Canadian Armed Forces Veterans Research Articles

Mental health of Canadian Armed Forces Veterans: Review of population studies

Introduction: The mental health of Canadian Armed Forces (CAF) populations emerged as an important concern in the wake of difficult CAF deployments in the 1990s. This article is the first comprehensive summary of findings from subsequent surveys of mental health and well-being in CAF Veterans, undertaken to inform mental health service renewals by CAF Health Services and Veterans Affairs Canada (VAC). Methods: Epidemiological findings in journal publications and government reports were summarized from four cross-sectional national surveys: a survey of Veterans participating in VAC programs in 1999 and three surveys of health and well-being representative of whole populations of Veterans in 2003, 2010, and 2013. Results: Although most Veterans had good mental health, many had mental health problems that affected functioning, well-being, and service utilization. Recent Veterans had a higher prevalence of mental health problems than the general Canadian population, earlier-era Veterans, and possibly the serving population. There were associations between mental health conditions and difficult adjustment to civilian life, physical health, and multiple socio-demographic factors. Mental health problems were key drivers of disability. Comparisons with other studies were complicated by methodological, era, and cultural differences. Discussion: The survey findings support ongoing multifactorial approaches to optimizing mental health and well-being in CAF Veterans, including strong military-to-civilian transition support and access to effective mental and physical health services. Studies underway of transitioning members and families in the peri-release period of the military-to-civilian transition and longitudinal studies of mental health in Veterans will address important knowledge gaps.

Canadian Armed Forces Veterans living with chronic pain.

Canadian Armed Forces Veterans living with chronic pain.

The nature and impacts of deployment-related encounters with children among Canadian military Veterans: a qualitative analysis

ABSTRACT Background: As armed conflict grows increasingly complex, the involvement of children in armed violence across diverse roles is rising. Consequently, military personnel are more likely to encounter children during deployment. However, little is known about deployment-related encounters with children and their impact on the mental health of military personnel and Veterans. Objective: This study qualitatively examines the nature and impacts of deployment-related encounters with children. Methods: We conducted semi-structured interviews with 16 Canadian Armed Forces Veterans, eliciting rich information on the nature of child encounters on deployment, the psycho-social-spiritual impacts of these encounters, and perceptions of support. Interview transcripts were analysed using thematic analysis. Results: Six primary themes were identified: types of encounters (i.e. factual aspects of deployment-related encounters with children), contextual factors (i.e. aspects of the mission, environment, and personal context relevant to one’s experience of the encounter), appraisals of encounters (i.e. sensory or sense-making experiences relevant to the encounter), impacts of encounters (i.e. psycho-social, existential, and occupational impacts), coping strategies engaged in both during and after deployment, and support experiences, describing both formal and informal sources of support. Conclusions: Encounters with children are diverse and highly stressful, resulting in impacts pertinent to mental health, including psychological and moral distress, and difficulties with identity, spirituality, and relationships. These impacts are prompted by complex interactions among appraisals, expectations of morality, cultural norms, and professional duties and are amplified by various personal factors (e.g. childhood maltreatment history, parenthood), feelings of unpreparedness, and lack of post-deployment support. Implications for prevention, intervention, and policy are discussed with the aim of informing future efforts to safeguard and support military personnel facing a high likelihood of encounters with children.

‘There’s no club, absolutely nothing’: Experiences of parents of Veterans living with illnesses and injuries in Canada

LAY SUMMARY Parents of Veterans are often excluded from literature or programs surrounding military and Veteran families. Parents can play an important role in their adult child’s life following an operational stress injury. Little research has been done to look at how supporting an adult child may affect the parents. Parents of Canadian Armed Forces Veterans were interviewed to discuss their experiences supporting an ill or injured adult child. Parents reported taking on many additional responsibilities and often feel worried, guilty, and lost. These demands impacted their own health, well-being, finances, jobs, and relationships. They described feeling forgotten and betrayed by the lack of support and programs available for them. It is important that all parents are given the support and programs required, demonstrating a need for more in-depth explorations of what families of Veterans experience and need in Canada.

Adult children in Canadian military families (1950–91): Balancing demands with capabilities

LAY SUMMARY The focus of this study was on family and community. Interviews with 23 adult children of Canadian Armed Forces Veterans who served between the Korean War and the Gulf War suggested key capabilities were developed that supported them in meeting demands and contributed to adaptation over the course of their lives. Living on military bases was identified as a significant resource shaping identities, intensifying bonds with others who also grew up as military children in that era. Participants shared insights on how their experiences could inform contemporary military family support programs and policies.

