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Mayhew E, Stuttard L, Beresford B. An Assessment of the Psychometric Properties of the GHQ-12 in an English Population of Autistic Adults Without Learning Difficulties. J Autism Dev Disord 2021; 51:1093-1106. [PMID: 32653976 PMCID: PMC7985123 DOI: 10.1007/s10803-020-04604-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Valid and reliable tools to measure mental health are a key requirement to developing a robust evidence base on mental health difficulties and autism. There are several reasons why mental health measures developed for the neurotypical population may not be valid and reliable when used with autistic adults. Using data collected from a national evaluation of community-based, specialist autism provision in England, this study assessed the psychometric properties of the General Health Questionnaire (GHQ-12) in a population of autistic adults without learning difficulties. We examined the measure’s acceptability, reliability and internal construct validity. The GHQ-12 was found to have good psychometric properties in this population. This provides first evidence that this measure can be used with autistic adults without LD.
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Affiliation(s)
- Emese Mayhew
- Social Policy Research Unit, Alcuin Block B, University of York, Heslington, York, YO10 5DD, UK.
| | - Lucy Stuttard
- Social Policy Research Unit, Alcuin Block B, University of York, Heslington, York, YO10 5DD, UK
| | - Bryony Beresford
- Social Policy Research Unit, Alcuin Block B, University of York, Heslington, York, YO10 5DD, UK
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Richardson A, Gurung G, Samaranayaka A, Gardner D, deGraaf B, Wyeth EH, Derrett S, Shepherd D, McBride D. Risk and protective factors for post-traumatic stress among New Zealand military personnel: A cross sectional study. PLoS One 2020; 15:e0231460. [PMID: 32303054 PMCID: PMC7164978 DOI: 10.1371/journal.pone.0231460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
Background Post-traumatic stress (PTS) is prevalent among military personnel. Knowledge of the risk and protective factors associated with PTS in this population may assist with identifying personnel who would benefit from increased or targeted support. Aims To examine factors associated with PTS among New Zealand military personnel. Methods For this cross-sectional study, currently serving and retired military personnel were invited to complete a questionnaire. The questionnaire included a measure of PTS (the Military Post-traumatic Stress Disorder Checklist; PCL-M), where scores ≥30 indicate the experience of significant PTS symptoms and scores ≥45 indicate a presumptive clinical diagnosis of post-traumatic stress. Potential risk and protective factors associated with PTS were examined using logistic regression modelling. Results 1817 military personnel completed the questionnaire. PCL-M scores were ≥30 for 549 (30%) participants and ≥45 for 179 (10%) participants. Factors associated with higher PCL-M scores were trauma exposure, older age, male sex, and Māori ethnicity. Factors associated with lower PCL-M scores were greater length of service, psychological flexibility, and better quality sleep. Conclusions PTS was found to be prevalent among New Zealand military personnel. The experience of trauma was strongly associated with PTS. However, factors such as psychological flexibility (the ability to adapt to changes in circumstances) and good sleep were protective, suggesting that these factors could be key targets for interventions designed to reduce PTS among military personnel in New Zealand.
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Affiliation(s)
- Amy Richardson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gagan Gurung
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ari Samaranayaka
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Dianne Gardner
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Brandon deGraaf
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Emma H. Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Daniel Shepherd
- Department of Psychology, Auckland University of Technology, Auckland, New Zealand
| | - David McBride
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- * E-mail:
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Taheri Mirghaed M, Abolghasem Gorji H, Panahi S. Prevalence of Psychiatric Disorders in Iran: A Systematic Review and Meta-analysis. Int J Prev Med 2020; 11:21. [PMID: 32175061 PMCID: PMC7050223 DOI: 10.4103/ijpvm.ijpvm_510_18] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/22/2019] [Indexed: 11/17/2022] Open
Abstract
The prevalence of mental disorders in Iran is rising for many reasons including the population growth and its problems, the collapse of the family foundation, the economic problems, etc. Epidemiological studies of psychiatric disorders play an important role in determining the general mental health of the population and policy-making and future planning of service delivery. To identify the relevant studies, two authors independently searched different scholarly databases including Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, Psych INFO, and Iranian databases such as MagIran, SID, IranPsych, and Irandoc from 1st January 2007 up to 1st July 2018. The gray literature (through Google Scholar) was also mined. Studies written in English or in the Persian language were searched. After searching the databases and removing duplicates cases, a total of 10 studies were selected and included in the study, which reported a total of 14 prevalence rates. There were a total of 72,262 participants, of whom 32,925 were male and 39,337 were female. The prevalence of psychiatric disorders in studies which used screening tool was 31.03% (95% confidence interval: 25.99–36.07). The prevalence was 25.42% in studies which used clinical interviews (95% CI: 15.96–34.88). There is an undeniable fact that the prevalence of mental disorders in Iran has been increasing, and this could be a warning to policy-makers and health system managers. Hence, it is necessary to pay attention to this issue to maintain social capital, vitality, and efficiency of individuals and society as a whole.
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Affiliation(s)
- Masood Taheri Mirghaed
- Department of Health Services and Administration, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Abolghasem Gorji
- Department of Health Services and Administration, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Sirous Panahi
- Department of Medical library and Information Science, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Jones N, Sharp ML, Phillips A, Stevelink SAM. Suicidal Ideation, Suicidal Attempts, and Self-Harm in the UK Armed Forces. Suicide Life Threat Behav 2019; 49:1762-1779. [PMID: 31290563 DOI: 10.1111/sltb.12570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/21/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In the UK military, suicide is infrequent and studies of self-harm behavior in this population are rare. OBJECTIVES To compare lifetime self-harm rates estimated on three occasions between 2004 and 2016 and to explore the associates of lifetime self-harm. METHOD Three phases of a UK AF cohort study (n = 10,272, 9,990, and 8,581, respectively) provided data. Telephone interviews assessed associates of self-harm among cohort members who reported subjective mental health problems in the past 3 years (n = 1,448). Validated measures of mental health and related stigmatization, social support, and help-seeking were obtained. RESULTS Lifetime self-harm increased significantly (p < .001) from 1.8% among serving personnel and 3.8% among veterans in 2004/06 to 1.9% and 4.5% in 2007/09 and to 4.2% and 6.6% in 2014/16 in the two groups, respectively. Veterans were consistently significantly more likely to report lifetime self-harm than serving personnel. Significant determinants of lifetime self-harm included current mental disorder symptoms, stigmatization, poor social support, suicidal ideation, and seeking help from formal medical sources. CONCLUSION Self-harm has increased over time in the UK serving and veteran community. Suicide prevention should focus on ameliorating mental disorder by encouraging engagement with health care, reducing negative views of mental illness, and fostering social support.
