Introduction. The mental health of Canadian Armed Forces (CAF) populations emerged as an important concern in the wake of difficult CAF deployments in the 1990s. This article is the first comprehensive summary of findings from subsequent surveys of mental health and well-being in CAF Veterans, undertaken to inform mental health service renewals by CAF Health Services and Veterans Affairs Canada (VAC). Methods. Epidemiological findings in journal publications and government reports were summarized from four cross-sectional national surveys: a survey of Veterans participating in VAC programs in 1999 and three surveys of health and well-being representative of whole populations of Veterans in 2003, 2010, and 2013. Results. Although most Veterans had good mental health, many had mental health problems that affected functioning, well-being, and service utilization. Recent Veterans had a higher prevalence of mental health problems than the general Canadian population, earlier-era Veterans, and possibly the serving population. There were associations between mental health conditions and difficult adjustment to civilian life, physical health, and multiple socio-demographic factors. Mental health problems were key drivers of disability. Comparisons with other studies were complicated by methodological, era, and cultural differences. Discussion. The survey findings support ongoing multifactorial approaches to optimizing mental health and well-being in CAF Veterans, including strong military-to-civilian transition support and access to effective mental and physical health services. Studies underway of transitioning members and families in the peri-release period of the military-to-civilian transition and longitudinal studies of mental health in Veterans will address important knowledge gaps.

The COVID-19 pandemic had, and probably continues having, a significant negative impact on access to pharmacological, physical, and psychological pain treatments.

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Background The COVID-19 pandemic has had a disproportionate impact on vulnerable populations, including individuals with chronic pain. We examined associations between geographical variations in COVID-19 infection rates, stress and pain severity, and investigated factors associated with changes in pain status and psychological distress among individuals living with chronic pain during the pandemic. Methods This investigation is part of a larger initiative, the Chronic Pain & COVID-19 Pan-Canadian Study, which adopted a cross-sectional observational design. A total of 3159 individuals living with chronic pain completed a quantitative survey between 16 April and 31 May 2020. Results Two-thirds (68.1%) of participants were between 40 and 69 years old, and 83.5% were women. Two-thirds (68.9%) of individuals reported worsened pain since pandemic onset. Higher levels of perceived pandemic-related risks (adjusted odds ratio: 1.27; 95% confidence interval: 1.03–1.56) and stress (1.21; 1.05–1.41), changes in pharmacological (3.17; 2.49–4.05) and physical/psychological (2.04; 1.62–2.58) pain treatments and being employed at the beginning of the pandemic (1.42; 1.09–1.86) were associated with increased likelihood of reporting worsened pain. Job loss (34.9% of individuals were employed pre-pandemic) was associated with lower likelihood (0.67; 0.48–0.94) of reporting worsened pain. Almost half (43.2%) of individuals reported moderate/severe levels of psychological distress. Negative emotions toward the pandemic (2.14; 1.78–2.57) and overall stress (1.43; 1.36–1.50) were associated with moderate/severe psychological distress. Conclusion Study results identified psychosocial factors to consider in addition to biomedical factors in monitoring patients’ status and facilitating treatment access for chronic pain patients during a pandemic.

