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Ward RN, Erickson AJ, Carlson KJ, Yalch MM. The role of unit cohesion and perceived resilience in substance use disorder. MILITARY PSYCHOLOGY 2024; 36:403-409. [PMID: 38913766 PMCID: PMC11197915 DOI: 10.1080/08995605.2023.2189861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
Soldiers have high rates of substance use disorders (SUD), often in the aftermath of stressors experienced during military deployments. There are several factors that protect against SUD. For example, individual factors like perceived resilience and group factors such as unit cohesion may make someone less likely to abuse substances. However, there is little research on the differential influence of these resilience factors on SUD over and above deployment stressors. In this study, we examined the relative effects of perceived resilience, unit cohesion, and deployment stressors on SUD in a sample of 21,449 active duty and reserve soldiers from the U.S. Army (primarily White and male, mean age = 28.66, SD = 7.41) using structural equation modeling. We found that unit cohesion (ß = -.17) and perceived resilience (ß = -.16) had negative effects on SUD over and above deployment stressors. The study findings clarify research on resilience to SUD and have implications for addressing substance use in the military, specifically regarding the importance of building unit cohesion.
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Affiliation(s)
- Rachel N. Ward
- Department of Psychology, Palo Alto University, Palo Alto, California
| | - Alexander J. Erickson
- Department of Psychology, Palo Alto University, Palo Alto, California
- Geriatric Research, Education, and Clinical Center, Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, California
| | - Katie J. Carlson
- Department of Psychology, Palo Alto University, Palo Alto, California
| | - Matthew M. Yalch
- Department of Psychology, Palo Alto University, Palo Alto, California
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2
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Blais RK, Xu B, Tannahill H, Dulin P. Male sex and hazardous alcohol use following military sexual assault increase suicide risk among US service members and veterans. Eur J Psychotraumatol 2024; 15:2312756. [PMID: 38568596 PMCID: PMC10993746 DOI: 10.1080/20008066.2024.2312756] [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] [Received: 09/15/2023] [Accepted: 01/20/2024] [Indexed: 04/05/2024] Open
Abstract
Background: Higher alcohol use and military sexual assault (MSA) are associated with increased risk of death by suicide. Risk for death by suicide is rapidly increasing among females, who report higher rates of MSA, yet actual death by suicide and alcohol use are higher among males. It is not well understood whether higher alcohol use confers greater suicide risk in male or female service members and veterans who have experienced MSA.Objective: To determine whether the association between alcohol misuse and suicide risk was moderated by biological sex in a sample of male and female service members (N = 400, 50% female) who reported MSA.Method: Participants completed surveys of alcohol use and suicide risk as well as a demographic inventory. Linear regression with an interaction term was used to determine if suicide risk differed by sex and alcohol use severity after accounting for discharge status, sexual orientation, and age.Results: Average scores on the suicide risk measure were consistent with an inpatient psychiatric sample and scores on the AUDIT-C were indicative of a probable positive screen for alcohol misuse. Suicide risk was most pronounced among males who reported higher levels of hazardous alcohol use. A sensitivity analysis examining suicide risk by sex and screening results for alcohol misuse (positive/negative) showed that men with a probable positive screen had higher suicide risk.Discussion: The current study provides novel findings on suicide risk among survivors of military sexual violence by including both male and female survivors. Interventions to decrease suicide risk following MSA may consider alcohol reduction strategies, and optimizing these interventions in males. Engaging military culture at both the US Departments of Defense and Veterans Affairs to encourage more healthy alcohol consumption may mitigate this public health concern. Future research may consider how country of origin relates to these associations.
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Affiliation(s)
- Rebecca K. Blais
- Psychology Department, Arizona State University, Tempe, AZ, USA
- Psychology Department, Utah State University, Logan, UT, USA
| | - Bingyu Xu
- Psychology Department, Arizona State University, Tempe, AZ, USA
| | - Hallie Tannahill
- Psychology Department, Utah State University, Logan, UT, USA
- Wright-Patterson Medical Center, Wright-Patterson Air Force Base
| | - Patrick Dulin
- Psychology Department, University of Alaska Anchorage, Anchorage, AK, USA
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3
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Mathes Winnicki BM, Lee DJ, Hawn SE, Livingston NA, Marx BP, Keane TM. Alcohol consumption and dependence risk among male and female Veterans: Trajectories and predictors. Drug Alcohol Depend 2024; 257:111138. [PMID: 38430789 DOI: 10.1016/j.drugalcdep.2024.111138] [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] [Received: 09/28/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND With few exceptions, previously conducted research on hazardous drinking among Veterans has employed samples in which the majority of participants identify as male. In addition, past studies have solely focused on alcohol consumption, rather than associated risk for dependence. In this study, we expanded upon the extant literature by investigating sex differences in trajectories and predictors of change in alcohol consumption and dependence risk among post-9/11 Veterans. METHODS A national sample of 1649 Veterans (50.0% female) were recruited in a five-wave longitudinal study that followed Veterans for up to 16 years after deployment. We used growth curve modeling to investigate trajectories of change in alcohol consumption and dependence risk among men and women Veterans. We examined predictors of growth, including demographics, support and resources, psychiatric symptoms, and trauma exposure. RESULTS Among male Veterans, alcohol consumption and dependence risk remained stagnant, which is in contrast to past work using non-Veteran samples. For female Veterans, consumption exhibited initial reductions that decelerated, and dependence risk reduced at a continuous rate. PTSD diagnosis was a significant predictor of individual differences in growth for men. Psychiatric symptoms (i.e., PTSD diagnosis, probable depression diagnosis, suicidal ideation) and psychosocial functioning were significant predictors of decreasing alcohol use for women. CONCLUSIONS Results highlight important sex differences in patterns and predictors of change in alcohol consumption and dependence risk among post-9/11 Veterans. Findings are discussed in relation to screening for hazardous alcohol use and intervention strategies in this at-risk population.
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Affiliation(s)
- Brittany M Mathes Winnicki
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
| | - Daniel J Lee
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States; Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Sage E Hawn
- Department of Psychology, Old Dominion University, Norfolk, VA, United States
| | - Nicholas A Livingston
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States; Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Brian P Marx
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States; Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Terence M Keane
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, United States; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States; Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
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4
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Blow FC, Walton M, Ilgen M, Ignacio RV, Walters H, Massey L, Barry KL, McCormick R, Coughlin LN. Peer- and web-based interventions for risky drinking among US National Guard members: Mission Strong randomized controlled trial. Addiction 2023; 118:1246-1257. [PMID: 37041669 DOI: 10.1111/add.16172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 02/07/2023] [Indexed: 04/13/2023]
Abstract
AIMS To test separatel the efficacy of a web-based and a peer-based brief intervention (BI), compared with an expanded usual care control (EUC) group, among military reserve component members using alcohoI in a hazardous and harmful manner. DESIGN In the randomized controlled trial, participants were assigned to: [1] web-based BI with web-based boosters (BI + web), [2] web-based BI with peer-based boosters (BI + peer) or [3] enhanced usual care (EUC). SETTING Michigan, USA. PARTICIPANTS A total of 739 Michigan Army National Guard members who reported recent hazardous alcohol use; 84% were male, the mean age was 28 years. INTERVENTION The BI consisted of an interactive program guided by a personally selected avatar. Boosters were delivered either on the web or personally by a trained veteran peer. A pamphlet, given to all participants, included information on hazardous alcohol use and military-specific community resources and served as the EUC condition. MEASUREMENTS The primary outcome measure was binge drinking episodes in the past 30 days, measured at 12 months after the BI. FINDINGS All randomized participants were included in the outcome analyses. In adjusted analyses, BI + peer [beta = -0.43, 95% confidence interval (CI) = -0.56 to -0.31, P < 0.001] and BI + web (beta = -0.34, 95% CI = -0.46 to -0.23, P < 0.001) reduced binge drinking compared with EUC. CONCLUSION This satudy was a web-based brief intervention for hazardous alcohol use, with either web- or peer-based boosters, reduced binge alcohol use among Army National Guard members.
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Affiliation(s)
- Frederic C Blow
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
| | - Maureen Walton
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Mark Ilgen
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Department of Veteran Affairs Healthcare, System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA
| | - Rosalinda V Ignacio
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Heather Walters
- Department of Veteran Affairs Healthcare, System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA
| | - Lynn Massey
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Kristen L Barry
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
| | - Richard McCormick
- Center for Healthcare Research and Policy, MetroHealth/Case Western Reserve University, Cleveland, OH, USA
| | - Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
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5
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Mazulyte-Rasytine E, Grigiene D, Gailiene D. Suicide Risk, Alcohol Consumption and Attitudes towards Psychological Help-Seeking among Lithuanian General Population Men, Conscripts and Regular Active Duty Soldiers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3457. [PMID: 36834153 PMCID: PMC9961175 DOI: 10.3390/ijerph20043457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to investigate the relationship between suicide risk, alcohol consumption, and attitudes towards professional psychological help among Lithuanian general population men, conscripts, and regular active duty (AD) soldiers. In total, 1195 Lithuanian adult males participated in the study: 445 men from the general population, 490 conscripts, and 260 regular AD soldiers from the Lithuanian Armed Forces. The study's measures included: general suicide risk, alcohol consumption levels, frequency of using alcohol as a means to suppress difficult thoughts and feelings, and attitudes toward psychological help. Both military samples showed significantly lower suicide risk than men from the general population. Alcohol use as a means to suppress difficult thoughts and feelings was the most significant predictor of suicide risk and a significant mediator between alcohol consumption and suicide risk in all study groups. Another significant suicide risk predictor and mediator between alcohol consumption and suicide risk-i.e., the value of seeking psychological treatment-was found only in the conscript sample. Results of the current study suggest that there is an opportunity for intervention aimed at the attitudes toward seeking professional psychological help for conscripts. However, that might not be the case for regular AD soldiers, nor the general population of Lithuanian men.
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Affiliation(s)
- Egle Mazulyte-Rasytine
- Suicide Research Centre, Institute of Psychology, Faculty of Philosophy, Vilnius University, 01513 Vilnius, Lithuania
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6
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Irizar P, Stevelink SAM, Pernet D, Gage SH, Greenberg N, Wessely S, Goodwin L, Fear NT. A comparison of probable post-traumatic stress disorder and alcohol consumption among active female members of the UK Police Service and UK Armed Forces. Soc Psychiatry Psychiatr Epidemiol 2023; 58:205-215. [PMID: 36071141 PMCID: PMC9922218 DOI: 10.1007/s00127-022-02356-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The British Police Service and Armed Forces are male-dominated occupations, characterised by frequent trauma exposure and intensive demands. Female police employees and military personnel may have unique experiences and face additional strains to their male counterparts. This analysis compared the levels of post-traumatic stress disorder (PTSD), hazardous/harmful alcohol consumption, and comorbidity in female police employees and military personnel. METHODS Police data were obtained from the Airwave Health Monitoring Study (N = 14,145; 2007-2015) and military data from the Health and Wellbeing Cohort Study (N = 928; phase 2: 2007-2009 and phase 3: 2014-2016). Multinomial/logistic regressions analysed sample differences in probable PTSD, hazardous (14-35 units per week) and harmful (35 + units per week) alcohol consumption, and comorbid problems. We compared covariate adjustment and entropy balancing (reweighting method controlling for the same covariates) approaches. RESULTS There were no significant differences in probable PTSD (police: 3.74% vs military: 4.47%) or hazardous drinking (police: 19.20% vs military: 16.32%). Female military personnel showed significantly higher levels of harmful drinking (4.71%) than police employees (2.42%; Adjusted Odds Ratios [AOR] = 2.26, 95% Confidence Intervals [CIs] = 1.60-3.21), and comorbidity (1.87%) than police employees (1.00%, AOR = 2.07, 95% CI = 1.21-3.54). Entropy balancing and covariate-adjustments obtained the same results. CONCLUSIONS Comparable levels of probable PTSD were observed, which are slightly lower than estimates observed in the female general population. Future research should explore the reasons for this. However, female military personnel showed higher levels of harmful drinking than police employees, emphasising the need for alcohol interventions in military settings.
