Psychological interventions for the treatment of depression, anxiety, alcohol misuse or anger in armed forces veterans and their families: systematic review and meta-analysis protocol

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Abstract

Background

Evidence highlights a high prevalence of common mental health disorders in armed forces veterans and their families, with depression, anxiety, alcohol misuse and anger being more common than PTSD. This paper presents a protocol for a systematic review and meta-analysis to identify existing randomised controlled trial (RCT) research testing the effectiveness of psychological interventions for these difficulties in armed forces veterans and their family members.

Methods

Electronic databases (CENTRAL, PsycInfo, MEDLINE, CINAHL, The Cochrane Register of Clinical Trials, EMBASE and ASSIA) will be searched to identify suitable studies for inclusion in the review supplemented by forward and backward reference checking, grey literature searches and contact with subject authors. Research including armed forces veterans and their family members will be included in the review with research including serving personnel or individuals under the age of 18 being excluded. Few RCTs examining the treatment of depression, anxiety, alcohol misuse or anger exist in armed forces veterans to date. The primary outcome will be symptomatic change following intervention for these difficulties. The secondary outcomes will include methodological aspects of interest such as discharge type and recruitment setting if data permits. In the event that the number of studies identified is too low to undertake a meta-analysis, a narrative review will be conducted. Quality assessment will be undertaken using the Cochrane Collaboration Tool and Cochran’s Q statistic calculated to test for heterogeneity as suggested by the Cochrane handbook.

Discussion

The review will examine the findings of existing intervention research for depression, anxiety, alcohol misuse or anger in armed forces veterans and their families, along with any effect sizes that may exist.

Systematic review registration

PROSPERO CRD42016036676

Electronic supplementary material

The online version of this article (doi:10.1186/s13643-017-0513-8) contains supplementary material, which is available to authorized users.

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Most cited references 28

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Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

Charles W Hoge, Carl A. Castro, Stephen C. Messer … (2004)

The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. Copyright 2004 Massachusetts Medical Society

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The stigma of mental health problems and other barriers to care in the UK Armed Forces

Amy Iversen, Lauren van Staden, Jamie Hughes … (2011)

Background As with the general population, a proportion of military personnel with mental health problems do not seek help. As the military is a profession at high risk of occupational psychiatric injury, understanding barriers to help-seeking is a priority. Method Participants were drawn from a large UK military health study. Participants undertook a telephone interview including the Patient Health Questionnaire (PHQ); a short measure of PTSD (Primary Care PTSD, PC-PTSD); a series of questions about service utilisation; and barriers to care. The response rate was 76% (821 participants). Results The most common barriers to care reported are those relating to the anticipated public stigma associated with consulting for a mental health problem. In addition, participants reported barriers in the practicalities of consulting such as scheduling an appointment and having time off for treatment. Barriers to care did not appear to be diminished after people leave the Armed Forces. Veterans report additional barriers to care of not knowing where to find help and a concern that their employer would blame them for their problems. Those with mental health problems, such as PTSD, report significantly more barriers to care than those who do not have a diagnosis of a mental disorder. Conclusions Despite recent efforts to de-stigmatise mental disorders in the military, anticipated stigma and practical barriers to consulting stand in the way of access to care for some Service personnel. Further interventions to reduce stigma and ensuring that Service personnel have access to high quality confidential assessment and treatment remain priorities for the UK Armed Forces.

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Military Families Under Stress: Implications for Family Life Education*

Amy Reinkober Drummet, Marilyn Coleman, Susan Cable (2003)

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Author and article information

Contributors

Luke O’Shea: L.OShea@exeter.ac.uk

Ed Watkins: E.R.Watkins@exeter.ac.uk

Paul Farrand: P.A.Farrand@exeter.ac.uk

Journal

Journal ID (nlm-ta): Syst Rev

Journal ID (iso-abbrev): Syst Rev

Title: Systematic Reviews

Publisher: BioMed Central (London )

ISSN (Electronic): 2046-4053

Publication date (Electronic): 15 June 2017

Publication date PMC-release: 15 June 2017

Publication date Collection: 2017

Volume: 6

Electronic Location Identifier: 112

Affiliations

[1 ]ISNI 0000 0004 1936 8024, GRID grid.8391.3, Mood Disorders Centre, School of Psychology, College of Life and Environmental Sciences, , University of Exeter, ; Exeter, UK

[2 ]ISNI 0000 0004 1936 8024, GRID grid.8391.3, Clinical Education Development and Research (CEDAR), Psychology: College of Life and Environmental Sciences, , University of Exeter, ; Exeter, UK

Article

Publisher ID: 513

DOI: 10.1186/s13643-017-0513-8

PMC ID: 5472945

PubMed ID: 28619078

SO-VID: ea5804f6-8de2-44d8-a2f4-966a6991513d

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 4 July 2016

Date accepted : 7 June 2017

Funding

Funded by: Libor

Award ID: N/A

Custom metadata

ScienceOpen disciplines: Public health

Keywords: veteran,armed forces,military,psychological,anger,alcohol misuse,depression,anxiety,systematic review,military family

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ScienceOpen disciplines: Public health

Keywords: veteran, armed forces, military, psychological, anger, alcohol misuse, depression, anxiety, systematic review, military family

Psychological interventions for the treatment of depression, anxiety, alcohol misuse or anger in armed forces veterans and their families: systematic review and meta-analysis protocol

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Abstract

Background

Methods

Discussion

Systematic review registration

Electronic supplementary material

Related collections

Chinese Journal of School Health

Most cited references 28

Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

The stigma of mental health problems and other barriers to care in the UK Armed Forces

Military Families Under Stress: Implications for Family Life Education*

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