Potentially Psychologically Traumatic Event Exposure Histories of new Royal Canadian Mounted Police Cadets.

OBJECTIVE: Royal Canadian Mounted Police (RCMP) report extremely frequent and varied exposures to potentially psychologically traumatic events (PPTEs). While occupational exposures to PPTEs may be one explanation for the symptoms of mental disorders prevalent among serving RCMP, exposures occurring prior to service may also play a role. The objective of the current study was to provide estimates of lifetime PPTE exposures among RCMP cadets in training and assess for associations with mental disorders or sociodemographic variables. METHODS: RCMP cadets (n = 772; 72.0% male) beginning the Cadet Training Program (CTP) completed a survey assessing self-reported PPTE exposures as measured by the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition-Extended. Binomial tests were conducted to compare the current results to previously collected data from the general population, a diverse sample of public safety personnel (PSP) and serving RCMP. RESULTS: Cadets reported statistically significantly fewer PPTE exposures for all PPTE types than serving RCMP (all p's < 0.001) and PSP (all p's < 0.001) but more PPTE exposures for all PPTE types than the general population (all p's < 0.001). Cadets also endorsed fewer PPTE types (6.00 ± 4.47) than serving RCMP (11.64 ± 3.40; p < 0.001) and other PSP (11.08 ± 3.23) but more types than the general population (2.31 ± 2.33; p < 0.001). Participants who reported being exposed to any PPTE type reported the exposures occurred 1-5 times (29.1% of participants), 6-10 times (18.3%) or 10 + times (43.1%) before starting the CTP. Several PPTE types were associated with positive screens for one or more mental disorders. There were associations between PPTE types and increased odds of screening positive for post-traumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD) (all p's < 0.05). Serious transport accident (11.1%), physical assault (9.5%) and sudden accidental death (8.4%) were the PPTEs most identified as the worst event, and all were associated with positive screens for one or more mental disorders. CONCLUSION: The current results provide the first information describing PPTE histories of cadets, evidencing exposure frequencies and types much higher than the general population. PPTE exposures may have contributed to the cadet's vocational choices. The current results support the growing evidence that PPTEs can be associated with diverse mental disorders; however, the results also suggest cadets may be uncommonly resilient, based on how few screened positive for mental disorders, despite reporting higher frequencies of PPTE exposures prior to CTP than the general population.

Suicidal Ideation, Planning, and Attempts Among new Royal Canadian Mounted Police Cadets.

BACKGROUND: Royal Canadian Mounted Police (RCMP) report diverse occupational stressors and repeated exposures to potentially psychologically traumatic events, which may increase the odds of screening positive for a mental disorder, and increase the risk of death by suicide. The current study was designed to provide prevalence information regarding suicidal behaviours (i.e., ideation, planning, attempts) and assess for sociodemographic differences among cadets at the start of the RCMP Cadet Training Program (CTP). METHOD: Cadets (n = 736, 74.0% male) were administered the structured Mini International Neuropsychiatric Interview by a mental health clinician or a supervised clinical psychologist trainee. The interview includes an assessment of past month suicidal ideation, planning, attempts and lifetime suicide attempts. RESULTS: Within 1 month of starting the CTP, a small percentage of cadets reported past month suicidal ideation (1.6%) and no cadets reported any suicidal planning (0%) or attempts (0%). Lifetime suicide attempts were reported by (1.5%) of cadets. CONCLUSIONS: The current results provide the first information describing the prevalence of suicidal ideation, planning, and attempts among RCMP cadets starting the CTP. The estimates of suicidal behaviours appear lower than the general population and lower than reports from serving RCMP. Higher prevalence estimates of suicidal behaviours reported by serving RCMP, relative to lower estimates among cadets starting the CTP in the current study, may be related to age, cumulative experiences or protracted exposures to operational and organizational stressors, rather than insufficient screening of recruits.

Mental Health of Royal Canadian Mounted Police at the Start of the Cadet Training Program.

