Military Mental Health Services Research Articles

ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder in mental health support-seeking former-serving Australian defence force veterans.

ICD-11 complex post-traumatic stress disorder is a more severe condition than post-traumatic stress disorder, and recent studies indicate it is more prevalent among military samples. In this study, we tested the psychometric properties of the International Trauma Questionnaire, assessed the relative prevalence rates of post-traumatic stress disorder and complex post-traumatic stress disorder in the sample population and explored relationships between complex post-traumatic stress disorder and post-traumatic stress disorder and a range of risk factors. Survey participants (N = 189) were mental health support-seeking former-serving veterans of the Australian Defence Force (ADF) recruited from primary care. Confirmatory factor analysis was used to test the factorial validity of the International Trauma Questionnaire. The latent structure of the International Trauma Questionnaire was best represented by a two-factor second-order model consistent with the ICD-11 model of complex post-traumatic stress disorder. The International Trauma Questionnaire scale scores demonstrated excellent internal reliability. Overall, 9.1% (95% confidence interval = [4.8%, 13.5%]) met diagnostic requirements for post-traumatic stress disorder and an additional 51.4% (95% confidence interval = [44.0%, 58.9%]) met requirements for complex post-traumatic stress disorder. Those meeting diagnostic requirements for complex post-traumatic stress disorder were more likely to have served in the military for 15 years or longer, had a history of more traumatic life events and had the highest levels of depression, anxiety and stress symptoms. The International Trauma Questionnaire can effectively distinguish between post-traumatic stress disorder and complex post-traumatic stress disorder within primary care samples of Australian Defence Force veterans. A significantly greater proportion of Australian Defence Force veterans met criteria for complex post-traumatic stress disorder than post-traumatic stress disorder. Australian military mental health services should adopt the International Trauma Questionnaire to routinely screen for complex post-traumatic stress disorder and develop complex post-traumatic stress disorder specific interventions to promote recovery in Australian Defence Force veterans with complex post-traumatic stress disorder.

Medical Cannabis for Chronic Posttraumatic Stress Disorder in Dutch Veterans: A Health Care Evaluation

Introduction: Medical cannabis has emerged as a promising treatment for Posttraumatic Stress Disorder (PTSD), particularly among veterans. Given the high prevalence of PTSD in this population and the limited availability of effective therapeutic options, medical cannabis has garnered increased interest. However, evidence remains scarce endorsing its efficacy and patients' experiences with this treatment. Method: To gain more insight into patients' experiences with medical cannabis, we interviewed 18 Dutch veterans diagnosed with chronic PTSD who were prescribed off-label medical cannabis for symptom relief at an outpatient clinic in the Dutch Military Mental Health Service. The interviews were recorded and transcribed verbatim, followed by a framework analysis with thematic coding. Results: A group of 18 patients turned to medical cannabis as an alternative to traditional treatments due to persistent symptoms iof PTSD. Of these, 15 continued using the Bediol strain, primarily before bedtime to aid sleep. They reported significant improvements, including increased peace of mind and reduced irritability. Although patients expressed satisfaction, they often asked assistance in dosage and reimbursement. Despite initial reservations from some family members, there was notable support, signaling a changing perception of medical cannabis through increased education. However, a few patients still faced lingering stigma. Through the analysis, five overarching themes were identified: (1) assessment phase, (2) intervention phase, (3) termination phase, (4) access and availability, and (5) social support. Conclusion: Based on the data collected, we advocate for the continued prescription of medical cannabis, as most of the interviewed patients reported positive effects, including alleviation of core symptoms like sleep disturbances, irritability, and hyperarousal. Secondly, we recommend the continued reimbursement of medical cannabis due to its positive impacts, as many patients expressed potential financial hardship if this reimbursement were halted. Furthermore, we propose the appointment of a cannabis coach to provide patient-centered care. Reliable information on cannabis use is often challenging for patients to access, and proper use, including dosage, strain, cannabidiol (CBD) to Tetrahydrocannabinol (THC) ratio, and timing of administration, is essential to ensure optimal benefits and minimize risks. Lastly, we emphasize the necessity for further research, including longitudinal studies and randomized controlled trials, to explore individualized treatment approaches that work best under specific conditions. Greater clarity on dosages and product selection is also essential to minimize confusion and potential over- or under-consumption risks. Overall, these recommendations can guide the advancement of medical cannabis treatment for chronic PTSD in veterans, enhancing patient outcomes and paving the way for evidence-based practices.

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Putting Suicide Policy through the Wringer: Perspectives of Military Members Who Attempted to Kill Themselves.

