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Deahl MP, Andreassen M. Ukraine: Meeting the mental health needs of service veterans. Int J Soc Psychiatry 2023; 69:1825-1828. [PMID: 37198874 DOI: 10.1177/00207640231175610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The current conflict in Ukraine is a tragedy of epic proportions that without doubt is causing serious psychological damage with inevitable long term consequences affecting combatants, civilians, not to mention displaced refugees. This paper focuses on the mental health needs of service veterans returning home to a country, devastated by the current conflict.
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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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Adler AB, Gutierrez IA. Acute Stress Reaction in Combat: Emerging Evidence and Peer-Based Interventions. Curr Psychiatry Rep 2022; 24:277-284. [PMID: 35353322 PMCID: PMC8965216 DOI: 10.1007/s11920-022-01335-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE OF REVIEW This paper highlights the topic of combat-related acute stress reactions (ASRs) in service members. Specifically, we contrast ASRs with related psychiatric conditions, report the estimated prevalence of ASRs for soldiers deployed to combat, and discuss how team members can effectively respond to these reactions. RECENT FINDINGS Although not regarded as a clinical disorder, ASRs can have a significant impact on high-risk occupations like the military in which impaired functioning can imperil team members and others. Based on self-report, 17.2% of soldiers who have deployed to combat report having experienced a possible ASR. To our knowledge, this is the first such prevalence estimate. The prevalence of ASRs underscores the need for improved prevention, management, and recovery strategies. Peer-based intervention protocols such as iCOVER may provide a useful starting point to address ASRs in team members.
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Affiliation(s)
- Amy B. Adler
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20910 USA
| | - Ian A. Gutierrez
- Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20910 USA
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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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Do the Military’s Frontline Psychiatry/Combat Operational Stress Control Programs Benefit Veterans? Part Two: Systematic Review of the Evidence. PSYCHOLOGICAL INJURY & LAW 2017. [DOI: 10.1007/s12207-016-9279-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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Boulos D, Zamorski MA. Do shorter delays to care and mental health system renewal translate into better occupational outcome after mental disorder diagnosis in a cohort of Canadian military personnel who returned from an Afghanistan deployment? BMJ Open 2015; 5:e008591. [PMID: 26644121 PMCID: PMC4679995 DOI: 10.1136/bmjopen-2015-008591] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Mental disorders in military personnel result in high rates of attrition. Military organisations have strengthened their mental health systems and attempted to overcome barriers to care in order to see better outcomes. This study investigated the roles of mental health services renewal and delay to care in Canadian Armed Forces (CAF) personnel diagnosed with mental disorders. DESIGN Administrative data were used to identify a retrospective cohort of 30,513 CAF personnel who deployed in support of the mission in Afghanistan. Study participants included 508 individuals with a mental disorder diagnosis identified from CAF medical records of a weighted, stratified random sample of 2014 individuals selected from the study cohort. Weighted Cox proportional hazards regression assessed the association of diagnosis era and delay to care with the outcome, after controlling for a broad range of potential confounders (eg, disorder severity, comorbidity). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics. PRIMARY OUTCOME The outcome was release from military service for medical reasons, assessed using administrative data for the 508 individuals with a mental disorder diagnosis. RESULTS 17.5% (95% CI 16.0% to 19.0%) of the cohort had a mental disorder diagnosis after an Afghanistan-related deployment, of which 21.3% (95% CI 17.2% to 25.5%) had a medical release over a median follow-up of 3.5 years. Medical release risk was elevated for individuals diagnosed before 30 April 2008 relative to those with recent diagnoses (adjusted HR (aHR)=1.77 (95% CI 1.01 to 3.11)) and for individuals with a long delay to care (>21 months after return) relative to those with intermediate delays (8-21 months, aHR 2.47=(95% CI 1.28 to 4.76)). CONCLUSIONS Mental health services renewal in the CAF was associated with a better occupational outcome for those diagnosed with mental disorders. Longer delays to care were associated with a less favourable outcome.
