Les sports extérieurs et autres types d’activités physiques sont des composantes essentielles de la guérison mentale et physique. Nous mènerons des recherches à l’aide d’un concept biopsychosocial utilisant une approche de méthodes mixtes afin de comprendre plus particulièrement la façon dont les Jeux Invictus (JI) contribuent à la guérison des vétéranes et des vétérans. Nous y parviendrons en acquérant des connaissances sur la façon dont la santé mentale et physique des vétéranes et des vétérans est affectée par la participation ou la non-participation aux Jeux Invictus. Nous avons réuni une équipe internationale de chercheuses et chercheurs possédant l’expertise de la collecte de données sur la santé mentale et physique sur des échantillons nationaux ou dans de grands événements sportifs (c.-à-d. les Jeux olympiques et paralympiques d’hiver de Vancouver en 2010). Cette équipe s’attellera aux tâches suivantes : 1) concevoir un questionnaire en ligne sur la santé mentale et les mesures de bien-être émotionnel (c.-à-d. TSPT, anxiété, dépression, régulation des émotions); 2) réaliser des entrevues virtuelles afin de mieux comprendre les expériences et les avantages ou obstacles à la participation aux JI; 3) collecter des données biométriques de manière virtuelle (c.-à-d. la capacité aérobique, la qualité du sommeil, le rythme cardiaque). Ces données seront recueillies chez les participantes et participants des JI et chez les individus ayant échoué à participer aux JI. Les données seront recueillies durant l’entraînement, lors des compétitions des JI et après les JI. Elles permettront d’élaborer des lignes directrices pour la création, le développement, l’exécution et le maintien de programmes de sports adaptés qui, en fin de compte, soutiennent la croissance post-traumatique et la guérison des vétéranes et vétérans et de leurs proches.

Chaque année, des milliers de membres des FAC sont libérés de leur service et retournent au monde civil. Cependant, bon nombre de vétéranes et vétérans souffrent de diverses formes de blessures lors de leur formation ou de leur service dans les Forces. Les thérapies par les arts créatifs ont fait leurs preuves en ce qui concerne la réadaptation physique et mentale. Dans cette analyse environnementale, notre équipe de recherche étudiera les approches existantes de thérapie par les arts créatifs au Canada. Dans la deuxième partie de cette étude de recherche, nous interrogerons un groupe restreint de parties prenantes afin de comprendre les moyens à prendre pour l’adoption de thérapies par les arts créatifs dans le soutien de la santé et du bien-être des membres des FAC et des vétéranes et vétérans. L’objectif ultime de cette analyse environnementale est l’élaboration d’une série de recommandations pour soutenir la réadaptation mentale et physique des membres des FAC et des vétéranes et vétérans et la création d’un réseau de soutien pour connecter les membres des FAC et les vétéranes et vétérans avec un groupe élargi de membres de la communauté qui adopte les thérapies par les arts créatifs et le bien-être personnel.

Ce projet de recherche vise à combler une lacune en examinant de manière uniforme plusieurs sources dans le but de comprendre l’état actuel des données en santé mentale des (militaires) vétéranes et vétérans au Canada et la manière dont elles sont exprimées au pays. L’équipe de recherche examinera les sources universitaires officielles (articles publiés dans des revues scientifiques) et les sources non universitaires (par exemple, rapports gouvernementaux et documents stratégiques). Les renseignements obtenus de ces sources seront résumés dans quatre secteurs clés : 1) quelles sont les bases de données canadiennes existantes qui intègrent des renseignements sur la santé mentale des vétéranes et vétérans? 2) comment ces sources de données partagent-elles l’information avec d’autres organisations? 3) quelles sont les politiques fédérales ou provinciales existantes liées au partage de données concernant la santé? et 4) quels sont les enjeux principaux qui entraînent des répercussions sur le partage de données liées à la santé sur le plan national au Canada? Ce résumé sera ensuite partagé avec les partenaires principaux susceptibles d’avoir la capacité de promouvoir le changement et d’améliorer les pratiques de partage au Canada.

