Stress-induced somatization in spouses of deployed and nondeployed servicemen

Association of self-reported psychiatric and systemic risk factors in dry eye disease in adult Korean population

PURPOSE

To evaluate the association between dry eye disease (DED) and various psychiatric and systemic diseases in an adult Korean population aged 40 years or older.

METHODS

Population-based cross-sectional data of 6,732 participants aged ≥40 years was extracted from the Korea National Health and Nutrition Examination Survey 2017-2018 (KNHANES VII). Data including DED, demographic variables, behavioral factors, psychiatric conditions, and systemic diseases was analysed to determine the prevalence and psychiatric and systemic risk factors for DED.

RESULTS

The weighted prevalence of DED was 7.9 ± 0.4% (mean ± SE). Multivariate analysis showed that female sex and urban residence were associated with an increased risk of DED. The prevalence of DED was lower in patients aged ≥70 years than in those aged 40-69 years. Self-reported psychological conditions including perceived stress and depression were associated with the risk of DED. Self-reported Systemic conditions, such as rheumatoid arthritis, degenerative arthritis, osteoporosis, ischemic heart disease, and chronic renal failure had association with an increased risk of DED.

CONCLUSION

DED may be associated with several self-reported psychiatric and systemic conditions, which highlights the need for an integrated approach to manage these diseases for optimal treatment of DED.

Perceived racial discrimination, psychosomatic symptoms, and resilience among Black individuals in Canada: A moderated mediation model

OBJECTIVE

Although no study has explored psychosomatic symptoms in Black communities in Canada, several studies in the United States showed that psychological distress is often express as physical pain among African Americans. Using a cross-sectional design, the present study documents the frequency of psychosomatic symptoms and its association to racial discrimination, and resilience among Black individuals aged 15 to 40 in Canada.

METHOD

A total of 860 participants (M_age = 25.0 years, SD = 6.3), predominantly born in Canada (79.1%) and women (75.6%), completed the Symptom Checklist-90-Revised (somatization subscale), the Everyday Discrimination Scale, and the Resilience Scale-14.

RESULTS

Findings revealed that 81.7% of participants experienced psychosomatic symptoms, with higher prevalence among women (84.2%) compared to men (70.7%;), ꭓ² = 21.5, p < .001; participants aged 25 to 40 years old (93.7%) compared to those aged 15-24 years old (75.2%) (ꭓ² = 45.0, p < .001). Participants reporting greater racial discrimination had more psychosomatic symptoms (89.4%) compared to others (72.9%), ꭓ² = 39.2, p < .001). A moderated mediation model showed that everyday racial discrimination was positively associated with psychosomatic symptoms (B = 0.1, SE = 0.01, p < .001). The model showed that the association between racial discrimination and psychosomatic symptoms was partially mediated by resilience (B = -0.01, SE = 0.0, p < .01), and negatively moderated by gender (B = -0.04, SE = 0.01, p < .01). In other words, being a woman is associated with higher levels of psychosomatic symptoms among those who have experienced racial discrimination.

CONCLUSION

By highlighting the association between racial discrimination and psychosomatic symptoms and the role of resilience and gender in this relation, this article reveals important factors to integrate to improve healthcare services, prevention, and interventions among Black individuals with psychosomatic symptoms.

The effect of war injury and combat deployment on military wives' mental health symptoms

BACKGROUND

Although much has been learned about the physical and psychological impacts of deployment and combat injury on military service members, less is known about the effects of these experiences on military spouses.

METHODS

The present study examined self-reported mental health symptoms (using the Brief Symptom Inventory [BSI]-18 and the posttraumatic stress disorder [PTSD] Checklist [PCL-C]) in wives of service members who were combat-injured (CI; n = 60); noninjured with cumulative deployment longer than 11 months (NI-High; n = 51); and noninjured with cumulativel deployment less than 11 months (NI-Low; n = 53).

RESULTS

36.7% and 11.7% of CI wives endorsed above threshold symptoms on the PCL-C and overall BSI-18, respectively. Multivariate linear regressions revealed that being a CI wife was associated with higher PCL-C, overall BSI-18, and BSI-18 anxiety subscale scores compared to NI-Low wives in models adjusted for individual and family characteristics, as well as prior trauma and childhood adversities. Compared with the NI-High group, the CI group was associated with higher overall BSI-18 scores.

