Canadian Forces Research Articles

Clinical Epidemiology of Alcohol Use Disorders in Military Personnel versus the General Population in Canada: Épidémiologie clinique des troubles liés à la consommation d’alcool chez les militaires par opposition à la population générale du Canada

Objectives: Research suggests a high prevalence of problematic alcohol use among military personnel relative to civilians. Our primary objectives were to compare the prevalence, correlates, help-seeking behaviors, perceived need for care, and barriers to care for alcohol use disorders (AUDs) in the Canadian Armed Forces (CAF) and the Canadian general population (CGP). Methods: Data were from 2 nationally representative surveys collected by Statistics Canada: (1) the Canadian Community Health Survey on Mental Health collected in 2012 ( N = 25,113; response rate = 68.9%) and (2) the Canadian Forces Mental Health Survey collected in 2013 ( N = 8,161; response rate = 79.8%). Descriptive statistics and logistic regression were used to examine differences in outcomes of interest associated with AUDs in the CAF and CGP. Results: The prevalence of lifetime AUDs was significantly higher in the CAF (32.0%) than the CGP (20.3%; adjusted odds ratio [AOR] = 1.14, 95% confidence interval [CI, 1.02 to 1.27]) after adjustment for sociodemographic covariates. In contrast, the past-year prevalence of AUDs was significantly lower among CAF personnel (4.5%) than civilians (3.8%; AOR = 0.78, 95% CI [0.61 to 0.99]) after adjustment for sociodemographic covariates. Child abuse history and comorbid mental disorders were strongly associated with past-year AUDs in both populations. CAF personnel compared to the CGP were more likely to perceive a need for care (AOR = 4.15, 95% CI [2.56 to 6.72]) and engage in help-seeking behaviors (significant AORs ranged from 1.85 to 5.54). CAF personnel and civilians with past-year AUDs reported different barriers to care. Conclusions: Findings argue for the value of different approaches to address unmet need for AUD care in the CAF and CGP.

Huszárezredek szervezete és feladatai a szövetségi haderőkben II.

A magyar huszár az a magyar könnyűlovas, aki az elmúlt fél évezred során szinte átformálta a hadviselés arculatát, és fénykorában a világ 34 országa adaptálta ezt a könnyűlovassági csapatnemet. Ezek közül számos huszáralakulat mind a mai napig az adott ország haderejének fontos elemét képezi. Az előzőleg már tárgyalt dán és francia huszárezredek folytatásaként alábbiakban Hollandia, Kanada és az Egyesült Királyság huszárezredeit mutatom be.

Mortality of Canadian military personnel over 40 years

Background Military personnel may be exposed to hazardous substances or environments, making health surveillance critical. However, surveillance is frequently handicapped by long lag times between exposure(s) and outcomes, which often manifest post-military release and are often not recorded.
 Aims To describe the burden of mortality in still serving and released Canadian Armed Forces (CAF) personnel.
 MethodsThe Canadian Forces Cancer and Mortality Study II (CF CAMS II) is an interdepartmental record linkage study using CAF pay data and Statistics Canada cancer and mortality data. The cohort included all Regular Force and class C Reservist men and women who first enrolled in the CAF between 1976 and 2012, inclusive. The anonymized linked data included death data, including cause and location of death. All-cause mortality (ACM) and International Classification of Disease (ICD)-10 chapter-level mortality (CLM) were quantified using standardized mortality ratios (SMRs), with the Canadian general population (CGP) as the reference population.
 ResultsApproximately 6870 deaths occurred during over 5 million person-years of observations. For ACM, the CAF risk of death was significantly lower than the CGP for both sexes (females: n = 540, SMR = 0.76 [95% CI 0.69–0.82]; males: n = 6330, SMR = 0.79 [95% CI 0.77–0.81]). In the CLM analysis, SMRs were significantly lower than, or not statistically different from, 1.0 for all ICD chapters.
 ConclusionsMilitary service may have a protective effect that may be partly explained by the healthy soldier effect and the stringent selection process at enrolment.

