Backgrounder — Post-Traumatic Stress Disorder

Post-trau­mat­ic stress dis­or­der (PTSD) is a psy­chi­atric dis­or­der that can be best described as an extreme reac­tion to stress. It is cat­e­go­rized as an anx­i­ety dis­or­der, along with oth­er con­di­tions such as pan­ic dis­or­der, pho­bias, and obses­sive-com­pul­sive dis­or­der.

PTSD may devel­op in response to an extreme­ly trau­mat­ic expe­ri­ence that involves a real or per­ceived threat to the safe­ty or life of either the indi­vid­ual suf­fer­ing or some­one else. As a result, the indi­vid­ual evokes feel­ings of intense fear, hor­ror, or hope­less­ness.

The dis­or­der is char­ac­ter­ized by a vari­ety of symp­toms that can gen­er­al­ly be grouped into three cat­e­gories:

  • re-expe­ri­enc­ing (night­mares, flash­backs and intru­sive thoughts);
  • avoid­ance (avoid­ance of peo­ple, places, or cir­cum­stances that remind the indi­vid­ual of the trau­mat­ic event); and
  • hyper­arousal (hyper­vig­ilince, exag­ger­at­ed star­tle response, mood swings and/or irri­tabil­i­ty, and dis­turbed sleep).

A diag­no­sis of PTSD requires that these symp­toms be present for at least one month and be severe enough to inter­fere with the individual’s abil­i­ty to func­tion at work, home, or in social sit­u­a­tions.

As with most psy­chi­atric con­di­tions, the exact cause of PTSD is not ful­ly under­stood. It can­not be explained why peo­ple who expe­ri­ence the same event might either devel­op PTSD or expe­ri­ence no symp­toms.

The under­stand­ing of the psy­chol­o­gy and biol­o­gy of PTSD con­tin­ues to grow. The Cana­di­an Forces (CF) con­duct sig­nif­i­cant research into the risk and resilien­cy fac­tors asso­ci­at­ed with the ill­ness. CF Health Ser­vices also uses exist­ing research and evi­dence to help con­duct PTSD-relat­ed screen­ing, edu­ca­tion, and train­ing.

Treat­ment of PTSD is pro­vid­ed pri­mar­i­ly by clin­i­cians with­in the CF clin­ics, led by sev­en region­al Oper­a­tional Trau­ma and Stress Sup­port Cen­tres. CF clin­i­cians are com­mit­ted to pro­vid­ing evi­dence-based treat­ment that includes med­ica­tion and expo­sure-based ther­a­py tai­lored for each indi­vid­ual patient. Most patients diag­nosed with PTSD respond to treat­ment. In cas­es where com­plete recov­ery is not pos­si­ble, health care providers help patients achieve the best qual­i­ty of life pos­si­ble through strate­gies that help mit­i­gate their symp­toms.

PTSD in the CF

The vast major­i­ty of CF mem­bers who deploy do not devel­op PTSD. A 2011 study on the cumu­la­tive inci­dence of PTSD and oth­er men­tal health dis­or­ders esti­mat­ed that eight-per-cent (8%) had been diag­nosed with PTSD. This study, which involved med­ical record reviews of a strat­i­fied ran­dom sam­ple of 2,045 per­son­nel, pro­vides the most rig­or­ous sci­en­tif­ic esti­mate of CF per­son­nel diag­nosed with PTSD fol­low­ing their deploy­ment in Afghanistan. The study pop­u­la­tion includ­ed all 30,518 per­son­nel who returned from deploy­ment in sup­port of the mis­sion in Afghanistan from Octo­ber 1, 2001 to Decem­ber 31, 2008 and was the first study to exam­ine clin­i­cal diag­noses made by a men­tal health pro­fes­sion­al, rather than self-com­plet­ed ques­tion­naires.

Afghanistan-relat­ed PTSD was more com­mon among those deployed to high­er-threat loca­tions, like Kan­da­har or Kab­ul, than in low­er-threat loca­tions like the Ara­bi­an Gulf or Camp Mirage. Army per­son­nel and junior non-com­mis­sioned mem­bers were shown to have a high­er cumu­la­tive inci­dence of PTSD attrib­uted to the mis­sion in Afghanistan.

Many of those diag­nosed with PTSD in the CF return to full duties, while some remain in the CF with some mod­i­fi­ca­tion to their duties. Some are also med­ical­ly released and tran­si­tioned to Vet­er­ans Affairs Cana­da (VAC).

CF Health Ser­vices has an ongo­ing part­ner­ship and a strong rela­tion­ship with VAC to ensure a seam­less tran­si­tion to VAC-deliv­ered care. Before release, each CF mem­ber is assigned a nurse case man­ag­er, who ensures that all the nec­es­sary care to be pro­vid­ed through VAC is in place and that provin­cial health cov­er­age is arranged.

Screen­ing, sur­veil­lance and pre­ven­tion

CF per­son­nel under­go a men­tal health screen­ing as part of their pre-deploy­ment health assess­ment. Deploy­ing per­son­nel also under­go a psy­choso­cial screen­ing by either a men­tal health chap­lain or a men­tal health pro­fes­sion­al.

