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1.
Addiction ; 117(1): 57-67, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34288194

RESUMEN

AIM: To identify the main trajectories of alcohol misuse among UK military personnel from 12 years after the start of the Iraq war (2003) and the factors associated with each trajectory. DESIGN: Longitudinal cohort study with three phases of data collection (2004-06, 2007-09 and 2014-16). SETTING: United Kingdom. PARTICIPANTS: Serving and ex-serving personnel of the UK Armed Forces (n = 7111) participating at Phase 1 and at least one follow-up phase of the King's Centre for Military Health Research (KCMHR) cohort study. MEASUREMENTS: Trajectories of alcohol misuse were derived from scores using the Alcohol Use Disorders Identification Test (AUDIT-10) over three data collection phases. Demographic and military characteristics were collected and, among the key covariates, post-traumatic stress disorder (PTSD) was measured using the PTSD checklist (PCL-C) and childhood interpersonal stress and violence was measured using items from the Adverse Childhood Experiences questionnaire. FINDINGS: Five trajectories of alcohol misuse were identified, including 'no misuse' (n = 2249, 31.6%) and 'hazardous' (n = 3398, 47.8%), 'harmful' (n = 832, 11.7%), 'severe-to-hazardous' (n = 258, 5.3%) and 'severe' (n = 374, 3.6%) drinking. Substantial changes were evident only among severe drinkers, where more than half reduced over the study period. The factors most strongly associated with belonging to harmful/severe drinking classes were young age, male gender and childhood adversities and antisocial behaviour. Severe drinkers at Phase 1 were more likely to report probable PTSD and shorter military careers and were less likely to serve as Officers. Persistent severe drinkers were less likely to serve in the RAF compared to the Army and were more likely to be reserves. Not misusing alcohol was also associated with reserve status and having left service. CONCLUSIONS: In a cohort of approximately 7000 UK military personnel, trajectories of alcohol misuse appeared stable between 2004 and 2016. More than half of severe drinkers made substantial improvements over the period, but 68% of the cohort continued to drink hazardously or harmfully. Lack of change for the majority of the sample signals the need for strategies to address alcohol misuse and its cultural and psychosocial drivers.

2.
Occup Environ Med ; 78(9): 643-647, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-33483458

RESUMEN

OBJECTIVES: While most UK military personnel transition successfully into civilian life, some experience unemployment and disability, which may be partly attributable to in-service factors. This study aims to determine the degree to which in-service mental health problems impact on postservice benefit claims. METHODS: Using data from a cohort of 5598 recent leavers from regular service in the UK Armed Forces linked with data from the Department for Work and Pensions, we assessed associations between in-service mental health and postservice benefit claims, and the population attributable fraction (PAF) of benefit claims related to in-service mental health. An analysis with postservice mental ill health as mediator was performed to determine the degree to which the observed effects were a consequence of persistent illness, as opposed to remitted. RESULTS: Mental illness occurring in-service predicted both unemployment and disability claims, partly mediated by postservice health (23%-52% total effects mediated), but alcohol misuse did not. Common mental disorder (CMD) (PAF 0.07, 95% CI: 0.02 to 0.11) and probable post-traumatic stress disorder (PTSD) (PAF 0.05, 95% CI 0.01 to 0.09) contributed to unemployment claims. Probable PTSD was the largest contributor to disability claims (PAF 0.25, 95% CI 0.13 to 0.36), with a smaller contribution from CMD (PAF 0.16, 95% CI 0.03 to 0.27). CONCLUSIONS: In-service mental ill health gives rise to benefit claims. These effects are only partly mediated by postservice mental health, implying that in-service (or pre-service) mental issues have carry-over effects into civilian life even if remitted. Better prevention and treatment of in-service PTSD symptoms may well reduce postservice disability claims.


