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Depression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS.
Patients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale – Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools.
In total, 190 patients were included. ET4 performed well as a ‘rule-out’ screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7.
ET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.
Little is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.
We examined the prevalence of mental disorders and alcohol misuse, whether this differed between serving and ex-serving regular personnel and by deployment status.
This is the third phase of a military cohort study (2014–2016; n = 8093). The sample was based on participants from previous phases (2004–2006 and 2007–2009) and a new randomly selected sample of those who had joined the UK armed forces since 2009.
The prevalence was 6.2% for probable post-traumatic stress disorder, 21.9% for common mental disorders and 10.0% for alcohol misuse. Deployment to Iraq or Afghanistan and a combat role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel.
The findings highlight an increasing prevalence of post-traumatic stress disorder and a lowering prevalence of alcohol misuse compared with our previous findings and stresses the importance of continued surveillance during service and beyond.
Declaration of interest:
All authors are based at King's College London which, for the purpose of this study and other military-related studies, receives funding from the UK Ministry of Defence (MoD). S.A.M.S., M.J., L.H., D.P., S.M. and R.J.R. salaries were totally or partially paid by the UK MoD. The UK MoD provides support to the Academic Department of Military Mental Health, and the salaries of N.J., N.G. and N.T.F. are covered totally or partly by this contribution. D.Mu. is employed by Combat Stress, a national UK charity that provides clinical mental health services to veterans. D.MacM. is the lead consultant for an NHS Veteran Mental Health Service. N.G. is the Royal College of Psychiatrists’ Lead for Military and Veterans’ Health, a trustee of Walking with the Wounded, and an independent director at the Forces in Mind Trust; however, he was not directed by these organisations in any way in relation to his contribution to this paper. N.J. is a full-time member of the armed forces seconded to King's College London. N.T.F. reports grants from the US Department of Defense and the UK MoD, is a trustee (unpaid) of The Warrior Programme and an independent advisor to the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee (unpaid) of Combat Stress and Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid). S.W. is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, the Department of Health, Public Health England or the UK MoD.
Risk factors for poor mental health among UK veterans include demonstrating symptoms while in service, being unmarried, holding lower rank, experiencing childhood adversity and having a combat role; however, deploy ment to a combat zone does not appear to be associated with mental health outcomes. While presentation of late-onset, post-service difficulties may explain some of the difference between veterans and those in service, delayed-onset post-traumatic stress disorder (PTSD) appears to be partly explained by prior subthreshold PTSD, as well as other mental health difficulties. In the longer term, veterans do not appear to suffer worse mental health than equivalent civilians. This overall lack of difference, despite increased mental health difficulties in those who have recently left, suggests that veterans are not at risk of worse mental health and/or that poor mental health is a cause, rather than a consequence, of leaving service.
Most accounts of deployment mental health in UK armed forces personnel
rely on retrospective assessments.
We present data relating to the burden of mental ill health and the
effect of support measures including operational, family, welfare and
medical support obtained on two occasions some 18 months apart.
A total of 2794 personnel completed a survey while deployed to
Afghanistan; 1363 in 2011 and 1431 in 2010. Their responses were compared
The prevalence of self-report mental health disorder was low and not
significantly different between the surveys; the rates of probable
post-traumatic stress disorder (PTSD) were 2.8% in 2010 and 1.8% in 2011;
for common mental health disorders the rates were 17.0% and 16.0%
respectively. Remembering receiving predeployment psychoeducation,
perceptions of good leadership and good family support were all
significantly associated with better mental health. Seeking support from
non-medical sources and reporting sick for medical reasons were both
significantly associated with poorer mental health.
Over a period of 18 months, deployment mental health symptoms in UK armed
forces personnel were fewer than those obtained from a military
population sample despite continuing deployment in a high-threat context
and were associated with perceptions of support.
Most studies of the mental health of UK armed forces focus on
retrospective accounts of deployment and few sample personnel while they
This study reports the results of a survey of deployed personnel,
examining the perceived impact of events at home and military support for
the family on current mental health during the deployment.
Surveys were conducted with 2042 British forces personnel serving in Iraq
and Afghanistan. Prevalence of common mental disorders was assessed with
the 12-item General Health Questionnaire (GHQ-12) and post-traumatic
stress disorder (PTSD) was assessed with the PTSD Checklist – Civilian
The prevalence of common mental disorders was 17.8% and of probable PTSD
was 2.8%. Perceived home difficulties significantly influenced the mental
health of deployed personnel; the greater the perception of negative
events in the home environment, the greater the reporting of adverse
mental health effects. This finding was independent of combat exposure
and was only partially mitigated by being well led and reporting
subjectively good unit cohesion; however, the effect of the totality of
home-front events was not improved by the latter. Poor perceived military
support for the family had a detrimental impact on deployment mental
The armed forces offer many support services to the partners and families
of deployed personnel and ensuring that the efforts being made on their
behalf are well communicated might improve the mental health of deployed