Search

Alcohol is the most used substance by women of childbearing age. Alcohol exposed pregnancies can have serious consequences to the fetus, and the UK has one of the highest rates of drinking during pregnancy. Alcohol use during motherhood is also a public health concern, linked with potential harms to the woman and child. This qualitative study investigated the attitudes and experiences of pregnant/parenting women and healthcare professionals regarding maternal drinking. A semi-structured focus group and interviews were conducted in the North West of England with pregnant women, mothers, and healthcare professionals. Quantitative measures captured demographics, alcohol use, and screened for mental ill-health for pregnant women and mothers. Reflexive thematic analysis was used to analyse narratives. Findings revealed that most participants believed avoiding alcohol during pregnancy is the safest option. However, some pregnant women and mothers stated that there was insufficient evidence to demonstrate the harms of low-level drinking and that abstinence guidelines were patronising. All participants reported that low-level drinking during motherhood was acceptable. Heavy drinking was believed to pose serious harm during pregnancy and motherhood to the baby and mother, in addition to damaging relationships. Strong motives were revealed for choosing and avoiding to drink, such as coping with the difficulties of motherhood and parental responsibilities, respectively. Contradictions were found across quantitative and qualitative self-reports of consumption, reflecting potential underreporting of alcohol use. Additionally, drinking levels were discussed in extremes only (low/heavy) without considering 'grey area' drinking. Clear, consistent advice and guidelines are needed to support women in reducing their alcohol use during pregnancy and motherhood. These should include the unique potential risks regarding maternal drinking, and the harm attributable to non-clinically dependent alcohol use. The maternal participants in this study were middle-class, therefore, research is needed to capture the views and experiences of women of all socioeconomic backgrounds. [ABSTRACT FROM AUTHOR]

Background: Migrant and ethnic inequalities in maternal and perinatal mortality persist across high‐income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence‐based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed. Methods: An inductive modelling approach was used to develop a new evidence‐based conceptual model of woman–midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social–ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman–midwife relationship. Results: Three key concepts influencing the woman–midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented. Conclusions: The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research. Patient or Public Contribution: At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees. [ABSTRACT FROM AUTHOR]

Background and Aims: Alcohol use by pregnant and parenting women can have serious and long‐lasting consequences for both the mother and offspring. We reviewed the evidence for psychosocial interventions to reduce maternal drinking. Design Literature searches of PsycINFO, PubMed and Scopus identified randomised controlled trials of interventions with an aim of reduced drinking or abstinence in mothers or pregnant women. Setting: Interventions were delivered in healthcare settings and homes. Participants: Pregnant women and mothers with dependent children. Interventions: Psychosocial interventions were compared with usual care or no intervention. Measurements The revised Cochrane risk‐of‐bias tool for randomised trials was used for quality assessments. Narrative synthesis summarised the findings of the studies with a subset of trials eligible for random‐effects meta‐analysis. General and alcohol‐specific behaviour change techniques (BCTs) were identified to investigate potential mechanism of change. Results: Twenty‐four studies were included (20 pregnancy, four motherhood). Because of quality of reporting, data from only six pregnancy and four motherhood studies could be pooled. A significant treatment effect was revealed by the meta‐analyses of pregnancy studies regarding abstinence (OR = 2.31, 95% CI = 1.61, 3.32; P < 0.001) and motherhood studies regarding a reduction in drinking (standardised mean difference [SMD] = −0.20, 95% CI = −0.38, −0.02; P = 0.03). Narrative synthesis of the remaining trials yielded inconsistent results regarding intervention effectiveness. A wide range of BCTs were used, present in both effective and ineffective interventions. The most commonly used general and alcohol‐specific BCTs included information about consequences, social support, goal setting and action planning. Conclusions: In pregnant women identified as consuming alcohol, psychosocial interventions appear to increase abstinence rates compared with usual care or no intervention. Similarly, such interventions appear to lead to a reduction in alcohol consumption in mothers with dependent children. It is unclear that behaviour change techniques are contributing to these effects. Conclusions from randomised controlled trials are only meaningful if the behavioural outcome, population, setting, intervention and comparator are clearly reported. An important barrier when it comes to identifying effective behaviour change techniques is a widespread failure to provide enough information in study reports. [ABSTRACT FROM AUTHOR]

Early advance care planningh as clear benefits for patients approaching the end of their life, yet many of those attended by UK paramedics do not have this planning in place. To explore staff stakeholder views on the role of UK paramedics in advance care planning, including the use of the Gold Standards Framework Proactive Identification Guidance for screening and referral of patients. In-depth semi-structured telephone interviews with paramedics, general practitioners, Emergency Department and community doctors and nurses in the South West of England. Seventeen staff stakeholders participated. Four main themes were identified: a lack of advance care planning; variation across health conditions; a lack of joined-up care; poor-quality end of life conversations. Paramedic use of the Gold Standards Framework Proactive Identification Guidance to screen and refer patients for advance care planning was seen as feasible and acceptable, with perceived benefitssuch as identifying patients not accessing primary care, and the potential to reduce avoidable hospital admissions. UK paramedics are well-placed toscreen and refer patients for advance care planning. Further research is needed to explore how this type of intervention might be developed to fit into a community-centred approach aimed at improving advance care planning. [ABSTRACT FROM AUTHOR]

Background: Military families can experience unique stressors that may contribute towards poorer well-being among the spouses/partners of Service personnel. However, there is little UK research regarding mental health or alcohol consumption among this population. Objective: This study examined mental health outcomes (probable depression and post-traumatic stress disorder (PTSD)) and alcohol consumption among UK military spouses/partners compared to women in the general population. Associations with military and socio-demographic characteristics were examined. Method: Survey data from 405 female spouses/partners of current and former UK Service personnel participating in a study of military-connected children (2010–2012) was analysed. Comparisons to women in the general population were made using the 2007 Adult Psychiatric Morbidity Survey (n = 1594). Results: Compared to women from the general population, military spouses/partners were significantly more likely to meet criteria for probable depression (adj. OR 2.50 (95% CI 1.52–4.11)). There was no significant difference regarding probable PTSD. Spouses/partners were significantly more likely to meet criteria for hazardous alcohol consumption (adj. OR 2.55 (95% CI 1.87–3.47)) and more likely to report episodes of weekly, daily or almost daily binge-drinking (adj. OR 2.15 (95% CI 1.28–3.61)) than women in the general population. Binge-drinking was significantly higher among spouses/partners of Service personnel reporting family separations of more than 2 months in the last 2 years compared to those reporting no, or shorter, separations (adj. OR 1.88 (95% CI 1.08–3.27)). Conclusion: This is the first study to examine mental health and alcohol consumption among UK military spouses/partners. The significantly higher prevalence of probable depression, hazardous alcohol consumption, and binge-drinking compared to women in the general population suggests further research is needed into the drivers of poor mental health and alcohol consumption among this population and in identifying or developing prevention campaigns to reduce alcohol use and support their well-being. [ABSTRACT FROM AUTHOR]

