Stressors Experienced During Deployment Among Canadian Armed Forces Personnel: Factor Structure of Two Combat Exposure Scales

Sudom, Kerry; Watkins, Kimberley; Born, Jennifer; Zamorski, Mark A.

doi:10.1037/mil0000108

Cited by 16 publications

(22 citation statements)

References 19 publications

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“…Eight deployment-related experiences were assessed: (1) ‘ever known someone who was seriously injured or killed’; (2) ‘ever found yourself in a threatening situation where you were unable to respond because of the rules of engagement’; (3) ‘ever been injured’; (4) ‘ever seen ill or injured women or children who you were unable to help’; (5) ‘ever received incoming artillery, rocket or mortar fire’; (6) ‘ever felt responsible for the death of a Canadian or ally personnel’; (7) ‘ever had a close call, for example shot or hit but protective gear saved you’ and (8) ‘ever had difficulty distinguishing between combatants and non-combatants’. These deployment experience items were adapted from the Combat Experiences Scale that was developed by the Walter Reed Army Institute for Research, following an assessment of their applicability among CAF personnel 35…”

Section: Methodsmentioning

confidence: 99%

Differences between the Canadian military’s Regular and Reserve Forces in perceived need for care, mental health services use and perceived sufficiency of care: a cross-sectional survey

Boulos

Fikretoglu

2019

BMJ Open

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ObjectiveThe primary objective was to explore differences in perceived need for care (PNC), mental health services use (MHSU) and perceived sufficiency of care (PSC) between Canadian Armed Forces Regular Force (RegF) and Reserve Force (ResF) personnel with an objective need for mental health services.DesignData came from the 2013 Canadian Armed Forces Mental Health Survey, a cross-sectional survey of serving personnel (n=72 629). Analyses were among those with an Afghanistan deployment and an identified mental disorder (population n=6160; sampled n=868). Logistic regression compared PNC, MHSU and PSC between RegF and ResF. Covariate-adjusted marginal prevalence difference estimates were computed.Primary outcome measureThe primary outcomes were PNC, MHSU and PSC. Each had three service categories, including an aggregate ‘any’ of the three: (1) information about problems, treatments or services; (2) medication and (3) counselling.ResultsResF had an 10.5% (95% CI −16.7% to −4.4%) lower perceived need for medication services but PNC differences were not significant for other service categories. MHSU tended to be lower for ResF; 9.1% (95%CI −15.5% to −2.6%) lower for medication, 5.4% (95% CI −11.5% to 0.7%) lower, with marginal significance, for counselling and 11.3% (95% CI −17.3% to −5.2%) lower for the ‘any’ service category. Additionally, ResF tended to have a lower fully met need for care; 13.4% (95% CI −22.1% to −4.6%) lower for information, 15.3% (95% CI −22.9% to −7.6%) lower for counselling and 14.6% (95% CI −22.4% to −6.8%) lower for the ‘any’ service category.ConclusionsOur findings suggest MHSU and PSC differences between Canadian RegF and ResF personnel that are not fully accounted for by PNC differences. Deficits in ResF members’ perceptions of the sufficiency of information services and counselling services suggest perceived, or experienced, barriers to care beyond any PNC barriers. Additional research assessing barriers to mental healthcare is warranted.

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Section: Methodsmentioning

confidence: 99%

Differences between the Canadian military’s Regular and Reserve Forces in perceived need for care, mental health services use and perceived sufficiency of care: a cross-sectional survey

Boulos

Fikretoglu

2019

BMJ Open

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“…These were assessed using a 30-item combat exposure scale [35], adapted from the US Army's Walter Reed Institute for Research Combat Experiences Scale [36]. Each item was a yes/no question assessing whether the experience had ever occurred over the most recent deployment.…”

Section: Potentially Traumatic Deployment Experiencesmentioning

confidence: 99%

“…Three subscales representing the simple sum of positive responses to constituent items were calculated, with the items for each subscale being identified using principal components analysis performed using the same dataset [35]. The first factor, "dangerous environment", (12 items, explaining 63.8% of variance, Cronbach's α = 0.9) reflected dangers inherent in the combat environment, including exposure to small arms fire, improvised explosive devices, and hostile civilians.…”

Section: Potentially Traumatic Deployment Experiencesmentioning

confidence: 99%

Contribution of traumatic deployment experiences to the burden of mental health problems in Canadian Armed Forces personnel: exploration of population attributable fractions

Born

Zamorski

2018

Soc Psychiatry Psychiatr Epidemiol

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Purpose Mental health problems are prevalent after combat; they are also common in its absence. Estimates of deploymentattributability vary. This paper quantifies the contribution of different subtypes of occupational trauma to post-deployment mental health problems. Methods Participants were a cohort of 16,193 Canadian personnel undergoing post-deployment mental health screening after return from the mission in Afghanistan. The screening questionnaire assessed post-traumatic stress disorder, depression, panic disorder, generalized anxiety disorder, and exposure to 30 potentially traumatic deployment experiences. Logistic regression estimated adjusted population attributable fractions (PAFs) for deployment-related trauma, which was treated as count variables divided into several subtypes of experiences based on earlier factor analytic work. Results The overall PAF for overall deployment-related trauma exposure was 57.5% (95% confidence interval 44

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“…The Deployment Experiences (DEX) module of the 2013 CFMHS assessed exposure to eight stressful deployment experiences using dichotomous items sourced from the Combat Experiences Scale (CES) (Hoge et al, 2004(Hoge et al, , 2008. The original CES measure was shortened based on conceptual considerations and validation (Sudom, Watkins, Born, & Zamorski, 2016;, and adapted for Canadian context by Canada's Department of National Defence. Respondents were provided with a list of eight stressful deployment experiences and were asked to identify any items that they have experienced while on deployment (aligning the CIDI trauma inventory process) (Kessler & Üstün, 2004).…”

Section: Potentially Morally Injurious Experiences (Pmies)mentioning

confidence: 99%

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

Nazarov

Fikretoglu

Liu

et al. 2020

European Journal of Psychotraumatology

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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.

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Stressors Experienced During Deployment Among Canadian Armed Forces Personnel: Factor Structure of Two Combat Exposure Scales

Cited by 16 publications

References 19 publications

Differences between the Canadian military’s Regular and Reserve Forces in perceived need for care, mental health services use and perceived sufficiency of care: a cross-sectional survey

Differences between the Canadian military’s Regular and Reserve Forces in perceived need for care, mental health services use and perceived sufficiency of care: a cross-sectional survey

Contribution of traumatic deployment experiences to the burden of mental health problems in Canadian Armed Forces personnel: exploration of population attributable fractions

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

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