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Areias AC, Doverspike D, Brostek DF, Janela D, Erwin MS, Pinter JM, Ficke JR, Costa F. Transforming Veteran Rehabilitation Care: Learnings from a Remote Digital Approach for Musculoskeletal Pain. Healthcare (Basel) 2024; 12:1518. [PMID: 39120221 PMCID: PMC11311802 DOI: 10.3390/healthcare12151518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
While musculoskeletal pain (MSP) stands as the most prevalent health condition among Veterans, timely and high-quality care is often hindered due to access barriers. Team Red, White & Blue (Team RWB), a nonprofit organization dedicated to promoting a healthier lifestyle among Veterans, aimed to assess innovative approaches to veteran care. This is a single-arm pilot study investigating the feasibility, clinical outcomes, engagement, and satisfaction of a remote multimodal digital care program among Veterans with MSP. The impact of deployment experience on outcomes was explored as a secondary aim. From 75 eligible Veterans, 61 started the program, reporting baseline pain frequently comorbid with mental distress. Program acceptance was suggested by the high completion rate (82%) and engagement levels, alongside high satisfaction (9.5/10, SD 1.0). Significant improvements were reported in all clinical outcomes: pain (1.98 points, 95%CI 0.13; 3.84, p = 0.036); mental distress, with those reporting at least moderate baseline depression ending the program with mild symptoms (8.50 points, 95%CI: 6.49; 10.51, p = 0.012); daily activity impairment (13.33 points, 95%CI 1.31; 25.34, p = 0.030). Deployed Veterans recovered similarly to their counterparts. Overall, the above results underscore the potential of a remote digital intervention to expand Veterans' access to timely MSP care.
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Affiliation(s)
- Anabela C. Areias
- Clinical Research, Sword Health, Inc., Draper, UT 84020, USA; (A.C.A.); (D.J.)
| | - Dan Doverspike
- Government Programs, Sword Health, Inc., Draper, UT 84020, USA;
| | | | - Dora Janela
- Clinical Research, Sword Health, Inc., Draper, UT 84020, USA; (A.C.A.); (D.J.)
| | | | - John M. Pinter
- Team Red, White, and Blue, Inc., Floyds Knobs, IN 47119, USA
| | - James R. Ficke
- Team Red, White, and Blue, Inc., Floyds Knobs, IN 47119, USA
| | - Fabíola Costa
- Clinical Research, Sword Health, Inc., Draper, UT 84020, USA; (A.C.A.); (D.J.)
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Born J, Liu A, Sudom K, Michaud K, Xi M, Fikretoglu D. Role of modifiable organisational factors in decreasing barriers to mental healthcare: a longitudinal study of mission meaningfulness, team relatedness and leadership trust among Canadian military personnel deployed on Operation LASER. BMJ Open 2024; 14:e076625. [PMID: 38331861 PMCID: PMC10860073 DOI: 10.1136/bmjopen-2023-076625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES The literature presents complex inter-relationships among individual-factors and organisational-factors and barriers to seeking mental health support after deployment. This study aims to quantify longitudinal associations between such factors and barriers to mental health support. DESIGN A longitudinal online survey of Canadian Armed Forces (CAF) personnel collected data at 3 months post-deployment (T1), 6 months post-deployment (T2) and 1 year post-deployment (T3). SETTING In 2020, as part of Canada's response to the COVID-19 pandemic, 2595 CAF personnel deployed on Operation LASER to support civilian long-term care facilities in Québec and Ontario. PARTICIPANTS All Operation LASER personnel were invited to participate: 1088, 582 and 497 responded at T1, T2 and T3, respectively. Most respondents were young, male, non-commissioned members. MAIN OUTCOME MEASURES Barriers to mental health support were measured using 25 self-reported items and grouped into theory-based factors, including eight factors exploring care-seeking capabilities, opportunities and motivations; and two factors exploring moral issues. Logistic regressions estimated the crude and adjusted associations of individual and organisational characteristics (T1) with barriers (T2 and T3). RESULTS When adjusting for sex, military rank and mental health status, increased meaningfulness of deployment was associated with lower probability of endorsing barriers related to conflicts with career goals and moral discomfort in accessing support at T2. Higher scores in trust in leadership were associated with lower probability of endorsing four barriers at T2, and five barriers at T3. CONCLUSIONS We identified several modifiable organisational-level characteristics that may help reduce perceived barriers to mental health support in military and other high-risk occupational populations. Results suggest that promoting individuals' sense of purpose, instilling trust in leadership and promoting relatedness among team members may improve perceptions of access to mental health supports in the months following a domestic deployment or comparable occupational exposure.
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Affiliation(s)
- Jennifer Born
- Director General Military Personnel Research and Analysis, Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - Aihua Liu
- Douglas Mental Health University Institute, Montreal, Québec, Canada
| | - Kerry Sudom
- Director General Military Personnel Research and Analysis, Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - Kathy Michaud
- Director General Military Personnel Research and Analysis, Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
| | - Min Xi
- Director General Military Personnel Research and Analysis, Department of National Defence and the Canadian Armed Forces, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Deniz Fikretoglu
- Defence Research and Development Canada Toronto Research Centre, Toronto, Ontario, Canada
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St Cyr K, Nazarov A, Le T, Nouri M, Saha P, Forchuk CA, Soares V, Wanklyn SG, Bird BM, Davis BD, King L, Ketcheson F, Richardson JD. Correlates of cannabis use in a sample of mental health treatment-seeking Canadian armed forces members and veterans. BMC Psychiatry 2023; 23:836. [PMID: 37964206 PMCID: PMC10644461 DOI: 10.1186/s12888-023-05237-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/30/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Canadian Armed Forces (CAF) members and Veterans are more likely to experience mental health (MH) conditions, such as posttraumatic stress disorder (PTSD), than the general Canadian population. Previous research suggests that an increasing number of individuals are employing cannabis for MH symptom relief, despite a lack of robust evidence for its effectiveness in treating PTSD. This research aimed to: (1) describe the prevalence of current cannabis use among MH treatment-seeking CAF members and Veterans; and (2) estimate the association between current cannabis use and a number of sociodemographic, military, and MH-related characteristics. METHOD Using cross-sectional intake data from 415 CAF members and Veterans attending a specialized outpatient MH clinic in Ontario, Canada, between January 2018 and December 2020, we estimated the proportion of CAF members and Veterans who reported current cannabis use for either medical or recreational purposes. We used multivariable logistic regression to estimate adjusted odds ratios for a number of sociodemographic, military, and MH-related variables and current cannabis use. RESULTS Almost half of the study participants (n = 187; 45.1%) reported current cannabis use. Respondents who reported current cannabis use for medical purposes had a higher median daily dose than those who reported current cannabis use for recreational purposes. The multivariable logistic regression identified younger age, lower income, potentially hazardous alcohol use, and increased bodily pain as statistically significant correlates of current cannabis use among our MH treatment-seeking sample. PTSD severity, depressive severity, sleep quality, and suicide ideation were not statistically associated with current cannabis use. CONCLUSIONS Almost half of our treatment-seeking sample reported current cannabis use for medical or recreational purposes, emphasizing the importance of screening MH treatment-seeking military members and Veterans for cannabis use prior to commencing treatment. Future research building upon this study could explore the potential impact of cannabis use on MH outcomes.
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Affiliation(s)
- Kate St Cyr
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Anthony Nazarov
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- Dept. of Psychiatry, Western University, London, ON, Canada
- Dept. of Psychiatry & Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
| | - Tri Le
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Maede Nouri
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Priyonto Saha
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Callista A Forchuk
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Vanessa Soares
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Sonya G Wanklyn
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- St. Joseph's OSI Clinic, St. Joseph's Health Care London, London, ON, Canada
| | - Brian M Bird
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- Dept. of Psychiatry & Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
- Peter Boris Centre for Addictions Research, McMaster University, Hamilton, ON, Canada
| | - Brent D Davis
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- Dept. of Psychiatry, Western University, London, ON, Canada
| | - Lisa King
- St. Joseph's OSI Clinic, St. Joseph's Health Care London, London, ON, Canada
| | - Felicia Ketcheson
- St. Joseph's OSI Clinic, St. Joseph's Health Care London, London, ON, Canada
| | - J Don Richardson
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada.
- Dept. of Psychiatry, Western University, London, ON, Canada.
- Dept. of Psychiatry & Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada.
- St. Joseph's OSI Clinic, St. Joseph's Health Care London, London, ON, Canada.
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St Cyr K, Kurdyak P, Smith PM, Mahar AL. Mental health service use among Canadian veterans within the first 5 years following service: methodological considerations for comparisons with the general population. Occup Environ Med 2023; 80:462-468. [PMID: 37230751 PMCID: PMC10423507 DOI: 10.1136/oemed-2022-108772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Previous research comparing veteran and civilian mental health (MH) outcomes often assumes stable rates of MH service use over time and relies on standardisation or restriction to adjust for differences in baseline characteristics. We aimed to explore the stability of MH service use in the first 5 years following release from the Canadian Armed Forces and the Royal Canadian Mounted Police, and to demonstrate the impact of using increasingly stringent matching criteria on effect estimates when comparing veterans with civilians, using incident outpatient MH encounters as an example. METHODS We used administrative healthcare data from veterans and civilians residing in Ontario, Canada to create three hard-matched civilian cohorts: (1) age and sex; (2) age, sex and region of residence; and (3) age, sex, region of residence and median neighbourhood income quintile, while excluding civilians with a history of long-term care or rehabilitation stay or receipt of disability/income support payments. Extended Cox models were used to estimate time-dependent HRs. RESULTS Across all cohorts, time-dependent analyses suggested that veterans had a significantly higher hazard of an outpatient MH encounter within the first 3 years of follow-up than civilians, but differences were attenuated in years 4-5. More stringent matching decreased baseline differences in unmatched variables and shifted the effect estimates, while sex-stratified analyses revealed stronger effects among women compared with men. CONCLUSIONS This methods-focused study demonstrates the implications of several study design decisions that should be considered when conducting comparative veteran and civilian health research.
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Affiliation(s)
- Kate St Cyr
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MacDonald Franklin OSI Research Centre, St Joseph's Health Care London, London, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Peter M Smith
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Alyson L Mahar
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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Li S, Huang S, Hu S, Lai J. Psychological consequences among veterans during the COVID-19 pandemic: A scoping review. Psychiatry Res 2023; 324:115229. [PMID: 37121218 PMCID: PMC10131745 DOI: 10.1016/j.psychres.2023.115229] [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: 01/29/2023] [Revised: 04/09/2023] [Accepted: 04/25/2023] [Indexed: 05/02/2023]
Abstract
Although there is an increasing number of studies reporting the psychological impact of COVID-19 on the general population and healthcare workers, relatively less attention has been paid to the veterans. This study aimed to review the existing literature regarding the psychological consequences of COVID-19 on veterans. A systematic search was conducted on PubMed, Embase, and the Cochrane Library from inception to December 3, 2022. A total of twenty-three studies were included with moderate-quality of evidence. Veterans experienced more mental health problems than civilians. The prevalence rates of alcohol use, anxiety, depression, post-traumatic stress disorder, stress, loneliness, and suicide ideation significantly increased during the pandemic, ranging from 9.6% to 47.4%, 9.4% to 53.5%, 8.6% to 55.1%, 4.1% to 58.0%, 4.3% to 39.4%, 15.9% to 28.4%, and 7.8% to 22.0%, respectively. The main risk factors of negative consequences included pandemic-related stress, poor family relationships, lack of social support, financial problems, and preexisting mental disorders. In contrast, higher household income and greater community interaction and support appeared to be resilience factors. In conclusion, the COVID-19 pandemic has increased adverse mental health consequences among veterans. Tackling mental health issues due to the COVID-19 pandemic among veterans should be a priority.
