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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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Wright E, Pagliaro C, Page IS, Diminic S. A review of excluded groups and non-response in population-based mental health surveys from high-income countries. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1265-1292. [PMID: 37212903 PMCID: PMC10423166 DOI: 10.1007/s00127-023-02488-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
National mental health surveys play a critical role in determining the prevalence of mental disorders in a population and informing service planning. However, current surveys have important limitations, including the exclusion of key vulnerable groups and increasing rates of non-response. This review aims to synthesise information on excluded and undersampled groups in national mental health surveys. We conducted a targeted review of nationally representative adult mental health surveys performed between 2005 and 2019 in high-income OECD countries. Sixteen surveys met our inclusion criteria. The response rate for included surveys ranged between 36.3% and 80.0%. The most frequently excluded groups included people who were homeless, people in hospitals or health facilities and people in correctional facilities. Males and young people were the most commonly underrepresented groups among respondents. Attempts to collect data from non-responders and excluded populations were limited, but suggest that mental health status differs among some of these cohorts. The exclusion of key vulnerable groups and high rates of non-response have important implications for interpreting and using the results of national mental health surveys. Targeted supplementary surveys of excluded or hard-to-reach populations, more inclusive sampling methodologies, and strategies aimed at improving response rates should be considered to strengthen the accuracy and usefulness of survey findings.
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Affiliation(s)
- Eryn Wright
- School of Public Health, The University of Queensland, Herston, Qld, 4006, Australia.
- Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, Qld, 4108, Australia.
| | - Claudia Pagliaro
- School of Public Health, The University of Queensland, Herston, Qld, 4006, Australia
- Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, Qld, 4108, Australia
| | - Imogen S Page
- School of Public Health, The University of Queensland, Herston, Qld, 4006, Australia
- Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, Qld, 4108, Australia
| | - Sandra Diminic
- School of Public Health, The University of Queensland, Herston, Qld, 4006, Australia
- Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, Qld, 4108, Australia
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Baez S, Tangarife MA, Davila-Mejia G, Trujillo-Güiza M, Forero DA. Performance in emotion recognition and theory of mind tasks in social anxiety and generalized anxiety disorders: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1192683. [PMID: 37275989 PMCID: PMC10235477 DOI: 10.3389/fpsyt.2023.1192683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
Social cognition impairments may be associated with poor functional outcomes, symptoms, and disability in social anxiety disorder (SAD) and generalized anxiety disorder (GAD). This meta-analysis aims to determine if emotion recognition and theory of mind (ToM) are impaired in SAD or GAD compared to healthy controls. A systematic review was conducted in electronic databases (PubMed, PsycNet, and Web of Science) to retrieve studies assessing emotion recognition and/or ToM in patients with SAD or GAD, compared to healthy controls, up to March 2022. Meta-analyses using random-effects models were conducted. We identified 21 eligible studies: 13 reported emotion recognition and 10 ToM outcomes, with 585 SAD patients, 178 GAD patients, and 753 controls. Compared to controls, patients with SAD exhibited impairments in emotion recognition (SMD = -0.32, CI = -0.47 - -0.16, z = -3.97, p < 0.0001) and ToM (SMD = -0.44, CI = -0.83 -0.04, z = -2.18, p < 0.01). Results for GAD were inconclusive due to the limited number of studies meeting the inclusion criteria (two for each domain). Relevant demographic and clinical variables (age, sex, education level, and anxiety scores) were not significantly correlated with emotion recognition or ToM impairments in SAD and GAD. Further studies employing ecological measures with larger and homogenous samples are needed to better delineate the factors influencing social cognition outcomes in both SAD and GAD.
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Affiliation(s)
| | | | | | | | - Diego A. Forero
- School of Health and Sport Sciences, Fundación Universitaria del Área Andina, Bogotá, Colombia
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Pankratz L, Sommer JL, Bolton SL, Sareen J, Enns MW, Afifi TO, El-Gabalawy R, Mota N. Prevalence and predictors of anxiety disorder courses in the Canadian Armed Forces. J Anxiety Disord 2022; 92:102612. [PMID: 36252350 DOI: 10.1016/j.janxdis.2022.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 11/07/2022]
Abstract
Few studies have examined the longitudinal courses of anxiety disorders in military members. This study examined the prevalence and predictors of courses of any anxiety disorder in members and veterans of the Canadian Armed Forces, including no lifetime, remitted, new onset, and persistent/recurrent anxiety disorder. The 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey is a 16-year follow-up of n = 2941 participants from the Canadian Community Health Survey: Canadian Forces Supplement in 2002. Diagnoses of any DSM-IV anxiety disorder (i.e., generalized anxiety, social anxiety, and/or panic disorder) in 2002 and 2018 were used to create four anxiety course groups. A large proportion of the sample (36.3 %; new onset = 24.6 %, remitting = 6.9 %, and persistent/recurrent = 4.8 %) met criteria for an anxiety disorder during one or both time points. Factors at baseline and/or between 2002 and 2018, including income, education, military rank, comorbidity of PTSD or depression, deployment history, and traumatic events, were positively associated with most anxiety courses relative to no anxiety in analyses. Targeted interventions are needed to help mitigate anxiety disorders among this population. Social support and active coping were protective factors for most anxiety courses and may need to be incorporated into targeted interventions.
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Affiliation(s)
- Lily Pankratz
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada.
| | - Jordana L Sommer
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada; Department of Clinical Health Psychology, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Shay-Lee Bolton
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Jitender Sareen
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada; Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Community Health Sciences, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Murray W Enns
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Tracie O Afifi
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Community Health Sciences, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Clinical Health Psychology, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
| | - Natalie Mota
- Department of Psychiatry, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada; Department of Clinical Health Psychology, University of Manitoba, 744 Bannatyne Ave, Winnipeg, Manitoba R3E 0W2, Canada.
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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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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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Rolland-Harris E. More Than Just Counting Deaths: The Evolution of Suicide Surveillance in the Canadian Armed Forces. Mil Med 2019; 184:37-42. [PMID: 30901452 DOI: 10.1093/milmed/usy353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/31/2018] [Indexed: 11/15/2022] Open
Abstract
Suicide prevention and surveillance are of primary concern to the Canadian Armed Forces (CAF) and to the CAF Health Services (CFHS). Suicide surveillance has been conducted on behalf of the CFHS by the Directorate of Force Health Protection for nearly 30 years. Over time, multiple changes have occurred within CAF: changes in its military role (from a primarily peacekeeping role to one also involving active combat), changes in operational tempo, temporal changes in at-risk subpopulations, as well as increased awareness and concern with suicide and suicide prevention. This has resulted in the annual reporting of CAF suicide rates and the evolution of the report's content to respond to the needs of its end users. More recently, Regular Force Army and Combat Arms males have been identified as being at significantly higher risk of suicide, relative to their counterparts, as well as to the Canadian general population. However, this trend has been fairly stable. To optimize the use of limited epidemiologic resources and to shift the focus from the rates themselves towards a better understanding of what they represent and how they can be modified, the suicide surveillance portfolio is evolving to include complementary data sources and elements. This paper describes the different data sources that constitute the CAF's enhanced suicide surveillance portfolio, the value-added evidence generated by the use of complementary data collection methods and sources, and how this evidence is used by CAF leadership in their efforts to prevent suicide amongst those who serve.
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Affiliation(s)
- Elizabeth Rolland-Harris
- Directorate of Force Health Protection, Department of National Defence, 101 Colonel By Drive, Carling Campus, Bldg 9S.1, Ottawa, ON, Canada
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