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Abstract
Background Many public safety personnel (PSP) experience trauma directly or indirectly in their occupational role, yet there remain barriers to accessing care or seeking help. Aims To understand how PSP interpret different potentially traumatic events and how perceived eligibility for being traumatized is determined among PSP. Methods We analysed open-ended comments provided by over 800 PSP in a survey designed to assess the prevalence of post-traumatic stress injuries and other mental disorders. Results We found evidence that a trauma hierarchy may exist among PSP. Certain experiences may be interpreted as more traumatic, based on both the event and the PSP role in the actual event. For example, involvement in a shooting may be interpreted as more traumatic than arriving on the scene later. Similarly, a single event may be deemed more traumatic than an accumulation of events. The role of the individual and social context in shaping experiences and interpretations of trauma may be largely ignored in line with confirmation biases. Conclusions The role that individuals and social contexts play in shaping experiences and interpretations of trauma appear suppressed by perceptions of a trauma hierarchy, facilitating systematic discrediting or valuation of some experiences, therein evidencing that trauma is subjective and reinforcing barriers to care seeking. A trauma hierarchy may also propagate stigma and legitimize discrimination regarding mental health. We argue that recognizing, engaging with, and dismantling the perception of a trauma hierarchy may help create a respectful and open occupational culture supportive of mental health needs.
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Affiliation(s)
- R Ricciardelli
- Department of Sociology, Memorial University of Newfoundland, St. John's, Newfoundland A1C 5S7, Canada
| | - S Czarnuch
- Department of Electrical and Computer Engineering and Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, Newfoundland A1C 5S7, Canada
| | - T O Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 0W3, Canada
| | - T Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 0W3, Canada
| | - R N Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan S4S 0A2, Canada
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Brennan-Olsen SL, Taillieu TL, Turner S, Bolton J, Quirk SE, Gomez F, Duckham RL, Hosking SM, Duque G, Green D, Afifi TO. Arthritis in adults, socioeconomic factors, and the moderating role of childhood maltreatment: cross-sectional data from the National Epidemiological Survey on Alcohol and Related Conditions. Osteoporos Int 2019; 30:363-373. [PMID: 30132028 DOI: 10.1007/s00198-018-4671-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED These data present associations between socioeconomic status (SES), different types of childhood maltreatment (CM) history and family dysfunction, and arthritis in men and women across a wide age range. Arthritis was less likely among those with higher SES, regardless of CM history. INTRODUCTION CM has been associated with increased risk of adult-onset arthritis; however, little is known about whether socioeconomic status moderates arthritis risk in those with CM history. We investigated arthritis across education, income, and race/ethnicity and whether CM moderated associations between SES and arthritis. METHODS Data were drawn from Wave 2 (2004-2005) of the nationally representative (USA) National Epidemiological Survey on Alcohol and Related Conditions (NESARC, n = 34,563; aged ≥ 20 years). Self-reported CM history included physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence (IPV). We used descriptive statistics and logistic regression to determine relationships between SES, CM, and arthritis. Interaction terms were used to test if CM moderated relationships between SES and arthritis. RESULTS Arthritis prevalence was 21.1% (n = 3093) among men and 30.1% (n = 6167) among women. In unadjusted analyses, women (p ≤ 0.001) and older age (both sexes, p ≤ 0.01) were associated with increased odds of arthritis. All CM types were associated with increased odds of arthritis, except exposure to IPV among women. In sex-stratified, age-adjusted analyses, lower education and income, family dysfunction, being Hispanic or Asian/Native Hawaiian/Pacific Islander, and ≥ 1 physical comorbidity were associated with increased odds of arthritis among those with and without CM: trends were similar for both sexes. In age-adjusted two-way interaction terms, CM did not moderate associations between SES and arthritis. CONCLUSIONS Although CM was associated with arthritis, associations between SES and arthritis were not amplified. Arthritis was less likely among those with higher SES, regardless of CM history.
