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Wolfson C, Gauvin DE, Schulz J, Magalhaes S, Tansey CM, Feinstein A, Aiken A, Scarfo B, Middleton J, Raina P, VanTil L, Molnar-Szakacs I. The Canadian Longitudinal Study on Aging: A Vehicle for Research on Aging in Older Veterans. Mil Med 2024; 189:1080-1088. [PMID: 36722191 PMCID: PMC11110616 DOI: 10.1093/milmed/usad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/18/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Research on the health of older Veterans in Canada is an emerging area. Few population-based studies in Canada have included older Veterans as a specific group of interest. This paper describes a cohort of self-identified Veterans within the Canadian Longitudinal Study on Aging (CLSA). MATERIALS AND METHODS Using data from the CLSA baseline assessment (2011-2015), we describe sociodemographic and health characteristics along with military-related variables in a cohort of Veterans in Canada. We also estimate the number of Canadian and non-Canadian Veterans living in Canada at the time of the CLSA baseline data collection. RESULTS We estimate that at the CLSA baseline, there were 718,893 (95% confidence interval [CI], 680,033-757,110) Canadian Veterans and 185,548 (95% CI, 165,713-205,100) non-Canadian Veterans aged 45-85 years living in Canada. Veterans were older and predominantly male compared to non-Veterans in the CLSA. Following age and sex adjustment, the distribution of sociodemographic and health characteristics was similar across all groups. The majority (> 85%) of participants in each comparison group reported self-rated general and mental health as excellent, very good, or good. Following age and sex adjustment, most characteristics across groups remained similar. One exception was mental health, where a greater proportion of Veterans screened positive for depression and anxiety relative to non-Veterans. CONCLUSIONS Using CLSA baseline data, we estimate the number of older Veterans in Canada and present descriptive data that highlight interesting differences and similarities between Veterans and non-Veterans living in Canada. Canadian and non-Canadian Veterans in the CLSA are presented separately, with the latter group having not been previously studied in Canada. This paper presents a snapshot of a cohort of self-identified Veterans within the CLSA at study baseline and highlights the potential of the CLSA as a vehicle for studying the aging Veteran population in Canada for years to come.
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Affiliation(s)
- Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1G1, Canada
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Danielle E Gauvin
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Juliana Schulz
- Department of Decision Sciences, HEC Montréal, Montréal, QC H3T 2A7, Canada
| | - Sandra Magalhaes
- New Brunswick Institute for Research, Data and Training and Department of Sociology, University of New Brunswick, Fredericton, NB E3C 1N8, Canada
| | - Catherine M Tansey
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alice Aiken
- Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Brittany Scarfo
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Jason Middleton
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Linda VanTil
- Research Directorate, Veterans Affairs Canada, Charlottetown, PEI C1A 8M9, Canada
| | - Istvan Molnar-Szakacs
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
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Harwood-Gross A, Stern N, Brom D. Exposure to combat experiences: PTSD, somatization and aggression amongst combat and non-combat veterans. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2023; 58:424-432. [PMID: 37199000 DOI: 10.1002/ijop.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 04/30/2023] [Indexed: 05/19/2023]
Abstract
To this date, the prevalence of posttraumatic stress disorder (PTSD) and associated psychological symptom profiles amongst non-combatant community-based veterans in Israel has not been studied. Data were analysed from a web-based survey of veterans via a market research platform during September 2021 and included 522 non-combat (e.g. intelligence, office-based or education corps) veterans and 534 combat (e.g. front-line infantry) veterans. The survey assessed PTSD, depression, anxiety and somatic symptoms in addition to the prevalence of self-reported aggression. A two-way multivariate analysis of covariance indicated that higher PTSD and somatic symptoms were prevalent for those exposed to combat experiences even when not in a combatant role. A logistic regression indicated that of those who did not self-define as aggressive prior to service, those exposed to combat were three times more likely to be aggressive following their service than veterans not exposed to combat. This effect was not demonstrated for combat soldiers compared to non-combat soldiers. Results indicate that mental health outreach would be better targeted towards those who have been exposed to combat-type experiences during their service even in non-combat units. The current study highlights the effect of combat exposure on secondary PTSD symptoms; aggression and somatization.