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Affiliation(s)
- Patricia Irizar
- Department of Sociology, School of Social Sciences, Faculty of Humanities, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Sharon A M Stevelink
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK.,King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Pernet
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
| | | | - Neil Greenberg
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
| | - Simon Wessely
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
| | - Laura Goodwin
- The Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nicola T Fear
- Institute of Psychiatry, Psychology and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK.,Academic Department of Military Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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7
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Hitch C, Toner P, Armour C. A Qualitative Systematic Review of Enablers and Barriers to HelpSeeking for Veterans that have Completely Left the Military Within the Context of Mental Health and Alcohol. JOURNAL OF VETERANS STUDIES 2023. [DOI: 10.21061/jvs.v9i1.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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8
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Hitch C, Toner P, Armour C. Enablers and barriers to military veterans seeking help for mental health and alcohol difficulties: A systematic review of the quantitative evidence. J Health Serv Res Policy 2023:13558196221149930. [PMID: 36636855 PMCID: PMC10363942 DOI: 10.1177/13558196221149930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Research exploring the enablers and barriers that exist for military veterans seeking to address their poor mental health has produced ambiguous results. To identify the enablers and barriers correctly, this study systematically reviews the literature, including research that included alcohol and had a clearly defined veteran population. METHODS Six databases were searched. Inclusion criteria specified that empirical studies related to veterans that had ceased military service and were seeking help for poor mental health and/or alcohol difficulties. Critical Appraisal Skills Programme and AXIS appraisal tools were used to assess quality and bias. A narrative synthesis approach was adopted for analysis. From 2044 studies screened, 12 were included featuring 5501 participants. RESULTS Forty-four enablers and barriers were identified, with thirty-two being statistically significant. Post-traumatic stress disorder had the greatest number of enabler/barrier endorsements to veterans seeking help. Depression, anxiety, experience and attitudes also acted as enablers/barriers. Most studies were of fair methodological quality. Limitations included that samples were skewed towards US army veterans. Little research exists concerning those that have ceased military service. CONCLUSIONS Veteran help-seeking is likely enabled by poor mental health symptomology and comorbidity, which suggests veterans reach a crisis point before they seek help. Further research on alcohol misuse and attitude formation is required. The field would also benefit from alternative study designs including qualitative studies with non-US participants.
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Affiliation(s)
- Catherine Hitch
- Stress Trauma and Related Conditions (STARC) Research Lab, School of Psychology, 1596Queen's University Belfast, Northern Ireland, UK
| | - Paul Toner
- School of Psychology, 1596Queen's University Belfast, Northern Ireland, UK
| | - Cherie Armour
- Stress Trauma and Related Conditions (STARC) Research Lab, School of Psychology, 1596Queen's University Belfast, Northern Ireland, UK
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Miloslavich K, Leonard SJ, Wardle MC, Vujanovic AA. Alcohol Use Severity, Anger and Drinking Motives among Firefighters. Subst Use Misuse 2023; 58:601-609. [PMID: 36803652 DOI: 10.1080/10826084.2023.2177113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background: Firefighters represent an understudied population with high rates of hazardous alcohol use and alcohol use disorder. This population is also at an increased risk of mental health disorders and related symptoms such as anger. Anger is a relatively understudied negative mood state with clinical relevance to alcohol use among firefighters. Anger is associated with greater alcohol use and may spur more approach-motivated reasons for drinking compared to other negative emotions. Objectives: This study sought to examine: 1. whether anger significantly contributes to alcohol use severity in firefighters above and beyond general negative mood; 2. which of four validated drinking motives (e.g., coping, social, enhancement and conformity) act as moderators in the relationship between anger and alcohol use severity in this population. The current study is a secondary analysis of data from a larger study examining health and stress behaviors among firefighters (N = 679) at a large urban fire department in the southern United States. Results: Results revealed that anger was positively associated with alcohol use severity, even after controlling for general negative mood. Further, social and enhancement motives for drinking were significant moderators of the relationship between anger and alcohol use severity. Conclusions: These findings identify anger specifically as an important factor to be considered when assessing alcohol use in firefighters, especially those who are drinking to make social experiences more enjoyable or to enhance their mood. These findings can be used to inform more specialized interventions for alcohol use by targeting anger more specifically in firefighters and other male-dominated first-responder populations.
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Affiliation(s)
- Krista Miloslavich
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Samuel J Leonard
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Margaret C Wardle
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anka A Vujanovic
- Department of Psychology, University of Houston, Houston, Texas, USA
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10
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Williamson C, Palmer L, Leightley D, Pernet D, Chandran D, Leal R, Murphy D, Fear NT, Stevelink SAM. Military veterans and civilians' mental health diagnoses: an analysis of secondary mental health services. Soc Psychiatry Psychiatr Epidemiol 2022:10.1007/s00127-022-02411-x. [PMID: 36547684 DOI: 10.1007/s00127-022-02411-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Healthcare provision in the United Kingdom (UK) falls primarily to the National Health Service (NHS) which is free at the point of access. In the UK, there is currently no national marker to identify military veterans in electronic health records, nor a requirement to record it. This study aimed to compare the sociodemographic characteristics and recorded mental health diagnoses of a sample of veterans and civilians accessing secondary mental health services. METHODS The Military Service Identification Tool, a machine learning computer tool, was employed to identify veterans and civilians from electronic health records. This study compared the sociodemographic characteristics and recorded mental health diagnoses of veterans and civilians accessing secondary mental health care from South London and Maudsley NHS Foundation Trust, UK. Data from 2,576 patients were analysed; 1288 civilians and 1288 veterans matched on age and gender. RESULTS Depressive disorder was the most prevalent across both groups in the sample (26.2% veterans, 15.5% civilians). The present sample of veterans accessing support for mental health conditions were significantly more likely to have diagnoses of anxiety, depressive, psychosis, personality, and stress disorders (AORs ranging 1.41-2.84) but less likely to have a drug disorder (AOR = 0.51) than age- and gender-matched civilians. CONCLUSION Veterans accessing secondary mental health services in South London had higher risks for many mental health problems than civilians accessing the same services. Findings suggest that military career history is a key consideration for probable prognosis and treatment, but this needs corroborating in other geographical areas including national population-based studies in the UK.
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Affiliation(s)
- Charlotte Williamson
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, SE5 9RJ, UK.
| | - Laura Palmer
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, SE5 9RJ, UK
| | - Daniel Leightley
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, SE5 9RJ, UK
| | - David Pernet
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, SE5 9RJ, UK
| | - David Chandran
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Ray Leal
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, SE5 9RJ, UK
| | - Dominic Murphy
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, SE5 9RJ, UK.,Research Department, Combat Stress, Leatherhead, KT22 0BX, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, SE5 9RJ, UK.,Academic Department of Military Mental Health, King's College London, Weston Education Centre, London, SE5 9RJ, UK
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, SE5 9RJ, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
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Simonetti O, Contini C, Martini M. The history of Gin and Tonic; the infectious disease specialist long drink. When gin and tonic was not ordered but prescribed. LE INFEZIONI IN MEDICINA 2022; 30:619-626. [PMID: 36482962 PMCID: PMC9714995 DOI: 10.53854/liim-3004-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/21/2022] [Indexed: 12/12/2022]
Abstract
UNLABELLED Winston Churchill statement promoting Gin and Tonic as a life saver during British Empire extension hides many truths. As a matter of fact, the modern cocktail is thought to be born in India where it was widely distributed by Royal Navy for its anti-malarial properties. The aim of the present work is to review and unveil the history of Gin and Tonic through the centuries. As a matter of facts, primitive Gin and Tonic protective effects were well understood by physicians far before the advent of the "germ theory" and its fortunate invention is one of the most fascinating approaches in the history of preventive medicine. Indeed, quinine, a compound with protective effects on the replicative cycle of Plasmodium spp was discovered in 18th Century and since 19th it become the main compound of tonic beverages such as Schweppe's ones. Interestingly, it was administered to British expatriates' seamen and soldiers in order to prevent febrile paroxysms. Soon after, British military doctors demonstrated that the addition of lime or lemon peels to tonics was effective in preventing scurvy. While, addition of alcoholic beverages and gin contributed to make more enjoyable the bitter and unpleasant taste of this beverages. RESULTS The spectacular voyage of Gin and Tonic teaches us that a popular recreational drink of our Century was a powerful prophylaxis which certainly helped British colonial expansion.
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Affiliation(s)
- Omar Simonetti
- Infectious Diseases Unit, University Hospital of Trieste,
Italy
| | - Carlo Contini
- Infectious Diseases and Dermatology Section, Department of Medical Sciences, University of Ferrara,
Italy
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12
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Vest BM, Weiss-Laxer NS, Homish DL, Homish GG. Lifetime trauma exposure profiles and alcohol use over time among U.S. Reserve and National Guard soldiers. J Trauma Stress 2022; 35:1642-1655. [PMID: 35901312 PMCID: PMC10440733 DOI: 10.1002/jts.22867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 12/24/2022]
Abstract
Although trauma exposure is a recognized risk factor for alcohol use, research on military populations has emphasized combat exposure, with minimal consideration of exposure to other potentially traumatic events (PTEs). We aimed to (a) identify, characterize, and quantify subgroups of service members based on PTE patterns; (b) examine associations between trauma exposure subgroups and alcohol use; and (c) examine these associations longitudinally. Data were drawn from Operation: SAFETY, a longitudinal study of health and well-being among U.S. Army Reserve/National Guard soldiers (N = 478). Exposure to 15 PTEs, including childhood maltreatment, noninterpersonal events (e.g., natural disasters, accidents), interpersonal trauma, and military-related exposures, was assessed at baseline. Latent profile analysis was conducted to characterize mutually exclusive trauma profiles; profile membership was used to longitudinally predict alcohol use in generalized estimating equation models. Four exposure profiles were identified: intimate partner violence (IPV)/combat trauma (8.4%, n = 40), combat trauma (24.7%, n = 118), childhood trauma (8.4%, n = 40), and low trauma (58.6%, n = 280). In adjusted models, compared to the low trauma profile, IPV/combat profile membership was longitudinally associated with alcohol problems, OR = 2.44, p =.005. Membership in other trauma profiles was not associated with alcohol use. Within the IPV/combat profile, men had a higher risk of frequent heavy drinking than women. Results suggest a need to comprehensively screen for lifetime PTE exposure, particularly IPV, in military populations. Given the high prevalence of nonmilitary PTEs, an inclusive, trauma-informed approach to health care and service provision is warranted.
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Affiliation(s)
| | | | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo
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13
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Matsegora Y, Kolesnichenko O, Prykhodko I, Kravchenkо O, Kуslyi V, Bayda M, Kryvokon N, Rumiantse Y, Marushchenko K, Pashchenko A. Social and psychological predictors of alcohol-related incidents involving servicemen. ROMANIAN JOURNAL OF MILITARY MEDICINE 2022. [DOI: 10.55453/rjmm.2022.125.4.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
"The aim of the research was to determine the social and psychological predictors of alcohol-related incidents involving servicemen. The research involved 310 servicemen, who were subjected to disciplinary and administrative penalties within 2016-2021 years for the offence commitment under the influence of alcohol. The control group included 650 servicemen who joined the service within this period. The analysis of psychological features of servicemen was carried out with the help of the following methods: “Determination of Type Accentuation of Character Traits and Temper” Questionnaire, “Self-Esteem Structures of Temper Questionnaire”, “Multilevel Personality ‘Adaptability’ Questionnaire”, “Progressive Matrix”, “16 PF Questionnaire”, and “Self-Esteem Structures of Temper Questionnaire”. Cluster analysis was used to differentiate servicemen who committed incidents under the influence of alcohol. The determined typology was valuable for the organization of preventive works, events dedicated to the improvement of socialization by recruits, adequate formation of servicemen image as well as their identification in accordance with it, and events dedicated to the prevention of suicidal behaviour."
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14
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Isaacs JY, Smith MM, Sherry SB, Seno M, Moore ML, Stewart SH. Alcohol use and death by suicide: A meta-analysis of 33 studies. Suicide Life Threat Behav 2022; 52:600-614. [PMID: 35181905 DOI: 10.1111/sltb.12846] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/02/2021] [Accepted: 01/21/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Decades of research show an association between alcohol use and death by suicide. However, findings on the temporal link between alcohol use and death by suicide are unclear. In the most comprehensive meta-analysis on the topic to date, we analyzed data from longitudinal studies to determine if alcohol use is a risk for death by suicide. We also explored moderators to uncover conditions where the alcohol use-suicide link is strengthened/weakened. METHODS Our literature search of six databases yielded 33 eligible studies involving 10,253,101 participants (community, psychiatric, and military samples). RESULTS Alcohol use was associated with a 94% increase in the risk of death by suicide. Specifically, random-effects meta-analysis revealed alcohol use displayed small-to-large significant risk and odds ratios with suicide for quantity of alcohol use and alcohol use diagnosis/alcohol-related problems. Meta-regression generally indicated larger effect sizes for studies with a higher percentage of women, younger age, unadjusted estimates, longer follow-up periods, military samples, and higher frequencies and quantities of alcohol use (relative to drinker/non-drinker status). CONCLUSION Our study highlights alcohol use as a substantive risk factor for death by suicide and underscores the importance of monitoring alcohol use among suicidal individuals and screening for suicidality among heavier alcohol users.
