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Chalker SA, Pozun CT, Ehret BC. Functional impairment, internalized stigma, and well-being: Considerations for recovery-oriented suicide prevention for U.S. Veterans with serious mental illness. PRACTICE INNOVATIONS (WASHINGTON, D.C.) 2023; 2023. [PMID: 37900980 PMCID: PMC10601383 DOI: 10.1037/pri0000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Veterans Health Administration's (VHA) Psychosocial Rehabilitation and Recovery Centers (PRRCs) provide recovery-oriented care to Veterans with serious mental illness (SMI). As part of program evaluation, PRRC providers regularly assess recovery-oriented outcomes. Given the high rates of suicidal thoughts and behaviors among Veterans with SMI, understanding such outcomes in relation to suicide risk is crucial. Among Veterans entering a PRRC (N=4,731), the present study aimed to a) report suicidal ideation frequency in the past two weeks across demographics and psychiatric diagnoses, b) explore rates of current functional impairment, internalized stigma, and well-being, and c) examine differences in suicidal ideation frequency and functional impairment, internalized stigma, and well-being. Measurements before treatment were utilized. Younger (ρ=-.08, p<.001), married (z=-5.23, p<.001) Veterans, those not identifying as Black or African American (z=-4.80, p<.001), not diagnosed with schizophrenia (z=-6.97, <.001), diagnosed with depressive disorders (z=-8.79, <.001), anxiety disorders (z=-5.01, <.001), posttraumatic stress disorder (z=-7.69, <.001), or personality disorders (z=-7.12, <.001) were significantly more likely to endorse suicidal ideation. Veterans in this cohort had higher than average functional impairment (M=18.05, SD=9.85), mild internalized stigma (M=2.36, SD=0.51), and lower than average well-being (M=18.96, SD=3.93). The more often a Veteran reported thinking about suicide in the past two weeks, the more likely the Veteran viewed themselves to be more functionally impaired (p<.001), reported higher levels of internalized stigma (p<.001), and reported lower levels of well-being (p<.001). Findings and limitations, particularly the suicidal ideation frequency measurement, are discussed to contextualize suggestions to integrate recovery-oriented practices and suicide prevention care.
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Affiliation(s)
- Samantha A Chalker
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- University of California, San Diego, Department of Psychiatry, San Diego, California, USA
| | - Cara T Pozun
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Blaire C Ehret
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- University of California, San Diego, Department of Psychiatry, San Diego, California, USA
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Chen K, Chen L, Dai J, Ye H. MAFLD in Patients with Cushing's Disease Is Negatively Associated with Low Free Thyroxine Levels Rather than with Cortisol or TSH Levels. Int J Endocrinol 2023; 2023:6637396. [PMID: 37091746 PMCID: PMC10115525 DOI: 10.1155/2023/6637396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose This study aims to analyze the clinical characteristic of metabolic associated fatty liver disease (MAFLD) in patients with active Cushing's disease (CD) and determine associations of thyroid hormones with MAFLD. Methods Patients with active CD were included in this cross-sectional study. All subjects were assessed for hepatic steatosis by abdominal ultrasonography and thyroid functions. Demographic and clinical characteristic parameters were collected for correlation analysis and logistic analysis. Results 290 individuals with active CD were included in Huashan hospital from January 2014 to February 2022. We found that the prevalence of CD with MAFLD was 33.79%. The MAFLD group had a lower level of FT4 and a higher level of FT3/FT4 but no difference in levels of cortisol, 24 h UFC, TSH, TT4, TT3, and FT3. Correlation analysis showed positive associations of TSH, TT4, TT3, FT3, and FT3/FT4 with BMI. In age-, BMI-, sex-, cortisol-, and 24 h UFC-adjusted analysis, FT4 was independently associated with MAFLD in patients with CD. This association remained similar even after adjusting for the presence of metabolic syndrome components. Conclusion Lower FT4 levels were associated with higher risk of MAFLD in patients with CD. FT4 may be used as a helpful indicator to predict MAFLD and provide novel ideas for the treatment of MAFLD in patients with CD in the future.
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Affiliation(s)
- Kuangyang Chen
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Lijiao Chen
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Jiarong Dai
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Hongying Ye
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
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Pankratz L, Sommer JL, Bolton SL, Sareen J, Enns MW, Afifi TO, El-Gabalawy R, Mota N. Prevalence and predictors of anxiety disorder courses in the Canadian Armed Forces. J Anxiety Disord 2022; 92:102612. [PMID: 36252350 DOI: 10.1016/j.janxdis.2022.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 11/07/2022]
Abstract
Few studies have examined the longitudinal courses of anxiety disorders in military members. This study examined the prevalence and predictors of courses of any anxiety disorder in members and veterans of the Canadian Armed Forces, including no lifetime, remitted, new onset, and persistent/recurrent anxiety disorder. The 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey is a 16-year follow-up of n = 2941 participants from the Canadian Community Health Survey: Canadian Forces Supplement in 2002. Diagnoses of any DSM-IV anxiety disorder (i.e., generalized anxiety, social anxiety, and/or panic disorder) in 2002 and 2018 were used to create four anxiety course groups. A large proportion of the sample (36.3 %; new onset = 24.6 %, remitting = 6.9 %, and persistent/recurrent = 4.8 %) met criteria for an anxiety disorder during one or both time points. Factors at baseline and/or between 2002 and 2018, including income, education, military rank, comorbidity of PTSD or depression, deployment history, and traumatic events, were positively associated with most anxiety courses relative to no anxiety in analyses. Targeted interventions are needed to help mitigate anxiety disorders among this population. Social support and active coping were protective factors for most anxiety courses and may need to be incorporated into targeted interventions.
