Little is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.AimsWe examined the prevalence of mental ...disorders and alcohol misuse, whether this differed between serving and ex-serving regular personnel and by deployment status.
This is the third phase of a military cohort study (2014-2016; n = 8093). The sample was based on participants from previous phases (2004-2006 and 2007-2009) and a new randomly selected sample of those who had joined the UK armed forces since 2009.
The prevalence was 6.2% for probable post-traumatic stress disorder, 21.9% for common mental disorders and 10.0% for alcohol misuse. Deployment to Iraq or Afghanistan and a combat role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel.
The findings highlight an increasing prevalence of post-traumatic stress disorder and a lowering prevalence of alcohol misuse compared with our previous findings and stresses the importance of continued surveillance during service and beyond.
All authors are based at King's College London which, for the purpose of this study and other military-related studies, receives funding from the UK Ministry of Defence (MoD). S.A.M.S., M.J., L.H., D.P., S.M. and R.J.R. salaries were totally or partially paid by the UK MoD. The UK MoD provides support to the Academic Department of Military Mental Health, and the salaries of N.J., N.G. and N.T.F. are covered totally or partly by this contribution. D.Mu. is employed by Combat Stress, a national UK charity that provides clinical mental health services to veterans. D.MacM. is the lead consultant for an NHS Veteran Mental Health Service. N.G. is the Royal College of Psychiatrists' Lead for Military and Veterans' Health, a trustee of Walking with the Wounded, and an independent director at the Forces in Mind Trust; however, he was not directed by these organisations in any way in relation to his contribution to this paper. N.J. is a full-time member of the armed forces seconded to King's College London. N.T.F. reports grants from the US Department of Defense and the UK MoD, is a trustee (unpaid) of The Warrior Programme and an independent advisor to the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee (unpaid) of Combat Stress and Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid). S.W. is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, the Department of Health, Public Health England or the UK MoD.
The prevalence of food allergy: A meta-analysis Rona, Roberto J., FFPH; Keil, Thomas, MD; Summers, Colin, BSc ...
Journal of allergy and clinical immunology,
09/2007, Letnik:
120, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Background There is uncertainty about the prevalence of food allergy in communities. Objective To assess the prevalence of food allergy by performing a meta-analysis according to the method of ...assessment used. Methods The foods assessed were cow's milk, hen's egg, peanut, fish, shellfish, and an overall estimate of food allergy. We summarized the information in 5 categories: self-reported symptoms, specific IgE positive, specific skin prick test positive, symptoms combined with sensitization, and food challenge studies. We systematically searched MEDLINE and EMBASE for publications since 1990. The meta-analysis included only original studies. They were stratified by age groups: infant/preschool, school children, and adults. Results A total of 934 articles were identified, but only 51 were considered appropriate for inclusion. The prevalence of self-reported food allergy was very high compared with objective measures. There was marked heterogeneity between studies regardless of type of assessment or food item considered, and in most analyses this persisted after age stratification. Self-reported prevalence of food allergy varied from 1.2% to 17% for milk, 0.2% to 7% for egg, 0% to 2% for peanuts and fish, 0% to 10% for shellfish, and 3% to 35% for any food. Conclusion There is a marked heterogeneity in the prevalence of food allergy that could be a result of differences in study design or methodology, or differences between populations. Clinical implications We recommend that measurements be made by using standardized methods, if possible food challenge. We need to be cautious in estimates of prevalence based only on self-reported food allergy.