The mammalian ISWI ( I mitation Swi tch ) genes SMARCA1 and SMARCA5 encode the ATP-dependent chromatin remodeling proteins SNF2L and SNF2H. The ISWI proteins interact with BAZ (bromodomain adjacent to PHD zinc finger) domain containing proteins to generate eight distinct remodeling complexes. ISWI complex-mediated nucleosome positioning within genes and gene regulatory elements is proving important for the transition from a committed progenitor state to a differentiated cell state. Genetic studies have implicated the involvement of many ATP-dependent chromatin remodeling proteins in neurodevelopmental disorders (NDDs), including SMARCA1 . Here we review the characterization of mice inactivated for ISWI and their interacting proteins, as it pertains to brain development and disease. A better understanding of chromatin dynamics during neural development is a prerequisite to understanding disease pathologies and the development of therapeutics for these complex disorders. [ABSTRACT FROM AUTHOR]

Background In 2015, 27.5% of births in England and Wales were to mothers born outside of the UK. Compared to their White British peers, minority ethnic and migrant women are at a significantly higher risk of maternal and perinatal mortality, along with lower maternity care satisfaction. Existing literature highlights the importance of midwife-woman relationships in care satisfaction and pregnancy outcomes; however, little research has explored midwife-woman relationships for migrant and minority ethnic women in the UK. Methods A focused ethnography was conducted in South Wales, UK, including semi-structured interviews with 9 migrant Pakistani participants and 11 practising midwives, fieldwork in the local migrant Pakistani community and local maternity services, observations of antenatal appointments, and reviews of relevant media. Thematic data analysis was undertaken concurrently with data collection. Findings The midwife-woman relationship was important for participants' experiences of care. Numerous social and ecological factors influenced this relationship, including family relationships, culture and religion, differing health-care systems, authoritative knowledge and communication of information. Marked differences were seen between midwives and women in the perceived importance of these factors. Conclusions Findings provide new theoretical insights into the complex factors contributing to the health-care expectations of pregnant migrant Pakistani women in the UK. These findings may be used to create meaningful dialogue between women and midwives, encourage women's involvement in decisions about their health care and facilitate future midwifery education and research. Conclusions are relevant to a broad international audience, as achieving better outcomes for migrant and ethnic minority communities is of global concern. [ABSTRACT FROM AUTHOR]

World governments have embraced 'legal empowerment' as an end in itself and as an essential element in the fight against poverty. Civil society groups work to advance legal empowerment around the globe but, to date, there is not a comprehensive understanding of the impact of those efforts. This article offers the first review and mapping of existing evidence on legal empowerment. We identified and analyzed 199 studies in total. These studies span every major continent and address a wide range of legal empowerment interventions, such as legal literacy, community-based paralegals, and use of right to information laws. The breadth and richness of this body of work suggest we should revisit previous perceptions that there is little evidence on what legal empowerment can achieve. Stronger agency-both people's willingness to act and actual action-as well as increased legal knowledge are the most common positive impacts reported in this collection of evidence. The evidence also suggests legal empowerment programs can lead to acquisition of legal remedies, effective conflict resolution, and even improvements in health and education outcomes. Nearly ninety studies find positive impacts of legal empowerment programs on institutions-changes in law, policy or practice at various levels of administration. After exploring distributions and trends in the evidence, the article concludes by identifying gaps and questions for further inquiry to guide future research and, ultimately, promote stronger, more evidence-based practice. [ABSTRACT FROM AUTHOR]

Background: The main behaviour change intervention available for coronary heart disease (CHD) patients is cardiac rehabilitation. There is little recognition of what the active ingredients of behavioural interventions for CHD might be. Using a behaviour change technique (BCT) framework to code existing interventions may help to identify this. The objectives of this systematic review are to determine the effectiveness of CHD behaviour change interventions and how this may be explained by BCT content and structure. Methods and Findings: A systematic search of Medline, EMBASE and PsycInfo electronic databases was conducted over a twelve year period (2003–2015) to identify studies which reported on behaviour change interventions for CHD patients. The content of the behaviour change interventions was coded using the Coventry Aberdeen and London—Refined (CALO-RE) taxonomy. Meta-regression analyses examined the BCT content as a predictor of mortality. Twenty two papers met the criteria for this review, reporting data on 16,766 participants. The most commonly included BCTs were providing information, and goal setting. There was a small but significant effect of the interventions on smoking (risk ratio (RR) = 0.89, 95% CI 0.81–0.97). The interventions did not reduce the risk of CHD events (RR = 0.86, 95% CI 0.68, 1.09), but significantly reduced the risk of mortality (RR = 0.82, 95% CI 0.69, 0.97). Sensitivity analyses did not find that any of the BCT variables predicted mortality and the number of BCTs included in an intervention was not associated with mortality (β = -0.02, 95% CI -0.06–0.03). Conclusions: Behaviour change interventions for CHD patients appear to have a positive impact on a number of outcomes. Using an existing BCT taxonomy to code the interventions helped us to understand which were the most commonly used techniques, providing information and goal setting, but not the active components of these complex interventions. [ABSTRACT FROM AUTHOR]

The recent increased suicide rate in the U.S. military has received widespread academic and media attention (Nock et al., 2013). "Big data" has been defined as large, complex, and linkable information (Khoury & Ioannidis, 2014) that can be used to investigate such changes in incidence at a population level. "Big health data" can revolutionize the future of epidemiological research, and this commentary discusses a specific example of how it can be used to progress suicide research. [ABSTRACT FROM AUTHOR]

The article presents a study that explores adaptation in patients with advanced cancer. The study examines the factor structure of the Mental Adjustment to Cancer Scale and examines associations between types of coping and psychological outcomes. It reveals that patients with a desire for hastened death had lower acceptance and positivity, and patients with higher global quality of life reported a higher level.

