Suchergebnisse

Terrorism is to create a state of terror and fear. Therefore it is important to study the psychological factors and to understand and mitigate our response to terrorism. It is the creation of states of mind, of reducing people's resilience and will to resist, and causing such psychological and social pressure that eventually the political aims of a terrorist group will be fulfilled. This book is not about the prevention of terrorism, but concerned with the consequences of acts of terror and their impact on populations. It describes what citizens, professionals and governments can do to mitigat

Objectives: To evaluate attempts in the military to screen for vulnerability to psychological disorders from World War I to the present. Methods: An extensive literature review was conducted by hand-searching leading medical and psychological journals relating to World Wars I and II. Recent publications were surveyed electronically and UK archives investigated for British applications. Results: Despite the optimism shown in World War I and the concerted efforts of World War II, follow-up studies showed that screening programmes did not succeed in reducing the incidence of psychological casualties. Furthermore, they had a counter-productive effect on manpower, often rejecting men who would have made good soldiers. Continued experimentation with screening methods for psychiatric vulnerability failed to yield convincing results during the post-war period. Conclusions: Although well-measured variables, such as intelligence, have been shown to predict success in training and aptitude, no instrument has yet been identified which can accurately assess psychological vulnerability. Previous attempts have failed because of false-positives, false-negatives and reluctance in the target population because of stigma. Early findings suggest that psychological surveillance, surveillance, if not screening, may yield valuable results when applied to military populations exposed to stress.

Background: Depleted uranium (DU) use has been implicated in the poor health of many service personnel who have served in the Gulf and the Balkans. Although the health related risks are thought to be small the UK government has offered to set up a voluntary screening programme for service personnel. This study aimed to find out the characteristics and possible exposures to DU for those personnel who desire DU screening.

BACKGROUND: Around 8% of the UK Armed Forces leave in any given year, and must navigate unfamiliar civilian systems to acquire employment, healthcare, and other necessities. This paper determines longer-term prevalences of mental ill health and socioeconomic outcomes in UK Service leavers, and how they are related to demographic factors, military history, and pre-enlistment adversity. METHODS: This study utilised data from a longitudinal sample of a cohort study UK Armed Forces personnel since 2003. A range of self-reported military and sociodemographic factors were analysed as predictors of probable Post-Traumatic Stress Disorder, common mental disorders, alcohol misuse, unemployment and financial hardship. Prevalences and odds ratios of associations between predictors and outcomes were estimated for regular veterans in this cohort. RESULTS: Veteran hardship was mostly associated with factors linked to socio-economic status: age, education, and childhood adversity. Few military-specific factors predicted mental health or socio-economic hardship, except method of leaving (where those leaving due to medical or unplanned discharge were more likely to encounter most forms of hardship as veterans), and rank which is itself related to socioeconomic status. CONCLUSION: Transition and resettlement provisions become increasingly generous with longer service, yet this paper shows the need for those services becomes progressively less necessary as personnel acquire seniority and skills, and instead could be best targeted at unplanned leavers, taking socioeconomic status into consideration. Many will agree that longer service should be more rewarded, but the opposite is true if provision instead reflects need rather than length of service. This is a social, political and ethical dilemma.

BACKGROUND: The perceived effects of a military career on service personnel's children have been largely overlooked. AIMS: To examine the views of military personnel about the impact their career has on their children in relation to socio-demographic variables, military characteristics and mental health symptoms. METHODS: Service personnel (regular and reserve) with one or more children (<18 years) were included. Data were taken from a large UK military cohort study completed between 2007 and 2009. Participants were asked to report whether they viewed their military career as having a positive, negative or no impact on their children. RESULTS: There were 3198 participants. Just over half (51%) of service personnel perceived their military career as having a negative impact on their children. Not being in a relationship (multinomial odds ratio 2.65, 95% CI 1.81-3.88), deployment for 13 months or more within a 3 year period (1.85, 1.31-2.62), symptoms of common mental health disorder (2.21, 1.65-2.96) and probable post-traumatic stress disorder (3.26, 1.39-7.66) were associated with perceiving military career as affecting children negatively. Reserves were less likely than regulars (0.37, 0.27-0.51) and other ranks were less likely than non-commissioned officers (0.67, 0.46-0.98) to report negative effects of their military career on their children. CONCLUSIONS: Contrary to previous research findings, regulars were more likely to report a negative impact, reflecting this study's focus on the wider military context, rather than just deployment. These findings are consistent with existing research showing links between deployment length and negative impact.

