Canadian Forces Personnel Research Articles

Association Between Self-Rated Positive Mental Health and Exposure to Potentially Morally Injurious Events in Deployed Canadian Forces Personnel

ABSTRACT Mental health has traditionally been viewed as an absence of mental illness; however more recent conceptualizations have begun to incorporate an ability to function in society. Thus, an individual’s mental health can be placed on a dual-continuum where someone who functions well but has a mental illness, can be considered mentally healthy; while another individual who is free of mental illness could be considered as lacking mental health if they are not functioning well. Using the Mental Health Continuum – Short Form (MHC-SF), this study set out to determine the prevalence rates of positive mental health in a sample of recently deployed Canadian Armed Forces (CAF) members, and how these rates of positive mental health might be affected by exposure to potentially morally injurious events (PMIE). Results revealed that the positive mental health status of CAF members differed only slightly from those reported for the Canadian population as a whole. However, when CAF members’ positive mental health statuses were compared according to PMIE exposure, those who reported exposure were 37% less likely to be considered flourishing (ranging from 25% to 37% depending on PMIE question), and 138% more likely to be languishing (ranging from 71% to 229% depending on PMIE question) when compared to those who were not exposed. Results support the need for further research into the emotional, psychological, and behavioral ramifications of PMIE exposure in military personnel.

Association between social support and mental health conditions in treatment-seeking Veterans and Canadian Forces personnel

Association between social support and mental health conditions in treatment-seeking Veterans and Canadian Forces personnel

Insomnia, psychiatric disorders and suicidal ideation in a National Representative Sample of active Canadian Forces members

BackgroundPast research on the association between insomnia and suicidal ideation (SI) has produced mixed findings. The current study explored the relationship between insomnia, SI, and past-year mental health status among a large Canadian Forces (CF) sample.MethodData was obtained from the 2013 Canadian Forces Mental Health Survey (CFMHS), and included a large representative sample of Canadian Regular Forces personnel (N = 6700). A series of univariate logistic regressions were conducted to test individual associations between past-year mental health status, insomnia, and potential confounds and SI. Mental health status included three groups: 0, 1, or two or more probable diagnoses of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD) and alcohol abuse/dependence. Stepwise multivariate logistic regression was used to assess the relationship between insomnia and SI with mental health status as a moderator.Results40.8% of respondents reported experiencing insomnia. Both insomnia and number of mental health conditions incrementally increased the risk of SI. However, past-year mental health status was a significant moderator of this relationship, such that for CF personnel with either no (AOR = 1.61, 1.37–1.89) or only one past-year mental health condition (AOR = 1.39, 1.12–1.73), an incremental increase in insomnia was associated with an increased likelihood of SI. However, in personnel with two or more past-year mental health disorders, insomnia was no longer significantly associated with SI (AOR = 1.04, 0.81–1.33).ConclusionsInsomnia significantly increased the odds of SI, but only among individuals with no or one mental health condition. Findings highlight the importance of assessing insomnia among CF members in order to further suicide prevention efforts.

Data Processing and Analysis for the 2012 Canadian Forces 3D Anthropometric Survey

The 2012 Canadian Forces Anthropometric Survey (CFAS 2012) is the first major 3D anthropometric survey of Canadian Forces personnel. 2200 full-body scans were conducted, together with traditional anthropometric measurements. This survey aims at providing accurate, detailed, and up-to-date body shape information for equipment design and procurement. In this paper, we describe the data processing and analysis of this dataset. This includes de-noising, template fitting, landmark identification, and statistical shape analysis. We also compare the military personnel with the general North American population using the CAESAR dataset.

Prevalence and correlates of mental health problems in Canadian Forces personnel who deployed in support of the mission in Afghanistan: findings from postdeployment screenings, 2009-2012.

An important minority of military personnel will experience mental health problems after overseas deployments. Our study sought to describe the prevalence and correlates of postdeployment mental health problems in Canadian Forces personnel. Subjects were 16 193 personnel who completed postdeployment screening after return from deployment in support of the mission in Afghanistan. Screening involved a detailed questionnaire and a 40-minute, semi-structured interview with a mental health clinician. Mental health problems were assessed using the Patient Health Questionnaire and the Posttraumatic Stress Disorder Checklist-Civilian Version. Logistic regression was used to explore independent risk factors for 1 or more of 6 postdeployment mental health problems. Symptoms of 1 or more of 6 mental health problems were seen in 10.2% of people screened; the most prevalent symptoms were those of major depressive disorder (3.2%), minor depression (3.3%), and posttraumatic stress disorder (2.8%). The strongest risk factors for postdeployment mental health problems were past mental health care (adjusted odds ratio [AOR] 2.89) and heavy combat exposure (AOR 2.57 for third tertile, compared with first tertile). These risk groups might be targeted in prevention and control efforts. In contrast to findings from elsewhere, Reservist status, deployment duration, and number of previous deployments had no relation with mental health problems. An important minority of personnel will disclose symptoms of mental health problems during postdeployment screening. Differences in risk factors seen in different nations highlight the need for caution in applying the results of research in one population to another.