Summary Background Violent offending by veterans of the Iraq and Afghanistan conflicts is a cause for concern and there is much public debate about the proportion of ex-military personnel in the ...criminal justice system for violent offences. Although the psychological effects of conflict are well documented, the potential legacy of violent offending has yet to be ascertained. We describe our use of criminal records to investigate the effect of deployment, combat, and post-deployment mental health problems on violent offending among military personnel relative to pre-existing risk factors. Methods In this cohort study, we linked data from 13 856 randomly selected, serving and ex-serving UK military personnel with national criminal records stored on the Ministry of Justice Police National Computer database. We describe offending during the lifetime of the participants and assess the risk factors for violent offending. Findings 2139 (weighted 17·0%) of 12 359 male UK military personnel had a criminal record for any offence during their lifetime. Violent offenders (1369 11·0%) were the most prevalent offender types; prevalence was highest in men aged 30 years or younger (521 20·6% of 2728) and fell with age (164 4·7% of 3027 at age >45 years). Deployment was not independently associated with increased risk of violent offending, but serving in a combat role conferred an additional risk, even after adjustment for confounders (violent offending in 137 6·3% of 2178 men deployed in a combat role vs 140 (2·4%) of 5797 deployed in a non-combat role; adjusted hazard ratio 1·53, 95% CI 1·15–2·03; p=0·003). Increased exposure to traumatic events during deployment also increased risk of violent offending (violent offending in 104 4·1% of 2753 men with exposure to two to four traumatic events vs 56 1·6% of 2944 with zero to one traumatic event, 1·77, 1·21–2·58, p=0·003; and violent offending in 122 5·1% of 2582 men with exposure to five to 16 traumatic events, 1·65, 1·12–2·40, p=0·01; test for trend, p=0·032). Violent offending was strongly associated with post-deployment alcohol misuse (violent offending in 120 9·0% of 1363 men with alcohol misuse vs 155 2·3% of 6768 with no alcohol misuse; 2·16, 1·62–2·90; p<0·0001), post-traumatic stress disorder (violent offending in 25 8·6% of 344 men with post-traumatic stress disorder vs 221 3·0% of 7256 with no symptoms of post-traumatic stress disorder; 2·20, 1·36–3·55; p=0·001), and high levels of self-reported aggressive behaviour (violent offending in 56 6·7% of 856 men with an aggression score of six to 16 vs 22 1·2% of 1685 with an aggression score of zero; 2·47, 1·37–4·46; p=0·003). Of the post-traumatic stress disorder symptoms, the hyperarousal cluster was most strongly associated with violent offending (2·01, 1·50–2·70; p<0·0001). Interpretation Alcohol misuse and aggressive behaviour might be appropriate targets for interventions, but any action must be evidence based. Post-traumatic stress disorder, though less prevalent, is also a risk factor for violence, especially hyperarousal symptoms, so if diagnosed it should be appropriately treated and associated risk monitored. Funding Medical Research Council and the UK Ministry of Defence.
Summary Background Concerns have been raised about the psychological effect of continued combat exposure and of repeated deployments. We examined the consequences of deployment to Iraq and ...Afghanistan on the mental health of UK armed forces from 2003 to 2009, the effect of multiple deployments, and time since return from deployment. Methods We reassessed the prevalence of probable mental disorders in participants of our previous study (2003–05). We also studied two new randomly chosen samples: those with recent deployment to Afghanistan, and those who had joined the UK armed forces since April, 2003, to ensure that the final sample continued to be representative of the UK armed forces. Between November, 2007, and September, 2009, participants completed a questionnaire about their deployment experiences and health outcomes. Findings 9990 (56%) participants completed the study questionnaire (8278 regulars, 1712 reservists). The prevalence of probable post-traumatic stress disorder was 4·0% (95% CI 3·5–4·5; n=376), 19·7% (18·7–20·6; n=1908) for symptoms of common mental disorders, and 13·0% (12·2–13·8; n=1323) for alcohol misuse. Deployment to Iraq or Afghanistan was significantly associated with alcohol misuse for regulars (odds ratio 1·22, 95% CI 1·02–1·46) and with probable post-traumatic stress disorder for reservists (2·83, 1·23–6·51). Regular personnel in combat roles were more likely than were those in support roles to report probable post-traumatic stress disorder (1·87, 1·26–2·78). There was no association with number of deployments for any outcome. There was some evidence for a small increase in the reporting of probable post-traumatic stress disorder with time since return from deployment in regulars (1·13, 1·03–1·24). Interpretation Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of probable post-traumatic stress disorder was low. These findings show the importance of continued health surveillance of UK military personnel. Funding UK Ministry of Defence.
Approximately 60% of military personnel who experience mental health problems do not seek help, yet many of them could benefit from professional treatment. Across military studies, one of the most ...frequently reported barriers to help-seeking for mental health problems is concerns about stigma. It is, however, less clear how stigma influences mental health service utilization. This review will synthesize existing research on stigma, focusing on those in the military with mental health problems. We conducted a systematic review and meta-analysis of studies between 2001 and 2014 to examine the prevalence of stigma for seeking help for a mental health problem and its association with help-seeking intentions/mental health service utilization. Twenty papers met the search criteria. Weighted prevalence estimates for the 2 most endorsed stigma concerns were 44.2% (95% confidence interval: 37.1, 51.4) for "My unit leadership might treat me differently" and 42.9% (95% confidence interval: 36.8, 49.0) for "I would be seen as weak." Nine studies found no association between anticipated stigma and help-seeking intentions/mental health service use and 4 studies found a positive association. One study found a negative association between self-stigma and intentions to seek help. Counterintuitively, those that endorsed high anticipated stigma still utilized mental health services or were interested in seeking help. We propose that these findings may be related to intention-behavior gaps or methodological issues in the measurement of stigma. Positive associations may be influenced by modified labeling theory. Additionally, other factors such as self-stigma and negative attitudes toward mental health care may be worth further attention in future investigation.
