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Carey LB, Bambling M, Hodgson TJ, Jamieson N, Bakhurst MG, Koenig HG. Pastoral Narrative Disclosure: The Development and Evaluation of an Australian Chaplaincy Intervention Strategy for Addressing Moral Injury. JOURNAL OF RELIGION AND HEALTH 2023; 62:4032-4071. [PMID: 37891396 DOI: 10.1007/s10943-023-01930-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 10/29/2023]
Abstract
This paper describes the development and initial chaplaincy user evaluation of 'Pastoral Narrative Disclosure' (PND) as a rehabilitation strategy developed for chaplains to address moral injury among veterans. PND is an empirically informed and integrated intervention comprising eight stages of pastoral counselling, guidance and education that was developed by combining two previously existing therapeutic techniques, namely Litz et al's (2017) 'Adaptive Disclosure' and 'Confessional Practice' (Joob & Kettunen, 2013). The development and results of PND can be categorized into five phases. Phase 1: PND Strategy Formation-based upon extensive international research demonstrating that MI is a complex bio-psycho-social-spiritual syndrome with symptoms sufficiently distinct from post-traumatic stress disorder. The review also provided evidence of the importance of chaplains being involved in moral injury rehabilitation. Phase II: Development and Implementation of 'Moral Injury Skills Training' (MIST)-which involved the majority of available Australian Defence Force (ADF) Chaplains (n = 242/255: 94.9%) completing a basic 'Introduction to Moral Injury' (MIST-1) as well as an 'Introduction to PND' (MIST-2). Phase III: MIST-3-PND-Pilot evaluation-involved a representative chaplaincy cohort (n = 13) undergoing the PND eight-stage strategy to ensure the integrity and quality of PND from a chaplaincy perspective prior to wider implementation. The pilot PND evaluation indicated a favourable satisfaction rating (n = 11/13: 84.6%; M = 4.73/5.0 satisfaction). Phase IV: MIST-3-PND Implementation-involved a larger cohort of ADF Chaplaincy participants (n = 210) completing a revised and finalized PND strategy which was regarded favourably by the majority of ADF Chaplains (n = 201/210: 95.7%; M = 4.73/5.0 satisfaction). Phase V: Summation. In conclusion the positive satisfaction ratings by a significant number of ADF chaplaincy personnel completing MIST-3-PND, provided evidence that chaplains evaluated PND as a suitable counselling, guidance and education strategy, which affirmed its utilisation and justifies further research for using PND to address MI among veterans, that may also prove valuable for other chaplains working in community health and first responder contexts.
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Affiliation(s)
- Lindsay B Carey
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, 3083, Australia.
- Australian Institute of Ethics and Society, University of Notre Dame, Sydney, Australia.
| | - Matthew Bambling
- Brisbane Central Clinical School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Timothy J Hodgson
- School of Historical and Philosophical Enquiry, University of Queensland, Brisbane, QLD, Australia
| | | | - Melissa G Bakhurst
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Australia
| | - Harold G Koenig
- Duke University Medical Center, Durham, North Carolina, USA
- King Abdulaziz University, Jeddah, Saudi Arabia
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Lawton A, Cadge W, Hamar Martinez J. How does the American public interact with chaplains? Evidence from a national survey. J Health Care Chaplain 2023:1-15. [PMID: 37486766 DOI: 10.1080/08854726.2023.2239109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
How does the American public understand the term chaplain? What fraction interact with chaplains and in what settings? What is the content of those interactions and do care recipients find them valuable? We answer these questions with data from a nationally representative survey (N = 1096) conducted in March 2022 and interviews with a subset (N = 50) of survey recipients who interacted with chaplains. We find that people in the United States do not have a consistent understanding of the term chaplain. Based on our definition, at least 18% of Americans have interacted with a chaplain. Among those who interacted with a chaplain as defined in the survey, the majority did so through healthcare organizations. Care recipients include people who were ill and their visitors/caregivers. The most common types of support received were prayer, listening and comfort. Overall, survey respondents found chaplains to be moderately or very valuable.
