UK military women: mental health, military service and occupational adjustment

Abstract Background Recently, the UK Armed Forces have revised the ground close combat role to include women. Aims To assess the potential mental health impact of this initiative we examined gender differences in deployment patterns, work strain, occupational factors, mental health, alcohol use and help-seeking following operational deployment. Methods The study was a secondary analysis of self-report survey data; 8799 men (88%) and 1185 women (12%) provided data. A sub-sample (47%, n = 4659) provided data concerning post-deployment help-seeking. The latter consisted of 408 women (8.8%) and 4251 men (91%). Results With the exception of alcohol misuse, which was significantly lower for women, women reported significantly more common mental disorder symptoms, subjective depression and self-harm. Women were significantly more likely to seek help from healthcare providers. Men were significantly more likely to have deployed operationally and for longer cumulative periods. Subjective work strain, but not job control, was significantly lower for women whose military careers were significantly shorter. Post-traumatic stress disorder (PTSD) symptom intensity was similar to men. Conclusions With the exception of PTSD and alcohol misuse, UK military women experience more mental health-related problems than military men. This finding was not related to the more arduous aspects of military service as women served for shorter times, deployed less and for shorter cumulative periods and were less likely to report work-related stress.

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British military women: combat exposure, deployment and mental health

Occupational Medicine ◽

10.1093/occmed/kqz103 ◽

2019 ◽

Author(s):

N Jones ◽

N Greenberg ◽

A Phillips ◽

A Simms ◽

S Wessely

Keyword(s):

Mental Health ◽

Help Seeking ◽

Common Mental Disorder ◽

Negative Relationship ◽

Mental Healthcare ◽

Combat Exposure ◽

Self Report ◽

Military Women ◽

Post Traumatic Stress ◽

Unit Cohesion

Abstract Background Internationally, women are about to undertake combat duties alongside their male colleagues. The psychological effect of this policy change is largely unknown. Aims To explore the mental health impact of combat exposure among military women. Methods Self-report, between-subjects survey data were collected in Iraq and Afghanistan on four occasions between 2009 and 2014 (n = 4139). Differences in mental health, stigmatization, deployment experiences, intimate relationship impact, perception of family support levels, unit cohesion, leadership and help-seeking were compared between deployed men and women. Comparisons were repeated with the study sample stratified by level of combat exposure. Outcomes were examined using logistic regression adjusted for socio-demographic, mental health and military factors. Results Overall, 4.1% of women and 4.3% of men reported post-traumatic stress disorder (PTSD) (odds ratio (OR) 1.31, 95% confidence interval (95% CI) 0.70–2.46); 22% of women and 16% of men reported symptoms of common mental disorder (CMD) (OR 1.52, 95% CI 1.11–2.08). Women were less likely to report mental health-related stigmatization (OR 0.68, 95% CI 0.53–0.87), negative relationship impact from deployment (OR 0.69, 95% CI 0.49–0.98) and subjective unit cohesion (OR 0.69, 95% CI 0.53–0.90). Help-seeking for emotional problems was similar by gender (OR 1.22, 95% CI 0.84–1.77). Overall, outcomes were minimally impacted by level of combat exposure. Conclusion Although women experienced more CMD symptoms, PTSD symptoms were similar by gender. Subject to confirmation of the study findings, women may not require enhanced mental healthcare during deployment for exposure-based conditions such as PTSD when undertaking the ground close combat role.

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Contribution of mental ill health during military service to postservice benefit claims in the UK

Occupational and Environmental Medicine ◽

10.1136/oemed-2020-107050 ◽

2021 ◽

pp. oemed-2020-107050

Author(s):

Howard Burdett ◽

Nicola T Fear ◽

Simon Wessely ◽

Neil Greenberg ◽

Roberto J Rona

Keyword(s):