Latent class analysis methods provide an opportunity to progress research investigating the co-occurence of alcohol and mental health problems. These approaches allow us not only to understand how alcohol use patterns differ in individuals with and without a mental disorder, but to also define phenotypes based upon mental health and alcohol use symptoms. [ABSTRACT FROM PUBLISHER]

Purpose: Diarrhoea and vomiting (D & V) was common in military personnel during deployment to the initial phases of the Iraq war. D & V is an established risk factor for irritable bowel syndrome (IBS). This study examined the prevalence of IBS in a military sample with a history of deployment to Iraq and the association between D & V and common mental disorder (CMD) with IBS. Methods: The study used data from a two-phase cohort study of military/personnel. The sample was restricted to individuals who had been deployed to Iraq before phase 1 of the study and who had completed the self-report D & V question. A measure of probable IBS was derived at both phases of the study based on self-reported symptoms in the previous month. CMD was assessed by the General Health Questionnaire (GHQ-12). Results: Fifty-nine percent of the sample reported a D & V event and 6.6 % met the criteria for probable IBS at phase 1. Reporting D & V, thinking one might be killed on deployment, poor physical health and CMD were associated with probable IBS at phase 1. CMD at phase 1 was strongly associated with chronic symptoms of IBS. Conclusions: There was a high prevalence of D & V during deployment to the early stages of the Iraq war, yet the prevalence of probable IBS on return from deployment was relatively low. D & V was strongly associated with IBS after deployment, and CMD was a risk factor for chronic symptoms of IBS. [ABSTRACT FROM AUTHOR]

Objectives: The general health questionnaire (GHQ) is commonly used to assess symptoms of common mental disorder (CMD). Prevalence estimates for CMD caseness from UK population studies are thought to be in the range of 14–17%, and the UK occupational studies of which we are aware indicate a higher prevalence. This review will synthesise the existing research using the GHQ from both population and occupational studies and will compare the weighted prevalence estimates between them. Methods: We conducted a systematic review and meta-analysis to examine the prevalence of CMD, as assessed by the GHQ, in all UK occupational and population studies conducted from 1990 onwards. Results: The search revealed 65 occupational papers which met the search criteria and 15 relevant papers for UK population studies. The weighted prevalence estimate for CMD across all occupational studies which used the same version and cut-off for the GHQ was 29.6% (95% confidence intervals (CIs) 27.3–31.9%) and for comparable population studies was significantly lower at 19.1% (95% CIs 17.3–20.8%). This difference was reduced after restricting the studies by response rate and sampling method (23.9% (95% CIs 20.5%–27.4%) vs. 19.2% (95 CIs 17.1%–21.3%)). Conclusions: Counter intuitively, the prevalence of CMD is higher in occupational studies, compared to population studies (which include individuals not in employment), although this difference narrowed after accounting for measures of study quality, including response rate and sampling method. This finding is inconsistent with the healthy worker effect, which would presume lower levels of psychological symptoms in individuals in employment. One explanation is that the GHQ is sensitive to contextual factors, and it seems possible that symptoms of CMD are over reported when participants know that they have been recruited to a study on the basis that they belong to a specific occupational group, as in nearly all “stress” surveys. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) was formally recognised as a psychiatric disorder in 1980, largely in response to America's attempts to make sense of the costs of the Vietnam war [Wessely, S., & Jones, E. (2004). Psychiatry and the 'lessons of Vietnam': What were they, and are they still relevant? War & Society, 22(1), 89-103.]. Interestingly, all of this occurred without much contribution from epidemiology, which came later (Wessely & Jones, 2004). This cannot be said of the current conflicts, where from the outset there has been a focus of attention on the epidemiology of PTSD in those who served in either Iraq or Afghanistan, even whilst the conflicts were ongoing. In this editorial, we focus on this recent epidemiological contribution to the understanding of PTSD in military personnel. [ABSTRACT FROM AUTHOR]

Kolk et al.’s model of symptom perception underlines the effects of trait negative affect, selective attention and external stressors. The current study tested this model in 263 males and 498 females from an occupational sample. Trait negative affect was associated with symptom reporting in females only, and selective attention and psychological job demands were associated with symptom reporting in both genders. Health anxiety was associated with symptom reporting in males only. Future studies might consider the inclusion of selective attention, which was more strongly associated with symptom reporting than negative affect. Psychological job demands appear to influence symptom reporting in both males and females. [ABSTRACT FROM PUBLISHER]

The article discusses a study in palliative care exploring factors associated with non-remission of depression. The study helps in determining whether specific psychiatric or psychological intervention is required. Results reveal that patients with low social support from family on referral require additional psychosocial care in the treatment of depression. Also discussed are the clinical implications for palliative care.

Abstract: Context: Representations of illness have been studied in several populations, but research is limited in palliative care. Objectives: To describe illness representations in a population with advanced disease receiving palliative care and to examine the relationship between illness perceptions, adaptive coping, and depression. Methods: A cross-sectional survey of 301 consecutive eligible patients recruited from a palliative care service in south London, U.K. Measures used included the Brief Illness Perception Questionnaire (Brief IPQ), the Mental Adjustment to Cancer (MAC) Scale, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire-9. Results: Scores were not normally distributed for most questions on the Brief IPQ. The correlations found between items on the Brief IPQ were understandable in the context of advanced disease. MAC helplessness-hopelessness and fighting spirit were highly correlated with items on the Brief IPQ in opposite directions. The Brief IPQ domains of consequences, identity, concern, personal control, and emotion were associated with depression, a relationship that was not explained by adaptive coping. Seven causal attribution themes were identified: don’t know, personal responsibility, exposure, pathological process, intrinsic personal factors, chance, fate or luck, and other. Both lung cancer diagnosis and gender were found to be independently associated with personal responsibility attribution. None of the attribution themes were associated with the presence of depression. Conclusion: Assessment of illness perceptions in palliative care is likely to yield important information about risk of depression and will help clinicians to personalize management of advanced disease. [Copyright &y& Elsevier]

