outcomes. CONCLUSIONS Assessment of suicide-specific cognitions may help to enhance suicide detection and prevention in veterans, especially in those who may not directly disclose thoughts of suicide. Intervention efforts to bolster perceived deficits in coping and problem-solving may help mitigate suicide risk in this population.
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Blakey SM, Rae Olmsted KL, Hirsch S, Asman K, Wallace D, Olmsted MG, Vandermaas-Peeler R, Karg RS, Walters BB. Differential posttraumatic stress disorder symptom cluster response to stellate ganglion block: secondary analysis of a randomized controlled trial. Transl Psychiatry 2024; 14:223. [PMID: 38811568 PMCID: PMC11137131 DOI: 10.1038/s41398-024-02926-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
Empirically supported treatments for posttraumatic stress disorder (PTSD) exist, but research suggests these therapies are less effective, acceptable, and feasible to deliver to active duty service members (SMs) compared to civilians. Stellate ganglion block (SGB) procedure, in which a local anesthetic is injected around the cervical sympathetic chain or stellate ganglion to temporarily inhibit sympathetic nervous activity, is gaining popularity as an alternative PTSD treatment in military settings. However, it is unknown whether certain PTSD symptoms are more responsive to SGB than others. The current study involved a secondary analysis of data collected from a previous randomized controlled trial of SGB compared to sham (normal saline) injection (N = 113 SMs). PTSD symptoms were assessed via clinical interview and self-report at baseline and 8 weeks post-SGB or sham. Logistic regression analyses showed that the marked alterations in arousal and reactivity PTSD symptom cluster demonstrated the greatest symptom severity reductions after SGB, relative to sham. The reexperiencing cluster also showed pronounced response to SGB in clinician-rated but not self-reported outcomes. Post-hoc item-level analyses suggested that arousal and reactivity cluster findings were driven by reductions in hypervigilance, concentration difficulties, and sleep disturbance, whereas clinician-rated reexperiencing cluster findings were driven by reductions in physiological reactions to trauma cues, emotional reactions to trauma cues, and intrusions. Our findings align with a burgeoning literature positioning SGB as a potential novel or adjunctive PTSD treatment. Results could guide future hypothesis-driven research on mediators of therapeutic change during SGB for PTSD symptoms in SMs.
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Affiliation(s)
| | | | - Shawn Hirsch
- RTI International, Research Triangle Park, NC, USA
| | - Kat Asman
- RTI International, Research Triangle Park, NC, USA
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Bogaers R, Sluik D, Helmhout P, Leijten F. A Workplace Health Promotion Program for a Predominantly Military Population: Associations with General Health, Mental Well-Being and Sustainable Employability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:625. [PMID: 38791839 PMCID: PMC11120656 DOI: 10.3390/ijerph21050625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024]
Abstract
Due to the globally increasing life expectancies, many countries are raising their official retirement age to prevent labor shortages and sustain retirement systems. This trend emphasizes the need for sustainable employability. Unhealthy lifestyles pose a risk to sustainable employability as they contribute to chronic diseases and decreased productivity. Workplace Health Promotion (WHP) programs have gained attention as a strategy to enhance employee health and well-being. The Netherlands Armed Forces, a unique employer with demanding psychological and physical requirements, was used as a case study to investigate the associations of a WHP Program with workers health and sustainable employability. The program offered tailor-made guidance to participants (N = 341) through individual coaching trajectories. The program's impact was evaluated by measuring self-reported health, mental well-being, and sustainable employability over a 6-month period. Results indicated significant improvements across all these dimensions after participation in the program. This study provides valuable insights into the benefits of tailor-made WHP programs. While this was an observational study without a control group, this study supports the importance of incorporating individualized approaches in WHP initiatives to foster positive outcomes in health and sustainable employability.
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Affiliation(s)
- Rebecca Bogaers
- Strategic Military Healthcare Department, Defence Healthcare Organisation, Ministry of Defence, 3584 AB Utrecht, The Netherlands; (D.S.)
| | - Diewertje Sluik
- Strategic Military Healthcare Department, Defence Healthcare Organisation, Ministry of Defence, 3584 AB Utrecht, The Netherlands; (D.S.)
| | - Pieter Helmhout
- Centre of Excellence, Training Medicine and Training Physiology, Royal Netherlands Army, Ministry of Defence, 3584 AB Utrecht, The Netherlands
| | - Fenna Leijten
- Strategic Military Healthcare Department, Defence Healthcare Organisation, Ministry of Defence, 3584 AB Utrecht, The Netherlands; (D.S.)
- Directorate of Strategy and Knowledge, Directorate-General of Policy, Ministry of Defence, 2511 CB The Hague, The Netherlands
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Trompeter N, Rafferty L, Dyball D, McKenzie A, Greenberg N, Fear NT, Stevelink SAM. Gender differences in structural and attitudinal barriers to mental healthcare in UK Armed Forces personnel and veterans with self-reported mental health problems. Soc Psychiatry Psychiatr Epidemiol 2024; 59:827-837. [PMID: 37855900 PMCID: PMC11087310 DOI: 10.1007/s00127-023-02567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Structural and attitudinal barriers often hinder treatment-seeking for mental health problems among members of the Armed Forces. However, little is known about potential gender differences in structural and attitudinal barriers among members of the UK Armed Forces. The current study aimed to explore how men and women differ in terms of these barriers to care among a sample of UK Armed Forces personnel and veterans with self-reported mental health problems. METHODS Currently serving and ex-serving members of the UK Armed Forces who self-reported a mental health problem were invited to participate in a semi-structured phone interview on mental health and treatment-seeking. The final sample included 1448 participants (1229 men and 219 women). All participants reported on their current mental health, public stigma, self-stigma, and barriers to mental healthcare. RESULTS Overall, men and women reported similar levels of both structural and attitudinal barriers, with no significant differences detected. The highest scores for both men and women were observed in attitudinal barriers relating to self-stigma domains, which encapsulate internalised attitudes and beliefs about mental illness and treatment. CONCLUSIONS Findings suggest that anti-stigma campaigns can be targeted simultaneously at both men and women within the Armed Forces. In particular, targeting self-stigma may be beneficial for health promotion campaigns.
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Affiliation(s)
- Nora Trompeter
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK.
| | - Laura Rafferty
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Daniel Dyball
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Amber McKenzie
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Neil Greenberg
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Nicola T Fear
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Sharon A M Stevelink
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, UK
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11
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Williamson C, Croak B, Simms A, Fear NT, Sharp ML, Stevelink SAM. Risk and protective factors for self-harm and suicide behaviours among serving and ex-serving personnel of the UK Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force: A systematic review. PLoS One 2024; 19:e0299239. [PMID: 38669252 PMCID: PMC11051630 DOI: 10.1371/journal.pone.0299239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Self-harm and suicide behaviours are a major public health concern. Several factors are associated with these behaviours among military communities. Identifying these factors may have important implications for policy and clinical services. The aim of this review was to identify the risk and protective factors associated with self-harm and suicide behaviours among serving and ex-serving personnel of the United Kingdom Armed Forces, Canadian Armed Forces, Australian Defence Force and New Zealand Defence Force. METHODS A systematic search of seven online databases (PubMed, Web of Science, Embase, Global Health, PsycINFO, PTSDpubs and CINAHL) was conducted alongside cross-referencing, in October 2022. Following an a priori PROSPERO approved protocol (CRD42022348867), papers were independently screened and assessed for quality. Data were synthesised using a narrative approach. RESULTS Overall, 28 papers were included: 13 from Canada, 10 from the United Kingdom, five from Australia and none from New Zealand. Identified risk factors included being single/ex-relationship, early service leavers, shorter length of service (but not necessarily early service leavers), junior ranks, exposure to deployment-related traumatic events, physical and mental health diagnoses, and experience of childhood adversity. Protective factors included being married/in a relationship, higher educational attainment, employment, senior ranks, and higher levels of perceived social support. CONCLUSION Adequate care and support are a necessity for the military community. Prevention and intervention strategies for self-harm and suicide behaviours may be introduced early and may promote social networks as a key source of support. This review found a paucity of peer-reviewed research within some populations. More peer-reviewed research is needed, particularly among these populations where current work is limited, and regarding modifiable risk and protective factors.
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Affiliation(s)
- Charlotte Williamson
- 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
| | - Amos Simms
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
- British Army, London, United Kingdom
| | - Nicola T. Fear
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
| | - Marie-Louise Sharp
- 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, King’s College London, London, United Kingdom
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Dodge J, Sullivan K, Miech E, Clomax A, Riviere L, Castro C. Exploring the Social Determinants of Mental Health by Race and Ethnicity in Army Wives. J Racial Ethn Health Disparities 2024; 11:669-684. [PMID: 36952121 PMCID: PMC10933139 DOI: 10.1007/s40615-023-01551-3] [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: 07/12/2022] [Revised: 01/26/2023] [Accepted: 02/22/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To explore the social determinants of mental health (SDoMH) by race/ethnicity in a sample with equal access to healthcare. Using an adaptation of the World Health Organization's SDoMH Framework, this secondary analysis examines the socio-economic factors that make up the SDoMH by race/ethnicity. METHOD This paper employed configurational comparative methods (CCMs) to analyze various racial/ethnic subsets from quantitative survey data from (N = 327) active-duty Army wives. Data was collected in 2012 by Walter Reed Army Institute of Research. RESULTS Initial exploratory analysis revealed the highest-scoring factors for each racial/ethnic subgroup: non-Hispanic Black: employment and a history of adverse childhood events (ACEs); Hispanic: living off post and a recent childbirth; junior enlisted non-Hispanic White: high work-family conflict and ACEs; non-Hispanic other race: high work-family conflict and not having a military history. Final analysis showed four models consistently explained clinically significant depression symptoms and four models consistently explained the absence of clinical depression symptoms, providing a solution for each racial/ethnic minority group (non-Hispanic Black, Hispanic, junior enlisted non-Hispanic White, and non-Hispanic other). DISCUSSION These findings highlight that Army wives are not a monolithic group, despite their collective exposure to military-specific stressors. These findings also highlight the potential for applying configurational approaches to gain new insights into mental health outcomes for social science and clinical researchers.