There is a high co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain in military personnel. Unfortunately, the mechanisms behind this relationship are poorly understood, leading to poor treatment outcomes for patients. Beyond occurring together, research suggests that PTSD and chronic pain might interact and aggravate each other through a common vulnerability: one’s susceptibility to fear and avoidance responses. To illuminate this interaction, this project will examine the relationship between pain and traumatic stress symptoms (especially fear and avoidance) in the Canadian military. We will also investigate the role that fear responses play in triggering and facilitating pain by examining “pain flashbacks,” a phenomenon in which individuals report re-experiencing the physical pain they experienced during trauma. If particular symptoms of PTSD prove to be contributing factors to chronic pain, it may be possible to prevent the development or exacerbation of chronic pain through interventions targeting both pain and PTSD. 

Le but de cette étude est d’examiner les expériences de première main vécues par les patientes et patients qui souffrent de TSPT en conjonction avec les données d’imagerie afin de permettre la clarification des différentes présentations cliniques du TSPT et leur signature neurale unique dans le cerveau. En nous permettant d’identifier les différentes façons dont le TSPT affecte le fonctionnement du cerveau, cette recherche aidera les cliniciens à mieux décider de l’approche de traitement appropriée pour aider les personnes souffrant de TSPT et ainsi améliorer les soins cliniques et les résultats des patientes et patients. Cette question revêt une très grande importance en raison des conséquences dévastatrices du TSPT sur les individus, sur leurs proches et sur l’économie (par exemple, taux d’absentéisme élevé et baisse de la productivité). Une telle approche a le potentiel de révolutionner les traitements du TSPT et pourrait donc affecter des milliers d’individus.

The overall objective of this study is to increase accessibility of physical rehabilitation to military or Veterans who have suffered a moderate or severe traumatic brain injury.

The primary objective of this study will be to determine the feasibility and effectiveness of remotely supervised intensive home-based exercise interventions. The secondary objectives will be to: 1) identify the differences between daily and weekly remotely supervised home-based intensive exercise intervention on program implementation measures as well as rehabilitation outcomes (i.e. balance, functional mobility and physical activity levels) for moderate and severe TBI survivors; and 2) identify key strategies for the use of remote supervision and home-based exercise intervention.

This study could have national impact on accessibility of supervised exercise interventions since it looks at integrating participants from rural communities and minority communities including francophones.

In May 2018, DGMPRA launched the DWWS Initiative, a comprehensive, proactive, and systematic approach to addressing the workplace well-being of CAF members and DND employees. This novel initiative will support the Total Health and Wellness Strategy and the Federal Public Service Workplace Mental Health Strategy, and help the CAF/DND maintain its prominent role in this domain within the Federal Public Service. CAF members – and, potentially, their families via spillover effects – will benefit from the proposed research project in that it will ascertain their well-being and pinpoint organizations and groups of individuals in need of attention, including those with high levels of burnout and psychological distress. These results will inform the design and implementation of positive actions where needed, and a future iteration of the DWWS will assess the impact of these actions.

Military members can experience trauma as a result of combat duties, being in a war zone, or peacekeeping under difficult conditions. It is estimated that up to 10% of those who have been in war zones will experience PTSD. Regarding Moral Injury (MI), of members deployed from 2001-2013, 58% were exposed to events that heightened their risk of engaging in or witnessing (in)actions that violated their deeply held values/beliefs. Feelings of shame, guilt, anxiety, depression and anger, together with loss of relationships, self-worth, and quality of life can manifest, as well as self-harming behaviour and suicide. The recent passage of Bill C-211 - Federal Framework on Post-Traumatic Stress Disorder Act - highlights Canada’s commitment to addressing PTSD among those who serve. This project aims to study the effectiveness of Project Trauma Support - an innovative, physician-led, community-based, 6-day, residential program focused on the treatment of PTSD/MI.