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Affiliation(s)
- Anna Harwood-Gross
- METIV Israel Psychotrauma Center, Herzog Medical Center, Jerusalem, Israel
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel
| | - Nadav Stern
- METIV Israel Psychotrauma Center, Herzog Medical Center, Jerusalem, Israel
| | - Danny Brom
- METIV Israel Psychotrauma Center, Herzog Medical Center, Jerusalem, Israel
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Waddell JT, Gress-Smith JL, Hartman JD, Doran N, Reed B. Age, sex, and race-varying rates of alcohol use, cannabis use, and alcohol and cannabis co-use in veterans vs. non-veterans. Addict Behav 2022; 134:107418. [PMID: 35816904 DOI: 10.1016/j.addbeh.2022.107418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/10/2022] [Accepted: 06/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Military veterans are a high-risk group for health risk behaviors, including alcohol and cannabis use. However, research on veteran vs. non-veteran rates of alcohol/cannabis use are inconsistent across studies. Further, no research has investigated veteran vs. non-veteran rates of alcohol and cannabis co-use, and few studies have tested whether demographic variables, particularly race/ethnicity, moderate group differences. Therefore, the current study tested whether 1) veteran vs. non-veterans differed in rates of alcohol use, cannabis use, and alcohol and cannabis co-use, and 2) whether demographic covariates (age, sex, race/ethnicity) moderated associations. METHODS Data on adults (N = 706,897; 53.4% female) were derived from the 2002-2019 National Study on Drug Use and Health. Participant demographics, alcohol use frequency, drinking quantity, and cannabis use frequency were self-reported. RESULTS Non-veterans reported higher drinking quantity, cannabis frequency, and co-use. However, being a veteran was a risk factor for heavier drinking for women, ethnic/racial minoritized participants, and adults under the age of 50. Additionally, veteran status was a risk factor for cannabis use frequency in racial/ethnic minoritized participants and women. Similarly, being a veteran was a risk factor for alcohol and cannabis co-use for racial/ethnic minoritized participants, and the buffering effect of being a Veteran on co-use was reduced for older participants and women. CONCLUSIONS Results suggest that, at the population level, non-veterans may be heavier alcohol/cannabis users. However, moderating analyses suggested that being a veteran is a risk factor for women, racial/ethnic minoritized individuals, and younger individuals. Findings are discussed in terms of public health implications.
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Affiliation(s)
- Jack T Waddell
- Arizona State University, United States; Phoenix VA Health Care System, United States.
| | | | | | - Neal Doran
- University of California-San Diego Health Care System, United States
| | - Brandon Reed
- University of California-San Diego Health Care System, United States
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Sommer JL, Mota N, Thompson JM, Asmundson GJ, Sareen J, Bernstein CN, Marrie RA, El-Gabalawy R. Associations between courses of posttraumatic stress disorder and physical health conditions among Canadian military personnel. J Anxiety Disord 2022; 87:102543. [PMID: 35168002 DOI: 10.1016/j.janxdis.2022.102543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/15/2021] [Accepted: 01/14/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and physical health conditions commonly co-occur and are both prevalent among military personnel. This study examined how courses of PTSD (no PTSD, remitted, new onset, persistent/recurrent) are associated with physical health conditions, among a population-based sample of Canadian military personnel. METHOD We analyzed data from the 2002 Canadian Community Health Survey-Mental Health and Well-being-Canadian Forces supplement (CCHS-CF) and the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS; N = 2941). Multivariable logistic regressions examined associations between PTSD courses (reference = no PTSD) and physical health conditions. RESULTS In general, physical health conditions were more prevalent among symptomatic PTSD courses compared to no PTSD. After adjustment, new onset PTSD was associated with increased odds of all physical health conditions with the exception of ulcers and cancer (AOR range: 1.41-2.31) and remitted PTSD was associated with increased odds of diabetes (AOR = 2.31). CONCLUSION Results suggest that new onset PTSD may be most strongly associated with physical health conditions. Findings may inform targeted screening and intervention methods among military personnel with PTSD and physical health conditions.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2 Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2 Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada
| | - James M Thompson
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Gordon Jg Asmundson
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2 Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada
| | - Charles N Bernstein
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9 Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9 Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2 Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2 Canada; Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada; Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada; CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9 Canada.
