Evaluating the before operational stress program: comparing in-person and virtual delivery.

Introduction: Public safety personnel (PSP) are at increased risk for posttraumatic stress injuries (PTSI). Before Operational Stress (BOS) is a mental health program for PSP with preliminary support mitigating PTSI. The current study compared the effectiveness of delivering BOS in-person by a registered clinician (i.e., Intensive) to virtually delivery by a trained clinician (i.e., Classroom). Methods: Canadian PSP completed the Intensive (n = 118; 61.9% male) or Classroom (n = 149; 50.3% male) program, with self-report surveys at pre-, post-, 1 month, and 4 months follow-ups. Results: Multilevel modelling evidenced comparable reductions in anxiety (p < 0.05, ES = 0.21) and emotional regulation difficulties (ps < 0.05, ESs = 0.20, 0.25) over time with no significant difference between modalities. Participants discussed benefits of the delivery modality they received. Discussion: The results support virtual delivery of the BOS program (Classroom) as an accessible mental health training option for PSP, producing effects comparable to in-person delivery by clinicians.

Exposures to potentially psychologically traumatic events among Royal Canadian Mounted Police.

OBJECTIVE: Royal Canadian Mounted Police (RCMP) are among the public safety sectors reporting the highest exposures to diverse potentially psychologically traumatic events (PPTEs), which contribute to the risk of developing mental health disorders. Current increases in prevalence of mental health disorders among RCMP are substantial and warrant updated prevalence estimates of PPTE exposures. The objective of the present study was to provide updated estimates of lifetime PPTE exposures among RCMP and assess for associations with mental disorders and sociodemographic variables. METHOD: Participants (n = 1,348) completed a survey assessing self-reported sociodemographic information, PPTE exposures as measured by the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) Extended, and mental health disorder symptoms. RESULTS: Participants reported exposure to more PPTE types (∼13) than previous samples of RCMP (∼11) and public safety personnel (PSP) (∼11). Prevalence for all the PPTE types was statistically significantly higher for the current sample than previously reported samples of PSP and RCMP, and higher than the Canadian general population. Participants reported highest exposures through any modality (i.e., directly or indirectly) to sudden violent death (98.3%), physical assault (97.9%), serious transport accident (97.0%), sudden accidental death (96.7%), and assault with a weapon (93.7%). Most PPTEs were statistically significantly associated with screening positive for posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, social anxiety disorder, and panic disorder, but not alcohol use disorder. CONCLUSION: Increased PPTE exposures reported by current participants compared to a previous sample of RCMP, coupled with the observed associations between PPTE exposures and mental health disorders, highlights the need for further resources and support for RCMP to mitigate and manage the impact of PPTEs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sexual victimization among Royal Canadian Mounted Police.

OBJECTIVE: The present study was designed to provide the first in-depth, academically peer-reviewed assessment of sexual victimization among Royal Canadian Mounted Police (RCMP). METHOD: A representative sample of RCMP (n = 1,324; 76.5% men) completed the self-report survey. RESULTS: Participants reported a higher overall lifetime history of sexual assault than would be expected for the general population (p < .05). Women participants reported a higher prevalence of lifetime history of sexual assault (p < .05). Participants reported being sexually assaulted during the RCMP Cadet Training Program (CTP; n = 27), with comparable proportions of men and women. Participants reported being sexually assaulted while on duty (n = 168), with a greater proportion of women reporting being sexually assaulted than men (p < .05). Women more often reported being sexually assaulted while on duty by a superior, coworker or peer, or subordinate, whereas men more often reported being sexually assaulted by a civilian. Participants (n = 94) reported being sexually harassed during the CTP and while on duty (n = 282), with a greater proportion of women reporting being sexually harassed during the CTP and while on duty. CONCLUSIONS: RCMP cadets appear to be sexually assaulted and sexually harassed less frequently than Canadian university and military college students, whereas RCMP appear to be sexually assaulted more often while on duty than Canadian men and women in the general population while at work; however, direct comparisons are problematic because of differing frames for questions and time spans. The current results help quantify sexual victimization among RCMP, which can support ongoing and novel prevention and intervention strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Perspectives and Experiences of Public Safety Personnel Engaged in a Peer-Led Workplace Reintegration Program Post Critical Incident or Operational Stress Injury: A Qualitative Thematic Analysis.