Canadian Armed Forces (CAF) members are exposed to stressors while in garrison, or on deployment that can result in Operational Stress Injuries (OSIs) (e.g., Posttraumatic Stress Disorder (PTSD), depression, and anxiety). Exposure to morally injurious events (MIEs) (i.e.., engaging in or witnessing (in)actions that violate deeply held beliefs/values) that results in development of Moral Injury (MI) has been found to: increase feelings of shame, guilt, and anger; compromise relationships, trust, and hope; perpetuate PTSD, depression, anxiety, and substance abuse; and strongly predict suicide in military personnel and veterans. Of CAF members deployed from 2001-2013, over 50% were exposed to potentially MIEs. Recent studies have examined Moral Injury (MI) and applicable interventions. Developing and testing interventions that address MI is apt and timely. This project aims to study the effectiveness of Adaptive Disclosure Therapy (ADT) as a treatment for MI. 

The proposed study will utilize clinical outcome and assessment data by leveraging machine learning computational methods and technology among Canadian Armed Forces (CAF) members and veterans, with a particular focus on subtyping of posttraumatic stress disorder (PTSD) and treatment response (e.g., recovery; suicidal behaviour). Critically, approximately 13% of CAF members and veterans will be diagnosed with a deployment-related mental disorder including PTSD and depression [1; Department of Defence]. Our group has already demonstrated the predictive validity of machine learning, where we were successful in classifying with over 90% accuracy: i) PTSD; ii) the dissociative subtype of PTSD; and iii) healthy individuals [2; Nicholson et al., 2018]. Here, we anticipate developing a machine learning tool that will enhance personalized medicine by identifying individualized prevention and treatment approaches, thus preventing illness, improving outcomes, and reducing suicidality among CAF members and veterans. 

• The study will utilize brain imaging data (fMRI) to determine if neurobiological machine learning algorithms can predict psychiatric symptomatology and treatment outcomes in CAF members, Veterans, their families, and civilians.
• This research will benefit CAF members and Veterans through the identification and clinical application of novel avenues to personalized medicine.
• Researchers anticipate developing a tool that can aid in the diagnosis of PTSD and its various subtypes, as well as inform treatment guidelines.

Although stress is a recurring and omnipresent problem, there are major gaps in knowledge about the hallmark condition related to traumatic stress (i.e. posttraumatic stress disorder [PTSD}). Over 70% of Canadians are exposed to traumatic events (e.g. physical injury, accidental death of loved one) in their lives. Although most are resilient, a substantial minority experience subsequent emotional problems. Major gaps exist in the literature on the incidence, longitudinal course, impact, and treatment needs of PTSD in Canadians. In particular, we know very little about the long-term impact of trauma exposure and PTSD among our Canadian soldiers. It is essential to understand the trajectory of PTSD within Canada’s unique demographic, sociocultural, and health care system influences.

The objectives of this research project are to:

1. Define the incidence and longitudinal course of PTSD in Canadian samples.
2. Develop prediction tools to identify those at risk for incident and persistent PTSD.
3. Define the impact of PTSD on subsequent risk for negative health outcomes.
4. Describe health care use and treatment needs among people with PTSD.

In the short term, this program of research will determine predictors of PTSD, the impact of PTSD on health outcomes, and treatment needs of civilians, active soldiers, and veterans with PTSD in Canada. In the long term, understanding these important questions will improve recognition and treatment of PTSD across health sectors, and will ultimately improve the lives of people with PTSD.

Although stress is a recurring and omnipresent problem, there are major gaps in knowledge about the hallmark condition related to traumatic stress (i.e. posttraumatic stress disorder [PTSD}). Over 70% of Canadians are exposed to traumatic events (e.g. physical injury, accidental death of loved one) in their lives. Although most are resilient, a substantial minority experience subsequent emotional problems. Major gaps exist in the literature on the incidence, longitudinal course, impact, and treatment needs of PTSD in Canadians. In particular, we know very little about the long-term impact of trauma exposure and PTSD among our Canadian soldiers. It is essential to understand the trajectory of PTSD within Canada’s unique demographic, sociocultural, and health care system influences.