Exposure to Mental Health Training and Variations in Work Strain, Coping, and Positive Mental Health in the Canadian Military

Promoting adaptive coping has been a central objective of mental health training for enhancing resilience. A multi-group path analysis was conducted on 2013 Canadian Forces Mental Health Survey data to assess the indirect effect of work strain on positive mental health (PMH) through coping among Canadian Armed Forces Regular Force members who either received or did not receive mental health training in the past 5 years (N = 6696). Results pointed to a more frequent use of positive coping and a higher level of PMH among those with mental health training exposure. Work strain was associated with using less adaptive coping strategies (i.e., less frequent use of positive coping, more frequent use of negative coping) and, along with such coping strategies, predicted lower PMH. Furthermore, results revealed an indirect effect of work strain on PMH through coping. However, the magnitude of these associations varied little by mental health training exposure. Results support the view that work strain can diminish personal resources and thereby negatively impact coping, and thus underscore the importance of providing service members with access to support programs and services to help them through stressful situations.

ASSESSMENT AND REMEDIATION OF A LIGHT NON-AQUEOUS PHASE LIQUID HYDROCARBON PLUME IN FRACTURED BEDROCK

INTRODUCTION During the extension of an access road on the Canadian Forces Base (CFB) Esquimalt in Colwood, British Columbia, a black, viscous, liquid hydrocarbon product was observed oozing from newly exposed bedrock fractures in the roadside. Road excavation was subsequently halted to undertake assessment and remediation of the hydrocarbon product. The exposed bedrock was dammed with sawdust, a geomembrane barrier was installed and the area was backfilled until an appropriate course of action could be determined. The site location is shown in Figure 1. The property boundary and key site features are shown in Figure 2; the hydrocarbon seep is shown in Figure 3. Bunker C oil is a heavy-end (high molecular weight) hydrocarbon product that has a specific gravity slightly less than water and is therefore a light non-aqueous phase liquid (LNAPL). The source of the LNAPL was inferred to originate from a decommissioned fuel depot located approximately 100 m distance uphill from the road, where 40,000 barrels of Bunker C fuel oil were historically stored in one of three, large above-ground storage tanks (ASTs). A Bunker C oil spill reportedly took place at the tank farm more than two decades prior; however, the spill volume was unknown and initial investigations found no evidence of contamination between the roadside LNAPL occurrence and the former AST. Furthermore, there was also anecdotal evidence that an historic asphalt manufacturing facility may have operated in the vicinity of the access road. A hydrocarbon product similar to Bunker C is used in the manufacture of asphalt. The source and extent of the LNAPL and the potential migration pathways to the roadside location were therefore unknown. When an LNAPL spill occurs in the subsurface, the LNAPL can migrate downward under gravity through the soil pore space in the unsaturated zone. When LNAPL encounters the ground water table (the top of the saturated zone), it tends to spread out laterally because it is less dense than water and will migrate primarily in the direction of the water table gradient (water table slope). However, when LNAPL encounters bedrock, the direction of LNAPL migration can become much more complicated depending on the degree and orientation of bedrock fractures that control its movement. When fracture density is sufficiently high and the fractures are interconnected, contamination is able to migrate down-gradient through the bedrock in the same manner as through unconsolidated materials. However, when dominant structural features are prevalent that favour specific orientations, preferential pathways are created that can result in the cross-gradient migration of LNAPL. This paper presents a case study for the assessment and remediation of LNAPL in bedrock at the Canadian Forces Base (CFB) Esquimalt (the site). Geological mapping of bedrock structural features has long been used by the mining industry to identify key structures associated with economic zones of mineralization and to predict the location and extent of mineralized targets. In a similar regard, to effectively remediate LNAPL within fractured bedrock requires the identification and characterization of any structural features that might be controlling the preferential migration of LNAPL within the subsurface to other areas of the site. A significant amount of surface outcrop is present at the site and this was recognized as a cost-effective opportunity to complete a geological assessment of the bedrock. A geological mapping program was subsequently undertaken to assess bedrock outcrops for fracture density, fracture aperture, the orientation of primary fracture sets and lithologic contacts. The area was also inspected for larger scale structural features such as faults, deformation and erosional features that might influence contaminant migration. Fracture sets and lithologic contacts were mapped by outcrop location, and fractures with visible LNAPL were mapped separately from those without LNAPL. The geological data collected was used to construct stereographic projections of structural planes on a stereonet. Poles to structural planes were plotted and colour-coded by area and by presence/absence of LNAPL. The plots were then analyzed individually, and as a composite plot, to identify the dominant preferential pathways controlling LNAPL migration at the site. By superimposing these features on areas where LNAPL was observed, LNAPL delineation targets were effectively identified and the plume was subsequently delineated with confidence and remediated.