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Affiliation(s)
- Jessica Dodge
- Center for Clinical Management Research, Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Kathrine Sullivan
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Edward Miech
- Regenstrief Institute, Center for Health Services Research, 1101 W 10th Street, Indianapolis, IN, 46202, USA
| | - Adriane Clomax
- Center for Innovation and Research on Veterans and Military Families, Suzanne Dworak-Peck School of Social Work, 669 West 34th Street, Suite 201D, Los Angeles, CA, 90089, USA
| | - Lyndon Riviere
- Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Carl Castro
- Center for Innovation and Research on Veterans and Military Families, Suzanne Dworak-Peck School of Social Work, 669 West 34th Street, Suite 201D, Los Angeles, CA, 90089, USA
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Gomes KD, Collette TL, Schlenk M, Judkins J, Sanchez-Cardona I, Channer B, Ross P, Fredrick G, Moore BA. Posttraumatic Stress Disorder, Suicidal ideation, and Stress: The Moderating Role of Dysfunctional and Recovery Cognitions. Arch Suicide Res 2024; 28:569-584. [PMID: 37073774 DOI: 10.1080/13811118.2023.2199798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Trauma and stressor-related behavioral health conditions are prevalent in military populations and have become a major public health concern in recent years. Individuals who commonly report suicidal ideation often have comorbid mental health diagnoses (i.e., posttraumatic stress disorder; PTSD). However, the mechanisms associated with stress, suicidal ideation, and PTSD are unclear. METHOD The present study examined the moderating role of dysfunctional and recovery cognitions between (i) PTSD and suicidal ideation, and (ii) stress and suicidal ideation in two distinct samples. Sample 1 was composed of civilians and military personnel (N = 322). Sample 2 was composed of (N = 377) student service members and veterans (SSM/Vs). RESULTS In Study 1, we found that low recovery cognitions at higher and moderate levels of PTSD symptoms were significantly associated with increased suicidal ideation. High dysfunctional cognitions were significantly associated with suicidal ideation at higher levels of PTSD symptoms. In Study 2, we found no differences in any level of recovery cognitions at low and moderate stress levels with suicidal ideation. Higher levels of stress were associated with high dysfunctional cognitions and suicidal ideation. CONCLUSION Promoting higher levels of recovery cognitions and reducing dysfunctional cognitions are important in addressing stress, suicidal ideation, and comorbid conditions such as PTSD. Future research should focus on examining the clinical utility of the Dispositional Recovery and Dysfunction Inventory (DRDI) in other populations (i.e., firefighters and paramedics). This could contribute to efforts of suicide prevention and the promotion of the well-being of individuals experiencing suicidal ideation.
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Glassman LH, Otis NP, Kobayashi Elliott KT, Michalewicz-Kragh B, Walter KH. Gender Differences in Psychological Outcomes Following Surf versus Hike Therapy among U.S. Service Members. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:241. [PMID: 38397730 PMCID: PMC10888301 DOI: 10.3390/ijerph21020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Surf and hike therapies have demonstrated effectiveness as adjunct interventions for service members with major depressive disorder (MDD). This study explores gender differences in intervention outcomes following a pragmatic, randomized controlled trial of Surf and Hike Therapy for service members with MDD (N = 96; men, n = 46; women, n = 50). METHODS Clinician-administered and self-report measures (depression, anxiety, positive affect, negative affect, resilience, and pain) were completed at preprogram, postprogram, and 3-month follow-up; brief measures (depression/anxiety and positive affect) were completed before and after each session. RESULTS Multilevel modeling results showed that anxiety decreased from pre- to postprogram and significantly differed by gender (B = -2.26, p = 0.029), with women reporting greater reductions. The remaining outcomes from pre- to postprogram demonstrated significant improvements that did not differ by gender (ps = 0.218-0.733). There were no gender differences through follow-up (ps = 0.119-0.780). However, within sessions, women reported greater improvements in depression/anxiety (B = -0.93, p = 0.005) and positive affect (B = 3.73, p = 0.001). The change in positive affect scores within sessions was greater for women in Hike Therapy compared to men (p = 0.016). CONCLUSIONS Overall, results demonstrate that both genders benefit from adjunctive Surf and Hike Therapies, but women exhibit a better response in terms of longer-term anxiety and immediate psychological outcomes.
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Affiliation(s)
- Lisa H. Glassman
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA 92106, USA; (N.P.O.); (K.H.W.)
- Leidos, Inc., San Diego, CA 92121, USA
| | - Nicholas P. Otis
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA 92106, USA; (N.P.O.); (K.H.W.)
- Leidos, Inc., San Diego, CA 92121, USA
| | | | | | - Kristen H. Walter
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA 92106, USA; (N.P.O.); (K.H.W.)
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15
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Sondhi A, Maguire L, Leidi A, Weston C. Exploring Reasons for Non-Engagement From a Peer-Led Diversionary Intervention for Veterans in Police Custody. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024:306624X231219992. [PMID: 38178544 DOI: 10.1177/0306624x231219992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
UK veterans with complex needs arrested in police custody can access support through pre-charge diversion into treatment and ancillary services. We consider why veterans in police custody disengaged from a peer-led criminal justice diversionary support service in one UK region that adopted a continuous case management approach. Seven hundred and fifty-seven veterans were assessed to have high levels of comorbid health needs and socio-economic harms, with one-quarter (26.7%, n = 202) subsequently disengaging from the service. A logistic regression model using Multivariate Imputation by Chained Equations identified that veterans of a younger age, no-fixed-abode, a history of incarceration, and those from a Royal Navy background were likelier to disengage from the intervention. We conclude that this peer-based diversionary model has some efficacy in maintaining the engagement of a highly complex, comorbid segment of criminally-justice-exposed UK military veterans. The perceived benefits of an integrated peer-based model predicated on continuous case-management techniques are discussed.
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Affiliation(s)
- Arun Sondhi
- Therapeutic Solutions (Addictions), London, UK
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Vidales CA, Smolenski DJ, Skopp NA, Vogel D, Wade N, Sheppard S, Speed K, Hood K, Cartwright P. Assessing the dimensionality and construct validity of the military stigma scale across current service members. MILITARY PSYCHOLOGY 2024; 36:49-57. [PMID: 38193877 PMCID: PMC10790807 DOI: 10.1080/08995605.2021.1997501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
US service members are at elevated risk for distress and suicidal behavior, compared to the general US population. However, despite the availability of evidence-based treatments, only 40% of Service members in need of mental health care seek help. One potential reason for the lower use of services is that service members experience stigma or concerns that the act of seeking mental health care from a mental health provider carries a mark of disgrace. The Military Stigma Scale (MSS) was designed to assess two theoretical dimensions of help-seeking stigma (public and self), specifically among service members. The goal of the current study was to further examine the validity of the MSS among 347 active duty service members. Examination of unidimensional, two-factor, and bifactor models revealed that a bifactor model, with a general (overall stigma), two specific factors (public and self-stigma), and one method factor (accounting for negatively worded items) provided the best fit to the data. Ancillary reliability analyses also supported the MSS measuring a broad stigma factor associated with seeking mental health care in the military. Subsequent model analyses showed that the MSS was associated with other stigma-related constructs. Overall, findings suggest that the MSS is a reliable and validated scale that can be used to assess military help-seeking stigma and to evaluate results of programs designed to reduce stigma.
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Affiliation(s)
| | - Derek J. Smolenski
- Psychological Health Center of Excellence (PHCoE), Silver Spring, Maryland, USA
| | - Nancy A. Skopp
- Psychological Health Center of Excellence (PHCoE), Silver Spring, Maryland, USA
| | - David Vogel
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - Nathaniel Wade
- Department of Psychology, Iowa State University, Ames, Iowa, USA
| | - Sean Sheppard
- Uniformed Services University of the Health Sciences (USUHS), Madigan Army Medical Center, Bethesda, Maryland, USA
| | - Katrina Speed
- Department of Psychology, Mississippi State University (MSU), Tacoma, Washington, USA
| | - Kristina Hood
- Department of Psychology, Mississippi State University (MSU), Tacoma, Washington, USA
| | - Patricia Cartwright
- Department of Psychology, Mississippi State University (MSU), Tacoma, Washington, USA
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17
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Williamson G, Carr E, Fear NT, Dymond S, King K, Simms A, Goodwin L, Murphy D, Leightley D. Digital Therapeutic Intervention for Women in the UK Armed Forces Who Consume Alcohol at a Hazardous or Harmful Level: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e51531. [PMID: 38113103 PMCID: PMC10762616 DOI: 10.2196/51531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Alcohol misuse is common in the United Kingdom Armed Forces (UKAF), with prevalence significantly higher than in the general population. To date, digital health initiatives to support alcohol misuse have focused on male individuals, who represent approximately 89% of the UKAF. However, female veterans drink disproportionally more than female members of the public. OBJECTIVE This 2-arm participant-blinded (single-blinded) confirmatory randomized controlled trial (RCT) aims to assess the efficacy of a brief alcohol intervention (DrinksRation) in reducing weekly self-reported alcohol consumption between baseline and a 3-month follow-up (day 84) among women who have served in the UKAF. METHODS In this 2-arm single-blinded RCT, a smartphone app that includes interactive user-focused features tailored toward the needs of female veterans and designed to enhance participants' motivations to reduce the amount of alcohol they consume is compared with the UK Chief Medical Officer guidance on alcohol consumption. The trial will be conducted among women who have served at least 1 day of paid service in the UKAF. Recruitment, consent, and data collection will be carried out automatically through the DrinksRation app or the BeAlcoholSmart platform. The primary outcome is change in self-reported weekly alcohol consumption between baseline (day 0) and the 3-month follow-up (day 84) measured using the Timeline Follow Back for alcohol consumption. The secondary outcome is the change in the Alcohol Use Disorders Identification Test score measured at baseline and 3-month follow-up between the control and intervention groups. The process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. RESULTS RCT recruitment will begin in January 2024 and last for 5 months. We aim to complete all data collection, including interviews, by May 2024. CONCLUSIONS This study will assess whether a smartphone app tailored to the needs of women who have served in the UKAF is efficacious in reducing self-reported alcohol consumption. If successful, the digital therapeutics platform could be used not only to support women who have served in the UKAF but also for other conditions and disorders. TRIAL REGISTRATION ClinicalTrials.gov NCT05970484; https://www.clinicaltrials.gov/study/NCT05970484. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/51531.