CONCLUSIONS

While CI wives evidenced fewer mental symptoms than expected, these findings suggest a negative impact of service member's combat injury on wives' mental health above that attributable to deployment, highlighting the need for trauma-informed interventions designed to support the needs of military wives affected by combat injury.

Perceived quality of life among oral health therapy and dental students: A cross-cultural comparison

OBJECTIVES

This cross-sectional study examined the perceived quality of life (QOL) of Oral Health Therapy (OHT) students and compared the domain differences between Dental students, gender, and year-of-study.

METHODS

OHT students from a local polytechnic were invited to participate (IRB no. (SHS-2019-001). Perceived QOL was assessed with the multidimensional World Health Organization QOL (WHOQOL)-BREF instrument. Demographic information and WHOQOL-BREF responses were collected electronically. Raw scores were converted to transformed scores and related to data of Dental students from other countries. Statistical analyses were performed with a T-test, one-way ANOVA/posthoc Tukey's test, and Pearson's correlation (p < 0.05).

RESULTS

Of the total cohort of 66 students, 65 consented to participation (98.5% response rate). The study sample (mean age 19.2 ± 2.9 years) comprised of 83.1% females (54/65). Mean domain scores were as follows: Physical health - 54.90 ± 9.78; psychological - 50.98 ± 17.36; social relationships - 60.69 ± 16.47; and environment - 66.80 ± 13.66. The psychological domain was rated the lowest as with most other studies on Dental students. Mean scores for the overall perception of QOL and "satisfaction with health" (SWH) were 3.46 ± 0.83 and 3.35 ± 0.89 respectively. No significant difference in the domain and overall QOL/SWH scores were observed between genders. Psychological and environmental domains scores were significantly different between the first and third-year students (p ≤ 0.02). Correlations coefficients between the QOL domains ranged from r_s  = 0.18-0.66.

CONCLUSION

Aside from the USA and Saudi Arabia, the perceived QOL of Asian OHT students was generally comparable to those of Dental students from other countries. Overall perceived QOL and satisfaction with health were moderately favourable.

Stress and emotional distress: their associations with somatic and temporomandibular disorder-related symptoms

Although Asians are posited to be predisposed to somatization, studies on the inter-relationships between emotional and physical symptoms in Asian youths are still limited. This study determined the associations between emotional, somatic, and Temporomandibular Disorder (TMD)-related symptoms in Asian youths. Youths were recruited from a local polytechnic and the prevalence/severity of emotional distress was ascertained with the Depression, Anxiety, and Stress Scale-21. Somatic and TMD-related symptoms were appraised with the Patient Health Questionnaire-15 and Fonseca Anamnestic Index. Data were analysed using non-parametric statistical and logistic regression analysis (p < 0.05). The study sample (n = 400; 209 females) had a mean age of 18.7 ± 1.7 years. Moderate-to-severe depression, anxiety, and stress were present in 31.0%, 36.8%, and 16.5% of the subjects respectively. Subjects with moderate-to-severe emotional distress had significantly higher somatic and TMD symptom scores (p < 0.001). Correlations between emotional and somatic/TMD symptom scores were moderately strong (r_s = 0.46-0.61). Stepwise logistic regression indicated that moderate-to-severe somatization was associated with the female gender, anxiety, and stress, and moderate-to-severe TMDs were related to somatization and stress. Asian youths with elevated emotional distress experienced significantly higher levels of somatic and TMD-related symptoms. The stress construct appears to pose a greater risk for somatization and TMDs than depression and anxiety.

Association between Dry Eye Disease and Psychological Stress among Paramedical Workers in Korea

This study was performed to evaluate the prevalence and risk factors of dry eye disease (DED) among paramedical workers at a university hospital in Korea. This cross-sectional study included 566 paramedical workers at a university hospital in Korea. Dry eye symptoms were assessed using a 9-item questionnaire, and DED was defined as having 1 or more dry eye symptoms often or all the time. A survey including demographic data and potential risk factors of DED was also performed. Psychological stress was measured using stress VAS and perceived stress scale 4 (PSS-4) questionnaires. Of the 566 paramedical workers, 232 (35 male and 197 female) completed the survey. Prevalence of DED was 42.7% (99/232). Univariate analysis revealed that female sex (P < 0.001), prolonged computer use (P = 0.003) and higher stress VAS (P < 0.001) and PSS-4 (P = 0.009) scores had significant association with DED. In multivariate analysis, DED had significant association with female sex (P = 0.003) and stress VAS (P = 0.013) after adjustment for sex, duration of computer use and stress VAS, and had significant association with female sex (P = 0.003) and durations of computer use (P = 0.029) after adjustment for sex, duration of computer use and PSS-4 score. In conclusion, DED was prevalent among paramedical workers in Korea. Its risk increased among females and workers with increased psychological stress. Prolonged use of computer was possibly associated with DED.