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Affiliation(s)
- David Boulos
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
| | - Mark A Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Fertout M, Jones N, Keeling M, Greenberg N. Mental health stigmatisation in deployed UK Armed Forces: a principal components analysis. J ROY ARMY MED CORPS 2015; 161 Suppl 1:i69-i76. [PMID: 26621815 DOI: 10.1136/jramc-2015-000587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION UK military research suggests that there is a significant link between current psychological symptoms, mental health stigmatisation and perceived barriers to care (stigma/BTC). Few studies have explored the construct of stigma/BTC in depth amongst deployed UK military personnel. METHOD Three survey datasets containing a stigma/BTC scale obtained during UK deployments to Iraq and Afghanistan were combined (n=3405 personnel). Principal component analysis was used to identify the key components of stigma/BTC. The relationship between psychological symptoms, the stigma/BTC components and help seeking were examined. RESULTS Two components were identified: 'potential loss of personal military credibility and trust' (stigma Component 1, five items, 49.4% total model variance) and 'negative perceptions of mental health services and barriers to help seeking' (Component 2, six items, 11.2% total model variance). Component 1 was endorsed by 37.8% and Component 2 by 9.4% of personnel. Component 1 was associated with both assessed and subjective mental health, medical appointments and admission to hospital. Stigma Component 2 was associated with subjective and assessed mental health but not with medical appointments. Neither component was associated with help-seeking for subjective psycho-social problems. CONCLUSIONS Potential loss of credibility and trust appeared to be associated with help-seeking for medical reasons but not for help-seeking for subjective psychosocial problems. Those experiencing psychological symptoms appeared to minimise the effects of stigma by seeking out a socially acceptable route into care, such as the medical consultation, whereas those who experienced a subjective mental health problem appeared willing to seek help from any source.
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Affiliation(s)
- Mohammed Fertout
- Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK
| | - N Jones
- Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK
| | - M Keeling
- Center for Innovation and Research on Veterans and Military Families (CIR), School of Social Work, University of Southern California, Los Angeles, California, USA
| | - N Greenberg
- Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, London, UK
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Ramchand R, Rudavsky R, Grant S, Tanielian T, Jaycox L. Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan. Curr Psychiatry Rep 2015; 17:37. [PMID: 25876141 DOI: 10.1007/s11920-015-0575-z] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review summarizes the epidemiology of posttraumatic stress disorder (PTSD) and related mental health problems among persons who served in the armed forces during the Iraq and Afghanistan conflicts, as reflected in the literature published between 2009 and 2014. One-hundred and sixteen research studies are reviewed, most of which are among non-treatment-seeking US service members or treatment-seeking US veterans. Evidence is provided for demographic, military, and deployment-related risk factors for PTSD, though most derive from cross-sectional studies and few control for combat exposure, which is a primary risk factor for mental health problems in this cohort. Evidence is also provided linking PTSD with outcomes in the following domains: physical health, suicide, housing and homelessness, employment and economic well-being, social well-being, and aggression, violence, and criminality. Also included is evidence about the prevalence of mental health service use in this cohort. In many instances, the current suite of studies replicates findings observed in civilian samples, but new findings emerge of relevance to both military and civilian populations, such as the link between PTSD and suicide. Future research should make effort to control for combat exposure and use longitudinal study designs; promising areas for investigation are in non-treatment-seeking samples of US veterans and the role of social support in preventing or mitigating mental health problems in this group.
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Affiliation(s)
- Rajeev Ramchand
- RAND Corporation, 1100 South Hayes Street, Arlington, VA, 22202-5050, USA,
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Cawkill P, Jones M, Fear NT, Jones N, Fertout M, Wessely S, Greenberg N. Mental health of UK Armed Forces medical personnel post-deployment. Occup Med (Lond) 2015; 65:157-64. [DOI: 10.1093/occmed/kqu200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Modifying attitudes to mental health using comedy as a delivery medium. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1667-76. [PMID: 24715235 DOI: 10.1007/s00127-014-0868-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 03/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Beliefs about other people's potential views or reactions may be powerful determinants of mental health help-seeking behaviours. United Kingdom Armed Forces (UK AF) have made considerable efforts to promote appropriate help seeking though it is often suggested that military personnel remain reluctant to seek help. This study evaluated a novel stigma-reduction method, stand-up comedy, in service personnel. METHOD Personnel viewed a regular comedy show or a show containing mental health information. Pre, immediately post-show and 3 months later, military stigmatisation, potential discrimination, mental health knowledge, help-seeking and coping behaviour, talking about mental health, current mental health and alcohol use were measured. RESULTS Response rates were 81.3 % pre-show, 67.6 % post-show and 18.9 % at follow-up. Inclusion of mental health material did not appear to detract from show satisfaction. Post-show, intervention group (IG) participants reported significantly less stigmatisation and accurately answered mental health-related questions; in the small numbers followed up, neither difference was maintained, however, IG personnel were statistically significantly more likely to discuss mental health and to advise others about mental health; adjusted analyses suggested that this was related to factors other than the show. CONCLUSION In UK AF personnel, embedding mental health awareness within a comedy show format had a short-term positive effect upon military stigmatisation regarding mental health. The low rate of follow-up limited our ability to assess whether this effect was durable. If the longevity of change can be adequately assessed and demonstrated in further research, comedy could potentially form a component of a comprehensive stigma-reduction strategy.