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Affiliation(s)
- Jason Y Isaacs
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin M Smith
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Simon B Sherry
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Seno
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mackenzie L Moore
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sherry H Stewart
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Psychiatry, QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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15
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Leightley D, Williamson C, Rona RJ, Carr E, Shearer J, Davis JP, Simms A, Fear NT, Goodwin L, Murphy D. Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e38991. [PMID: 35724966 PMCID: PMC9254042 DOI: 10.2196/38991] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction intervention that is personalized to support the UK AF. OBJECTIVE To address this gap, we investigated the efficacy of a 28-day brief alcohol intervention delivered via a mobile app in reducing weekly self-reported alcohol consumption among UK veterans seeking help for mental health difficulties. METHODS We performed a 2-arm participant-blinded randomized controlled trial (RCT). We compared a mobile app that included interactive features designed to enhance participants' motivation and personalized messaging (intervention arm) with a version that provided government guidance on alcohol consumption only (control arm). Adults were eligible if they had served in the UK AF, were currently receiving or had received clinical support for mental health symptoms, and consumed 14 units (approximately 112 g of ethanol) or more of alcohol per week. Participants received the intervention or the control mobile app (1:1 ratio). The primary outcome was a change in self-reported weekly alcohol consumption between baseline and day 84 assessed using the validated Timeline Follow Back for Alcohol Consumption (TLFB) (prior 7 days), with a secondary outcome exploring self-reported change in the Alcohol Use Disorder Identification Test (AUDIT) score. RESULTS Between October 2020 and April 2021, 2708 individuals were invited to take part, of which 2531 (93.5%) did not respond, 54 (2%) were ineligible, and 123 (4.5%) responded and were randomly allocated (62, 50.4%, intervention; 61, 49.6%, control). At day 84, 41 (66.1%) participants in the intervention arm and 37 (60.7%) in the control arm completed the primary outcome assessment. Between baseline and day 84, weekly alcohol consumption reduced by -10.5 (95% CI -19.5 to -1.5) units in the control arm and -28.2 (95% CI -36.9 to -19.5) units in the intervention arm (P=.003, Cohen d=0.35). We also found a significant reduction in the AUDIT score of -3.9 (95% CI -6.2 to -1.6) in the intervention arm (Cohen d=0.48). Our primary and secondary effects did not persist over the longer term (day 168). Two adverse events were detected during the trial. CONCLUSIONS This study examined the efficacy of a fully automated 28-day brief alcohol intervention delivered via a mobile app in a help-seeking sample of UK veterans with hazardous alcohol consumption. We found that participants receiving Drinks:Ration reduced their alcohol consumption more than participants receiving guidance only (at day 84). In the short term, we found Drinks:Ration is efficacious in reducing alcohol consumption in help-seeking veterans. TRIAL REGISTRATION ClinicalTrials.gov NCT04494594; https://tinyurl.com/34em6n9f. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/19720.
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Affiliation(s)
- Daniel Leightley
- Institute of Psychiatry, Psychology & Neuroscience, King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Charlotte Williamson
- Institute of Psychiatry, Psychology & Neuroscience, King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Roberto J Rona
- Institute of Psychiatry, Psychology & Neuroscience, King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Ewan Carr
- Department of Biostatistics and Health Informatics, King's College London, London, United Kingdom
| | - James Shearer
- King's Health Economics, King's College London, London, United Kingdom
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Amos Simms
- Academic Department of Military Mental Health, King's College London, London, United Kingdom.,British Army, London, United Kingdom
| | - Nicola T Fear
- Institute of Psychiatry, Psychology & Neuroscience, King's Centre for Military Health Research, King's College London, London, United Kingdom.,Academic Department of Military Mental Health, King's College London, London, United Kingdom
| | - Laura Goodwin
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Dominic Murphy
- Institute of Psychiatry, Psychology & Neuroscience, King's Centre for Military Health Research, King's College London, London, United Kingdom.,Combat Stress, Leatherhead, United Kingdom
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16
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Osborne AK, Wilson-Menzfeld G, McGill G, Kiernan MD. Military service and alcohol use: a systematic narrative review. Occup Med (Lond) 2022; 72:313-323. [PMID: 35674143 PMCID: PMC9272263 DOI: 10.1093/occmed/kqac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Despite research highlighting the role of alcohol in military life, specifically in relation to mental health and certain combat experiences, there is no synthesised evidence looking at the relationship between military service and alcohol use. Aims To synthesize and examine evidence exploring the relationship between military service and alcohol use. Methods Six databases were examined across a 10-year period. Papers were included if they involved a military population and focused on alcohol use. From 4046 papers identified, 29 papers were included in the review. Results Military characteristics and experience were linked to high levels of alcohol use across military populations. Societal and cultural factors also played a role in alcohol use in military populations. Predatory behaviour of alcohol establishments, pressures to conform, an acceptance of alcohol use, and the role of religious services and military affiliated social networks were all considered. Excessive drinking impacted physical and mental health. Those diagnosed with PTSD and associated symptoms appeared to have greater alcohol use. Conclusions This review identified certain characteristics and experiences of military service that are associated with higher levels of alcohol use. It is important to identify risk factors for alcohol misuse to develop appropriate policy, targeting prevention.
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Affiliation(s)
- A K Osborne
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - G Wilson-Menzfeld
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - G McGill
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - M D Kiernan
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
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17
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Panza KE, Kline AC, Na PJ, Potenza MN, Norman SB, Pietrzak RH. Epidemiology of DSM-5 alcohol use disorder in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. Drug Alcohol Depend 2022; 231:109240. [PMID: 34974271 DOI: 10.1016/j.drugalcdep.2021.109240] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) is a prevalent public health concern in the U.S. that disproportionately affects veterans relative to civilians. Given changes to the demographic composition of the veteran population and AUD diagnostic criteria in the DSM-5, updated knowledge regarding the epidemiology of DSM-5 AUD in a national sample of veterans is critical to informing the population-based burden of this disorder. METHODS Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4069 U.S. veterans. Lifetime DSM-5 AUD (mild, moderate, severe) and past-year DSM-5 AUD were assessed using validated self-report measures, and sociodemographic, military, and psychiatric characteristics associated with lifetime and past-year AUD were evaluated. RESULTS Prevalences of lifetime and past-year DSM-5 AUD were 40.8% (95% confidence interval [CI]=39.2-42.3%) and 10.5% (95%CI=9.6-11.5%), respectively. Lifetime prevalences of mild, moderate, and severe AUD were 20.5%, 8.3%, and 12.0%, respectively. Veterans with lifetime AUD had elevated rates of psychiatric disorders and suicidal behavior, which generally increased as a function of AUD severity. Lifetime AUD was also associated with being younger, male, white, unmarried, retired and experiencing more adverse childhood experiences and traumas. For past-year AUD, being younger, male, white, having more adverse childhood experiences, and experiencing lifetime PTSD were significant correlates. CONCLUSIONS AUD is highly prevalent among U.S. veterans and associated with substantial psychopathology, including elevated odds of suicidal behaviors. Results underscore the importance of comprehensive screening and preventive efforts for AUD, and interventions that concurrently target overlapping alcohol use and psychiatric difficulties.
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Affiliation(s)
- Kaitlyn E Panza
- VA San Diego Healthcare System, San Diego, CA 92161, USA; Department of Psychiatry, University of California, San Diego, CA 92093, USA.
| | - Alexander C Kline
- VA San Diego Healthcare System, San Diego, CA 92161, USA; Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06516, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06516, USA; Department of Neuroscience, Yale University, New Haven, CT 06516, USA; Child Study Center, Yale School of Medicine, New Haven, CT 06516, USA; Connecticut Mental Health Center, New Haven, CT 06516, USA; Connecticut Council on Problem Gambling, Wethersfield, CT 06109, USA
| | - Sonya B Norman
- VA San Diego Healthcare System, San Diego, CA 92161, USA; Department of Psychiatry, University of California, San Diego, CA 92093, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA; National Center for PTSD, White River Junction, VT 05009, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06516, USA; National Center for PTSD, West Haven, CT 06516, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06511, USA
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18
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Palmer L, Norton S, Jones M, Rona RJ, Goodwin L, Fear NT. Trajectories of alcohol misuse among the UK Armed Forces over a 12-year period. Addiction 2022; 117:57-67. [PMID: 34288194 PMCID: PMC9292297 DOI: 10.1111/add.15592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/13/2020] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
AIM To identify the main trajectories of alcohol misuse among UK military personnel from 12 years after the start of the Iraq war (2003) and the factors associated with each trajectory. DESIGN Longitudinal cohort study with three phases of data collection (2004-06, 2007-09 and 2014-16). SETTING United Kingdom. PARTICIPANTS Serving and ex-serving personnel of the UK Armed Forces (n = 7111) participating at Phase 1 and at least one follow-up phase of the King's Centre for Military Health Research (KCMHR) cohort study. MEASUREMENTS Trajectories of alcohol misuse were derived from scores using the Alcohol Use Disorders Identification Test (AUDIT-10) over three data collection phases. Demographic and military characteristics were collected and, among the key covariates, post-traumatic stress disorder (PTSD) was measured using the PTSD checklist (PCL-C) and childhood interpersonal stress and violence was measured using items from the Adverse Childhood Experiences questionnaire. FINDINGS Five trajectories of alcohol misuse were identified, including 'no misuse' (n = 2249, 31.6%) and 'hazardous' (n = 3398, 47.8%), 'harmful' (n = 832, 11.7%), 'severe-to-hazardous' (n = 258, 5.3%) and 'severe' (n = 374, 3.6%) drinking. Substantial changes were evident only among severe drinkers, where more than half reduced over the study period. The factors most strongly associated with belonging to harmful/severe drinking classes were young age, male gender and childhood adversities and antisocial behaviour. Severe drinkers at Phase 1 were more likely to report probable PTSD and shorter military careers and were less likely to serve as Officers. Persistent severe drinkers were less likely to serve in the RAF compared to the Army and were more likely to be reserves. Not misusing alcohol was also associated with reserve status and having left service. CONCLUSIONS In a cohort of approximately 7000 UK military personnel, trajectories of alcohol misuse appeared stable between 2004 and 2016. More than half of severe drinkers made substantial improvements over the period, but 68% of the cohort continued to drink hazardously or harmfully. Lack of change for the majority of the sample signals the need for strategies to address alcohol misuse and its cultural and psychosocial drivers.
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Affiliation(s)
- Laura Palmer
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Sam Norton
- Centre for Rheumatic Diseases and Department of PsychologyInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Margaret Jones
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Roberto J. Rona
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
| | - Laura Goodwin
- Department of PsychologyUniversity of LiverpoolEleanor Rathbone Building LiverpoolUK,Liverpool Centre for Alcohol ResearchLiverpool Health PartnersLiverpoolUK
| | - Nicola T. Fear
- King's Centre for Military Health ResearchInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK,Academic Department of Military Mental HealthInstitute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education CentreLondonUK
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19
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Edwards ER, Epshteyn G, Dichiara A, Snyder S, Gorman D. Historical Trends in Veteran Community Substance Use Treatment: 2000-2019. Subst Use Misuse 2022; 57:1642-1645. [PMID: 35819019 DOI: 10.1080/10826084.2022.2096235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Substance use is a significant health crisis for the Veteran population. Prior research has thoroughly examined Veteran substance use within Veterans Health Administration (VHA) settings. However, such data tends to be outdated, and there is minimal research on substance use services delivered outside of VHA systems. This study examines historical patterns of Veteran substance use using a large sample of community-based substance-use treatment admissions. Methods: Data were drawn from the Substance Abuse and Mental Health Data Archive Treatment Episode Data Set-Admissions. Of the 39,425,886 total admissions between 2000 and 2019, 1,361,339 were of Veterans. Analyses compared Veteran versus non-Veteran admissions on demographics and historical trends in nature of substance-use admissions. Results: Relative to non-Veterans, Veteran admissions were more likely to be prompted by alcohol use. Over time, heterogeneity in substances prompting admissions has increased dramatically for both Veterans and non-Veterans, with particularly notable increases in opiate and stimulant use. Conclusion: Results suggest Veterans admitted to community substance-use treatment are unique relative to their non-Veteran peers. Development and implementation of treatments to target a range of substances while also considering the environmental challenges (e.g., homelessness) commonly faced by this population appear essential to best servicing community-based Veterans.
