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Harwood H, Rhead R, Chui Z, Bakolis I, Connor L, Gazard B, Hall J, MacCrimmon S, Rimes KA, Woodhead C, Hatch SL. Variations by ethnicity in referral and treatment pathways for IAPT service users in South London. Psychol Med 2023; 53:1084-1095. [PMID: 34334151 PMCID: PMC9976018 DOI: 10.1017/s0033291721002518] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Improving Access to Psychological Therapies (IAPT) programme aims to provide equitable access to therapy for common mental disorders. In the UK, inequalities by ethnicity exist in accessing and receiving mental health treatment. However, limited research examines IAPT pathways to understand whether and at which points such inequalities may arise. METHODS This study examined variation by ethnicity in (i) source of referral to IAPT services, (ii) receipt of assessment session, (iii) receipt of at least one treatment session. Routine data were collected on service user characteristics, referral source, assessment and treatment receipt from 85 800 individuals referred to South London and Maudsley NHS Foundation Trust IAPT services between 1st January 2013 and 31st December 2016. Multinomial and logistic regression analysis was used to assess associations between ethnicity and referral source, assessment and treatment receipt. Missing ethnicity data (18.5%) were imputed using census data and reported alongside a complete case analysis. RESULTS Compared to the White British group, Black African, Asian and Mixed ethnic groups were less likely to self-refer to IAPT services. Black Caribbean, Black Other and White Other groups are more likely to be referred through community services. Almost all racial and minority ethnic groups were less likely to receive an assessment compared to the White British group, and of those who were assessed, all racial and ethnic minority groups were less likely to be treated. CONCLUSIONS Racial and ethnic minority service users appear to experience barriers to IAPT care at different pathway stages. Services should address potential cultural, practical and structural barriers.
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Affiliation(s)
- Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Health Service & Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Luke Connor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jheanell Hall
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katharine A. Rimes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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Chui Z, Leightley D, Jones M, Landau S, McCrone P, Hayes RD, Wessely S, Fear NT, Goodwin L. Mental health problems and admissions to hospital for accidents and injuries in the UK military: A data linkage study. PLoS One 2023; 18:e0280938. [PMID: 36693079 PMCID: PMC9873160 DOI: 10.1371/journal.pone.0280938] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Accidents are the most common cause of death among UK military personnel. It is a common misconception in the general public that accidental injuries are always the result of random events, however research suggests that mental health problems and the increased levels of risky behaviour in military personnel may play a role. The objective of this study was to further our understanding of injuries and deaths not related to deployment by examining the associations of mental health, alcohol misuse and smoking with inpatient admission to hospital for accidents and injuries, and attendance to accident and emergency (A&E) departments. METHODS Data on all hospital admissions for accidents and injuries and A&E attendance at NHS hospitals in England, Scotland and Wales were linked to data on self-reported mental health problems, alcohol misuse and smoking from a large, representative UK military cohort of serving and ex-serving personnel (n = 8,602). Logistic regression was used to examine the associations between having a hospital admission for an accident or injury with self-reported mental health problems, alcohol misuse and smoking. Cox proportional-hazards regression was then conducted to assess the associations of mental health problems, alcohol misuse and smoking with time to hospital admission for an accident or injury. Finally, negative binomial regression was used to examine associations between the number of A&E attendances with mental health problems, alcohol misuse and smoking. RESULTS Personnel reporting symptoms of common mental disorder (CMD) or probable post-traumatic stress disorder (PTSD) were more likely to have an admission to hospital for an accident or injury (fully adjusted odds ratio 1.39, 95% confidence interval [CI] 1.05-1.84), than those who did not report these symptoms, and also had more attendances to A&E (fully adjusted incidence rate ratio [IRR] 1.32, 95% CI 1.16-1.51). A&E attendances were also more common in personnel who were smokers (fully adjusted IRR 1.21, 95% CI 1.09-1.35) following adjustment for demographic, military and health characteristics. CONCLUSIONS The findings suggest that accidents and injuries among military personnel are not always random events and that there are health and behavioural factors, including poor mental health and smoking, which are associated (with small effect sizes) with an increased risk of being involved in an accident. Clinicians treating individuals attending hospital after an accident should consider their healthcare needs holistically, including issues related to mental health and health damaging behaviours.
