The health and well-being of LGBTQ serving and ex-serving personnel: a narrative review.

The relaxation of discriminatory policies against lesbian, gay, bisexual, transgender, and queer (LGBTQ) service personnel has led to increased diversity among military populations. Given this increase, it is important to assess sexual and gender minority groups' health and well-being in the context of military service. This narrative review assessed these outcomes in LGBTQ military personnel. The electronic databases OVID Medline, PsycInfo, and Embase were searched for papers published between January 2000 and July 2018. Thirty papers were included. In line with life course model, studies aligned with four themes: (1) mental health and well-being; (2) stigma and healthcare utilization; (3) sexual trauma; and (4) physical health. These themes highlighted that LGBTQ military personnel and veterans have poorer mental health and well-being; report more stigma and barriers to mental healthcare, which reduces uptake of accessed healthcare services; experience more sexual trauma; and have poorer physical health than heterosexual military personnel and veterans. However, there are substantial gaps in the current evidence for this population. Future research should aim to address limitations of the literature, and to ensure that data on LGBTQ personnel and veterans is collected as standard.

Post-traumatic growth in the military: a systematic review.

BACKGROUND: Post-traumatic growth is defined as positive psychological, social or spiritual growth after a trauma. OBJECTIVES: This systematic review aimed to identify studies that quantitatively measured post-traumatic growth among (ex-) military personnel, to determine whether there is evidence of growth in this context and whether such growth is associated with any sociodemographic, military, trauma or mental health factors. DATA SOURCES: The electronic databases PsycInfo, OVIDmedline and Embase were searched for studies published between 2001 and 2017. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: Papers were retained if they involved military or ex-military personnel, where some had been deployed to Iraq or Afghanistan. STUDY APPRAISAL: Quality assessment was conducted on all studies. RESULTS: 21 studies were retained. The Post-Traumatic Growth Inventory was employed by 14 studies: means ranged from 32.60 (standard deviation = 14.88) to 59.07 (23.48). The Post-Traumatic Growth Inventory Short Form was used by five studies: means ranged from 17.11 (14.88) to 20.40 (11.88). These values suggest moderate growth. Higher levels of social support, spirituality and rumination and minority ethnicity were most frequently associated with more post-traumatic growth. LIMITATIONS: The involved studies may lack generalisability and methodological quality. CONCLUSIONS: Overall, this paper confirms that negative reactions to trauma, particularly post-traumatic stress disorder, are not the only possible outcomes for service personnel, as moderate post-traumatic growth can also be observed. IMPLICATIONS OF KEY FINDINGS: Interventions aimed at helping current and former armed forces personnel to identify and promote post-traumatic growth post-conflict may be beneficial for their well-being.

Using Twins to Better Understand Sibling Relationships.

We compared the nature of the sibling relationship in dyads of varying genetic relatedness, employing a behavioural genetic design to estimate the contribution that genes and the environment have on this familial bond. Two samples were used-the Sisters and Brothers Study consisted of 173 families with two target non-twin children (mean ages = 7.42 and 5.22 years respectively); and the Twins, Family and Behaviour study included 234 families with two target twin children (mean age = 4.70 years). Mothers and fathers reported on their children's relationship with each other, via a postal questionnaire (the Sisters and Brothers Study) or a telephone interview (the Twins, Family and Behaviour study). Contrary to expectations, no mean level differences emerged when monozygotic twin pairs, dizygotic twin pairs, and non-twin pairs were compared on their sibling relationship quality. Behavioural genetic analyses also revealed that the sibling bond was modestly to moderately influenced by the genetic propensities of the children within the dyad, and moderately to substantially influenced by the shared environment common to both siblings. In addition, for sibling negativity, we found evidence of twin-specific environmental influence-dizygotic twins showed more reciprocity than did non-twins. Our findings have repercussions for the broader application of results from future twin-based investigations.

A harsh parenting team? Maternal reports of coparenting and coercive parenting interact in association with children's disruptive behaviour.