INTRODUCTION: Public safety personnel (PSP) experience operational stress injuries (OSIs), which can put them at increased risk of experiencing mental health and functional challenges. Such challenges can result in PSP needing to take time away from the workplace. An unsuccessful workplace reintegration process may contribute to further personal challenges for PSP and their families as well as staffing shortages that adversely affect PSP organizations. The Canadian Workplace Reintegration Program (RP) has seen a global scale and spread in recent years. However, there remains a lack of evidence-based literature on this topic and the RP specifically. The current qualitative study was designed to explore the perspectives of PSP who had engaged in a Workplace RP due to experiencing a potentially psychologically injurious event or OSI. METHODS: A qualitative thematic analysis analyzed interview data from 26 PSP who completed the RP. The researchers identified five themes: (1) the impact of stigma on service engagement; (2) the importance of short-term critical incident (STCI) program; (3) strengths of RP; (4) barriers and areas of improvement for the RP; and (5) support outside the RP. DISCUSSION: Preliminary results were favorable, but further research is needed to address the effectiveness, efficacy, and utility of the RP. CONCLUSION: By addressing workplace reintegration through innovation and research, future initiatives and RP iterations can provide the best possible service and support to PSP and their communities.

Sleep quality and mental disorder symptoms among correctional workers in Ontario, Canada.

Correctional workers (CWs) report high levels of work stressors, frequent exposures to potentially psychologically traumatic events (PPTEs), and substantial mental health challenges. There is evidence of associations between sleep disturbances and diverse mental health challenges, including preliminary evidence from public safety personnel; however, replications and extensions would better inform interventions to support mental health. The current study was designed to examine associations between quality of sleep, work stress, and mental health disorders in a sample of diverse CWs employed in a provincial correctional service in Ontario, Canada. Data were analyzed from 943 CWs who participated in the cross-sectional, web-based Ontario Provincial Correctional Worker Mental Health and Well-Being Study conducted from December 2017 to June 2018. Sleep quality indicators included symptoms of insomnia, total hours of sleep per night on work nights and off-shift nights, number of days feeling rested per week, and overall sleep quality. Descriptive statistics, analyses of variance, correlational analyses, and logistic regression were used to examine relationships among sleep quality, stress of shift work, and mental health disorder symptoms. CWs slept an average of 6.0 h per night when working and 7.2 h during off-shift nights. CWs reported waking up feeling rested an average of 2.6 days per week and rated their overall quality of sleep in the fair to poor range. Many CWs (64.9%) screened positive for clinically significant symptoms of insomnia. There were also differences across occupational groups such that CWs working as correctional officers reported the most sleep problems. There were statistically significant relationships between insomnia and mental health disorder symptoms. Higher levels of stress from shift work were associated with worse sleep quality. CWs, especially those working as correctional officers in a provincial prison, reported many indicators consistent with poorer quality of sleep. Poor quality of sleep was also associated with work stress and mental health disorders.

Trouble with the curve: the 90-9-1 rule to measure volitional participation inequalities among Royal Canadian Mounted Police cadets during training.

Objective: The Royal Canadian Mounted Police (RCMP) Study includes longitudinal multimodal assessments of RCMP cadets from pre-training (i.e., starting the Cadet Training Program [CTP]) to post-deployment and for five years thereafter. The data allow for investigating the multidimensionality of volitional participation in digital health data collection frameworks within serial data collection platforms and the impact of participation inequalities by classifying cadets using the 90-9-1 rule. By classifying cadets as Lurkers, Contributors, and Superusers formally described by the 90-9-1 rule, where 90% of actors do not participate, 9% seldom contribute, and 1% contribute substantially allows for the assessing of relationships between participation inequalities in self-monitoring behaviors as well as whether mental health disorder symptoms at pre-training (i.e., starting the CTP) were associated with subsequent participation. Methods: Participants were asked to complete a Full Assessment prior to their training at CTP, as well as short daily surveys throughout their training. Participation frequency was described using a process where participants were rank ordered by the number of daily surveys completed and classified into one of three categories. Full assessment surveys completed prior to their training at CTP included screening tools for generalized anxiety disorder (GAD), major depressive disorder (MDD), posttraumatic stress disorder (PTSD), alcohol use disorder (AUD), and panic disorder (PD). The Kruskal-Wallis H test was used to assess differences in participation rates between mental health disorder symptom screening groups for each measure at pre-training, and Spearman's Rho was used to test for associations amongst self-reported Full Assessment screening tool responses and the number of daily surveys completed during CTP. Results: There were 18557 daily survey records collected from 772 participants. The rank-ordering of cadets by the number of daily surveys completed produced three categories in line with the 90-9-1 rule: Superusers who were the top 1% of cadets (n=8) and produced 6.4% of all recordings; Contributors who were the next 9% of cadets (n=68) and produced 49.2% of the recordings; and Lurkers who were the next 90% of cadets (n=695) and produced 44.4% of daily survey recordings. Lurkers had the largest proportion of positive screens for self-reported mental health disorders at pre-training. Conclusion: The creation of highly individualized, population-based mental health injury programs has been limited by an incomplete understanding of the causal relationships between protective factors and mental health. Disproportionate rates of disengagement from persons who screen positive for mental health disorders further compounds the difficulty in understanding the relationships between training programs and mental health. The current results suggest persons with mental health challenges may be less likely to engage in some forms of proactive mental health training. The current results also provide useful information about participation, adherence, and engagement that can be used to inform evidence-based paradigm shifts in health-related data collection in occupational populations.

