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Abstract Correctional workers (CWs) report high levels of work stressors, frequent exposures to potentially psychologically traumatic events (PPTEs), and substantial mental health challenges. There is evidence of associations between sleep disturbances and diverse mental health challenges, including preliminary evidence from public safety personnel; however, replications and extensions would better inform interventions to support mental health. The current study was designed to examine associations between quality of sleep, work stress, and mental health disorders in a sample of diverse CWs employed in a provincial correctional service in Ontario, Canada. Data were analyzed from 943 CWs who participated in the cross-sectional, web-based Ontario Provincial Correctional Worker Mental Health and Well-Being Study conducted from December 2017 to June 2018. Sleep quality indicators included symptoms of insomnia, total hours of sleep per night on work nights and off-shift nights, number of days feeling rested per week, and overall sleep quality. Descriptive statistics, analyses of variance, correlational analyses, and logistic regression were used to examine relationships among sleep quality, stress of shift work, and mental health disorder symptoms. CWs slept an average of 6.0 h per night when working and 7.2 h during off-shift nights. CWs reported waking up feeling rested an average of 2.6 days per week and rated their overall quality of sleep in the fair to poor range. Many CWs (64.9%) screened positive for clinically significant symptoms of insomnia. There were also differences across occupational groups such that CWs working as correctional officers reported the most sleep problems. There were statistically significant relationships between insomnia and mental health disorder symptoms. Higher levels of stress from shift work were associated with worse sleep quality. CWs, especially those working as correctional officers in a provincial prison, reported many indicators consistent with poorer quality of sleep. Poor quality of sleep was also associated with work stress and mental health disorders.

IntroductionAirport firefighters are responsible for providing emergency responses to aviation incidents on a runway or in the vicinity of an airport, including airplane crashes, mass casualty events, emergency landings and many other concerns on airport grounds. While data exist on the occupational stressors of firefighters and public safety personnel in general, there is a gap in knowledge regarding the experiences of airport firefighters, particularly in relation to their organizational stressors, peer supports and attitudes toward mental health treatment. MethodsWe conducted two focus groups with 10 career firefighters working at an airport in Atlantic Canada in 2019. Focus groups were recorded; the recordings were transcribed and later coded using thematic analysis, which took an inductive, iterative, narrative approach. ResultsAirport firefighters face unique challenges, and operational stressors are overshadowed by organizational stressors. Additionally, peer support is an integral aspect of coping with both organizational stressors and critical incidents. Firefighters were found to have positive attitudes toward mental health treatment in general, but several barriers still remain, such as stigma, fear of being placed on leave and fear of confidentiality breach. ConclusionSpecialized treatment options for public safety personnel and airport firefighters who engage in serious incidents outside of their regular duties are needed.

IntroductionLes pompiers d’aéroport ont la responsabilité de fournir des services d’intervention d’urgence en cas d’incidents aéronautiques sur une piste d’atterrissage ou à proximité d’un aéroport, que ce soit en cas d’écrasement d’avion, d’incident faisant un grand nombre de victimes, d’atterrissage d’urgence ou de nombreux autres problèmes survenant sur les terrains de l’aéroport. Bien qu’il existe des données sur les facteurs de stress professionnels des pompiers et du personnel de la sécurité publique en général, il y a un manque de connaissances concernant les expériences des pompiers d’aéroport, en particulier en ce qui concerne leurs facteurs de stress organisationnels, le soutien par leurs pairs et leur attitude à l’égard des soins de santé mentale. MéthodologieEn 2019, nous avons dirigé deux groupes de discussion regroupant dix pompiers professionnels travaillant dans un aéroport du Canada atlantique. Les discussions ont été enregistrées et les enregistrements transcrits puis codés par analyse thématique à l’aide d’une méthode narrative, itérative et inductive. RésultatsLes pompiers d’aéroport sont confrontés à des défis spécifiques et les facteurs de stress opérationnels sont occultés par les facteurs de stress organisationnels. De plus, le soutien par les pairs est un aspect intégral de la gestion des facteurs de stress organisationnels et des incidents critiques. On a constaté que les pompiers avaient une attitude positive à l’égard des soins de santé mentale en général, mais plusieurs obstacles subsistent, en particulier la stigmatisation, la crainte d’être mis en congé et la crainte d’une violation de la confidentialité. ConclusionDes options de traitement spécialisées sont nécessaires pour le personnel de la sécurité publique et les pompiers d’aéroport qui interviennent en cas d’incidents graves en dehors de leurs fonctions habituelles.

