Social and economic costs of gambling problems and related harm among UK military veterans.

INTRODUCTION: Military veterans are at heightened risk of problem gambling. Little is known about the costs of problem gambling and related harm among United Kingdom (UK) Armed Forces (AF) veterans. We investigated the social and economic costs of gambling among a large sample of veterans through differences in healthcare and social service resource use compared with age-matched and gender-matched non-veterans from the UK AF Veterans' Health and Gambling Study. METHODS: An online survey measured sociodemographic characteristics, gambling experience and problem severity, mental health and healthcare resource utilisation. Healthcare provider, personal social service and societal costs were estimated as total adjusted mean costs and utility, with cost-consequence analysis of a single timepoint. RESULTS: Veterans in our sample had higher healthcare, social service and societal costs and lower utility. Veterans had greater contacts with the criminal justice system, received more social service benefits, had more lost work hours and greater accrued debt. A cost difference of £590 (95% CI -£1016 to -£163) was evident between veterans with scores indicating problem gambling and those reporting no problems. Costs varied by problem gambling status. CONCLUSIONS: Our sample of UK AF veterans has higher healthcare, social service and societal costs than non-veterans. Veterans experiencing problem gambling are more costly but have no reduction in quality of life.

Randomized controlled trial of multi-modular motion-assisted memory desensitization and reconsolidation (3MDR) for male military veterans with treatment-resistant post-traumatic stress disorder.

OBJECTIVE: To explore the potential efficacy of multi-modular motion-assisted memory desensitization and reprocessing (3MDR) in British military veterans with treatment-resistant service-related PTSD. METHODS: Exploratory single-blind, randomized, parallel arm, cross-over controlled trial with nested process evaluation to assess fidelity, adherence and factors that influence outcome. RESULTS: A total of 42 participants (all male) were randomized with 83% retention at 12 weeks and 86% at 26 weeks. The difference in mean Clinician-Administered PTSD Scale for DSM-5 scores between the immediate and delayed 3MDR arms was -9.38 (95% CI -17.33 to -1.44, P = 0.021) at 12 weeks and -3.59 (-14.39 to 7.20, P = 0.513) at 26 weeks when both groups had received 3MDR. The likely effect size of 3MDR was found to be 0.65. Improvements were maintained at 26-week follow-up. 3MDR was found to be acceptable to most, but not all, participants. Several factors that may impact efficacy and acceptability of 3MDR were identified. CONCLUSION: 3MDR is a promising new intervention for treatment-resistant PTSD with emerging evidence of effect.

Experience of implementing an adult educational approach to treating anxiety disorders.

This paper describes the background to the development and delivery of a self-help package for anxiety disorders. Evidence of effectiveness is summarized. The paper outlines the intervention and describes the experience of two mental health nurses, who set out to assess its acceptability, evaluate its outcomes in routine clinical practice and assess the feasibility of its delivery by mental health nurses. Acceptability of the intervention was high, judged by retention and attendance rates. The pilot study produced promising clinical outcomes, especially for people with depression secondary to anxiety. Clinical measures showed significant improvements from pre-course to 6-month follow-up in anxiety, psychological well-being and depression. The outcomes suggest that appropriately trained mental health nurses could deliver the intervention as a routine treatment. The paper concludes by discussing future plans, including a randomized controlled trial and implementation in primary care.

Unreliable evidence.

As the need for effective evidence-based practice comes under close scrutiny we investigate the effectiveness of three interventions; thought suppression, reassurance and relaxation, that are routinely offered to clients. These strategies have very little evidence to support their continued use. The article continues by discussing and describing situations where more helpful evidence-based interventions are better suited.

Behavioral treatment of PTSD in a perpetrator of manslaughter: a single case study.

Studies of posttraumatic stress disorder (PTSD) have predominantly focused on victims of trauma. Some studies have examined the after-effects of a person's own violent actions in combat or police situations. However, there is a sparsity of literature examining the development of PTSD in convicted perpetrators of violent crime, and there is no literature concerning the treatment of PTSD in such perpetrators. This single-case study presents the outcome of behavioral treatment in one case in which the patient had PTSD consequential to being a perpetrator of manslaughter. The theoretical implications of this case are briefly discussed.

Using EMDR to treat post-traumatic stress disorder in a prison setting.

This article describes the treatment of a young man who developed post-traumatic stress disorder (PTSD) following the sudden unexpected miscarriage of his unborn child. He was diagnosed with this anxiety disorder while serving a term of imprisonment. He was treated with a controversial psychological treatment for PTSD, eye movement desensitisation reprocessing (EMDR) therapy, during one, 1-hour session. After this session, his progress was monitored by a further three follow-up appointments at 1 week, 1 month and 3 months, where the self-report questionnaires were repeated and compared with pre-treatment scores. These demonstrated improvement post-treatment and at a 3-month follow-up session. The discussion arising from the treatment will concentrate on EMDR as an effective treatment for PTSD, particularly within a prison setting. Data from recent research highlight the potential risks of PTSD within a community population and the implications for midwives and nurses who treat and care for traumatized patients are discussed.

Suicide policies in secure environments.

A cohort of nurses and prison officers working in regional secure units, special hospitals and prisons were surveyed to establish their attitudes about observation policies designed to prevent patients/inmates from committing suicide. The results suggest that policies are rarely, if ever, reviewed, although there appear to be differences of emphasis in the three environments. Recommendations of the study include the need for improved staff communication, regular review of policies and better preparation of personnel.