Canadian Armed Forces Veterans' Perspectives on the Effects of Exposure to Children in Armed Conflict During Military Service: Protocol for a Qualitative Study.

The mental health of military personnel has garnered increased attention over the last few decades; however, the impacts of perpetuating, observing, or failing to prevent acts that transgress deeply held moral standards, referred to as moral injuries, are less understood, particularly in relation to encounters with children during deployment. This paper describes a multiphased research protocol that centers around the lived experiences of Canadian Armed Forces (CAF) Veterans to understand how encounters with children during military deployments impact the well-being and mental health of military personnel. This study has four objectives: (1) highlight the lived experiences of CAF Veterans who encountered children during military deployments; (2) improve understanding of the nature of experiences that military personnel faced that related to observing or engaging with children during military service; (3) improve understanding of the mental health impacts of encountering children during military service; and (4) use participatory action research (PAR) to develop recommendations for improving preparation, training, and support for military personnel deployed to contexts where encounters with children are likely. The research project has 2 main phases where phase 1 includes qualitative interviews with CAF Veterans who encountered children during military deployments and phase 2 uses PAR to actively engage Canadian Veterans with lived experiences of encountering children during military deployments, as well as health professionals and researchers to identify recommendations to better address the mental health effects of these encounters. As of January 26, 2024, a total of 55 participants and research partners have participated in the 2 phases of the research project. A total of 16 CAF Veterans participated in phase 1 (qualitative interviews), and 39 CAF Veterans, health professionals, and researchers participated in phase 2 (PAR). The results for phase 1 have been finalized and are accepted for publication. Data collection and analysis are ongoing for phase 2. Prioritizing and valuing the experiences of CAF Veterans has deepened our understanding of the intricate nature and impacts of potentially morally injurious events involving children during military deployments. Together with health professionals and researchers, the PAR approach empowers CAF Veterans to articulate important recommendations for developing and improving training and mental health support. This support is crucial not only during the deployment cycle but also throughout the military career, helping lessen the effects of moral injury among military personnel. DERR1-10.2196/57146.

Evidence for Locus Coeruleus–Norepinephrine System Abnormality in Military Posttraumatic Stress Disorder Revealed by Neuromelanin-Sensitive Magnetic Resonance Imaging

BackgroundThe complex neurobiology of posttraumatic stress disorder (PTSD) calls for the characterization of specific disruptions in brain functions that require targeted treatment. One such alteration could be an overactive locus coeruleus (LC)–norepinephrine system, which may be linked to hyperarousal symptoms, a characteristic and burdensome aspect of the disorder. MethodsStudy participants were Canadian Armed Forces veterans with PTSD related to deployment to combat zones (n = 34) and age- and sex-matched healthy control participants (n = 32). Clinical measures included the Clinician-Administered PTSD Scale for DSM-5, and neuroimaging measures included a neuromelanin-sensitive magnetic resonance imaging scan to measure the LC signal. Robust linear regression analyses related the LC signal to clinical measures. ResultsCompared with control participants, the LC signal was significantly elevated in the PTSD group (t62 = 2.64, p = .010), and this group difference was most pronounced in the caudal LC (t56 = 2.70, Cohen’s d = 0.72). The caudal LC signal was also positively correlated with the severity of Clinician-Administered PTSD Scale for DSM-5 hyperarousal symptoms in the PTSD group (t26 = 2.16, p = .040). ConclusionsThese findings are consistent with a growing body of evidence indicative of elevated LC-norepinephrine system function in PTSD. Furthermore, they indicate the promise of neuromelanin-sensitive magnetic resonance imaging as a noninvasive method to probe the LC-norepinephrine system that has the potential to support subtyping and treatment of PTSD or other neuropsychiatric conditions.