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Affiliation(s)
- Norman Jones
- Academic Department of Military Mental Health, Floor 3 Weston Education Centre, King's College London, London, UK
| | - Marie-Louise Sharp
- King's Centre for Military Mental Health Research, Weston Education Centre, King's College London, London, UK
| | - Ava Phillips
- Academic Department of Military Mental Health, Floor 3 Weston Education Centre, King's College London, London, UK
| | - Sharon A M Stevelink
- King's Centre for Military Mental Health Research, Weston Education Centre, King's College London, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Khanna P, Chatterjee K, Goyal S, Pisharody RR, Patra P, Sharma N. Psychological stress in the navy and a model for early detection. JOURNAL OF MARINE MEDICAL SOCIETY 2019. [DOI: 10.4103/jmms.jmms_84_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bøg M, Filges T, Jørgensen AMK. Deployment of personnel to military operations: impact on mental health and social functioning. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-127. [PMID: 37131363 PMCID: PMC8427986 DOI: 10.4073/csr.2018.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This Campbell systematic review examines the effects of deployment on mental health. The review summarizes evidence from 185 studies. All studies used observational data to quantify the effect of deployment. This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment). Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. Plain language summary Deployment to military operations negatively affects the mental health functioning of deployed military personnel: While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel.What is this review about?: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health.The primary condition under consideration is deployment to an international military operation. Deployment to a military operation is not a uniform condition; rather, it covers a range of scenarios. Military deployment is defined as performing military service in an operation at a location outside the home country for a limited time period, pursuant to orders.The review included studies that reported outcomes for individuals who had been deployed. This review looked at the effect of deployment on mental health outcomes. The mental health outcomes are: post-traumatic stress disorder (PTSD), major depressive disorder (MDD), common mental disorders (depression, anxiety and somatisation disorders) and substance-related disorders.By identifying the major effects of deployment on mental health and quantifying these effects, the review can inform policy development on deployment and military activity as well as post-deployment support for veterans. In this way the review enables decision-makers to prioritise key areas.What are the main findings of this review?: What studies are included?: This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment).Does deployment have an effect on mental health?: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive.What do the findings of this review mean?: The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long-lasting.Overall the risk of bias in the majority of included studies was high. While it is difficult to imagine a randomised study design to understand how deployment affects mental health, other matters such as changes to personnel policy, or unanticipated shocks to the demand for military personnel, could potentially be a rich source of quasi-experimental variation.How up-to-date is this review?: The review authors searched for studies up to 2017. This Campbell systematic review was published in March 2018. Executive summary BACKGROUND: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health. Research suggests that the increased risk to mental health is mainly due to the hazards of war, combat exposure: firing weapons, road side bombs, seeing fellow soldiers, friends, civilians, and enemies being injured, maimed or killed. These experiences may lead to severe mental stress. The adverse impact on mental health is the psychological cost of war, and it is of interest to policymakers to learn the magnitude of these effects. This review sets out to synthesise available evidence about the consequences of deployment for deployed military personnel in the mental health and social functioning domains.OBJECTIVES: The objective of this review isto synthesise the consequences of deployment to military operation on the mental health and social functioning of deployed military personnel.SEARCH METHODS: We searched electronic databases, grey literature, and references from primary studies and related reviews. No language or date restrictions were applied to the searches. We searched the following electronic databases: Academic Search Elite, Cochrane Library, EMBASE, ERIC, MEDLINE, PsycINFO, Science Citation Index, Social Science Citation Index, SocINDEX, as well as the Nordic platforms: bibliotek.dk, BIBSYS, and LIBRIS. The conclusions of this review are based on the most recent searches performed. The last search was performed in April 2017.SELECTION CRITERIA: Primary studies had to meet the following inclusion criteria: Participants: The participants should be military personnel.Intervention: The condition should be deployment to a military operation.Comparison: The relevant comparisons were either comparing a) deployed military personnel to non-deployed military personnel, b) deployed military personnel to military personnel deployed elsewhere, for example personnel deployed to non-combat operations, c) military personnel deployed to the same operation but stratified by combat exposure.Outcomes: The study should report on one or more mental health outcomes, and/or social functioning for the deployed participants. In particular studies should report on one or more of the following mental health outcomes: PTSD, major depression, substance abuse or dependence (including alcohol), and common mental disorders (depression and anxiety disorders). The following social functioning outcomes were relevant: employment, and homelessness.Study Designs: Both experimental and quasi-experimental designs with a comparison group were eligible for inclusion in the review. Studies were excluded if they: Reported on deployments taking place before 1989.Used a within group pre-post study design.Did not report on at least one of the mental health or social functioning outcomes. DATA COLLECTION AND ANALYSIS: The total number of potentially relevant studies constituted31,049records. A total of 185 studies met the inclusion criteria and were critically appraised by the review authors. The final selection of 185 studies was from 13 different countries.Forty eight of the 185 studies did not report effect estimates or provide data that would allow the calculation of an effect size and standard error. Fifty four studies were excluded because of overlapping samples. The majority of those studies were from USA but the main reason for not using studies from USA in the synthesis was lack of information to calculate an effect size. Nearly half the studies from the UK could not be used in the synthesis due to overlap of data samples. Forty three studies were judged to have a very high risk of bias (5 on the scale) and, in accordance with the protocol, we excluded these from the data synthesis on the basis that they would be more likely to mislead than inform., Thus a total of 40 studies, from five different countries, were included in the data synthesis.Random effects models were used to pool data across the studies. We used the odds ratio. Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were calculated. The meta-analyses were carried out by time since exposure (short, medium, long, and other time since exposure) and by type of comparison (deployed versus non-deployed, all deployed but stratified by either combat operations versus non-combat operations, or stratified by combat exposure). We performed single factor subgroup analysis. The assessment of any difference between subgroups was based on 95% confidence intervals. Funnel plots were used to assess the possibility of publication bias. Sensitivity analysis was used to evaluate whether the pooled effect sizes were robust across components of methodological quality.MAIN RESULTS: The findings were mixed, depending on the outcome, the time since exposure and the approach (deployed versus non-deployed termed absolute or stratified by extent of combat termed relative) used to investigate the effect. It was not possible to analyse the outcomes homelessness and employment. All studies that could be used in the data synthesis reported on the impact of deployment on mental health; PTSD, depression, substance use or common mental disorder.For assessments taken less than 24 months since exposure the evidence was inconclusive either because too few studies reported results in the short and medium term and/or the degree of heterogeneity between studies was large.For assessments taken at other time points (a variable number of months since exposure) the evidence was inconclusive for the relative comparisons due to either too few studies or a substantial degree of heterogeneity between studies. For the absolute comparison the analysis of common mental disorder was inconclusive, whereas the average effects of PTSD and depression were positive and statistically significant (PTSD odds ratio (OR) was 1.91 (95% confidence interval (CI): 1.28 to 2.85) and OR=1.98 (95% CI: 1.05 to 3.70) for depression). The analysis concerning substance use indicated that deployed participants did not have higher odds of screening positive for substance use compared to non-deployed participants (OR=1.15 (95% CI: 0.98 to 1.36)).For assessments taken more than 24 months post exposure, meta-analyses indicated that the odds of screening positive for PTSD, depression, substance use and common mental disorder were higher for participants in the deployed group compared to participants in the group that were not deployed (PTSD OR=3.31 (95% CI: 2.69 to 4.07), OR=2.19 (95% CI: 1.58 to 3.03) for depression, OR=1.27 (95% CI: 1.15 to 1.39) for substance use, and OR=1.64 (95% CI: 1.38 to 1.96) for common mental disorder). Likewise, participants reporting high combat exposure had higher odds of screening positive for PTSD and depression than participants reporting lower exposure for long term assessments (PTSD OR=3.05 (95% CI: 1.94 to 4.80) and OR=1.81 (95% CI: 1.28 to 2.56) for depression). The analyses of substance use and common mental disorder were inconclusive due to too few studies.On the basis of the prevalence of mental health problems in pre-deployed or non-deployed population based comparison sampleswe would therefore expect the long term prevalence of PTSD in post-deployed samples to be in the range 6.1 - 14.9%, the long term prevalence of depression to be in the range from 7.6% to 18%, the long term prevalence of substance use to be in the range from 2.4% to 17.5% and the prevalence of common mental disorder to be in the range from 10% to 23%.Sensitivity analyses resulted in no appreciable change in effect size, suggesting that the results are robust.It was only possible to assess the impact of two types of personnel characteristics (branch of service and duty/enlistment status) on the mental health outcomes. We found no evidence to suggest that the effect of deployment on any outcomes differ between these two types of personnel characteristics.AUTHORS' CONCLUSIONS: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. We focused on the effect of deployment on PTSD (post-traumatic stress disorder), depression, substance abuse/dependence, and common mental disorders (depression and anxiety disorders). For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all domains, particularly on PTSD. There is increased political awareness of the need to address post deployment mental health problems. The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long lasting. Mental illness is of particular concern in the military for operational reasons, but they may be hard to detect in the military setting because a military career is intimately linked with mental and physical strength.It was not possible to examine a number of factors which we had reason to expect would impact on the magnitude of the effect. This would have been particularly relevant from a policy perspective because these are direct parameters that one could use to optimally "organize" deployment in order to minimize impacts on mental health functioning.While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel. The next step is to begin to examine preventive measures and policies for organizing deployment, in order to minimize the effects on mental health.
