Trauma-related guilt and posttraumatic stress among journalists.

This study explored the psychological impact of exposure to work-related trauma among journalists. It was hypothesised that positive associations would exist between (a) exposure and PTSD symptoms, (b) exposure and guilt cognitions, and (c) guilt cognitions and PTSD symptoms, and that the relationship between exposure and PTSD symptoms would be mediated by guilt cognitions. The sample consisted of 50 journalists (response rate = 15%), who had recently been exposed to work-related trauma. They were predominantly male, aged 40 years or older, well-educated, and most had worked in journalism for at least 15 years. Participants completed an online questionnaire that explored their work-related experiences of trauma, PTSD symptoms, and trauma-related guilt cognitions. The findings showed that higher levels of exposure to work-related trauma were significantly associated with higher levels of PTSD symptoms (r = .36) and trauma-related guilt cognitions (r = .29). Guilt cognitions were significantly and positively independently associated with PTSD symptoms (r = .12) and were consistent with partial mediation of relationship between exposure to work-related trauma and PTSD symptoms. This study provides greater insight into the psychological processing of work-related traumatic events among journalists and emphasizes the importance of posttrauma appraisals of guilt regarding their experiences.

Help-seeking and receipt of treatment among UK service personnel.

BACKGROUND: For armed forces personnel, data on help-seeking behaviour and receipt of treatment for mental disorders are important for both research and policy. AIMS: To examine mental healthcare service use and receipt of treatment in a sample of the UK military. METHOD: Participants were drawn from an existing UK military health cohort. The sample was stratified by reserve status and by participation in the main war-fighting period of the Iraq War. Participants completed a telephone-based structured diagnostic interview comprising the Patient Health Questionnaire and Primary Care Post-Traumatic Stress Disorder Screen (PC-PTSD), and a series of questions about service utilisation and treatment receipt. RESULTS: Only 23% of those with common mental disorders and still serving in the military were receiving any form of medical professional help. Non-medical sources of help such as chaplains were more widely used. Among regular personnel in receipt of professional help, most were seen in primary care (79%) and the most common treatment was medication or counselling/psychotherapy. Few regular personnel were receiving cognitive-behavioural therapy (CBT). These findings are comparable with those reported for the general population. CONCLUSIONS: In the UK armed forces, the majority of those with mental disorders are not currently seeking medical help for their symptoms. Further work to understand barriers to care is important and timely given that this is a group at risk of occupational psychiatric injury.

The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study.

BACKGROUND: The mental health of the Armed Forces is an important issue of both academic and public interest. The aims of this study are to: a) assess the prevalence and risk factors for common mental disorders and post traumatic stress disorder (PTSD) symptoms, during the main fighting period of the Iraq War (TELIC 1) and later deployments to Iraq or elsewhere and enlistment status (regular or reserve), and b) compare the prevalence of depression, PTSD symptoms and suicidal ideation in regular and reserve UK Army personnel who deployed to Iraq with their US counterparts. METHODS: Participants were drawn from a large UK military health study using a standard two phase survey technique stratified by deployment status and engagement type. Participants undertook a structured telephone interview including the Patient Health Questionnaire (PHQ) and a short measure of PTSD (Primary Care PTSD, PC-PTSD). The response rate was 76% (821 participants). RESULTS: The weighted prevalence of common mental disorders and PTSD symptoms was 27.2% and 4.8%, respectively. The most common diagnoses were alcohol abuse (18.0%) and neurotic disorders (13.5%). There was no health effect of deploying for regular personnel, but an increased risk of PTSD for reservists who deployed to Iraq and other recent deployments compared to reservists who did not deploy. The prevalence of depression, PTSD symptoms and subjective poor health were similar between regular US and UK Iraq combatants. CONCLUSION: The most common mental disorders in the UK military are alcohol abuse and neurotic disorders. The prevalence of PTSD symptoms remains low in the UK military, but reservists are at greater risk of psychiatric injury than regular personnel.

Patterns of drinking in the UK Armed Forces.

AIMS: To examine patterns of drinking in the UK Armed Forces, how they vary according to gender and other demographics, and to make comparisons with the general population. DESIGN: Large cross-sectional postal questionnaire study (response rate 60%). SETTING: United Kingdom. PARTICIPANTS: A random representative sample of the regular UK Armed Forces who were in service in March 2003 (n = 8686; 7937 men, 749 women). Comparisons were made with the general population of Great Britain. MEASUREMENTS: Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT). FINDINGS: Sixty-seven per cent of men and 49% of women in the UK Armed Forces had an AUDIT score of 8+ (defined as hazardous drinking), compared to 38% of men and 16% of women in the general population. In both sexes, for all ages, the military have a higher prevalence of hazardous drinking. Binge drinking was associated with being younger, being in the Army, being single, being a smoker and being white. Among military men, heavy drinking (AUDIT score 16+) was associated with holding a lower rank, being younger, being single, being in the Naval Service or Army, being deployed to Iraq, not having children, being a smoker, having a combat role and having a parent with a drink or drug problem. CONCLUSIONS: Excessive alcohol consumption is more common in the UK Armed Forces than in the general population. There are certain socio-demographic characteristics associated with heavy drinking within the military; for example, young age, being single and being a smoker, which may allow the targeting of preventive interventions.

Explanations for the increase in mental health problems in UK reserve forces who have served in Iraq.

