Suchergebnisse

ABSTRACT
ObjectiveSecondary health systems in the United Kingdom (UK) are unique for recording Outpatient, Inpatient and Accident & Emergency (A&E) visits in the form of electronic health (eHealth) records. Linking regional healthcare datasets is a problematic, further challenging when linking externally, such as to the King's College Military Cohort Study (KCMCS). We introduce our methodology used for eRecord linkage.
ApproacheHealth records from England, Scotland and Wales offer a variety of parameters such as admission/discharge date, diagnosis, treatment/procedure undertaken and the cost of treatment. To acquire eHealth records, unique patient identifiers: NHS number, forename, surname, sex and date of birth extracted from KCMCS were provided to each region. The KCMCS contains self-reported questionnaire results for 9,990 serving/ex-serving military personal, 8,602 participants consented to linkage. eHealth records prepared for linkage in two stages. First, admission and discharge date were checked to ensure a valid date. Second, episodes were checked for consistency, ensuring that no records for individual participants were duplicated. Data available varied based on the region, this disparity between regions can result in data type variation. Hence, linkage was performed on mutual variables to ensure a uniform admission history. Creation of the linked dataset was as follows. First, records and episodes relating to an individual were brought together, to create a personal admission history. Secondly, personal admission history were linked to the KCMCS.
ResultsLinking to regional health datasets is not without its challenges. England, Scotland and Wales obtain, store and process eHealth records using different methodologies. A total of 6,336 (76.66%) participants were matched by regional health providers, with a total of 61,558 eHealth records. A total of 187 eHealth records were identified and discounted from linkage due to failure to meet criteria listed above. Verifying diagnoses completeness, Inpatient admissions were consistently code, with full completeness. Conversely, Outpatient admissions were poorly coded with 98% lacking any type of diagnosis. In addition, A&E records were sparsely coded; we identified four different regional and local coding systems to identify reason for admission. The eHealth records show promise for identifying health traits of the military. However, further work is required to identify synergy and overcome regional variations.
ConclusionLinkage techniques provide new opportunities for exploring the health of serving and veteran population. However, quality of identifier and linkage error are still of major concern. Further, record completeness, diagnoses accuracy and data cleaning impact the data quality.

Background: Military families can experience unique stressors that may contribute towards poorer well-being among the spouses/partners of Service personnel. However, there is little UK research regarding mental health or alcohol consumption among this population. Objective: This study examined mental health outcomes (probable depression and post-traumatic stress disorder (PTSD)) and alcohol consumption among UK military spouses/partners compared to women in the general population. Associations with military and socio-demographic characteristics were examined. Method: Survey data from 405 female spouses/partners of current and former UK Service personnel participating in a study of military-connected children (2010–2012) was analysed. Comparisons to women in the general population were made using the 2007 Adult Psychiatric Morbidity Survey (n = 1594). Results: Compared to women from the general population, military spouses/partners were significantly more likely to meet criteria for probable depression (adj. OR 2.50 (95% CI 1.52–4.11)). There was no significant difference regarding probable PTSD. Spouses/partners were significantly more likely to meet criteria for hazardous alcohol consumption (adj. OR 2.55 (95% CI 1.87–3.47)) and more likely to report episodes of weekly, daily or almost daily binge-drinking (adj. OR 2.15 (95% CI 1.28–3.61)) than women in the general population. Binge-drinking was significantly higher among spouses/partners of Service personnel reporting family separations of more than 2 months in the last 2 years compared to those reporting no, or shorter, separations (adj. OR 1.88 (95% CI 1.08–3.27)). Conclusion: This is the first study to examine mental health and alcohol consumption among UK military spouses/partners. The significantly higher prevalence of probable depression, hazardous alcohol consumption, and binge-drinking compared to women in the general population suggests further research is needed into the drivers of poor mental health and alcohol consumption among this population and in identifying or developing prevention campaigns to reduce alcohol use and support their well-being.

Repeated military relocations (accompanied postings) can have a detrimental effect on employment and well-being among the spouses and partners of military personnel. Semi-structured telephone interviews were conducted with 19 spouses of British Army/Royal Air Force personnel with recent experience of accompanied postings to explore this issue through the lens of self-determination theory; all were married women with at least one child. Participants explained how employment contributed to an independent identity, enabling social connectedness, providing a sense of self-confidence and value but limiting agency over employment decisions. Spouse employment, and therefore, well-being could be improved by the provision of better childcare access or additional support in finding employment and training opportunities.

Abstract
Purpose
Indicators of socioeconomic status (SES), such as education and occupational grade, are known to be associated with alcohol use but this has not been examined among individuals with a mental health problem. This study developed latent classes of SES, their associations with alcohol use, and examined the indirect effect via social support and neighbourhood environment.