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Affiliation(s)
- Zoe Chui
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Daniel Leightley
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Margaret Jones
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sabine Landau
- Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Paul McCrone
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Richard D. Hayes
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Simon Wessely
- 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
| | - 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
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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Woodhead C, Onwumere J, Rhead R, Bora-White M, Chui Z, Clifford N, Connor L, Gunasinghe C, Harwood H, Meriez P, Mir G, Jones Nielsen J, Rafferty AM, Stanley N, Peprah D, Hatch SL. Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff. Ethn Health 2022; 27:1555-1574. [PMID: 34092149 PMCID: PMC7614854 DOI: 10.1080/13557858.2021.1936464] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. DESIGN Twenty-five semi-structured interviews were conducted (October 2020-January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. RESULTS Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. CONCLUSIONS Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by de-contextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake.
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Affiliation(s)
- Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Naomi Clifford
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Luke Connor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cerisse Gunasinghe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paula Meriez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Ghazala Mir
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Anne Marie Rafferty
- Department of Adult Nursing, Florence Nightingale Faculty for Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Nathan Stanley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dorothy Peprah
- London School of Hygiene and Tropical Medicine, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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Chilman N, Song X, Roberts A, Tolani E, Stewart R, Chui Z, Birnie K, Harber-Aschan L, Gazard B, Chandran D, Sanyal J, Hatch S, Kolliakou A, Das-Munshi J. Text mining occupations from the mental health electronic health record: a natural language processing approach using records from the Clinical Record Interactive Search (CRIS) platform in south London, UK. BMJ Open 2021; 11:e042274. [PMID: 33766838 PMCID: PMC7996661 DOI: 10.1136/bmjopen-2020-042274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We set out to develop, evaluate and implement a novel application using natural language processing to text mine occupations from the free-text of psychiatric clinical notes. DESIGN Development and validation of a natural language processing application using General Architecture for Text Engineering software to extract occupations from de-identified clinical records. SETTING AND PARTICIPANTS Electronic health records from a large secondary mental healthcare provider in south London, accessed through the Clinical Record Interactive Search platform. The text mining application was run over the free-text fields in the electronic health records of 341 720 patients (all aged ≥16 years). OUTCOMES Precision and recall estimates of the application performance; occupation retrieval using the application compared with structured fields; most common patient occupations; and analysis of key sociodemographic and clinical indicators for occupation recording. RESULTS Using the structured fields alone, only 14% of patients had occupation recorded. By implementing the text mining application in addition to the structured fields, occupations were identified in 57% of patients. The application performed on gold-standard human-annotated clinical text at a precision level of 0.79 and recall level of 0.77. The most common patient occupations recorded were 'student' and 'unemployed'. Patients with more service contact were more likely to have an occupation recorded, as were patients of a male gender, older age and those living in areas of lower deprivation. CONCLUSION This is the first time a natural language processing application has been used to successfully derive patient-level occupations from the free-text of electronic mental health records, performing with good levels of precision and recall, and applied at scale. This may be used to inform clinical studies relating to the broader social determinants of health using electronic health records.
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Affiliation(s)
- Natasha Chilman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Xingyi Song
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Angus Roberts
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Esther Tolani
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Zoe Chui
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karen Birnie
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- King's College Hospital NHS Trust, London, UK
| | - Lisa Harber-Aschan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Billy Gazard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Chandran
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jyoti Sanyal
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani Hatch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
| | - Anna Kolliakou
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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Chui Z, Gazard B, MacCrimmon S, Harwood H, Downs J, Bakolis I, Polling C, Rhead R, Hatch SL. Inequalities in referral pathways for young people accessing secondary mental health services in south east London. Eur Child Adolesc Psychiatry 2021; 30:1113-1128. [PMID: 32683491 PMCID: PMC8295086 DOI: 10.1007/s00787-020-01603-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
Differences in health service use between ethnic groups have been well documented, but little research has been conducted on inequalities in access to mental health services among young people. This study examines inequalities in pathways into care by ethnicity and migration status in 12-29 years old accessing health services in south east London. This study analyses anonymized electronic patient record data for patients aged 12-29 referred to a south east London mental health trust between 2008 and 2016 for an anxiety or non-psychotic depressive disorder (n = 18,931). Multinomial regression was used to examine associations between ethnicity, migration status, and both referral source and destination, stratified by age group. Young people in the Black African ethnic group were more likely to be referred from secondary health or social/criminal justice services compared to those in the White British ethnic group; the effect was most pronounced for those aged 16-17 years. Young people in the Black African ethnic group were also significantly more likely to be referred to inpatient and emergency services compared to those in the White British ethnic group. Black individuals living in south east London, particularly those who identify as Black African, are referred to mental health services via more adverse pathways than White individuals. Our findings suggest that inequalities in referral destination may be perpetuated by inequalities generated at the point of access.