Purpose: To examine the associations between family social support, community 'social capital' and mental health and educational outcomes. Methods: The data come from the Longitudinal Study of Young People in England, a multi-stage stratified nationally representative random sample. Family social support (parental relationships, evening meal with family, parental surveillance) and community social capital (parental involvement at school, sociability, involvement in activities outside the home) were measured at baseline (age 13-14), using a variety of instruments. Mental health was measured at age 14-15 (GHQ-12). Educational achievement was measured at age 15-16 by achievement at the General Certificate of Secondary Education. Results: After adjustments, good paternal (OR = 0.70, 95% CI 0.56-0.86) and maternal (OR = 0.65, 95% CI 0.53-0.81) relationships, high parental surveillance (OR = 0.81, 95% CI 0.69-0.94) and frequency of evening meal with family (6 or 7 times a week: OR = 0.77, 95% CI 0.61-0.96) were associated with lower odds of poor mental health. A good paternal relationship (OR = 1.27, 95% CI 1.06-1.51), high parental surveillance (OR = 1.37, 95% CI 1.20-1.58), high frequency of evening meal with family (OR = 1.64, 95% CI 1.33-2.03) high involvement in extra-curricular activities (OR = 2.57, 95% CI 2.11-3.13) and parental involvement at school (OR = 1.60, 95% CI 1.37-1.87) were associated with higher odds of reaching the educational benchmark. Participating in non-directed activities was associated with lower odds of reaching the benchmark (OR = 0.79, 95% CI 0.70-0.89). Conclusions: Building social capital in deprived communities may be one way in which both mental health and educational outcomes could be improved. In particular, there is a need to focus on the family as a provider of support. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we investigate whether prospective associations between psychopathology, physical activity, and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) observed in the 1946 and 1970 birth cohorts were replicable in the 1958 British birth cohort. Methods: Prospective study using the 1958 British birth cohort, which included 98.7% of births from 1 week in March 1958 in England, Wales, and Scotland. The outcome was self-reported CFS/ME by the age of 42 years, at which point 11,419 participants remained in the study. Psychopathology was assessed by the Rutter scales in childhood and the Malaise Inventory in adulthood. Physical activity was reported by the cohort member, mother and teacher in childhood and adulthood. Results: The prevalence of CFS/ME was 1.0% (95% confidence interval [CI] = 0.9–1.3) and the median age of onset was 34 years. Premorbid psychopathology at 23 years (odds ratio [OR] = 1.85, 95% CI = 1.06–3.22) and 33 years (OR = 2.81, 95% CI = 1.28–6.18) significantly increased the odds of developing CFS/ME, supporting the 1946 cohort findings. Childhood psychopathology, sedentary behavior in childhood, and persistent exercise in adulthood were not associated with CFS/ME. Conclusions: In cohort studies premorbid psychopathology in adulthood is a replicated risk marker for CFS/ME, whereas premorbid extremes of physical activity are not. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The goals of the current study were to investigate: (i) how the manipulation of psychophysiological state (stress vs. relaxation) would influence heartbeat detection performance in a laboratory environment and (ii) whether interoceptive accuracy had a relationship with symptom reporting. Method: Forty participants (20 males) performed a stressor (a demanding mental arithmetic task) and a relaxation exercise during two counterbalanced sessions, both of which included baseline (control) conditions. Performance of both tasks was interspersed with a heartbeat detection task, i.e., a two-choice Whitehead paradigm. Data were collected from subjective mood scales as well as the electrocardiogram. Results: Both stress and relaxation conditions had the anticipated influence on subjective mood. There was no effect of stress or relaxation on heartbeat detection accuracy for male participants. However, the heartbeat detection accuracy of female participants showed a significant decline during the stressor condition. There was evidence that lower mean heart rate tended to improve heartbeat detection performance. A regression analysis revealed that two traits from the Body Perception Questionnaire (autonomic reactivity and body awareness) predicted heartbeat detection accuracy but not in the expected direction. Conclusions: The study provided evidence of a gender-specific decrement of heartbeat detection accuracy due to a laboratory stressor. However, the relevance of this finding for health psychology may be limited, as interoceptive accuracy had no significant relationship with symptom reporting. [Copyright &y& Elsevier]

The authors describe and illustrate 6 factors that affect the size of a Pearson correlation: (a) the amount of variability in the data, (b) differences in the shapes of the 2 distributions, (c) lack of linearity, (d) the presence of 1 or more "outliers," (e) characteristics of the sample, and (f) measurement error. Also discussed are ways to determine whether these factors are likely affecting the correlation, as well as ways to estimate the size of the influence or reduce the influence of each. [ABSTRACT FROM AUTHOR]

This article describes the establishment in fall 2002 of a School of Education Research Center designed to support faculty in increasing productivity and quality in research. Details are provided about center goals, services, staffing, space, resources, and logistics during the first year of operation. In addition, data are shared about faculty usage of the Center, the level of faculty satisfaction with center services in the first year, and initial increases in faculty productivity. The article concludes with plans for continued data collection to monitor the impact of the Center, a discussion of lessons learned at this point in the Center's development, and possibilities for the evolution of the Center. [ABSTRACT FROM AUTHOR]

Abstract: This paper reports the results of a study conducted within the context of a school–university partnership. Researchers investigated the degree to which clinical teachers regularly use and model proficiently the skills and knowledge required of teacher candidates to successfully move towards initial licensure. Results were encouraging for most domains, although less so for areas such as math, standards-based curriculum, and technology. Results indicated differences in the perceptions of clinical teachers, site coordinators, site professors, and other faculty within the professional development school. Researchers discuss the implications for the teacher education and professional development components of school–university partnerships. [Copyright &y& Elsevier]