Asunto(s)
Trastornos Mentales/epidemiología , Personal Militar/psicología , Ayuda a Lisiados de Guerra/estadística & datos numéricos , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Desempleo/psicología , Desempleo/estadística & datos numéricos , Reino Unido/epidemiología
3.
JMIR Res Protoc ; 9(10): e19720, 2020 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-33006569

RESUMEN

BACKGROUND: Alcohol misuse is higher in the UK Armed Forces than in the general population. Previous research has shown that interventions delivered via smartphones are efficacious in promoting self-monitoring of alcohol use, have utility in reducing alcohol consumption, and have a broad reach. OBJECTIVE: This single-blinded randomized controlled trial (RCT) aims to assess the efficacy of a 28-day brief alcohol intervention delivered via a smartphone app (Drinks:Ration) in reducing weekly self-reported alcohol consumption between baseline and 3-month follow-up among veterans who drink at a hazardous or harmful level and receive or have received support for mental health symptoms in a clinical setting. METHODS: In this two-arm, single-blinded RCT, a smartphone app that includes interactive features designed to enhance participants' motivation and personalized messaging is compared with a smartphone app that provides only government guidance on alcohol consumption. The trial will be conducted in a veteran population that has sought help through Combat Stress, a UK veteran's mental health charity. Recruitment, consent, and data collection will be carried out automatically through the Drinks:Ration platform. The primary outcome is the change in self-reported weekly alcohol consumption between baseline (day 0) and 3-month follow-up (day 84) as measured using the Time-Line Follow back for Alcohol Consumption. Secondary outcome measures include (1) change in the baseline to 3-month follow-up (day 84) Alcohol Use Disorder Identification Test score and (2) change in the baseline to 3-month follow-up (day 84) World Health Organization Quality of Life-BREF score to assess the quality of adjusted life years. Process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. The primary and secondary outcomes will also be reassessed at the 6-month follow-up (day 168) to assess the longer-term benefits of the intervention, which will be reported as a secondary outcome. RESULTS: The study will begin recruitment in October 2020 and is expected to require 12 months to complete. The study results will be published in 2022. CONCLUSIONS: This study assesses whether a smartphone app is efficacious in reducing self-reported alcohol consumption in a veteran population that has sought help through Combat Stress using personalized messaging and interactive features. This innovative approach, if successful, may provide a means to deliver a low-cost health promotion program that has the potential to reach large groups, in particular those who are geographically dispersed, such as military personnel. TRIAL REGISTRATION: ClinicalTrials.gov NCT04494594; https://clinicaltrials.gov/ct2/show/NCT04494594. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/19720.

4.
J Head Trauma Rehabil ; 35(1): 46-56, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31033752

RESUMEN

OBJECTIVES: We assessed whether mild traumatic brain injury (mTBI) reported by UK service personnel between 2007 and 2009 was associated with postconcussion symptoms (PCS) 7 to 8 years later. SETTING: United Kingdom. PARTICIPANTS: A total of 4601 service personnel all of whom had deployed to Iraq and/or Afghanistan. DESIGN: Longitudinal study. MAIN OUTCOME MEASURES: Nine PCS reported in a survey carried out between 2014 and 2016. The main independent variable was mTBI reported between 2007 and 2009. RESULTS: A total of 2318 (50.4%) out of 4601 participants completed the follow-up questionnaire. Mild traumatic brain injury was associated with 2 of 9 PCS. Mild traumatic brain injury at baseline was associated with dizziness at follow-up in the fully adjusted model, in comparison with either "other injury" or "no injury" group. Mild traumatic brain injury was associated with loss of concentration in comparison with "no injury" but in comparison with the "other injury" group, it was not in the fully adjusted model. The prevalence of 7 of the 9 PCS increased over time regardless of mTBI status. CONCLUSIONS: Mild traumatic brain injury reported in 2007-2009 was associated with dizziness and possibly with loss of concentration 7 years later but not with most PCS. The prevalence of most PCS increased over time independently of mTBI.