Stigma and its impact on the families of former soldiers of the German Armed Forces: an exploratory study

BACKGROUND

Military families who have a family member with a mental illness see themselves confronted with many demands. Stigmatization is one of these challenges. Stigmatization affects not only the individual who suffers from a mental illness but also other family members via stigma by association and vicarious stigma. Stigma by association occurs when mental illness stigma spills over to individuals associated with an individual with a mental illness. Vicarious stigma describes the suffering of family members when they note the impact of stigma on their relative with mental illness. As a societal phenomenon, stigma plays out in social interactions and might therefore influence the social networks of families. It is also associated with healthcare utilization.

METHOD

Narrative interviews were conducted with 15 family members (partners, spouses, parents and children) of former soldiers of the German Armed Forces with a service-induced mental illness. The transcribed interview data were analyzed using a thematic analysis approach, in which codes were formed and emerging themes were systemized. Relationships between stigma, the families' reactions to it, its effects on their social relationships and its interference with their healthcare utilization were analyzed.

RESULTS

This study provides a detailed description of how relatives of former German soldiers with mental health problems experience stigma by association and vicarious stigma. Their perceptions are shown in a model that describes stigma-related attitudes, reactions to them and their effects on the social relationships of former soldiers' families. These families felt stigmatized because of the former soldiers' mental illness (mental illness stigma) and the military context in which it occurred (former soldier stigma). They reacted with nondisclosure, anger, acceptance and self-blame. Stigma was associated with smaller and weaker social networks that were characterized by social exclusion, self-segregation and conflicts with extended family, friends and colleagues. Stigma also affected the families' healthcare utilization.

CONCLUSIONS

Urgently needed anti-stigma campaigns, particularly in the civilian context, should address the stigmatization of both mental illness and the military participation of the families affected. They should consider the needs of both former soldiers with a mental illness and their families.

Prevalence of psychiatric morbidity in United States military spouses: The Millennium Cohort Family Study

BACKGROUND

Approximately half of US service members are married, equating to 1.1 million military spouses, yet the prevalence of psychiatric morbidity among military spouses remains understudied. We assessed the prevalence and correlates of eight mental health conditions in spouses of service members with 2-5 years of service.

METHOD

We employed baseline data from the Millennium Cohort Family Study, a 21-year longitudinal survey following 9,872 military-affiliated married couples representing all US service branches and active duty, Reserve, and National Guard components. Couples were surveyed between 2011 and 2013, a period of high military operational activity associated with Operation Iraqi Freedom and Operation Enduring Freedom. Primary outcomes included depression, anxiety, posttraumatic stress disorder (PTSD), panic, alcohol misuse, insomnia, somatization, and binge eating, all assessed with validated self-report questionnaires.

RESULTS

A total of 35.90% of military spouses met criteria for at least one psychiatric condition. The most commonly endorsed conditions were moderate-to-severe somatization symptoms (17.63%) and moderate-to-severe insomnia (15.65%). PTSD, anxiety, depression, panic, alcohol misuse, and binge eating were endorsed by 9.20%, 6.65%, 6.05%, 7.07%, 8.16%, and 5.23% of spouses, respectively. Having a partner who deployed with combat resulted in higher prevalence of anxiety, insomnia, and somatization. Spouses had lower prevalence of PTSD, alcohol misuse, and insomnia but higher rates of panic and binge eating than service members. Both members of a couple rarely endorsed having the same psychiatric problem.

CONCLUSIONS

One third of junior military spouses screened positive for one or more psychiatric conditions, underscoring the need for high-quality prevention and treatment services.

