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McKenzie A, Burdett H, Croak B, Rafferty L, Greenberg N, Stevelink SAM. Adjustment disorder in the Armed Forces: a systematic review. J Ment Health 2023; 32:962-984. [PMID: 36330797 DOI: 10.1080/09638237.2022.2140792] [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: 02/10/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the UK military, adjustment disorder (AjD) is reported as one of the most diagnosed mental disorders, alongside depression, in personnel presenting to mental health services. Despite this, little is understood about what may predict AjD, common treatment or outcomes for this population. AIM The systematic review aimed to summarise existing research for AjD in Armed Forces (AF) populations, including prevalence and risk factors, and to outline clinical and occupational outcomes. METHOD A literature search was conducted in December 2020 to identify research that investigated AjD within an AF population (serving or veteran) following the PRISMA guidelines. RESULTS Eighty-three studies were included in the review. The AjD prevalence estimates in AF populations with a mental disorder was considerably higher for serving AF personnel (34.9%) compared to veterans (12.8%). Childhood adversities were identified as a risk factor for AjD. AjD was found to increase the risk of suicidal ideation, with one study reporting a risk ratio of 4.70 (95% Confidence Interval: 3.50-6.20). Talking therapies were the most common treatment for AjD, however none reported on treatment effectiveness. CONCLUSION This review found that AjD was commonly reported across international AF. Despite heterogeneity in the results, the review identifies several literature gaps.
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Affiliation(s)
- Amber McKenzie
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Howard Burdett
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Bethany Croak
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Laura Rafferty
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Jones N, Fear NT, Wessely S, Thandi G, Greenberg N. The long term occupational fitness of UK military personnel following community mental health care. J Ment Health 2017. [PMID: 28649884 DOI: 10.1080/09638237.2017.1340596] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fitness to undertake operational deployment is a key requirement of military service. AIM To assess individual deployment fitness at a single point from one month to eight years following discharge from mental healthcare. METHOD Survival analyses assessed levels of deployability; the predictive effects of key covariates upon time to being classified as non-deployable were examined using univariate and multivariate Cox proportional hazards regression procedures. RESULTS A total of 1405 individuals provided study data. 437 individuals (31.1%) were non-deployable or discharged from service during follow-up. 17.2% were non-deployable in the first year following mental healthcare; the proportion did not rise above this level until year seven when it was 19.1% and then 30.6% in year eight. Risk factors for being classified as non-deployable were female sex, receipt of intermediate duration therapy, management by the multidisciplinary team and previous referral to mental health services. Previous deployment was significantly associated with reduced risk. Overall, the levels of non-deployability appeared to be no higher than those found among the wider military services. CONCLUSION Non-deployable status among mental healthcare recipients was broadly similar to that found among the wider UK military; risk factors for non-deployability could be amenable to targeted relapse prevention measures.
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Affiliation(s)
| | | | - Simon Wessely
- b Academic Department of Psychological Medicine , Institute of Psychiatry, Weston Education Centre , London , United Kingdom , and.,c King's Centre for Military Health Research , London , United Kingdom
| | | | - Neil Greenberg
- a Academic Department of Military Mental Health.,b Academic Department of Psychological Medicine , Institute of Psychiatry, Weston Education Centre , London , United Kingdom , and
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Forward psychiatry - early intervention for mental health problems among UK armed forces in Afghanistan. Eur Psychiatry 2016; 39:66-72. [PMID: 27816610 DOI: 10.1016/j.eurpsy.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This observational study examined return to duty (RTD) rates following receipt of early mental health interventions delivered by deployed mental health practitioners. METHOD In-depth clinical interviews were conducted among 975 UK military personnel referred for mental health assessment whilst deployed in Afghanistan. Socio-demographic, military, operational, clinical and therapy outcomes were recorded in an electronic health record database. Rates and predictors of EVAC were the main outcomes examined using adjusted binary logistic regression analyses. RESULTS Overall 74.8% (n=729) of personnel RTD on completion of care. Of those that underwent evacuation home (n=246), 69.1% (n=170) returned by aeromedical evacuation; the remainder returned home using routine air transport. Predictors of evacuation included; inability to adjust to the operational environment, family psychiatric history, previously experiencing trauma and thinking about or carrying out acts of deliberate self-harm. CONCLUSION Deployed mental health practitioners helped to facilitate RTD for three quarters of mental health casualties who consulted with them during deployment; psychological rather than combat-related factors predicted evacuation home.
