Re: Investigating the impact of financial concerns on symptoms of depression in UK healthcare workers: data from the UK-REACH nationwide cohort study

This editorial comments on the paper by Martin McBride and the UK REACH team (published in 2023) investigating financial concerns in UK healthcare workers and depressive symptoms. The research concludes that reporting future financial concerns at baseline increased the odds of depressive symptoms at follow-up around 18 months later. We discuss these findings in the context of the cost-of-living crisis and pay disputes within the NHS, important policy implications and directions for future research

A service evaluation of the military headfit initiative:An implementation study

(1) Background: UK Armed Forces personnel provide first response, support and protection during national and international disasters and conflicts. They thus have a psychologically challenging role which requires them to maintain a good state of mental health and wellbeing. HeadFIT is a preventative initiative developed to help foster mental fitness through various self-help tools and resources online including techniques to de-stress and increase drive. This paper reports on an independent service evaluation of HeadFIT to examine feasibility and acceptability among Ministry of Defence (MOD) personnel. (2) Methods: Qualitative interviews were held with the HeadFIT beneficiaries, including military personnel and civil servants. The beneficiaries provided feedback on HeadFIT through questionnaires and interviews, and website traffic data were also collected. Qualitative data were analysed using framework analysis. (3) Results: Beneficiaries generally reported positive views on the HeadFIT initiative, with most agreeing that the tools could support them to foster their mental fitness. However, concerns were raised around the uptake of HeadFIT and participants suggested methods to improve usability. (4) Conclusions: Several recommendations were made to improve the resources, usability, uptake, and implementation and communication of HeadFIT

Evaluating a Smartphone App to Support the Mental Health of UK Armed Forces Veterans (MeT4VeT): A Randomised Controlled Feasibility Trial

BackgroundPrevious research demonstrates that less than 50% of military veterans experiencing mental health difficulties seek formal support. Veterans often struggle to identify problems as mental health difficulties. In addition, they may fail to recognize the need for support before reaching a crisis point and face difficulties navigating care pathways to access support. ObjectiveA feasibility trial was conducted to assess a novel digital smartphone app (Mental Health Toolkit for Veterans Project [MeT4VeT]) for UK Armed Forces (UKAF) veterans experiencing mental health difficulties. The trial aimed to explore the feasibility and acceptability of trial procedures for a later randomized controlled trial (RCT) and to assess the acceptability of the MeT4VeT app. MethodsParticipants were recruited at UK military medical centers, by advertising on social media, and through veteran third-sector organizations between February and November 2021, and assessed for eligibility (male, owned a smartphone, served at least 2 years in the UKAF, left the UKAF within the last 2 years, not undertaking formal mental health treatment). Eligible participants were assigned, on a 1:1 ratio, to either the intervention group (full app) or a control group (noninteractive app with signposting information). Three key objectives were determined a priori to assess the practicality of running an RCT including an assessment of recruitment and retention, evaluation of the technical app delivery and measurement processes, and acceptability and usability of the intervention. ResultsIn total, 791 individuals completed the participant information sheet, of which 261 (33%) were ineligible, 377 (48%) declined or were unable to be contacted for consent, and 103 (13%) did not download the app or complete the baseline measures. Of this, 50 participants completed baseline measures and were randomly assigned to the intervention group (n=24) or the control group (n=26). The trial was effective at enabling both the technical delivery of the intervention and collection of outcome measures, with improvements in mental health demonstrated for the intervention group from baseline to the 3-month follow-up. Recruitment and retention challenges were highlighted with only 50 out of the 530 eligible participants enrolled in the trial. The acceptability and usability of the MeT4VeT app were generally supported, and it was reported to be a useful, accessible way for veterans to monitor and manage their mental health. ConclusionsThe results highlighted that further work is needed to refine recruitment processes and maintain engagement with the app. Following this, an RCT can be considered to robustly assess the ability of the app to positively affect mental health outcomes indicated within this trial. Trial RegistrationClinicalTrials.gov NCT05993676; https://clinicaltrials.gov/ct2/show/NCT0599367

Do errors in the GHQ-12 response options matter?

Background: The twelve item General Health Questionnaire (GHQ-12) is a widely used measure of psychological wellbeing. Because there are seven different sets of response options across the twelve items, there is scope for transcription errors to occur when researchers assemble their study materials. The impact of such errors might be more important if they occur in the first set of response options than if they occur later in the questionnaire, once participants have become aware that options to the right of the GHQ-12 response sets always indicate worse wellbeing. Aims: To test the impact of introducing errors into the first and eighth set of response options for the GHQ-12 that render those response sets partially illogical. Methods: We used a double-blind randomised controlled trial, pre-registered with Open Science Framework (osf.io/syhwf). Participants were recruited by a market research company from their existing panel of respondents in Great Britain. Participants were randomly allocated to receive one of three versions of the GHQ-12: a correct version (n=500), a version with a mistake in the first item (n=502), or a mistake in the eighth item (n=502). Mistakes replaced ‘better than usual’ (item one) or ‘more so than usual’ (item eight) with ‘not at all.’ Results: We found no differences between the versions in terms of number of participants with possible poor psychological wellbeing (χ2=0.32, df=2, p=0.85) or in mean GHQ-12 scores for the three groups (F(2, 1501)=0.26, p=0.77). Conclusions: Small deviations from the standard GHQ-12 wording do not have a substantive impact on results

Evaluation of Community Reinforcement and Family Therapy in the UK military community