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Affiliation(s)
- Lily Pankratz
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada.
| | - Jordana L Sommer
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada; Department of Clinical Health Psychology, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Shay-Lee Bolton
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Jitender Sareen
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada; Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Community Health Sciences, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Murray W Enns
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Tracie O Afifi
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Community Health Sciences, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Clinical Health Psychology, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Natalie Mota
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Clinical Health Psychology, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
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Wei W, Liu W. Sleep Pattern Is Related to Mental Health among Chinese Collegiate Student Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158961. [PMID: 35897332 PMCID: PMC9329793 DOI: 10.3390/ijerph19158961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023]
Abstract
Regarding the association between sleep and napping duration and mental health in young and older adults, some studies indicated a positive association, while others indicated a negative, or no, association between them. Moreover, collegiate student athletes have different mental health stressors, such as training pressure, improving sports performance, and relationships with coaches. Therefore, sleep is important for athletes. Whether sleep duration is related to their mental health is unclear. Thus, this study aimed to examine the association between nighttime sleep duration, daytime napping duration, and mental health among collegiate student athletees. This cross-sectional study included 700 college athletes. Sleep and daytime napping durations were assessed using a self-reported questionnaire. The Zung Self-rating Depression Scale and Generalized Anxiety Disorder-7 assessed mental health. A multivariate logistic regression analysis was conducted to examine the adjusted association between sleep duration and mental health. In this study, the odds ratios for depression and anxiety symptoms were significantly higher for short sleep duration (<7 h). Additionally, a significant positive association was found between daytime napping duration and the prevalence of depression. This study indicates that short nighttime sleep and long daytime napping duration may be risk factors for collegiate student athletes’ mental health, having important implications for educators and coaches.
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Affiliation(s)
- Wei Wei
- School of Physical Education, Central China Normal University, 152 Luoyu Road, Wuhan 430079, China
- Department of Physical Education, Hohai University, 1 Xikang Road, Nanjing 210098, China
- Correspondence: (W.W.); (W.L.)
| | - Weimin Liu
- School of Physical Education, Central China Normal University, 152 Luoyu Road, Wuhan 430079, China
- Correspondence: (W.W.); (W.L.)
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Enns MW, Mota N, Afifi TO, Bolton SL, Richardson JD, Patten SB, Sareen J. Course and Predictors of Major Depressive Disorder in the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey: Cours et Prédicteurs du Trouble de Dépression Majeure Dans l'Enquête de Suivi Sur la Santé Mentale Auprès Des Membres des Forces Armées Canadiennes et des ex-Militaires. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:971-981. [PMID: 33406886 PMCID: PMC8649828 DOI: 10.1177/0706743720984677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The present report is the first study of Canadian military personnel to use longitudinal survey data to identify factors that determine major depressive episodes (MDEs) over a period of 16 years. METHODS The study used data from the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS) collected in 2018 (n = 2,941, response rate 68.7%) and linked baseline data from the same participants that were collected in 2002 when they were Canadian Regular Force members. The study used structured interviews to identify 5 common Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders and collected demographic data, as well as information about traumatic experiences, childhood adversities, work stress, and potential resilience factors. Respondents were divided into 4 possible MDE courses: No Disorder, Remitting, New Onset, and Persistent/Recurrent. Relative risk ratios (RRRs) from multinomial regression models were used to evaluate determinants of these outcomes. RESULTS A history of anxiety disorders and post-traumatic stress disorder (RRRs: 1.50 to 20.55), mental health service utilization (RRRs: 1.70 to 12.34), veteran status (RRRs: 1.64 to 2.15), deployment-associated traumatic events (RRRs: 1.71 to 2.27), sexual traumas (RRRs: 1.91 to 2.93), other traumas (RRRs: 1.67 to 2.64), childhood adversities (RRRs: 1.39 to 1.97), avoidance coping (RRRs 1.09 to 1.49), higher frequency of religious attendance (RRRs: 1.54 to 1.61), and work stress (RRRs: 1.05 to 1.10) were associated with MDE courses in most analyses. Problem-focused coping (RRRs: 0.73 to 0.91) and social support (RRRs: 0.95 to 0.98) were associated with protection against MDEs. CONCLUSIONS The time periods following deployment and trauma exposure and during the transition from active duty to veteran status are particularly relevant for vulnerability to depression in military members. Interventions that enhance problem-focused coping and social support may be protective against MDEs in military members.
