Factors associated with poor self-reported health within the UK military and comparisons with the general population: a cohort study

Objective: To investigate the self-rated health of the UK military and explore factors associated with poor self-rated health. Compare self-rated health of the military to the general population. / Design: A cohort study. / Participants: A total of 7626 serving and ex-serving UK military personnel, aged between 25 and 49; 19,452,300 civilians from England and Wales. / Setting: United Kingdom (military), England and Wales (civilians). / Main outcome measures: Self rated health for both populations. Additional data for the military sample included measures of symptoms of common mental disorder (General Health Questionnaire-12), probable post-traumatic stress disorder (post-traumatic stress disorder checklist Civilian Version), alcohol use (Alcohol Use Disorders Identification Test), smoking behaviour, history of self-harm and body mass index. / Results: In the military sample, poor self-rated health was significantly associated with: common mental disorders and post-traumatic stress disorder symptomology, a history of self-harm, being obese, older age (ages 35–49) and current smoking status. However, the majority of military personnel report good health, with levels of poor self-rated health (13%) not significantly different to those reported by the general population (12.1%). / Conclusions: Self-rated health appears to relate to aspects of both physical and psychological health. The link between poor self-rated health and psychological ill-health emphasises the need for military support services to continue addressing mental health problems

Prevalence of at-risk drinking recognition: A systematic review and meta-analysis

Background: There is a prominent “treatment gap” in relation to at-risk drinking (ARD), whereby a minority of at-risk drinkers ever access treatment. Research suggests that recognition of problem drinking is a necessary precursor for help-seeking and treatment. Objective: This systematic review and meta-analysis aimed to estimate the prevalence of ARD recognition within those meeting criteria for ARD. Method: PsycINFO, Web of Science, Scopus, and MEDLINE were searched using the terms: problem* AND (recogni* OR perceive* OR perception OR self-identif*) AND alcohol - to identify studies published in English between 2000 and 2022. Studies reported the frequency (weighted or unweighted) of participants meeting ARD criteria that also directly identified ARD, perceived a need for help, or endorsed a readiness to change. The prevalence of ARD recognition was estimated using a random-effects meta-analysis with 95% confidence intervals (CIs). Results: 17 studies were included which provided data for 33,349 participants with ARD. Most (n = 14) were US studies. ARD was self-identified via a single indicator in 7 studies, whereas recognition was assessed via stages of change in 4 studies and need for help in 6 studies. The pooled prevalence of ARD recognition was 31% (95% CI: 25%−36%), and subgroup analyses indicated alcohol use severity, measure of recognition, and population type to be significant sources of heterogeneity. Conclusions: Most individuals with ARD fail to recognise their drinking problem so preventive approaches that promote recognition may be helpful. However, we must be cautious of how inconsistency in question framing affects self-reported problem recognition

Cardiovascular and lifestyle risk factors of mild cognitive impairment in UK veterans and non-veterans

Acknowledgement: We thank all volunteers who participated in the PROTECT study.Key learning points: What is already known about this subject: · Previous evidence in the general population has shown exposure to cardiovascular health, or lifestyle choices, are modifiable risk factors for mild cognitive impairment. · This is concerning as veterans are at an increased risk of cardiovascular health or lifestyle factors. This could potentially have a negative consequence on their cognitive function with age. What this study adds: · This is the first study to quantify the risk of mild cognitive impairment in UK veterans exposed to nine key cardiovascular health and lifestyle risk factors compared to the non-veteran population using longitudinal data. · Obesity, alcohol consumption and physical inactivity reduced the risk of mild cognitive impairment in veterans compared to non-veterans. · Within the veteran sample, diabetes and high cholesterol increased the risk of mild cognitive impairment. What impact this may have on practice or policy: · Early diagnosis and intervention of modifiable risk factors may reduce the risk of mild cognitive impairment and subsequently dementia in both veterans and non-veterans.Background: The link between poor cardiovascular health (CVH), lifestyle and mild cognitive impairment (MCI) has been well established in the general population. However, there is limited research exploring these associations in ageing UK veterans. Aims: This study explored the risk of MCI and its association with nine CVH and lifestyle risk factors (including diabetes, heart disease, high cholesterol, high blood pressure, obesity, stroke, physical inactivity, the frequency of alcohol consumption and smoking) in UK veterans and non-veterans. Methods: This prospective cohort study comprised data from the PROTECT study between 2014 and 2022. Participants comprised of UK military veterans and non-veterans aged ≥50 years at baseline. Veteran status was defined using the Military Service History Questionnaire. CVH and lifestyle risk factors were defined using a combination of self-report measures, medication history or physical measurements. MCI was defined as the presence of subjective and objective cognitive impairment. Results: Based on a sample of 9378 veterans (n = 488) and non-veterans (n = 8890), the findings showed the risk of MCI significantly reduced in veterans with obesity, those who frequently consumed alcohol and were physically inactive compared to non-veterans. The risk of MCI significantly increased in veterans with diabetes (hazards ratio [HR] = 2.22, 95% confidence interval [CI] 1.04–4.75, P ≤ 0.05) or high cholesterol (HR = 3.11, 95% CI 1.64–5.87, P ≤ 0.05) compared to veterans without. Conclusions: This study identified CVH and lifestyle factors of MCI in UK veterans and non-veterans. Further work is needed to understand these associations and the underpinning mechanisms which could determine intervention strategies to reduce the risk of MCI.This study was funded as part of a PhD studentship by Alzheimer’s Society (award no. 475 [AS-PhD-18b-002]). The PROTECT study was externally funded/supported by the National Institute of Health and Care Research Exeter Biomedical Research Centre. The Family History of Neurological Disease Questionnaire was funded in part by the Alzheimer’s Research UK South West Network

