Narratives of holistic mental health recovery in New Zealand Defence Force personnel.

Research on military mental health recovery has tended to focus on therapy outcomes while backgrounding the role of diverse healing influences. The New Zealand Defence Force (NZDF) is a bicultural military integrated with Maori customs and cultural perspectives on holistic health and wellbeing. This study used narrative analysis to examine the semi-structured interviews of 21 active duty NZDF personnel who had accessed mental healthcare to understand what factors contributed to their return to wellness. Narratives described an orientation toward recovery as a process, where many interrelated wellbeing and social factors together supported the return to health. Culturally available Maori wellbeing metaphors were adopted as heuristics by service members in their storying of growth and healing. Findings are considered in terms of how wellbeing and recovery are conceptualized and promoted within militaries with diverse cultures. Discussion focuses on how narratives within military institutions can promote resilience and support service member recovery from mental distress.

Barriers to Alcohol Screening Among Hypertensive Patients and the Role of Stigma: Lessons for the Implementation of Screening and Brief Interventions in European Primary Care Settings.

AIMS: 1. To quantify barriers to alcohol screening among hypertensive patients reported by primary healthcare professionals. 2. To examine whether education and screening frequency measures are associated with stigma-related barriers. METHODS: A web survey was conducted among 3081 primary healthcare professionals from France, Germany, Italy, Spain and the UK. Participants were asked about perceived barriers to alcohol screening as free-text response. The replies were independently categorized by two raters. Stigma-related barriers were predicted by logistic regressions with education, knowledge on alcohol as risk factor and frequency of alcohol screening. RESULTS: In France and Italy, almost half of the reported barriers were stigma-related, whereas time constraints were cited most commonly in Spain and the UK. In Germany, nearly half of respondents rated the importance of alcohol screening for hypertension as low. Perception that regular screening is inappropriate or associated with too much effort, beliefs that screening is unnecessary, and insufficient knowledge of screening tools were cited as further barriers. Professional education on alcohol use was consistently rated to be poorer than the equivalent education on hypertension, and only a minority of respondents perceived alcohol as important risk factor for hypertension. Stigma-related barriers could not be significantly predicted by education, knowledge or screening frequency in most models. CONCLUSIONS: Overall, regular alcohol screening among hypertensive patients seems to be widely accepted, but further education (Germany) and structural support (Spain, UK) could contribute to increase screening rates. In France and Italy, screening uptake could be improved by addressing stigma. SHORT SUMMARY: Alcohol screening among hypertensive patients was largely accepted among general practitioners from five different European countries. Reported screening barriers varied between countries and included time constraints, stigma and underrated importance of alcohol. Results did not indicate a positive impact of education and screening frequency on perception of stigma as barrier to screening.

The role of alcohol in the management of hypertension in patients in European primary health care practices - a survey in the largest European Union countries.

BACKGROUND: Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care. METHODS: Internet based survey of 3081 primary care physicians, recruited via the mailing lists of associations for general practitioners (GPs) in France, Germany, Italy, Spain and the UK. Clinical practice, attitudes, knowledge, education and training were assessed. Logistic regression to predict screening, brief intervention and treatment for alcohol dependence in the management of hypertension were assessed. RESULTS: Overall, about one third of the interviewed GPs reported sufficient screening in cases with HTN (34.0 %, 95 % confidence interval (CI):32.1-35.8 %). One out of five GPs screened and delivered brief interventions in HTN patients with hazardous consumption (22.2 %, 95 % CI: 20.6-23.8 %) and about one in 13 GPs provided treatment for HTN patients with alcohol dependence other than advice or brief intervention (7.8 %, 95 % CI: 6.8-8.9 %). Post-graduate training and belief in their effectiveness predicted interventions. There were marked differences between countries. CONCLUSIONS: While current interventions were overall low, marked differences between countries indicate that current practices could be improved. Education and post-graduate training seems to be key in improving clinical practice of including interventions for problematic alcohol consumption and alcohol dependence in primary health care.

Mindfulness-Based Attention Training in the Navy: A Feasibility Study.

Mind wandering is common during daily activities and is even more prevalent under stressful conditions, which could lead to lapses in attention and poor performance. Newly recruited military personnel who undergo demanding training often experience high levels of stress. It is therefore imperative to find ways to foster mental health and avoid performance deterioration related to mind wandering in times of intense military training. This feasibility study investigated the effectiveness of an established low-dose mindfulness-based intervention (MBI), called Mindfulness-based Attention Training (MBAT), on mind wandering, attentional performance, and well-being, delivered by a facilitator who was taught how to deliver MBAT. A sample of newly recruited Royal New Zealand Navy (RNZN) Junior Officers (n = 17) undergoing demanding training participated in the 8-week long MBI with one weekly contact session. Measures of well-being and the Sustained Attention to Response Task (SART) were completed 4 weeks prior to the MBAT, at the start of the MBAT, at the end of the MBAT and 4 weeks after completion of the MBAT. Results suggest that MBAT might protect from performance decline during intense training and enhance levels of well-being at follow-up. These findings highlight the valuable role of mindfulness as a component in military training.

Effectiveness of a low-dose mindfulness-based intervention for alleviating distress in young unemployed adults.

While the effectiveness of mindfulness-based interventions (MBIs) with respect to distress has been widely researched, unemployed individuals, who often suffer from high levels of distress, have largely been neglected in MBI research. The present study aimed to investigate the effects of a low-dose MBI on distress in a sample of young unemployed adults. The sample included 239 young unemployed adults enrolled for a 6-week long employability-related training camp. Participants were allocated into an intervention group that received weekly 1-hour mindfulness training over 4 weeks, and a control group. Dispositional mindfulness, distress and well-being were assessed in the entire sample prior to the start and upon completion of the mindfulness training. A mixed model ANCOVA showed that distress was inversely and significantly predicted by baseline levels of mindfulness and well-being. After accounting for the baseline levels of mindfulness and well-being, a significant effect of the mindfulness intervention was evident. This result shows that a low-dose MBI can decrease distress in a sample of young unemployed adults and its effectiveness is positively associated with initial levels of dispositional mindfulness and well-being.