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Kluge MG, Maltby S, Kuhne C, Walker N, Bennett N, Aidman E, Nalivaiko E, Walker FR. Evaluation of a Virtual Reality Platform to Train Stress Management Skills for a Defense Workforce: Multisite, Mixed Methods Feasibility Study. J Med Internet Res 2023; 25:e46368. [PMID: 37930751 PMCID: PMC10659241 DOI: 10.2196/46368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Psychological stress-related injuries within first-responder organizations have created a need for the implementation of effective stress management training. Most stress management training solutions have limitations associated with scaled adoption within the workforce. For instance, those that are effective in civilian populations often do not align with the human performance culture embedded within first-responder organizations. Programs involving expert-led instructions that are high in quality are often expensive. OBJECTIVE This study sought to evaluate a tailored stress management training platform within the existing training schedule of the Australian Defense Force (ADF). The platform, known as Performance Edge (PE), is a novel virtual reality (VR) and biofeedback-enabled stress management skills training platform. Focusing on practical training of well-established skills and strategies, the platform was designed to take advantage of VR technology to generate an immersive and private training environment. This study aimed to assess the feasibility of delivering the VR platform within the existing group-based training context and intended training population. In this setting, the study further aimed to collect data on critical predictors of user acceptance and technology adoption in education, including perceived usability, usefulness, and engagement, while also assessing training impacts. METHODS This study used a mixed methods, multisite approach to collect observational, self-reported, and biometric data from both training staff and trainers within a real-world "on-base" training context in the ADF. Validated scales include the Presence Questionnaire and User Engagement Scale for perceived usefulness, usability, and engagement, as well as the State Mindfulness Scale and Relaxation Inventory, to gain insights into immediate training impacts for specific training modules. Additional surveys were specifically developed to assess implementation feedback, intention to use skills, and perceived training impact and value. RESULTS PE training was delivered to 189 ADF trainees over 372 training sessions. The platform was easy to use at an individual level and was feasible to deliver in a classroom setting. Trainee feedback consistently showed high levels of engagement and a sense of presence with the training content and environment. PE is overall perceived as an effective and useful training tool. Self-report and objective indices confirmed knowledge improvement, increased skill confidence, and increased competency after training. Specific training elements resulted in increased state mindfulness, increased physical relaxation, and reduced breathing rate. The ability to practice cognitive strategies in a diverse, private, and immersive training environment while in a group setting was highlighted as particularly valuable. CONCLUSIONS This study found the VR-based platform (PE) to be a feasible stress management training solution for group-based training delivery in a defense population. Furthermore, the intended end users, both trainers and trainees, perceive the platform to be usable, useful, engaging, and effective for training, suggesting end-user acceptance and potential for technology adoption.
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Affiliation(s)
- Murielle G Kluge
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Steven Maltby
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Caroline Kuhne
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, Australia
| | - Nicole Walker
- Army School of Health, Australian Defence Force, Canberra, Australia
| | - Neanne Bennett
- Joint Health Command, Department of Defence, Canberra, Australia
| | - Eugene Aidman
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- Human and Decision Sciences Division, Defence Science & Technology Group, Edinburgh, Australia
| | - Eugene Nalivaiko
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Frederick Rohan Walker
- Centre for Advanced Training Systems, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences & Pharmacy, Faculty of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, Australia
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Abu-El-Noor MK, Abu-El-Noor NI, Alswerki M, Naim FN, Elessi KA, Al-Asmar YZ, Afifi T. Post-traumatic stress disorder among victims of great march of return in the Gaza Strip, Palestine: A need for policy intervention. Arch Psychiatr Nurs 2022; 36:48-54. [PMID: 35094825 DOI: 10.1016/j.apnu.2021.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 07/26/2021] [Accepted: 10/29/2021] [Indexed: 11/02/2022]
Abstract
This study aimed to assess the level of Post-Traumatic Stress Disorder (PSTD) and to examine the relationship between exposure to war stress and posttraumatic symptoms among people who were injured during the Great March of Return (GMR) in the Gaza Strip, Palestine. A sample of 264 adults who were injured during participation in the events of GMR completed the Impact Event Scale-Revised (IES-R). IES-R has three sub-scales; intrusion, avoidance, and hyper-arousal. Only 27.3% of the participants had two or more injuries and 38.4% of participants reported having disability due to their injuries. The results showed that 95.4% of the participants had severe posttraumatic symptoms. Total score of IES-R ranged between 29 and 88 (mean = 61.28). The most frequent symptoms of trauma subscales was "Intrusion" (mean = 2.90), followed by "Avoidance" (mean = 2.73), and then "Hyper-arousal" (mean = 2.70). Level of PTSD was affected by working status, need for hospitalization, need for a referral for treatment outside the Gaza Strip, disability and severity of injury. Such high level of PSTD will have negative consequences on participants' physical and mental status. Therefore, a need for special counseling programs is required to help them to survive with least consequences of PTSD on their wellbeing.