The impact of military deployment on children: Placing developmental risk in context

During recent conflicts in the Middle East, U.S. military families have endured multiple separations, relocations, and alterations in family structure/routines, combined with other significant stressors. This review examines what is known about children's mental health and functioning in relation to parental military deployment during conflicts spanning the last 14years. Findings are organized and considered by age group (i.e., toddlers and preschoolers, school age children, and adolescents) in an effort to highlight unique challenges and strengths present at different stages of development. Across all age groups, numerous studies document an increase in the number of military-connected children receiving mental health services in relation to parental deployment, though specific types of problems and long-term outcomes are not well understood. Evidence for a concerning increase in rates of child maltreatment related to parental deployment has also emerged. However, findings are largely based on aggregate data and the specific perpetrator is often unclear. Overall, we emphasize several critical next steps for research in this area including investigations characterized by greater methodological rigor, consideration of broader parental and contextual influences on child mental health, objective indicators of stress and coping, and longitudinal designs to examine persistence of child emotional/behavioral problems. A focus on adaptive/resilient outcomes is equally essential for understanding long-term outcomes and developing effective intervention programs.

Life goes on: the experiences of wives of multiply-deployed National Guard soldiers

Whether a service member is active duty or part of the National Guard, deployment of these service members is a major issue for most families. There is limited knowledge of the experience of multiple deployments on the family. The purpose of this study was to describe experiences of wives of National Guard soldiers that were deployed more than once. Nine wives were interviewed. An analysis of the interviews revealed four themes: (1) "Life Goes On" (i.e., despite the repeated deployments, life continues at home); (2) the "Guard is a Different Animal" (i.e., life as a National Guard spouse is different from that of an active duty spouse); (3) "It's a Mind-Set" (i.e., how wives cope their husband's deployment); and (4) "Going Back Again" (i.e., wives' experiences of multiple deployments). Exploring how multiple deployments affects wives of National Guard soldiers is helpful in understanding their experiences and the adjustments that must be made in family life. Knowledge of the experiences of these wives may help in formulating more effective interventions with families who have experienced multiple deployments.

Caring for military spouses in primary care

PURPOSE

To provide primary care providers with knowledge of unique challenges faced by military families. By understanding how military families cope with military lifestyle and deployment, providers can be more effective in their care of these patients and offer assistance in optimizing their health.

DATA SOURCES

Research articles, World Wide Web search of resources for military families and Department of Defense documents.

CONCLUSIONS

Military families are faced with many challenges and hardships such as frequent geographic relocations, social isolation, periodic deployments and separations, and risk of injury and death. Unique stressors associated with deployment include assumption of single parent role, altered finances, change in social support from family and friends, and concerns for the safety of the service member. Ineffective coping with stressors can manifest both physically and/or psychologically.

IMPLICATIONS FOR PRACTICE

Healthcare providers should routinely inquire about a patient's possible military affiliation. Military spouses need to be assessed for current stress levels and coping behaviors used in order to provide the most appropriate recommendations and referrals. As healthcare providers, understanding the unique demands of the military lifestyle is necessary to provide effective quality care with optimal health outcomes in this population.

Military wives' transition and coping: deployment and the return home

The objective of this qualitative study is to explore the experiences of wives of deployed soldiers. Semistructured interviews were used to answer the research questions. Meleis' Transitions Theory was used to guide the understanding of the wives' experiences. Phase One: news of deployment, property of awareness, themes of emotional chaos and making preparations. Phase Two: during deployment, property of engagement, themes of taking the reins and placing focus elsewhere, along with the property of change and difference, with themes of emotional and physical turmoil, staying strong, and reaching out. Phase Three: after deployment, property of time span, themes of absence makes the heart grow fonder and reestablishing roles. The study concluded that the wife often feels forgotten during deployment. Nurses can give better care by understanding how the different phases of deployment and separation affect the wife's coping ability and her physical and emotional health.

The impact of deployment to Iraq or Afghanistan on partners and wives of military personnel

Deployment has well documented psychological consequences for military personnel. To fully understand the human cost of war, the psychosocial impact of separation and homecoming of military personnel on their families must also be considered. Recent arduous conflicts in Iraq and Afghanistan make understanding the impact of war on spouses topical and pertinent. Widespread psychological morbidity and social dysfunction have been reported in spouses of military personnel who have been deployed to combat zones such as Vietnam, with difficulties most acute for spouses of military personnel with post-traumatic stress disorder (PTSD). A review of the literature published between 2001 and 2010 assessing the impact of deployments to Iraq and Afghanistan on spouses of military personnel was conducted. A total of 14 US-based studies were identified which examined psychological morbidity, help seeking, marital dysfunction and stress in spouses. Longer deployments, deployment extensions and PTSD in military personnel were found to be associated with psychological problems for the spouse. Methodological differences in the studies limit direct comparisons. Recommendations for future research are outlined. The needs of spouses of military personnel remain an important issue with implications for service provision and occupational capability of both partners.