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Affiliation(s)
- Murray W Enns
- Department of Psychiatry, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Departments of Clinical Health Psychology and Psychiatry, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O Afifi
- Departments of Community Health Sciences and Psychiatry, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shay-Lee Bolton
- Department of Psychiatry, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - J Don Richardson
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, 2129University of Calgary, Calgary, Alberta, Canada
| | - Jitender Sareen
- Departments of Psychiatry and Psychology and Community Health Sciences, 8664University of Manitoba, Winnipeg, Manitoba, Canada
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Afifi TO, Bolton SL, Mota N, Marrie RA, Stein MB, Enns MW, El-Gabalawy R, Bernstein CN, Mackenzie C, VanTil L, MacLean MB, Wang JL, Patten S, Asmundson GJG, Sareen J. Rationale and Methodology of the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS): A 16-year Follow-up Survey: Raison D'être Et Méthodologie De L'enquête De Suivi Sur La Santé Mentale Des Membres Des Forces Armées Canadiennes Et Des Anciens Combattants, 2018 (ESSMFACM). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:942-950. [PMID: 33624524 PMCID: PMC8649811 DOI: 10.1177/0706743720974837] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Knowledge is limited regarding the longitudinal course and predictors of mental health problems, suicide, and physical health outcomes among military and veterans. Statistics Canada, in collaboration with researchers at the University of Manitoba and an international team, conducted the Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS). Herein, we describe the rationale and methods of this important survey. METHOD The CAFVMHS is a longitudinal survey design with 2 time points (2002 and 2018). Regular Force military personnel who participated in the first Canadian Community Health Survey Cycle 1.2-Mental Health and Well-Being, Canadian Forces Supplement (CCHS-CFS) in 2002 (N = 5,155) were reinterviewed in 2018 (n = 2,941). The World Mental Health Survey-Composite International Diagnostic Interview was used with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. RESULTS The CAFVMHS includes 2,941 respondents (66% veterans; 34% active duty) and includes data on mental disorder diagnoses, physical health conditions, substance use, medication use, general health, mental health services, perceived need for care, social support, moral injury, deployment experiences, stress, physical activity, military-related sexual assault, childhood experiences, and military and sociodemographic information. CONCLUSIONS The CAFVMHS provides a unique opportunity to further understand the health and well-being of military personnel in Canada over time to inform intervention and prevention strategies and improve outcomes. The data are available through the Statistics Canada Research Data Centres across Canada and can be used cross-sectionally or be longitudinally linked to the 2002 CCHS-CFS data.
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Affiliation(s)
- Tracie O Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shay-Lee Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Faculty of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murray B Stein
- Department of Psychiatry, UCSD School of Medicine, California, USA.,The Harold Wertheim School of Public Health and Human Longevity Science, UCSD, California, USA.,Altman Clinical and Translational Research Institute, UCSD School of Medicine, California, USA
| | - Murray W Enns
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Anesthesia, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Corey Mackenzie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Linda VanTil
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Mary Beth MacLean
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Jian Li Wang
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | - Scott Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Jitender Sareen
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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Mota N, Bolton SL, Enns MW, Afifi TO, El-Gabalawy R, Sommer JL, Pietrzak RH, Stein MB, Asmundson GJG, Sareen J. Course and Predictors of Posttraumatic Stress Disorder in the Canadian Armed Forces: A Nationally Representative, 16-Year Follow-up Study: Cours et prédicteurs du trouble de stress post-traumatique dans les Forces armées canadiennes: une étude de suivi de 16 ans nationalement représentative. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:982-995. [PMID: 33522288 PMCID: PMC8649830 DOI: 10.1177/0706743721989167] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study examined baseline risk and protective predictors and interim correlates of the persistence/recurrence, remission, and onset of posttraumatic stress disorder (PTSD) in a 16-year prospective, nationally representative sample of Canadian Forces members and veterans. METHODS The 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey is a prospective study of 2,941 regular force service members and veterans who participated in the 2002 Canadian Community Health Survey on Mental Health and Wellbeing: Canadian Forces Supplement (n = 5,155; ages 15 to 64 years; response rate 68%). PTSD diagnoses in 2002 and 2018 were used to create 4 groups: (1) no lifetime, (2) remitted, (3) new onset, and (4) persistent/recurrent PTSD. Multinomial regressions were conducted to identify predictors of PTSD courses. RESULTS Female sex, being a junior noncommissioned member (vs. officer), and land (vs. air) operations in 2002 were associated with all PTSD courses relative to no lifetime PTSD (relative risk ratio [RRR] range: 1.28 to 3.65). After adjusting for sociodemographic variables, baseline predictors of all PTSD courses included lifetime mental disorder, history of mental health care utilization, all trauma type categories (deployment-associated, sexual, "other"), and the number of lifetime traumatic events (RRR range: 1.14 to 8.95). New ("since 2002") traumas, transitioning to veteran status, and alcohol dependence were mostly associated with the new onset and persistent/recurrent PTSD courses (RRR range: 1.79 to 4.31), while mental health care utilization and greater avoidance coping were associated with all PTSD courses (RRR range: 1.10 to 17.87). Protective factors for several PTSD courses at one or both time points included social support, social network size, and problem-focused coping (RRR range: 0.71 to 0.98). CONCLUSIONS This is the first population-based survey to examine the longitudinal course of PTSD in Canadian Forces members. Prevention and intervention programs focused on bolstering social support and active coping strategies as possible protective factors/correlates may help mitigate the development and persistence of PTSD.