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Affiliation(s)
- Amy Lawton
- Department of Sociology, Brandeis University, Waltham, MA, USA
| | - Wendy Cadge
- Department of Sociology, Brandeis University, Waltham, MA, USA
| | - Jessica Hamar Martinez
- College of Social & Behavioral Sciences, University Analytics & Institutional Research, University of Arizona, Tucson, AZ, USA
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3
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Tunks Leach K, Simpson P, Lewis J, Levett-Jones T. The Role and Value of Chaplains in an Australian Ambulance Service: A Comparative Study of Chaplain and Paramedic Perspectives. JOURNAL OF RELIGION AND HEALTH 2023; 62:98-116. [PMID: 36402854 PMCID: PMC9676825 DOI: 10.1007/s10943-022-01685-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 05/11/2023]
Abstract
Chaplains are embedded in several ambulance services across Australia, however as Australia's religiosity is currently in decline and questions are being asked about retaining chaplains, little is actually known about their role and value within Ambulance services. The aim of this paper is to present the key findings from interviews with chaplains about their role and value of being ambulance chaplains. These findings are then compared with those of paramedics derived from an earlier phase of this study. Thirteen chaplains participated in semi-structured interviews, and data were analysed using framework analysis. The results indicated that ambulance chaplains provided paramedic-centred emotional and spiritual care through proactively and reactively supporting paramedics in their work. Chaplains saw value in their relational approach which facilitated trust and access, did not seek to 'fix' or diagnose but instead offered physical and emotional presence, and promoted supportive conversations. Chaplains and paramedics valued operationally trained and equipped ambulance chaplains who provided a relational, around the clock, 'frontline' staff support presence in paramedic workplaces, regardless of the paramedic's personal religious/spiritual beliefs.
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Affiliation(s)
- Katie Tunks Leach
- Faculty of Health, University of Technology Sydney, Sydney, Australia.
- New South Wales Ambulance, Sydney, Australia.
| | - Paul Simpson
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Joanne Lewis
- School of Nursing and Health, Avondale University, Wahroonga, Australia
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Wortmann JH, Nieuwsma JA, Cantrell W, Fernandez P, Smigelsky M, Meador K. Chaplain Training in Evidence-Based Practices to Promote Mental Health and Improve Care for Suicidality in Veterans and Service Members. Arch Suicide Res 2023; 27:122-134. [PMID: 34520687 DOI: 10.1080/13811118.2021.1972884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Chaplains are key care providers in a comprehensive approach to suicide prevention, which is a priority area for the U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD). In a cohort of 87 VA and military chaplains who completed the Mental Health Integration for Chaplain Services (MHICS) training-an intensive, specialty education in evidence-based psychosocial and collaborative approaches to mental health care-we assessed chaplains' self-perceptions, intervention behaviors, and use of evidence-based practices, including Acceptance and Commitment Therapy (ACT), Problem-Solving Therapy (PST), and Motivational Interviewing (MI), in providing care for suicidality. METHOD Chaplains responded to a battery of items Pre- and Post-training and provided deidentified case examples describing their use of evidence-based practices in spiritual care for service members and veterans (SM/V) on various levels of a suicide prevention continuum. RESULTS Post-training, chaplains reported increased abilities to provide care and mobilize collaborative resources. Over the course of MHICS, 87% of chaplains used one or more evidence-based practices with a SM/V at risk for suicide or acutely suicidal. Fifty-six percent of chaplains reported intervening with an acutely suicidal SM/V by using principles from ACT, 36% PST, and 48% MI. With persons at risk for suicide, 81% used principles from ACT, 66% PST, and 71% MI. Cases exemplified diverse evidence-based practice applications. CONCLUSIONS Findings indicate chaplains trained in evidence-based practices report effective application in caring for SM/V who are suicidal, thus offering a valuable resource to meet needs in a priority area for VA and DoD.HIGHLIGHTSChaplains provide essential care for SM/V who are at risk for suicide or acutely suicidalTraining helps chaplains mobilize interdisciplinary and community resources in suicide careEvidence-based practices can effectively integrate within the scope of chaplaincy practice for suicide care.