Is lifetime traumatic brain injury a risk factor for mild cognitive impairment in veterans compared to non-veterans?

Data availability statement: Owing to the nature of the research, for ethical reasons supporting data are not available.Supplemental data for this article can be accessed online at: https://doi.org/10.1080/20008066.2023.2291965 .Copyright . Background: Traumatic brain injury (TBI) is prevalent in veterans and may occur at any stages of their life (before, during, or after military service). This is of particular concern, as previous evidence in the general population has identified TBI as a strong risk factor for mild cognitive impairment (MCI), a known precursor of dementia. Objectives: This study aimed to investigate whether exposure to at least one TBI across the lifetime was a risk factor for MCI in ageing UK veterans compared to non-veterans. Method: This cross-sectional study comprised of data from PROTECT, a cohort study comprising UK veterans and non-veterans aged ≥ 50 years at baseline. Veteran and TBI status were self-reported using the Military Service History Questionnaire (MSHQ) and the Brain Injury Screening Questionnaire (BISQ), respectively. MCI was the outcome of interest, and was defined as subjective cognitive impairment and objective cognitive impairment. Results: The sample population comprised of veterans (n = 701) and non-veterans (n = 12,389). TBI was a significant risk factor for MCI in the overall sample (OR = 1.21, 95% CI 1.11–1.31) compared to individuals without TBI. The prevalence of TBI was significantly higher in veterans compared to non-veterans (69.9% vs 59.5%, p < .001). There was no significant difference in the risk of MCI between veterans with TBI and non-veterans with TBI (OR = 1.19, 95% CI 0.98–1.45). Conclusion: TBI remains an important risk factor for MCI, irrespective of veteran status. The clinical implications indicate the need for early intervention for MCI prevention after TBI.Resumen: Antecedentes: El traumatismo encéfalocraneano (TEC) es frecuente en veteranos, el cual puede ocurrir en cualquier etapa de sus vidas (antes, durante o después del servicio militar). Esto es motivo de preocupación, ya que evidencia previa en la población general ha identificado al TEC como un fuerte factor de riesgo de Deterioro Cognitivo Leve (DCL), un precursor conocido de demencia. Objetivo: Este estudio tuvo como objetivo investigar si la exposición a al menos un Traumatismo encéfalocraneano a lo largo de la vida era un factor de riesgo de Deterioro Cognitivo Leve en veteranos del Reino Unido en comparación con no veteranos. Método: Este estudio de corte transversal incluyó datos de PROTECT, un estudio de cohorte que incluye a veteranos y no veteranos del Reino Unido de ≥50 años al inicio del estudio. El estatus de veterano y de Traumatismo encéfalocraneano (TEC) se auto-reportaron utilizando el Cuestionario de Historia de Servicio Militar (MSHQ, por sus siglas en inglés) y el Cuestionario de Detección de Traumatismo encéfalocraneano (BISQ, por sus siglas en inglés), respectivamente. El Deterioro Cognitivo Leve (DCL) fue el resultado de interés, definido como deterioro cognitivo subjetivo y deterioro cognitivo objetivo. Resultados: La muestra poblacional incluyó a veteranos (n = 701) y no veteranos (n = 12.389). El Traumatismo encéfalocraneano (TEC) fue un factor de riesgo significativo de Deterioro Cognitivo Leve (DCL) en la muestra total (OR = 1.21, IC del 95% 1.11–1.31) en comparación con individuos sin TEC. La prevalencia de TEC fue significativamente mayor en veteranos en comparación con no veteranos (69.9% vs 59.5%, p < .001). No hubo diferencia significativa en el riesgo de DCL entre veteranos con TEC y no veteranos con TEC (OR = 1.19, IC del 95% 0.98–1.45). Conclusión: El Traumatismo encéfalocraneano (TEC) continúa siendo un factor de riesgo significativo de Deterioro Cognitivo Leve (DCL), independiente del estatus de veterano. Las implicaciones clínicas sugieren la necesidad de intervenciones tempranas para la prevención de DCL después de un TEC.PhD studentship by the Alzheimer’s Society (award no. 475 [AS-PhD-18b-002]). The PROTECT study was externally funded/supported by the National Institute of Health and Care Research, Exeter Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The Family History of Neurological Disease Questionnaire was funded in part by the Alzheimer’s Research UK South West Network

'You get looked at like you're failing': A reflexive thematic analysis of experiences of mental health and wellbeing support for NHS staff

