Evaluation of the Warrior Programme intervention among UK ex-service personnel.

BACKGROUND: Research has shown that of the myriad services available to veterans in the UK, very few have been independently evaluated. This report presents the results of a randomized controlled trial assessing the impact of Time Line Therapy™ delivered by the Warrior Programme (a third-sector organization). AIMS: This study was aimed to determine if the intervention is effective in reducing emotional and functional difficulties in ex-service personnel. METHODS: A mixed-design analysis of variance model was used to investigate whether the Warrior Programme had a statistically significant impact on self-reported scores. The intervention and control group provided data on measures prior to and immediately after the intervention, and at 3-month follow-up. RESULTS: Those in the intervention group (n = 23) reported statistically significant improvements in self-reported scores immediately following intervention: the Clinical Outcomes in Routine Evaluation (CORE) scores (CORE global distress mean difference [MD] = 45.0, 95% confidence interval [CI] 31-60) (CORE subjective well-being MD = 5.9, 95% CI 3.5-8.3) (CORE functioning MD = 16.7, 95% CI 11.4-21.9) (CORE problems/symptoms MD = 19.4, 95% CI 13.1-25.7), general self-efficacy (MD = -9.8, 95% CI -13.6 to -6.8), anxiety (MD = 8.6, 95% CI 5.2-12.1), depression (MD = 10, 95% CI 6.6-13.5), post-traumatic stress disorder (MD = 26.3, 95% CI 17-25) and functional impairment (MD = 11.1, 95% CI 5.3-16.8) over time, compared to the control group (n = 29). However, score improvement was not sustained over time or statistically significant at follow-up. CONCLUSIONS: The Warrior Programme was effective in reducing emotional and functional difficulties in ex-service personnel immediately after the intervention, but the effect was not sustained at 3-month follow-up.

"It didn't bring back the old me but helped me on the path to the new me": exploring posttraumatic growth in British veterans with PTSD.

PURPOSE: This study explores the role of scuba diving therapy in growth experiences of ex-servicemen. Previous research has focused on difficulties arising from re-entering civilian life after deployment. Known mental health challenges occurring after severe combat related trauma exposure include depression, anxiety, and posttraumatic stress disorder (PTSD). However, less is known about the potential positive transformation which can occur when individuals navigate these challenges. Known facilitators of this positive transformation, often referred to as posttraumatic growth (PTG), are still sparse in this participant pool. METHODS: This study utilized an in-depth qualitative approach of interpretative phenomenological analysis utilizing semi-structured interviews. A homogeneous sample of five male British ex-service personnel with a diagnosis of PTSD who identified with PTG was recruited. RESULTS: All participants reported positive mental health benefits from diving with four themes emerging: human connection; meaningful leisure; embodiment; and the calm. CONCLUSIONS: Scuba diving appeared to afford instant access to lasting relief of anxiety, stress, and symptoms of PTSD and reduction of physical symptoms of their trauma connected to underwater weightlessness. The reduction of PTSD symptoms carved space for PTG, facilitated through a meaningful leisure environment with opportunities for human connection with individuals who had gone through similar experiences.Implications for rehabilitationVeterans with posttraumatic stress disorder (PTSD) respond less well to conventional treatments for PTSD than civilian populations.Scuba diving has the potential to benefit veterans by giving access to relief from anxiety and symptoms of PTSD, such as hypervigilance and invasive thoughts.Scuba diving not only reduces symptoms of physical and psychological ill health but can facilitate wellbeing and growth.Scuba diving, as a meaningful leisure activity, could potentially enhance medical and psychological therapy.

A latent profile analysis of PTSD symptoms among UK treatment seeking veterans.

Background: Significant numbers of individuals leave the military and experience symptoms of posttraumatic stress disorder (PTSD). Veterans with PTSD symptoms rarely experience them in isolation, more commonly they are co-morbid with a range of other difficulties. Objective: Latent profile analysis (LPA) was used to explore the heterogeneity of PTSD symptom presentation. Following this, regression analysis was used to examine variables that predicted membership to the identified PTSD profiles. Methods: Data on childhood adversity, socio-demographic characteristics and mental health outcomes was collected from 386 male veterans who had engaged with mental health services in the UK. Results: LPA identified a six-profile model to best describe the sample. There was a Low symptom profile, a Severe symptom profile and four Moderate symptom profiles. The Severe symptom profile was the largest one, accounting for 37.57% of the sample. Five out of the six profiles had mean PTSD scores above the cut-off for probable PTSD. Higher rates of common mental health difficulties were associated with more symptomatic profiles. Discussion: As the vast majority of veterans met criteria for probable PTSD, the finding of six different profiles differing primarily quantitatively, but to some extent also qualitatively, suggests the importance of moving away from a 'one-size fits all' approach when it comes to treatments, towards developing interventions that are tailored to meet the specific PTSD and co-morbid symptoms profiles.