OBJECTIVE: Serving Royal Canadian Mounted Police (RCMP) have screened positive for one or more mental disorders based on self-reported symptoms with substantial prevalence (i.e., 50.2%). Mental health challenges for military and paramilitary populations have historically been attributed to insufficient recruit screening; however, cadet mental health when starting the Cadet Training Program (CTP) was unknown. Our objective was to estimate RCMP Cadet mental health when starting the CTP and test for sociodemographic differences. METHOD: Cadets starting the CTP completed a survey assessing self-reported mental health symptoms (n = 772, 72.0% male) and a clinical interview (n = 736, 74.4% male) with a clinician or supervised trainee using the Mini-International Neuropsychiatric Interview to assess current and past mental health. RESULTS: The percentage of participants screening positive for one or more current mental disorders based on self-reported symptoms (15.0%) was higher than the diagnostic prevalence for the general population (10.1%); however, based on clinical interviews, participants were less likely to screen positive for any current mental disorder (6.3%) than the general population. Participants were also less likely to screen positive for any past mental disorder based on self-report (3.9%) and clinical interviews (12.5%) than the general population (33.1%). Females were more likely to score higher than males (all ps<.01; Cohen's ds .23 to .32) on several self-report mental disorder symptom measures. CONCLUSIONS: The current results are the first to describe RCMP cadet mental health when starting the CTP. The data evidenced a lower prevalence of anxiety, depressive, and trauma-related mental disorders than the general population based on clinical interviews, contrasting notions that more rigorous mental health screening would reduce the high prevalence of mental disorders among serving RCMP. Instead, protecting RCMP mental health may require ongoing efforts to mitigate operational and organizational stressors.

Multilevel Meta-Analysis of Individual Participant Data of Single-Case Experimental Designs: One-Stage versus Two-Stage Methods.

To conduct a multilevel meta-analysis of multiple single-case experimental design (SCED) studies, the individual participant data (IPD) can be analyzed in one or two stages. In the one-stage approach, a multilevel model is estimated based on the raw data. In the two-stage approach, an effect size is calculated for each participant and these effect sizes and their sampling variances are subsequently combined to estimate a meta-analytic multilevel model. The multilevel model in the two-stage approach has fewer parameters to estimate, in exchange for the reduction of information of the raw data to effect sizes. In this paper we explore how the one-stage and two-stage IPD approaches can be applied in the context of meta-analysis of single-case designs. Both approaches are compared for several single-case designs of increasing complexity. Through a simulation study we show that the two-stage approach obtains better convergence rates for more complex models, but that model estimation does not necessarily converge at a faster speed. The point estimates of the fixed effects are unbiased for both approaches across all models, as such confirming results from methodological research on IPD meta-analysis of group-comparison designs. In light of these results, we discuss the implementation of both methods in R.

Estimating outcome-specific effects in meta-analyses of multiple outcomes: A simulation study.

In meta-analysis, primary studies often include multiple, dependent effect sizes. Several methods address this dependency, such as the multivariate approach, three-level models, and the robust variance estimation (RVE) method. As for today, most simulation studies that explore the performance of these methods have focused on the estimation of the overall effect size. However, researchers are sometimes interested in obtaining separate effect size estimates for different types of outcomes. A recent simulation study (Park & Beretvas, 2019) has compared the performance of the three-level approach and the RVE method in estimating outcome-specific effects when several effect sizes are reported for different types of outcomes within studies. The goal of this paper is to extend that study by incorporating additional simulation conditions and by exploring the performance of additional models, such as the multivariate model, a three-level model that specifies different study-effects for each type of outcome, a three-level model that specifies a common study-effect for all outcomes, and separate three-level models for each type of outcome. Additionally, we also tested whether the a posteriori application of the RV correction improves the standard error estimates and the 95% confidence intervals. Results show that the application of separate three-level models for each type of outcome is the only approach that consistently gives adequate standard error estimates. Also, the a posteriori application of the RV correction results in correct 95% confidence intervals in all models, even if they are misspecified, meaning that Type I error rate is adequate when the RV correction is implemented.

The application of meta-analytic (multi-level) models with multiple random effects: A systematic review.