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Kulason K, Nouchi R, Hoshikawa Y, Noda M, Okada Y, Kawashima R. The Beneficial Effects of Cognitive Training With Simple Calculation and Reading Aloud (SCRA) in the Elderly Postoperative Population: A Pilot Randomized Controlled Trial. Front Aging Neurosci 2018; 10:68. [PMID: 29643802 PMCID: PMC5882834 DOI: 10.3389/fnagi.2018.00068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 02/28/2018] [Indexed: 11/13/2022] Open
Abstract
Background: There has been little research conducted regarding cognitive treatments for the elderly postsurgical population. Patients aged ≥60 years have an increased risk of postoperative cognitive decline, a condition in which cognitive functions are negatively affected. This cognitive decline can lead to a decline in quality of life. In order to maintain a high quality of life, the elderly postsurgical population may benefit from treatment to maintain and/or improve their cognitive functions. This pilot study investigates the effect of simple calculation and reading aloud (SCRA) cognitive training in elderly Japanese postsurgical patients. Methods: Elderly patients undergoing non-cardiovascular thoracic surgery under general anesthesia were recruited (n = 12). Subjects were randomly divided into two groups—one that receives 12 weeks of SCRA intervention, and a waitlisted control group. Before and after the intervention, we measured cognitive function [Mini-Mental Status Exam-Japanese (MMSE-J), Frontal Assessment Battery (FAB), computerized Cogstate Brief Battery (CBB)] and emotional state [General Health Questionnaire-12 (GHQ-12), Geriatric Depression Scale (GDS), Quality of Life Scale-5 (QOL-5)]. Results: Group difference analyses using ANCOVA with permutation test showed that the intervention SCRA group had a significant improvement in FAB motor programming sub-score, GDS, and QOL-5 compared to the control group. Within-group analyses using Wilcoxon signed-rank test to compare baseline and follow-up showed that the SCRA intervention group total FAB scores, FAB motor programming sub-scores, and QOL-5 scores were significantly improved. Discussion: This pilot study showed that there are important implications for the beneficial effects of SCRA intervention on cognitive function and emotional state in the postoperative elderly population; however, further investigations are necessary to reach any conclusions. Trial registration: This study was registered with the University Hospital Medical Information Network (UMIN) Clinical Trial Registry (UMIN000019832).
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Affiliation(s)
- Kay Kulason
- Department of Advanced Brain Science, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.,New York Institute of Technology College of Osteopathic Medicine, New York, NY, United States
| | - Rui Nouchi
- Department of Advanced Brain Science, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.,Creative Interdisciplinary Research Division, Frontier Research Institute for Interdisciplinary Science, Tohoku University, Sendai, Japan.,Human and Social Response Research Division, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Yasushi Hoshikawa
- Department of Thoracic Surgery, Fujita Health University School of Medicine, Toyoake, Japan.,Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Ryuta Kawashima
- Department of Advanced Brain Science, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.,Division of Developmental Cognitive Neuroscience, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
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Gould M, Sharpley J, Greenberg N. Patient characteristics and clinical activities at a British military department of community mental health. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.107.016337] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo describe patient characteristics and clinical activities at a British military department of community mental health (DCMH). Data were drawn from a clinical database over a 1-year period (n=409).ResultsMean age was 29 years, 50% were single and 76% were from the junior ranks. Women were over-represented compared with the wider military population. Mean length of service prior to presentation was 5 years. The main presenting problem was alcohol misuse (33%) followed by depression (19%). Twenty-five per cent were referred for psychotherapy and 68% returned to full employment after treatment.Clinical ImplicationsPatient characteristics of those treated at a DCMH differ from those in the wider military. An out-patient occupational mental health service returns a substantial number of patients to occupational fitness within the Armed Forces.
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Kulason K, Nouchi R, Hoshikawa Y, Noda M, Okada Y, Kawashima R. Indication of Cognitive Change and Associated Risk Factor after Thoracic Surgery in the Elderly: A Pilot Study. Front Aging Neurosci 2017; 9:396. [PMID: 29259553 PMCID: PMC5723308 DOI: 10.3389/fnagi.2017.00396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/16/2017] [Indexed: 12/02/2022] Open
Abstract
Background: This pilot study investigated the effects of partial pulmonary lobectomy lung surgery on cognitive functions of elderly Japanese patients. It is recognized that elderly patients undergoing surgery have increased risk of Postoperative Cognitive Decline (POCD), a condition in which learning, memory, and processing speed is greatly reduced after surgery. Since elderly patients are more likely to exhibit symptoms of POCD, the incidence is increasing as the population receiving surgery is aging. Methods: Cognitive function was measured for all subjects (n = 12) before and after surgery using three different cognitive tests: Mini-Mental Status Exam-Japanese (MMSE-J), Frontal Assessment Battery (FAB), and a computerized Cogstate Brief Battery (CBB). Changes in these measures indicate changes in cognitive function. In addition, the 12-item General Health Questionnaire (GHQ-12), the Geriatric Depression Scale (GDS), and the 5-item Quality of Life questionnaire (QOL-5) were administered at each time point to measure mental and emotional state. Changes in outcome measures were analyzed via Wilcoxon signed-rank test. Exploratory correlation analysis was conducted using Spearman’s rho. Results: Data show a decline in detection (DET; p = 0.045) and identification (IDN; p = 0.038). Spearman’s correlation coefficient show a significant correlation between postoperative DET scores and postoperative IDN scores (ρ = 0.78, p = 0.005), a significant correlation between change in IDN and baseline GHQ-12 scores (ρ = -0.595, p = 0.027), and a significant correlation between change in one-back (OBK) scores and duration of anesthesia (ρ = -0.72, p = 0.012). Discussion: This was the first report to examine cognitive decline after major thoracic surgery in Japanese patients. Previous studies have evidenced that POCD is a common phenomenon after surgery, and that age is a major risk factor. The CCB measured significant change in two cognitive domains: attention and psycomotor function. This study clarified that decline in cognition is detectable in certain measures after thoracic surgery in the elderly Japanese patient population. Additionally, longer anesthetic exposure may negatively impact attention and working memory, and preoperative mental wellbeing is a possible predictor of POCD. These preliminary results have important implications and support the need for future studies.
