Tag: Mental Disorder

Are Pre-service Military-related & Mental Disorder Factors Associated with Leaving the UK Armed Forces?

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Research Paper Title

Pre-service Military-related and Mental Disorder Factors Associated with Leaving the UK Armed Forces.

Background

The UK Armed Forces (UKAF) have a substantial manning deficit as more personnel leave than join.

This article identified pre-service, military, and mental health factors giving rise to leaving the UKAF and estimated the contributions to leaving of those factors which are potentially amenable to modification.

Methods

This study utilised data from a three-phase cohort study (2004-2006, 2007-2009 and 2014-2016), commencing while respondents were serving in the UKAF (n = 10,836; 6,046 (55.8%) had left service).

Associations between leaving the services and socio-demographics, military career and experiences, and mental health were determined using Cox regression.

Contribution to leaving was based on population attributable fractions (PAF) from Cox regression.

Analyses were stratified by rank due to the different career structures of Commissioned Officers and enlisted personnel.

Results

Leaving the UKAF was associated with joining when older, being a woman with a child/children, Army service, combat role, lower education level, and poor mental health.

Factors contributing a significant proportion of leaving among enlisted personnel were joining over the age of 17, history of externalising behaviour, being female, common mental disorders, and alcohol misuse.

Among Commissioned Officers only age at joining and sex contributed significant proportions to leaving.

Conclusions

The key factors for leaving are education and higher age at recruitment.

These are not amenable to intervention, for policy, equity, and legal reasons.

Heavy drinking and common mental disorder symptoms may be more amenable to modification and hence reduce rates of leaving the UKAF.

Women are more likely to leave due to childbearing.

Reference

Burdett, H., Stevelink, S.A.M., Jones, N., Hull, L., Wessely, S. & Rona, R. (2020) Pre-service Military-related and Mental Disorder Factors Associated with Leaving the UK Armed Forces. Psychiatry. 1-16. doi: 10.1080/00332747.2020.1729063. [Epub ahead of print].

A Review into Effective & Cost Effective Interventions of Child Mental Health Problems

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Research Paper Title

Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review.

Background

This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs).

Methods

The researchers will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS.

They will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations.

Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V. Interventions which address suicide, self-harm will also be included, if identified during the extraction process.

They will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical ad/or functional outcomes) and which have been delivered to young people in LAMICs.

They will also consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils).

In the pilot of screening procedures, 5% of all references will be screened by two reviewers.

Divergences will be resolved by one expert in mental health research.

Reviewers will be retrained afterwards to ensure reliability.

The remaining 95% will be screened by one reviewer. Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction.

Results

The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences.

The results will be presented descriptively and, if possible, meta-analysis will be conducted.

Ethical approval is not needed for anonymised secondary data.

Conclusions

The systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.

Reference

Grande, A.J., Ribeiro, W.S., Faustino, C., de Miranda, C.T., Mcdaid, D., Fry, A., de Moraes, S.H.M., de Oliveira, S.M.D.V.L., de Farias, J.M., de Tarso Coelho Jardim, P., King, D., Silva, V., Ziebold, C. & Evans-Lacko, S. (2020) Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review. Medicine (Baltimore). 99(1):e18611. doi: 10.1097/MD.0000000000018611.

What is the Evidence for the Use of Nutrient Supplements in the Treatment of Mental Disorders?

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Research Paper Title

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials.

Background

The role of nutrition in mental health is becoming increasingly acknowledged. Along with dietary intake, nutrition can also be obtained from “nutrient supplements”, such as polyunsaturated fatty acids (PUFAs), vitamins, minerals, antioxidants, amino acids and pre/probiotic supplements.

Recently, a large number of meta-analyses have emerged examining nutrient supplements in the treatment of mental disorders.

Methods

To produce a meta-review of this top-tier evidence, the researchers identified, synthesised and appraised all meta-analyses of randomised controlled trials (RCTs) reporting on the efficacy and safety of nutrient supplements in common and severe mental disorders.

Results

Their systematic search identified 33 meta-analyses of placebo-controlled RCTs, with primary analyses including outcome data from 10,951 individuals. The strongest evidence was found for PUFAs (particularly as eicosapentaenoic acid) as an adjunctive treatment for depression.