Burden of Cancer Mortality in the Canadian Armed Forces, 1976-2012: A Retrospective Cohort Study.

Military personnel may have potential exposures to carcinogens during their military careers. However, the generalizability of causal evidence between occupational exposures and cancer outcomes in military personnel is limited. This study aims to describe the epidemiology cause-specific cancer mortality in still serving and released Canadian Armed Forces (CAF) personnel recruited between 1976 and 2012. Data came from the Canadian Forces Cancer and Mortality Study II (CF CAMS II), a record-linkage study of approximately 228,685 CAF Regular Force personnel and Reservists. Sex-stratified standardized mortality ratios (SMR) were calculated for each neoplasm subcategory, with the Canadian general population (CGP) as the reference. Approximately 1,450 deaths were attributable to neoplasms. Cancer mortality was lower in both men and women with military service (SMR = 0.77 and 0.78, respectively) versus CGP. Females had a significantly lower risk of breast cancer. Males in the cohort had a significantly lower risk of lip, oral cavity and pharynx, digestive organs, respiratory and intrathoracic organs, bone and articular cartilage, and mesothelial and soft-tissue cancers. However, males also had a significantly increased risk for neoplasms of the central nervous system and lymphoid cells, as well as for certain specific cancer diagnoses. Current and former CAF personnel were at comparable, or lower risk than, the CGP for cancer-related deaths. However, there was an increased risk for certain neoplasm subcategories and specific cancers. These findings contribute to the limited body of evidence investigating the link between military service and cancer mortality.

Family snapshot: Characteristics of the economic and social environment and their associations with mental health in Canadian military personnel with a history of deployment

The high volume of deployments related to military operations in southwest Asia over the past two decades have generated interest in research on factors that may influence mental health among service members with a history of deployment. Identifying key risk and protective factors for mental health disorders in military populations is an integral step towards developing or improving policies and programs aimed at enhancing resilience to deployment stress. In line with the growing consideration of research on social determinants of health, the objectives of the present study were to i) examine the characteristics of Canadian Armed Forces (CAF) members’ economic and social environment and ii) examine the associations between these characteristics and mental health. Participants included 6,040 CAF members who were deployed at least once in support of a mission and completed the 2013 Canadian Forces Mental Health Survey (CFMHS). A range of economic and social environmental characteristics were examined, including education, income, marital status, household composition, and social support. Accounting for various other demographic and military characteristics, results indicated that living as a single parent was associated with increased odds of reporting any past year anxiety or mood disorder. Additionally, those with a Bachelor’s degree or higher appeared to have decreased odds of reporting any past year anxiety or mood disorder. The results underline at risk groups and reinforce the value of considering the personal and social circumstances of military personnel in research on their mental health and well-being.

Hydro-biogeochemical impacts of fugitive methane on a shallow unconfined aquifer

Oil and gas development can result in natural gas migration into shallow groundwater. Methane (CH4), the primary component of natural gas, can subsequently react with solutes and minerals in the aquifer to create byproducts that affect groundwater chemistry. Hydro-biogeochemical processes induced by fugitive gas from leaky oil and gas wells are currently not well understood. We monitored the hydro-biogeochemical responses of a controlled natural gas release into a well-studied Pleistocene beach sand aquifer (Canadian Forces Base Borden, Ontario, Canada). Groundwater samples were collected before, during, and up to 700 days after gas injection and analyzed for pH, major and minor ions, alkalinity, dissolved gases, stable carbon isotope ratios of CO2 and CH4, and microbial community composition. Gas injection resulted in a dispersed plume of free and dissolved phase natural gas, affecting groundwater chemistry in two distinct temporal phases. Initially (i.e. during and immediately after gas injection), pH declined and major ions and trace elements fluctuated; at times increasing above baseline concentrations. Changes in the short-term were due to invasion of deep groundwater with elevated total dissolved solids entrained with the upward migration of free phase gas and, reactions that were instigated through the introduction of constituents other than CH4 present in the injected gas (e.g. CO2). At later times, more pronounced aerobic and anaerobic CH4 oxidation led to subtle increases in major ions (e.g. Ca2+, H4SiO4) and trace elements (e.g. As, Cr). Microbial community profiling indicated a persistent perturbation to community composition with a conspicuous ingrowth of taxa implicated in aerobic CH4 oxidation as well anaerobic S, N and Fe species metabolism.