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Reyes Velez J, Thompson JM, Sweet J, Busse JW, VanTil L. Cluster analysis of Canadian Armed Forces veterans living with chronic pain: Life After Service Studies 2016. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2021; 5:81-95. [PMID: 34189392 PMCID: PMC8210876 DOI: 10.1080/24740527.2021.1898278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: This study explored the heterogeneity of Canadian Armed Forces veterans living with chronic pain to inform service needs planning and research using cluster analysis. Design: We used a national cross-sectional Statistics Canada population survey. Participants: Participants included 2754 Canadian Armed Forces (CAF) Regular Force veterans released from service between 1998 and 2015 and surveyed in 2016. Methods: We used cluster analysis of veterans with chronic pain based on pain severity, mental health, and activity limitation characteristics. We compared clusters for sociodemographic, health, and service utilization characteristics. Results: Of 2754 veterans, 1126 (41%) reported chronic pain. Veterans in cluster I (47%) rarely had severe pain (2%) or severe mental health problems (8%), and none had severe activity limitations. Veterans in cluster II (26%) more often than veterans in cluster I but less often than veterans in cluster III endorsed severe pain (27%) and severe mental health problems (22%) and were most likely to report severe activity limitation (91%). Veterans in cluster III (27%) were most likely to report severe pain (36%) and severe mental health problems (96%), and a majority reported severe activity limitations (72%). There was evidence of considerable heterogeneity among individuals in terms of socioeconomic characteristics, pain characteristics, mental and physical health status, activity limitations, social integration, and service utilization indicators. Conclusions: About half of Canadian veterans living with chronic pain infrequently endorse severe pain or serious mental health issues without severe activity limitations. The other half had more complex characteristics. The heterogeneity of CAF veterans with chronic pain emphasizes the need for support systems that can address variability of needs.
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Affiliation(s)
| | - James M Thompson
- Department of Public Health Sciences, Queens University, Kingston, Ontario, Canada
| | - Jill Sweet
- VAC Research Directorate, Charlottetown, Prince Edward Island, Canada
| | - Jason W Busse
- Michael DeGroote Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Linda VanTil
- VAC Research Directorate, Charlottetown, Prince Edward Island, Canada
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Turna J, MacKillop J. Cannabis use among military veterans: A great deal to gain or lose? Clin Psychol Rev 2021; 84:101958. [PMID: 33486280 DOI: 10.1016/j.cpr.2021.101958] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/11/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022]
Abstract
Policy changes have resulted in dramatic increases in access to cannabis for medical purposes. Veterans are disproportionately affected by conditions for which medical cannabis is often pursued, making an evidence-based perspective on risks versus benefits of high priority. The current review sought to examine the state of the evidence on the correlates and consequences of cannabis use among veterans. Using a comprehensive search strategy, 501 articles were identified and 86 studies met criteria for inclusion. The literature was predominated by cross-sectional studies (67%) of male veterans (71.4%-100% male) from the United States (93.0%). Three overarching themes emerged, comprising cannabis associations with other substance use, mental health, and physical health outcomes. The balance of the evidence associated cannabis use with negative health outcomes, with consistent positive associations with other substance use, psychiatric disorders, and self-harm/suicidality. Few studies examined the therapeutic effects of cannabis, thus limiting the potential to evaluate evidence of efficacy. Priority areas for future research are studies using designs that can examine the directionality of links between cannabis and health in veterans more conclusively, and studies directly examining therapeutic efficacy of cannabis-based therapies in veterans. Methodologically rigorous design will be essential to inform clinical recommendations and practices guidelines in an era of burgeoning access to cannabis.
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Affiliation(s)
- Jasmine Turna
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada
| | - James MacKillop
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Homewood Research Institute, 150 Delhi St. Riverslea Building, Guelph, ON N1E 6K9, Canada.
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Walker RAJ, Colclough M, Limbert C, Smith PM. Perceived barriers to, and benefits of physical activity among British military veterans that are wounded, injured, and/or sick: a Behaviour Change Wheel perspective. Disabil Rehabil 2020; 44:901-909. [PMID: 32568568 DOI: 10.1080/09638288.2020.1781940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Many British military veterans that are wounded, injured, and/or sick (WIS) face significant physical, psychological and social challenges following discharge from the military. There is increasing evidence to support the application and benefit of physical activity for veterans that are WIS. Understanding engagement in physical activity is therefore imperative so that physical activity interventions and initiatives can be designed effectively, and their benefits optimised. Therefore, the aim of this study is to identify the perceived barriers to, and benefits of physical activity among veterans that are WIS.Materials and methods: Nine semi-structured interviews were conducted to explore perceived barriers to, and benefits of physical activity amongst veterans that are WIS. A thematic analysis was conducted, and themes mapped to the Behaviour Change Wheel's capability, opportunity, motivation-behaviour (COM-B) model.Results: Perceptions related to physical capability, psychological capability, physical opportunity and reflective motivation were predominant barriers to engagement in physical activity. As well providing opportunities to socialise, the perceived benefits of engagement in physical activity seemed to mirror the perceived barriers, suggesting a reciprocal relationship.Conclusions: Using the Behaviour Change Wheel, incentivisation, education, persuasion, enablement and environmental restructuring were identified as potentially beneficial intervention functions when seeking to increase levels of physical activity among veterans that are WIS living within the United Kingdom.IMPLICATIONS FOR REHABILITATIONUK-based veterans that are wounded, injured, and/or sick (WIS) often face significant challenges with respect to physical, mental, and social well-being.Perceived barriers, in the form of limited opportunities and a self-perceived lack of capability impact on levels of motivation and are viewed as obstacles to becoming physically active by veterans that are WIS.Providing education and complementary incentives may help reduce the extent of perceived barriers in veterans that are WIS.Approaches that allow veterans that are WIS to socialise while developing self-efficacy will likely increase physical activity engagement.
