Stigma, Barriers to Care, and Use of Mental Health Services Among Active Duty and National Guard Soldiers After Combat

Research into social determinants of mental and emotional health problems highlighted the need to understand the cultural factors. Mental health of immigrants is influenced by a variety of cultural, psychological, social, and economic factors. There is some evidence to suggest that South Asian people have higher rates of mental and emotional health problems than the rest of the Canadian population. Limited research also suggests that psycho-social factors are highly likely to be responsible for these high rates of mental health problems. These psychosocial factors may be impeding access and engagement with the services. These socially determined emotional and mental health problems are more likely to respond to psychosocial interventions than biological treatments. Evidence-based psychosocial interventions such as Cognitive Behaviour Therapy (CBT) and Acceptance and Commitment Therapy (ACT) might offer the way forward. CBT can be offered in a low-cost, low intensity format in a variety of settings, thus addressing the attached stigma. However, these interventions need to be culturally adapted, as these are underpinned by a Western value system. CBT has been culturally adapted and found to be effective in this group elsewhere. This opinion paper describes the need to enhance research on psychosocial determinants of the mental and emotional health problems, status, and the psychosocial determinants of health amongst South Asians in Canada to inform our understanding of the cultural specificity of psychosocial interventions.

Loneliness has been shown to predict mental health problems and suicide in active duty soldiers. In the present study, we examined distal (e.g., demographic & socioeconomic characteristics) to proximal factors (e.g., platoon relations, relationship quality) that were associated with loneliness in active duty soldiers in the U.S. Army. Results revealed a set of factors that were associated with loneliness in active duty soldiers, including age, frequency of contact with friends and family by phone, childhood trauma, self-reported overall emotional health, intra-platoon harassment, perceived stress, perceived platoon cohesion and support, organizational citizenship behavior, relationship satisfaction with friends, and relationship satisfaction with platoon members. The association between loneliness and both perceived stress and relationship satisfaction with platoon members reached a moderate effect size in the multivariate models. Although some of predictors overlap with those identified in studies of civilians, most were unique to soldiers. Implications are discussed for understanding loneliness in an organization like the military and for the early identification of and intervention with active duty soldiers who may be at risk for mental and behavioral problems.

The Link Between Homeless Women's Mental Health and Service System Use

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

To report the response to low-dose risperidone in individuals with combat-related post-traumatic stress disorder (PTSD) combat nightmares. Case series. Veterans Affairs Medical Center Mental Health Clinic and collaborative VA-U.S. Army Fort Bragg Warrior Transition Telepsychiatry Clinic. Veterans at the VA; soldiers that have severe medical and mental health problems in the Warrior Transition Telepsychiatry Clinic. No response: no change in frequency and/or severity of nightmares; partial response: decrease in frequency and/or severity of nightmares; full response: total cessation of recall of nightmares. The four individuals included one active duty soldier and three veterans, ranging from 40 to 76 years of age. All served in the infantry, each in a different combat theater. Two participants had a reduction in the frequency and severity of nightmares at risperidone 1 mg at night. One veteran with blood alcohol levels greater than 300 mg/mL had a partial response with risperidone 3 mg at night. Without active substance abuse, the four individuals had a total cessation of nightmares the first night at a risperidone dose of 2 mg at night. The total cessation of nightmares with risperidone continued despite changes in concurrent antidepressants, anxiolytics, and hypnotics. No medication side effects were reported. The use of low-dose risperidone (1-3 mg) at night can reduce the severity and frequency or stop the recall of PTSD combat nightmares in some veterans and active duty soldiers. Risperidone may be an effective medication for combat nightmares of PTSD and merits additional exploration.

Do Canada and the United States Differ in Prevalence of Depression and Utilization of Services?

Canino, MC, Foulis, SA, Zambraski, EJ, Cohen, BS, Redmond, JE, Hauret, KG, Frykman, PN, and Sharp, MA. U.S. Army Physical Demands Study: Differences in physical fitness and occupational task performance between trainees and active duty soldiers. J Strength Cond Res 33(7): 1864-1870, 2019-U.S. Army initial entry training (IET) is designed to prepare trainees for the military environment and subsequent training, including specific programs to increase physical fitness to perform job-specific tasks to the minimal acceptable performance standard (MAPS). The aim of this study was to compare physical fitness and occupational task performance of trainees at the end of IET to that of active duty soldiers. One hundred seventy-nine male combat arms trainees at the end of IET and 337 male combat arms active duty soldiers performed a sandbag carry (SBC), casualty drag (CD), and move under direct fire (MUF). Physical fitness was assessed using Army Physical Fitness Test scores. A questionnaire was administered to determine frequency of task performance. Active duty soldiers compared with trainees were older (p < 0.01) and performed more push-ups (p < 0.01) and sit-ups (p < 0.01). Trainees performed the 2-mile run faster (p < 0.01). Ninety-four percent of trainees and 99% of active duty soldiers performed the 3 tasks to the MAPSs. Active duty soldiers performed significantly faster on both the SBC (p < 0.01) and CD (p < 0.01) and reported a higher task frequency on the SBC (p = 0.03) and CD (p < 0.01). No difference in MUF performance (p = 0.16) and task frequency (p = 0.13) was detected. Initial entry training seems to provide sufficient physical training as most trainees were able to meet the MAPSs; however, performance differences were still apparent between trainees and active duty soldiers. Additional practice performing the physically demanding tasks may help maximize performance on the physically demanding job requirements.