The treatment of validity in the newest edition of Standards for Educational and Psychological Testing (Standards; American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, 1999) is quite different from coverage in earlier editions of the Standards and in most measurement textbooks. The view of validity in the 1999 Standards is discussed, and suggestions for instructors of measurement courses are offered. [ABSTRACT FROM AUTHOR]

The distinction between interrater (or interobserver, interjudge, interscorer) "agreement" and "reliability" is discussed. A total of 3 approaches or techniques for the estimation of interrater agreement and reliability are illustrated and compared, using data from a hypothetical study. The 3 approaches are (a) simple percentage of agreement and kappa, (b) simple correlational techniques, and (c) generalizability (G) theory techniques. In discussing the relative advantages and disadvantages of the various approaches, the G theory techniques are emphasized-because they are the most comprehensive and flexible, allowing the researcher to isolate multiple sources of measurement error in one study. Some recommendations regarding the "method of choice" for various situations are offered. [ABSTRACT FROM AUTHOR]

Investigates the relationship between the Angoff ratings and the observed item difficulty levels for borderline examinees in the United States. Tendency for the judges to be influenced by the factors influencing item difficulty; Inclination of the judges to overestimate performance of borderline groups; Use of the Angoff method in setting examination standards.

Examines the role of factor analysis in the estimation of construct validity. Discussion on the separate histories of validity and factor analysis; Distinctions between exploratory and confirmatory factor analysis; Cautions against overreliance on factor analysis in the estimation of construct validity.

Studies the responses of 250 faculty members to questions about `good' teaching. Analysis by gender, rank and discipline.

Discusses several different approaches to the estimation of interinterviewer reliability for an instrument like the Consumer Satisfaction Inventory used in special education research. Percentage of agreement techniques; Correlational techniques; Generalizability theory techniques.

Analyzes the statistical techniques used in the 'Journal of Educational Psychology.' Tabulation of statistical techniques as to level of coursework; Concerns on the appropriateness of statistical techniques used in the journal; Percentage of inter-rater reliability.

Mindfulness is characterized by skills such as heightened awareness and acceptance of internal experiences, which may be helpful for people who have experienced trauma. The consistency and strength of the relationship between trait mindfulness and PTSD symptomology, however, is unknown. Studies were included in this review if they were published in an English language peer-reviewed journal, reported on a correlational relationship between validated measures of mindfulness and PTSD, and all participants were over the age of 18. A random effects meta-analysis showed that there was a robust, pooled relationship between total mindfulness and PTSD (r + = −0.39, 95% CI [-0.47 to −0.30]), based on 35 datasets with 13,370 participants, with low risk of publication bias. Sixteen articles reported on facets of mindfulness and PTSD symptomology [5,206 to 5,600 participants]: the strongest associations were with Act with Awareness (r + = −0.37) and Non-judge (r + = −0.37), followed by Describe (r + = −0.22) and Non-react (r + = −0.21). Observe was not significantly associated with PTSD symptoms. Results from this analysis suggest that people who are more mindful also report fewer symptoms of PTSD ; the strength of the relationship varies across mindfulness facets. There was high heterogeneity across studies. • A meta-analysis measured the relationship between trait mindfulness and PTSD symptoms. • Greater levels of trait mindfulness were associated with fewer symptoms of PTSD. • Facets of mindfulness had different relationships with PTSD symptoms. [ABSTRACT FROM AUTHOR]

Purpose: Indicators of socioeconomic status (SES), such as education and occupational grade, are known to be associated with alcohol use but this has not been examined among individuals with a mental health problem. This study developed latent classes of SES, their associations with alcohol use, and examined the indirect effect via social support and neighbourhood environment. Methods: A secondary analysis of the 2014 Adult Psychiatric Morbidity Survey was conducted among participants with a mental health problem (N = 1,436). SES classes were determined using a range of indicators. Alcohol use was measured using the Alcohol Use Disorder Identification Test. Social support and neighbourhood neighbourhood environment were measured using validated questionnaires. A latent class analysis was conducted to develop SES classes. Multinomial logistic regression examined associations of SES and alcohol use. Structural equation models tested indirect effects via social support and neighbourhood environment. Results: A four-class model of SES was best-fitting; "economically inactive,GCSE-level and lower educated,social renters", "intermediate/routine occupation,GCSE-level educated,mixed owner/renters", "retired, no formal education,homeowners", and "professional occupation,degree-level educated,homeowners". Compared to "professional occupation,degree-level educated, homeowners", SES classes were more likely to be non-drinkers; odds were highest for "economically inactive,GCSE-level and lower educated,social renters" (OR = 4.96,95%CI 3.10–7.93). "Retired, no formal education,homeowners" were less likely to be hazardous drinkers (OR = 0.35,95%CI 0.20–0.59). Associations between "economically inactive,GCSE-level and lower educated,social renters" and "retired, no formal education,homeowners" and non- and harmful drinking via social support and neighbourhood environment were significant. Conclusions: In contrast to the alcohol harms paradox, among individuals with a mental health problem, lower SES groups were more likely to be non-drinkers while no associations with harmful drinking were found. There is also a need to examine the alcohol harms paradox in the context of the area in which they live. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic negatively impacted mental health in the general population in Britain. Ethnic minority people suffered disproportionately, in terms of health and economic outcomes, which may contribute to poorer mental health. We compare the prevalence of depression and anxiety across 18 ethnic groups in Britain during the COVID-19 pandemic. Secondary analysis of cross-sectional data (February–November 2021) from 12,161 participants aged 18–60 years old (N with data on outcomes = 11,540 for depression & 11,825 for anxiety), obtained from the Evidence for Equality National Survey (EVENS). Data were weighted to account for selection bias and coverage bias. Weighted regression models examined ethnic differences in depression (Centre for Epidemiologic Studies Depression Scale) and anxiety (Generalised Anxiety Disorder-7). Effect modification analyses explored whether ethnic differences in outcomes were consistent within age and sex sub-groups. Compared to White British people, greater odds of anxiety caseness (and greater anxiety symptoms) were observed for Arab (OR = 2.57; 95 % CI = 1.35–4.91), Mixed White and Black Caribbean (1.57; 1.07–2.30), any other Black (2.22, 1.28–3.87) and any other Mixed (1.58; 1.08–2.31) ethnic groups. Lower odds of depression caseness (and lower depressive symptoms) were identified for Chinese (0.63; 0.46–0.85), Black African (0.60; 0.46–0.79), and any other Asian (0.55; 0.42–0.72) ethnic groups. Cross-sectional data limits the opportunity to identify changes in ethnic inequalities in mental health over time. We have identified certain ethnic groups who may require more targeted mental health support to ensure equitable recovery post-pandemic. Despite finding lower levels of depression for some ethnic groups, approximately one third of people within each ethnic group met criteria for depression. • Cross-sectional analysis of the largest UK survey of ethnic minority people • Ethnic differences in depression and anxiety were compared against White British. • Arab and any other Black people had more than double the odds of reporting anxiety. • Mixed White and Black Caribbean and any other Mixed people also had greater odds. • Lower levels of depression observed for some ethnic minority groups. [ABSTRACT FROM AUTHOR]