Background There is uncertainty regarding the prevalence of allergies to plant food. Objective To assess the prevalence of allergies to plant food according to the different subjective and objective ...assessment methods. Methods Our systematic search of population-based studies (since 1990) in the literature database MEDLINE focused on fruits, vegetables/legumes, tree nuts, wheat, soy, cereals, and seeds. Prevalence estimates were categorized by food item and method used (food challenges, skin prick test, serum IgE, parent/self-reported symptoms), complemented by appropriate meta-analyses. Results We included 36 studies with data from a total of over 250,000 children and adults. Only 6 studies included food challenge tests with prevalences ranging from 0.1% to 4.3% each for fruits and tree nuts, 0.1% to 1.4% for vegetables, and <1% each for wheat, soy, and sesame. The prevalence of sensitization against any specific plant food item assessed by skin prick test was usually <1%, whereas sensitization assessed by IgE against wheat ranged as high as 3.6% and against soy as high as 2.9%. For fruit and vegetables, prevalences based on perception were generally higher than those based on sensitization, but for wheat and soy in adults, sensitization was higher. Meta-analyses showed significant heterogeneity between studies regardless of food item or age group. Conclusion Population-based prevalence estimates for allergies to plant products determined by the diagnostic gold standard are scarce. There was considerable heterogeneity in the prevalence estimates of sensitization or perceived allergic reactions to plant food.
Summary Background The effectiveness of post-deployment screening for mental disorders has not been assessed in a randomised controlled trial. We aimed to assess whether post-deployment screening for ...post-traumatic stress disorder (PTSD), depression, anxiety, or alcohol misuse was effective. We defined screening as the presumptive identification of a previously unrecognised disorder using tests to distinguish those who probably had the disorder from those who probably did not so that those people with a probable disorder could be referred appropriately, and assessed effectiveness and consequences for help-seeking by the odds ratio at follow-up between those receiving tailored help-seeking advice and those who received general mental health advice. Methods We did a cluster randomised controlled trial among Royal Marines and Army personnel in the UK military after deployment to Afghanistan. Platoons were randomly assigned (1:1 initially, then 2:1) by stratified block randomisation with randomly varying block sizes of two and four to the screening group, which received tailored help-seeking advice, or the control group, which received general mental health advice. Initial assessment took place 6–12 weeks after deployment; follow-up assessments were done 10–24 months later. Follow-up measures were the PTSD Checklist–Civilian Version, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 scale, Alcohol Use Disorder Identification Test (AUDIT), and self-reported help-seeking from clinical and welfare providers comparing those receiving tailored advice and those receiving only general advice. All participants and all investigators other than the person who analysed the data were masked to allocation. The primary outcomes were PTSD, depression or generalised anxiety disorder, and alcohol misuse at follow-up. A key secondary outcome was assessment of whether post-deployment screening followed by tailored advice would modify help-seeking behaviour. Comparisons were made between screening and control groups, with primary analyses by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN19965528. Findings Between Oct 24, 2011, and Oct 31, 2014, 434 platoons comprising 10 190 personnel were included: 274 (6350 personnel) in the screening group and 160 (3840 personnel) in the control group. 5577 (88%) of 6350 personnel received screening and 3996 (63%) completed follow-up, whereas 3149 (82%) of 3840 received the control questionnaire and 2369 (62%) completed follow-up. 1958 (35%) of 5577 personnel in the screening group declined to see the tailored advice, but those with PTSD (83%) or anxiety or depression (84%) were more likely than non-cases (64%) to view the advice (both p<0·0001). At follow-up, there were no significant differences in prevalence between groups for PTSD (adjusted odds ratio 0·92, 95% CI 0·75–1·14), depression or anxiety (0·91, 0·71–1·16), alcohol misuse (0·88, 0·73–1·06), or seeking support for mental disorders (0·92, 0·78–1·08). Interpretation Post-deployment screening for mental disorders based on tailored advice was not effective at reducing prevalence of mental health disorders nor did it increase help-seeking. Countries that have implemented post-deployment screening programmes for mental disorders should consider monitoring the outcomes of their programmes. Funding The US Army Medical Research and Materiel Command–Military Operational Medicine Research Program (USAMRMC–MOMRP).
The aim of this study was to examine trajectories of posttraumatic stress disorder (PTSD) symptoms over a 14-year period and the risk factors associated with each trajectory. 1885 UK military ...personnel provided information at four time points since 2002. The PTSD Check list-Civilian Version (PCL-C) was used at all time points. Growth mixture models (GMM) were estimated to examine whether individuals could be clustered into discrete groups with similar trajectories. Multinomial logistic regressions were carried out to investigate factors associated with class membership. The three-class GMM was the most parsimonious solution. This included 90.2% in the resilient class, 4.1% in the improving class and 5.7% in the deteriorating class. Both the deteriorating and improving classes were associated with childhood adversity (odds ratios (OR) 3.9 (95% CI 2.3, 6.7) and 3.3 (95% CI 2.1, 5.0) respectively) and antisocial behaviour (OR 2.8 (95% CI 1.9, 4.2) and 3.7 (95% CI 2.4, 5.8) respectively), alcohol misuse (OR 3.5 (95% CI 2.4, 5.1) and 3.3 (95% CI 2.1, 5.2) respectively) and longer time since leaving Service in comparison to the resilient group. Those in the youngest group and those in a combat role (OR 0.32, 95% CI 0.19, 0.54) were more likely to belong to the deteriorating class. 10% of the cohort had symptoms of PTSD; of those, up to half were symptomatic for most of the follow-up period. Those whose score improved did not reach the low scores of the resilient group. Younger age and combat role were associated with worse prognosis of PTSD.