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M ilitary personnel transitioning from military service to civilian life undergo a complex, multifaceted process with variable institutional, health, psychological, work, family, and community dimensions. 1-4 For most, transition is relatively smooth; for some, transition is characterized by decreased wellbeing, including compromised physical and mental health, social problems, role disability, disadvantages in determinants of health and decreased quality of life. 5 While there is no clear consensus on how to define successful transition, optimum self-perceived wellbeing is an important public policy objective. 6-8 The terms "wellbeing" and "quality of life" are often used interchangeably, and there is little consensus on definitions. 9 The well-being of serving and former Canadian Forces (CF) personnel is of interest to Veterans Affairs Canada (VAC), the Department of National Defence (DND), the CF, and to Veterans administrations internationally. 10-12 There are no publications quantitatively describing the well-being of Canadian Veterans after transition to civilian life. More is known about Veterans participating in VAC programs, but in 2010 only 10% of the 590,000 living Veterans with service in other than the Second World War and the Korean War were VAC clients. 3,13 The 2010 Survey on Transition to Civilian Life (STCL) provided an opportunity to study health-related quality of life (HRQoL) in former CF Regular Force personnel who released from service during 1998-2007. 5 They enrolled during the 1960s to 2000s and had varied experience in training (19% released as recruits or cadets), domestic disaster response, international peacekeeping and the recent increased operational tempo experienced by the CF since the first Persian Gulf War in 1990-91. 5 The survey was conducted before Canada's Afghanistan combat role ceased in 2011, and at a time when CF, DND and VAC were introducing major initiatives to improve disease prevention, health promotion, health care, and disability management for serving and released personnel. 14,15 The objectives of this study were to describe the HRQoL of recently released CF personnel (Veterans) in relation to socio-demographics, health, disability and determinants of health, to identify possible protective and risk factors for HRQoL, and to compare HRQoL to

Medical interventions regarding trauma resuscitation have increased survivorship to levels not previously attained. Multiple examples from recent conflicts illustrate the potential return to high-level function of severely injured service members following medical and rehabilitative interventions. This review addresses the goals of rehabilitation, distills hard-won lessons of the last decade of military trauma and rehabilitation, and recommends the use of a bio-psychosocial-spiritual approach to care that can be applied at all tiers of the health care system. Questions on enabling participation in meaningful life activities include the following: Why do some patients do well and others do not? What elements contribute to positive outcomes? What factors relate to suboptimal results? Lessons learned revolve around the importance of considering the physical, psychosocial and spiritual aspects of a person’s well-being; empowering patients by fostering self-efficacy; and helping patients find meaning in life events and set high-level goals. A bio-psychosocial-spiritual model from the rehabilitation medicine literature — the Canadian Model of Occupational Performance and Engagement — is proposed as a guide to the provision of person-centred care and the maximization of a person’s functioning posttrauma.

uicide is an important public health problem and therefore is of interest to Veterans Affairs Canada (VAC) and similar agencies worldwide that support the well-being of veterans and their families. The protracted conflicts in Afghanistan and Iraq have triggered renewed interest in the life-course health effects of military service, including suicide. 1,2 Historically, suicide rates among serving and released (veteran) military populations have tended to be similar or lower than in civilian populations, consistent with a healthy worker effect. 2-5 Suicide rates have increased in the US and UK in the past decade among serving personnel 2-4,6-9 and in some veteran subpopulations, including young males and those with chronic health problems. 3,6-8,10,11 A mortality study of Canadian Armed Forces personnel who enrolled in 1972-2005 found elevated rates among veterans. 4 Suicide risk in contemporary veterans needs explanation. 2 Mental health problems are strongly associated with suicidality (ideation, attempt and death) and are known military occupational risks. 1,2,11-19 In an expert consensus framework proposed for suicide prevention, stressful life events, psychiatric disorders and dispositional risks, including personality and social factors, were viewed as key pathways toward suicidal behaviour, but physical health was not included. 20 The possibility that physical health also plays a role in explaining suicide risk has not been well explored in veterans. A broad range of chronic physical health conditions also occur in military service. 1 In veterans, as in the general public, physical conditions are about 2-4 times more prevalent than diagnosed mental health conditions, and the prevalence of some physical conditions, particularly musculoskeletal disorders, has been higher in some veteran populations than among comparable civilians. 21,22 Age and sex have been consistently associated with suicidality, and socioeconomic factors, including marital status, education and financial status, have been associated with suicidality as influencing factors. 2,4,5,7,10-13,23-30 Military rank has been found to be associated with Canadian and UK veteran suicide. 4,8 Associations between physical health and suicidality are supported by a developing body of evidence in civilian studies, particularly of chronic pain, 10,23-26,31 but are less well established than for mental disorders owing to inconsistent findings and methodological variability. 25 Physical health has been little studied as a risk factor for veteran suicidal ideation. In US veteran studies,