In meta-analysis, study participants are nested within studies, leading to a multilevel data structure. The traditional random effects model can be considered as a model with a random study effect, but additional random effects can be added in order to account for dependent effects sizes within or across studies. The goal of this systematic review is three-fold. First, we will describe how multilevel models with multiple random effects (i.e., hierarchical three-, four-, five-level models and cross-classified random effects models) are applied in meta-analysis. Second, we will illustrate how in some specific three-level meta-analyses, a more sophisticated model could have been used to deal with additional dependencies in the data. Third and last, we will describe the distribution of the characteristics of multilevel meta-analyses (e.g., distribution of the number of outcomes across studies or which dependencies are typically modeled) so that future simulation studies can simulate more realistic conditions. Results showed that four- or five-level or cross-classified random effects models are not often used although they might account better for the meta-analytic data structure of the analyzed datasets. Also, we found that the simulation studies done on multilevel meta-analysis with multiple random factors could have used more realistic simulation factor conditions. The implications of these results are discussed, and further suggestions are given.

Multilevel meta-analysis of multiple regression coefficients from single-case experimental studies.

The focus of the current study is on handling the dependence among multiple regression coefficients representing the treatment effects when meta-analyzing data from single-case experimental studies. We compare the results when applying three different multilevel meta-analytic models (i.e., a univariate multilevel model avoiding the dependence, a multivariate multilevel model ignoring covariance at higher levels, and a multivariate multilevel model modeling the existing covariance) to deal with the dependent effect sizes. The results indicate better estimates of the overall treatment effects and variance components when a multivariate multilevel model is applied, independent of modeling or ignoring the existing covariance. These findings confirm the robustness of multilevel modeling to misspecifying the existing covariance at the case and study level in terms of estimating the overall treatment effects and variance components. The results also show that the overall treatment effect estimates are unbiased regardless of the underlying model, but the between-case and between-study variance components are biased in certain conditions. In addition, the between-study variance estimates are particularly biased when the number of studies is smaller than 40 (i.e., 10 or 20) and the true value of the between-case variance is relatively large (i.e., 8). The observed bias is larger for the between-case variance estimates compared to the between-study variance estimates when the true between-case variance is relatively small (i.e., 0.5).

A demonstration and evaluation of the use of cross-classified random-effects models for meta-analysis.

It is common for the primary studies in meta-analyses to report multiple effect sizes, generating dependence among them. Hierarchical three-level models have been proposed as a means to deal with this dependency. Sometimes, however, dependency may be due to multiple random factors, and random factors are not necessarily nested, but rather may be crossed. For instance, effect sizes may belong to different studies, and, at the same time, effect sizes might represent the effects on different outcomes. Cross-classified random-effects models (CCREMs) can be used to model this nonhierarchical dependent structure. In this article, we explore by means of a simulation study the performance of CCREMs in comparison with the use of other meta-analytic models and estimation procedures, including the use of three- and two-level models and robust variance estimation. We also evaluated the performance of CCREMs when the underlying data were generated using a multivariate model. The results indicated that, whereas the quality of fixed-effect estimates is unaffected by any misspecification in the model, the standard error estimates of the mean effect size and of the moderator variables' effects, as well as the variance component estimates, are biased under some conditions. Applying CCREMs led to unbiased fixed-effect and variance component estimates, outperforming the other models. Even when a CCREM was not used to generate the data, applying the CCREM yielded sound parameter estimates and inferences.

Analysis of single-case experimental count data using the linear mixed effects model: A simulation study.

When (meta-)analyzing single-case experimental design (SCED) studies by means of hierarchical or multilevel modeling, applied researchers almost exclusively rely on the linear mixed model (LMM). This type of model assumes that the residuals are normally distributed. However, very often SCED studies consider outcomes of a discrete rather than a continuous nature, like counts, percentages or rates. In those cases the normality assumption does not hold. The LMM can be extended into a generalized linear mixed model (GLMM), which can account for the discrete nature of SCED count data. In this simulation study, we look at the effects of misspecifying an LMM for SCED count data simulated according to a GLMM. We compare the performance of a misspecified LMM and of a GLMM in terms of goodness of fit, fixed effect parameter recovery, type I error rate, and power. Because the LMM and the GLMM do not estimate identical fixed effects, we provide a transformation to compare the fixed effect parameter recovery. The results show that, compared to the GLMM, the LMM has worse performance in terms of goodness of fit and power. Performance in terms of fixed effect parameter recovery is equally good for both models, and in terms of type I error rate the LMM performs better than the GLMM. Finally, we provide some guidelines for applied researchers about aspects to consider when using an LMM for analyzing SCED count data.

