Visual impairment, coping strategies and impact on daily life: a qualitative study among working-age UK ex-service personnel.

BACKGROUND: Sustaining a visual impairment may have a substantial impact on various life domains such as work, interpersonal relations, mobility and social and mental well-being. How to adjust to the loss of vision and its consequences might be a challenge for the visually impaired person. The purpose of the current study was to explore how younger male ex-Service personnel cope with becoming visually impaired and how this affects their daily life. METHODS: Semi-structured interviews with 30 visually impaired male ex-Service personnel, all under the age of 55, were conducted. All participants are members of the charity organisation Blind Veterans UK. Interviews were analysed thematically. RESULTS: Younger ex-Service personnel applied a number of different strategies to overcome their loss of vision and its associated consequences. Coping strategies varied from learning new skills, goal setting, integrating the use of low vision aids in their daily routine, to social withdrawal and substance misuse. Vision loss affected on all aspects of daily life and ex-Service personnel experienced an on-going struggle to accept and adjust to becoming visually impaired. CONCLUSIONS: Health care professionals, family and friends of the person with the visual impairment need to be aware that coping with a visual impairment is a continuous struggle; even after a considerable amount of time has passed, needs for emotional, social, practical and physical support may still be present.

The mental health of UK ex-servicemen with a combat-related or a non-combat-related visual impairment: does the cause of visual impairment matter?

AIMS: Since the start of the conflicts in Iraq and Afghanistan, the numbers of young service personnel who have sustained a combat-related visual impairment have increased. This cross-sectional study examined the mental well-being of ex-servicemen (aged 22-55 years) with a visual impairment and determined if the mental health of those with a combat-related visual impairment differed from those whose visual impairment is not combat-related. METHODS: Male ex-service personnel with a visual impairment completed a telephone interview assessing the presence of depressive symptomatology, probable anxiety disorder, post-traumatic stress disorder (PTSD) symptomatology and alcohol misuse. Data were analysed using descriptive statistics. RESULTS: 77 participants were included in the study, reflecting a response rate of 76.2%. Of those with complete data (n=74), 20 ex-servicemen had a combat-related visual impairment. Among ex-service personnel with a combat-related visual impairment, 10.0% (95% CI 0 to 23.2) screened positive for a probable depression, 25.0% (95% CI 6.0 to 44.0) for probable anxiety and 10.0% (95% CI 0 to 23.2) for probable PTSD. The prevalence of probable depression and probable PTSD differed among those with a non-combat-related visual impairment, namely 18.5% (95% CI 8.1 to 28.9) and 16.7% (95% CI 6.8 to 26.7), respectively. Probable anxiety was 18.5% (95% CI 8.1 to 28.9) among non-combat-related visually impaired ex-service personnel. 45.0% (95% CI 23.2 to 66.8) of combat-related visually impaired personnel reported hazardous drinking, compared with 20.4% (95% CI 9.7 to 31.2) of those with a non-combat-related visual impairment. CONCLUSIONS: Mental health problems were prevalent among visually impaired younger ex-servicemen. No statistically significant differences were found in the prevalence of mental health problems among ex-servicemen with a combat-related visual impairment compared with those with a non-combat-related visual impairment.

Care pathways for UK and US service personnel who are visually impaired.

OBJECTIVES: The aim of this paper is to outline the different care pathways for sudden and gradual vision loss within UK and US military systems, as well as the provision of support by the main third-sector organisations looking after visually impaired (ex-) service personnel. METHODS: The Defence Medical Rehabilitation Centre, Headley Court and Queen Elizabeth Hospital Birmingham were consulted to obtain information and relevant documentation on UK care pathways. Experts in the field of visual impairment and the military-provided information on care pathways for US service personnel were consulted. The majority of the information on US care pathways was gathered from the Department of Veterans Affairs website and unclassified documents. RESULTS: The care pathways for UK and US service personnel with a visual impairment vary depending on the cause of visual impairment. Blind Veterans UK and the Blinded Veterans Association are the main organisations that support UK and US (ex-) service personnel, often filling in the gaps that other services do not have the resources to provide. The main difference between the two pathways, other than the UK healthcare system being free at the point of service, is that the Veteran Health Administration is one of the first national healthcare systems to integrate rehabilitation services for personnel with a visual impairment into the health services provided. DISCUSSION: The UK could benefit from having specific care coordinators for service personnel that specifically integrate rehabilitation, medical care and treatment for their visual impairment.

The impact of exercise projects to promote mental wellbeing.

BACKGROUND: There is a well-established link between physical activity and psychological wellbeing, but less evidence on whether it can increase comfort in disclosure of mental health problems and help to reduce the perceived stigma of mental illness. AIMS: To investigate whether exercise projects, funded by the time to change anti-stigma programme to reduce mental health-related stigma and discrimination in England, can improve (1) wellbeing, (2) participation in physical activity, (3) readiness to disclose mental health problems or (4) perceived reduction in levels of stigma and discrimination. METHODS: Participants of exercise projects run in routine community settings by local Mind and Rethink Mental Illness associations completed the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and questions addressing the other three outcomes at baseline and three month follow-up (N = 2663 baseline; N = 531 three month follow-up). RESULTS: There was significant improvement at three months on the WEMWBS (t(386) = -7.64, p = <0.001, r = 0.36); readiness to disclose (χ(2)(1) = 10.86, p = 0.001) and participation in physical activity outside of the project (χ(2)(1) = 12.01, p = 0.001). CONCLUSIONS: Community-based exercise projects have the potential to produce multifaceted positive outcomes for people with mental health problems; however, more methodologically robust studies are needed to adequately determine the effects of exercise.

