Course and Predictors of Posttraumatic Stress Disorder in the Canadian Armed Forces: A Nationally Representative, 16-Year Follow-up Study: Cours et prédicteurs du trouble de stress post-traumatique dans les Forces armées canadiennes: une étude de suivi de 16 ans nationalement représentative

The application of machine learning techniques in posttraumatic stress disorder: a systematic review and meta-analysis

Posttraumatic stress disorder (PTSD) recently becomes one of the most important mental health concerns. However, no previous study has comprehensively reviewed the application of big data and machine learning (ML) techniques in PTSD. We found 873 studies meet the inclusion criteria and a total of 31 of those in a sample of 210,001 were included in quantitative analysis. ML algorithms were able to discriminate PTSD with an overall accuracy of 0.89. Pooled estimates of classification accuracy from multi-dimensional data (0.96) are higher than single data types (0.86 to 0.90). ML techniques can effectively classify PTSD and models using multi-dimensional data perform better than those using single data types. While selecting optimal combinations of data types and ML algorithms to be clinically applied at the individual level still remains a big challenge, these findings provide insights into the classification, identification, diagnosis and treatment of PTSD.

Recurrence of post-traumatic stress disorder: systematic review of definitions, prevalence and predictors

BACKGROUND

Many people will experience a potentially traumatic event in their lifetime and a minority will go on to develop post-traumatic stress disorder (PTSD). A wealth of literature explores different trajectories of PTSD, focusing mostly on resilient, chronic, recovered and delayed-onset trajectories. Less is known about other potential trajectories such as recurring episodes of PTSD after initial recovery, and to date there has been no estimate of what percentage of those who initially recover from PTSD later go on to experience a recurrence. This systematic review aimed to synthesise existing literature to identify (i) how 'recurrence' of PTSD is defined in the literature; (ii) the prevalence of recurrent episodes of PTSD; and (iii) factors associated with recurrence.

METHODS

A literature search of five electronic databases identified primary, quantitative studies relevant to the research aims. Reference lists of studies meeting pre-defined inclusion criteria were also hand-searched. Relevant data were extracted systematically from the included studies and results are reported narratively.

RESULTS

Searches identified 5,398 studies, and 35 were deemed relevant to the aims of the review. Results showed there is little consensus in the terminology or definitions used to refer to recurrence of PTSD. Because recurrence was defined and measured in different ways across the literature, and prevalence rates were reported in numerous different ways, it was not possible to perform meta-analysis to estimate the prevalence of recurrence. We also found no consistent evidence regarding predictors of PTSD recurrence.

CONCLUSION

A clear and consistent evidence-based definition of recurrence is urgently needed before the prevalence and predictors of recurrence can be truly understood.

Machine learning methods to discriminate posttraumatic stress disorder: A protocol of systematic review and meta-analysis

Introduction

Recent years have witnessed a persistent threat to public mental health, especially during and after the COVID-19 pandemic. Posttraumatic stress disorder (PTSD) has emerged as a pivotal concern amidst this backdrop. Concurrently, machine learning (ML) techniques have progressively applied in the realm of mental health. Therefore, our present undertaking seeks to provide a comprehensive assessment of studies employing ML methods that use diverse data modalities on the classification of people with PTSD.

Methods and analysis

In pursuit of pertinent studies, we will search both English and Chinese databases from January 2000 to May 2022. Two researchers will independently conduct screening, extract data and assess study quality. We intend to employ the assessment framework introduced by Luis Francisco Ramos-Lima in 2020 for quality evaluation. Rate, standard error and 95% CIs will be utilized for effect size measurement. A Cochran's Q test will be applied to assess heterogeneity. Subgroup and sensitivity analysis will further elucidate the source of heterogeneity and funnel plots and Egger's test will detect publication bias.

Ethics and dissemination

This systematic review and meta-analysis does not encompass patient interactions or engagements with healthcare providers. The outcomes of this research will be disseminated through scholarly channels, including presentations at scientific conferences and publications in peer-reviewed journals.PROSPERO registration number CRD42023342042.

Characteristics and Correlates of Ten-Year Trajectories of Posttraumatic Stress Symptoms in Older U.S. Military Veterans

OBJECTIVES

To examine the nature and correlates of 10-year trajectories of posttraumatic stress disorder (PTSD) symptoms in older U.S. military Veterans.

DESIGN AND SETTING

A nationally representative web-based survey of older U.S. Veterans who participated in the National Health and Resilience in Veterans Study over 5 waves between 2011 and 2021.

PARTICIPANTS

A total of 1,843 U.S. Veterans aged 50 and older (mean age = 67).

MEASUREMENTS

PTSD symptoms were assessed using the PTSD Checklist. Self-report measures at baseline assessed sociodemographic characteristics; trauma exposures; psychiatric and substance use disorders; mental, cognitive, and physical functioning; and psychosocial factors including expectations of aging. Latent growth mixture modeling identified the nature and correlates of 10-year PTSD symptom trajectories.

