The long term occupational fitness of UK military personnel following community mental health care.

BACKGROUND: Fitness to undertake operational deployment is a key requirement of military service. AIM: To assess individual deployment fitness at a single point from one month to eight years following discharge from mental healthcare. METHOD: Survival analyses assessed levels of deployability; the predictive effects of key covariates upon time to being classified as non-deployable were examined using univariate and multivariate Cox proportional hazards regression procedures. RESULTS: A total of 1405 individuals provided study data. 437 individuals (31.1%) were non-deployable or discharged from service during follow-up. 17.2% were non-deployable in the first year following mental healthcare; the proportion did not rise above this level until year seven when it was 19.1% and then 30.6% in year eight. Risk factors for being classified as non-deployable were female sex, receipt of intermediate duration therapy, management by the multidisciplinary team and previous referral to mental health services. Previous deployment was significantly associated with reduced risk. Overall, the levels of non-deployability appeared to be no higher than those found among the wider military services. CONCLUSION: Non-deployable status among mental healthcare recipients was broadly similar to that found among the wider UK military; risk factors for non-deployability could be amenable to targeted relapse prevention measures.

Systematic review of caregiver burden in spouses and partners providing informal care to wounded, injured or sick (WIS) military personnel.

INTRODUCTION: For the purposes of this review, caregivers are individuals who provide care that is typically unpaid and usually takes place at home. This systematic review aims to identify burden among spouses/partners caring for wounded, injured or sick military personnel and the factors associated with caregiver burden. METHODS: A systematic review was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Five electronic databases and relevant websites were searched. Two reviewers appraised the quality of the studies and carried out data extraction. RESULTS: Ten original papers were identified, of which eight were quantitative studies and two were qualitative. These papers highlighted the potential negative impact caregiving can have on spouses/partners and also some of the positive aspects of caring that can strengthen intimate relationships. CONCLUSIONS: Caring for an injured or ill military spouse or partner is a difficult task, compounded by the complexity of dealing with potentially both their physical and mental health problems. However, research has also identified some positive aspects of caring that can strengthen intimate relationships.

Informal caregiving and intimate relationships: the experiences of spouses of UK military personnel.

AIM: Currently, there is no research available on the experiences of spouses providing informal care to wounded, injured or sick (WIS) UK military personnel. The aim of this study was to fill this gap by investigating the relationship experiences of non-military partners caring for WIS UK military personnel. METHODS: Spouses of WIS military personnel (n=25) completed telephone interviews with the research team. The data were transcribed and analysed using thematic analysis. The transcripts were cross-coded and checked for inter-rater reliability. RESULTS: Six major themes were identified: (1) communication between couples, (2) adverse family environment, (3) reintegration, (4) intimacy, (5) financial uncertainty and (6) transition from partner to caregiver. CONCLUSIONS: Partners caring for injured/ill military personnel appear to be at risk of experiencing personal distress caused by impaired relationship functioning, which may lead to diminished physical and mental well-being. Partners of WIS military personnel experience significant levels of distress and burden associated with caregiving in the form of arguments with the military partner, problems in reintegration and a lack of physical and emotional intimacy.

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.

Stigmatisation, perceived barriers to care, help seeking and the mental health of British Military personnel.

INTRODUCTION: The relationship between mental health symptoms, stigmatising beliefs about mental health and help seeking is complex and poorly understood. METHOD: 1636 UK Armed Forces personnel provided study data immediately after deployment (T1) and approximately 6 months later (T2). Stigmatising beliefs were assessed using an eight-item scale previously used in studies of UK military personnel. Symptoms of probable common mental disorder, probable post-traumatic stress disorder and subjective stressful, emotional, relationship and family problems were evaluated at T1 and T2. Help seeking during deployment was assessed at T1 and post-deployment help seeking at T2. Alcohol use and subjective alcohol problems were assessed at T2 only. RESULTS: Reporting a probable mental health disorder or potentially harmful alcohol use following deployment was both significantly associated with higher levels of stigmatising beliefs. The reported degree of stigma was associated with changes in mental health symptom levels; compared to those who were never classified as a probable mental health disorder case, recovered cases experienced significantly lower levels of stigmatisation, whereas new onset cases reported significantly higher levels. CONCLUSION: The way that individuals report mental health stigmatisation is not static; rather stigma fluctuates in proportion to the frequency and severity of psychological symptoms. These results suggest that public health stigma-reduction strategies which aim to promote engagement with mental health services should be focused towards people who are experiencing worsening mental health. Our results suggest that willing volunteers who have recovered from a mental-ill-health episode may be well placed to assist in the delivery of such a strategy.