Background: Participation in temporary alcohol abstinence campaigns such as 'Dry January' may prompt enduring reductions in alcohol consumption. A randomized controlled trial (RCT) is required to establish any long-term benefits or negative consequences of temporary abstinence. In the present study, we randomized heavy drinkers to complete or intermittent alcohol abstinence for 4 weeks, in order to evaluate the feasibility of conducting a large-scale RCT. Methods: This was a mixed methods feasibility study in which we explored recruitment and retention to a randomized trial, compliance with alcohol abstinence instructions and barriers to compliance, and acceptability of study procedures (primary feasibility outcomes). A community sample of women aged between 40 and 60 who drank in excess of 28 alcohol units per week were randomized to abstain from alcohol for 4 weeks either completely or intermittently (at least four abstinent days per week). To monitor compliance, both groups provided regular breath samples on a cellular breathalyser. A subsample completed a semi-structured interview that probed barriers to compliance with abstinence instructions and acceptability of study procedures. Results: Within 5 months, we recruited, screened and randomized 25 participants (20% of participants who responded to advertisements: 14 in the complete abstinence group, 11 in the intermittent abstinence group), 24 of whom were retained throughout the 28-day intervention period. Participants in both groups tended to comply with the instructions: the median number of breathalyser-verified abstinent days was 24 (IQR = 15.5–25.0; 86% of target) in the complete abstinence group versus 12 (IQR = 10–15; 75% of target) in the intermittent abstinence group. Semi-structured interviews identified some barriers to compliance and methodological issues that should be considered in future research. No adverse events were reported. Conclusions: It is feasible to recruit heavy drinking women from community settings and randomize them to either complete or intermittent abstinence from alcohol for 4 weeks. The majority of participants were retained in the study and compliance with the abstinence instructions was good, albeit imperfect. A comprehensive RCT to compare temporary alcohol abstinence with other alcohol reduction strategies on long-term alcohol consumption is feasible. Findings from such a trial would inform implementation of alcohol campaigns and interventions. [ABSTRACT FROM AUTHOR]

LINE-1 (L1) is a non-long terminal repeat (LTR) retrotransposon inserted throughout the human genome. APOBEC3 (A3) proteins are part of a network of host intrinsic defenses capable of restricting retroviruses and the replication of L1 retroelements. These enzymes inactivate retroviruses primarily through deamination of single-stranded viral DNA. In contrast, only A3A deaminates L1 DNA, while the other six A3 proteins restrict L1 to varying degrees through yet poorly defined mechanisms. Here we provide further insight into the molecular attributes of L1 restriction by A3 proteins. We specifically investigated the roles of A3 protein oligomerization, interactions with RNA and their binding to the various L1 proteins. Our results show that compromising the ability of A3 proteins to oligomerize or interact with a nucleic acid substrate diminished L1 restriction to varying degrees. However the efficiency of their binding to L1 proteins did not predict restriction or the potency of the restriction. [ABSTRACT FROM AUTHOR]

Background: For the past decade, Maternal Mortality Reports, published in the United Kingdom every three years, have consistently raised concerns about maternal observations in maternity care. The reports identify that observations are not being done, not being completed fully, are not recorded on Early Warning Score systems, and/or are not escalated appropriately. This has resulted in delays in referral, intervention and increases the risk of maternal morbidity or mortality. However there has been little exploration of the possible reasons for non-completion of maternal observations.Methods: The aim of this study was to explore midwives' experiences of performing maternal observations and escalating concerns in rural and urban maternity settings in the West Midlands of England. A qualitative design involving a series of six focus groups with midwives and Supervisors of Midwives was employed to investigate the facilitators of, and barriers to the completion of maternal observations.Results: Eighteen Midwives and 8 Supervisors of Midwives participated in a total of 6 focus groups. Three key themes emerged from the data: (1) Organisation of Maternal Observations (including delegation of tasks to Midwifery Support Workers, variation in their training, the care model used e.g. one to one care, and staffing issues); (2) Prioritisation of Maternal Observations (including the role of professional judgement and concerns expressed by midwives that they did not feel equipped to care for women with complex clinical needs; and (3) Negotiated Escalation (including the inappropriate response from senior staff to use of Modified Early Warning Score systems, and the emotional impact of escalation).Conclusions: A number of organisational and cultural barriers exist to the completion of maternal observations and the escalation of concerns. In order to address these the following actions are recommended: standardised training for Midwifery Support Workers, review of training of midwives to ensure it addresses the increasing complexity of the maternal population, identification and agreement regarding the organisation of maternal observations among staff, an emphasis on increasing the priority placed on maternal observations in all clinical settings, and clarification and reinforcement of escalation procedures for both midwives and senior clinicians. [ABSTRACT FROM AUTHOR]