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Affiliation(s)
- Robert A J Walker
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Martin Colclough
- Help for Heroes: United Kingdom Armed Forces and Military Veterans Charity, Tedworth House, England, UK
| | - Caroline Limbert
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Paul M Smith
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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Thompson JM, Heber A, VanTil L, Simkus K, Carrese L, Sareen J, Pedlar D. Life course well-being framework for suicide prevention in Canadian Armed Forces Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2018-0020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: The risks of suicidality (suicidal ideation or behaviour) are higher in Canadian Armed Forces (CAF) Veterans (former members) than in the Canadian general population (CGP). Suicide prevention is everyone’s responsibility, but it can be difficult for many to see how they can help. This article proposes an evidence-based theoretical framework for discussing suicide prevention. The framework informed the 2017 joint CAF – Veterans Affairs Canada (VAC) suicide prevention strategy. Methods: Evidence for the framework was derived from participation in expert panels conducted by the CAF in 2009 and 2016, a review of findings from epidemiological studies of suicidality in CAF Veterans released since 1976, suicide prevention literature reviews conducted at VAC since 2009, and published theories of suicide. Results: Common to all suicide theories is the understanding that suicide causation is multifactorial, complex, and varies individually such that factors interact rather than lie along linear causal chains. Discussion: The proposed framework has three core concepts: a composite well-being framework, the life course view, and opportunities for prevention along the suicide pathway from ideation to behaviour. Evidence indicates that Veterans are influenced onto, along, and off the pathway by variable combinations of mental illness, stressful well-being problems and life events, individual factors including suicidal diathesis vulnerability, barriers to well-being supports, acquired lethal capability, imitation, impulsivity, and access to lethal means. The proposed framework can inform discussions about both whole-community participation in prevention, intervention and postvention activities at the individual and population levels, and the development of hypotheses for the increased risk of suicidality in CAF Veterans.
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Affiliation(s)
- James M. Thompson
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
- Queen’s University, Kingston, Ontario, Canada
| | - Alexandra Heber
- Veterans Affairs Canada, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Linda VanTil
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | | | - Lina Carrese
- Veterans Affairs Canada, Montreal, Quebec, Canada
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MacLean MB, Keough J, Poirier A, McKinnon K, Sweet J. Labour market outcomes of Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2019. [DOI: 10.3138/jmvfh.2017-0016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: Employment is important to health, well-being, and adjustment from military to civilian life. Given the importance of employment, we examine Veteran labour force outcomes in Canada. Methods: We examined labour market indicators from the 2010 and 2013 Life After Service Studies cross-sectional Survey on Transition to Civilian Life, along with the 2013 Income Study for Canadian Regular Force Veterans (released since 1998). Results: In Canada, most Regular Force Veterans surveyed were employed after release and satisfied with their work – both employment and satisfaction rates grew over time. The unemployment rate did not differ from that of the general Canadian population. However, Veterans were more likely than the general Canadian population to experience activity limitations at work. Variations in outcomes were found across diverse groups of the population. For example, unemployed Veterans were younger at release, had the fewest years of service, and were more likely to have served in the Army than employed Veterans. Veterans who were not in the labour force were older and had more years of service, and many were experiencing barriers to work. Employment rates were lower among female Veterans and among medically released Veterans. Discussion: Labour market outcomes vary across sub-groups of the Veteran population, suggesting targeted approaches to improve labour market outcomes. Findings suggest that the prevention of work disability is important for improving outcomes. Best practices in preventing work disability include restructuring compensation to recognize varying degrees of earnings capacity and to encourage labour market engagement and supported employment programs.
