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BackgroundInterest in the mental health of women deployed to modern military campaigns is increasing, although research examining gender differences is limited. Little is known about experiences women have had on these deployments, or whether men and women respond differently to combat exposure.MethodThe current study used data from a representative sample of UK Armed Forces personnel to examine gender differences among those deployed to Iraq and Afghanistan (n=432 women,n=4554 men) in three measures of experience: ‘risk to self’, ‘trauma to others’ and ‘appraisal of deployment’. We examined the impact of such experiences on post-deployment symptoms of post-traumatic stress disorder (PTSD), symptoms of common mental disorder (CMD) and hazardous alcohol use.ResultsAfter adjustment, men reported more exposure to ‘risk to self’ and ‘trauma to others’ events and more negative appraisals of their deployment. Among both genders, all measures of combat experience were associated with symptoms of PTSD and CMD (except ‘risk to self’ events on symptoms of CMD among women) but not with alcohol misuse. Women reported higher scores on the PTSD Checklist – Civilian Version (PCL-C) among those exposed to lower levels of each experience type but this did not hold in the higher levels. Women reported greater symptoms of CMD and men reported greater hazardous alcohol use across both levels of each experience type. Examining men and women separately suggested similar responses to exposure to adverse combat experiences.ConclusionsThe current findings suggest that, although gender differences in mental health exist, the impact of deployment on mental health is similar among men and women.

Important cognitive skills decline with age, but we retain a considerable mental richness in later life, say Marcus Richards and Stephani Hatch

Background Fibromyalgia syndrome (FMS) presents a challenge for patients and health care staff across many medical specialities. The aetiology is multi-dimensional, involving somatic, psychological and social factors. Patients' views were obtained to understand their experience of living with this long-term condition, using qualitative interviews. Methods 12 patients were recruited and stratified by age, gender and ethnicity from one rheumatology outpatient clinic, and a departmental held database of patients diagnosed with FMS. Results Patients' accounts of their experience of FMS resonated well with two central concepts: social identity and illness intrusiveness. These suggested three themes for the analytical framework: life before and after diagnosis (e.g. lack of information about FMS, invisibility of FMS); change in health identity (e.g. mental distress, impact on social life) and perceived quality of care (e.g. lack of contact with nurses, attitudes of specialists). The information provided from one male participant did not differ from the female patients, but black and ethnic community patients expressed a degree of suspicion towards the medication prescribed, and the attitudes displayed by some doctors, a finding that has not been previously reported amongst this patient group. Patients expected more consultation time and effective treatment than they received. Subjective experiences and objective physical and emotional changes were non-overlapping. Patients' accounts revealed that their physical, mental and social health was compromised, at times overwhelming and affected their identity. Conclusion FMS is a condition that intrudes upon many aspects of patients' lives and is little understood. At the same time, it is a syndrome that evokes uneasiness in health care staff (as current diagnostic criteria are not well supported by objective markers of physiological or biochemical nature, and indeed because of doubt about the existence of the condition) and places great demands on resources in clinical practice. Greater attention needs to be paid to the links between the explanatory models of patients and staff, and most important, to the interrelationship between the complex physical, psychological and social needs of patients with FMS. Taking a less medical but more holistic approach when drawing up new diagnostic criteria for FMS might match better individuals' somatic and psycho-social symptom profile and may result in more effective treatment.

Objectives To identify public perceptions of the risk to health after the poisoning of Alexander Litvinenko with polonium-210 (210Po) in London and to assess the impact of public health communications. Design Cross sectional telephone survey and qualitative interviews. Setting London, United Kingdom. Participants 1000 people completed the cross sectional survey and 86 potentially exposed people completed the qualitative interviews. Main outcome measures Perception of risk to personal health after the 210Po incident. Qualitative interviews were analysed with an emphasis on information needs. Results 11.7% of the survey sample (n=117) perceived their health to be at risk. Aside from personal variables the main predictors of perceived risk to health were believing that the incident was related to terrorism (odds ratio 2.7, 95% confidence interval 1.5 to 4.6) rather than to espionage, that it was targeted at the wider public rather than one person (5.9, 3.2 to 10.9), and that it could affect people who had not been in the contaminated area (3.2, 2.1 to 5.1). Participants in the qualitative interviews were generally satisfied with the information they had received, although they would have preferred more information about their individual risk of exposure, the results of their urine tests, and the health implications of the incident. Conclusions Perceptions of the public that the 210Po incident in London in 2006 was related to espionage helped to reassure them that the risks to personal health were low. In the event of future incidents it is important to ensure that detailed, comprehensible information about the risks of any exposure is available.

