Prevalence and Correlates of Military Sexual Trauma in Service Members and Veterans: Results From the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey.

INTRODUCTION: Military sexual trauma (MST) is an ongoing problem. We used a 2002 population-based sample, followed up in 2018, to examine: (1) the prevalence of MST and non-MST in male and female currently serving members and veterans of the Canadian Armed Forces, and (2) demographic and military correlates of MST and non-MST. METHODS: Data came from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (n = 2,941, ages 33 years + ). Individuals endorsing sexual trauma were stratified into MST and non-MST and compared to individuals with no sexual trauma. The prevalence of lifetime MST was computed, and correlates of sexual trauma were examined using multinomial regression analyses. RESULTS: The overall prevalence of MST was 44.6% in females and 4.8% in males. Estimates were comparable between currently serving members and veterans. In adjusted models in both sexes, MST was more likely among younger individuals (i.e., 33-49 years), and MST and non-MST were more likely in those reporting more non-sexual traumatic events. Among females, MST and non-MST were more likely in those reporting lower household income, non-MST was less likely among Officers, and MST was more likely among those with a deployment history and serving in an air environment. Unwanted sexual touching by a Canadian military member or employee was the most prevalent type and context of MST. INTERPRETATION: A high prevalence of MST was observed in a follow-up sample of Canadian Armed Forces members and veterans. Results may inform further research as well as MST prevention efforts.

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

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

Validation of the Patient Health Questionnaire-2 to screen for depression in Canadian Armed Forces personnel.

Post-deployment screening within the Canadian Armed Forces (CAF) aims to capture those with mental health issues so that appropriate and timely treatment can be provided. However, the process is lengthy and places considerable burden on CAF members and clinicians. Evaluation of shorter measures of mental health is an important step toward reducing the length of the process while still capturing those in need of care. This study evaluated the 2-item Patient Health Questionnaire (PHQ-2) as a potential brief measure of depression to be included in screening. Operating characteristics of the PHQ-2 were assessed against the full scale using existing recommended cutoffs, as well as clinician impressions of depression being of major concern. Correlations of the PHQ-2 with other measures of health were also examined. The PHQ-2 demonstrated good sensitivity and specificity for detecting depression compared to the full scale and to clinician impressions, at cutoffs similar to those found in past research. As well, it exhibited high correlations with other measures of mental health. This study provides evidence for the validity of the PHQ-2 as a brief screening tool for depression in CAF members following deployment.

Validation of a brief measure of combat exposure among Canadian Armed Forces personnel.

BACKGROUND: Exposure to military combat is associated with mental health problems, including posttraumatic stress disorder (PTSD) and depression. To understand the effects of combat on adverse health outcomes, the sound measurement of combat experiences is required; however, many scales used in past research are lengthy. A brief measure of combat exposure benefits militaries by reducing the burden on respondents as well as administration time in post-deployment settings and large population-based health surveys. DATA AND METHODS: The current study sought to describe the psychometric properties of a brief measure of combat exposure among Canadian Armed Forces (CAF) personnel. Data from post-deployment screening were used to compare the psychometric properties of an 8-item scale with the full scale that it was derived from. RESULTS: The 8-item measure did not fit a one-factor solution well and did not offer a statistically significant improvement in model fit over the full 30-item measure. However, its association with increased odds of a number of health outcomes indicates that it could be useful as a brief measure of combat exposure in settings where using the full scale is not feasible. DISCUSSION: Brief measures of combat exposure are valuable for assessing events experienced during deployment among military personnel. Although the 8-item Combat Exposure Scale assessed in the current study represents a potentially useful measure for CAF personnel, further research is necessary to improve its fit.

Role of modifiable organisational factors in decreasing barriers to mental healthcare: a longitudinal study of mission meaningfulness, team relatedness and leadership trust among Canadian military personnel deployed on Operation LASER.