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Affiliation(s)
- Mary Beth MacLean
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Jacinta Keough
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Alain Poirier
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | | | - Jill Sweet
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
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Forbes D, Pedlar D, Adler AB, Bennett C, Bryant R, Busuttil W, Cooper J, Creamer MC, Fear NT, Greenberg N, Heber A, Hinton M, Hopwood M, Jetly R, Lawrence-Wood E, McFarlane A, Metcalf O, O'Donnell M, Phelps A, Richardson JD, Sadler N, Schnurr PP, Sharp ML, Thompson JM, Ursano RJ, Hooff MV, Wade D, Wessely S. Treatment of military-related post-traumatic stress disorder: challenges, innovations, and the way forward. Int Rev Psychiatry 2019; 31:95-110. [PMID: 31043106 DOI: 10.1080/09540261.2019.1595545] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Post-traumatic stress disorder (PTSD) is one of the common mental disorders in military and veteran populations. Considerable research and clinical opinion has been focused on understanding the relationship between PTSD and military service and the implications for prevention, treatment, and management. This paper examines factors associated with the development of PTSD in this population, considers issues relating to engagement in treatment, and discusses the empirical support for best practice evidence-based treatment. The paper goes on to explore the challenges in those areas, with particular reference to treatment engagement and barriers to care, as well as treatment non-response. The final section addresses innovative solutions to these challenges through improvements in agreed terminology and definitions, strategies to increase engagement, early identification approaches, understanding predictors of treatment outcome, and innovations in treatment. Treatment innovations include enhancing existing treatments, emerging non-trauma-focused interventions, novel pharmacotherapy, personalized medicine approaches, advancing functional outcomes, family intervention and support, and attention to physical health.
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Affiliation(s)
- David Forbes
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - David Pedlar
- b Canadian Institute for Military and Veteran Health Research , Kingston , ON, Canada
| | - Amy B Adler
- c Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research , Silver Spring , MD , USA
| | - Clare Bennett
- d New Zealand Defence Force , Wellington , New Zealand
| | - Richard Bryant
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.,e School of Psychology , University of New South Wales , Sydney , Australia
| | | | - John Cooper
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Mark C Creamer
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Nicola T Fear
- g King's Centre for Military Health Research, King's College London , London , UK.,h Academic Centre for Military Mental Health Research , London , UK
| | - Neil Greenberg
- g King's Centre for Military Health Research, King's College London , London , UK
| | - Alexandra Heber
- i Veterans Affairs Canada , Charlottetown , Canada.,j Department of Psychiatry , University of Ottawa , Ottawa , Canada
| | - Mark Hinton
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Mal Hopwood
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Rakesh Jetly
- k Directorate of Mental Health , Canadian Armed Forces , Ottawa , Canada
| | - Ellie Lawrence-Wood
- l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Alexander McFarlane
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia.,l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Olivia Metcalf
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Meaghan O'Donnell
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Andrea Phelps
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - J Don Richardson
- m Department of Psychiatry , Western University , London , Canada.,n McDonald/Franklin OSI Research Centre , London , Canada
| | - Nicole Sadler
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Paula P Schnurr
- o National Center for PTSD , White River Junction , VT , USA.,p Department of Psychiatry , Geisel School of Medicine , Hanover , NH , USA
| | - Marie-Louise Sharp
- g King's Centre for Military Health Research, King's College London , London , UK
| | - James M Thompson
- i Veterans Affairs Canada , Charlottetown , Canada.,q Department of Public Health Sciences , Queen's University , Kingston , ON , Canada
| | - Robert J Ursano
- r Center for the Study of Traumatic Stress, Department of Psychiatry , Uniformed Services University School of Medicine , Bethesda , MD , USA
| | - Miranda Van Hooff
- l Centre for Traumatic Stress Studies , University of Adelaide , Adelaide , Australia
| | - Darryl Wade
- a Centenary of Anzac Centre, Phoenix Australia-Centre for Posttraumatic Mental Health, Department of Psychiatry , University of Melbourne , Carlton , Australia
| | - Simon Wessely
- g King's Centre for Military Health Research, King's College London , London , UK
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MacKillop J, Busse JW. Prioritizing research on cannabis use among Canadian Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.4.2.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- James MacKillop
- Michael G. DeGroote Centre for Medicinal Cannabis Research at McMaster University and St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Jason W. Busse
- Michael G. DeGroote Centre for Medicinal Cannabis Research at McMaster University and St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
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Vun E, Turner S, Sareen J, Mota N, Afifi TO, El-Gabalawy R. Prevalence of comorbid chronic pain and mental health conditions in Canadian Armed Forces active personnel: analysis of a cross-sectional survey. CMAJ Open 2018; 6:E528-E536. [PMID: 30389752 PMCID: PMC6221807 DOI: 10.9778/cmajo.20180093] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. INTERPRETATION 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.
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Affiliation(s)
- Everett Vun
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Sarah Turner
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Jitender Sareen
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Natalie Mota
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Tracie O Afifi
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Renée El-Gabalawy
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.