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Affiliation(s)
- Shaoli Li
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Shu Huang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shaohua Hu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; The Key Laboratory of Mental Disorders' Management in Zhejiang Province, Hangzhou 310003, China; Brain Research Institute of Zhejiang University, Hangzhou 310058, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China; Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, School of Brain Science and Brian Medicine, and MOE Frontier Science Center for Brain Science and Brain-Machine Integration, Zhejiang University School of Medicine, Hangzhou 310003, China.
| | - Jianbo Lai
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; The Key Laboratory of Mental Disorders' Management in Zhejiang Province, Hangzhou 310003, China; Brain Research Institute of Zhejiang University, Hangzhou 310058, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China; Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, School of Brain Science and Brian Medicine, and MOE Frontier Science Center for Brain Science and Brain-Machine Integration, Zhejiang University School of Medicine, Hangzhou 310003, China.
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King L, Campbell D, Finkbeiner M, Gallimore J, Kennedy J, McCarthy E, Ketcheson F. The mySELF group: Recreation- and art-based group therapy as adjunct treatment for posttraumatic stress disorder. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2023. [DOI: 10.3138/jmvfh-2022-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
LAY SUMMARY Military personnel and Veterans receiving psychotherapy for mental health diagnoses such as posttraumatic stress disorder (PTSD) often have only modest symptom improvement. The authors wondered whether participating in a therapeutic recreation and creative arts group along with psychotherapy would aid recovery. A 12-week program called the my Social life, Expression, Leisure and Food (mySELF) group was created that offered therapeutic recreation, art, and music therapy. A total of 36 clients, most with PTSD, who had been receiving psychotherapy for an average of three years completed the program and submitted pre- and post-group questionnaires. The authors examined leisure attitudes, quality of life, and mental health symptoms before, immediately after, and four months after the group. Results showed significant improvements in leisure attitudes, environmental quality of life and depression, anxiety, stress, and PTSD symptoms. These preliminary results suggest that therapeutic recreation, art, and music therapy are beneficial for military personnel, Veterans, and Royal Canadian Mounted Police receiving psychotherapy.
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Affiliation(s)
- Lisa King
- St. Joseph’s Health Care Parkwood Institute, Operational Stress Injury Clinic, London, Ontario, Canada
| | - Doreen Campbell
- St. Joseph’s Health Care Parkwood Institute, Veterans Care, London, Ontario, Canada
| | - Marie Finkbeiner
- St. Joseph’s Health Care Parkwood Institute, Veterans Care, London, Ontario, Canada
| | - Jane Gallimore
- St. Joseph’s Health Care Parkwood Institute, Operational Stress Injury Clinic, London, Ontario, Canada
| | - Jill Kennedy
- St. Joseph’s Health Care Parkwood Institute, Veterans Care, London, Ontario, Canada
| | - Emily McCarthy
- St. Joseph’s Health Care Parkwood Institute, Veterans Care, London, Ontario, Canada
| | - Felicia Ketcheson
- St. Joseph’s Health Care Parkwood Institute, Operational Stress Injury Clinic, London, Ontario, Canada
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Hansen KT, Plouffe RA, Walker DL, Wanklyn SG, Lamrock L, Maher P, Nazarov A, Richardson JD. Impact of the COVID-19 pandemic on the mental health and well-being of Veterans' spouses: a cross sectional analysis. BMC Psychiatry 2023; 23:188. [PMID: 36949446 PMCID: PMC10032243 DOI: 10.1186/s12888-023-04687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/15/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND COVID-19 has negatively impacted the mental health and well-being of both Canadians and the world as a whole, with Veterans, in particular, showing increased rates of depression, anxiety, and PTSD. Spouses and common-law partners often serve as primary caregivers and sources of support for Veterans, which may have a deleterious effect on mental health and increase risk of burnout. Pandemic related stressors may increase burden and further exacerbate distress; yet the effect of the pandemic on the mental health and well-being of Veterans' spouses is currently unknown. This study explores the self-reported mental health and well-being of a group of spouses of Canadian Armed Forces Veterans and their adoption of new ways to access healthcare remotely (telehealth), using baseline data from an ongoing longitudinal survey. METHODS Between July 2020 and February 2021, 365 spouses of Veterans completed an online survey regarding their general mental health, lifestyle changes, and experiences relating to the COVID-19 pandemic. Also completed were questions relating to their use of and satisfaction with health-care treatment services during the pandemic. RESULTS Reported rates of probable major depressive disorder (MDD), generalized anxiety disorder (GAD), alcohol use disorder (AUD), and PTSD were higher than the general public, with 50-61% believing their symptoms either directly related to or were made worse by the pandemic. Those reporting being exposed to COVID-19 were found to have significantly higher absolute scores on mental health measures than those reporting no exposure. Over 56% reported using telehealth during the pandemic, with over 70% stating they would continue its use post-pandemic. CONCLUSIONS This is the first Canadian study to examine the impact of the COVID-19 pandemic specifically on the mental health and well-being of Veterans' spouses. Subjectively, the pandemic negatively affected the mental health of this group, however, the pre-pandemic rate for mental health issues in this population is unknown. These results have important implications pertaining to future avenues of research and clinical/programme development post-pandemic, particularly relating to the potential need for increased support for spouses of Veterans, both as individuals and in their role as supports for Veterans.
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Affiliation(s)
- Kevin T Hansen
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada.
- Department of Psychiatry, Western University, London, ON, Canada.
| | - Rachel A Plouffe
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
| | - Deanna L Walker
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
| | - Sonya G Wanklyn
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- St. Joseph's OSI Clinic, Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
| | - Laryssa Lamrock
- The Atlas Institute for Veterans and Families, Ottawa, ON, Canada
| | - Polliann Maher
- The Atlas Institute for Veterans and Families, Ottawa, ON, Canada
| | - Anthony Nazarov
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - J Don Richardson
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- St. Joseph's OSI Clinic, Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Gratz KL, Kiel EJ, Mann AJD, Tull MT. The prospective relation between borderline personality disorder symptoms and suicide risk: The mediating roles of emotion regulation difficulties and perceived burdensomeness. J Affect Disord 2022; 313:186-195. [PMID: 35772631 DOI: 10.1016/j.jad.2022.06.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/27/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Despite the strong link between borderline personality disorder (BPD) symptoms and suicide risk, little is known about the mechanisms underlying this association. Theory-driven research clarifying the pathways through which BPD symptoms increase suicide risk over time is needed and may highlight relevant treatment targets for decreasing suicide risk among individuals with heightened BPD symptoms. This study examined the prospective relations among BPD symptoms, emotion regulation (ER) difficulties, perceived burdensomeness, thwarted belongingness, and suicide risk across five assessments over a 7-month period. Consistent with the interpersonal theory of suicide, we hypothesized that greater BPD symptoms would predict greater suicide risk over time via greater ER difficulties and, subsequently, greater perceived burdensomeness. METHODS A U.S. nationwide sample of 500 adults (47 % women; mean age = 40.0 ± 11.64) completed a prospective online study, including an initial assessment and four follow-up assessments over the next seven months. RESULTS Results revealed a significant indirect relation between BPD symptoms and greater suicide risk over time through greater ER difficulties and later perceived burdensomeness. Results also provided evidence for transactional relations between BPD symptoms and ER difficulties and suicide risk over time. LIMITATIONS All constructs were assessed via self-report questionnaire data. Our measure of suicide risk focuses on only suicidal ideation, plans, and impulses, and not suicide attempts or preparatory behaviors. CONCLUSIONS Results highlight both ER- and interpersonal-related factors as key mechanisms underlying suicide risk among community adults with BPD symptoms.
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Affiliation(s)
- Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, OH, USA.
| | | | - Adam J D Mann
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, OH, USA
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Thériault FL, Momoli F, Hawes RA, Garber BG, Gardner W, Colman I. Spinal pain and major depression in a military cohort: bias analysis of dependent misclassification in electronic medical records. Soc Psychiatry Psychiatr Epidemiol 2022; 57:575-581. [PMID: 34374826 DOI: 10.1007/s00127-021-02160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spinal pain and major depression are prevalent conditions in adult populations and are particularly impactful in the military. However, the temporal relationship between these two conditions remains poorly understood. METHODS Using data extracted from electronic medical records, we assessed the association between incident diagnoses of spinal pain and major depression in a cohort of 48,007 Canadian Armed Forces personnel followed from January 2017 to August 2018. We used multivariate Poisson regression to measure the association between the period prevalence of these two conditions. We used probabilistic bias modelling to correct our estimates for misclassification of spinal pain and major depression. RESULTS After correcting for misclassification with probabilistic bias modelling, subjects newly diagnosed with spinal pain during the study period were 1.41 times (95% interval 1.25, 1.59) more likely also to be diagnosed with incident major depression, and personnel newly diagnosed with major depression were 1.28 times (95% interval 1.17, 1.39) more likely also to be diagnosed with spinal pain, compared to undiagnosed counterparts of the same age and sex. Without bias corrections, we would have overestimated the magnitude of the association between major depression and spinal pain by a factor of approximately 2.0. CONCLUSION Our results highlight a moderate and bi-directional association between two of the most prevalent disorders in military populations. Our results also highlight the importance of correcting for misclassification in electronic medical record data research.
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Affiliation(s)
- François L Thériault
- Canadian Forces Health Services Group, Department of National Defence, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
| | - Franco Momoli
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Robert A Hawes
- Canadian Forces Health Services Group, Department of National Defence, Ottawa, Canada
| | - Bryan G Garber
- Canadian Forces Health Services Group, Department of National Defence, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - William Gardner
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Hall AL, Sweet J, Tweel M, MacLean MB. Comparing negative health indicators in male and female veterans with the Canadian general population. BMJ Mil Health 2022; 168:82-87. [PMID: 32868291 PMCID: PMC8788043 DOI: 10.1136/bmjmilitary-2020-001526] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Sex-based information on differences between Canadian veterans and the general population is important to understand veterans' unique health needs and identify areas requiring further research. This study compared various health indicators in male and female veterans with their Canadian counterparts. METHODS Health indicators for recent-era Regular Force veterans (released between 1998 and 2015) were obtained from the 2016 Life After Service Survey and compared with the general population in the 2015-16 Canadian Community Health Survey using a cross-sectional approach. Age-adjusted rates and 95% CIs were calculated for males and females separately. RESULTS Compared with Canadians, veterans (both sexes) reported higher prevalence of fair or poor health and mental health, needing help with one or more activity of daily living, lifetime suicidal ideation and being diagnosed with mood and anxiety disorders, post-traumatic stress disorder, migraines, back problems, chronic pain, arthritis, ever having cancer, hearing problems, chronic pain and gastrointestinal problems. A higher prevalence of cardiovascular disease (all types) and high blood pressure was observed in male veterans compared with their Canadian counterparts. Within veterans only, males reported a higher prevalence of diagnosed hearing problems and cardiovascular disease compared with females; conversely females reported a higher prevalence of diagnosed migraines, mood, anxiety and gastrointestinal disorders, and needing help with activities of daily living. These sex differences are similar to the Canadian general population. Some similarities in reporting prevalence between male and female veterans (eg, fair or poor mental health, lifetime suicidal ideation, arthritis, asthma, lifetime cancer incidence, chronic pain and diabetes) were not observed in other Canadians. CONCLUSION Male and female veterans differed from comparable Canadians, and from each other, in various areas of health. Further research is needed to explore these findings, and veteran-based policies and services should consider sex differences.