Canadian Veterans’ Experiences of Living with Chronic Pain: A Descriptive Qualitative Study

ABSTRACT Background An estimated 30% of veterans live with chronic pain, compared to 20% of Canadians in the general population. Veterans face health care challenges upon release from the military, increasing difficulties in obtaining chronic pain care. Aims We explored experiences of Canadian Armed Forces veterans living with chronic pain, their transition from military to civilian care, perceived barriers and facilitators to chronic pain care, and impacts of their pain on the domains of well-being. Methods We conducted a qualitative descriptive study using semistructured interviews. We used a deductive/inductive approach to derive themes and concepts from interview transcripts. Results Thirty-five veterans living with chronic pain participated. Participants reported that pain affected their lives in numerous ways, including negatively impacting relationships and limiting activities of daily living and leisure. They identified barriers to care, including lack of access to family doctors or health care services, reluctance to ask for help, and challenges in obtaining coverage for services from Veterans Affairs Canada. Facilitators included support from other veterans and online resources. Chronic pain had bidirectional effects on domains of well-being. Conclusions Experiences of pain varied among Canadian veterans, and military culture played a role in perceptions and management of pain. Barriers and facilitators to chronic pain care were highlighted from their time in the military into their transition to civilian care. Participants described the impact of chronic pain on their overall well-being. Determining whether these findings are relevant to a larger population of Canadian veterans will be important for future research and knowledge translation to improve chronic pain care for Canadian veterans.

Exploring Veteran cultural competency in Canadian health care services

LAY SUMMARY On leaving the military, Canadian Armed Forces Veterans begin receiving health care services in the civilian community. Health care providers may not understand the military culture from which Veterans come and how military service can affect health and well-being. The purpose of this study was to identify what civilian health care providers need to know and do to provide culturally competent care to Canadian Veterans. Veterans and health care providers (family physicians and an occupational therapist) were interviewed, and specific knowledge, skills, and abilities were identified as important when establishing a quality health care relationship. This information can be used to develop resources for health care providers when beginning work with Veterans and their families, as well as for Veterans themselves as they transition to receiving care in civilian systems.

Contemporary prescription opioid use for pain among Canadian Armed Forces Veterans in Ontario

Contemporary prescription opioid use for pain among Canadian Armed Forces Veterans in Ontario

The space in between: Notes on a research-based play about moral injury and the transition to civilian life

LAY SUMMARYDominant biomedical framings of military trauma and resulting treatment approaches for mental health issues can sometimes fall short for military members and Veterans and risk individualizing and pathologizing normal human reactions to the emotions at the core of moral injury. Accordingly, philosophical and aesthetic exploration are warranted. This research-based theatre project was inspired by the work of Jonathan Shay, who looked to ancient Greek theatre to develop his concept of moral injury and argued that healing can only take place in community. In-depth interviews with nine Canadian Armed Forces Veterans led to the creation of a research-based play in which each scene represents one of the major themes identified during or after interview sessions (family, betrayal, brotherhood and mothering, public honour, sickness and coping). Sub-themes (heroism, the body, militarized masculinity, the role of women) became smaller or transition scenes in the play.

Impact of the COVID-19 pandemic on the mental health and well-being of Veterans’ spouses: a cross sectional analysis

BackgroundCOVID-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.MethodsBetween 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.ResultsReported 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.ConclusionsThis 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.

The roles of personality and resilience in associations between combat experiences and posttraumatic stress disorder among Canadian Armed Forces Veterans

Canadian Armed Forces (CAF) Veterans encounter unique challenges associated with their service. Exposure to service-related traumatic events places them at risk for developing adverse mental health outcomes, including posttraumatic stress disorder (PTSD). Our research aimed to assess whether the HEXACO personality model and resilience impacted associations between combat experiences and PTSD symptomatology in CAF Veterans in the past month. We recruited a sample of 245 CAF Veterans (81 % men; Mage = 48.47, SDage = 10.34) to complete a battery of questionnaires. PTSD symptoms were significantly associated with more combat experience, lower resilience, lower extraversion, higher emotionality, and lower agreeableness. However, personality traits did not moderate the relationship between combat experiences and PTSD symptoms. Overall, this research can be used to enhance researchers' and clinicians' understanding of personality traits as risk and protective factors for PTSD symptoms.

