Canadian Armed Forces Research Articles

Factor structure of the parent-rated strengths and difficulties questionnaire in a sample of Canadian children from military families.

The Strengths and Difficulties Questionnaire is a 25-item screening tool designed to measure the emotional and behavioral well-being of children. It includes five subscales including Emotional Symptoms, Conduct Problems, Peer Problems, Hyperactivity-Inattention and Prosocial Behavior. While the Strengths and Difficulties Questionnaire has been studied extensively on a global scale, it has not yet been evaluated among Canadian children from military families. This study used data collected from spouses and partners of Canadian Armed Forces members who completed a questionnaire assessing their quality of life, including the Strengths and Difficulties Questionnaire for respondents with children aged 3-16 years (N = 651). Using two independent randomized samples drawn from the overall group of respondents, the factorial structure was studied using exploratory factor analysis (n = 323) and confirmatory factor analysis (n = 328). Results of this study provide evidence for the factorial validity of the parent-rated Strengths and Difficulties Questionnaire for a sample of children from military families. Specifically, the exploratory factor analysis and confirmatory factor analysis supported the original proposed five-factor solution (CFI = 0.84; TLI = 0.82; SRMR = 0.073; RMSEA = 0.065) with good internal reliability of the Total Difficulties Scale and subscales. Overall, the results of this study were found to align with past research findings on the Strengths and Difficulties Questionnaire and support the future utility of this tool in assessing the well-being of Canadian children from military families.

Negative cognitions in the context of suicidality after exposure to military-related potentially morally injurious events

LAY SUMMARY Moral injury (MI) refers to the psycho-spiritual consequences of events that deeply transgress a person’s core moral beliefs and values. Such events are reportedly common in the military context, and strong associations have been demonstrated between exposure to potentially morally injurious events (PMIEs) and suicidality. This study explored differences in negative cognitions between treatment-seeking Canadian Armed Forces members and Veterans with and without current suicidal thoughts and behaviours (STBs), all of whom reported current distress in response to a PMIE. Those exhibiting STBs reported stronger negative beliefs about the self. Scores for event-related guilt cognitions and self-blame were similar across individuals with and without STBs. Individuals reporting STBs also displayed higher depression and symptoms of posttraumatic stress disorder. The results suggest that severity of mental health symptoms and negative self-evaluations may be most pertinent in their association with suicidality in the MI context. Results remain preliminary, however, and additional research is needed to properly examine how event and self-related evaluations affect suicidality after PMIEs.

Psychosocial factors and military-to-civilian transition challenges: A dyadic analysis of Veterans and their spouses

LAY SUMMARY Limited research has explored the influence Veterans and their spouses have on each other’s experiences during Veterans’ transition from military to civilian life. Analyses of the Canadian Armed Forces Transition and Well-being Survey were conducted to examine whether perceived challenges among Veterans and their spouses during this transition (i.e., whether they experienced financial difficulties, had trouble finding a health care provider, or felt a loss of military identity) are associated with the extent to which each believes they are able to handle stress, have access to social support, and have a strong sense of belonging to their community. Results show how the experiences of both Veterans and their spouses might be interdependent and emphasize the importance of ensuring each is better prepared for, and supported, during this important period of change.

MILTITARY POLICE TRAUMA AND MENTAL HEALTH SUPPORT

On November 23, 2022, Master Warrant Officer (MWO) John Palmer, CD, presented on Military Police Trauma and Mental Health Support. The presentation was followed by a question-and-answer period with questions from the audience and CASIS-Vancouver executives. The key points discussed were the mental health and impact of trauma on Military Police (MP) personnel, the diverse range of services which are coordinated through the different Canadian Armed Forces (CAF) programs, and the realization of how MP personnel are continually exposed to trauma sources (domestic and outside of Canada deployments). Received: 2022-12-08Revised: 2022-12-09

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.