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Affiliation(s)
- Amy L Hall
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada
| | - J Sweet
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada
| | - M Tweel
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada
| | - M B MacLean
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Voth M, Chisholm S, Sollid H, Jones C, Smith-MacDonald L, Brémault-Phillips S. Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation. JMIR Mhealth Uhealth 2022; 10:e26453. [PMID: 35044307 PMCID: PMC8811698 DOI: 10.2196/26453] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/09/2021] [Accepted: 11/19/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Military members (MMs) and public safety personnel (PSP) are vulnerable to occupational stress injuries because of their job demands. When MMs and PSP transition out of these professions, they may continue to experience mental health challenges. The development and implementation of resilience-building mobile health (mHealth) apps as an emergent mental health intervention platform has allowed for targeted, cost-effective, and easily accessible treatment when in-person therapy may be limited or unavailable. However, current mHealth app development is not regulated, and often lacks both clear evidence-based research and the input of health care professionals. OBJECTIVE This study aims to evaluate the evidence-based quality, efficacy, and effectiveness of resilience-building mobile apps targeted toward the MMs, PSP, and veteran populations via a scoping literature review of the current evidence base regarding resilience apps for these populations and an evaluation of free resilience apps designed for use among these populations. METHODS The studies were selected using a comprehensive search of MEDLINE, CINAHL Plus, PsycINFO, SocINDEX, Academic Search Complete, Embase, and Google and were guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A narrative synthesis of the resulting papers was performed. The Alberta Rating Index for Apps was used to conduct a review of each of the identified apps. The inclusion criteria consisted of apps that were free to download in either the Google Play Store or the Apple App Store; updated within the last 3 years; available in English and in Canada; and intended for use by MMs, veterans, and PSP. RESULTS In total, 22 apps met the inclusion criteria for evaluation. The resilience strategies offered by most apps included psychoeducation, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy. Overall, 50% (11/22) of apps had been tested in randomized controlled trials, 7 (32%) apps had been evaluated using other research methods, and 5 (23%) apps had not been studied. Using the Alberta Rating Index for Apps, the app scores ranged from 37 to 56 out of 72, with higher rated apps demonstrating increased usability and security features. CONCLUSIONS The mHealth apps reviewed are well-suited to providing resilience strategies for MMs, PSP, and veterans. They offer easy accessibility to evidence-based tools while working to encourage the use of emotional and professional support with safety in mind. Although not intended to function as a substitute for professional services, research has demonstrated that mHealth apps have the potential to foster a significant reduction in symptom severity for posttraumatic stress disorder, depression, anxiety, and other mental health conditions. In clinical practice, apps can be used to supplement treatment and provide clients with population-specific confidential tools to increase engagement in the treatment process.
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Affiliation(s)
- Melissa Voth
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Shannon Chisholm
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Hannah Sollid
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Chelsea Jones
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- Operational Stress Injury Clinic, Alberta Health Services, Edmonton, AB, Canada
| | - Lorraine Smith-MacDonald
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Suzette Brémault-Phillips
- Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Occupational Therapy, Faculty of Rehabilitation, University of Alberta, Edmonton, AB, Canada
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12
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Easterbrook B, Plouffe RA, Houle SA, Liu A, McKinnon MC, Ashbaugh AR, Mota N, Afifi TO, Enns MW, Richardson JD, Nazarov A. Risk Factors for Moral Injury Among Canadian Armed Forces Personnel. Front Psychiatry 2022; 13:892320. [PMID: 35633790 PMCID: PMC9130953 DOI: 10.3389/fpsyt.2022.892320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The traumatic nature of high-risk military deployment events, such as combat, is well-recognized. However, whether other service-related events and demographic factors increase the risk of moral injury (MI), which is defined by consequences of highly stressful and morally-laden experiences, is poorly understood. Therefore, the objective of this study was to examine determinants of MI in Canadian Armed Forces (CAF) personnel. METHODS Data were obtained from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS; unweighted n = 2,941). To identify military characteristics, sociodemographic variables, and deployment-related factors associated with increased levels of MI, a series of multiple linear regressions were conducted across deployed and non-deployed groups. RESULTS When all variables were considered among the deployed personnel, rank, experiencing military related sexual trauma, child maltreatment (i.e., physical abuse, emotional abuse and neglect), and stressful deployment experiences were significant predictors of increased MI total scores (β = 0.001 to β = 0.51, p < 0.05). Feeling responsible for the death of an ally and inability to respond in a threatening situation were the strongest predictors of MI among stressful deployment experiences. Within the non-deployed sample, experiencing military-related or civilian sexual trauma and rank were significant predictors of increased MI total scores (β = 0.02 to β = 0.81, p < 0.05). CONCLUSION Exposure to stressful deployment experiences, particularly those involving moral-ethical challenges, sexual trauma, and childhood maltreatment were found to increase levels of MI in CAF personnel. These findings suggest several avenues of intervention, including education and policies aimed at mitigating sexual misconduct, as well as pre-deployment training to better prepare military personnel to deal effectively with morally injurious experiences.
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Affiliation(s)
- Bethany Easterbrook
- MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada.,Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
| | - Rachel A Plouffe
- MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada.,Department of Psychiatry, Western University, London, ON, Canada
| | | | - Aihua Liu
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Margaret C McKinnon
- Homewood Research Institute, Guelph, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | | | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Tracie O Afifi
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Murray W Enns
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.,Deer Lodge Centre Operational Stress Injury Clinic, Winnipeg, MB, Canada
| | - J Don Richardson
- MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada.,Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry, Western University, London, ON, Canada
| | - Anthony Nazarov
- MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada.,Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry, Western University, London, ON, Canada
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13
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St Cyr K, Liu A, Plouffe RA, Nouri MS, Forchuk CA, Wanklyn SG, Bird BM, Fikretoglu D, Mahar AL, Nazarov A, Richardson JD. Mental health services use among Canadian Armed Forces members and Veterans: Data from the 2018 Canadian Armed Forces members and Veterans mental health follow-up survey (CAFMVHS). FRONTIERS IN HEALTH SERVICES 2022; 2:954914. [PMID: 36925872 PMCID: PMC10012627 DOI: 10.3389/frhs.2022.954914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022]
Abstract
Background Differences in healthcare delivery systems and pathways to mental healthcare for Canadian Armed Forces (CAF) members and Veterans may contribute to variations in mental health services use (MHSU) and the factors associated with it. We: (1) estimated the prevalence of past 12-month MHSU (≥1 visit with a medical or mental health professional); and (2) identified sociodemographic, military-, trauma-, and health-related variables associated with MHSU among CAF members and Veterans. Methods The current study used data from the 2018 CAF Members and Veterans Mental Health Follow-Up Survey (CAFVMHS). Model variables were selected a priori, and their respective associations with MHSU were estimated among (1) CAF members and (2) Veterans using separate multivariable logistic regression models. Results Similar proportions of CAF members and Veterans reported past 12-month MHSU (26.9 vs. 27.5%, respectively). For both CAF members and Veterans, meeting criteria for at least one past 12-month MH disorder was associated with past 12-month MHSU [adjusted odds ratio (AOR) = 7.80, 95% confidence interval (CI) = 7.18-8.46; and AOR = 11.82, 95% CI: 11.07-12.61, respectively). Past-year suicide ideation, a history of sexual trauma, and endorsement of adverse childhood experiences were also significantly associated with MHSU among CAF members and Veterans. Significance Similar to previous research, meeting screening criteria for a past 12-month MH disorder was strongly associated with MHSU among both samples. This study extends our existing knowledge about factors associated with MHSU among CAF members and Veterans, and offers direction for future research to increase MHSU.
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Affiliation(s)
- Kate St Cyr
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aihua Liu
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Rachel A Plouffe
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada.,Department of Psychiatry, Western University, London, ON, Canada
| | - Maede S Nouri
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Callista A Forchuk
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Sonya G Wanklyn
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada.,St. Joseph's Operational Stress Injury Clinic, St. Joseph's Healthcare London, London, ON, Canada
| | - Brian M Bird
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada.,Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Deniz Fikretoglu
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Anthony Nazarov
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada.,Department of Psychiatry, Western University, London, ON, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - J Don Richardson
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada.,Department of Psychiatry, Western University, London, ON, Canada.,St. Joseph's Operational Stress Injury Clinic, St. Joseph's Healthcare London, London, ON, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
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14
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Denov M. Encountering children and child soldiers during military deployments: the impact and implications for moral injury. Eur J Psychotraumatol 2022; 13:2104007. [PMID: 35979504 PMCID: PMC9377244 DOI: 10.1080/20008066.2022.2104007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: During a deployment, soldiers must make seemingly impossible decisions, including having to engage with child soldiers. Such moral conflicts may continue to affect service members and veterans in the aftermath of a deployment, sometimes leading to severe moral distress, anguish, and personal crises. Service providers have increasingly argued that as a diagnosis, Post-Traumatic Stress Disorder (PTSD) cannot account for these deeply personal and painful moral conflicts. In light of this, the concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans. Objective: This paper addresses encounters with children and child soldiers during military deployments, as well as the risk for moral injury during and following these encounters, and their implications. This exploratory paper brings together existing literature on the topic to introduce, illustrate, and offer potential and promising interventions. Results: Given the potential moral conflicts that may ensue, military personnel who encounter child soldiers during a military deployment may be at risk for moral injury during and following these encounters. The introduction of the concept of moral injury provides a way for these largely unnamed personal and painful moral conflicts and violations to be recognized, addressed, and with appropriate care, remedied. Although there is limited research into their effectiveness at treating moral injury, individual and group-based interventions have been identified as potentially beneficial. Conclusion: As encounters with children during deployments are likely to continue, systematic research, training, healing interventions and prevention strategies are vital to support and protect children in conflict settings, as well as to ensure the mental health and well-being of service members and veterans. HIGHLIGHTS Profound moral conflicts may affect service members and veterans in the aftermath of a military deployment, sometimes leading to severe moral distress, anguish, and personal crises. The concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans.Encountering children and child soldiers during a military deployment, may present unique challenges, stress, and moral crises leading to potentially moral injurious events. In particular, transgression-based events which result from an individual perpetrating or engaging in acts that contravene his or her deeply held moral beliefs and expectations such as harming children, and betrayal-based events, which results from witnessing or falling victim to the perceived moral transgressions of others, may lead to lasting psychological, biological, spiritual, behavioural and social impairments.Interventions applied in both an individual-based context such as Cognitive Processing Therapy, Impact of Killing, Adaptive Disclosure, and a group-based context such as Acceptance and Commitment Therapy and Resilience Strength Training, have been identified as potentially beneficial to addressing moral injury. However, more research is required to ascertain appropriate and effective intervention and healing strategies.
