The prevalence of common mental health problems in the military is higher than in the general population, but remains stable. While PTSD accounts for only a small number of cases, combat troops and reservists are at higher risk of developing it. Regulars who leave service early, and reservists, have a higher risk of developing mental health problems than their peers. Outcomes for early service leavers are likely to relate to pre-enlistment risk factors. Drinking at harmful levels is widespread in the Forces. The MOD has several strategies to protect the mental health of the Armed Forces. However, stigma associated with mental ill health is a major barrier to accessing help. A lack of research means that the impact of service on families is poorly understood.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P