Asunto(s)
Campaña Afgana 2001- , Guerra de Irak 2003-2011 , Despliegue Militar , Personal Militar/psicología , Síndrome Posconmocional/epidemiología , Síndrome Posconmocional/psicología , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Síndrome Posconmocional/diagnóstico , Factores de Tiempo , Reino Unido
5.
Occup Environ Med ; 76(10): 726-732, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31375543

RESUMEN

OBJECTIVES: In the first study of its kind in the UK, we linked pensions data on benefit claims with data from the King's Military Cohort to assess uptake of unemployment and disability benefits in military veterans of the UK Armed Forces. METHODS: Benefits data were matched with data on the mental health, demographics and military-related variables for 7942 veterans who had previously served as regulars and transitioned to civilian life between 2003 and 2016. Associations between demographic and service-related factors and benefit claims were assessed using Cox regression to take into account period at risk. RESULTS: Around 20% of veterans claim unemployment benefits (UB) shortly after leaving, but this proportion drops rapidly to around 2% in the first 2 years post service. Receipt of disability benefits (DB) is less common (1.5%), but longer-term. The most consistent predictors of postservice benefit usage were: low rank (a proxy for socio-economic status while in service) (HR 1.42 (95% CI 1.23 to 1.65) for UB and 1.59 (95% CI 1.11 to 2.27) for DB); leaving service (HR 1.29 (95% CI 1.07 to 1.56) between unplanned leaving and UB, and 7.51 (95% CI 5.31 to 10.6) between medical discharge and DB), and having a history of claiming benefits before joining the Services (HR 1.62 (95% CI 1.34 to 1.95) between preservice and postservice UB, and 2.86 (95% CI 1.09 to 7.47) between preservice and postservice DB). CONCLUSIONS: Benefit claims by veterans are largely driven by socioeconomic, rather than military, factors. Additional employment-focused support to Service leavers may be particularly useful to lower-ranked personnel and those leaving in an unplanned way. Continuity of care and medical oversight is a key concern for those with medical discharges.


Asunto(s)
Personas con Discapacidad/estadística & datos numéricos , Desempleo/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Femenino , Humanos , Masculino , Clase Social , Reino Unido
6.
JMIR Mhealth Uhealth ; 7(5): e12267, 2019 05 24.
Artículo en Inglés | MEDLINE | ID: mdl-31127726

RESUMEN

BACKGROUND: Alcohol consumption in the UK Armed Forces is higher than in the general population, and this pattern continues after leaving the service. Smartphone apps may be useful to increase ex-serving personnel's awareness of their alcohol consumption, support self-monitoring, and prompt a change in behavior. OBJECTIVE: The study aimed to explore the acceptability of Information about Drinking in Ex-serving personnel (InDEx), a tailored smartphone app, combined with personalized short message service (SMS) text messaging designed to target ex-serving personnel who meet the criteria for hazardous alcohol use. METHODS: The InDEx intervention included 4 key modules: (1) assessment and normative feedback, (2) self-monitoring and feedback, (3) goal setting and review, and (4) personalized SMS text messaging. A semistructured telephone interview study was conducted with ex-serving personnel after using the app for a 28-day period. Interviews were used to explore the acceptability of app modules and its functionality and the perceived changes in participant's drinking. Interview transcripts were analyzed using inductive thematic analysis. RESULTS: Overall, 94% (29/31) participants who used InDEx agreed to take part in a telephone interview. Overall, 4 themes were identified: Credibility, Meeting their needs, Simplicity, and Helpful for ex-serving personnel. The importance of credibility, functionality, and meeting the individual needs of ex-serving personnel was emphasized. Acceptability and engagement with specific modules of the app and text messages were influenced by the following: (1) if they felt it provided credible information, (2) whether the content was appropriately personalized to them, (3) the ease of use, and (4) beliefs about their own drinking behaviors. Participants recommended that the app would be most suitable for personnel about to leave the Armed Forces. CONCLUSIONS: InDEx was an acceptable smartphone app for ex-serving personnel for monitoring alcohol consumption and in providing meaningful feedback to the individual. Pages that met the participant's interests and provided real time personalized, credible feedback on their drinking and text messages tailored to participant's interactions with the app were particularly favored.