Point-of-care resuscitation research: From extreme to mainstream: Trauma Association of Canada Fraser Gurd Lecture 2019.

The Gurd Family surgical legacy was deeply intertwined with National service in both World Wars. My own personal research mission has attempted to emulate such service, by enhancing the tools and techniques available to facilitate point-of-care diagnosis and resuscitation in extreme and adverse environments. Our efforts involving point-of-care diagnosis/resuscitation and the telementored guidance of those remotely responding to catastrophic injury have included collaborations with National Aeronautics and Space Administration (NASA) the Canadian Space Agency, the Canadian Forces, its democratic allies, and non-governmental surgical organizations. Research has been conducted in resuscitative suites and operating theaters, research laboratories, parabolic flight aircraft, on humanitarian surgical missions, and from ski-hills and firehalls. The initial phases of these efforts involved inaugural studies in resuscitative sonography including defining the Extended Focused Assessment with Sonography for Trauma (EFAST) examination. Although the original work was commissioned for Space Medicine, generalization to mainstream practice further justifies space medicine research. Iterative steps in advancing telementored resuscitation have subsequently involved the maturation of space-mandated telementored ultrasound support (TMUS), exploration of TMUS in terrestrial clinical practice, and the creation of increasingly mobile (hand-held) TMUS solutions. Subsequently it was recognized that teleultrasound is simply one informatic dimension of remote telemedicine, and current efforts are focused in a Program known as TeleMentored Ultrasound Supported Medical Interactions (TMUSMI) of remote responders required to intervene with catastrophic trauma. While this research program has yielded many techniques and findings that have benefited mainstream terrestrial practice, these investigations are currently ongoing, and we hope to demonstrate that TMUSMI may benefit all Canadians especially those in remote areas, as well as potentially every global inhabitant without immediate access to care. Further, we propose that to fully utilize these techniques, a new specialty, that of the remote medical mentor will be required, a new specialty that will require the creation and scientific validation of its principles and techniques.

Are personnel with a past history of mental disorders disproportionately vulnerable to the effects of deployment-related trauma? A cross-sectional study of Canadian military personnel

BackgroundPast mental disorders predict future disorders, both in the presence and absence of trauma exposure. However, it is not clear whether those with past mental disorders are disproportionately vulnerable to the negative effects of a given level of trauma.MethodsThe data source was the 2013 Canadian Forces Mental Health Survey (CFMHS), of which 1820 respondents had deployed only once in their military careers—all in support of the mission in Afghanistan. The primary outcomes were past 12-month depression and past 12-month PTSD. Multivariate logistic regression was performed for each outcome variable, looking primarily for differences in the marginal effect of deployment-related trauma in those with and without a pre-deployment history of each disorder.ResultsA history of each pre-deployment disorder did indeed interact with deployment-related trauma with respect to the corresponding past 12-month disorder. In addition, pre-deployment history of depression and of PTSD interacted with each other, though only for the outcome of past 12-month PTSD. The average marginal effect of deployment-related trauma on past 12-month PTSD was highest in those with a pre-deployment history of depression in the absence of a pre-deployment history of PTSD. This group was twice as vulnerable to post-deployment PTSD relative to those without a pre-deployment history of both disorders and four times as vulnerable to post-deployment PTSD relative to those with a pre-deployment history of both disorders. No significant differences were seen in the marginal effects of trauma on past 12-month depression in the presence or absence of a pre-deployment history of that disorder.ConclusionThere is modest differential vulnerability to past 12-month PTSD as a function of deployment-related trauma in those who had a pre-deployment history of PTSD or depression when compared to those who did and did not have a pre-deployment history of one or both disorders.