A systematic review of mental disorders and perpetration of domestic violence among military populations.

PURPOSE: Military populations may experience more severe forms of domestic violence than the general population. Although mental disorders are associated with domestic violence perpetration among the general population, it is not clear whether this is the case for military populations. This review aimed to establish the prevalence and odds of domestic violence perpetration among male and female military personnel with mental disorders. METHODS: Systematic review: searches of eleven electronic databases were supplemented by hand searches, reference screening, citation tracking and expert recommendations. RESULTS: Ten studies were included; nine reporting on partner violence and one on violence against an adult family member. Median prevalence estimates were calculated for partner violence perpetration among male military personnel with post-traumatic stress disorder (PTSD); estimates on other disorders were not possible due to lack of data. 27.5 % of men with PTSD reported past year physical violence perpetration against a partner and 91.0 % reported past year psychological violence perpetration against a partner. Due to limited data, no median estimates could be calculated for female military personnel. Data from individual papers indicate increased odds of past year partner violence perpetration among male and female military personnel with depression; inconsistent findings were reported for risk of partner violence perpetration among male and female military personnel with PTSD. CONCLUSIONS: There is some evidence that mental disorders among military personnel are associated with past year domestic violence perpetration, though current data cannot confirm direction of causality. Research is needed to inform the development of interventions targeted to reduce domestic violence perpetration among military personnel.

The psychological effects of improvised explosive devices (IEDs) on UK military personnel in Afghanistan.

OBJECTIVE: To explore the psychological consequences of improvised explosive device (IED) exposure as IEDs have been the greatest threat to UK military personnel in Afghanistan though the mental health consequences of IED exposure are largely unknown. METHOD: Deployed UK military personnel completed a survey while deployed in Afghanistan. Combat personnel and those dealing specifically with the IED threat were compared with all other deployed personnel; the relationship between IED exposure, general combat experiences, Post Traumatic Stress Disorder (PTSD) Checklist-Civilian Version (PCL-C) and General Health Questionnaire scores were evaluated. RESULTS: The response rate was 98% (n=2794). Half reported IED-related concerns, a third experienced exploding IEDs and a quarter gave medical aid to IED casualties. Combat and counter-IED threat personnel had higher levels of IED exposure than other deployed personnel. 18.8% of personnel who witnessed exploding IEDs scored positive for common mental disorder (General Health Questionnaire-12 scores ≥4) and 7.6% scored positive for probable PTSD symptoms (PTSD Checklist-Civilian Version scores ≥44). After adjusting for general combat exposure and other observed confounders, PTSD symptoms were associated with IED exposure whereas common mental disorder symptoms were not. IED exposure, IED-related concerns and functional impairment accumulated during deployment but functional impairment was related to factors other than IED exposure alone. CONCLUSIONS: In Afghanistan, a substantial proportion of personnel were exposed to exploding IEDs however, the majority of exposed personnel were psychologically healthy. Psychological effects were similar for combat personnel and those dealing specifically with the IED threat but both groups were at greater psychological risk than other deployed personnel.

Mild traumatic brain injury (mTBI) among UK military personnel whilst deployed in Afghanistan in 2011.

INTRODUCTION: mTBI has been termed the 'signature injury' of recent conflicts in Afghanistan and Iraq. Most mTBI research uses retrospective accounts of exposure and point of injury symptoms; mTBI is reportedly less common among UK than US Forces. METHODS: This study examined the rate of mTBI exposure and symptoms in 1363 UK military personnel deployed in Afghanistan in 2011 using a self-report questionnaire. Data were collected in the operational location during the 5th month of a 6-month deployment. Personnel reported injuries and symptoms related to six events including fragmentation, blast, bullet, fall, motor vehicle accident and 'other' exposure. RESULTS: Eighty (5.9%) reported at least one potential mTBI exposure during the current deployment and 1.6% (n = 22) reported injury and one or more mTBI symptoms (1 year incidence rate = 3.2%). Higher PTSD symptom scores were significantly associated with reporting potential mTBI (p ≤ 0.001) and mTBI with symptoms (p ≤ 0.001). CONCLUSION: This study used contemporaneous data gathered in the deployed location which are subject to less memory distortion than studies using post-deployment recall. The incidence of mTBI was substantially lower than those reported in both US and UK post-deployment studies which is consistent with inflated reporting of symptoms when measured post-deployment.