A qualitative study of the capabilities of family members of veterans living with operational stress injuries

AbstractObjectiveThis qualitative study explores the experiences of 26 family members supporting Canadian Armed Forces veterans living with mental health problems including operational stress injuries (OSIs).BackgroundThe research focusing on military‐connected families emphasizes the impacts of service on the families. Little is known about how families impact military veterans, particularly those diagnosed with OSIs. This research addresses that gap by revealing the capabilities and demands characterizing their everyday lives.MethodSemistructured interviews with 26 individuals identifying as family members of Canadian Armed Forces (CAF) veterans and three focus groups (three participants in each group for a total of nine) with family members of CAF veterans released within the preceding 10 years were conducted. The veterans were living with broadly defined diagnosed and undiagnosed mental health problems including OSIs. Using the family adjustment and adaptation (FAAR) model as an organizational framework, demands and capabilities embodied within the everyday lives of the family members were revealed.ResultsMonitoring the well‐being of the veteran, managing daily life, accessing and mobilizing resources, and caregiving were discussed as capabilities by participants in this study. These capabilities buffer the demands associated with the veteran's mental health problems.ConclusionsResults of this study endorse recommendations for family‐centered program and service development, modeled on approaches that recognize the systemic and relational contexts instrumental in supporting positive outcomes for veterans with OSIs.ImplicationsFurther research exploring the complex, interdependent, and interactional role of families supporting veterans with OSIs is warranted.

Predictors of self-reported health and psychological distress among recently released Canadian Armed Forces Veterans

ABSTRACT Recent research has found that, while the majority of Veterans report a positive adjustment to post-service life, the number who report experiencing transition difficulties is increasing. This study aims to describe some of the predictors of general health, mental health, and psychological distress, with a focus on recently released Canadian Armed Forces Veterans. Analysis was performed on a sample of Veterans (N=909) who released in the past five years. Separate stepwise logistic regression models explored the odds of reporting each negative health outcome, first controlling for individual and military characteristics, then exploring the relative associations of well-being indicators. Presence of chronic physical and mental health conditions was associated with all negative health outcomes. Other indicators associated with a higher likelihood of negative health outcomes included dissatisfaction with one’s main activity since retirement, having a low sense of community belonging, being disabled and not being in the workforce. Higher mastery was associated with a lower likelihood of distress and poor general health, and was marginally significantly associated with a lower likelihood of poor mental health. The results demonstrate the importance of individual factors, social integration, and chronic health conditions in predicting the health outcomes of recently released CAF Veterans.

Barriers and facilitators of help seeking among morally injured Canadian Armed Forces Veterans and service members: A qualitative analysis

LAY SUMMARY Moral injury (MI) refers to the psycho-spiritual consequences of extremely challenging events that threaten one’s moral beliefs and core values. MI is characterized by intense shame, guilt, anger, loss of trust in oneself and others, and social withdrawal — factors that may impede a person’s willingness to seek help for mental health problems. The authors analyzed interviews with 13 Canadian Armed Forces service members and Veterans struggling with MI. They identified themes representing four main barriers to help seeking (stigma, denial, no knowledge of problem or MI, negative perceptions of the military health system) and five main facilitators of help seeking (a sense of shared experience, screening, encouragement from others to seek help, purpose as motivation, alternatives to formal mental health care). The themes identified largely overlap with factors shown in previous research to be barriers to help seeking among military samples. The results of this study suggest that additional education on the mental health consequences associated with MI, and enhanced screening for this type of distress, may lead to increased support seeking among service members and Veterans struggling with MI.

Well-being of Canadian Armed Forces Veterans and Spouses of Veterans During the COVID-19 Pandemic: Protocol for a Prospective Longitudinal Survey.

BackgroundThe COVID-19 pandemic has resulted in significant changes to everyday life, including social distancing mandates, changes to health care, and a heightened risk of infection. Previous research has shown that Canadian Armed Forces (CAF) veterans are at higher risk of developing mental and physical health conditions. Veterans and their families may face unique social challenges that can compound with pandemic-related disruptions to negatively impact well-being.ObjectiveThis study aims to longitudinally characterize the mental health of CAF veterans and spouses of CAF veterans throughout the pandemic and to understand the dynamic influences of pandemic-related stressors on psychological health over time.MethodsWe employed a prospective longitudinal panel design using an online data collection platform. Study participation was open to all CAF veterans and spouses of CAF veterans residing in Canada. Participants were asked to complete a comprehensive battery of assessments representing psychological well-being, chronic pain, health care access patterns, physical environment, employment, social integration, and adjustment to pandemic-related lifestyle changes. Follow-up assessments were conducted every 3 months over an 18-month period. This study was approved by the Western University Health Sciences and Lawson Health Research Institute Research Ethics Boards.ResultsBaseline data were collected between July 2020 and February 2021. There were 3 population segments that participated in the study: 1047 veterans, 366 spouses of veterans, and 125 veterans who are also spouses of veterans completed baseline data collection. As of November 2021, data collection is ongoing, with participants completing the 9- or 12-month follow-up surveys depending on their date of self-enrollment. Data collection across all time points will be complete in September 2022.ConclusionsThis longitudinal survey is unique in its comprehensive assessment of domains relevant to veterans and spouses of veterans during the COVID-19 pandemic, ranging from occupational, demographic, social, mental, and physical domains, to perceptions and experiences with health care treatments and access. The results of this study will be used to inform policy for veteran and veteran family support, and to best prepare for similar emergencies should they occur in the future.International Registered Report Identifier (IRRID)DERR1-10.2196/34984