Antecedentes: Un número significativo de individuos deja el servicio militar y experimenta síntomas de trastorno de estrés postraumático (TEPT). Los veteranos con síntomas de TEPT rara vez los experimentan de forma aislada, más comúnmente son comórbidos con una variedad de otras dificultades.Objetivo: Se utilizó el análisis de perfiles latentes (LPA, en sus siglas en inglés) para explorar la heterogeneidad de la presentación de síntomas del TEPT. A continuación se usó análisis de regresión para examinar variables que predijeran la pertenencia a los perfiles de TEPT identificados.Método: Se obtuvieron datos sobre la adversidad infantil, las características sociodemográficas y los resultados de salud mental de 386 veteranos varones que habían consultado en servicios de salud mental en el Reino Unido.Resultados: LPA identificó un modelo de seis perfiles que mejor describen la muestra. Hubo un perfil de síntomas bajos, un perfil de síntomas graves y cuatro perfiles de síntomas moderados. El perfil de síntomas severos fue el más grande, representando el 37.57% de la muestra. Cinco de los seis perfiles tenían puntajes promedio de TEPT por encima del puntaje de corte para probable TEPT. Tasas más altas de dificultades de salud mental comunes se asociaron con más perfiles sintomáticos.Discusión: Como la gran mayoría de los veteranos cumplieron con los criterios de probable TEPT, el hallazgo de seis perfiles diferentes que se distinguen principalmente de forma cuantitativa, pero en cierta medida también cualitativamente, sugiere la importancia de alejarse de un enfoque 'de una sola talla' para todos cuando se trata de tratamientos, hacia el desarrollo de intervenciones que se adapten a los perfiles específicos de TEPT y síntomas comórbidos.

Describing the profile of a population of UK veterans seeking support for mental health difficulties.

Background: Evidence suggests that veterans with mental health issues have poorer treatment outcomes than civilian counterparts. Understanding the difficulties faced by veterans could help focus treatments and improve outcomes.Aims: To survey a representative sample of treatment-seeking veterans to explore their mental health needs.Methods: A random sample of UK veterans who had engaged with a national mental health charity in the UK was drawn. Individuals completed questionnaires about their health, military experiences and pre-enlistment vulnerabilities.Results: Four hundred and three out of six hundred (67.2%) participants returned completed questionnaires. PTSD was the most commonly endorsed mental health difficulty (82%), followed by problems with anger (74%), common mental health difficulties (72%) and alcohol misuse (43%). Comorbidity was frequent; with 32% of those with PTSD meeting criteria for three other health outcomes versus only 5% with PTSD alone.Conclusions: Results indicate the complexity of presentations within treatment seeking veterans. These difficulties may partly explain the poorer treatment outcomes reported in veterans in comparison to the general public. As such, it would be prudent for interventions targeted at veterans with mental health difficulties to attempt to address the range of issues faced by this population rather than focus on a particular presenting problem.

Pathways into mental health care for UK veterans: a qualitative study.

Background: It is well established that veterans suffering from mental health difficulties under use mental health services. Objective: This study aimed to understand more about the barriers that prevent veterans from seeking professional help and the enablers that assist veterans in seeking professional help. It also aimed to explore potential mechanisms to improve veterans' help-seeking and pathways to care. Method: The study employed a qualitative design whereby 17 veterans who had recently attended specialist veteran mental health services took part in semi-structured interviews. The resultant data were analysed using grounded theory. Results: Participants described two distinct stages to their help-seeking: initial help-seeking and pathways through treatment. Specific barriers and enablers to help-seeking were identified at each stage. Initial barriers included recognizing that there is a problem, self-stigma and anticipated public stigma. Initial enablers included being in crisis, social support, motivation and the media. Treatment pathway barriers included practical factors and negative beliefs about health services and professionals. Treatment pathway enablers included having a diagnosis, being seen in a veteran-specific service and establishing a good therapeutic relationship. Participants provided some suggestions for interventions to improve veterans' help-seeking in future; these focussed on enhancing both veterans and health professionals' knowledge regarding mental health difficulties. Conclusions: This study identified a number of barriers and enablers that may impact a veteran's journey in seeking help from professional services for mental health difficulties. Enablers such as reaching a crisis point, social support, the media, having a diagnosis of PTSD and veteran-specific mental health services appeared to be important in opposing stigma-related beliefs and in supporting veterans to engage in help-seeking behaviours.