Staff in the National Health Service (NHS) are under considerable strain, exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. We interviewed 48 healthcare workers from 18 NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking, such as manager training and peer support facilitated by building in time for this during working hours, but this will require long-term strategic planning to address workforce shortages

Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional study

BACKGROUND: Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We aimed to estimate prevalence of common mental disorders and post-traumatic stress disorder (PTSD) among health-care workers in England using diagnostic interviews. METHODS: We did a two-phase, cross-sectional study comprising diagnostic interviews within a larger multisite longitudinal cohort of health-care workers (National Health Service [NHS] CHECK; n=23 462) during the COVID-19 pandemic. In the first phase, health-care workers across 18 NHS England Trusts were recruited. Baseline assessments were done using online surveys between April 24, 2020, and Jan 15, 2021. In the second phase, we selected a proportion of participants who had responded to the surveys and conducted diagnostic interviews to establish the prevalence of mental disorders. The recruitment period for the diagnostic interviews was between March 1, 2021 and Aug 27, 2021. Participants were screened with the 12-item General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule-Revised (CIS-R) for common mental disorders or were screened with the 6-item Post-Traumatic Stress Disorder Checklist (PCL-6) and assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD. FINDINGS: The screening sample contained 23 462 participants: 2079 participants were excluded due to missing values on the GHQ-12 and 11 147 participants due to missing values on the PCL-6. 243 individuals participated in diagnostic interviews for common mental disorders (CIS-R; mean age 42 years [range 21-70]; 185 [76%] women and 58 [24%] men) and 94 individuals participated in diagnostic interviews for PTSD (CAPS-5; mean age 44 years [23-62]; 79 [84%] women and 15 [16%] men). 202 (83%) of 243 individuals in the common mental disorders sample and 83 (88%) of 94 individuals in the PTSD sample were White. GHQ-12 screening caseness for common mental disorders was 52·8% (95% CI 51·7-53·8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14·3% (10·4-19·2), population prevalence of depression was 13·7% (10·1-18·3), and combined population prevalence of generalised anxiety disorder and depression was 21·5% (16·9-26·8). PCL-6 screening caseness for PTSD was 25·4% (24·3-26·5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7·9% (4·0-15·1). INTERPRETATION: The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention. FUNDING: UK Medical Research Council; UCL/Wellcome; Rosetrees Trust; NHS England and Improvement; Economic and Social Research Council; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King's College London (KCL); NIHR Protection Research Unit in Emergency Preparedness and Response at KCL

Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic

OBJECTIVES: This study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK. METHODS: Preliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale. RESULTS: Analyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one's moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse. CONCLUSIONS: Our findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic

Parental reports of serious illness and disability among children aged 3–16 years from UK military families

Prevalence rates of child illness according to parents have been found to vary greatly in the general population, with even less known about children of military parents. Mothers are generally considered more informed about their children's problems than fathers. This paper aimed to establish the prevalence of serious illness and disability among children from military families, noting the difference between parental reports.Male serving and ex-serving personnel with children aged 3-16 years were invited to take part in an online questionnaire and telephone interview based on their child's health. The mothers of their children were invited via post if the father gave permission to make contact. Data were analysed using descriptive statistics and Cohen's kappa.378 fathers and 383 mothers provided information for 610 children. The vast majority of parents did not perceive their child to have a serious illness or disability; fathers reported problems in 7.7% of their children (respiratory conditions most common), while mothers reported problems in 6.2% (physical health problems rated most prevalent). A moderate agreement was found between parent's reports; kappa=0.51 (p&lt;0.001).The prevalence of serious illnesses and disabilities is low among military children according to parent reports. Fathers were more likely to disclose a problem in their child, and these differences were visible in the type of problem reported also. This disparity suggests mothers' and fathers' views should both be considered when making decisions that involve the child's care, in addition to clinical diagnoses

Parental reports of serious illness and disability among children aged 3–16 years from UK military families

Prevalence rates of child illness according to parents have been found to vary greatly in the general population, with even less known about children of military parents. Mothers are generally considered more informed about their children's problems than fathers. This paper aimed to establish the prevalence of serious illness and disability among children from military families, noting the difference between parental reports.Male serving and ex-serving personnel with children aged 3-16 years were invited to take part in an online questionnaire and telephone interview based on their child's health. The mothers of their children were invited via post if the father gave permission to make contact. Data were analysed using descriptive statistics and Cohen's kappa.378 fathers and 383 mothers provided information for 610 children. The vast majority of parents did not perceive their child to have a serious illness or disability; fathers reported problems in 7.7% of their children (respiratory conditions most common), while mothers reported problems in 6.2% (physical health problems rated most prevalent). A moderate agreement was found between parent's reports; kappa=0.51 (p<0.001).The prevalence of serious illnesses and disabilities is low among military children according to parent reports. Fathers were more likely to disclose a problem in their child, and these differences were visible in the type of problem reported also. This disparity suggests mothers' and fathers' views should both be considered when making decisions that involve the child's care, in addition to clinical diagnoses