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Affiliation(s)
- Kay Kulason
- Department of Advanced Brain Science, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Rui Nouchi
- Department of Advanced Brain Science, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.,Creative Interdisciplinary Research Division, Frontier Research Institute for Interdisciplinary Science, Tohoku University, Sendai, Japan.,Human and Social Response Research Division, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Yasushi Hoshikawa
- Department of Thoracic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan.,Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Ryuta Kawashima
- Department of Advanced Brain Science, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.,Division of Developmental Cognitive Neuroscience, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
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Murphy D, Palmer E, Hill K, Ashwick R, Busuttil W. Living alongside military PTSD: a qualitative study of female partners’ experiences with UK Veterans. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2017. [DOI: 10.3138/jmvfh.4011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Dominic Murphy
- Combat Stress, Leatherhead, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
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Jones GL, Hanley T. The psychological health and well-being experiences of female military veterans: a systematic review of the qualitative literature. J ROY ARMY MED CORPS 2017; 163:311-318. [DOI: 10.1136/jramc-2016-000705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/07/2017] [Accepted: 01/26/2017] [Indexed: 11/04/2022]
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Abstract
The purpose of this article is to illustrate prescient issues relating to current and ex-military communities in the United Kingdom who have featured heavily within the policy arena over the past decade in relation to several key areas of importance. It will be illustrated how this population becomes visible within the public imagination (via military losses), how discourses relating to the harms they experience are structured and articulated within political and policy domains (particularly in relation to mental health) via “state talk” (qua Sim), and what the potential social consequences are for politically rendering an unproblematized populist view of current and ex-military communities (i.e., pending crises). This argument is made with the express intention of reengaging critical recognition of the distancing of the military institution from the physical and psychological vulnerability of those who have participated in war and military environments. This is an argument returned to pertinence from the recent publication of the Chilcot Inquiry into British involvement in the Iraq war.
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Karatza C, Zyga S, Tziaferi S, Prezerakos P. Workplace bullying and general health status among the nursing staff of Greek public hospitals. Ann Gen Psychiatry 2016; 15:7. [PMID: 26949408 PMCID: PMC4778280 DOI: 10.1186/s12991-016-0097-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/25/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The arduous emotional and physical nurses' work, the gradual nursing staff cutbacks and the lack of recognition that nurses feel regarding their skills and overall capabilities are some of the factors that act of bullying between nursing staff and management, between nurses and patients/families or even among nurses themselves. Workplace bullying has physical and psychological effects on worker-victims and, by extension, patients themselves. The purpose of this study was to investigate the relationship between the phenomenon of workplace bullying and general health status among the nursing staff of Greek public hospitals. METHODS A cross-sectional study was conducted on a convenience sample of 841 members of the nursing staff working in five major hospitals of the 1st Regional Health Authority of Attica, located in Athens. The response rate was 84.1 %. The respondents completed the Negative Acts Questionnaire (NAQ) and the General Health Questionnaire (GHQ-12) and also their demographic characteristics. The appropriate permissions were obtained by the Hospitals' Ethics Committees and the questionnaire's authors. Data were collected from March to July 2013. Data analysis was performed with IBM SPSS 21.0 and included t test, χ (2) test and regression analysis. The two-tailed significance level was set ≤0.05. RESULTS 30.2 % of the respondents reported that they had been psychologically harassed in their workplaces during the preceding 6 months. Statistical analysis revealed that relative to other respondents, respondents who had received support from their families and friends enjoyed better health but respondents who perceived their work environments more negatively because of work-related bullying suffered from worse general health. CONCLUSIONS Workplace bullying among nursing staff is a major concern in Greece. Support systems play a crucial role in addressing the negative effects of bullying and they should be taken into account when designing prevention and troubleshooting policies about bullying.
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Affiliation(s)
- Christina Karatza
- Faculty of Nursing, University of Peloponnese, E and S Valioti and Plateon, 23100 Sparta, Greece
| | - Sofia Zyga
- Faculty of Nursing, University of Peloponnese, E and S Valioti and Plateon, 23100 Sparta, Greece
| | - Styliani Tziaferi
- Faculty of Nursing, University of Peloponnese, E and S Valioti and Plateon, 23100 Sparta, Greece
| | - Panagiotis Prezerakos
- Faculty of Nursing, University of Peloponnese, E and S Valioti and Plateon, 23100 Sparta, Greece
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Barak S, Mendoza-Laiz N, Fuentes MTG, Rubiera M, Huyzler Y. Psychosocial effects of competitive Boccia program in persons with severe chronic disability. ACTA ACUST UNITED AC 2016; 53:973-988. [DOI: 10.1682/jrrd.2015.08.0156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 04/14/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Sharon Barak
- The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel; Kaye Academic College of Education, Beer-Sheba, Israel
| | - Nuria Mendoza-Laiz
- Facultad de Ciencias del Deporte, Universidad de Castilla La Mancha-Toledo, Spain
| | | | - Maria Rubiera
- CRE de Discapacidad y Dependencia, IMSERSO, León, Spain
| | - Yeshayahu Huyzler
- Zinman College of Physical Education and Sport Sciences and Israel Sport Center for the Disabled, Israel
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Post-traumatic stress disorder and alcohol misuse: comorbidity in UK military personnel. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1171-80. [PMID: 26864534 PMCID: PMC4977328 DOI: 10.1007/s00127-016-1177-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 01/17/2016] [Indexed: 11/11/2022]
Abstract
AIMS To determine the prevalence of comorbid probable post-traumatic stress disorder and alcohol misuse in a UK military cohort study and to determine the level of co-occurrence between these disorders; further aims were to investigate the association between alcohol misuse and the different PTSD symptom clusters, and to assess what factors are associated with probable PTSD in participants with alcohol misuse. METHODS Data from 9984 participants of Phase 2 of the health and well-being survey of serving and ex-serving members of the UK Armed Forces were assessed for probable PTSD and alcohol misuse using the PTSD checklist (PCL-C) and the alcohol use disorders identification test (AUDIT), respectively. RESULTS 1.8 % [95 % confidence interval (CI) 1.5-2.1] of the sample met the criteria for both PTSD and alcohol misuse. All three symptom clusters of PTSD were significantly associated with alcohol misuse, with similar odds ranging from 2.46 to 2.85. Factors associated with probable PTSD in individuals reporting alcohol misuse were age [ages 30-34 (years): OR 2.51, 95 % CI 1.15-5.49; ages 40-44 years: OR 2.77, 95 % CI 1.18-6.47], officer rank (OR 0.36, 95 % CI 0.16-0.85), being in a combat role in parent unit (OR 1.99, 95 % CI 1.20-3.31) and common mental disorder (CMD) (OR 21.56, 95 % CI 12.00-38.74). CONCLUSIONS This study provides strong evidence that PTSD and alcohol misuse are often co-occurring. CMD was highly associated with probable PTSD in individuals with alcohol misuse.
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Okeke BO. Social support seeking and self-efficacy-building strategies in enhancing the emotional well-being of informal HIV/AIDS caregivers in Ibadan, Oyo state, Nigeria. SAHARA J 2016; 13:35-40. [PMID: 26831832 PMCID: PMC5642436 DOI: 10.1080/17290376.2015.1126794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study examined the relative efficacy of social support seeking (SSS) and self-efficacy building (SEB) in the management of emotional well-being of caregivers of people suffering from HIV/AIDS. It was based at the United States President's Emergency Plan for AIDS Relief (PEPFAR) center in the University College Hospital, Ibadan, Oyo state, being the first and the largest teaching hospital in Nigeria. A 3 × 2 factorial design consisting of treatment and a control group was used. The columns have two levels of gender being male and female caregivers. One-hundred and sixty-five (165) caregivers who were taking care of people that are suffering from HIV/AIDS were purposively selected and randomly assigned to the treatment groups and control. The treatment was carried out for a period of eight weeks. Two null hypotheses were tested, both at .05 levels of significance. Data were collected with the use of standardized intruments rating scale; social support scale, general self-efficacy scale and emotional well-being scale. ANCOVA was used to establish significant treatment effects with the pretest as covariate. Even though SSS and SEB were both found to be effective in enhancing the emotional well-being of informal caregivers in this study when compared to the controls, SSS was significantly more effective than SEB in achieving this goal. Since the HIV/AIDS patients cannot be adequately cared for in the hospital settings due to severe shortages of material, personnel and time, serious efforts should be made by the three levels of the health care system viz: the primary, secondary and tertiary health care systems, to encourage the employment of the psychological management of caregivers of people suffering from HIV/AIDS. Also, the psychologists, clinical psychologists and the significant others should be encouraged to employ this psychological management in the care of HIV/AIDS informal caregivers.