Validation of a Self-Assessment Tool for Identifying Need for Assistance in Military to Civilian Transition

A self-assessment tool was developed to encourage releasing service members to reflect on their preparedness for military to civilian transition and need for assistance. The aim of this paper was to examine its validity among recently released Canadian Armed Forces (CAF) members using data from the Canadian Armed Forces Transition and Well-Being Survey (CAFTWS). The survey was administered in 2017 to a total of 1,414 CAF Veterans (former CAF members), representing a response rate of 75%. The validity of the self-assessment tool was confirmed, as shown by the significant correlations between each of its indicators and variables corresponding to six domains of well-being: employment or other meaningful activity, finances, health, life skills and preparedness, social integration, and housing/physical environment. The potential utility of the self-assessment tool for assessing military to civilian transition outcomes was also supported by its significant associations with difficult adjustment to civilian life in the manner expected. The current study provides further evidence for the validity of the self-assessment tool for identifying needs for assistance that Veterans may have during military to civilian transition. The tool holds promise for encouraging transitioning members and families to seek assistance and should be considered as a complement to active screening.

Correlates of Perceived Military-to-Civilian Transition Challenges by Medical Release: An Analysis of the Canadian Armed Forces Transition and Well-Being Survey

The transition from military-to-civilian life may be difficult for military members, but early or unplanned release can be especially stressful, and may be associated with different challenges from those who planned their release. This study examined transition challenges, and identified whether associated factors differed by release type. The Canadian Armed Forces (CAF) Transition and Well-being Survey surveyed 1,414 recently released CAF Veterans (86% male; 52% 30‒49 years old; 58% Noncommissioned Members; 51% 20+ years of service; 58% Army) using a stratified random sample. Respondents indicated how challenging they perceived ten items related to the military-to-civilian transition (e.g., financial preparedness). They also were asked about their current health, release type (i.e., medical or non-medical release), demographic, and military characteristics. Results revealed that being female, releasing mid-career, having poorer health, and having fewer social provisions may place all Veterans at higher risk for transition challenges. However, certain correlates, such as age, rank, or education level, may be differentially associated with challenging transitions depending on whether Veterans released for medical or for other reasons. Identifying patterns of correlates for perceived challenges can provide insight into how to best support CAF members who are releasing for varying reasons – whether medically, or other circumstances.

Identifying Key Correlates of Social Well-Being among Canadian Armed Forces Veterans: An Analysis of the 2016 Life after Service Study

Many Veterans experience disruptions to their social connections during military to civilian transition. As low social support has been associated with difficulties adjusting to civilian life, there is value in better understanding social support in Veteran populations. The purpose of this study was to identify correlates of social support among recent Canadian Armed Forces (CAF) Veterans. Data were collected as part of the 2016 Life After Service Survey, which was administered to a sample of CAF Regular Force Veterans. This study focuses on more recently released Veterans, 5 years prior to the survey (n = 1,723) to better reflect the impact of transitioning to civilian life. Social support was measured using the 10-item Social Provision Scale. Regression models examined the relative associations of individual, release, and post-transition characteristics (i.e., family/household composition and main activity) with social support. Models explained up to 23% of the variance in social support. Lower social support was associated with being: male, older, of noncommissioned rank at release, and released involuntarily (p ≤ .05). Family/household composition, most notably living with a partner, was also associated with greater social support, especially among Veterans who were not in the workforce. Veterans’ main activity in the last year explained the most variance in social support, with a strong association noted for satisfaction with one’s main activity (p ≤ .001). Social support is an important and modifiable factor in the transition to civilian life. Results point to specific subgroups who may be at risk for low social support after military service. Supplemental data for this article is available online at https://doi.org/10.1080/21635781.2021.2007182 .