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Affiliation(s)
- Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Catherine Polling
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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Rhead RD, Chui Z, Bakolis I, Gazard B, Harwood H, MacCrimmon S, Woodhead C, Hatch SL. Impact of workplace discrimination and harassment among National Health Service staff working in London trusts: results from the TIDES study. BJPsych Open 2020; 7:e10. [PMID: 33323151 PMCID: PMC7791556 DOI: 10.1192/bjo.2020.137] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Harassment and discrimination in the National Health Service (NHS) has steadily increased over the past 5 years with London being the worst performing region. There is a lack of data and research on the impact this is having on staff health and job satisfaction. Such data are necessary to inform the development of effective workplace interventions to mitigate the effects these experiences have on staff. AIMS Examine the impact of harassment and discrimination on NHS staff working in London trusts, utilising data from the 2019 TIDES cross-sectional survey. METHOD In total, 931 London-based healthcare practitioners participated in the TIDES survey. Regression analysis was used to examine associations between the sociodemographic characteristics of participants, exposure to discrimination and harassment, and how such exposures are associated with physical and mental health, job satisfaction and sickness absence. RESULTS Women, Black ethnic minority staff, migrants, nurses and healthcare assistants were most at risk of discrimination and/or harassment. Experiencing either of the main exposures was associated with probable anxiety or depression. Experiencing harassment was also associated with moderate-to-severe somatic symptoms. Finally, both witnessing and experiencing the main exposures were associated with low job satisfaction and long periods of sickness absence. CONCLUSIONS NHS staff, particularly those working in London trusts, are exposed to unprecedented levels of discrimination and harassment from their colleagues. Within the context of an already stretched and under-resourced NHS, in order to combat poor job satisfaction and high turnover rates, the value of all healthcare practitioners must be visibly and continuously reinforced by all management and senior leaders.
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Affiliation(s)
- Rebecca D Rhead
- Department of Psychological Medicine, King's College London, UK
| | - Zoe Chui
- Department of Psychological Medicine, King's College London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department and Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Billy Gazard
- Department of Psychological Medicine, King's College London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, King's College London, UK
| | | | - Charlotte Woodhead
- Department of Psychological Medicine, King's College London; and ESRC Centre for Society and Mental Health, King's College London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, King's College London; and ESRC Centre for Society and Mental Health, King's College London, UK
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Chui Z, Fear NT, Greenberg N, Jones N, Jones E, Goodwin L. Combat exposure and co-occurring mental health problems in UK Armed Forces personnel. J Ment Health 2020; 31:624-633. [PMID: 32437210 DOI: 10.1080/09638237.2020.1766666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ABSTARCTBackground: Mental disorders and alcohol misuse are often comorbid, and this comorbidity is more common in those who develop mental disorders following exposure to traumatic events.Aims: To investigate the relationship between combat exposure and operational role (support versus combat) with mental disorders and associated comorbidity in a UK military cohort.Methods: 4896 participants from a UK military cohort reported their operational role and frequency of exposure to combat events during deployment. Outcome measures included self-reported post-traumatic stress disorder, common mental disorder and alcohol misuse.Results: Personnel reporting higher levels of combat exposure were more likely to meet criteria for two or more co-occurring mental disorders (odds ratio [OR] 3.90, 95% confidence interval [CI] 2.73-5.58). While having a combat role increased the risk of developing co-occurring disorders compared to having a support role (OR 1.67, 95% CI 1.26-2.23), this effect diminished following adjustment for variables including combat exposure (OR 0.89, 95% CI 0.62-1.27).Conclusions: Combat exposure may play a greater role in the development of comorbid mental disorders than operational role, i.e. job title. Clinicians treating military personnel should be alert to the increased risk of comorbid mental disorders and alcohol misuse among those with a history of combat exposure.