Cardiometabolic Multimorbidity and Activity Limitation Among Older Canadians

<h3>Research Objectives</h3> To i) estimate the prevalence of activity limitation among Canadians with cardiometabolic multimorbidity (CM); and ii) to quantify the association between CM and activity limitation. Cardiometabolic multimorbidity is the diagnosis of two or more of stroke, heart disease and diabetes. <h3>Design</h3> Cross-sectional population study (n=13,118,474) using the Canadian Longitudinal Study on Aging (CLSA) data. <h3>Setting</h3> Canada. <h3>Participants</h3> The CLSA includes Canadians aged 45–85 years, and excludes persons living on federal First Nations reserves, full-time members of the Canadian Armed Forces, individuals living in institutions, and people who were not able to respond in English or French. In our analyses, we further excluded individuals with missing or incomplete data. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> CM was operationally defined as the diagnosis of two or more of diabetes/prediabetes, myocardial infarction, and stroke. Activity limitation as defined in the International Classification of Functioning, Disability and Health, is "difficulties an individual may have in executing activities." Activity limitation was evaluated using the Older Americans Resources and Services scale. <h3>Results</h3> The estimated prevalence of activity limitation among participants living with CM was 27.4% compared with 7.5% with no cardiometabolic conditions. Activity limitation increased in prevalence and severity with increasing numbers of cardiometabolic conditions. People with CM had increased odds of activity limitation compared with those without any cardiometabolic conditions (adjusted relative risk ratio = 3.99, 95% confidence interval [3.35–4.75]), and the odds increased with each additional condition. Stroke survivors had greater odds of activity limitation than those without a history of stroke and the same number of cardiometabolic conditions. <h3>Conclusions</h3> Activity limitation is common among Canadians living with CM. Odds of activity limitation increase with each additional cardiometabolic condition, especially for stroke survivors. <h3>Author(s) Disclosures</h3> None to report.

2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

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.

Assessment of Training Load, Sleep, Injuries, and Operational Physical Performance During Basic Military Qualification.

Optimizing training load (TL) and sleep is essential to maximize physical performance and prevent musculoskeletal injuries (MSKIs) for Canadian forces recruits during the 10-week basic military qualification (BMQ) course. The purpose of this study was to assess the TL, sleep duration, the occurrence of MSKIs during the BMQ, and the operation fitness performance during the BMQ. Forty Canadian recruits, eight females and 32 males, (age 24 ± 5 years; height 176.4 ± 10.4 cm), were monitored with an accelerometer (GENEActiv) on their wrist between weeks 1 and 9 to evaluate the TL and sleep duration. During weeks 2 and 10, the recruits completed an operational fitness evaluation. Injury surveillance was performed over 10 weeks. TL intensity was significantly different (P = 0.0001) from week to week. The weekly average total time of moderate and vigorous physical activity was 189.7 ± 48.1 min and 44.7 ± 15.2 min, respectively. The average sleep duration was 5.4 ± 0.4 h per night and decreased to 4.2 h ± 0.4 during field exercises. A significant difference in sleep duration was observed between recruits with and without a MSKI. The recruits accumulated a total of 95 days under medical restrictions with an average of 3.8 consecutive days. The VO2peak estimated from the Fitness for Operational Requirements of Canadian Armed Forces Employment job-based simulation test significantly improved from weeks 2 to 10 (pre, 47.1 ± 6.3; post: 50.2 ± 5.8; P = 0.001). TL is of high magnitude and varies from week to week. The reported mean sleep duration per week may perhaps negatively impact the occurrence of MSKI. No significant improvement was detected in operational fitness by the end of the BMQ.

A moderated-mediation analysis of pathways in the association between Veterans’ health and their spouse’s relationship satisfaction: The importance of social support

Military personnel and Veterans are at increased risk of mental and physical health conditions, which can impact their families. Spouses often perform a vital role in caring for service members and Veterans facing illness or injury, which can lead to caregiver burden. In turn, this may contribute to relationship issues. Research suggests that ensuring that spouses are well supported can alleviate some of these negative effects. The current study examined whether social support received by spouses of newly released Veterans buffers the impact of Veterans' health on caregiver burden, subsequently impacting spouses' relationship satisfaction. Data were collected as part of the Canadian Armed Forces Transition and Well-being Survey. The sample included N = 595 spouses of Regular Force Veterans who released in 2016 with at least 2 years of service. We examined Veterans' mental and physical health and spouses' caregiver burden, social support, and relationship satisfaction. A moderated mediation model was tested using structural equation modeling. There was a significant indirect association between Veterans' health (both physical and mental) and spouses' relationship satisfaction through caregiver burden. Furthermore, social support moderated the association, as evidenced by a weaker association between Veterans' health and caregiver burden at low levels (-1SD) of social support compared to high levels (+1SD). Findings suggest additional efforts should be made to ensure sufficient support is provided to spouses, especially when they are caring for a service member or Veteran facing illness or injury, to strengthen their families' well-being.