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Affiliation(s)
- Bernedette Okwuchukwu Okeke
- Ph.D clinical Psychology (Guidance and Counselling), Fontanna International School, 6B Adenuga Street, Kongi, New Bodija, Ibadan, Oyo State, Nigeria
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17
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Xue C, Ge Y, Tang B, Liu Y, Kang P, Wang M, Zhang L. A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PLoS One 2015; 10:e0120270. [PMID: 25793582 PMCID: PMC4368749 DOI: 10.1371/journal.pone.0120270] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/03/2015] [Indexed: 11/18/2022] Open
Abstract
Post-traumatic stress disorder (PTSD), a complex and chronic disorder caused by exposure to a traumatic event, is a common psychological result of current military operations. It causes substantial distress and interferes with personal and social functioning. Consequently, identifying the risk factors that make military personnel and veterans more likely to experience PTSD is of academic, clinical, and social importance. Four electronic databases (PubMed, Embase, Web of Science, and PsycINFO) were used to search for observational studies (cross-sectional, retrospective, and cohort studies) about PTSD after deployment to combat areas. The literature search, study selection, and data extraction were conducted by two of the authors independently. Thirty-two articles were included in this study. Summary estimates were obtained using random-effects models. Subgroup analyses, sensitivity analyses, and publication bias tests were performed. The prevalence of combat-related PTSD ranged from 1.09% to 34.84%. A total of 18 significant predictors of PTSD among military personnel and veterans were found. Risk factors stemming from before the trauma include female gender, ethnic minority status, low education, non-officer ranks, army service, combat specialization, high numbers of deployments, longer cumulative length of deployments, more adverse life events, prior trauma exposure, and prior psychological problems. Various aspects of the trauma period also constituted risk factors. These include increased combat exposure, discharging a weapon, witnessing someone being wounded or killed, severe trauma, and deployment-related stressors. Lastly, lack of post-deployment support during the post-trauma period also increased the risk of PTSD. The current analysis provides evidence of risk factors for combat-related PTSD in military personnel and veterans. More research is needed to determine how these variables interact and how to best protect against susceptibility to PTSD.
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Affiliation(s)
- Chen Xue
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
| | - Yang Ge
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
| | - Bihan Tang
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
| | - Yuan Liu
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
| | - Peng Kang
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
| | - Meng Wang
- Faculty of Health Service, Second Military Medical University, Shanghai, China
| | - Lulu Zhang
- Institute of Military Health Management, Second Military Medical University, Shanghai, China
- * E-mail:
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Klanecky AK, Cadigan JM, Martens MP, Rogers RE. Examining Spouse/Partner Presence as a Moderator in the Relationship between Mental Health Symptoms and Alcohol Use in OEF/OIF Veterans. MILITARY PSYCHOLOGY 2014; 26:366-375. [PMID: 25530669 DOI: 10.1037/mil0000048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Veterans from the conflicts in Afghanistan (Operation Enduring Freedom; OEF) and Iraq (Operation Iraqi Freedom; OIF) have reported elevated rates of alcohol consumption, and greater depression and posttraumatic stress disorder (PTSD) symptoms are associated with increased alcohol use. Presence of a spouse/partner, which has been associated with reduced drinking, may buffer the relationship between mental health symptoms and alcohol consumption. To examine this hypothesis, the current study utilized baseline survey data from OEF/OIF veterans (N=325) enrolled in a brief alcohol intervention. Spouse/partner presence moderated the relationship between depression symptoms and alcohol consumption such that depression was positively associated with drinking for veterans without a spouse/partner. Exploratory analyses indicated that the relationship between depression and alcohol use may be particularly salient for veterans without a spouse/partner and a lower number of deployments. Spouse/partner presence did not moderate the relationship between PTSD symptoms and alcohol consumption. Implications of the findings are discussed.
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Affiliation(s)
- Alicia K Klanecky
- Psychology Department, 2500 California Plaza, Creighton University, Omaha, NE, 68178, USA
| | - Jennifer M Cadigan
- Department of Educational, School, and Counseling Psychology, 16 Hill Hall, University of Missouri-Columbia, Columbia, MO, 65211, USA
| | - Matthew P Martens
- Department of Educational, School, and Counseling Psychology, 16 Hill Hall, University of Missouri-Columbia, Columbia, MO, 65211, USA
| | - Randall E Rogers
- Harry S. Truman Memorial Veterans' Hospital, 800 Hospital Drive, Columbia, MO, 65201, USA
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Chou HW, Tzeng WC, Chou YC, Yeh HW, Chang HA, Kao YC, Tzeng NS. Psychological morbidity, quality of life, and self-rated health in the military personnel. Neuropsychiatr Dis Treat 2014; 10:329-38. [PMID: 24570587 PMCID: PMC3933722 DOI: 10.2147/ndt.s57531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The mental health of military personnel varies as a result of different cultural, political, and administrative factors. The purpose of this study was to evaluate the psychological morbidity and quality of life of military personnel in Taiwan. MATERIALS AND METHODS This cross-sectional study utilized the World Health Organization Quality of Life Instrument, brief version, Taiwan version, the General Health Questionnaire-12, Chinese version, and the Visual Analog Scale (VAS) in several military units. RESULTS More than half of the subjects (55.3%) identified themselves as mentally unhealthy on the General Health Questionnaire-12, Chinese version; however, a higher percentage of officers perceived themselves as healthy (57.4%) than did noncommissioned officers (38.5%) or enlisted men (42.2%). Officers also had higher total quality of life (QOL) scores (83.98) than did enlisted men (79.67). Scores on the VAS also varied: officers: 72.5; noncommissioned officers: 67.7; and enlisted men: 66.3. The VAS and QOL were positively correlated with perceived mental health among these military personnel. CONCLUSION Our subjects had higher rates of perceiving themselves as mentally unhealthy compared to the general population. Those of higher rank perceived themselves as having better mental health and QOL. Improving mental health could result in a better QOL in the military. The VAS may be a useful tool for the rapid screening of self-reported mental health, which may be suitable in cases of stressful missions, such as in disaster rescue; however, more studies are needed to determine the optimal cut-off point of this measurement tool.
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Affiliation(s)
- Han-Wei Chou
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine ; Department of Psychiatry, Tri-Service General Hospital, Beitou Branch, National Defense Medical Center, Taipei, Taiwan; ; Department of Psychiatry, Tao-Yuan General Hospital, Tao-Yuan, Taiwan
| | - Wen-Chii Tzeng
- Department of Nursing, Tri-Service General Hospital, School of Nursing ; Student Counseling Center
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Hui-Wen Yeh
- Department of Nursing, Tri-Service General Hospital, School of Nursing ; Department of Nursing, School of Nursing, Kang-Ning Health Care and Management College, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine ; Student Counseling Center
| | - Yu-Cheng Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine ; Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine ; Student Counseling Center
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Hunt EJF, Wessely S, Jones N, Rona RJ, Greenberg N. The mental health of the UK Armed Forces: where facts meet fiction. Eur J Psychotraumatol 2014; 5:23617. [PMID: 25206948 PMCID: PMC4138705 DOI: 10.3402/ejpt.v5.23617] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 04/05/2014] [Accepted: 05/21/2014] [Indexed: 11/14/2022] Open
Abstract
A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals.
