Mental Health and Well-Being among Children of Public Safety Personnel in Canada.

Public safety personnel (PSP) often experience stress due to their occupational demands that affect the family environment (e.g., work-family conflict, marital breakdown, disruption to home routines, and holidays). A substantial base of research has focused on the impact of PSP work on the marital relationship, but fewer studies have focused specifically on children's functioning within PSP families. The current study investigated mental health, well-being, and functioning among children of PSP in Canada, as reported by PSP. Data were collected between 2016 and 2017 as part of a large pan-Canadian study of PSP. Participants (n = 2092; 72.5% women) were PSP parents who responded to questions about their 4- to 17-year-old children. Overall, a substantial proportion of PSP parents reported their children have at least some difficulties with sadness (15.4%), worries and fear (22.0%), disobedience or anger (22.0%), attention (21.0%), and friendships (11.4%). Firefighters reported the fewest problems among their children compared to other PSP groups. Almost 40% of participants indicated that their child's problems were related to their work as a PSP. The results highlight the need to find ways to identify children that are struggling and provide support to those families. Organizations and PSP leadership should develop and prioritize efforts to support families of PSP members, with the likely outcome of enhancing PSP member well-being.

Assessing the Perceptions and Impact of Critical Incident Stress Management Peer Support among Firefighters and Paramedics in Canada.

Relative to the general population, public safety personnel (PSP) appear at an increased risk of developing mental health challenges as a result of repeated exposure to potentially psychologically traumatic events (PPTEs). To help mitigate the impact of PPTEs on PSP mental health, many PSP agencies have implemented diverse peer support despite limited empirical evidence. The current study was designed to expand the empirical evidence surrounding peer support by investigating one of the most widely used and structured peer support resources: Critical Incident Stress Management (CISM). Specifically, the current study with integrated firefighters and paramedics assessed (a) the prevalence of mental disorders; (b) perceptions of high fidelity CISM peer support; and (c) the comparative associations of CISM with high fidelity (n = 91) versus unknown fidelity (n = 60) versus no CISM (n = 64) and mental health. Results indicated that (a) mental disorders are prevalent among PSP irrespective of gender, age, and years of service; (b) participants perceived CISM peer support as offering beneficial and valuable tools (e.g., skills and coping strategies); and (c) high fidelity CISM environments offer some mental health benefits to individuals who screen positive for alcohol use disorder and generalized anxiety disorder. Overall, the current study offers novel information that can inform future directions for evidence-based peer support and policy decisions designed to support the mental health of PSP.

"It Is Difficult to Always Be an Antagonist": Ethical, Professional, and Moral Dilemmas as Potentially Psychologically Traumatic Events among Nurses in Canada.

AIMS: We explore social and relational dynamics tied to an unexplored potentially psychologically traumatic event (PPTE) that can impact nurses' well-being and sense of their occupational responsibilities: namely, the moral, ethical, or professional dilemmas encountered in their occupational work. DESIGN: We used a semi-constructed grounded theory approach to reveal prevalent emergent themes from the qualitative, open-ended component of our survey response data as part of a larger mixed-methods study. METHODS: We administered a national Canadian survey on nurses' experiences of occupational stressors and their health and well-being between May and September 2019. In the current study, we analyzed data from four open text fields in the PPTE section of the survey. RESULTS: In total, at least 109 participants noted that their most impactful PPTE exposure was a moral, professional, and/or ethical dilemma. These participants volunteered the theme as a spontaneous addition to the list of possible PPTE exposures. CONCLUSIONS: Emergent theme analytic results suggest that physicians, other nurses, staff, and/or the decision-making power of patients' families can reduce or eliminate a nurse's perception of their agency, which directly and negatively impacts their well-being and may cause them to experience moral injury. Nurses also report struggling when left to operationalize patient care instructions with which they disagree. IMPACT: Nurses are exposed to PPTEs at work, but little is known about factors that can aggravate PPTE exposure in the field, impact the mental wellness of nurses, and even shape patient care. We discuss the implications of PPTE involving moral, professional, and ethical dilemmas (i.e., potentially morally injurious events), and provide recommendations for nursing policy and practice.

Sex differences in mental disorder symptoms among Canadian police officers: the mediating role of social support, stress, and sleep quality.

