Employment and mental health among UK ex-service personnel during the initial period of the COVID-19 pandemic
Abstract: The COVID-19 pandemic has interrupted participation in the labour force and may have affected mental health, both directly through the effects of illness and isolation and indirectly through negative effects on employment. Former military personnel may be at particular risk as a result of both additional exposure to risk factors for poor mental health and barriers to labour market participation raised by the transition from military to civilian working environments. This article examines furlough and unemployment as a result of the COVID-19 pandemic among UK working-age ex-service personnel and its associations with poor mental health. Participants from an existing cohort study of Iraq- and Afghanistan-era UK Armed Forces personnel were invited to provide information on employment before the COVID-19 pandemic and how it has changed since the pandemic. Mental health was measured using the General Health Questionnaire and compared with data collected pre-pandemic. Although Veteran unemployment is not higher than civilian unemployment (4.7% and 4.8%, respectively, in September 2020), it rose during the pandemic from a lower level (1.3%). Part-time and self-employed Veterans were more likely than full-time employees to experience furlough or unemployment. A negative impact on employment was associated with the onset of new mental ill health. Employment of ex-service personnel was more negatively affected by the COVID-19 pandemic, possibly because ex-service personnel are mostly men, and men were more affected in the UK general population. This employment instability has negative consequences for mental health that are not mitigated by furlough.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.