The stigma of mental health problems and other barriers to care in the UK Armed Forces.

BACKGROUND: As with the general population, a proportion of military personnel with mental health problems do not seek help. As the military is a profession at high risk of occupational psychiatric injury, understanding barriers to help-seeking is a priority. METHOD: Participants were drawn from a large UK military health study. Participants undertook a telephone interview including the Patient Health Questionnaire (PHQ); a short measure of PTSD (Primary Care PTSD, PC-PTSD); a series of questions about service utilisation; and barriers to care. The response rate was 76% (821 participants). RESULTS: The most common barriers to care reported are those relating to the anticipated public stigma associated with consulting for a mental health problem. In addition, participants reported barriers in the practicalities of consulting such as scheduling an appointment and having time off for treatment. Barriers to care did not appear to be diminished after people leave the Armed Forces. Veterans report additional barriers to care of not knowing where to find help and a concern that their employer would blame them for their problems. Those with mental health problems, such as PTSD, report significantly more barriers to care than those who do not have a diagnosis of a mental disorder. CONCLUSIONS: Despite recent efforts to de-stigmatise mental disorders in the military, anticipated stigma and practical barriers to consulting stand in the way of access to care for some Service personnel. Further interventions to reduce stigma and ensuring that Service personnel have access to high quality confidential assessment and treatment remain priorities for the UK Armed Forces.

Help-seeking and receipt of treatment among UK service personnel.

BACKGROUND: For armed forces personnel, data on help-seeking behaviour and receipt of treatment for mental disorders are important for both research and policy. AIMS: To examine mental healthcare service use and receipt of treatment in a sample of the UK military. METHOD: Participants were drawn from an existing UK military health cohort. The sample was stratified by reserve status and by participation in the main war-fighting period of the Iraq War. Participants completed a telephone-based structured diagnostic interview comprising the Patient Health Questionnaire and Primary Care Post-Traumatic Stress Disorder Screen (PC-PTSD), and a series of questions about service utilisation and treatment receipt. RESULTS: Only 23% of those with common mental disorders and still serving in the military were receiving any form of medical professional help. Non-medical sources of help such as chaplains were more widely used. Among regular personnel in receipt of professional help, most were seen in primary care (79%) and the most common treatment was medication or counselling/psychotherapy. Few regular personnel were receiving cognitive-behavioural therapy (CBT). These findings are comparable with those reported for the general population. CONCLUSIONS: In the UK armed forces, the majority of those with mental disorders are not currently seeking medical help for their symptoms. Further work to understand barriers to care is important and timely given that this is a group at risk of occupational psychiatric injury.

50 ways to trace your veteran: increasing response rates can be cheap and effective.

BACKGROUND: while low response rates need not introduce bias into research, having a lower percentage of responders does increase the potential for this to occur. This is of particular concern given the decline that has been occurring in response rates since the 1950s. However, there are various methods that can be incorporated into the study design, which can assist in increasing levels of participation. OBJECTIVE: To outline the methods used by the King's Centre for Military Health Research (KCMHR) when conducting a recent telephone survey of serving and ex-Service military personnel. DESIGN: Using participants who had already taken part in a questionnaire-based study on the health effects of serving in the UK Armed Forces (n=10,272), a subsample was selected for an in-depth telephone interview-based follow-up study. The subsample consisted of 1,105 participants, selected on the basis of their mental health status. An adjusted response rate of 76% was achieved (n=821). RESULTS: Various methods of contact were used in this study to ensure an adequate response rate was achieved. CONCLUSIONS: Simple research strategies increase response rates and are likely to reduce bias. Use of multiple simultaneous tracing methods and customisation of the approach to the target population increases rapport between participants, ensuring that those who take part feel valued as members of the study. In the current climate of decreasing participation in studies, research teams need to engage with their study population and devise innovative strategies to keep participants involved in the research being undertaken.

The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study.

BACKGROUND: The mental health of the Armed Forces is an important issue of both academic and public interest. The aims of this study are to: a) assess the prevalence and risk factors for common mental disorders and post traumatic stress disorder (PTSD) symptoms, during the main fighting period of the Iraq War (TELIC 1) and later deployments to Iraq or elsewhere and enlistment status (regular or reserve), and b) compare the prevalence of depression, PTSD symptoms and suicidal ideation in regular and reserve UK Army personnel who deployed to Iraq with their US counterparts. METHODS: Participants were drawn from a large UK military health study using a standard two phase survey technique stratified by deployment status and engagement type. Participants undertook a structured telephone interview including the Patient Health Questionnaire (PHQ) and a short measure of PTSD (Primary Care PTSD, PC-PTSD). The response rate was 76% (821 participants). RESULTS: The weighted prevalence of common mental disorders and PTSD symptoms was 27.2% and 4.8%, respectively. The most common diagnoses were alcohol abuse (18.0%) and neurotic disorders (13.5%). There was no health effect of deploying for regular personnel, but an increased risk of PTSD for reservists who deployed to Iraq and other recent deployments compared to reservists who did not deploy. The prevalence of depression, PTSD symptoms and subjective poor health were similar between regular US and UK Iraq combatants. CONCLUSION: The most common mental disorders in the UK military are alcohol abuse and neurotic disorders. The prevalence of PTSD symptoms remains low in the UK military, but reservists are at greater risk of psychiatric injury than regular personnel.

Transition back into civilian life: a study of personnel leaving the U.K. armed forces via "military prison".

OBJECTIVE: The purpose of this study was to identify the factors associated with poor outcomes for personnel leaving the United Kingdom Armed Forces early. METHOD: We studied a population thought to be at high risk of poor outcomes: those leaving the Services early via the United Kingdom Military Corrective Training Centre. Participants were interviewed 1 week before leaving (predischarge) and followed up 6 months later. One hundred eleven participants completed predischarge interviews. Seventy-four (67%) were successfully followed up and interviewed 6 months later. RESULTS: Thirty-eight of those followed up (56%) were classed as being disadvantaged after leaving. Being disadvantaged at follow-up was associated with: having predischarge mental health problems, receiving an administrative discharge, or having a short sentence length. CONCLUSION: Factors associated with poor outcomes on leaving were often interrelated, making causal relationships complex. However, this study does provide a basis from which to identify, at the point of discharge, those most at risk of further disadvantage.