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Affiliation(s)
- Grace Williamson
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Ewan Carr
- Biostatistics & Health Informatics, King's College London, London, United Kingdom
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Academic Department of Military Health, King's College London, London, United Kingdom
| | - Simon Dymond
- School of Psychology, Swansea University, Swansea, United Kingdom
- Department of Psychology, Reykjavík University, Reykjavík, Iceland
| | - Kate King
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Academic Department of Military General Practice, Defence Medical Services, Birmingham, United Kingdom
| | - Amos Simms
- Academic Department of Military Health, King's College London, London, United Kingdom
| | - Laura Goodwin
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Dominic Murphy
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Combat Stress, Leatherhead, United Kingdom
| | - Daniel Leightley
- King's Centre for Military Health Research, King's College London, London, United Kingdom
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ER F, DUYAN V. An Overview of the Stigmatization of Soldiers in the Context of Mental Health from a Social Work Perspective. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1163149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Due to its nature, the army is an environment with a high risk of mental illness. Research shows that mental health stigma is a common and serious barrier to early and effective treatment for mental disorders that result from the stress of military operations. Given the need for timely and effective mental health intervention, it is important to understand the barriers to seeking mental health help in a military context. Although there is stigma related to mental health in the studies and compilations carried out in the civil and military context in the national and international literature, there is no literature on mental health stigmatization in the military context, especially in the national literature. This study is a compilation research created by reviewing the national and international literature. In this article, it is aimed to present some innovative social work interventions in order to address the sources of stigma that hinders access to mental health care and the factors that reinforce them, in a military context, to potentially reduce stigma and to maximize the benefit of mental health care.
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Affiliation(s)
- Filiz ER
- Van İl Sağlık Müdürlüğü, İpek Yolu İlçe Sağlık Müdürlüğü
| | - Veli DUYAN
- ANKARA ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ ENSTİTÜSÜ
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Boulter MK, Holland TJ, Blackadder-Weinstein J, Smith M, King K. Social prescribing in the military: is it time to embrace a change? BMJ Mil Health 2023:e002468. [PMID: 37696653 DOI: 10.1136/military-2023-002468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Matthew K Boulter
- Academic Department of Military General Practice, Research and Clinical Innovation, Defence Medical Services, Birmingham, UK
- Atlantic Medical Group, Penzance, UK
| | - T J Holland
- Academic Department of Military General Practice, Research and Clinical Innovation, Defence Medical Services, Birmingham, UK
| | - J Blackadder-Weinstein
- Academic Department of Military General Practice, Research and Clinical Innovation, Defence Medical Services, Birmingham, UK
| | - M Smith
- Academic Department of Military General Practice, Research and Clinical Innovation, Defence Medical Services, Birmingham, UK
| | - K King
- Academic Department of Military General Practice, Research and Clinical Innovation, Defence Medical Services, Birmingham, UK
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20
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Yamazaki M, Nagamine M, Kitano M, Waki F, Edo N, Koga M, Tachimori H, Toda H. Identifying factors related to stigma toward psychiatric illness and mental health services and attitudes of help-seeking among Japan Ground Self-Defense Force members. J Psychiatr Res 2023; 165:241-247. [PMID: 37523976 DOI: 10.1016/j.jpsychires.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/09/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
The stigma that military personnel feel toward mental illness and mental healthcare hinders their access to mental health services. Stigma is influenced by culture-specifically, that held by military personnel is closely related to military culture. To our knowledge, this is the first large-scale investigation aimed at identifying the factors, including demographic factors and elements of military culture, related to stigma among members of the Japan Ground Self-Defense Force. An anonymous questionnaire was administered to 4754 members. The questionnaire included items regarding demographic factors, history of psychiatric visits, military rank, overseas deployment experience, disaster relief experience, supervisor leadership, unit cohesion, general psychological distress, stigma toward perceived mental illness, and attitudes toward help-seeking. Multiple regression analysis was used to identify the various factors related to stigma. Responses were obtained from 4305 (90.5%) participants, among which 3723 (78.3%) were valid. Multiple regression analyses revealed that a variety of factors including age, psychiatric consultation, leadership, and cohesiveness were markedly associated with stigma and attitudes toward help-seeking. This study revealed that various factors including demographic factors and military culture factors such as supervisor leadership and unit cohesion are related to stigma and attitudes toward mental health services among Japan Ground Self-Defense Force personnel. Further studies are needed to examine the results in depth.
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Affiliation(s)
- Masayuki Yamazaki
- Department of Psychiatry, School of Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Masanori Nagamine
- Department of Behavioral Health, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Masato Kitano
- Department of Behavioral Health, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Fumiko Waki
- Department of Behavioral Health, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Naoki Edo
- Department of Behavioral Health, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Minori Koga
- Department of Psychiatry, School of Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
| | - Hisateru Tachimori
- Endowed Course for Health System Innovation, School of Medicine, Keio University, 35, Shinano-machi, Shinjuku Ward, Tokyo, 160-0016, Japan.
| | - Hiroyuki Toda
- Department of Psychiatry, School of Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan.
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Osgood JM, Yates HK, Holzinger JB, Quartana PJ. Cognitive reappraisal moderates the effect of combat or other exposures on negative behavioral health symptoms. MILITARY PSYCHOLOGY 2023:1-11. [PMID: 37643329 DOI: 10.1080/08995605.2023.2250709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
Understanding the individual differences that can buffer the impact of combat and other adverse exposures on deleterious behavioral health outcomes could lead to more targeted prevention and intervention efforts. Cognitive reappraisal, an antecedent-focused emotion regulation strategy, is linked to positive health outcomes such as lower levels of post-traumatic stress disorder, anxiety, and depression. This study examined the moderating effect of individual differences in cognitive reappraisal use on the association between combat exposure and behavioral health outcomes in active-duty U.S. Soldiers (N = 2,290). This study utilized survey data collected approximately 18 months following a combat deployment to Afghanistan in 2014. Results showed that individual differences in cognitive reappraisal use significantly moderated the effect of combat exposure on anxiety and post-traumatic stress symptoms but not depressive symptoms. Specifically, increasing combat exposures predicted a steeper increase in negative behavioral health symptoms for Soldiers reporting lesser (versus greater) cognitive reappraisal use. These findings highlight a role for cognitive reappraisal as a targetable factor that can mitigate the behavioral health consequences of exposure to combat stressors.
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Affiliation(s)
- Jeffrey M Osgood
- US Army Medical Research Directorate West, Walter Reed Army Institute of Research, Joint Base Lewis McChord, WA, USA
| | - Hunter K Yates
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Jayne B Holzinger
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Phillip J Quartana
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Carreno-Davidson JT, Faller TN, Richardson M, Roy TC. Diagnosed Behavioral Health Disorders, Related Duty Limitations, and Return to Duty Time in the U.S. Army: Population-based Data, from 2017 to 2019. Mil Med 2023; 188:e3167-e3172. [PMID: 37158993 DOI: 10.1093/milmed/usad122] [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: 09/21/2022] [Revised: 01/05/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Less than half of service members with a behavioral health (BH) problem seek care. Soldiers may avoid seeking needed care because of concerns related to being placed on a duty-limiting profile and the related medical disclosures that follow. MATERIALS AND METHODS This study used a retrospective population-based design to identify all new BH diagnoses across the U.S. Army. The relationship between diagnostic category, risk of being issued a duty limitation (profile), and time until return to full duty was also examined. Data were collected from a comprehensive data repository that includes medical and administrative records. Soldiers with a new BH diagnosis were identified from 2017 to 2018. All duty limitation profiles within 12 months of initial diagnosis were identified. RESULTS Records for 614,107 unique service members were reviewed. This cohort was mostly male, enlisted, unmarried, and White. The mean age was 27.13 years (SD = 8.05). Soldiers with a new BH diagnosis accounted for 16.7% (n = 102,440) of the population. The most common diagnostic category was adjustment disorder (55.7%). About a quarter (23.6%) of soldiers with a new diagnosis were issued a related profile. The mean length of these profiles was 98.55 days (SD = 56.91). Of those with a new diagnosis, sex and race failed to have an effect on the odds of being placed on a profile. Overall, enlisted, unmarried, or younger soldiers had greater odds of being placed on a profile. CONCLUSION These data provide relevant information for both the service member who seeks care and command teams seeking readiness projections.
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Affiliation(s)
- Jamie T Carreno-Davidson
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Theresa N Faller
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- The department of mental health, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Melissa Richardson
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Tanja C Roy
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Operational Health Services, Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
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Dunbar MS, Breslau J, Collins R, Beckman R, Engel CC. Heterogeneity in Unmet Treatment Need and Barriers to Accessing Mental Health Services Among U.S. Military Service Members with Serious Psychological Distress. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01289-4. [PMID: 37596460 DOI: 10.1007/s10488-023-01289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/20/2023]
Abstract
The goal of the current study is to examine heterogeneity in mental health treatment utilization, perceived unmet treatment need, and barriers to accessing care among U.S. military members with probable need for treatment. Using data from the 2018 Department of Defense Health Related Behavior Survey, we examined a subsample of 2,336 respondents with serious psychological distress (SPD; past-year K6 score ≥ 13) and defined four mutually exclusive groups based on past-year mental health treatment (treated, untreated) and self-perceived unmet treatment need (recognized, unrecognized). We used chi-square tests and adjusted regression models to compare groups on sociodemographic factors, impairment (K6 score; lost work days), and endorsement of treatment barriers. Approximately 43% of respondents with SPD reported past-year treatment and no unmet need (Needs Met). The remainder (57%) met criteria for unmet need: 18% endorsed treatment and recognized unmet need (Treated/Additional Need); 7% reported no treatment and recognized unmet need (Untreated/Recognized Need); and 32% reported no treatment and no unmet need (Untreated/Unrecognized Need). Compared to other groups, those with Untreated/Unrecognized Need tended to be younger (ages 18-24; p = 0.0002) and never married (p = 0.003). The Treated/Additional Need and Untreated/Recognized Need groups showed similar patterns of treatment barrier endorsement, whereas the Untreated/Unrecognized Need group endorsed nearly all barriers at lower rates. Different strategies may be needed to increase appropriate mental health service use among different subgroups of service members with unmet treatment need, particularly those who may not self-perceive need for treatment.