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Eikenaar T. Relating to moral injuries: Dutch mental health practitioners on moral injury among military and police workers. Soc Sci Med 2022; 298:114876. [PMID: 35278976 DOI: 10.1016/j.socscimed.2022.114876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
Abstract
In recent years the concept of moral injury has become a common term to describe the lasting impact of moral transgressions on frontline workers. This article aims to broaden the largely clinical debate by involving the views of a diverse group of mental health practitioners who support military and police personnel in the Netherlands. These practitioners are chaplains, confidential counsellors, social workers, psychologists and integrity officers. How do these practitioners describe the moral injuries of servicemen and police officers and how do they think these should be approached? Through interviews with thirty different practitioners this study shows that definitions of moral injuries diverge considerably. In addition, the article analyses six different approaches to moral injuries. These range from framing moral injury as an exceptional problem that requires specific expertise, to seeing it as a broad issue that places workers in a larger moral community. An analysis of this variety both serves as an indication of possible ways to deal with moral injuries, and as a basis for a critical reflection on the implications of various approaches.
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Affiliation(s)
- Teun Eikenaar
- Centre for International Conflict Analysis and Management (CICAM), Radboud University Nijmegen, Postbus 9108, 6500, HK, Nijmegen, the Netherlands.
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Layson MD, Tunks Leach K, Carey LB, Best MC. Factors Influencing Military Personnel Utilizing Chaplains: A Literature Scoping Review. JOURNAL OF RELIGION AND HEALTH 2022; 61:1155-1182. [PMID: 35059963 DOI: 10.1007/s10943-021-01477-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 05/11/2023]
Abstract
Chaplains have been embedded in military settings for over a millennium. In recent years however, the decline in spiritual/religious (S/R) affiliation of military personnel across Western cultures has led to some commentators questioning the utilization of religious chaplains by defence personnel. This scoping review maps the literature on S/R and non-S/R factors that influence utilizing military chaplains-with a particular emphasis on the Australian military context. A systematic scoping review of tertiary literature databases using Arksey and O'Malley (2003) and Joanna Briggs Institute methodologies (JBI, 2021), revealed a total of 33 articles meeting the inclusion criteria. Results fell into three broad categories: (i) how personal religious views influence utilization of military chaplaincy, (ii) barriers and enablers to personnel utilizing military chaplains, and (iii) the impact of chaplaincy. Despite the current reduction in religiosity in Western society, findings from this scoping review suggest there is little evidence that low religiosity among military personnel forms a significant barrier to utilizing chaplaincy services. To the contrary, the literature revealed that chaplains provide trusted, confidential, and holistic support for military personnel that if diminished or compromised would leave a substantial gap in staff well-being services.
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Affiliation(s)
- Mark D Layson
- Faculty of Arts and Education, Charles Sturt University, Bathurst, NSW, Australia.
- St Mark's National Theological Centre, Charles Sturt University, Canberra, ACT, Australia.
| | - Katie Tunks Leach
- University of Technology Sydney, Sydney, NSW, Australia
- New South Wales Ambulance, Sydney, NSW, Australia
| | - Lindsay B Carey
- Palliative Care Unit, La Trobe University, Melbourne, VIC, Australia
- Centre for Spirituality, Theology and Health, Duke University, Durham, NC, USA
| | - Megan C Best
- Institute for Ethics and Society at the University of Notre Dame, Sydney, NSW, Australia
- School of Medicine, University of Sydney, Sydney, NSW, Australia
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Hodgson TJ, Carey LB, Koenig HG. Moral Injury, Australian Veterans and the Role of Chaplains: An Exploratory Qualitative Study. JOURNAL OF RELIGION AND HEALTH 2021; 60:3061-3089. [PMID: 34553273 DOI: 10.1007/s10943-021-01417-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 05/11/2023]
Abstract
Military personnel deployed to war zones or assigned to other morally challenging military duties are likely to be exposed to potentially morally injurious events (PMIE) that may inflict a moral injury (MI). This qualitative study formed 'Phase 1' of a larger study into PMIEs experienced by Australian veterans and the potential pastoral/spiritual care role of chaplains. Two seminars were conducted that involved 10 veterans being interviewed and audio recorded about their deployment experiences to evaluate whether there was any evidence among Australian veterans of a PMIE. Narrative data analysis indicated that all participants had been exposed to, or were involved in, a PMIE of one kind or another. Seven key themes were identified from the analyzed qualitative data: (i) immoral acts, (ii) death and injury, (iii) betrayal, (iv) ethical dilemmas, (v) disproportionate violence, (vi) retribution and (vii) religious/spiritual issues. Given this preliminary PMIE evidence identified, there is a need for further research, as well as the development of a suitable moral injury assessment scale appropriate for Australian veterans. Furthermore, given the ethical, moral, and spiritual issues involved, the implementation of a rehabilitation program suitable for Australian veterans which can be provided by chaplains is also suggested-namely 'Pastoral Narrative Disclosure.' It is argued that moral injury needs to be recognized, not just as an issue affecting individual personnel and their families, but is also a community health, organizational and government responsibility.
