Event Description:

Join APA for five days of sessions, courses, and more in the vibrant New York City to leave you feeling inspired, energized, and better prepared. Connect with colleagues and industry experts from around the globe. Choose from 500+ educational sessions led by psychiatry and mental health expert educators. Engage with an array of exhibitors featuring the latest therapeutics and technologies in psychiatry.

Poster Presentation:

Dr. Jenny Liu; Psychotherapies and pharmacotherapies for military posttraumatic stress: A meta-analysis

Description: Data estimate that up to 1 in 5 Veterans are diagnosed with posttraumatic stress disorder (PTSD) in their lifetime. Given the high rates of PTSD in military and Veteran populations, the provision of care with consideration for the characteristics of the population and treatments are of critical importance. This poster will overview overall findings from a meta-analysis that evaluates the relative effectiveness of psychotherapies, pharmacotherapies, and combination therapies for PTSD in military and Veteran populations, with data from 172 studies. Meta-analytic findings indicate significant heterogeneities in the literature and found that the pooled estimate of effects for psychotherapies and pharmacotherapies were comparable overall (g of 1.06 - 1.12, CI(0.95, 1.28), p<.001. However, the combination of psychotherapy with pharmacotherapy was significantly higher g = 2.48, CI(1.68, 3.29), p<.001). Results indicate that combining psychotherapy and pharmacotherapy contributed to significantly larger effects compared to psychotherapy or pharmacotherapy alone. These findings hold strong implications for future directions in treatment development and practice recommendations.

Event Description:

Individuals with an interest in pain from all around the world come together to share knowledge and expertise on the latest advancements in pain mechanisms, evaluation, and management.

Poster Presentation:

Dr. Brent Davis; Decoding Pain Management Discourse: A Social Media Analytics Approach to the Canadian Armed Forces Community Online

Introduction/Aim: The prevalence of chronic pain among Canadian Armed Forces (CAF) personnel and Veterans has prompted increasing interest in alternative and emerging pain management strategies. This study aims to analyze discussions related to pain and pain treatment methods within the /r/CanadianForces subreddit on Reddit, focusing on key terms such as "Ketamine," "Mushrooms" (for Psilocybin), and "Pain," to gauge interest and sentiment towards these topics over time.

Methods: Utilizing the complete historical data of the /r/CanadianForces subreddit up to the end of 2023, we conducted a frequency analysis of the specified key terms to identify trends. Additionally, a Latent Dirichlet Allocation (LDA) topic model was applied to a subset of posts directly mentioning "pain," aiming to uncover underlying topics and associated phenomena, with a particular focus on "tinnitus" as indicated by the model.

Results: The frequency analysis revealed a growing interest in alternative treatments, notably Ketamine and Psilocybin, alongside a consistent concern for pain management. The topic modeling highlighted several pain-related discussions, with "tinnitus" emerging as one concern. A subsequent trend analysis of "tinnitus" mentions corroborated its increasing relevance within the community discussions.

Discussion/Conclusions: This study offers insights into evolving perspectives of CAF personnel and Veterans on pain and its treatment, emphasizing an openness to emerging therapies. The identification of tinnitus as a notable topic is curious in the context of "long covid" related causation. This analysis method proves effective in elucidating complex dynamics of military-related health discussions on social media, paving the way for future investigations into specific interests and concerns regarding chronic pain management.

Dr. Brent Davis; Sex based differences in pain reporting in clinician notes: A natural language processing approach

Introduction/Aim: Chronic pain management and documentation practices within healthcare settings are pivotal for patient care. This study leverages natural language processing (NLP) techniques to examine clinician notes from an operational stress injury clinic chronic, aiming to identify patterns and linguistic habits in chronic pain descriptions and explore the impact of patient sex on documentation practices.

Methods: Employing a bag of words approach, our analysis encompassed a dataset of 3669 clinician notes which were analyzed for mentions of pain. A key methodological step involved extracting patient sex from medical records, facilitating a sex-stratified analysis to investigate disparities in pain documentation.

Results: The analysis unveiled notable differences in pain documentation, with references to pain being twice as prevalent in notes pertaining to female patients as opposed to male patients. This finding suggests potential gender biases in clinical assessments or reporting, emphasizing the need to consider sex as a critical variable in medical documentation and research. Furthermore, our study began to uncover additional linguistic patterns, indicating the potential for broader applications of NLP in understanding chronic pain documentation.

Discussion/Conclusions: This research highlights significant disparities in how pain is documented in clinical notes based on patient sex, pointing to underlying gender biases in pain perception and reporting. The application of NLP techniques in this context not only reveals clinician documentation habits but also opens avenues for further studies aimed at developing more equitable and informed pain management strategies. Through continued exploration and expansion of our dataset, we anticipate uncovering more insights that could enhance chronic pain documentation and treatment practices.

Dr. Jenny Liu; Investigating the Comorbidity of PTSD and Chronic Pain: Prescription Patterns and Treatment Considerations in OSI Clinics Across Canada

Introduction/Aim: We overview findings from a two-part survey on the prescription practices of clinicians in treating posttraumatic stress disorder (PTSD) in Operational Stress Injury (OSI) clinics across Canada. Specifically, we examine the characteristics and prescribed medications of patients with PTSD and chronic pain comorbidity.

Results: Findings indicate distinct differences in characteristics of patients with PTSD, including PTSD specifier and mental health comorbidity. We also noted commonly prescribed medications in the management of chronic pain comorbid PTSD.

Discussion/Conclusions: Taken together, these findings illuminate the current practices in OSI clinics while emphasizing the importance of considering chronic pain as a significant factor in the treatment of military-related PTSD. These insights will aid in guiding future policies and research aimed at refining and personalizing treatment strategies for PTSD in military personnel and Veterans, especially those living with chronic pain.

Dr. Jenny Liu; Considerations for Ketamine in the Effective Management of Chronic Pain and Mental Health for Veterans: A systematic review and meta-analysis

Introduction: Ketamine has emerged as a promising treatment alternative for the management of chronic pain. Despite encouraging findings in civilian populations and favorable results from trials examining its efficacy in military populations, there is still a dearth of information for chronic pain and mental health conditions in military populations.

Aim: To address this gap, we sought to conduct a systematic review and meta-analysis synthesizing evidence on the effectiveness, tolerability, and feasibility of ketamine in the management of chronic pain and mental health conditions in Veterans.

Methods: The pre-registered review was conducted following PRISMA and Cochrane guidelines. A total of 1020 studies were reviewed, and 11 studies were retained for data analysis. From each study, the following information was extracted: study characteristics, study data, and potential moderator/study rigour information.

Results: Ketamine led to significant reductions in mental health symptoms and pain, with moderate-to-large effects. These improvements were observed in both active-duty and Veteran groups, and for different routes of ketamine administration, frequencies of ketamine administration, duration of ketamine treatments, dosage, study design, and allowance for concurrent treatments.