Concealed correlations meta-analysis: A new method for synthesizing standardized regression coefficients.

The synthesis of standardized regression coefficients is still a controversial issue in the field of meta-analysis. The difficulty lies in the fact that the standardized regression coefficients belonging to regression models that include different sets of covariates do not represent the same parameter, and thus their direct combination is meaningless. In the present study, a new approach called concealed correlations meta-analysis is proposed that allows for using the common information that standardized regression coefficients from different regression models contain to improve the precision of a combined focal standardized regression coefficient estimate. The performance of this new approach was compared with that of two other approaches: (1) carrying out separate meta-analyses for standardized regression coefficients from studies that used the same regression model, and (2) performing a meta-regression on the focal standardized regression coefficients while including an indicator variable as a moderator indicating the regression model to which each standardized regression coefficient belongs. The comparison was done through a simulation study. The results showed that, as expected, the proposed approach led to more accurate estimates of the combined standardized regression coefficients under both random- and fixed-effect models.

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.

Mental health and social support among Royal Canadian Mounted Police cadets.

Introduction: Certain populations, such as public safety personnel (PSP), experience frequent exposures to potentially psychologically traumatic events and other occupational stressors, increasing their risk for mental health challenges. Social support has been evidenced as a protective factor for mental health. However, research examining perceived social support and its associations with symptoms related to mental disorders among PSP recruits is limited. Methods: RCMP cadets (n = 765, 72% male) completed self-report surveys assessing: sociodemographic information, social support, and symptoms related to posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, and alcohol use disorder. Results: The results indicated statistically significant associations between higher social support and decreased odds of positive screens for generalized anxiety disorder, social anxiety disorder, and panic disorder (i.e., significant Adjusted Odds Ratios = 0.90 to 0.95). Discussion: Cadets' perceived levels of social support are comparable to the Canadian general population and higher than serving RCMP. Social support appears to offer a protective element against anxiety-related disorders among participating cadets. Reductions in perceived levels of social support may be a function of RCMP service. Factors contributing to decreased levels of perceived social support should be considered.

Examining mental health knowledge, stigma, and service use intentions among Royal Canadian Mounted Police cadets.

Background: Royal Canadian Mounted Police (RCMP) officers experience an elevated risk for mental health disorders due to inherent work-related exposures to potentially psychologically traumatic events and occupational stressors. RCMP officers also report high levels of stigma and low levels of intentions to seek mental health services. In contrast, very little is known about the levels of mental health knowledge and stigma of RCMP cadets starting the Cadet Training Program (CTP). The current study was designed to: (1) obtain baseline levels of mental health knowledge, stigma against peers in the workplace, and service use intentions in RCMP cadets; (2) determine the relationship among mental health knowledge, stigma against peers in the workplace, and service use intentions among RCMP cadets; (3) examine differences across sociodemographic characteristics; and (4) compare cadets to a sample of previously surveyed serving RCMP. Methods: Participants were RCMP cadets (n = 772) starting the 26-week CTP. Cadets completed questionnaires assessing mental health knowledge, stigma against coworkers with mental health challenges, and mental health service use intentions. Results: RCMP cadets reported statistically significantly lower levels of mental health knowledge (d = 0.233) and stigma (d = 0.127), and higher service use intentions (d = 0.148) than serving RCMP (all ps < 0.001). Female cadets reported statistically significantly higher scores on mental health knowledge and service use and lower scores on stigma compared to male cadets. Mental health knowledge and service use intentions were statistically significantly positively associated. For the total sample, stigma was inversely statistically significantly associated with mental health knowledge and service use intentions. Conclusion: The current results indicate that higher levels of mental health knowledge were associated with lower stigma and higher intention to use professional mental health services. Differences between cadets and serving RCMP highlight the need for regular ongoing training starting from the CTP, designed to reduce stigma and increase mental health knowledge. Differences between male and female cadets suggest differential barriers to help-seeking behaviors. The current results provide a baseline to monitor cadet mental health knowledge and service use intentions and stigma as they progress throughout their careers.

Putative risk and resiliency factors among Royal Canadian Mounted Police cadets.