• UK adults commonly experience discrimination and mental health problems. • Social inequalities exist for discrimination and mental health problems. • Discrimination may in part explain some social inequalities in mental health problems. • SES moderated some associations between disadvantaged subgroups and outcomes. Experiencing discrimination is associated with poorer mental health and the demographic patterning of discrimination may explain social inequalities in mental health. The present research examined prevalence of perceived discrimination in the UK and associations with social inequalities in mental health. Data were taken from the UK Household Longitudinal Study (n = 32,003). Population subgroups (sex, age, ethnicity, health, religiousness, income, education, and occupation), perceived personal discrimination (personal experience) and perceived belonging to a discriminated group (identified as belonging to a group discriminated against in this country), and probable mental health problems (GHQ-12 assessed, cut off 4+) were reported on in 2019/2020. Nineteen percent of participants perceived personal discrimination in the last year, 9% perceived belonging to a discriminated group, and 22% had probable mental health problems. There were significant inequalities in both perceived discrimination and mental health. Being a younger adult, of mixed ethnicity, having health problems, having a university degree, and being unemployed increased risk of mental health problems and these associations were partially explained by perceived discrimination being more common among these groups. Perceived discrimination is common among UK adults, but prevalence differs by population subgroup. Perceived discrimination may contribute to social inequalities in mental health. [ABSTRACT FROM AUTHOR]

Background: There is strong evidence for the co-occurrence of mental health conditions and alcohol problems, yet physical health outcomes among this group are not well characterised. This study aimed to identify clusters of physical health conditions and their associations with mental health and problematic alcohol use in England's general population. Methods: Cross-sectional analysis of the 2014 Adult Psychiatric Morbidity Survey (N = 7546) was conducted. The survey used standardised measures of problematic alcohol use and mental health conditions, including the Alcohol Use Disorders Identification Test (AUDIT) and the Clinical Interview Schedule-Revised. Participants self-reported any lifetime physical health conditions. Latent class analysis considered 12 common physical illnesses to identify clusters of multimorbidity. Multinomial logistic regression (adjusting for age, gender, ethnicity, education, and occupational grade) was used to explore associations between mental health, hazardous drinking (AUDIT 8 +), and co-occurring physical illnesses. Results: Five clusters were identified with statistically distinct and clinically meaningful disease patterns: 'Physically Healthy' (76.62%), 'Emerging Multimorbidity' (3.12%), 'Hypertension & Arthritis' (14.28%), 'Digestive & Bowel Problems" (3.17%), and 'Complex Multimorbidity' (2.8%). Having a mental health problem was associated with increased odds of 'Digestive & Bowel Problems' (adjusted multinomial odds ratio (AMOR) = 1.58; 95% CI [1.15–2.17]) and 'Complex Multimorbidity' (AMOR = 2.02; 95% CI [1.49–2.74]). Individuals with co-occurring mental health conditions and problematic alcohol use also had higher odds of 'Digestive & Bowel Problems' (AMOR = 2.64; 95% CI [1.68–4.15]) and 'Complex Multimorbidity' (AMOR = 2.62; 95% CI [1.61–4.23]). Conclusions: Individuals with a mental health condition concurrent with problematic alcohol use experience a greater burden of physical illnesses, highlighting the need for timely treatment which is likely to include better integration of alcohol and mental health services. [ABSTRACT FROM AUTHOR]

Purpose: Despite the higher prevalence of problem drinking in the UK military compared to the general population, problem recognition appears to be low, and little is known about which groups are more likely to recognise a problem. This study examined prevalence of problem drinking recognition and its associations. Methods: We analysed data from 6400 regular serving and ex-serving personnel, collected in phase 3 (2014–2016) of the King's Centre for Military Health Research cohort study. Measurements: Participants provided sociodemographic, military, health and impairment, life experiences, problem drinking, and problem recognition information. Problem drinking was categorised as scores ≥ 16 in the AUDIT questionnaire. Associations with problem recognition were examined with weighted logistic regressions. Findings: Among personnel meeting criteria for problem drinking, 49% recognised the problem. Recognition was most strongly associated (ORs ≥ 2.50) with experiencing probable PTSD (AOR = 2.86, 95% CI = 1.64–5.07), social impairment due to physical or mental health problems (AOR = 2.69, 95% CI = 1.51–4.79), adverse life events (AOR = 2.84, 95% CI = 1.70–4.75), ever being arrested (AOR = 2.99, CI = 1.43–6.25) and reporting symptoms of alcohol dependence (AOR = 3.68, 95% CI = 2.33–5.82). To a lesser extent, recognition was also statistically significantly associated with experiencing psychosomatic symptoms, feeling less healthy, probable common mental health disorders, and increased scores on the AUDIT. Conclusion: Half of UK military personnel experiencing problem drinking does not self-report their drinking behaviour as problematic. Greater problem drinking severity, poorer mental or physical health, and negative life experiences facilitate problem recognition. [ABSTRACT FROM AUTHOR]

Background: The British Police Service and Armed Forces are male-dominated occupations, characterised by frequent trauma exposure and intensive demands. Female police employees and military personnel may have unique experiences and face additional strains to their male counterparts. This analysis compared the levels of post-traumatic stress disorder (PTSD), hazardous/harmful alcohol consumption, and comorbidity in female police employees and military personnel. Methods: Police data were obtained from the Airwave Health Monitoring Study (N = 14,145; 2007–2015) and military data from the Health and Wellbeing Cohort Study (N = 928; phase 2: 2007–2009 and phase 3: 2014–2016). Multinomial/logistic regressions analysed sample differences in probable PTSD, hazardous (14–35 units per week) and harmful (35 + units per week) alcohol consumption, and comorbid problems. We compared covariate adjustment and entropy balancing (reweighting method controlling for the same covariates) approaches. Results: There were no significant differences in probable PTSD (police: 3.74% vs military: 4.47%) or hazardous drinking (police: 19.20% vs military: 16.32%). Female military personnel showed significantly higher levels of harmful drinking (4.71%) than police employees (2.42%; Adjusted Odds Ratios [AOR] = 2.26, 95% Confidence Intervals [CIs] = 1.60–3.21), and comorbidity (1.87%) than police employees (1.00%, AOR = 2.07, 95% CI = 1.21–3.54). Entropy balancing and covariate-adjustments obtained the same results. Conclusions: Comparable levels of probable PTSD were observed, which are slightly lower than estimates observed in the female general population. Future research should explore the reasons for this. However, female military personnel showed higher levels of harmful drinking than police employees, emphasising the need for alcohol interventions in military settings. [ABSTRACT FROM AUTHOR]