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Affiliation(s)
- Zoe Chui
- King's Centre for Military Health Research, London, United Kingdom of Great Britain and Northern Ireland
| | - Nicola T Fear
- King's Centre for Military Health Research, London, United Kingdom of Great Britain and Northern Ireland
| | - Neil Greenberg
- Academic Department of Military Mental Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Norman Jones
- Academic Department of Military Mental Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Edgar Jones
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom of Great Britain and Northern Ireland
| | - Laura Goodwin
- King's Centre for Military Health Research, London, United Kingdom of Great Britain and Northern Ireland.,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland
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8
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Gazard B, Chui Z, Harber-Aschan L, MacCrimmon S, Bakolis I, Rimes K, Hotopf M, Hatch SL. Barrier or stressor? The role of discrimination experiences in health service use. BMC Public Health 2018; 18:1354. [PMID: 30526564 PMCID: PMC6286602 DOI: 10.1186/s12889-018-6267-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/26/2018] [Indexed: 01/01/2023] Open
Abstract
Background Discrimination is a well-established stressor that is substantially associated with poor health and a known contributor to health inequalities. However, the role of discrimination in health service use is less explored. This study will take an intersectional approach to investigate differences in health service use and examine the role of discrimination experiences. Methods Data on health service use were assessed in a diverse inner London sample of 1052 participants in the South East London Community Health (SELCoH) Study. Latent class analysis (LCA) was used to define classes of intersectional social status using multiple indicators of socioeconomic status (SES), ethnicity and migration status. Adjusted associations between intersectional social status and discrimination experiences with health service use indicators are presented. Results Using latent class analysis allowed us to identify an intersectional social status characterized by multiple disadvantage that was associated with decreased secondary physical health service use and a class characterized by both privilege and disadvantage that was associated with increased health service use for mental disorder after controlling for age, gender and health status. Anticipated discrimination was also associated with increased service use for mental disorder in adjusted models. There was no evidence to suggest that discrimination experiences were acting as a barrier to health service use. Conclusions This study highlights the complex ways in which discrimination experiences may increase the need for health services whilst also highlighting differences in health service use at the intersection of ethnicity, migration status and SES. Findings from this study illustrate the importance of measuring multiple levels of discrimination and taking an intersectional approach for health service use research.
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Affiliation(s)
- Billy Gazard
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.
| | - Zoe Chui
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
| | - Lisa Harber-Aschan
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Shirlee MacCrimmon
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department, Psychology and Neuroscience, Institute of Psychiatry, King's College London, London, UK.,Department of Biostatistics and Health Informatics, Psychology and Neuroscience, Institute of Psychiatry, King's College London, London, UK
| | - Katharine Rimes
- Psychology and Neuroscience, King's College London, Psychology, Institute of Psychiatry, London, UK
| | - Matthew Hotopf
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
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9
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von Werthern M, Robjant K, Chui Z, Schon R, Ottisova L, Mason C, Katona C. The impact of immigration detention on mental health: a systematic review. BMC Psychiatry 2018; 18:382. [PMID: 30522460 PMCID: PMC6282296 DOI: 10.1186/s12888-018-1945-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of asylum seekers, refugees and internally displaced people worldwide has increased dramatically over the past 5 years. Many countries are continuing to resort to detaining asylum seekers and other migrants, despite concerns that this may be harmful. In light of the considerable body of recent research, this review aims to update and expand on a 2009 systematic review on the mental health consequences of detention on adult, adolescent and child immigration detainees, which found (on the basis on 9 studies) that there was consistent evidence that immigration detention had adverse effects on mental health. METHODS Three databases were searched using key terms relating to immigration detention and mental health. Electronic searches were supplemented by reference screening. Studies were included if they were quantitative, included individuals detained for immigration purposes, reported on mental health problems and were published in peer-reviewed journals. Two reviewers independently screened papers for eligibility, and a further two reviewers completed quality appraisals for included studies. RESULTS Twenty- six studies (21 of which were not included in the 2009 review) reporting on a total of 2099 participants were included in the review. Overall, these studies indicated that adults, adolescents and children experienced high levels of mental health problems. Anxiety, depression and post-traumatic stress disorder were most commonly reported both during and following detention. Higher symptom scores were found in detained compared to non-detained refugees. In addition (and more clearly than was evident in 2009), detention duration was positively associated with severity of mental symptoms. Greater trauma exposure prior to detention was also associated with symptom severity. CONCLUSIONS The literature base reviewed in this paper consistently demonstrated severe mental health consequences amongst detainees across a wide range of settings and jurisdictions. There is a pressing need for the proper consideration of mental health and consequent risk of detention-related harm in decisions surrounding detention as well as for improved care for individuals within detention facilities. Recommendations based on these findings are presented, including increased focus on the identification of vulnerability and on minimising the duration of detention.