In response to the Air Force Surgeon General, Lieutenant General Mark Ediger’s call for medical services to be guided by service members’ values, preferences, and experiences within the medical system, we conducted an interpretive phenomenological analysis of transcripts in which service members shared their experiences of military mental health policy and practices after being identified as suicidal. Themes of their experiences underscore nuances as it relates to intersectionality of policy when faced with unique military contextual factors and power differentials; both of which were missing in available research literature. Their experiences also illuminate further the innate “Catch 22” which happens when accessing help. Catch 22 basically means if you know you need help than you are rational; but if you actually seek help, then you are crazy and not trustworthy to do your job. Themes presented center on the lack of confidentiality of Service Members in the Workplace, effects of Unit Members’ Surveillance and Command Directed Evaluations, and experiences of Military Mental Health Services. Critical discussions of policy and taken for granted assumptions that often drive narrow responses to suicide, treatment, prevention, and stigma are presented. Particular attention is given to the lived experiences of service members when placed under the demands of circumstances created by policy that may inadvertently lead in some cases to further suffering. The paper closes with recommendations from participants and the authors for policy makers and future directions in research.

Prevalence of Professional Burnout Among Military Mental Health Service Providers.

Professional burnout is a well-documented occupational phenomenon, characterized by the gradual "wearing away" of an individual's physical and mental well-being, resulting in a variety of adverse job-related outcomes. It has been suggested that burnout is more common in occupations that require close interpersonal relationships, such as mental health services. This study surveyed 488 mental health clinicians working with military populations about work-related outcomes, including level of professional burnout, job satisfaction, and other work-related domains. Approximately 21% (weighted) of the sample reported elevated levels of burnout; several domains were found to be significantly associated with burnout. Education about professional burnout symptoms and early intervention are essential to ensure that providers continue to provide optimal care for service members and veterans.

A Decade of War: Adapting to Meet the Mental Health Training Demands

War has long yielded advancements inmedical techniques and understanding. The past 13 years have seen the USA fight two enduring wars and have brought forward numerous medical advances to include those that have impacted pre-hospital care, medical evacuation, bleeding control, and trauma response; however, some of the most critical advances have occurred in the identification and treatment of the invisible wounds of the war, posttraumatic stress disorder, and traumatic brain injury. With increased awareness and understanding of these conditions, nearly one out of every five returning combat veterans is identified with a mental health disorder [1]. This has significantly increased the demand for military mental health services and the requirements for military mental health providers. In the US Army alone, there has been a more than 150 % increase in mental health providers required to meet the mental health care needs of the returning soldiers [2]. The other military services and the Veterans Affairs (VA) hospitals have seen similar increases in demand. This situation was further complicated by the fact that during the post-ColdWar era of the 1990s, the uniformed services underwent a significant personnel reduction and Base Realignment and Closure. The result was a 30 % reduction in the uniformed medical provider force and closure of three of the nine military psychiatry training programs during this time frame [3, 4]. Because those military training programs produce more than 90 % of the uniformed service psychiatrists, growing the force in short demand presented numerous challenges. This prolonged period of war impacted those training programs. The type of patient and care demands at the teaching facilities significantly changed, teaching staffs were temporarily decreased in size as many of the military psychiatry staff were deployed to Iraq or Afghanistan, and residents were prepared for not only upcoming board certification exams but also soon-to-occur deployments to war zones. Additionally, faculty were challenged to manage and cope with their own deployment experiences while facing demands to teach new residents all while the profession of military psychiatry was facing increased scrutiny over rising suicide rates, deployment mental health screening, quality of posttraumatic stress disorder treatment, and even one military psychiatry graduate conducting a mass shooting. The purpose of this special collection of Academic Psychiatry is to highlight some of these unique challenges and address both the lessons learned and the advancements made in military psychiatry education. This collection opens with perspective and commentary pieces written by graduates of several military psychiatry training programs. Groom et al. [5] provide an interesting view from resident training at different points in time during the war effort. The period early in the war was marked by anxiety and unknown futures, whereas later in the war, challenges shifted to the expectation of deployment to a war zone as well as a growing sense of negativity toward the profession on the basis of enduring media reports. Complementing this perspective is a commentary from Capaldi and Zembrzuska [6] that highlights the challenges graduating residents faced deploying to a war zone less than a year after completing their training. Of note, military psychiatric residents completed all of the same Accreditation Council for Graduate Medical Education requirements as any other trainee but also had to prepare for the challenges of the battlefield. West et al. [7] highlight a specific training program that provides some of that preparation called Operation Bushmaster. * Christopher H. Warner christopher.h.warner.mil@mail.mil

Do soldiers seek more mental health care after deployment? Analysis of mental health consultations in the Netherlands Armed Forces following deployment to Afghanistan

