Canadian Armed Forces Personnel Research Articles

Fathering at a distance in the military: Techniques for presence and emotion work among Canadian Armed Forces fathers

LAY SUMMARY Many men aspire to involved parenting, but careers that require high mobility, such as military service, make this difficult. This study explored how military men father while deployed. Through interviews with Canadian Armed Forces personnel and spouses, techniques for fathering at a distance were identified, and implications for how military fathers maintain presence with their families were explored. Emotion work undertaken by fathers is also discussed. Understanding how fathering is accomplished at a distance can improve support for personnel, addressing concerns related to work-life balance that are a source of significant tension.

Optimizing military mental health and stress resilience training through the lens of trainee preferences: A conjoint analysis approach

ABSTRACT Effective mental health and stress resilience (MHSR) training is essential in military populations given their exposure to operational stressors. The scarcity of empirical evidence supporting the benefits of these programs emphasizes the need for research dedicated to program optimization. This paper aims to identify the relative importance of MHSR training attributes preferred by military members. Conjoint analysis (CA), an experimental method used to prioritize end-user preferences for product feature development, was conducted using an online survey with 567 Canadian Armed Forces (CAF) personnel. Participants made a series of choices between hypothetical MHSR training options that were systematically varied across seven training attributes. Each training attribute consisted of 3–4 variations in the nature of the attribute or its intensity. Participants also completed questions on health beliefs, mental health and previous MHSR training experiences, and demographics, to assess whether preferences varied by individual characteristics. CA demonstrated that instructor type, leadership buy-in, degree of skills practice, and content relevance/applicability were attributes of highest and relatively equal importance. This was followed by degree of accessible supplemental content. Lowest importance was placed on degree of behavioral nudging and demographic similarity between the trainee and trainer. Sociodemographic factors were not associated with MHSR training preferences. Programs that incorporate expert-led instruction, demonstrate leadership buy-in, embed practical applications within simulated stress environments, and provide a digitally-accessible platform to augment training may be well-received among military members. Understanding and accommodating personal preferences when designing MHSR training programs may increase relevance, foster acceptance and trust, and support sustained engagement.

A feasibility study assessing a program of care for chiropractors managing spinal pain in Canadian Armed Forces personnel

LAY SUMMARY Spinal pain is responsible for a large proportion of pain and disability in the Canadian Armed Forces (CAF). The authors developed and implemented a program of care (PoC) that included communication strategies and care pathways supporting chiropractic care for CAF personnel with spine-related problems. The authors tested the feasibility of implementing the PoC on two select CAF bases and found that it was feasible to implement, with a high rate of completion of patient outcomes, adherence to clinical pathways, and enhanced interprofessional communication and reporting. Participants reported satisfaction with the program. Successful implementation of a PoC could provide guidance and support for interprofessional collaborative care for CAF personnel with spine-related pain.

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

ObjectivesThe 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...

Moral Distress, Mental Health, and Risk and Resilience Factors among Canadian Armed Forces Personnel Deployed to Canadian Long-Term Care Facilities during COVID-19 (Operation LASER COVID-19 Response): Research Protocol and Participation Metrics.

The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID cases and COVID-related deaths among residents of long-term care facilities (LTCF). As part of Canada's response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (i.e., related to important values; e.g., witnessing human suffering). The objective of the research study is to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury and traditional mental health and well-being outcomes of Operation (Op) LASER LTCF CAF personnel. The objective of this manuscript is to document the methodology, implementation procedures, and participation metrics. A multimethod research initiative was conducted, consisting of two primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with online self-report questionnaires administered at three timepoints (3, 6, and 12 months post-deployment). The qualitative arm consisted of individual interviews conducted virtually, with a focus on understanding the nuanced lived experiences of individuals taking part in the Op LASER LTCF deployment. CAF personnel deployed to Op LASER LTCF (n = 2,595) were invited to participate in the study. Data collection is now complete. Overall, 1,088, 582, and 497 individuals responded to the survey at Time 1 (3 months), Time 2 (6 months), and Time 3 (12 months) post-deployment, providing a participation rate of 41.9%, 22.4%, and 19.2% for Time 1, Time 2, and Time 3, respectively. Data for all three timepoints was obtained from 212 participants (representing 19.5% of all Time 1 responses). Interest in participating in qualitative interviews surpassed expectations with over 200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Op LASER LTCF role, and province. In total, 53 interviews were conducted. The data generated by this research has the potential to inform and better understand the well-being and mental health of Op LASER LTCF personnel over time, identify general and Op LASER LTCF-specific risk and protective factors, provide necessary supports to the military personnel who served in this mission, and to inform preparation and interventions for future missions, especially those more of a domestic and humanitarian nature. DERR1-10.2196/44299.