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Affiliation(s)
| | | | | | - Fadel N Naim
- Faculty of Medicine, Islamic University of Gaza, P.O. Box 108, Gaza, Gaza Strip, Palestine.
| | - Khamis A Elessi
- Faculty of Medicine, Islamic University of Gaza, P.O. Box 108, Gaza, Gaza Strip, Palestine.
| | | | - Tayseer Afifi
- Faculty of Medicine, Islamic University of Gaza, P.O. Box 108, Gaza, Gaza Strip, Palestine
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Strodl E, Shakespeare-Finch J, Alichniewicz KK, Brown K, Quinn C, Hides L, White A, Gossage G, Poerio L, Batras D, Jackson S, Styles J, Kavanagh DJ. Clinicians' perceptions of PTSD Coach Australia. Internet Interv 2020; 21:100333. [PMID: 32939341 PMCID: PMC7476854 DOI: 10.1016/j.invent.2020.100333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Applications or "mobile apps" are a potentially important source of assistance for serving and ex-serving Defence members with mental health problems. PTSD Coach Australia is a modified version of an application developed by the US Department of Veteran Affairs. Clinician perceptions of mobile apps are important as they influence the dissemination and adoption of apps. This study aimed to explore the perceptions of PTSD Coach Australia by clinicians with experience in assisting Defence members with mental health problems. METHOD The study involved two samples of participants who were asked about their perceptions of PTSD Coach Australia. The first involved 33 clinicians who participated in one of five focus groups. The second comprised 30 clinicians who were individually interviewed by telephone. Qualitative responses to questions regarding PTSD Coach Australia were analysed to identify representative themes. Participants in the focus group sample also rated the app on the user version of the Mobile Apps Rating Scale (uMARS). RESULTS On the uMARS, clinicians rated the mobile app's subjective quality as 'average' to 'good'. Participants generally saw the app as a useful to help track symptoms, improve engagement and help implement strategies between sessions. However, they also expressed concerns with the app not being user-friendly (e.g. too wordy, poor layout/navigation) and having technical issues (freezing or crashing on Android devices). DISCUSSION PTSD Coach Australia is generally seen as being acceptable and useful by mental health clinicians. However, it is important to include their concerns in future developments of PTSD Coach Australia and similar mobile apps in order to maximize their utilisation in Defence members.
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Affiliation(s)
- Esben Strodl
- Institute of Health & Biomedical Innovation, School of Psychology & Counselling, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia
| | - Jane Shakespeare-Finch
- Institute of Health & Biomedical Innovation, School of Psychology & Counselling, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia
| | - Karolina K. Alichniewicz
- Centre for Children's Health Research, Queensland University of Technology, 62 Raymond Terrace, South Brisbane, Qld 4101, Australia
| | - Kelly Brown
- Centre for Children's Health Research, Queensland University of Technology, 62 Raymond Terrace, South Brisbane, Qld 4101, Australia
| | - Catherine Quinn
- Lives Lived Well Research Group, School of Psychology, University of Queensland, St Lucia, Qld 4072, Australia
| | - Leanne Hides
- Lives Lived Well Research Group, School of Psychology, University of Queensland, St Lucia, Qld 4072, Australia
| | - Angela White
- Royal Brisbane & Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Gabrial Gossage
- Department of Veterans' Affairs, GPO Box 9998, Brisbane, QLD 4001, Australia
| | - Loretta Poerio
- Department of Veterans' Affairs, GPO Box 9998, Brisbane, QLD 4001, Australia
| | - Dimitri Batras
- Department of Veterans' Affairs, GPO Box 9998, Brisbane, QLD 4001, Australia
- Attained Success Consulting, GPO Box 2728, Melbourne, Vic 3001, Australia
| | - Samantha Jackson
- Mental Health Strategy & Research, Joint Health Command, CP3-7-100, Northcott Drive, Campbell, ACT 2600, Australia
| | - Jess Styles
- Mental Health Strategy & Research, Joint Health Command, CP3-7-100, Northcott Drive, Campbell, ACT 2600, Australia
| | - David J. Kavanagh
- Institute of Health & Biomedical Innovation, School of Psychology & Counselling, Queensland University of Technology, GPO Box 2434, Brisbane, Qld 4001, Australia
- Centre for Children's Health Research, Queensland University of Technology, 62 Raymond Terrace, South Brisbane, Qld 4101, Australia
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Duparc S, Chalon S, Miller S, Richardson N, Toovey S. Neurological and psychiatric safety of tafenoquine in Plasmodium vivax relapse prevention: a review. Malar J 2020; 19:111. [PMID: 32169086 PMCID: PMC7071640 DOI: 10.1186/s12936-020-03184-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/06/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Tafenoquine is an 8-aminoquinoline anti-malarial drug recently approved as a single-dose (300 mg) therapy for Plasmodium vivax relapse prevention, when co-administered with 3-days of chloroquine or other blood schizonticide. Tafenoquine 200 mg weekly after a loading dose is also approved as travellers' prophylaxis. The development of tafenoquine has been conducted over many years, using various dosing regimens in diverse populations. METHODS This review brings together all the preclinical and clinical data concerning tafenoquine central nervous system safety. Data were assembled from published sources. The risk of neuropsychiatric adverse events (NPAEs) with single-dose tafenoquine (300 mg) in combination with chloroquine to achieve P. vivax relapse prevention is particularly examined. RESULTS There was no evidence of neurotoxicity with tafenoquine in preclinical animal models. In clinical studies in P. vivax relapse prevention, nervous system adverse events, mainly headache and dizziness, occurred in 11.4% (36/317) of patients with tafenoquine (300 mg)/chloroquine versus 10.2% (19/187) with placebo/chloroquine; and in 15.5% (75/483) of patients with tafenoquine/chloroquine versus 13.3% (35/264) with primaquine (15 mg/day for 14 days)/chloroquine. Psychiatric adverse events, mainly insomnia, occurred in 3.8% (12/317) of patients with tafenoquine/chloroquine versus 2.7% (5/187) with placebo/chloroquine; and in 2.9% (14/483) of patients with tafenoquine/chloroquine versus 3.4% (9/264) for primaquine/chloroquine. There were no serious or severe NPAEs observed with tafenoquine (300 mg)/chloroquine in these studies. CONCLUSIONS The risk:benefit of single-dose tafenoquine/chloroquine in P. vivax relapse prevention is favourable in the presence of malaria, with a low risk of NPAEs, similar to that seen with chloroquine alone or primaquine/chloroquine.