The mental health of the UK Armed Forces is a topic much debated by healthcare professionals, politicians and the media. While the current operations in Afghanistan, and the recent conflict in Iraq, are relevant to this debate, much of what is known about the effects of war upon the psyche still derives from the two World Wars. This paper will examine the historical and contemporary evidence about why it is that some Service personnel suffer psychological injuries during their military service and others do not. The paper will also consider some of the strategies that today's Armed Forces have put in place to mitigate the effects of sending military personnel into danger.

The mental health of the UK Armed Forces is a topic much debated by healthcare professionals, politicians and the media. While the current operations in Afghanistan, and the recent conflict in Iraq, are relevant to this debate, much of what is known about the effects of war upon the psyche still derives from the two World Wars. This paper will examine the historical and contemporary evidence about why it is that some Service personnel suffer psychological injuries during their military service and others do not. The paper will also consider some of the strategies that today's Armed Forces have put in place to mitigate the effects of sending military personnel into danger.

Method: Cross sectional postal survey of three cohorts of United Kingdom military personnel comprising Gulf veterans (n=3531), those who had served in Bosnia (n=2050), and those serving during the Gulf war but not deployed there (Era cohort, n=2614).

Aims: To determine the prevalence of comorbid probable post-traumatic stress disorder and alcohol misuse in a UK military cohort study and to determine the level of co-occurrence between these disorders; further aims were to investigate the association between alcohol misuse and the different PTSD symptom clusters, and to assess what factors are associated with probable PTSD in participants with alcohol misuse. Methods: Data from 9984 participants of Phase 2 of the health and well-being survey of serving and ex-serving members of the UK Armed Forces were assessed for probable PTSD and alcohol misuse using the PTSD checklist (PCL-C) and the alcohol use disorders identification test (AUDIT), respectively. Results: 1.8 % [95 % confidence interval (CI) 1.5–2.1] of the sample met the criteria for both PTSD and alcohol misuse. All three symptom clusters of PTSD were significantly associated with alcohol misuse, with similar odds ranging from 2.46 to 2.85. Factors associated with probable PTSD in individuals reporting alcohol misuse were age [ages 30–34 (years): OR 2.51, 95 % CI 1.15–5.49; ages 40–44 years: OR 2.77, 95 % CI 1.18–6.47], officer rank (OR 0.36, 95 % CI 0.16–0.85), being in a combat role in parent unit (OR 1.99, 95 % CI 1.20–3.31) and common mental disorder (CMD) (OR 21.56, 95 % CI 12.00–38.74). Conclusions: This study provides strong evidence that PTSD and alcohol misuse are often co-occurring. CMD was highly associated with probable PTSD in individuals with alcohol misuse.

Introduction: There are higher levels of alcohol misuse in the military compared to the general population. Yet there is a dearth of research in military populations on the longitudinal patterns of alcohol use. This study aims to identify group trajectories of alcohol consumption in the UK military and to identify associations with childhood adversity, deployment history and mental disorder. Methods: Data on weekly alcohol consumption across an eight year period and three phases of a UK military cohort study (n = 667) were examined using growth mixture modelling. Results: Five alcohol trajectory classes were identified: mid-average drinkers (55%), abstainers (4%), low level drinkers (19%), decreasing drinkers (3%) and heavy drinkers (19%). Alcohol consumption remained stable over the three periods in all classes, other than in the small decreasing trajectory class. Individuals in the heavy drinking class were more likely to have deployed to Iraq. Abstainers and heavy drinkers were more likely to report post-traumatic stress disorders at baseline compared to average drinkers. Conclusions: Heavy drinkers in the UK military did not change their drinking pattern over a period of eight years. This highlights the need to develop effective preventive programmes to lessen the physical and psychological consequences of long-term heavy alcohol use. Individuals with a mental health problem appeared more likely to either be drinking at a high level or to be abstaining from use.