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Affiliation(s)
- Natalie Mota
- Departments of Clinical Health Psychology and Psychiatry, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shay-Lee Bolton
- Department of Psychiatry, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murray W Enns
- Department of Psychiatry, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O Afifi
- Departments of Community Health Sciences and Psychiatry, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Departments of Anesthesiology, Perioperative and Pain Medicine, and Clinical Health Psychology, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jordana L Sommer
- Departments of Psychology and Anesthesiology, Perioperative and Pain Medicine, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert H Pietrzak
- Department of Psychiatry, 5755Yale University School of Medicine, New Haven, CT, USA.,National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Murray B Stein
- Departments of Psychiatry and of Family Medicine and Public Health, University of California San Diego, La Jolla, and VA San Diego Healthcare System, San Diego, CA, USA
| | - Gordon J G Asmundson
- Department of Psychology and Anxiety and Illness Behaviours Lab, 8664University of Regina, Regina, Canada
| | - Jitender Sareen
- Department of Psychiatry, 8664University of Manitoba, Winnipeg, Manitoba, Canada
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Holmberg C, Gremyr A, Torgerson J, Mehlig K. Clinical validity of the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders. BMC Psychiatry 2021; 21:147. [PMID: 33691655 PMCID: PMC7945302 DOI: 10.1186/s12888-021-03101-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/02/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) is a self-administered instrument to assess functional impairment. It is used in the general population as well as different patient groups. However, its application to patients with psychotic disorders may be hampered by disease-specific difficulties of self-estimation. This study aimed to examine the psychometric properties of the short (12-item) WHODAS-2.0 in a naturalistic sample of outpatients attending a psychosis clinic in Gothenburg, Sweden. METHODS Annual data from two outpatient clinics registered 2016-2019 were analyzed retrospectively. The assessment of the short WHODAS-2.0 was based on the first questionnaire completed by 881 patients. Confirmatory factor analysis evaluated previously validated models. Item convergent and discriminant validity as well as internal reliability were computed. Construct validity was assessed by comparing mean differences in accord with previous research regarding patients' characteristics associated with functioning such as advanced age, diagnosed comorbidities, antipsychotic treatment status, and symptom severity measured with PANSS-8 remission items. RESULTS A heterogeneous sample was obtained in terms of age (range: 20-92), various living situations, and different geographic areas of birth. Most patients (75%) had been diagnosed with psychotic disorders more than 10 years ago and the majority (89%) were on antipsychotic medication. We confirmed an adjusted two-level factor model with a single second-order disability factor and six first-order factors representing the six IFC dimensions. The WHODAS-2.0 sum score measuring general disability showed good reliability (Cronbach's alpha = 0.89). Construct validity was confirmed as older patients, patients with comorbidities, and patients in assisted living had higher WHODAS-2.0 scores. Patients with no or mild psychotic symptoms had significantly lower WHODAS-2.0 sum scores than patients with more severe symptoms. CONCLUSIONS The findings further validate the 12-item WHODAS-2.0 in a naturalistic sample of outpatients with psychotic disorders. This study corroborates the clinical significance of the short, 12-item WHODAS-2.0 by demonstrating consistent associations between patients' age, medical comorbidities, living situation, antipsychotic treatment status, and psychotic symptom severity.
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Affiliation(s)
- Christopher Holmberg
- Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Göteborg, Sweden
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Gremyr
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Jarl Torgerson
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kirsten Mehlig
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Snell DL, Siegert RJ, Silverberg ND. Rasch analysis of the World Health Organization Disability Assessment Schedule 2.0 in a mild traumatic brain injury sample. Brain Inj 2020; 34:610-618. [PMID: 32078408 DOI: 10.1080/02699052.2020.1729417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this study we examined the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0 12-item version) in a mild traumatic brain injury (MTBI) sample.Materials and Methods: Treatment-seeking adults (n = 131) with MTBI recruited from outpatient clinics in Vancouver Canada, were assessed 1- and 3-months following clinic intake. Dimensionality, reliability, and differential item functioning of the WHODAS 2.0 were examined with Rasch analysis. Associations between change in WHODAS 2.0 scores and symptom, work and perceived improvement outcomes were examined.Results: Adequate fit to the Rasch model was achieved for 1-month follow-up assessment WHODAS 2.0 scores without altering the response format or item content [X2 (24, n = 130) = 21.2, p = .6]. The best model fit for 3-month follow-up assessment scores was achieved when two items (problems with dressing and washing) were combined [X2 (22, n = 115) = 20.9, p = .5]. Associations were evident between changes in WHODAS total Rasch scores and other outcome indicators such as return to productivity and percieved improvement.Conclusions: The WHODAS 2.0 (12-item version) is a psychometrically sound measure of functional outcome for adults seeking treatment following MTBI. Our table of ordinal to interval score conversions is recommended for future research examining MTBI outcomes.