Factor structure of a coping measure in the 2013 Canadian Forces Mental Health Survey.

Coping has been the subject of numerous studies over the past decades, yet significant debate remains regarding the structure of this construct. Exploratory and confirmatory factor analyses were conducted on 2013 Canadian Forces Mental Health Survey (CFMHS) data to examine the factor structure of coping items. A total of 6,696 Canadian Armed Forces (CAF) Regular Force members completed a coping inventory that assessed 14 coping strategies (e.g., problem solving, talking to others). Results indicated that coping among CAF Regular Force members was best represented by two factors: positive coping and negative coping. Coping strategies categorized as positive coping included active efforts to confront the stressor or improve one's well-being, whereas those categorized as negative coping reflected passive or avoidant efforts or behaviours that may compromise one's health. Positive coping factor scores were positively associated with perceptions of one's ability to handle difficult problems and day-to-day demands, while negative coping factor scores were negatively associated with such perceptions, suggesting that the factors had good concurrent validity. Additional analyses pointed to higher positive and negative coping scores among female Regular Force members compared with male Regular Force members. The additional analyses also showed generally less favourable coping scores among lower-ranking Regular Force members and those with a history of deployment to Afghanistan relative to their respective counterparts. Lastly, Regular Force members who received mental health training demonstrated higher positive coping scores. The report discusses implications for the use of coping indicators in future analyses involving the CFMHS.

Analysis of Unconfined Flow Induced by Constant Rate Pumping Based on the Lagging Theory

AbstractThis study proposes a new mathematical model for describing the drawdown distribution due to a constant rate pumping (CRP) in an unconfined aquifer considering the lagging theory. We introduce two lag times in Darcy's law and in turn in a free surface equation to reflect the effects of the capillary fringe and the capillary suction on the water table motion. The present free surface equation can reduce to those used in previous studies. The Laplace and Weber transform methods are used to derive the semianalytical solution to the model including the effect of wellbore storage. The algorithm of numerical Laplace inversion is applied to obtain the transient solution of the model. We find that the delay index, commonly used in the literature, is equivalent to the lag time associated with the effect of the capillary suction. The sensitivity analysis is performed to assess the drawdown behavior in response to the change in each aquifer parameter. The drawdown distributions predicted by the present solution agree fairly well to the field data taken from CRP tests at Cape Cod, Massachusetts; the Canadian Forces Base Borden, Ontario; and Saint Pardon de Conques, Gironde (France). The lag times determined by both CRP tests seem to decrease linearly with increasing distance on the logarithmic scale from the pumping well. The consideration of two lag times considerably improves the accuracy in estimated specific yields.

Comparison of past-year mental health services use in Canadian Army, Navy, and Air Force personnel

Introduction: What causes the excess burden of mental disorders and related outcomes in the Army remains unclear. Deployment-related trauma has been one intuitive explanation. However, there may be other factors at play – for example, lower mental health services use (MHSU) in Army personnel. This study compares MHSU across the Canadian Army, Navy, and Air Force. Methods: Data were drawn from the 2013 Canadian Forces Mental Health Survey. The sample consisted of Regular Force members ( N = 6,696). The primary outcomes for past-year MHSU were: (1) any past-year MHSU; (2) intensity of care (total clinical contact hours), and (3) perceived helpfulness of care (PHC). ­Modified Poisson regression and analysis of covariance (ANCOVA) were used to assess the relationship between the elements (Army, Navy, Air Force) and each outcome, adjusting for sociodemographic and military characteristics, as well as clinical variables such as the presence of five past-year mental disorders. Results: In unadjusted analyses, Army personnel had significantly greater past-year MHSU and intensity of care relative to Air Force personnel. No significant relationship was found between the element and any of the MHSU parameters after adjustment. Discussion: Differences in past-year MHSU are an unlikely contributing factor to the higher risk of mental disorders and related outcomes among Army personnel; the true explanation must lie elsewhere. Findings argue for a system-wide, and not element-specific, approach to improving Canadian Armed Forces (CAF) programs and services.

