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DeBlois JP, London AS, Heffernan KS. Hypertension at the nexus of veteran status, psychiatric disorders, and traumatic brain injury: Insights from the 2011 Behavioral Risk Factor Surveillance System. PLoS One 2024; 19:e0298366. [PMID: 38498456 PMCID: PMC10947695 DOI: 10.1371/journal.pone.0298366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/24/2024] [Indexed: 03/20/2024] Open
Abstract
Variable military service-related experiences, such as combat exposure, psychiatric disorders (PD), and traumatic brain injuries (TBI), may differentially affect the likelihood of having health care professional-identified high blood pressure (i.e., hypertension). PURPOSE Compare the odds of self-reported hypertension among non-combat and combat veterans with and without PD/TBI to non-veterans and each other. METHODS We used data from men from the 2011 Behavioral Risk Factor Surveillance System and distinguished: non-veterans (n = 21,076); non-combat veterans with no PD/TBI (n = 3,150); combat veterans with no PD/TBI (n = 1,979); and veterans (combat and non-combat) with PD and/or TBI (n = 805). Multivariable, hierarchical logistic regression models included exogenous demographic, socioeconomic attainment and family structure, health behavior and conditions, and methodological control variables. RESULTS One-third of men reported having been told at least once by a medical professional that they had high blood pressure. Bivariate analyses indicated that each veteran group had a higher prevalence of self-reported hypertension than non-veterans (design-based F = 45.2, p<0.001). In the fully adjusted model, no statistically significant differences in the odds of self-reported hypertension were observed between non-veterans and: non-combat veterans without PD/TBI (odds ratio [OR] = 0.92); combat veterans without PD/TBI (OR = 0.87); veterans with PD and/or TBI (OR = 1.35). However, veterans with PD and/or TBI had greater odds of reporting hypertension than both combat and non-combat veterans without PD/TBI (p<0.05). DISCUSSION Military service-related experiences were differentially associated with a survey-based measure of hypertension. Specifically, veterans self-reporting PD and/or TBI had significantly higher odds of self-reporting hypertension (i.e., medical provider-identified high blood pressure).
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Affiliation(s)
- Jacob P. DeBlois
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States of America
| | - Andrew S. London
- Department of Sociology, Syracuse University, Syracuse, NY, United States of America
| | - Kevin S. Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States of America
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Lee SH, Han C, Kim J, Jeong HG, Lee MS, Choi JH, Choi H. Embitterment in Vietnam War Veterans Predicted by Symptoms of Posttraumatic Stress Disorder. Psychiatry Investig 2024; 21:191-199. [PMID: 38433418 PMCID: PMC10910164 DOI: 10.30773/pi.2023.0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE Research on the association between posttraumatic embitterment disorder (PTED) and other psychopathologies in veterans and adults aged ≥65 years is lacking. This study aimed to assess embitterment among elderly war veterans and its association with major psychopathological factors. METHODS Participants included Vietnam War veterans who visited a psychiatric clinic. Based on the Posttraumatic Embitterment Disorder Self-Rating Scale (PTEDS) score, the participants were divided into the embitterment (PTED(+), mean score of PTEDS items [mPTEDS] ≥1.6) and non-embitterment (PTED(-), mPTEDS <1.6) groups. Demographic characteristics, combat exposure severity, depression, anxiety, sleep, and alcohol use disorder symptom scores of the participants were collected and compared between the PTED(+) and PTED(-) groups. A correlation analysis between symptom measure scores and the mPTEDS was conducted. The influence of psychopathology on embitterment was investigated using stepwise multiple linear regression analysis. RESULTS In total, 60 participants (28 in PTED(+) and 32 in PTED(-)) were included. Among those in PTED(+), 21 (35.0%) showed mild embitterment symptoms (1.6≤ mPTEDS <2.5) and 7 (11.7%) reported moderate or severe embitterment symptoms (mPTEDS ≥2.5). The mean scores of posttraumatic stress disorder (PTSD), depression, and anxiety were significantly higher in the PTED(+) than in the PTED(-) group. The mPTEDS were significantly correlated with PTSD, depression, anxiety, and sleep disorder scores. The PTSD symptoms significantly explained the higher mPTEDS score in a regression model. CONCLUSION Embitterment symptoms were associated with PTSD, depression, anxiety, and insomnia symptoms in elderly veterans, similar to the results of prior studies involving only the general population.
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Affiliation(s)
- Seung-Hoon Lee
- Department of Psychiatry, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
- Department of Psychiatry, Veteran Health Service Medical Center, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Junhyung Kim
- Department of Psychiatry, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Moon-Soo Lee
- Department of Psychiatry, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
- Department of Life Sciences, Korea University, Seoul, Republic of Korea
| | - Jin Hee Choi
- Department of Psychiatry, Veteran Health Service Medical Center, Seoul, Republic of Korea
| | - Hayun Choi
- Department of Psychiatry, Veteran Health Service Medical Center, Seoul, Republic of Korea
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Carra K, Curtin M, Fortune T, Gordon B. Service and demographic factors, health, trauma exposure, and participation are associated with adjustment for former Australian Defense Force members. MILITARY PSYCHOLOGY 2023; 35:480-492. [PMID: 37615555 PMCID: PMC10453966 DOI: 10.1080/08995605.2022.2120312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/17/2022] [Indexed: 10/24/2022]
Abstract
Approximately 50% of transitioning service members report difficulty adjusting to civilian life. However, there is limited research exploring factors that influence adjustment for former Australian Defence Force (ADF) members. The aim of this study was to investigate the influence of demographic and service-related characteristics, trauma exposure, health, and participation in meaningful occupations on adjustment for former ADF members. One hundred and ninety-eight former ADF members completed a voluntary, online survey containing validated self-report measures for adjustment, health, and exposure to combat and military sexual trauma. Participation in meaningful occupations was assessed using open-ended questions and a rating scale for frequency of participation. A more difficult adjustment was reported by participants who had completed operational service, reported exposure to combat and/or military sexual trauma, had poor physical health and were discharged for medical reasons. Other characteristics associated with a difficult adjustment included emotional distress, involuntary discharge, age category 30-49 years, final rank of Senior Noncommissioned Officer/Warrant Officer or below, and discharge 6-8 years previously. Employment, voluntary work and care, and social and community interaction were associated with an easier adjustment. Screening tools that consider health, age, deployment type, final rank, type of discharge and exposure to combat or military sexual trauma may be helpful to identify and refer high risk individuals to employment, rehabilitation or transition support programs.