Discussion/Conclusions: The evidence suggests that ketamine may be a promising treatment for mental health and chronic pain in military populations.

Event Description:

The International Congress on Academic Medicine (ICAM) is the first international gathering dedicated to academic medicine. It will be the place for the academic medicine community to meet, network, and develop new relationships and collaborations with colleagues from around the world.

ICAM will showcase innovation and scholarship in medical education and health research. Medical students, residents and graduate students will have the opportunity to present their work, network and connect with medical education and research mentors as well as prospective employers.

Oral Presentation:

Dr. J. Don Richardson; Time to Revel: Workplace supports for a flourishing workforce

Background/Purpose: Physicians play a crucial role within the healthcare system. However, the COVID-19 pandemic has placed an immense burden on them, leading to unprecedented levels of burnout. It is essential to implement safeguards that prioritize resilience and wellness, reduce the risk of adverse mental health outcomes, and ensure timely and effective support for those facing difficulties.

Methods: In response to this need, our team embarked on developing an organizational framework to implement wellbeing changes within healthcare organizations. Our approach aims to address the siloed nature of the system by bringing together voices from different levels to co-develop workplace support solutions. The project, REVEL, funded by the Public Health Agency of Canada (PHAC), outlines the steps taken to support healthcare workers at the individual, team, leadership, and organizational levels. To pilot the framework's development, we collaborated with three organizations: St. Joseph's Health Care London, Schulich School of Medicine and Dentistry-Western, and the Royal Ottawa Hospital. Additionally, we created tools tailored to each level of engagement, covering readiness and preparation, creating a supportive environment, and implementation methods.

Results: Traditionally, physician wellbeing initiatives have focused on individual-level interventions, such as mindfulness groups, self-care practices, and resilience skill-building. Unfortunately, many exhausted physicians lack the capacity for additional online modules. Therefore, there is a need to go beyond individual interventions and explore organizational-level approaches to tackle burnout challenges. Through our experiences of co-creating and co-developing solutions, we have realized that promoting physician wellbeing necessitates a departure from individual interventions. Instead, we require systems-based solutions to address organizational disconnect, lack of support, and restore faith in the healthcare system.

Discussion: The REVEL framework and its accompanying tools fill an urgent gap in initiatives addressing physician wellbeing beyond individual-level interventions. It is adaptable for implementation in various healthcare organizations, offering much-needed support to physicians in the future.

Event Description:
The ISTSS Annual Meeting provides a forum for the sharing of research, clinical strategies, public policy concerns and theoretical formulations of trauma. The annual meeting is also where professionals get to see old friends and colleagues, meet new ones and develop and strengthen collaborative relationships in order to move the field of traumatic stress forward. It is an international assembly of professionals and students representing an array of disciplines, including psychiatrists, psychologists, social workers, nurses, counselors, researchers, administrators, victim advocates, journalists, clergy and others with an interest in the study and treatment of traumatic stress.

Event Description:
The conference is a key opportunity to explore new perspectives, reconnect with colleagues and learn from the passions of others in the field of psychiatry. It promises interactive engagement with the best minds in psychiatry from across the country.

Research Paper:

Dr. Jenny Liu; Treatment Approaches and Efficacy for Post-Traumatic Stress Disorder in Military Populations: A Meta-Analysis

Lay Summary: Data estimate that up to one in five Veterans are diagnosed with post-traumatic stress disorder (PTSD) in their lifetime. Given the high rates of PTSD in military and Veteran populations, providing care with consideration for the characteristics of the population and treatments are of critical importance. This presentation will overview initial findings from a meta-analysis that evaluates the relative effectiveness of treatment approaches for PTSD in military and Veteran populations. The preregistered review is conducted per PRISMA and Cochrane guidelines. A search was conducted with PsycINFO, MEDLINE, Embase, Cinahl, and ProQuest dissertations and theses. After removing duplicates, we screened 12,002 studies for inclusion. The final sample includes data from over 400 studies providing psychotherapy, pharmacotherapy, and alternative / emerging therapies to treat PTSD. Meta-analytic findings indicate significant heterogeneities in the literature and found that pharmacotherapies and psychotherapies were comparable overall. Finally, results indicate that combining psychotherapy and pharmacotherapy contributed significantly more significant effects than psychotherapy or pharmacotherapy alone. Results confirm the diversity of available treatments for military-related PTSD and the comparability of various treatments and underscore the additive effects of combination therapies. Our work provides a snapshot of current evidence on treatment approaches in military-related PTSD while identifying factors that may influence treatment outcomes. These findings will better inform clinical decision making for service providers and service users and suggest future directions in treatment development and practice recommendations to better support the well-being of military and Veteran populations.

Event Description:
With 71,500 Regular Force members in the Canadian Armed Forces, 30,000 Reserve Force members, 60,600 military families and 629,300 Veterans, Canada has a significant population with unique risks, exposures and experiences that demands new standards of protection, prevention and care for the ill and injured. Each year, CIMVHR works to engage existing academic and government research resources, facilitate new research, increase research capacity and foster knowledge translation. This work is showcased each year, when thought leaders from government, academia, industry and philanthropic sectors gather at Forum to present new research, exchange ideas, share insight, learn and collaborate.

Workshop:

Dr. Maya Roth; Important considerations for the assessment, treatment and research of military/Veteran PTSD – an updated primer

Lay Summary: The proposed workshop will review guidelines with case examples on best practice and special considerations for assessment, treatment and research of military/Veteran PTSD. Psychotherapy, pharmacotherapy and collaborative care will be highlighted with break out discussion opportunities. Assessment topics will include the importance of identifying an index trauma, connecting assessment of symptomatology to this trauma, considerations when using self-report questionnaires in treatment, and highlighting the importance of outcome monitoring. Treatment discussion will focus integrating ketamine and rTMS into standard psychopharmacology, pharmacogenetics, and exploring factors underlying the research literature suggestion that military/Veteran PTSD is less responsive to treatment. To promote research, the importance of continuing to emphasize evidence-based treatments that work with continued exploration of ways to adapt these treatments will be reviewed, and areas of much needed research will be highlighted. Strategies to engage and educate Veterans in treatment to better inform outcomes and collaborative treatment decision making will be discussed.

Event Description:
The CPA’s 2023 Annual General Meeting and National Convention is scheduled to take place from June 23rd – 25th, 2023, at the Sheraton Centre in Toronto, ON. This year’s CPA Convention is being held in conjunction with the 5th North American Correctional and Criminal Justice Psychology Conference (NACCJPC). Numerous pre-convention events, including the CPA’s Pre-Convention Professional Development Workshops, will take place on June 22nd.