Background There has been concern about the impact of tour length on the mental health of the UK Armed Forces. In 2007 we reported that cumulative length of deployment was associated with mental illnesses among military personnel. This gave empirical evidence to support the UK advisory policy on tour length, known as Harmony Guidelines. If fully implemented, the guidelines would be expected to be a tool to prevent mental illnesses. This study re-evaluates the relationship between cumulative length of deployment and number of deployments over three years, and mental illnesses in the UK forces. Methods We assessed 3,982 UK regulars, from a representative study of the military, who had deployed during the three years prior to completing a questionnaire between November 2007 and September 2009. The outcomes of the study were posttraumatic stress disorder checklist (PCL), General Health Questionnaire (GHQ-12), multiple physical symptoms (MPS), Alcohol Use Disorders Identification Test (AUDIT), and problems at home during and post-deployment. The key independent factors were deployment for 13 or more months and number of deployments in the last three years. Findings Deployment for longer than 13 months decreased from 22% in our previous study to 12% now. Cumulative length of deployment as a continuous variable was associated with all outcomes. 13 or more months of deployment was associated with MPS, PCL (score 40 or more), problems at home, but not PCL (score 50 or more), GHQ-12 (score four or more) and AUDIT (score 16 or more). Number of deployments was not associated with worse mental illness status or problems at home. Interpretation The Harmony Guidelines have been shown to prevent mental illness in the UK Armed Forces and its introduction has decreased the number deploying in excess of its recommendations since 2006. Monitoring cumulative length of deployment is effective in reducing mental illness in the UK military. Key words: Alcohol misuse, physical symptoms, population study, posttraumatic stress disorder (PTSD), psychological distress, problems at home

OBJECTIVES—To study the association between occupational factors specific to the Armed Forces (rank, functional roles, Service, regular or reservist status and deployment factors) and symptomatic health problems in Gulf veterans, after sociodemographic and lifestyle factors have been accounted for. DESIGN—A postal cross sectional survey of randomly selected UK Gulf veterans was conducted six to seven years after the Gulf conflict. Physical ill health was measured using the Fatigue Questionnaire and a measure of the Centers for Disease Control and Prevention (CDC) multi-symptom syndrome. Psychological ill health was measured using the General Health Questionnaire and a post-traumatic stress measure. SETTING—Population of servicemen who were serving in the UK Armed Forces during the Gulf conflict between 1 September 1990 and 30 June 1991. PARTICIPANTS—3297 Gulf veterans. MAIN RESULTS—In multivariate logistic regression, there was an inverse relation between higher rank and psychological and physical ill health (test of trend: General Health Questionnaire, p=0.004 ; post-traumatic stress, p=0.002; fatigue, p=0.015; CDC case, p=0.002). Having left the Armed Forces was associated with a two to three times increase in reporting ill health. Of the deployment factors, there was a weak association between being deployed as an individual reinforcement in a combat role and post-traumatic stress but there was no association between receiving pre-deployment training or post-deployment leave and ill health. Marital status and smoking were associated with psychological and physical ill health. CONCLUSIONS—Rank was the main occupational factor associated with both psychological and physical ill health in Gulf veterans. This may parallel the associations between socioeconomic status and morbidity in civilian populations. Ill health seems to be greater in those who return to civilian life. Sociodemographic factors also seem to be important in ill health in Gulf veterans. Keywords: military; Gulf veterans; rank