OBJECTIVES: The literature presents complex inter-relationships among individual-factors and organisational-factors and barriers to seeking mental health support after deployment. This study aims to quantify longitudinal associations between such factors and barriers to mental health support. DESIGN: A longitudinal online survey of Canadian Armed Forces (CAF) personnel collected data at 3 months post-deployment (T1), 6 months post-deployment (T2) and 1 year post-deployment (T3). SETTING: In 2020, as part of Canada's response to the COVID-19 pandemic, 2595 CAF personnel deployed on Operation LASER to support civilian long-term care facilities in Québec and Ontario. PARTICIPANTS: All Operation LASER personnel were invited to participate: 1088, 582 and 497 responded at T1, T2 and T3, respectively. Most respondents were young, male, non-commissioned members. MAIN OUTCOME MEASURES: Barriers to mental health support were measured using 25 self-reported items and grouped into theory-based factors, including eight factors exploring care-seeking capabilities, opportunities and motivations; and two factors exploring moral issues. Logistic regressions estimated the crude and adjusted associations of individual and organisational characteristics (T1) with barriers (T2 and T3). RESULTS: When adjusting for sex, military rank and mental health status, increased meaningfulness of deployment was associated with lower probability of endorsing barriers related to conflicts with career goals and moral discomfort in accessing support at T2. Higher scores in trust in leadership were associated with lower probability of endorsing four barriers at T2, and five barriers at T3. CONCLUSIONS: We identified several modifiable organisational-level characteristics that may help reduce perceived barriers to mental health support in military and other high-risk occupational populations. Results suggest that promoting individuals' sense of purpose, instilling trust in leadership and promoting relatedness among team members may improve perceptions of access to mental health supports in the months following a domestic deployment or comparable occupational exposure.

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

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

Recommendations for follow-up care during post-deployment screening of Canadian Armed Forces personnel: how well does self-reported mental health predict referral decisions?

OBJECTIVE: Canadian Armed Forces (CAF) post-deployment screening aims to facilitate early care for members with mental health issues. The process consists of a questionnaire to screen for mental health problems, followed by an interview with a healthcare provider during which recommendations for follow-up care are provided if needed. In this study, we examined the association of self-reported mental health from the screening questionnaire with recommendation for follow-up care during the interview. DESIGN: Using screening data collected from CAF members who deployed from 2009 to 2012 (n=14 957), logistic regression analysis was conducted to examine the association of self-reported mental health from the screening questionnaire with clinicians' recommendation for follow-up care. RESULTS: In total, 19.7% of screened individuals were recommended for follow-up care. In the adjusted logistic regression model, some demographic characteristics, as well current and prior mental healthcare and self-reported mental health problems, had a substantial association with recommendation for follow-up. Compared with each mental health problem's lowest severity category, recommendation for follow-up care was higher by approximately 12%-17% for those with mild to severe depression, 7% for those with panic disorder, 8%-10% for those with mild to severe anxiety, 8% for those experiencing high levels of stressors, 4%-10% for those at risk of alcohol use disorder and 7%-12% for those at risk of post-traumatic stress disorder. CONCLUSIONS: Although the presence of mental health problems was significantly associated with receiving a follow-up recommendation, the relationships between self-reported mental health and subsequent recommendations for care were not as high as expected. Although this may partly reflect time delays between the questionnaire and interview, further research is needed on the extent to which other factors contributed to referral decisions.

Calibrating the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for detecting alcohol-related problems among Canadian, UK and US soldiers: cross-sectional pre-deployment and post-deployment survey results.