Asunto(s)
Consumo de Bebidas Alcohólicas/prevención & control , Personal Militar/psicología , Aplicaciones Móviles/normas , Aceptación de la Atención de Salud/psicología , Adulto , Consumo de Bebidas Alcohólicas/psicología , Femenino , Humanos , Entrevistas como Asunto/métodos , Masculino , Personal Militar/estadística & datos numéricos , Aplicaciones Móviles/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Reino Unido
7.
J Ment Health ; : 1-8, 2019 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-30902023

RESUMEN

BACKGROUND: Little is known about the economic impact of military mental health screening. AIMS: To investigate (a) whether post-deployment screening of military personnel affects use and cost of services and (b) the impact of psychiatric morbidity on costs. METHODS: Participants were recruited from UK Royal Marine and Army platoons and randomised to an intervention group (which received tailored advice predicated upon mental health status) or a control group (which received general advice following assessment of mental health status). The intervention costs were calculated while service use and associated costs were assessed at 12-month follow-up. RESULTS: Data were available for 6323 participants. Mean screening cost was £34. Service costs were slightly higher in the control group compared to the intervention group (£1197 vs. £1147) which was not statistically significant (bootstrapped 95%CI, -£363 to £434. In both groups, screening and control, costs were significantly higher for those who screened positive for mental health problems. CONCLUSIONS: Costs were not affected by screening. In countries that have already implemented post-deployment screening, the political cost of disinvestment needs careful consideration. Those who develop psychiatric morbidity have substantially higher care costs than those who do not.

8.
9.
Eur J Psychotraumatol ; 10(1): 1556552, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30693074

RESUMEN

Background: UK armed forces personnel are at risk of occupational psychological injury; they are often reluctant to seek help for such problems. Objective: We aimed to examine and describe sources of support, prevalence and associates of help-seeking among UK serving and ex-serving personnel. Method: A total of 1450 participants who self-reported a stress, emotional or mental health problem in the past 3 years were sampled from a health and wellbeing study and subsequently completed a telephone interview comprising measures of mental disorder symptoms, alcohol misuse and help-seeking behaviour. Results: Seven per cent of participants had not sought any help, 55% had accessed medical sources of support (general practitioner or mental health specialist), 46% had received formal non-medical (welfare) support and 86% had used informal support. Gender, age, perceived health, functional impairment, social support, deployment, alcohol and comorbidity impacted upon the choice of help source. Conclusions: This study found that the majority of those with perceived mental health problems sought some form of help, with over half using formal medical sources of support.

10.
J Psychiatr Res ; 109: 156-163, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30551022

RESUMEN

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.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Alcoholismo/epidemiología , Trastornos de Combate/epidemiología , Progresión de la Enfermedad , Personal Militar/estadística & datos numéricos , Resiliencia Psicológica , Trastorno de la Conducta Social/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Adulto , Factores de Edad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores de Tiempo , Reino Unido/epidemiología , Veteranos/estadística & datos numéricos , Adulto Joven
12.
Br J Psychiatry ; 213(6): 690-697, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30295216

RESUMEN

BACKGROUND: Little is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.AimsWe examined the prevalence of mental disorders and alcohol misuse, whether this differed between serving and ex-serving regular personnel and by deployment status. METHOD: This is the third phase of a military cohort study (2014-2016; n = 8093). The sample was based on participants from previous phases (2004-2006 and 2007-2009) and a new randomly selected sample of those who had joined the UK armed forces since 2009. RESULTS: The prevalence was 6.2% for probable post-traumatic stress disorder, 21.9% for common mental disorders and 10.0% for alcohol misuse. Deployment to Iraq or Afghanistan and a combat role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel. CONCLUSIONS: The findings highlight an increasing prevalence of post-traumatic stress disorder and a lowering prevalence of alcohol misuse compared with our previous findings and stresses the importance of continued surveillance during service and beyond. DECLARATION OF INTEREST: All authors are based at King's College London which, for the purpose of this study and other military-related studies, receives funding from the UK Ministry of Defence (MoD). S.A.M.S., M.J., L.H., D.P., S.M. and R.J.R. salaries were totally or partially paid by the UK MoD. The UK MoD provides support to the Academic Department of Military Mental Health, and the salaries of N.J., N.G. and N.T.F. are covered totally or partly by this contribution. D.Mu. is employed by Combat Stress, a national UK charity that provides clinical mental health services to veterans. D.MacM. is the lead consultant for an NHS Veteran Mental Health Service. N.G. is the Royal College of Psychiatrists' Lead for Military and Veterans' Health, a trustee of Walking with the Wounded, and an independent director at the Forces in Mind Trust; however, he was not directed by these organisations in any way in relation to his contribution to this paper. N.J. is a full-time member of the armed forces seconded to King's College London. N.T.F. reports grants from the US Department of Defense and the UK MoD, is a trustee (unpaid) of The Warrior Programme and an independent advisor to the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee (unpaid) of Combat Stress and Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid). S.W. is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, the Department of Health, Public Health England or the UK MoD.