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Affiliation(s)
- Kylie Carra
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Michael Curtin
- School of Community Health, Charles Sturt University, Albury, Australia
| | - Tracy Fortune
- Occupational Therapy, Social Work and Social Policy, La Trobe University, Bundoora, Australia
| | - Brett Gordon
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
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Scott-Storey K, O’Donnell S, Perrin N, Wuest J. Cumulative Lifetime Violence, Gender, Social Determinants of Health and Mental Health in Canadian Men: A Latent Class Analysis. JOURNAL OF FAMILY VIOLENCE 2023; 39:665-680. [PMID: 38644980 PMCID: PMC11031490 DOI: 10.1007/s10896-023-00502-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 04/23/2024]
Abstract
Purpose Among men, violence is pervasive and associated with poor mental health, but little is known about which men are most vulnerable. Our purpose is to address this gap by exploring mental health and social determinants of health (SDOH) including gender role conflict (GRC) in heterogenous groups of men with distinct patterns of cumulative lifetime violence (CLV) as target and perpetrator. Methods Latent class analysis was conducted using means of 64 indicators of CLV severity collected from a community sample of 685 eastern Canadian men, ages 19 to 65 years. Class differences by SDOH, and depression, anxiety, and posttraumatic stress disorder (PTSD) were explored with Chi-square and analysis of variance. Results A 4-class solution was optimal. Class 1 had the lowest CLV severity; were more likely to be better educated, employed, and have little difficulty living on their incomes; and had better mental health than other classes. Class 2, characterized by moderate psychological violence as both target and perpetrator, had mean depression and PTSD scores at clinical levels, and more difficulty living on income than Class 1. Classes 3 and 4 were typified by high severity CLV as target but differentiated by Class 4 having the highest perpetration severity, higher GRC, and being older. In both classes, mean mental health scores were above cut-offs for clinical symptomology and higher than Classes 1 and 2. Conclusion This is the first evidence that distinct patterns of CLV severity among men intersect with GRC and SDOH and are uniquely associated with mental health.
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Affiliation(s)
| | - Sue O’Donnell
- Faculty of Nursing, University of New Brunswick, Fredericton, NB Canada
| | - Nancy Perrin
- School of Nursing, Johns Hopkins University, Baltimore, MD USA
| | - Judith Wuest
- Faculty of Nursing, University of New Brunswick, Fredericton, NB Canada
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Rhead R, MacManus D, Jones M, Greenberg N, Fear NT, Goodwin L. Mental health disorders and alcohol misuse among UK military veterans and the general population: a comparison study. Psychol Med 2022; 52:292-302. [PMID: 32777197 DOI: 10.1017/s0033291720001944] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND For a small minority of personnel, military service can have a negative impact on their mental health. Yet no studies have assessed how the mental health of UK veterans (who served during the recent operations in Afghanistan or Iraq) compares to non-veterans, to determine if they are at a disadvantage. We examine the prevalence of mental disorders and alcohol misuse in UK veterans compared to non-veterans. METHODS Veteran data were taken from the third phase of the King's Centre for Military Health Research cohort study (n = 2917). These data were compared with data on non-veterans taken from two large general population surveys: 2014 Adult Psychiatric Morbidity Survey (n = 5871) and wave 6 of the UK Household Longitudinal Study (UKHLS, n = 22 760). RESULTS We found that, overall, UK veterans who served at the time of recent military operations were more likely to report a significantly higher prevalence of common mental disorders (CMD) (23% v. 16%), post-traumatic stress disorder (PTSD) (8% v. 5%) and alcohol misuse (11% v. 6%) than non-veterans. Stratifying by gender showed that the negative impact of being a veteran on mental health and alcohol misuse was restricted to male veterans. Being ill or disabled was associated with a higher prevalence of CMD and PTSD for both veterans and non-veterans. CONCLUSION Whilst the same sociodemographic groups within the veteran and non-veteran populations seemed to have an increased risk of mental health problems (e.g. those who were unemployed), male veterans, in particular, appear to be at a distinct disadvantage compared to those who have never served.
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Affiliation(s)
- Rebecca Rhead
- Department of Forensic and Neurodevelopmental Science, King's College London, London, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Deirdre MacManus
- Department of Forensic and Neurodevelopmental Science, King's College London, London, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Margaret Jones
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
| | - Laura Goodwin
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Bogaers R, Geuze E, van Weeghel J, Leijten F, Rüsch N, van de Mheen D, Varis P, Rozema A, Brouwers E. Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military. BMJ Open 2021; 11:e049370. [PMID: 34706950 PMCID: PMC8559108 DOI: 10.1136/bmjopen-2021-049370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Many workers in high-risk occupations, such as soldiers, are exposed to stressors at work, increasing their risk of developing mental health conditions and substance abuse (MHC/SA). Disclosure can lead to both positive (eg, support) and negative (eg, discrimination) work outcomes, and therefore, both disclosure and non-disclosure can affect health, well-being and sustainable employment, making it a complex dilemma. The objective is to study barriers to and facilitators for disclosure in the military from multiple perspectives. DESIGN Qualitative focus groups with soldiers with and without MHC/SA and military mental health professionals. Sessions were audiotaped and transcribed verbatim. Content analysis was done using a general inductive approach. SETTING The study took place within the Dutch military. PARTICIPANTS In total, 46 people participated in 8 homogeneous focus groups, including 3 perspectives: soldiers with MHC/SA (N=20), soldiers without MHC/SA (N=10) and military mental health professionals (N=16). RESULTS Five barriers for disclosure were identified (fear of career consequences, fear of social rejection, lack of leadership support, lack of skills to talk about MHC/SA, masculine workplace culture) and three facilitators (anticipated positive consequences of disclosure, leadership support, work-related MHC/SA). Views of the stakeholder groups were highly congruent. CONCLUSIONS Almost all barriers (and facilitators) were related to fear for stigma and discrimination. This was acknowledged by all three perspectives, suggesting that stigma and discrimination are considerable barriers to sustainable employment and well-being. Supervisor knowledge, attitudes and behaviour were critical for disclosure, and supervisors thus have a key role in improving health, well-being and sustainable employment for soldiers with MHC/SA. Furthermore, adjustments could be made by the military on a policy level, to take away some of the fears that soldiers have when disclosing MHC/SA.
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Affiliation(s)
- Rebecca Bogaers
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands
- Brain Research and Innovation Centre, Netherlands Ministry of Defence, Utrecht, The Netherlands
| | - Elbert Geuze
- Brain Research and Innovation Centre, Netherlands Ministry of Defence, Utrecht, The Netherlands
- Brain Center Rudolf Magnus, University Medical Centre Utrecht Psychiatry, Utrecht, The Netherlands
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands
| | - Fenna Leijten
- Strategic Military Healthcare Department, Netherlands Ministry of Defence, Utrecht, The Netherlands
| | - Nicolas Rüsch
- Department of Psychiatry II, University of Ulm, Ulm, Germany
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands
| | - Piia Varis
- Department of Culture Studies, Tilburg School of Humanities and Digital Sciences Tilburg University, Tilburg, The Netherlands
| | - Andrea Rozema
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands
| | - Evelien Brouwers
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences Tilburg University, Tilburg, The Netherlands
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Asare-Doku W, Donnir GM, Ayuurebobi Ae-Ngibise K, Peprah J, Awuviry-Newton K, Acquah F. Psychiatric Disorders among the Military in West Africa: A Systematic Narrative Review. Behav Sci (Basel) 2021; 11:bs11100138. [PMID: 34677231 PMCID: PMC8533190 DOI: 10.3390/bs11100138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/25/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Military combat impacts the mental health of veterans and active military personnel. Although various studies, the majority of which are from Westernized countries, have provided insight into how combat causes psychiatric disorders, such as post-traumatic stress disorder (PTSD), depression, and anxiety among veterans, there appears to be scant published literature on psychiatric disorders among military personnel in the West African region. It is important to contextually understand the psychiatric disorders among military personnel in this region who may be faced with similar vulnerabilities to their counterparts from Western cultures. (2) Methods: This study follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were published in English between January 2010 and January 2021 and assessed mental health problems or psychiatric disorders among soldiers in West Africa. (3) Results: All three included studies were from Nigeria. High prevalence rates of substance and alcohol use were reported. (4) Conclusions: This review highlights the need for more research in this population as well as identifying the intervention needs of the soldiers and their implications.