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Affiliation(s)
- Myriam Denov
- School of Social Work, McGill University, Montreal, Canada
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15
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Richardson JD, St Cyr K, Forchuk C, Liu JJW, Plouffe RA, Le T, Gargala D, Deda E, Soares V, Hosseiny F, Smith P, Dupuis G, Roth M, Bridgen A, Marlborough M, Jetly R, Heber A, Lanius R, Nazarov A. Well-being of Canadian Veterans during the COVID-19 pandemic: cross-sectional results from the COVID-19 Veteran well-being study. Eur J Psychotraumatol 2022; 13:2012374. [PMID: 35087643 PMCID: PMC8788339 DOI: 10.1080/20008198.2021.2012374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The impacts of the COVID-19 pandemic have disproportionally affected different population groups. Veterans are more likely to have pre-existing mental health conditions compared to the general Canadian population, experience compounded stressors resulting from disruptions to familial, social, and occupational domains, and were faced with changes in health-care delivery (e.g. telehealth). The objectives of this study are to assess (a) the mental health impact of COVID-19 and related life changes on the well-being of Veterans and (b) perceptions of and satisfaction with changes in health-care treatments and delivery during the pandemic. METHODS A total of 1136 Canadian Veterans participated in an online survey. Participants completed questions pertaining to their mental health and well-being, lifestyle changes, and concerns relating to the COVID-19 pandemic, as well as experiences and satisfaction with health-care treatments during the pandemic. RESULTS Results showed that 55.9% of respondents reported worse mental health functioning compared to before the pandemic. The frequency of probable posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, alcohol use disorder, and suicidal ideation were 34.2%, 35.3%, 26.8%, 13.0%, and 22.0%, respectively. Between 38.6% and 53.1% of respondents attributed their symptoms as either directly related to or exacerbated by the pandemic. Approximately 18% of respondents reported using telehealth for mental health services during the pandemic, and among those, 72.8% indicated a choice to use telehealth even after the pandemic. CONCLUSIONS This study found that Veterans experienced worsening mental health as a result of the COVID-19 pandemic. The use of telehealth services was widely endorsed by mental health treatment-seeking Veterans who transitioned to virtual care during the pandemic. Our findings have important clinical and programmeadministrator implications, emphasizing the need to reach out to support veterans, especially those with pre-existing mental health conditions and to enhance and maintain virtual care even post-pandemic.
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Affiliation(s)
- J Don Richardson
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada.,St. Joseph's OSI Clinic, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada
| | - Kate St Cyr
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Callista Forchuk
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario, Canada
| | - Jenny J W Liu
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
| | - Rachel A Plouffe
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
| | - Tri Le
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario, Canada
| | - Dominic Gargala
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario, Canada
| | - Erisa Deda
- St. Joseph's OSI Clinic, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada
| | - Vanessa Soares
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario, Canada
| | - Fardous Hosseiny
- Centre of Excellence for PTSD, Ottawa, Ontario, Canada.,The Royal's Institute for Mental Health Research, Ottawa, Ontario, Canada
| | - Patrick Smith
- Centre of Excellence for PTSD, Ottawa, Ontario, Canada.,The Royal's Institute for Mental Health Research, Ottawa, Ontario, Canada
| | - Gabrielle Dupuis
- Centre of Excellence for PTSD, Ottawa, Ontario, Canada.,The Royal's Institute for Mental Health Research, Ottawa, Ontario, Canada
| | - Maya Roth
- St. Joseph's OSI Clinic, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada.,School of Graduate Studies, Ryerson University, Toronto, Ontario, Canada
| | - Andrew Bridgen
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
| | - Michelle Marlborough
- Department of Psychiatry, Western University, London, Ontario, Canada.,St. Joseph's OSI Clinic, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada
| | - Rakesh Jetly
- The Royal's Institute for Mental Health Research, Ottawa, Ontario, Canada
| | - Alexandra Heber
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada.,Veterans Affairs Canada, Ottawa, Ontario, Canada
| | - Ruth Lanius
- Department of Psychiatry, Western University, London, Ontario, Canada.,St. Joseph's OSI Clinic, Parkwood Institute, St. Joseph's Health Care, London, Ontario, Canada
| | - Anthony Nazarov
- The MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
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16
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Fikretoglu D, Sharp ML, Adler AB, Bélanger S, Benassi H, Bennett C, Bryant R, Busuttil W, Cramm H, Fear N, Greenberg N, Heber A, Hosseiny F, Hoge CW, Jetly R, McFarlane A, Morganstein J, Murphy D, O'Donnell M, Phelps A, Richardson DJ, Sadler N, Schnurr PP, Smith P, Ursano R, Hooff MV, Wessely S, Forbes D, Pedlar D. Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective. Clin Psychol Rev 2021; 91:102100. [PMID: 34871868 DOI: 10.1016/j.cpr.2021.102100] [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] [Received: 04/30/2021] [Revised: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022]
Abstract
Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the past six years to update and broaden the discussion on pathways to mental healthcare in military populations. We find that at a broad population level, there is improvement in several indicators of mental health care access, with greater gains in initial engagement, time to first treatment contact, and subjective satisfaction with care, and smaller gains in objective indicators of adequacy of care. Among individual-level barriers to care-seeking, there is progress in improving recognition of need for care and reducing stigma concerns. Among organizational-level barriers, there are advances in availability of services and cultural acceptance of care-seeking. Other barriers, such as concerns around confidentiality, career impact, and deployability persist, however, and may account for some remaining unmet need. To address these barriers, new initiatives that are more evidence-based, theoretically-driven, and culturally-sensitive, are therefore needed, and must be rigorously evaluated to ensure they bring about additional improvements in pathways to care.
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Affiliation(s)
- Deniz Fikretoglu
- Defence Research and Development Canada, 1133 Sheppard Ave. West, Toronto, ON, Canada.
| | | | - Amy B Adler
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | | | | | | | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | | | | | | | - Fardous Hosseiny
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | - Charles W Hoge
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rakesh Jetly
- Department of National Defence, Ottawa, ON, Canada
| | | | | | - Dominic Murphy
- Combat Stress, Leatherhead, Surrey, UK; King's College London, London, UK
| | - Meaghan O'Donnell
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Andrea Phelps
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - Don J Richardson
- Parkwood Institute- St. Joseph's Health Care London, London, ON, Canada
| | - Nicole Sadler
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | | | - Patrick Smith
- Centre of Excellence on Post-Traumatic Stress Disorder (PTSD), Ottawa, ON, Canada
| | | | - Miranda Van Hooff
- Military and Emergency Services Health Australia (MESHA), Woodville, SA, Australia
| | | | - David Forbes
- Phoenix, Australia: Centre for Posttraumatic Mental Health, Carlton, Australia
| | - David Pedlar
- Canadian Institute for Military and Veteran Health Research, Queen's University, Kingston, ON, Canada
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17
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Sareen J, Bolton SL, Mota N, Afifi TO, Enns MW, Taillieu T, Stewart-Tufescu A, El-Gabalawy R, Marrie RA, Richardson JD, Stein MB, Bernstein CN, Bolton JM, Wang J, Asmundson GJG, Thompson JM, VanTil L, MacLean MB, Logsetty S. Lifetime Prevalence and Comorbidity of Mental Disorders in the Two-wave 2002-2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS): Prévalence et Comorbidité de Durée de vie Des Troubles Mentaux Dans l'Enquête de Suivi Sur la Santé Mentale Auprès des Membres des Forces Armées Canadiennes et Des ex-Militaires (ESSMFACM) en Deux Cycles de 2002 à 2018. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:951-960. [PMID: 33715467 PMCID: PMC8649821 DOI: 10.1177/07067437211000636] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The current study used the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS) to (1) examine the incidence and prevalence of mental disorders and (2) estimate the comorbidity of mental disorders over the follow-up period. METHOD The CAFVMHS (2018) is a longitudinal study with two time points of assessment. The sample is comprised of 2,941 Canadian Forces members and veterans who participated in the 2002 Canadian Community Health Survey: Canadian Forces Supplement. The World Health Organization Composite International Diagnostic Interview (WHO-CIDI) was utilized to diagnose Diagnostic and Statistical Manual-IV post-traumatic stress disorder (PTSD), major depressive episode (MDE), generalized anxiety disorder, social anxiety disorder (SAD), and alcohol abuse and dependence. Self-report health professional diagnoses were assessed for attention deficit hyperactivity disorder (ADHD), mania, obsessive compulsive disorder (OCD), and personality disorder. We established weighted prevalence of mental disorders and examined the association between mental disorders using logistic regression. RESULTS In 2018, lifetime prevalence of any WHO-CIDI-based or self-reported mental disorder was 58.1%. Lifetime prevalence of any mood or anxiety disorder or PTSD was 54.0% in 2018. MDE (39.9%), SAD (25.7%), and PTSD (21.4%) were the most common mental disorders. There was a substantial increase in new onset or recurrence/persistence of mental disorders between the two measurement points (16-year assessment gap); 2002-2018 period prevalences were 43.5% for mood and anxiety disorder and 16.8% for alcohol abuse or dependence. The prevalence of self-reported ADHD, OCD, any personality disorder, and mania were 3.3%, 3.0%, 0.8%, and 0.8%, respectively. Comorbidity between mental disorders increased over the follow-up. CONCLUSIONS This study demonstrates a high burden of mental disorders among a large Canadian military and veteran cohort. These findings underscore the importance of prevention and intervention strategies to reduce the burden of mental disorders and alcohol use disorders in these populations.
