Impact of life-threatening military incidents during deployments abroad on the relationships between military personnel and their families

INTRODUCTION: The influence of deployments on family relationships has hardly been investigated. Following a recently proposed new research strategy, military personnel with and without deployment-related life-threatening military incidents during deployment were compared. The hypothesis was that partner and family relationships of military personnel who experienced such an event would deteriorate more.METHODS: This study included N = 255 military personnel who had a romantic partner ( n = 78 of them had children) when deployed to Afghanistan. Of these, n = 68 military personnel experienced a deployment-related critical event during the deployment, n = 187 did not. Partnership quality was assessed using a semi-structured pre- and post-deployment interview. RESULTS: The partner relationships of military personnel who experienced a deployment-related life-threatening military incident during deployment broke up significantly more often. The partner relationships of all military personnel deteriorated significantly, with greater deterioration after deployment in the group who faced such incidents. These results were independent of age, rank or number of previous deployments. In addition, there was a significant deterioration in the relationships between all military personnel and their children with greater deterioration after deployment in the group who faced such incidents.CONCLUSION: Life-threatening military incidents during a deployment abroad appear to have a considerable influence on the quality and stability of the partner and family relationships of military personnel. These findings can be used to inform the development of specific pre- and post-deployment measures and training.</p

PROXIMITY TO COVID-19 ON MENTAL HEALTH SYMPTOMS AMONG HOSPITAL MEDICAL STAFF

Background: Exposure to patients with COVID-19 can have a significant impact on mental health of hospital medical staff. The aim of this study was to examine the influence of proximity to patients with COVID-19 considering occupational position and gender on the mental health of hospital staff. Subjects and methods: N=78 participants were included in the study, with n=40 of them with direct contact to patients with COVID-19 (51%); eight had contact with patients suspected of having COVID-19 (10%), and n=30 with no direct contact to people with COVID-19 (39%). Results: Multinomial regression analyses showed that proximity had a negative (inverse) influence on avoidance behaviour as part of PTSD, physical symptoms, somatization, compulsiveness and anger expression-in as tendency to suppress anger. In addition, there was a significant impact of the female gender on increased physical symptoms, while age, work experience and occupation had no further influence. Conclusions: These results that hospital medical staff is less psychologically stressed when closer to COVID-19 patients are inconsistent with previous studies. Self-efficacy and locus of control in these situations are relevant for processing the trauma. In summary, perception of personal risk is essential. Proximity is believed to be a proxy variable for personal risk perception. As a synopsis of these results, regular briefings of the hospital staff are recommended to prevent psychological impairment. They should contain specific information about conditions in the affected wards and the risk of infection, which could help reduce risk perception of medical personnel

changes in PTSD prevalence in military personnel

Background: Recently, changes have been introduced to the diagnostic criteria for posttraumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). Objectives: This study investigated the effect of the diagnostic changes made from DSM-IV to DSM-5 and from ICD-10 to the proposed ICD-11. The concordance of provisional PTSD prevalence between the diagnostic criteria was examined in a convenience sample of 100 members of the German Armed Forces. Method: Based on questionnaire measurements, provisional PTSD prevalence was assessed according to DSM-IV, DSM-5, ICD-10, and proposed ICD-11 criteria. Consistency of the diagnostic status across the diagnostic systems was statistically evaluated. Results: Provisional PTSD prevalence was the same for DSM-IV and DSM-5 (both 56%) and comparable under DSM-5 versus ICD-11 proposal (48%). Agreement between DSM-IV and DSM-5, and between DSM-5 and the proposed ICD-11, was high (both p < .001). Provisional PTSD prevalence was significantly increased under ICD-11 proposal compared to ICD-10 (30%) which was mainly due to the deletion of the time criterion. Agreement between ICD-10 and the proposed ICD-11 was low (p = .014). Conclusion: This study provides preliminary evidence for a satisfactory concordance between provisional PTSD prevalence based on the diagnostic criteria for PTSD that are defined using DSM-IV, DSM-5, and proposed ICD-11. This supports the assumption of a set of PTSD core symptoms as suggested in the ICD-11 proposal, when at the same time a satisfactory concordance between ICD-11 proposal and DSM was given. The finding of increased provisional PTSD prevalence under ICD-11 proposal in contrast to ICD-10 can be of guidance for future epidemiological research on PTSD prevalence, especially concerning further investigations on the impact, appropriateness, and usefulness of the time criterion included in ICD-10 versus the consequences of its deletion as proposed for ICD-11

