The underlying mechanisms by which Post-Traumatic Growth is associated with cardiovascular health in male UK military personnel: The ADVANCE cohort study.

Post-Traumatic Growth (PTG) is associated with good cardiovascular health, but the mechanisms of this are poorly understood. This cross-sectional analysis assessed whether factors of PTG (Appreciation of Life (AOL), New Possibilities (NP), Personal Strength (PS), Relating to Others (RTO) and Spiritual Change (SC)) are associated with cardiovascular health in a cohort of 1006 male UK military personnel (median age 34). The findings suggest AOL, PS and RTO are associated with better cardiovascular health through cardiometabolic effects (lower levels of triglycerides, and total cholesterol) and haemodynamic functioning (lower diastolic blood pressure), but not inflammation. However, NP and SC were associated with poorer cardiovascular health through cardiometabolic effects (lower levels of high-density lipoproteins and higher levels of total cholesterol) and AOL had a non-linear association with low-density lipoproteins. These findings suggest that the relationship between PTG and cardiovascular functioning is complex and in need of further scrutiny.

'You get looked at like you're failing': A reflexive thematic analysis of experiences of mental health and wellbeing support for NHS staff.

Staff in the National Health Service (NHS) are under considerable strain, exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. We interviewed 48 healthcare workers from 18 NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking, such as manager training and peer support facilitated by building in time for this during working hours, but this will require long-term strategic planning to address workforce shortages.

The underlying mechanisms by which PTSD symptoms are associated with cardiovascular health in male UK military personnel: The ADVANCE cohort study.

Post-Traumatic Stress Disorder (PTSD) has been identified as an independent risk factor for cardiovascular disease, but the mechanisms of this relationship are not well understood. This study investigates the associations between PTSD symptom clusters (hyperarousal, intrusive thoughts, avoidance behaviours and emotional numbing) and mechanisms of cardiovascular disease including cardiometabolic effects, inflammation, and haemodynamic functioning. In the ADVANCE study cohort of UK male military personnel, 1111 participants were assessed for PTSD via questionnaire and cardiovascular risk via venous blood sampling, pulse wave analysis and dual energy x-ray absorptiometry between 2015 and 2020. Variable selection procedures were conducted to assess which of the symptom clusters if any were associated with cardiovascular risk outcomes. Associations were confirmed via robust regression modelling. Avoidance behaviours were associated with greater systolic Blood Pressure (BP) (Adjusted Coefficient (AC) 0.640 (95% Confidence Interval (CI) 0.065, 1.149). Emotional numbing was associated with greater estimated glucose disposal rate (AC -0.021 (95%CI -0.036, -0.005). Hyperarousal was associated with greater levels of (log)triglycerides (exponentiated-AC 1.009 (95%CI 1.002, 1.017). Intrusive thoughts were associated with greater visceral adipose tissue (AC 0.574 (95%CI 0.020, 1.250). Nonlinear relationships were observed between emotional numbing with heart rate and intrusive thoughts with systolic BP. Limited evidence is present for symptom associations with lipoproteins and pulse wave velocity. No associations were observed between PTSD symptom clusters and high sensitivity c-reactive protein, diastolic BP, total cholesterol, or haemoglobin fasting glucose. In conclusion, symptom clusters of PTSD were associated with increased cardiovascular risk via cardiometabolic and haemodynamic functioning mechanisms, but not inflammation.

Factors associated with poor self-reported health within the UK military and comparisons with the general population: a cohort study.

OBJECTIVE: To investigate the self-rated health of the UK military and explore factors associated with poor self-rated health. Compare self-rated health of the military to the general population. DESIGN: A cohort study. PARTICIPANTS: A total of 7626 serving and ex-serving UK military personnel, aged between 25 and 49; 19,452,300 civilians from England and Wales. SETTING: United Kingdom (military), England and Wales (civilians). MAIN OUTCOME MEASURES: Self rated health for both populations. Additional data for the military sample included measures of symptoms of common mental disorder (General Health Questionnaire-12), probable post-traumatic stress disorder (post-traumatic stress disorder checklist Civilian Version), alcohol use (Alcohol Use Disorders Identification Test), smoking behaviour, history of self-harm and body mass index. RESULTS: In the military sample, poor self-rated health was significantly associated with: common mental disorders and post-traumatic stress disorder symptomology, a history of self-harm, being obese, older age (ages 35-49) and current smoking status. However, the majority of military personnel report good health, with levels of poor self-rated health (13%) not significantly different to those reported by the general population (12.1%). CONCLUSIONS: Self-rated health appears to relate to aspects of both physical and psychological health. The link between poor self-rated health and psychological ill-health emphasises the need for military support services to continue addressing mental health problems.

Factors associated with unintended weight change in the UK Armed Forces: a cohort study.

OBJECTIVE: To examine factors associated with self-reported unintended weight change in (ex-) military personnel of the UK Armed Forces. DESIGN: A cohort study whereby a self-report questionnaire was administered at baseline (2003-2005) and follow-up (2007-2009). PARTICIPANTS: A total of 6352 former and serving military personnel of the UK Armed Forces. SETTING: United Kingdom. MAIN OUTCOME MEASURES: Personnel were asked about socio-demographic, military and (mental) health characteristics, including screening measures for common mental health disorders. Further, participants were asked to report unintended weight fluctuations (none, < or > than 10 lbs in the past month). Multinomial regression analyses were used to identify factors associated with self-reported weight change at follow-up. RESULTS: Out of the 6352 former and serving military personnel, 123 (2.1%) reported unintended weight loss and 577 (9.0%) reported unintended weight gain in the past month. At follow-up, multivariable analyses indicated that unintended weight loss or weight gain was more likely to be reported by those who screened positive for mental health problems and those reporting weight changes at baseline. Reported weight loss was more common among smokers than non-smokers, whereas reported weight gain at follow-up was associated with having a higher BMI at baseline. CONCLUSIONS: At follow-up, self-reported unintended weight changes in former and serving military personnel of the UK Armed Forces were found to be associated with mental health problems, body mass index, smoking and self-reported weight changes at baseline.