Police officers, and specifically women officers, report elevated mental disorder rates relative to the general population, which may be impacted by sleep quality, policing-related stress, and social support. In a sample of Canadian police officers, sex was indirectly related to post traumatic stress, depression, generalized anxiety, panic, and social anxiety symptoms through its relationships with social support and sleep quality, but not through policing-related stress. Sex was indirectly related to problematic alcohol use symptoms through sleep quality only. Differences in clinical symptom severity between both sexes may be partially accounted for by the worsened sleep quality reported by women officers relative to their men counterparts. Conversely, general social support appears to be a protective, albeit insufficient, factor influencing the mental health of women police officers. Male and women police officers did not differ in their reports of policing-related stress. The current results underscore the importance of incorporating strategies to improve sleep practices into police workplace environments. Additionally, findings that general social support and policing-related stress do not help explain the trend of increased clinical severity reported by women police suggest that more research is still needed to identify and delineate other contributing factors.

Evaluation of Before Operational Stress: A Program to Support Mental Health and Proactive Psychological Protection in Public Safety Personnel.

Public safety personnel (PSP; e.g., communications officials, corrections workers, firefighters, paramedics, and police officers) are at risk of developing mental health problems due to experiencing potentially psychologically traumatic events during their career. Research examining evidence-based treatments for psychological injuries resulting from operational duties (also known as operational stress injuries) has not yielded robust results that would indicate ongoing interventions as the best solution for managing PSP mental health injuries; as such, proactive psychological interventions designed to bolster resilience are being considered potentially beneficial for mitigating the impact of occupational stress on PSP. Despite the growing popularity of resilience programs, most are delivered in a single session after an event deemed particularly problematic with no follow-up. Longer interventions may better support sustained resiliency, mitigate the impact of operational stress, and increase positive PSP workplace outcomes. The current article introduces the Before Operational Stress (BOS) program, which was designed for delivery early in a PSP career to enhance self-awareness and healthy relationships. The year-long program is derived from cognitive behavior therapy and group therapeutic techniques to meet program objectives. The current BOS program evaluation demonstrated small, statistically significant improvements in symptoms of PTSD, quality of life, stigma, and perceived social support from baseline (Time 1) to 6 months (Time 4). There were also non-significant improvements observed in symptoms of depression, anxiety, stress, alcohol use, as well as in emotional regulation and resilience. Qualitative results indicated participants positively perceived the BOS program, with participants reporting specific improvements in self-awareness, avoidant behaviors, and relationships with family and colleagues. The BOS program content (e.g., functional disconnection and functional reconnection) and processes (e.g., psychoeducation within a supportive learning structure; mutually empowering group interactions) appear unique relative to other PSP resilience programs, with promising initial results in support of PSP mental health. Recommendations for future research and program development are provided.

Nursing Leadership Has an Important Role in the Management of Nurses' Mental Health.

Canadian nurses have higher rates of mental disorder symptoms, suicidal behaviour and burnout than the general Canadian population. Exposure to potentially psychologically traumatic events (PPTEs), such as severe human suffering, life-threatening illness or injury and physical assault, can partially explain the decrease in nurses' well-being; however, nurses will continue to regularly face PPTEs as long as they remain in their career. Recent research suggests that operational stressors (e.g., shift work) and organizational stressors (e.g., staff shortages) can also contribute to significant mental health problems. Systemic change is needed to lessen or eliminate the impact of these modifiable stressors. Nursing leadership should advocate for change and solutions to support the mental health of front-line nurses.

Functional disconnection and reconnection: an alternative strategy to stoicism in public safety personnel.

Background: North American public safety personnel (PSP; e.g., police, firefighters, paramedics) training programmes often focus on the importance of controlling emotional reactions (i.e. remaining stoic) to make sound decisions in high-stress environments. Many PSP carry avoidant coping strategies into their personal lives, however, resulting in disrupted relationships and deterioration of well-being. Objective: We argue for an alternative perspective, functional disconnection and functional reconnection (FD/FR), that limits stoicism and avoidant coping in PSP work environments. FD/FR instead suggests that PSP can receive support and training focused on intentional and cognizant changes of the physical, emotional, mental, and spiritual aspects of their occupational roles; the same intention should be given to supporting reconnection when re-integrating into personal roles following the workday. Conclusion: FD/FR strategies can be incorporated into clinical treatment, existing training programmes and embraced by organizational leadership to facilitate a necessary shift towards prioritizing PSP well-being.