BackgroundMilitary deployment to combat zones puts military personnel to a number of physical and mental challenges that may adversely affect mental health. Until now, few studies have been performed in Europe on mental health utilization after military deployment.ObjectiveWe compared the incidence of mental health consultations with the Military Mental Health Service (MMHS) of military deployed to Afghanistan to that of non-deployed military personnel.MethodWe assessed utilization of the MMHS by the full cohort of the Netherlands Armed Forces enlisted between 2008 and 2010 through linkage of mental health and human resource information systems.ResultsThe total population consisted of 50,508 military (18,233 deployed, 32,275 non-deployed), who accounted for 1,906 new consultations with the MMHS. The follow-up was limited to the first 2 years following deployment. We observed higher mental health care utilization in deployed vs. non-deployed military personnel; hazard ratio (HR), adjusted for sex, military branch and time in service, 1.84 [95% CI 1.61–2.11] in the first and 1.28 [1.09–1.49] in the second year after deployment. An increased risk of adjustment disorders (HR 2.59 [2.02–3.32] and 1.74 [1.30–2.32]) and of anxiety disorders (2.22 [1.52–3.25] and 2.28 [1.50–3.45]) including posttraumatic stress disorder (5.15 [2.55–10.40] and 5.28 [2.42–11.50]), but not of mood disorders (1.33 [0.90–1.97] and 1.11 [0.68–1.82]), was observed in deployed personnel in the first- and second-year post-deployment, respectively. Military personnel deployed in a unit with a higher risk of confrontation with potentially traumatic events had a higher HR (2.13 [1.84–2.47] and 1.40 [1.18–1.67]).ConclusionsThough absolute risk was low, in the first and second year following deployment to Afghanistan there was an 80 and 30% higher risk for mental health problems resulting in a consultation with the Dutch MMHS compared to military never deployed to Afghanistan. These observations underscore the need for an adequate mental health infrastructure for those returning from deployment.

Factors Affecting Mental Health Service Utilization Among Deployed Military Personnel

This study contrasts the characteristics of clients using military mental health services in deployed and nondeployed settings, the communications between their mental health providers and commanders, and the impact of mental health services on their military duties. The study explored the rates of command communication and duty restrictions across settings and referral sources. The study used secondary data from two predominantly Air Force sources: (1) deployed data collected in 2005 at Al Udeid Air Base, Qatar; and (2) nondeployed data collected in 2001 at various nondeployed settings. Chi2 analyses were used to compare the demographic variables, command communication, and duty restrictions. Among self-referrals, there were higher rates of command communication and duty restrictions in the deployed setting. Further analysis found that the rate of self-referral to mental health services did not vary significantly across settings despite the barriers of increased command communications and duty restrictions in the deployed setting. This study extends the findings of Rowan and Campise's 2006 initial nondeployed study into the deployed environment.

Patient Preferences for the Delivery of Military Mental Health Services

Knowledge of patients' preferences of military mental health care is required to inform service planning. The objective was to inform service planning by quantifying, and identifying predictors of, patient preferences for mental health care providers and location of facilities. Sociodemographic and service characteristics and concerns about stigma were investigated for patients presenting to 4 U.K. Armed Forces Departments of Community Mental Health over a 2-months period (n = 163). 5% preferred to be seen by a uniformed mental health clinician, 30% by a nonuniformed clinician, and 65% reported no preference. Gender and service were associated with care provider preference and service was associated with location preference. The Armed Forces need to explore and identify ways of accommodating their patients' preference, especially regarding the uniformed status of their care provider, to achieve good engagement and acceptability.

Military ombudsman to again review mental health services

National Defence and Canadian Forces Ombudsman Pierre Daigle will conduct a follow-up review of a 2008 investigation into military mental health services that found that too many soldiers with operational stress injuries (OSIs) were slipping through cracks in the system. Though the Canadian

A review of one year of British Armed Forces mental health hospital admissions

ObjectivesThe paper provides a review of one year of military Mental Health (MH) hospital admissions. This includes an exploration into demographic trends, differences in clinical opinion and how information gained...

Adaptation of Immigrant Psychiatrists from the Former Soviet Union in the Department of Mental Health of the Israel Defense Forces

Psychiatrists from the former Soviet Union serve in the Department of Mental Health of the Israel Defense Forces. The new immigrant psychiatrists confront a wide range of difficulties during the process of integration to the military system and adaptation to the specifically military aspects of psychiatry. These include unfamiliarity with the military system, cultural clashes with the different groups of soldiers representing the various subgroups of the absorbing society, the psychopathology of soldiers, which is different from that seen in civil psychiatry, and the change in focus in the military mental health service, which emphasizes the importance of evaluating ego strength. Arbitrarily, one can describe four stages of adaptation that the immigrant psychiatrist has to pass through before recruitment and during service until adaptation and integration in the new role take place. Individual and group supervision are the main means by which the assimilation process is eased. The military service smooth the acculturation process and has an important role in helping the immigrant's adaptation to Israeli society and in building his or her professional identity.