OBJECTIVES: Excessive alcohol use can bring about adverse health and work-related consequences in civilian and military populations. Screening for excessive drinking can help identify individuals at risk for alcohol-related problems who may require clinical interventions. The brief validated measures of alcohol use such as the Alcohol Use Disorders Identification Test (AUDIT), or abbreviated AUDIT-Consumption (AUDIT-C), are often included in military deployment screening and epidemiologic surveys, but appropriate cut-points must be used to effectively identify individuals at risk. Although the conventional AUDIT-C cut-points ≥4 for men and ≥3 for women are commonly used, recent validation studies of veterans and civilians recommend higher cut-points to minimise misclassification and overestimation of alcohol-related problems. This study aims to ascertain optimal AUDIT-C cut-points for detecting alcohol-related problems among serving Canadian, UK and US soldiers. DESIGN: Cross-sectional pre/post-deployment survey data were used. SETTINGS: Comprised Army locations in Canada and UK, and selected US Army units. PARTICIPANTS: Included soldiers in each of the above-mentioned settings. OUTCOME MEASURES: Soldiers' AUDIT scores for hazardous and harmful alcohol use or high levels of alcohol problems served as a benchmark against which optimal sex-specific AUDIT-C cut-points were assessed. RESULTS: Across the three-nation samples, AUDIT-C cut-points of ≥6/7 for men and ≥5/6 for women performed well in detecting hazardous and harmful alcohol use and provided comparable prevalence estimates to AUDIT scores ≥8 for men and ≥7 for women. The AUDIT-C cut-point ≥8/9 for both men and women performed fair-to-good when benchmarked against AUDIT ≥16, although inflated AUDIT-C-derived prevalence estimates and low positive predictive values were observed. CONCLUSION: This multi-national study provides valuable information regarding appropriate AUDIT-C cut-points for detecting hazardous and harmful alcohol use, and high levels of alcohol problems among soldiers. Such information can be useful for population surveillance, pre-deployment/post-deployment screening of military personnel, and clinical practice.

Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics.

BACKGROUND: The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19-related deaths among residents of long-term care facilities (LTCFs). As part of Canada's response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes. OBJECTIVE: This study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics. METHODS: A multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment. RESULTS: CAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93%), 582 (22.43%), and 497 (19.15%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted. CONCLUSIONS: The data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF-specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44299.

Well-being of Canadian Armed Forces members during the COVID-19 pandemic: the influence of positive health behaviours. / Bien-être des membres des Forces armées canadiennes pendant la pandémie de COVID-19 : influence des comportements propices à la santé.

INTRODUCTION: The COVID-19 pandemic has been linked to increased depression, anxiety and other adverse mental health outcomes. Understanding the behaviours that positively influence health is important for the development of strategies to maintain andimprove well-being during the pandemic. METHODS: This study focussed on Canadian Armed Forces Regular Force members (N = 13 668) who participated in the COVID-19 Defence Team Survey, administered between April and May 2020. The use of positive health behaviours and the extent to which such behaviours were associated with anxiety, depression and self-reported change in health and stress levels compared to before the pandemic were examined. RESULTS: Depression and anxiety were experienced by 14% and 15% of the sample, respectively, while 36% reported that their mental health had gotten worse since the pandemic started, and close to half reported worse physical health and stress levels. The most common behaviours respondents reported engaging in to maintain or improve their health were exercising outdoors, healthy eating and connecting with loved ones. Although most behaviours were associated with better health outcomes, meditation and connecting with loved ones showed associations with worse health. CONCLUSION: Engaging in behaviours such as exercise and healthy eating was generally associated with better health outcomes. Unexpected relationships of meditation and connecting with loved ones are discussed in terms of their use in stressful times among those with mental health issues, past research on coping strategies and impacts of the pandemic and physical distancing on social connections. The findings may have implications for strategies to promote healthy behaviours during the remainder of the pandemic and similar crises in the future.

Conducting research during the COVID-19 pandemic: the Op LASER study. / Mener des recherches au cours de la pandémie de COVID-19 : l'étude sur l'Opération LASER.

The Canadian Armed Forces (CAF) deployed 2595 regular and reserve force personnel on Operation (Op) LASER, the CAF's mission to provide support to civilian staff at longterm care facilities in Ontario and in the Centres d'hébergement de soins de longue durée in Quebec. An online longitudinal survey and in-depth virtual discussions were conducted by a multidisciplinary team of researchers with complementary expertise. This paper highlights the challenges encountered in conducting this research and their impact on the design and implementation of the study, and provides lessons learned that may be useful to researchers responding to similar public health crises in the future.