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Affiliation(s)
- S L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, Level 3, WCHRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia.
| | - T L Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J Bolton
- 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
| | - S E Quirk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - F Gomez
- Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | - R L Duckham
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - S M Hosking
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
- IMPACT SRC, Deakin University, Geelong, Victoria, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - G Duque
- Department of Medicine-Western Health, The University of Melbourne, Level 3, WCHRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
| | - D Green
- Department of Medicine-Western Health, The University of Melbourne, Level 3, WCHRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
| | - T O Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Carleton RN, Afifi TO, Turner S, Taillieu T, El-Gabalawy R, Sareen J, Asmundson GJG. Chronic pain among public safety personnel in Canada. Canadian Journal of Pain 2017; 1:237-246. [PMID: 35005358 PMCID: PMC8730622 DOI: 10.1080/24740527.2017.1410431] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Chronic pain is highly prevalent in the general population and may be even higher among public safety personnel (PSP; e.g., correctional officers, dispatchers, firefighters, paramedics, police). Comprehensive data on chronic pain among diverse Canadian PSP are relatively sparse. Aims: The current study was designed to provide initial estimates of chronic pain frequency and severity among Canadian PSP. Methods: Estimates of chronic pain frequency and severity (i.e., intensity and duration) at different bodily locations were derived from self-reported data collected through an online survey. Participants included 5093 PSP (32.5% women) grouped into six categories (i.e., call center operators/dispatchers, correctional officers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police [RCMP]). Results: Substantial proportions of participants reported chronic pain, with estimates ranging from 35.3% to 45.4% across the diverse PSP categories. Across PSP categories, chronic lower back pain was the most prevalent. For some pain locations, firefighters and municipal/provincial police reported lower prevalence, but paramedics reported lower intensity, and duration, than some other PSP groups. Over 50% of RCMP and paramedics reporting chronic pain indicated that the pain was associated with an injury related to active duty. Conclusions: Discrepancies emerged across PSP members with respect to prevalence, location, and severity. The current data suggest that additional resources and research are necessary to mitigate the development and maintenance of distressing or disabling chronic pain for Canadian PSP.
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Affiliation(s)
- R. N. Carleton
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - T. O. Afifi
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S. Turner
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - T. Taillieu
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - R. El-Gabalawy
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J. Sareen
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - G. J. G. Asmundson
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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Sareen J, Henriksen CA, Stein MB, Afifi TO, Lix LM, Enns MW. Common mental disorder diagnosis and need for treatment are not the same: findings from a population-based longitudinal survey. Psychol Med 2013; 43:1941-1951. [PMID: 23217846 DOI: 10.1017/s003329171200284x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Controversy exists regarding whether people in the community who meet criteria for a non-psychotic mental disorder diagnosis are necessarily in need of treatment. Some have argued that these individuals require treatment and that policy makers need to develop outreach programs for them, whereas others have argued that the current epidemiologic studies may be diagnosing symptoms of distress that in many cases are self-limiting and likely to remit without treatment. All prior studies that have addressed this issue have been cross-sectional. We examined the longitudinal outcomes of individuals with depressive, anxiety and substance use (DAS) disorder(s) who had not previously received any treatment. Method Data came from a nationally representative US sample. A total of 34 653 non-institutionalized adults (age ≥20 years) were interviewed at two time points, 3 years apart. DAS disorders, mental health service use and quality of life (QoL) were assessed at both time points. RESULTS Individuals with a DAS disorder who had not previously received any treatment were significantly more likely than those who had been previously treated to have remission of their index disorder(s) without subsequent treatment, to be free of co-morbid disorder(s) and not to have attempted suicide during the 3-year follow-up period (50.7% v. 33.0% respectively, p < 0.05). At wave 2, multiple linear regression demonstrated that people with a remission of their baseline DAS disorder(s) had levels of functioning similar to those without a DAS disorder. CONCLUSIONS Individuals with an untreated DAS disorder at baseline have a substantial likelihood of remission without any subsequent intervention.