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Affiliation(s)
- Deborah L Snell
- Concussion Clinic, Canterbury District Health Board, Christchurch, New Zealand.,Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Richard J Siegert
- Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand
| | - Noah D Silverberg
- Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, Canada.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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Contribution of traumatic deployment experiences to the burden of mental health problems in Canadian Armed Forces personnel: exploration of population attributable fractions. Soc Psychiatry Psychiatr Epidemiol 2019; 54:145-156. [PMID: 30027449 DOI: 10.1007/s00127-018-1562-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Mental health problems are prevalent after combat; they are also common in its absence. Estimates of deployment-attributability vary. This paper quantifies the contribution of different subtypes of occupational trauma to post-deployment mental health problems. METHODS Participants were a cohort of 16,193 Canadian personnel undergoing post-deployment mental health screening after return from the mission in Afghanistan. The screening questionnaire assessed post-traumatic stress disorder, depression, panic disorder, generalized anxiety disorder, and exposure to 30 potentially traumatic deployment experiences. Logistic regression estimated adjusted population attributable fractions (PAFs) for deployment-related trauma, which was treated as count variables divided into several subtypes of experiences based on earlier factor analytic work. RESULTS The overall PAF for overall deployment-related trauma exposure was 57.5% (95% confidence interval 44.1, 67.7) for the aggregate outcome of any of the four assessed problems. Substantial PAFs were seen even at lower levels of exposure. Among subtypes of trauma, exposure to a dangerous environment (e.g., receiving small arms fire) and to the dead and injured (e.g., handling or uncovering human remains) had the largest PAFs. Active combat (e.g., calling in fire on the enemy) did not have a significant PAF. CONCLUSIONS Military deployments involving exposure to a dangerous environment or to the dead or injured will have substantial impacts on mental health in military personnel and others exposed to similar occupational trauma. Potential explanations for divergent findings in the literature on the extent to which deployment-related trauma contributes to the burden of mental disorders are discussed.
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11
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Battaglia AM, Protopopescu A, Boyd JE, Lloyd C, Jetly R, O'Connor C, Hood HK, Nazarov A, Rhind SG, Lanius RA, McKinnon MC. The relation between adverse childhood experiences and moral injury in the Canadian Armed Forces. Eur J Psychotraumatol 2019; 10:1546084. [PMID: 30693070 PMCID: PMC6338272 DOI: 10.1080/20008198.2018.1546084] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/27/2018] [Accepted: 10/20/2018] [Indexed: 11/27/2022] Open
Abstract
Background: There is increasing evidence that moral injuries (MIs) may affect the mental health of Canadian Armed Forces (CAF) members and veterans. Despite knowledge suggesting that MIs are related to multiple negative mental health outcomes, including the onset of post-traumatic stress disorder (PTSD), it is unknown whether pre-traumatic variables, including the presence of childhood abuse, are related to MIs. Objective: This study seeks to investigate the potential relationship between adverse childhood experiences and later onset MI in military members. Methods: Thirty-three patients newly admitted to an inpatient unit for treatment of trauma-related disorders received a standardized self-assessment package, including the PTSD Checklist for DSM-5 (PCL-5), the Moral Injury Events Scale (MIES; adapted for the Canadian context), and the Adverse Childhood Experiences Questionnaire (ACE-Q), which is a retrospective measure of childhood abuse. Results: Analyses revealed a significant relation between childhood emotional abuse and the presence of MI in adulthood. Specifically, emotional abuse during childhood was correlated with total score on the MIES (p = 0.006) and with its two subscales, perceived betrayals (p = 0.022) and perceived transgressions (p = 0.016). These correlations remained significant when controlling for age and gender. Conclusions: Among CAF members and veterans, childhood events are related to the presence of MI during adulthood. These preliminary data are provocative in suggesting that emotional abuse during childhood may increase the likelihood of endorsing MI during adult military service. Further work is needed to identify pre-traumatic variables that may serve to increase risk or enhance resilience to the development of MI in military members.