Somatic symptoms and health-related quality of life among treatment-seeking Canadian Forces personnel with PTSD

This study examined the association between somatic complaints and health-related quality of life (HR-QoL) in treatment-seeking Canadian military personnel with military-related Posttraumatic Stress Disorder (PTSD). Current and former Canadian Forces (CF) members attending the Parkwood Hospital Operational Stress Injury Clinic in London, Ontario (N=291) were administered self-report questionnaires assessing number and severity of somatic complaints, PTSD and depressive symptom severity, and mental and physical health-related quality of life (HR-QoL) prior to commencing treatment. Regression analyses were used to identify the role of somatic complaints on physical and mental HR-QoL, after controlling for PTSD symptom cluster and depressive symptom severity. Somatic symptom severity accounted for only a small amount of the variance in mental HR-QoL after accounting for PTSD symptom cluster and depressive symptom severity, but accounted for a larger proportion of the variance in physical HR-QoL after accounting for PTSD cluster and depressive symptom severity. Understanding the role of somatization in the symptom-presentation of military personnel with PTSD may provide additional avenues for treatment with this population.

Protective Factors for Mental Disorders and Psychological Distress in Female, Compared with Male, Service Members in a Representative Sample

Although military interest in promoting psychological resilience is growing, resources protective against psychopathology have been understudied in female service members. Using a representative sample of Canadian Forces personnel, we investigated whether religious attendance, spirituality, coping, and social support were related to mental disorders and psychological distress in female service members, and whether sex differences occurred in these associations. Religious attendance and spirituality were self-reported. Coping items were taken from 3 scales and produced 3 factors (active, avoidance, and self-medication). Social support was assessed with the Medical Outcomes Study Social Support Survey. Past-year mental disorders were diagnosed with the World Mental Health Composite International Diagnostic Interview. The Kessler Psychological Distress Scale assessed distress. Multivariate regression models investigated links between correlates and psychological outcomes within each sex. For associations that were statistically significant in only one sex, sex by correlate interactions were computed. In female service members, inverse relations were found between social support and MDD, any MDD or anxiety disorder, suicidal ideation, and distress. No associations were found between religious attendance and outcomes, and spirituality was associated with an increased likelihood of some outcomes. Active coping was related to less psychological distress, while avoidance coping and self-medication were linked to a higher likelihood of most outcomes. Although several statistically significant associations were found in only one sex, only one sex by correlate interaction was statistically significant. Social support was found to be inversely related to several negative mental health outcomes in female service members. Few differences between men and women reached statistical significance. Future research should identify additional helpful resources for female service members.

Deployment-related mental disorders among Canadian Forces personnel deployed in support of the mission in Afghanistan, 2001–2008

The conflict in Afghanistan has exposed more Canadian Forces personnel to a greater degree of adversity than at any time in recent memory. We determined the incidence of Afghanistan deployment-related mental disorders and associated risk factors among personnel previously deployed in support of this mission. The study population consisted of 30,513 Canadian Forces personnel who began a deployment in support of the mission in Afghanistan before Jan. 1, 2009. The primary outcome was a mental disorder perceived by a Canadian Forces clinician to be related to the Afghanistan deployment. Data on diagnoses and perceptions were abstracted from medical records of a stratified random sample of 2014 personnel. Sample design weights were used in all analyses to generate descriptive statistics for the entire study population. Over a median follow-up of 1364 days, 13.5% (95% confidence interval [CI] 12.1%-14.8%) of the study population had a mental disorder that was attributed to the Afghanistan deployment. Posttraumatic stress disorder was the most common diagnosis (in 8.0%, 95% CI 7.0%-9.0%, of personnel). Deployment to higher-threat locations, service in the Canadian Army and lower rank were independent risk factors associated with an Afghanistan-related diagnosis (e.g., hazard ratio for deployment to Kandahar Province 5.6, 95% CI 2.6-12.5, relative to deployment to the United Arab Emirates). In contrast, sex, Reserve Forces status, multiple deployments and deployment length were not independent risk factors. An important minority of Canadian Forces personnel deployed in support of the Afghanistan mission had a diagnosis of a mental disorder perceived to be related to the deployment. Determining long-term outcomes is an important next step.