Printed Poster:

Dr. Rachel Plouffe; The Mediating Roles of Workplace Support and Ethical Work Environment in Associations Between Leadership and Moral Distress in Canadian Health Care Workers During the COVID-19 Pandemic

Background/Rationale: The COVID-19 pandemic has resulted in heightened moral distress among health care workers (HCWs) worldwide. Past research has shown that effective leadership may mitigate the impact of moral distress. However, no research to-date has considered the mechanisms by which leadership has an influence on moral distress. We sought to evaluate longitudinally whether Canadian HCWs’ perceptions of workplace support and ethical work environment would mediate associations between leadership and moral distress.
Methods: A total of 239 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in a longitudinal online survey. Participants completed measures of organizational and supervisory leadership at baseline and follow-up assessments of workplace supports, evidence for an ethical work environment, and moral distress.
Results: Associations between both organizational and supervisory leadership, and moral distress were fully mediated by workplace supports and perceptions of an ethical work environment.
Conclusions and Impact: To ensure HCW well-being and quality of care, it is important to ensure that HCWs are provided with adequate workplace supports, including manageable work hours, social support, and recognition for efforts, as well as evidence of an ethical workplace environment.

Event Description:
This conference focuses on bringing together a broad multidisciplinary range of professionals who work to support those who have experienced trauma at some point during their life. The aim is to collectively share best practice in theoretical, empirical, and clinical advances through the presentation of cutting-edge research relevant to the field of traumatic stress. Equality, inclusion and diversity are at the very core of ESTSS values and therefore will hear from researchers across many geographical, disciplinary, and economic backgrounds in addition to those at a variety of different stages of their careers. Of special interest will be contributions closely related to the conference theme of Trauma and Resilience Through the Ages: A life course perspective. However, all submission that relate to the field of traumatic stress are welcome.

Symposium:

Dr. J. Don Richardson; Veteran Mental Health Across International Boundaries

Overall Outline: This symposium brings together researchers in  Veteran mental health from Australia, Canada, Northern Ireland, and the United Kingdom, who have together established the International Veteran Dataset Initiative. The symposium will present research undertaken in each country on mental health prevalence, treatment, and factors contributing to treatment outcomes, highlighting similarities and differences across countries in both the research that has been undertaken to date, and research findings. The symposium will conclude by outlining the collective ambitions of the International Veteran Dataset Initiative, which aims to combine several datasets to facilitate data analysis on a globally impactful level while answering key strategic questions around military and Veteran mental health. This initiative will allow researchers to determine whether approaches which work for one nation may also be effective in another and develop recommendations for program and policy modifications which may improve Veteran mental health on a larger scale.
Learning Objectives:
Objective 1: Identify, synthesize, and differentiate the existing literature on Veteran mental health across Australia, Canada, Northern Ireland, and the United Kingdom.
Objective 2: Explain and contrast service delivery and funding availability for Veteran mental health across Australia, Canada, Northern Ireland, and the United Kingdom.
Objective 3: Describe the International Veteran Dataset Initiative and its strategic research ambitions to enhance our understanding of Veteran mental health.

Individual Paper:

Dr. Stephanie Houle; Latent profiles of moral injury and their associations with longitudinal mental health outcomes

Background: Previous research supports the clinical relevance of moral injury (MI), however more research is needed to identify whether specific patterns of MI are clinically informative, and how such patterns may generalize between occupational settings.
Objective: This study is the first to identify latent profiles of MI using the Moral Injury Outcome Scale (MIOS). We examined profiles’ associations with psychiatric symptoms (PTSD, depression, anxiety) in two longitudinal datasets (Veterans; n=387 and health care workers (HCWs); n=270) collected during the COVID-19 pandemic.
Method: Latent profile analysis was conducted using the MIOS. Mean comparisons of indicator scores by group examined particular items’ relevance in differentiating profiles. A linear mixed model for longitudinal data assessed profiles’ associations with psychiatric symptoms over time.
Results: A 3-profile solution best fit both samples (healthy, low-MI and high-MI). Effect sizes for mean comparisons suggest that, in both samples, items indicative of shame most strongly differentiated profiles, with the largest effect size observed for the item “I have lost pride in myself” among Veterans (η2=0.61). Symptom scores on all measures decreased significantly over time among high-MI Veterans, with the lowest magnitude decrease observed for avoidance symptoms of PTSD. Among high-MI HCWs, scores of arousal, avoidance, and depression remained consistent over the course of the pandemic.
Conclusion: Consistent with theory, findings suggest shame may be a driving factor in MI distress. Differences observed among Veterans and HCWs may represent differences in acute versus chronic stress reactions, though further research is needed to replicate and extend findings beyond the pandemic context.

Dr. Stephanie Houle; The clinical utility of a syndrome conceptualization of moral injury: Results of a pilot study and directions for future research

Background: Moral injury (MI), the distress prompted by experiences that violate one’s core moral beliefs, has garnered significant interest, with recognition that MI may not be well captured in our current psychiatric taxonomy. No study has yet empirically assessed how a syndrome conceptualization of MI might apply in practice, however, precluding our understanding of the construct’s clinical utility.
Objective: To examine how access to a MI syndrome description affects clinical decision-making.
Method: In this pilot study, 16 clinicians in Canada (n=13 clinical psychologists; n=3 psychiatrists) were randomized into two groups (access to MI as a diagnosis or not). Participants were presented with vignettes describing symptoms consistent with PTSD, depression, or MI, and asked to provide a diagnosis. All participants also answered structured questions rating their perceptions of the clinical utility of MI.
Results: Percent agreement in diagnosis across vignettes suggest that access to the MI symptom set worsened diagnostic agreement for cases of PTSD and depression, but improved agreement for the MI vignette. Light’s kappa demonstrated fair agreement across cases in both groups (MI-Group = .20; No-MI Group=.33, both p>.05). The majority of clinicians agreed that MI is not properly addressed in current clinical practice, and that the construct captures experiences not otherwise covered by existing diagnoses. Most clinicians also agreed that the MI description provided fit with cases they currently see in practice.
Conclusion: While most clinicians agree that MI is a clinically useful construct, additional research is needed to understand how best to apply MI in clinical practice.

Poster:

Dr. Jenny Liu; Posttraumatic Stress in the Military - Development of a Treatment Algorithm

Abstract: Posttraumatic stress disorder (PTSD) in Canadian Veterans has been reported to be as high as 18%. Effective treatments for PTSD must consider many individual (e.g., age, gender, trauma exposures, and comorbidity) and treatment (e.g., availability, access, response, and tolerability) factors. In addition, the availability of diverse psychotherapies, pharmacotherapies, alternative, and emerging treatments for PTSD further complicate treatment prescription and preferences of both patients and care providers. In this workshop, we will overview the rationale, methodology, preliminary results, and implications of an ongoing collaborative project that seeks to build consensus in the assessment and treatment of PTSD in military and Veteran populations in Canada. This project contains three components: (1) A scan of available treatment approaches for military-related PTSD via meta-analysis and systematic review; (2) The identification of prescribing patterns and practices of psychiatrists treating PTSD across Operational Stress Injury (OSI) clinics across Canada; and (3) The development of a consensus model to guide the treatment of military-related PTSD, with particular emphasis on treatment-resistant PTSD. We will engage participants to reflect on the challenges and considerations in working with military and Veteran populations, and explore the clinical and practical utility of treatment algorithms for PTSD for military and Veteran populations. Participants will be engaged in experiential learning exercises, such as consensus-building as well as case work to explore various applications of the treatment algorithm.