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Affiliation(s)
- Elizabeth J F Hunt
- Academic Centre for Defence Mental Health (ACDMH), King's College London, Western Education Centre, London, UK
| | - Simon Wessely
- King's Centre for Military Health Research (KCMHR), King's College London, Western Education Centre, London, UK
| | - Norman Jones
- Academic Centre for Defence Mental Health (ACDMH), King's College London, Western Education Centre, London, UK
| | - Roberto J Rona
- King's Centre for Military Health Research (KCMHR), King's College London, Western Education Centre, London, UK
| | - Neil Greenberg
- Academic Centre for Defence Mental Health (ACDMH), King's College London, Western Education Centre, London, UK
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Are reports of psychological stress higher in occupational studies? A systematic review across occupational and population based studies. PLoS One 2013; 8:e78693. [PMID: 24223840 PMCID: PMC3817075 DOI: 10.1371/journal.pone.0078693] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 09/16/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The general health questionnaire (GHQ) is commonly used to assess symptoms of common mental disorder (CMD). Prevalence estimates for CMD caseness from UK population studies are thought to be in the range of 14-17%, and the UK occupational studies of which we are aware indicate a higher prevalence. This review will synthesise the existing research using the GHQ from both population and occupational studies and will compare the weighted prevalence estimates between them. METHODS We conducted a systematic review and meta-analysis to examine the prevalence of CMD, as assessed by the GHQ, in all UK occupational and population studies conducted from 1990 onwards. RESULTS The search revealed 65 occupational papers which met the search criteria and 15 relevant papers for UK population studies. The weighted prevalence estimate for CMD across all occupational studies which used the same version and cut-off for the GHQ was 29.6% (95% confidence intervals (CIs) 27.3-31.9%) and for comparable population studies was significantly lower at 19.1% (95% CIs 17.3-20.8%). This difference was reduced after restricting the studies by response rate and sampling method (23.9% (95% CIs 20.5%-27.4%) vs. 19.2% (95 CIs 17.1%-21.3%)). CONCLUSIONS Counter intuitively, the prevalence of CMD is higher in occupational studies, compared to population studies (which include individuals not in employment), although this difference narrowed after accounting for measures of study quality, including response rate and sampling method. This finding is inconsistent with the healthy worker effect, which would presume lower levels of psychological symptoms in individuals in employment. One explanation is that the GHQ is sensitive to contextual factors, and it seems possible that symptoms of CMD are over reported when participants know that they have been recruited to a study on the basis that they belong to a specific occupational group, as in nearly all "stress" surveys.
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Martins LCX, Kuhn L. Prevalência de transtornos mentais comuns em jovens brasileiros recém-incorporados ao Serviço Militar Obrigatório e fatores associados. CIENCIA & SAUDE COLETIVA 2013. [DOI: 10.1590/s1413-81232013000600031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A saúde mental de militares das Forças Armadas é uma área de investigação ainda pouco explorada no Brasil. O presente estudo teve por objetivo estimar a prevalência de transtornos mentais comuns (TMC) e identificar os fatores a estes associados em jovens brasileiros recém-incorporados ao serviço militar obrigatório: os recrutas. A população de estudo foi composta de 78 jovens adultos do sexo masculino. A ocorrência de TMC (variável dependente) foi avaliada por meio do General Health Questionnaire, versão 12 itens (GHQ-12). Para estimar as associações entre TMC e as variáveis independentes foram utilizados o teste χ²(Qui-quadrado)e a regressão logística. Os resultados mostraram uma prevalência de TMC de 43,6% (IC 95% 33,14 - 54,64). As razões de prevalência de TMC mostraram-se entre 4 e 5 vezes maiores entre os que apresentavam distúrbios do sono, sendo que estes se mostraram como único fator associado a TMC. Estes resultados parecem indicar que as situações vivenciadas pelos recrutas em seu ambiente de trabalho podem estar associadas com TMC de forma causal. Outros estudos, com desenho longitudinal, são necessários para que tal efeito seja confirmado.
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Verma R, Mina S, Deshpande SN. An analysis of paramilitary referrals to psychiatric services at a tertiary care center. Ind Psychiatry J 2013; 22:54-9. [PMID: 24459375 PMCID: PMC3895314 DOI: 10.4103/0972-6748.123622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is a dearth of specialized mental health services for Indian paramilitary service personnel. Those requiring psychiatric evaluation are referred to government psychiatric services often with minimal information. Hence, major diagnostic and decision making relies on the psychiatrist's clinical evaluation and judgment. The aim of the present study was to quantitatively evaluate the paramilitary referrals to psychiatric services at a tertiary care referral center. MATERIALS AND METHODS A retrospective chart analysis of all consecutive referrals by various Indian paramilitary services to a tertiary care hospital (2008-2010) was carried out. RESULTS Among the sample of 18 referrals, all were males (mean age: 37 years ± standard deviation (SD) =7.79). Various reasons for referral included: Evaluation of fitness for duty (83.3%), fitness to handle firearms (16.7%), and for disability certification (5.6%). There were no informants at all in 22.2%, and family members were available in only 11.1%. Hence, most referrals were admitted to the psychiatry ward for observation for various lengths of time. The mean duration of assessment (outpatient and inpatient) was 17.89 days (SD = 20.74) and final reported diagnoses were schizophrenia, depression, and bipolar disorder in 16.7, 11.1, and 11.1%, respectively. There was concurrent history of alcohol and nicotine dependence (40%). A large group (40%) was diagnosed not to suffer from a major mental illness, while a firm and final diagnosis could not be arrived at in 16.7% subjects. Only one subject was given the fitness to handle firearms, fitness for duty was refused in three (16.7%) subjects, and one subject was referred to neurology after being diagnosed as a case of seizure disorder. CONCLUSION There is an urgent need for intensive training both to paramilitary physicians as well as to general hospital psychiatrists regarding proper assessment of paramilitary personnel, as there are frequent chances of the cases being undiagnosed or improperly diagnosed.
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Affiliation(s)
- Rohit Verma
- Department of Psychiatry, Lady Hardinge Medical College and Smt. S. K. Hospital, New Delhi, India
| | - Shaily Mina
- Department of Psychiatry, Lady Hardinge Medical College and Smt. S. K. Hospital, New Delhi, India
| | - Smita N. Deshpande
- Departments of Psychiatry, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Lee EAD. Complex contribution of combat-related post-traumatic stress disorder to veteran suicide: facing an increasing challenge. Perspect Psychiatr Care 2012; 48:108-15. [PMID: 22458724 DOI: 10.1111/j.1744-6163.2011.00312.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this case study is to present the complex contribution of combat-related post-traumatic stress disorder (PTSD) to suicide and international standards of treatment among veterans deployed to the Middle East. CONCLUSIONS PTSD carries increased physical and psychological health risk in combat soldiers. Internationally, guidelines for PTSD promote cognitive behavior therapies, specifically exposure therapy, as first line treatment; however, implementation varies among countries. PRACTICE IMPLICATIONS Evidence supports the benefit of exposure-based psychotherapy for combat-related PTSD. Commonly prescribed antidepressants and other psychotherapy treatments may not be as beneficial.
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Affiliation(s)
- Elizabeth A D Lee
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
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Martins LCX, Lopes CS. Military hierarchy, job stress and mental health in peacetime. Occup Med (Lond) 2012; 62:182-7. [PMID: 22402895 DOI: 10.1093/occmed/kqs006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Most studies of mental health in the armed forces focus primarily on post-traumatic stress disorders among military personnel in combat situations. AIMS To evaluate the prevalence of common mental disorders (CMD) and job stress, and the association between the two, among military personnel in peacetime. Additionally, it sought to identify occupational subgroups with higher prevalences of CMD. METHODS The study participants were 506 military personnel from a Brazilian army directorate in Rio de Janeiro City. CMD were evaluated using the 12-item version General Health Questionnaire. Job characteristics were measured using the effort-reward imbalance (ERI) model and by categories of military rank. Prevalence ratios (PRs) were estimated by Poisson regression to obtain robust (95%) confidence intervals (CIs). RESULTS The prevalence of CMD was 33% (95% CI 29-37). After adjusting for age, education, income, lifestyle and other occupational characteristics, ERI was associated with CMD (PR = 2.03; 95% CI 1.3-3.1). Overcommitment proved to be an important component of job stress. Independently of socio-economic, demographic, lifestyle and job stress variables, the rank of lieutenant associated strongly with CMD (PR = 2.02; 95% CI 1.2-4 0.1). CONCLUSIONS This study found that job stress among armed forces personnel is associated with CMD. In addition, the specific occupational characteristics of the military environment can lead to a higher prevalence of CMD among those holding the rank of lieutenant.