Asunto(s)
Campaña Afgana 2001- , Guerra de Irak 2003-2011 , Trastornos Mentales/epidemiología , Salud Mental , Personal Militar/psicología , Adulto , Alcoholismo/epidemiología , Estudios de Cohortes , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Autoinforme , Factores Socioeconómicos , Trastornos por Estrés Postraumático/epidemiología , Reino Unido/epidemiología
13.
JMIR Mhealth Uhealth ; 6(9): e10074, 2018 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-30206054

RESUMEN

BACKGROUND: Self-reported alcohol misuse remains high in armed forces personnel even after they have left service. More than 50% of ex-serving personnel meet the criteria for hazardous alcohol use; however, many fail to acknowledge that they have a problem. Previous research indicates that interventions delivered via smartphone apps are suitable in promoting self-monitoring of alcohol use, have a broad reach, and may be more cost-effective than other types of brief interventions. There is currently no such intervention specifically designed for the armed forces. OBJECTIVE: This study sought to describe the development of a tailored smartphone app and personalized text messaging (short message service, SMS) framework and to test the usability and feasibility (measured and reported as user engagement) of this app in a hard-to-engage ex-serving population. METHODS: App development used Agile methodology (an incremental, iterative approach used in software development) and was informed by behavior change theory, participant feedback, and focus groups. Participants were recruited between May 2017 and June 2017 from an existing United Kingdom longitudinal military health and well-being cohort study, prescreened for eligibility, and directed to download either Android or iOS versions of the "Information about Drinking for Ex-serving personnel" (InDEx) app. Through the app, participants were asked to record alcohol consumption, complete a range of self-report measures, and set goals using implementation intentions (if-then plans). Alongside the app, participants received daily automated personalized text messages (SMS) corresponding to specific behavior change techniques with content informed by the health action process approach with the intended purpose of promoting the use of the drinks diary, suggesting alternative behaviors, and providing feedback on goals setting. RESULTS: Invitations to take part in the study were sent to ex-serving personnel, 22.6% (31/137) of whom accepted and downloaded the app. Participants opened the InDEx app a median of 15.0 (interquartile range [IQR] 8.5-19.0) times during the 4 week period (28 days), received an average of 36.1 (SD 3.2) text messages (SMS), consumed alcohol on a median of 13.0 (IQR 11.0-15.0) days, and consumed a median of 5.6 (IQR 3.3-11.8) units per drinking day in the first week, which decreased to 4.7 (IQR 2.0-6.9) units by the last week and remained active for 4.0 (IQR 3.0-4.0) weeks. CONCLUSIONS: Personnel engaged and used the app regularly as demonstrated by the number of initializations, interactions, and time spent using InDEx. Future research is needed to evaluate the engagement with and efficacy of InDEx for the reduction of alcohol consumption and binge drinking in an armed forces population.

15.
Lancet ; 389(10077): 1410-1423, 2017 04 08.
Artículo en Inglés | MEDLINE | ID: mdl-28215661

RESUMEN

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).


