Meta-analysis and meta-regression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders.

Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is the most investigated biological risk marker in functional somatic disorders (FSDs), such as chronic fatigue syndrome (CFS), fibromyalgia (FM), and irritable bowel syndrome (IBS). Our aim was to assess whether there is an association between basal hypocortisolism and FSD and to identify potential moderators of this association. Meta-analysis on 85 studies revealed that although basal cortisol levels were generally lower in FSD subjects compared to controls, this association did not reach statistical significance (SMD -0.

A clinical follow-up study of reserve forces personnel treated for mental health problems following demobilisation.

Background: The Reserves Mental Health Programme (RMHP) provides a clinical service for members of the United Kingdom's Reserve Forces deployed to combat operations since 2003.

Aim: To assess whether mental health and occupational functioning changed after treatment.

Methods: We examined a treatment group with operationally attributable mental health problems and a non-intervention group with non-operationally attributable problems.

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

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.

Using electronic patient records to assess the impact of swine flu (influenza H1N1) on mental health patients.

Background: Electronic patient records are increasingly used in primary care research, but rarely in psychiatric research. Little is known about how people with pre-existing mental illness respond to public health threats.

Aims: To outline the swine flu related concerns and behaviours of mental health patients and to determine whether marked concern was associated with any specific demographic or diagnostic groups.

Reverse causality in the association between whiplash and symptoms of anxiety and depression: the HUNT study.

Study Design: Longitudinal population-based cohort study.

Objective: The aim of this study was to examine the possibility of reverse causality, that is, if symptoms of anxiety and depression are associated with incident self-reported whiplash injury. The clinical relevance of self-reported whiplash injury was evaluated by its association with subsequent disability pension award.

Long-term military work outcomes in soldiers who become mental health casualties when deployed on operations.

Background: little is known about longer term military work outcomes in UK military personnel who develop mental health problems when operationally deployed. Deployed Field Mental Health Teams (FMHTs) who support them follow the principles of "Forward Psychiatry," aiming to treat psychiatric casualties close to the front line to maximize operational effectiveness and occupational retention.

Aim: to examine the short- and long-term military work outcomes in soldiers deployed to Iraq between 2003 and 2007 who were referred to the FMHT.

The subjective utility of early psychosocial interventions following combat deployment.

Background: Third Location Decompression (TLD) is the process through which personnel, returning from combat operations, begin to psychologically 'unwind'. Decompression comprises welfare activities, such as contacting home, beach events, social events, psycho-educational briefings and controlled re-introduction to alcohol.

Aims: To assess the subjective utility of decompression by surveying all British troops transiting the TLD facility in Cyprus, during 2008.

The injured mind in the UK Armed Forces.

The mental health of the UK Armed Forces is a topic much debated by healthcare professionals, politicians and the media. While the current operations in Afghanistan, and the recent conflict in Iraq, are relevant to this debate, much of what is known about the effects of war upon the psyche still derives from the two World Wars. This paper will examine the historical and contemporary evidence about why it is that some Service personnel suffer psychological injuries during their military service and others do not.

New influenza A/H1N1 ("swine flu"): information needs of airport passengers and staff.

Background: Airports are the entrances of infectious diseases. Particularly at the beginning of an outbreak, information and communication play an important role to enable the early detection of signs or symptoms and to encourage passengers to adopt appropriate preventive behaviour to limit the spread of the disease.

Objectives: To determine the adequacy of the information provided to airport passengers and staff in meeting their information needs in relation to their concerns.

Mental health of UK military personnel while on deployment in Iraq.

Background: Most research on the mental health of UK armed forces personnel has been conducted either before or after deployment; there is scant evidence concerning personnel while they are on deployment.

Aims: To assess the mental health of UK armed forces personnel deployed in Iraq and identify gaps in the provision of support on operations.

Method: Personnel completed a questionnaire about their deployment experiences and health status.

Differential effects of pre and post-payment on neurologists' response rates to a postal survey.

Background: Monetary incentives are an effective way of increasing response rates to surveys, though they are generally less effective in physicians, and are more effective when the incentive is paid up-front rather than when made conditional on completion.

Methods: In this study we examine the effectiveness of pre- and post-completion incentives on the response rates of all the neurologists in the UK to a survey about conversion disorder, using a cluster randomised controlled design. A postal survey was sent to all practicing consultant neurologists, in two rounds, including either a book token, the promise of a book token, or nothing at all.