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Affiliation(s)
- Winifred Asare-Doku
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031, Australia
- Correspondence:
| | - Gordon Maanianu Donnir
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia; (G.M.D.); (K.A.-N.); (J.P.)
| | - Kenneth Ayuurebobi Ae-Ngibise
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia; (G.M.D.); (K.A.-N.); (J.P.)
- Kintampo Health Research Centre, Kintampo P.O Box 200, Bono East Region, Ghana
| | - Jennifer Peprah
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia; (G.M.D.); (K.A.-N.); (J.P.)
| | | | - Francis Acquah
- Positive Wellness Recovery Centre, Melbourne, VIC 3076, Australia;
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Carra K, Curtin M, Fortune T, Gordon B. Participation in occupations, health and adjustment during the transition from military service: A cross-sectional study. MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1962180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kylie Carra
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Michael Curtin
- School of Community Health, Charles Sturt University, Albury, Australia
| | - Tracy Fortune
- Occupational Therapy, Social Work and Social Policy, La Trobe University, Bundoora, Australia
| | - Brett Gordon
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
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Roughead EE, Ramsay EN, Kalisch Ellett LM, Khoo A, Moffatt A, Pratt NL. Variation in health service use by veterans with an accepted disability of post-traumatic stress disorder who had a service record post 1975: a cluster analysis. BMJ Mil Health 2021; 168:76-81. [PMID: 33547192 PMCID: PMC8788042 DOI: 10.1136/bmjmilitary-2020-001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
Background The use of health services is likely to vary among veterans with an accepted disability of post-traumatic stress disorder (PTSD), however, the extent of variation is not known. We aimed to determine the extent and type of health services used by veterans with an accepted disability of PTSD. Methods The cohort included veterans who served post 1975, were eligible for all Australian Government Department of Veterans’ Affairs funded health services, had PTSD as an accepted disability prior to July 2015 and were alive at the 30 June 2016. Veterans were assigned to groups based on their use of health services using K-means cluster analysis. Results The cohort comprised five clusters involving 2286 veterans. The largest cluster (43%) were a younger, general practitioner (GP) managed cluster who saw their GP quarterly and the psychiatrist twice a year. The second GP cluster (30%) had higher levels of physical comorbidity. The psychiatrist managed cluster (14%) had a mean of 12 psychiatrist visits and one PTSD hospitalisation in the year. The remaining two clusters involved GP and allied healthcare, but no psychologist care. High levels of antidepressant use occurred in all clusters, ranging from 44% up to 69%. The psychiatrist managed cluster had 47% on antipsychotics and 58% on anxiolytics. Conclusion Our study highlights the heterogeneity in health service use. These results identify the significant health utilisation required for up to one-sixth of veterans with PTSD and the significant role of primary care physicians in supporting veterans with PTSD.
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Affiliation(s)
- Elizabeth Ellen Roughead
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - E N Ramsay
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - L M Kalisch Ellett
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - A Khoo
- Toowong Private Hospital, Gallipoli Medical Research Foundation, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - A Moffatt
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - N L Pratt
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Godier-McBard LR, Castle CL, Heinze N, Hussain SF, Borowski S, Vogt DS, Gomes RSM, Fossey M. A preliminary investigation of the well-being of visually impaired ex-service personnel in the United Kingdom. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2020. [DOI: 10.1177/0264619620973683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research has shown that visual impairment may impact daily functioning, health, and well-being negatively for adults of all ages. Ex-service personnel (‘veterans’) too may be at risk of poor health and well-being outcomes associated with post-military life, and this may be exacerbated by the presence of visual impairment. Despite this, research considering the experience of blind veterans has been limited and has not yet assessed well-being for these individuals across a broad spectrum of life domains. Rather, it has highlighted poor mental health and psychological well-being in working-age visually impaired veterans. However, the experiences of older visually impaired veterans (who make up the majority of visually impaired veterans in the United Kingdom) have been poorly represented in the literature. This pilot study aimed to provide a preliminary assessment of holistic well-being in an adult sample of 97 UK blind veterans, predominantly composed of older age veterans (majority over 80 years). Cross-sectional well-being data were collected using a validated measure of well-being (the Well-Being Inventory [WBI]). Results suggest that members of Blind Veterans UK are functioning well and are satisfied across four life domains (vocation, finances, health, and social relationships). Lower health satisfaction was identified, particularly in blind veterans with comorbid mental health conditions. Results are discussed in relation to the older age of the sample, the limitations of face-to-face survey administration, and the applicability of the WBI finance domain in this age cohort. Recommendations are made for future research in this population.
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Affiliation(s)
- Lauren R Godier-McBard
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, UK
| | | | | | | | | | - Dawne S Vogt
- National Centre for PTSD, VA Boston Healthcare System, USA; Boston University School of Medicine, USA
| | | | - Matt Fossey
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, UK
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Bi Y, Zhao X, Zhou Y, Lao L, Jiang S. Factors associated with the depression among people with disabilities: A cross-sectional study in Chinese communities of Shanghai. Medicine (Baltimore) 2020; 99:e23331. [PMID: 33217872 PMCID: PMC7676543 DOI: 10.1097/md.0000000000023331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Depression has become a growing health issue in the world and is projected to become a leading cause of global burden. However, there is little scientific research on the factors associated with depression in people with disabilities in China. In this cross-sectional study, we aimed to explore the prevalence and related factors of depression among people with disabilities in communities in mainland China.Participants with disability certificates were recruited via face-to-face interviews to complete questionnaires. Contents include participants' demographic characteristics, the Modified Barthel Index (MBI), chronic medical history, and the Patient Health Questionnaire-9 (PHQ-9).A total of 1815 participants (M age = 60.35 ± 13.66) whose questionnaires are eligible were finally included. Among them the incidence rate of depressive symptoms was up to 39.9%. Multifactor regression analysis showed that grade I disability (odds ratio (OR) = 1.37, P < .05), impairment activities of daily living (OR = 3.23, P < .001), diabetes (OR = 1.43, P < .05), and hyperlipidemia (OR = 1.59, P < .001) were associated with depression in the disabled. However, intelligence disability is a protective factor of depression (OR = 0.69, P < .05).The data demonstrates that the depression of the disabled should arouse the attention of our society. Furthermore, the interventions to disability degree, impairment activities of daily living, diabetes, and hyperlipidemia may help to improve the mental health of the disabled people.
