Introduction Despite increases in the number of ex-service personnel seeking treatment for post-traumatic stress disorder (PTSD), there remain a number of barriers to help-seeking which prevents many veterans from accessing psychological therapies. Tele-therapy provides one potential method of increasing the number of veterans accessing support. This review aimed to systematically review the literature in order to summarise what lessons have been learned so far from providing trauma-focused tele-therapies to veterans with PTSD. Methods A systematic literature review was conducted from which 41 papers were reviewed. Studies were included if they involved the use of trauma-focused therapies carried out using tele-therapy technologies. Only studies using tele-therapy interventions via video or telephone with populations of ex-military personnel with PTSD were included. Results In the majority of cases tele-therapy was found to be as effective in reducing PTSD symptoms as in-person interventions. Similarly, there were few differences in most process outcomes such as dropout rates, with tele-therapy helping to increase uptake in some cases. Veterans using tele-therapy reported high levels of acceptability and satisfaction. Some challenges were reported in terms of therapeutic alliance, with some studies suggesting that veterans felt less comfortable in using tele-therapy. Several studies suggested it was harder for clinicians to read non-verbal communication in tele-therapy, but this did not affect their ability to build rapport. Technological issues were encountered, but these were not found to impede therapy processes or outcomes. Discussion Tele-therapy provides a viable alternative to in-person therapies and has the potential to increase access to therapy for veterans. Tele-therapy should continue to be evaluated and scrutinised in order to establish the most effective methods of delivery.

Police face an increased risk of developing mental health problems, yet reliable estimates of their psychological difficulties remain unknown. This systematic review and meta-analysis estimate the pooled prevalence and risk factors for mental health problems among police personnel worldwide. Three independent reviewers searched 16 databases and screened 11 506 articles published between January 1980 and October 2019. Eligible studies involved at least 100 active police professionals and used validated instruments to ascertain specific mental health problems. Estimates were pooled using random-effects meta-analyses. In total, 60 cross-sectional and seven longitudinal studies, involving 272 463 police personnel from 24 countries met criteria for inclusion. The overall pooled point prevalence was 14.6% for depression (95% CI 10.9% to 18.6%), 14.2% for post-traumatic stress disorder (PTSD; 95% CI 10.3% to 18.7%), 9.6% for a generalised anxiety disorder (95% CI 6.7% to 12.9%), 8.5% for suicidal ideation (95% CI 6.1% to 11.2%), 5.0% for alcohol dependence (95% CI 3.5% to 6.7%) and 25.7% for hazardous drinking (95% CI 19.6% to 32.4%). The strongest risk factor for depression and suicidal ideation was higher occupational stress, and the strongest risk factors for PTSD were higher occupational stress and avoidant coping strategies. Higher levels of peer-support were associated with significantly lower PTSD symptoms. Our findings suggest that the prevalence of mental health problems among police exceeds twice that previously reported in mixed samples of first responders, and is associated with poor social support, occupational stress and maladaptive coping strategies. Without effective intervention, psychological difficulties will remain a substantial health concern among police.

Results indicate the complexity of presentations within treatment seeking veterans. These difficulties may partly explain the poorer treatment outcomes reported in veterans in comparison to the general public. As such, it would be prudent for interventions targeted at veterans with mental health difficulties to attempt to address the range of issues faced by this population rather than focus on a particular presenting problem.

Background: Previous research exploring the psychometric properties of the scores of measures of posttraumatic stress disorder (PTSD) suggests there is variation in their functioning depending on the target population. To date, there has been little study of these properties within UK veteran populations. Objective: This study aimed to determine optimally efficient cut-off values for the Impact of Event Scale-Revised (IES-R) and the PTSD Checklist for DSM-5 (PCL-5) that can be used to assess for differential diagnosis of presumptive PTSD. Methods: Data from a sample of 242 UK veterans assessed for mental health difficulties were analysed. The criterion-related validity of the PCL-5 and IES-R were evaluated against the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Kappa statistics were used to assess the level of agreement between the DSM-IV and DSM-5 classification systems. Results: The optimal cut-off scores observed within this sample were 34 or above on the PCL-5 and 46 or above on the IES-R. The PCL-5 cut-off is similar to the previously reported values, but the IES-R cut-off identified in this study is higher than has previously been recommended. Overall, a moderate level of agreement was found between participants screened positive using the DSM-IV and DSM-5 classification systems of PTSD. Conclusions: Our findings suggest that the PCL-5 and IES-R can be used as brief measures within veteran populations presenting at secondary care to assess for PTSD. The use of a higher cut-off for the IES-R may be helpful for differentiating between veterans who present with PTSD and those who may have some sy`mptoms of PTSD but are sub-threshold for meeting a diagnosis. Further, the use of more accurate optimal cut-offs may aid clinicians to better monitor changes in PTSD symptoms during and after treatment.