BACKGROUND: Deployment to the 2003 Iraq War was associated with ill health in reserve armed forces personnel. AIMS: To investigate reasons for the excess of ill health in reservists. METHOD: UK personnel who were deployed to the 2003 Iraq War completed a health survey about experiences on deployment to Iraq. Health status was measured using self-report of common mental disorders, post-traumatic stress disorder (PTSD), fatigue, physical symptoms and well-being. RESULTS: Reservists were older and of higher rank than the regular forces. They reported higher exposure to traumatic experiences, lower unit cohesion, more problems adjusting to homecoming and lower marital satisfaction. Most health outcomes could be explained by role, experience of traumatic events or unit cohesion in theatre. PTSD symptoms were the one exception and were paradoxically most powerfully affected by differences in problems at home rather than events in Iraq. CONCLUSIONS: The increased ill-health of reservists appears to be due to experiences on deployment and difficulties with homecoming.

A Review of Psychological Models and Interventions for Medically Unexplained Somatic Symptoms in Children.

The aim of this review is to outline the various psychological models of medically unexplained somatic symptoms in children and the interventions derived from these. The interventions that have been evaluated in randomised controlled trials are reviewed, and the implications of the findings for the models are described.

Mental health screening in armed forces before the Iraq war and prevention of subsequent psychological morbidity: follow-up study.

OBJECTIVE: To assess whether screening for mental disorder before the start of the 2003 Iraq war would have predicted subsequent mental disorders. DESIGN: Longitudinal cohort study of the United Kingdom armed forces. PARTICIPANTS: 2820 of 2873 personnel of the three services who completed an initial questionnaire in 2002 were asked to complete a second questionnaire between June 2004 and 2 March 2006. SETTING: Regiments, air stations, bases, ships, and homes for those who had left the services. MAIN OUTCOME MEASURES: Positive and negative likelihood ratios, and positive and negative predictive value of first assessment compared with assessment two to three years later of post-traumatic stress disorder, general health questionnaire, physical symptoms, self perception of health, and alcohol misuse for the entire group and for those deployed to the Iraq war. RESULTS: The response rate to the follow-up questionnaire was 69%, adjusted for return to senders. The positive likelihood ratio of post-traumatic stress disorder was high (13.1, 95% confidence interval 7.2 to 23.8), but the negative likelihood ratio was close to 1 (0.78, 0.67 to 0.91). The positive predictive values were low because of the low prevalence of post-traumatic stress disorder in the period before the Iraq war. The positive likelihood ratios for the other psychological assessments varied between 2.7 and 5.6, and the negative likelihood ratios were slightly lower than for post-traumatic stress disorder, indicating that these were not good candidates for screening. Results were the same for the analyses restricted to those who were deployed. CONCLUSIONS: Screening for common mental disorders before deployment in this cohort would not have reduced subsequent morbidity or predicted post-traumatic stress disorder, but this may change if there is a considerable increase in the prevalence of the disorder.

The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study.

BACKGROUND: Concerns have been raised about the mental and physical health of UK military personnel who deployed to the 2003 war in Iraq and subsequent tours of duty in the country. METHODS: We compared health outcomes in a random sample of UK armed forces personnel who were deployed to the 2003 Iraq war with those in personnel who were not deployed. Participants completed a questionnaire covering the nature of the deployment and health outcomes, which included symptoms of post-traumatic stress disorder, common mental disorders, general wellbeing, alcohol consumption, physical symptoms, and fatigue. FINDINGS: The participation rate was 62.3% (n=4722) in the deployed sample, and 56.3% (n=5550) in the non-deployed sample. Differences in health outcomes between groups were slight. There was a modest increase in the number of individuals with multiple physical symptoms (odds ratio 1.33; 95% CI 1.15-1.54). No other differences between groups were noted. The effect of deployment was different for reservists compared with regulars. In regulars, only presence of multiple physical symptoms was weakly associated with deployment (1.32; 1.14-1.53), whereas for reservists deployment was associated with common mental disorders (2.47, 1.35-4.52) and fatigue (1.78; 1.09-2.91). There was no evidence that later deployments, which were associated with escalating insurgency and UK casualties, were associated with poorer mental health outcomes. INTERPRETATION: For regular personnel in the UK armed forces, deployment to the Iraq war has not, so far, been associated with significantly worse health outcomes, apart from a modest effect on multiple physical symptoms. There is evidence of a clinically and statistically significant effect on health in reservists.

Is there an Iraq war syndrome? Comparison of the health of UK service personnel after the Gulf and Iraq wars.

BACKGROUND: UK armed forces personnel who took part in the 1991 Gulf war experienced an increase in symptomatic ill health, colloquially known as Gulf war syndrome. Speculation about an Iraq war syndrome has already started. METHODS: We compared the health of male regular UK armed forces personnel deployed to Iraq during the 2003 war (n=3642) with that of their colleagues who were not deployed (n=4295), and compared these findings with those from our previous survey after the 1991 war. Data were obtained by questionnaire. FINDINGS: Graphs comparing frequencies of 50 non-specific symptoms in the past month in deployed and non-deployed groups did not show an increase in prevalence of symptoms equivalent to that observed after the Gulf war. For the Iraq war survey, odds ratios (ORs) for self-reported symptoms ranged from 0.8 to 1.3. Five symptoms were significantly increased, and two decreased, in deployed individuals, whereas prevalence greatly increased for all symptoms in the Gulf war study (ORs 1.9-3.9). Fatigue was not increased after the 2003 Iraq war (OR 1.08; 95% CI 0.98-1.19) but was greatly increased after the 1991 Gulf war (3.39; 3.00-3.83). Personnel deployed to the Gulf war were more likely (2.00, 1.70-2.35) than those not deployed to report their health as fair or poor; no such effect was found for the Iraq war (0.94, 0.82-1.09). INTERPRETATION: Increases in common symptoms in the 2003 Iraq war group were slight, and no pattern suggestive of a new syndrome was present. We consider several explanations for these differences.