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Affiliation(s)
- Emily R Edwards
- Transitioning Service Member/Veteran and Suicide Prevention Center, VISN 2 MIRECC, James J Peters VA Medical Center, Bronx, New York, USA.,Deparment of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gabriella Epshteyn
- Transitioning Service Member/Veteran and Suicide Prevention Center, VISN 2 MIRECC, James J Peters VA Medical Center, Bronx, New York, USA.,Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Ariana Dichiara
- Transitioning Service Member/Veteran and Suicide Prevention Center, VISN 2 MIRECC, James J Peters VA Medical Center, Bronx, New York, USA.,Wholeview Wellness, New York, New York, USA
| | - Shayne Snyder
- Transitioning Service Member/Veteran and Suicide Prevention Center, VISN 2 MIRECC, James J Peters VA Medical Center, Bronx, New York, USA.,Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Daniel Gorman
- Transitioning Service Member/Veteran and Suicide Prevention Center, VISN 2 MIRECC, James J Peters VA Medical Center, Bronx, New York, USA
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20
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Gil Calado V. 'A man can only be truly known in drunkenness and war.' An anthropological perspective on alcohol use during the Portuguese Colonial War. Addiction 2021; 116:3261-3268. [PMID: 34033188 DOI: 10.1111/add.15583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/26/2020] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM To understand the use of psychoactive substances, one must consider the context and the social circumstances in which the substance use occurs. This paper discusses alcohol use from a socio-cultural perspective, based on the use of alcoholic beverages among the Portuguese servicemen who fought in the Portuguese Colonial War (1961-74). METHOD In-depth interviews were carried out with 17 former Portuguese soldiers. Simultaneously, extensive bibliographic and documentary research was carried out based on a broad set of biographical and autobiographical texts by former military personnel. Finally, an on-line survey (n = 210) was conducted among ex-combatants of the Portuguese Colonial War. RESULTS Alcohol drinking among Portuguese servicemen was high during the Portuguese Colonial War. Socio-cultural factors (such as regarding alcohol consumption as therapeutic and affirming masculinity) explain why alcohol drinking was so intense and frequent, and why repeated drunken behaviour was tolerated and undervalued by the military authorities, who considered it normal and not a health problem or disorder. CONCLUSION The use of alcohol in the Portuguese Colonial War is an empirical example of how what is considered 'acceptable', 'normal' or 'pathological' may depend more on socio-cultural norms than on objective and measurable criteria, including clinical criteria.
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Affiliation(s)
- Vasco Gil Calado
- General Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD), Parque de Saúde Pulido Valente, Alameda das Linhas de Torres, Lisbon, Portugal
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21
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Irizar P, Puddephatt JA, Gage SH, Fallon V, Goodwin L. The prevalence of hazardous and harmful alcohol use across trauma-exposed occupations: A meta-analysis and meta-regression. Drug Alcohol Depend 2021; 226:108858. [PMID: 34214883 DOI: 10.1016/j.drugalcdep.2021.108858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Trauma exposure is associated with hazardous and/or harmful alcohol use. Occupational groups frequently exposed to trauma may be at risk of alcohol harm. This meta-analysis determined the prevalence of hazardous and harmful alcohol use across trauma-exposed occupations and meta-regressions explored the impact of pre-defined covariates on the variance in prevalence estimates. METHOD Literature was searched from 2000 to March 2020, using Scopus, Web of Science and PsycINFO. Studies were included in the meta-analysis if they used a standardized measure of alcohol use (e.g., Alcohol Use Disorder Identification Test (AUDIT)). Studies were excluded if they measured alcohol use following an isolated sentinel event (e.g., 9/11). The following occupations were included: first responders, health care workers, Armed Forces, war journalists and train drivers. RESULTS 1882 studies were identified; 55 studies were eligible. The pooled prevalence of hazardous use was 22% (95% Confidence Intervals [CI]: 17%-27%) and 11% (95% CI: 8%-14%) for harmful use. Hazardous alcohol use was significantly lower in health care workers (13%; 95% CI: 10%-16%) than first responders (26%; 95% CI: 20%-32%) and Armed Forces (34%; 95% CI: 18%-52%). There was marked heterogeneity across studies and higher prevalence rates in low-quality studies. The meta-regression identified higher proportion of males and younger mean age as predictors of variance. CONCLUSIONS Male-dominated occupations, such as police officers and military personnel, showed higher levels of hazardous and harmful alcohol use, indicating that interventions tailored specifically for these occupational groups may be needed.
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Affiliation(s)
- Patricia Irizar
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom.
| | - Jo-Anne Puddephatt
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Suzanne H Gage
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
| | - Laura Goodwin
- Department of Psychology, Institute of Population Health, University of Liverpool, United Kingdom
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22
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Sharp ML, Serfioti D, Jones M, Burdett H, Pernet D, Hull L, Murphy D, Wessely S, Fear NT. UK veterans' mental health and well-being before and during the COVID-19 pandemic: a longitudinal cohort study. BMJ Open 2021; 11:e049815. [PMID: 34452965 PMCID: PMC8406464 DOI: 10.1136/bmjopen-2021-049815] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To investigate the impact of the COVID-19 pandemic on the health and well-being of UK ex-service personnel (veterans) before and during the pandemic, and to assess associations of COVID-19 experiences and stressors with mental health, alcohol use and loneliness. DESIGN An additional wave of data was collected from a longitudinal cohort study of the UK Armed Forces. SETTING Online survey June-September 2020. PARTICIPANTS Cohort members were included if they had completed a questionnaire at phase 3 of the King's Centre for Military Health Research health and well-being study (2014-2016), had left the Armed Forces after regular service, were living in the UK, had consented to follow-up and provided a valid email address. Invitation emails were sent to N=3547 with a 44% response rate (n=1562). PRIMARY OUTCOME MEASURES Common mental health disorders (CMDs) (measured using the General Health Questionnaire, 12 items-cut-off ≥4), hazardous alcohol use (measured using the Alcohol Use Disorder Identification Test, 10 items-cut off ≥8) and loneliness (University of California, Los Angeles, Loneliness Scale- 3 items-cut-off ≥6). RESULTS Veterans reported a statistically significant decrease in hazardous drinking of 48.5% to 27.6%, while CMD remained stable (non-statistically significant increase of 24.5% to 26.1%). 27.4% of veterans reported feelings of loneliness. The COVID-19 stressors of reporting difficulties with family/social relationships, boredom and difficulties with health were statistically significantly associated with CMD, hazardous drinking and loneliness, even after adjustment for previous mental health/hazardous alcohol use. CONCLUSIONS Our study suggests a COVID-19 impact on veterans' mental health, alcohol use and loneliness, particularly for those experiencing difficulties with family relationships. Veterans experienced the pandemic in similar ways to the general population and in some cases may have responded in resilient ways. While stable levels of CMD and reduction in alcohol use are positive, there remains a group of veterans who may need mental health and alcohol treatment services.
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Affiliation(s)
- Marie-Louise Sharp
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Danai Serfioti
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Margaret Jones
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Howard Burdett
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - David Pernet
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Lisa Hull
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Dominic Murphy
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
- Research Department, Combat Stress, Leatherhead, UK
| | - Simon Wessely
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Psychological Medicine, King's College London, London, UK
- Academic Department of Military Mental Health, Psychological Medicine, King's College London, London, UK
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23
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Bahorik A, Bobrow K, Hoang T, Yaffe K. Increased risk of dementia in older female US veterans with alcohol use disorder. Addiction 2021; 116:2049-2055. [PMID: 33449402 DOI: 10.1111/add.15416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/15/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
AIM To determine whether alcohol use disorder (AUD) is associated with increased dementia risk among older women veterans. DESIGN Cohort study. SETTING United States. PARTICIPANTS Women veterans with AUD aged ≥ 55 years (n = 2207), receiving care from Veterans Health Administration medical centers from October 2004 to September 2015 with one or more follow-up visit and an age-matched sample of women veterans without AUD (n = 2207). Women at baseline with prevalent dementia or AUD in remission were excluded. MEASUREMENTS AUD, substance use disorder (SUD), smoking, psychiatric (depression, anxiety, post-traumatic stress disorder, anxiety) and medical comorbidities (diabetes, hypertension, stroke, chronic obstructive pulmonary disorder, traumatic brain disorder) and dementia determined by the International Classification of Diseases, 9th revision, Clinical Modification codes. Cox proportional hazards models were used to determine the association between AUD and dementia risk during follow-up. Sensitivity analyses were performed by excluding women (n = 349) with comorbid SUD and by excluding women (n = 1568) currently smoking. FINDINGS Veteran women had a mean [standard deviation (SD)] age of 65.0 (5.6) years at baseline. During follow-up (median 4 years, interquartile range: 2-6) 3.7% of women (n = 82) with AUD developed dementia compared with 1.1% (n = 24) without AUD (P < 0.001). After adjustment for demographics, medical and psychiatric conditions and accounting for different Veteran's Integrated Service Networks, the adjusted hazard ratio (aHR) for dementia was 3.12 (95% CI = 1.90-5.12) for women with AUD compared with women without AUD. After removing women with SUD (aHR = 3.53, 95% CI = 2.13-5.85) and women currently smoking (aHR = 3.80, 95% CI = 2.11-6.84), results were similar. CONCLUSIONS Alcohol use disorder among female US veterans aged more than 55 years appears to be associated with a more than threefold increase of dementia.
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Affiliation(s)
- Amber Bahorik
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Kirsten Bobrow
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Tina Hoang
- Northern California Institute for Research and Education, San Francisco, CA, USA.,San Francisco VA Medical Center, California, CA, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, CA, USA.,Northern California Institute for Research and Education, San Francisco, CA, USA.,San Francisco VA Medical Center, California, CA, USA.,Department of Neurology, University of California, San Francisco, CA, USA
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24
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Blakey SM, Tsai J, Elbogen EB. Drinking to Cope with Posttraumatic Stress: A Nationally Representative Study of Men with and without Military Combat Experience. J Dual Diagn 2021; 17:101-112. [PMID: 33730991 DOI: 10.1080/15504263.2021.1891360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Posttraumatic stress disorder (PTSD) and hazardous alcohol use are prevalent among trauma survivors. Despite higher rates of both PTSD and hazardous alcohol use among military combat veterans than civilians, scant research has examined whether military combat experience is associated with drinking alcohol to cope with PTSD symptoms. This study tested the hypothesis that compared to trauma-exposed men without combat experience, men with military combat experience would be more likely to endorse drinking alcohol to cope with their PTSD symptoms. Methods: Interview data from N = 11,474 men who reported at least one lifetime traumatic experience were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a face-to-face interview study that recruited a nationally representative sample of adults living in the United States between 2004 and 2005. Results: Among men endorsing lifetime trauma exposure, men with military combat experience (n = 1,386) were more likely than men without combat experience (n = 10,088) to report drinking alcohol to cope (7.22 vs. 2.61% in unweighted analyses, 6.46 vs. 2.37% in weighted analyses). Total number of lifetime trauma types, lifetime PTSD severity, and lifetime alcohol abuse/dependence were significantly associated with drinking to cope in bivariate and multivariate analyses. Military combat experience was significantly associated with drinking to cope in multivariate analyses adjusting for lifetime PTSD diagnosis. Military combat experience was not significantly associated with drinking to cope in multivariate analyses adjusting for lifetime PTSD symptom count. Conclusions: Although military combat experience was significantly associated with drinking to cope in bivariate analyses, multivariate analyses yielded mixed findings: combat experience was significantly associated with drinking to cope in models adjusting for PTSD diagnosis, but not in models adjusting for PTSD symptom count. Findings highlight the importance of assessing and targeting PTSD symptom-related alcohol use, even in the absence of alcohol abuse/dependence. Results from this preliminary study could inform future research on drinking to cope with PTSD symptoms among military combat veterans and other trauma survivors.
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Affiliation(s)
- Shannon M Blakey
- Durham VA Health Care System, Durham, North Carolina, USA.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA
| | - Jack Tsai
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA.,VA National Center on Homelessness Among Veterans, Tampa, Florida, USA
| | - Eric B Elbogen
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA.,VA National Center on Homelessness Among Veterans, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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25
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Dorrington S, Carr E, Polling C, Stevelink S, Ashworth M, Roberts E, Broadbent M, Hatch S, Madan I, Hotopf M. Health condition at first fit note and number of fit notes: a longitudinal study of primary care records in south London. BMJ Open 2021; 11:e043889. [PMID: 33771823 PMCID: PMC8006821 DOI: 10.1136/bmjopen-2020-043889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The fit note replaced the sick note in the UK in 2010, with the aim of improving support for patients requiring sickness absence, yet there has been very little research into fit note use. This study aims to describe number of fit notes by condition, to improve our understanding of patterns of fit note use in primary care. Previous fit note research has relied on extracting diagnoses directly from fit notes, rather than extracting information from clinical records. In this paper, we extract information from clinical records to explore demographic factors and conditions associated with number of fit notes issued. DESIGN This is a longitudinal study of clinical data. We analysed individual-level anonymised data from general practitioner consultations, including demographic information and condition recorded at first fit note. The latter encompassed diagnoses, individual symptoms and psychosocial issues. SETTING A database called Lambeth DataNet, containing electronic clinical records on 326 415 adults (ages 16-60) from all 45 general practices within the London Borough of Lambeth from 1 January 2014 to 30 April 2017. PARTICIPANTS Our analytical sample contained 40 698 people with a condition recorded at first fit note. PRIMARY OUTCOME MEASURE Predicted number of fit notes in the period January 2014-April 2017 RESULTS: Of all studied diagnostic groups, mental illness had the highest predicted number of fit notes (n=3.3; 95% CI: 3.1 to 3.4) after controlling for demographic factors and long-term conditions. The highest predicted number of fit notes for any condition subgroup was among patients presenting for drug and/or alcohol misuse (n=4.5; 95% CI: 4.1 to 4.8). CONCLUSIONS For the first time, we show drug and/or alcohol misuse at first fit note are associated with the highest number of fit notes. Research is needed to understand the trajectories of individuals at highest risk of long-term sickness absence, in particular, people presenting with drug and/or alcohol misuse.