Prevalence of current chronic pain in Royal Canadian Mounted Police cadets.

Background: Nearly half of active duty Royal Canadian Mounted Police (RCMP) officers report experiencing current chronic pain (43%; i.e. pain lasting longer than 3 months). Most RCMP officers who report chronic pain indicate that the pain started after working as RCMP officers (91%). Baseline data on chronic pain prevalence among RCMP cadets has not been available. Aims: The current study was designed to provide cross-sectional estimates of chronic pain prevalence among RCMP cadets starting the Cadet Training Program and to assess for sociodemographic differences among participants. Methods: The RCMP Study uses a longitudinal prospective sequential experimental cohort design to create a clustered randomized trial that engages individual participants for 5.5 years. The current article provides cross-sectional associations between chronic pain prevalence and sociodemographic characteristics. Participants were RCMP cadets starting the Cadet Training Program (n = 770). Location, intensity (on a 0-10 scale and days per week experienced), and duration (number of months) of chronic pain were reported. Differences across sociodemographic characteristics were examined. Results: Few RCMP cadets reported experiencing chronic pain (10%); lower back pain was rated as the most severe in terms of intensity and duration and second most frequently reported in number of days experienced per week. Prevalence of chronic pain was lower among RCMP cadets than among RCMP officers. Conclusions: Chronic pain prevalence among active duty RCMP officers may result from or be moderated by operational duties, as well as routine aging. Future researchers could examine ways to mitigate chronic pain development during RCMP officer careers.

Contexte: Près de la moitié des agents de la Gendarmerie royale du Canada (GRC) en service actif déclarent souffrir de douleur chronique (43 %; c'est-à-dire une douleur qui dure plus de trois mois). La plupart des agents de la GRC qui déclarent souffrir de douleur chronique indiquent que la douleur a commencé après avoir travaillé comme agents de la GRC (91 %). Il n'existe pas de données de référence sur la prévalence de la douleur chronique chez les cadets de la GRC.Objectifs: La présente étude a été conçue pour fournir des estimations transversales de la prévalence de la douleur chronique chez les cadets de la GRC qui commencent le Programme de formation des cadets et évaluer les différences sociodémographiques entre les participants.Méthodes: L'étude sur la GRC utilise un devis de cohorte expérimental séquentiel prospectif longitudinal pour créer un essai randomisé en grappes impliquant des participants individuels pendant 5,5 ans. Le présent article présente des associations transversales entre la prévalence de la douleur chronique et les caractéristiques sociodémographiques. Les participants étaient des cadets de la GRC qui commençaient le Programme de formation des cadets (n = 770). Le lieu, l'intensité (sur une échelle de 0 à 10 et selon le nombre de jours par semaine où la douleur était ressentie), de même que la durée (nombre de mois) pendant laquelle la douleur chronique était ressentie, ont été déclarés.Résultats: Peu de cadets de la GRC ont déclaré souffrir de douleur chronique (10 %); la douleur lombaire a été évaluée comme la plus sévère en termes d'intensité et de durée, et la deuxième la plus fréquemment rapportée en nombre de jours par semaine. La prévalence de la douleur chronique était plus faible chez les cadets de la GRC que chez les agents de la GRC.Conclusions: La prévalence de la douleur chronique chez les agents de la GRC en service actif peut résulter des tâches opérationnelles ou être modérée par celles-ci, ainsi que par le vieillissement normal. Les futurs chercheurs pourraient examiner les moyens d'atténuer le développement de la douleur chronique au cours de la carrière des agents de la GRC.

Effects of Trauma Cue Exposure and Posttraumatic Stress Disorder (PTSD) on Affect and Cannabis Craving in Cannabis Users With Trauma Histories: Use of Expressive Writing as an Online Cue-Reactivity Paradigm: Effets de l'exposition aux signaux traumatiques et du SSPT sur l'affect et le besoin de cannabis chez les consommateurs de cannabis ayant des antécédents de traumatismes : utilisation de l'écriture expressive comme paradigme de réactivité en ligne.