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Affiliation(s)
- Anthony M Battaglia
- Departments of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Alina Protopopescu
- Departments of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
| | - Jenna E Boyd
- Departments of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
| | - Chantelle Lloyd
- Departments of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Rakesh Jetly
- Department of National Defence, Government of Canada, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Charlene O'Connor
- Homewood Research Institute, Guelph, ON, Canada.,Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, ON, Canada
| | - Heather K Hood
- Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, ON, Canada.,Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Anthony Nazarov
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Shawn G Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Ruth A Lanius
- Homewood Research Institute, Guelph, ON, Canada.,Departments of Psychiatry, Western University, London, ON, Canada.,Departments of Neuroscience, Western University, London, ON, Canada.,Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada.,Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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12
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Paul MA, Love RJ, Jetly R, Richardson JD, Lanius RA, Miller JC, MacDonald M, Rhind SG. Blunted Nocturnal Salivary Melatonin Secretion Profiles in Military-Related Posttraumatic Stress Disorder. Front Psychiatry 2019; 10:882. [PMID: 31866882 PMCID: PMC6910089 DOI: 10.3389/fpsyt.2019.00882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Sleep disturbances are a hallmark of posttraumatic stress disorder (PTSD), yet few studies have evaluated the role of dysregulated endogenous melatonin secretion in this condition. Methods: This study compared the sleep quality and nocturnal salivary melatonin profiles of Canadian Armed Forces (CAF) personnel diagnosed with PTSD, using the Clinician Administered PTSD Scale (CAPS score ≥50), with two healthy CAF control groups; comprising, a "light control" (LC) group with standardized evening light exposure and "normal control" (NC) group without light restriction. Participants were monitored for 1-week using wrist actigraphy to assess sleep quality, and 24-h salivary melatonin levels were measured (every 2h) by immunoassay on the penultimate day in a dim-light (< 5 lux) laboratory environment. Results: A repeated measures design showed that mean nocturnal melatonin concentrations for LC were higher than both NC (p = .03) and PTSD (p = .003) with no difference between PTSD and NC. Relative to PTSD, NC had significantly higher melatonin levels over a 4-h period (01 to 05 h), whereas the LC group had higher melatonin levels over an 8-h period (23 to 07 h). Actigraphic sleep quality parameters were not different between healthy controls and PTSD patients, likely due to the use of prescription sleep medications in the PTSD group. Conclusions: These results indicate that PTSD is associated with blunted nocturnal melatonin secretion, which is consistent with previous findings showing lower melatonin after exposure to trauma and suggestive of severe chronodisruption. Future studies targeting the melatonergic system for therapeutic intervention may be beneficial for treatment-resistant PTSD.
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Affiliation(s)
- Michel A Paul
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
| | - Ryan J Love
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, ON, Canada
| | - J Donald Richardson
- Department of Psychiatry, Western University, London, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Operational Stress Injury Clinic, Parkwood Institute, London, ON, Canada.,MacDonald Franklin Operational Stress Injury Research Centre, Lawson Research Institute, London, ON, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, ON, Canada.,Department of Neuroscience, Western University, London, ON, Canada
| | - James C Miller
- Department of Life Sciences, Texas A&M University Corpus Christi, Corpus Christi, TX, United States
| | - Michael MacDonald
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, ON, Canada
| | - Shawn G Rhind
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
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13
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Zamorski MA, Rusu C, Guest K, Fikretoglu D. Exposure to mental health training and education in Canadian Armed Forces personnel. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.2017-0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Mark A. Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Deceased 17 August 2018
| | - Corneliu Rusu
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kim Guest
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
| | - Deniz Fikretoglu
- Defence Research and Development Canada, Toronto, Ontario, Canada
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14
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Sampasa-Kanyinga H, Zamorski MA, Colman I. Mental Disorder, Psychological Distress, and Functional Status in Canadian Military Personnel. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:620-628. [PMID: 29490473 PMCID: PMC6109882 DOI: 10.1177/0706743718762098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We examined the overlap between mood and anxiety disorders and psychological distress and their associations with functional status in Canadian Armed Forces (CAF) personnel. METHOD Data on Regular Forces personnel ( N = 6700) were derived from the 2013 Canadian Forces Mental Health Survey, a nationally representative survey of the CAF personnel. Current psychological distress was assessed using the Kessler K10 scale. Past-month mood and anxiety disorders were assessed using the World Health Organization World Mental Health Composite Diagnostic Interview. RESULTS The prevalence of psychological distress was the same as that of any past-month mood or anxiety disorder (7.1% for each). A total of 3.8% had both distress and past-month mood or anxiety disorder, 3.3% had past-month disorder without psychological distress, while another 3.3% had psychological distress in the absence of a past-month mood or anxiety disorder. After adjusting for age, sex, marital, education, income, language, element, rank, and alcohol use disorder, individuals with both psychological distress and past-month mood and anxiety disorders exhibited the highest levels of disability, days out of role, and work absenteeism relative to those with neither mental disorders nor psychological distress. Relative to individuals with both disorder and distress, those who endured distress in the absence of mental disorder exhibited lower, but meaningful, levels of disability compared with those with neither disorder nor distress. CONCLUSIONS Disability is most severe among CAF personnel with both distress and past-month mood and anxiety disorders. Nevertheless, distress in the absence of disorder is prevalent and is associated with meaningful levels of disability.