Planteamiento: Está bien establecido que los veteranos que sufren de problemas de salud mental infrautilizan los servicios de salud mental. Objetivo: Este estudio estaba dirigido a comprender más sobre las barreras que impiden que los veteranos busquen ayuda profesional y aquello que les facilita su búsqueda de ayuda profesional. También tenía como objetivo explorar posibles mecanismos para mejorar la búsqueda de ayuda y las vías que llevan a dicha atención de los veteranos. Método: El estudio empleó un diseño cualitativo mediante el cual 17 veteranos, que habían asistido recientemente a servicios especializados de salud mental para veteranos, participaron en entrevistas semiestructuradas. Los datos resultantes se analizaron utilizando una teoría fundamentada. Resultados: Los participantes describieron dos etapas distintas en su búsqueda de ayuda: búsqueda inicial de ayuda; y vías del tratamiento. En cada etapa se identificaron las barreras específicas y los facilitadores para dicha búsqueda de ayuda. Las barreras iniciales incluyeron el reconocimiento de que existe un problema, el autoestigma y el estigma público anticipado. Los facilitadores iniciales incluyeron estar en crisis, apoyo social, motivación y los medios de comunicación. Las barreras a recibir tratamiento incluían factores prácticos y creencias negativas sobre los servicios de salud y los profesionales. Lo que facilitaba el recibir tratamiento incluía tener un diagnóstico, ser vistos en un servicio específico para veteranos y establecer una buena relación terapéutica. Los participantes proporcionaron algunas sugerencias de intervenciones para mejorar la búsqueda de ayuda de los veteranos en el futuro; estos se enfocaron en mejorar el conocimiento sobre las dificultades de salud mental. tanto de los veteranos como el de los profesionales de la salud. Conclusiones: Este estudio identificó una serie de barreras y facilitadores que pueden influir en que los veteranos busquen ayuda de servicios profesionales para las dificultades de salud mental. Facilitadores como llegar a un punto de crisis, el apoyo social, los medios de comunicación, tener un diagnóstico de TEPT y servicios de salud mental específicos para veteranos parecían ser importantes a la hora de enfrentarse a creencias estigmatizadas y de apoyar a los veteranos a implicarse en conductas de búsqueda de ayuda.

Post-traumatic growth among the UK veterans following treatment for post-traumatic stress disorder.

INTRODUCTION: The aim of this paper was to examine levels of post-traumatic growth (PTG) in a sample of the UK veterans who had received treatment for post-traumatic stress disorder (PTSD). METHODS: The study followed-up 149 UK veterans after they had completed standardised treatment for PTSD provided by Combat Stress. Data had previously been collected on a range of mental health outcomes before treatment, and then repeated 6 months after the end of treatment. For the current study, participants completed the post-traumatic growth inventory (PTGI) measure. Analysis was conducted to explore levels of PTG and whether there were any relationships between pretreatment and post-treatment ratings of mental health and PTG. RESULTS: The mean score on the PTGI was 32.6. Evidence of a treatment effect on levels of PTG was observed. There appeared to be a relationship between improvements in symptoms of PTSD and depression and higher levels of PTG. CONCLUSIONS: This study observed the presence of PTG following exposure to traumatic events within a sample of the UK veterans following their treatment for PTSD. PTG scores were moderately low in comparison to similar studies in the USA.

Mental Health Difficulties and Help-Seeking Beliefs within a Sample of Female Partners of UK Veterans Diagnosed with Post-Traumatic Stress Disorder.

In the UK there is a paucity of research about the needs of partners who are supporting ex-service personnel with mental health difficulties. In this study, we surveyed the mental health needs and barriers to help-seeking within a sample of partners of UK veterans who had been diagnosed with PTSD. Our sample included 100 participants. Forty-five percent met criteria for alcohol problems, 39% for depression, 37% for generalised anxiety disorder and 17% for symptoms of probable PTSD. Participants who met case criteria for depression, anxiety and problems with alcohol were more likely to report a greater number of help-seeking barriers. Participants who were experiencing mental health difficulties were more likely to endorse barriers connected to stigmatising beliefs than those associated with practical issues around accessing mental health services. The evidence presented suggests there may be a considerable burden of mental illness within this population. It would seem prudent to conduct further work to understand how best to address this clinical need.

Help for heroes? Evaluating a case management programme for ex-service personnel in the United Kingdom.

AIMS: There is increasing recognition of the health and social needs of ex-service personnel, but the UK evidence base on interventions is small. This article presents the findings from an evaluation of a vocational case management programme co-funded by the National Health Service (NHS) to prevent ill health among ex-service personnel. METHODS: Qualitative, semi-structured interviews with 15 ex-service personnel were conducted. Five interviews with case management staff were also undertaken. Data were transcribed, thematically coded and analysed using NVivo. RESULTS: Ex-service personnel valued the service and consistently highlighted 'being listened to', 'being made to feel valued by programme staff', 'having their problems taken seriously' and 'being treated as an individual' as the most valuable aspects of the programme. Respondents particularly valued the personal support that case managers provided and the environment in which the service was delivered. CONCLUSION: Case management is a viable way in which the military, health professionals and support services can provide ongoing support for ex-service personnel in transitioning successfully to civilian life.