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Mental health research funding priorities in high-income countries must balance longer-term investment in identifying neurobiological mechanisms of disease with shorter-term funding of novel prevention and treatment strategies to alleviate the current burden of mental illness. Prioritising one area of science over others risks reduced returns on the entire scientific portfolio.
The contraceptive consultation differs across international healthcare systems in relation to the setting, scope of practice, provider-responsibility and the available time frame. The key to a successful consultation is to ensure that the patient leaves with their contraceptive needs met, either with the immediate provision of a contraceptive method or a plan for initiation at a specified future date. This chapter provides guidance on how to fulfill this outcome. In a generalist setting, posters inviting patients to discuss sexual health issues, brochures on contraception and information on confidentiality may be of assistance in setting the scene for the consultation. Where time is limited, an effective contraception consultation lies in its shaping. There are a variety of tools ranging from websites to models that can be useful to support a contraceptive consultation. The chapter presents cases, which illustrate approaches and principles in a sample of contraceptive consultations across the reproductive lifespan.
Exposure to childhood adversity may explain why only a minority of combatants exposed to trauma develop psychological problems.
To examine the association between self-reported childhood vulnerability and later health outcomes in a large randomly selected male military cohort.
Data are derived from the first stage of a cohort study comparing Iraq veterans and non-deployed UK military personnel. We describe data collected by questionnaire from males in the regular UK armed forces (n=7937).
Pre-enlistment vulnerability is associated with being single, of lower rank, having low educational attainment and serving in the Army. Pre-enlistment vulnerability is associated with a variety of negative health outcomes. Two main factors emerge as important predictors of ill health: a ‘family relationships’ factor reflecting the home environment and an ‘externalising behaviour’ factor reflecting behavioural disturbance.
Pre-enlistment vulnerability is an important individual risk factor for ill health in military men. Awareness of such factors is important in understanding post-combat psychiatric disorder.
Little is known about the psychological health or treatment experiences of those who have left the British armed forces.
To describe the frequency and associations of common mental disorders and help-seeking behaviours in a representative sample of UK veterans at high risk of mental health problems.
A cross-sectional telephone survey of 496 ‘vulnerable’ ex-service personnel selected from an existing epidemiological military cohort.
The response rate was 64%; 44% of these had a psychiatric diagnosis, most commonly depression. Those with a diagnosis were more likely to be of lower rank and divorced or separated. Just over half of those with self-reported mental health problems were currently seeking help, most from their general practitioners. Most help-seekers received treatment, usually medication; 28% were in touch with a service charity and 4% were receiving cognitive-behavioural therapy.
Depression is more common than post-traumatic stress disorder in UK ex-service personnel. Only about half of those who have a diagnosis are seeking help currently, and few see specialists.
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