There are a number of challenges involved in conducting longitudinal research in an applied military setting during a global public health crisis such as the COVID-19 pandemic. These challenges include but are not limited to a sudden transition to a distributed remote work environment, tight timelines, the need to obtain approvals from different agencies and departments, having to prioritize multiple study objectives, and survey fatigue. To overcome these challenges in future public health crises, it is important to (1) develop and maintain collaborative networks across government, academia and industry; (2) develop a standard set of pre-deployment demographic and health indicators to establish a baseline; and (3) use mixed methods approaches for a richer understanding of mental health trajectories following stressful events.

La réalisation d'une enquête longitudinale dans un contexte militaire concret pendant une crise mondiale de santé publique, comme la pandémie de COVID-19, vient avec son lot de défis. Parmi ces défis, on peut relever une transition subite vers un environnement de travail à distance, des délais serrés, la nécessité d'obtenir des approbations de différents organismes et ministères, la nécessité de prioriser plusieurs objectifs d'étude et la lassitude à l'égard des enquêtes. Pour relever ces défis au cours des futures crises de santé publique, il sera essentiel : 1) de créer et d'entretenir des réseaux de collaboration qui relieront le gouvernement, le milieu universitaire et les divers secteurs d'activité, 2) de créer un ensemble normalisé d'indicateurs démographiques et sanitaires avant le déploiement, en vue de l'obtention de données de référence et 3) de recourir à des méthodes mixtes pour mieux comprendre les trajectoires en matière de santé mentale à la suite d'événements stressants.

Trials and tribulations among members of Canada's Defence Team early in the pandemic: key insights from the COVID-19 Defence Team Survey. / Les défis auxquels ont fait face les membres de l'Équipe de la Défense du Canada au début de la pandémie : principales conclusions du sondage de l'Équipe de la Défense sur la COVID-19.

INTRODUCTION: Due to the unprecedented impact of COVID-19, there is a need for research assessing pandemic-related challenges and stressors. The current study aimed to assess key concerns and general well-being among members of Canada's Defence Team, including Canadian Armed Forces personnel and members of the Department of National Defence (DND) Public Service. METHODS: The COVID-19 Defence Team Survey was administered electronically to Defence Team staff in April and May of 2020 and was completed by 13 688 Regular Force, 5985 Reserve Force and 7487 civilian DND Public Service personnel. Along with demographic information, the survey included assessments of work arrangement, pandemic-related concerns, general well-being and social and organizational support. Weighted data (to ensure representation) were used in all analyses. RESULTS: The majority of respondents were working from home, with a small minority unable to work due to restrictions. Though many concerns were endorsed by a substantial proportion of respondents, the most prevalent concerns were related to the health and well-being of loved ones. The majority of respondents reported their partner, family, supervisors, friends, colleagues and children provided general support. Half of the civilian defence staff and one-third of military respondents reported a decline in mental health. Women, younger respondents, those with dependents and, in some cases, those who were single without children were at risk of lower well-being. CONCLUSION: The pandemic has negatively impacted a substantial portion of the Defence Team. When responding to future crises, it is recommended that leaders of organizations provide additional supports to higher-risk groups and to supervisors who are ideally positioned to support employees during challenging times.

Role of hardiness in the psychological well-being of Canadian Forces officer candidates.

Previous research has found that hardiness is associated with greater psychological well-being and lower levels of stress. This study examined the role of hardiness in the psychological well-being of military officer candidates undergoing basic training. Although most researchers have conceptualized hardiness as a global psychological construct, it is possible that military-specific hardiness, which pertains specifically to work experiences in the military environment, may be a more relevant measure. The role of both general and military-specific hardiness in life satisfaction, health symptoms, training satisfaction, and training stress was examined. The results of this study were consistent with those of previous research, suggesting that military-specific hardiness is an important predictor of psychological well-being of military personnel. Furthermore, military-specific hardiness served as a better predictor of the psychological well-being of military personnel than general hardiness. The implications of the findings and future research suggestions are discussed.