They stand on guard: Canadian Armed Forces and public safety personnel in the context of global crises

They stand on guard: Canadian Armed Forces and public safety personnel in the context of global crises

Recommendations for follow-up care during post-deployment screening of Canadian Armed Forces personnel: how well does self-reported mental health predict referral decisions?

ObjectiveCanadian Armed Forces (CAF) post-deployment screening aims to facilitate early care for members with mental health issues. The process consists of a questionnaire to screen for mental health problems, followed...

Blast-Induced Neurotrauma Results in Spatially Distinct Gray Matter Alteration Alongside Hormonal Alteration: A Preliminary Investigation

Blast-induced neurotrauma (BINT) frequently occurs during military training and deployment and has been linked to long-term neuropsychological and neurocognitive changes, and changes in brain structure. As military personnel experience frequent exposures to stress, BINT may negatively influence stress coping abilities. This study aimed to determine the effects of BINT on gray matter volume and hormonal alteration. Participants were Canadian Armed Forces personnel and veterans with a history of BINT (n = 12), and first responder controls (n = 8), recruited due to their characteristic occupational stress professions. Whole saliva was collected via passive drool on the morning of testing and analyzed for testosterone (pg/mL), cortisol (μg/dL), and testosterone/cortisol (T/C) ratio. Voxel-based morphometry was performed to compare gray matter (GM) volume, alongside measurement of cortical thickness and subcortical volumes. Saliva analyses revealed distinct alterations following BINT, with significantly elevated testosterone and T/C ratio. Widespread and largely symmetric loci of reduced GM were found specific to BINT, particularly in the temporal gyrus, precuneus, and thalamus. These findings suggest that BINT affects hypothalamic-pituitary-adrenal and -gonadal axis function, and causes anatomically-specific GM loss, which were not observed in a comparator group with similar occupational stressors. These findings support BINT as a unique injury with distinct structural and endocrine consequences.

Moral injury associated with increased odds of past-year mental health disorders: a Canadian Armed Forces examination

ABSTRACT Background: Potentially morally injurious experiences (PMIEs) are common during military service. However, it is unclear to what extent PMIEs are related to well-established adverse mental health outcomes. Objective: The objective of this study was to use a population-based survey to determine the associations between moral injury endorsement and the presence of past-year mental health disorders in Canadian Armed Forces (CAF) personnel and Veterans. Methods: Data were obtained from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS). With a sample of 2,941 respondents, the weighted survey sample represented 18,120 active duty and 34,380 released CAF personnel. Multiple logistic regressions were used to assess the associations between sociodemographic characteristics (e.g. sex), military factors (e.g. rank), moral injury (using the Moral Injury Events Scale [MIES]) and the presence of specific mental health disorders (major depressive episode, generalized anxiety disorder, panic disorder, social anxiety disorder, PTSD, and suicidality). Results: While adjusting for selected sociodemographic and military factors, the odds of experiencing any past-year mental health disorder were 1.97 times greater (95% CI = 1.94–2.01) for each one-unit increase in total MIES score. Specifically, PTSD had 1.91 times greater odds (95% CI = 1.87–1.96) of being endorsed for every unit increase in MIES total score, while odds of past-year panic disorder or social anxiety were each 1.86 times greater (95% CI = 1.82–1.90) for every unit increase in total MIES score. All findings reported were statistically significant (p < .001). Conclusion: These findings emphasize that PMIEs are robustly associated with the presence of adverse mental health outcomes among Canadian military personnel. The results of this project further underscore the necessity of addressing moral injury alongside other mental health concerns within the CAF.