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Affiliation(s)
- Timothy J Hodgson
- School of Historical and Philosophical Inquiry, University of Queensland, Brisbane, Australia
| | - Lindsay B Carey
- Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University (Melbourne Campus), Bundoora, Melbourne, 3086, Australia.
| | - Harold G Koenig
- Departments of Psychiatry and Medicine, Duke University Health System , Duke University, Durham, NC, USA
- Division of Psychiatry, Department of Medicine , King Abdulaziz University, Jeddah, Saudi Arabia
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Hastuti R, Timming AR. An inter-disciplinary review of the literature on mental illness disclosure in the workplace: implications for human resource management. INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT 2021. [DOI: 10.1080/09585192.2021.1875494] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Rina Hastuti
- School of Management, RMIT University, Melbourne, VIC, Australia
- Faculty of Islamic Business and Economics, IAIN, Surakarta, Central Java, Indonesia
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Thériault FL, Gardner W, Momoli F, Garber BG, Kingsbury M, Clayborne Z, Cousineau-Short DY, Sampasa-Kanyinga H, Landry H, Colman I. Mental Health Service Use in Depressed Military Personnel: A Systematic Review. Mil Med 2020; 185:e1255-e1262. [PMID: 32073617 DOI: 10.1093/milmed/usaa015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/23/2019] [Accepted: 05/22/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Major depression is a leading cause of morbidity in military personnel and an important impediment to operational readiness in military organizations. Although treatment options are available, a large proportion of individuals with depression do not access mental health services. Quantifying and closing this treatment gap is a public health priority. However, the scientific literature on the major depression treatment gap in military organizations has never been systematically reviewed. METHODS We systematically searched the EMBASE, MEDLINE, and PsychINFO databases for studies measuring recent mental health service use in personnel serving in the armed forces of a Five-Eye country (Australia, Canada, New Zealand, the United Kingdom, or the United States). We excluded studies conducted with retired veterans. Because of the substantial heterogeneity in included studies, we did not pool their results. Instead, we computed median period prevalence of mental health service use. RESULTS Twenty-eight studies were included in the systematic review; 12 had estimated mental health service use in personnel with depression, and another 16 had estimated mental health service use in personnel with depression or another mental health disorder. The period prevalence of mental health service use in depressed military personnel ranged from 20 to 75% in 12 included studies, with a median of 48%, over 2-12 months. The other 16 studies yielded similar conclusions; they reported period prevalence of mental health service use in personnel with any mental health disorder ranging from 14 to 75%, with a median of 36%, over 1-12 months. The median was higher in studies relying on diagnostic interviews to identify depressed personnel, compared to studies relying on screening tools (60% vs. 44%). CONCLUSIONS There is a large treatment gap for major depression in particular, and for mental health disorders in general, among military personnel. However, our results highlight the association between the use of measurement tools and treatment gaps: estimated treatment gaps were larger when depressed patients were identified by screening tools instead of diagnostic interviews. Researchers should be wary of overestimating the mental health treatment gap when using screening tools in future studies.