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Affiliation(s)
- Yahong Bi
- General Practice Department, Zhongshan Hospital, Fudan University, Shanghai
- Jiangsu Provincial People's Hospital, Nanjing, Jiangsu Province
| | - Xincai Zhao
- Department of Pharmacy, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Yanyan Zhou
- Xinzhuang Community Health Center, Minhang District, Shanghai
| | - Limin Lao
- General Practice Department, Zhongshan Hospital, Fudan University, Shanghai
| | - Sunfang Jiang
- General Practice Department, Zhongshan Hospital, Fudan University, Shanghai
- Healthcare Center, Zhongshan Hospital, Fudan University, Shanghai, China
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Adapting Cognitive Processing Therapy for PTSD for People With Disabilities: A Case Study With a U.S. Veteran. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Bennett AN, Dyball DM, Boos CJ, Fear NT, Schofield S, Bull AMJ, Cullinan P. Study protocol for a prospective, longitudinal cohort study investigating the medical and psychosocial outcomes of UK combat casualties from the Afghanistan war: the ADVANCE Study. BMJ Open 2020; 10:e037850. [PMID: 33127630 PMCID: PMC7604820 DOI: 10.1136/bmjopen-2020-037850] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/16/2020] [Accepted: 09/21/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The Afghanistan war (2003-2014) was a unique period in military medicine. Many service personnel survived injuries of a severity that would have been fatal at any other time in history; the long-term health outcomes of such injuries are unknown. The ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) study aims to determine the long-term effects on both medical and psychosocial health of servicemen surviving this severe combat related trauma. METHODS AND ANALYSIS ADVANCE is a prospective cohort study. 1200 Afghanistan-deployed male UK military personnel and veterans will be recruited and will be studied at 0, 3, 6, 10, 15 and 20 years. Half are personnel who sustained combat trauma; a comparison group of the same size has been frequency matched based on deployment to Afghanistan, age, sex, service, rank and role. Participants undergo a series of physical health tests and questionnaires through which information is collected on cardiovascular disease (CVD), CVD risk factors, musculoskeletal disease, mental health, functional and social outcomes, quality of life, employment and mortality. ETHICS AND DISSEMINATION The ADVANCE Study has approval from the Ministry of Defence Research Ethics Committee (protocol no:357/PPE/12) agreed 15 January 2013. Its results will be disseminated through manuscripts in clinical/academic journals and presentations at professional conferences, and through participant and stakeholder communications. TRIAL REGISTRATION NUMBER The ADVANCE Study is registered at ISRCTN ID: ISRCTN57285353.
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Affiliation(s)
- Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Daniel Mark Dyball
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Christopher J Boos
- Department of Cardiology, University Hospital Dorset, NHS Trust, Poole, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, UK
- Academic Department for Military Mental Health, King's College London, London, UK
| | - Susie Schofield
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Imperial College London, London, UK
| | - Paul Cullinan
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College, London, UK
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Lever I, Dyball D, Greenberg N, Stevelink SAM. Health consequences of bullying in the healthcare workplace: A systematic review. J Adv Nurs 2019; 75:3195-3209. [PMID: 30816567 DOI: 10.1111/jan.13986] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/01/2018] [Accepted: 12/17/2018] [Indexed: 01/29/2023]
Abstract
AIMS To review both mental and physical health consequences of bullying for healthcare employees. DESIGN Systematic literature review. DATA SOURCES EMBASE, MEDLINE, PsycINFO, PUBMED and Web of Science Core Collection were searched for articles published between 2005 - January 2017. REVIEW METHODS This review was conducted using the framework described by Khan and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two independent reviewers performed systematic data extraction and appraised the methodological quality of included articles. A pooled mean prevalence of bullying was estimated. RESULTS Forty-five papers met inclusion criteria. Bullying prevalence ranged from 3.9% to 86.5%, with a pooled mean estimate of 26.3%. Perceived bullying was associated with mental health problems including psychological distress, depression and burnout, and physical health problems including insomnia and headache. Bullied staff took more sick leave. CONCLUSION Bullying occurs frequently amongst healthcare staff and is deleterious to health and occupational functionality.
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Affiliation(s)
- Isabel Lever
- Faculty of Life Sciences and Medicine, King's College London, Henriette Raphael House, Guy's Campus, London, UK
| | - Daniel Dyball
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
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Cultural adaptations of CBT: a summary and discussion of the Special Issue on Cultural Adaptation of CBT. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractCognitive behavioural therapy (CBT) in its current form might not be acceptable to service users from a variety of backgrounds. Therefore, it makes sense to adapt CBT when working with diverse populations. Contributors to this special issue of theCognitive Behaviour Therapisthave tackled the issues around the cultural adaptation of CBT from various perspectives, using a variety of methods, and have addressed topics ranging from cultural adaptation to improving access to CBT. Here, I briefly summarize and discuss the papers in this special issue. I start with a systematic review of CBT for social anxiety across cultures. Seven articles cover aspects of adaptation of therapies for people from different backgrounds. Three papers discuss the issues of gender and sexuality when using CBT, while another three papers focus on refugees, asylum seekers and the homeless, and two papers describe the application of CBT with religious populations. Finally, there are seven papers on issues related to service delivery, practice and training and supervision when working with a diverse population. Collectively, papers in this special issue provide us with sufficient evidence that cultural considerations play a vital role when using CBT, offer practical suggestions for improving cultural competence and most importantly, can catalyse future research. However, the full potential of culturally adapted interventions will not be realized until and unless access to CBT is improved. Therefore, there is a need to build robust evidence to convince funders, policy makers and service managers.
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Klimova B, Maresova P, Kuca K. Combat Military Personnel and Selective Risk Factors for the Development of Dementias - A Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666190114155451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
:
Due to the growth of life expectancies and the increasing number of elderly population all
over the world, there is a risk of growth of aging diseases such as dementia. Recent research studies
also indicate that there will be a growing number of military veterans who will be affected by dementia,
already at the age of 55+ years. In the case of combat military personnel, the most common
dementias are Alzheimer’s disease and vascular dementia. These two dementias are very similar
because their main symptoms are the same. The purpose of this review is to explore two main risk
factors influencing the development of the dementias. These include posttraumatic stress disorder
(PTSD) and traumatic brain injury (TBI). Furthermore, the authors of this study focus on the exploration
of the treatment of PTSD and TBI in order to delay the development of dementias among
combat military personnel.