Methods
A secondary analysis of the 2014 Adult Psychiatric Morbidity Survey was conducted among participants with a mental health problem (N = 1,436). SES classes were determined using a range of indicators. Alcohol use was measured using the Alcohol Use Disorder Identification Test. Social support and neighbourhood neighbourhood environment were measured using validated questionnaires. A latent class analysis was conducted to develop SES classes. Multinomial logistic regression examined associations of SES and alcohol use. Structural equation models tested indirect effects via social support and neighbourhood environment.

Results
A four-class model of SES was best-fitting; "economically inactive,GCSE-level and lower educated,social renters", "intermediate/routine occupation,GCSE-level educated,mixed owner/renters", "retired, no formal education,homeowners", and "professional occupation,degree-level educated,homeowners". Compared to "professional occupation,degree-level educated, homeowners", SES classes were more likely to be non-drinkers; odds were highest for "economically inactive,GCSE-level and lower educated,social renters" (OR = 4.96,95%CI 3.10–7.93). "Retired, no formal education,homeowners" were less likely to be hazardous drinkers (OR = 0.35,95%CI 0.20–0.59). Associations between "economically inactive,GCSE-level and lower educated,social renters" and "retired, no formal education,homeowners" and non- and harmful drinking via social support and neighbourhood environment were significant.

Conclusions
In contrast to the alcohol harms paradox, among individuals with a mental health problem, lower SES groups were more likely to be non-drinkers while no associations with harmful drinking were found. There is also a need to examine the alcohol harms paradox in the context of the area in which they live.

Repeated military relocations (accompanied postings) can have a detrimental effect on employment and well-being among the spouses and partners of military personnel. Semi-structured telephone interviews were conducted with 19 spouses of British Army/Royal Air Force personnel with recent experience of accompanied postings to explore this issue through the lens of self-determination theory; all were married women with at least one child. Participants explained how employment contributed to an independent identity, enabling social connectedness, providing a sense of self-confidence and value but limiting agency over employment decisions. Spouse employment, and therefore, well-being could be improved by the provision of better childcare access or additional support in finding employment and training opportunities.

Background Alcohol misuse is particularly high among both the UK and US Armed Forces. As alcohol use among couples is associated, military spouses or partners may therefore be at a higher risk of acquiring hazardous drinking behaviours than people in relationships with other occupational groups. Method A literature review using a systematic approach was undertaken in four medical databases and supplemented with hand searches of specialist publications and reference lists. The prevalence of hazardous alcohol consumption among military spouses or partners was estimated and potential sociodemographic and military factors associated with this outcome were identified. Results Nine papers met inclusion criteria, of which eight focused on female spouses or partners only. The limited evidence suggests hazardous alcohol consumption was not a common outcome among spouses or partners. None of the papers statistically compared the prevalence among spouses or partners to estimates from the general population and few reported associations with sociodemographic or military factors. Deployment abroad did not appear to be significantly associated with hazardous consumption, although increasing periods of separation from Service personnel may be associated with increased hazardous consumption among spouses or partners. Conclusion Limited evidence was found concerning the prevalence of hazardous alcohol consumption among military spouses or partners or which sociodemographic and military factors might be associated with this outcome. The a dominance of US studies means applying the estimates of these outcomes to other nations must be undertaken with care due to differences in cultural attitudes to alcohol as well as differences between military structure and operations between the US and other nations.

LAY SUMMARY Prior research has found low levels of help seeking for alcohol problems among serving and ex-serving military populations. This study aimed to understand what factors were associated with help seeking for self-reported alcohol problems among serving and ex-serving UK military personnel. It was found that help seeking for alcohol problems among Veterans and serving personnel remains low. Although fewer than 10% of participants self-reported alcohol problems, more than 70% did not seek help for this issue. Formal medical services were the most accessed form of support when seeking help but were less likely to be used by those with current alcohol problems. Future research should prioritize understanding pathways to help seeking and target stigma regarding accessing clinical support among both serving and ex-serving personnel.

Abstract
One-third of UK police employees drink to at-risk levels, with both at-risk drinking and abstinence being associated with poor mental health. This research aimed to qualitatively explore police employees' experiences of at-risk alcohol use or abstinence, their motivations for drinking/abstaining, and the organizational culture of drinking. Semi-structured telephone interviews with 16 UK serving police employees (12 at-risk drinkers, four abstainers) were conducted and analysed using thematic analysis. Five themes were identified. Participants described the 'organizational culture of drinking and changes over time', outlining a cultural shift. Motivations for drinking were reflected across two themes, 'alcohol as a coping mechanism' and 'alcohol and socializing', with an additional theme representing 'motivations for abstinence/cutting down'. The final theme highlighted the 'contrasting perceptions of available support'. Though the drinking culture is no longer as prominent, using alcohol socially and to cope, is normalized. The implications and recommendations for practice are outlined.