Positive functioning and emotional well-being among military personnel and the general population with and without a history of child abuse in Canada

Introduction: Child abuse exposure is highly prevalent among military personnel compared with the general population. However, little is known regarding its relationship to compromised positive mental health outcomes, particularly in the Canadian Armed Forces (CAF). The objectives of this study were (1) to describe the prevalence of overall positive functioning and emotional well-being among CAF personnel with and without a child abuse history compared with the Canadian general population (CGP) and (2) to examine the relationships between child abuse and positive functioning and emotional well-being among the CAF compared with the CGP. Methods: Data were drawn from two nationally representative datasets: the 2013 Canadian Forces Mental Health Survey (Regular Forces, n = 6,692, response rate = 79.8%; Reserve Forces, n = 1,469, response rate = 78.7%) and the 2012 Canadian Community Health Survey–Mental Health ( n = 23,395; response rate = 68.9%). Keyes’ Mental Health Continuum–Short Form was used to measure positive functioning and emotional well-being. Results: Compared with the CGP, CAF personnel had reduced functioning and emotional well-being. All child abuse types were associated with increased odds of experiencing moderate and languishing mental health and decreased odds of reporting individual indicators of positive functioning and emotional well-being among the CGP and CAF personnel. One significant population interaction effect was found, indicating that among the CAF, exposure to intimate partner violence had a stronger relationship with moderate mental health than among the CGP. Discussion: Child abuse history may be an important factor to consider when trying to improve positive functioning and emotional well-being among CAF personnel.

Growing up in Armyville: Canada's Military Families during the Afghanistan Mission by Deborah Harrisson and Patrizia Albanese

Reviewed by: Growing up in Armyville: Canada's Military Families during the Afghanistan Mission by Deborah Harrisson and Patrizia Albanese Andrew Burtch Harrisson, Deborah and Patrizia Albanese – Growing up in Armyville: Canada's Military Families during the Afghanistan Mission. Waterloo: Wilfrid Laurier University Press, 2016. Pp. 258 Once, while leading a tour of an exhibition about the Afghanistan War at the Canadian War Museum, a woman who was present with her two middle school-aged children approached to apologetically (but firmly) explain that they needed to leave. Her husband, a Canadian Armed Forces member, was deployed to Afghanistan at the time, and the exhibition was hitting a bit too close to home for her and her children. I thought of that family when reading Growing up in Armyville. The book takes a close look generally at the people of Canadian Forces Base "Armyville" (a pseudonym), with a specific focus on the experiences of a sample of students who attended Armyville High School between 2006 and 2010. During this period, 800 soldiers from the base prepared to deploy, separated from family to serve overseas in Afghanistan, and returned and reintegrated postdeployment. Some 1,000 students filled out the authors' survey, based on questions from the National Longitudinal Survey of Children and Youth. The authors also interviewed 61 self-selected students and graduates from the community, whose open reflections about fear, withdrawal, stress, loss, and service are included at length in each chapter, expressing the advantages and stressors of military family life in their own words. The effort undertaken by Harrison and Albanese's team was not just academic. They engaged with the Armyville School District. Using a collaborative action research (CAR) approach, the team collaborated with the community [End Page 234] and administrators that would benefit from the end results of their study. As the researchers searched for insight into the impact of deployments on military family life, the school-affiliated participants sought information about how to improve supports for affected families during deployments (p. 4). The results of their research were communicated at a symposium following the surveys and interviews, leading to recommendations about how to better calibrate the school district and educators during high-stress periods such as the deployment to Afghanistan. The book is very well organized, and structured so that even nonspecialist readers can access its findings. Beginning with a brief synopsis of the patterns of Canadian military operations overseas, including Afghanistan, the authors proceed to describe the key terminology used in the study and introduce the reader to "Armyville." They then bring the reader through three chapters dedicated to the three stages of deployment as they affect families—the year or so leading up to deployment, the period during which a military member is separated from their family, and the longer postdeployment period, when military members and their families reintegrate with each other and settle into a new pattern of life. The concluding chapters focus on the recommendations made to the school district through the team's symposium and the outcome of those recommendations. The three chapters covering the predeployment, deployment, and postdeployment phases are informative and engrossing, thanks to the authors' lively writing and generous use of excerpts from interviews with adolescents. Consider the following student insight into the limited effect of superficial supports coupled with an unwillingness or inability to address the root causes of anxiety and depression: "We all had Support the Troops stickers. We all wear red on Friday, and all that. But the real stuff that's making these kids sad, it just gets pushed under the table. … Talking about it now makes me realize that there's so many kids that still aren't getting the support they need" (p. 129). Harrison and Albanese's findings provide valuable insights to military historians as well as historians of childhood, family, and gender. Their careful parsing of their findings reveals how boys and girls responded to stressors differently, how boys and girls responded to their own changing roles in the families as fathers or mothers deployed, and how they chafed against going back into the box of adolescence and childhood once their absent parent returned and tried to restore predeployment...

