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The 2013 Canadian Forces Mental Health Survey (CFMHS) collected detailed information on mental health problems, their impacts, occupational and nonoccupational determinants of mental health, and the use of mental health services from a random sample of 8200 serving personnel. The objective of this article is to provide a firm scientific foundation for understanding and interpreting the CFMHS findings. Methods: This narrative review first provides a snapshot of the Canadian Armed Forces (CAF), focusing on 2 key determinants of mental health: the deployment of more than 40,000 personnel in support of the mission in Afghanistan and the extensive renewal of the CAF mental health system. The findings of recent population-based CAF mental health research are reviewed, with a focus on findings from the very similar mental health survey done in 2002. Finally, key aspects of the methods of the 2013 CFMHS are presented. Results: The findings of 20 peer-reviewed publications using the 2002 mental health survey data are reviewed, along with those of 25 publications from other major CAF mental health research projects executed over the past decade. Conclusions: More than a decade of population-based mental health research in the CAF has provided a detailed picture of its mental health and use of mental health services. This knowledge base and the homology of the 2013 survey with the 2002 CAF survey and general population surveys in 2002 and 2012 will provide an unusual opportunity to use the CFMHS to situate mental health in the CAF in a historical and societal perspective. Abré gé Objectif : L'Enquête de 2013 sur la santé mentale dans les Forces canadiennes (ESMFC) a recueilli une information détaillée sur les problèmes de santé mentale, leurs effets, les déterminants professionnels et non professionnels de la santé mentale, et l'utilisation des services de santé mentale dans un échantillon aléatoire de 8200 militaires en activité. L'objectif de cet article est d'offrir une fondation scientifique solide pour comprendre et interpréter les résultats de l'ESMFC. Mé thodes : Cette revue narrative offre d'abord un portrait des Forces armées canadiennes (FAC), axé sur deux principaux déterminants de la santé mentale : le déploiement de plus de 40 000 militaires pour soutenir la mission en Afghanistan et le renouvellement approfondi du système de santé mentale des FAC. Les résultats d'une récente étude sur la santé mentale dans la population menée par les FAC sont examinés, parallèlement aux résultats de l'enquête sur la santé mentale très semblable menée en 2002. Enfin, les principaux aspects des méthodes de l'ESMFC de 2013 sont présentés.

Comparaison de la pré valence des troubles mentaux et des comportements suicidaires de l'anné e pré cé dente entre les Forces armé es canadiennes et la population gé né rale canadienne

Objective: More than 40

BackgroundAs Canada's mission in Afghanistan winds down, the Canadian Forces (CF) are reflecting on the psychological impact of the mission on more than 40,000 deployed personnel.MethodsAll major CF studies of mental health outcomes done before and during the Afghanistan era are summarized, with an eye toward getting the most complete picture of the mental health impact of the mission. Studies on traumatic brain injury (TBI), high-risk drinking, and suicidality are included given their conceptual link to mental health.ResultsCF studies on the mental health impact of pre-Afghanistan deployments are few, and they have inadequate detail on deployment experiences. Afghanistan era findings confirm service-related mental health problems (MHPs) in an important minority. The findings of the studies cohere, both as a group and in the context of data from our Allies. Combat exposure is the most important driver of deployment-related MHPs, but meaningful rates will be found in those in low-threat areas. Reserve service and cumulative effects of multiple deployments are not major risk factors in the CF. Many deployed personnel will seek care, but further efforts to decrease the delay are needed. Only a fraction of the overall burden of mental illness is likely deployment attributable. Deployment-related mental disorders do not translate into an overall increase in in-service suicidal behavior in the CF, but there is concerning evidence of increased suicide risk after release. TBI occurred in a distinct minority on this deployment, but severe forms were rare. Most TBI cases do not have persistent “post-concussive” symptoms; such symptoms are closely associated with MHPs.ConclusionThe mental health impact of the mission in Afghanistan is commensurate with its difficult nature. While ongoing and planned studies will provide additional detail on its impacts, greater research attention is needed on preventive and therapeutic interventions.

Rates of HIV transmission remain a challenge in both the United States and Canada as overall diagnosis rates have not decreased in recent years. Renewed prevention efforts are needed to further reduce the high HIV diagnosis rates among racial/ethnic minorities and to decrease HIV transmission among men who have sex with men.

Contribution de la mission en Afghanistan au fardeau des troubles mentaux de l'anné e pré cé dente du personnel des Forces armé es canadiennes, 2013

ObjectiveMental disorders in military personnel result in high rates of attrition. Military organisations have strengthened their mental health systems and attempted to overcome barriers to care in order to see better outcomes. This study investigated the roles of mental health services renewal and delay to care in Canadian Armed Forces (CAF) personnel diagnosed with mental disorders.DesignAdministrative data were used to identify a retrospective cohort of 30 513 CAF personnel who deployed in support of the mission in Afghanistan. Study participants included 508 individuals with a mental disorder diagnosis identified from CAF medical records of a weighted, stratified random sample of 2014 individuals selected from the study cohort. Weighted Cox proportional hazards regression assessed the association of diagnosis era and delay to care with the outcome, after controlling for a broad range of potential confounders (eg, disorder severity, comorbidity). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics.Primary outcomeThe outcome was release from military service for medical reasons, assessed using administrative data for the 508 individuals with a mental disorder diagnosis.Results17.5% (95% CI 16.0% to 19.0%) of the cohort had a mental disorder diagnosis after an Afghanistan-related deployment, of which 21.3% (95% CI 17.2% to 25.5%) had a medical release over a median follow-up of 3.5 years. Medical release risk was elevated for individuals diagnosed before 30 April 2008 relative to those with recent diagnoses (adjusted HR (aHR)=1.77 (95% CI 1.01 to 3.11)) and for individuals with a long delay to care (>21 months after return) relative to those with intermediate delays (8–21 months, aHR 2.47=(95% CI 1.28 to 4.76)).ConclusionsMental health services renewal in the CAF was associated with a better occupational outcome for those diagnosed with mental disorders. Longer delays to care were associated with a less favourable outcome.