IntroductionThe study objective was to compare the mental health and risk-taking behaviour of Canadian youth in military-connected families to those not in military-connected families in a contemporary sample. We hypothesized that youth in military-connected families have worse mental health, lower life satisfaction and greater engagement in risk-taking behaviours than those not in military-connected families. MethodsThis cross-sectional study used 2017/18 Health Behaviour in School-aged Children in Canada survey data, a representative sample of youth attending Grades 6 to 10. Questionnaires collected information on parental service and six indicators of mental health, life satisfaction and risk-taking behaviour. Multivariable Poisson regression models with robust error variance were implemented, applying survey weights and accounting for clustering by school. ResultsThis sample included 16 737 students; 9.5% reported that a parent and/or guardian served in the Canadian military. After adjusting for grade, sex and family affluence, youth with a family connection to the military were 28% more likely to report low well-being (95% CI: 1.17–1.40), 32% more likely to report persistent feelings of hopelessness (1.22–1.43), 22% more likely to report emotional problems (1.13–1.32), 42% more likely to report low life satisfaction (1.27–1.59) and 37% more likely to report frequent engagement in overt risk-taking (1.21–1.55). ConclusionYouth in military-connected families reported worse mental health and more risk-taking behaviours than youth not in military-connected families. The results suggest a need for additional mental health and well-being supports for youth in Canadian military-connected families and longitudinal research to understand underlying determinants that contribute to these differences.

IntroductionL’objectif de l’étude était de comparer la santé mentale et les comportements à risque de jeunes Canadiens de familles liées au milieu militaire (« familles de militaires ») et de jeunes Canadiens de familles de civils au sein d’un échantillon récent. Nous avons émis l’hypothèse que les jeunes de familles de militaires auraient une moins bonne santé mentale, une moins grande satisfaction à l’égard de la vie et une plus grande propension à prendre des risques que les jeunes de familles de civils. MéthodologieDans cette étude transversale, nous avons utilisé les données de l’Enquête sur les comportements de santé des jeunes d’âge scolaire au Canada menée en 2017-2018, dont les participants constituaient un échantillon représentatif des jeunes de la 6e à la 10e années. Les questionnaires utilisés ont permis de recueillir des renseignements sur l’emploi des parents dans l’armée et sur six indicateurs de santé mentale, de satisfaction à l’égard de la vie et de comportements à risque. Nous avons utilisé des modèles multivariés de régression de Poisson avec une variance d’erreur robuste, en pondérant les données de l’enquête et en tenant compte des grappes correspondant aux écoles. RésultatsL’échantillon comprenait 16 737 élèves, dont 9,5 % ont indiqué qu’un parent ou un tuteur servait ou avait servi dans l’armée canadienne. Après ajustement pour le niveau scolaire, le sexe et le niveau d’aisance familiale, les jeunes de famille de militaires étaient 28 % plus susceptibles de faire état d’un faible sentiment de bien-être (IC à 95 % : 1,17 à 1,40), 32 % plus susceptibles de faire état de sentiments persistants de désespoir (1,22 à 1,43), 22 % plus susceptibles de faire état de problèmes émotionnels (1,13 à 1,32), 42 % plus susceptibles de faire état d’un faible degré de satisfaction à l’égard de la vie (1,27 à 1,59) et 37 % plus susceptibles de déclarer adopter fréquemment des comportements à risque (1,21 à 1,55). ConclusionLes jeunes de familles de militaires ont déclaré avoir une moins bonne santé mentale et adopter davantage de comportements à risque que les jeunes issus de familles de civils. Les résultats laissent penser qu’il faudrait prévoir un soutien supplémentaire en matière de santé mentale et de bien-être pour les jeunes Canadiens de familles de militaires et qu’il faudrait mener des travaux de recherche longitudinaux pour comprendre les déterminants sous-jacents qui contribuent à ces différences.

Public safety personnel (PSP) are known to experience difficult and demanding occupational environments, an environment that has been complicated by the COVID-19 pandemic. Firefighters, paramedics, and public safety communicators were among the front-line workers that continued to serve the public throughout the course of the pandemic. The present study considered the potential impacts of the COVID-19 pandemic on self-reported symptoms of mental health challenges in Canadian firefighters, paramedics, and public safety communicators. Participants were firefighters (n = 123), paramedics (n = 246), and public safety communicators (n = 48), who completed an online survey, including demographics, questions related to COVID-19 exposure and worry, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Social Interaction Phobia Scale, and the Posttraumatic Stress Disorder Checklist-5. Results revealed that risk factors for increased mental health symptom reporting were paramedic occupation, self-identified female, younger in age, COVID-19 personal contact, requirement to self-isolate, and self-perception of COVID-19 contraction (without confirmation through testing). The COVID-19 pandemic should be considered a risk factor for increased mental health symptom reporting in PSP.