Bariatric Surgery Should Be Offered to Active-Duty Military Personnel: a Retrospective Study of the Canadian Armed Forces’ Experience

PurposeLike most Western armies, obesity affects Canadian Armed Forces (CAF) personnel. Bariatric surgery is an effective treatment for obesity. However, this is not yet accepted for active-duty soldiers in most countries. The CAF have approved bariatric surgery since 2005. Our aim is to assess weight loss, resolution of obesity-related comorbidities, and impacts of bariatric surgery on military careers.Materials and MethodsWe retrospectively reviewed the perioperative data, long-term bariatric results, and military outcomes of 108 CAF active-duty military personnel who underwent bariatric surgery in Canada over a 61-month period.ResultsThe cohort was predominantly male (66.7%) with a mean preoperative body mass index (BMI) of 43.6 ± 5.8 kg/m2. Roux-Y gastric bypass was performed in 59 patients, sleeve gastrectomy in 29, and gastric banding in 20. All the surgeries were performed laparoscopically. The total body weight loss at the last follow-up visit was 22.5 ± 11.0%. Remission or improvement of hypertension was observed in 91.2%, diabetes in 85.7%, gastroesophageal reflux disorder (GERD) in 43.6%, sleep apnea in 43.1%, and dyslipidemia in 42.9%. One patient (0.9%) was medically released due to postoperative complications. Fifteen patients (13.9%) were deployed postoperatively. The combined deployable and possibly deployable statuses increased from 35.4% preoperatively to 47.9% postoperatively.ConclusionThis is the largest series of bariatric surgeries performed in active-duty military personnel. Bariatric surgery is effective and safe and improves deployability without impairing military careers. These results are relevant to the military of many industrialized countries. Bariatric surgery should be considered for all active-duty military personnel who meet surgical criteria for the treatment of obesity.Graphical

Montreal Cognitive Assessment scores of Veterans and Canadian Armed Forces personnel seeking mental health treatment

LAY SUMMARY The Montreal Cognitive Assessment (MoCA) is a test of mild cognitive impairment that is commonly administered to military personnel seeking mental health treatment. However, there is little research on the average MoCA score for military Veterans. This study looked at MoCA scores provided by Canadian Armed Forces members and Veterans receiving services for an operational-related mental health condition. Scores below the cut-off for mild cognitive impairment were not uncommon and were related to education level, as well as to severity of posttraumatic stress disorder and depression. These findings will help clinicians better contextualize score variation among clients.

Unethical behaviour in the military: The role of supervisor ethicality, ethical climate, and right-wing authoritarianism

ABSTRACT Using an anonymous self-report survey of 350 Canadian Armed Forces (CAF) personnel, this study investigated the effect of perceptions of the ethicality of one’s immediate supervisor (supervisor ethics), right-wing authoritarianism (RWA), and ethical climate on self-reported unethical behavior in the form of discrimination and obeying an unlawful command (past behavior, behavioral intentions). As well, we investigated how supervisor ethics and RWA interact when predicting unethical behavior, and whether ethical climate mediated the relation between supervisor ethics and self-reported unethical behavior. Unethical behavior depended on perceptions of the ethicality of one’s supervisor and RWA. RWA predicted discrimination toward a gay man (behavioral intentions), and supervisor ethics predicted discrimination against outgroups of people, and obedience of an unlawful command (past behavior). As well, the effects of ethical supervision on discrimination (past behavior, behavioral intentions) depended on participants’ level of RWA . Finally, ethical climate mediated the relation between supervisor ethics and obeying an unlawful command, such that higher perceptions of supervisor ethics led to a higher ethical climate, which led to less obedience of an unlawful command in the past. This suggests that leaders can affect the ethical climate of on organization, which in turn affects ethical behavior of followers.

Validation of the mental health continuum: Short form among Canadian Armed Forces personnel.

