Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial.

BACKGROUND: The effectiveness of post-deployment screening for mental disorders has not been assessed in a randomised controlled trial. We aimed to assess whether post-deployment screening for post-traumatic stress disorder (PTSD), depression, anxiety, or alcohol misuse was effective. We defined screening as the presumptive identification of a previously unrecognised disorder using tests to distinguish those who probably had the disorder from those who probably did not so that those people with a probable disorder could be referred appropriately, and assessed effectiveness and consequences for help-seeking by the odds ratio at follow-up between those receiving tailored help-seeking advice and those who received general mental health advice. METHODS: We did a cluster randomised controlled trial among Royal Marines and Army personnel in the UK military after deployment to Afghanistan. Platoons were randomly assigned (1:1 initially, then 2:1) by stratified block randomisation with randomly varying block sizes of two and four to the screening group, which received tailored help-seeking advice, or the control group, which received general mental health advice. Initial assessment took place 6-12 weeks after deployment; follow-up assessments were done 10-24 months later. Follow-up measures were the PTSD Checklist-Civilian Version, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 scale, Alcohol Use Disorder Identification Test (AUDIT), and self-reported help-seeking from clinical and welfare providers comparing those receiving tailored advice and those receiving only general advice. All participants and all investigators other than the person who analysed the data were masked to allocation. The primary outcomes were PTSD, depression or generalised anxiety disorder, and alcohol misuse at follow-up. A key secondary outcome was assessment of whether post-deployment screening followed by tailored advice would modify help-seeking behaviour. Comparisons were made between screening and control groups, with primary analyses by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN19965528. FINDINGS: Between Oct 24, 2011, and Oct 31, 2014, 434 platoons comprising 10 190 personnel were included: 274 (6350 personnel) in the screening group and 160 (3840 personnel) in the control group. 5577 (88%) of 6350 personnel received screening and 3996 (63%) completed follow-up, whereas 3149 (82%) of 3840 received the control questionnaire and 2369 (62%) completed follow-up. 1958 (35%) of 5577 personnel in the screening group declined to see the tailored advice, but those with PTSD (83%) or anxiety or depression (84%) were more likely than non-cases (64%) to view the advice (both p<0·0001). At follow-up, there were no significant differences in prevalence between groups for PTSD (adjusted odds ratio 0·92, 95% CI 0·75-1·14), depression or anxiety (0·91, 0·71-1·16), alcohol misuse (0·88, 0·73-1·06), or seeking support for mental disorders (0·92, 0·78-1·08). INTERPRETATION: Post-deployment screening for mental disorders based on tailored advice was not effective at reducing prevalence of mental health disorders nor did it increase help-seeking. Countries that have implemented post-deployment screening programmes for mental disorders should consider monitoring the outcomes of their programmes. FUNDING: The US Army Medical Research and Materiel Command-Military Operational Medicine Research Program (USAMRMC-MOMRP).

Randomized controlled trial of Functional Family Therapy for offending and antisocial behavior in UK youth.

BACKGROUND: Youth offending and antisocial behavior (ASB) are associated with low quality mental health and relationships and usually lead to poor adult functioning; they are very costly for society. Family interventions are effective in children but there are few reliably effective and inexpensive interventions for adolescents. Functional Family Therapy (FFT) is an evidence-based intervention but seldom tested outside the United States. METHODS: One hundred and eleven adolescents (10-17 years of age, M = 15.0, SD = 1.63) and their families were randomized to FFT + Management As Usual (MAU) (n = 65) or to MAU (n = 46). Assessments were made at baseline 6, and 18 months after randomization and included interviews and questionnaires of parenting behaviors, conduct disorders (CDs) and offending. Parent-child interaction was directly observed and police records obtained. TRIAL REGISTRATION: ISRCTN27650478. RESULTS: Eighty-nine (80%) were followed-up. In both groups, there were large reductions over time in all measures of offending and antisocial behavior (e.g. primary outcome p < 0.001), but no significant changes over time in parenting behavior or the parent-child relationship. However, there were no differences between intervention and control groups at 6 or 18 months on self-reported delinquency, police records of offending, symptoms or diagnoses of CDs, parental monitoring or supervision, directly observed child negative behavior, or parental positive or negative behavior. Against predictions, the intervention group showed lower levels of directly observed child positive behavior at 18 months compared to controls. CONCLUSIONS: In contrast to most previous trials of FFT, FFT+MAU did not lead to greater reductions in youth ASB and offending compared to MAU alone, and did not lead to improvements in parenting or the parent-child relationship. This may be because the trial was more rigorously conducted than prior studies; equally, the possibility that MAU was effective requires further research.

Medical and Welfare Officers beliefs about post-deployment screening for mental health disorders in the UK Armed Forces: a qualitative study.

BACKGROUND: This study aimed to examine currently serving United Kingdom (UK) military Medical and Welfare Officers views on the potential introduction of post-deployment screening for mental ill health. METHODS: Semi-structured interviews were conducted with 21 Medical and Welfare Officers. Interview transcripts were analysed using data-driven thematic analysis. RESULTS: Four themes were identified: positive views of screening; reliability of responses; impact on workload; and suggestions for implementation. Interviewees viewed the introduction of screening post-deployment as likely to increase awareness of mental health problems whilst also reporting that service personnel were likely to conceal their true mental health status by providing misleading responses to any screening tool. Concern over reliability of responses may provide one explanation for the reluctance of service personnel to seek help for problems, as they could feel they will not be taken seriously. Welfare Officers felt they would not have the knowledge or experience to respond to help-seeking. Although participants were concerned about potential impact on their personal workload, they indicated a desire to positively engage with the screening programme if research showed it was an effective tool to improve mental health care. CONCLUSIONS: Welfare and healthcare providers are well disposed towards a screening programme for mental health but highlight a few concerns in its implementation. In particular Welfare Officers appear to require more training in how to respond to mental ill health. Concerns about available funding and resources to respond to increased workload will need to be addressed should post-deployment screening for mental health be introduced in the UK military.

The mental health and well-being among partners and children of military personnel and veterans with a combat-related physical injury: A scoping review of the quantitative research.

BACKGROUND: Little research has focused on the impact of combat-related physical injuries on the mental health and well-being of partners and children of military personnel and veterans. OBJECTIVES: This scoping review identifies the consequences of combat-related physical injuries (CRPIs) on the mental health and well-being of partners and children of military personnel and veterans. METHODS: Quantitative articles examining mental health and well-being in partners and children of military personnel and veterans with CRPIs from the UK, US, Canada, New Zealand, Australia, European Union (EU), or Israel published since 2000 were identified. RESULTS: Seven articles were included, six from the US. The findings indicate the potential negative and positive impacts CRPIs can have on the health and well-being of partners of military partners and the negative impacts identified among children, and how this differs from psychological injuries. CONCLUSIONS: This scoping review highlights the lack of research focusing on the impact of CRPIs on the family members of military personnel and veterans. Additional research is needed to understand how psychological injuries might have different effects on the mental health and well-being partners and children of military personnel and veterans compared to different types of CRPIs.