More nascent evidence suggested that PUFAs may also be beneficial for attention-deficit/hyperactivity disorder, whereas there was no evidence for schizophrenia.

Folate-based supplements were widely researched as adjunctive treatments for depression and schizophrenia, with positive effects from RCTs of high dose methylfolate in major depressive disorder.

There was emergent evidence for N-acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia.

All nutrient supplements had good safety profiles, with no evidence of serious adverse effects or contraindications with psychiatric medications.

Conclusions

In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentaenoic acid in depression), but also made aware of those currently lacking evidentiary support.

Future research should aim to determine which individuals may benefit most from evidence-based supplements, to further elucidate the underlying mechanisms.

Reference

Firth, J., Teasdale, S.B., Allott, K., Siskind, D., Marz, W., Cotter, J., Veronese, N., Schuch, F., Smith, L., Solmi, M., Carvalho, A.F., Vancampfort, D., Berk, M., Stubbs, B> & Sarris, J. (2019) The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials. World Psychiatry. 18, pp.308-324.

Some Common Myths about Mental Health Problems

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Myth:

Only a few people get mental illnesses and they are unusual or odd, so it is obvious who they are.

Fact:

Mental health problems are common and we are often unaware of the person’s diagnosis.

Myth:

People with a diagnosis of mental illness are going to struggle for the rest of their lives.

Fact:

Most people recover from mental illness and go on to live fulfilling lives. Recovery is a unique and personal journey and often the person feels that they experienced personal growth and a new way of being through the process of recovery.

Myth:

People who attempt suicide or self-harm are doing it to get attention and are not really serious.

Fact:

All suicidal thoughts and self-harm, as well as all other forms and expressions of distress, are serious. Dismissing another person’s feelings as attention seeking only makes them withdraw from asking for help and may result in death or serious injury.

Myth:

People who have mental illnesses have brought it upon themselves, or their parents are to blame.

Fact:

Anyone can experience mental illness or experience mental distress regardless of their background or upbringing. Some people are more at risk through circumstances beyond their own control.

Some Important Facts about Mental Health Problems

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Mental health problems are common and can affect anyone.

People with mental health problems do not lose their personality or intelligence, although the symptoms can sometimes change the way a person behaves when they are unwell.

People with mental health problems usually recover – there is a better chance of recovery from mental health problems than from some physical illnesses.

People with mental health problems want to work and to contribute to society, but it is often other people’s attitudes that prevent them from doing so.

Two thirds of employers, when asked, said that they did not feel comfortable employing a person with a mental health problem.

Many people with mental health problems continue to live life to the full, working and enjoying positive relationships and activities.

Sometimes, having a severe and enduring mental illness has a devastating effect on people’s live. With the right treatment and support, the person has a better chance of improvement and recovery.

People with schizophrenia do not have a split personality.

People with severe and enduring mental health problems are not usually dangerous – in fact, they are more likely to be victims of crime.

People with mental health problems are not weak and they do not bring the problems on themselves.

A growing body of evidence suggests that mental health problems cannot be separated from physical health, as the mind and body are closely interrelated.

Sometimes people dismiss others’ mental health problems or distress by judging them as weak. This is no more helpful or appropriate than judging someone for having a physical illness or disability.

Ordinary members of the public can help people experiencing mental health problems and make a real difference to their recovery.

Mental Health: Stigma & Myth

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Most people know that it is not appropriate to deliberately treat someone with mental health problems badly.

This awareness means that stigma is often expressed in less obvious ways, such as unkind jokes or ignoring a person.

Stigma and the fear of stigma is a serious issue that has an effect on people’s ability to cope with and recover from a mental health problem.

There is a lot of evidence to show that people are treated differently when they experience a mental health problem.

Stigma is based on myths and false assumptions about mental health problems.

Therefore, it is best addressed by gaining knowledge and an understanding of the facts.

Research has found that attitudes towards people with mental health problems have improved significantly in the United Kingdom (UK) since anti-stigma campaigns like ‘See Me’ were introduced.

We can make a difference to people’s mental health by gaining understanding and knowledge, and sharing it with others.

We can also make a difference by treating people with mental health problems as equals, and offering kindness and support when they are unwell.