Antecedentes: Los programas de capacitación del personal de seguridad pública de América del Norte (PSP, en sus siglas en inglés; por ejemplo, la policía, los bomberos, los paramédicos) a menudo se centran en la importancia de controlar las reacciones emocionales (es decir, permanecer estoico) para tomar decisiones acertadas en entornos de alto estrés. Sin embargo, muchos PSP llevan a sus vidas personales estrategias de afrontamiento evasivas, lo que da lugar a la interrupción de las relaciones y al deterioro del bienestar.Objetivo: Sostenemos una perspectiva alternativa, la desconexión y reconexión funcional (FD/FR, en sus siglas en inglés), que limite el estoicismo y el afrontamiento evasivo en los entornos de trabajo del PSP. FD/FR sugiere, en cambio, que el PSP puede recibir apoyo y entrenamiento enfocado en cambios intencionales y conscientes de los aspectos físicos, emocionales, mentales y espirituales de sus roles ocupacionales; la misma intención debería darse al apoyo de la reconexión cuando se reintegran a los roles personales después de la jornada laboral.Conclusión: Las estrategias de FD/FR pueden incorporarse al tratamiento clínico, a los programas de formación existentes y ser adoptadas por el liderazgo organizacional para facilitar un cambio necesario hacia la priorización del bienestar del PSP.

Brief Mental Health Disorder Screening Questionnaires and Use with Public Safety Personnel: A Review.

Brief mental health disorder screening questionnaires (SQs) are used by psychiatrists, physicians, researchers, psychologists, and other mental health professionals and may provide an efficient method to guide clinicians to query symptom areas requiring further assessment. For example, annual screening has been used to help identify military personnel who may need help. Nearly half (44.5%) of Canadian public safety personnel (PSP) screen positive for one or more mental health disorder(s); as such, regular mental health screenings for PSP may be a valuable way to support mental health. The following review was conducted to (1) identify existing brief mental health disorder SQs; (2) review empirical evidence of the validity of identified SQs; (3) identify SQs validated within PSP populations; and (4) recommend appropriately validated brief screening questionnaires for five common mental health disorders (i.e., generalized anxiety disorder (GAD), major depressive depression (MDD), panic disorder, posttraumatic stress disorder, alcohol use disorder). After reviewing the psychometric properties of the identified brief screening questionnaires, we recommend the following four brief screening tools for use with PSP: the Patient Health Questionnaire-4 (screening for MDD and GAD), the Brief Panic Disorder Symptom Screen-Self-Report, the Short-Form Posttraumatic Checklist-5, and the Alcohol Use Disorders Identification Test-Consumption.

Exposures to Potentially Psychologically Traumatic Events Among Nurses in Canada.

BACKGROUND: Nurses are regularly exposed to diverse potentially psychologically traumatic events (PPTEs) as a function of their work. Cumulative exposure to PPTEs can lead to clinically significant symptoms of mental disorders. PURPOSE: We designed the current study to investigate the prevalence of different PPTEs among Canadian nurses and estimate the associations between diverse exposures and several mental disorders. METHODS: Canadian nurses (i.e., registered nurses, registered psychiatric nurses, licensed practical nurses, nurse practitioners) completed an online, self-reported survey. In total, 4067 participants (94.8% women) completed all relevant survey measures. RESULTS: Nurses reported exposures to several PPTE categories including severe human suffering, life threatening illness or injury, and physical assault, often 11 or more times. There were significant (p<.05) associations between diverse traumatic events and all mental disorders (i.e., Posttraumatic Stress Disorder, Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder) except Alcohol Use Disorder. CONCLUSIONS: The current findings suggest that Canadian nurses are substantially exposed to traumatic events, which vary by several sociodemographic categories. PPTE exposures were significantly associated with mental disorders; that is, if PPTEs were eliminated among Canadian nurses in the sample, symptoms would be reduced between 42.0% and 58.0%.

Associations Between Burnout and Mental Disorder Symptoms Among Nurses in Canada.

BACKGROUND: Nurses appear to be at a greater risk of burnout compared to other medical professionals. Higher levels of burnout are significantly associated with higher levels of anxiety, stress, and depression symptoms. PURPOSE: The current study was designed to estimate levels of burnout among Canadian nurses, examine the association between burnout and mental disorder symptoms, and identify characteristics that may increase the risk for reporting symptoms of burnout. METHOD: Canadian nurses (n = 3257; 94.3% women) were surveyed online in both English and French. The survey assessed current symptoms of burnout and mental disorders (i.e., Posttraumatic Stress Disorder, Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder). RESULTS: Most nurses (63.2%) reported at least some symptoms of burnout and many (29.3%) reported clinically significant levels of burnout. Age and years of service were the only demographic variables that explained burnout rates. Participants reporting clinically significant levels of burnout were significantly more likely than participants with no burnout to screen positive for all mental disorders, but particularly for Major Depressive Disorder. CONCLUSIONS: Monitoring burnout may be an effective way to identify nurses at risk of developing symptoms of mental disorders. Younger and early-career nurses are an important group to target for prevention programs.

Mental Disorder Symptoms Among Nurses in Canada.