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Affiliation(s)
- Stephan Duparc
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Geneva 15, Switzerland.
| | - Stephan Chalon
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Geneva 15, Switzerland
| | | | | | - Stephen Toovey
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Geneva 15, Switzerland.,Pegasus Research, London, UK
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Graham K, Searle A, Van Hooff M, Lawrence-Wood E, McFarlane A. The Associations Between Physical and Psychological Symptoms and Traumatic Military Deployment Exposures. J Trauma Stress 2019; 32:957-966. [PMID: 31774592 DOI: 10.1002/jts.22451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 01/08/2023]
Abstract
Current paradigms regarding the effects of traumatic exposures on military personnel do not consider physical symptoms unrelated to injury or illness as independent outcomes of trauma exposure, characteristically dealing with these symptoms as comorbidities of psychological disorders. Our objective was to ascertain the proportions of deployed military personnel who experienced predominantly physical symptoms, predominantly psychological symptoms, and comorbidity of the two and to examine the association between traumatic deployment exposures (TDEs) and these symptomatic profiles. Data were taken from a cross-sectional study of Australian Defence Force personnel who were deployed to the Middle East during 2001-2009 (N = 14,032). Four groups were created based on distributional splits of physical and psychological symptom scales: low-symptom, psychological, physical, and comorbid. Multinomial logistic regression models assessed the probability of symptom group membership, compared with low-symptom, as predicted by self-reported TDEs. Group proportions were: low-symptom, 78.3%; physical, 5.0%; psychological, 9.3%; and comorbid, 7.5%. TDEs were significant predictors of all symptom profiles. For subjective, objective, and human death and degradation exposures, respectively, the largest relative risk ratios (RRRs) were for the comorbid profile, RRRs = 1.47, 1.19, 1.48; followed by the physical profile, RRRs = 1.27, 1.15, 1.40; and the psychological profile, RRRs = 1.22, 1.07, 1.22. Almost half of participants with physical symptoms did not have comorbid psychological symptoms, suggesting that physical symptoms can occur as a discrete outcome trauma exposure. The similar dose-response association between TDEs and the physical and psychological profiles suggests trauma is similarly associated with both outcomes.
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Affiliation(s)
- Kristin Graham
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, Australia
| | - Amelia Searle
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, Australia
| | - Ellie Lawrence-Wood
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, Australia
| | - Alexander McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, Australia
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Graham K, Dipnall J, Van Hooff M, Lawrence-Wood E, Searle A, Ao AM. Identifying clusters of health symptoms in deployed military personnel and their relationship with probable PTSD. J Psychosom Res 2019; 127:109838. [PMID: 31698167 DOI: 10.1016/j.jpsychores.2019.109838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Among military personnel posttraumatic stress disorder is strongly associated with non-specific health symptoms and can have poor treatment outcomes. This study aimed to use machine learning to identify and describe clusters of self-report health symptoms and examine their association with probable PTSD, other psychopathology, traumatic deployment exposures, and demographic factors. METHOD Data were from a large sample of military personnel who deployed to the Middle East (n = 12,566) between 2001 and 2009. Participants completed self-report measures including health symptoms and deployment trauma checklists, and several mental health symptom scales. The data driven machine learning technique of self-organised maps identified health symptom clusters and logistic regression examined their correlates. RESULTS Two clusters differentiated by number and severity of health symptoms were identified: a small 'high health symptom cluster' (HHSC; n = 366) and a large 'low health symptom cluster' (LHSC; n = 12,200). The HHSC had significantly higher proportions of (Gates et al., 2012 [1]) scaled scores indicative of PTSD (69% compared with 2% of LHSC members), Unwin et al. (1999a) [2] scores on other psychological scales that were indicative of psychopathology, and (Graham et al., n.d. [3]) deployment trauma. HHSC members with probable PTSD had a stronger relationship with subjective (OR 1.25; 95% CI 1.12, 1.40) and environmental (OR 1.08; 95% CI 1.03, 1.13) traumatic deployment exposures than LHSC members with probable PTSD. CONCLUSION These findings highlights that health symptoms are not rare in military veterans, and that PTSD is strongly associated with health symptoms. Results suggest that there may be subtypes of PTSD, differentiated by health symptoms.