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Affiliation(s)
| | - Mark A Zamorski
- 2 Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario.,3 Department of Family Medicine, University of Ottawa, Ottawa, Ontario
| | - Ian Colman
- 1 School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
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15
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Beliveau PJH, Boulos D, Zamorski MA. Contribution of mental and physical disorders to disability in military personnel. Occup Med (Lond) 2018; 68:332-339. [PMID: 29788489 PMCID: PMC6012132 DOI: 10.1093/occmed/kqy066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Combat operations in Southwest Asia have exposed millions of military personnel to risk of mental disorders and physical injuries, including traumatic brain injury (TBI). The contribution of specific disorders to disability is, however, uncertain. Aims To estimate the contributions of mental and physical health conditions to disability in military personnel. Methods The sample consisted of military personnel who participated in the cross-sectional 2013 Canadian Forces Mental Health Survey. Disability was measured using the World Health Organization Disability Assessment. The International Classification of Functioning, Disability, and Health was used to classify participants with moderate/severe disability. Chronic mental disorders and physical conditions were measured by self-reported health professional diagnoses, and their contribution to disability was assessed using logistic regression and resulting population attributable fractions. Results Data were collected from 6696 military members. The prevalence of moderate/severe disability was 10%. Mental disorders accounted for 27% (95% confidence interval [CI] 23–31%) and physical conditions 62% (95% CI 56–67%) of the burden of disability. Chronic musculoskeletal problems 33% (95% CI 26–39%), back problems 29% (95% CI 23–35%), mood disorders 16% (95% CI 11–19%) and post-traumatic stress disorder (PTSD) 9% (95% CI 5–12%) were the leading contributors to disability. After-effects of TBI accounted for only 3% (95% CI 1–4%) of disability. Mental and physical health interacted broadly, such that those with mental disorders experienced disproportionate disability in the presence of physical conditions. Conclusions Chronic musculoskeletal conditions, back problems, mood disorders and PTSD are primary areas of focus in prevention and control of disability in military personnel.
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Affiliation(s)
- P J H Beliveau
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - D Boulos
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - M A Zamorski
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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16
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Sampasa-Kanyinga H, Zamorski MA, Colman I. The psychometric properties of the 10-item Kessler Psychological Distress Scale (K10) in Canadian military personnel. PLoS One 2018; 13:e0196562. [PMID: 29698459 PMCID: PMC5919406 DOI: 10.1371/journal.pone.0196562] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 04/16/2018] [Indexed: 01/16/2023] Open
Abstract
The psychometric properties of the ten-item Kessler Psychological Distress scale (K10) have been extensively explored in civilian populations. However, documentation of its psychometric properties in military populations is limited, and there is no universally accepted cut-off score on the K10 to distinguish clinical vs. sub-clinical levels of distress. The objective of this study was to examine the psychometric properties of the K10 in Canadian Armed Forces personnel. Data on 6700 Regular Forces personnel were obtained from the 2013 Canadian Forces Mental Health Survey. The internal consistency and factor structure of the K10 (range, 0–40) were examined using confirmatory factor analysis (CFA). Receiver Operating Characteristic (ROC) analysis was used to select optimal cut-offs for the K10, using the presence/absence of any of four past-month disorders as the outcome (posttraumatic stress disorder, major depressive episode, generalized anxiety disorder, and panic disorder). Cronbach’s alpha (0.88) indicated a high level of internal consistency of the K10. Results from CFA indicated that a single-factor 10-item construct had an acceptable overall fit: root mean square error of approximation (RMSEA) = 0.05; 90% confidence interval (CI):0.05–0.06, comparative fit index (CFI) = 0.99, Tucker-Lewis Index (TLI) = 0.99, weighted root mean square residual (WRMR) = 2.06. K10 scores were strongly associated with both the presence and recency of all four measured disorders. The area under the ROC curve was 0.92, demonstrating excellent predictive value for past-30-day disorders. A K10 score of 10 or greater was optimal for screening purposes (sensitivity = 86%; specificity = 83%), while a score of 17 or greater (sensitivity = 53%; specificity = 97%) was optimal for prevalence estimation of clinically significant psychological distress, in that it resulted in equal numbers of false positives and false negatives. Our results suggest that K10 scale has satisfactory psychometric properties for use as a measure of non-specific psychological distress in the military population.