Objective: Mental health disorders are prevalent among active-duty Royal Canadian Mounted Police (RCMP) officers. The current study was designed to assess whether RCMP cadets commencing the Cadet Training Program are inherently at greater risk of developing mental health challenges by statistically comparing cadet putative risk and resiliency scores to scores from young adult populations. The study was also designed to assess for sociodemographic differences in putative risk and resiliency variables among RCMP cadets in order to facilitate future comparisons. Methods: Cadets (n = 772; 72.2% men) completed self-report measures of several putative risk variables (i.e., anxiety sensitivity, fear of negative evaluation, pain anxiety, illness and injury sensitivity, intolerance of uncertainty, and state anger) and resiliency. Scores were statistically compared to samples from Canadian, American, Australian, and European young adult populations. Results: Cadets had statistically significantly lower scores on all putative risk variables and statistically significantly higher resiliency scores compared to the young adult populations. In the cadet sample, there were statistically significant differences in putative risk and resiliency variables across gender and sex. Conclusion: Cadets' significantly lower scores on putative risk variables and higher scores on resiliency suggest that they may be psychologically strong; as such, it may be that the nature of police work, as opposed to inherent individual differences in risk and resiliency, accounts for active-duty RCMP officers' comparatively higher prevalence of mental health disorders over time.Clinical Trial Registration: ClinicalTrials.gov, Identifier NCT05527509.

Daily survey participation and positive changes in mental health symptom scores among Royal Canadian Mounted Police Cadets.

Introduction: Royal Canadian Mounted Police (RCMP) officers self-report high levels of mental health disorder symptoms, such as alcohol use disorder, generalized anxiety disorder, major depressive disorder, panic disorder, and posttraumatic stress disorder. Participation in regular mental health monitoring has been associated with improved mental health disorder symptom reporting and may provide an accessible tool to support RCMP mental health. The current study assessed relationships between self-reported mental health disorder symptoms and the completion of daily surveys (i.e., daily mental health disorder symptom monitoring) by RCMP cadets during the Cadet Training Program (CTP). Methods: Participants were RCMP cadets (n = 394; 76.1% men) in the Standard Training Program who completed the 26-week CTP and daily self-monitoring surveys, as well as full mental health assessments at pre-training (i.e., starting the CTP) and pre-deployment (i.e., ~2 weeks prior to deployment to the field). Symptoms of alcohol use disorder, generalized anxiety disorder, major depressive disorder, panic disorder, and posttraumatic stress disorder were assessed. Changes in mental health disorder symptom reporting from pre-training to pre-deployment were calculated. Spearman's rank correlations were estimated for number of daily surveys completed and change in mental health disorder symptom scores between pre-training and pre-deployment. Results: There were statistically significant inverse relationships between number of daily surveys completed and number of mental health disorder symptoms reported; specifically, cadets who completed more daily surveys during CTP reported fewer symptoms of alcohol use disorder, generalized anxiety disorder, major depressive disorder, panic disorder, and posttraumatic stress disorder. Conclusion: An inverse correlation between number of daily surveys completed and mental health disorder symptom scores indicated that participation in daily mental health monitoring was associated with improvements in self-reported mental health disorder symptoms between pre-training and pre-deployment. Regular self-monitoring of mental health disorder symptoms may help to mitigate mental health challenges among RCMP cadets and officers.

Prophylactic relationship between mental health disorder symptoms and physical activity of Royal Canadian Mounted Police Cadets during the cadet training program.