:
For the purpose of this study, a method of literature review of available sources exploring these two
main risk factors of dementia among combat military personnel was used. Based on the evaluation
of these literature sources, possibilities of pharmacological and non-pharmacological approaches to
the treatment and care of these people were described.
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Affiliation(s)
- Blanka Klimova
- Department of Neurology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Petra Maresova
- Faculty of Informatics and Management, University of Hradec Kralove, Rokitanského 62, 50003, Hradec Kralove, Czech Republic
| | - Kamil Kuca
- Philosophical Faculty, University of Hradec Kralove, Rokitanského 62, 50003, Hradec Kralove, Czech Republic
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Ashtiani AF, Afzali SM, Ebadi A, Hassanabadi H. Design and assessment of psychometric features of life skills inventory. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2018; 7:86. [PMID: 30079357 PMCID: PMC6052772 DOI: 10.4103/jehp.jehp_41_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 12/05/2017] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The importance of life skills and their application in promoting personal, family, and occupational health in military personnel is well recognized. It is, therefore, important to identify and assess life skills in military personnel with a valid and reliable tool. The present study aims to develop such a tool and evaluate its psychometric features in military personnel. MATERIALS AND METHODS As part of a mixed study, a qualitative concept analysis study was conducted using hybrid approach to redefine life skills in military personnel, and results obtained were used to form a pool of items. Next, in a methodological study, psychometric evaluation, qualitative and quantitative face validity, qualitative and quantitative content validity, and construct validity (exploratory factor analysis), and reliability (using test-retest and internal consistency) were performed on the inventory. RESULTS Initial pool of items was designed with 156 items, which were reduced to 93, following qualitative face validity, and further reduced to 80 after quantitative face validity (item impact score). No further reduction was implemented after qualitative and quantitative content validity (content validity ratio and content validity index ratio). Following construct validity (factor analysis), the remaining 80 items were summarized in 5 factors. Cronbach's alpha for the 5 factors was found 0.7, and correlation coefficient of test-retest results exceeded 0.9 and was significant at 0.01. CONCLUSION Given the acceptable results of psychometric features, this tool can be used as a valid and reliable tool for assessing life skills in military personnel.
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Affiliation(s)
- Ali Fathi Ashtiani
- Behavioral Sciences Research Center, Baqiyatallah Universityof Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Afzali
- PHD Student of Nursing, Baqiyatallah University of Medical Sciences, and Scientific Member of Faculty of Nursing in Shahre-Kurd University of Medical Sciences, Shahre-Kurd, Chaharmahalva Bakhtiari Province, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamidreza Hassanabadi
- Department of Educational Psychology, School of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran
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18
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Martz E, Livneh H, Southwick SM, Pietrzak RH. Posttraumatic growth moderates the effect of posttraumatic stress on quality of life in U.S. military veterans with life-threatening illness or injury. J Psychosom Res 2018; 109:1-8. [PMID: 29773146 DOI: 10.1016/j.jpsychores.2018.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Erin Martz
- Rehability Oregon, and Veterans Affairs Portland Health Care System, USA.
| | - Hanoch Livneh
- Rehabilitation Counseling Program, Portland State University, USA
| | - Steven M Southwick
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Brunes A, Hansen MB, Heir T. Post-traumatic stress reactions among individuals with visual impairments: a systematic review. Disabil Rehabil 2018; 41:2111-2118. [PMID: 29644887 DOI: 10.1080/09638288.2018.1459884] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose: To conduct a systematic review of post-traumatic stress reactions among individuals with visual impairment (VI). Materials and methods: Qualitative and quantitative studies were identified through searches in MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Libraries. The literature search was limited to humans, of English and Scandinavian languages and publication year between 1980 and 2017. Study quality was assessed for all the included studies and extracted data were synthesized using narrative analysis. Results: Of 4235 records identified through literature search, eleven were included in the analyses. Results from the qualitative studies illustrated multiple physical, behavioral, emotional, and cognitive manifestations of trauma. Four out of five quantitative studies showed that various types of potentially traumatic events were significantly associated with mental health adversities (p < 0.05). The prevalence of post-traumatic mental disorders was 4-21.2% for depression, 0.9% for dysthymia, and 32% for substance misuse. The quality of the reviewed studies was considered low to moderate. Conclusion: Traumatic experiences appear to have a great impact on the mental health in people with visual impairment (VI) and these results highlight their need for mental health care. Future studies with higher methodological rigor are recommended. Implications for rehabilitation Visual impairment entails a greater susceptibility to some types of potentially traumatic events, especially threats in everyday life. This calls for a greater emphasis on safe community environments and universal design in public spaces. In rehabilitation after serious accidents or potentially traumatic events, professionals working with people with vision impairment should be aware of the different manifestations of post-traumatic stress responses and that some stress responses may cause additional disability. The high prevalence of traumatic events and their impact on mental health in individuals with visual impairments highlights a need of mental health care.
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Affiliation(s)
- Audun Brunes
- a Norwegian Centre for Violence and Traumatic Stress Studies , Oslo , Norway
| | - Marianne B Hansen
- a Norwegian Centre for Violence and Traumatic Stress Studies , Oslo , Norway
| | - Trond Heir
- a Norwegian Centre for Violence and Traumatic Stress Studies , Oslo , Norway.,b Faculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway
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20
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Mendoza C, Barreto GE, Iarkov A, Tarasov VV, Aliev G, Echeverria V. Cotinine: A Therapy for Memory Extinction in Post-traumatic Stress Disorder. Mol Neurobiol 2018; 55:6700-6711. [PMID: 29335846 DOI: 10.1007/s12035-018-0869-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/07/2018] [Indexed: 12/14/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a mental disorder that may develop after exposure to exceptionally threatening or unescapable horrifying events. Actual therapies fail to alleviate the emotional suffering and cognitive impairment associated with this disorder, mostly because they are ineffective in treating the failure to extinguish trauma memories in a great percentage of those affected. In this review, current behavioral, cellular, and molecular evidence supporting the use of cotinine for treating PTSD are reviewed. The role of the positive modulation by cotinine of the nicotinic acetylcholine receptors (nAChRs) and their downstream effectors, the protection of astroglia, and the inhibition of microglia in the PTSD brain are also discussed.
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Affiliation(s)
- Cristhian Mendoza
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia.,Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Alexandre Iarkov
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - Vadim V Tarasov
- Institute of Pharmacy and Translational Medicine, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
| | - Gjumrakch Aliev
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, Severniy Proezd, Chernogolovka, Moscow Region, 1142432, Russia. .,"GALLY" International Biomedical Research Consulting LLC, San Antonio, TX, 78229, USA. .,School of Health Sciences and Healthcare Administration, University of Atlanta, Johns Creek, GA, 30097, USA.
| | - Valentina Echeverria
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile. .,Bay Pines VA Healthcare System, Research and Development, Bay Pines, FL, 33744, USA.
