Predictors of burnout among military mental health providers

Mental health treatment of military service members places unique demands on providers as their patients experience combat stress. This study assessed levels and predictors of burnout among mental health providers (N = 97) at military facilities, using a self-administered survey of demographic and work-related measures and the Maslach Burnout Inventory. Burnout levels were comparable to studies of civilian mental health providers but were less severe than those of the Maslach Burnout Inventory normative sample. Working more hours, having more patients with personality disorders, increased patient caseloads, female gender, and being a psychiatrist were predictive of higher burnout scores. Having more confidants at work, a greater percentage of patients with traumatic brain injury, more clinical experience, and being a psychologist predicted lower burnout scores. These findings suggest that burnout levels among military providers are similar to those among civilian providers and may be alleviated by interventions targeting general institutional risk factors.     

Strategic planning for military occupational health care

OBJECTIVE: This article describes a framework and system for planning appropriate occupational health contributions to military manpower availability and operational capability, and auditing the complete and effectiveness of implementation. METHODS: Prepared through author-led consensus-seeking serial deliberations with occupational health experts over initial and consequential drafts of, latterly, a populated strategic planning framework based on key stages in a military career. Illustrative examples are provided from the author's experience and, along with referenced sources of further information, the scientific literature. RESULTS: The resulting framework facilitates timely management of occupational health risks to recruiting, retention, operational availability and capability, and the general well-being of military personnel. Monitoring and audit are integral to the activity to provide an evidence-based spiral of refinement of the plan and improvement of outcomes. CONCLUSIONS: Key stages of the military career may provide manageable challenge bites for planning with executive and health care colleagues to forecast and control occupational health risks to operational capability and thus contribute to achieving military objectives.     

Ketamine for procedural sedation and analgesia by nonanesthesiologists in the field: a review for military health care providers

Military health care providers located in field environments frequently face situations in which procedural sedation and analgesia are necessary, without the advantage of sophisticated monitoring equipment. Ketamine is a unique agent that can be administered either intravenously or intramuscularly to produce predictable and profound analgesia, with an exceptional safety profile. We review the issues unique to ketamine and provide a practical guide for the use of ketamine for adult and pediatric patients in a field environment.     

军队离退休干部心理健康量表的编制

目的：编制军队离退休干部的心理健康量表。方法：依据老年人心理健康理论,构建军队离退休老干部的心理健康题目库,在兰州地区抽取1068例军队离退休老干部施测。结果：通过因素分析,最终建立50道题的正式量表,量表内部一致性稳定,因素分析显示量表具有良好结构效度。结论：该量表达到了心理测量学的要求。     

Characteristics of deployed Operation Iraqi Freedom military personnel who seek mental health care

INTRODUCTION: This study reports on the feasibility of using validated mental health screening instruments for deployed Operation Iraqi Freedom military personnel. METHODS: For a 3-month period in 2005, all service members (N=296) who initially presented to the U.S. Military Hospital Kuwait mental health clinic completed an intake questionnaire that gathered demographic information and contained validated instruments to screen for mental disorders and functional impairment. RESULTS: A total of 19% of the sample subjects screened positive for post-traumatic stress disorder-related symptoms, 35% for a major depressive disorder, and 11% for severe misuse of alcohol. Significant levels of distress and functional impairment were reported by 58% of the sample. Women represented a disproportionately high percentage of those presenting for care (27%). CONCLUSIONS: Screening instruments were well accepted and useful in detecting psychopathological conditions and functional impairment. Female service members might represent a high-risk group. These results are useful for those caring for service members during or after deployment.     

Contracting out military health care

The military health care system is currently facing a critical provider supply versus patient demand imbalance. Contracting out health care through the Civilian Health and Medical Program of the Uniformed Services and the Primary Medical Care for the Uniformed Services programs is one approach that Army Medical Department leaders have taken to correct the problem. This article critically analyzes the success of this approach using data from an Army hospital in the eastern United States. The article concludes with three suggestions aimed at improving the current situation.     