Purpose: Accidents are the most common cause of death among UK military personnel. It is a common misconception in the general public that accidental injuries are always the result of random events, however research suggests that mental health problems and the increased levels of risky behaviour in military personnel may play a role. The objective of this study was to further our understanding of injuries and deaths not related to deployment by examining the associations of mental health, alcohol misuse and smoking with inpatient admission to hospital for accidents and injuries, and attendance to accident and emergency (A&E) departments. Methods: Data on all hospital admissions for accidents and injuries and A&E attendance at NHS hospitals in England, Scotland and Wales were linked to data on self-reported mental health problems, alcohol misuse and smoking from a large, representative UK military cohort of serving and ex-serving personnel (n = 8,602). Logistic regression was used to examine the associations between having a hospital admission for an accident or injury with self-reported mental health problems, alcohol misuse and smoking. Cox proportional-hazards regression was then conducted to assess the associations of mental health problems, alcohol misuse and smoking with time to hospital admission for an accident or injury. Finally, negative binomial regression was used to examine associations between the number of A&E attendances with mental health problems, alcohol misuse and smoking. Results: Personnel reporting symptoms of common mental disorder (CMD) or probable post-traumatic stress disorder (PTSD) were more likely to have an admission to hospital for an accident or injury (fully adjusted odds ratio 1.39, 95% confidence interval [CI] 1.05–1.84), than those who did not report these symptoms, and also had more attendances to A&E (fully adjusted incidence rate ratio [IRR] 1.32, 95% CI 1.16–1.51). A&E attendances were also more common in personnel who were smokers (fully adjusted IRR 1.21, 95% CI 1.09–1.35) following adjustment for demographic, military and health characteristics. Conclusions: The findings suggest that accidents and injuries among military personnel are not always random events and that there are health and behavioural factors, including poor mental health and smoking, which are associated (with small effect sizes) with an increased risk of being involved in an accident. Clinicians treating individuals attending hospital after an accident should consider their healthcare needs holistically, including issues related to mental health and health damaging behaviours. [ABSTRACT FROM AUTHOR]

Background: The use of digital technology within health care service delivery, monitoring, and research is becoming progressively popular, particularly given the ongoing COVID-19 pandemic. Mobile health (m-health) apps, one form of digital technology, are increasingly being used to promote positive health related behavior change. Therefore, it is important to conduct research to understand the efficacy of m-health apps. The process of participant recruitment is an essential component in producing strong research evidence, along with ensuring an adequately powered sample to conduct meaningful analyses and draw robust conclusions. Methods: In this work we outline and reflect on the strategies used to recruit help-seeking military veterans into an intervention study, which aimed to evaluate the efficacy of an app (Drinks:Ration) to modify behavior in alcohol misusers. Recruitment strategies included through (1) partner organizations and (2) social media and Facebook advertising (ads). Results: Facebook ads were live for a period of 88 days and were viewed by a total audience of 29,416 people. In total 168 military veterans were recruited across all recruitment strategies, meaning that Drinks:Ration exceeded its recruitment targets. Half of the sample (n = 84) were recruited through social media, including Facebook ads. Conclusions: The current article highlighted that targeted Facebook ads were an efficient strategy to recruit military veterans into a digital intervention trial aiming to reduce alcohol consumption because they reduced the amount of time and resources required to contact a large number of potentially eligible individuals for our study. This article acts as a starting point for other researchers to evaluate their recruitment pathways for recruiting military veterans into alcohol misuse research. [ABSTRACT FROM AUTHOR]

One-third of UK police employees drink to at-risk levels, with both at-risk drinking and abstinence being associated with poor mental health. This research aimed to qualitatively explore police employees' experiences of at-risk alcohol use or abstinence, their motivations for drinking/abstaining, and the organizational culture of drinking. Semi-structured telephone interviews with 16 UK serving police employees (12 at-risk drinkers, four abstainers) were conducted and analysed using thematic analysis. Five themes were identified. Participants described the 'organizational culture of drinking and changes over time', outlining a cultural shift. Motivations for drinking were reflected across two themes, 'alcohol as a coping mechanism' and 'alcohol and socializing', with an additional theme representing 'motivations for abstinence/cutting down'. The final theme highlighted the 'contrasting perceptions of available support'. Though the drinking culture is no longer as prominent, using alcohol socially and to cope, is normalized. The implications and recommendations for practice are outlined. [ABSTRACT FROM AUTHOR]

Discusses findings of a study designed to determine is health care professionals choose their family or community roles during disaster. Study design; Number of women health care workers with family-community role conflict; Lack of significant differences in family or community role choices by men health care workers; Less psychological stress of health care workers who chose the famiyl role.

Points out major statistical problems involved in the use of change scores. Recommended alternate procedures that can improve the reliability and validity of the findings from studies concerned with change; Unreliability problem; Negative correlation with pre-test scores; Uses of change scores on nursing research.

Discusses the use of generalizability theory techniques to estimate reliability of measures. Alternative to classical test theory as basis for conceptualizing and estimating the reliability of instruments; Analysis data from the Nurse Practitioner Rating Form; Relative advantages and disadvantages of generalizability theory techniques; Uses of the technique on nursing research.

Mental disorders and alcohol misuse are often comorbid, and this comorbidity is more common in those who develop mental disorders following exposure to traumatic events. To investigate the relationship between combat exposure and operational role (support versus combat) with mental disorders and associated comorbidity in a UK military cohort. 4896 participants from a UK military cohort reported their operational role and frequency of exposure to combat events during deployment. Outcome measures included self-reported post-traumatic stress disorder, common mental disorder and alcohol misuse. Personnel reporting higher levels of combat exposure were more likely to meet criteria for two or more co-occurring mental disorders (odds ratio [OR] 3.90, 95% confidence interval [CI] 2.73–5.58). While having a combat role increased the risk of developing co-occurring disorders compared to having a support role (OR 1.67, 95% CI 1.26–2.23), this effect diminished following adjustment for variables including combat exposure (OR 0.89, 95% CI 0.62–1.27). Combat exposure may play a greater role in the development of comorbid mental disorders than operational role, i.e. job title. Clinicians treating military personnel should be alert to the increased risk of comorbid mental disorders and alcohol misuse among those with a history of combat exposure. [ABSTRACT FROM AUTHOR]