Those Who Teach Must Also Do: Diversity, Equity and Inclusion in Legal Education and the Canadian Armed Forces

Diversity, Equity and Inclusion (DE&amp;I) initiatives have become a priority for many organizations within Canada. In legal academia it has become both a procedural and substantive imperative, as it grapples with meaningful integration of these considerations, and appropriate adaptation to current social and technological challenges. This paper sketches selected considerations in implementing DE&amp;I within legal education, and transplants them into Canadian Armed Forces (CAF) engagements with DE&amp;I implementation, with a focus on the transmission of legal norms and values in a non-legal environment and teaching context, using an explicitly socio-legal orientation. Drawing from legal education literature highlighting the challenges and opportunities within the university, and key insights regarding DE&amp;I implementation’s history and current developments within the CAF derived by scholars in a themed-2020 conference, I argue that a process of translation and adaptation of legal education practices and engagement with DE&amp;I into the CAF context will provide valuable insights into both communities of practice and transform and be transformed in the process, in particular with developing key concepts, solidifying abstract concepts and challenges, leveraging case study and simulation techniques, exploiting remote and hybrid pedagogical tools, and furthering legal education engagement outside the academy.

Health differences by entry stream among Canadian Armed Forces officer cadets

LAY SUMMARYThis study compared the baseline physical and mental health of officer candidates attending military college and officer training programs (i.e., non-direct-entry officer or non-DEO stream) with those of officers entering through a direct stream (direct-entry officer or DEO stream). Overall, DEO candidates had better health than non-DEO candidates. Female DEO and non-DEO candidates also reported more physical activity than male DEO and non-DEO candidates, and female non-DEO candidates had more symptoms of mental illness than male non-DEO candidates. A better understanding of these groups may lead to opportunities to customize health screening and supports depending on officer entry stream and sex; however, more research is needed to inform policy.

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.

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.

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. 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. 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. 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.

Association Between Reproductive Health Factors and Musculoskeletal Injuries in Female Canadian Armed Forces Members.

Background: Musculoskeletal injuries (MSKi) play a role in member retention in the military. In general, female military members have higher rates of MSKi than males and female reproductive health characteristics may be contributing to these disparities. This study seeks to characterize reproductive health factors in female Canadian Armed Forces (CAF) members and their relationship with MSKi. Materials and Methods: An electronic survey (SurveyMonkey®) was made available to present and former CAF members 18-65 years of age. Responses were collected between September 2020 and February 2021. Seven female reproductive characteristics were assessed: age of menarche, menstrual cycle regularity, birth control use, having given birth while serving, endometriosis, early menopause, and secondary oligomenorrhea/amenorrhea. Binary logistic regressions were used to analyze associations between reproductive characteristics with repetitive strain (RSI) and acute injuries. Results: A total of 2,001 participants consented to the survey with 855 respondents being female. Females reporting menstrual cycles as never regular, irregular for a few months, who never had a period, and whose periods stopped while serving presented a greater likelihood of reporting RSI compared to their peers who reported regular menstrual cycles (adjusted odds ratio [aOR]: 1.898, confidence interval [CI]: 1.138-3.166). Participants who have experienced endometriosis presented a higher likelihood of reporting acute injuries than those who did not (aOR: 2.426, CI: 1.030-5.709). Conclusion: This examination of females within the CAF suggests that irregular menstrual cycles or absent periods increase the likelihood of experiencing MSKi, namely those categorized as RSI injuries and reporting endometriosis were associated with greater rates of acute injuries.

Canadian Veteran chronic disease prevalence and health services use in the five years following release: a matched retrospective cohort study using routinely collected data