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Affiliation(s)
- Jitender Sareen
- 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
| | - Tracie O. Afifi
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murray W. Enns
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tamara Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Renée El-Gabalawy
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J. Don Richardson
- Department of Psychiatry, Western University, London, Ontario, Canada
- St. Joseph’s OSI Clinic, London, Ontario, Canada
| | - Murray B. Stein
- Department of Psychiatry, UCSD School of Medicine, La Jolla, CA, USA
| | - Charles N. Bernstein
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M. Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jianli Wang
- Institute of Mental Health Research, University of Ottawa, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - James M. Thompson
- Department of Public Health Sciences, Queens University, Kingston, Ontario, Canada
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda VanTil
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Mary Beth MacLean
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Sarvesh Logsetty
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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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] [MESH Headings] [Grants] [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, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Natalie Mota
- Departments of Clinical Health Psychology and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O. Afifi
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shay-Lee Bolton
- Department of Psychiatry, University 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, University of Calgary, Calgary, Alberta, Canada
| | - Jitender Sareen
- Departments of Psychiatry and Psychology and Community Health Sciences, University 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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20
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Family snapshot: Characteristics of the economic and social environment and their associations with mental health in Canadian military personnel with a history of deployment. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Oliffe JL, Kelly MT, Montaner GG, Links PS, Kealy D, Ogrodniczuk JS. Segmenting or Summing the Parts? A Scoping Review of Male Suicide Research in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:433-445. [PMID: 33719600 PMCID: PMC8107953 DOI: 10.1177/07067437211000631] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Suicide in Canadian men is high and rising. Research consistently indicates increased suicide risk in male subgroups including sexual minority, Indigenous, middle-aged, and military men. The current scoping review addresses the research question: Among male subgroups featured in Canadian suicide research, what are the key findings to inform suicide prevention efforts?. METHOD A scoping review was undertaken in accord with PRISMA-ScR guidelines. Structured searches were conducted in CIHAHL, Medline, PsychInfo, and Web of Science to identify studies reporting suicidality (suicidal ideation, plans and/or attempts) and suicide among men in Canada. Inclusion criteria comprised primary empirical studies featuring Canadian male subgroups published in English from 2009 to 2020 inclusive. RESULTS Sixty-eight articles met the inclusion criteria, highlighting significant rates of male suicidality and/or suicide in 3 categories: (1) health inequities (n = 29); (2) age-specific (n = 30); and (3) occupation (n = 9). The health inequities category included sexual minority men, Indigenous, and other marginalized males (i.e., homeless, immigrant men, and men who use opiates). Age-specific men focused on adolescents and youth, and middle-aged and older males. Active military, veterans, and first responders featured in the occupation category. Studies compared at risk male subgroups to females, general male populations, and/or other marginalized groups in emphasizing mental health disparities and increased suicide risk. Some men's suboptimal connections to existing mental health care services were also highlighted. CONCLUSION While male subgroups who are vulnerable to suicidality and suicide were consistently described, these insights have not translated to tailored upstream suicide prevention services for Canadian boys and men. There may be some important gains through integrating social and mental health care services for marginalized men, implementing school-based masculinity programs for adolescent males, orientating clinicians to the potential for men's mid-life suicide risks (i.e., separation, bereavement, retirement) and lobbying employers to norm help-seeking among activate military, veterans, and first responder males.
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Affiliation(s)
- John L. Oliffe
- School of Nursing, University of British
Columbia, Vancouver, BC, Canada
- Department of Nursing, The University of Melbourne, Melbourne,
Australia
| | - Mary T. Kelly
- School of Nursing, University of British
Columbia, Vancouver, BC, Canada
| | | | - Paul S. Links
- Department of Psychiatry and Behavioural
Neurosciences at McMaster University, Hamilton, ON, Canada
| | - David Kealy
- Department of Psychiatry, University of
British Columbia, Vancouver, BC, Canada
| | - John S. Ogrodniczuk
- Department of Psychiatry, University of
British Columbia, Vancouver, BC, Canada
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McCuaig Edge HJ, Lee JEC. The Mediating Role of Alexithymia in the Association Between Adverse Childhood Experiences and Postdeployment Mental Health in Canadian Armed Forces Personnel. J Trauma Stress 2020; 33:1029-1038. [PMID: 32974957 DOI: 10.1002/jts.22547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 11/09/2022]
Abstract
Recent studies showing an association between adverse childhood experiences and the development of alexithymia in military personnel have generated interest regarding the role of alexithymia in the pathway linking childhood trauma exposure to mental health disorders. Accordingly, the current study was conducted to (a) examine the associations among adverse childhood experiences, alexithymia, and symptoms of depression and posttraumatic stress disorder (PTSD) among recently deployed Canadian military personnel and (b) assess the mediating role of alexithymia in these associations. Data collected from 2,927 members of the Canadian Armed Forces at baseline and after their return from an overseas deployment were subjected to a prospective path analysis. The results of the path analysis, R2 = .35, pointed to a significant direct effect of childhood adversity on postdeployment mental health symptoms. Contrary to our expectations, the results also pointed to a negative indirect effect of childhood neglect, suggesting that childhood neglect contributed to lower levels of postdeployment depression and PTSD symptoms through the dimension of alexithymia related to difficulty in describing feelings. These patterns of associations, for the most part, persisted even when accounting for combat exposure during recent deployments, R2 = .42. The present results are discussed in light of study limitations and methodological considerations, and policy and clinical implications are noted.
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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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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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Taillieu TL, Afifi TO, Zamorski MA, Turner S, Cheung K, Stein MB, Sareen J. [Not Available]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:253-263. [PMID: 31994914 PMCID: PMC7385426 DOI: 10.1177/0706743720902651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Research suggests a high prevalence of problematic alcohol use among military
personnel relative to civilians. Our primary objectives were to compare the
prevalence, correlates, help-seeking behaviors, perceived need for care, and
barriers to care for alcohol use disorders (AUDs) in the Canadian Armed
Forces (CAF) and the Canadian general population (CGP). Methods: Data were from 2 nationally representative surveys collected by Statistics
Canada: (1) the Canadian Community Health Survey on Mental Health collected
in 2012 (N = 25,113; response rate = 68.9%) and (2) the
Canadian Forces Mental Health Survey collected in 2013 (N =
8,161; response rate = 79.8%). Descriptive statistics and logistic
regression were used to examine differences in outcomes of interest
associated with AUDs in the CAF and CGP. Results: The prevalence of lifetime AUDs was significantly higher in the CAF (32.0%)
than the CGP (20.3%; adjusted odds ratio [AOR] = 1.14, 95% confidence
interval [CI, 1.02 to 1.27]) after adjustment for sociodemographic
covariates. In contrast, the past-year prevalence of AUDs was significantly
lower among CAF personnel (4.5%) than civilians (3.8%; AOR = 0.78, 95% CI
[0.61 to 0.99]) after adjustment for sociodemographic covariates. Child
abuse history and comorbid mental disorders were strongly associated with
past-year AUDs in both populations. CAF personnel compared to the CGP were
more likely to perceive a need for care (AOR = 4.15, 95% CI [2.56 to 6.72])
and engage in help-seeking behaviors (significant AORs ranged from 1.85 to
5.54). CAF personnel and civilians with past-year AUDs reported different
barriers to care. Conclusions: Findings argue for the value of different approaches to address unmet need
for AUD care in the CAF and CGP.
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Affiliation(s)
- Tamara L Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Sarah Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristene Cheung
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murray B Stein
- Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California-San Diego, La Jolla, CA, USA
| | - 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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Duparc S, Chalon S, Miller S, Richardson N, Toovey S. Neurological and psychiatric safety of tafenoquine in Plasmodium vivax relapse prevention: a review. Malar J 2020; 19:111. [PMID: 32169086 PMCID: PMC7071640 DOI: 10.1186/s12936-020-03184-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/06/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Tafenoquine is an 8-aminoquinoline anti-malarial drug recently approved as a single-dose (300 mg) therapy for Plasmodium vivax relapse prevention, when co-administered with 3-days of chloroquine or other blood schizonticide. Tafenoquine 200 mg weekly after a loading dose is also approved as travellers' prophylaxis. The development of tafenoquine has been conducted over many years, using various dosing regimens in diverse populations. METHODS This review brings together all the preclinical and clinical data concerning tafenoquine central nervous system safety. Data were assembled from published sources. The risk of neuropsychiatric adverse events (NPAEs) with single-dose tafenoquine (300 mg) in combination with chloroquine to achieve P. vivax relapse prevention is particularly examined. RESULTS There was no evidence of neurotoxicity with tafenoquine in preclinical animal models. In clinical studies in P. vivax relapse prevention, nervous system adverse events, mainly headache and dizziness, occurred in 11.4% (36/317) of patients with tafenoquine (300 mg)/chloroquine versus 10.2% (19/187) with placebo/chloroquine; and in 15.5% (75/483) of patients with tafenoquine/chloroquine versus 13.3% (35/264) with primaquine (15 mg/day for 14 days)/chloroquine. Psychiatric adverse events, mainly insomnia, occurred in 3.8% (12/317) of patients with tafenoquine/chloroquine versus 2.7% (5/187) with placebo/chloroquine; and in 2.9% (14/483) of patients with tafenoquine/chloroquine versus 3.4% (9/264) for primaquine/chloroquine. There were no serious or severe NPAEs observed with tafenoquine (300 mg)/chloroquine in these studies. CONCLUSIONS The risk:benefit of single-dose tafenoquine/chloroquine in P. vivax relapse prevention is favourable in the presence of malaria, with a low risk of NPAEs, similar to that seen with chloroquine alone or primaquine/chloroquine.
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Affiliation(s)
- Stephan Duparc
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Geneva 15, Switzerland.
| | - Stephan Chalon
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Geneva 15, Switzerland
| | | | | | - Stephen Toovey
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Geneva 15, Switzerland.,Pegasus Research, London, UK
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Fikretoglu D, Liu A, Nazarov A, Blackler K. A group randomized control trial to test the efficacy of the Road to Mental Readiness (R2MR) program among Canadian military recruits. BMC Psychiatry 2019; 19:326. [PMID: 31664960 PMCID: PMC6819517 DOI: 10.1186/s12888-019-2287-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/11/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite increased interest in workplace mental health interventions, the evidence for beneficial effects is mixed. Furthermore, many existing studies lack methodological rigor. We report results from a group randomized control trial to test the efficacy of a vastly popular intervention in Canada, the Road to Mental Readiness (R2MR) program, which has been widely disseminated in military, first responder, and civilian settings. METHODS The trial took place among Canadian Armed Forces military recruits completing their basic military qualification (BMQ) training, and randomized 65 platoons (N = 2831) into either (a) an Intervention (R2MR at week 2 of BMQ), or (b) a delayed Intervention Control (R2MR at week 9 of BMQ) condition. The principal investigator, participants, and data collection staff were blinded to platoon condition. Individual-level psychological functioning, resilience, mental health service use attitudes, intentions, and behaviours, and additional covariates were assessed with questionnaires around week 2 (a day or two before Intervention platoons received R2MR), at week 5, and at week 9 (a day or two before the Control platoons received R2MR). Military performance outcomes were obtained from administrative databases. RESULTS The full trial results were mixed; for some outcomes (psychological functioning, resilience, and military performance), we saw no evidence of beneficial effects; where we did see benefits (mental health service use attitudes, intentions, behaviours), the effects were very small, or disappeared over time. Analyses among two subsamples (Group 1: Intervention platoons with a Fidelity Check and their Controls, and Group 2: Intervention platoons without Fidelity Check and their Controls) indicated that for some outcomes (attitudes and help-seeking), under high fidelity conditions, the beneficial effects of R2MR were increased and better sustained; Conversely, under poor fidelity conditions, decreased beneficial effects or even iatrogenic effects were observed. Analyses across three training divisions indicated the larger organizational climate further influences efficacy. CONCLUSIONS Our findings paint a very complex picture in which it is made evident that sensible, evidence-informed workplace mental health interventions such as R2MR may work under high fidelity conditions, but may yield no discernable benefit or even inadvertent iatrogenic effects if implemented poorly or without sufficient consideration to the larger organizational context. TRIAL REGISTRATION ISRCTN 52557050 Registered 13 October 2016.