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Affiliation(s)
- Hugues Sampasa-Kanyinga
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
- * E-mail:
| | - Mark A. Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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17
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Axelsson E, Lindsäter E, Ljótsson B, Andersson E, Hedman-Lagerlöf E. The 12-item Self-Report World Health Organization Disability Assessment Schedule (WHODAS) 2.0 Administered Via the Internet to Individuals With Anxiety and Stress Disorders: A Psychometric Investigation Based on Data From Two Clinical Trials. JMIR Ment Health 2017; 4:e58. [PMID: 29222080 PMCID: PMC5741825 DOI: 10.2196/mental.7497] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 08/19/2017] [Accepted: 10/04/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a widespread measure of disability and functional impairment, which is bundled with the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) for use in psychiatry. Administering psychometric scales via the Internet is an effective way to reach respondents and allow for convenient handling of data. OBJECTIVE The aim was to study the psychometric properties of the 12-item self-report WHODAS 2.0 when administered online to individuals with anxiety and stress disorders. The WHODAS 2.0 was hypothesized to exhibit high internal consistency and be unidimensional. We also expected the WHODAS 2.0 to show high 2-week test-retest reliability, convergent validity (correlations approximately .50 to .90 with other self-report measures of functional impairment), that it would differentiate between patients with and without exhaustion disorder, and that it would respond to change in primary symptom domain. METHODS We administered the 12-item self-report WHODAS 2.0 online to patients with anxiety and stress disorders (N=160) enrolled in clinical trials of cognitive behavior therapy, and analyzed psychometric properties within a classical test theory framework. Scores were compared with well-established symptom and disability measures, and sensitivity to change was studied from pretreatment to posttreatment assessment. RESULTS The 12-item self-report WHODAS 2.0 showed high internal consistency (Cronbach alpha=.83-.92), high 2-week test-retest reliability (intraclass correlation coefficient=.83), adequate construct validity, and was sensitive to change. We found preliminary evidence for a three-factorial structure, but one strong factor accounted for a clear majority of the variance. CONCLUSIONS We conclude that the 12-item self-report WHODAS 2.0 is a psychometrically sound instrument when administered online to individuals with anxiety and stress disorders, but that it is probably fruitful to also report the three subfactors to facilitate comparisons between studies. TRIAL REGISTRATION Clinicaltrials.gov NCT02540317; https://clinicaltrials.gov/ct2/show/NCT02540317 (Archived by WebCite at http://www.webcitation.org/6vQEdYAem); Clinicaltrials.gov NCT02314065; https://clinicaltrials.gov/ct2/show/NCT02314065 (Archived by WebCite at http://www.webcitation.org/6vQEjlUU8).
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Affiliation(s)
- Erland Axelsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Gustavsberg Primary Care Clinic, Gustavsberg, Sweden
| | - Elin Lindsäter
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Gustavsberg Primary Care Clinic, Gustavsberg, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Gustavsberg Primary Care Clinic, Gustavsberg, Sweden.,Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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18
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Snell DL, Iverson GL, Panenka WJ, Silverberg ND. Preliminary Validation of the World Health Organization Disability Assessment Schedule 2.0 for Mild Traumatic Brain Injury. J Neurotrauma 2017; 34:3256-3261. [DOI: 10.1089/neu.2017.5234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Deborah L. Snell
- Concussion Clinic, Canterbury District Health Board, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Burwood Hospital, Christchurch, New Zealand
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts
| | - William J. Panenka
- British Columbia Neuropsychiatry Program, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Noah D. Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Rehabilitation Research Program, GF Strong Rehab Centre, Rehabilitation Research Program, Vancouver, British Columbia, Canada
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19
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Zamorski MA, Bennett RE, Boulos D, Garber BG, Jetly R, Sareen J. The 2013 Canadian Forces Mental Health Survey: Background and Methods. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:10S-25S. [PMID: 27270738 PMCID: PMC4800478 DOI: 10.1177/0706743716632731] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The 2013 Canadian Forces Mental Health Survey (CFMHS) collected detailed information on mental health problems, their impacts, occupational and nonoccupational determinants of mental health, and the use of mental health services from a random sample of 8200 serving personnel. The objective of this article is to provide a firm scientific foundation for understanding and interpreting the CFMHS findings. METHODS This narrative review first provides a snapshot of the Canadian Armed Forces (CAF), focusing on 2 key determinants of mental health: the deployment of more than 40,000 personnel in support of the mission in Afghanistan and the extensive renewal of the CAF mental health system. The findings of recent population-based CAF mental health research are reviewed, with a focus on findings from the very similar mental health survey done in 2002. Finally, key aspects of the methods of the 2013 CFMHS are presented. RESULTS The findings of 20 peer-reviewed publications using the 2002 mental health survey data are reviewed, along with those of 25 publications from other major CAF mental health research projects executed over the past decade. CONCLUSIONS More than a decade of population-based mental health research in the CAF has provided a detailed picture of its mental health and use of mental health services. This knowledge base and the homology of the 2013 survey with the 2002 CAF survey and general population surveys in 2002 and 2012 will provide an unusual opportunity to use the CFMHS to situate mental health in the CAF in a historical and societal perspective.
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Affiliation(s)
- Mark A Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario Department of Family Medicine, University of Ottawa, Ottawa, Ontario
| | - Rachel E Bennett
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario
| | - David Boulos
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario
| | - Bryan G Garber
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario
| | - Jitender Sareen
- Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
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20
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Patten SB. Mental Health in the Canadian Armed Forces: New Data, New Answers, and New Questions. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:4S-6S. [PMID: 27270742 PMCID: PMC4800472 DOI: 10.1177/0706743715625424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Scott B Patten
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
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