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Affiliation(s)
- Kristin Graham
- Centre for Traumatic Stress studies, The University of Adelaide, Level 1/30 Frome Rd, Adelaide, SA 5000, Australia.
| | - Joanna Dipnall
- Research Fellow, Pre-hospital, Emergency and Trauma Unit., Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress studies, The University of Adelaide, Level 1/30 Frome Rd, Adelaide, SA 5000, Australia
| | - Ellie Lawrence-Wood
- Centre for Traumatic Stress studies, The University of Adelaide, Level 1/30 Frome Rd, Adelaide, SA 5000, Australia
| | - Amelia Searle
- Centre for Traumatic Stress studies, The University of Adelaide, Level 1/30 Frome Rd, Adelaide, SA 5000, Australia
| | - Alexander McFarlane Ao
- Centre for Traumatic Stress studies, The University of Adelaide, Level 1/30 Frome Rd, Adelaide, SA 5000, Australia
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Graham K, Searle A, Van Hooff M, Lawrence-Wood E, McFarlane A. The Value of Physical Symptoms in Screening For Posttraumatic Stress Disorder in the Military. Assessment 2019; 27:1139-1150. [PMID: 31328529 DOI: 10.1177/1073191119864662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physical symptoms are highly comorbid with posttraumatic stress disorder (PTSD). As PTSD is underdiagnosed, this study explored the value of self-reported physical symptoms in screening for 30-day PTSD in military personnel. Two physical symptom scales were constructed using items from a 67-item health symptom checklist, clinical interviews were used as the diagnostic reference standard, and diagnostic utility of physical symptoms was compared with the current gold standard screen, the PTSD checklist (PCL). Receiver operating characteristic analyses showed that both a 9-item and a 10-item physical symptom scale were of value in predicting PTSD (areas under the curve 0.81 and 0.85). Importantly, two thirds of PTSD positive personnel missed by the PCL were captured with physical symptoms scales, and when physical symptoms were added to the PCL, prediction was improved (areas under the curve 0.90 to 0.92). Our findings highlight the value of including assessing physical symptoms in PTSD screening.
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Affiliation(s)
- Kristin Graham
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Amelia Searle
- The University of Adelaide, Adelaide, South Australia, Australia
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Bøg M, Filges T, Jørgensen AMK. Deployment of personnel to military operations: impact on mental health and social functioning. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-127. [PMID: 37131363 PMCID: PMC8427986 DOI: 10.4073/csr.2018.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This Campbell systematic review examines the effects of deployment on mental health. The review summarizes evidence from 185 studies. All studies used observational data to quantify the effect of deployment. This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment). Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. Plain language summary Deployment to military operations negatively affects the mental health functioning of deployed military personnel: While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel.What is this review about?: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health.The primary condition under consideration is deployment to an international military operation. Deployment to a military operation is not a uniform condition; rather, it covers a range of scenarios. Military deployment is defined as performing military service in an operation at a location outside the home country for a limited time period, pursuant to orders.The review included studies that reported outcomes for individuals who had been deployed. This review looked at the effect of deployment on mental health outcomes. The mental health outcomes are: post-traumatic stress disorder (PTSD), major depressive disorder (MDD), common mental disorders (depression, anxiety and somatisation disorders) and substance-related disorders.By identifying the major effects of deployment on mental health and quantifying these effects, the review can inform policy development on deployment and military activity as well as post-deployment support for veterans. In this way the review enables decision-makers to prioritise key areas.What are the main findings of this review?: What studies are included?: This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment).Does deployment have an effect on mental health?: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive.What do the findings of this review mean?: The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long-lasting.Overall the risk of bias in the majority of included studies was high. While it is difficult to imagine a randomised study design to understand how deployment affects mental health, other matters such as changes to personnel policy, or unanticipated shocks to the demand for military personnel, could potentially be a rich source of quasi-experimental variation.How up-to-date is this review?: The review authors searched for studies up to 2017. This Campbell systematic review was published in March 2018. Executive summary BACKGROUND: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health. Research suggests that the increased risk to mental health is mainly due to the hazards of war, combat exposure: firing weapons, road side bombs, seeing fellow soldiers, friends, civilians, and enemies being injured, maimed or killed. These experiences may lead to severe mental stress. The adverse impact on mental health is the psychological cost of war, and it is of interest to policymakers to learn the magnitude of these effects. This review sets out to synthesise available evidence about the consequences of deployment for deployed military personnel in the mental health and social functioning domains.OBJECTIVES: The objective of this review isto synthesise the consequences of deployment to military operation on the mental health and social functioning of deployed military personnel.SEARCH METHODS: We searched electronic databases, grey literature, and references from primary studies and related reviews. No language or date restrictions were applied to the searches. We searched