Background: Recently, proposals have been made to improve mental health care for UK military veterans. Combat Stress (CS), a veteran's charity, has provided mental health services for veterans since 1919. Since 2003, service users have included veterans from the Iraq and Afghanistan conflicts; however, their pattern of help-seeking has not been evaluated. Aims: To describe the characteristics of the veteran population of the recent Iraq or Afghanistan conflicts who sought help from CS between 2003 and May 2011. Methods: CS Iraq and Afghanistan veteran clinical and welfare records were evaluated. Results: Nine hundred and eighty-eight records were evaluated. The median time for veterans of recent conflicts to seek help from CS since discharge from military service was ~2 years, considerably shorter than the mean time of 14 years previously estimated by CS. Approximately, three-quarters of the veterans receiving a full clinical assessment (n = 114), received a diagnosis of post traumatic stress disorder (PTSD) (n = 87). Approximately half of the clinically assessed veterans self-referred to CS (51%); their most frequent diagnosis was PTSD. Conclusions: Veterans who have served in Iraq and Afghanistan are presenting to Combat Stress sooner, and at a younger age, than veterans of previous conflicts and operations.

Background Little is known about the social and emotional well-being of children whose fathers have been deployed to the conflicts in Iraq/Afghanistan or who have post-traumatic stress disorder (PTSD). Aims To examine the emotional and behavioural well-being of children whose fathers are or have been in the UK armed forces, in particular the effects of paternal deployment to the conflicts in Iraq or Afghanistan and paternal PTSD. Method Fathers who had taken part in a large tri-service cohort and had children aged 3–16 years were asked about the emotional and behavioural well-being of their child(ren) and assessed for symptoms of PTSD via online questionnaires and telephone interview. Results In total, 621 (67%) fathers participated, providing data on 1044 children. Paternal deployment to Iraq or Afghanistan was not associated with childhood emotional and behavioural difficulties. Paternal probable PTSD were associated with child hyperactivity. This finding was limited to boys and those under 11 years of age. Conclusions This study showed that adverse childhood emotional and behavioural well-being was not associated with paternal deployment but was associated with paternal probable PTSD.

Background: The long-term psychosocial outcomes of UK armed forces personnel who sustained serious combat injuries during deployment to Afghanistan are largely unknown. We aimed to assess rates of probable post-traumatic stress disorder (PTSD), depression, anxiety, and mental health-associated multimorbidity in a representative sample of serving and ex-serving UK military personnel with combat injuries, compared with rates in a matched sample of uninjured personnel. Methods: This analysis used baseline data from the ADVANCE cohort study, in which injured individuals were recruited from a sample of UK armed forces personnel who were deployed to Afghanistan and had physical combat injuries, according to records provided by the UK Ministry of Defence. Participants from the uninjured group were frequency-matched by age, rank, regiment, deployment, and role on deployment. Participants were recruited through postal, email, and telephone invitations. Participants completed a comprehensive health assessment, including physical health assessment and self-reported mental health measures (PTSD Checklist, Patient Health Questionnaire-9, and Generalised Anxiety Disorder-7). The mental health outcomes were rates of PTSD, depression, anxiety, and mental health-associated multimorbidity in the injured and uninjured groups. The ADVANCE study is ongoing and is registered with the ISRCTN registry, ISRCTN57285353. Findings: 579 combat-injured participants (161 with amputation injuries and 418 with non-amputation injuries) and 565 uninjured participants were included in the analysis. Participants had a median age of 33 years (IQR 30–37 years) at the time of assessment. 90·3% identified as White and 9·7% were from all other ethnic groups. The rates of PTSD (16·9% [n=89] vs 10·5% [n=53]; adjusted odds ratio [AOR] 1·67 [95% CI 1·16–2·41], depression (23·6% [n=129] vs 16·8% [n=87]; AOR 1·46 [1·08–2·03]), anxiety (20·8% [n=111] vs 13·5% [n=71]; AOR 1·56 [1·13–2·24]) and mental health-associated multimorbidity (15·3% [n=81] vs 9·8% ...