Public's View of Mental Health Services for the Elderly: Responses to Dear Abby

10.1176/appi.ps.59.1.105

The Comparison of Single Serum Antibody Values Against B. pertussis, C. pneumoniae , and M. pneumoniae Antigens in Active Duty American Soldiers in Korea Who Had Prolonged Cough Illnesses (Cases) with Similar Antibody Values in Sera from Well Active Duty Soldiers in Hawaii (Controls)

Intradiscal electrothermal therapy (IDET) for chronic low back pain in active-duty soldiers: 2-year follow-up

Background: Political violence in Kashmir was a common occurrence. The phenomenon had occurred often and repeatedly in an unmanageable fashion. It had consequential implications for each member of society including children and adolescents. Aim: The study aimed to analyze the teachers’ perspective on mental health problems of adolescents in Kashmir. In Kashmir’s precarious circumstances, school-going adolescents were exceptionally vulnerable to mental health issues. Addressing unrecognized mental health issues among school-going adolescents established an important rationale for corresponding further deterioration. Methods: The study used the standardized tools of the Rutter’s Children Behavior Questionnaire (RCBQ-B) and the Strengths and Difficulties Questionnaire (SDQ). Cluster sampling was employed in the study. About 45 schoolteachers rated the behaviors of 160 school-going adolescents of Kashmir from numerous schools. The data were statistically analyzed using descriptive and inferential statistics such as t-test and one-way analysis of variance and correlation. Results: We found that behavioral and emotional problems (BEPs) rose significantly, most notably indications of BEPs with risk factors. Across the socioeconomic status, age, adolescence type, and education, the results found an upward trend of 47% prevalence rate of mental health problems among adolescents with 45% as peer problems, 39% hyperactivity, 34% conduct, and 9% emotional problems. Conclusion: An increasing number of adolescents in prevailing situations in Kashmir suffered from mental health problems. The study findings reveal that there is a need to create effective mental health services and interventions for school-going adolescents in Kashmir.

Children and adolescents with a low socioeconomic status (SES) are significantly more often affected by mental health problems than their peers with a high SES. So far, little is known about the association between family's SES and utilization of mental health care. This study examines the mental health care utilization by children and adolescents depending on their SES and symptoms of mental health problems as well as the impact of mental health problems. The analysis comprisesd data from the population-based BELLA-study, which investigates mental health in a representative subsample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Between 2014 and 2017, 1,580 participants aged 7 to 17 years were examined. SES was measured by the indicators of household income, parental educational attainment and parental occupation status. Symptoms and impairment of mental health problems were measured using the Strength and Difficulties Questionnaire (SDQ and SDQ-Impact). To investigate mental health care, the consultation of child and adolescent psychiatrists, medical and psychological psychotherapists and psychologists was considered. A hierarchic binary logistic regression model was calculated predicting mental health care use. In addition, effects of SES-indicators on associations between symptoms and impairment as well as mental health care utilization (moderator analysis) were investigated. Children and adolescents with a low SES were more likely to utilize mental health care services than their peers with a high SES. Mental health care utilization was significantly predicted by symptoms of mental health problems (OR=1.15, p≤0.001) as well as by the impairment caused by these problems (OR=1.68, p≤0.001); we found no significant moderation effects for household income, parental education or parental occupation. The probability of mental health care utilization by children and adolescents is significantly predicted by the symptoms and the impairments caused by mental health problems, but not by household income, parental education or parental occupation.

