Jennifer E.C. Lee, Ph.D.Defence Scientist

Personnel and Family Support Research Team

May 3, 2016

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

Faculty/Presenter Disclosure

• Faculty: Jennifer Lee

• Relationships with commercial interests:– None

CFPC CoI Templates: Slide 1

Mitigating Potential Bias

• Not applicable

CFPC CoI Templates: Slide 3

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

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

Recruit Mental Health TrendsMethods

• 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)

Recruit Mental Health TrendsResults

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• 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)

4.8%

6.3% 6.7% 6.9% 7.4%8.7%

8.1% 8.3%

5.1% 5.0%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Proportion Screening Positive for 1+ Mental Health Condition

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 • 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%)

• Objectives– 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)

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Prospective Analysis of Post-Deployment HealthResults – Baseline Only

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Mild Traumatic Brain Injury

PTSD

Depression

Somatic Symptoms

Combat Exposure

PTSD

Depression

Somatic Symptoms

Post-Concussive-Like Symptoms

Baseline Deployment* Post-Deployment

*Assessed post-deployment

Prospective Analysis of Post-Deployment HealthResults – Baseline and Deployment

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Mild Traumatic Brain Injury

PTSD

Depression

Somatic Symptoms

Combat Exposure

PTSD

Depression

Somatic Symptoms

Post-Concussive-Like Symptoms

Baseline Deployment* Post-Deployment

*Assessed post-deployment

Prospective Analysis of Post-Deployment HealthResults – All Stages

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Mild Traumatic Brain Injury

PTSD

Depression

Somatic Symptoms

Combat Exposure

PTSD

Depression

Somatic Symptoms

Post-Concussive-Like Symptoms

Baseline Deployment* Post-Deployment

*Assessed post-deployment

Correlates of Mental Health Care Use IntentionsMethods

• Participants– 244 CAF recruits who were part of a larger study on the effects of

various teaching methods for mental health training• 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

• Objectives– 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)

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Correlates of Mental Health Care Use IntentionsResults

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“Big Five” Traits• Agreeableness • Conscientiousness• Extroversion• Neuroticism• Openness

Social Norms

Attitudes

Behavioral Control

MHSU Intentions

Salutogenic “Happy” Factors• Hardiness• Mastery• Positive Affect

Emotional Processing• Difficulty Describing Feelings• Difficulty Identifying Feelings• Externally-Oriented Thinking

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

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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), 65-74.

• 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), 124-131.

• 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), 1006-1017.

• 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), 377-385.

• 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), 327-337.

• Skomorovsky, A., & Lee, J.E.C. (2012). Alcohol use among Canadian Forces candidates: The role of psychological health and personality. Military Psychology, 24(6), 513-528.

• Lee, J.E.C., McCreary, D., & Villeneuve, LCol M. (2011). Prospective multifactorial analysis of Canadian Forces basic training attrition. Military Medicine, 176(7), 777-784.

• 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), 222-234.

• Lee, J.E.C. (2010). Predicting basic training attrition. Proceedings of the International Military Testing Association Conference, Lucerne, Switzerland.

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