Aims. Provision and need for mental health services among military personnel are a major concern across nations. Two recent comparisons suggest higher rates of mental disorders in US and UK military personnel compared with civilians. However, these findings may not apply to other nations. Previous studies have focused on the overall effects of military service rather than the separate effects of military service and deployment. This study compared German military personnel with and without a history of deployment to sociodemographically matched civilians regarding prevalence and severity of 12-month DSM-IV mental disorders. Method. 1439 deployed soldiers (DS), 779 never deployed soldiers (NS) and 1023 civilians were assessed with an adapted version of the Munich Composite International Diagnostic interview across the same timeframe. Data were weighted using propensity score methodology to assure comparability of the three samples. Results. Compared with adjusted civilians, the prevalence of any 12-month disorder was lower in NS (OR: 0.7, 95% CI: 0.5–0.99) and did not differ in DS. Significant differences between military personnel and civilians regarding prevalence and severity of individual diagnoses were only apparent for alcohol (DS: OR: 0.3, 95% CI: 0.1–0.6; NS: OR: 0.2, 95% CI: 0.1–0.6) and nicotine dependence (DS: OR: 0.5, 95% CI: 0.3–0.6; NS: OR: 0.5, 95% CI: 0.3–0.7) with lower values in both military samples. Elevated rates of panic/agoraphobia (OR: 2.7, 95% CI: 1.4–5.3) and posttraumatic stress disorder (OR: 3.2, 95% CI: 1.3–8.0) were observed in DS with high combat exposure compared with civilians. Conclusions. Rates and severity of mental disorders in the German military are comparable with civilians for internalising and lower for substance use disorders. A higher risk of some disorders is reduced to DS with high combat exposure. This finding has implications for mental health service provision and the need for targeted interventions. Differences to previous US and UK studies that suggest an overall higher prevalence in military personnel might result from divergent study methods, deployment characteristics, military structures and occupational factors. Some of these factors might yield valuable targets to improve military mental health.

Approximately 60% of military personnel who experience mental health problems do not seek help, yet many of them could benefit from professional treatment. Across military studies, one of the most frequently reported barriers to help-seeking for mental health problems is concerns about stigma. It is, however, less clear how stigma influences mental health service utilization. This review will synthesize existing research on stigma, focusing on those in the military with mental health problems. We conducted a systematic review and meta-analysis of studies between 2001 and 2014 to examine the prevalence of stigma for seeking help for a mental health problem and its association with help-seeking intentions/mental health service utilization. Twenty papers met the search criteria. Weighted prevalence estimates for the 2 most endorsed stigma concerns were 44.2% (95% confidence interval: 37.1, 51.4) for "My unit leadership might treat me differently" and 42.9% (95% confidence interval: 36.8, 49.0) for "I would be seen as weak." Nine studies found no association between anticipated stigma and help-seeking intentions/mental health service use and 4 studies found a positive association. One study found a negative association between self-stigma and intentions to seek help. Counterintuitively, those that endorsed high anticipated stigma still utilized mental health services or were interested in seeking help. We propose that these findings may be related to intention-behavior gaps or methodological issues in the measurement of stigma. Positive associations may be influenced by modified labeling theory. Additionally, other factors such as self-stigma and negative attitudes toward mental health care may be worth further attention in future investigation.

Background:The use of digital technology within health care service delivery, monitoring, and research is becoming progressively popular, particularly given the ongoing COVID-19 pandemic. Mobile health (m-health) apps, one form of digital technology, are increasingly being used to promote positive health related behavior change. Therefore, it is important to conduct research to understand the efficacy of m-health apps. The process of participant recruitment is an essential component in producing strong research evidence, along with ensuring an adequately powered sample to conduct meaningful analyses and draw robust conclusions. Methods:In this work we outline and reflect on the strategies used to recruit help-seeking military veterans into an intervention study, which aimed to evaluate the efficacy of an app (Drinks:Ration) to modify behavior in alcohol misusers. Recruitment strategies included through (1) partner organizations and (2) social media and Facebook advertising (ads). Results:Facebook ads were live for a period of 88 days and were viewed by a total audience of 29,416 people. In total 168 military veterans were recruited across all recruitment strategies, meaning that Drinks:Ration exceeded its recruitment targets. Half of the sample (n = 84) were recruited through social media, including Facebook ads. Conclusions:The current article highlighted that targeted Facebook ads were an efficient strategy to recruit military veterans into a digital intervention trial aiming to reduce alcohol consumption because they reduced the amount of time and resources required to contact a large number of potentially eligible individuals for our study. This article acts as a starting point for other researchers to evaluate their recruitment pathways for recruiting military veterans into alcohol misuse research.