Introduction: An increased risk of emotional burden in partners of military Veterans with mental health difficulties has been observed. This study aimed to explore the experiences and needs of female partners of Veterans seeking help. Methods: Our sample of eight female partners was drawn from a population of help-seeking Veterans who had received treatment for PTSD. Qualitative data were collected using a semi-structured interview schedule. Results: Super-ordinate themes of challenges faced, desired type of support, and barriers to support were each described by a set of sub-themes. Challenges faced were described with the themes of inequality in relationship, loss of congruence with own identity, volatile environment, and emotional distress and isolation. Desired type of support was described by the themes of practical focus on improving, sharing with fellow experts, and support tailored to the partner. Barriers to support were described by the themes feeling restricted by practical barriers and ambivalence about the involvement of others. Conclusions: Interventions to support partners of Veterans with mental health difficulties need to address their individual needs, focus on practical techniques, and consider practical limitations.Introduction : Le risque accru d'un fardeau émotionnel des partenaires des vétéran(e)s militaires avec des problèmes de santé mentale a été identifié. Cette étude visait à explorer les expériences et les besoins des conjointes de vétérans qui demandent de l'aide. Méthodes : Notre échantillon qui comprenait huit conjointes a été établi à partir d'une population de vétérans demandant de l'aide et qui recevaient des traitements pour l'état de stress post-traumatique (ESPT). Nous avons recueilli des données qualitatives en utilisant une grille d'entrevue semi-structurée. Résultats : Les thèmes principaux 'les grands défis', 'le type de soutien désiré' et 'les obstacles au soutien' ont tous été définis selon des sous-thèmes. Les grands défis ont été définis par le recours aux thèmes suivants : l'inégalité dans la relation, l'absence de cohérence dans leur propre identité, un environnement volatile et la détresse émotionnelle, ainsi que l'isolation. Le type de soutien désiré a été décrit par les thèmes pratiques qui se portent sur l'amélioration, le partage avec les autres expert(e)s et un soutien adapté au partenaire. Les défis au soutien ont été décrits par les thèmes de restrictions de barrière pratique, et des ambivalences des autres groupes. Conclusions : Cette étude a décrit les défis vécus par les partenaires de vétéran(e)s avec des troubles de santé mentale. Les interventions pour cette population doivent prendre en considération leur besoin individuel, se concentrer sur les technique pratiques et prendre en considération les limites pratiques.

Background: Research shows that veterans with mental health difficulties are reluctant to engage with treatment due to a number of practical and psychological barriers. Tele-therapy has been proposed as an alternative method of delivering therapy to ensure hard-to-reach groups receive the care they need.Objective: This study aimed to explore the acceptability of using tele-therapy for treating PTSD in a sample of UK veterans.Methods: Sixteen participants who had engaged with tele-therapy for PTSD were contacted following the cessation of their treatment, including those who had not completed the full course of therapy. Semi-structured qualitative interviews were conducted and the transcripts were analysed using thematic analysis.Results: Five key themes emerged: Effect of your own environment, Importance of good therapeutic alliance, Technicalities and practicalities, Personal accountability and Measuring change. Effect of your own environment was described with sub-themes of control over your own environment, lack of support between sessions and snap back to reality. The Importance of good therapeutic alliance encompassed putting a face to the name, impersonal feeling and no different from being in the room. Technicalities and practicalities depicted good preparation is key, the flexibility of Skype, technical aspects and session length and timing. Personal accountability detailed finding the time and space, managing attendance and engagement and moving forward. Measuring change illustrated negative past experiences with therapy, improving self-recognition and managing symptoms.Discussion: Tele-therapy appeared to be acceptable within this sample of veterans with many reporting overall positive experiences and improvements to their health. Future research is needed to foster a more supportive environment during and after therapy.

The findings from this paper suggest that a greater focus needs to be placed on treating physical problems in Northern Irish veterans. Alcohol misuse should be addressed in more detail in treatment programmes, particularly in Scotland and Wales. As few differences were found in the mental health presentations, this suggests that standardised services are adequate.

ObjectiveElectronic health records (EHRs) are routinely used to identify family violence, yet reliable evidence of their validity remains limited. We conducted a systematic review and meta-analysis to evaluate the positive predictive values (PPVs) of coded indicators in EHRs for identifying intimate partner violence (IPV) and child maltreatment (CM), including prenatal neglect.MethodsWe searched 18 electronic databases between January 1980 and May 2020 for studies comparing any coded indicator of IPV or CM including prenatal neglect defined as neonatal abstinence syndrome (NAS) or fetal alcohol syndrome (FAS), against an independent reference standard. We pooled PPVs for each indicator using random effects meta-analyses.ResultsWe included 88 studies (3 875 183 individuals) involving 15 indicators for identifying CM in the prenatal period and childhood (0–18 years) and five indicators for IPV among women of reproductive age (12–50 years). Based on the International Classification of Disease system, the pooled PPV was over 80% for NAS (16 studies) but lower for FAS (<40%; seven studies). For young children, primary diagnoses of CM, specific injury presentations (eg, rib fractures and retinal haemorrhages) and assaults showed a high PPV for CM (pooled PPVs: 55.9%–87.8%). Indicators of IPV in women had a high PPV, with primary diagnoses correctly identifying IPV in >85% of cases.ConclusionsCoded indicators in EHRs have a high likelihood of correctly classifying types of CM and IPV across the life course, providing a useful tool for assessment, support and monitoring of high-risk groups in health services and research.