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Affiliation(s)
- Deniz Fikretoglu
- Defence Research and Development Canada - Toronto Research Centre, 1133 Sheppard Ave West, Toronto, Ontario, M3K 2C9, Canada.
| | - Aihua Liu
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Anthony Nazarov
- The MacDonald Franklin OSI Research Centre, Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Kristen Blackler
- Defence Research and Development Canada - Toronto Research Centre, 1133 Sheppard Ave West, Toronto, Ontario, M3K 2C9, Canada
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Kennedy JE, Lu LH, Reid MW, Leal FO, Cooper DB. Correlates of Depression in U.S. Military Service Members With a History of Mild Traumatic Brain Injury. Mil Med 2019; 184:148-154. [PMID: 30901404 DOI: 10.1093/milmed/usy321] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/22/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are identified as signature injuries of the Wars in Iraq and Afghanistan. Statistics have confirmed a high incidence of PTSD among military personnel with mild TBI (mTBI) who served in these conflicts. Although receiving less attention, individuals with a history of mTBI are also at increased risk for depressive disorders. This study examines the incidence and correlates of depression in service members with a history of mTBI received an average of 4-1/2 years prior to evaluation. METHODS Retrospective analysis of 184 service members with a history of mTBI extracted from a data repository maintained at a military medical center. RESULTS One-third of the sample (34.2%) was clinically diagnosed with a depressive disorder in the month preceding evaluation. Of those with depression, 81% (51 of 63) were also diagnosed with PTSD. Proportionately more women than men had depression. Depression was more common among those who were undergoing a Military Evaluation Board and those who served in more than three combat deployments. CONCLUSIONS Results confirm chronically elevated the rates of depressive disorders and PTSD comorbidity among service members with a history of mTBI. Depression screening and treatment within the Military Health System should remain a priority for service members reporting a remote history of mTBI. Individuals with chronic PTSD, women, service members undergoing MEB and those who served in greater than three combat deployments are at particular risk.
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Affiliation(s)
- Jan E Kennedy
- Defense and Veterans Brain Injury Center, Department of Neurology, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft Sam Houston, TX
| | - Lisa H Lu
- Defense and Veterans Brain Injury Center, Department of Neurology, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft Sam Houston, TX
| | - Matthew W Reid
- Defense and Veterans Brain Injury Center, Department of Neurology, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft Sam Houston, TX
| | - Felix O Leal
- Defense and Veterans Brain Injury Center, Department of Neurology, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Ft Sam Houston, TX
| | - Douglas B Cooper
- Defense and Veterans Brain Injury Center, Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, Audie L. Murphy Memorial VA Hospital, 7400 Merton Minter, San Antonio, TX.,Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Dr., San Antonio, TX
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Rolland-Harris E, Simkus K, Weeks M. Burden of Cancer Mortality in the Canadian Armed Forces, 1976-2012: A Retrospective Cohort Study. Cancer Epidemiol Biomarkers Prev 2019; 28:1364-1369. [PMID: 31160349 DOI: 10.1158/1055-9965.epi-19-0215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/30/2019] [Accepted: 05/28/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Military personnel may have potential exposures to carcinogens during their military careers. However, the generalizability of causal evidence between occupational exposures and cancer outcomes in military personnel is limited. This study aims to describe the epidemiology cause-specific cancer mortality in still serving and released Canadian Armed Forces (CAF) personnel recruited between 1976 and 2012. METHODS Data came from the Canadian Forces Cancer and Mortality Study II (CF CAMS II), a record-linkage study of approximately 228,685 CAF Regular Force personnel and Reservists. Sex-stratified standardized mortality ratios (SMR) were calculated for each neoplasm subcategory, with the Canadian general population (CGP) as the reference. RESULTS Approximately 1,450 deaths were attributable to neoplasms. Cancer mortality was lower in both men and women with military service (SMR = 0.77 and 0.78, respectively) versus CGP. Females had a significantly lower risk of breast cancer. Males in the cohort had a significantly lower risk of lip, oral cavity and pharynx, digestive organs, respiratory and intrathoracic organs, bone and articular cartilage, and mesothelial and soft-tissue cancers. However, males also had a significantly increased risk for neoplasms of the central nervous system and lymphoid cells, as well as for certain specific cancer diagnoses. CONCLUSIONS Current and former CAF personnel were at comparable, or lower risk than, the CGP for cancer-related deaths. However, there was an increased risk for certain neoplasm subcategories and specific cancers. IMPACT These findings contribute to the limited body of evidence investigating the link between military service and cancer mortality.
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Affiliation(s)
- Elizabeth Rolland-Harris
- Directorate of Force Health Protection, Department of National Defence, Ottawa, Ontario, Canada.
| | - Kristen Simkus
- Directorate of Force Health Protection, Department of National Defence, Ottawa, Ontario, Canada.,Research Directorate, Veterans Affairs Canada, Charlottetown, Canada
| | - Murray Weeks
- Directorate of Force Health Protection, Department of National Defence, Ottawa, Ontario, Canada
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Mahar AL, Aiken AB, Whitehead M, Tien H, Cramm H, Fear NT, Kurdyak P. Suicide in Canadian veterans living in Ontario: a retrospective cohort study linking routinely collected data. BMJ Open 2019; 9:e027343. [PMID: 31160275 PMCID: PMC6549618 DOI: 10.1136/bmjopen-2018-027343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To compare the risk of death by suicide in male veterans with age-matched civilians. DESIGN Retrospective cohort study linking provincial administrative databases between 1990 and 2013 with follow-up complete until death or December 31, 2015. SETTING Population-based study in Ontario, Canada. PARTICIPANTS Ex-serving Canadian Armed Forces and Royal Canadian Mounted Police veterans living in Ontario who registered for provincial health insurance were included. A civilian comparator group was matched 4:1 on age and sex. MAIN OUTCOME Death by suicide was classified using standard cause of death diagnosis codes from a provincial registry of mandatory data collected from death certificates. Fine and Gray sub-distribution hazards regression compared the risk of death by suicide between veterans and civilians. Analyses were adjusted for age, residential region, income, rurality and major physical comorbidities. RESULTS 20 397 male veterans released to Ontario between 1990 and 2013 and 81 559 age-sex matched civilians were included. 4.2% of veterans died during the study time frame, compared with 6.5% of the civilian cohort. Death by suicide was rare in both cohorts, accounting for 4.6% and 3.6% of veteran and civilian deaths, respectively. After adjustment for confounders, veterans had an 18% lower risk of dying from causes other than suicide (HR 0.82, 95% CI 0.76 to 0.89) and a similar risk of dying by suicide (HR 1.01, 95% CI 0.71 to 1.43), compared with civilians. CONCLUSIONS Deaths by suicide were rare in male veterans residing in Ontario. Our findings demonstrate that veterans had a similar risk of suicide-related mortality as an age-matched civilian population. A better understanding of effective suicide prevention as well as clarifying pathways to seeking and receiving mental health supports and services are important areas for future consideration.
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Affiliation(s)
- Alyson L Mahar
- Community Health Sciences, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - Alice B Aiken
- Office of Research and Innovation, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Homer Tien
- 1 Canadian Field Hospital, Canadian Armed Forces, Toronto, Ontario, Canada
| | - Heidi Cramm
- School of Rehabilitation Therapy, Queens University, Kingston, Ontario, Canada
| | | | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Thériault FL, Garber BG, Momoli F, Gardner W, Zamorski MA, Colman I. Mental Health Service Utilization in Depressed Canadian Armed Forces Personnel. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:59-67. [PMID: 30016882 PMCID: PMC6364141 DOI: 10.1177/0706743718787792] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Major depression is prevalent, impactful, and treatable in military populations, but not all depressed personnel seek professional care in a given year. Care-seeking patterns (including the use of primary vs. specialty care) and factors associated with the likelihood of mental health service utilization in depressed military personnel are poorly understood. METHODS Our sample included 520 Regular Force respondents to the 2013 Canadian Forces Mental Health Survey. All study participants had past-year major depression. Subjects reported whether they had spoken about their mental health with at least one health professional in the past 12 months. We used multivariate Poisson regression to explore factors associated with past-year mental health service use. RESULTS Three-quarters of Canadian military personnel with past-year depression had sought mental health care in the previous 12 months. Among care-seeking personnel, 70% had seen a psychologist or psychiatrist, while 5% had exclusively received care from a primary care physician. Belief in the effectiveness of mental health care was the factor most strongly associated with care seeking. Female gender, functional impairments, and psychiatric comorbidities were also associated with care seeking. Surprisingly, stigma perceptions had no independent association with care seeking. CONCLUSIONS The proportion of depressed Canadian Armed Forces personnel who seek professional care and who access specialty mental health care is higher than in most other populations. However, an important minority of patients are not accessing health services. Efforts to further increase mental health service utilization in the Canadian military should continue to target beliefs about the effectiveness of mental health care.
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Affiliation(s)
- François L. Thériault
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
- Directorate of Force Health Protection, Canadian Forces Health Services Group Headquarters, Department of National Defence, Ottawa, Ontario
| | - Bryan G. Garber
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Department of National Defence, Ottawa, Ontario
| | - Franco Momoli
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
| | - William Gardner
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario
| | - Mark A. Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Department of National Defence, Ottawa, Ontario
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario
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Frank C, Zamorski MA, Colman I. Stigma doesn't discriminate: physical and mental health and stigma in Canadian military personnel and Canadian civilians. BMC Psychol 2018; 6:61. [PMID: 30567607 PMCID: PMC6300033 DOI: 10.1186/s40359-018-0273-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Illness-related stigma has been identified as an important public health concern. Past research suggests there is a disproportionate risk of mental-health stigma in the military, but this same finding has not yet been established for physical-health stigma. The current study aimed to assess the independent contribution of mental and physical health on both enacted stigma (discriminatory behaviour) and felt stigma (feelings of embarrassment) and to determine whether these associations were stronger for military personnel than civilians. Methods Data were obtained from the 2002 Canadian Community Health Survey - Mental Health and Well-being and its corresponding Canadian Forces Supplement. Logistic regressions were used to examine a potential interaction between population (military [N = 1900] versus civilian [N = 2960]), mental health, and physical health in predicting both enacted and felt stigma, with adjustments made for socio-demographic information, mental health characteristics, and disability. Results Mental health did not predict enacted or felt stigma as a main effect nor in an interaction. There was a strong link between physical health and enacted and felt stigma, where worse physical health was associated with an increased likelihood of experiencing both facets of stigma. The link between physical health and enacted stigma was significantly stronger for military personnel than for civilians. Conclusions Physical health stigma appears to be present for both civilians and military personnel, but more so for military personnel. Elements of military culture (e.g., the way care is sought, culture of toughness, strict fitness requirements) as well as the physical demands of the job could be potential predictors of group differences.