Asunto(s)
Conducta de Búsqueda de Ayuda , Tamizaje Masivo/métodos , Trastornos Mentales/diagnóstico , Personal Militar/psicología , Adolescente , Adulto , Alcoholismo/epidemiología , Alcoholismo/psicología , Ansiedad/epidemiología , Ansiedad/psicología , Análisis por Conglomerados , Depresión/epidemiología , Depresión/psicología , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Salud Mental , Evaluación de Resultado en la Atención de Salud , Autoinforme , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Reino Unido/epidemiología , Adulto Joven
16.
BMC Psychiatry ; 16(1): 333, 2016 Sep 22.
Artículo en Inglés | MEDLINE | ID: mdl-27659728

RESUMEN

BACKGROUND: US studies have shown an increase of posttraumatic stress disorder (PTSD) and depression, but not alcohol misuse related to time of assessment since returning from deployment. We assessed if similar trends occur in the UK Armed Forces. METHODS: We selected UK studies based on our data base of King's Centre for Military Health Research publications from 2006 until January 2016 with at least one of the following measures: PTSD checklist-civilian version (PCL-C), the General Health Questionnaire (GHQ-12) and the Alcohol Use Disorders Identification Test (AUDIT). The studies included personnel assessed for these outcomes after their most recent deployment. A search in Medline, Psycho-Info and Embase confirmed that no relevant publication was missed. RESULTS: Twenty one thousand, seven hundred and forty-six deployed personnel from nine studies contributed to the meta-analyses by time since end of deployment in the PTSD analysis. The number of studies for period of time varied from two to four studies. The trend by time-category of questionnaire completion since returning from deployment were for PTSD ß = 0.0021 (95 % CI -0.00046 to 0.0049, p = 0.12), for psychological distress ß = 0.0123 (95 % CI 0.005 to 0.019, p = 0.002) and for alcohol misuse ß = 0.0013 (-0.0079 to 0.0105, p = 0.77). CONCLUSIONS: There was no evidence that the prevalence of PTSD and alcohol misuse changed according to time since the end of deployment over a three-year period, but there was evidence for an association with increasing psychological distress.

17.
BMC Pulm Med ; 16(1): 116, 2016 08 08.
Artículo en Inglés | MEDLINE | ID: mdl-27503476

RESUMEN

BACKGROUND: We investigated the net changes in prevalence of symptoms of asthma and rhinitis over 10 years in a cohort of young by baseline sensitization status. METHODS: One thousand one hundred ninety three Chilean adults subjects aged 22-28 living in a semi-rural area of central Chile answered a lifestyle and the European Community Respiratory Health Survey (ECRHS) questionnaires. Bronchial hyper-responsiveness (BHR) and skin prick test (SPT) to eight allergens were measured at baseline in 2001. Ten years later, 772 participants completed the questionnaires again. Estimates of adjusted net changes in prevalence of symptoms by sensitization status at baseline and association between sensitization status at baseline and respiratory symptoms ten years later were assessed. RESULTS: A quarter of the participants were sensitized to at least one allergen in 2001. Prevalence of wheeze had a net change per year of -0.37 % (95 % Confidence Interval -0.71 to 0.02 %; p = 0.067). Self-reported nasal allergies in the last 12 months increased by 0.83 % per year (95 % CI 0.49 to 1.17 %; p < 0.001). Those sensitized to either cat fur (OR 1.76; CI 1.01 to 3.05), cockroach, (OR 2.09; 1.13 to 3.86) blend of grass and pollens (1.78; 95 % CI 1.08 to 2.92), or weeds (OR 1.77; 95 % CI 1.01 to 3.12) in 2001 were more likely to have wheeze in the last 12 months 10 years later. CONCLUSION: Symptoms of asthma remained stable or slightly changed over 10 years in adults, whilst rhinitis and nasal allergies greatly increased. Being sensitized to at least one allergen is a risk factor for persistent symptoms of asthma and rhinitis, but not for determining net changes of symptoms over time. The underlying causes for the contrasting trends between asthma and nasal allergy are unknown.