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Affiliation(s)
- Michael S Dunbar
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213-2665, USA.
| | - Joshua Breslau
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213-2665, USA
| | - Rebecca Collins
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Robin Beckman
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Charles C Engel
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Health Services Research & Development Center for Innovation, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
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Treichler EBH, Reznik SJ, Oakes D, Girard V, Zisman-Ilani Y. Military culture and collaborative decision-making in mental healthcare: cultural, communication and policy considerations. BJPsych Open 2023; 9:e154. [PMID: 37578050 PMCID: PMC10486237 DOI: 10.1192/bjo.2023.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/20/2023] [Accepted: 06/06/2023] [Indexed: 08/15/2023] Open
Abstract
Military culture relies on hierarchy and obedience, which contradict the implementation and use of collaborative care models. In this commentary, a team of lived experience, clinical and research experts discuss, for the first time, cultural, communication and policy considerations for implementing collaborative care models in military mental healthcare settings.
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Affiliation(s)
- Emily B. H. Treichler
- VA San Diego Mental Illness Research, Education and Clinical Center, San Diego, California, USA; and Department of Psychiatry, University of California, San Diego, California, USA
| | - Samantha J. Reznik
- VA San Diego Psychosocial Rehabilitation and Recovery Center, San Diego, California, USA; and Texas Institute for Excellence in Mental Health, University of Texas at Austin, Austin, Texas, USA
| | - David Oakes
- VA San Diego Mental Illness Research, Education and Clinical Center, San Diego, California, USA
| | - Vanessa Girard
- VA San Diego Psychosocial Rehabilitation and Recovery Center, VA San Diego, San Diego, California, USA
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA; and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
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Born J, Frank C. Direct and indirect barriers to hypothetical access to care among Canadian forces health services personnel. RESEARCH IN HEALTH SERVICES & REGIONS 2023; 2:11. [PMID: 39177892 PMCID: PMC11281741 DOI: 10.1007/s43999-023-00026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/13/2023] [Indexed: 08/24/2024]
Abstract
BACKGROUND Though research among Canadian Forces Health Services (CFHS) personnel is limited, the literature suggests formal healthcare is underused. Though much research has been conducted on particular barriers (e.g., stigma), examining a breadth of barriers could better inform behavioral interventions. Furthermore, work has yet to examine the indirect effects of barriers through their impact on intentions to access care. METHODS CFHS participants were randomly assigned to complete either a mental health (N = 503) or physical health (N = 530) version of the survey. The survey included questions on the perceived impact of barriers, health-related information (e.g., past access to care), intention to seek care, and two hypothetical scenarios (i.e., pneumonia and back injury or post-traumatic stress disorder and depression) as a proxy of access to care. Multiple regressions using Hayes PROCESS macro were conducted to assess the direct and indirect effects (through intentions) of the barriers on hypothetical access to care. RESULTS Results show conflict with career goals barriers were indirectly linked to all health outcomes, and directly linked to mental health outcomes. Treatment preference barriers were directly and indirectly linked to care seeking only for mental health, while resource barriers were directly linked to care seeking only for physical health. Knowledge and ability to access care barriers were directly linked to care seeking for depression and pneumonia. IMPLICATIONS Interventions to improve treatment-seeking should be developed only after the behavioural antecedents are understood, and should focus on combining evidence-based techniques to simultaneously target multiple aspects of the behaviour.
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Affiliation(s)
- Jennifer Born
- Department of National Defence and the Canadian Armed Forces, Director General Military Personnel Research and Analysis, Ottawa, Ontario, Canada.
| | - Christine Frank
- Department of National Defence and the Canadian Armed Forces, Director General Military Personnel Research and Analysis, Ottawa, Ontario, Canada
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Pebole MM, Singleton CR, Hall KS, Petruzzello SJ, Alston RJ, Whitworth JW, Gobin RL. Impact of Military Affiliation on Exercise Perceptions Among Survivors of Sexual Violence. Mil Med 2023; 188:e2257-e2265. [PMID: 36653919 DOI: 10.1093/milmed/usac431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/06/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Military service members disproportionately experience sexual violence (SV) and its related health concerns. Although recent work has shown physical activity to be an effective strategy for improving physical and mental health among trauma-exposed military populations, little of this work has focused specifically on military service members with a history of SV. To address these gaps in knowledge and practice, this study identified the most salient perceived benefits/barriers of exercise among men and women survivors of SV with military affiliations. Additionally, these analyses explore willingness to engage in exercise programs, and preferences for the structure/content of these programs, among men and women survivors of SV with military affiliations. MATERIALS AND METHODS An online, cross-sectional survey of women (n = 355) and men (n = 198) survivors of SV was completed using Amazon Mechanical Turk. Inclusion criteria were men and women, age between 18 and 65 years, self-reported history of SV, and located in the United States. Information on sociodemographics and post-traumatic stress disorder symptoms was collected alongside perceived barriers and benefits to exercise, willingness to engage in exercise programs, and preferences for the structure/content of these programs. Analyses were stratified by sex. Comparisons by history of military involvement (active duty military or veteran; no military involvement/civilian) were reported. RESULTS Both military-involved men (n = 68) and women (n = 139) were more likely to prefer at-home and online exercise options when compared to civilians (Ps < .05; Cramer's Vs 0.19-0.36). Additionally, both men and women with military involvement reported strongly favoring exercising with an instructor over no instructor and preferred that this instructor identifies with their same gender (Ps < .01; Cramer's Vs 0.28-0.36). Women with military involvement also preferred shorter program durations and exercising alone or in a group online or in person, whereas men with military involvement were open to longer program durations, when compared to their civilian counterparts (Ps < .05; Cramer's Vs 0.19-0.37). Women and men with military involvement were more likely than their civilian counterparts to perceive that exercise benefits their psychological outlook and social interactions. They were also more likely than civilians to indicate poor exercise environment, high time expenditure, and family discouragement as perceived barriers to exercise (Ps < .05; Cohen's ds 0.21-0.97). Military-involved women were also more likely than civilian women to endorse the perceived barrier of hard physical exercise (P < .05; Cohen's d = 0.25). CONCLUSIONS This study identified perceived benefits and barriers to exercise, along with willingness to engage in exercise programs, and exercise preferences among men and women survivors of SV with military involvement. Targeting these factors in intervention planning will be important for physical activity promotion and program engagement among veterans to reduce the disproportionate impact of SV and disease burden among U.S. service members and veterans.
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Affiliation(s)
- Michelle M Pebole
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61280, USA
| | - Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA
| | - Katherine S Hall
- Department of Medicine, Duke University, Durham, NC 27710, USA
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC 27705, USA
| | - Steven J Petruzzello
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61280, USA
| | - Reginald J Alston
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61280, USA
| | - James W Whitworth
- National Center for PTSD, Behavioral Science Division, Veterans Affairs Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Robyn L Gobin
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61280, USA
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Engelhardt EC, Bicknell G, Oliver M, Flaherty C, Line K, King E. Theory of Planned Behavior and Active Duty Air Force Members' Mental Health Help-Seeking. Mil Med 2023; 188:e2217-e2222. [PMID: 36321880 DOI: 10.1093/milmed/usac326] [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: 08/29/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Although military members often encounter significant atypical stressors while serving, many service members are still reluctant to seek mental health (MH) treatment. Help-seeking behavior for MH needs is a rising concern for active duty Air Force personnel. Conditions such as post-traumatic stress disorder, depression, anxiety, and substance abuse are just a few issues that military members deal with, but things like stigma, attitudes toward MH, and behavioral control might keep these individuals from seeking services. This study utilizes the theory of planned behavior (TPB) to identify better and understand barriers to the help-seeking behavior of active duty Air Force members. MATERIALS AND METHODS The 2017 Air Force Community Feedback Tool was used for this study. This confidential survey was completed by a large sample of the military population (N = 10,705). The survey was used to examine relationships between the TPB-related variables and respondents with mood problems identifying a need for professional counseling, seeking MH services, and reporting that the services met their needs. Multiple linear and binary logistic regression models were utilized to analyze findings from this sample. RESULTS This study highlights how attitudes, subjective norms, and perceived behavioral control impact help-seeking behavior for these individuals. Findings include the MH providers' good reputations, wait times for services, ease of access to care, and negative experiences with supervisor permission, all of which showed a statistically significant impact on help-seeking behavior. Dependent variables included "I need professional counseling," "I contacted a MH care provider in the past year to try to meet this need," and "How much the MH care provider helped you meet your needs." Each of these variables had statistically significant relationships with the connecting variables of the TPB. CONCLUSIONS Findings from this study reveal how attitudes, subjective norms, and perceived behavioral control play an essential role in an active duty Air Force member's decision to seek help for MH concerns. This study suggests that active duty military members are less concerned about the belief that seeking MH care could harm their reputations and more aware of the potential negative reputations of MH clinics. Finally, actionable steps are outlined to better support help-seeking behavior, which might be recommended to better train and encourage military leaders to address the MH needs of themselves and the members of their units.
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Affiliation(s)
- Ethan C Engelhardt
- College of Social Work, University of Kentucky, Lexington, KY 40508, USA
| | - Graeme Bicknell
- University of Kentucky/US Army Master of Social Work Program, Fort Sam Houston, TX 78234, USA
| | - Mark Oliver
- University of Kentucky/US Army Master of Social Work Program, Fort Sam Houston, TX 78234, USA
| | - Chris Flaherty
- College of Social Work, University of Kentucky, Lexington, KY 40508, USA
| | - Katelynn Line
- College of Social Work, University of Kentucky, Lexington, KY 40508, USA
| | - Erika King
- University of Kentucky/US Army Master of Social Work Program, Fort Sam Houston, TX 78234, USA
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Walter KH, Otis NP, Hose MK, Ober KM, Glassman LH. The effectiveness of the National Veterans Summer Sports Clinic for veterans with probable posttraumatic stress disorder. Front Psychol 2023; 14:1207633. [PMID: 37492451 PMCID: PMC10363688 DOI: 10.3389/fpsyg.2023.1207633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/16/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Recreational and adaptive sports programs may be beneficial therapeutic interventions for improving psychological outcomes among veterans and service members with posttraumatic stress disorder (PTSD) because they provide opportunities for exercise, socialization, respite, and time outdoors. Although there are an increasing number of sports programs for veterans and service members with PTSD, data evaluating the outcomes of such programs are limited. Materials and methods The sample included 74 U.S. veterans who participated in the National Veterans Summer Sports Clinic (NVSSC), an annual, week-long adaptive sports program in San Diego, California. Participants were categorized into two subgroups: those who met criteria for probable PTSD using the PTSD Checklist for DSM-5 (n = 20) and those who did not (n = 54). Participants completed self-report assessments before and after each daily activity, before and after the program, and 3 months following program completion. Results Over the course of NVSSC program participation, the diagnostic subgroups (probable PTSD vs. no PTSD) did not significantly differ on changes in depression, positive affect, negative affect, or insomnia. Compared to those without PTSD, veterans with PTSD experienced greater reduction in generalized anxiety during the program (MD = -3.07, p = 0.034). Veterans with PTSD also experienced significant improvements in PTSD symptoms at postprogram (MD = -23.76, p < 0.001). For both groups, significant benefits were shown during the program but rebounded by the 3-month follow-up. Over the course of each daily activity, positive affect (MD = 2.71, p < 0.001) and depression/anxiety scores significantly decreased (MD = -0.75, p < 0.001), with no differences between PTSD diagnostic groups across time (ps = 0.714 and 0.961, respectively). Conclusion Veterans with and without PTSD benefited from participation in the NVSSC. Participants with probable PTSD experienced greater improvements in generalized anxiety at postprogram only; there were no other significant differences between the two groups at postprogram or at 3-month follow-up. In line with prior research, benefits for those with PTSD were lost by 3-month follow-up, suggesting that regular engagement in recreational and adaptive sports may be necessary to sustain psychological health improvements.