Dr. Rachel Plouffe; The Impact of Effective Supervisory Leadership in Mitigating Moral Distress for Canadian Health Care Workers During the COVID-19 Pandemic

Background: Throughout the COVID-19 pandemic, health care workers (HCWs) have frequently encountered situations where their ethical and moral values were challenged in the workplace, resulting in high levels of moral distress. Some protective factors against moral distress have been identified, including effective leadership (Ness et al., 2021). However, no research to date has identified whether effective supervisory leadership buffers against the development of moral distress when HCWs lack workplace resources and risk developing COVID-19 in the workplace.
Objective: The purpose of this study is to evaluate whether effective supervisory leadership moderates associations between COVID-19 risk perceptions and moral distress, as well as resource adequacy and moral distress in Canadian HCWs during the pandemic.
Method: A sample of 1,383 Canadian HCWs were recruited to complete a series of online questionnaires between June and December 2020.
Results: Supervisory leadership significantly moderated the relation between resource adequacy and moral distress, such that when resource adequacy was low, effective supervisory leadership buffered against the development of moral distress. However, although COVID-19 risk perception was positively correlated with moral distress, effective supervisory leadership did not moderate the association between the risk of contracting COVID-19 and moral distress.
Conclusions: Based on the results of this study, it is evident that when supervisors exhibits effective communication including honesty and safety, HCWs may benefit by experiencing lower levels of moral distress, especially in circumstances when resources are limited. This has important implications for healthcare organizations to ensure that supervisors are appropriately trained and supported to ensure positive workplace environment for healthcare workers.

Dr. Stephanie Houle; The psycho-social impacts of encountering children during military deployments: Promoting prevention, intervention, and policy change

Background: Global trends show that armed conflict is becoming increasingly complex, with children increasingly engaged in armed violence in a variety of roles. Scant research exists on the impacts that deployment-related encounters with children (DREC) have on military personnel. This presentation showcases findings from a multi-phase, multi-method research program undertaken to address this gap.
Objectives and Method: Phase 1: We systematically reviewed and summarized existing evidence on the nature and impacts of DREC. Phase 2: We qualitatively examined the psychosocial impacts of DREC in a sample of Canadian Veterans. Phase 3: Using a Participatory Action Research (PAR) approach, we are engaging with individuals with lived experience to help refine findings and formulate recommendations for research and policy change.
Results: Our review identified limited evidence, mostly clinical and anecdotal, showing consequences of DREC include mental health concerns, moral struggles, sleep disturbances, physical injuries, and social isolation. Little guidance exists regarding military training and policies related to DREC. Qualitative analysis identified themes including troubling aspects of DREC, influence of personal circumstances, and health consequences associated with DREC. The PAR approach is currently validating findings from the review and interviews, indicating a need for additional supports and training for military personnel encountering DREC.
Conclusions: The psychosocial impacts of DREC are multi-faceted and have important implications for the well-being of military personnel. Minimal guidance exists to support military members who encounter DREC. Additional research is needed to promote prevention, intervention, and policy change efforts which support those at risk of exposure to DREC.

Event Description:
CIPHER and nine additional projects will exhibit their research and created resources for public safety personnel and healthcare workers' mental health, including their families and caregivers.

Symposium:

Dr. J Don Richardson; Time to Revel: Workplace Supports

Event Description:
The ISTSS Annual Meeting provides a forum for the sharing of research, clinical strategies, public policy concerns and theoretical formulations of trauma. The annual meeting is also where professionals get to see old friends and colleagues, meet new ones and develop and strengthen collaborative relationships in order to move the field of traumatic stress forward. It is an international assembly of professionals and students representing an array of disciplines, including psychiatrists, psychologists, social workers, nurses, counselors, researchers, administrators, victim advocates, journalists, clergy and others with an interest in the study and treatment of traumatic stress.

Symposium:
Dr. Rachel Plouffe; The International Development and Psychometric Evaluation of the Moral Injury Outcome Scale (MIOS)
An international team of clinical researchers present the results of the development and psychometric evaluation of the Moral Injury Outcome Scale (MIOS) in Veteran, military and healthcare worker populations. The symposium also presents the results of early research using the MIOS to investigate the relationship between moral injury and complex PTSD, propensity to forgiveness and perceived social support. The results confirm that moral injury (MI) is best understood as a transdiagnostic construct that is associated with mental health disorder, but goes beyond traditional diagnostic categories in capturing broad psychological social and spiritual outcomes of experiences that transgress deeply help moral beliefs or expectations.

Presenters:
Dr. J Don Richardson; Prevalence and Correlates of Cannabis Use Among Mental Health Treatment-Seeking Canadian Armed Forces Members and Veterans
Canadian Armed Forces (CAF) members and Veterans are at increased risk of posttraumatic stress disorder (PTSD) and other mental health (MH) conditions compared to civilians. While PTSD treatment guidelines exist, efficacy within Veteran populations may be diminished, and a proportion of Veterans may turn to cannabis for symptom relief. This study aims to: 1) describe the prevalence of cannabis use among MH treatment-seeking CAF members and Veterans; 2) estimate the association between cannabis use and PTSD, depressive, anxious, and alcohol use symptom severity; and 3) identify predictors of cannabis use. Methods: Using retrospective data from 415 CAF members and Veterans, mean symptom severity scores were compared by current cannabis use status using ANOVA and Tukey post-hoc tests; and predictors of cannabis use were identified via logistic regression. Results: 41.5% of participants reported current cannabis use, with about half that indicating medical use. Medical cannabis users tended to have higher symptom severity scores than recreational or non-users across MH conditions [e.g., depression: FWelch(2, 183.22) = 2.56; p = 0.08; Cohen’s f = 0.11]; no significant difference was noted for PTSD scores. Significance: Potential explanations for observed differences and clinical implications of cannabis use in this population will be discussed.

Dr. Jenny Liu; Treatment approaches and efficacy for posttraumatic stress disorder in military populations: A meta-analysis
Nearly one in 12 veterans are diagnosed with posttraumatic stress disorder (PTSD) upon return to civilian life. Given the high rates of PTSD in military and veteran populations, the provision of care with consideration for the characteristics of the population and treatments are of critical importance. This presentation will overview the protocol and initial findings from a meta-analysis that evaluates the relative effectiveness of treatment approaches for PTSD in military populations. The preregistered review is conducted in accordance with PRISMA and Cochrane guidelines. The literature search was conducted using PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertations and Theses. After removal of duplicates, a total of 12002 studies were screened for inclusion. The final sample included data from over 400 studies providing psychotherapy, pharmacotherapy, and alternative / emerging therapies to treat PTSD in military and veteran populations. Results provide a snapshot of the current state of evidence on treatment approaches in military-related PTSD while identifying factors that may influence treatment outcomes. Findings will better inform clinical decision-making for service providers and service users and suggest future directions in treatment development and practice recommendations to better support the wellbeing of military and veteran populations.