OBJECTIVES: Posttraumatic stress disorder (PTSD) and cannabis use disorder (CUD) commonly co-occur. Conditioned associations between psychological trauma cues, distress, cannabis use, and desired relief outcomes may contribute to the comorbidity. These conditioned associations can be studied experimentally by manipulating trauma cue exposure in a cue-reactivity paradigm (CRP) and examining effects on affective and cognitive outcomes in participants with and without PTSD. However, traditional CRPs take place in-lab limiting recruitment/power. We aimed to examine the effects of CRP condition (trauma and neutral) and PTSD group (likely PTSD+ and PTSD-) on affective and craving outcomes using a stand-alone online expressive writing CRP. METHODS: Participants (n = 202; 43.6% male; Mage = 42.94 years, SD = 14.71) with psychological trauma histories and past-month cannabis use completed a measure of PTSD symptoms (PTSD Checklist-5 for DSM-5 [PCL-5]) and were randomized to complete either a trauma or neutral expressive writing task. Then they completed validated measures of affect (Positive and Negative Affect Schedule-Short Form [PANAS-SF]) and cannabis craving (Marijuana Craving Questionnaire-Short Form [MCQ-SF]). RESULTS: Linear mixed models tested the hypothesized main and interactive effects of CRP condition (trauma and neutral) and PTSD group (likely PTSD+ and PTSD-) on negative and positive affect (PANAS-SF) and cannabis craving dimensions (MCQ-SF). The hypothesized main effects of trauma versus neutral expressive writing were found for negative affect and the expectancy dimension of cannabis craving and of PTSD group for negative affect and all cannabis craving dimensions; no interactions were observed. CONCLUSIONS: Expressive writing appears a useful online CRP. Interventions focused on reducing negative affect and expectancy craving to trauma cues may prevent/treat CUD among cannabis users with PTSD. PLAIN LANGUAGE SUMMARY TITLE: The Use of an Online Expressive Writing as a Trauma Cue Exposure: Effects on Craving and Emotions.

People who have gone through trauma sometimes experience both post-traumatic stress disorder (PTSD) and a tendency to use cannabis excessively (cannabis use disorder or CUD). Researchers believe that there's a connection between traumatic memories, emotional distress, cannabis use, and the relief people feel afterward. These associations can be studied experimentally by using a cue-reactivity paradigm (CRP) to examine effects on craving and affective outcomes in those with and without PTSD. This study included 202 participants who had a history of trauma and reported regular cannabis use. They were randomly assigned to write about a traumatic or neutral personal experience. After, they filled out questionnaires about their PTSD symptoms, emotions (both positive and negative), and cravings for cannabis during the task. We expected that the type of writing task (those assigned to the trauma vs. neutral condition) and PTSD status would be associated with increased cannabis craving, negative emotions, and reduced positive emotions. We found that writing about trauma increased negative feelings and positive expectations about using cannabis for relief, especially for those with PTSD. People with PTSD also seemed to have more ongoing negative feelings and cravings for cannabis. The authors suggest that traditional in-lab experiments might be necessary to fully understand how trauma reminders can influence cravings and emotions in individuals with PTSD-CUD.

Outcomes of transdiagnostic internet-delivered cognitive behavioural therapy tailored to public safety personnel: A longitudinal observational study.

First responders and other public safety personnel (PSP) experience high rates of mental health problems and face barriers to accessing mental healthcare. Internet-delivered cognitive behavioural therapy (ICBT) is an effective and accessible treatment for various mental health concerns. Canadian PSP report favorable attitudes toward ICBT, and preliminary outcomes demonstrate that they benefit from it. Expanding on this research, the current study consisted of a longitudinal observational study of 560 Canadian PSP who participated in ICBT. It was designed to assess the longer term effectiveness of ICBT and moderators of outcomes by gender, linguistic and occupational group, and years of occupational experience. We evaluated symptom change at 8, 26, and 52 weeks post-enrollment, and results among PSP who had elevated clinical scores, showed large reductions (Hedges' g) in symptoms of depression (g = 1.3), anxiety (g =1.48), posttraumatic stress (g =1.24), panic (g =1.19), and anger (g =1.07) and moderate reductions in symptoms of social anxiety (g =.48-.56). Moderator analyses revealed modest differences in pre-treatment symptoms among certain groups but no group differences in symptom change over time. Clients showed good completion of treatment materials and reported high treatment satisfaction. The results suggest further study of ICBT tailored to PSP is warranted, including evaluating ICBT tailored for PSP in other countries.