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Affiliation(s)
- Kristen H. Walter
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Nicholas P. Otis
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
| | | | | | - Lisa H. Glassman
- Health and Behavioral Sciences, Naval Health Research Center, San Diego, CA, United States
- VA San Diego Healthcare System, San Diego, CA, United States
- Leidos, Inc., San Diego, CA, United States
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Wessely S. What next for student mental health? Ir J Psychol Med 2023:1-3. [PMID: 37246514 DOI: 10.1017/ipm.2023.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
When I became President of the UK Royal College of Psychiatrists, I rashly promised to visit every UK medical school to talk with students about mental health. In this article, I share my impressions after concluding this 'grand tour' and ponder the dangers of creating the false impression that universities are 'toxic' for mental health.
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Affiliation(s)
- Simon Wessely
- King's Centre for Military Health Research, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Royal College of Psychiatrists, London, UK
- Royal Society of Medicine, London, UK
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30
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Halverson TF, Calhoun PS, Elbogen EB, Andover MS, Beckham JC, Pugh MJ, Kimbrel NA. Nonsuicidal self-injury among veterans is associated with psychosocial impairment, suicidal thoughts and behaviors, and underutilization of mental health services. DEATH STUDIES 2023; 48:238-249. [PMID: 37235533 PMCID: PMC10676439 DOI: 10.1080/07481187.2023.2216169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a robust predictor of suicide attempts. However, understanding of NSSI and associated treatment utilization among Veterans is limited. Although impairment may be assumed, few studies examine the association between NSSI and psychosocial functioning, a core component of the rehabilitation framework of mental health. In a national survey of Veterans, current NSSI (n = 88) was associated with higher rates of suicidal thoughts and behaviors and more severe psychosocial impairment after adjusting for demographics and probable diagnoses of posttraumatic stress disorder, major depressive disorder, and alcohol use disorder, compared to Veterans without NSSI (n = 979). Only half of Veterans with NSSI were engaged with mental health services, with few appointments attended, suggesting that these Veterans are not receiving treatment interventions. Results underscore the adverse outcomes associated with NSSI. Underutilization of mental health services highlights the importance of screening for NSSI among Veterans to improve psychosocial outcomes.
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Affiliation(s)
- Tate F Halverson
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Eric B Elbogen
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA National Center on Homelessness Among Veterans, Tampa, Florida, USA
| | | | - Jean C Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Mary Jo Pugh
- VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
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Misca G, Augustus J, Russell J, Walker J. Meaning(s) of transition(s) from military to civilian life at the intersection with mental health: implications for clinical settings. Front Psychol 2023; 14:1142528. [PMID: 37228334 PMCID: PMC10203708 DOI: 10.3389/fpsyg.2023.1142528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/31/2023] [Indexed: 05/27/2023] Open
Abstract
The experiences of military personnel moving into civilian life can be varied for the individual, families and communities. This paper aims to shed light on the various meanings of the multiple and "nested" transitions of military personnel to civilian life in the context of attending a mental health service in the UK. This was achieved through secondary analysis of semi-structured interviews with veterans who were engaging with a mental health service in the UK and a further interview with the mental health service lead. A thematic analysis was employed based on a descriptive phenomenological approach. Results indicate that an appropriate support infrastructure needs to be put in place for veterans prior to, during and after the transition to civilian life. The support appropriateness includes themes specific to connectedness to others, support service accessibility, mental health professionals' military culture awareness and mental health stigma. Although the findings suggest that community services need an awareness of veterans' specific needs, many of the themes are similar to those of the general population. Therefore, the need for an integrated healthcare system is essential in the transition of military service personnel to civilian life. Drawing on international evidence as well as the current findings, implications for policy and practice are highlighted throughout.
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Affiliation(s)
- Gabriela Misca
- School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Jo Augustus
- Institute of Health, University of Cumbria, Cumbria, United Kingdom
| | - Jade Russell
- School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Janet Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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Lane R, Alves-Costa F, Gribble R, Taylor A, Howard LM, Fear NT, MacManus D. Help-seeking for Intimate Partner Violence and Abuse: Experiences of Serving and Ex-serving UK Military Personnel. JOURNAL OF FAMILY VIOLENCE 2023; 39:1-17. [PMID: 37358979 PMCID: PMC10038774 DOI: 10.1007/s10896-023-00534-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 06/28/2023]
Abstract
Purpose Intimate Partner Violence and Abuse (IPVA) is as a major health concern globally. The prevalence of IPVA perpetration and victimisation has been found to be higher in military compared to civilian populations. Of concern, help-seeking for other psychosocial difficulties among military communities has been shown to be both limited and challenging, and military personnel could face additional or amplified barriers to help-seeking for IPVA than their civilian counterparts. This study aimed to use qualitative methods to explore the experiences of, and barriers to, help-seeking for IPVA victimisation and perpetration among UK military personnel. Methods Thematic analysis was conducted on 40 one-to-one semi-structured interviews with military personnel (29 male, 11 female). Results Four superordinate themes were derived, thematically organised according to different levels of the social ecological model: Military cultural factors; Support service factors; Interpersonal factors; and Individual factors. At a military cultural level, participants described difficulties in help-seeking for IPVA resulting from widespread stigma and hypermasculine attitudes in military communities, minimisation of violence, perceived pressure from chain of command, and fear of consequences of reporting. At a support-service level, participants' negative views or experiences and lack of awareness of services were also significant in deterring help-seeking. At an interpersonal level, participants recounted how relationships with military colleagues, their partner and their family could be both instrumental or a hindrance to help-seeking for IPVA. At an individual level, lack of insight into IPVA and different forms of abuse were suggested through minimisation of violence and described to contribute to delay in help-seeking. Shame, compounded by multi-layered stigma present at each social ecological model level, was a key reason for delaying or avoiding help-seeking. Conclusions The findings indicate the added challenges in help-seeking for IPVA experienced by military personnel and highlight a need for a whole systems approach to improve the provision of support for IPVA in the military serving and ex-serving community to instil meaningful change.
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Affiliation(s)
- Rebecca Lane
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AB UK
| | - Filipa Alves-Costa
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AB UK
- Barnet, Enfield & Haringey Mental Health NHS Trust (North London Forensic Service), London, UK
| | - Rachael Gribble
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
| | - Anna Taylor
- Research Department of Clinical, Educational and Health Psychology, University College London, 1–19 Torrington Place, London, WC1E 7HB UK
| | - Louise M. Howard
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Dr Crespigny Park, London, SE5 8AF UK
| | - Nicola T. Fear
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ UK
| | - Deirdre MacManus
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AB UK
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Hansen KT, Plouffe RA, Walker DL, Wanklyn SG, Lamrock L, Maher P, Nazarov A, Richardson JD. Impact of the COVID-19 pandemic on the mental health and well-being of Veterans' spouses: a cross sectional analysis. BMC Psychiatry 2023; 23:188. [PMID: 36949446 PMCID: PMC10032243 DOI: 10.1186/s12888-023-04687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/15/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND COVID-19 has negatively impacted the mental health and well-being of both Canadians and the world as a whole, with Veterans, in particular, showing increased rates of depression, anxiety, and PTSD. Spouses and common-law partners often serve as primary caregivers and sources of support for Veterans, which may have a deleterious effect on mental health and increase risk of burnout. Pandemic related stressors may increase burden and further exacerbate distress; yet the effect of the pandemic on the mental health and well-being of Veterans' spouses is currently unknown. This study explores the self-reported mental health and well-being of a group of spouses of Canadian Armed Forces Veterans and their adoption of new ways to access healthcare remotely (telehealth), using baseline data from an ongoing longitudinal survey. METHODS Between July 2020 and February 2021, 365 spouses of Veterans completed an online survey regarding their general mental health, lifestyle changes, and experiences relating to the COVID-19 pandemic. Also completed were questions relating to their use of and satisfaction with health-care treatment services during the pandemic. RESULTS Reported rates of probable major depressive disorder (MDD), generalized anxiety disorder (GAD), alcohol use disorder (AUD), and PTSD were higher than the general public, with 50-61% believing their symptoms either directly related to or were made worse by the pandemic. Those reporting being exposed to COVID-19 were found to have significantly higher absolute scores on mental health measures than those reporting no exposure. Over 56% reported using telehealth during the pandemic, with over 70% stating they would continue its use post-pandemic. CONCLUSIONS This is the first Canadian study to examine the impact of the COVID-19 pandemic specifically on the mental health and well-being of Veterans' spouses. Subjectively, the pandemic negatively affected the mental health of this group, however, the pre-pandemic rate for mental health issues in this population is unknown. These results have important implications pertaining to future avenues of research and clinical/programme development post-pandemic, particularly relating to the potential need for increased support for spouses of Veterans, both as individuals and in their role as supports for Veterans.
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Affiliation(s)
- Kevin T Hansen
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada.