Stigma doesn\u2019t discriminate: physical and mental health and stigma in Canadian military personnel and Canadian civilians

BackgroundIllness-related stigma has been identified as an important public health concern. Past research suggests there is a disproportionate risk of mental-health stigma in the military, but this same finding has not yet been established for physical-health stigma. The current study aimed to assess the independent contribution of mental and physical health on both enacted stigma (discriminatory behaviour) and felt stigma (feelings of embarrassment) and to determine whether these associations were stronger for military personnel than civilians.MethodsData were obtained from the 2002 Canadian Community Health Survey - Mental Health and Well-being and its corresponding Canadian Forces Supplement. Logistic regressions were used to examine a potential interaction between population (military [N = 1900] versus civilian [N = 2960]), mental health, and physical health in predicting both enacted and felt stigma, with adjustments made for socio-demographic information, mental health characteristics, and disability.ResultsMental health did not predict enacted or felt stigma as a main effect nor in an interaction. There was a strong link between physical health and enacted and felt stigma, where worse physical health was associated with an increased likelihood of experiencing both facets of stigma. The link between physical health and enacted stigma was significantly stronger for military personnel than for civilians.ConclusionsPhysical health stigma appears to be present for both civilians and military personnel, but more so for military personnel. Elements of military culture (e.g., the way care is sought, culture of toughness, strict fitness requirements) as well as the physical demands of the job could be potential predictors of group differences.

Exploring Chiropractic Services in the Canadian Forces Health Services - Perceptions of Facilitators and Barriers Among Key Informants.

Musculoskeletal (MSK) conditions have a significant impact on the health and operational readiness of military members. The Canadian Forces Health Services (CFHS) provides a spectrum of health services in managing Canadian Armed Forces (CAF) personnel health care needs with on-base and off-base services provided by civilian and uniformed health care professionals, including chiropractors. Although chiropractic services are available in US DoD and VA systems, little is known about the facilitators and barriers to integrating on-base chiropractic services within the CFHS. This study explored key informants' perceptions of facilitators and barriers to the integration of on-base chiropractic services within the CFHS. We conducted a qualitative study to describe and understand how an integrated chiropractic service could be designed, implemented, and evaluated within the current interdisciplinary CFHS. Telephone interviews were conducted, using a semi-structured interview guide, to explore key informants' perceptions and experiences of chiropractic care within the CFHS. In total, we invited 27 individuals across Canada to participate; 15 were identified through purposeful sampling, 12 through a snowball sampling technique, and 2 declined. The 25 participants included military personnel (52%), public servants and contractors employed by the Department of Defense (24%), as well as civilian health care providers (24%). All participants were health care providers [physicians (MD) (7), physiotherapists (PT) (13), chiropractors (DC) (5)]. Interviews were audio-recorded and transcribed verbatim. Transcripts were prepared and analyzed using an interpretivist approach that explored key informants' perceptions and experiences. Qualitative analysis revealed numerous facilitators and barriers to chiropractic services in the CFHS. These were categorized under three broad themes: base-to-base variations, variable gatekeeper roles, and referral processes. Barriers to integrating chiropractic services included: lack of clarity about a chiropractor's clinical knowledge and skills; CFHS team members' negative prior experiences with chiropractors (e.g., inappropriate patient-focused communication, clinical management that was not evidence-based, ignorance of military culture); suboptimal bi-directional communication between CAF personnel and DCs across bases; and wide-ranging perspectives pertaining to duplication of services offered by PTs and DCs in managing MSK conditions. Facilitators associated with the integration of chiropractic services within a collaborative and interdisciplinary CAF environment included: patient benefits associated with multiple approaches utilized by different providers; adoption of up-to-date, high-quality evidence and guidelines to standardize care and curtail "dependency" between patient and providers; and co-location of providers to strengthen existing interprofessional communication and relationships. Key informants called for patient care that is collaborative, integrated and patient-centered, rather than "patient-driven" care; civilian providers understanding and respecting military culture rather than assuming transferability of patient management processes from the public civilian sector; standardization of communication protocols and measures to evaluate outcomes of care; and the need to move slowly and respectfully within the current CAF health care system if planning the on-base implementation of chiropractic services. This study illuminated many opportunities and barriers, in complex and diverse domains, related to introducing collaborative chiropractic services in the CFHS. The findings are relevant to increasing understanding and strengthening interprofessional collaborative care within the unique CAF health care delivery system.