A Comparison of Suicides in Public Safety Personnel With Suicides in the General Population in Ontario, 2014 to 2018.

Background: There is conflicting evidence on the suicide rates of different public safety personnel (PSP). There have been few studies that compare suicides in PSP with the general population and none that have used a detailed comparison of coroner records. Aims: The current study estimates suicide rates among different PSP and compares PSP suicides with the general population. Method: We identified coroner records of PSP suicides from January 2014 to December 2018 and compared each one to two matched general population controls. Results: We identified 36 PSP suicides and 72 general population controls. Police had a higher suicide rate than other PSP groups. PSP were more likely to die by firearm, be separated/divorced or married, die in a motor vehicle, have problems at work, and have a PTSD diagnosis. PSP were less likely to die by jumping. Limitations: The study may have not identified all PSP suicides. Apart from the cause of death, data in coroner records are not systematically collected, so information may be incomplete. Conclusion: PSP suicides appear different than the general population. Death records need to have an occupation identifier to enable monitoring of trends in occupational groups, such as PSP.

Examining how organizational leaders perceive internet-delivered cognitive behavioural therapy for public safety personnel using the RE-AIM implementation framework.

Background: Within Canada, internet-delivered cognitive behavioural therapy (ICBT) has recently been tailored by PSPNET to meet the needs of public safety personnel (PSP) to help address high rates of mental health problems within this population. Perceptions and outcomes of ICBT among PSP are promising, but it remains unknown how PSPNET is perceived by PSP organizational leaders. It is important to assess this gap because these leaders have significant potential to influence the uptake of ICBT. Methods: In the current study, PSP leaders (n = 10) were interviewed to examine their perceptions of PSPNET and opportunities to improve ICBT implementation. The RE-AIM evaluation framework was used to assess PSP leaders' perceptions of PSPNET in terms of reach, effectiveness, adoption, implementation, and maintenance. Results: The results evidenced that leaders perceived PSPNET as effective in reaching and serving PSP and PSP organizations. PSP leaders reported perceiving ICBT as effectively implemented, especially for being freely offered to individual PSP and for improving PSP's access to experienced therapists specifically trained to work with PSP. Participants indicated organizations have promoted and will continue promoting PSPNET longer-term, facilitating adoption and maintenance. Factors perceived as facilitating successful service delivery included building relationships and trust with PSP organizations and general support for PSP leadership mental health initiatives. PSP leaders identified perceived areas for improving ICBT implementation (e.g., ensuring leaders have access to data on PSPNET uptake and outcomes, creating promotional videos, expanding availability of PSPNET to other provinces, offering additional options for receiving therapist support). Implications: Overall, the study provides insights into PSP leaders' perceptions of the implementation of ICBT among PSP and ideas for optimizing implementation efforts.

Measuring moral distress and moral injury: A systematic review and content analysis of existing scales.

BACKGROUND: Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use. METHOD: We identified psychometric studies describing the development or validation of MD or MI scales and extracted information on methodological and psychometric qualities. Content analyses identified specific outcomes measured by each scale. RESULTS: We reviewed 77 studies representing 42 unique scales. The quality of psychometric approaches varied greatly across studies, and most failed to examine convergent and divergent validity. Content analyses indicated most scales measure exposures to potential moral stressors and outcomes together, with relatively few measuring only exposures (n = 3) or outcomes (n = 7). Scales using the term MD typically assess general distress. Scales using the term MI typically assess several specific outcomes. CONCLUSIONS: Results show how the terms MD and MI are applied in research. Several scales were identified as appropriate for research and clinical use. Recommendations for the application, development, and validation of MD and MI scales are provided.

Web-Based Mindfulness Meditation as an Adjunct to Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Feasibility Evaluation Study.