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Affiliation(s)
- L C X Martins
- Department of Epidemiology, Institute of Social Medicine, State University of Rio de Janeiro (IMS/UERJ), Rua São Francisco Xavier 524, Rio de Janeiro, RJ 20550-900, Brazil.
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Mota NP, Medved M, Wang J, Asmundson GJG, Whitney D, Sareen J. Stress and mental disorders in female military personnel: comparisons between the sexes in a male dominated profession. J Psychiatr Res 2012; 46:159-67. [PMID: 22024487 DOI: 10.1016/j.jpsychires.2011.09.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 09/09/2011] [Accepted: 09/29/2011] [Indexed: 12/19/2022]
Abstract
The proportion of women in militaries is growing; however, many studies in the area of military mental health have been conducted with majority male samples. The present study examined sex differences in trauma exposure, work stress, and mental disorders in the Canadian Community Health Survey - Canadian Forces Supplement, a representative sample of 5155 regular force personnel and 3286 reservists ages 16-54. Past-year DSM-IV mental disorders (depression, generalized anxiety disorder, panic disorder, social phobia, PTSD, and alcohol dependence), lifetime exposure to 28 traumatic events, and work stress were assessed. Regular and reserve female personnel were less likely than males to experience deployment-related traumas, accidents, and several events involving violence (adjusted odds ratio [AOR] range 0.10-0.62). Women were more likely to endorse sexual trauma, partner abuse, and being stalked (AOR range 3.60-13.63). For work stress, regular force women reported higher levels of job demand and stress around social support than men, whereas regular and reserve force women reported less physical exertion. After adjusting for a range of covariates, regular female personnel were more likely than males to have PTSD (AOR 1.88, 99% CI 1.01-3.50), while reservist women were more likely than men to have depression, panic disorder, and any mood or anxiety disorder (AOR range 1.87-6.98). Both regular and reservist women had lower rates of alcohol dependence (AOR range 0.30-0.34). Clinicians working with female personnel should screen for trauma/stressors and mental disorders that are particularly common in this population.
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Affiliation(s)
- Natalie P Mota
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
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Occupational Stress in Naval Personnel. Med J Armed Forces India 2011; 63:154-6. [PMID: 27407974 DOI: 10.1016/s0377-1237(07)80062-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 12/06/2006] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Increased stress levels have been reported and it has been implicated for mental illness amongst service personnel. However no study has been reported among Indian naval sailors. METHODS Occupational stress and life satisfaction was measured in 413 naval personnel serving afloat and ashore. RESULT Naval personnel serving on board submarine and ship had lower levels of occupational stress as compared to those serving on shore establishments. Occupational stress scores were higher among junior sailors (36.7%) as compared to officers and senior sailors (20%). Life satisfaction scores were lower in junior sailors. Greater occupational stress was linked to lower life satisfaction. CONCLUSION The findings of high occupational stress in junior sailors needs to be investigated further with a larger sample.
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Greenberg N, Langston V, Iversen AC, Wessely S. The acceptability of 'Trauma Risk Management' within the UK Armed Forces. Occup Med (Lond) 2011; 61:184-9. [PMID: 21467245 DOI: 10.1093/occmed/kqr022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Trauma-support programmes may benefit employees of organizations that routinely expose their staff to traumatic events. However, in order for such programmes to be effective, staff need to find them acceptable. AIMS To investigate whether Trauma Risk Management (TRiM), an example of such a programme, is acceptable within a military population and whether it is viewed as complementing or replacing pre-existing personnel support systems. METHODS Semi-structured interviews were undertaken with serving Royal Navy personnel who had served on one of six ships, which had received TRiM training some 12-18 months previously. Three hundred and thirty interview transcripts were subjected to qualitative analysis and themed categories were generated. RESULTS The majority of personnel who were aware of TRiM were supportive of its aims. TRiM was also viewed as supplementing other personnel support measures rather than replacing them. Personnel interviewed thought that TRiM practitioners needed to be carefully selected, supported by line management and to pay particular attention to the issue of confidentiality. CONCLUSIONS The TRiM system appeared generally acceptable to military personnel and is seen to supplement rather than replace existing mechanisms. However, these data support careful selection of potential TRiM practitioners and demonstrate the need for senior management support for the system if it is to be accepted by those who might benefit from its use.
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Affiliation(s)
- N Greenberg
- Academic Centre for Defence Mental Health, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
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Abstract
The aim of the present study was to provide a critical review of prevalence estimates of combat-related post-traumatic stress disorder (PTSD) among military personnel and veterans, and of the relevant factors that may account for the variability of estimates within and across cohorts, including methodological and conceptual factors accounting for differences in prevalence rates across nations, conflicts/wars, and studies. MEDLINE and PsycINFO databases were examined for literature on combat-related PTSD. The following terms were used independently and in combinations in this search: PTSD, combat, veterans, military, epidemiology, prevalence. The point prevalence of combat-related PTSD in US military veterans since the Vietnam War ranged from approximately 2% to 17%. Studies of recent conflicts suggest that combat-related PTSD afflicts between 4% and 17% of US Iraq War veterans, but only 3-6% of returning UK Iraq War veterans. Thus, the prevalence range is narrower and tends to have a lower ceiling among combat veterans of non-US Western nations. Variability in prevalence is likely due to differences in sampling strategies; measurement strategies; inclusion and measurement of the DSM-IV clinically significant impairment criterion; timing and latency of assessment and potential for recall bias; and combat experiences. Prevalence rates are also likely affected by issues related to PTSD course, chronicity, and comorbidity; symptom overlap with other psychiatric disorders; and sociopolitical and cultural factors that may vary over time and by nation. The disorder represents a significant and costly illness to veterans, their families, and society as a whole. Further carefully conceptualized research, however, is needed to advance our understanding of disorder prevalence, as well as associated information on course, phenomenology, protective factors, treatment, and economic costs.
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Affiliation(s)
| | - B. Christopher Frueh
- The Menninger Clinic and Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Ronald Acierno
- Veterans Affairs Medical Center and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Henderson A, Langston V, Greenberg N. Alcohol misuse in the Royal Navy. Occup Med (Lond) 2009; 59:25-31. [DOI: 10.1093/occmed/kqn152] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Greenberg N, Wessely S. Gulf War syndrome: an emerging threat or a piece of history? EMERGING HEALTH THREATS JOURNAL 2008; 1:e10. [PMID: 22460210 PMCID: PMC3167584 DOI: 10.3134/ehtj.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 06/18/2008] [Accepted: 07/15/2008] [Indexed: 11/18/2022]
Abstract
‘Gulf War syndrome’ is a phrase coined after the 1991 Gulf War to group together disparate, unexplained health symptoms in Gulf veterans. This paper examines the many hypotheses that have been put forward about the origins of the concept and gives an overview of the studies that have attempted to explain the lasting health effects associated with Gulf service. Our review finds that although in the UK there has not yet been evidence of a new Gulf War syndrome as a result of the current conflicts in Iraq and Afghanistan, there is a rise in post-conflict psychiatric disorders now being reported in the USA. We postulate that after conflicts military personnel will always face some form of post-conflict syndrome and the nature of the threats experienced is likely to dictate the form the syndrome might take. We also postulate that media reporting is likely to have influenced and to continue unhelpfully to influence the health of service personnel.