Public significance statements/highlights Research on how to mitigate posttraumatic stress injuries (PTSIs) among public safety personnel (PSP) who are exposed to potentially psychologically traumatic events is limited. The PSP PTSI Study has been designed to develop, implement, and assess the impact of tools and skills designed to proactively mitigate PTSIs. PSP recruited into the study to receive the augmented training are assessed before and after training, and again 1 year later. The PSP PTSI Study results are expected to benefit the mental health of all participants and other PSP by informing strategies to mitigate PTSI.

BackgroundSpouses and significant others (SSOs) of public safety personnel (PSP) are affected by the risks and requirements of these occupations. Internet-delivered cognitive behavioral therapy (ICBT) provides a convenient and accessible treatment format that can be tailored to the needs of SSOs of PSP. ObjectiveThis study aimed to assess the initial use and client perceptions (eg, likes, helpfulness, and areas for improvement) of a self-guided, transdiagnostic ICBT course designed for Canadian SSOs of PSP and identify opportunities to further tailor ICBT for this group. MethodsSSOs were invited to complete a 5-lesson, self-guided, transdiagnostic ICBT course. Descriptive statistics were used to analyze the demographic and clinical characteristics of participants. Content analysis was used to analyze the data from open-ended survey responses and interviews to understand their experiences with ICBT. ResultsClients (N=118) endorsed various mental health concerns (eg, depression, anxiety, posttraumatic stress symptoms, and relationship concerns) with a range of severity levels. Most clients identified as White (110/116, 94.8%) and women (108/116, 91.5%), with a mean age of 42.03 (SD 9.36) years. Of the 26 clients who were interviewed, 89% (23/26) reported believing that ICBT is helpful and 92% (24/26) reported finding at least 1 skill helpful. Clients provided suggestions for course improvements. On the basis of this feedback and quantitative data, changes were made to areas such as the delivery of materials, content, case stories, and timelines. Overall, the results indicated that many SSOs of PSP had positive perceptions of ICBT tailored to their needs and found several aspects of the course helpful, supporting the continued delivery of tailored ICBT to this population. However, there remains a need for continued promotion of the course and outreach to diverse groups of SSOs of PSP. ConclusionsFindings from this formative evaluation provide insight into the unique experiences and needs of SSOs of PSP and provide preliminary evidence for the use of tailored ICBT to support the mental health of this group in Canada.

Abstract Background Occupational exposures may result in Canadian military Veterans having poorer health and higher use of health services after transitioning to civilian life compared to the general population. However, few studies have documented the physical health and health services use of Veterans in Canada, and thus there is limited evidence to inform public health policy and resource allocation. Methods In a retrospective, matched cohort of Veterans and the Ontario general population between 1990–2019, we used routinely collected provincial administrative health data to examine chronic disease prevalence and health service use. Veterans were defined as former members of the Canadian Armed Forces or RCMP. Crude and adjusted effect estimates, and 95% confidence limits were calculated using logistic regression (asthma, COPD, diabetes, myocardial infarction, rheumatoid arthritis, family physician, specialist, emergency department, and home care visits, as well as hospitalizations). Modified Poisson was used to estimate relative differences in the prevalence of hypertension. Poisson regression compares rates of health services use between the two groups. Results The study included 30,576 Veterans and 122,293 matched civilians. In the first five years after transition to civilian life, Veterans were less likely than the general population to experience asthma (RR 0.50, 95% CI 0.48–0.53), COPD (RR 0.32, 95% CI 0.29–0.36), hypertension (RR 0.74, 95% CI 0.71–0.76), diabetes (RR 0.71, 95% CI 0.67–0.76), myocardial infarction (RR 0.76, 95% CI 0.63–0.92), and rheumatoid arthritis (RR 0.74, 95% CI 0.60–0.92). Compared to the general population, Veterans had greater odds of visiting a primary care physician (OR 1.76, 95% CI 1.70–1.83) or specialist physician (OR 1.39, 95% CI 1.35–1.42) at least once in the five-year period and lower odds of visiting the emergency department (OR 0.95, 95% CI 0.92–0.97). Risks of hospitalization and of receiving home care services were similar in both groups. Conclusions Despite a lower burden of comorbidities, Veterans had slightly higher physician visit rates. While these visits may reflect an underlying need for services, our findings suggest that Canadian Veterans have good access to primary and specialty health care. But in light of contradictory findings in other jurisdictions, the underlying reasons for our findings warrant further study.

The impacts of suicidality on families are well known, which is particularly relevant in at-risk populations, such as active duty military personnel and Veteran communities. This scoping review describes how military and Veteran families have been conceptualized within suicide prevention research. A systematic, multi-database search was conducted, and 4,835 studies were screened. All included studies underwent quality assessment. Bibliographic, participant, methodological, and family-relevant data was extracted and descriptively analyzed into Factors, Actors, and Impacts. In total, 51 studies (2007 – 2021) were included. Most studies focused on suicidality rather than suicide prevention. Factor studies described family constructs as a suicidality risk or protective factor for military personnel or Veterans. Actor studies described families’ roles or responsibilities to act in relation to the suicidality of military personnel or Veterans. Impacts studies described the impacts of suicidality on military and Veteran family members. The search was limited to English language studies. There were few studies on suicide prevention interventions for or including military and Veteran family members. Family was typically considered peripheral to the military personnel or Veteran experiencing suicidality. However, there was also emerging evidence of suicidality and its consequences in military-connected family members.