Background: Partners and family can play a key role in encouraging military service and ex-service personnel to seek help for their mental health. Community Reinforcement Approach and Family Training (CRAFT) was developed to equip concerned significant others (CSOs) of those experiencing substance use disorders with skills to encourage their loved one to enter treatment and improve their own well-being. It was adapted in the US for CSOs of ex-service personnel with post-traumatic stress disorder (PTSD) (VA-CRAFT). Objective: This study aimed to evaluate an adaptation of VA-CRAFT for use with CSOs of serving and ex-service personnel experiencing PTSD and Common Mental Disorders in the UK (UKV-CRAFT). Method: Acceptability of UKV-CRAFT was assessed with interviews with experts, namely key stakeholders (n = 15) working in support provision for serving and ex-service personnel. In addition, individuals who took part in a small-scale demonstrative trial of UKV-CRAFT (three CSOs and three facilitators who delivered UKV-CRAFT) provided feedback. Results: UKV-CRAFT was viewed positively, with interviewees highlighting that programmes like UKV-CRAFT filled a gap in provision for UK Armed Forces families as most services were only available to the serving or ex-service personnel. Interviewees praised how UKV-CRAFT enhanced CSO well-being and communication with their loved one. Concerns over the confidentiality of taking part in UKV-CRAFT were raised due to the perceived negative effects of highlighting a loved one’s mental ill health, especially for CSOs of serving personnel. Ideas for improvement included broadening access to all CSOs regardless of whether their loved one was seeking treatment. Conclusion: Interviewees regarded UKV-CRAFT as a potentially useful intervention suggesting it could be proactively offered universally to support timely help-seeking if required. We recommend further evaluation of UKV-CRAFT on a wider scale, incorporating our recommendations, to assess its effectiveness accurately. Community Reinforcement And Family Therapy (CRAFT), a programme for the concerned significant others (CSOs) of people experiencing Substance Abuse Disorders (SUDs), was adapted for the CSOs of UK Armed Forces serving and ex-service personnel (UKV-CRAFT).UKV-CRAFT aimed to equip CSOs with the skills to encourage their Armed Forces loved ones to seek mental health treatment; it was evaluated by post-trial interviews with UKV-CRAFT facilitators, recipients, and Armed Forces stakeholders.UKV-CRAFT was found to be a useful intervention for CSOs but would benefit from further evaluation on a wider scale.Evaluation of Community Reinforcement And Family Therapy in the UK military community. Community Reinforcement And Family Therapy (CRAFT), a programme for the concerned significant others (CSOs) of people experiencing Substance Abuse Disorders (SUDs), was adapted for the CSOs of UK Armed Forces serving and ex-service personnel (UKV-CRAFT). UKV-CRAFT aimed to equip CSOs with the skills to encourage their Armed Forces loved ones to seek mental health treatment; it was evaluated by post-trial interviews with UKV-CRAFT facilitators, recipients, and Armed Forces stakeholders. UKV-CRAFT was found to be a useful intervention for CSOs but would benefit from further evaluation on a wider scale. Evaluation of Community Reinforcement And Family Therapy in the UK military community.</p

Capturing the experiences of UK healthcare workers during the COVID-19 pandemic: A structural topic modelling analysis of 7412 free-text survey responses

BACKGROUND: Healthcare workers (HCWs) have provided vital services during the COVID-19 pandemic, but existing research consists of quantitative surveys (lacking in depth or context) or qualitative interviews (with limited generalisability). Structural Topic Modelling (STM) of large-scale free-text survey data offers a way of capturing the perspectives of a wide range of HCWs in their own words about their experiences of the pandemic. METHODS: In an online survey distributed to all staff at 18 geographically dispersed NHS Trusts, we asked respondents, “Is there anything else you think we should know about your experiences of the COVID-19 pandemic?”. We used STM on 7,412 responses to identify topics, and thematic analysis on the resultant topics and text excerpts. RESULTS: We identified 33 topics, grouped into two domains, each containing four themes. Our findings emphasise: the deleterious effect of increased workloads, lack of PPE, inconsistent advice/guidance, and lack of autonomy; differing experiences of home working as negative/positive; and the benefits of supportive leadership and peers in ameliorating challenges. Themes varied by demographics and time: discussion of home working decreasing over time, while discussion of workplace challenges increased. Discussion of mental health was lowest between September-November 2020, between the first and second waves of COVID-19 in the UK. DISCUSSION: Our findings represent the most salient experiences of HCWs through the pandemic. STM enabled statistical examination of how the qualitative themes raised differed according to participant characteristics. This relatively underutilised methodology in healthcare research can provide more nuanced, yet generalisable, evidence than that available via surveys or small interview studies, and should be used in future research

Data files supporting "<b>Do errors in the GHQ-12 response options matter?"</b>

Background: The twelve item General Health Questionnaire (GHQ-12) is a widely used measure of psychological wellbeing. Because there are seven different sets of response options across the twelve items, there is scope for transcription errors to occur when researchers assemble their study materials. The impact of such errors might be more important if they occur in the first set of response options than if they occur later in the questionnaire, once participants have become aware that options to the right of the GHQ-12 response sets always indicate worse wellbeing.Aims: To test the impact of introducing errors into the first and eighth set of response options for the GHQ-12 that render those response sets partially illogical.Methods: We used a double-blind randomised controlled trial, pre-registered with Open Science Framework (osf.io/syhwf). Participants were recruited by a market research company from their existing panel of respondents in Great Britain. Participants were randomly allocated to receive one of three versions of the GHQ-12: a correct version (n=500), a version with a mistake in the first item (n=502), or a mistake in the eighth item (n=502). Mistakes replaced ‘better than usual’ (item one) or ‘more so than usual’ (item eight) with ‘not at all.’Results: We found no differences between the versions in terms of number of participants with possible poor psychological wellbeing (χ2=0.32, df=2, p=0.85) or in mean GHQ-12 scores for the three groups (F(2, 1501)=0.26, p=0.77).Conclusions: Small deviations from the standard GHQ-12 wording do not have a substantive impact on results.</p