Objective: Royal Canadian Mounted Police report experiencing extremely frequent potentially psychologically traumatic events (PPTE). In a recent study, approximately half of participating RCMP screened positive for one or more mental disorders, which is approximately five times the diagnostic proportion for the general Canadian population. Increased reporting of mental health symptoms been linked to PPTE exposures. Programs promoting physical activity may be useful interventions to supplement or pair with mental health interventions, providing anxiolytic, antidepressant, and stress-buffering effects. The current study was designed to assess the relationship between physical activity behaviors and reported mental health disorder symptoms of cadets during the Royal Mounted Canadian Police (RCMP) Cadet Training Program (CTP). The current study also examined the relationship between exercise and mental health disorder symptoms of cadets during the CTP. Methods: The study included data from 394 cadets (76.1% male). An analysis of variance (ANOVA) and a series of t-tests were used to assess several differences across sociodemographic groups. Bivariate Spearman's Rank correlations were performed between the average number of active calories burned per day, as recorded by Apple Watches, and changes in self-reported mental health disorder symptoms (i.e., Generalized Anxiety Disorder [GAD], Major Depressive Disorder [MDD], Posttraumatic Stress Disorder [PTSD], Social Anxiety Disorder [SAD]. Alcohol Use Disorders [AUD], Panic Disorder [PD]) from pre-training (starting the CTP) to pre-deployment (completing the CTP) 26 weeks later. Results: There were statistically significant correlations between physical activity and self-reported mental health disorder symptom scores during CTP. Cadets who performed more physical activity from pre-training to pre-deployment had statistically significantly greater decreases in symptoms of GAD (ρ = -0.472, p < 0.001), MDD (ρ = -0.307, p < 0.001), PTSD (ρ = -0.343, p < 0.001), and AUD (ρ = -0.085, p < 0.05). There was no statistically significant relationship between physical activity and changes in PD symptoms (ρ = -0.037, p > 0.05). There were also no statistically significant relationships between pre-CTP mental health disorder symptom scores and the volume of physical activity performed during CTP. Conclusion: There was evidence of a significant relationship between reductions in mental health disorder symptom scores and physical activity during the 26-week CTP. The results highlight the role that exercise can play as an important tool for reducing mental health disorder symptoms, considering there was no relationship between pre-CTP baseline mental health scores and physical activity performed during CTP. Further research is needed to understand differences in physical activity behaviours among cadets and serving RCMP.

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.

Mental Health Disorders and Suicidal Behaviors Among Provincial Correctional Workers.

OBJECTIVE: We examined the prevalence ofmental health disorders and suicidal behaviors (ideation, planning, and attempts) among a sample of provincial correctional workers in Manitoba. METHODS: Self-reported mental health data from a survey on correctional worker mental health and well-being were analyzed for 491 correctional workers. RESULTS: Over half (57%) of respondents screened positive for mental health disorder, most commonly major depressive disorder, and over one-third of respondents (37%) screened positive for more than one disorder. Positive mental health screens for all mental health disorders were associated with statistically significantly increased odds of lifetime suicidal ideation, and positive screens for most disorders were associated with past year suicidal ideation. CONCLUSIONS: Relative to other public safety personnel and the general public, correctional workers appear have a higher prevalence of mental health disorders and suicidal behaviors. The association between positive screens for mental health disorders and suicidal behaviors highlights the vulnerability of correctional workers in regards to mental well-being.

Network Meta-Analysis for Single-Case Design Studies: An Illustration.

Single-case designs (SCDs) are used to evaluate the effects of interventions on individual participants. By repeatedly measuring participants under different conditions, SCD studies focus on individual effects rather than on group summaries. The main limitation of SCDs remains its generalisability to wider populations, reducing the relevance of their findings for practice and policy making. With this limitation in mind, methodological developments for synthesising SCD data from different studies that investigate the same research question have intensified in the past decades (e.g. multilevel modelling). However, these techniques are restricted to comparing two interventions at a time and can only incorporate evidence from studies that directly compare the two treatments of interest. These limitations could be addressed by using network meta-analysis that incorporates both direct and indirect evidence to simultaneously compare multiple interventions. Despite its potential, network meta-analytical techniques have yet to be applied to SCD data. Thus, in this paper, we argue that network meta-analysis can be a valuable tool to synthesise SCD data. We demonstrate the use of network meta-analysis in SCD data using a real dataset, and we conclude by reflecting on the challenges that SCD researchers might face when applying network meta-analysis methods to their data.

Assessing the Efficacy of a Cultural and Artistic Intervention for Indigenous Women Who Have Experienced Intimate Partner Violence.

nato' we ho win is a trauma-and-violence-informed artistic and cultural intervention for Indigenous women who have experienced intimate partner violence. The results of this study provide evidence that engagement in nato' we ho win had a positive impact on participants' well-being. Participants completed self-report questionnaires at intake, post-intervention, and at one-year follow-up. Multilevel modeling analyses assessed for within-participant changes over time. There was a statistically significant increase in participants' self-reported sense of resilience (p < 0.001), personal agency, connectedness, and post-traumatic growth (ps < 0.05). There were statistically significant decreases in participants' self-reported anxiety and depression (ps < 0.01) from intake to one-year follow-up.