Prevalence and risk of experiences of intimate partner violence among people with eating disorders: a systematic review.

OBJECTIVES: To estimate the prevalence and risk of lifetime and past year intimate partner violence (IPV) among males and females with eating disorders. METHODS: Systematic review. We searched 15 electronic databases, supplemented by hand searching, citation tracking, updating a review on victimisation and mental disorder and expert recommendations. RESULTS: Eight papers were included, involving 6775 females and 4857 males. Individual studies reported that eating disorders are associated with a high prevalence and increased odds of lifetime IPV among both males and females. Evidence is lacking on eating disorder and past year IPV, on whether associations between eating disorder and IPV vary by type of IPV, and temporality. DISCUSSION: More research is needed to investigate the strength and nature of the association between eating disorders and IPV, including with regards to the direction of causality between eating disorders and IPV, and whether associations are mediated by childhood abuse.

Influence of Time to Change's social marketing interventions on stigma in England 2009-2011.

BACKGROUND: England's Time To Change (TTC) social marketing campaign emphasised social contact between people with and without mental health problems to reduce stigma and discrimination. AIMS: We aimed to assess the effectiveness of the mass media component and also that of the mass social contact events. METHOD: Online interviews were performed before and after each burst of mass media social marketing to evaluate changes in knowledge, attitudes and behaviour and associations between campaign awareness and outcomes. Participants at social contact events were asked about the occurrence and quality of contact, attitudes, readiness to discuss mental health and intended behaviour towards people with mental health problems. RESULTS: Prompted campaign awareness was 38-64%. A longitudinal improvement was noted for one intended behaviour item but not for knowledge or attitudes. Campaign awareness was positively associated with greater knowledge (ß = 0.80, 95% CI 0.52-1.08) and more favourable attitudes (commonality OR 1.37, 95% CI 1.10-1.70; dangerousness OR 1.41, 95% CI 1.22-1.63) and intended behaviour (ß = 0.75, 95% CI 0.53-0.96). Social contact at events demonstrated a positive impact (M = 2.68) v. no contact (M = 2.42) on perceived attitude change; t(211) = 3.30, P = 0.001. Contact quality predicted more positive attitude change (r = 0.33, P<0.01) and greater confidence to challenge stigma (r = 0.38, P<0.01). CONCLUSIONS: The favourable short-term consequences of the social marketing campaign suggest that social contact can be used by anti-stigma programmes to reduce stigma.

Mental illness among journalists: a systematic review.

BACKGROUND: Mass media depictions of people with mental illness have a strong influence on public attitudes, to the extent that changes in these depictions can reduce public stigmatization of people with such illness. Journalists' mental health may influence their depiction of those with mental illness, but little is known about this. AIMS: To investigate mental illness among journalists in five key areas: (1) journalists' mental health status; (2) journalists' personal attitudes towards mental illness; (3) attitudes and support journalists expect or have experienced from colleagues when they have a mental health problem; (4) effect of journalism's professional culture on the course of mental illness; and (5) effect of journalism's professional culture on mass media depictions of people with mental illness. METHODS: We performed a systematic screening of MEDLINE, PsycINFO, EMBASE, Web of Science and the Cochrane Library regarding the study aims. RESULTS: We identified 19, 12, seven and four studies for aims 1, 2, 3, and 4, respectively. No articles were found for aim 5. CONCLUSIONS: The prevalence of post-traumatic stress disorder (PTSD) among journalists is higher than that among the general population. Journalists have positive personal attitudes towards mental illness, but there are perceived workplace disincentives to disclose mental health problems.

Systematic review of beliefs, behaviours and influencing factors associated with disclosure of a mental health problem in the workplace.

BACKGROUND: Stigma and discrimination present an important barrier to finding and keeping work for individuals with a mental health problem. This paper reviews evidence on: 1) employment-related disclosure beliefs and behaviours of people with a mental health problem; 2) factors associated with the disclosure of a mental health problem in the employment setting; 3) whether employers are less likely to hire applicants who disclose a mental health problem; and 4) factors influencing employers' hiring beliefs and behaviours towards job applicants with a mental health problem. METHODS: A systematic review was conducted for the period 1990-2010, using eight bibliographic databases. Meta-ethnography was used to provide a thematic understanding of the disclosure beliefs and behaviours of individuals with mental health problem. RESULTS: The searches yielded 8,971 items which was systematically reduced to 48 included studies. Sixteen qualitative, one mixed methods and seven quantitative studies were located containing evidence on the disclosure beliefs and behaviours of people with a mental health problem, and the factors associated with these beliefs and behaviours. In the meta-ethnography four super-ordinate themes were generated: 1) expectations and experiences of discrimination; 2) other reasons for non-disclosure; 3) reasons for disclosure; and 4) disclosure dimensions. Two qualitative, one mixed methods and 22 quantitative studies provided data to address the remaining two questions on the employers perspective. CONCLUSIONS: By presenting evidence from the perspective of individuals on both sides of the employment interaction, this review provides integrated perspective on the impact of disclosure of a mental health problem on employment outcomes.