Mental Health ◽

Military Service ◽

Mental Health Problems ◽

Common Mental Disorder ◽

Population Attributable Fraction ◽

Armed Forces ◽

Post Traumatic Stress ◽

Civilian Life ◽

Carry Over ◽

The Uk

ObjectivesWhile most UK military personnel transition successfully into civilian life, some experience unemployment and disability, which may be partly attributable to in-service factors. This study aims to determine the degree to which in-service mental health problems impact on postservice benefit claims.MethodsUsing data from a cohort of 5598 recent leavers from regular service in the UK Armed Forces linked with data from the Department for Work and Pensions, we assessed associations between in-service mental health and postservice benefit claims, and the population attributable fraction (PAF) of benefit claims related to in-service mental health. An analysis with postservice mental ill health as mediator was performed to determine the degree to which the observed effects were a consequence of persistent illness, as opposed to remitted.ResultsMental illness occurring in-service predicted both unemployment and disability claims, partly mediated by postservice health (23%–52% total effects mediated), but alcohol misuse did not. Common mental disorder (CMD) (PAF 0.07, 95% CI: 0.02 to 0.11) and probable post-traumatic stress disorder (PTSD) (PAF 0.05, 95% CI 0.01 to 0.09) contributed to unemployment claims. Probable PTSD was the largest contributor to disability claims (PAF 0.25, 95% CI 0.13 to 0.36), with a smaller contribution from CMD (PAF 0.16, 95% CI 0.03 to 0.27).ConclusionsIn-service mental ill health gives rise to benefit claims. These effects are only partly mediated by postservice mental health, implying that in-service (or pre-service) mental issues have carry-over effects into civilian life even if remitted. Better prevention and treatment of in-service PTSD symptoms may well reduce postservice disability claims.

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Military psychological trauma and therapy: a review of EMDR treatment and supervision in the UK Ministry of Defence

Journal of the Royal Army Medical Corps ◽

10.1136/jramc-2018-001060 ◽

2018 ◽

Vol 165 (2) ◽

pp. 90-93 ◽

Cited By ~ 2

Author(s):

Wendy Frappell-Cooke ◽

M McCauley

Keyword(s):

Mental Health ◽

Clinical Supervision ◽

Military Service ◽

Help Seeking ◽

Armed Forces ◽

Psychological Trauma ◽

Psychological Injury ◽

British Military ◽

The Uk ◽

The Military

Psychological injury has been associated with military service, and this can result in a variety of mental health symptoms and disorders. A range of barriers to help-seeking have been identified in the military and mental health services have sought to address such factors through effective and efficient care and consultation. The use of eye movement desensitisation and reprocessing forms part of a repertoire of trauma-focused therapies within the UK’s Armed Forces. This article will outline the application of this approach within the British military, along with the role of specialist clinical supervision in treating those affected by operational trauma.

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Do Junior Entrants to the UK Armed Forces have worse outcomes than Standard Entrants?

BMJ Military Health ◽

10.1136/bmjmilitary-2021-001787 ◽

2021 ◽

pp. bmjmilitary-2021-001787

Author(s):

Margaret Jones ◽

N Jones ◽

H Burdett ◽

B P Bergman ◽

N T Fear ◽

...

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Alcohol Misuse ◽

Common Mental Disorders ◽

Armed Forces ◽

Physical Symptoms ◽

Self Report ◽

Adult Service ◽

Self Harm ◽

The Uk

IntroductionThe UK is the only permanent member of the UN Security Council that has a policy of recruiting 16 and 17 year old individuals into its regular Armed Forces. Little is known about the consequences of enlisting as a Junior Entrant (JE), although concerns have been expressed. We compare the mental health, deployment history, and pre-enlistment and post-enlistment experiences of personnel who had enlisted as JEs with personnel who joined as Standard Entrants (SEs).MethodParticipants from a large UK military cohort study completed a self-report questionnaire between 2014 and 2016 that included symptoms of probable post-traumatic stress disorder (PTSD), common mental disorders, alcohol consumption, physical symptoms and lifetime self-harm. Data from regular non-officer participants (n=4447) from all service branches were used in the analysis. JEs were defined as having enlisted before the age of 17.5 years. A subgroup analysis of participants who had joined or commenced adult service after April 2003 was carried out.ResultsJEs were not more likely to deploy to Iraq or Afghanistan but were more likely to hold a combat role when they did (OR 1.25, 95% CI 1.00 to 1.56). There was no evidence of an increase in symptoms of common mental disorders, PTSD, multiple somatic symptoms (MSS), alcohol misuse or self-harm in JEs in the full sample, but there was an increase in alcohol misuse (OR 1.84, 95% CI 1.18 to 2.87), MSS (OR 1.51, 95% CI 1.04 to 2.20) and self-harm (OR 2.13, 95% CI 1.15 to 3.95) in JEs who had commenced adult service after April 2003. JEs remain in adult service for longer and do not have more difficulties when they leave service.ConclusionsJEs do not have worse mental health than SEs, but there is uncertainty in relation to alcohol misuse, MSS and self-harm in more recent joiners. Monitoring these concerns is advisable.