- Department of Psychiatry, Western University, London, ON, Canada.
| | - Rachel A Plouffe
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
| | - Deanna L Walker
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
| | - Sonya G Wanklyn
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- St. Joseph's OSI Clinic, Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
| | - Laryssa Lamrock
- The Atlas Institute for Veterans and Families, Ottawa, ON, Canada
| | - Polliann Maher
- The Atlas Institute for Veterans and Families, Ottawa, ON, Canada
| | - Anthony Nazarov
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - J Don Richardson
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- St. Joseph's OSI Clinic, Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Luu A, Campbell-Sills L, Sun X, Kessler RC, Ursano RJ, Jain S, Stein MB. Prospective Association of Unmet Mental Health Treatment Needs With Suicidal Behavior Among Combat-Deployed Soldiers. Psychiatr Serv 2023:appips20220248. [PMID: 36872895 DOI: 10.1176/appi.ps.20220248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Military personnel frequently report discontinuing or not pursuing psychiatric treatment despite perceiving a need for services. This study aimed to examine how unmet need for treatment or support among U.S. Army soldiers relates to future suicidal ideation (SI) or suicide attempt (SA). METHODS Mental health treatment need and help seeking in the past 12 months were evaluated for soldiers (N=4,645) who subsequently deployed to Afghanistan. Weighted logistic regression models were used to examine the prospective association of predeployment treatment needs with SI and SA during and after deployment, with adjustment for potential confounders. RESULTS Compared with soldiers without predeployment treatment needs, those who reported not seeking help despite needing it had increased risk for SI during deployment (adjusted OR [AOR]=1.73), past-30-day SI at 2-3 months postdeployment (AOR=2.08), past-30-day SI at 8-9 months postdeployment (AOR=2.01), and SA through 8-9 months postdeployment (AOR=3.65). Soldiers who sought help and stopped treatment without improvement had elevated SI risk at 2-3 months postdeployment (AOR=2.35). Those who sought help and stopped after improving did not have increased SI risk during or 2-3 months after deployment but had elevated risks for SI (AOR=1.71) and SA (AOR=3.43) by 8-9 months postdeployment. Risks for all suicidality outcomes were also elevated among soldiers who reported receiving ongoing treatment before deployment. CONCLUSIONS Unmet or ongoing needs for mental health treatment or support before deployment are associated with increased risk for suicidal behavior during and after deployment. Detecting and addressing treatment needs among soldiers before deployment may help prevent suicidality during deployment and reintegration periods.
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Affiliation(s)
- Andrew Luu
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Laura Campbell-Sills
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Xiaoying Sun
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Ronald C Kessler
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Robert J Ursano
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Sonia Jain
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
| | - Murray B Stein
- Department of Psychiatry (Luu, Campbell-Sills, Stein) and Herbert Wertheim School of Public Health and Human Longevity Science (Sun, Jain, Stein), University of California San Diego, La Jolla; Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Psychiatry, Uniformed Services University, Bethesda (Ursano)
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Pettersen RJ, Debesay J. Substance use and help-seeking barriers: a qualitative study of East African migrants' experiences of access to Norwegian healthcare services. BMC Health Serv Res 2023; 23:107. [PMID: 36726096 PMCID: PMC9891897 DOI: 10.1186/s12913-023-09110-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Migration to Norway has increased rapidly in recent decades. Migrants have a lower prevalence of substance use, but may have an elevated risk of developing mental health issues and substance use problems due to various migration and post-migration factors. Few studies have sought to understand substance use problems among migrants in Norway. This study aimed to explore how people of East African background experience help-seeking for substance use problems in the Norwegian healthcare system. METHODS Using an explorative approach, in-depth individual interviews were conducted with six adult participants from Somalia, Eritrea and Sudan who had been in contact with the Norwegian healthcare system. The goal of the interviews was to facilitate in-depth and nuanced descriptions of the participants' lived experience of help-seeking for substance use problems. The data were analysed using interpretive phenomenological analysis. RESULTS The analysis resulted in five themes in which participants described their help-seeking experiences for substance use problems as lack of knowledge and access to information, scepticism towards a 'white system', fear of exclusion from family and ethnic community, racism as a barrier to help-seeking, and positive experiences and ideas for future treatment practices. CONCLUSION This study provides an improved understanding of how migrants with substance use problems experience help-seeking in healthcare. The variety of barriers illustrates inequality in substance use care for East African migrants in Norway.
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Affiliation(s)
- Ruben Jervell Pettersen
- grid.412414.60000 0000 9151 4445Faculty of Health, Department of Nursing, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, NO-0130 Oslo, Norway
| | - Jonas Debesay
- grid.412414.60000 0000 9151 4445Faculty of Health, Department of Nursing, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, NO-0130 Oslo, Norway
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Novak LA, LaCroix JM, Perera KU, Stivers M, Schvey NA, Goodie JL, Olsen C, Sbrocco T, Goldston DB, Soumoff A, Weaver J, Ghahramanlou-Holloway M. Help-seeking among psychiatrically hospitalized military personnel at risk for suicide. Suicide Life Threat Behav 2023; 53:75-88. [PMID: 36369831 DOI: 10.1111/sltb.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/20/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Promoting help-seeking is a key suicide prevention strategy. Yet, research on help-seeking patterns by high-risk individuals is limited. This study examined help-seeking among United States military Service members admitted for psychiatric inpatient care. METHODS Participants were active duty Service members (N = 111) psychiatrically hospitalized for a suicide-related event. Data were collected as part of a larger randomized controlled trial. Reported types and perceived helpfulness of resources sought 30 days before hospitalization were examined. Hierarchical binary logistic regressions were used to examine associations among types of helping resources, mental health treatment stigma, and perceived social support. RESULTS Approximately 90% of participants sought help prior to hospitalization, most frequently from behavioral health providers and friends. Accessed resources were generally considered helpful. Adjusting for covariates, mental health treatment stigma was not associated with seeking help from any resource type. Higher perceived social support was associated with greater likelihood of help-seeking from a friend (OR = 1.08, p = 0.013 [95% CI = 1.02, 1.14]). Marital status, education level, and organizational barriers were associated with specific types of resources, and/or not seeking help. CONCLUSION Help-seeking is a complex human behavior. Promoting help-seeking among vulnerable subgroups requires further understanding of multiple interconnected factors.
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Affiliation(s)
- Laura A Novak
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jessica M LaCroix
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kanchana U Perera
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Max Stivers
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Natasha A Schvey
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jeffrey L Goodie
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Cara Olsen
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tracy Sbrocco
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alyssa Soumoff
- Directorate for Behavioral Health, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jennifer Weaver
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Vadvilavičius T, Varnagirytė E, Jarašiūnaitė-Fedosejeva G, Gustainienė L. The Effectiveness of Mindfulness-Based Interventions for Police Officers' Stress Reduction: a Systematic Review. JOURNAL OF POLICE AND CRIMINAL PSYCHOLOGY 2023; 38:223-239. [PMID: 36741275 PMCID: PMC9885068 DOI: 10.1007/s11896-022-09570-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 06/18/2023]
Abstract
The profession of a police officer is associated with high levels of stress, which can have harmful consequences for officers' personal lives, the police organisation, and society. This systematic review aims to synthesise recent literature on the effectiveness of mindfulness-based intervention related to stress reduction (MBIs) in a sample of police officers. The search of relevant articles was applied in four databases (SpringerLink, Web of Science, Academic Search Ultimate (EBSCO), and PubMed), using the following inclusion criteria: (1) study involved police officers; (2) study used (quasi)experimental research design; (3) mindfulness-based stress reduction intervention was applied as the main intervention; and (4) study presented pre- and post-intervention measures and quantitative results of stress. The systematic review of eight articles included in the analysis revealed that MBIs were effective in reducing police officers' stress and other stress-related outcomes (sleep problems, post-traumatic stress disorder (PTSD), negative affect, burnout).
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Affiliation(s)
- Tadas Vadvilavičius
- Department of Psychology, Faculty of Social Sciences, Vytautas Magnus University, Jonavos St. 66/328, 44191 Kaunas, Lithuania
| | - Erika Varnagirytė
- Department of Psychology, Faculty of Social Sciences, Vytautas Magnus University, Jonavos St. 66/328, 44191 Kaunas, Lithuania
| | - Gabija Jarašiūnaitė-Fedosejeva
- Department of Psychology, Faculty of Social Sciences, Vytautas Magnus University, Jonavos St. 66/328, 44191 Kaunas, Lithuania
| | - Loreta Gustainienė
- Department of Psychology, Faculty of Social Sciences, Vytautas Magnus University, Jonavos St. 66/328, 44191 Kaunas, Lithuania
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Hitch C, Toner P, Armour C. A Qualitative Systematic Review of Enablers and Barriers to HelpSeeking for Veterans that have Completely Left the Military Within the Context of Mental Health and Alcohol. JOURNAL OF VETERANS STUDIES 2023. [DOI: 10.21061/jvs.v9i1.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Hitch C, Toner P, Armour C. Enablers and barriers to military veterans seeking help for mental health and alcohol difficulties: A systematic review of the quantitative evidence. J Health Serv Res Policy 2023:13558196221149930. [PMID: 36636855 PMCID: PMC10363942 DOI: 10.1177/13558196221149930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Research exploring the enablers and barriers that exist for military veterans seeking to address their poor mental health has produced ambiguous results. To identify the enablers and barriers correctly, this study systematically reviews the literature, including research that included alcohol and had a clearly defined veteran population. METHODS Six databases were searched. Inclusion criteria specified that empirical studies related to veterans that had ceased military service and were seeking help for poor mental health and/or alcohol difficulties. Critical Appraisal Skills Programme and AXIS appraisal tools were used to assess quality and bias. A narrative synthesis approach was adopted for analysis. From 2044 studies screened, 12 were included featuring 5501 participants. RESULTS Forty-four enablers and barriers were identified, with thirty-two being statistically significant. Post-traumatic stress disorder had the greatest number of enabler/barrier endorsements to veterans seeking help. Depression, anxiety, experience and attitudes also acted as enablers/barriers. Most studies were of fair methodological quality. Limitations included that samples were skewed towards US army veterans. Little research exists concerning those that have ceased military service. CONCLUSIONS Veteran help-seeking is likely enabled by poor mental health symptomology and comorbidity, which suggests veterans reach a crisis point before they seek help. Further research on alcohol misuse and attitude formation is required. The field would also benefit from alternative study designs including qualitative studies with non-US participants.