Before deploy­ment, per­son­nel par­tic­i­pate in the CF’s pre-deploy­ment men­tal health edu­ca­tion and train­ing pro­gram — The Road to Men­tal Readi­ness (R2MR). The pro­gram com­bines class­room and inter­ac­tive learn­ing to help par­tic­i­pants under­stand:

  • the impact of men­tal health on deploy­ment;
  • the phys­i­o­log­i­cal reac­tion to stress and how to mit­i­gate it;
  • the impor­tance and appli­ca­tion of goal set­ting, visu­al­iza­tion, self talk and arousal man­age­ment;
  • the chal­lenges that may be encoun­tered while deployed and their poten­tial impact;
  • the impact of val­ues, beliefs and mean­ing in men­tal readi­ness;
  • the impor­tance of a social sup­port sys­tem;
  • how to pre­vent and man­age stress; and
  • fam­i­ly stres­sors asso­ci­at­ed with deploy­ment (fam­i­ly mem­bers are invit­ed to attend).

The R2MR web­site pro­vides deploy­ing sol­diers and their fam­i­lies with easy access to infor­ma­tion about the deploy­ment process. This infor­ma­tion is intend­ed as a tool to not only pro­vide more con­crete infor­ma­tion as it per­tains to fam­i­lies but also pro­vide them with some gen­er­al insight on what the Cana­di­an Forces mem­bers are receiv­ing as train­ing as well. For more infor­ma­tion, please vis­it the R2MR web­site.

Sol­diers return­ing to Cana­da after a lengthy deploy­ment also par­tic­i­pate in the CF’s five-day Third Loca­tion Decom­pres­sion (TLD) pro­gram. Through­out the pro­gram, per­son­nel are also edu­cat­ed about PTSD and oper­a­tional stress injuries. To help ease the tran­si­tion to life back home, the men­tal health team also pro­vides infor­ma­tion about home, work and com­mu­ni­ty life. Dur­ing TLD, each deployed per­son­nel has the oppor­tu­ni­ty to speak to a men­tal health pro­fes­sion­al and to raise con­cerns.

Addi­tion­al­ly, per­son­nel return­ing from an inter­na­tion­al oper­a­tion of 60 or more days also under­go the Enhanced Post-Deploy­ment Screen­ing process, nor­mal­ly three to six months after their return to Cana­da. This screen­ing helps iden­ti­fy those with deploy­ment-relat­ed prob­lems, with a par­tic­u­lar focus on psy­cho­log­i­cal issues. Through­out the screen­ing, CF mem­bers com­plete a detailed health ques­tion­naire and have an in-depth inter­view with a men­tal health pro­fes­sion­al. If required, fol­low-up care is rec­om­mend­ed and arranged.

Results from this post-deploy­ment screen­ing (occur­ring three to six months after deploy­ment) have shown that approx­i­mate­ly four-per-cent (4%) of per­son­nel report symp­toms of PTSD at the time of their screen­ing.

The men­tal health of CF mem­bers is also con­tin­u­al­ly assessed through reg­u­lar peri­od­ic med­ical check-ups. Screen­ing ques­tions per­tain­ing to PTSD, depres­sion, sui­cide and oth­er men­tal health con­di­tions are rou­tine­ly asked and respons­es are record­ed as part of reg­u­lar exam­i­na­tions.

Men­tal health aware­ness pro­grams are also a sig­nif­i­cant part of the men­tal health con­tin­u­um at CF Health Ser­vices because they encour­age per­son­nel to rec­og­nize the signs of stress and to seek or pro­mote ear­ly treat­ment.

CF Health Ser­vices has many pro­grams aimed at pre­vent­ing or mit­i­gat­ing the effects of stress. Edu­ca­tion­al pro­grams are deliv­ered to var­i­ous lev­els of lead­er­ship and cov­er the full deploy­ment and career cycles. These cours­es are aimed at increas­ing men­tal health lit­er­a­cy and decreas­ing stig­ma among CF mem­bers. They also include train­ing in var­i­ous stress man­age­ment tech­niques that can be used before, dur­ing, or after stress­ful events such as com­bat. Cours­es cov­er areas such as anger and stress man­age­ment, cre­at­ing a healthy home life, sui­cide inter­ven­tion, and addic­tions aware­ness.

Treat­ment

CF Health Ser­vices has a strong men­tal health pro­gram that pro­vides ded­i­cat­ed and respon­sive care for ill and injured CF mem­bers and empha­sizes the elim­i­na­tion of the bar­ri­ers to men­tal health care. The CF pro­grams are cur­rent­ly deliv­ered by approx­i­mate­ly 380 mil­i­tary and civil­ian men­tal health providers plus addi­tion­al sup­port staff. As well, a sig­nif­i­cant amount of men­tal health care is deliv­ered by pri­ma­ry care providers.

Men­tal health care in the CF is guid­ed by evi­dence-based prac­tices and is deliv­ered through mul­ti­dis­ci­pli­nary teams includ­ing pri­ma­ry care clin­i­cians, psy­chi­a­trists, psy­chol­o­gists, social work­ers, men­tal health nurs­es, addic­tions coun­sel­lors, and chap­lains.

