Clinical utility of moral injury in a treatment-seeking military-Veteran mental health population

Moral injury (MI) can be defined as a diverse set of outcomes associated with actions that transgress one’s moral beliefs or values. MI can be distressing for an individual at the interpersonal level (e.g., shifting relationships, feelings of betrayal) and the intrapersonal level (e.g., internalized guilt and shame). Indeed, these transgressions of moral beliefs and values have been associated with a high prevalence of mental illnesses, such as posttraumatic stress disorder (PTSD) and depression. Although various forms of assessment exist to identify MI in the individual, treatments for MI are often interlinked or embedded in evidence-based treatments for PTSD and depression. As such, unique contributions of MI as a target of treatment remain largely unclear. In this article, the authors explore existing treatments that may be used to treat MI as a distinct mental health construct and examine their utility in reducing symptoms of MI in military and Veteran populations

Posttraumatic Stress Disorder and Health-Related Quality of Life among a Sample of Treatment- and Pension-Seeking Deployed Canadian Forces Peacekeeping Veterans

Objectives: To examine the health-related quality of life (HRQOL) in deployed Canadian Forces peacekeeping veterans, addressing associations with posttraumatic stress disorder (PTSD), and depression severity. Methods: Participants (n = 125) were consecutive male veterans who were referred for a psychiatric assessment. Instruments administered included the Clinician-Administered PTSD Scale, Hamilton Depression Scale, Short-Form-36 Health Survey, and sociodemographic characteristics. Results: Mental HRQOL was significantly lower for peacekeepers with, than without, PTSD. Using univariate analyses, PTSD and depression severity were each significantly negatively related to mental HRQOL. In sequential regression analyses controlling for age, we found that PTSD and depression severity significantly predicted both mental and physical HRQOL. Conclusions: Veterans with PTSD have significant impairments in mental and physical HRQOL. This information is useful for clinicians and Veterans Affairs administrators working with the newer generation of veterans, as it stresses the importance of including measures of quality of life in the psychiatric evaluation of veterans to better address their rehabilitation need

The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD

Purpose A dissociative-posttraumatic stress disorder (PTSD) subtype has been included in the DSM-5. However, it is not yet clear whether certain socio-demographic characteristics or psychological/clinical constructs such as comorbid psychopathology differentiate between severe PTSD and dissociative-PTSD. The current study investigated the existence of a dissociative-PTSD subtype and explored whether a number of trauma and clinical covariates could differentiate between severe PTSD alone and dissociative-PTSD. Methods The current study utilized a sample of 432 treatment seeking Canadian military veterans. Participants were assessed with the Clinician Administered PTSD Scale (CAPS) and self-report measures of traumatic life events, depression, and anxiety. CAPS severity scores were created reflecting the sum of the frequency and intensity items from each of the 17 PTSD and 3 dissociation items. The CAPS severity scores were used as indicators in a latent profile analysis (LPA) to investigate the existence of a dissociative-PTSD subtype. Subsequently, several covariates were added to the model to explore differences between severe PTSD alone and dissociative-PTSD. Results The LPA identified five classes: one of which constituted a severe PTSD group (30.5 %), and one of which constituted a dissociative-PTSD group (13.7 %). None of the included, demographic, trauma, or clinical covariates were significantly predictive of membership in the dissociative-PTSD group compared to the severe PTSD group. Conclusions In conclusion, a significant proportion of individuals report high levels of dissociation alongside their PTSD, which constitutes a dissociative-PTSD subtype. Further investigation is needed to identify which factors may increase or decrease the likelihood of membership in a dissociative-PTSD subtype group compared to a severe PTSD only group

Posttraumatic Stress Disorder and Health-Related Quality of Life among a Sample of Treatment- and Pension-Seeking Deployed Canadian Forces Peacekeeping Veterans