Dr. Rachel Plouffe; The Roles of Personality and Resilience in Associations Between Combat Experiences and Posttraumatic Stress Disorder Among Canadian Armed Forces Veterans
Canadian Armed Forces (CAF) Veterans encounter unique challenges associated with their service. Exposure to service-related traumatic events places them at risk for developing adverse mental health outcomes, such as posttraumatic stress disorder (PTSD). Despite the high prevalence of mental health conditions among CAF Veterans, not all Veterans exposed to occupational stressors develop PTSD. This research aimed to assess whether personality traits, including resilience, impacted associations between combat experiences and past-month PTSD symptomatology in a sample of 245 CAF Veterans (81% men; Mage=48.47, SDage=10.34). Participants completed online questionnaires reflecting demographics, personality traits, exposure to combat experiences, and PTSD symptoms. Results showed that combat experiences, resilience, extraversion, emotionality, and agreeableness significantly predicted PTSD symptoms. However, personality traits did not moderate the impact of combat experiences on PTSD symptoms, suggesting that combat experiences influence Veterans’ mental health regardless of trait levels. Overall, this research can be used to enhance military researchers’ and clinicians’ understanding of personality traits as risk and protective factors for PTSD symptoms. This can be considered for early interventions designed to decrease mental health symptoms associated with traumatic combat events.

Event Description:
The conference is a key opportunity to explore new perspectives, reconnect with colleagues and learn from the passions of others in the field of psychiatry. It promises interactive engagement with the best minds in psychiatry from across the country.

Workshop:
Dr. Jenny Liu; Posttraumatic Stress in the Military – Development of a Treatment Algorithm
Posttraumatic stress disorder (PTSD) in Canadian veterans has been reported to be as high as 18%. Effective treatments for PTSD must consider many individual (e.g., age, gender, trauma exposures, and comorbidity) and treatment (e.g., availability, access, response, and tolerability) factors. In addition, the availability of diverse psychotherapies, pharmacotherapies, alternative, and emerging treatments for PTSD further complicate treatment prescription and preferences of both patients and care providers. In this workshop, we will overview the rationale, methodology, preliminary results, and implications of an ongoing collaborative project that seeks to build consensus in the assessment and treatment of PTSD in military and Veteran populations in Canada. This project contains three components: (1) A scan of available treatment approaches for military-related PTSD via meta-analysis and systematic review; (2) The identification of prescribing patterns and practices of psychiatrists treating PTSD across Operational Stress Injury (OSI) clinics across Canada; and (3) The development of a consensus model to guide the treatment of military-related PTSD, with particular emphasis on treatment-resistant PTSD. We will engage participants to reflect on the challenges and considerations in working with military and Veteran populations, and explore the clinical and practical utility of treatment algorithms for PTSD for military and Veteran populations. Participants will be engaged in experiential learning exercises, such as consensus-building as well as case work to explore various applications of the treatment algorithm.

Presenter:
Dr. J Don Richardson; Prevalence and Correlates of Cannabis Use Among Mental Health Treatment-Seeking Canadian Armed Forces Members and Veterans
Canadian Armed Forces (CAF) members and Veterans are at increased risk of posttraumatic stress disorder (PTSD) and other mental health (MH) conditions compared to civilians. While PTSD treatment guidelines exist, efficacy within Veteran populations may be diminished, and a proportion of Veterans may turn to cannabis for symptom relief. This study aims to: 1) describe the prevalence of cannabis use among MH treatment-seeking CAF members and Veterans; 2) estimate the association between cannabis use and PTSD, depressive, anxious, and alcohol use symptom severity; and 3) identify predictors of cannabis use. Methods: Using retrospective data from 415 CAF members and Veterans, mean symptom severity scores were compared by current cannabis use status using ANOVA and Tukey post-hoc tests; and predictors of cannabis use were identified via logistic regression. Results: 41.5% of participants reported current cannabis use, with about half that indicating medical use. Medical cannabis users tended to have higher symptom severity scores than recreational or non-users across MH conditions [e.g., depression: FWelch(2, 183.22) = 2.56; p = 0.08; Cohen’s f = 0.11]; no significant difference was noted for PTSD scores. Significance: Potential explanations for observed differences and clinical implications of cannabis use in this population will be discussed.

Event Description:
With 71,500 Regular Force members in the Canadian Armed Forces, 30,000 Reserve Force members, 60,600 military families and 629,300 Veterans, Canada has a significant population with unique risks, exposures and experiences that demands new standards of protection, prevention and care for the ill and injured. Each year, CIMVHR works to engage existing academic and government research resources, facilitate new research, increase research capacity and foster knowledge translation. This work is showcased each year, when thought leaders from government, academia, industry and philanthropic sectors gather at Forum to present new research, exchange ideas, share insight, learn and collaborate.

Symposium:
Dr. Rachel Plouffe; Feeling Psychologically Safe in the Military: Development and Validation of the Psychological Safety Inventory
Introduction: Feeling psychologically safe, whether at an individual or organizational level, is vital for organizational effectiveness. Given the importance of military organisations’ ability to adapt quickly to fluctuating and demanding conditions, it is imperative that teams foster high levels of psychological safety, defined as perceptions that the individual within a team and organization is supported and feels safe in tackling emerging challenges. However, there is no consensus on how psychological safety should be measured in an occupational setting. Here, we develop a self-report measure of psychological safety (i.e., Psychological Safety Inventory (PSI)) in response to the needs of organizations to accurately assess psychological safety. Methods: Item generation, expert review, and initial item trimming were conducted. A preliminary, 70-item version of the PSI was administered to 497 full-time civilian employees (238 males, 248 females, 4 other, 7 missing) from Canada (n = 113), the United States (n = 104), and the United Kingdom (n = 277; 3 missing country) using an online survey. Participants completed the preliminary PSI, an alternative measure of psychological safety, as well as measures of leadership, team climate, organizational perceptions, and organizational support. Results: The initial set of 102 items was generated reflecting the following domains of psychological safety: Interpersonal Risk-Taking; Mutual Trust/Respect; Organizational/Structural Support; Identity and Clarity in Context of Team; and Supportive Leadership. A total of 16 content domain (military, psychological safety) and psychometrics experts reviewed and rated items. Based on this review, we reduced the item set to 70 items. Based on exploratory and confirmatory factor analyses, we reduced the preliminary PSI to a 30-item, 5-factor scale. We further examined convergent validity of the measure and found that the PSI subscales and total scale correlated as anticipated with other measures of psychological safety, leadership, team climate, organizational perceptions, and organizational support. Conclusion: Given the high stakes demands and extreme conditions associated with serving in the military, it is imperative that military teams function in ways that promote psychological safety. However, to enhance levels of psychological safety in the military, valid and reliable psychometric tools must be implemented to measure the construct accurately. Based on our analyses, the PSI is a valid and reliable measurement tool designed to evaluate levels of workplace psychological safety. Future research should ensure that the demonstrated validity of the PSI holds in the CAF population and context.