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21
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Oster C, Morello A, Venning A, Redpath P, Lawn S. The health and wellbeing needs of veterans: a rapid review. BMC Psychiatry 2017; 17:414. [PMID: 29284431 PMCID: PMC5747125 DOI: 10.1186/s12888-017-1547-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/20/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND For the majority of serving members, life in the military has a positive effect on wellbeing. However, the type, intensity and duration of service, along with the transition from fulltime military to civilian life, may have a negative effect on veterans' wellbeing. Such negative consequences, alongside the growing veteran population, indicate the need for greater exploration of veterans' physical, mental and social wellbeing. METHODS The current paper reports on the findings of a rapid review of the literature on the health and wellbeing needs of veterans, commissioned by the Australian Department of Veterans' Affairs to inform future programs and services. The databases Embase, Medline, Cinahl, PubMed, Web of Science and Cochrane Database were searched for systematic reviews reporting on veterans' physical, mental and social wellbeing published in English in peer-reviewed journals. RESULTS A total of 21 systematic reviews were included. The reviews reported on a range of mental, physical and social health problems affecting veterans. While there was limited information on prevalence rates of physical, mental and social health problems in veterans compared to civilian populations, the reviews demonstrated the interconnection between these domains and the effect of demographic and military service factors. CONCLUSIONS A key finding of the review is the interconnection of the mental, physical, and social health of veterans, highlighting the importance that an integrated approach to veterans' wellbeing is adopted. It is suggested that understanding key factors, such as demographic factors and factors relating to military service, can support improved service provision for veterans.
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Affiliation(s)
- Candice Oster
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia.
| | - Andrea Morello
- 0000 0004 0367 2697grid.1014.4Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - Anthony Venning
- 0000 0004 0367 2697grid.1014.4Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | | | - Sharon Lawn
- 0000 0004 0367 2697grid.1014.4Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, GPO Box 2100, Adelaide, South Australia 5001 Australia
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Unique Contributions of Body Diagram Scores and Psychosocial Factors to Pain Intensity and Disability in Patients With Musculoskeletal Pain. J Orthop Sports Phys Ther 2017; 47:88-96. [PMID: 27819193 DOI: 10.2519/jospt.2017.6778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Retrospective cross-sectional cohort of military patients with musculoskeletal pain. Background Body diagrams are used to document symptoms and can also serve as a proxy to assess psychological influence. However, literature to support this is conflicting. Objectives To (1) examine the unique contribution of pain and nonpain symptom distribution to magnitude of self-reported pain intensity and disability, and (2) assess the moderating influence of psychological factors and body diagram score on concurrent pain intensity and disability. Methods Pain, numbness, and tingling were denoted on a body diagram at initial evaluation. Fear-avoidance beliefs, pain catastrophizing, and region-specific self-reported disability measures were collected. The contributions of pain and nonpain symptom distribution to pain intensity and disability were assessed to determine which body diagram symptom scoring method (pain only, nonpain, or composite) was appropriate for subsequent analyses. Hierarchical linear regression analyses were then used to determine the moderating effects of the Pain Catastrophizing Scale and Fear-Avoidance Beliefs Questionnaire and the body diagram score on concurrent pain and disability. Results The Pain Catastrophizing Scale and Fear-Avoidance Beliefs Questionnaire explained between 16% and 17% of the variance in pain intensity, and 8% of variance in disability (all, P<.001). The composite symptom score explained an additional 4% to 5% variance in concurrent disability and pain intensity (all, P<.001). The Pain Catastrophizing Scale moderated the relationship between body diagram score and pain intensity. The positive relationship between composite symptom score and concurrent pain intensity is stronger for patients with low catastrophizing. Conclusion The clinical utility of body diagrams with low symptom distribution may be improved by concomitant assessment of pain catastrophizing and warrants further longitudinal investigation. Level of Evidence Symptom prevalence, level 2b. J Orthop Sports Phys Ther 2017;47(2):88-96. Epub 5 Nov 2016. doi:10.2519/jospt.2017.6778.
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23
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Himmerich H, Willmund GD, Wesemann U, Jones N, Fear NT. European military mental health research: benefits of collaboration. J ROY ARMY MED CORPS 2016; 163:155-157. [PMID: 27903838 DOI: 10.1136/jramc-2016-000676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/07/2016] [Accepted: 11/06/2016] [Indexed: 11/03/2022]
Abstract
Despite joint participation in international military operations, few collaborative military mental health research projects have been undertaken by European countries. From a common perspective of military mental health researchers from Germany and the UK, the lack of shared research might be related not only to the use of different languages but also the different ways in which the two militaries provide mental health and medical support to operations and differences in military institutions. One area that is suitable for military health research collaboration within UK and German forces is mental health and well-being among military personnel. This could include the study of resilience factors, the prevention of mental disorder, mental health awareness, stigma reduction and the treatment of mental disorder. Military mental health research topics, interests and the studies that have been conducted to date in the UK and Germany have considerable overlap and commonality of purpose. To undertake the investigation of the long-term consequences of operational deployment, the specific burdens placed on military families and to further the understanding of the role of factors such as biomarkers for use in military mental health research, it seems advisable to forge international research alliances across European nations, which would allow for researchers to draw transcultural and generalisable conclusions from their work. Such an enterprise is probably worthwhile given the shared research interests of Germany and the UK and the common perspectives on military mental health in particular.
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Affiliation(s)
- Hubertus Himmerich
- Centre for Psychiatry and Psychotraumatology, German Armed Forces Hospital, Berlin, Germany.,Department of Psychological Medicine, King's College London, London, UK
| | - G D Willmund
- Centre for Psychiatry and Psychotraumatology, German Armed Forces Hospital, Berlin, Germany
| | - U Wesemann
- Centre for Psychiatry and Psychotraumatology, German Armed Forces Hospital, Berlin, Germany
| | - N Jones
- Department of Psychological Medicine, King's College London, London, UK.,King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - N T Fear
- Department of Psychological Medicine, King's College London, London, UK.,King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
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24
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Edward KL, Ousey K. The role of resilience in rebuilding lives of injured veterans. J Wound Care 2016; 25:571-575. [PMID: 27681587 DOI: 10.12968/jowc.2016.25.10.571] [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: 11/11/2022]
Abstract
The aim of this commentary is to discuss potential clinical implications of introducing resilience-building interventions into care for veterans who are living with a war wound. Some war veterans are expected to live with a wound upon discharge from an active military role and also to fit into civilian life. These lifestyle adjustments can tax the person's coping abilities and in that context may hinder successful adaptation. The experience of living with a wound or wounds, either acute or chronic, is connected to losses, including loss of mobility, loss of financial capacity (unable to work at times) and losses attached to changed social roles. Psychological stress is also a common experience for veterans returning to civilian life. Psychological stress is associated with impaired wound healing. Modern health practice is centred on symptom reduction and working with pathology, however, working with people's adaptive behaviours such as resilience has not been considered. Using the resilience model as a conceptual framework health-care professionals can engage with veterans towards resilience within the context of their personal experience of ill health. Using this contemporary framework for considering these aspects of care has the potential to facilitate resistance to stressors associated with being injured, possibly preventing quality-of-life impairments. DECLARATION OF INTEREST There are no declarations of interest.