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Affiliation(s)
- Christine Frank
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada. .,Department of National Defence, Ottawa, ON, Canada.
| | - Mark A Zamorski
- Canadian Forces Health Services Group, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ian Colman
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Ketcheson F, Cyr K, King L, Richardson JD. Influence of PTSD and MDD on somatic symptoms in treatment-seeking military members and Veterans. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.2017-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Felicia Ketcheson
- Operational Stress Injury Clinic, Parkwood Institute, London, Ontario, Canada
| | - Kate Cyr
- Operational Stress Injury Clinic, Parkwood Institute, London, Ontario, Canada
| | - Lisa King
- Operational Stress Injury Clinic, Parkwood Institute, London, Ontario, Canada
| | - J. Don Richardson
- Operational Stress Injury Clinic, Parkwood Institute, London, Ontario, Canada
- Department of Psychiatry, Western University, London, Ontario, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
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Vun E, Turner S, Sareen J, Mota N, Afifi TO, El-Gabalawy R. Prevalence of comorbid chronic pain and mental health conditions in Canadian Armed Forces active personnel: analysis of a cross-sectional survey. CMAJ Open 2018; 6:E528-E536. [PMID: 30389752 PMCID: PMC6221807 DOI: 10.9778/cmajo.20180093] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Chronic pain conditions and mental disorders have high prevalence rates in military populations. However, few investigations have examined the comorbidity between chronic pain conditions and specific mental disorders among Canadian active military personnel. METHODS We conducted a secondary analysis of data from the 2013 Canadian Forces Mental Health Survey (CFMHS) concerning the population of regular members. Diagnostic interviews assessed the presence of mental disorders, and participants self-reported chronic pain conditions (i.e., arthritis, back problems, musculoskeletal conditions, migraines) and indicators of pain severity. We used multiple logistic regressions to assess associations between chronic pain conditions and mental disorders. We used cross-tabulations to assess the prevalence of pain severity indicators in comorbid relationships compared with the chronic pain condition alone. We used moderation analyses to examine the interactions between pain condition by pain severity, and pain condition by activity limitation, respectively, on mental disorders. RESULTS The CFMHS included data from 6696 regular members and had a response rate of 79.8%. About one-quarter (n = 1761) of military personnel reported having chronic pain. In the fully adjusted model, all assessed pain conditions were significantly associated with posttraumatic stress disorder (PTSD) (odds ratio [OR] range 1.86-2.55), and several pain conditions were associated with major depressive episode, generalized anxiety disorder and panic disorder. Back problems were significantly associated with all mental disorders apart from alcohol use disorders (OR range 1.40-2.17). Cross-tabulations showed higher prevalence estimates of endorsement for pain severity indicators among pain conditions and comorbid mental disorders, compared with pain conditions alone. Formal moderation analyses showed a significant relationship between migraine and activity limitation on PTSD. INTERPRETATION Chronic pain conditions are prevalent and co-occur with mental disorders among Canadian regular force members. Greater understanding of these chronic pain conditions and mental disorders and their impact on people's abilities to adapt to both military and civilian life is needed.
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Affiliation(s)
- Everett Vun
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Sarah Turner
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Jitender Sareen
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Natalie Mota
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Tracie O Afifi
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Renée El-Gabalawy
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.
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Fikretoglu D, Liu A, Zamorski MA, Rusu C, Jetly R. Do Investments in Mental Health Systems Result in Greater Use of Mental Health Services? National Trends in Mental Health Service Use (MHSU) in the Canadian Military and Comparable Canadian Civilians, 2002-2013. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:602-609. [PMID: 29439596 PMCID: PMC6109883 DOI: 10.1177/0706743718760291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mental disorders constitute a significant public health problem worldwide. Ensuring that those who need mental health services access them in an appropriate and timely manner is thus an important public health priority. We used data from 4 cross-sectional, nationally representative population health surveys that employed nearly identical methods to compare MHSU trends in the Canadian military versus comparable civilians. METHOD The surveys were all conducted by Statistics Canada, approximately a decade apart (Military-2002, Military-2013, Civilian-2002, and Civilian-2012). The sample size for the pooled data across the surveys was 35,984. Comparisons across the 4 surveys were adjusted for differences in need in the 2 populations at the 2 time points. RESULTS Our findings suggested that first, in the Canadian military, there was a clear and consistent pattern of improvement (i.e., increase) in MHSU over the past decade across a variety of provider types. The magnitudes of the changes were large, representing an absolute increase of 7.15% in those seeking any professional care, corresponding to an 84% relative increase. Second, in comparable Canadian civilians, MHSU remained either unchanged or increased only slightly. Third, the increases in MHSU over time were consistently greater in the military than in the comparable civilian sample. CONCLUSIONS Our findings point to advantages with respect to MHSU of the military mental health system over the civilian system in Canada; these advantages have widened substantially over time. These findings speak strongly to the potential impact of analogous changes in other health systems, both military and civilian.
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Affiliation(s)
- Deniz Fikretoglu
- 1 Defence Research and Development, Toronto, Ontario.,2 Douglas University Institute in Mental Health, McGill University, Montréal, Quebec
| | - Aihua Liu
- 2 Douglas University Institute in Mental Health, McGill University, Montréal, Quebec
| | - Mark Allen Zamorski
- 3 Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario.,4 Department of Family Medicine, University of Ottawa, Ottawa, Ontario
| | - Corneliu Rusu
- 5 School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario
| | - Rakesh Jetly
- 3 Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario
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Taillieu TL, Afifi TO, Turner S, Cheung K, Fortier J, Zamorski M, Sareen J. Risk Factors, Clinical Presentations, and Functional Impairments for Generalized Anxiety Disorder in Military Personnel and the General Population in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:610-619. [PMID: 29304289 PMCID: PMC6109886 DOI: 10.1177/0706743717752878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE This study sought to examine differences in sociodemographic risk factors, comorbid mental conditions, clinical presentations, and functional impairments associated with past-year generalized anxiety disorder (GAD) between Canadian Armed Forces (CAF) Regular Force personnel and the Canadian general population (CGP). METHOD Data were from 2 nationally representative surveys collected by Statistics Canada: 1) the Canadian Community Health Survey on Mental Health, collected in 2012 ( N = 25,113; response rate = 68.9%); and 2) the Canadian Forces Mental Health Survey, collected in 2013 ( N = 8,161; response rate = 79.8%). RESULTS The prevalence of lifetime and past-year GAD was significantly higher in the CAF (12.1% and 4.7%) than in the CGP (9.5% and 3.0%). Comorbid mental disorders were strongly associated with GAD in both populations. Although the content area of worry and the GAD symptoms endorsed were similar, CAF personnel were significantly more likely to endorse specific types of worries (i.e., success at school/work, social life, mental health, being away from home or loved ones, and war or revolution) and specific symptoms of GAD (i.e., restless, keyed up, or on edge and more irritable than usual) than civilians, after adjusting for sociodemographic covariates and comorbid mental disorders. CAF personnel with past-year GAD reported significantly higher functional impairment at home than civilians with past-year GAD. CONCLUSION GAD is a substantial public health concern associated with significant impairment and disability in both military and civilian populations. GAD in military and civilian populations shows similarities and differences: Key similarities include its extensive comorbidity and significant functional impairment, whereas key differences include the focus of worries and symptom profile.
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Affiliation(s)
- Tamara L. Taillieu
- Applied Health Sciences Program, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O. Afifi
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah Turner
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristene Cheung
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janique Fortier
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario, Canada
| | - Jitender Sareen
- Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Frank C, Zamorski MA, Lee JEC, Colman I. Deployment-related trauma and post-traumatic stress disorder: does gender matter? Eur J Psychotraumatol 2018; 9:1486123. [PMID: 30013724 PMCID: PMC6041783 DOI: 10.1080/20008198.2018.1486123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/23/2018] [Indexed: 02/05/2023] Open
Abstract
Objective: Military research has attempted to identify whether women have an increased vulnerability to mental health issues following deployment-related trauma, but findings have been mixed. Most studies have controlled for childhood abuse, but not other non-deployment trauma (e.g. life-threatening illness), which may partly explain previous mixed results. This study assessed gender differences in the association between deployment-related trauma and post-traumatic stress disorder (PTSD) while controlling for non-deployment trauma. Methods: Data came from the 2013 Canadian Forces Mental Health Survey. Regular or reserve personnel who had been deployed at least once were included in this study (n = 5980). Logistic regression was used to examine the interaction between gender and deployment-related trauma in predicting lifetime PTSD. Results: After controlling for non-deployment trauma, the association of gender with PTSD went from being significant to being marginally significant. The interaction between gender and deployment-related trauma was not significant. Conclusion: Though controlling for non-deployment trauma did not completely dissipate gender differences in PTSD, such differences were greatly reduced, indicating that these may be partly related to traumatic experiences outside deployment. As gender did not moderate the link between deployment-related trauma and PTSD, the findings suggest that trauma experienced while on deployment does not disproportionately affect women compared to their male counterparts.
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Affiliation(s)
- Christine Frank
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
- Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON, Canada
| | - Mark A. Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer E. C. Lee
- Military Personnel Research and Analysis, Department of National Defence, Ottawa, ON, Canada
| | - Ian Colman
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Mahar AL, Aiken AB, Cramm H, Whitehead M, Groome P, Kurdyak P. Mental Health Services Use Trends in Canadian Veterans: A Population-Based Retrospective Cohort Study in Ontario. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:378-386. [PMID: 28903578 PMCID: PMC5971406 DOI: 10.1177/0706743717730826] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A substantial evidence base in the peer-reviewed literature exists investigating mental illness in the military, but relatively less is documented about mental illness in veterans. This study uses provincial, administrative data to study the use of mental health services by Canadian veterans in Ontario. METHOD This was a retrospective cohort study of Canadian Armed Forces and Royal Canadian Mounted Police veterans who were released between 1990 and 2013 and resided in Ontario. Mental health-related primary care physician, psychiatrist, emergency department (ED) visits, and psychiatric hospitalisations were counted. Repeated measures were presented in 5-year intervals, stratified by age at release. RESULTS The cohort included 23,818 veterans. In the first 5 years following entry into the health care system, 28.9% of veterans had ≥1 mental health-related primary care physician visit, 5.8% visited a psychiatrist at least once, and 2.4% received acute mental health services at an ED. The use of mental health services was consistent over time. Almost 8% of veterans aged 30 to 39 years saw a psychiatrist in the first 5 years after release, compared to 3.5% of veterans aged ≥50 years at release. The youngest veterans at release (<30 years) were the most frequent users of ED services for a mental health-related reason (5.1% had at least 1 ED visit). CONCLUSION Understanding how veterans use the health care system for mental health problems is an important step to ensuring needs are met during the transition to civilian life.
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Affiliation(s)
- Alyson L Mahar
- 1 Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario.,2 Canadian Institute for Military & Veteran Health Research, Kingston, Ontario
| | - Alice B Aiken
- 2 Canadian Institute for Military & Veteran Health Research, Kingston, Ontario.,3 Faculty of Health, Dalhousie University, Halifax Nova Scotia
| | - Heidi Cramm
- 2 Canadian Institute for Military & Veteran Health Research, Kingston, Ontario.,4 School of Rehabilitation Therapy, Queen's University, Kingston, Ontario
| | - Marlo Whitehead
- 5 Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Patti Groome
- 5 Institute for Clinical Evaluative Sciences, Toronto, Ontario.,6 Department of Public Health Sciences, Queen's University, Kingston, Ontario
| | - Paul Kurdyak
- 5 Institute for Clinical Evaluative Sciences, Toronto, Ontario.,7 Centre for Addictions & Mental Health, Toronto, Ontario
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Ketcheson F, King L, Richardson JD. Association between social support and mental health conditions in treatment-seeking Veterans and Canadian Armed Forces personnel. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.2017-0001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Lisa King
- Parkwood Operational Stress Injury Clinic, London, Ontario, Canada
| | - J Don Richardson
- Parkwood Operational Stress Injury Clinic, London, Ontario, Canada
- Department of Psychiatry, Western University, London, Ontario, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
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Psychiatric comorbidity pattern in treatment-seeking veterans. Psychiatry Res 2017; 258:488-493. [PMID: 28899613 DOI: 10.1016/j.psychres.2017.08.091] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 07/28/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022]
Abstract
This study investigated comorbidity patterns in treatment-seeking veterans and currently-serving Canadian Forces members of an outpatient mental health clinic from September 2006-September 2014. Using a retrospective cohort design, latent class analysis was conducted to determine latent classes of comorbidity (including posttraumatic stress disorder [PTSD], major depressive disorder [MDD], generalized anxiety disorder, panic disorder, and alcohol use disorder [AUD]). Multiple logistic regression was used to determine which covariates (age, gender, number of deployments, and service duration) were predictors of latent class membership. Among the 486 participants, 79.2% had more than one probable mental health condition. The most common comorbidity was PTSD and MDD (61.5%), followed by PTSD and GAD (52.3%). Among those with PTSD, almost all (95%) had a subsequent condition, predominantly MDD (82.6% of those with PTSD had MDD). A two-class model was the best fitting model with a high comorbidity and a low comorbidity class. Older age and shorter service duration significantly increased the probability of being in the high comorbidity class when not controlling for member status. Results showed that treatment-seeking veterans and military personnel have high rates of comorbidity, particularly alongside PTSD. Therefore, it is critical for clinicians to be able to assess and treat comorbidity.