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A systematic review of help-seeking and mental health service utilization among military service members

Clinical Psychology Review ◽

10.1016/j.cpr.2017.01.008 ◽

2017 ◽

Vol 53 ◽

pp. 59-78 ◽

Cited By ~ 36

Author(s):

Melanie A. Hom ◽

Ian H. Stanley ◽

Matthew E. Schneider ◽

Thomas E. Joiner

Keyword(s):

Mental Health ◽

Systematic Review ◽

Mental Health Service ◽

Health Service ◽

Service Utilization ◽

Military Service ◽

Help Seeking ◽

Health Service Utilization ◽

Mental Health Service Utilization ◽

Military Service Members

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Mental Health Problems and Help-Seeking among Adolescents

Sibirskiy psikhologicheskiy zhurnal ◽

10.17223/17267080/79/11 ◽

2021 ◽

pp. 189-202

Author(s):

E.V. Rezun ◽

◽

H.R. Slobodskaya ◽

N.B. Semenova ◽

T.O. Rippinen ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Help Seeking ◽

Sleep Disturbances ◽

Mental Health Problems ◽

Health Problems ◽

Self Report ◽

Emotional And Behavioral Problems ◽

Seeking Help

The mental health problems among adolescents have long-lasting effects throughout life. However, research evidence indicates that only 10–30% of adolescents who needed mental health care had received specialized help. The present study reports the prevalence of mental health problems and help-seeking among adolescents, taking into account gender and age differences. The sample included 1752 adolescents (47 % boys,) aged 12-17 years. Data were collected on in two Siberian cities (Novosibirsk and Krasnoyarsk) using an international self-report questionnaire developed for the school-based Eurasian Child Mental Health Study. Participants were recruited from 18 schools, students completed questionnaires anonymously during school lessons. Statistical analysis included analysis of variance (ANOVA), multiple regression analysis, and crosstabs using a chi-squared test. The level of emotional and behavioral problems in Siberian adolescents was slightly higher than that found in European and Asian countries. Twenty three percent of adolescents reported frequent headaches (at least once a week), 11 % reported frequent abdominal pain and 14% suffered from frequent sleep disturbances (3–5 times a week or more). Girls reported a significantly higher level of problems than boys, with the largest gender differences for emotional problems, recurrent pains and sleep disturbances. Weekly consumption of alcohol and daily use of nicotine among boys was more common than among girls (3 % and 6 %, respectively), whereas less frequent use of alcohol and nicotine was commoner in girls (16 %) than in boys (10 %); 7 % of boys and girls had tried drugs at least once. Suicidal thoughts were reported by 22 % of adolescents, 6 % reported suicide attempts and 6 % reported repeated self-harm. One third of adolescents considered seeking outside help and 9 % had actually done so. Girls reported more help-seeking than boys; older girls sought help more often than younger and middle-aged ones. Around one third of adolescents sought help from their relatives; 26 % from friends, the Internet or other non-professional sources; 5 % reported seeking help from a doctor or nurse, and 3 % from a psychologist. The most important independent predictors of seeking help were emotional symptoms, suicidal ideation and hyperactivity/inattention. The results suggest a need for future investigation of the factors associated with help-seeking behavior among adolescents. It is also necessary to develop mental health promotion programs for adolescents, interventions to improve mental health literacy and access to mental health care.

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MIlitary Combat Mental Health Framework

BMJ Military Health ◽

10.1136/bmjmilitary-2020-001439 ◽

2020 ◽

pp. bmjmilitary-2020-001439

Author(s):

Martin Bricknell

Keyword(s):

Mental Health ◽

Military Service ◽

Current Knowledge ◽

Armed Forces ◽

Well Being ◽

Therapeutic Interventions ◽

Future Research ◽

The Subject ◽

Mental Well Being ◽

Military Combat

This paper describes a framework for understanding military combat mental health based on the possible mental ill-health consequences of exposure to ‘potential trauma events’ for members of the armed forces and after their military service as veterans. It uses a life course approach that maps an individual’s mental well-being against four ‘states’: fit, reacting, injured and ill. It then considers five categories of factors that influence the risk of mental illness from this exposure based on research evidence; prejoining vulnerability, resilience, precipitating, treatment and recovery. This framework offers a structure to debate current knowledge, inform policy and therapeutic interventions, provide education and to guide future research into the subject.