the following electronic databases: Academic Search Elite, Cochrane Library, EMBASE, ERIC, MEDLINE, PsycINFO, Science Citation Index, Social Science Citation Index, SocINDEX, as well as the Nordic platforms: bibliotek.dk, BIBSYS, and LIBRIS. The conclusions of this review are based on the most recent searches performed. The last search was performed in April 2017.SELECTION CRITERIA: Primary studies had to meet the following inclusion criteria: Participants: The participants should be military personnel.Intervention: The condition should be deployment to a military operation.Comparison: The relevant comparisons were either comparing a) deployed military personnel to non-deployed military personnel, b) deployed military personnel to military personnel deployed elsewhere, for example personnel deployed to non-combat operations, c) military personnel deployed to the same operation but stratified by combat exposure.Outcomes: The study should report on one or more mental health outcomes, and/or social functioning for the deployed participants. In particular studies should report on one or more of the following mental health outcomes: PTSD, major depression, substance abuse or dependence (including alcohol), and common mental disorders (depression and anxiety disorders). The following social functioning outcomes were relevant: employment, and homelessness.Study Designs: Both experimental and quasi-experimental designs with a comparison group were eligible for inclusion in the review. Studies were excluded if they: Reported on deployments taking place before 1989.Used a within group pre-post study design.Did not report on at least one of the mental health or social functioning outcomes. DATA COLLECTION AND ANALYSIS: The total number of potentially relevant studies constituted31,049records. A total of 185 studies met the inclusion criteria and were critically appraised by the review authors. The final selection of 185 studies was from 13 different countries.Forty eight of the 185 studies did not report effect estimates or provide data that would allow the calculation of an effect size and standard error. Fifty four studies were excluded because of overlapping samples. The majority of those studies were from USA but the main reason for not using studies from USA in the synthesis was lack of information to calculate an effect size. Nearly half the studies from the UK could not be used in the synthesis due to overlap of data samples. Forty three studies were judged to have a very high risk of bias (5 on the scale) and, in accordance with the protocol, we excluded these from the data synthesis on the basis that they would be more likely to mislead than inform., Thus a total of 40 studies, from five different countries, were included in the data synthesis.Random effects models were used to pool data across the studies. We used the odds ratio. Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were calculated. The meta-analyses were carried out by time since exposure (short, medium, long, and other time since exposure) and by type of comparison (deployed versus non-deployed, all deployed but stratified by either combat operations versus non-combat operations, or stratified by combat exposure). We performed single factor subgroup analysis. The assessment of any difference between subgroups was based on 95% confidence intervals. Funnel plots were used to assess the possibility of publication bias. Sensitivity analysis was used to evaluate whether the pooled effect sizes were robust across components of methodological quality.MAIN RESULTS: The findings were mixed, depending on the outcome, the time since exposure and the approach (deployed versus non-deployed termed absolute or stratified by extent of combat termed relative) used to investigate the effect. It was not possible to analyse the outcomes homelessness and employment. All studies that could be used in the data synthesis reported on the impact of deployment on mental health; PTSD, depression, substance use or common mental disorder.For assessments taken less than 24 months since exposure the evidence was inconclusive either because too few studies reported results in the short and medium term and/or the degree of heterogeneity between studies was large.For assessments taken at other time points (a variable number of months since exposure) the evidence was inconclusive for the relative comparisons due to either too few studies or a substantial degree of heterogeneity between studies. For the absolute comparison the analysis of common mental disorder was inconclusive, whereas the average effects of PTSD and depression were positive and statistically significant (PTSD odds ratio (OR) was 1.91 (95% confidence interval (CI): 1.28 to 2.85) and OR=1.98 (95% CI: 1.05 to 3.70) for depression). The analysis concerning substance use indicated that deployed participants did not have higher odds of screening positive for substance use compared to non-deployed participants (OR=1.15 (95% CI: 0.98 to 1.36)).For assessments taken more than 24 months post exposure, meta-analyses indicated that the odds of screening positive for PTSD, depression, substance use and common mental disorder were higher for participants in the deployed group compared to participants in the group that were not deployed (PTSD OR=3.31 (95% CI: 2.69 to 4.07), OR=2.19 (95% CI: 1.58 to 3.03) for depression, OR=1.27 (95% CI: 1.15 to 1.39) for substance use, and OR=1.64 (95% CI: 1.38 to 1.96) for common mental disorder). Likewise, participants reporting high combat exposure had higher odds of screening positive for PTSD and depression than participants reporting lower exposure for long term assessments (PTSD OR=3.05 (95% CI: 1.94 to 4.80) and OR=1.81 (95% CI: 1.28 to 2.56) for depression). The analyses of substance use and common mental disorder were inconclusive due to too few studies.On the basis of the prevalence of mental health problems in pre-deployed or non-deployed population based comparison sampleswe would therefore expect the long term prevalence of PTSD in post-deployed samples to be in the range 6.1 - 14.9%, the long term prevalence of depression to be in the range from 7.6% to 18%, the long term prevalence of substance use to be in the range from 2.4% to 17.5% and the prevalence of common mental disorder to be in the range from 