PROXIMITY TO COVID-19 ON MENTAL HEALTH SYMPTOMS AMONG HOSPITAL MEDICAL STAFF

Background: Exposure to patients with COVID-19 can have a significant impact on mental health of hospital medical staff. The aim of this study was to examine the influence of proximity to patients with COVID-19 considering occupational position and gender on the mental health of hospital staff. Subjects and methods: N=78 participants were included in the study, with n=40 of them with direct contact to patients with COVID-19 (51%); eight had contact with patients suspected of having COVID-19 (10%), and n=30 with no direct contact to people with COVID-19 (39%). Results: Multinomial regression analyses showed that proximity had a negative (inverse) influence on avoidance behaviour as part of PTSD, physical symptoms, somatization, compulsiveness and anger expression-in as tendency to suppress anger. In addition, there was a significant impact of the female gender on increased physical symptoms, while age, work experience and occupation had no further influence. Conclusions: These results that hospital medical staff is less psychologically stressed when closer to COVID-19 patients are inconsistent with previous studies. Self-efficacy and locus of control in these situations are relevant for processing the trauma. In summary, perception of personal risk is essential. Proximity is believed to be a proxy variable for personal risk perception. As a synopsis of these results, regular briefings of the hospital staff are recommended to prevent psychological impairment. They should contain specific information about conditions in the affected wards and the risk of infection, which could help reduce risk perception of medical personnel

The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial.

Leppert F, Siebermair J, Wesemann U, et al. The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial. Clinical research in cardiology : official journal of the German Cardiac Society. 2020.BACKGROUND: Impact of telemedicine with remote patient monitoring (RPM) in implantable cardioverter-defibrillator (ICD) patients on clinical outcomes has been investigated in various clinical settings with divergent results. However, role of RPM on patient-reported-outcomes (PRO) is unclear. The INFRARED-ICD trial aimed to investigate the effect of RPM in addition to standard-of-care on PRO in a mixed ICD patient cohort.; METHODS AND RESULTS: Patients were randomized to RPM (n=92) or standard in-office-FU (n=88) serving as control group (CTL). At baseline and on a monthly basis over 1 year, study participants completed the EQ-5D questionnaire for the primary outcome Quality of Life (QoL), the Hospital Anxiety and Depression Scale, and the Florida Patient Acceptance Survey questionnaire for secondary outcomes. Demographic characteristics (82% men, mean age 62.3years) and PRO at baseline were not different between RPM and CTL. Primary outcome analysis showed that additional RPM was not superior to CTL with respect to QoL over 12months [+1.2 vs.+3.9 points in CTL and RPM group, respectively (p=0.24)]. Pre-specified analyses could not identify subgroups with improved QoL by the use of RPM. Neither levels of anxiety (-0.4 vs. -0.3, p=0.88), depression (+0.3 vs.±0.0, p=0.38), nor device acceptance (+1.1 vs.+1.6, p=0.20) were influenced by additional use of RPM.; CONCLUSION: The results of the present study show that PRO were not improved by RPM in addition to standard-of-care FU. Careful evaluation and planning of future trials in selected ICD patients are warranted before implementing RPM in routine practice

Incidence of mental disorders in soldiers deployed to Afghanistan who have or have not experienced a life-threatening military incident—a quasi-experimental cohort study

IntroductionThere is very good international research on deployment-related mental disorders in military personnel. The incidence rates show a very wide range. A new strategy is therefore proposed in order to achieve better standardization and thus better comparability of the studies. In addition to a non-deployed comparison group, we propose to compare deployed soldiers with and without critical military incidents during the deployment. This additional distinction makes it possible to differentiate between the influencing variables of actual threat and general deployment stress.MethodsN = 358 male combat soldiers deployed to Afghanistan were included in the study. Clinical interviews were conducted several days before deployment and after deployment. Of them, n = 80 soldiers suffered a life-threatening military incident during deployment, whereas 278 soldiers did not. Odds ratios (OR) were calculated for the groups with and without critical military incidents and the new onset for PTSD, anxiety disorders and depressive disorders.ResultsWhen comparing both groups, we found significantly higher 1-year incidence rates in the group with critical military incidents: 6.4% vs. 1.1% (OR 6.2) for post-traumatic stress disorder (PTSD); 7.0% vs. 1.1% (OR 6.5) for depression; and 15.9% vs. 2.8% (OR 6.6) for anxiety disorders. The 1-year incidence rate of mental multimorbidity (PTSD with anxiety or depression) was 4.8% vs. 0.4% (OR 12.0).DiscussionThese results indicate that life-threatening military incidents during military deployment are important to mental health. As the different threat levels of the various missions are taken into account, additional predictors could be determined more precisely in further research

