Resilience-based intervention for UK military recruits: a randomised controlled trial.

OBJECTIVES: We evaluated a military resilience intervention which aimed to help UK military recruits to manage their personal health and well-being more effectively. METHODS: Trainers within six pre-existing training teams were randomly allocated by team to deliver a resilience-based intervention (SPEAR) or usual training (control) during recruit training. 23 trainers delivered SPEAR; 18 delivered the control training. 707 recruits participated (n=358 SPEAR and n=349 controls). Outcome measures were obtained before and after recruit training and 3 months later. Measures of post-traumatic stress disorder (PTSD), common mental disorder (CMD) symptoms, alcohol use, homesickness and mental health stigmatisation were obtained at baseline. Repeat baseline scales plus measures of help-seeking, cohesion, leadership and training impact were obtained at the two follow-up points. RESULTS: Response rates were 91.7% (baseline), 98.1% (post) and 73.6% (follow-up). Following adjustment for potential confounders, levels of PTSD, CMD symptoms, alcohol misuse, help-seeking and homesickness were not significantly different between groups at any measurement point. Stigmatisation was significantly lower among SPEAR recipients at baseline but was not significantly different at the two follow-up points. Following adjustment for mental health confounders, there were no significant between-group differences in perceptions of leadership and cohesion and in ratings of six training outcomes at the two follow-up points. CONCLUSIONS: We found no evidence that resilience-based training had any specific benefit to the health and well-being of UK military recruits.

Risk factors of suicidal ideation in a population of UK military veterans seeking support for mental health difficulties.

BACKGROUND: Little has been reported regarding the risk factors of suicidal ideation in individuals once they have left the military in the UK. The aim of this paper was to explore the risk factors associated with suicidal ideation in a sample of treatment-seeking veterans. METHODS: Using a cross-sectional design, participants included veterans (n=144) seeking treatment from a national mental health charity in the UK. Individuals completed questionnaires regarding their military experiences, pre-enlistment factors and health. Data were then linked to risk assessments extracted from clinical records. RESULTS: After controlling for relevant variables, suicidal ideation was significantly higher in veterans who were unemployed (OR 8.01; 95% CI 1.79 to 35.80), were early service leavers (OR 8.46; 95% CI 2.21 to 32.35) and those with a history of childhood adversity (OR 6.92; 95% CI 2.10 to 22.82). In addition, taking longer than 5 years to seek help was associated with a reduced risk of suicidal ideation (OR 0.10; 95% CI 0.06 to 0.87). There was no association between health outcomes and suicidal ideation. CONCLUSIONS: Risk factors associated with suicidal ideation in this sample of veterans included: being unemployed, an early service leaver, taking less than 5 years to seek help and experiencing preservice adversity.

Correction to: Psychosocial and Clinical Correlates of Fatigue in Haemodialysis Patients: the Importance of Patients' Illness Cognitions and Behaviours.

We wish to highlight a discrepancy with regards to the reported mean fatigue severity score (mean = 28.3, standard deviation = 6.5). Since publication we have followed this sample up over time and are currently evaluating the longitudinal trajectories of fatigue severity.

Psychosocial and Clinical Correlates of Fatigue in Haemodialysis Patients: the Importance of Patients' Illness Cognitions and Behaviours.

PURPOSE: Fatigue is commonly experienced in end-stage kidney disease (ESKD) and is associated with poor outcomes. Currently, little research has examined the psychosocial correlates of fatigue severity and its impact on renal disease patients. We predicted that psychological factors (distress, cognitions and behaviours) would be associated with fatigue severity and impairment in ESKD patients even when controlling for clinical and disease factors. METHOD: One hundred seventy-four haemodialysis patients completed the Chalder Fatigue Questionnaire (fatigue severity) and the Work and Social Adjustment Scale (fatigue-related impairment) in addition to measures evaluating distress, fatigue perceptions, symptom beliefs and behaviours. Demographic and clinical data were also collected. RESULTS: Fatigue severity was not related to haemoglobin levels, serum albumin or dialysis vintage. In hierarchical regression models, demographic and clinical factors explained 20 % of the variance in fatigue (ethnicity, body mass index, exercise, log C-reactive protein and multimorbidity). Psychological distress (beta = 0.21, p < 0.01), negative beliefs about fatigue (beta = 0.10, p = 0.01) and unhelpful behaviours (all-or-nothing behaviour [beta = 0.28, p < 0.01] and avoidance [beta = 0.16, p < 0.01]) explained an additional 36.4 % of the variance. Fatigue-related impairment was associated with psychological distress, perceptions that symptoms indicate damage, avoidance behaviour and the level of fatigue severity. CONCLUSION: Patients' mood, beliefs and behaviours are associated with fatigue in dialysis patients. Psychological interventions to alter these factors may reduce fatigue severity and fatigue-related disability in ESKD patients.

A systematic review of psychological training or interventions given to UK military personnel prior to deployment.

INTRODUCTION: Predeployment stress management/mental health training is routinely delivered in an effort to mitigate potential adverse psychological effects. Little is known about the effectiveness of such interventions. METHODS: A systematic literature review explored research outcomes related to this subject, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. An electronic database search using key terms identified studies published between January 2007 and March 2019. Comprehensive inclusion/exclusion criteria were applied and study quality was appraised by two reviewers using 12 criteria adapted from the Critical Appraisal Skills Programme (CASP) checklist. Papers were excluded if they were allocated CASP scores ≤10 out of 24. RESULTS: 2003 references were identified; 15 papers fulfilled inclusion criteria and quality threshold requirements. Included studies were randomised controlled trial design (n=8), quasi-experimental (n=5), case report (n=1) and cross-sectional (n=1). Duration of follow-up assessment varied from immediately postintervention to 24 months. The included studies were heterogeneous so clear recommendations relating to predeployment training for military personnel could not be made. Although somewhat disparate, predeployment interventions shared the aim of promoting prior to, during and after deployment health and well-being. Social benefits such as improved cohesion and improved stress management skills were identified in some studies, although substantial mental health and well-being benefits were not found. CONCLUSIONS: Evidence for the effectiveness of predeployment psychological interventions is scant. Every attempt should be made to use methods and measures to facilitate comparisons across studies, to attempt a longer follow-up timescale and to clarify key trainer characteristics.