Podium:

Dr. Anthony Nazarov; Longitudinal Mental Health Outcome Trajectories among Military Personnel Deployed to Long-term Care Facilities as part of Operation LASER

Dr. Anthony Nazarov; Moral Distress and Moral Injury among CAF personnel following deployment to Op LASER

Dr. Anthony Nazarov; Moral Injury Due to Exposure to Children in Armed Violence During Military Service: a Participatory Action Research Project
Introduction: The Dallaire Institute for Children, Peace and Security, in partnership with CAMH and the MacDonald Franklin Operational Stress Injury Research Centre, are conducting research to explore the experiences of military personnel who have engaged with children recruited and used as soldiers. The deployment of child soldiers in conflict zones is becoming more common, which may put military personnel at greater risk for moral injury stemming from encounters with children recruited and used as soldiers. While a breadth of research has examined the mental health of former child soldiers, to date, there is no evidence documenting the impacts of witnessing or interacting with child soldiers on the mental health and wellbeing of military personnel. Methods: This is a multi-phased participatory action research (PAR) project, led by a multi-disciplinary research team and advisory group that includes experts in mental health, military and veteran health, aims to co-identify and develop strategies that will mitigate the impacts of morally injurious experiences involving exposure to children recruited and used as soldiers during military service. This PAR project builds on previous research by our team, involving the collection of rich qualitative data on people’s lived experiences encountering children recruited and used as soldiers during military service, and the mental health effects of these experiences. Based on key themes that emerge from these data, this PAR project will meaningfully and actively engage people with lived experience as well as mental health experts and military personnel in a process that seeks to situate power within the research process with those who are most affected by an issue and its interventions. Through the PAR process, military personnel will develop strategies for prevention, support and training to mitigate the impacts of morally injurious experiences. Expected Results: This research is expected to inform prevention and treatment. Enhanced training and policies will better prepare personnel for complex deployments. Enhanced treatment will ensure appropriate care is provided for those who experience morally injurious events. The project will also foster greater collaboration between academics, the security sector, and health professionals to improve interventions in the area of moral injury. Conclusions: This participatory action research project is improving our understanding of the moral injury associated with witnessing children recruited and used as soldiers on military personnel's mental health and will help identify opportunities to enhance training, planning, and treatment to improve operational effectiveness and enhance protection for military personnel, veterans and their families.

Dr. Brent Davis; Piloting advanced document representations for the prediction of one year treatment outcome from initial clinician assessment notes
Introduction: To support improved treatment outcomes in mental health, it is critical to integrate as much information as possible from early stages of treatment to help inform clinicians and patients predict any difficulties in treatment. Research has consistently shown that combat or military related post-traumatic stress disorder (PTSD) impacted individuals demonstrate a poor treatment outcome for both pharmacotherapy and psychotherapy. One of the earliest sources of information from a professional comes in the form of clinician notes and intake surveys. In this work, we take written clinician notes and apply a structured machine learning and natural language processing approach to aggregate the collection of words describing a patient’s earliest presentations into a digital representation summarizing the words used to describe them. We demonstrate these representations can be used to predict treatment outcomes. The trained model is then capable of generating a risk score based on the language used in early assessments. Methods: The representations used are a multi-stage learning process involving word representations and then document representations. Clinician notes from a single author (n=6192) were lower cased and had common English stop words removed. A word embedding was trained on the entire corpus of clinician notes using the GloVe word embedding method, giving each word used in the clinician notes a vector representation capturing similarity to other words in the corpus. These word representations were used to form document representations for initial assessment notes (n=133) for whom treatment outcome was known by taking a tf-idf weighted average of the vector form of words in the clinician note. The features of this vector are used with a support vector machine to predict treatment outcomes at 1 year using cross validation. Lastly, by using vector properties of the separating hyperplane the SVM produces, the individual words which are most impactful to this classification are obtained. Expected Results: The word embedding was trained in GloVe with a (metrics from training GloVe embedding here). The accuracy of using these representations in aggregated tf-idf format per clinician note to measure was promising for a pilot study. The most common words are visualized using a word cloud. Conclusions: This study highlights the importance of strong early assessment as a way of assessing treatment progress over time. Our results highlight the ability for aggregative data techniques to extract insights over a population, and could scale to larger combined datasets with improved results. Future research involving larger populations and different authoring clinicians are warranted.

Dr. Brent Davis; Network analysis of posttraumatic stress disorder symptoms and correlates in Canadian military veterans
Introduction: One of the approaches taken to psychometrics is the integration of network models which allow visualizing the entire topology of relationships between traits and questions that are used to analyze disorders such as PTSD. This analytical approach takes the assumption that symptoms co-occur owing to a causal interaction between them. Understanding the complexities and interactions of these symptoms is important for a more holistic understanding of PTSD in veteran populations as supported by data driven techniques. This study looks at the network structure among (1) the 20 DSM-5 PTSD symptoms, including common clinical covariates and (2) all of the prior including the Trauma-Related Altered States of Consciousness (TRASC) symptoms. We perform k-means clustering on this set to look for significant clusters which may be impacting the network analysis. Methods: We utilized a large sample of Canadian military veterans, and analyzed the data from a subsample of 642 veterans who reported clinically significant DSM-5 PTSD symptoms. We reproduced the methodology of a state of the art network analysis using regularized partial correlation models. Clustering was performed on this set to look for significant clusters, first by using the gap statistic to determine the optimal number of clusters based on variance in the dataset. Results: Consistent with previous studies we found DSM-5 PTSD symptoms were positively connected within the network, especially a strong connection between nightmares and flashbacks. Additionally in the TRASC set, we see strong correlations between divided or multiple senses of self and losing time. There is a gender specific association to the TRASC dissociative item of feeling foreign body parts, and this feeling foreign body parts phenomenon has a strong linkage to out of body experiences. When examining network centrality for the non-TRASC analysis, we found the centrality of negative trauma-related emotions and detachment. Conclusions: These results are supportive that network analysis can be reproduced between different populations, as we are able to reproduce the most significant findings between a US and Canadian military veteran cohort. The integration of other covariates and survey questions is a promising avenue for discovering further significant associations. Combined with clustering, this can help our understanding of PTSD subtypes.