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Affiliation(s)
- M. von Werthern
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
| | - K. Robjant
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
| | - Z. Chui
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
| | - R. Schon
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
| | - L. Ottisova
- Health Services and Population Research Department, Kings College London, London, UK
| | - C. Mason
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
| | - C. Katona
- Helen Bamber Foundation, Bruges Place, 15-20 Baynes Street, London, NW1 0TF UK
- Division of Psychiatry, University College London, London, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Leightley D, Chui Z, Jones M, Landau S, McCrone P, Hayes RD, Wessely S, Fear NT, Goodwin L. Integrating electronic healthcare records of armed forces personnel: Developing a framework for evaluating health outcomes in England, Scotland and Wales. Int J Med Inform 2018; 113:17-25. [PMID: 29602429 PMCID: PMC5887874 DOI: 10.1016/j.ijmedinf.2018.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 02/13/2018] [Accepted: 02/17/2018] [Indexed: 12/24/2022]
Abstract
A framework which integration national Electronic Healthcare Record datasets from England, Scotland and Wales is proposed. Variable similarity is used to develop a schema which allows for variables to be linked and combined across the nations. Evaluation of integration shows that it is possibly to perform data linkage across the nations.
Background Electronic Healthcare Records (EHRs) are created to capture summaries of care and contact made to healthcare services. EHRs offer a means to analyse admissions to hospitals for epidemiological research. In the United Kingdom (UK), England, Scotland and Wales maintain separate data stores, which are administered and managed exclusively by devolved Government. This independence results in harmonisation challenges, not least lack of uniformity, making it difficult to evaluate care, diagnoses and treatment across the UK. To overcome this lack of uniformity, it is important to develop methods to integrate EHRs to provide a multi-nation dataset of health. Objective To develop and describe a method which integrates the EHRs of Armed Forces personnel in England, Scotland and Wales based on variable commonality to produce a multi-nation dataset of secondary health care. Methods An Armed Forces cohort was used to extract and integrate three EHR datasets, using commonality as the linkage point. This was achieved by evaluating and combining variables which shared the same characteristics. EHRs representing Accident and Emergency (A&E), Admitted Patient Care (APC) and Outpatient care were combined to create a patient-level history spanning three nations. Patient-level EHRs were examined to ascertain admission differences, common diagnoses and record completeness. Results A total of 6,336 Armed Forces personnel were matched, of which 5,460 personnel had 7,510 A&E visits, 9,316 APC episodes and 45,005 Outpatient appointments. We observed full completeness for diagnoses in APC, whereas Outpatient admissions were sparsely coded; with 88% of diagnoses coded as “Unknown/unspecified cause of morbidity”. In addition, A&E records were sporadically coded; we found five coding systems for identifying reason for admission. Conclusion At present, EHRs are designed to monitor the cost of treatment, enable administrative oversight, and are not currently suited to epidemiological research. However, only small changes may be needed to take advantage of what should be a highly cost-effective means of delivering important research for the benefit of the NHS.
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Affiliation(s)
- Daniel Leightley
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Zoe Chui
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Margaret Jones
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Sabine Landau
- Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Paul McCrone
- Health Services & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Richard D Hayes
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Simon Wessely
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Nicola T Fear
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Laura Goodwin
- Department of Psychological Sciences, University of Liverpool, United Kingdom.
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Leightley D, Chui Z, Goodwin L. Understanding NHS hospital admissions in England, Scotland and Wales: data linkage to the King’s College Military Cohort Study. Int J Popul Data Sci 2017. [PMCID: PMC9350994 DOI: 10.23889/ijpds.v1i1.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chui Z, Goodwin L, Leightley D. P09 Developing a framework of non-communicable physical diseases. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Goodwin L, Leightley D, Chui Z, Wessely S, Fear NT. P10 Using electronic hospital records to identify the most common physical disorders in the UK military: a data linkage study. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Leightley D, Chui Z, Goodwin L. P102 Understanding hospital admissions for military personnel in England, Scotland and Wales: a data linkage study. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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