Psychological well-being of Canadian Forces officer candidates: the unique roles of hardiness and personality.

Previous research has found that individual characteristics play an important role in psychological wellbeing and perception of stress. Although the Five Factor Model of personality has been found to consistently predict psychological well-being in the general population and among military personnel, hardiness has also been found to be a predictor of well-being. This study examined the unique role of hardiness, above that of personality, in the well-being and stress perceptions of Canadian Forces officer candidates undergoing basic training. The results of the study were consistent with those of previous research, suggesting that military hardiness is an important predictor of well-being and stress perceptions. Furthermore, hardiness was related to all domains of psychological well-being and training perceptions when the Five Factor Model of personality was statistically controlled. These findings demonstrate that hardiness and personality constitute 2 different constructs, both of which have significant contributions to well-being.

Pain in Canadian Veterans: analysis of data from the Survey on Transition to Civilian Life.

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.

A longitudinal pilot study of resilience in Canadian military personnel.

Research on psychological resilience is important for occupations involving routine exposure to trauma or critical events. Such research can allow for the identification of factors to target in training, education and intervention programs, as well as groups that may be at higher risk for mental health problems. Although efforts have been made to determine the individual characteristics that contribute to positive outcomes under stress, little is known about whether such characteristics are stable over time or how stressful events can impact psychological resilience in high-risk occupations such as military service. Following a review of the evidence on variations in resilience over time, results of a pilot study of Canadian Armed Forces personnel are presented in which differences in resilience characteristics were examined from military recruitment to several years after enrollment. While there was little change in resilience characteristics over time on average, there was considerable individual variation, with some individuals showing marked improvement and others showing marked deterioration in resilience characteristics. At both time points, individuals who had been deployed showed greater resilience characteristics than those who had never been deployed. Implications for the promotion of psychological resilience in military populations and personnel employed in other high-risk occupations are discussed.

Postmilitary adjustment to civilian life: potential risks and protective factors.

BACKGROUND: Adjustment to civilian life in Canadian veterans after release from military service has not been well studied. OBJECTIVES: The objectives of this study were: (1) to explore dimensions of postmilitary adjustment to civilian life and (2) to identify demographic and military service characteristics associated with difficult adjustment. DESIGN: Data were analyzed from a national sample of 3,154 veterans released from the regular Canadian Forces during 1998 to 2007 in a cross-sectional survey conducted in 2010 called the Survey on Transition to Civilian Life. METHODS: The prevalence of difficult adjustment to civilian life for selected characteristics was analyzed descriptively, and confidence intervals were calculated at the 95% level. Multivariable logistic regression analysis was used to identify characteristics available at the time of release that were associated with difficult adjustment. RESULTS: The prevalence of difficult adjustment to civilian life was 25%. Statistically significant differences were found across indicators of health, disability, and determinants of health. In multivariable regression, lower rank and medical, involuntary, mid-career, and Army release were associated with difficult adjustment, whereas sex, marital status, and number of deployments were not. LIMITATIONS: Findings cannot be generalized to all veterans because many characteristics were self-reported, important characteristics may have been omitted, and causality and association among health, disability, and determinants of health characteristics could not be determined. CONCLUSIONS: Postmilitary adjustment to civilian life appears to be multidimensional, suggesting the need for multidisciplinary collaboration between physical therapists and other service providers to mitigate difficult transition. Potential risk and protective factors were identified that can inform interventions, outreach strategies, and screening activities, as well as further research.

Longitudinal analysis of psychological resilience and mental health in Canadian military personnel returning from overseas deployment.