Objectives: To examine the health-related quality of life (HRQOL) in deployed Canadian Forces peacekeeping veterans, addressing associations with posttraumatic stress disorder (PTSD), and depression severity. Methods: Participants (n = 125) were consecutive male veterans who were referred for a psychiatric assessment. Instruments administered included the Clinician-Administered PTSD Scale, Hamilton Depression Scale, Short-Form-36 Health Survey, and sociodemographic characteristics. Results: Mental HRQOL was significantly lower for peacekeepers with, than without, PTSD. Using univariate analyses, PTSD and depression severity were each significantly negatively related to mental HRQOL. In sequential regression analyses controlling for age, we found that PTSD and depression severity significantly predicted both mental and physical HRQOL. Conclusions: Veterans with PTSD have significant impairments in mental and physical HRQOL. This information is useful for clinicians and Veterans Affairs administrators working with the newer generation of veterans, as it stresses the importance of including measures of quality of life in the psychiatric evaluation of veterans to better address their rehabilitation needs

Predictors of Likelihood and Intensity of Past-Year Mental Health Service Use in an Active Canadian Military Sample

Objective: This study examined associations between sociodemographic, military, and psychiatric need variables and past-year mental health service use among active Canadian military members. The likelihood and intensity of services were examined across two provider types— mental health providers and medical providers. Methods: Data were drawn from the first epidemiological survey of mental health in the Canadian Forces, conducted by Statistics Canada in 2002. Survey instruments included the Composite International Diagnostic Interview, which was used to assess mental health and service use. Results: Of the 8,441 military members who participated in the survey, 14.5% (N=1,220) met criteria for having a mental disorder in the past year. However, of the 8,441 only 9.1% (N=767) contacted a mental health provider in the past year for mental health problems; even fewer (N=539, 6.4%) contacted a medical provider. Across the two provider types, the majority of those seeing a provider reported five or fewer mental health visits in the past year. In univariate and multivariate analyses across the two provider types, psychiatric need variables were consistently associated with both greater service use likelihood and intensity. In multivariate analyses, lower military rank was consistently associated with both greater service use likelihood and intensity. Conclusions: Of the entire military sample, only a small percentage used mental health services. The observed associations between military and psychiatric need variables and mental health service use in this study should be used by military health care providers and administrators to increase mental health service use among those most at risk of not using services

Faculty-Wide Peer-Support Program During the COVID-19 Pandemic: Design and Preliminary Results

Background: Physicians experience higher rates of burnout relative to the general population. Concerns of confidentiality, stigma, and professional identities as health care providers act as barriers to seeking and receiving appropriate support. In the context of the COVID-19 pandemic, factors that contribute to burnout and barriers to seeking support have been amplified, elevating the overall risks of mental distress and burnout for physicians. Objective: This paper aimed to describe the rapid development and implementation of a peer support program within a health care organization located in London, Ontario, Canada. Methods: A peer support program leveraging existing infrastructures within the health care organization was developed and launched in April 2020. The “Peers for Peers” program drew from the work of Shapiro and Galowitz in identifying key components within hospital settings that contributed to burnout. The program design was derived from a combination of the peer support frameworks from the Airline Pilot Assistance Program and the Canadian Patient Safety Institute. Results: Data gathered over 2 waves of peer leadership training and program evaluations highlighted a diversity of topics covered through the peer support program. Further, enrollment continued to increase in size and scope over the 2 waves of program deployments into 2023. Conclusions: Findings suggest that the peer support program is acceptable to physicians and can be easily and feasibly implemented within a health care organization. The structured program development and implementation can be adopted by other organizations in support of emerging needs and challenge

Bilateral sequential theta burst stimulation in depressed veterans with service related posttraumatic stress disorder: a feasibility study

Background: Depression comorbid with posttraumatic stress disorder (PTSD) can be disabling and treatment resistant. Preliminary evidence suggests that repetitive transcranial magnetic stimulation (rTMS), may have a role in helping these patients. There are only few published studies using different rTMS paradigms including bilateral intermittent theta burst (iTBS) and low frequency rTMS. Methods: In this small cohort observation study, we examined the efficacy of bilateral sequential theta-burst stimulation (bsTBS) in 8 treatment resistant depression (TRD) military veterans with PTSD comorbidity stemming from military service experience. Results: bsTBS was generally well tolerated and resulted in 25% and 38% remission and response rates on Depression scores respectively; 25% remission and response rate on PTSD scores. Discussion: This study demonstrates preliminary feasibility and safety of bsTBS in TRD with comorbid military service related PTSD. We concluded that this paradigm might hold promise as a therapeutic tool to help patients with TRD co-morbid with military service related PTSD. Further adequately powered studies to compare rTMS treatment paradigms in this patient group are warranted