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Affiliation(s)
- J Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.
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Pietrzak RH, Kinley J, Afifi TO, Enns MW, Fawcett J, Sareen J. Subsyndromal depression in the United States: prevalence, course, and risk for incident psychiatric outcomes. Psychol Med 2013; 43:1401-1414. [PMID: 23111093 DOI: 10.1017/s0033291712002309] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Subsyndromal depression (SD) may increase risk for incident major depressive and other disorders, as well as suicidality. However, little is known about the prevalence, course, and correlates of SD in the US general adult population. Method Structured diagnostic interviews were conducted to assess DSM-IV Axis I and II disorders in a nationally representative sample of 34 653 US adults who were interviewed at two time-points 3 years apart. RESULTS A total of 11.6% of US adults met study criteria for lifetime SD at Wave 1. The majority (9.3%) had <5 total symptoms required for a diagnosis of major depression; the remainder (2.3%) reported ⩾5 symptoms required for a diagnosis of major depression, but denied clinically significant distress or functional impairment. SD at Wave 1 was associated with increased likelihood of developing incident major depression [odds ratios (ORs) 1.72-2.05], as well as dysthymia, social phobia, and generalized anxiety disorder (GAD) at Wave 2 (ORs 1.41-2.92). Among respondents with SD at Wave 1, Cluster A and B personality disorders, and worse mental health status were associated with increased likelihood of developing incident major depression at Wave 2. CONCLUSIONS SD is prevalent in the US population, and associated with elevated rates of Axis I and II psychopathology, increased psychosocial disability, and risk for incident major depression, dysthymia, social phobia, and GAD. These results underscore the importance of a dimensional conceptualization of depressive symptoms, as SD may serve as an early prognostic indicator of incident major depression and related disorders, and could help identify individuals who may benefit from preventive interventions.
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Affiliation(s)
- R H Pietrzak
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA.
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Sareen J, Henriksen CA, Bolton SL, Afifi TO, Stein MB, Asmundson GJG. Adverse childhood experiences in relation to mood and anxiety disorders in a population-based sample of active military personnel. Psychol Med 2013; 43:73-84. [PMID: 22608015 DOI: 10.1017/s003329171200102x] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although it has been posited that exposure to adverse childhood experiences (ACEs) increases vulnerability to deployment stress, previous literature in this area has demonstrated conflicting results. Using a cross-sectional population-based sample of active military personnel, the present study examined the relationship between ACEs, deployment related stressors and mood and anxiety disorders. METHOD Data were analyzed from the 2002 Canadian Community Health Survey-Canadian Forces Supplement (CCHS-CFS; n = 8340, age 18-54 years, response rate 81%). The following ACEs were self-reported retrospectively: childhood physical abuse, childhood sexual abuse, economic deprivation, exposure to domestic violence, parental divorce/separation, parental substance abuse problems, hospitalization as a child, and apprehension by a child protection service. DSM-IV mood and anxiety disorders [major depressive disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic attacks/disorder and social phobia] were assessed using the composite international diagnostic interview (CIDI). RESULTS Even after adjusting for the effects of deployment-related traumatic exposures (DRTEs), exposure to ACEs was significantly associated with past-year mood or anxiety disorder among men [adjusted odds ratio (aOR) 1.34, 99% confidence interval (CI) 1.03-1.73, p < 0.01] and women [aOR 1.37, 99% CI 1.00-1.89, p = 0.01]. Participants exposed to both ACEs and DRTEs had the highest prevalence of past-year mood or anxiety disorder in comparison to those who were exposed to either ACEs alone, DRTEs alone, or no exposure. CONCLUSIONS ACEs are associated with several mood and anxiety disorders among active military personnel. Intervention strategies to prevent mental health problems should consider the utility of targeting soldiers with exposure to ACEs.
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Affiliation(s)
- J Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.
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