The relationship between exposure to combat stressors and poorer postdeployment health is well documented. Still, some individuals are more psychologically resilient to such outcomes than others. Researchers have sought to identify the factors that contribute to resilience in order to inform resilience-building interventions. The present study assessed the criterion validity of a model of psychological resilience composed of various intrapersonal and interpersonal variables for predicting mental health among Canadian Forces (CF) members returning from overseas deployment. Participants included 1,584 male CF members who were deployed in support of the mission in Afghanistan between 2008 and 2010. Data on combat experiences and mental health collected through routine postdeployment screening were linked with historical data on the intrapersonal and interpersonal variables from the model. The direct and moderating effects of these variables were assessed using multiple linear regression analyses. Analyses revealed direct effects of only some intrapersonal and interpersonal resilience variables, and provided limited support for moderating effects. Specifically, results emphasized the protective nature of conscientiousness, emotional stability, and positive social interactions. However, other variables demonstrated unexpected negative associations with postdeployment mental health (e.g., positive affect and affectionate social support). Ultimately, results highlight the complexities of resilience, the limitations of previous cross-sectional research on resilience, and potential targets for resilience-building interventions. Additional longitudinal research on the stability of resilience is recommended to build a better understanding of how resilience processes may change over time and contribute to mental health after adverse experiences.

Health-related quality of life of Canadian Forces veterans after transition to civilian life.

OBJECTIVES: Describe health-related quality of life (HRQoL) of former Canadian Forces (CF) men and women in uniform (Veterans) after transition to civilian life, and compare to age- and sex-adjusted Canadian norms. METHODS: The 2010 Survey on Transition to Civilian Life was a national computer-assisted telephone survey of CF Regular Force personnel who released during 1998-2007. HRQoL was assessed using the SF-12 Physical (PCS) and Mental (MCS) Component Summary scores. Descriptive analysis of HRQoL was conducted for socio-demographic, health, disability and determinants of health characteristics. RESULTS: Mean age was 46 years (range 20-67). Compared to age- and sex-adjusted Canadian averages, PCS (47.3) was low and MCS was similar (52.0). PCS and MCS were variably below average for middle age groups and lowest for non-commissioned ranks, widowed/divorced/separated, 10-19 years of service, physical and mental health conditions, disability, dissatisfaction with finances, seeking work/not working, low social support and difficulty adjusting to civilian life. Among Veterans Affairs Canada clients, 83% had below-average physical PCS, 49% had below-average MCS, and mean PCS (38.2) was significantly lower than mean MCS (48.3). CONCLUSIONS: HRQoL varied across a range of biopsychosocial factors, suggesting possible protective factors and vulnerable subgroups that may benefit from targeted interventions. These findings will be of interest to agencies supporting Veterans in transition to civilian life and to researchers developing hypotheses to better understand well-being in Canadian Veterans.

Influence of chronic interleukin-2 infusion and stressors on sickness behaviors and neurochemical change in mice.

OBJECTIVES: Major depression is associated with increased circulating interleukin-2 (IL-2) levels, and IL-2 immunotherapy may provoke depressive symptoms, leading to the suggestion that this cytokine may contribute to the evolution of affective disorders. Although depression is a relatively chronic condition, and immunotherapy involves repeated cytokine administration, animal studies have typically assessed the consequences of acute cytokine treatment. The present investigation assessed several behavioral and neurochemical effects of chronic IL-2 infusion. METHODS: Behaviors reflecting anhedonia and/or anorexia, sickness behavior, plasma corticosterone and norepinephrine (NE) activity in the paraventricular nucleus (PVN) of the hypothalamus were assessed following continuous infusion of IL-2 over 7 days in CD-1 mice. RESULTS: The cytokine treatment reduced the consumption of a highly favored palatable substance (chocolate milk) and reduced locomotor activity monitored over the course of the 7-day period. Although sickness behaviors were also increased significantly by the treatment, the degree of sickness behavior was actually modest. While a chronic, variable stressor also affected consumption of the palatable food, this treatment did not enhance the effects of IL-2. Furthermore, in contrast to acute and chronic stressors that increased plasma corticosterone levels and the utilization of NE within the PVN of the hypothalamus, IL-2 did not promote such effects and did not modify the impact of the stressors. CONCLUSION: While IL-2 may induce anorexia or anhedonia, the effects of this treatment are distinguishable from those elicited by stressors and those typically elicited by proinflammatory cytokines. The data are related to findings suggesting a link between IL-2 and depressive illness.