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Affiliation(s)
- François L Thériault
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada
| | - William Gardner
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,CHEO Research Institute, Children Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Franco Momoli
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,CHEO Research Institute, Children Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.,Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Bryan G Garber
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada
| | - Mila Kingsbury
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Zahra Clayborne
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Daniel Y Cousineau-Short
- Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada.,Department of Health Sciences, Carleton University, 2305 Health Sciences Building, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada
| | - Hugues Sampasa-Kanyinga
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Hannah Landry
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Ian Colman
- Centre for Fertility and Health, Norwegian Institute of Public Health, Postbox 222 Skøyen, N-0213 Oslo, Norway
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Harper KL, Stanley MA, Exline JJ, Pargament KI, Fletcher TL, Teng EJ. The impact of social support and morally injurious events on PTSD symptoms in Veterans. MILITARY PSYCHOLOGY 2020; 32:352-362. [PMID: 38536328 PMCID: PMC10013442 DOI: 10.1080/08995605.2020.1760684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/22/2020] [Indexed: 10/23/2022]
Abstract
Potentially morally injurious events (PMIEs), including committing transgressions (Transgressions-Self) and perceiving betrayals, have been positively associated with posttraumatic stress disorder (PTSD). A proposed mechanism for the association between PMIEs and PTSD symptoms is social disconnection. However, research on PMIEs and social disconnection is limited. Secondary data analysis from a larger study examined the moderating role of different sources of perceived social support (Family, Friends, and Significant Other) on the relation between PMIEs (Transgressions-Self and Betrayal) and PTSD. The interaction of Transgressions-Self and perceived social support subscales did not predict PTSD symptoms. However, the interaction of Betrayals and perceived social support (Significant Other and Family) predicted PTSD symptoms. Results suggest that perceived social support provides a protective effect for low to mean levels of perceived betrayals; however, for Veterans reporting high levels of betrayal, perceived social support did not attenuate PTSD symptom severity. Additional research on perceived betrayals and the association with PTSD is needed, especially for Veterans who experience high levels of perceived betrayals.
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Affiliation(s)
- Kelly L Harper
- Michael E. DeBakey Veteran Affairs Medical Center, Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Melinda A Stanley
- Michael E. DeBakey Veteran Affairs Medical Center, Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina
- Baylor College of Medicine, Houston, Texas
| | - Julie J Exline
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Kenneth I Pargament
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio
| | - Terri L Fletcher
- Michael E. DeBakey Veteran Affairs Medical Center, Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Ellen J Teng
- Michael E. DeBakey Veteran Affairs Medical Center, Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- Baylor College of Medicine, Houston, Texas
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Incidence of major depression diagnoses in the Canadian Armed Forces: longitudinal analysis of clinical and health administrative data. Soc Psychiatry Psychiatr Epidemiol 2020; 55:581-588. [PMID: 31559441 DOI: 10.1007/s00127-019-01754-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/20/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Major depression is a leading cause of morbidity in military populations. However, due to a lack of longitudinal data, little is known about the rate at which military personnel experience the onset of new episodes of major depression. We used a new source of clinical and administrative data to estimate the incidence of major depression diagnoses in Canadian Armed Forces (CAF) personnel, and to compare incidence rates between demographic and occupational factors. METHODS We extracted all data recorded in the electronic medical records of CAF Regular Force personnel, at every primary care and mental health clinical encounter since 2016. Using a 12-month lookback period, we linked data over time, and identified all patients with incident diagnoses of major depression. We then linked clinical data to CAF administrative records, and estimated incidence rates. We used multivariate Poisson regression to compare adjusted incidence rates between demographic and occupational factors. RESULTS From January to December 2017, CAF Regular Force personnel were diagnosed with major depression at a rate of 29.2 new cases per 1000 person-years at risk. Female sex, age 30 years and older, and non-officer ranks were associated with significantly higher incidence rates. CONCLUSIONS We completed the largest study to date on diagnoses of major depression in the Canadian military, and have provided the first estimates of incidence rates in CAF personnel. Our results can inform future mental health resource allocation, and ongoing major depression prevention efforts within the Canadian Armed Forces and other military organizations.