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Affiliation(s)
- Catherine Hitch
- Stress Trauma and Related Conditions (STARC) Research Lab, School of Psychology, 1596Queen's University Belfast, Northern Ireland, UK
| | - Paul Toner
- School of Psychology, 1596Queen's University Belfast, Northern Ireland, UK
| | - Cherie Armour
- Stress Trauma and Related Conditions (STARC) Research Lab, School of Psychology, 1596Queen's University Belfast, Northern Ireland, UK
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Disner SG, Mattson EK, Nelson NW, Armistead-Jehle P. The role of posttraumatic stress symptoms on memory complaints and performance in active-duty service members. Clin Neuropsychol 2023; 37:141-156. [PMID: 34779345 DOI: 10.1080/13854046.2021.1998635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Memory complaints are the most common form of cognitive limitation reported by military service members, but prior research suggests that posttraumatic stress symptoms (PTSS) may account for the link between subjective cognitive complaints and objective cognitive performance. The mechanisms underlying this relationship are largely unknown, including whether the finding applies to memory complaints and performance, which clinical dimensions are involved, and how the association varies when memory complaints are non-credible. METHOD Using a sample of 196 US military service members, the present study aims to address these gaps by modeling the relationship between objective memory performance and plausible/implausible subjective memory complaints, then evaluating how the association is influenced by PTSS and clinical traits commonly found within PTSS (e.g. depression, anxiety, and somatic concerns). RESULTS Overall memory complaints were associated with immediate and delayed recall, but both associations were fully mediated by PTSS (95% CI -0.14, -0.01; 95% CI -0.14, -0.02, respectively). Implausible memory complaints, however, were inconsistently linked to memory performance, and no PTSS mediation was observed. Of the clinical traits, only depression moderated the impact of PTSS, specifically by influencing the link between PTSS and overall memory complaints (β = -0.02, SE = 0.004, p < .001). CONCLUSIONS These results corroborate the importance of assessment for PTSS and depression in service members who report subjective memory complaints and highlight how targeted intervention for these conditions may play a key role in the management of memory complaints.
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Affiliation(s)
- Seth G Disner
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Elsa K Mattson
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
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Senior E, Clarke A, Wilson-Menzfeld G. The military spouse experience of living alongside their serving/veteran partner with a mental health issue: A systematic review and narrative synthesis. PLoS One 2023; 18:e0285714. [PMID: 37200312 DOI: 10.1371/journal.pone.0285714] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/01/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Military healthcare studies have reported a wide range of mental health issues amongst military personnel. Globally, mental health issues are one of the main causes of ill health. Military personnel have a greater prevalence of mental health issues than that of the general population. The impact of mental health issues can be wide and far reaching for family and carers. This systematic narrative review explores the military spouse experience of living alongside their serving or veteran partner with a mental health issue. METHODS The systematic review performed was based on the PRISMA guide for searching, screening, selecting papers for data extraction and evaluation. Studies were identified from CINHAL, ASSIA, Proquest Psychology, Proquest Nursing & Allied Health source, Proquest Dissertations & Theses, ETHOS, PsychArticles, Hospital collection, Medline, Science Direct Freedom Collection and hand searching of citations and reference lists. RESULTS Twenty-seven studies were included in the narrative synthesis. Five overarching themes from the experiences of military spouses' living alongside their serving/veteran partners mental health issue were identified: caregiver burden, intimate relationships, psychological/psychosocial effects on the spouse, mental health service provision and spouse's knowledge and management of symptoms. CONCLUSIONS The systematic review and narrative synthesis identified that the majority of studies focused on spouses of veterans, very few were specific to serving military personnel, but similarities were noted. Findings suggest that care burden and a negative impact on the intimate relationship is evident, therefore highlight a need to support and protect the military spouse and their serving partner. Likewise, there is a need for greater knowledge, access and inclusion of the military spouse, in the care and treatment provision of their serving partner's mental health issue.
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Affiliation(s)
- Emma Senior
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
| | - Amanda Clarke
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
| | - Gemma Wilson-Menzfeld
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
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Remigio-Baker RA, Hungerford LD, Lee-Tauler SY, Bailie JM, Caswell M, Babakhanyan I, Ettenhofer ML. Disparities in mental health symptoms recovery across race/ethnicity and education level following mild traumatic brain injury. DIALOGUES IN HEALTH 2022; 1:100048. [PMID: 38515877 PMCID: PMC10953859 DOI: 10.1016/j.dialog.2022.100048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 03/23/2024]
Abstract
Purpose The purpose of this study was to investigate the relationship between race/ethnicity and post-concussive mental health (i.e., depressive, post-traumatic stress disorder [PTSD]) and neurobehavioral symptoms among service members, and whether this association differed by education level. Methods The study sample consisted of 524 patients from a multidisciplinary US military outpatient treatment facility for post-concussive symptoms. Poisson regression with robust error variance was utilized to investigate outcome (i.e., clinically-elevated depressive [Patient Health Questionnaire-8 ≥15], PTSD [PTSD Checklist, DSM 5 ≥38] and neurobehavioral [Neurobehavioral Symptom Inventory >75th percentile] symptoms at admission and last follow-up in this cohort study. Modification by education level (low [no college degree] vs. high [associate's degree or higher]) was additionally evaluated. Results The relationship between race/ethnicity and mental health/neurobehavioral symptoms varied by education level (p-interaction: depressive symptoms = 0.002, PTSD symptoms = 0.035, neurobehavioral symptoms = 0.040). Specifically, non-Whites were at a significantly higher prevalence for clinically-elevated depressive symptoms post-treatment than Whites, but only among those with higher education level (PR = 2.22, CI = 1.37-3.59). A similar trend was demonstrated for PTSD and neurobehavioral symptoms. Conclusion Military healthcare may need to increase depression-focused treatment options that are acceptable for racial/ethnic minority patients, particularly those with higher education, while they are recovering from comorbid traumatic brain injury.
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Affiliation(s)
- Rosemay A. Remigio-Baker
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
| | - Lars D. Hungerford
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
| | - Su Yeon Lee-Tauler
- Henry M. Jackson Foundation, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M. Bailie
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Melissa Caswell
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Ida Babakhanyan
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Hospital Camp Pendleton, Camp Pendleton, CA, USA
| | - Mark L. Ettenhofer
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
- University of California, San Diego, La Jolla, CA, USA
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Rosing T, Malka M, Brafman D, Fisher PW. A qualitative study of equine-assisted therapy for Israeli military and police veterans with PTSD-impact on self-regulation, bonding and hope. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5074-e5082. [PMID: 35852225 DOI: 10.1111/hsc.13922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/09/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Equine-assisted therapy (EAT) is an increasingly popular form of treatment for people suffering from post-traumatic stress disorder (PTSD) who, for one reason or another, find psychotherapy and other traditional treatment approaches unsuitable or unhelpful. However, the concomitant growth of research in the field is yet to engage with key factors relating to EAT; specifically, there are few studies considering the phenomenological perspective of patients, and the embodied knowledge deriving from the lived experience of PTSD patients who participated in EAT-based intervention programmes. Based on a qualitative-phenomenological study, interviews were conducted with 12 PTSD patients who had completed an EAT-based intervention programme. From these, three main themes characterising the meanings they gave to participation in an EAT-based treatment programme were identified: the ability to relax (self-regulation); establishing a relationship (bonding) and transformation and hope for the future. The findings of this study point to a process whereby participation in an EAT-based treatment programme facilitates the ability to cope with PTSD symptoms in a way that bridges the patient's emotional, social and spiritual-existential dimensions. The findings suggest that EAT can contribute to the healing process of veterans suffering from PTSD.
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Affiliation(s)
- Thom Rosing
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Menny Malka
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Dorit Brafman
- School of Social Work, Ariel University, Hamada, Ariel, Israel
- Therapeutic riding and Canine Institute (ngo), Derech Halord Tel Mond, Tel Mond, Israel
| | - Prudence W Fisher
- Clinical Psychiatric Social Work (in Psychiatry), Columbia University, New York City, New York, USA
- New York State Psychiatric Institute, New York City, New York, USA
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Community-Based Recreational Therapy for Veterans with Behavioral Health Disorders: Impacts on Quality of Life, Participation, and Happiness. Community Ment Health J 2022; 58:1477-1486. [PMID: 35312929 DOI: 10.1007/s10597-022-00962-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 03/10/2022] [Indexed: 01/27/2023]
Abstract
Identifying evidenced-based interventions that improve health outcomes for Veterans with behavioral health disorders is a national priority. Thus, this study examined the outcomes of a community-based recreational therapy (RT) program focused on health promotion for Veterans with behavioral health disorders. Fifty-five Veterans with disabilities completed pretest and posttest questionnaires that assessed Quality of Life (QOL), Participation, and Happiness. Significant improvements were found in Overall QOL, Environmental QOL, Psychological QOL, QOL Rated, Satisfaction with Health, Participation, and Happiness. Younger age and female gender were significantly associated with improved Overall QOL. Factors significantly associated with improved Environmental QOL included younger age and non-Caucasian race. Older age was significantly associated with improved Participation. Female gender was positively associated with improved Happiness, while being divorced/separated was negatively associated with Happiness. These results have important implications for the use and expansion of community-based RT health promotion programs for Veterans with behavioral health disorders.
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Morris PA, Carpenter D, Agbonlahor O, Rodriguez F. Examining mental health stigma in a first-year seminar for student veterans. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:2247-2252. [PMID: 33513068 DOI: 10.1080/07448481.2020.1851231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 09/11/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
Objective: To examine perceptions of mental health stigma among first-year student service members/veterans (SSM/Vs). Participants: 107 SSM/Vs enrolled in a first-semester seminar completed a pre- and post-test measuring five constructs; 1) stigma toward mental health in the military, 2) academic readiness, 3) mental health stigma in college, 4) connection to campus, and 5) resiliency. Methods: Data were analyzed using paired samples t-tests to measure growth on the scales of interest, along with a multiple regression analysis to establish predictors of growth. Results: Stigma-Military and Connection to Campus increased while Stigma-College reduced (p<.05). For the regression analysis, statistically significant predictors of stigma include number of deployments and having served in a combat role (p<.05) Conclusions: Results suggest classroom interventions for SSM/Vs on campus may be related to reduced stigma toward mental health services. This study provides a starting point for expanding research on health and wellness curricular interventions for SSM/V.