CF Health Ser­vices offers com­pre­hen­sive treat­ment to its per­son­nel that is indi­vid­u­al­ized and may include psy­chother­a­py (indi­vid­ual, group, cou­ple) and med­ica­tion as required. Should in-patient care be nec­es­sary, the CF have long-stand­ing rela­tion­ships with civil­ian health care facil­i­ties to ensure that per­son­nel get the care they need.

The CF have a wide vari­ety of men­tal health ser­vices avail­able to its mem­bers. These ser­vices are deliv­ered through:

  • Twen­ty-six men­tal health clin­ics at bases across Cana­da. These clin­ics vary in size depend­ing on the size of the base they sup­port. The small­est would pro­vide psy­cho-social ser­vices through a social work­er.
  • The five largest men­tal health clin­ics are the region­al clin­ics (Hal­i­fax, Val­carti­er, Ottawa, Edmon­ton, and Esquimalt). These clin­ics pro­vide a full range of care, includ­ing gen­er­al men­tal health care, oper­a­tional trau­ma and stress sup­port, psy­cho-social ser­vices, and addic­tions coun­selling.

Oper­a­tional Trau­ma and Stress Sup­port Cen­tres (OTSS­Cs) are the CF’s cen­tres of excel­lence in areas such as PTSD. The cen­tres have four man­dates —assess­ment, treat­ment, out­reach (edu­ca­tion), and research. These cen­tres are locat­ed in Edmon­ton, Esquimalt, Gage­town, Hal­i­fax, Ottawa, Petawawa and Val­carti­er.

As well as pro­vid­ing direct care to CF per­son­nel, these cen­tres are also com­mu­ni­ty lead­ers in the area of men­tal health and have forged part­ner­ships with civil­ian and aca­d­e­m­ic insti­tu­tions. CF pro­fes­sion­als are involved in lead­ing edge research and are con­tin­u­al­ly look­ing to their col­leagues in the civil­ian sec­tor and oth­er coun­tries for oppor­tu­ni­ties to build on care pro­vid­ed.

In addi­tion to deter­min­ing the inci­dence of PTSD amongst those CF mem­bers who deployed in sup­port of the mis­sion in Afghanistan from 2001 to 2008, the 2011 PTSD and oth­er men­tal health dis­or­ders cumu­la­tive inci­dence study also exam­ined the pro­por­tion of those per­son­nel who uti­lized spe­cial­ty men­tal health ser­vices upon their return from deploy­ment. The study found that close to one third of all deployed per­son­nel received spe­cial­ty men­tal health­care after their return. This fig­ure is reas­sur­ing as it shows that CF mem­bers are seek­ing care for poten­tial oper­a­tional stress injuries with­out fear of being stig­ma­tised or out of fear of career impact.

Sup­port

Beyond the treat­ment options men­tioned above there are a num­ber of pro­grams in place to sup­port those CF mem­bers suf­fer­ing from PTSD and oth­er con­di­tions. These include:

  • The CF Mem­ber Assis­tance Pro­gram: This pro­gram pro­vides a con­fi­den­tial 24/7 toll-free tele­phone advi­so­ry and refer­ral ser­vice to all CF mem­bers and their fam­i­lies. It also pro­vides short-term (up to nine ses­sions) con­fi­den­tial exter­nal (civil­ian) coun­selling for those in need.
  • The Oper­a­tional Stress Injury Social Sup­port (OSISS) Pro­gram: This pro­gram pro­vides peer sup­port and fam­i­ly coun­selling to those suf­fer­ing from PTSD or oth­er Oper­a­tional Stress Injuries.
  • The Road to Men­tal Readi­ness (R2MR) Pro­gram: The R2MR pro­gram and web­site pro­vide deploy­ing sol­diers, their fam­i­lies and ser­vice providers with easy access to infor­ma­tion about the deploy­ment process.
  • The Mil­i­tary Fam­i­ly Resource Cen­tres (locat­ed at all major CF bases): Forty Mil­i­tary Fam­i­ly Resource Cen­tres (MFRCs) are locat­ed at CF instal­la­tions across the coun­try, in the U.S., and in Europe. These cen­tres can pro­vide infor­ma­tion on sub­jects of inter­est to mil­i­tary fam­i­lies, includ­ing men­tal health. Staff can direct fam­i­ly mem­bers in greater need to appro­pri­ate ser­vice providers. The MFRCs can pro­vide emer­gency shel­ter, fund­ing, and child care, as well as psy­choso­cial sup­port through coun­selling and refer­ral ser­vices to com­ple­men­tary pro­grams in the larg­er com­mu­ni­ty.
  • Addi­tion­al cri­sis inter­ven­tion through a net­work of Mil­i­tary Police, med­ical per­son­nel, social work­ers and inter­faith chap­lains.
  • Full access to civil­ian com­mu­ni­ty pro­grams, agen­cies and shel­ters for mem­bers and depen­dants.

Source:
Depart­ment of Nation­al Defence, Cana­da

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