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Kazman JB, Gutierrez IA, Schuler ER, Alders EA, Myatt CA, Jeffery DD, Charters KG, Deuster PA. Who sees the chaplain? Characteristics and correlates of behavioral health care-seeking in the military. J Health Care Chaplain 2020; 28:1-12. [PMID: 32031506 DOI: 10.1080/08854726.2020.1723193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Chaplains have a critical role in the military organization and health care. Using the 2015 Health-Related Behavior Survey, we compared Service Members' (SM) use of chaplaincy services to their use of other behavioral health (BH) services: 26.2% used any BH service and 8.0% met with a chaplain/clergyperson for BH. Among the 36.5% of SM who self-identified needing counseling, percentages of SMs receiving counseling were lower among those perceiving stigma associated with BH services (51.0%) than those not perceiving stigma (66.7%). Of SM who sought counseling: many used multiple counseling sources (48.0%), with the most common sources being a BH professional (71.6%), a medical doctor (37.5%), and a chaplain or clergyperson (30.2%). SM who met with a chaplain or clergyperson had more severe histories of abuse, were more likely to have a mental health diagnosis, and had fewer positive health behaviors than SM who sought other sources of counseling.
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Affiliation(s)
- Josh B Kazman
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Ian A Gutierrez
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Eric R Schuler
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Elizabeth A Alders
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Craig A Myatt
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Diana D Jeffery
- Department of Medical Affairs, Clinical Support Division, Defense Health Agency, Falls Church, VA, USA
| | - Kathleen G Charters
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
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Nazarov A, Fikretoglu D, Liu A, Richardson JD, Thompson M. Help-seeking for mental health issues in deployed Canadian Armed Forces personnel at risk for moral injury. Eur J Psychotraumatol 2020; 11:1729032. [PMID: 32194921 PMCID: PMC7067158 DOI: 10.1080/20008198.2020.1729032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 10/31/2022] Open
Abstract
Objective: Potentially morally injurious experiences (PMIE) (events that transgress an individual's subjective moral standards) have been associated with psychologically distressing moral emotions such as shame and guilt. Military leaders and clinicians have feared that those with PMIEs may be less likely to seek help due to the withdrawing nature of shame/guilt; however, to date, help-seeking patterns of military personnel with PMIEs has not been explored. Our objective is to address this research gap. Method: Data from a nationally-representative mental health survey of active Canadian military personnel were analysed. To assess the association between exposure to three PMIEs and past-year help-seeking across different provider categories (i.e. professionals, para-professionals (those delegated with mental health advisory tasks but are not licenced to practice as medical professionals), non-professionals), a series of logistic regressions were conducted, controlling for exposure to other deployment and non-deployment-related psychological trauma, psychiatric variables, military factors, and sociodemographic variables. Analytical data frame included only personnel with a history of Afghanistan deployment (N = 4854). Results: Deployed members exposed to PMIEs were more likely to seek help from their family doctor/general practitioner (OR = 1.72; 95%CI = 1.25-2.36), paraprofessionals (OR = 1.72; 95%CI = 1.25-2.36), and non-professionals (OR = 1.44; 95%CI = 1.06-1.95) in comparison to members not exposed to PMIEs. Those exposed to PMIEs were also more likely to seek professional care from the civilian health care system (OR = 1.94; 95%CI = 1.27-2.96). Conclusion: Contrary to long-held, but untested, assumptions regarding the impact of PMIEs on help-seeking, we found those with PMIEs are more likely to seek help from gatekeeper professionals (i.e. general practitioners), para-professionals, and non-professionals rather than specialized mental health professionals (e.g. psychologists). Increased utilization of civilian professionals raises concerns that active military members may be avoiding military health services. Clinically, this highlights the need to increase awareness of moral injury to ensure that actively serving military members are provided with appropriate advice and treatment.