10% to 23%.Sensitivity analyses resulted in no appreciable change in effect size, suggesting that the results are robust.It was only possible to assess the impact of two types of personnel characteristics (branch of service and duty/enlistment status) on the mental health outcomes. We found no evidence to suggest that the effect of deployment on any outcomes differ between these two types of personnel characteristics.AUTHORS' CONCLUSIONS: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. We focused on the effect of deployment on PTSD (post-traumatic stress disorder), depression, substance abuse/dependence, and common mental disorders (depression and anxiety disorders). For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all domains, particularly on PTSD. There is increased political awareness of the need to address post deployment mental health problems. The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long lasting. Mental illness is of particular concern in the military for operational reasons, but they may be hard to detect in the military setting because a military career is intimately linked with mental and physical strength.It was not possible to examine a number of factors which we had reason to expect would impact on the magnitude of the effect. This would have been particularly relevant from a policy perspective because these are direct parameters that one could use to optimally "organize" deployment in order to minimize impacts on mental health functioning.While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel. The next step is to begin to examine preventive measures and policies for organizing deployment, in order to minimize the effects on mental health.
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Sudom K, Watkins K, Born J, Zamorski M. Stressors Experienced During Deployment Among Canadian Armed Forces Personnel: Factor Structure of Two Combat Exposure Scales. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kerry Sudom
- Department of National Defence, Defence Research and Development Canada, Ontario, Canada
| | - Kimberley Watkins
- Department of National Defence, Defence Research and Development Canada, Ontario, Canada
| | - Jennifer Born
- Department of National Defence, Defence Research and Development Canada, Ontario, Canada
| | - Mark Zamorski
- Department of National Defence, Canadian Forces Health Services Group HQ, Ontario, Canada
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Association of Stressful Life Events with Psychological Problems: A Large-Scale Community-Based Study Using Grouped Outcomes Latent Factor Regression with Latent Predictors. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2017; 2017:3457103. [PMID: 29312459 PMCID: PMC5625761 DOI: 10.1155/2017/3457103] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 11/21/2022]
Abstract
Objective The current study is aimed at investigating the association between stressful life events and psychological problems in a large sample of Iranian adults. Method In a cross-sectional large-scale community-based study, 4763 Iranian adults, living in Isfahan, Iran, were investigated. Grouped outcomes latent factor regression on latent predictors was used for modeling the association of psychological problems (depression, anxiety, and psychological distress), measured by Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ-12), as the grouped outcomes, and stressful life events, measured by a self-administered stressful life events (SLEs) questionnaire, as the latent predictors. Results The results showed that the personal stressors domain has significant positive association with psychological distress (β = 0.19), anxiety (β = 0.25), depression (β = 0.15), and their collective profile score (β = 0.20), with greater associations in females (β = 0.28) than in males (β = 0.13) (all P < 0.001). In addition, in the adjusted models, the regression coefficients for the association of social stressors domain and psychological problems profile score were 0.37, 0.35, and 0.46 in total sample, males, and females, respectively (P < 0.001). Conclusion Results of our study indicated that different stressors, particularly those socioeconomic related, have an effective impact on psychological problems. It is important to consider the social and cultural background of a population for managing the stressors as an effective approach for preventing and reducing the destructive burden of psychological problems.
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Madsen T, Sadowa Vedtofte M, Nordentoft M, Ravnborg Nissen L, Bo Andersen S. Comparing post-deployment mental health services utilization in soldiers deployed to Balkan, Iraq and Afghanistan. Acta Psychiatr Scand 2017; 135:564-572. [PMID: 28466972 DOI: 10.1111/acps.12736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Insight on how different missions have impacted rates of mental health service (MHS) utilization is unexplored. We compared postdeployment MHS utilization in a national cohort of first-time deployed to missions in Balkan, Iraq, and Afghanistan respectively. METHODS A prospective national cohort study of 13 246 first-time deployed in the period 1996 through 2012 to missions in Balkan area, Iraq, or Afghanistan respectively. Soldiers 'MHS utilization was also compared with a 5:1 sex-, age-, and calendar year-matched never-deployed background population. Postdeployment utilization of MHS was retrieved from national coverage registers. Using Cox survival analyses, participants were followed and compared with regard to receiving three different types of psychiatric services: (i) admission to psychiatric hospital, (ii) psychiatric outpatient contact, and (iii) prescriptions of psychotropics. RESULTS Utilizing of psychiatric outpatient services and psychotropics was significantly higher in first-time deployed to Iraq and Afghanistan compared with deployed to Balkan. However, the rate of postdeployment admission to psychiatric hospital did not differ between missions. Postdeployment rates of psychiatric admission and psychiatric outpatient treatment were significantly higher in Afghanistan-deployed personnel compared with the background population. CONCLUSIONS Utilization of MHS differed significantly between mission areas and was highest after the latest mission to Afghanistan.