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Affiliation(s)
- Sarah Dorrington
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley Mental Health NHS Trust, London, UK
| | - Ewan Carr
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - C Polling
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley Mental Health NHS Trust, London, UK
| | - Sharon Stevelink
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, London, London, UK
| | - Emmert Roberts
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley Mental Health NHS Trust, London, UK
- National Addiction Centre, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Matthew Broadbent
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley Mental Health NHS Trust, London, UK
| | - Stephani Hatch
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley Mental Health NHS Trust, London, UK
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26
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Irizar P, Stevelink SAM, Pernet D, Gage SH, Greenberg N, Wessely S, Goodwin L, Fear NT. Probable post-traumatic stress disorder and harmful alcohol use among male members of the British Police Forces and the British Armed Forces: a comparative study. Eur J Psychotraumatol 2021; 12:1891734. [PMID: 33968324 PMCID: PMC8079084 DOI: 10.1080/20008198.2021.1891734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: British Armed Forces' and Police Forces' personnel are trained to operate in potentially traumatic conditions. Consequently, they may experience post-traumatic stress disorder (PTSD), which is often comorbid with harmful alcohol use. Objective: We aimed to assess the proportions, and associations, of probable PTSD and harmful alcohol use among a covariate-balanced sample of male military personnel and police employees. Methods: Proportions of probable PTSD, harmful alcohol use, and daily binge drinking, were explored using data from the police Airwave Health Monitoring Study (2007-2015) (N = 23,826) and the military Health and Wellbeing Cohort Study (phase 2: 2007-2009, phase 3: 2014-2016) (N = 7,399). Entropy balancing weights were applied to the larger police sample to make them comparable to the military sample on a range of pre-specified variables (i.e. year of data collection, age and education attainment). Multinomial and logistic regression analyses determined sample differences in outcome variables, and associated factors (stratified by sample). Results: Proportions of probable PTSD were similar in military personnel and police employees (3.67% vs 3.95%), although the large sample size made these borderline significant (Adjusted Odds Ratio (AOR): 0.84; 95% Confidence Intervals (CI): 0.72 to 0.99). Clear differences were found in harmful alcohol use among military personnel, compared to police employees (9.59% vs 2.87%; AOR: 2.79; 95% CI: 2.42 to 3.21). Current smoking, which was more prevalent in military personnel, was associated with harmful drinking and binge drinking in both samples but was associated with PTSD in military personnel only. Conclusions: It is generally assumed that both groups have high rates of PTSD from traumatic exposures, however, low proportions of PTSD were observed in both samples, possibly reflecting protective effects of unit cohesion or resilience. The higher level of harmful drinking in military personnel may relate to more prominent drinking cultures or unique operational experiences.
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Affiliation(s)
- Patricia Irizar
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - David Pernet
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Suzanne H Gage
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Simon Wessely
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Laura Goodwin
- Department of Psychology, Institute of Population Health, University of Liverpool, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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27
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Gibson M, Williamson L, Henwood G, Chalmers D, Dell CA. Perceptions and Use of Alcohol and Medical Cannabis among Canadian Military Veterans Living with PTSD. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i1.200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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28
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Godier-McBard LR, Castle CL, Heinze N, Hussain SF, Borowski S, Vogt DS, Gomes RSM, Fossey M. A preliminary investigation of the well-being of visually impaired ex-service personnel in the United Kingdom. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2020. [DOI: 10.1177/0264619620973683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research has shown that visual impairment may impact daily functioning, health, and well-being negatively for adults of all ages. Ex-service personnel (‘veterans’) too may be at risk of poor health and well-being outcomes associated with post-military life, and this may be exacerbated by the presence of visual impairment. Despite this, research considering the experience of blind veterans has been limited and has not yet assessed well-being for these individuals across a broad spectrum of life domains. Rather, it has highlighted poor mental health and psychological well-being in working-age visually impaired veterans. However, the experiences of older visually impaired veterans (who make up the majority of visually impaired veterans in the United Kingdom) have been poorly represented in the literature. This pilot study aimed to provide a preliminary assessment of holistic well-being in an adult sample of 97 UK blind veterans, predominantly composed of older age veterans (majority over 80 years). Cross-sectional well-being data were collected using a validated measure of well-being (the Well-Being Inventory [WBI]). Results suggest that members of Blind Veterans UK are functioning well and are satisfied across four life domains (vocation, finances, health, and social relationships). Lower health satisfaction was identified, particularly in blind veterans with comorbid mental health conditions. Results are discussed in relation to the older age of the sample, the limitations of face-to-face survey administration, and the applicability of the WBI finance domain in this age cohort. Recommendations are made for future research in this population.
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Affiliation(s)
- Lauren R Godier-McBard
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, UK
| | | | | | | | | | - Dawne S Vogt
- National Centre for PTSD, VA Boston Healthcare System, USA; Boston University School of Medicine, USA
| | | | - Matt Fossey
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, UK
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29
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Blair CS, Dunlap S, Tzen M, Castro CA, Goldbach JT, Holloway IW. Mental Health, Sexual Orientation, and Perceived Social Network Support in Relation to Hazardous Alcohol Consumption Among Active Duty Military Men. Am J Mens Health 2020; 14:1557988320976306. [PMID: 33267728 PMCID: PMC7720330 DOI: 10.1177/1557988320976306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/02/2022] Open
Abstract
Knowledge surrounding perceived network support and alcohol consumption among active duty U.S. military personnel is limited, particularly among sexual minorities.We sought to determine the correlates of hazardous alcohol consumption and whether perceived network support moderated the relationship between sexual orientation and Alcohol Use Identification Test (AUDIT-C) score.The sample comprised cisgender men currently serving in the U.S. military (N = 292). Participants were recruited through respondent-driven sampling and completed an online survey. Logistic regression analysis evaluated associations between positive AUDIT-C with sociodemographic characteristics (including sexual orientation), military service, mental health, and perceived social network support. Interaction analysis assessed the moderating effect of perceived network support on sexual orientation and AUDIT-C.Among study participants, 52.7% (154/292) had positive AUDIT-C, while 65.4% (191/292) self-identified as heterosexual/straight and 34.6% (101/292) identified as gay or bisexual. In adjusted analysis, positive AUDIT-C was associated with increased post-traumatic stress disorder symptomatology (adjusted odds ratio [adjOR] 1.03; 95% CI [1.00, 1.06]; p = .019) and high perceived network support (adjOR 1.85; 95% CI [1.04, 3.29]; p = .036), while mental health service utilization had reduced odds of positive AUDIT-C (adjOR 0.40; 95% CI [0.20, 0.78]; p = .007). In interaction analysis, high perceived network support was associated with increased odds of positive AUDIT-C among sexual minority men (adjOR 3.09; 95% CI [1.21, 7.93]; p = .019) but not heterosexual men (adjOR 1.38; 95% CI [0.68, 2.81]; p = .37).Hazardous alcohol use was prevalent among all men in our sample. Perceived social network support may influence hazardous alcohol consumption, particularly among sexual minority servicemen. These findings suggest the potential role of tailored social network-based interventions to decrease hazardous alcohol use among military personnel.
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Affiliation(s)
- Cheríe S. Blair
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shannon Dunlap
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - Michael Tzen
- California Center for Population Research, University of California, Los Angeles, CA, USA
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jeremy T. Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Ian W. Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
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30
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Ramachandran A, Makhashvili N, Javakhishvili J, Karachevskyy A, Kharchenko N, Shpiker M, Ezard N, Fuhr DC, Roberts B. Alcohol use among conflict-affected persons in Ukraine: risk factors, coping and access to mental health services. Eur J Public Health 2020; 29:1141-1146. [PMID: 31230084 DOI: 10.1093/eurpub/ckz117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are approximately 1.5 million internally displaced persons (IDPs) in Ukraine as a result of the conflict in eastern Ukraine. Exposure to violence, forced displacement and increased mental disorders are potential risk-factors for alcohol use disorder (AUD). The aim of this study was to estimate the prevalence of and risk factors for AUD among Ukrainian IDPs and investigate the relationship between AUD, mental health service utilization and coping behaviours. METHODS A nation-wide cross-sectional survey of 2203 IDPs was conducted. Data were collected on AUD [using alcohol use disorder identification test (AUDIT)], mental health disorders, utilization of health services and coping behaviours. Multivariable logistic regression was used to identify risk factors for AUD, and to estimate the odds ratios for the association between alcohol use and utilization of health services and coping behaviours. RESULTS Of 2203 IDPs surveyed, 8.4% of men and 0.7% of women screened positive for AUD (AUDIT >7). Among current drinkers, AUD was present in 14.9% of men and 1.8% of women. Age, cumulative trauma exposure and anxiety were significantly associated with AUD in multivariable analysis. Alcohol users were 43% less likely to access health services for mental health compared with non-users. AUD was associated with more negative coping behaviours. CONCLUSIONS AUD is present within the male Ukrainian IDP population. Alcohol use was significantly associated with lower utilization of mental health services and more negative coping behaviours. AUD screening and low-intensity treatment services should be expanded for IDPs in Ukraine, particularly if integrated into mental health and psychosocial support programmes.
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Affiliation(s)
- Anu Ramachandran
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Nino Makhashvili
- Global Initiative on Psychiatry-Tbilisi, Tbilisi, Georgia.,Ilia State University, Tbilisi, Georgia
| | - Jana Javakhishvili
- Global Initiative on Psychiatry-Tbilisi, Tbilisi, Georgia.,Ilia State University, Tbilisi, Georgia
| | | | | | - Marina Shpiker
- Kiev International Institute of Sociology (KIIS), Kiev, Ukraine
| | - Nadine Ezard
- University of New South Wales Sydney, Sydney, Australia.,St Vincent's Hospital Sydney, Sydney, Australia
| | - Daniela C Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
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31
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Leightley D, Rona RJ, Shearer J, Williamson C, Gunasinghe C, Simms A, Fear NT, Goodwin L, Murphy D. Evaluating the Efficacy of a Mobile App (Drinks:Ration) and Personalized Text and Push Messaging to Reduce Alcohol Consumption in a Veteran Population: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19720. [PMID: 33006569 PMCID: PMC7568221 DOI: 10.2196/19720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 01/30/2023] Open
Abstract
Background Alcohol misuse is higher in the UK Armed Forces than in the general population. Previous research has shown that interventions delivered via smartphones are efficacious in promoting self-monitoring of alcohol use, have utility in reducing alcohol consumption, and have a broad reach. Objective This single-blinded randomized controlled trial (RCT) aims to assess the efficacy of a 28-day brief alcohol intervention delivered via a smartphone app (Drinks:Ration) in reducing weekly self-reported alcohol consumption between baseline and 3-month follow-up among veterans who drink at a hazardous or harmful level and receive or have received support for mental health symptoms in a clinical setting. Methods In this two-arm, single-blinded RCT, a smartphone app that includes interactive features designed to enhance participants’ motivation and personalized messaging is compared with a smartphone app that provides only government guidance on alcohol consumption. The trial will be conducted in a veteran population that has sought help through Combat Stress, a UK veteran’s mental health charity. Recruitment, consent, and data collection will be carried out automatically through the Drinks:Ration platform. The primary outcome is the change in self-reported weekly alcohol consumption between baseline (day 0) and 3-month follow-up (day 84) as measured using the Time-Line Follow back for Alcohol Consumption. Secondary outcome measures include (1) change in the baseline to 3-month follow-up (day 84) Alcohol Use Disorder Identification Test score and (2) change in the baseline to 3-month follow-up (day 84) World Health Organization Quality of Life-BREF score to assess the quality of adjusted life years. Process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. The primary and secondary outcomes will also be reassessed at the 6-month follow-up (day 168) to assess the longer-term benefits of the intervention, which will be reported as a secondary outcome. Results The study will begin recruitment in October 2020 and is expected to require 12 months to complete. The study results will be published in 2022. Conclusions This study assesses whether a smartphone app is efficacious in reducing self-reported alcohol consumption in a veteran population that has sought help through Combat Stress using personalized messaging and interactive features. This innovative approach, if successful, may provide a means to deliver a low-cost health promotion program that has the potential to reach large groups, in particular those who are geographically dispersed, such as military personnel. Trial Registration ClinicalTrials.gov NCT04494594; https://clinicaltrials.gov/ct2/show/NCT04494594 International Registered Report Identifier (IRRID) PRR1-10.2196/19720
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Affiliation(s)
- Daniel Leightley
- King's College London, King's Centre for Military Health Research, London, United Kingdom
| | - Roberto J Rona
- King's College London, King's Centre for Military Health Research, London, United Kingdom
| | - James Shearer
- King's College London, King's Health Economics, London, United Kingdom
| | | | - Cerisse Gunasinghe
- King's College London, Department of Psychological Medicine, London, United Kingdom
| | - Amos Simms
- Academic Department of Military Mental Health, King's College London, London, United Kingdom.,British Army, London, United Kingdom
| | - Nicola T Fear
- King's College London, King's Centre for Military Health Research, London, United Kingdom.,Academic Department of Military Mental Health, King's College London, London, United Kingdom
| | - Laura Goodwin
- University of Liverpool, Department of Psychological Sciences, Liverpool, United Kingdom
| | - Dominic Murphy
- King's College London, King's Centre for Military Health Research, London, United Kingdom.,Combat Stress, Leatherhead, United Kingdom
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32
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Anderson Goodell EM, Johnson RM, Latkin CA, Homish DL, Homish GG. Risk and protective effects of social networks on alcohol use problems among Army Reserve and National Guard soldiers. Addict Behav 2020; 103:106244. [PMID: 31838442 DOI: 10.1016/j.addbeh.2019.106244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Military personnel engage in alcohol-related behaviors for a variety of reasons, some of which may be socially-motivated. Although civilian-based research has established that peers' drinking behaviors are correlated with individuals' own drinking behaviors, military work has not yet examined the influence of social network characteristics on soldier drinking behaviors. This study describes characteristics of soldiers' social networks in association with soldier alcohol use problems. METHODS This study includes data on 353 U.S. Reserve and National Guard (R/NG) soldiers and their 2154 past-year social ties. Descriptive analyses examined social tie characteristics (e.g., military affiliation, substance misuse, and drinking influence). Negative binomial regression models examined relationships between social network characteristics and soldier alcohol use problems. RESULTS On average, 14% of a R/NG soldier's social network was comprised of military-affiliated ties. Further, an average of 14% of ties in a soldier's network were considered drinking buddies, and 8% of ties were heavy-drinkers. More drinking buddies and heavy-drinking ties in a soldier's social network and greater average number of past-month days drinking with ties were associated with increases in soldier alcohol problems. For deployed soldiers, larger military-affiliated social networks were protective against alcohol problems. CONCLUSIONS Drinking-related social network characteristics are associated with increased alcohol problems among soldiers, while military-affiliated ties are protective specifically for deployed soldiers. Interventions to reduce alcohol use problems may focus on enhancing social connections between R/NG soldiers and providing opportunities to connect deployed R/NG soldiers with one another during and after reintegration.