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Affiliation(s)
- Anthony Nazarov
- The MacDonald Franklin OSI Research Centre, Lawson Health ResearchInstitute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Deniz Fikretoglu
- Department of National Defence, Defence Research and Development Canada, Toronto, Ontario, Canada.,Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Aihua Liu
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - J Don Richardson
- The MacDonald Franklin OSI Research Centre, Lawson Health ResearchInstitute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Operational Stress Injury Clinic, St. Joseph's Health Care, London, Ontario, Canada
| | - Megan Thompson
- Department of National Defence, Defence Research and Development Canada, Toronto, Ontario, Canada
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14
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Griffin BJ, Purcell N, Burkman K, Litz BT, Bryan CJ, Schmitz M, Villierme C, Walsh J, Maguen S. Moral Injury: An Integrative Review. J Trauma Stress 2019; 32:350-362. [PMID: 30688367 DOI: 10.1002/jts.22362] [Citation(s) in RCA: 265] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 12/18/2022]
Abstract
Individuals who are exposed to traumatic events that violate their moral values may experience severe distress and functional impairments known as "moral injuries." Over the last decade, moral injury has captured the attention of mental health care providers, spiritual and faith communities, media outlets, and the general public. Research about moral injury, especially among military personnel and veterans, has also proliferated. For this article, we reviewed scientific research about moral injury. We identified 116 relevant epidemiological and clinical studies. Epidemiological studies described a wide range of biological, psychological/behavioral, social, and religious/spiritual sequelae associated with exposure to potentially morally injurious events. Although a dearth of empirical clinical literature exists, some authors debated how moral injury might and might not respond to evidence-based treatments for posttraumatic stress disorder (PTSD) whereas others identified new treatment models to directly address moral repair. Limitations of the literature included variable definitions of potentially morally injurious events, the absence of a consensus definition and gold-standard measure of moral injury as an outcome, scant study of moral injury outside of military-related contexts, and clinical investigations limited by small sample sizes and unclear mechanisms of therapeutic effect. We conclude our review by summarizing lessons from the literature and offering recommendations for future research.
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Affiliation(s)
- Brandon J Griffin
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA
| | - Natalie Purcell
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Social and Behavioral Sciences, University of California-San Francisco, San Francisco, CA, USA
| | - Kristine Burkman
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA, USA.,Departments of Psychiatry and Psychology, Boston University, Boston, MA, USA
| | - Craig J Bryan
- National Center for Veterans Studies, The University of Utah, Salt Lake City, UT, USA.,Department of Psychology, The University of Utah, Salt Lake City, UT, USA
| | - Martha Schmitz
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA
| | - Claudia Villierme
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Jessica Walsh
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Shira Maguen
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA
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15
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Büssing A, Recchia DR, Toussaint LL. German Soldiers' Needs to Clarify Open Aspects in Their Life, to Talk About Fears and Worries, and to Forgive and to Be Forgiven as a Matter of Life Reflection. Front Psychiatry 2018; 9:582. [PMID: 30498459 PMCID: PMC6250047 DOI: 10.3389/fpsyt.2018.00582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/24/2018] [Indexed: 11/27/2022] Open
Abstract
Background: In missions, soldiers are confronted with difficult situations which may impair their physical and mental health. As the resulting problems are commonly regarded as stigmata, soldiers may obviate talking about their experiences and try to oppress them. It was aim of this study to clarify whether soldiers do perceive needs to reflect back on life, to seek release from "open aspects" of their life, and to talk with others about fears and worries, to forgive others or to be forgiven. Further we intended to clarify whether these needs were related to stress perception, post-traumatic stress disorders (PTSD) symptoms and reduced life satisfaction on the one hand, and religious trust as a resource to cope on the other hand. Methods: Cross-sectional survey of 1,097 German soldiers (92% men). Existential/spiritual needs and mental health indicators, including stress perception, PTSD symptoms, life satisfaction, were assessed using standardized questionnaires. Results: For 30% of soldiers it was important to reflect on life, 23% had a strong need to clarify open aspects of life, 30% had a strong need to talk with others about their fears and worries, 13% had strong needs to forgive, and 13% had a strong need to be forgiven. Soldiers' needs to clarify open (and probably conflicting) aspects of life were moderately related to their intention to forgive others and to be forgiven (rs > 0.35). Soldiers treated in the hospital for psycho-mental trauma had significantly higher needs scores than soldiers still serving on active duty, particularly for the need to talk with others (F = 39.1; p < 0.0001) and to be forgiven (F = 26.0; p < 0.0001). Across all soldiers the best predictors of these needs were PTSD symptoms and stress perception, albeit with relatively weak predictive power (βs < 0.25; R 2s < 0.24). Conclusions: The process of life reflection and subsequent intention to solve conflicting situations and experiences can be considered a process of coping with one's own failures, guilt, and mistakes. It should be noted that these needs were significantly stronger in soldiers with trauma. Addressing unmet needs may help them to communicate and to reject the stigma of "weakness."