Strengthening the mental fitness of emergency responders

Einsatzkräfte unterscheiden sich aufgrund der Berufsselektion und dem damit zusammenhängenden Berufsstatus und Lebensalter von der Allgemeinbevölkerung. Ansonsten ist ihr „Lebensrisiko“ zur Entwicklung von psychischen Beeinträchtigungen vergleichbar – mit der Ausnahme der berufsbedingten Risiken. Da bei psychischen Störungen von Einsatzkräften keine von der Allgemeinbevölkerung unterschiedlichen Therapieverfahren eingesetzt werden müssen, bleiben zur Minimierung der diesbezüglichen beruflichen Risiken die Säulen der Einsatzvor- und -nachbereitung sowie die der De-Stigmatisierung. Um die Einsatzvor- und -nachbereitung möglichst spezifisch auf die unterschiedlichen Berufsgruppen und Geschlechter auszurichten, ist die Erfassung der verschiedenen Risikoprofile notwendig. Dieses Wissen kann dann direkt in die Maßnahmen und in die berufliche Ausbildung einfließen. Ein regelmäßiges Überprüfen der mentalen Fitness kann in diesem Segment ebenfalls helfen, Fördermöglichkeiten zu identifizieren. Da solche Ansätze jedoch maßgeblich von der Akzeptanz der Teilnehmenden abhängen, sollten sie freiwillig bleiben und den Fokus auf positive Aspekte wie Trainierbarkeit oder Resilienz richten. Zudem ist ein repetitives Screening meist nur dann sinnvoll, wenn entsprechende Trainings- und Fördermöglichkeiten zur Verfügung stehen, die unterhalb psychotherapeutischer Interventionen angesiedelt sind. Diese könnten beispielsweise im Rahmen eines betrieblichen Gesundheitsmanagements umgesetzt werden. Wenn sie eine entsprechende Bandbreite abdecken, dürfte dies auch einen positiven Einfluss auf die Perzeption dieser Angebote haben. Ein weiterer wichtiger Baustein ist die De-Stigmatisierung. Einsatzkräfte neigen aus Angst vor Stigmatisierung stärker dazu, Symptome psychischer Störungen zu verschweigen und sich nicht behandeln zu lassen. Angst vor Karrierenachteilen und der Wunsch, allein mit dem Problem fertig zu werden, sind die angegebenen Hauptgründe dafür (Wittchen et al., 2012; DePierro et al., 2021). Unter dem Ansatz „vom Helden zum Profi“ konnten Einsatzkräfte zu einer kognitiven Neubewertung gelangen und anerkennen, dass psychische Störungen genauso zu den berufsbedingten Risiken gehören wie physische Verletzungen (Wesemann et al., 2016). Häufig sind es jedoch nicht nur die Betroffenen selbst, die unter den Störungen leiden, sondern auch ihre Angehörigen. Der frühe Einbezug dieser Gruppe könnte eine Trendwende in der De-Stigmatisierung darstellen. Da die Angehörigen die Betroffenen in der Regel sehr gut kennen, bemerken sie die Veränderungen meist unmittelbar. Dieses frühe Erkennen kann aber auch zu Unsicherheiten bezüglich der eigenen Einschätzung führen. Sofern sie ein Instrument zur Beurteilung, ob diese Veränderungen noch im normalen Bereich liegen, zur Hand hätten, wäre eine gewisse Handlungssicherheit gegeben. Damit könnten sie die Betroffenen gezielter ansprechen und gemeinsam nach Lösungsmöglichkeiten suchen. Die größte Wirkung kann vermutlich erzielt werden, indem alle genannten Ansätze in einem Gesamtkonzept umgesetzt werden.Emergency responders differ from the general population in terms of their choice of occupation and the associated professional position and age. Otherwise, their “life risk” of developing psychological impairments is comparable – with the exception of the occupational risks. Since no other therapy methods than in the general population have to be used in the case of mental disorders in emergency service personnel, the pillars of deployment preparation and follow-up as well as destigmatization to minimize the corresponding occupational risks remain in place. In order to align the deployment preparation and follow-up as specifically as possible to the different professional groups and genders, it is necessary to record the different risk profiles. This knowledge can then flow directly into the measures and training. Regular checks of mental fitness can also help to identify funding opportunities in this segment. However, since such approaches largely depend on the acceptance of the participants, they should remain voluntary and focus on positive aspects such as trainability or resilience. In addition, repeat screening is usually only useful if appropriate training and support options are available that are subordinate to psychotherapeutic interventions. These could be implemented, for example, as part of company health management. If they cover a corresponding range, this should also have a positive effect on the perception of these offers. Another important building block is destigmatization. For fear of stigma, emergency responders are more likely to hide symptoms of mental disorders and refuse to seek treatment. The main reasons given are the fear of professional disadvantages and the desire to cope with the problem alone (Wittchen et al., 2012; DePierro et al., 2021). As part of the "from hero to pro" approach, emergency responders were able to perform a cognitive reassessment and recognize that mental disorders are as much an occupational hazard as physical injuries (Wesemann et al., 2016). Frequently, however, not only those affected suffer from the diseases, but also their relatives. The early involvement of this group could represent a trend reversal in destigmatization. Since the relatives usually know those affected very well, they usually notice the changes immediately. However, this early detection can also lead to uncertainties in one's own assessment. If they had a tool to assess whether these changes were still within normal limits, there would be some certainty to act. In this way, they could address those affected more specifically and look for possible solutions together. The greatest effect can probably be achieved if all the approaches mentioned are implemented in an overall concept