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Vermetten E, Greenberg N, Boeschoten MA, Delahaije R, Jetly R, Castro CA, McFarlane AC. Deployment-related mental health support: comparative analysis of NATO and allied ISAF partners. Eur J Psychotraumatol 2014; 5:23732. [PMID: 25206953 PMCID: PMC4138710 DOI: 10.3402/ejpt.v5.23732] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/26/2014] [Accepted: 06/26/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND For years there has been a tremendous gap in our understanding of the mental health effects of deployment and the efforts by military forces at trying to minimize or mitigate these. Many military forces have recently systematized the mental support that is provided to support operational deployments. However, the rationale for doing so and the consequential allocation of resources are felt to vary considerably across North Atlantic Treaty Organisation (NATO) International Security Assistance (ISAF) partners. This review aims to compare the organization and practice of mental support by five partnering countries in the recent deployment in Afghanistan in order to identify and compare the key methods and structures for delivering mental health support, describe bottlenecks and illustrate new developments. METHOD Information was collected through document analysis and semi-structured interviews with key military mental healthcare stakeholders. The review resulted from close collaboration between key military mental healthcare professionals within the Australian Defense Forces (ADF), Canadian Armed Forces (CAF), United Kingdom Armed Forces (UK), Netherlands Armed Forces (NLD), and the United States Army (US). Key stakeholders were interviewed about the mental health support provided during a serviceperson's military career. The main items discussed were training, prevention, early identification, intervention, and aftercare in the field of mental health. RESULTS All forces reported that much attention was paid to mental health during the individual's military career, including deployment. In doing so there was much overlap between the rationale and applied methods. The main method of providing support was through training and education. The educative focus was to strengthen the mental resilience of individual soldiers while providing a range of mental healthcare services. All forces had abandoned standard psychological debriefing after critical incidents. Instead, by default, mental healthcare professionals acted to support the leader and peer led "after action" reviews. All countries provided professional mental support close to the front line, aimed at early detection and early return to normal activities within the unit. All countries deployed a mental health support team that consisted of a range of mental health staff including psychiatrists, psychologists, social workers, mental health nurses, and chaplains. There was no overall consensus in the allocation of mental health disciplines in theatre. All countries (except the US) provided troops with a third location decompression (TLD) stop after deployment, which aimed to recognize what the deployed units had been through and to prepare them for transition home. The US conducted in-garrison 'decompression', or 'reintegration training' in the US, with a similiar focus to TLD. All had a reasonably comparable infrastructure in the field of mental healthcare. Shared bottlenecks across countries included perceived stigma and barriers to care around mental health problems as well as the need for improving the awareness and recognition of mental health problems among service members. CONCLUSION This analysis demonstrated that in all five partners state-of-the-art preventative mental healthcare was included in the last deployment in Afghanistan, including a positive approach towards strengthening the mental resilience, a focus on self-regulatory skills and self-empowerment, and several initiatives that were well-integrated in a military context. These initiatives were partly/completely implemented by the military/colleagues/supervisors and applicable during several phases of the deployment cycle. Important new developments in operational mental health support are recognition of the role of social leadership and enhancement of operational peer support. This requires awareness of mental problems that will contribute to reduction of the barriers to care in case of problems. Finally, comparing mental health support services across countries can contribute to optimal preparation for the challenges of military deployment.
