Steve Reid

The mental health of UK Gulf war veterans: phase 2 of a two phase cohort study

Abstract Objectives: To examine the prevalence of psychiatric disorders in veterans of the Gulf war with or without unexplained physical disability (a proxy measure of ill health) and in similarly disabled veterans who had not been deployed to the Gulf war (non-Gulf veterans). Design: Two phase cohort study. Setting: Current and ex-service UK military personnel. Participants: Phase 1 consisted of three randomly selected samples of Gulf veterans, veterans of the 1992-7 Bosnia peacekeeping mission, and UK military personnel not deployed to the Gulf war (Era veterans) who had completed a postal health questionnaire. Phase 2 consisted of randomly selected subsamples from phase 1 of Gulf veterans who reported physical disability (n=111) or who did not report disability (n=98) and of Bosnia (n=54) and Era (n=79) veterans who reported physical disability. Main outcome measure: Psychiatric disorders assessed by the schedule for clinical assessment in neuropsychiatry and classified by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Results: Only 24% (n=27) of the disabled Gulf veterans had a formal psychiatric disorder (depression, anxiety, or alcohol related disorder). The prevalence of psychiatric disorders in non-disabled Gulf veterans was 12%. Disability and psychiatric disorders were weakly associated in the Gulf group when confounding was adjusted for (adjusted odds ratio 2.4, 99% confidence interval 0.8 to 7.2, P=0.04). The prevalence of psychiatric disorders was similar in disabled non-Gulf veterans and disabled Gulf veterans (19% v 24%; 1.3, 0.5 to 3.4). All groups had rates for post-traumatic stress disorder of between 1% and 3%. Conclusions: Most disabled Gulf veterans do not have a formal psychiatric disorder. Post-traumatic stress disorder is not higher in Gulf veterans than in other veterans. Psychiatric disorders do not fully explain self reported ill health in Gulf veterans; alternative explanations for persistent ill health in Gulf veterans are needed.

Frequent attenders in secondary care: a 3-year follow-up study of patients with medically unexplained symptoms

BACKGROUND There are few longitudinal studies of patients with medically unexplained symptoms. The aim of this study was to investigate outcome in frequent attenders in secondary care who present repeatedly with medically unexplained symptoms. METHOD Forty-eight patients presenting with medically unexplained symptoms, from a sample of 61, participated in a 3-year follow-up study. Psychiatric morbidity, functional impairment and use of services were evaluated. RESULTS At follow-up there was a high prevalence of psychiatric morbidity with 69% having at least one psychiatric diagnosis. The sample continued to be high users of a range of health services and substantial functional impairment was reported. CONCLUSION In this group of frequent attenders with medically unexplained symptoms outcome as measured by psychiatric morbidity, service use and functional impairment remained poor after 3 years.

The retention of community service officers for an additional year at district hospitals in KwaZulu-Natal and the Eastern Cape and Limpopo provinces

Abstract Background: Community service (CS) is an effective recruitment strategy for underserved areas, using legislation as the driver; however, it is not a retention strategy. By the end of each year, most CS officers working in district hospitals (DHs) are skilled, valued and valuable members of the health team, able to cope with the demands of working in the public health service within the resources available at DHs. Their exodus at the end of each annual cycle represents a net loss of valuable skills and experience by the public service, measured by the time and effort required to orientate and induct the following cohort of CS officers. This in turn has a negative effect on the level of service delivery and the quality of patient care. This study sought to gain understanding of the motivations of CS officers to continue working at the same DH for a subsequent year after their obligatory year was over. The objectives were to determine the number of CS officers who actually remained at the same DH after completing their CS in 2002, the major factors that influenced them to remain and factors that would encourage the 2003 cohort of CS officers to remain at the same DH for an additional year. Methods: A descriptive cross-sectional study design was employed using qualitative methods with the cohort of CS officers who had completed their compulsory CS year in 2002 and who were still working at the same DH in July 2003. This was followed by a quantitative survey of CS officers doing their CS at DHs in KwaZulu-Natal (KZN), the Eastern Cape (EC) and Limpopo Province (LP) in November 2003. Results: Twenty-two out of 278 (8%) of the 2002 cohort of CS officers in KZN, EC and LP remained at the same DH in the year following their CS. The reasons given, in order of decreasing priority, were that they were close to home, had been allocated as part of their CS, had been personally recruited, had bursary commitments, had heard about the hospital from friends, had visited the hospital prior to starting CS and had visited as a medical student. Four CS officers did not specify reasons. In the larger quantitative study 150 out of 221 questionnaires were returned. More than 80% of the respondents felt that there had been opportunities to develop confidence in their own ability to make independent decisions, that they had had good relations with the hospital staff and that they had been able to make a difference in health care delivery. Between 67% and 76% of respondents felt that they were providing a good standard of care, that there were learning opportunities, that they were doing worthwhile work and that CS provided excellent work experience. However, only 52% of respondents felt that there had been opportunities for personal growth, 38% felt that appropriate equipment was available, 37% had a supportive mentor figure and 29% felt that there were adequate levels of staffing at the hospital. In total 24 (16%) of the 150 officers who responded to the questionnaire indicated a willingness to remain at the same DH after completion of their year of CS. The intention to continue for a further year was statistically significantly associated with the following factors: ethnic group, province, rural origin, allocation priority and bursary commitment. Conclusions: The retention in the same DH of only 8% of the CS officer cohort in three rural provinces indicates a serious loss of skills on a recurrent annual basis. Local hospital management can do much to strengthen the factors that would attract CS officers to stay on by improving orientation, mentoring, teamwork, professional development opportunities, medical equipment and accommodation.

Music as a metaphor for the medical consultation

This is the story of a journey down a path of ideas and reflections about the role of music in the practice of medicine. It was stimulated, amongst other events, by a workshop entitled “The Arts in Medicine” presented at the 2007 ‘Network: Towards Unity for Health’ conference in Uganda, by a team from the University of New Mexico. This led me to an article in the Annals of Family Medicine entitled “Jazz and the ‘Art’ of Medicine: Improvisation in the Medical Encounter” by Paul Haidet.1 But it is also informed, as many journeys are, by half a lifetime of experiences and unanswered questions, in my case, of medicine and of music as two separate and mutually exclusive activities. Medicine has taken the lions share of my time and energy, and is clearly work for which I get paid, whereas music has been relegated to a hobby when time and energy allow. And I believe that there are many others in a similar situation—doctors or nurses or other health care professionals who are in fact very creative people, but for whom the demands and prerogative of the medical vocation has squeezed out music, art or other forms of expression, and relegated them to less central roles in their busy lives.

The African Family Physician

A group of 8 South African academics in Family Medicine met recently at a workshop in Kampala, Uganda, with some 20 colleagues from a number of sub-Saharan African countries in order to promote the development of Family Medicine throughout the continent. While this seems a lofty goal, the practitioner on the ground may ask: “What for?” Well, this is one response South African Family Practice Vol. 49 (9) 2007: pp. 3