Compared to the general Canadian population, military members exhibit a higher prevalence of depressive disorders, anxiety disorders, and post-traumatic stress disorder. However, there is a paucity of research investigating the extent to which military members experience positive mental health. Validation of positive mental health measures, including the Mental Health Continuum - Short Form (MHC-SF), is necessary to determine whether well-being can be assessed in a valid and reliable manner among Canadian Armed Forces (CAF) military members. The purpose of this research was to assess the internal consistency reliability, convergent validity, factor structure, and measurement invariance of the MHC-SF among CAF Regular Force and Reserve Force military members. Data were drawn from the nationally representative 2013 Canadian Forces Mental Health Survey (CFMHS) conducted by Statistics Canada. A random sample of 8,200 CAF military personnel completed the CFMHS, representing 64,400 Regular Force and 4,460 Reserve Force CAF personnel. As expected, all three MHC-SF subscales (psychological, social, and emotional well-being) correlated positively with life satisfaction, self-rated mental health, sense of belonging, and social support, and correlated negatively with psychological distress and disability due to health conditions. Internal consistency was high. Confirmatory factor analysis supported the three-factor structure of the MHC-SF, and measurement invariance was satisfied. Findings provided support for the reliability, convergent validity, factorial validity, and measurement invariance of the MHC-SF among both Regular Force and Reserve Force military samples. Therefore, researchers and clinicians can reliably implement the MHC-SF as a tool to assess, interpret, and predict military members' psychological, social, and emotional well-being.

Risk Factors for Moral Injury Among Canadian Armed Forces Personnel.

ObjectivesThe 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.MethodsData 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.ResultsWhen 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).ConclusionExposure 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.

Injury surveillance in the Canadian Armed Forces: An environmental scan

LAY SUMMARY Injuries can affect the operational readiness, wellness, and careers of Canadian Armed Forces (CAF) personnel. Many injuries are preventable; thus, it is important for the CAF to create a sustainable, accurate, and timely injury surveillance system (ISS) that can be used to describe injury incidence, populations at risk, and other causal factors to effectively direct injury prevention efforts. As a first step in the creation of an ISS, the authors conducted a rapid environmental scan that included a review of both the peer-reviewed scientific literature and publicly available information, along with an internal organization scan, to gather information on ISS facilitators, barriers, recommendations, data sources, and potential injury indicators. The results of this work will be used to plan the next steps in the development and implementation of the CAF ISS. In addition, this information can be used to facilitate engagement and collaboration with stakeholders and decision makers to ensure that the ISS collects and reports key data needed to target and prioritize interventions most likely to have the greatest impact on reducing injuries and improving the health and operational readiness of CAF personnel.

Use of the Operational Stress Injury Social Support (OSISS) Program in a Nationally Representative Sample of Canadian Active Duty Military Personnel

IntroductionRecent research evidence indicates increased mental health needs among Canadian Armed Forces (CAF) personnel. Research evidence also indicates that a portion of CAF personnel with mental health needs do not seek professional mental health care or significantly delay initiating treatment. The current study was designed to examine individual correlates of use for a paraprofessional peer support program available to CAF personnel, veterans, and their families (i.e., Operational Stress Injury Social Support [OSISS]). Methods: Participants included 6,700 CAF Regular members. Prevalence estimates were computed for all variables of interest and hierarchical logistic regression analyses served to identify correlates of OSISS use. Results: The results indicate that meeting criteria for posttraumatic stress disorder had the strongest association with OSISS use (OR = 22.31 [95% CI = 13.36-37.28]), but only a small number of CAF personnel (1.2%) seek help from OSISS. Discussion: Results suggest that OSISS use was limited and tended to occur in conjunction with professional mental health service use. Efforts could be engaged to emphasize the availability of peer support as a resource for all operational stress injuries and to increase the reach of peer support programs for military personnel.

Trials and tribulations among members of Canada's Defence Team early in the pandemic: key insights from the COVID-19 Defence Team Survey.

Due to the unprecedented impact of COVID-19, there is a need for research assessing pandemic-related challenges and stressors. The current study aimed to assess key concerns and general well-being among members of Canada's Defence Team, including Canadian Armed Forces personnel and members of the Department of National Defence (DND) Public Service. The COVID-19 Defence Team Survey was administered electronically to Defence Team staff in April and May of 2020 and was completed by 13 688 Regular Force, 5985 Reserve Force and 7487 civilian DND Public Service personnel. Along with demographic information, the survey included assessments of work arrangement, pandemic-related concerns, general well-being and social and organizational support. Weighted data (to ensure representation) were used in all analyses. The majority of respondents were working from home, with a small minority unable to work due to restrictions. Though many concerns were endorsed by a substantial proportion of respondents, the most prevalent concerns were related to the health and well-being of loved ones. The majority of respondents reported their partner, family, supervisors, friends, colleagues and children provided general support. Half of the civilian defence staff and one-third of military respondents reported a decline in mental health. Women, younger respondents, those with dependents and, in some cases, those who were single without children were at risk of lower well-being. The pandemic has negatively impacted a substantial portion of the Defence Team. When responding to future crises, it is recommended that leaders of organizations provide additional supports to higher-risk groups and to supervisors who are ideally positioned to support employees during challenging times.