International survey of military mental health professionals

This paper reports on data from a survey of international military mental health professionals. In a series of open-ended questions, respondents were asked to describe their country in terms of the field of military psychology, the role of mental health professionals on deployment, the degree to which the field of mental health is accepted in the military, and their contact with their international counterparts. The survey was mailed to 44 different countries from July 1995 through July 1996. The data are based on 30 individual responses from 23 different countries. Cultural differences included the role of psychologists in the military and on deployment, the degree of professional isolation, and specific services provided by psychologists. Cultural similarities included the ambivalent response to the mental health field by military leaders, the use of psychology as a prevention tool, and the degree of interest in international contact and exchange. The discussion focuses on three obstacles to the acceptance of the mental health field and possible avenues for greater exchange of information among military professionals working in psychology-related fields.     

Soldiers' experiences with military health care

Patient satisfaction can be enhanced by narrowing gaps between what health care consumers experience and what they expect. A study was therefore conducted to better understand health care experiences and expectations among Army beneficiaries. Data collected using focus groups were analyzed by using qualitative research methods. A concept was identified and labeled "Soldier Care." It involves first-line care delivered at the unit level as well as the interface between first-line care and military treatment facilities. There are four features of Soldier Care, i.e., provider competence, the sick call cycle, getting appointments, and unit leadership. Together, these features affect soldiers' time from injury to recovery. Insights about Soldier Care can provide decision-makers with direction for initiating changes that may contribute to improved soldier satisfaction with health care.     

Self-rated health and health care utilization after military deployments

Self-rated general health is one element of the standard health assessment required of U.S. military service members upon completion of major deployments. A cohort study of 22,229 male U.S. Army and Air Force personnel returning from Europe or Southwest Asia in 2000 used survival analysis methods and Cox proportional hazard models to examine postdeployment self-rated health (SRH) status and subsequent hospitalization, separation, and ambulatory care visits. Self-rated health was fair/poor for 1.5% and good for 20.4%; 11% documented at least one health concern. During 30,433 person-years of follow-up (median, 1.5 person-years), there were 22.8 hospitalizations per 1,000 person-years and 4.0 ambulatory care visits per person-years. After adjustment, deployers with fair/poor SRH had an increased risk for hospitalization (hazard ratio [HRI, 1.6; 95% confidence interval [CI], 1.0,2.7); the risk was lower for those with good SRH (HR, 1.3; 95% CI,1.1,1.5). Deployers with fair/poor SRH health had an increased risk for illness-related ambulatory care visits (HR, 1.8, 95%; CI, 1.6,2.1) and administrative visits (HR, 1.4; 95% CI, 1.1,1.7), but not injury-related visits (HR, 1.2; 95% CI, 0.8,1.7). Self-reported low health status and other health concerns identify military members with higher levels of health care needs following return from major deployments.     

Evaluation of dermatologic conditions by primary care providers in deployed military settings

Dermatologic illnesses have historically been a significant source of morbidity and resource utilization in fielded military forces. The impact of cutaneous diseases during U.S. military conflicts is reviewed, and recent data from Craig Joint Theater Hospital at Bagram Air Field in Afghanistan are presented, confirming previous experience. A discussion of the difficulties of diagnosing and treating dermatologic conditions for deployed primary care providers is provided, including recommendations to improve patient care and military unit readiness.     

The stigma of mental health problems in the military

The present review addresses the perceived stigma associated with admitting a mental health problem and seeking help for that problem in the military. Evidence regarding the public stigma associated with mental disorders is reviewed, indicating that the public generally holds negative stereotypes toward individuals with psychological problems, leading to potential discrimination toward these individuals. The internalization of these negative beliefs results in self-stigma, leading to reduced self-esteem and motivation to seek help. Even if soldiers form an intention to seek help for their psychological difficulty, barriers to mental health care may prevent the soldier from receiving the help they need. An overall model is proposed to illustrate how the stigma associated with psychological problems can prevent soldiers getting needed help for psychological difficulties and proposed interventions for reducing stigma in a civilian context are considered for military personnel.