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Jones N, Campion B, Keeling M, Greenberg N. Cohesion, leadership, mental health stigmatisation and perceived barriers to care in UK military personnel. J Ment Health 2016; 27:10-18. [DOI: 10.3109/09638237.2016.1139063] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Norman Jones
- Academic Department of Military Mental Health, and
- Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK, and
| | - Ben Campion
- Academic Department of Military Mental Health, and
- Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK, and
| | - Mary Keeling
- Center for Innovation and Research on Veterans and Military Families (CIR), School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Neil Greenberg
- Academic Department of Military Mental Health, and
- Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK, and
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de Burgh HT. The training value of working with armed forces inpatients in psychiatry. J ROY ARMY MED CORPS 2016; 162:85-7. [DOI: 10.1136/jramc-2015-000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/10/2015] [Indexed: 11/03/2022]
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Osório C, Jones N, Fertout M, Greenberg N. Perceptions of stigma and barriers to care among UK military personnel deployed to Afghanistan and Iraq. ANXIETY STRESS AND COPING 2013; 26:539-57. [DOI: 10.1080/10615806.2012.725470] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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An initial evaluation of the clinical and fitness for work outcomes of a military group behavioural activation programme. Behav Cogn Psychother 2013; 42:243-7. [PMID: 23714222 DOI: 10.1017/s135246581300043x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Behavioural Activation (BA) is an evidence-based psychological treatment for depression based on behavioural theory. However, in common with other talking therapies, there is limited evidence about occupational factors related to treatment. This is an important gap in the research given the emphasis placed on employment considerations in recent service initiatives. AIM A service evaluation to investigate the clinical and fitness to work outcomes of a group BA programme for serving military personnel. METHOD 46 patients experiencing moderate to severe depression attended a 12-session Military Behavioural Activation and Rehabilitation Course (MBARC). The primary outcomes were the Patient Health Questionnaire-9 (PHQ-9), a self-report measure of depression and the patient's medical employability category. RESULTS Clinical and statistically significant changes were found on the PHQ-9 between pre-course and 3-month follow-up. Pretreatment 3 patients (6.5%) were psychologically fit to deploy on full operational duties in their primary role; this increased to 25 (56.8%) and 29 (65.9%) at 3 and 6-months respectively. CONCLUSION Preliminary findings suggest that MBARC is a clinically and occupationally effective treatment for depression in military personnel. Further research is required to identify if BA delivered in a group setting would be effective in non-military settings and whether treatment benefits are maintained in the longer term.
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Deahl MP, Klein S, Alexander DA. The costs of conflict: meeting the mental health needs of serving personnel and service veterans. Int Rev Psychiatry 2011; 23:201-9. [PMID: 21521090 DOI: 10.3109/09540261.2011.557059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Military mental health has, until recently, been a neglected and marginalized area of interest and although both World Wars saw important advances, in peacetime we typically forget lessons learned in earlier conflicts. Since 2003 however, with high intensity war-fighting on two fronts involving the service personnel of many nations, attention has, once again focused on the immediate and long-term emotional and psychological impact of combat. Whilst we know a lot about posttraumatic stress disorder (PTSD), much less attention has been paid to a variety of other equally, if not more salient yet superficially less dramatic problems facing service personnel deployed on operations, but which are much more likely to lead to mental disorder than traumatic events and the 'horrors of war'. This article describes some of these broader yet less tangible and under-researched issues and discusses the provision of services for the burgeoning veteran community. The mental health of service personnel and veterans is politically sensitive and attracts significant public and media interest. Understanding and responding appropriately to the needs of this group should be of concern to all mental health professionals and it has important consequences, not only for affected individuals but, for the public perception of mental health services as a whole.
