An evaluation of large group cognitive behaviour therapy with mindfulness (CBTm) classes.

BACKGROUND: Ensuring equitable and timely access to Cognitive Behaviour Therapy (CBT) is challenging within Canada's service delivery model. The current study aims to determine acceptability and effectiveness of 4-session, large, Cognitive Behaviour Therapy with Mindfulness (CBTm) classes. METHODS: A retrospective chart review of adult outpatients (n = 523) who attended CBTm classes from 2015 to 2016. Classes were administered in a tertiary mental health clinic in Winnipeg, Canada and averaged 24 clients per session. Primary outcomes were (a) acceptability of the classes and retention rates and (b) changes in anxiety and depressive symptoms using Generalized Anxiety Disorder 7-item (GAD-7) and Patient Health Questionnaire 9-item (PHQ-9) scales. RESULTS: Clients found classes useful and > 90% expressed a desire to attend future sessions. The dropout rate was 37.5%. A mixed-effects linear regression demonstrated classes improved anxiety symptoms (GAD-7 score change per class = - 0.52 [95%CI, - 0.74 to - 0.30], P < 0.001) and depressive symptoms (PHQ-9 score change per class = - 0.65 [95%CI, - 0.89 to - 0.40], P < 0.001). Secondary analysis found reduction in scores between baseline and follow-up to be 2.40 and 1.98 for the GAD-7 and PHQ-9, respectively. Effect sizes were small for all analyses. CONCLUSIONS: This study offers preliminary evidence suggesting CBTm classes are an acceptable strategy to facilitate access and to engage and maintain clients' interest in pursuing CBT. Clients attending CBTm classes experienced improvements in anxiety and depressive symptoms. Symptom improvement was not clinically significant. Study limitations, such as a lack of control group, should be addressed in future research.

Negotiating home base: Narratives of psychological well-being among female military members.

The current study aimed to understand how active duty service women with low levels of current psychological distress make sense of their military experiences in ways that might contribute to psychological well-being. Semi-structured interviews were conducted with active duty female members in the Canadian Forces and transcripts were analyzed using narrative analysis. A sense of belonging was found to be of utmost salience to the women, with several participants negotiating and constructing places that felt like home to them, and with different degrees of attachment to the military versus civilian world. The findings of this work are discussed within the context of focusing prevention and intervention efforts on increasing belongingness and a sense of home for female service members.

Protective factors for mental disorders and psychological distress in female, compared with male, service members in a representative sample.

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

Objectif : Quoique l'intérêt militaire pour la promotion de la résilience psychologique va en grandissant, les ressources protectrices contre la psychopathologie ont été sous-étudiées chez les membres féminins des forces armées. À l'aide d'un échantillon représentatif du personnel des Forces canadiennes, nous avons recherché si la pratique religieuse, la spiritualité, l'adaptation, et le soutien social étaient liés aux troubles mentaux et à la détresse psychologique chez le personnel féminin des Forces, et si des différences selon le sexe survenaient dans ces associations. Méthode : La pratique religieuse et la spiritualité étaient auto-déclarées. Les items d'adaptation étaient tirés de 3 échelles et produisaient 3 facteurs (actif, évitement, et automédication). Le soutien social était évalué par le Medical Outcomes Study Social Support Survey. Les troubles mentaux de l'année précédente ont été diagnostiqués au moyen du World Mental Health Composite International Diagnostic Interview. L'Échelle de détresse psychologique de Kessler a évalué la détresse. Des modèles de régression multivariée ont servi à rechercher les liens entre les corrélats et les résultats psychologiques de chaque sexe. Pour les associations qui n'étaient statistiquement significatives que pour un sexe, les interactions des sexes par corrélat ont été calculées. Résultats : Chez les membres féminins des forces, des relations inverses ont été constatées entre le soutien social et le trouble dépressif majeur (TDM), tout TDM ou trouble anxieux, l'idéation suicidaire, et la détresse. Aucune association n'a été détectée entre la pratique religieuse et les résultats, et la spiritualité était associée à la probabilité accrue de certains résultats. L'adaptation active était liée à moins de détresse psychologique, tandis que l'adaptation par évitement et l'automédication étaient liées à la probabilité accrue de la plupart des résultats. Bien que plusieurs associations statisquement significatives n'aient été observées que chez un seul sexe, seulement une interaction des sexes par corrélat était statistiquement significative. Conclusions : Le soutien social s'est révélé être inversement lié à plusieurs résultats négatifs de santé mentale chez les membres féminins des forces armées. Peu de différences entre les hommes et les femmes ont atteint la signification statistique. La recherche future devrait identifier des ressources utiles additionnelles pour les membres féminins des forces armées.

Stress and mental disorders in female military personnel: comparisons between the sexes in a male dominated profession.

The proportion of women in militaries is growing; however, many studies in the area of military mental health have been conducted with majority male samples. The present study examined sex differences in trauma exposure, work stress, and mental disorders in the Canadian Community Health Survey - Canadian Forces Supplement, a representative sample of 5155 regular force personnel and 3286 reservists ages 16-54. Past-year DSM-IV mental disorders (depression, generalized anxiety disorder, panic disorder, social phobia, PTSD, and alcohol dependence), lifetime exposure to 28 traumatic events, and work stress were assessed. Regular and reserve female personnel were less likely than males to experience deployment-related traumas, accidents, and several events involving violence (adjusted odds ratio [AOR] range 0.10-0.62). Women were more likely to endorse sexual trauma, partner abuse, and being stalked (AOR range 3.60-13.63). For work stress, regular force women reported higher levels of job demand and stress around social support than men, whereas regular and reserve force women reported less physical exertion. After adjusting for a range of covariates, regular female personnel were more likely than males to have PTSD (AOR 1.88, 99% CI 1.01-3.50), while reservist women were more likely than men to have depression, panic disorder, and any mood or anxiety disorder (AOR range 1.87-6.98). Both regular and reservist women had lower rates of alcohol dependence (AOR range 0.30-0.34). Clinicians working with female personnel should screen for trauma/stressors and mental disorders that are particularly common in this population.