BACKGROUND: Parenting and coparenting are both important for children's adjustment, but their interaction has been little explored. Using a longitudinal design and considering two children per family, we investigated mothers' and fathers' perceptions of coparenting as moderators of associations between their coercive parenting and children's disruptive behaviour. METHODS: Mothers and fathers from 106 'intact' families were included from the Twins, Family and Behaviour study. At Time 1 (Mchild age  = 3 years 11 months, SDchild age  = 4.44 months) parents reported on their coercive parenting and children's disruptive behaviour via questionnaire; at Time 2 (Mchild age  = 4 years 8 months, SDchild age  = 4.44 months) perceptions of coparenting and the marital relationship were collected by telephone interview. Questionnaire-based reports of children's disruptive behaviour were collected at follow-up (Mchild age  = 5 years 11 months, SDchild age  = 5.52 months). Multilevel modelling was used to examine child-specific and family-wide effects. RESULTS: Conservative multilevel models including both maternal and paternal perceptions demonstrated that maternal perceptions of coparenting and overall coercive parenting interacted in their prediction of parent-reported child disruptive behaviour. Specifically, accounting for perceived marital quality, behavioural stability, and fathers' perceptions, only in the context of perceived higher quality coparenting was there a positive association between mother-reported overall coercive parenting and children's disruptive behaviour at follow-up. CONCLUSIONS: When combined with highly coercive parenting, maternal perceptions of high quality coparenting may be detrimental for children's adjustment.

The Maternal Emotional Climate Predicts Twin Sibling Relationship Quality.

We investigated the association between maternal expressed emotion and twin relationship quality, after controlling for a maternal questionnaire measure of the mother-child relationship. This was explored within a community sample of 156 mothers and their two young twin children (M child age = 3.69 years; SD child age = 0.37). Mothers reported on the twin-twin relationship and the mother-child relationship via questionnaire. They were also interviewed about each child using the innovative Preschool Five Minute Speech Sample (Daley et al., 2003), which yields information about relative positive:negative maternal expressed emotion. Mothers who expressed more family-wide positive emotion and less family-wide negative emotion also reported more positivity, but not negativity, within the twin relationship - even when controlling for questionnaire reports of the mother-child relationship. Counter to expectations, discrepancies in mothers' expressed emotion between their twins also predicted more positive sibling relationships. Our findings corroborate the well established spill-over effect, whereby families are viewed as emotional units of interdependent individuals, none of whom can be understood in isolation from one another. Most importantly, the Preschool Five Minute Speech Sample provides information about mothering that questionnaire reports may not, and thus it is a useful tool in better understanding the twin family system.

The Development of the Military Service Identification Tool: Identifying Military Veterans in a Clinical Research Database Using Natural Language Processing and Machine Learning.

BACKGROUND: Electronic health care records (EHRs) are a rich source of health-related information, with potential for secondary research use. In the United Kingdom, there is no national marker for identifying those who have previously served in the Armed Forces, making analysis of the health and well-being of veterans using EHRs difficult. OBJECTIVE: This study aimed to develop a tool to identify veterans from free-text clinical documents recorded in a psychiatric EHR database. METHODS: Veterans were manually identified using the South London and Maudsley (SLaM) Biomedical Research Centre Clinical Record Interactive Search-a database holding secondary mental health care electronic records for the SLaM National Health Service Foundation Trust. An iterative approach was taken; first, a structured query language (SQL) method was developed, which was then refined using natural language processing and machine learning to create the Military Service Identification Tool (MSIT) to identify if a patient was a civilian or veteran. Performance, defined as correct classification of veterans compared with incorrect classification, was measured using positive predictive value, negative predictive value, sensitivity, F1 score, and accuracy (otherwise termed Youden Index). RESULTS: A gold standard dataset of 6672 free-text clinical documents was manually annotated by human coders. Of these documents, 66.00% (4470/6672) were then used to train the SQL and MSIT approaches and 34.00% (2202/6672) were used for testing the approaches. To develop the MSIT, an iterative 2-stage approach was undertaken. In the first stage, an SQL method was developed to identify veterans using a keyword rule-based approach. This approach obtained an accuracy of 0.93 in correctly predicting civilians and veterans, a positive predictive value of 0.81, a sensitivity of 0.75, and a negative predictive value of 0.95. This method informed the second stage, which was the development of the MSIT using machine learning, which, when tested, obtained an accuracy of 0.97, a positive predictive value of 0.90, a sensitivity of 0.91, and a negative predictive value of 0.98. CONCLUSIONS: The MSIT has the potential to be used in identifying veterans in the United Kingdom from free-text clinical documents, providing new and unique insights into the health and well-being of this population and their use of mental health care services.