BACKGROUND: Public safety personnel (PSP) are individuals who work to ensure the safety and security of communities (eg, correctional workers, firefighters, paramedics, and police officers). PSP have a high risk of developing mental disorders and face unique barriers to traditional mental health treatments. The PSP Wellbeing Course is a transdiagnostic, internet-delivered cognitive behavioral therapy (iCBT) course tailored to assist PSP with symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). The initial course outcomes are promising, but some clients report some challenges with learning skills and recommend adding additional resources. Mindfulness meditations, which help people to experience the world and their reactions to the world in open and nonjudgmental ways, may complement the existing PSP Wellbeing Course. OBJECTIVE: This study aims to examine the feasibility of mindfulness meditations in iCBT tailored for PSP. Information was gathered to evaluate engagement and client experiences with mindfulness meditations, symptom change, and the relationship between mindfulness meditation use and symptom change. METHODS: A mixed methods study was conducted on PSP enrolled in the PSP Wellbeing Course who were offered 5 mindfulness meditations during the program (ie, 1/lesson). Clients completed questionnaires on depression, anxiety, PTSD, anger, insomnia, resilience, and mindfulness at pretreatment and at 8 weeks; an 8-week treatment satisfaction questionnaire; and brief weekly measures of mindfulness meditation engagement. We used paired sample t tests (2-tailed) to assess changes in outcomes over time and partial correlations to assess whether mindfulness meditation use predicted outcomes at posttreatment. A total of 12 clients were interviewed about their perceptions of the mindfulness meditations, and interviews were analyzed using directed content analysis. RESULTS: Among the 40 clients enrolled, 27 (68%) reported using the mindfulness meditations, practicing for an average of 4.8 (SD 8.1) minutes each week. Most interviewees described the mindfulness meditations as beneficial but also reported challenges, such as discomfort while sitting with their feelings. Clients provided suggestions for better integration of mindfulness into iCBT. Overall, clients who completed the PSP Wellbeing Course with mindfulness meditations experienced statistically significant improvements in symptoms of anxiety (P=.001), depression (P=.001), PTSD (P=.001), and anger (P=.001) but not insomnia (P=.02). Clients also experienced improvements in resilience (P=.01) and mindfulness (P=.001). Self-reported time spent meditating was not associated with changes in symptoms over time. CONCLUSIONS: This study provides new insight into the integration of mindfulness meditations with iCBT for PSP. It demonstrates the partial feasibility of adding mindfulness meditations to iCBT, revealing that some, but not all, PSP engaged with the meditations and reported benefits. PSP reported using the mindfulness meditations inconsistently and described challenges with the meditations. Improvements can be made to better integrate mindfulness meditation into iCBT, including offering mindfulness meditation as an optional resource, providing more psychoeducation on managing challenges, and offering shorter meditations.

Child Maltreatment History, Deployment-Related Traumatic Events, and Past 12-Month Cannabis Use Among Veterans in Canada.

OBJECTIVE: Cannabis use among veterans in Canada is an understudied public health priority. The current study examined cannabis use prevalence and the relationships between child maltreatment histories and deployment-related traumatic events (DRTEs) with past 12-month cannabis use including sex differences among Canadian veterans. METHOD: Data were drawn from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (response rate 68.7%; veterans only n = 1,992). Five child maltreatment types and 9 types of DRTEs were assessed in relation to the past 12-month cannabis use. RESULTS: The prevalence of lifetime and past 12-month cannabis use was 49.4% and 16.7%, respectively. Females were less likely than males to report lifetime cannabis use (41.9% vs. 50.4%; odds ratio [OR] 0.71; 95% CI, - 0.59 to 0.86). No sex differences were noted for past 12-month cannabis use (14.1% vs. 17.0%; OR 0.80; 95% CI, 0.60 to 1.07). Physical abuse, sexual abuse, neglect, any child maltreatment, most individual DRTEs, and any DRTE were associated with increased odds of past 12-month cannabis use after adjusting for sociodemographic and military variables. Some models were attenuated and/or nonsignificant after further adjustments for mental disorders and chronic pain conditions. Sex did not statistically significantly moderate these relationships. Cumulative effects of having experienced both child maltreatment and DRTEs compared to DRTEs alone increased the odds of past 12-month cannabis use. Statistically significant interaction effects between child maltreatment history and DRTE on cannabis use were not found. CONCLUSIONS: Child maltreatment histories and DRTEs increased the likelihood of past 12-month cannabis use among Canadian veterans. A history of child maltreatment, compared to DRTEs, indicated a more robust relationship. Understanding the links between child maltreatment, DRTEs, and cannabis use along with mental disorders and chronic pain conditions is important for developing interventions and improving health outcomes among veterans.

Factor structure and factorial invariance of the PTSD checklist for DSM-5 in public safety personnel: Results from a large and diverse sample.