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Alcohol use and sexual risk behaviors in the Armed Forces of the Democratic Republic of the Congo. BMC Public Health 2019; 19:1394. [PMID: 31660935 PMCID: PMC6819617 DOI: 10.1186/s12889-019-7794-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Alcohol misuse is an important contributor to sexual acquisition and transmission of HIV in military communities. This cross-sectional study quantified the prevalence of probable problematic alcohol use among male service members in the Armed Forces of the Democratic Republic of the Congo (FARDC), identified associated factors, and investigated associations of alcohol misuse with risky sexual behaviors.
Methods
Participants included 2549 active duty male soldiers ≥ 18 years old. Data were collected via computer-assisted personal-interview from October 2013–April 2014. The Alcohol Use Disorders Identification Test (AUDIT) was used to identify probable problematic alcohol use (AUDIT score ≥ 8) compared to no/low-risk alcohol use (AUDIT score ≤ 7). Bivariate logistic regressions were used to identify factors associated with probable problematic alcohol use. Several multivariable logistic regressions (adjusted for age, marital status, education level) were used to examine associations of probable problematic alcohol use with risky sexual behaviors. Tests were two sided; statistical significance was defined as p < 0.05.
Results
Fifteen percent of men screened positive for probable problematic alcohol use. The odds of probable problematic alcohol use were elevated among men who were single and living with a partner (OR = 1.66; 95% CI = 1.24–2.21), ranked as a non-commissioned officer [NCO] (OR = 1.40; 95% CI = 1.10–1.77), and in the 30–39 and 40–49 age groups (OR 30–39 age group = 2.17; 95% CI = 1.56–3.02; OR 40–49 age group = 1.79; 95% CI = 1.26–2.55). Probable problematic alcohol use was associated with increased odds of having sex with a sex worker (SW), having multiple sexual partners, and participating in transactional sex (aOR sex with a SW = 2.36; 95% CI = 1.78–3.13; aOR multiple sexual partners = 2.08; 95% CI = 1.66–2.60; aOR transactional sex = 1.99; 95% CI = 1.59–2.50).
Conclusions
Results emphasize the need to address alcohol use in the FARDC and integrate alcohol abuse education into HIV prevention programs among male service members. Alcohol abuse prevention efforts should target men who are 30–49 years of age, unmarried, and ranked as a NCO. Messages and interventions to reduce alcohol misuse in relation to risky sexual behaviors are needed.
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Selman J, Rogers R, Molloy S. Negative Alcohol and Tobacco Consumption Behaviors in an Australian Army Combat Brigade. Mil Med 2019. [DOI: 10.1093/milmed/usz406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Western militaries have consumption rates of alcohol and tobacco which are higher than the associated civilian populations, and are concerned about the negative effects on health, wellbeing, and military performance that such high rates may have.
Materials and Methods
A survey questionnaire which collected nonidentifiable data was distributed to all accessible members of an Australian Army Combat Brigade over the annual induction training and prefield exercise period between January and March 2019. The survey was composed of personal and demographic questions, followed by questions concerning the personal consumption habits of alcohol and tobacco. 1,606 complete and valid surveys were returned, representing 55.3% of the Brigade’s posted strength. Ethical clearance for this project was provided by the Australian Defence Force Joint Health Command Low Risk Ethics Panel (18-012).
Results
Almost one quarter of the Combat Brigade exceeded the Australian daily risk guideline for alcohol consumption, and over three quarters exceeded the occasion risk guideline; with 6.1% of soldiers drinking alcohol daily. 24.3% identified as tobacco smokers, with 15.9% smoking daily. Smoking rates and volumes were higher when deployed on field training exercises and on international training and operational deployments; as was the consumption of roll-your-own cigarettes. Overall, the main determinants of the negative consumption behaviors were gender (male) and age (under 25).
Conclusions
This study confirmed that the members of an Australian Army Combat Brigade have higher negative health consumption behaviors concerning alcohol and tobacco than the general civilian population. The results also identified a cohort of Senior Non-Commissioned Officers and Warrant Officers (E5–E9) between the ages of 35 and 44 who had high negative consumption behaviors which could result in poor health outcomes. This could be a suitable cohort for a targeted campaign to reduce tobacco and alcohol consumption and to assist to make healthy life changes.
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Affiliation(s)
- Jason Selman
- HQ 3rd Brigade, Australian Army, Lavarack Barracks, Townsville, Queensland 4813, Australia
| | - Rona Rogers
- HQ 3rd Brigade, Australian Army, Lavarack Barracks, Townsville, Queensland 4813, Australia
| | - Sara Molloy
- HQ 3rd Brigade, Australian Army, Lavarack Barracks, Townsville, Queensland 4813, Australia
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Brady LL, Credé M, Harms P, Bachrach DG, Lester PB. Meta-analysis of risk factors for substance abuse in the US military. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1657754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Lisa L. Brady
- Department of Management, The University of Alabama, Tuscaloosa, Alabama
| | - Marcus Credé
- Department of Psychology, Iowa State University, Ames, Iowa
| | - P.D. Harms
- Department of Management, The University of Alabama, Tuscaloosa, Alabama
| | - Daniel G. Bachrach
- Department of Management, The University of Alabama, Tuscaloosa, Alabama
| | - Paul B. Lester
- Army Analytics Group Research Facilitation Laboratory, Monterey, California
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Anderson L, Campbell-Sills L, Ursano RJ, Kessler RC, Sun X, Heeringa SG, Nock MK, Bliese PD, Gonzalez CPTOI, Wynn LTCGH, Jain S, Stein MB. Prospective associations of perceived unit cohesion with postdeployment mental health outcomes. Depress Anxiety 2019; 36:511-521. [PMID: 30694009 PMCID: PMC7058190 DOI: 10.1002/da.22884] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Prior investigations have found negative associations between military unit cohesion and posttraumatic stress disorder (PTSD); however, most relied on cross-sectional data and few examined relationships of unit cohesion to other mental disorders. This study evaluates prospective associations of perceived unit cohesion with a range of mental health outcomes following combat deployment. METHODS U.S. Army soldiers were surveyed approximately 1-2 months before deployment to Afghanistan (T0); and 1 month (T1), 3 months (T2), and 9 months (T3) after return from deployment. Logistic regression was performed to estimate associations of perceived unit cohesion at T0 with risk of PTSD, major depressive episode (MDE), generalized anxiety disorder (GAD), alcohol or substance use disorder (AUD/SUD), and suicidal ideation at T2 or T3 among soldiers who completed all study assessments (N = 4,645). Models were adjusted for sociodemographic and Army service characteristics, predeployment history of the index outcome, and deployment stress exposure. RESULTS Higher perceived unit cohesion at T0 was associated with lower risk of PTSD, MDE, GAD, AUD/SUD, and suicidal ideation at T2 or T3 (AORs = 0.72 to 0.85 per standard score increase in unit cohesion; P-values < 0.05). Models of incidence of mental disorders and suicidal ideation among soldiers without these problems predeployment yielded similar results, except that perceived unit cohesion was not associated with incident AUD/SUD. CONCLUSIONS Soldiers who reported strong unit cohesion before deployment had lower risk of postdeployment mental disorders and suicidal ideation. Awareness of associations of perceived unit cohesion with postdeployment mental health may facilitate targeting of prevention programs.
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Affiliation(s)
- Lauren Anderson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Steven G. Heeringa
- University of Michigan, Institute for Social Research, Ann Arbor, MI, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Paul D. Bliese
- Department of Management, Darla Moore School of Business, University of South Carolina, Columbia, SC, USA
| | - CPT Oscar I. Gonzalez
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - LTC Gary H. Wynn
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA
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Woodruff SI, Hurtado SL, Simon-Arndt CM. U.S. Marines' Perceptions of Environmental Factors Associated With Alcohol Binge Drinking. Mil Med 2019; 183:e240-e245. [PMID: 29425366 DOI: 10.1093/milmed/usx121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/21/2017] [Indexed: 11/12/2022] Open
Abstract
Introduction Alcohol misuse, in particular binge drinking, is a serious concern among military personnel because it is strongly associated with adverse consequences and has a deleterious effect on readiness. Although most alcohol misuse studies have focused on individual risk factors, studies are increasingly examining environmental influences and strategies for reducing alcohol risks. The purpose of this study is to address gaps in what is known about how service members' perceptions of environmental factors are related to binge drinking in the U.S. Marine Corps. Materials and Methods The relationship between Marines' self-reports of environmental factors and alcohol binge drinking was assessed in this correlational study using data from three large Marine Corps installations drawn from the Department of Defense 2011 Health Related Behaviors Survey of Active Duty Military Personnel (N = 2,933). We proposed several directional hypotheses based on existing civilian and military studies of alcohol use and misuse, as well as health behavior theory. Results Agreement with the statements that alcoholic beverages cost too much, that drinking might negatively affect one's military career, and that one's immediate supervisor and installation discourage alcohol use were independently associated with decreased odds of binge drinking (i.e., protective factors). Perceptions that alcoholic beverages are difficult to get was particularly protective; the odds of having binged were lower for participants who endorsed this belief than for those who did not. Perceptions that drinking is part of being in one's unit was a risk factor for binge drinking (odds ratio = 1.29). Conclusion Even after accounting for strong sociodemographic correlates, binge drinking was independently associated with a number of environmentally oriented perceptions. Beliefs that alcohol is affordable and easy to access were the strongest environmental correlates of increased risk of binge drinking. Addressing the threat alcohol misuse poses to both Marines and mission readiness will likely require multiple strategies, including both policy and environmental changes.
