The evolution of PTSD symptoms in serving and ex-serving personnel of the UK armed forces from 2004 to 16: A longitudinal examination

Whilst most military personnel do not develop Post-Traumatic Stress Disorder (PTSD), ex-serving personnel exhibit higher levels compared to those in the military. The heterogeneity of symptom development for serving and ex-serving personnel has not yet been compared in the UK Armed Forces (UK AF). Latent class growth modelling was employed to estimate the trajectories of PTSD symptoms from three waves of data from the PTSD Checklist (PCL-C) from a UK AF sample (N = 7357). Regression mixture models were conducted to investigate covariates of class membership. Five trajectory classes were identified. Most of the sample reported no-low symptoms (71.3%). Of those reporting probable PTSD during the 12 year-period, 4.6% showed improvements, 4.9% worsened, and 1.8% displayed chronic symptoms. A class with subthreshold elevated symptoms (17.3%) was also identified. Trajectories of serving and ex-serving personnel were not substantially different, but more ex-serving personnel were symptomatic and those with chronic symptoms worsened over time. Chronic disorder was associated with lower rank, experiencing violent combat, and proximity to wounding/death on deployment. Worsening symptoms were associated with childhood stress/violence, lower rank, not being in a relationship, inconsistent post-deployment social support, proximity to wounding/death, and voluntary, or medical discharge. The present study found most UKAF personnel did not report PTSD symptoms between 2004 and 16 but, among those experiencing probable PTSD, more participants reported deteriorating/persistent symptoms than who improved. PTSD-onset was related to adversities across childhood and deployment, and lack of social support. Findings underscore the importance of addressing the through-life contributors of PTSD in order to prevent ingrained disorder.

Social Functioning in Individuals With Post-Traumatic Stress Disorder: A Systematic Review

Post-traumatic stress disorder (PTSD) can lead to multiple deleterious outcomes and has negative, sometimes debilitating, impacts on general functioning of those affected. This systematic review of 26 articles evaluates the existing literature on social functioning outcomes used in PTSD research, the association between PTSD and social functioning, and the impact of interventions for PTSD on social functioning. A review of 26 articles using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic reviews showed that PTSD was associated with significant impairment in global social functioning. This review also reveals the need for both standardized definitions and better assessment methods to operationalize social functioning and improve our ability to compare findings across studies. The literature also suggests that some evidence-based treatments for PTSD improve social functioning despite not explicitly targeting social functioning in the treatment. The findings of this review suggest that there are ample opportunities for improving both research and interventions to improve global social functioning in PTSD.

Promoting Healthier Masculinities as a Suicide Prevention Intervention in a Regional Australian Community: A Qualitative Study of Stakeholder Perspectives

Regionally-based Australian men have a higher risk of suicide than those in urban centers, with similar trends observed internationally. Adopting a place-based approach to understanding men's suicide and harm prevention provides contextual insights to guide localised opportunities for the development of tailored gender-specific interventions. Men in rural Australia are typically portrayed as embodying idealized masculinity-dominant and tough, upholding strength and stoicism in the face of hardship. Such values can increase suicide risk in men by reducing help-seeking. The Macedon Ranges Shire is an inner regional municipality with a population of approximately 50,000 people spanning across 10 regional towns and surrounding farming areas in Victoria, Australia. Understanding the influence of masculinities on men's wellbeing and help seeking behaviours in a regional context is vital in order to inform effective local suicide prevention efforts. The present research involved in-depth qualitative interviews with 19 community stakeholders (M = 49.89 years, SD = 11.82) predominantly working in healthcare and community services including emergency services and education. Using thematic analysis, interview transcripts were coded and themes inductively derived. Stakeholders identified three key areas for understanding suicide risk and wellbeing for local men; 1) localizing masculinities, 2) belonging in community, and 3) engaging men. Findings illustrate that addressing men's wellbeing in regional areas requires a multifaceted whole-of-community approach. While diverse, local expressions of masculinities were seen as contributors to men's challenges understanding their emotional worlds and reticence for help-seeking. Of vital need is to provide diverse opportunities for men to connect with others in the region, and offer inclusive spaces where men feel accepted, welcomed and able to meaningfully contribute to the community. Not only will this assist by bolstering men's sense of self, identity, and mental wellbeing, it may also provide valuable informal inroads to normalizing healthy communication around mental health and seeking mental health care. These findings offer important suggestions for the promotion of healthier masculinities in regionally-based Australian men, which may help to improve wellbeing of these men and their entire communities.

Mental health and social support among public safety personnel

BACKGROUND

Social support may be a protective factor for the mental health of public safety personnel (PSP), who are frequently exposed to potentially psychologically traumatic events and report substantial post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) symptoms. Research examining perceived social support and its association with PTSD and MDD in different PSP categories (e.g. firefighters, paramedics) is limited.

AIMS

To examine differences in perceived social support across PSP and determine whether perceived social support is associated with differences in rates of MDD and PTSD.

METHODS

We asked Canadian PSP, including correctional workers and officers, public safety communications officials, firefighters, paramedics, municipal and provincial police officers, and Royal Canadian Mounted Police (RCMP) officers, to complete an online anonymous survey that assessed socio-demographic information (e.g. occupation, sex, marital status, service years), social supports and symptoms of mental disorders, including PTSD and MDD. Analyses included ANOVA and logistic regression models.

RESULTS

Perceived social support differed by PSP occupation. RCMP officers reported lower social support than all other PSP except paramedics. For most PSP categories, PSP who reported greater social support were less likely to screen positive for PTSD (adjusted odds ratios [AORs]: 0.90-0.93). Across all PSP categories, greater perceived social support was associated with a decreased likelihood of screening positive for MDD (AORs: 0.85-0.91).

CONCLUSIONS

Perceived social support differs across some PSP categories and predicts PTSD and MDD diagnostic status. Studies involving diagnostic clinical interviews, longitudinal designs and social support interventions are needed to replicate and extend our results.

Community-based men’s health promotion programs: eight lessons learnt and their caveats

Long-standing commentaries about men’s reticence for accessing clinical medical services, along with the more recent recognition of men’s health inequities, has driven work in community-based men’s health promotion. Indeed, the 2000s have seen rapid growth in community-based programs targeting men, and across this expanse of innovative work, experiential and empirical insights afford some important lessons learnt, and caveats to guide existing and future efforts. The current article offers eight lessons learnt regarding the design, content, recruitment, delivery, evaluation and scaling of community-based men’s health promotion programs. Design lessons include the need to address social determinants of health and men’s health inequities, build activity-based programming, garner men’s permission and affirmation to shift masculine norms, and integrate content to advance men’s health literacy. Also detailed are lessons learnt about men-friendly spaces, recruitment and retention strategies, the need to incrementally execute program evaluations, and the limits for program sustainability and scaling. Drawing from diverse community-based programs to illustrate the lessons learnt, caveats are also detailed to contextualize and caution some aspects of the lessons that are shared. The express aim of discussing lessons learnt and their caveats, reflected in the purpose of the current article, is to guide existing and future work in the ever growing field of community-based men’s health promotion.