Drivers of the Perceived Value of a Third-Location Decompression Program for Canadian Forces Personnel Returning From Afghanistan

The drivers of the perceived value of third-location decompression (TLD) programs are unclear. For this study, 14,253 Canadian personnel completed evaluations at the end of a TLD program. Results showed that sociodemographic and military characteristics were weak predictors of the perceived value of TLD. Instead, satisfaction with 10 out of 13 aspects of the program was predictive of the perceived value of TLD. The strongest predictors were support for the general concept of TLD and satisfaction with the educational and rest-and-relaxation components of the program. It was concluded that support for the concept and satisfaction with key program components drive the perceived value of TLD.

Mental Health of Canadian Forces Members While on Deployment to Afghanistan

The deployed environment poses special challenges to the delivery of effective in-theatre mental health care. Our study sought to identify the prevalence and impact of symptoms of mental health problems in Canadian Forces (CF) personnel serving in Task Force Afghanistan; and, to determine the use of, and perceived need for, mental health services in CF personnel while deployed. Our study consisted of a cross-sectional survey of all 2779 CF personnel deployed to the province of Kandahar, Afghanistan, from February 15, 2010, to March 15, 2010. An important minority (8.5%) of the 1572 respondents (response rate = 57%) exceeded civilian criteria for symptoms of acute traumatic stress, major depression, or generalized anxiety. Prevalence of these 3 mental health problems increased with higher combat exposure and location in more isolated posts. A much larger fraction (31%) reported suffering a stress, emotional, alcohol, or family problem during the deployment. Only a minority of respondents with a mental health problem (26%) were currently interested in getting help. Almost one-half of respondents with a mental health problem perceived occupational dysfunction as a result, though two-thirds of respondents with occupational dysfunction were in the group without the 3 mental health problems assessed. The needs base for psychosocial support extends beyond personnel who meet conventional questionnaire criteria for traumatic stress, depression, or generalized anxiety. Future research is needed to understand what precise problems are driving this larger needs base and what precise supports (clinical or nonclinical) would be most appropriate.

Alcohol Use Among Canadian Forces Candidates: The Role of Psychological Health and Personality

There is evidence to suggest that exposure to military stressors may contribute to alcohol consumption among military personnel. The present study analyzed health questionnaire data from 3,852 Canadian Forces (CF) candidates in an effort to identify psychological health and personality characteristics that could be targeted in order to prevent or reduce problem drinking among CF personnel. Results revealed that some of the psychological health and personality characteristics examined (i.e., PTSD, depression symptoms, agreeableness, conscientiousness, and extroversion) were significantly associated with alcohol use. Some methodological constraints and the potential implications for the prevention of problem drinking among military personnel are discussed.

Beyond Battlemind: Evaluation of a New Mental Health Training Program for Canadian Forces Personnel Participating in Third-Location Decompression

Battlemind training, which improves postdeployment well-being, has been part of Canada's postdeployment Third-location Decompression (TLD) program since 2006. In 2010, a new educational program drawing on Battlemind was implemented to make it more consistent with Canada's current mental health training strategy. Subjects consisted of 22,113 Canadian personnel returning from Afghanistan via TLD in Cyprus; 3,024 (14%) received the new program. Pre-/post-training attitude and self-efficacy questionnaires assessed the impact of the training. In addition, a quasi-experimental approach used questionnaires administered at the end of TLD to compare the satisfaction, attitudes, and self-efficacy under the old vs. new program. Pre-/post-training questionnaires showed medium to large positive effects of the training on targeted attitudes and self-efficacy (Cohen's d = 0.44-1.02). Participants completing the new program were more satisfied with the educational program (adjusted odds ratio = 3.2), perceived the TLD to be more valuable (odds ratio = 1.7), and had at least certain more favorable post-TLD attitudes and self-efficacy (d ranging from 0.00 to 0.29). All of these findings point to the superiority of the new program. However, quasi-experimental approaches are bias-prone, and it is unknown whether these advantages will translate into meaningful improvements in well-being.