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Affiliation(s)
- K-L Edward
- Faculty of Health Sciences, Australian Catholic University.,School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield
| | - K Ousey
- Faculty of Health Sciences, Australian Catholic University.,School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield
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Military Chronic Musculoskeletal Pain and Psychiatric Comorbidity: Is Better Pain Management the Answer? Healthcare (Basel) 2016; 4:healthcare4030038. [PMID: 27417626 PMCID: PMC5041039 DOI: 10.3390/healthcare4030038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/06/2016] [Accepted: 06/27/2016] [Indexed: 11/26/2022] Open
Abstract
Chronic musculoskeletal pain, such as low back pain, often appears in the presence of psychiatric comorbidities (e.g., depression, posttraumatic stress disorder (PTSD)), especially among U.S. military service members serving in the post-9/11 combat era. Although there has been much speculation about how to best address pain/trauma psychiatric symptom comorbidities, there are little available data to guide practice. The present study sought to examine how pre-treatment depression and PTSD influence outcomes in a functional restoration pain management program using secondary analysis of data from the Department of Defense-funded Functional and Orthopedic Rehabilitation Treatment (FORT) trial. Twenty-eight FORT completers were analyzed using a general linear model exploring how well depression and PTSD symptoms predict post-treatment pain (Visual Analog Scale (VAS) pain rating), disability (Oswestry Disability Index; Million Visual Analog Scale), and functional capacity (Floor-to-Waist and Waist-to-Eye Level progressive isoinertial lifting evaluation scores) in a sample of active duty military members with chronic musculoskeletal pain and comorbid depression or PTSD symptoms. Analysis revealed that pre-treatment depression and PTSD symptoms did not significantly predict rehabilitation outcomes from program completers. Implications of these findings for future research on trauma-related pain comorbidities are discussed.
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26
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Weeks M, Garber BG, Zamorski MA. Disability and Mental Disorders in the Canadian Armed Forces. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:56S-63S. [PMID: 27270743 PMCID: PMC4800473 DOI: 10.1177/0706743716628853] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The initial goal was to validate the use of a self-report measure of disability in the Canadian Armed Forces (CAF). The main goal was to document the extent of disability in personnel with and without mental disorders. METHODS Data were obtained from the 2013 Canadian Forces Mental Health Survey; the sample included 6700 Regular Forces personnel. Disability was measured with the 12-item version of the World Health Organization Disability Assessment Schedule (WHODAS-2); established cut points were used to demarcate severe, moderate, minimal, and no disability. The following recent (past-year) and remote (lifetime but not past-year) disorders were assessed with diagnostic interviews: posttraumatic stress disorder, major depressive episode, generalized anxiety disorder, panic disorder, and alcohol use disorder. RESULTS The WHODAS-2 showed good internal consistency (α = 0.89) and a 1-factor structure. Most personnel had no disability (59.2%) or minimal disability (30.8%). However, an important minority had moderate or severe disability (8.4% and 1.6%, respectively). Individuals with recent disorders reported greater disability than those without lifetime disorders, although many had minimal or no disability (41.2% and 24.7%, respectively). Disability increased with the number of recent disorders. Relative to those without lifetime disorders, individuals with remote disorders showed slightly greater disability, but most had no disabilty (57.1%) or minimal disability (35.0%). CONCLUSIONS The 12-item WHODAS-2 is a valid measure of disability in the CAF. Mental disorders may be important drivers of disability in this population, although limited residual disability is seen in individuals with remote disorders.
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Affiliation(s)
- Murray Weeks
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON
| | - Bryan G Garber
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON
| | - Mark A Zamorski
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON Department of Family Medicine, University of Ottawa, Ottawa, ON
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Stevelink SAM, Fear NT. Psychosocial impact of visual impairment and coping strategies in female ex-Service personnel. J ROY ARMY MED CORPS 2016; 162:129-33. [DOI: 10.1136/jramc-2015-000518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/12/2015] [Indexed: 11/03/2022]
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Stevelink SAM, Malcolm EM, Fear NT. Visual impairment, coping strategies and impact on daily life: a qualitative study among working-age UK ex-service personnel. BMC Public Health 2015; 15:1118. [PMID: 26563137 PMCID: PMC4643496 DOI: 10.1186/s12889-015-2455-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 10/26/2015] [Indexed: 11/25/2022] Open
Abstract
Background Sustaining a visual impairment may have a substantial impact on various life domains such as work, interpersonal relations, mobility and social and mental well-being. How to adjust to the loss of vision and its consequences might be a challenge for the visually impaired person. The purpose of the current study was to explore how younger male ex-Service personnel cope with becoming visually impaired and how this affects their daily life. Methods Semi-structured interviews with 30 visually impaired male ex-Service personnel, all under the age of 55, were conducted. All participants are members of the charity organisation Blind Veterans UK. Interviews were analysed thematically. Results Younger ex-Service personnel applied a number of different strategies to overcome their loss of vision and its associated consequences. Coping strategies varied from learning new skills, goal setting, integrating the use of low vision aids in their daily routine, to social withdrawal and substance misuse. Vision loss affected on all aspects of daily life and ex-Service personnel experienced an on-going struggle to accept and adjust to becoming visually impaired. Conclusions Health care professionals, family and friends of the person with the visual impairment need to be aware that coping with a visual impairment is a continuous struggle; even after a considerable amount of time has passed, needs for emotional, social, practical and physical support may still be present. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2455-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sharon A M Stevelink
- King's Centre for Military Health Research, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ, London, United Kingdom.
| | - Estelle M Malcolm
- King's Centre for Military Health Research, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ, London, United Kingdom.
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ, London, United Kingdom. .,Academic Department of Military Mental Health, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ, London, United Kingdom.
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Duffy JR, Warburg FE, Koelle SFT, Werner MU, Nielsen PR. Pain-related psychological distress, self-rated health and significance of neuropathic pain in Danish soldiers injured in Afghanistan. Acta Anaesthesiol Scand 2015; 59:1367-76. [PMID: 26132862 DOI: 10.1111/aas.12579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/21/2015] [Accepted: 06/04/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pain and mental health concerns are prevalent among veterans. While the majority of research has focused on chronic pain as an entity, there has been little work directed towards investigating the role of neuropathic pain in relation to psychological comorbidity. As such, we hypothesised that participants with signs of neuropathic pain would report higher levels of psychological distress and diminished self-rated health compared to those without a neuropathic component. METHODS A retrospective review of standardised questionnaires (PainDETECT Questionnaire, Post-traumatic Stress Disorder Checklist-Civilian, the Hospital Anxiety and Depression Scale, and EuroQOL Visual Analogue Scale) administered to injured soldiers. The participants were classified into three groups according to the PainDETECT questionnaire: non-neuropathic pain, possible neuropathic pain and definite neuropathic pain. RESULTS Fifty-three participants were included. The Post-traumatic Stress Disorder Checklist-Civilian score was in median (interquartile range) 26 (22-31), the Hospital Anxiety and Depression Scale score was 4 (2-6.5) and 2 (1-5) for anxiety and depression respectively. Evidence of neuropathic pain correlated positively with the Post-traumatic Stress Disorder Checklist-Civilian score (rho = 0.469, P < 0.001) and Hospital Anxiety and Depression Scale subscale for anxiety score (rho = 0.357, P = 0.009), and inversely with the EuroQOL Visual Analogue Scale score (rho = -0.361, P = 0.008). In multivariate regression analyses, the associations remained when adjusting for socio-demographics and clinical characteristics. CONCLUSIONS The results from the present study suggest that neuropathic pain is related to increased psychological distress and deterioration in self-rated health in injured soldiers.