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Beliveau PJH, Boulos D, Zamorski MA. Contribution of mental and physical disorders to disability in military personnel. Occup Med (Lond) 2018; 68:332-339. [PMID: 29788489 PMCID: PMC6012132 DOI: 10.1093/occmed/kqy066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Combat operations in Southwest Asia have exposed millions of military personnel to risk of mental disorders and physical injuries, including traumatic brain injury (TBI). The contribution of specific disorders to disability is, however, uncertain. Aims To estimate the contributions of mental and physical health conditions to disability in military personnel. Methods The sample consisted of military personnel who participated in the cross-sectional 2013 Canadian Forces Mental Health Survey. Disability was measured using the World Health Organization Disability Assessment. The International Classification of Functioning, Disability, and Health was used to classify participants with moderate/severe disability. Chronic mental disorders and physical conditions were measured by self-reported health professional diagnoses, and their contribution to disability was assessed using logistic regression and resulting population attributable fractions. Results Data were collected from 6696 military members. The prevalence of moderate/severe disability was 10%. Mental disorders accounted for 27% (95% confidence interval [CI] 23–31%) and physical conditions 62% (95% CI 56–67%) of the burden of disability. Chronic musculoskeletal problems 33% (95% CI 26–39%), back problems 29% (95% CI 23–35%), mood disorders 16% (95% CI 11–19%) and post-traumatic stress disorder (PTSD) 9% (95% CI 5–12%) were the leading contributors to disability. After-effects of TBI accounted for only 3% (95% CI 1–4%) of disability. Mental and physical health interacted broadly, such that those with mental disorders experienced disproportionate disability in the presence of physical conditions. Conclusions Chronic musculoskeletal conditions, back problems, mood disorders and PTSD are primary areas of focus in prevention and control of disability in military personnel.
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Affiliation(s)
- P J H Beliveau
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - D Boulos
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - M A Zamorski
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Thompson JM, Zamorski MA, Fikretoglu D, VanTil L, Sareen J, MacLean MB, Carrese P, Macintosh S, Pedlar D. Out of the shadows: mental health of Canadian armed forces veterans. Int Psychiatry 2018. [DOI: 10.1192/s1749367600004653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In the past 15 years in Canada, as in other nations, the mental health of veterans has emerged as a key concern for both government and the public. As mental health service enhancement unfolded, the need for wider population studies became apparent. This paper describes the renewal of services and key findings from national surveys of serving personnel and veterans.
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Carleton RN, Afifi TO, Turner S, Taillieu T, El-Gabalawy R, Sareen J, Asmundson GJG. Chronic pain among public safety personnel in Canada. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2017; 1:237-246. [PMID: 35005358 PMCID: PMC8730622 DOI: 10.1080/24740527.2017.1410431] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background: Chronic pain is highly prevalent in the general population and may be even higher among public safety personnel (PSP; e.g., correctional officers, dispatchers, firefighters, paramedics, police). Comprehensive data on chronic pain among diverse Canadian PSP are relatively sparse. Aims: The current study was designed to provide initial estimates of chronic pain frequency and severity among Canadian PSP. Methods: Estimates of chronic pain frequency and severity (i.e., intensity and duration) at different bodily locations were derived from self-reported data collected through an online survey. Participants included 5093 PSP (32.5% women) grouped into six categories (i.e., call center operators/dispatchers, correctional officers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police [RCMP]). Results: Substantial proportions of participants reported chronic pain, with estimates ranging from 35.3% to 45.4% across the diverse PSP categories. Across PSP categories, chronic lower back pain was the most prevalent. For some pain locations, firefighters and municipal/provincial police reported lower prevalence, but paramedics reported lower intensity, and duration, than some other PSP groups. Over 50% of RCMP and paramedics reporting chronic pain indicated that the pain was associated with an injury related to active duty. Conclusions: Discrepancies emerged across PSP members with respect to prevalence, location, and severity. The current data suggest that additional resources and research are necessary to mitigate the development and maintenance of distressing or disabling chronic pain for Canadian PSP.
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Affiliation(s)
- R. N. Carleton
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - T. O. Afifi
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S. Turner
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - T. Taillieu
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - R. El-Gabalawy
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J. Sareen
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - G. J. G. Asmundson
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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Hinojosa R, Hinojosa MS. Activity-Limiting Musculoskeletal Conditions in US Veterans Compared to Non-Veterans: Results from the 2013 National Health Interview Survey. PLoS One 2016; 11:e0167143. [PMID: 28005905 PMCID: PMC5179052 DOI: 10.1371/journal.pone.0167143] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022] Open
Abstract
Past military service is associated with health outcomes, both positive and negative. In this study we use the 2013 National Health Interview Survey to examine the constellation of conditions referred to as musculoskeletal disorders (MSDs) for Veterans and non-veterans with health conditions that limit their daily activities. Multivariate logistic regression analysis reveal that Veterans are more likely to report MSDs like neck and back problems, fracture bone and joint problems as an activity limiting problem compared to non-veterans. The relationship between age and reports of activity limiting MSDs is moderated by Veteran status. Veterans in this sample report more activity limiting MSDs at younger ages compared to non-veterans and fewer MSDs at older ages. This research contributes to our understanding of potentially limiting health conditions at earlier ages for Veterans.