Fourteen-year trajectories of posttraumatic stress disorder (PTSD) symptoms in UK military personnel, and associated risk factors.

The aim of this study was to examine trajectories of posttraumatic stress disorder (PTSD) symptoms over a 14-year period and the risk factors associated with each trajectory. 1885 UK military personnel provided information at four time points since 2002. The PTSD Check list-Civilian Version (PCL-C) was used at all time points. Growth mixture models (GMM) were estimated to examine whether individuals could be clustered into discrete groups with similar trajectories. Multinomial logistic regressions were carried out to investigate factors associated with class membership. The three-class GMM was the most parsimonious solution. This included 90.2% in the resilient class, 4.1% in the improving class and 5.7% in the deteriorating class. Both the deteriorating and improving classes were associated with childhood adversity (odds ratios (OR) 3.9 (95% CI 2.3, 6.7) and 3.3 (95% CI 2.1, 5.0) respectively) and antisocial behaviour (OR 2.8 (95% CI 1.9, 4.2) and 3.7 (95% CI 2.4, 5.8) respectively), alcohol misuse (OR 3.5 (95% CI 2.4, 5.1) and 3.3 (95% CI 2.1, 5.2) respectively) and longer time since leaving Service in comparison to the resilient group. Those in the youngest group and those in a combat role (OR 0.32, 95% CI 0.19, 0.54) were more likely to belong to the deteriorating class. 10% of the cohort had symptoms of PTSD; of those, up to half were symptomatic for most of the follow-up period. Those whose score improved did not reach the low scores of the resilient group. Younger age and combat role were associated with worse prognosis of PTSD.

A comparison of the Work and Social Adjustment Scale (WSAS) across different patient populations using Rasch analysis and exploratory factor analysis.

INTRODUCTION: The Work and Social Adjustment Scale (WSAS) is designed to measure patients' perceived functional impairment associated with a health problem. There is a paucity of studies that explore the stability of the item hierarchy in the WSAS across different disease populations. This study investigated the unidimensional structure of the WSAS across different disease populations. METHODS: Secondary data analysis was conducted on pooled patient data (HIV, breast cancer, and inflammatory conditions) to create a new dataset (n=554). The data were analysed using Rasch analysis and exploratory factor analysis. RESULTS: Exploratory factor analysis and principle component analysis of the WSAS showed a good fit as a unidimensional scale, person and item separation indices were >2 suggesting that the WSAS is sensitive enough to distinguish between participants of varying levels of ability. Some differential item functioning was seen by diagnosis and by sex for items 1 and 5 of the WSAS. CONCLUSIONS: Overall, a one dimensional structure was identified for the WSAS. However, a small number of differential item functioning (DIF) was identified, suggesting that scores from the WSAS cannot be compared across groups.

Alcohol misuse in the United Kingdom Armed Forces: A longitudinal study.

OBJECTIVES: We assessed changes in Alcohol Use Disorders Identification Test (AUDIT) scores over time. We investigated the impact of life events and changes in mental health status on AUDIT scores over time in UK military personnel. METHODS: A random representative sample of regular UK military personnel who had been serving in 2003 were surveyed in 2004-2006 (phase 1) and again in 2007-2009 (phase 2). The impact of changes in symptoms of psychological distress, probable post-traumatic stress disorder (PTSD), marital status, serving status, rank, deployment to Iraq/Afghanistan and smoking was assessed between phases. RESULTS: We found a statistically significant but small decrease in AUDIT scores between phases 1 and 2 (mean change=-1.01, 95% confidence interval=-1.14, -0.88). Participants reported a decrease in AUDIT scores if they experienced remission in psychological distress (adjusted mean -2.21, 95% CI -2.58, -1.84) and probable PTSD (adjusted mean -3.59, 95% CI -4.41, -2.78), if they stopped smoking (adjusted mean -1.41, 95% CI -1.83, -0.98) and were in a new relationship (adjusted mean -2.77, 95% CI -3.15, -2.38). On the other hand, reporting new onset or persistent symptoms of probable PTSD (adjusted mean 1.34, 95% CI 0.71, 1.98) or a relationship breakdown (adjusted mean 0.53, 95% CI 0.07, 0.99) at phase 2 were associated with an increase in AUDIT scores. CONCLUSIONS: The overall level of hazardous alcohol consumption remains high in the UK military. Changes in AUDIT scores were linked to mental health and life events but not with deployment to Iraq or Afghanistan.