RESULTS

Most of the sample had no/low PTSD symptoms (88.7%), while 6.0% had consistently subthreshold symptoms, 2.7% consistently high symptoms, and 2.6% increasing symptoms. Relative to the no/low symptom group, the subthreshold and high symptom groups reported more medical conditions and cognitive difficulties, with younger age and more lifetime traumatic events additionally linked to the high symptom trajectory. Relative to the no/low symptom group, Veterans with increasing symptoms were more likely to report functional disability and lifetime nicotine use disorder, cognitive difficulties, negative expectations regarding physical and emotional aging, and traumatic events over the study period.

CONCLUSIONS

Despite high rates of trauma exposure, most older Veterans do not evidence symptomatic PTSD trajectories; however, about 11% do. Results underscore the importance of assessing PTSD symptoms in this population and considering longitudinal trajectories as well as associated risk and protective factors.

Prevalence and Correlates of Military Sexual Trauma in Service Members and Veterans: Results From the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey

INTRODUCTION

Military sexual trauma (MST) is an ongoing problem. We used a 2002 population-based sample, followed up in 2018, to examine: (1) the prevalence of MST and non-MST in male and female currently serving members and veterans of the Canadian Armed Forces, and (2) demographic and military correlates of MST and non-MST.

METHODS

Data came from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (n = 2,941, ages 33 years + ). Individuals endorsing sexual trauma were stratified into MST and non-MST and compared to individuals with no sexual trauma. The prevalence of lifetime MST was computed, and correlates of sexual trauma were examined using multinomial regression analyses.

RESULTS

The overall prevalence of MST was 44.6% in females and 4.8% in males. Estimates were comparable between currently serving members and veterans. In adjusted models in both sexes, MST was more likely among younger individuals (i.e., 33-49 years), and MST and non-MST were more likely in those reporting more non-sexual traumatic events. Among females, MST and non-MST were more likely in those reporting lower household income, non-MST was less likely among Officers, and MST was more likely among those with a deployment history and serving in an air environment. Unwanted sexual touching by a Canadian military member or employee was the most prevalent type and context of MST.

INTERPRETATION

A high prevalence of MST was observed in a follow-up sample of Canadian Armed Forces members and veterans. Results may inform further research as well as MST prevention efforts.

Prevalence and predictors of anxiety disorder courses in the Canadian Armed Forces

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.

Associations between courses of posttraumatic stress disorder and physical health conditions among Canadian military personnel

BACKGROUND

Posttraumatic stress disorder (PTSD) and physical health conditions commonly co-occur and are both prevalent among military personnel. This study examined how courses of PTSD (no PTSD, remitted, new onset, persistent/recurrent) are associated with physical health conditions, among a population-based sample of Canadian military personnel.

METHOD

We analyzed data from the 2002 Canadian Community Health Survey-Mental Health and Well-being-Canadian Forces supplement (CCHS-CF) and the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS; N = 2941). Multivariable logistic regressions examined associations between PTSD courses (reference = no PTSD) and physical health conditions.

RESULTS

In general, physical health conditions were more prevalent among symptomatic PTSD courses compared to no PTSD. After adjustment, new onset PTSD was associated with increased odds of all physical health conditions with the exception of ulcers and cancer (AOR range: 1.41-2.31) and remitted PTSD was associated with increased odds of diabetes (AOR = 2.31).

CONCLUSION

Results suggest that new onset PTSD may be most strongly associated with physical health conditions. Findings may inform targeted screening and intervention methods among military personnel with PTSD and physical health conditions.

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

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.

The global prevalence of depression, suicide ideation, and attempts in the military forces: a systematic review and Meta-analysis of cross sectional studies

BACKGROUND

Given the wide range of depressive disorders, suicidal ideation and suicide attempts in various military studies around the world, determining the exact prevalence of these disorders in line with health planning as well as care and treatment service designing for military forces can be useful. The aim of the present meta-analysis was to determine the pooled prevalence of depressive disorders, suicide thoughts, and attempts in the military.

METHODS

The present systematic review and meta-analysis study was performed based on PRISMA criteria in 5 steps of the search strategy, screening and selection of articles, data extraction, evaluation of article quality and meta-analysis. International databases (PubMed (Medline), Scopus, Web of science, Embase (Elsevier), PsycInfo (Ovid), Cochrane CENTRAL (Ovid)) were searched using related keywords extracted from Mesh and Emtree. After screening and final selection of articles, data were extracted and qualitative evaluation was performed using the NOS checklist.

RESULTS

The results of meta-analysis showed that the prevalence of depression in active military forces and veterans was 23% (%95 CI: 20-26%) and 20% (%95 CI: 18-22%), respectively. In addition, the prevalence of suicidal ideation and attempts in the military was 11% (%95 CI: 10-13%) and 11% (%95 CI: 9-13%), respectively. The prevalence of suicide ideation and attempts in drug-using military was 18% (%95 CI: 7-33%) and 30% (%95 CI: 23-36%), respectively. The prevalence of suicidal ideation and attempts in military consuming alcohol were 9% (%95 CI: 4-13%) and 8% (%95 CI: 7-10%), respectively. In militaries with AIDS / HIV, the prevalence of suicide attempts was 5% (%95 CI: 4-8%).

CONCLUSION

Therefore, it is necessary to develop and design training and intervention programs in order to increase the awareness of the military, especially veterans, to prevent the occurrence of suicide and depression.