Project Description

This research project aims to address a gap with a standardized review of several sources to understand the current state of (military) Veterans' mental health data in Canada and how it is currently shared across the country. The research team will review both formal academic research sources (published journal articles) as well as non-academic sources (e.g. government reports, policy papers). The information obtained from these sources will be summarized in four key areas: 1) what are the existing Canadian databases that include information about Veterans' mental health, 2) how do these data sources share information with other organizations, 3) what are the existing provincial/federal policies related to sharing health data, and 4) what are the key challenges that impact national-level data sharing within Canada. This summary would then be shared with key partners who may have the ability to promote change and improve data sharing practices in Canada.

Project Description

The aim of this study is to examine the first-person lived experience of patients with PTSD in combination with imaging data to allow us to better capture different clinical presentations of PTSD and their unique neural signatures in the brain. By allowing us to identify the many different ways PTSD affects brain functioning, this research will help clinicians to better decide which treatment approach they will use to assist individual patients with PTSD, thus improving clinical care and patient outcomes. This is very important given the devastating impact of PTSD on patients, their families and the economy (e.g., absence from work, lost productivity). Such an approach has the potential to revolutionize PTSD treatment and could therefore affect thousands of individuals.   

Project Description

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. 

Project Description

Sexual trauma during military service refers to any type of sexual assault or harassment experienced while enlisted in military service. It is a compounding risk factor for the development of posttraumatic stress disorder (PTSD) and depression in service members. Moreover, recent evidence suggests that military members having experienced potential moral injury (MI), which may include incidents of sexual trauma during service, are more likely to develop PTSD than their non-exposed counterparts. In order to develop effective prevention and intervention strategies for sexual trauma during military service and moral injury among Canadian, female-identifying military members and veterans, it is necessary to first characterize this population. Therefore, our primary objectives are: 1) to analyze the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS) to determine whether sexual trauma during military service is an independent risk factor for MI; and 2) to conduct individual interviews with Canadian servicewomen and female-identifying veterans exposed to sexual trauma during military service to capture their unique experiences. 

Project Description

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. 

Project Description

PTSD is a common and disabling condition among Canadian military and veterans, and associated with intimate relationship problems and partners’ own mental health problems. Recognizing the need to improve access to evidence-based treatments for military personnel/Veterans and their families, our team is developing a Guided, Internet-delivered intervention to improve PTSD, enhance relationships, and improve partners’ mental health: Couple HOPES. The proposed two-phase project involves providing the intervention to 10 couples in Phase 1 to pilot and refine the assessment processes, intervention, and Coaching manual. Phase 2 involves a RCT with 70 couples across Canada testing Couple HOPES against a delayed intervention group (all couples will be treated within 2 months) to assess safety, desirability, and efficacy. Gold-standard methodology will be used to improve access to psychological interventions for military/Veterans and their families. Barriers to our study to mitigate include: adequate recruitment, retention in the intervention, and minimizing dropout from assessment. 

Project Description

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. 

Project Description

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.

Project Description

• 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.

Project Description

• The goal of the research project is to further our understanding and clinical management of Canadian Forces service members and Veterans suffering from a complex medical triad of traumatic brain injury, chronic pain, and post-traumatic stress disorder.
• Using a Computer Assisted Rehabilitation Environment (CAREN) this research will collect and consolidate a series of non-invasive whole-body biological measurements from patients during immersive therapy sessions in the CAREN Virtual Reality facility.
• High-performance computing and machine learning will be used to develop and deploy real-time estimators of sympathetic neural activation of the autonomic nervous system (SAANS).
• These systems will allow clinicians to create individualized treatment plans for patients, thereby maximizing rehabilitation benefits and avoiding costly setbacks in patient treatment.

Project Description

• CIMVHR, affiliated research partners, and IBM have identified a significant and universal issue facing health researchers that applies to MVFH research and health research for the Canadian population at large.
• Comprehensive and complete medical records for any given population are generally not available for research purposes due to access challenges and strict privacy protection practices.
• This project proposes to explore a safe harbour environment that includes secure data extraction and linking components and adheres to the strict policies that protect the access to the source data while facilitating creation of properly de-identified linked datasets from different sources to facilitate more complete future MVFH research.

Project Description

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.

Project Description

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.

Project Description

Programs for military families are targeted towards the needs of young families with young children, emphasizing needs for spouses and children; programs for veteran families are geared towards the ageing veteran. However, for many young serving members who do not have a significant other, ageing parents may need to step into a caregiving role should the member be injured in the line of duty. These parents, who may have their own health, work, and financial concerns, can find themselves unexpectedly navigating a complicated caregiving situation without the benefit of support available through programming, compounding their stress and experience of isolation. We will interview 20 to 30 parents of ill and injured veterans who are providing ongoing caregiving to their adult children. These in-depth interviews will yield new insights into the experiences and needs of ageing parents that can inform the development of relevant and inclusive policy and programming.

Project Description

The well-being of the Canadian Armed Forces (CAF) after they leave the military is a national priority. Yet, we do not know very much about the health of Canadian Veterans or how they access the public healthcare system. We want to know if Canadian Veterans use the healthcare system in ways that are similar or different to civilians, and if they have similar patterns of different diseases. We also want to compare health and healthcare use of male and female Veterans, and explore if the length of military service has an impact on health and health use. To answer these questions, we will analyze information that is being routinely collected within the Ontario healthcare system. We will work closely with government, healthcare, and service provider stakeholders to ensure that our findings feed directly into policy for improving health and well-being of Canadian veterans and their families.

Project Description

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.

Project Description

Military service challenges the stability and functioning of military family members, including children. For some children, however, the stresses associated with mobility, separation and risk build capacity, fostering a sense of belonging, enhanced self-confidence, increased family and community cohesion, and comfort with the unfamiliar. It is not known if these capacities are sustained through adulthood. We will interview 20-30 adult children of Canadian Armed Forces veterans who served from the Korean War through to the Cold War. This is an understudied group whose childhood experiences occured before formal supports were available to military families. Capturing their stories will address two gaps in Canadian military family research, specifically, the inclusion of retrospective accounts from adult children of their experiences growing up in military families and a focus on positive outcomes of military service for family members. This research will provide new insights that will inform policy and program development.

Project Description

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.

Project Description

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.

Project Description

• 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.

Project Description

• 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.

Project Description

• 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.