Stigma and Barriers to Mental Health Care in Deployed Canadian Forces Personnel

Mental disorders are prevalent on deployed operations, but only a small fraction of those with problems access care due to a range of barriers. A survey measuring need for care, perceived barriers, and care-seeking propensity was administered to Canadian Forces personnel during deployment in Afghanistan. Complex characteristics of barriers to care on deployment were found: stigma had no association with care-seeking propensity; perceived structural barriers were associated with greater care-seeking propensity; and perceived structural barriers were greater in more isolated locations. Only negative attitudes toward care had the expected negative association with care-seeking propensity. Research and practical considerations are discussed.

Good Interventions That Few Use: Uptake of Insect Bite Precautions in a Group of Canadian Forces Personnel Deployed to Kabul, Afghanistan

We evaluated use of interventions to prevent insect bites in Canadian personnel deployed to Kabul, Afghanistan. Data were collected through a self-report written survey. The response rate was 92%, and intervention uptake was 11% applied repellent that day, 21% slept under a bednet their last sleep, and 78% wore insecticide-treated clothing. Two associations were usually evident in multivariate analyses: persons perceiving risk of exposure as high were more likely to use bednets and repellent, and individuals reminded to use an intervention had higher odds of doing so. However, even if perception of exposure risk was high and reminders were received, the use of bednets (60%) and repellent (40%) was relatively low. Hence, on the one hand, increased uptake of interventions through targeted messaging might be possible. On the other hand, effectiveness of these interventions might be substantially constrained because of nonuse, even in a motivated and informed population.

Predictors of posttraumatic stress disorder, depression, and suicidal ideation among Canadian Forces personnel in a National Canadian Military Health Survey

Despite efforts to elucidate the relationship between traumatic event exposure and adverse mental health outcomes, our ability to understand why only some trauma-exposed individuals become emotionally affected remains challenged. The aim of the current study is to determine the relations between social support, religiosity, and number of lifetime traumatic events experienced on past-12 month posttraumatic stress disorder (PTSD), depression, and suicidal ideation (SI) in a nationally representative sample of Canadian Forces personnel. The current study used data from the Canadian Community Health Survey Cycle 1.2 – Canadian Forces Supplement. The impact of a number of predictive and mediating factors was assessed using structural equation modeling. Social support and number of lifetime traumatic events experienced were significant predictors of past-year PTSD, depression, and SI; however PTSD did not mediate the relationship between number of traumatic events and SI nor between social support and SI. Conversely, depression mediated the relationship between number of traumatic events and SI. Possible mechanisms for these findings and their implications are discussed.

Bringing the troops back home: Modeling the postdeployment reintegration experience.

Using a sample of Canadian Forces personnel (N = 490) returning from deployment in Afghanistan, we tested a model of reintegration experiences, with a focus on affective organizational commitment, support factors, posttraumatic stress symptoms, changes in alcohol use, and turnover intentions. The model provided an excellent fit to the data, although homecoming experiences were not associated with commitment as predicted. No differences emerged between novice (single tour) and experienced (multiple tours) personnel, although the number of tours was associated with increased affective commitment as expected.

Fairness Perceptions and Trust as Mediators on the Relationship Between Leadership Style, Unit Commitment, and Turnover Intentions of Canadian Forces Personnel

Whether fairness perceptions and leader trust mediate the relationship between leadership style and commitment and turnover was evaluated among Canadian Forces personnel (N = 1,443). Correlational analyses and structural equation modeling results provided support for the proposed meditational model. However, the influence of transactional leadership on commitment and turnover was due to its direct influence on fairness perceptions, whereas the influence of transformational leadership on these outcomes was based on its direct and indirect influence on both fairness perceptions and leader trust. It thus appears that both types of leadership style influence commitment and turnover, but the mechanism through which their effects occur may be distinct. The implications of these findings for theory, research, and practice are discussed.

Key factors associated with the high burden of injuries in the Canadian forces

BackgroundMilitary populations are particularly vulnerable to injury due the nature of their work and the required levels of physical training. The Canadian Forces Health and Lifestyle Information Survey (HLIS) is...

Development of an injury surveillance system for the Canadian forces

Injuries represent a leading cause of morbidity and mortality in the Canadian military. The 2008/2009 Health and Lifestyle Information Survey (HLIS) found that in the preceding 12 months 23% of...

Correlates of Perceived Need for Mental Health Care Among Active Military Personnel

Correlates of Perceived Need for Mental Health Care Among Active Military Personnel