Elevations in psychiatric disorders and suicides among American military constitute a pressing public-health concern. In today’s military in America, there are intensive efforts to screen, assess, and intervene to improve mental health and maintain an optimal military workforce. Yet, during the extended deployments in Afghanistan and Iraq, increases in psychiatric disorders and suicide are apparent among active-duty military and military veterans. Clearly, a completed suicide is a complex, multiply determined event. Commonly, it is precipitated by the presence of psychiatric and substance abuse conditions. Are these elevations in rates a function of deployment stress, combat stress, pre-existing propensities, current-day stressors, or an interaction of all these factors? The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS [1] ) represents a systematic attempt to provide definitive information on rates of psychiatric conditions and suicide in active-duty soldiers by using epidemiological, clinical, and neurobiological methods to triangulate factors that affect onset, course, and initiation of these major mental health concerns. The goal of this great effort is for information derived from Army STARRS to generate best practices and guidelines for screening, intervention, and prevention. This issue of Depression & Anxiety (D&A) presents important new information from the remarkable scientific team assembled to study mental health and suicide in the U.S. Army. Using epidemiological methods to more fully understand risk and resilience factors, these articles present new, important, and nuanced information. Against the backdrop of a suite of articles in JAMA Psychiatry this past spring, these D&A articles provide information stemming from the New Soldier Study (NSS) rather than the All Army Survey (AAS) reported earlier. The NSS began its data collection at the point of

Back to table of contents Previous article Next article Professional NewsFull AccessCombat Just One Cause of Army Suicide CrisisAaron LevinAaron LevinSearch for more papers by this authorPublished Online:6 Mar 2009https://doi.org/10.1176/pn.44.5.0004Suicides among members of the U.S. Army increased for the fourth straight year in 2008, nearly doubling since 2004, despite the service's efforts at awareness and prevention. The Army also said that as many as 24 service members may have committed suicide in January, more than the number killed in combat in Iraq and Afghanistan that month.At least 128 suicides occurred among active-duty soldiers in 2008, and 15 cases are still under investigation by the Armed Forces medical examiner. In 2004, 67 soldiers committed suicide.The 2008 deaths represented a suicide rate of 20.2 per 100,000 active-duty personnel, up from 12.7 in 2005. The comparable, demographically adjusted rate for the overall U.S. population was 19.2 per 100,000 in 2005.Further, 43 members of the Army Reserve or National Guard not on active duty also killed themselves last year.Comparison with civilian or national rates is difficult, however, because the military background of persons committing suicide in the general population is not always recorded on death certificates.“We want the families who have lost loved ones to suicide to understand how deeply we feel their loss and that we are committed to doing everything possible to prevent this tragedy in our Army,” said Secretary of the Army Pete Geren in a statement.According to the Army, 30 percent of suicides occurred during deployment to Iraq or Afghanistan, 35 percent happened after deployment, and 35 percent occurred among troops who had never deployed to a war zone.The Army figures do not include the suicides by soldiers who have left the service. The Department of Veterans Affairs (VA) reported last year that 254 veterans (of all services) under its care who left the military between September 11, 2001, and the end of 2006 committed suicide.The rise in those numbers partly reflects the increased number of veterans leaving military service since 2001. Not all discharged military personnel choose to obtain medical care from the VA, so the VA count may underestimate the number of suicides among those who served in the two current conflicts.Suicide remains a challenge for which military leaders must identify effective prevention initiatives, said Adm. Mike Mullen, chair of the Joint Chiefs of Staff.“We have got to be able to support those individuals in ways that, in some cases, we haven't quite figured out yet,” said Mullen in a February speech at Grove City College in Pennsylvania. “Part of [the problem] has got to be the pressure of these constant deployments into combat, where young individuals ... whose lives change forever see things and do things they had never imagined.”The Army has developed or expanded programs in recent years to try to decrease the stigma surrounding mental health issues and encourage soldiers to seek help for themselves or for troubled buddies. The “Battlemind” program, originally designed to prepare soldiers psychologically for the stresses of combat, has now been expanded to include spouses and also cover the homecoming from war.“Battlemind” is part of a new Comprehensive Soldier Fitness strategy intended to give mental resiliency the same status traditionally accorded to physical health. The Army Chaplains Corps provides training for officers and soldiers in suicide risk recognition and prevention. The service has also begun hiring additional psychiatrists, psychologists, social workers, and other mental health care providers to support its troops.In January the Army ordered commanders throughout the service to hold two to four hours of suicide prevention training between February 15 and March 15, followed by a “chain-teaching” program to reach all members of the service.The deaths by suicide of four Army recruiters in the Houston area were attributed to “poor command climate, failing personal relationships, and long stressful workdays....” Those conclusions prompted Geren to order a one-day “standdown” on February 13 for all Army and Army Reserve recruiters during which they could receive training in leadership, suicide-prevention, and coping skills.To improve the research base about suicide in the armed forces, the Army also signed a memorandum of understanding with the National Institute of Mental Health last October to study ways to reduce suicide.The proposed research seeks to evaluate risk and protective factors leading to suicide-related events to influence the development of effective strategies to reduce suicide risk and enhance resilience, according to the NIMH request for applications.“This study will evaluate selected samples of soldiers across all phases of Army service, both cross-sectionally and longitudinally, including entry-level training and service, predeployment training, deployment and noncombat assignments, postdeployment, and postseparation reintegration to civilian life,” according to the Army-NIMH memo. ▪ ISSUES NewArchived