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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.
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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.
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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.
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Transtornos Mentais , Humanos , Ontário/epidemiologia , Masculino , Adulto , Feminino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Estudos Transversais , Qualidade do Sono , Estresse Ocupacional/epidemiologia , Prisões , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Saúde Mental , Adulto Jovem , Servidores PenitenciáriosRESUMO
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 (â¼13) than previous samples of RCMP (â¼11) and public safety personnel (PSP) (â¼11). 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).
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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.
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Terapia Cognitivo-Comportamental , Internet , Humanos , Masculino , Feminino , Estudos Longitudinais , Terapia Cognitivo-Comportamental/métodos , Adulto , Pessoa de Meia-Idade , Canadá , Resultado do Tratamento , Depressão/terapia , Intervenção Baseada em Internet , Ansiedade/terapia , Transtornos de Estresse Pós-Traumáticos/terapiaRESUMO
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.
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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.
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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).
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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.
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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.
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Local de Trabalho , Humanos , Masculino , Adulto , Feminino , Local de Trabalho/psicologia , Pessoa de Meia-Idade , Canadá , Pesquisa Qualitativa , Estresse Ocupacional/psicologia , Grupo Associado , Saúde OcupacionalRESUMO
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.
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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.
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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.