Depression and Anxiety as Mediators of PTSD Symptom Clusters and Pain in Treatment-Seeking Canadian Forces Members and Veterans.

Chronic pain (CP) commonly presents alongside psychiatric conditions such as depression, PTSD, and generalized anxiety. The current study sought to better understand this complex relationship by determining whether anxiety and depression symptom severity mediated the relationship between DSM-5 PTSD symptom clusters and pain symptoms in a sample of 663 Canadian Armed Forces (CAF) personnel and veterans seeking treatment for mental health conditions. Generalized anxiety disorder, depression, and PTSD symptom severity were measured using self-report scales provided as part of a standard intake protocol. Pain symptoms were measured using the Bodily Pain subscale of the SF-36 (SF-36 BPS). Linear regressions were used to explore the relationship between PTSD symptom clusters, depression, anxiety, and pain. Bootstrapped resampling analyses were employed to test mediation effects. The average SF-36 BPS score in this sample was 36.6, nearly 1.5 SDs below the population health status, enforcing the salience of pain symptoms as a concern for veterans and CAF seeking treatment for military-related psychiatric conditions. The effects of PTSD symptom clusters avoidance, negative mood and cognitions, and arousal on pain were fully mediated by anxiety and depression severity. However, the effect of intrusion on pain was not mediated by depression and only partly mediated by anxiety. Findings emphasize the importance of including anxiety and depression in models of PTSD and pain, particularly in samples where psychiatric comorbidity is high. Clinically, results highlight the need for improved treatment regimens that address pain symptoms alongside common psychiatric comorbidities.

Building Connections through Sport and Physical Activity for Ill and Injured Military Members and Veterans: Determining the Optimal Time for Program Involvement

Research has shown that physical fitness can benefit individuals with an injury or illness, enhancing their psycho-social health and well-being. The Soldier On program supports Canadian Armed Forces personnel and veterans in overcoming their physical and mental health injuries through promotion of physical activity and sport. Using a qualitative research design, a key question was investigated: are there optimal time points during which ill/injured military members and veterans have higher levels of readiness that would facilitate maximum benefit from program involvement? Semi-structured, in-person interviews were conducted with participants (n = 75) at Soldier On events across Canada. Results suggest there may be critical points following the onset of a significant injury/illness where event participation has the potential to enhance the positive impacts. For service members, this was identified to be following the official medical release decision and duration leading up to their transition out of the military. For veterans, it was found to be only after there was sufficient time post-release to allow for the full reintegration into civilian life. Findings suggest that when considering enrollment of military members and veterans into physical and sport therapy programs, it is important to tailor programs to these critical time periods for each individual.

Development of a Risk Prediction Model for Assessing Dental Readiness in the Canadian Armed Forces.

The establishment and sustainment of a high state of dental readiness in the Canadian Armed Forces (CAF) are the primary missions of the Royal Canadian Dental Corps. The objective of this study was to develop a risk prediction tool to estimate dental readiness in active CAF personnel. The prediction model was developed to predict the classification of non-deployable (yes/no) within 12 months (primary) and 18 months (secondary) using both dental history data (including dental attendance, restorations, root canals, and third molar status) and demographic information. Two cohorts were used for development: a recruit cohort who enrolled between April 2016 and March 2017 and a longer-serving member (LSM) cohort who had their recall dental exam between May 2014 and October 2014. Each group was followed until April 26, 2018. Elastic net logistic regression models were used to create the models. Model performance was evaluated using area under the curve, F1, and the Brier score. The recruit cohort included 2,828 individuals and the LSM cohort included 2,398 individuals. Overall, the classification of non-deployable occurred in 5.1% of the study population within 12 months and 9.6% of the population within 18 months. The models predicted the outcome with an area under the receiver operating curve of 0.77 in recruits and 0.70 in LSMs. The prediction model shows potential but its performance and usability could be further improved through the consistent collection of high quality, discretely entered, epidemiological data following standardized diagnostic terminology and coding. A recalibrated and automated version of this model could assist in decision making, resource allocation, and the enhancement of military dental readiness.