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Affiliation(s)
- N Greenberg
- King's College London, Department of Academic Psychological Medicine, Academic Centre for Defence Mental Health, London, UK
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Wilson J, Jones M, Hull L, Hotopf M, Wessely S, Rona RJ. Does prior psychological health influence recall of military experiences? a prospective study. J Trauma Stress 2008; 21:385-93. [PMID: 18720395 DOI: 10.1002/jts.20352] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In a prospective study, we evaluated pre- and postdeployment psychological health on recall of risk factors to assess recall bias. Measures of the General Health Questionnaire (GHQ), PTSD Checklist (PCL), and symptom clusters from the PCL were obtained from 681 UK military personnel along with information on traumatic and protective risk factors. Postdeployment psychological health was more important in explaining recall of traumatic experiences than predeployment psychological health. Predeployment intrusive cluster scores were highly associated with traumatic exposures. Postdeployment, but not predeployment GHQ showed small effects for most risk factors. With the exception of intrusive thoughts, there is insufficient evidence to suggest predeployment psychological status would be useful in correcting for recall bias in subsequent cross-sectional studies.
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Affiliation(s)
- Jennifer Wilson
- Department of Psychological Medicine, King's Centre for Military Health Research, King's College, London, UK
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Greenberg N, Iversen A, Hull L, Bland D, Wessely S. Getting a peace of the action: measures of post traumatic stress in UK military peacekeepers. J R Soc Med 2008; 101:78-84. [PMID: 18299627 DOI: 10.1258/jrsm.2007.070024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aimed to measure prevalence of post traumatic stress disorder (PTSD) in a sample of UK Armed Forces peacekeepers. The study also aimed to explore the influence of deploying without an established peer group (deployment status) upon health outcomes using an accepted diagnostic tool for PTSD (PCL-M) and an alternative measure of post-traumatic distress. DESIGN Using a sub-sample of the King's military cohort we surveyed personnel that deployed on peacekeeping operations between 1991 and 2000 (n=1198). SETTING Respondents' mean age was 36 years (min, 23 to max, 60) and 81% (n=964) were serving in the Armed Forces at the time of participation. MAIN OUTCOME MEASURES PTSD prevalence was determined in British military peacekeepers using the PLC-M (cut-offs 44 and 50), the General Health Questionnaire (GHQ-12) and a composite brief measure of potential post traumatic symptomology, 'PostTraumatic Stress Reaction' (PTSR) for comparison. RESULTS PTSD prevalence varied from 3.6 to 5.5%. Officers and married personnel were less likely to be cases. Neither gender, age or deployment status influenced PTSD prevalence. CONCLUSIONS PTSD was an uncommon disorder in this sample of British military peacekeepers, with prevalence rates being lower than those reported by other nations. Deploying without an established peer group was not associated with developing PTSD. We postulate that differences in culture and operational practices may account for the lower rates of PTSD.
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Affiliation(s)
- Neil Greenberg
- Academic Centre for Defence Mental Health , King's College London, Weston Education Centre, London, SE5 9RJ, UK.
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Whelan P, Meerten M, Rao R, Jarrett P, Muthukumaraswamy A, Bhugra D. Stress, lies and red tape: the views, success rates and stress levels of the MTAS cohort. J R Soc Med 2008; 101:313-8. [PMID: 18515779 DOI: 10.1258/jrsm.2008.070449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To track the success rates in obtaining a specialist training (ST) post of a cohort of medical training application system (MTAS) applicants, as well as canvassing their views of the process and measuring symptoms of psychological distress during application and after job allocation. DESIGN A follow-up cross-sectional survey. Setting Two large south London psychiatry training schemes. Participants 101 MTAS applicants. MAIN OUTCOME MEASURES Success in obtaining an ST post, respondents' views about MTAS and General Health Questionnaire-12 (GHQ-12) scores. RESULTS 48 Of the original sample responded to the follow-up survey. Data were available about post-MTAS job status for a further 41 trainees. 64% of candidates obtained an ST post. Of those, however, 12% were only offered a fixed-term post. Most unsuccessful candidates were doing locum (34%) or non-training grade (21%) jobs. UK/European Economic Area (EEA) doctors were more successful than non-EEA applicants in obtaining an ST post (odds ratio 5.5, 95% confidence interval 2.1-14.3), as were women candidates compared to men (3.7, 0.5-9.3). The respondents' views about MTAS were globally negative (even if they were successful in obtaining an ST post). The median GHQ-12 score for respondents was 7 out of a potential total score of 12. 79% of the sample scored above the threshold (GHQ-12 > or =4) for psychological distress and 21% experienced significant distress (GHQ-12 > or =8). CONCLUSIONS MTAS was a flawed system. A considerable proportion (36%) of candidates who had been on a Senior House Officer training scheme were left without a training post after MTAS. The system seems to favour UK/EEA applicants. Applicants suffered significant psychological distress during and after the MTAS process.
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Hankins M. The factor structure of the twelve item General Health Questionnaire (GHQ-12): the result of negative phrasing? Clin Pract Epidemiol Ment Health 2008; 4:10. [PMID: 18435842 PMCID: PMC2373289 DOI: 10.1186/1745-0179-4-10] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 04/24/2008] [Indexed: 11/12/2022]
Abstract
BACKGROUND The 12-item General Health Questionnaire (GHQ-12) is used routinely as a unidimensional measure of psychological morbidity. Many factor-analytic studies have reported that the GHQ-12 has two or three dimensions, threatening its validity. It is possible that these 'dimensions' are the result of the wording of the GHQ-12, namely its division into positively phrased (PP) and negatively phrased (NP) statements about mood states. Such 'method effects' introduce response bias which should be taken into account when deriving and interpreting factors. METHODS GHQ-12 data were obtained from the 2004 cohort of the Health Survey for England (N = 3705). Following exploratory factor analysis (EFA), the goodness of fit indices of one, two and three factor models were compared with those of a unidimensional model specifying response bias on the NP items, using structural equation modelling (SEM). The hypotheses were (1) the variance of the responses would be significantly higher for NP items than for PP items because of response bias, and (2) that the modelling of response bias would provide the best fit for the data. RESULTS Consistent with previous reports, EFA suggested a two-factor solution dividing the items into NP and PP items. The variance of responses to the NP items was substantially and significantly higher than for the PP items. The model incorporating response bias was the best fit for the data on all indices (RMSEA = 0.068, 90%CL = 0.064, 0.073). Analysis of the frequency of responses suggests that the response bias derives from the ambiguity of the response options for the absence of negative mood states. CONCLUSION The data are consistent with the GHQ-12 being a unidimensional scale with a substantial degree of response bias for the negatively phrased items. Studies that report the GHQ-12 as multidimensional without taking this response bias into account risk interpreting the artefactual factor structure as denoting 'real' constructs, committing the methodological error of reification. Although the GHQ-12 seems unidimensional as intended, the presence of such a large response bias should be taken into account in the analysis of GHQ-12 data.
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Affiliation(s)
- Matthew Hankins
- King's College London, Department of Psychology (at Guy's), Institute of Psychiatry, London, UK.
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Greenberg N, Wessely S. Gulf War syndrome: an emerging threat or a piece of history? EMERGING HEALTH THREATS JOURNAL 2008. [DOI: 10.3402/ehtj.v1i0.7071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- N Greenberg
- King’s College London, Department of Academic Psychological Medicine, Academic Centre for Defence Mental Health, London, UK
| | - S Wessely
- King’s College London, Department of Academic Psychological Medicine, Academic Centre for Defence Mental Health, London, UK
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