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Affiliation(s)
- Susan I Woodruff
- School of Social Work, San Diego State University, 5500 Campanile Drive, HH 203, San Diego, CA
| | - Suzanne L Hurtado
- Health and Behavioral Sciences Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA
| | - Cynthia M Simon-Arndt
- Health and Behavioral Sciences Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA.,Leidos, Inc., 140 Sylvester Road, San Diego, CA
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MORAN DOMINIQUE, TURNER JENNIFER, ARNOLD HELEN. Soldiering On? The Prison‐Military Complex and Ex‐Military Personnel as Prison Officers: Transition, Rehabilitation and Prison Reform. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/hojo.12316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- DOMINIQUE MORAN
- Dominique Moran is Professor in Carceral GeographyUniversity of Birmingham
| | - JENNIFER TURNER
- Jennifer Turner is Lecturer in Human GeographyUniversity of Liverpool
| | - HELEN ARNOLD
- Helen Arnold is Senior Lecturer in CriminologyUniversity of Suffolk
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Willmund GD, Waechter H, Helms C, Wesemann U, Heß J, Seiffert A, Bambridge D, Lutz Zimmermann P, Himmerich H. German research perspectives on suicidality and the rationale for future multinational suicide prevention projects among military service personnel. Int Rev Psychiatry 2019; 31:60-74. [PMID: 31041871 DOI: 10.1080/09540261.2019.1581146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As a result of scientific publications indicating that the last two decades have seen an increase in the number of suicides in the US Armed Forces, the topic of suicide in the military of other countries, such as Germany, has also received a lot of attention in media and science alike. Risk factors for suicidal behaviour and suicide were identified in several research projects in the US, Canada, the UK, and Germany. Until now, German suicide research among military service personnel has mainly focused on epidemiological aspects of suicides and suicidality, individual risk factors, sub-groups at risk for suicide, suicides and deployment abroad, and associations of suicide and suicide attempts with acute mental disorders. The key findings are summarized in this review article. Efforts should be made to develop and evaluate risk group-focused and occupation-focused prevention and intervention programs. Future multinational studies should address potential differences between risk groups for fatal and non-fatal suicidal behaviour.
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Affiliation(s)
- Gerd-Dieter Willmund
- a Bundeswehr Centre for Military Mental Health , Bundeswehr Hospital Berlin , Berlin , Germany
| | - Henriette Waechter
- a Bundeswehr Centre for Military Mental Health , Bundeswehr Hospital Berlin , Berlin , Germany
| | - Christian Helms
- a Bundeswehr Centre for Military Mental Health , Bundeswehr Hospital Berlin , Berlin , Germany.,b Department of Psychiatry and Psychotherapy Campus Charité Mitte Berlin , St. Hedwig Hospital , Berlin , Germany
| | - Ulrich Wesemann
- a Bundeswehr Centre for Military Mental Health , Bundeswehr Hospital Berlin , Berlin , Germany
| | - Julius Heß
- c Bundeswehr Centre for Military History and Social Sciences , Potsdam , Germany
| | - Anja Seiffert
- c Bundeswehr Centre for Military History and Social Sciences , Potsdam , Germany
| | - Darren Bambridge
- d Academic Department of Military Mental Health , Weston Education Centre , London , UK.,e Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN) , King's College London , London , UK
| | - Peter Lutz Zimmermann
- a Bundeswehr Centre for Military Mental Health , Bundeswehr Hospital Berlin , Berlin , Germany
| | - Hubertus Himmerich
- a Bundeswehr Centre for Military Mental Health , Bundeswehr Hospital Berlin , Berlin , Germany.,e Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN) , King's College London , London , UK
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Marchi J, Mayet A, Chamonaz C, de Laval F, Paul F, Marimoutou C. Differential Impact According to Mission's Operational Intensity on Psychoactive Substance Use: A Retrospective Cohort of French Male Army Service Members. Subst Use Misuse 2019; 54:841-851. [PMID: 30648459 DOI: 10.1080/10826084.2018.1547908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Stressful deployments in combat areas are known to increase the risk of substance abuse in military personnel. OBJECTIVES The aim of the study was to compare deployment on stressful, high-intensity missions (HIMs) to deployment on low-intensity missions (LIMs) in order to understand factors associated with substance use variations across the mission. METHODS A retrospective cohort study based on a one-shot self-questionnaire was performed four months after their return on two samples of male French Army service members: one returning from an HIM and one from an LIM. The questionnaire focused on tobacco, alcohol, cannabis, cocaine, and psychoactive medication use at three times: before, during, and after the mission. RESULTS During an HIM, the frequency of tobacco use increased, alcohol use remained stable - although 38% declared a decrease in consumption - and illicit drug use decreased. During an LIM, tobacco and alcohol use increased, cannabis use remained stable, and only cocaine and medication use decreased. After their return, use levels among both samples reverted to values similar to those reported before the mission, except for a decrease in tobacco use observed at return from an HIM. The main factors perceived as related to variations were stress in an HIM and low cost in an LIM. Conclusions/importance: The study suggests a differential impact of deployment on substance use according to the operational intensity of the mission. Variations in use are predominant during the mission with a washout effect after returning home.
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Affiliation(s)
- Joffrey Marchi
- a CESPA, Centre d'Epidémiologie et de Santé Publique des Armées , SSA, Service de Santé des Armées , Marseille , France
| | - Aurélie Mayet
- a CESPA, Centre d'Epidémiologie et de Santé Publique des Armées , SSA, Service de Santé des Armées , Marseille , France.,b INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ , Marseille , France
| | - Claire Chamonaz
- c Hôpital d'Instruction des Armées Laveran , Marseille , France
| | - Franck de Laval
- a CESPA, Centre d'Epidémiologie et de Santé Publique des Armées , SSA, Service de Santé des Armées , Marseille , France
| | - Frédéric Paul
- c Hôpital d'Instruction des Armées Laveran , Marseille , France
| | - Catherine Marimoutou
- a CESPA, Centre d'Epidémiologie et de Santé Publique des Armées , SSA, Service de Santé des Armées , Marseille , France.,b INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ , Marseille , France
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Shahini M, Rescorla LA, Shala M, Ukshini S. Living on the Edge: Emotional and Behavioral Problems in a Sample of Kosovar Veterans and Wives of Veterans 16 Years Postwar. Front Psychiatry 2019; 10:598. [PMID: 31572226 PMCID: PMC6753182 DOI: 10.3389/fpsyt.2019.00598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/29/2019] [Indexed: 11/18/2022] Open
Abstract
Aim: This study aimed to explore the effects of war traumatic exposure on emotional and behavioral problems in a sample of Kosovar war veterans and the wives of veterans 16 years after the 1998-1999 war, as well as whether the level of education, income, well-being, and substance use are predictors for emotional and behavioral problems. Methods: Self-report data were obtained from 373 adults, 247 male war veterans (66.2% of the sample) and 126 wives of other male war veterans (33.8% of the sample). The sample was recruited from a list of war veterans provided by the Kosovar National Association of War Veterans. The mean age of participants was 45.42 [standard deviation (SD), 7.64] years. Measurements comprised a sociodemographic brief structured interview, the Well-Being Index (WHO-5), the Harvard Trauma Questionnaire, and the Adult Self Report (ASR). Logistic regression analysis was conducted to explore if the demographic variables were predictors for ASR general scales and subscales. Multivariate analysis of covariance was performed by adding as covariates the continuous variables pointed out in the logistic regression analysis as discriminating factors between the groups. Post hoc analyses were corrected, and we estimated partial η2 to measure the effect size. Results: The higher traumatic exposure during the war, the greater the tendency to have emotional problems and behavioral problems for both kinds of participants. The result showed that there were no differences on the prevalence of emotional and behavioral problems between the two groups, and both veterans and wives of veterans had no differences on seeking professional help for their emotional and behavioral problems. Wives of veterans living in rural areas showed higher scores on almost all ASR scales compared with those living in urban areas or even with those of veterans from urban and rural areas. Veterans with elementary education level had the highest scores compared with other groups. Veterans with poor well-being had the highest scores compared with other groups. Using Internalizing, Externalizing, and Total Problems as outcome variables and trauma exposure, smoking, drinking alcohol, and well-being as predictors, we found that the model was a significant predictor for both male and female participants on these three scales. Conclusion: The relationship found between the level of exposure to traumatic events and emotional and behavior problems, as well as the factors that moderated such relations, in war veterans and their wives, should help global mental health researchers address the contextual dimensions of this relationship and identify better ways to prevent and treat those problems.
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Affiliation(s)
- Mimoza Shahini
- Department of Psychiatry, University Clinical Center of Kosovo, Pristina, Kosovo
| | - Leslie A Rescorla
- Department of Psychology, Bryn Mawr College, Bryn Mawr, PA, United States
| | - Merita Shala
- Department of Education, Mitrovica University, Mitrovica, Kosovo
| | - Shqipe Ukshini
- Department of Psychology, University Clinical Center of Kosovo, Pristina, Kosovo
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Rushton R, Lynch K. Development of alcohol treatment for UK military personnel. J ROY ARMY MED CORPS 2018; 165:98-101. [PMID: 30415214 DOI: 10.1136/jramc-2018-001050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 12/11/2022]
Abstract
The consumption of alcohol in the UK Armed Forces (AF) as 'an agent to assist cohesion and informal operational debriefing' is a social and psychological conceptualisation that has some empirical support. Indisputable data exist to suggest that high levels of alcohol misuse and related problems are prevalent among UK AF. Recent research indicates that the overall level of hazardous alcohol consumption remains high in the UK military, with little evidence of reduced consumption over time. Meanwhile, risky drinking in the general population appears to be decreasing. This paper describes work to develop a key aspect of an integrated care pathway for UK military personnel at all levels of alcohol risk. The project focuses on the development of an evidence-based treatment response across primary care and mental health services that will link with preventative initiatives. Specialist (ie, substance misuse) input from the Defence Clinical Psychology Service across and within Departments of Community Mental Health lends an overarching perspective to a major healthcare and organisational concern for the UK AF. Work towards a consistent treatment pathway for alcohol misuse is also benefiting from collaboration between the Ministry of Defence and Public Health England.
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Affiliation(s)
| | - K Lynch
- Public Health England, London, UK
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43
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Berzins TL, Van Dulmen MHM, Deluca H. Alcohol use affects sleep duration among military couples. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1521684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Haylee Deluca
- Department of Psychological Sciences, Kent State University, Kent, Ohio
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Leightley D, Puddephatt JA, Jones N, Mahmoodi T, Chui Z, Field M, Drummond C, Rona RJ, Fear NT, Goodwin L. A Smartphone App and Personalized Text Messaging Framework (InDEx) to Monitor and Reduce Alcohol Use in Ex-Serving Personnel: Development and Feasibility Study. JMIR Mhealth Uhealth 2018; 6:e10074. [PMID: 30206054 PMCID: PMC6231744 DOI: 10.2196/10074] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/25/2018] [Accepted: 06/11/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Self-reported alcohol misuse remains high in armed forces personnel even after they have left service. More than 50% of ex-serving personnel meet the criteria for hazardous alcohol use; however, many fail to acknowledge that they have a problem. Previous research indicates that interventions delivered via smartphone apps are suitable in promoting self-monitoring of alcohol use, have a broad reach, and may be more cost-effective than other types of brief interventions. There is currently no such intervention specifically designed for the armed forces. OBJECTIVE This study sought to describe the development of a tailored smartphone app and personalized text messaging (short message service, SMS) framework and to test the usability and feasibility (measured and reported as user engagement) of this app in a hard-to-engage ex-serving population. METHODS App development used Agile methodology (an incremental, iterative approach used in software development) and was informed by behavior change theory, participant feedback, and focus groups. Participants were recruited between May 2017 and June 2017 from an existing United Kingdom longitudinal military health and well-being cohort study, prescreened for eligibility, and directed to download either Android or iOS versions of the "Information about Drinking for Ex-serving personnel" (InDEx) app. Through the app, participants were asked to record alcohol consumption, complete a range of self-report measures, and set goals using implementation intentions (if-then plans). Alongside the app, participants received daily automated personalized text messages (SMS) corresponding to specific behavior change techniques with content informed by the health action process approach with the intended purpose of promoting the use of the drinks diary, suggesting alternative behaviors, and providing feedback on goals setting. RESULTS Invitations to take part in the study were sent to ex-serving personnel, 22.6% (31/137) of whom accepted and downloaded the app. Participants opened the InDEx app a median of 15.0 (interquartile range [IQR] 8.5-19.0) times during the 4 week period (28 days), received an average of 36.1 (SD 3.2) text messages (SMS), consumed alcohol on a median of 13.0 (IQR 11.0-15.0) days, and consumed a median of 5.6 (IQR 3.3-11.8) units per drinking day in the first week, which decreased to 4.7 (IQR 2.0-6.9) units by the last week and remained active for 4.0 (IQR 3.0-4.0) weeks. CONCLUSIONS Personnel engaged and used the app regularly as demonstrated by the number of initializations, interactions, and time spent using InDEx. Future research is needed to evaluate the engagement with and efficacy of InDEx for the reduction of alcohol consumption and binge drinking in an armed forces population.