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Affiliation(s)
- Phillip A Morris
- Leadership, Research, and Foundations, University of Colorado at Colorado Springs, Colorado Springs, Colorado, USA
| | - Dick Carpenter
- Leadership, Research, and Foundations, University of Colorado at Colorado Springs, Colorado Springs, Colorado, USA
| | - Osasohan Agbonlahor
- Leadership, Research, and Foundations, University of Colorado at Colorado Springs, Colorado Springs, Colorado, USA
| | - Freddie Rodriguez
- Leadership, Research, and Foundations, University of Colorado at Colorado Springs, Colorado Springs, Colorado, USA
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van Beukering IE, Smits SJC, Janssens KME, Bogaers RI, Joosen MCW, Bakker M, van Weeghel J, Brouwers EPM. In What Ways Does Health Related Stigma Affect Sustainable Employment and Well-Being at Work? A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:365-379. [PMID: 34487290 PMCID: PMC9576674 DOI: 10.1007/s10926-021-09998-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 05/26/2023]
Abstract
PURPOSE Studies are increasingly showing that health related stigma is a barrier to employment, but it is not known how. The aim of this systematic review is to identify, appraise and analyse studies that have directly or indirectly addressed ways in which stigma affects sustainable employment and well-being at work of people with disabilities. METHODS Using a multiphase screening process, this review is based on a comprehensive literature search (2000-2019) carried out in six electronic databases: Embase, Web of Science, Medline Ovid, Cochrane CENTRAL, PsycINFO and Google Scholar. RESULTS 7.263 publications were identified; 96 studies were found eligible to be included in the review. 72% of the studies were conducted in North America or Europe. Few studies directly assessed how stigma affects the employment of people with disabilities. Most studies highlighted that attitudes and behaviour of employers formed a barrier to employment, as well as anticipated stigma and self-stigma in people with health problems. However, the findings also showed that the attitudes and behaviour of co-workers, health care professionals, reintegration professionals, customers, and family and friends could act as a barrier to employment although these influences are under-researched. Although many similarities were seen in the relevant findings of studies about both physical and mental disabilities, several nuances were found. CONCLUSION Stigma hampers sustainable employment and well-being in multiple ways. Whereas the number of publications on this topic is rapidly increasing, the roles of health care professionals, reintegration professionals, co-workers, customers, and family and friends particularly warrant more attention.
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Affiliation(s)
- I E van Beukering
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
- Inspectorate SZW, Den Haag, The Netherlands.
- , P.O. Box 90513, 5000 LE, Tilburg, The Netherlands.
| | - S J C Smits
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Summa College, Eindhoven, The Netherlands
| | - K M E Janssens
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - R I Bogaers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Brain Research and Innovation Centre, Ministry of Defense, Den Haag, The Netherlands
| | - M C W Joosen
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - M Bakker
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - J van Weeghel
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Phrenos Center of Expertise, Utrecht, The Netherlands
| | - E P M Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Winslow BD, Kwasinski R, Hullfish J, Ruble M, Lynch A, Rogers T, Nofziger D, Brim W, Woodworth C. Automated stress detection using mobile application and wearable sensors improves symptoms of mental health disorders in military personnel. Front Digit Health 2022; 4:919626. [PMID: 36082233 PMCID: PMC9445306 DOI: 10.3389/fdgth.2022.919626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Leading causes in global health-related burden include stress, depression, anger, fatigue, insomnia, substance abuse, and increased suicidality. While all individuals are at risk, certain career fields such as military service are at an elevated risk. Cognitive behavioral therapy (CBT) is highly effective at treating mental health disorders but suffers from low compliance and high dropout rates in military environments. The current study conducted a randomized controlled trial with military personnel to assess outcomes for an asymptomatic group (n = 10) not receiving mental health treatment, a symptomatic group (n = 10) using a mHealth application capable of monitoring physiological stress via a commercial wearable alerting users to the presence of stress, guiding them through stress reduction techniques, and communicating information to providers, and a symptomatic control group (n = 10) of military personnel undergoing CBT. Fifty percent of symptomatic controls dropped out of CBT early and the group maintained baseline symptoms. In contrast, those who used the mHealth application completed therapy and showed a significant reduction in symptoms of depression, anxiety, stress, and anger. The results from this study demonstrate the feasibility of pairing data-driven mobile applications with CBT in vulnerable populations, leading to an improvement in therapy compliance and a reduction in symptoms compared to CBT treatment alone. Future work is focused on the inclusion of passive sensing modalities and the integration of additional data sources to provide better insights and inform clinical decisions to improve personalized support.
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Affiliation(s)
- Brent D. Winslow
- Design Interactive, Inc., Orlando, FL, United States
- Correspondence: Brent D. Winslow
| | | | | | | | - Adam Lynch
- Design Interactive, Inc., Orlando, FL, United States
| | - Timothy Rogers
- Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Debra Nofziger
- Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - William Brim
- Department of Medical and Clinical Psychology, Center for Deployment Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Craig Woodworth
- Department of Behavioral Health, Brook Army Medical Center, Fort Sam Houston, TX, United States
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Charles-Britton C, Woodyatt L, Bowen-Salter H, Hines S, Lane J. Causal theoretical frameworks that explain veteran mental health help-seeking behavior: a scoping review protocol. JBI Evid Synth 2022; 20:1861-1868. [PMID: 36164717 DOI: 10.11124/jbies-21-00331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This scoping review will determine what causal theoretical frameworks have been used to examine veteran mental health help-seeking behavior. The review will also examine the causal factors proposed by these theoretical frameworks, and whether they account for the complex cultural, social, and affective experiences of veterans, which may drive both uptake or avoidance of mental health help-seeking. INTRODUCTION Some military veterans delay mental health help-seeking, preventing early intervention, creating poor long-term quality of life and functional outcomes, and increasing the likelihood of reaching crisis point before seeking help. There is a distinct lack of research utilizing causal motivational frameworks to explain veteran mental health help-seeking behavior (both engagement and avoidance). To date, no review has been conducted on motivational frameworks used to explain veteran help-seeking behavior. This scoping review will be the first to identify the motivational models that have been used to explain veteran mental health help-seeking, as well as table the proposed causal factors, and determine whether the models account for the cultural, social, and affective experiences of veterans. INCLUSION CRITERIA This scoping review will only consider studies on veteran cohorts. Studies in English that utilize or create an explanatory theory, model, or framework for veteran mental health help-seeking behavior will be included. Literature that focuses solely on intentions rather than behavior will be excluded. METHODS Published and unpublished studies and gray literature will be included. Titles and abstracts will be screened, followed by full-text screening. Factors, theories, models, and frameworks used to explain veteran help-seeking behavior will be extracted, charted, and narratively summarized. The JBI methodology for scoping reviews will be used.
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Affiliation(s)
- Cameron Charles-Britton
- College of Education Psychology and Social Work, Flinders University, Adelaide, SA, Australia.,Military and Emergency Services Health Association (MESHA), Adelaide, SA, Australia
| | - Lydia Woodyatt
- College of Education Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Holly Bowen-Salter
- Military and Emergency Services Health Association (MESHA), Adelaide, SA, Australia
| | - Sonia Hines
- The Centre for Remote Health: A JBI Affiliated Group, Alice Springs, NT, Australia
| | - Jonathan Lane
- School of Medicine, University of Tasmania, Hobart, Tas, Australia
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Screening PLHIV for depression using PHQs: A RCT comparing non-selective with selective screening strategy within a primary health care facility in Uganda. PLoS One 2022; 17:e0270175. [PMID: 35767586 PMCID: PMC9242435 DOI: 10.1371/journal.pone.0270175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Depression is rarely screened for among People Living with Human Immunodeficiency Virus (PLHIV) although it is 2 to 3 times more prevalent among PLHIV than in the general population. In instances where depression is screened for using screening tools, it usually follows noticing depression risk factors. This practice of selectively screening for depression could be leaving some cases of depression unattended to. On the other hand, subjecting every client to screening tools (non-selective screening) offers every patient an opportunity to be managed for depression. However, this could require additional resources as compared to selective screening. We present and discuss results on whether non-selective and selective screening strategies differ in depression case detection, and in addition, we also present perceptions of the stake holders on the two screening strategies. METHODS The study was conducted in Princess Diana Memorial Health Centre IV HIV clinic using a randomized controlled trial with a qualitative component. To determine whether there was a difference in depression case detection, consecutively sampled participants were randomly allocated to either non-selective or selective screening strategy. Participants allocated to selective screening were screened for depression using the patient health questionnaire (s) (PHQs) if they were at "crisis points". While those allocated to non-selective screening were screened regardless of whether the "crisis points" were noticed or not. The PHQ-2 and PHQ-9 were used in sequence. 326 PLHIV participated in the study. Outcomes of the MINI evaluation were analyzed for those with PHQ-9 scores of 10 or more to confirm major depressive disorder (MDD). Data was analyzed using the two sample Z-test for proportions with Stata 2013 software. To explore the perceptions of the stake holders, key informant interviews were performed with six stakeholders that experienced the study. RESULTS Cases of depression (PHQ-9 score ≥ 5) were more likely to be detected by the non-selective screening strategy 30.2% (49/162) compared to the selective screening strategy 19.5% (32/164) (difference in proportions 0.107, 95% confidence interval 0.014-0.200, Cohen's h = 0.25, P = 0.03). The stake holders thought it was important to screen for depression among PLHIV with preference to non-selective screening strategy. CONCLUSION Evidence from this data suggests that more cases of depression (PHQ-9 score ≥ 5) are likely to be detected with non-selective screening as opposed to selective screening. TRIAL REGISTRATION PACTR201802003141213 (name: comparison of routine versus selective screening for depression strategies among PLHIV attending Princess Diana Memorial Health Centre iv Soroti).
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Sulistiyani S, Andriany M, Dewi NS. Psychological Well-being Structure of Indonesian Soldiers: Systematic Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND. Work-related stress can increase maladaptive coping behavior, like smoking behavior, in Indonesian soldiers. Pressure to achieve maximum performance might affect psychological condition of soldiers at work place. Most research results discuss negative psychological well-being, while positive well-being of Indonesian soldiers is still rarely discussed. OBJECTIVE. to elaborate structure of psychological well-being of Indonesian soldiers regarding their coping ability during military duty. METHOD. Research method used in this research is systematic review. Sources of database are retrieved from Google Scholar, Medline, PubMeds, Wiley Library, ScienceDirect, and Emerald with limitation in articles published between 2010 and 2018. Inclusion criteria of scientific articles reviewed are articles about soldiers, who are active-duty and retired, which are written in English and Indonesian. RESULTS. In 11 articles regarding psychological well-being in Indonesian soldiers that can elaborate six structures: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. These six structures of psychological well-being can explain adaptive and maladaptive coping skills in Indonesian soldiers while they do military duty. CONCLUSION. Structure of positive psychological well-being based on evidence in Indonesian soldiers is critically needed during military duty. Improving adaptive coping skill in soldiers might be able to banish negative thoughts in order to maintain their mental health.
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