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Affiliation(s)
- Martin P Deahl
- South Staffordshire and Shropshire NHS Partnership Trust, UK.
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Jones N, Wink P, Brown RA, Berrecloth D, Abson E, Doyle J, Fear NT, Wessely S, Greenberg N. A clinical follow-up study of reserve forces personnel treated for mental health problems following demobilisation. J Ment Health 2011; 20:136-45. [PMID: 21314326 DOI: 10.3109/09638237.2010.541299] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Reserves Mental Health Programme (RMHP) provides a clinical service for members of the United Kingdom's Reserve Forces deployed to combat operations since 2003. AIM To assess whether mental health and occupational functioning changed after treatment. METHODS We examined a treatment group with operationally attributable mental health problems and a non-intervention group with non-operationally attributable problems. A self-report, repeat measures study design examined post traumatic stress disorder (PTSD), common mental disorders, alcohol use and occupational functioning at follow up delivered by either telephone or post. RESULTS One hundred three reservists were offered an initial assessment. Adjusted response rates were 66.7% (n=16) for the no treatment group and 62.7% (n=37) for the treatment group. The treatment group were more likely to be cases at baseline on all mental health outcome measures other than PTSD, but at follow up, they were no more likely to be so. A one-way ANCOVA was conducted to evaluate treatment outcome. This was not significant for all measures except for PTSD. On completion of treatment, three quarters of serving personnel returned to full occupational fitness. CONCLUSION The RMHP appears to offer a clinically and occupationally effective intervention to recently de-mobilised reservists with operationally attributable mental health problems.
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Affiliation(s)
- N Jones
- Academic Centre for Defence Mental Health, Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK.
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Coetzee RH, Simpson RG, Greenberg N. Detecting post-deployment mental health problems in primary care. J ROY ARMY MED CORPS 2010; 156:196-9. [PMID: 20919625 DOI: 10.1136/jramc-156-03-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Post-deployment mental health problems are a source of potential concern for health professionals and politicians in military forces in the world; the UK Armed Forces are no exception. This article examines practical ways in which General Practitioners in Primary Care can enhance their ability to detect post-deployment mental health problems and offers suggestions on immediate management and assessment, based on contemporary evidence and clinical experience.
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Affiliation(s)
- R H Coetzee
- Department of Community Mental Health, HM Naval Base Portsmouth.
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Jones N, Fear NT, Greenberg N, Hull L, Wessely S. Occupational outcomes in soldiers hospitalized with mental health problems. Occup Med (Lond) 2009; 59:459-65. [PMID: 19666961 DOI: 10.1093/occmed/kqp115] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the longer term occupational outcome in UK military personnel who require hospital-based treatment for mental health problems. AIMS To examine the documented occupational outcomes following hospital-based treatment for mental health problems within the British Army. METHODS Hospital admission records were linked to occupational outcome data from a database used for personnel administration. RESULTS A total of 384 records were identified that were then linked to occupational outcome after an episode of hospitalization. Seventy-four per cent of those admitted to hospital with mental health problems were discharged from the Army prematurely, and 73% of the discharges occurred in the first year following hospitalization. Discharge from the Army was associated with holding a junior rank, completing <5 years military service, having a combat role, being male and receiving community mental health team treatment prior to admission. CONCLUSIONS Hospitalization for a mental health problem in a military context is associated with a low rate of retention in service. Outcome was not influenced greatly by duration of hospital stay; however, those who reported receiving individual rather than group-based therapy while in hospital appeared to do better.
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Affiliation(s)
- Norman Jones
- Academic Centre for Defence Mental Health, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London SE5 9RJ, UK.
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Pook A, Tarn M, Harrison J, McAllister P, Greenberg N. A career in military psychiatry. J ROY ARMY MED CORPS 2008; 154:120-3. [PMID: 19043993 DOI: 10.1136/jramc-154-02-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A Pook
- Academic Centre for Defence Mental Health. Weston Education Centre - KCL, Cutcombe Road, London
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