A recent scoping review found that stressors involved in the military lifestyle (i.e., frequent relocation, parental absence, and risk of parental injury) may be associated with mental health issues among military-children. However, most of the included studies were conducted in the United States with little Canadian representation. To examine the degree to which the scoping review findings are relevant to the Canadian context, we conducted a qualitative study and interviewed 37 parents in Canadian military families. Through the use of a qualitative description approach and content analysis, three themes were identified: 1. Military lifestyle factors have an impact on child mental health; 2. Military life can promote both resilience and vulnerability; and 3. Military lifestyle impacts on parental mental health had an impact on children. These themes align with the scoping review findings asserting that military lifestyle factors can influence child mental health and have significant implications for health care providers working with military-connected children.

Abstract Background Military-related posttraumatic stress disorder (PTSD) is a complex diagnosis with non-linear trajectories of coping and recovery. Current approaches to the evaluation of PTSD and treatment discontinuation often rely on biomedical models that dichotomize recovery based on symptom thresholds. This approach may not sufficiently capture the complex lived experiences of Veterans and their families. To explore conceptualizations of recovery, we sought perspectives from Veterans and their partners in a pilot study to understand: 1) how Veterans nearing completion of treatment for military-related PTSD and their partners view recovery; and 2) the experience of progressing through treatment towards recovery. Methods We employed a concurrent mixed methods design. Nine Veterans nearing the end of their treatment at a specialized outpatient mental health clinic completed quantitative self-report tools assessing PTSD and depressive symptom severity, and an individual, semi-structured interview assessing views on their treatment and recovery processes. Veterans’ partners participated in a separate interview to capture views of their partners’ treatment and recovery processes. Descriptive analyses of self-report symptom severity data were interpreted alongside emergent themes arising from inductive content analysis of qualitative interviews. Results While over half of Veterans were considered “recovered” based on quantitative assessments of symptoms, individual reflections of “recovery” were not always aligned with these quantitative assessments. A persistent narrative highlighted by participants was that recovery from military-related PTSD was not viewed as a binary outcome (i.e., recovered vs. not recovered); rather, recovery was seen as a dynamic, non-linear process. Key components of the recovery process identified by participants included a positive therapeutic relationship, social support networks, and a toolkit of adaptive strategies to address PTSD symptoms. Conclusions For participants in our study, recovery was seen as the ability to navigate ongoing issues of symptom management, re-engagement with meaningful roles and social networks, and a readiness for discontinuing intensive, specialized mental health treatment. The findings of this study highlight important considerations in balancing the practical utility of symptom severity assessments with a better understanding of the treatment discontinuation-related needs of Veterans with military-related PTSD and their families, which align with a contemporary biopsychosocial approach to recovery.

Emergency responders (ERs), often termed First Responders, such as police, fire and paramedic roles are exposed to occupational stressors including high workload, and exposure to trauma from critical incidents, both of which can affect their mental health and wellbeing. Little is known about the impact of the ER occupation on the mental health and wellbeing of their families. The aim of the current study was to investigate what mental health and wellbeing outcomes and experiences have been researched internationally in ER families, and to examine the prevalence and associated risk and protective factors of these outcomes. We conducted a systematic review in accordance with an a priori PROSPERO approved protocol (PROSPERO 2019 CRD42019134974). Forty-three studies were identified for inclusion. The majority of studies used a quantitative, cross-sectional design and were conducted in the United States; just over half assessed police/law enforcement families. Themes of topics investigated included: 1) Spousal/partner mental health and wellbeing; 2) Couple relationships; 3) Child mental health and wellbeing; 4) Family support and coping strategies; and 5) Positive outcomes. The review identified limited evidence regarding the prevalence of mental health and wellbeing outcomes. Family experiences and risk factors described were ER work-stress spillover negatively impacting spousal/partner wellbeing, couple relationships, and domestic violence. Traumatic exposure risk factors included concerns family had for the safety of their ER partner, the negative impact of an ER partners’ mental health problem on the couples’ communication and on family mental health outcomes. Protective factors included social support; however, a lack of organisational support for families was reported in some studies. Study limitations and future research needs are discussed. Progressing this area of research is important to improve knowledge of baseline needs of ER families to be able to target interventions, improve public health, and support ER’s operational effectiveness.