Mental health care provision in the U.K. armed forces.

Like the United States, the United Kingdom (U.K.) population expresses ongoing interest in the mental health of their nation's armed forces and veterans.

The impact of deployment length on the health and well-being of military personnel: a systematic review of the literature.

To determine the current state of knowledge regarding the effects of deployment length and a 'mismatch' between the expected and actual length of deployments on the health and well-being of military personnel in order to draw relevant conclusions for all organisations that deploy personnel to conflict zones. A systematic review was conducted of studies measuring deployment length to theatres of operations and the issue of 'mismatch' between expected and actual tour lengths. The nine studies included were rated for quality.

Can exposure to a terrestrial trunked radio (TETRA)-like signal cause symptoms? A randomised double-blind provocation study.

Objectives: Concerns have been raised about possible health effects from radiofrequency fields pulsing at around 16 Hz. A radio system used by UK police (TETRA) employs signals which pulse at 17.6 Hz.

Mental health among commando, airborne and other UK infantry personnel.

Background: Despite having high levels of combat exposure, commando and airborne forces may be at less risk of mental ill-health than other troops.

Aims: To examine differences in mental health outcomes and occupational risk factors between Royal Marines Commandos (RMCs), paratroopers (PARAs) and other army infantry (INF).

Methods: Three groups of personnel (275 RMCs, 202 PARAs and 572 INF) were generated from a UK military cohort study of personnel serving at the time of the 2003 Iraq war.

British prisoners-of-war: from resilience to psychological vulnerability: reality or perception.

In contemporary culture, soldiers held as prisoners-of-war (POWs) or as hostages are considered at significant risk of mental illness, in particular post-traumatic stress disorder (PTSD). This assumption contrasts with the psychiatric orthodoxy of the First World War when it was concluded in both Britain and Germany that POWs were protected against 'war neurosis'. Although 'barbed wire disease' was identified during time of captivity, post-release effects were not recognized.

A cluster randomized controlled trial to determine the efficacy of Trauma Risk Management (TRiM) in a military population.

Trauma Risk Management is a peer-support program that aims to promote help-seeking in the aftermath of traumatic events. Prior to its implementation, the British military conducted a randomized controlled trial of Trauma Risk Management against standard care in 12 warships; 6 were randomized to use Trauma Risk Management after collecting baseline measurements. Follow up after 12-18 months found no significant change in psychological health or stigma scores in either group; however, the studied vessels only encountered low numbers of critical incidents.

Help-seeking and receipt of treatment among UK service personnel.

Background: For armed forces personnel, data on help-seeking behaviour and receipt of treatment for mental disorders are important for both research and policy.

Aims: To examine mental healthcare service use and receipt of treatment in a sample of the UK military.

Method: Participants were drawn from an existing UK military health cohort.

Reassuring and managing patients with concerns about swine flu: qualitative interviews with callers to NHS Direct.

Background: During the early stages of the 2009 swine flu (influenza H1N1) outbreak, the large majority of patients who contacted the health services about the illness did not have it. In the UK, the NHS Direct telephone service was used by many of these patients. We used qualitative interviews to identify the main reasons why people approached NHS Direct with concerns about swine flu and to identify aspects of their contact which were reassuring, using a framework approach.

Frequency and predictors of mass psychogenic illness.

Background: Mass psychogenic illness refers to outbreaks of illness attributed to a toxic agent but for which no plausible organic cause is found. We determined the frequency and predictors of mass psychogenic illness within a sample of chemical incidents.

Methods: Information was collected on a random sample of 280 chemical incidents.

Psycho-educational interventions designed to prevent deployment-related psychological ill-health in Armed Forces personnel: a review.

Background: Employers such as the Armed Forces (AF) and emergency services, who predictably expose their staff to potentially traumatic events (PTEs), often provide psycho-educational briefings in an attempt to mitigate possible adverse psychological sequelae. Within the military, psycho-educational briefings are widely used, particularly following exposure to PTEs on operations. The aim of this review was to evaluate the efficacy of these interventions and make appropriate recommendations.

The origins of factitious disorder.

Factitious disorder is the deliberate simulation of illness for the purpose of seeking the sick role. It is a 20th-century diagnosis, though the grounds for its introduction are uncertain. While previous authors have considered the social changes contributing to growth in the disorder, this article looks at some of the pressures on doctors that may have created the diagnostic need for a disorder between hysteria and malingering.