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Affiliation(s)
- T Madsen
- Psychiatric Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - M Sadowa Vedtofte
- The Danish Veteran Centre, Research and Knowledge Centre, Ringsted, Denmark
| | - M Nordentoft
- Psychiatric Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - L Ravnborg Nissen
- The Danish Veteran Centre, Research and Knowledge Centre, Ringsted, Denmark
| | - S Bo Andersen
- The Danish Veteran Centre, Research and Knowledge Centre, Ringsted, Denmark
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Tafenoquine for malaria prophylaxis in adults: An integrated safety analysis. Travel Med Infect Dis 2017; 17:19-27. [PMID: 28495354 DOI: 10.1016/j.tmaid.2017.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tafenoquine is a new prophylactic antimalarial drug. The current analysis presents an integrated safety assessment of the Tafenoquine Anticipated Clinical Regimen (Tafenoquine ACR) from 5 clinical trials, including 1 conducted in deployed military personnel and 4 in non-deployed residents, which also incorporated placebo and mefloquine comparator groups. METHODS Adverse events (AEs) were coded according to the Medical Dictionary for Regulatory Activities (MedDRA®, Version 15.0) and summarized. Among all subjects who had received the Tafenoquine ACR, safety findings were compared for subjects who were deployed military personnel from the Australian Defence Force (Deployed ADF) versus non-deployed residents (Resident Non-ADF). RESULTS The incidence of at least one AE was 80.6%, 64.1%, 67.6% and 94.9% in the mefloquine, placebo, tafenoquine Resident Non-ADF and tafenoquine Deployed ADF groups, respectively. The latter group had a higher incidence of AEs related to military deployment. AEs that occurred at ≥ 1% incidence in both tafenoquine sub-groups and at a higher frequency than placebo included diarrhea, nausea, vomiting, gastroenteritis, nasopharyngeal tract infections, and back/neck pain. CONCLUSIONS Weekly administration of tafenoquine for up to six months increased the incidence of gastrointestinal AEs, certain infections, and back/neck pain, but not the overall incidence of AEs versus placebo. CLINICAL TRIAL REGISTRATION NUMBERS/CLINICALTRIALS. GOV IDENTIFIERS NCT02491606; NCT02488980; NCT02488902.
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Abstract
AIMS Understanding the time-course of post-traumatic stress disorder (PTSD), and the underlying events, may help to identify those most at risk, and anticipate the number of individuals likely to be diagnosed after exposure to traumatic events. METHOD Data from two health surveys were combined to create a cohort of 1119 Australian military personnel who deployed to the Middle East between 2000 and 2009. Changes in PTSD Checklist Civilian Version (PCL-C) scores and the reporting of stressful events between the two self-reported surveys were assessed. Logistic regression was used to examine the association between the number of stressful events reported and PTSD symptoms, and assess whether those who reported new stressful events between the two surveys, were also more likely to report older events. We also assessed, using linear regression, whether higher scores on the Kessler Psychological Distress Scale or the Alcohol Use Disorder Identification Test were associated with subsequent increases in the PCL-C in those who had experienced a stressful event, but who initially had few PTSD symptoms. RESULTS Overall, the mean PCL-C scores in the two surveys were similar, and 78% of responders stayed in the same PCL-C category. Only a small percentage moved from having few symptoms of PTSD (PCL-C < 30) in Survey 1 to meeting the criteria for PTSD (PCL-C ≥ 50) at Survey 2 (1% of all responders, 16% of those with PCL-C ≥ 50 at Survey 2). Personnel who reported more stressful lifetime events were more likely to score higher on the PCL-C. Only 51% reported the same stressful event on both surveys. People who reported events occurring between the two surveys were more likely to record events from before the first survey which they had not previously mentioned (OR 1.48, 95% CI (1.17, 1.88), p < 0.001), than those who did not. In people who initially had few PTSD symptoms, a higher level of psychological distress, was significantly associated with higher PCL-C scores a few years later. CONCLUSIONS The reporting of stressful events varied over time indicating that while the impact of some stressors endure, others may increase or decline in importance. When screening for PTSD, it is important to consider both traumatic experiences on deployment and other stressful life events, as well as other mental health problems among military personnel, even if individuals do not exhibit symptoms of PTSD on an initial assessment.