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Bridging the gap between child mental health need and professional service utilisation: Examining the influence of mothers’ parental attributions on professional help-seeking intentions

European Child & Adolescent Psychiatry ◽

10.1007/s00787-020-01682-6 ◽

2020 ◽

Author(s):

Vilas Sawrikar ◽

Antonio Mendoza Diaz ◽

Lucy Tully ◽

David J. Hawes ◽

Caroline Moul ◽

...

Keyword(s):

Mental Health ◽

Subgroup Analysis ◽

Self Efficacy ◽

Child Mental Health ◽

Help Seeking ◽

Self Report ◽

Professional Service ◽

Service Utilisation ◽

Parental Attributions ◽

Professional Help

AbstractThere is a significant gap between the need for child mental health services and use of these services by families. Parental attributions may play a role in this. This study examined whether mothers’ attributions about their child’s problems influence professional help-seeking intentions in a general sample of community mothers. Secondary analysis re-examined this hypothesis in a subgroup of mothers of children with clinically elevated mental health symptoms. Cross-sectional survey data were collected from mothers (N = 184) of children aged between 2 and 12 years recruited from the community. Mothers completed self-report questionnaires measuring parental attributions: child-responsible attributions and parental self-efficacy; professional help-seeking intentions; and psychosocial covariates: child mental health, mothers’ anxiety and depression, child age, gender, marital status, education, and professional help-seeking experience. Hierarchical regression modelling indicated that parental attributions explained professional help-seeking intentions after controlling for covariates in both the general sample (ΔF = 6.07; p = .003) and subgroup analysis (ΔF = 10.22, p = .000). Professional help-seeking intentions were positively associated with child-responsible attributions (β = .19, p = .002) but not parental self-efficacy (β = – .01, p = .865) in the general sample, while positively associated with child-responsible attributions (β = .20, p = .009) and negatively associated with parental self-efficacy (β = – .16, p = .034) in the subgroup analysis. Findings were independent of the presence of clinically elevated symptoms, problem type, and severity. Overall, the findings support models suggesting that parental attributions have a role in professional help-seeking for child mental health problems.

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Attitudinal and demographic factors associated with seeking help and receiving antidepressant medication for symptoms of common mental disorder

BMC Psychiatry ◽

10.1186/s12888-020-02971-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Elena A. Manescu ◽

Emily J. Robinson ◽

Claire Henderson

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Disorder ◽

Mental Health Problem ◽

Health Problem ◽

Help Seeking ◽

Common Mental Disorder ◽

General Health Questionnaire ◽

Seeking Help ◽

Positive Effect

Abstract Background Despite the increased attention given to improvement of mental health-related knowledge and attitudes, rates of help-seeking for mental illness remain low even in countries with well-developed mental health services. This study examines the relationships between attitudes to mental illness, symptoms of common mental disorder and seeking-help and receiving medication for a mental health problem. Methods We used data from the nationally representative Health Survey for England 2014 to design three logistic regression models to test for the effects of attitudes to mental illness (measured by a shortened version of the Community Attitudes toward the Mentally Ill, CAMI scale) on: recent contact with a doctor for a mental health problem; use of any type of mental health service in the last 12 months; and having antidepressants currently prescribed, while controlling for symptoms of common mental disorder (measured by the General Health Questionnaire, GHQ). We also tested for an interaction between attitudes to mental illness and symptoms of common mental disorder on the outcomes. Results A significant but very small effect of CAMI score was found on ‘antidepressants currently prescribed’ model (OR = 1.01(1.00, 1.02) but not on the two indicators of help-seeking. We also found a significant but very small interaction between CAMI and GHQ scores on recent contact with a doctor (OR = 0.99, 95% CI (0.990, 0.998); adjusted Wald test P = 0.01)). Knowing someone with a mental illness had a significant positive effect on help-seeking indicated by: (a) recent contact with a doctor (2.65 (1.01, 6.98)) and (b) currently prescribed antidepressant (2.67 (1.9, 3.75)) after controlling for attitudes to mental illness. Conclusions Our results suggest that knowing someone with a mental health problem seems to have a further positive effect on help-seeking, beyond improving attitudes to mental illness. Furthermore, multiple different types and aspects of stigma may contribute to help-seeking behaviours, consequently multi-faceted approaches are likely to be most efficient.

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