Much research has shown that reports of stressful life events are related to a wide variety of psychiatric and physical health outcomes. Relatively little research exists, however, on the distribution of the events according to gender, age, racial/ethnic background, and socioeconomic status (SES). Such information would help identify groups at greatest risk for further investigation. This paper presents a review of the relevant studies. We find that traumatic (e.g., life threatening) events appear to be more frequent for men, while men and women differ more consistently on types rather than on overall numbers of stressful events other than traumatic. Traumatic and other stressful events tend to be more frequent in low SES and racial/ethnic minorities groups, and finally, both traumatic and other stressful events are reported more by younger age groups in samples 18 years of age and older. The limitations and implications of these findings for further research and preventive interventions are discussed, especially the need for more detailed information about individual events.

Well-being is characterized by the capacity to actively participate in work and recreation, create meaningful relationships with others, develop a sense of autonomy and purpose in life, and to experience positive emotions. Well-being varies with age, and with personality and age-related attributes such as educational attainment and health status that are known to be shaped by early life experience. Thus we argue for a life course approach that investigates how experiences from the beginning of life promote (or threaten) the development and maintenance of overall well-being, and its physiological, cognitive and psychosocial components. A life course perspective has been actively promoted by many disciplines within the behavioural, biomedical and social sciences (Cairns et al. 1996; Magnusson 1996; Panter-Brick and Worthman 1999; Giele and Elder 1998; Kuh and Ben-Shlomo 2004). Investigating the independent, cumulative and interactive effects of risk and protective factors at each life stage on later health or well-being is methodologically challenging (De Stavola et al. 2006). Up until now more attention has been paid to chains of risk leading to chronic disease or functional loss in later life rather than to protective chains that promote long-term well-being. The life course approach can, and should, accommodate both types of outcome.

Urban cities are polarized environments combining risks and protective behaviors. This polarization tends to follow the distribution of goods and resources in our society. Racial/ethnic minority groups occupy the lower end of our society and are concentrated in areas with a high level of people living below poverty, high unemployment, high proportion of people on pubic assistance, lack of health insurance, and limited access to health care. Therefore, minorities occupy a higher risk position in our society and particularly so in urban areas. Minority groups’ exposures to health damaging circumstances and promotion of negative health behaviors are a function of their social position. Therefore, to understand the contribution of the urban environment in shaping the health of their residents, the structures and processes driving the racial/ethnic relationships of our society needs to be placed in the context of the historic, economic, and social forces creating and ultimately shaping these relationships in our day-to-day life. Specifically, the historic meaning of race, and more recently ethnicity, needs to be deconstructed to provide equal opportunities to all racial/ethnic groups in our society and to eventually eliminate the health damaging effects of the urban environment.

Introduction. The challenge of personalised medicine is to identify components of addiction that are relevant to an individual in a way that treatment and drug overdose preventions can be tailored. Opioid misusers continue to have recognised extremely high mortality but the influence of psychiatric comorbidity in excess all-cause and cause-specific mortality is questionable. Methods. Opioid-dependent (OD) patients were identified in London-based patient register, which contains records on over 220,000 cases linked to national mortality tracing. We used Cox regression to model the effect of psychiatric co-morbidity on mortality, controlling for a broad range of potential confounders. Results. We identified 4837 OD patients with 176 deaths. The presence of comorbid personality disorder (PD) and alcohol use disorder (AUD) was found to be associated with increased all-cause mortality in all models, including the fully adjusted model. AUD was associated with two-fold increased risk of fatal overdose and seven-fold risk for liver-related deaths. Individuals with OUD and comorbid PD had almost four-times greater risk of liver related deaths compared to those without PD. Conclusions. The study highlights the importance of assessment for PD and alcohol misuse among opioid addicts in order to identify individuals at substantially elevated mortality risk for a more personalised approach to their medical care. This research is part of a larger project, which focusses on electronic-based personalised medicine in drug addiction. The complete research plan as well as research October '14 research update will also be provided.