The objectives of this research project are to: 
1. Define the incidence and longitudinal course of PTSD in Canadian samples.
2. Develop prediction tools to identify those at risk for incident and persistent PTSD.
3. Define the impact of PTSD on subsequent risk for negative health outcomes
4. Describe health care use and treatment needs among people with PTSD. 
In the short term, this program of research will determine predictors of PTSD, the impact of PTSD on health outcomes, and treatment needs of civilians, active soldiers, and veterans with PTSD in Canada. In the long term, understanding these important questions will improve recognition and treatment of PTSD across health sectors, and will ultimately improve the lives of people with PTSD. 

• Concussions are extremely common in deployment and in military and civilian activities. The diagnosis of concussion and “post-concussive syndrome” (PCS) is currently based on a patient’s report of their symptoms and a physical exam.
• In this study, researchers will utilize a dataset collected over the last four years (which contains MRI, neuropsychological, eye-movement, imaging and free text data) to apply complex analytical methods to define more sensitive and specific tests.
• These tools may be used in both a military and civilian setting, allowing for more personalized treatment and recovery programs, thereby lessening the burden of concussion and PCS.

Ce project de recherche se fera en deux phases. La première phase consistera à produire une revue de l'état actuel des programmes et des services existant en santé mental au Québec destinés aux familles militaires et aux vétérans.

Quatre catégories de programmes et de services seront présentées par région du Québec:

1. programmes fédéraux;
2. programmes provinciaux;
3. programmes communautaires et sans but lucratif; et ;
4. services privés.

La seconde phase consistera à développer et à administrer un questionnaire qui sera destiné aux familles militaires et aux vétérans afin de cerner leurs besoins/leurs évaluations/leurs utilisations en matière de programmes et de services en santé mentale. Les deux phases de ce project de recherche se feront avec l'aide de partenaires comme les Centres de la famille du Québec et les organisations de vétérans. Un rapport complet sera produit afin d'exposer les résultats des deux phases du project de recherche et afin de soumettre des recommandations.

Preliminary research into 1940s post-war Canadian veterans’ policy indicates that efforts to foster sense of purpose, self-reliance, and to create opportunities for meaningful employment, affordable homes, and sense of community contributed to successful post-war transitions, thereby reducing the ill effects of combat service for injured and non-injured Canadian veterans alike. The original Veterans Charter emphasised re-establishment over compensation so as to better reintegrate Veterans in to civil. University education, vocational training and assistance with business creation and farming stood among priority services. This focus appears to have been successful but to date there has been no scholarly research to measure their performance. This project aims to do that by employing historical case studies on the returned men of 1945 to better understand how some become active and contributing members of their community and others required long-term treatment and compensation. These findings will inform today's Canadian veterans' public policy discussions.

• Researchers will apply algorithmic and natural language processing techniques to establish a validated definition to identify PTSD within electronic medical records (EMR) and to identify key features related to suicide attempts and moral injury.
• This research will benefit CAF members, Veterans, and their families through the identification and clinical application of predictors of moral injury, suicidal behaviours, and patterns of comorbidity.
• The research team anticipates that the findings will provide much needed insight into the primary care experiences of patients with PTSD including a cohort of Veteran and related family members, as well as be generalizable to similar treatment-seeking military and veteran populations.

• Researchers will develop the IBM HERE4U Military Version, an instant messaging smartphone application to connect military family members to a mental health counselling solution.
• The application will be enabled by the IBM Watson cognitive platform using an advanced "Chat Bot" conversation system.
• Watson will engage with the client to identify a presenting problem and when clinically serious, triage to a counselor for guidance and referral.