BackgroundOccupational exposures may result in Canadian military Veterans having poorer health and higher use of health services after transitioning to civilian life compared to the general population. However, few studies have documented the physical health and health services use of Veterans in Canada, and thus there is limited evidence to inform public health policy and resource allocation.MethodsIn a retrospective, matched cohort of Veterans and the Ontario general population between 1990–2019, we used routinely collected provincial administrative health data to examine chronic disease prevalence and health service use. Veterans were defined as former members of the Canadian Armed Forces or RCMP. Crude and adjusted effect estimates, and 95% confidence limits were calculated using logistic regression (asthma, COPD, diabetes, myocardial infarction, rheumatoid arthritis, family physician, specialist, emergency department, and home care visits, as well as hospitalizations). Modified Poisson was used to estimate relative differences in the prevalence of hypertension. Poisson regression compares rates of health services use between the two groups.ResultsThe study included 30,576 Veterans and 122,293 matched civilians. In the first five years after transition to civilian life, Veterans were less likely than the general population to experience asthma (RR 0.50, 95% CI 0.48–0.53), COPD (RR 0.32, 95% CI 0.29–0.36), hypertension (RR 0.74, 95% CI 0.71–0.76), diabetes (RR 0.71, 95% CI 0.67–0.76), myocardial infarction (RR 0.76, 95% CI 0.63–0.92), and rheumatoid arthritis (RR 0.74, 95% CI 0.60–0.92). Compared to the general population, Veterans had greater odds of visiting a primary care physician (OR 1.76, 95% CI 1.70–1.83) or specialist physician (OR 1.39, 95% CI 1.35–1.42) at least once in the five-year period and lower odds of visiting the emergency department (OR 0.95, 95% CI 0.92–0.97). Risks of hospitalization and of receiving home care services were similar in both groups.ConclusionsDespite a lower burden of comorbidities, Veterans had slightly higher physician visit rates. While these visits may reflect an underlying need for services, our findings suggest that Canadian Veterans have good access to primary and specialty health care. But in light of contradictory findings in other jurisdictions, the underlying reasons for our findings warrant further study.

Body Regions Susceptible To Musculoskeletal Injuries In Canadian Armed Forces Pilots

Musculoskeletal injuries (MSKi) are a significant burden on military pilots. Exploring which body regions are most affected by MSKi and describing injury types is essential for developing preventative strategies. Additionally, gaining insight into between-sex differences may serve as a valuable component of MSKi prevention strategies as the number of female pilots is rapidly increasing. PURPOSE This study is a preliminary investigation of potential sex differences in MSKi rates and regions in actively-serving Canadian Armed Forces (CAF) pilots. METHODS Members of the CAF completed an online cross-sectional survey to capture information about MSKi risks. For the present study, participants who indicated they were actively serving pilots were included. Chi-square analyses were used to evaluate questionnaire items that identified type and region of MSKi to compare response frequency by sex (significance accepted as P < 0.05). RESULTS Seventy-three respondents identified as pilots, of which 53 were male (35.6 + 7.2yrs) and 20 were female (39.9 + 11.1yrs). Figure 1 describes the rates of repetitive strain injuries (RSI) per body region. CONCLUSION RSI rates appear higher for female CAF pilots, and between-sex differences exist in body regions most affected by MSKi. Further research is needed to guide strategies to address sex-disparities and reduce the overall burden of MSKi among CAF pilots.

Medical support for future large-scale combat operations

LAY SUMMARY Assumptions for how the Canadian Armed Forces cares for injured soldiers on the battlefield may no longer hold true. Previous treatments were designed for counterinsurgency operations where Allied forces dominated the air and land during operations. However, the recent fighting in Ukraine highlights the need to develop a doctrine for pre-hospital care on the battlefield for large-scale combat operations. In these operations, modern weapons are extremely lethal, and the casualty rate is extremely high. This review examines the development of tactical combat casualty care and the assumptions behind its treatment algorithms. It suggests changes need to be made to better support Canadian soldiers if fighting in large-scale combat operations.

Facteurs influençant l’apport alimentaire en rations des soldats canadiens dans l’Arctique : un sondage national

Purpose: To document Canadian Armed Forces (CAF) soldiers' perceptions of factors influencing their dietary intake of combat rations during Arctic field training.Methods: A bilingual digital questionnaire was sent nationally to soldiers who trained in the Arctic between 2015 and 2018. It consisted of 6open-ended and 33closed-ended questions on factors influencing ration intake and acceptability.Results: Of the 54 completed questionnaires (response rate: 31%), 6 were incomplete and were excluded. The final sample consisted of 48 military personnel from nine provinces with an average of 12.1 ± 6.8 years of CAF experience. Factors with the greatest negative impact on dietary intake were food temperature, eating on the move, exercise and activity schedules, and equipment needed for preparation and eating. Participants reported consuming between 61% and 71% of their rations. They noted that a considerable amount of time was required to prepare the rations since they were frozen. Sixty-five percent of soldiers reported weight loss while training in the Arctic.Conclusions: Multiple factors influenced soldiers' dietary intake and practices. These results will guide future research and assist in decision-making regarding possible changes to Arctic rations.