Background Polydrug use is an understudied phenomenon with potential implications for individual functioning and health. Its frequency within the general public and its individual costs thus need to be documented. This study’s aims were to compare the types of polydrug users in the general public at a national and a local level, and to examine how risk factors and impairments differed between them. Methods Using comparable datasets from a local community in South East London during 2008–2010 (n=1,698) and from England in 2007 (n=7,403), latent class analysis was used to construct profiles of polydrug users. Eight binary indices reporting drug use in the last year for cannabis, amphetamine, cocaine, ecstasy, LSD, tranquilisers, crack, heroin, and two items for hazardous alcohol drinking and current cigarette smoking, were regressed on a latent variable of polydrug use with age and sex covariates. The latent class solution from each dataset was then used in a multinomial logistic regression comparing risk factors from socio-demographic, neighbourhood, social support, and mental health domains. Results Both datasets produced three class solutions with comparable proportions: in London, 61.6% were in the “Nondrug user” group, 30.5% in the “Moderate user group” (characterised by hazardous drinking, cigarettes and some cannabis use) and 7.9% in the “High Drug User” group (characterised by drug use across all substances); in the national dataset the proportions were 57.4%, 37.9 %, and 4.6% respectively. In a logistic regression comparing both polydrug user groups to the nonuser group, both samples reported higher odds for polydrug use and common mental disorder, suicidal ideation, and functional limitation; higher levels of education, stressful life events and a never-married status were also associated with polydrug use. Differences between the local and national samples for polydrug use were found on factors such as ethnicity, social support, and employment status. Further analysis revealed no difference between the “Moderate” and “High Drug” groups in the local sample for these risk factors and mental health indicators, whereas several dose-response relationships between these groups were found nationally. Conclusion Approximately a third of the general public both nationally and locally exhibit a pattern of moderate polydrug use associated with mental health and daily functioning impairments. Furthermore, local services and policy makers should note that higher education is a risk factor for polydrug use, and that factors related to employment and social support may be differentially linked to substance use depending on geographical residence.

Objective: To explore the views of sick doctors on the obstacles preventing them returning to work. Design: Qualitative study. Setting: Single participating centre recruiting doctors from all over the UK. Participants: Doctors who had been away from work for at least 6 months with physical or mental health problems, drug or alcohol problems, General Medical Council involvement or any combination of these, were eligible. Eligible doctors were recruited in conjunction with the Royal Medical Benevolent Fund, the General Medical Council and the Practitioner Health Programme. These organisations approached 77 doctors; 19 participated. Each doctor completed an in-depth semistructured interview. We used a constant comparison method to identify and agree on the coding of the data and the identification of a number of central themes. Results: The doctors described that being away from work left them isolated and sad. Many experienced negative reactions from their family and some deliberately concealed their problems. Doctors described a lack of support from colleagues and feared a negative response when returning to work. Selfstigmatisation was central to the participants’ accounts; several described themselves as failures and appeared to have internalised the negative views of others. Conclusions: Self-stigmatising views, which possibly emerge from the belief that ‘doctors are invincible’, represent a major obstacle to doctors returning to work. From medical school onwards cultural change is necessary to allow doctors to recognise their vulnerabilities so they can more easily generate strategies to manage if they become unwell.

Purpose Few studies have examined discrimination and mental health in the UK, particularly by migrant status and in urban contexts with greater demographic diversity. This study aims to (1) describe the prevalence of discrimination experiences across multiple life domains; (2) to describe associations between discrimination experiences and common mental disorder (CMD); (3) to determine whether or not the relationship between discrimination and CMD varies by migrant status and ethnicity. Methods Data on major, anticipated and everyday discrimination and CMD symptoms were collected from an ethnically diverse prospective sample of 1052 participants followed up from 2008 to 2013 in the South East London Community Health study, a population-based household survey. Results With few exceptions, discrimination was most prevalent among those in the Black Caribbean group. However, those in the White Other ethnic group had similar or greater reporting major and anticipated discrimination to Black or mixed ethnic minority groups. The effects of discrimination on CMD were most pronounced for individuals who had recently migrated to the UK, an ethnically heterogeneous group, and for Black and Mixed ethnic minority groups in partially adjusted models. Prior CMD accounted for differences between the Mixed and White British ethnic groups, but the strength of the association for the most recent migrant group and the Black ethnic groups remained two or more times greater than the reference groups. Conclusions The strength of the relationship suggests a need for more consideration of migration status along with ethnicity in examining the impact of discrimination on mental disorder in community and clinical samples. Electronic supplementary material The online version of this article (doi:10.1007/s00127-016-1191-x) contains supplementary material, which is available to authorized users.

We assessed whether job demand and job control have independent effects on psychological symptoms or whether job control modifies effect of job demand; we also assessed whether rank modified associations between job strain and psychological symptoms. We used the Post Traumatic Stress Disorder (PTSD) Checklist (PCL-C), General Health Questionnaire-12 (GHQ-12), Chalder Fatigue Scale, a checklist of 53 physical symptoms, and the WHO's Alcohol Use Disorders Identification Test (AUDIT). Job control, job demand, and rank were independently associated with PTSD, common mental disorders, multiple physical symptoms, and fatigue, but not with severe alcohol problems. Job control and demand had additive effects on psychological symptoms. Commissioned officers had lower risk of caseness for psychological symptoms than other ranks. Adjustment for rank had negligible effect on level of association between job strain and psychological symptoms. Reported job strain and rank contributed independently to psychological symptoms.