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Affiliation(s)
- Arndt Büssing
- Professorship Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Daniela Rodrigues Recchia
- Professorship Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Loren L Toussaint
- Department of Psychology, Luther College, Decorah, IA, United States
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16
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Hodgson TJ, Carey LB. Moral Injury and Definitional Clarity: Betrayal, Spirituality and the Role of Chaplains. JOURNAL OF RELIGION AND HEALTH 2017; 56:1212-1228. [PMID: 28526912 DOI: 10.1007/s10943-017-0407-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This article explores the developing definition of moral injury within the current key literature. Building on the previous literature regarding 'Moral Injury, Spiritual Care and the role of Chaplains' (Carey et al. in JORH 55(4):1218-1245, 2016b. doi: 10.1007/s10943-016-0231-x ), this article notes the complexity that has developed due to definitional variations regarding moral injury-particularly with respect to the concepts of 'betrayal' and 'spirituality'. Given the increasing recognition of moral injury and noting the relevance and importance of utilizing a bio-psycho-social-spiritual model, this article argues that betrayal and spirituality should be core components for understanding, defining and addressing moral injury. It also supports the role of chaplains being involved in the holistic care and rehabilitation of those affected by moral injury.
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Affiliation(s)
- Timothy J Hodgson
- Department of Religious Studies, School of Historical and Philosophical Inquiry, University of Queensland, St. Lucia, QLD, Australia.
| | - Lindsay B Carey
- Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, VIC, 3083, Australia.
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17
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Kopacz MS, Kane CP, Pigeon WR, Nieuwsma JA. Chaplaincy Encounters Following a Suicide Attempt. J Health Care Chaplain 2017; 23:167-173. [PMID: 28426335 DOI: 10.1080/08854726.2017.1312813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This descriptive study examines the provision of chaplaincy services to veterans who sought health care at a Department of Veterans Affairs (VA) Medical Center following a suicide attempt. A system-wide VA database of suicidal behavior was used to identify a cohort of n = 22,701 veterans who survived a suicide attempt. Next, an electronic review of VA clinical records found that n = 7,447 (32.8%) received chaplaincy services in the 30 days following their attempt. Of this group, the overwhelming majority of first chaplaincy encounters took place in in-patient settings: n = 6890 (92.5%). First chaplaincy encounters most often occurred 1-7 days following the attempt: n = 5,033 (67.6%). Most chaplaincy service users had only one chaplaincy encounter: n = 3,514 (47.2%). The findings suggest that, at VA Medical Centers, a relatively sizeable percentage of suicide attempt survivors have contact with chaplaincy services. Additional research is needed to ascertain if chaplaincy services yield any therapeutic benefit for this group.
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Affiliation(s)
- Marek S Kopacz
- a VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA
| | - Cathleen P Kane
- a VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA
| | - Wilfred R Pigeon
- a VISN 2 Center of Excellence for Suicide Prevention , Canandaigua , New York , USA.,b University of Rochester Medical Center , Rochester , New York , USA
| | - Jason A Nieuwsma
- c Mid-Atlantic Mental Illness Research, Education and Clinical Center, Mental Health and Chaplaincy , Durham , North Carolina , USA.,d Duke University Medical Center , Durham , North Carolina , USA
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18
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McCormick WH, Carroll TD, Slagel BA, Drescher KD, Nieuwsma JA, Currier JM. Professional Quality of Life and Changes in Spirituality Among VHA Chaplains: A Mixed Methods Investigation. J Health Care Chaplain 2017; 23:113-129. [DOI: 10.1080/08854726.2017.1295675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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