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Affiliation(s)
- Ramon Hinojosa
- Department of Sociology, University of Central Florida, 4297 Andromeda Loop North, Howard Phillips Hall 406, Orlando, FL, United States of America
| | - Melanie Sberna Hinojosa
- Department of Sociology, University of Central Florida, 4297 Andromeda Loop North, Howard Phillips Hall 406, Orlando, FL, United States of America
- * E-mail:
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Weeks M, Garber BG, Zamorski MA. Disability and Mental Disorders in the Canadian Armed Forces. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:56S-63S. [PMID: 27270743 PMCID: PMC4800473 DOI: 10.1177/0706743716628853] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The initial goal was to validate the use of a self-report measure of disability in the Canadian Armed Forces (CAF). The main goal was to document the extent of disability in personnel with and without mental disorders. METHODS Data were obtained from the 2013 Canadian Forces Mental Health Survey; the sample included 6700 Regular Forces personnel. Disability was measured with the 12-item version of the World Health Organization Disability Assessment Schedule (WHODAS-2); established cut points were used to demarcate severe, moderate, minimal, and no disability. The following recent (past-year) and remote (lifetime but not past-year) disorders were assessed with diagnostic interviews: posttraumatic stress disorder, major depressive episode, generalized anxiety disorder, panic disorder, and alcohol use disorder. RESULTS The WHODAS-2 showed good internal consistency (α = 0.89) and a 1-factor structure. Most personnel had no disability (59.2%) or minimal disability (30.8%). However, an important minority had moderate or severe disability (8.4% and 1.6%, respectively). Individuals with recent disorders reported greater disability than those without lifetime disorders, although many had minimal or no disability (41.2% and 24.7%, respectively). Disability increased with the number of recent disorders. Relative to those without lifetime disorders, individuals with remote disorders showed slightly greater disability, but most had no disabilty (57.1%) or minimal disability (35.0%). CONCLUSIONS The 12-item WHODAS-2 is a valid measure of disability in the CAF. Mental disorders may be important drivers of disability in this population, although limited residual disability is seen in individuals with remote disorders.
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Affiliation(s)
- Murray Weeks
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON
| | - Bryan G Garber
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON
| | - Mark A Zamorski
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON Department of Family Medicine, University of Ottawa, Ottawa, ON
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Thompson JM, VanTil LD, Zamorski MA, Garber B, Dursun S, Fikretoglu D, Ross D, Richardson JD, Sareen J, Sudom K, Courchesne C, Pedlar DJ. Mental health of Canadian Armed Forces Veterans: review of population studies. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2016. [DOI: 10.3138/jmvfh.3258] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction. The mental health of Canadian Armed Forces (CAF) populations emerged as an important concern in the wake of difficult CAF deployments in the 1990s. This article is the first comprehensive summary of findings from subsequent surveys of mental health and well-being in CAF Veterans, undertaken to inform mental health service renewals by CAF Health Services and Veterans Affairs Canada (VAC). Methods. Epidemiological findings in journal publications and government reports were summarized from four cross-sectional national surveys: a survey of Veterans participating in VAC programs in 1999 and three surveys of health and well-being representative of whole populations of Veterans in 2003, 2010, and 2013. Results. Although most Veterans had good mental health, many had mental health problems that affected functioning, well-being, and service utilization. Recent Veterans had a higher prevalence of mental health problems than the general Canadian population, earlier-era Veterans, and possibly the serving population. There were associations between mental health conditions and difficult adjustment to civilian life, physical health, and multiple socio-demographic factors. Mental health problems were key drivers of disability. Comparisons with other studies were complicated by methodological, era, and cultural differences. Discussion. The survey findings support ongoing multifactorial approaches to optimizing mental health and well-being in CAF Veterans, including strong military-to-civilian transition support and access to effective mental and physical health services. Studies underway of transitioning members and families in the peri-release period of the military-to-civilian transition and longitudinal studies of mental health in Veterans will address important knowledge gaps.