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Affiliation(s)
- Daniel Leightley
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jo-Anne Puddephatt
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Norman Jones
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Toktam Mahmoodi
- Department of Informatics, King's College London, London, United Kingdom
| | - Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Matt Field
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.,UK Centre for Tobacco and Alcohol Studies, Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Colin Drummond
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Roberto J Rona
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Nicola T Fear
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Laura Goodwin
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
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45
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Vest BM, Homish DL, Fillo J, Homish GG. Military status and alcohol problems: Former soldiers may be at greater risk. Addict Behav 2018; 84:139-143. [PMID: 29679924 PMCID: PMC5975126 DOI: 10.1016/j.addbeh.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The goal of this study was to explore differences in alcohol problems as a function of military status (current soldier, previous soldier and civilian spouses), and the possible interaction between sex and military status. We hypothesized that 1) soldiers would be at greater risk for alcohol problems than civilian spouses, and 2) former soldiers would be at greater risk compared to current soldiers. METHODS Data were drawn from Operation: SAFETY, a longitudinal study examining physical and mental health among U.S. Army Reserve and National Guard soldiers and their partners. The analytic sample included male and female participants who completed both the baseline and first follow-up assessments (N = 772). Negative binomial regression models were used to examine differences between military status group on alcohol problems at follow-up, controlling for sex and alcohol consumption at baseline. Interactions between military status and sex were also examined. RESULTS Among current soldiers, males experienced significantly more alcohol problems compared to women (4.47, 3.46; p = 0.005). Likewise, among previous soldiers, males experienced significantly more alcohol problems compared to women (6.69, 2.92; p = 0.002). Male previous soldiers had significantly more alcohol problems compared to both male current soldiers and male civilian spouses (6.69, 4.47, p = 0.04; 6.69, 3.96; p = 0.02). Among women, there were no significant differences by military status. CONCLUSIONS Our results indicate that male previous soldiers are at greater risk of alcohol problems than both current soldiers and civilian spouses. Health care and service providers should consider screening and monitoring soldiers who separate from the military, as alcohol use may increase.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY 14203, United States.
| | - D Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY 14214, United States
| | - Jennifer Fillo
- Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203, United States
| | - Gregory G Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY 14214, United States
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46
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Fulton E, Wild D, Hancock J, Fernandez E, Linnane J. Transition from service to civvy street: the needs of armed forces veterans and their families in the UK. Perspect Public Health 2018; 139:49-58. [PMID: 29975177 DOI: 10.1177/1757913918785650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS: Although many veterans make the transition from military to civilian life without difficulty, a small proportion struggle due to an impact on mental and physical wellbeing. Stigma and a reluctance to seek help further exacerbate this problem. The Armed Forces Covenant outlines the importance of ensuring that public services are aware of the specific needs of veterans; however, evidence suggests that knowledge among professional staff may be limited. METHODS: This exploratory study included three phases. Phase 1 (questionnaires) explored the needs of veterans and their families in Warwickshire (UK) regarding information about their health and wellbeing and the barriers and facilitators to accessing local public health services. Also in Phase 1, health and public services staff knowledge of veterans' needs and the Covenant is explored. In Phase 2, both samples attended a related focus group for a more in-depth exploration of the issues identified in Phase 1; in order to inform a Phase 3 workshop to co-develop an intervention. RESULTS: Veterans, their families and friends, wanted more information about what services do, how and when to access them and what to expect. Confusion over when to seek help for mental health 'symptoms' was highlighted. More support for families was identified, alongside a need for health and social care staff to have a better understanding of the unique experiences and needs of veterans. Only 35% of staff reported a good understanding of the Armed Forces Covenant and their responsibilities to uphold it. CONCLUSIONS: Public health teams within UK local authorities are well placed to ensure veterans have more knowledge about and access to public services. Interventions to address stigma and veterans' reluctance to seek help were needed. To this end, interventions for local veterans, their loved ones and staff in public services, designed in co-creation with these groups, is discussed.
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Affiliation(s)
- E Fulton
- Health Behaviour and Interventions Research, Faculty of Health & Life Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK.,Public Health Warwickshire, Warwickshire County Council, Warwick, UK
| | - D Wild
- Health Behaviour and Interventions Research, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - J Hancock
- Health Behaviour and Interventions Research, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - E Fernandez
- Public Health Warwickshire, Warwickshire County Council, Warwick, UK
| | - J Linnane
- Public Health Warwickshire, Warwickshire County Council, Warwick, UK
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Wooten NR, Brittingham JA, Pitner RO, Tavakoli AS, Jeffery DD, Haddock KS. Purchased Behavioral Health Care Received by Military Health System Beneficiaries in Civilian Medical Facilities, 2000-2014. Mil Med 2018; 183:e278-e290. [PMID: 29420772 PMCID: PMC6027075 DOI: 10.1093/milmed/usx101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/25/2017] [Accepted: 11/15/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014. Materials and Methods Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study. Results From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78.8%) and care was most often received in EDs (56%). Most commonly treated diagnoses included mood, tobacco use, and alcohol use disorders. ED visits were associated with being treated for anxiety (excluding post-traumatic stress disorder; Adjusted odds ratio [AOR]: 9.14 [95% confidence interval (CI): 8.26, 10.12]), alcohol use disorders (AOR = 1.67 [95% CI: 1.53, 1.83]), tobacco use (AOR = 1.16 [95% CI: 1.06, 1.26]), nondependent cocaine abuse (AOR = 5.47 [95% CI: 3.28, 9.12]), nondependent mixed/unspecified drug abuse (AOR = 7.30 [95% CI: 5.11, 10.44]), and psychosis (AOR = 1.38 [95% CI: 1.20, 1.58]). Compared with adults age 60 yr and older, adolescents (ages 12-17 yr), and adults under age 60 yr were more likely to be treated for suicidal ideation, adjustment, mood, bipolar, post-traumatic stress disorder, nondependent cocaine, and mixed/unspecified drug abuse. Adults under age 60 yr also had increased odds of being treated for tobacco use disorders, alcohol use disorders, and opioid/combination opioid dependence compared with adults age 60 yr and older. Conclusions Over the past 15 yr, purchased behavioral health care received by MHS beneficiaries in acute care facilities increased significantly. MHS beneficiaries received the majority of purchased behavioral health care for mental health disorders and were treated most often in the ED. Receiving behavioral health care in civilian EDs raises questions about access to outpatient behavioral health care and patient-centered care coordination between civilian and military facilities. Given the influx of new Veterans Health Administration users from the MHS, findings have implications for military, veteran, and civilian facilities providing behavioral health care to military and veteran populations.
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Affiliation(s)
- Nikki R Wooten
- College of Social Work, University of South Carolina, Hamilton College, Columbia, SC
| | - Jordan A Brittingham
- Arnold School of Public Health, University of South Carolina, 921 Assembly St., Columbia, SC
| | - Ronald O Pitner
- College of Social Work, University of South Carolina, Hamilton College, Columbia, SC
| | - Abbas S Tavakoli
- College of Nursing, University of South Carolina, 1601 Greene St., Columbia, SC
| | - Diana D Jeffery
- Clinical Support Division, Health Operations Directorate, Defense Health Agency, U.S. Department of Defense, 7700 Arlington Blvd, Suite 5101, Falls Church, VA
| | - K Sue Haddock
- Research Service, WJB Dorn Veterans Administration Medical Center, 6439 Garners Ferry Road, Columbia, SC
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Kiernan MD, Osbourne A, McGill G, Jane Greaves P, Wilson G, Hill M. Are veterans different? Understanding veterans' help-seeking behaviour for alcohol problems. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:725-733. [PMID: 29851155 DOI: 10.1111/hsc.12585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
Alcohol misuse in the United Kingdom's veteran community is not an isolated phenomenon. Internationally, alcohol and wider substance misuse would appear to be an historic and current global issue within veteran communities. Although research has been undertaken both in the United Kingdom and the United States into why veterans are reluctant to seek help for mental health problems, little is understood as to why veterans encounter difficulties in engaging with treatment for alcohol misuse. The aim of this study was to understand why veterans in the United Kingdom are either reluctant or have difficulty in accessing help for alcohol problems. An applied social policy research methodology was used, employing in-depth semi-structured interviews with 19 UK veterans in the North East of England, who had a history of alcohol misuse. The findings showed that participants appeared to excuse or normalise their excessive alcohol consumption, which led to a delay in meaningful engagement in substance misuse services, resulting in complex and complicated presentations to health and social care services. The findings of this study clearly suggest that veterans who misuse alcohol have a range of distinctive and unique difficulties that subtly differentiate them from the wider civilian substance misuse population, and that the use of peer-support models would appear to mitigate against them disengaging from alcohol treatment services.
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Affiliation(s)
- Matthew D Kiernan
- Northern Hub for Veteran and Military Families' Research, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Alison Osbourne
- Northern Hub for Veteran and Military Families' Research, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Gill McGill
- Northern Hub for Veteran and Military Families' Research, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Peta Jane Greaves
- Northern Hub for Veteran and Military Families' Research, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Gemma Wilson
- Northern Hub for Veteran and Military Families' Research, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Mick Hill
- Northern Hub for Veteran and Military Families' Research, Northumbria University Newcastle, Newcastle upon Tyne, UK
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Holt M, Reed M, Woodruff SI, DeMers G, Matteucci M, Hurtado SL. Adaptation of Screening, Brief Intervention, Referral to Treatment to Active Duty Military Personnel in an Emergency Department: Findings From a Formative Research Study. Mil Med 2018; 182:e1801-e1807. [PMID: 28810975 DOI: 10.7205/milmed-d-16-00333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The transient nature of military life coupled with environmental and psychosocial stressors increase the risk for alcohol misuse and abuse among active duty (AD) military service members and recent epidemiological studies demonstrate high rates of heavy drinking among AD personnel. Over the past decade, Department of Defense health care systems have observed increases in the utilization of substance use services among military personnel demobilizing from Operation Enduring Freedom and Operation Iraqi Freedom. Given the high rates of heavy drinking and increased use of substance use services in this population of AD personnel, the purpose of this study was to investigate how to best translate and implement an effective alcohol abuse prevention intervention tool (screening, brief intervention, and referral to treatment [SBIRT]) used in civilian populations to a military emergency department (ED) setting. METHODS We conducted focus groups with ED staff as well as short interviews with AD personnel at a Naval Medical Center in the southwestern United States to determine the suitability of SBIRT with military populations as well as how to best translate SBIRT to a military hospital setting. FINDINGS Participants expressed support for utilizing civilian health educators to conduct the SBIRT intervention; however, many were concerned with issues of confidentiality and were skeptical of whether AD would speak truthfully about alcohol consumption. CONCLUSIONS Results of this formative research study clearly indicate the implementation and translation of SBIRT into a military medical setting require attention to issues related to confidentiality, the veracity of alcohol reporting, as well as use of civilians over AD military personnel to deliver the SBIRT intervention. Furthermore, most participants expressed support for the SBIRT model and felt it could be implemented, with caveats, into a military health care setting such as an ED.
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Affiliation(s)
- Megan Holt
- San Diego State University, School of Social Work/Center for Alcohol and Drug Studies and Services, 6386 Alvarado Court Suite 224, San Diego, CA 92124
| | - Mark Reed
- San Diego State University, School of Social Work/Center for Alcohol and Drug Studies and Services, 6386 Alvarado Court Suite 224, San Diego, CA 92124
| | - Susan I Woodruff
- San Diego State University, School of Social Work/Center for Alcohol and Drug Studies and Services, 6386 Alvarado Court Suite 224, San Diego, CA 92124
| | - Gerard DeMers
- Emergency Medicine Department, Naval Medical Center, San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134
| | - Michael Matteucci
- Emergency Medicine Department, Naval Hospital Rota Spain, PSC 819 Box 18, FPO AE 09645-0018
| | - Suzanne L Hurtado
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106
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50
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Richmond RR, Henebry AD. A Maisonneuve Fracture in an Active Duty Sailor: A Case Report. Mil Med 2018; 183:e278-e280. [PMID: 29415223 DOI: 10.1093/milmed/usx080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/04/2017] [Indexed: 11/13/2022] Open
Abstract
Maisonneuve fractures are relatively well known in the sports medicine, and orthopedic communities, however, can be commonly missed among primary care providers. The following case outlines an active duty 35-yr-old female patient who presented with acute pain on the left ankle and lower leg after she misjudged a step. The injury is a combination of high fibular and medial malleolar fractures with a disruption of the tibiofibular syndesmosis ligaments. This is a result of extreme external rotation and pronation of a fixed foot. The proper diagnosis is reliant on ankle and tibiofibular films, to include orthogonal views. This case serves as a reminder to always examine joints above and below the injury site, obtain orthogonal views of a fracture, as well as the unstable nature of syndesmosis injuries. This fracture is commonly a sports-related injury; thus, it is particularly important for military providers to be aware of Maisonneuve fractures and the common pitfalls in diagnosis and treatment.
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Affiliation(s)
- Ryan R Richmond
- Naval Health Branch Clinic Naval Air Technical Training Command, Naval Hospital Pensacola, 6000 West Highway 98, Pensacola, FL 32512
| | - Andrew D Henebry
- Department of Orthopedics, Naval Hospital Pensacola, 6000 West Highway 98, Pensacola, FL 32512
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