Dr. J Don Richardson; Prevalence and correlates of cannabis use among mental health treatment-seeking Canadian Armed Forces members and Veterans
Introduction: Canadian Armed Forces (CAF) members and Veterans are at increased risk of posttraumatic stress disorder (PTSD) and other mental health (MH) conditions compared to civilians. While PTSD treatment guidelines exist, efficacy within Veteran populations may be diminished, and a proportion of Veterans may turn to cannabis for symptom relief. This study aims to: 1) describe the prevalence of current cannabis use among MH treatment-seeking CAF members and Veterans; 2) estimate the association between current cannabis use and a number of physical and mental health-related conditions, including PTSD, depressive, anxious, and alcohol use symptom severity, chronic pain, and sleep quality; and 3) identify sociodemographic and health-related variables associated with current cannabis use. Methods: This study used retrospective data collected from a convenience sample of 415 CAF members and Veterans attending a specialized outpatient mental health clinic for operational stress injuries between January 2018 and December 2020. Participants’ current cannabis use was categorized as no use, use for medical purposes, and use for recreational purposes. Participants who endorsed using cannabis for medical and recreational use were excluded from the analyses due to small numbers. Mean symptom severity scores were compared by current cannabis use status using ANOVA and Tukey post-hoc tests; and sociodemographic and health-related variables associated with current cannabis use type were identified via multinomial logistic regression. Results: The majority of the sample were Veterans of the CAF (92.3%; n = 383). Most participants met the recommended cutoff for probable MDD (82.2%; n = 341), probable PTSD (74.0%; n = 307), and probable GAD (73.7%, n = 306). One-quarter (25.5%, n = 123) met the cut-off score for potentially harmful alcohol use. 41.5% of participants (n = 187) reported current cannabis use, with about half that indicating use for medical purposes (n = 93). Individuals who reported current cannabis use for medical purposes tended to have higher symptom severity scores than recreational or non-users across MH conditions [e.g., depression: F (2, 226) = 2.59; p = 0.08; Cohen’s f = 0.11]; however, no significant difference across groups was noted for PTSD scores [F(2, 693) = 1.03; p = 0.36; Cohen’s f = 0.07]. Conclusions: Veterans who reported current cannabis use for medical purposes tended to have higher symptom severity scores across a range of psychometric measures. Potential explanations for observed differences and clinical implications of cannabis use, both recreational and medical, in this population will be discussed.

Dr. Jenny Liu; The effects of encountering children recruited and used as soldiers on the well-being of military personnel: A systematic review
Introduction: Military personnel disproportionally report high exposures to potentially psychologically traumatic experiences. A documented source of trauma for military personnel is encountering children recruited and used as soldiers. Given that seeing children in the throes of violence can prompt difficult moral reactions, these encounters can have devastating short- and long-term consequences on the mental and physical well-being of military personnel, as well as influence their social relationships, occupational outcomes, and possible moral injury development. This presentation will describe the design, implementation, and preliminary evidence of a systematic review that evaluates the diverse outcomes reported by military personnel who have encountered children recruited and used as soldiers in their lines of duty. In addition, the review will identify the presence and absence of training programs, policies, and support services available to military personnel in preparation or response to these exposures. Methods: This systematic review was conducted using PRISMA guidelines. The search used the databases PsycINFO-OVID and ProQuest Dissertations & Theses. In addition, The Defense Technical Information Centre was used to extend the search into existing military databases. The search strategy yielded 2807 articles for this review. Results: From each study, the following information will be extracted: (1) characteristics of the military personnel involved in the encounter with children recruited and used as soldiers (e.g., gender, citizenship), (2) the type of data collected about the interaction (e.g., single person account via interview), (3) information about whether any training or mental health treatments are available for the military personnel (e.g., whether military personnel sought any treatment, any mention of recommendations and/or suggestions), (4) information about the encounter with the child (e.g., characteristics of the child, context of the encounter), and (5) any outcomes the military personnel experienced as a result of the encounter with the child (e.g., psychological, physical). Conclusion: This systematic review will overview the availability of evidence on examinations of acute and long-term effects that encounters with children recruited and used as soldiers have on military personnel. The identification of important training, policies, and services will be considered in light of the consequences of these potential exposures. Together, findings will provide insights for future training, treatment, and policy recommendations in order to build capacity to support the well-being of military and Veteran populations in anticipation of these encounters.

Dr. Jenny Liu; Towards treatment algorithms for posttraumatic stress disorder in military populations
Abstract: The prevalence of posttraumatic stress disorder (PTSD) in Canadian veterans range from 8 – 18%. To treat PTSD, healthcare providers need to consider individual factors such as age, gender, and trauma exposures, as well as treatment factors such as availability, access, response, and tolerability. This presentation will overview a three-part project towards building consensus in the assessment and treatment of PTSD in military and Veteran populations. These components collectively seek to: (1) Provide a comprehensive scan of available treatment approaches for military-related PTSD via meta-analysis and systematic review; (2) Identify prescribing patterns and practices of psychiatrists treating PTSD across Operational Stress Injury (OSI) clinics across Canada; and (3) Develop a consensus model to guide the treatment of military-related PTSD, with particular emphasis on treatment-resistant PTSD. The pre-registered meta-analysis is conducted in accordance with PRISMA and Cochrane guidelines. A comprehensive search of the literature was conducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertations and Theses. After removal of duplicates, a total of 12,002 studies were screened for inclusion. The final sample includes data from over 400 studies providing psychotherapy, pharmacotherapy, and alternative and emerging therapies to treat PTSD in military and Veteran populations. Findings from the meta-analysis will provide a snapshot of the current state of evidence on treatment approaches while identifying factors that may influence treatment outcomes. In parallel, a survey assessing at prescription patterns and practices will be released to psychiatrists treating Veterans within the OSI networks across Canada. The survey will gather information reflecting factors that influence prescribing practices, as well as patient information that determines the decision-making process during care. Together, results from the meta-analysis and the prescription patterns survey will be aggregated and used as the basis of a consensus-building practice amongst treatment providers. Findings will better inform clinical decision-making for service providers and service users while shedding insights for future treatment development and practice recommendations to better support the wellbeing of military and Veteran populations.