Rates and Associated Factors of Secondary Mental Health Care Utilisation among Ex-Military Personnel in the United States: A Narrative Review.

Little is known about ex-serving military personnel who access secondary mental health care. This narrative review focuses on studies that quantitatively measure secondary mental health care utilisation in ex-serving personnel from the United States. The review aimed to identify rates of mental health care utilisation, as well as the factors associated with it. The electronic bibliographic databases OVID Medline, PsycInfo, PsycArticles, and Embase were searched for studies published between January 2001 and September 2018. Papers were retained if they included ex-serving personnel, where the majority of the sample had deployed to the recent conflicts in Iraq or Afghanistan. Fifteen studies were included. Modest rates of secondary mental health care utilisation were found in former military members-for mean percentage prevalence rates, values ranged from 12.5% for at least one psychiatric inpatient episode, to 63.2% for at least one outpatient mental health appointment. Individuals engaged in outpatient care visits most often, most likely because these appointments are the most commonly offered source of support. Post-traumatic stress disorder, particularly re-experiencing symptoms, and comorbid mental health problems were most consistently associated with higher mental health care utilisation. Easily accessible interventions aimed at facilitating higher rates of help seeking in ex-serving personnel are recommended.

Identifying Veterans Using Electronic Health Records in the United Kingdom: A Feasibility Study.

There is a lack of quantitative evidence concerning UK (United Kingdom) Armed Forces (AF) veterans who access secondary mental health care services-specialist care often delivered in high intensity therapeutic clinics or hospitals-for their mental health difficulties. The current study aimed to investigate the utility and feasibility of identifying veterans accessing secondary mental health care services using National Health Service (NHS) electronic health records (EHRs) in the UK. Veterans were manually identified using the Clinical Record Interactive Search (CRIS) system-a database holding secondary mental health care EHRs for an NHS Trust in the UK. We systematically and manually searched CRIS for veterans, by applying a military-related key word search strategy to the free-text clinical notes completed by clinicians. Relevant data on veterans' socio-demographic characteristics, mental disorder diagnoses and treatment pathways through care were extracted for analysis. This study showed that it is feasible, although time consuming, to identify veterans through CRIS. Using the military-related key word search strategy identified 1600 potential veteran records. Following manual review, 693 (43.3%) of these records were verified as "probable" veterans and used for analysis. They had a median age of 74 years (interquartile range (IQR): 53-86); the majority were male (90.8%) and lived alone (38.0%). The most common mental diagnoses overall were depressive disorders (22.9%), followed by alcohol use disorders (10.5%). Differences in care pathways were observed between pre and post national service (NS) era veterans. This feasibility study represents a first step in showing that it is possible to identify veterans through free-text clinical notes. It is also the first to compare veterans from pre and post NS era.

Coparenting and children's disruptive behavior: Interacting processes for parenting sense of competence.

Parenting sense of competence (PSOC) is a critical aspect of parental adjustment that may be undermined by children's disruptive behavior. Interparental relationships have been shown to shape how parents react and respond to their children's characteristics, but little is known about the role of parenting teamwork, known as 'coparenting.' We examined mothers' and fathers' perceptions of children's disruptive behavior and the quality of coparenting, as well as their interaction in association with PSOC. Mothers and fathers from 108 'intact' families participating in the Twins, Family, and Behavior (TFaB) Study reported on their children's disruptive behavior, coparenting and PSOC via postal questionnaire (Mchild age = 6 years, SDchild age = 6.12 months). Dyadic multilevel analyses revealed that higher levels of children's disruptive behavior related to lower levels of parents' PSOC and perceptions of higher-quality coparenting were associated with higher PSOC. Notably, and as hypothesized, there was a significant interaction between coparenting and children's disruptive behavior such that perceptions of high quality coparenting buffered PSOC from its negative association with children's disruptive behavior. High-quality coparenting is an important aspect of family functioning that may protect the PSOC of parents dealing with high levels of children's disruptive behavior. (PsycINFO Database Record