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Affiliation(s)
- Eric Vermetten
- Military Mental Health Research, Department of Defence, Utrecht, The Netherlands
- Department Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Arq Psychotrauma Research Group, Diemen, The Netherlands
| | - Neil Greenberg
- Academic Centre for Defence Mental Health, Weston Education Centre, Kings College London, London, UK
| | | | - Roos Delahaije
- Netherlands Organization for Applied Scientific Research (TNO), Defense Safety and Security, Soesterberg, The Netherlands
| | - Rakesh Jetly
- Directorate of Mental Health, Health Services Group, National Defence, Ottawa, Canada
| | - Carl A. Castro
- School of Social Work, University Southern California, Los Angeles CA, USA
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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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Forbes HJ, Jones N, Woodhead C, Greenberg N, Harrison K, White S, Wessely S, Fear NT. What are the effects of having an illness or injury whilst deployed on post deployment mental health? A population based record linkage study of UK army personnel who have served in Iraq or Afghanistan. BMC Psychiatry 2012; 12:178. [PMID: 23095133 PMCID: PMC3507752 DOI: 10.1186/1471-244x-12-178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 09/23/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The negative impact of sustaining an injury on a military deployment on subsequent mental health is well-documented, however, the relationship between having an illness on a military operation and subsequent mental health is unknown. METHODS Population based study, linking routinely collected data of attendances at emergency departments in military hospitals in Iraq and Afghanistan [Operational Emergency Department Attendance Register (OpEDAR)], with data on 3896 UK Army personnel who participated in a military health study between 2007 and 2009 and deployed to Iraq or Afghanistan between 2003 to 2009. RESULTS In total, 13.8% (531/3896) of participants had an event recorded on OpEDAR during deployment; 2.3% (89/3884) were medically evacuated. As expected, those medically evacuated for an injury were at increased risk of post deployment probable PTSD (odds ratio 4.27, 95% confidence interval 1.80-10.12). Less expected was that being medically evacuated for an illness was also associated with a similarly increased risk of probable PTSD (4.39, 1.60-12.07) and common mental disorders (2.79, 1.41-5.51). There was no association between having an OpEDAR event and alcohol misuse. Having an injury caused by hostile action was associated with increased risk of probable PTSD compared to those with a non-hostile injury (3.88, 1.15 to 13.06). CONCLUSIONS Personnel sustaining illnesses on deployment are just as, if not more, at risk of having subsequent mental health problems as personnel who have sustained an injury. Monitoring of mental health problems should consider those with illnesses as well as physical injuries.
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Affiliation(s)
- Harriet J Forbes
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Norman Jones
- Academic Centre for Defence Mental Health, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Charlotte Woodhead
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Neil Greenberg
- Academic Centre for Defence Mental Health, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Kate Harrison
- DASA Health Information, Defence Analytical Services and Advice (DASA), UK Ministry of Defence, Ensleigh, Bath, BA1 5AB, UK
| | - Sandra White
- DASA Health Information, Defence Analytical Services and Advice (DASA), UK Ministry of Defence, Ensleigh, Bath, BA1 5AB, UK
| | - Simon Wessely
- King’s Centre for Military Health Research, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK
| | - Nicola T Fear
- Academic Centre for Defence Mental Health, King’s College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ, UK
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Jones N, Seddon R, Fear NT, McAllister P, Wessely S, Greenberg N. Leadership, cohesion, morale, and the mental health of UK Armed Forces in Afghanistan. Psychiatry 2012; 75:49-59. [PMID: 22397541 DOI: 10.1521/psyc.2012.75.1.49] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UK Armed Forces (AF) personnel deployed to Afghanistan are frequently exposed to intense combat and yet little is known about the short-term mental health consequences of this exposure and the potential mitigating effects of military factors such as cohesion, morale, and leadership. To assess the possible modulating influence of cohesion, morale, and leadership on post-traumatic stress disorder (PTSD) symptoms and common mental disorders resulting from combat exposure among UK AF personnel deployed to Afghanistan, UK AF personnel, during their deployment to Afghanistan in 2010, completed a self-report survey about aspects of their current deployment, including perceived levels of cohesion, morale, leadership, combat exposure, and their mental health status. Outcomes were symptoms of common mental disorder and symptoms of PTSD. Combat exposure was associated with both PTSD symptoms and symptoms of common mental disorder. Of the 1,431 participants, 17.1% reported caseness levels of common mental disorder, and 2.7% were classified as probable PTSD cases. Greater self-reported levels of unit cohesion, morale, and perceived good leadership were all associated with lower levels of common mental disorder and PTSD. Greater levels of unit cohesion, morale, and good leadership may help to modulate the effects of combat exposure and the subsequent development of mental health problems among UK Armed Forces personnel deployed to Afghanistan.
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Affiliation(s)
- Norman Jones
- Academic Centre for Defence Mental Health, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK.
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