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Affiliation(s)
- J. R. Duffy
- Multidisciplinary Pain Centre; Neuroscience Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - F. E. Warburg
- Department of Orthopaedic Surgery; Centre for Head and Orthopaedics; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - S.-F. T. Koelle
- Department of Plastic Surgery, Breast Surgery and Burns Treatment; Centre for Head and Orthopaedics; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - M. U. Werner
- Multidisciplinary Pain Centre; Neuroscience Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - P. R. Nielsen
- Multidisciplinary Pain Centre; Neuroscience Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
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Ladlow P, Phillip R, Etherington J, Coppack R, Bilzon J, McGuigan MP, Bennett AN. Functional and Mental Health Status of United Kingdom Military Amputees Postrehabilitation. Arch Phys Med Rehabil 2015; 96:2048-54. [PMID: 26254949 DOI: 10.1016/j.apmr.2015.07.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/20/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the functional and mental health status of severely injured traumatic amputees from the United Kingdom military at the completion of their rehabilitation pathway and to compare these data with the published normative data. DESIGN Retrospective independent group comparison of descriptive rehabilitation data recorded postrehabilitation. SETTING A military complex trauma rehabilitation center. PARTICIPANTS Amputees (N=65; mean age, 29±6 y) were evaluated at the completion of their rehabilitation pathway; of these, 54 were operationally (combat) injured (23 unilateral, 23 bilateral, 8 triple) and 11 nonoperationally injured (all unilateral). INTERVENTIONS Continuous ∼4-week inpatient, physician-led, interdisciplinary rehabilitation followed by ∼4-weeks of patient-led, home-based rehabilitation. MAIN OUTCOME MEASURES The New Injury Severity Score at the point of injury was used as the baseline reference. The 6-minute walk test, Amputee Mobility Predictor with Prosthesis, Special Interest Group in Amputee Medicine, Defence Medical Rehabilitation Centre mobility and activity of daily living scores as well as depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder Scale-7), mental health support, and pain scores were recorded at discharge and compared with the published normative data. RESULTS The mean New Injury Severity Score was 40±15. After 34±14 months of rehabilitation, amputees achieved a mean 6-minute walk distance of 489±117 m compared with age-matched normative distances of 459 to 738 m. The 2 unilateral groups walked (544 m) significantly further (P>.05) than did the bilateral amputee (445±104 m) and triple amputee (387±99 m) groups. All groups demonstrated mean functional mobility scores consistent with scores of either active adults or community ambulators with limb loss. In total, 85% could walk/run independently and 95% could walk and perform activities of daily living independently with an aid/adaptation. No significant difference in mental health outcome was reported between the groups (P>.05). At discharge, 98% of patients were able to control their pain. CONCLUSIONS Severely injured military amputees who completed intensive interdisciplinary rehabilitation achieved levels of physical function comparable with those in age-matched healthy adults. Mental health outcomes were indicative of preparedness for full integration back into society.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Headley, Epsom, Surrey, UK; Department for Health, University of Bath, Bath, UK
| | - Rhodri Phillip
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Headley, Epsom, Surrey, UK
| | - John Etherington
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Headley, Epsom, Surrey, UK
| | - Russell Coppack
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Headley, Epsom, Surrey, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
| | | | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Headley, Epsom, Surrey, UK.
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Stevelink SAM, Malcolm EM, Gill PC, Fear NT. The mental health of UK ex-servicemen with a combat-related or a non-combat-related visual impairment: does the cause of visual impairment matter? Br J Ophthalmol 2015; 99:1103-8. [PMID: 25908837 PMCID: PMC4518753 DOI: 10.1136/bjophthalmol-2014-305986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/25/2015] [Indexed: 11/05/2022]
Abstract
Aims Since the start of the conflicts in Iraq and Afghanistan, the numbers of young service personnel who have sustained a combat-related visual impairment have increased. This cross-sectional study examined the mental well-being of ex-servicemen (aged 22–55 years) with a visual impairment and determined if the mental health of those with a combat-related visual impairment differed from those whose visual impairment is not combat-related. Methods Male ex-service personnel with a visual impairment completed a telephone interview assessing the presence of depressive symptomatology, probable anxiety disorder, post-traumatic stress disorder (PTSD) symptomatology and alcohol misuse. Data were analysed using descriptive statistics. Results 77 participants were included in the study, reflecting a response rate of 76.2%. Of those with complete data (n=74), 20 ex-servicemen had a combat-related visual impairment. Among ex-service personnel with a combat-related visual impairment, 10.0% (95% CI 0 to 23.2) screened positive for a probable depression, 25.0% (95% CI 6.0 to 44.0) for probable anxiety and 10.0% (95% CI 0 to 23.2) for probable PTSD. The prevalence of probable depression and probable PTSD differed among those with a non-combat-related visual impairment, namely 18.5% (95% CI 8.1 to 28.9) and 16.7% (95% CI 6.8 to 26.7), respectively. Probable anxiety was 18.5% (95% CI 8.1 to 28.9) among non-combat-related visually impaired ex-service personnel. 45.0% (95% CI 23.2 to 66.8) of combat-related visually impaired personnel reported hazardous drinking, compared with 20.4% (95% CI 9.7 to 31.2) of those with a non-combat-related visual impairment. Conclusions Mental health problems were prevalent among visually impaired younger ex-servicemen. No statistically significant differences were found in the prevalence of mental health problems among ex-servicemen with a combat-related visual impairment compared with those with a non-combat-related visual impairment.
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Affiliation(s)
- Sharon A M Stevelink
- Department of Psychological Medicine, King's Centre for Military Health Research (KCMHR), King's College London, London, UK
| | - Estelle M Malcolm
- Department of Psychological Medicine, King's Centre for Military Health Research (KCMHR), King's College London, London, UK
| | - Pashyca C Gill
- King's College School of Medicine, King's College London, London, UK
| | - Nicola T Fear
- Department of Psychological Medicine, King's Centre for Military Health Research (KCMHR), King's College London, London, UK Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
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