Asunto(s)
Asma/epidemiología , Ruidos Respiratorios/etiología , Rinitis Alérgica Estacional/epidemiología , Adulto , Alérgenos/inmunología , Animales , Gatos , Chile/epidemiología , Cucarachas/inmunología , Perros , Femenino , Humanos , Inmunoglobulina E/sangre , Modelos Logísticos , Masculino , Polen/inmunología , Estudios Prospectivos , Pruebas Cutáneas , Adulto Joven
18.
J Hypertens ; 34(6): 1062-7, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-27077730

RESUMEN

OBJECTIVES: To assess whether the association between birth weight and blood pressure (BP) increases with age using three different statistical methods. METHODS: A representative sample of 1232 study participants born between 1974-1978 in Limache, Chile were assessed in 2000-2002, of whom 796 were reassessed in 2010-2012. An 'amplification effect' was assessed by the change in the ß coefficient in the two periods, the association between birth weight and the difference of BP overtime, and the interaction between birth weight and BP in the two periods. RESULTS: Birth weight was negatively associated with SBP in 2000-2002 (ß = -2.46, 95% confidence interval (CI) -3.77 to -1.16) and in 2010-2012 (ß = -3.64, 95% CI -5.20 to -2.08), and with DBP in 2000-2002 (ß = -1.26, 95% CI -2.23 to -0.29) , and 2010-2012 (ß = -1.64, 95% CI -2.84 to -0.45) after adjustment for sex, physical activity, and BMI. There was no association between birth weight and the difference in BP between the two periods or the interaction between birth weight, BP, and time interval. CONCLUSION: Birth weight is a factor associated with BP in adults. This association increased with age, but amplification was shown only with one of the three methods.


Asunto(s)
Peso al Nacer/fisiología , Presión Sanguínea/fisiología , Adulto , Factores de Edad , Diástole , Femenino , Humanos , Estudios Longitudinales , Masculino , Estadística como Asunto , Sístole , Factores de Tiempo , Adulto Joven
19.
Int J Methods Psychiatr Res ; 25(3): 168-77, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-26799987

RESUMEN

Two-phase mental health screening methods, in which an abridged mental health measure is used to establish who should receive a more comprehensive assessment, may be more efficient and acceptable to respondents than a stand-alone complete questionnaire. Such two-phase methods are in use in US armed forces post-deployment mental health screening. This study assesses the sensitivity and specificity of abridged instruments (used in the first phase) compared to the full instruments (the second phase), and whether false negative cases resulting from the use of abridged tests were detected by another test, among a UK military screening sample. Data from a group of UK Armed Forces personnel (n = 1464) who had completed full questionnaires assessing symptoms of post-traumatic stress disorder (PTSD) (PTSD Checklist - Civilian Version, PCL-C) and alcohol misuse (Alcohol Use Disorder Identification Test, AUDIT) were used. An abridged version of the PCL-C performed well in discriminating potential PTSD cases (as measured by the full instrument); AUDIT showed less discriminatory power, particularly due to poor specificity. Many cases missed by one abridged test would have been detected by an alternative test. Thus two-phase screening designs reduce the resource burden of a project without substantial loss of sensitivity for PTSD, but are less effective in discriminating potential cases of alcohol misuse. Copyright © 2016 John Wiley & Sons, Ltd.


Asunto(s)
Personal Militar , Escalas de Valoración Psiquiátrica/normas , Trastornos por Estrés Postraumático/diagnóstico , Encuestas y Cuestionarios/normas , Adulto , Femenino , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Reino Unido/epidemiología , Adulto Joven
20.
Drug Alcohol Depend ; 156: 78-83, 2015 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-26409753

RESUMEN

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.


Asunto(s)
Alcoholismo/epidemiología , Personal Militar/estadística & datos numéricos , Adulto , Campaña Afgana 2001- , Estudios de Cohortes , Femenino , Humanos , Guerra de Irak 2003-2011 , Estudios Longitudinales , Masculino , Salud Mental , Persona de Mediana Edad , Fumar/efectos adversos , Fumar/psicología , Factores Socioeconómicos , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/psicología , Encuestas y Cuestionarios , Reino Unido/epidemiología , Adulto Joven
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