Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics (Preprint)

Abstract

BACKGROUND The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID cases and COVID-related deaths among residents of long-term care facilities (LTCF; also known as centres d’hébergement et de soins de longue durée [CHSLD] in Québec). As part of Canada’s response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (i.e., related to important values; e.g., witnessing human suffering). Emerging data from healthcare workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages was also pointing to such experiences being associated with increased risk of adverse mental health outcomes. OBJECTIVE To identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury and traditional mental health and well-being outcomes of Operation (Op) LASER LTCF CAF personnel. METHODS A multimethod research initiative was conducted, consisting of two primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with online self-report questionnaires administered at three timepoints (3, 6, and 12 months post-deployment). The qualitative arm consisted of individual interviews conducted virtually, with a focus on understanding the nuanced lived experiences of individuals taking part in the Op LASER LTCF deployment. RESULTS CAF personnel deployed to Op LASER LTCF (n = 2,595) were invited to participate in the study. Overall, 1,088, 582, and 497 individuals responded to the survey at Time 1 (3 months), Time 2 (6 months), and Time 3 (12 months) post-deployment, providing a participation rate of 41.9%, 22.4%, and 19.2% for Time 1, Time 2, and Time 3, respectively. Data for all three timepoints was obtained from 212 participants (representing 19.5% of all Time 1 responses). The target sample size for qualitative interviews was set at approximately 50, with considerations for resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations with over 200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Op LASER LTCF role, and province. In total, 53 interviews were conducted. CONCLUSIONS The data generated by this research is being used to inform and better understand the well-being and mental health of Op LASER LTCF personnel over time, identify general and Op LASER LTCF-specific risk and protective factors, provide necessary supports to the military personnel who served in this mission, and to inform preparation and interventions for future missions, especially those more of a domestic and humanitarian nature.

Role of modifiable organisational factors in decreasing barriers to mental healthcare: a longitudinal study of mission meaningfulness, team relatedness and leadership trust among Canadian military personnel deployed on Operation LASER

“…Overall response rates were 41.9% at T1, 22.4% at T2 and 19.2% at T3, these aligned with rates from similar studies 46 47. The majority of respondents were men, junior non-commissioned members under the age of 30, and were deployed inside LTCFs (as opposed to positions outside LTCFs, such as logistics support or headquarters staff, see table 1).…”

“…A maximum of two email reminders were sent at each time point, approximately 2 weeks apart. Additional details of the survey methods are available in the study protocol 46…”

“…Perceptions of barriers to accessing mental health support were measured at T2 and T3 using 25 items scored, as detailed in the study protocol by Nazarov and colleagues,46 which includes further methodological details. The barrier items were a subset chosen from the validated Barriers to Care Scale developed for CAF HCPs48 based on the COM-B system 12.…”

“…All analyses were conducted using SAS V.9.4 (SAS Institute, Cary, NC, USA). Estimates were adjusted using survey weights generated based on the available sociodemographic, military and Op LASER characteristics of the source population to reduce non-response bias and improve the representativeness of the study findings to the source population 46. Specific weights were generated to adjust for attrition: barrier endorsement estimates at T2 and T3 were weighted to the T2 and T3 source populations, respectively, while regression estimates were weighted to the T1 source population.…”

“…Specific weights were generated to adjust for attrition: barrier endorsement estimates at T2 and T3 were weighted to the T2 and T3 source populations, respectively, while regression estimates were weighted to the T1 source population. The weights combined poststratification and propensity score inverse weighting derived from administrative data 46…”