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Zhou Z, Liu T, Zhang Z. Skin disease in United Nations peacekeepers in Lebanon. J ROY ARMY MED CORPS 2016; 163:27-30. [DOI: 10.1136/jramc-2015-000601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/09/2015] [Indexed: 01/01/2023]
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Abstract
BACKGROUND Volunteering in international military missions has been scrutinized for its effects on mental health. Different kinds of exposures to traumatic events are associated with a variety of mental disorders, mainly heightened rates of post-traumatic stress disorder (PTSD) and alcohol abuse. AIMS Based on the literature we discuss risk and protective factors concerning the psychological well-being of soldiers attending to international military operations. METHODS A systematic literature search was carried out using relevant search terms to identify the articles for this review. RESULTS AND CONCLUSIONS The ability to recognize and treat acute stress reactions during deployments is important. Post-deployment psychosocial support and services have a role in lowering barriers to care, diminishing stigma and also in recognizing individuals who suffer from psychological distress or psychiatric symptoms, to connect them with appropriate care. Further investigation of gender differences and the role of stigmatization is warranted. Most of those participating in international military operations are repatriated without problems, but repeated exposure to combat situations and other stressors may affect mental health in various ways. Stigmatization is still a barrier to care.
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Affiliation(s)
- Noora M Kaikkonen
- a Noora M. Kaikkonen, Centre for Military Medicine, Finnish Defence Forces , Helsinki , Finland
| | - Tanja Laukkala
- b Tanja Laukkala, Field Medicine Services Unit, Centre for Military Medicine, Finnish Defence Forces , Helsinki , Finland
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Abstract
Peacekeeping operations are but one aspect of the systems of peace that have evolved over the past seven decades in a world that is riven with violence of all kinds. With the end of cold war in the late eighties of the last century we have come to see much intrastate violence, in addition to usual interstate hostilities and war, arising out of religious, political, ethnic and economic differences between people. In the changed scenario peacekeeping operations have become complex politico-military-humanitarian efforts. A soldier, trained for conventional military operations, is obliged to participate in the unconventional operations of waging peace in alien lands often in volatile and violent situations and in the process he stands to get exposed to widely variable demands for adjustment that have the potential to bring to the fore many maladaptive responses. Peacekeeping operations also have the potential to offer opportunities for growth and resilience. India is a major player in peacekeeping activities for well over sixty years all over the world. It is necessary for the commanders and mental health professionals to understand the multifarious factors that impinge on the peacekeeping soldier's mind and the emerging patterns of responses thereof for effective management trained manpower and fulfillment of mission objectives.
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Affiliation(s)
- M S V K Raju
- Department of Psychiatry, Peoples College of Medical Sciences and Research Centre, Bhopal, India
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Shaar KH. Post-traumatic stress disorder in adolescents in Lebanon as wars gained in ferocity: a systematic review. J Public Health Res 2013; 2:e17. [PMID: 25170488 PMCID: PMC4147728 DOI: 10.4081/jphr.2013.e17] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/14/2013] [Indexed: 12/12/2022] Open
Abstract
Significance for public health Post traumatic stress disorder (PTSD) in adolescents has been implicated in developmental impairments, mental and scholastic problems, alcohol and drug abuse, and antisocial behavior in its victims among others. Absence of review studies regarding the prevalence of PTSD in adolescents in Lebanon, a country plagued by decades of civil strife and external occupation and invasion, is noted. Such information may reinforce the need to develop national public health policies to identify PTSD in children and adolescents, provide them with counseling and treatment, and formulate prevention strategies to protect vulnerable youth from devastations of war. For decades, Lebanon was war-torn by civil strife, and occupation and invasion by neighboring countries. In time, these wars have escalated in intensity from sniping, barricading streets and random shelling of residential quarters to the use of rockets, aerial bombing, and heavy artillery. Adverse mental health effects are noted in times of war with post traumatic stress disorder (PTSD) as a main outcome. The aim of this study was to carry out a systematic review of published studies documenting the prevalence of PTSD in the adolescent population of Lebanon, to investigate the increase in these rates with the escalation of war intensity, and to examine PTSD determinants. A search strategy was developed for online databases (PubMed and Google Scholar) between inception to the first week of January 2013. Search terms used were PTSD, adolescents and Lebanon. Eleven studies reporting PTSD in adolescents met the inclusion criteria for a total number of 5965 adolescents. Prevalence rates of PTSD ranged from 8.5% to 14.7% for the civil war, 3.7% for adolescents with sensory disabilities, 21.6% for the Grapes of Wrath War, and 15.4% to 35.0% for the 2006 July War. Some increase in PTSD rates in time is noted. Type of trauma such as bereavement, injury, house destruction, and economic problems, low self efficacy and scholastic impairment were related to PTSD. These findings may help in the development of public health policies for PTSD prevention and treatment for the protection of adolescents from war atrocities and their consequences.
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