The CAF Recruit Health Questionnaire: Longitudinal Studies of Resilience in CAF Recruits

Transcription

1 The CAF Recruit Health Questionnaire: Longitudinal Studies of Resilience in CAF Recruits Jennifer E.C. Lee, Ph.D. Defence Scientist Personnel and Family Support Research Team May 3, 2016

2 CFPC CoI Templates: Slide 1 Faculty/Presenter Disclosure Faculty: Jennifer Lee Relationships with commercial interests: None

3 CFPC CoI Templates: Slide 3 Mitigating Potential Bias Not applicable

4 Background Health Surveillance Reform Key challenges (Young, Gibson, & Ryan, 2006) Lag behind time-sensitive deployments Deployment awareness and accuracy of medical/psychological data Necessity of baseline health data Evaluation of health risks and behaviours before military service Understanding of potential impacts of deployments throughout service Development and assessment of intervention and prevention programs

5 Background Baseline Health Assessment in the CAF Since July 2003, baseline health assessment among CAF non-commissioned member (NCM) and officer candidates of the Regular Force has been carried out using the Recruit Health Questionnaire (RHQ) This presentation will provide a summary of research that highlights the different uses of the RHQ in mental health research to: Monitor health Conduct prospective health research Complement other research projects

6 Recruit Mental Health Trends Methods Participants 30,195 participants from 2003 to 2012; 8,379 since 2010 Estimated overall response rate of 75% Mainly male (86%) NCM candidates (78%) of 23.7 (±6.1) years of age, on average Objectives Examine the proportion of recruits who screened positive for at least one mental health condition in each cohort year from 2003 to 2012 Taking into account any differences in the age or sex profile of cohorts across the years, determine if there is a significant increase or decrease A) across the 10 years and B) in the 4 most recent years (using logistic regression analysis)

7 Recruit Mental Health Trends Results Positive screen on depression, posttraumatic stress disorder (PTSD), panic disorder or other anxiety disorder based on Patient Health Questionnaire or PTSD Checklist for Civilians screening tools (Kroenke et al., 2001; Spitzer et al., 1999, 2000; Weathers et al., 1993) 2003 to 2012: no change 2009 to 2012: significant decrease (χ²(3) = 90.00, p<.001) Proportion Screening Positive for 1+ Mental Health Condition 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 8.7% 8.1% 8.3% 6.3% 6.7% 6.9% 7.4% 4.8% 5.1% 5.0%

8 Prospective Analysis of Post-Deployment Health Methods Participants 3,319 Regular Force personnel who completed the Enhanced Post- Deployment Screening between 2008 and 2011 and the RHQ Objectives 27.0 (±5.3) years of age, on average Median years of service of four years Primarily male (90.0%) Primarily single/never married (54.5%) Mostly NCM (89.6%) and Army (87.8%) Examine the association of pre-military mental health conditions and somatic symptoms with post-deployment health outcomes; namely, post-concussive-like symptoms (using sequential negative binomial regression analysis) 8

9 Prospective Analysis of Post-Deployment Health Results Baseline Only Baseline Deployment* Post-Deployment Depression Combat Exposure Depression PTSD Somatic Symptoms Mild Traumatic Brain Injury PTSD Somatic Symptoms Post-Concussive- Like Symptoms *Assessed post-deployment 9

10 Prospective Analysis of Post-Deployment Health Results Baseline and Deployment Baseline Deployment* Post-Deployment Depression PTSD Somatic Symptoms Combat Exposure Mild Traumatic Brain Injury Depression PTSD Somatic Symptoms Post-Concussive- Like Symptoms *Assessed post-deployment 10

11 Prospective Analysis of Post-Deployment Health Results All Stages Baseline Deployment* Post-Deployment Depression PTSD Somatic Symptoms Combat Exposure Mild Traumatic Brain Injury Depression PTSD Somatic Symptoms Post-Concussive- Like Symptoms *Assessed post-deployment 11

12 Correlates of Mental Health Care Use Intentions Methods Participants 244 CAF recruits who were part of a larger study on the effects of various teaching methods for mental health training Objectives 213 men and 31 women; average age of 22.6 years (±4.8) 15.7% reported having a biological parent with a history of mental health problems 4.3% consulted a health professional about their emotional health in the past year Identify personality/individual difference characteristics that are associated with mental health care use (MHSU) intentions Determine if personality/individual difference characteristics are associated with MHSU intentions because they are associated with MHSU-related attitudes and beliefs (using multiple mediation analysis) 12

13 Correlates of Mental Health Care Use Intentions Results Big Five Traits Agreeableness Conscientiousness Extroversion Neuroticism Openness Attitudes Emotional Processing Difficulty Describing Feelings Difficulty Identifying Feelings Externally-Oriented Thinking Social Norms MHSU Intentions Behavioral Control Salutogenic Happy Factors Hardiness Mastery Positive Affect 13

14 Discussion RHQ has been integral to enhancing the CAF/DND s capacity to: Monitor recruit health Conduct methodologically stronger prospective health research Provide complementary data to integrate into other studies Other work has involved linking the RHQ to other data records to: Identify predictors of basic training attrition Identify predictors of other post-deployment health outcomes Understand pathways linking childhood adversity to adult health Assess the stability of psychological resilience Its prospective research potential will continue to grow as the CF Health Electronic Records and Outcomes (CF-HERO) capacity increases 14

15 Other Relevant References Lee, J.E.C., Fikretoglu, D., Blais, A.-R., Sudom, K.A., & Beatty, R. (in press). Mental health services use intentions among Canadian military recruits. Military Psychology. Lee, J.E.C., Hawes, R.A., & Melançon, F. (2016). Analysis of trends and behavioral risk factors associated with excess weight in Canadian military recruits. Military Behavioral Health, 4(1), Lee, J.E.C., Phinney, B., Watkins, K., & Zamorski (2016). Psychosocial pathways linking adverse childhood experiences to mental health in recently deployed Canadian military service members. Journal of Traumatic Stress, 29(2), Lee, J.E.C., Garber, B., & Zamorski, M.A. (2015). Prospective analysis of premilitary mental health, somatic symptoms, and postdeployment postconcussive symptoms. Psychosomatic Medicine, 77(9), Sudom, K.A., Lee, J.E.C., & Zamorski, M.A. (2014). A longitudinal pilot study of resilience in Canadian military personnel. Stress and Health, 30(5), Lee., J.E.C., Sudom, K.A., & Zamorski, M.A. (2013). Longitudinal analysis of psychological resilience and mental health in Canadian military personnel returning from overseas deployment. Journal of Occupational Health Psychology, 18(3), Skomorovsky, A., & Lee, J.E.C. (2012). Alcohol use among Canadian Forces candidates: The role of psychological health and personality. Military Psychology, 24(6), Lee, J.E.C., McCreary, D., & Villeneuve, LCol M. (2011). Prospective multifactorial analysis of Canadian Forces basic training attrition. Military Medicine, 176(7), Lee, J.E.C., Sudom, K., & McCreary, D. (2011). Higher-order model of resilience in the Canadian Forces. Canadian Journal of Behavioural Science, 43(3), Lee, J.E.C. (2010). Predicting basic training attrition. Proceedings of the International Military Testing Association Conference, Lucerne, Switzerland. 15