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Rebeira M, Grootendorst P, Coyte P. Factors associated with mental health in Canadian Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2017. [DOI: 10.3138/jmvfh.4098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Mayvis Rebeira
- Canadian Centre for Health Economics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paul Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Peter Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Stein MB, Campbell-Sills L, Gelernter J, He F, Heeringa SG, Nock MK, Sampson NA, Sun X, Jain S, Kessler RC, Ursano RJ. Alcohol Misuse and Co-Occurring Mental Disorders Among New Soldiers in the U.S. Army. Alcohol Clin Exp Res 2016; 41:139-148. [PMID: 27883222 DOI: 10.1111/acer.13269] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/09/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Problem drinking that predates enlistment into military service may contribute to the overall burden of alcohol misuse in the Armed Forces; however, evidence bearing on this issue is limited. This study examines prevalence and correlates of alcohol misuse among new U.S. Army soldiers. METHODS Cross-sectional survey data were collected from soldiers reporting for basic combat training. The survey retrospectively assessed lifetime alcohol consumption and substance abuse/dependence, enabling estimation of the prevalence of lifetime binge drinking and heavy drinking in a sample of 30,583 soldiers and of probable alcohol use disorder (AUD) among 26,754 soldiers with no/minimal lifetime use of other drugs. Co-occurrence of mental disorders and other adverse outcomes with binge drinking, heavy drinking, and AUD was examined. Discrete-time survival analysis, with person-year the unit of analysis and a logistic link function, was used to estimate associations of AUD with subsequent onset of mental disorders and vice versa. RESULTS Weighted prevalence of lifetime binge drinking was 27.2% (SE = 0.4) among males and 18.9% (SE = 0.7) among females; respective estimates for heavy drinking were 13.9% (SE = 0.3) and 9.4% (SE = 0.4). Among soldiers with no/minimal drug use, 9.5% (SE = 0.2) of males and 7.2% (SE = 0.5) of females had lifetime AUD. Relative to no alcohol misuse, binge drinking, heavy drinking, and AUD were associated with increased odds of all mental disorders and other adverse outcomes under consideration (adjusted odds ratios [AORs] = 1.5 to 4.6; ps < 0.001). Prior mental disorders and suicidal ideation were associated with onset of AUD (AORs = 2.3 to 2.8; ps < 0.001), and prior AUD was associated with onset of mental disorders and suicidal ideation (AORs = 2.0 to 3.2, ps < 0.005). CONCLUSIONS Strong bidirectional associations between alcohol misuse and mental disorders were observed in a cohort of soldiers beginning Army service. Conjoint recognition of alcohol misuse and mental disorders upon enlistment may provide opportunities for risk mitigation early in a soldier's career.
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Affiliation(s)
- Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Laura Campbell-Sills
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Joel Gelernter
- Department of Psychiatry, Yale University, West Haven, Connecticut
| | - Feng He
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | | | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | | | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | | | - Robert J Ursano
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Laukkala T, Parkkola K, Henriksson M, Pirkola S, Kaikkonen N, Pukkala E, Jousilahti P. Total and cause-specific mortality of Finnish military personnel following service in international peacekeeping operations 1990-2010: a comprehensive register-based cohort study. BMJ Open 2016; 6:e012146. [PMID: 27799241 PMCID: PMC5093393 DOI: 10.1136/bmjopen-2016-012146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/23/2016] [Accepted: 09/30/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate total and cause-specific mortality after international peacekeeping deployments among the Finnish military peacekeeping personnel in comparison to the general population of similar age and sex. DESIGN A register-based study of a cohort of military peacekeeping personnel in 1990-2010 followed for mortality until the end of 2013. Causes of death were obtained from the national Causes of Death Register. The standardised mortality ratio (SMR) for total and cause-specific mortality was calculated as the ratio of observed and expected number of deaths. SETTING Finland (peacekeeping operations in different countries in Africa, Asia and in an area of former Yugoslavia in Europe). PARTICIPANTS 14 584 men and 418 women who had participated in international military peacekeeping operations ending between 1990 and 2010. INTERVENTIONS Participation in military peacekeeping operations. MAIN OUTCOME Total and cause-specific mortality. RESULTS 209 men and 3 women died after their peacekeeping service. The SMR for all-cause mortality was 0.55 (95% CI 0.48 to 0.62). For the male peacekeeping personnel, the SMR for all diseases was 0.44 (95% CI 0.35 to 0.53) and for accidental and violent deaths 0.69 (95% CI 0.57 to 0.82). The SMR for suicides was 0.71 (95% CI 0.53 to 0.92). CONCLUSIONS Even though military peacekeeping personnel are working in unique and often stressful conditions, their mortality after their service is lower compared with the general population. Military peacekeeping personnel appear to be a selected population group with low general mortality and no excess risk of any cause of death after peacekeeping service.
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Affiliation(s)
- T Laukkala
- Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - K Parkkola
- School of Medicine, University of Tampere, Tampere, Finland
| | - M Henriksson
- National Supervisory Authority for Welfare and Health, Helsinki, Finland
- Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - S Pirkola
- School of Health Sciences, University of Tampere, and Tampere University Hospital, Tampere, Finland
| | - N Kaikkonen
- Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - E Pukkala
- School of Health Sciences, University of Tampere, Tampere Finland and the Finnish Cancer Registry, Helsinki, Finland
| | - P Jousilahti
- National Institute for Health and Welfare, Helsinki, Finland
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Scott RL, Lasiuk GC, Norris CM. Depression in Lesbian, Gay, and Bisexual Members of the Canadian Armed Forces. LGBT Health 2016; 3:366-72. [DOI: 10.1089/lgbt.2016.0050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roger L. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Gerri C. Lasiuk
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Aiken AB, Mahar AL, Kurdyak P, Whitehead M, Groome PA. A descriptive analysis of medical health services utilization of Veterans living in Ontario: a retrospective cohort study using administrative healthcare data. BMC Health Serv Res 2016; 16:351. [PMID: 27488736 PMCID: PMC4973105 DOI: 10.1186/s12913-016-1596-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 07/28/2016] [Indexed: 11/21/2022] Open
Abstract
Background Health services utilization by Veterans following release may be different than the general population as the result of occupational conditions, requirements and injuries. This study provides the first longitudinal overview of Canadian Veteran healthcare utilization in the Ontario public health system. Methods This is a retrospective cohort study designed to use Ontario’s provincial healthcare data to study the demographics and healthcare utilization of Canadian Armed Forces (CAF) & RCMP Veterans living in Ontario. Veterans were eligible for the study if they released between January 1, 1990 and March 31, 2013. Databases at the Institute for Clinical Evaluative Sciences were linked by a unique identifier to study non-mental health related hospitalizations, emergency department visits, and physician visits. Overall and age-stratified descriptive statistics were calculated in five-year intervals following the date of release. Results The cohort is comprised of 23, 818 CAF or RCMP Veterans. Following entry into the provincial healthcare system, 82.6 % (95 % CI 82.1–83.1) of Veterans saw their family physician at least once over the first five years following release, 60.7 % (95 % CI 60.0–61.3) saw a non-mental health specialist, 40.8 % (95 % CI 40.2–41.5) went to the emergency department in that same time period and 9.9 % (9.5–10.3) were hospitalized for non-mental health related complaints. Patterns of non-mental health services utilization appeared to be time and service dependant. Stratifying health services utilization by age of the Veteran at entry into the provincial healthcare system revealed significant differences in service use and intensity. Conclusion This study provides the first description of health services utilization by Veterans, following release from the CAF or RCMP. This work will inform the planning and delivery of support to Veterans in Ontario. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1596-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alice B Aiken
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.
| | - Alyson L Mahar
- Department of Public Health, Queen's University, Kingston, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marlo Whitehead
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Patti A Groome
- Department of Public Health, Queen's University, Kingston, ON, Canada
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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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Fikretoglu D, Liu A, Zamorski MA, Jetly R. Perceived Need for and Perceived Sufficiency of Mental Health Care in the Canadian Armed Forces: Changes in the Past Decade and Comparisons to the General Population. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:36S-45S. [PMID: 27270740 PMCID: PMC4800475 DOI: 10.1177/0706743716628855] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Failure to perceive need for care (PNC) is the leading barrier to accessing mental health care. After accessing care, many individuals perceive that their needs were unmet or only partially met, an additional problem related to perceived sufficiency of care (PSC). The Canadian Armed Forces (CAF) invested heavily in workplace mental health in the past decade to improve PNC/PSC; yet, the impact of these investments remains unknown. To assess the impact of these investments, this study 1) captures changes in PNC/PSC over the past decade in the CAF and 2) compares current PNC/PSC between the CAF and civilians. METHODS Data were drawn from the 2013 and 2002 CAF surveys and the 2012 civilian mental health survey (total N = ∼40 000), conducted by Statistics Canada using similar methodology. Exclusions were applied to the civilian sample to make them comparable to the military sample. Prevalence rates for No need, Need met, Need partially met, and Need unmet categories across service types (Information, Medication, Counselling and therapy, Any services) were calculated and compared between 1) the 2 CAF surveys and 2) the 2013 CAF and 2012 civilian surveys after sample matching. RESULTS Reports of Any need and Need met were higher in the CAF in 2013 than in 2002 by approximately 6% to 8% and 2% to 8%, respectively, and higher in the CAF than in civilians by 3% to 10% and 2% to 8%, respectively. CONCLUSIONS These results suggest that investments in workplace mental health, such as those implemented in the CAF, can lead to improvements in recognizing the need for care (PNC) and subsequently getting those needs met (PSC).
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Affiliation(s)
- Deniz Fikretoglu
- Defence Research and Development Canada, Toronto, Ontario Douglas Mental Health University Institute, McGill University, Montreal, Quebec
| | - Aihua Liu
- Douglas Mental Health University Institute, McGill University, Montreal, Quebec
| | - Mark A Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario Department of Family Medicine, University of Ottawa, Ottawa, Ontario
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario
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McFarlane A. Accountability for the Psychological Costs of Military Service: A Benchmark Set by the Canadian Armed Forces. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:7S-9S. [PMID: 27270745 PMCID: PMC4800471 DOI: 10.1177/0706743715625423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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