Help-seeking for mental health issues in deployed Canadian Armed Forces personnel at risk for moral injury

Abstract

Objective: Potentially morally injurious experiences (PMIE) (events that transgress an individual's subjective moral standards) have been associated with psychologically distressing moral emotions such as shame and guilt. Military leaders and clinicians have feared that those with PMIEs may be less likely to seek help due to the withdrawing nature of shame/ guilt; however, to date, help-seeking patterns of military personnel with PMIEs has not been explored. Our objective is to address this research gap. Method: Data from a nationally-representative mental health survey of active Canadian military personnel were analysed. To assess the association between exposure to three PMIEs and past-year help-seeking across different provider categories (i.e. professionals, para-professionals (those delegated with mental health advisory tasks but are not licenced to practice as medical professionals), non-professionals), a series of logistic regressions were conducted, controlling for exposure to other deployment and non-deployment-related psychological trauma, psychiatric variables, military factors, and sociodemographic variables. Analytical data frame included only personnel with a history of Afghanistan deployment (N = 4854). Results: Deployed members exposed to PMIEs were more likely to seek help from their family doctor/general practitioner (OR = 1.72; 95%CI = 1.25-2.36), paraprofessionals (OR = 1.72; 95% CI = 1.25-2.36), and non-professionals (OR = 1.44; 95%CI = 1.06-1.95) in comparison to members not exposed to PMIEs. Those exposed to PMIEs were also more likely to seek professional care from the civilian health care system (OR = 1.94; 95%CI = 1.27-2.96). Conclusion: Contrary to long-held, but untested, assumptions regarding the impact of PMIEs on help-seeking, we found those with PMIEs are more likely to seek help from gatekeeper professionals (i.e. general practitioners), para-professionals, and nonprofessionals rather than specialized mental health professionals (e.g. psychologists). Increased utilization of civilian professionals raises concerns that active military members may be avoiding military health services. Clinically, this highlights the need to increase awareness of moral injury to ensure that actively serving military members are provided with appropriate advice and treatment.

Decreased Emotional Dysregulation Following Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation Therapy (3MDR): Identifying Possible Driving Factors in Remediation of Treatment-Resistant PTSD

“…ED associated with both PTSD and MI may also be addressed through 3MDR. Exposure to morally injurious experiences, which frequently overlaps with exposure to traumatic experiences associated with combat-related TR-PTSD, is a high-risk factor for the development of MI [4,7], and the comorbidity of MI and PTSD can lead to TR-PTSD. Protopopescu et al [45] suggest that MI severity is positively correlated with severity of cluster C and D PTSD symptoms (avoidance and negative alterations in cognition and mood; APA, 2013).…”

“…Symptoms of PTSD among MMs often include hypervigilance, reduced cognitive abilities, emotional dysregulation (ED), and comorbidities of anxiety and mood disorders [5]. MMs may also experience moral injury (MI) concurrently with PTSD, which is associated with feelings of shame, guilt, and distress following exposure to potentially morally injurious events (PMIEs) and violations of core morals and beliefs [6,7].…”

Sex and gender: More than just demographic variables

“…Of those articles that did include race, ethnicity, or ethno-cultural identity, these important components of social identity were treated solely as demographic variables, without implementing GBA+ in the analysis. [10][11][12][13][14] Fourteen of the articles were based on data collected in projects with data collection ending in 2016, [10][11][12][15][16][17][18][19][20][21][22][23][24][25] and seven did not clearly indicate when their data were collected, [26][27][28][29][30][31][32] raising the question of whether GBA+ was considered when the projects were initially conceived and data collection occurred.…”

Decreased Emotional Dysregulation Following Multi-modal Motion-assisted Memory Desensitization and Reprocessing Therapy (3MDR): Identifying Driving Factors in Remediation of Treatment-Resistant PTSD

“…ED associated with both PTSD and MI may also be addressed through 3MDR. Exposure to morally injurious experiences, which frequently overlaps with exposure to traumatic experiences associated with combat related TR-PTSD, is a high-risk factor for the development of MI (Vermetten and Ambaum, 2019;Nazarov et al, 2020), and the comorbidity of MI and PTSD can lead to TR-PTSD. Protopopescu et al (2020) suggest that MI severity is positively correlated with severity of cluster C and D PTSD symptoms (avoidance and negative alterations in cognition and mood; APA, 2013).…”

“…Symptoms of PTSD among MMs often include hypervigilance, reduced cognitive abilities, emotional dysregulation (ED), and comorbidities of anxiety and mood disorders (Bryant, 2019). MMs may also experience Moral Injury (MI) concurrently with PTSD, which is associated with feelings of shame, guilt, and distress following exposure to potentially morally injurious events (PMIEs) and violations of core morals and beliefs (Vermetten and Jetly, 2018;Nazarov et al, 2020).…”