Aim
To identify the main trajectories of alcohol misuse among UK military personnel from 12 years after the start of the Iraq war (2003) and the factors associated with each trajectory.
Design
...Longitudinal cohort study with three phases of data collection (2004–06, 2007–09 and 2014–16).
Setting
United Kingdom.
Participants
Serving and ex‐serving personnel of the UK Armed Forces (n = 7111) participating at Phase 1 and at least one follow‐up phase of the King's Centre for Military Health Research (KCMHR) cohort study.
Measurements
Trajectories of alcohol misuse were derived from scores using the Alcohol Use Disorders Identification Test (AUDIT‐10) over three data collection phases. Demographic and military characteristics were collected and, among the key covariates, post‐traumatic stress disorder (PTSD) was measured using the PTSD checklist (PCL‐C) and childhood interpersonal stress and violence was measured using items from the Adverse Childhood Experiences questionnaire.
Findings
Five trajectories of alcohol misuse were identified, including ‘no misuse’ (n = 2249, 31.6%) and ‘hazardous’ (n = 3398, 47.8%), ‘harmful’ (n = 832, 11.7%), ‘severe‐to‐hazardous’ (n = 258, 5.3%) and ‘severe’ (n = 374, 3.6%) drinking. Substantial changes were evident only among severe drinkers, where more than half reduced over the study period. The factors most strongly associated with belonging to harmful/severe drinking classes were young age, male gender and childhood adversities and antisocial behaviour. Severe drinkers at Phase 1 were more likely to report probable PTSD and shorter military careers and were less likely to serve as Officers. Persistent severe drinkers were less likely to serve in the RAF compared to the Army and were more likely to be reserves. Not misusing alcohol was also associated with reserve status and having left service.
Conclusions
In a cohort of approximately 7000 UK military personnel, trajectories of alcohol misuse appeared stable between 2004 and 2016. More than half of severe drinkers made substantial improvements over the period, but 68% of the cohort continued to drink hazardously or harmfully. Lack of change for the majority of the sample signals the need for strategies to address alcohol misuse and its cultural and psychosocial drivers.
Whilst most military personnel do not develop Post-Traumatic Stress Disorder (PTSD), ex-serving personnel exhibit higher levels compared to those in the military. The heterogeneity of symptom ...development for serving and ex-serving personnel has not yet been compared in the UK Armed Forces (UK AF). Latent class growth modelling was employed to estimate the trajectories of PTSD symptoms from three waves of data from the PTSD Checklist (PCL-C) from a UK AF sample (N = 7357). Regression mixture models were conducted to investigate covariates of class membership. Five trajectory classes were identified. Most of the sample reported no-low symptoms (71.3%). Of those reporting probable PTSD during the 12 year-period, 4.6% showed improvements, 4.9% worsened, and 1.8% displayed chronic symptoms. A class with subthreshold elevated symptoms (17.3%) was also identified. Trajectories of serving and ex-serving personnel were not substantially different, but more ex-serving personnel were symptomatic and those with chronic symptoms worsened over time. Chronic disorder was associated with lower rank, experiencing violent combat, and proximity to wounding/death on deployment. Worsening symptoms were associated with childhood stress/violence, lower rank, not being in a relationship, inconsistent post-deployment social support, proximity to wounding/death, and voluntary, or medical discharge. The present study found most UKAF personnel did not report PTSD symptoms between 2004 and 16 but, among those experiencing probable PTSD, more participants reported deteriorating/persistent symptoms than who improved. PTSD-onset was related to adversities across childhood and deployment, and lack of social support. Findings underscore the importance of addressing the through-life contributors of PTSD in order to prevent ingrained disorder.
•Most serving and ex-serving personnel did not experience PTSD between 2004–16.•Among those who did meet levels of probable disorder, more worsened or experienced persistent symptoms than improved.•The PTSD classes of serving and ex-serving personnel were similar but more ex-serving personnel had higher levels of symptoms and fewer recovered.•A chronic symptom trajectory, rather than an improving trajectory, was related to low rank and deployment exposures.•New onset PTSD was related to adversities in childhood, deployment exposures and lack of social support.
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