OBJECTIVE: Public safety personnel (PSP; e.g., correctional workers, firefighters, paramedics, and police officers) are frequently exposed to potentially psychologically traumatic events (PPTEs) and report posttraumatic stress disorder (PTSD) difficulties more frequently than the general population. The PTSD checklist for DSM-5 (PCL-5) is a commonly used measure to screen PSP for PTSD. A single previous study assessed PCL-5 factorial invariance among PSP but used a small homogenous sample. The current study evaluated factorial invariance with a large (n = 5,855) and diverse PSP sample. METHOD: Multigroup confirmatory factor analyses (mCFAs; n = 98) were conducted using six competing factor models of the PCL-5 across seven PSP sectors, five age groups, and two gender groups. RESULTS: The seven-factor hybrid model of PTSD (i.e., reexperiencing, avoidance, negative alterations in cognitions and mood, hyperarousal, intrusion, emotional numbing, dysphoria, dysphoric arousal, anxious arousal, anhedonia, negative affect) produced consistently superior fit across all sectors assessed and produced marginally better absolute values than the six-factor anhedonia model, supporting PCL-5 factorial invariance among PSP. CONCLUSIONS: The current study is the first to use a large and diverse PSP sample to assess PCL-5 factorial invariance. The results support the PCL-5 as invariant across PSP sectors, age groups, and men and women. Consistent with other studies, the seven-factor hybrid model of PTSD produced the best fit, followed closely by the six-factor anhedonia model. Future research could use structured clinical interviews to further investigate the factorial structure and invariance of PTSD symptoms among PSPs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Applying the Theoretical Domains Framework to identify police, fire, and paramedic preferences for accessing mental health care in a First Responder Operational Stress Injury Clinic: a qualitative study. / Application du cadre Theoretical Domains Framework pour cerner les préférences des policiers, des pompiers et des ambulanciers en matière d'accès aux soins de santé mentale dans une clinique de traitement des blessures de stress opérationnel pour les premiers répondants : une étude qualitative.

INTRODUCTION: First responders and other public safety personnel (PSP; e.g. correctional workers, firefighters, paramedics, police, public safety communicators) are often exposed to events that have the potential to be psychologically traumatizing. Such exposures may contribute to poor mental health outcomes and a greater need to seek mental health care. However, a theoretically driven, structured qualitative study of barriers and facilitators of help-seeking behaviours has not yet been undertaken in this population. This study used the Theoretical Domains Framework (TDF) to identify and better understand critical barriers and facilitators of help-seeking and accessing mental health care for a planned First Responder Operational Stress Injury (OSI) clinic. METHODS: We conducted face-to-face, one-on-one semistructured interviews with 24 first responders (11 firefighters, five paramedics, and eight police officers), recruited using purposive and snowball sampling. Interviews were analyzed using deductive content analysis. The TDF guided study design, interview content, data collection, and analysis. RESULTS: The most reported barriers included concerns regarding confidentiality, lack of trust, cultural competency of clinicians, lack of clarity about the availability and accessibility of services, and stigma within first responder organizations. Key themes influencing help-seeking were classified into six of the TDF's 14 theoretical domains: environmental context and resources; knowledge; social influences; social/professional role and identity; emotion; and beliefs about consequences. CONCLUSION: The results identified key actions that can be utilized to tailor interventions to encourage attendance at a First Responder OSI Clinic. Such approaches include providing transparency around confidentiality, policies to ensure greater cultural competency in all clinic staff, and clear descriptions of how to access care; routinely involving families; and addressing stigma.

Cardiac function and posttraumatic stress disorder: a review of the literature and case report. / Fonction cardiaque et trouble de stress post-traumatique : revue de la littérature et étude de cas.

INTRODUCTION: Posttraumatic stress disorder (PTSD) can induce an elevation in sympathetic tone; however, research pertaining to the cardiac cycle in patients with PTSD is limited. METHODS: A literature review was conducted with PubMed, MEDLINE and Web of Science. Articles discussing changes and associations in echocardiography and PTSD or related symptoms were synthesized for the current review. We have also included data from a case report of a male participant aged 33 years experiencing potentially psychologically traumatic events, who wore a noninvasive cardiac sensor to assess the timing intervals and contractility parameters of the cardiac cycle using seismocardiography. The intervals included systolic time, isovolumic contraction time (IVCT) and isovolumic relaxation time (IVRT). Calculations of systolic (IVCT/systole), diastolic (IVRT/systole) and myocardial [(IVCT+IVRT)/systole] performance indices were completed. RESULTS: The review identified 55 articles, 14 of which assessed cardiac function using echocardiography in patients with PTSD symptoms. Cardiac dysfunction varied across studies, with diastolic and systolic impairments found in patients with PTSD. Our case study showed that occupational stress elevated cardiac performance indices, suggesting increased ventricular stress and supporting results in the existing literature. CONCLUSIONS: The literature review results suggest that a controlled approach to assessing cardiac function in patients with PTSD is required. The case study results further suggest that acute bouts of stress can alter cardiac function, with potential for sustained occupational stress to induce changes in cardiac function. Cardiac monitoring can be used prospectively to identify changes induced by potentially psychologically traumatic event exposures that can lead to the development of PTSD symptoms.