Special Issue: Diagnostic Tools to Assess In Situ Remediation System Performance

Special Issue: Diagnostic Tools to Assess In Situ Remediation System Performance

Prevalence of comorbid chronic pain and mental health conditions in Canadian Armed Forces active personnel: analysis of a cross-sectional survey.

Chronic pain conditions and mental disorders have high prevalence rates in military populations. However, few investigations have examined the comorbidity between chronic pain conditions and specific mental disorders among Canadian active military personnel. We conducted a secondary analysis of data from the 2013 Canadian Forces Mental Health Survey (CFMHS) concerning the population of regular members. Diagnostic interviews assessed the presence of mental disorders, and participants self-reported chronic pain conditions (i.e., arthritis, back problems, musculoskeletal conditions, migraines) and indicators of pain severity. We used multiple logistic regressions to assess associations between chronic pain conditions and mental disorders. We used cross-tabulations to assess the prevalence of pain severity indicators in comorbid relationships compared with the chronic pain condition alone. We used moderation analyses to examine the interactions between pain condition by pain severity, and pain condition by activity limitation, respectively, on mental disorders. The CFMHS included data from 6696 regular members and had a response rate of 79.8%. About one-quarter (n = 1761) of military personnel reported having chronic pain. In the fully adjusted model, all assessed pain conditions were significantly associated with posttraumatic stress disorder (PTSD) (odds ratio [OR] range 1.86-2.55), and several pain conditions were associated with major depressive episode, generalized anxiety disorder and panic disorder. Back problems were significantly associated with all mental disorders apart from alcohol use disorders (OR range 1.40-2.17). Cross-tabulations showed higher prevalence estimates of endorsement for pain severity indicators among pain conditions and comorbid mental disorders, compared with pain conditions alone. Formal moderation analyses showed a significant relationship between migraine and activity limitation on PTSD. Chronic pain conditions are prevalent and co-occur with mental disorders among Canadian regular force members. Greater understanding of these chronic pain conditions and mental disorders and their impact on people's abilities to adapt to both military and civilian life is needed.

Improving psychiatric–psychological assessment capacity by matching level of care to client outcomes: enhancing discharge planning at an operational stress injury clinic in Canada

Mental health centres that assess and treat Canadian Forces members and Veterans have been experiencing an increasing number of referrals. At an Operational Stress Injury Clinic located in London, Ontario, which is mandated to treat this population, approximately half of clients are discharged within a year and another 12.1% require treatment for 5–9 years. The increasing complexities, such as multiple comorbidities, of these long-term clients reduce clinics’ ability to rapidly assess and treat new clients. This article explores the decision point of whether to continue treatment or to discharge a client to a different level of care as well as how best to provide treatment while keeping care transitions in mind. Enhancing the discharge process could lead to a greater capacity for treating new referrals.