BACKGROUND: Nurses face regular exposures to potentially psychologically traumatic events as part of their occupational responsibilities. Cumulative stress due to repeated exposure to such events is associated with poor mental health and an increased risk of developing clinically significant symptoms consistent with some mental disorders. PURPOSE: The current study was designed to estimate rates of mental disorder symptoms among nurses in Canada and identify demographic characteristics that are associated with increased risk for mental disorder symptoms. METHOD: An online survey was conducted with Canadian nurses in both English and French. Participants were recruited largely through the Canadian Federation of Nurses Unions (CFNU) member unions, non-CFNU member unions, and social media. The survey assessed current mental disorder symptoms using well-validated screening measures. RESULTS: A total of 4267 participants (93.8% women) completed the survey. Almost half of participants screened positive for a mental disorder (i.e., 47.9%). No gender differences emerged. Significant differences in proportions of positive screens based on each measure were found across demographic groups (e.g., age, province of residence, type of nurse). CONCLUSIONS: The rate of positive screens appears much higher than mental disorder prevalence rates in the general Canadian population, but there were important methodological differences. The current results provide potentially important information to support researchers and healthcare administrators to investigate possible ways to mitigate and manage mental health in nursing workplaces.

Suicidal Behaviors Among Nurses in Canada.

BACKGROUND: Nurses are regularly exposed to potentially psychologically traumatic events, experience high rates of burnout, and may be at an elevated risk of death by suicide. Few studies have assessed for suicidal behaviors among Canadian nurses, and factors that may increase risk for suicidal behaviors are unknown. PURPOSE: The current study was designed to assess past-year and lifetime suicidal behavior (i.e., ideation, plans, and attempts) using a large sample of Canadian nurses. METHOD: Participants (n = 3969; 94.3% women) completed an online survey including measures of suicidal behavior and symptoms of mental disorders. RESULTS: Considerable proportions of participants reported past-year and/or lifetime suicidal ideation (10.5%, 33.0%), plans (4.6%, 17.0%), and attempts (0.7%, 8.0%), considerably higher than general population estimates. Significant differences were identified across age groups, years of service, marital status, regional location, and nursing type (e.g., registered psychiatric nurses, licensed practical nurses, registered nurses). Participants who screened positive for almost all measured mental disorders had significantly higher rates of suicidal behavior. CONCLUSIONS: The results necessitate further research to evaluate risk factors contributing to suicidal behavior in Canadian nurses and methods to decrease the risk (e.g., developing effective monitoring and prevention measures).

Nurses' Mental Health and Well-Being: COVID-19 Impacts.

The editorial will introduce a special section on nurses' mental health and well-being that will showcase results from a groundbreaking pan-Canadian study of nurses' occupational stress. The article series highlights research efforts toward better supporting nurses' mental health. In this editorial, we discuss the importance of this research in light of the COVID-19 pandemic. We review the current stressors faced by nurses and anticipate how nurses' mental health and well-being will be impacted by COVID-19.

Examining Mental Health Knowledge, Stigma, and Service Use Intentions Among Public Safety Personnel.

INTRODUCTION: Public safety personnel (PSP; e.g., communications officials [e.g., 911 call center operators/dispatchers], correctional service employees, firefighters, paramedics, police officers) experience an elevated risk for mental disorders due to inherent work-related stress. Several programs have been designed to increase mental health knowledge, intending to reduce stigma, and increase mental health service help-seeking (e.g., resilience training); however, extant programs have not demonstrated sustained improvements for PSP mental health. The current study assessed levels of mental health knowledge, stigma, and service use intentions in a sample of Canadian PSP and compared trends to published estimates of mental health symptoms across PSP categories to inform future programming. METHODS: PSP completed questionnaires assessing mental health knowledge, stigma against coworkers with mental illness, and professional service use intentions. Correlations among variables and one-way analyses of variance were conducted to assess differences among categories. PSP were categorized into six categories for comparison: communication officials, correctional workers, firefighters, municipal/provincial police, paramedics, and Royal Canadian Mounted Police (RCMP). RESULTS: There were significant differences between categories for each variable. Correctional workers reported the most mental health knowledge, least stigma, and highest intentions to use mental health services, and the highest positive screens for mental disorders. Conversely, firefighters reported the lowest mental health knowledge, highest stigma, and lowest willingness to seek professional help, and the lowest prevalence of positive screens for mental disorders. DISCUSSION: The results contrast previously hypothesized associations among mental health variables where education, stigma reduction, and help-seeking have been expected to improve mental health. The discrepant results offer potentially critical information for organizational policies to better support PSP. Individuals reporting mental health symptoms may be a more appropriate target audience for intervention strategies, given the possible, crucial role personal experience plays in increasing mental health knowledge, and ultimately, encouraging help-seeking.