Background Many people with mental illness do not seek or delay seeking care. This study aimed to develop, and provide an initial validation of, a comprehensive measure for assessing barriers to access to mental health care including a ‘treatment stigma’ subscale, and to present preliminary evidence about the prevalence of barriers experienced by adults currently or recently using secondary mental health services in the UK. Methods The Barriers to Access to Care Evaluation scale (BACE) was developed from items in existing scales, systematic item reduction, and feedback from an expert group. It was completed in an online survey by 117 individuals aged 18 and over who had received care from secondary mental health services in the past 12 months. Internal consistency, test-retest reliability, convergent validity (correlation of treatment stigma subscale with the Stigma Scale for Receiving Psychological Help (SSRPH) and with the Internalised Stigma of Mental Illness Scale (ISMI)), respondent opinion and readability were assessed. Results The BACE items were found to have acceptable test-retest reliability as all but one of the items exceeded the criterion for moderate agreement. The treatment stigma subscale had acceptable test-retest-reliability and good internal consistency. As hypothesised the subscale was significantly positively correlated with the SSRPH and the ISMI demonstrating convergent validity. The developmental process ensured content validity. Respondents gave the BACE a median rating of 8 on the 10-point quality scale. Readability scores indicated the measure can be understood by the average 11 to 12 year-old. The most highly endorsed barrier was ‘concern that it might harm my chances when applying for jobs’. The scale was finalised into a 30-item measure with a 12-item treatment stigma subscale. Conclusions There is preliminary evidence demonstrating the reliability, validity and acceptability of the BACE. It can be used to ascertain key barriers to access to mental health care which may help to identify potential interventions to increase care seeking and service use. Further research is needed to establish its factor analytic structure and population norms.

This study is an ethnographic examination of differences in the male-to-female ratio among cocaine users in epidemiological indicators from emergency room departments, local drug-user treatment programs, and the pretrial detention center. In-depth interviews were conducted with female cocaine users. The lower female ratio in drug treatment and emergency department sources seems related to barriers to drug-user treatment for women and the image of emergency departments as an extension of the criminal justice system. The women's involvement in visible illegal activities and their perception as easy arrestees may explain the arrestee data ratio. The findings indicate that epidemiological indicators may misrepresent the gender distribution among drug users.

Background Responses to public health need require information on the distribution of mental and physical ill health by demographic and socioeconomic factors at the local community level. Methods The South East London Community Health (SELCoH) study is a community psychiatric and physical morbidity survey. Trained interviewers conducted face-to-face computer assisted interviews with 1698 adults aged 16 years and over, from 1076 randomly selected private households in two south London boroughs. We compared the prevalence of common mental disorders, hazardous alcohol use, long standing illness and general physical health by demographic and socioeconomic indicators. Unadjusted and models adjusted for demographic and socioeconomic indicators are presented for all logistic regression models. Results Of those in the sample, 24.2% reported common mental disorder and 44.9% reported having a long standing illness, with 15.7% reporting hazardous alcohol consumption and 19.2% rating their health as fair or poor. The pattern of indicators identifying health inequalities for common mental disorder, poor general health and having a long term illness is similar; individuals who are socioeconomically disadvantaged have poorer health and physical health worsens as age increases for all groups. The prevalence of poor health outcomes by ethnic group suggests that there are important differences between groups, particularly for common mental disorder and poor general health. Higher socioeconomic status was protective for common mental disorder, fair or poor health and long standing illness, but those with higher socioeconomic status reported higher levels of hazardous alcohol use. The proportion of participants who met the criteria for common mental disorder with co-occurring functional limitations was similar or greater to those with poor physical health. Conclusions Health service providers and policy makers should prioritise high risk, socially defined groups in combating inequalities in individual and co-occurring poor mental and physical problems. In population terms, poor mental health has a similar or greater burden on functional impairment than long term conditions and perceived health.

The COVID-19 pandemic is expected to have profound and enduring effects on mental health but, until we have data, we will not know its form, extent, duration or distribution. An appropriate public health response to mitigate and manage mental health sequelae is likely to require significant diversion of resources. In the post-COVID environment, such decisions must be underpinned by reliable information: policymakers, commissioners and services need to know both the scale of need and who is most vulnerable. A recent position paper in this journal1 highlights “an immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups”. This should be a clarion-call for governments to fund, and researchers to gather, timely, high-quality population mental health data which represents the true need arising from the pandemic., Unfunded