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Affiliation(s)
- James M. Thompson
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Linda D. VanTil
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Mark A. Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - Bryan Garber
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - Sanela Dursun
- Director General Military Personnel Research and Analysis (DGMPRA), Ottawa, Ontario, Canada
| | - Deniz Fikretoglu
- Defense Research and Development Canada, Toronto, Ontario, Canada
| | - David Ross
- National Centre for Operational Stress Injuries, Veterans Affairs Canada, Sainte-Anne-de-Bellevue, QC
| | | | - Jitender Sareen
- Departments of Psychiatry, Psychology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kerry Sudom
- Director General Military Personnel Research and Analysis (DGMPRA), Ottawa, Ontario, Canada
| | - Cyd Courchesne
- Health Professionals, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - David J. Pedlar
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
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Rebeira M, Grootendorst P, Coyte PC. Determinants of chronic physical health conditions in Canadian Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2015. [DOI: 10.3138/jmvfh.3091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: Limited information is available about the determinants of chronic health conditions of Veterans despite the increasingly perilous nature of military engagements in recent decades. Methods: Econometric analysis, using probit and negative binomial models, was conducted on the basis of data from a cross-sectional self-reported health survey of Canadian Veterans to investigate the determinants of musculoskeletal, respiratory, gastrointestinal, and cardiovascular health conditions; pain; and diabetes. Results: The results stress the role of military service–related factors in the increased likelihood of chronic physical health conditions in Canadian Veterans. Army Veterans had an increased probability of musculoskeletal (0.08, p ≤ 0.001) and gastrointestinal (0.05, p ≤ 0.001) conditions and pain (0.07, p ≤ 0.01). Veterans who were deployed had an increased risk of musculoskeletal conditions (0.08, p ≤ 0.001) and pain (0.06, p ≤ 0.001). In terms of non–service-related factors, the results confirm the role of obesity as a statistically significant determinant of chronic musculoskeletal, respiratory, and cardiovascular conditions; pain; and diabetes. Female Veterans were also at higher risk of respiratory and gastrointestinal conditions. Low-income Veterans have increased probability of musculoskeletal, gastrointestinal, pain, and cardiovascular conditions, and the risk decreased with rising income level. Finally, Veterans with mental health conditions had increased odds of musculoskeletal (OR = 2.79, p ≤ 0.001), respiratory (OR = 2.40, p ≤ 0.001), gastrointestinal (3.66, p ≤ 0.001), pain (OR = 2.61, p ≤ 0.001), and cardiovascular (OR = 1.45, p ≤ 0.01) conditions and diabetes (OR = 1.37, p ≤ 0.05). Discussion: The findings have important clinical and health resource use implications as Veterans seek treatment in community settings once they transition from military to civilian life. They also serve to advance the research agenda on the health of Veterans, an understudied population in Canada.
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Affiliation(s)
- Mayvis Rebeira
- Centre for Health Economics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
| | - Paul Grootendorst
- Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Peter C. Coyte
- Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
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Abstract
In the United States, extensive research has been conducted investigating chronic pain among Veterans; however, such research has not been conducted among Canadians who served in the military. Accordingly, this study aimed to investigate the prevalence of chronic pain among Canadian Veterans, and to determine correlates of chronic pain in this population. Data for this study were obtained from the Survey on Transition to Civilian Life; 3154 Veterans released from service between January 1, 1998 and December 31, 2007 responded to the survey. BACKGROUND: Little is known about the prevalence of chronic pain among Veterans outside the United States. OBJECTIVE: To describe the prevalence of chronic pain and associated sociodemographic, health behaviour, employment/income, disability, and physical and mental health factors in Canadian Veterans. METHODS: The 2010 Survey on Transition to Civilian Life included a nationally representative sample of 3154 Canadian Armed Forces Regular Force Veterans released from service between 1998 and 2007. Data from a telephone survey of Veterans were linked with Department of National Defence and Veterans Affairs Canada administrative databases. Pain was defined as constant/reoccurring pain (chronic pain) and as moderate/severe pain interference with activities. RESULTS: Forty-one percent of the population experienced constant chronic pain and 23% experienced intermittent chronic pain. Twenty-five percent reported pain interference. Needing help with tasks of daily living, back problems, arthritis, gastrointestinal conditions and age ≥30 years were independently associated with chronic pain. Needing help with tasks of daily living, back problems, arthritis, mental health conditions, age ≥30 years, gastrointestinal conditions, low social support and noncommissioned member rank were associated with pain interference. CONCLUSIONS: These findings provide evidence for agencies and those supporting the well-being of Veterans, and inform longitudinal studies to better understand the determinants and life course effects of chronic pain in military Veterans.
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