Glossary of terms: A shared understanding of the common terms used to describe psychological trauma, version 3.0. / Glossaire des termes : une compréhension commune des termes courants utilisés pour décrire les traumatismes psychologiques ­ Version 3.0.

Terms in the current glossary are arranged alphabetically by the most commonly used synonym. Most of the terms have two complementary definitions: a "general public definition" or introductory definition, geared towards a wider readership, and an "academic definition," which may be more detailed, or "expert." There is some overlap between the definitions, and readers may choose to read either or both.

Les termes du glossaire sont classés par ordre alphabétique selon le synonyme le plus couramment utilisé. La plupart des termes comportent deux définitions complémentaires : une « définition grand public ¼, c'est-à-dire une définition d'introduction, destinée à un lectorat plus vaste, et une « définition scientifique ¼, susceptible d'être plus détaillée ou destinée à des « spécialistes ¼11-76. Il y a un certain chevauchement entre les définitions, et les lecteurs ont le choix de lire l'une, l'autre ou les deux.

Cardioautonomic lability assessed by heart rate variability changes in Royal Canadian Mounted Police cadets during the cadet training program.

Objective: The current study examined variations in cardioautonomic lability during the Royal Canadian Mounted Police (RCMP) Cadet Training Program (CTP) between cadets starting their training who did or did not screen positive for one or more mental health disorders (i.e., posttraumatic stress disorder [PTSD], major depressive disorder [MDD], social anxiety disorder [SAD], generalized anxiety disorder [GAD], panic disorder [PD], alcohol use disorder [AUD]). Methods: Electrocardiogram (ECG) signals integrated into Hexoskin garments were used to record ECG and heart rate Over the 26-week CTP. There were 31 heart rate variability (HRV) parameters calculated using Kubios Premium HRV analysis software. Mann-Whitney U-tests were used to perform groupwise comparisons of participant raw values and HRV during the CTP. Results: A total of 157 cadets (79% male) were screened for any mental disorder using self-report surveys and then grouped by positive and negative screening. Analyses indicated a statistically significant (p < 0.05) decrease in low frequency (LF): High Frequency (HF) variability during CTP, but only for cadets who endorsed clinically significant anxiety symptoms on the GAD-7 at the start of their training. There were no other statistically significant groupwise differences. Conclusion: The results indicate the participants have excellent cardiac health overall and suggest potentially important differences between groups, such that cadets who endorsed clinically significant anxiety symptoms on the GAD-7 showed less variability in the LF:HF ratio over the course of the CTP. The relatively lower variability suggests decreased parasympathetic tone in those without clinically significant anxiety symptoms. The results also have important implications for future investigations of cardioautonomic dysfunction and chronic hypothalamic pituitary adrenal (HPA) axis deviations in policing populations with anxiety disorders; specifically, cardioautonomic inflexibility related to cardiovascular morbidity and mortality. In any case, the current results provide an important baseline for future cardiac research with cadets and serving officers.

"Collapsing into Darkness": An Exploratory Qualitative Thematic Analysis of the Experience of Workplace Reintegration among Nurses with Operational Stress Injuries.

BACKGROUND: Nurses are engaged in an unpredictable and dynamic work environment where they are exposed to events that may cause or contribute to physical and/or psychological injuries. Operational stress injury (OSI) may lead to an extended time away from work or nurses leaving the profession altogether. A deliberate focus on the workplace reintegration phase of the mental health recovery process may lead to the increased retention of nurses in their profession. Prior to the creation and implementation of potential solutions to address workplace reintegration, it is imperative to explore the experiences and perceptions of nurses affected by OSI. This qualitative study aims to investigate the experiences and perceptions of nurses (N = 7) employed within a Canadian provincial healthcare system who have attempted workplace reintegration after being off of work with an OSI. METHODS: Nurses were recruited via social media, unit emails, and word of mouth. Data were collected through recorded semi-structured interviews conducted over videoconferencing. Once transcribed, the data were thematically analyzed using an inductive approach. RESULTS: The resulting themes included (1) heroes to zeros, (2) changing the status quo, (3) connection is key, and (4) post-traumatic growth: advocacy and altruism. Study participants indicated both that nursing culture and a cumulation of events contributed to a need for a leave of absence from work and that a formalized process was desired by nurses to assist in returning to work. CONCLUSIONS: The development, implementation, and exploration of innovative policies, procedures, and initiatives to bridge the gap from clinical interventions to workplace reintegration are needed for nurses experiencing OSI. Further research is also needed regarding mental health impacts and appropriate resources to support nurses in their workplace reintegration process after experiencing psychological and/or physical injury.