Kate St. Cyr; Differences in mental health service use between Canadian Armed Forces members and Veterans: data from the 2018 CAF Members and Veterans Mental Health Follow-Up Survey
Introduction: Military careers carry unique occupational risks, including exposure to psychologically distressing events, which may increase the prevalence of mental health disorders among Canadian Armed Forces (CAF) members and Veterans compared to the general Canadian population. Previous research has aimed to quantify patterns and predictors of mental health services use (MHSU) among Canadian military and Veteran populations; however, there is little evidence about whether factors associated with MHSU differ between active CAF members and Veterans. Objectives: This study aims to describe differences in MHSU by comparing a sample of Veterans who left the CAF between 2002 and 2018 to a group of CAF members who were employed within the CAF in both 2002 and 2018. The specific objectives of this manuscript are to: 1) compare prevalence of past 12-month MHSU (defined as ≥1 visit with a psychiatrist, family doctor, other medical doctor, psychologist, nurse, or social worker) between CAF members and Veterans; and 2) identify sociodemographic, military-, trauma- and health-related variables associated with past 12-month MHSU among CAF members and Veterans. Methods: The current study uses data from the 2018 CAF Members and Veterans Mental Health Follow-Up Survey (CAFVMHS), which is a follow-up survey of current and former members of the CAF who participated in the 2002 Canadian Community Health Study – Canadian Forces Supplement (CCHS-CFS). Sociodemographic, military-, trauma-, and mental health-related variables were selected a priori, and their respective associations with MHSU among 1) CAF members and 2) Veterans were estimated using multiple logistic regression models. Results: Among both the CAF member and Veteran subsamples, meeting criteria for at least one past 12-month mental health disorder (posttraumatic stress disorder, major depressive episode, generalized anxiety disorder, panic disorder, and/or social phobia) was strongly associated with past 12-month MHSU [CAF members: AOR = 7.80 (95% CI: 7.18 - 8.46); Veterans: 11.82 (95% CI: 11.07 - 12.61)]. Past 12-month suicide ideation, history of sexual trauma, and history of adverse childhood experiences were also significantly associated with MHSU among both subsamples. Deployment outside of Canada, age, sex, and education level were associated with MHSU among Veterans, but not active personnel. Conclusions: As anticipated, the presence of a past 12-month mental health disorder was associated more strongly with MHSU than any of the other variables considered. Some differences in variables associated with MHSU between CAF and Veteran subsamples were observed; potential reasons for these differences and their implications will be discussed.

Dr. Rachel Plouffe; Roles of Personality and Resilience in Associations Between Combat Experiences and Posttraumatic Stress Disorder Among Canadian Armed Forces Veterans
Introduction: Canadian Armed Forces (CAF) Veterans encounter unique challenges associated with their service. Exposure to service-related traumatic events places them at risk for developing adverse mental health outcomes, including posttraumatic stress disorder (PTSD). Although some risk and protective factors associated with CAF Veteran mental health have been identified, past empirical research has not yet considered the impact of individual differences in personality on the development of PTSD. Given that models of personality, as well as resilience, have been shown to predict many important outcomes across psychological, vocational, and interpersonal domains, it is plausible that personality traits have an impact on associations between Veterans’ combat experiences and PTSD. This research sought to assess whether seven personality traits (i.e., honesty-humility, extraversion, openness, emotionality, conscientiousness, agreeableness, and resilience) impacted associations between combat experiences and PTSD symptomatology in CAF Veterans in the past month. Methods: We recruited a sample of 245 CAF Veterans (81% men; Mage=48.47, SDage=10.34) via participant recruitment platforms (i.e., ParticipAid.co), word of mouth, social media, and email distributions within professional and Veteran networks. Participants completed a battery of questionnaires online through Research Electronic Data Capture (REDCap) pertaining to their personality trait levels, stressful experiences during military operations, and past-month symptoms of PTSD. Participant demographic information was also collected. Results: Results showed that resilience, extraversion, and agreeableness were significantly and negatively associated with PTSD symptoms, whereas combat experiences and emotionality were significantly and positively associated with PTSD symptoms. Despite these relations, personality traits did not moderate the impact of combat experiences on PTSD symptoms. This suggests that although adaptive personality traits were generally protective against PTSD symptoms, combat experiences influenced Veterans’ mental health regardless of personality trait levels. Conclusion: To date, no research has investigated whether broad personality traits impact the associations between combat experiences and PTSD. Through this project, we anticipate that clinicians can implement the findings in practice to enhance the well-being of Veterans and their families. For example, our findings demonstrated that trait resilience reduced levels of PTSD among CAF Veterans. Thus, clinicians can use this information to implement early interventions for Veterans designed to enhance facets of resilience, including their personal competence, tolerance of negative affect, and positive acceptance of change. Overall, this research supports the well-being of CAF Veterans and their families by enhancing military organizations’, researchers’, and policymakers’ understanding of personality traits as risk and protective factors for PTSD symptoms.

Poster:

Dr. Anthony Nazarov; Improving Canadian Armed Forces mental health and resilience training: understanding trainee preferences for the Road to Mental Readiness Program
Introduction: The Canadian Armed Forces (CAF) employs the Road to Mental Readiness (R2MR) program as its primary source of mental health and stress resilience training. However, empirical findings suggest limited psychological and resilience benefits from the current program, highlighting opportunities for refinement. To identify targets for improvement, it is necessary to understand what CAF personnel prioritize in a training program. This information can be derived using Conjoint Analysis (CA), a method used to understand preferences for multifaceted products. When applied to training programs, CA can quantify the relative importance of training program features based on selections that trainees (i.e., CAF personnel) make between hypothetical program options. Given that health preferences vary by individual differences, it is plausible that training preferences will also need to account for individual characteristics to reflect the needs of CAF members. The purpose of this research is to use CA to extract, quantify, and synthesize CAF members’ prioritized training features generally, and according to CAF-member characteristics. Methods: Approximately 400 CAF personnel will be recruited to complete an online survey comprising a CA module and questions on health beliefs (health locus of control), mental health and R2MR experiences, and demographics. In the CA module, participants will make a series of choices between hypothetical training options where each training option represents a unique combination of training attributes (e.g., training instructor) defined by one level of each attribute (e.g., instructor is a CAF peer vs. instructor is a mental health clinician). Expected Results: Statistical analyses will quantify the sample-level and subgroup-specific relative preferences for training program attributes and attribute levels. Hierarchical Bayes (HB) estimation will be used to derive individual-level training preferences, which can be examined in relation to participant variation across other data collected (e.g., degree of internal vs. external health locus of control) to understand whether preference patterns reliably vary according to participant characteristics. Together, analyses will reveal a set of prioritized training features, sensitive to individual differences. Conclusions: The purpose of this research is to quantitatively identify a hierarchy of prioritized training features derived from CAF members’ feedback. Results of this survey will be used to guide R2MR improvements in alignment with the needs of Canadian military members, both generally and with respect to individual variation. Outcomes of this research will establish clear priorities for the design, implementation, and policies regarding the content and delivery of R2MR program within the CAF.

Cassidy Trahair; An Interview Study of Beliefs About Confidentiality and Attitudes Towards Disclosure of Moral Injury
Introduction: Military members and Veterans often encounter potentially morally injurious events (PMIEs) during their service. These encounters can put them at higher risk for developing moral injury, defined as the psychological distress in response to morally-transgressive situations. If untreated, moral injury can lead to such negative health outcomes as depression, suicide ideation, substance abuse, and posttraumatic stress disorder. However, the rate of help-seeking among military members who experience mental health issues is remarkably low. This study qualitatively evaluated factors associated with mental health help-seeking among individuals with CAF experience, including perceived confidentiality of information, and whether PMIEs impact the decision-making process. Methods: The sample currently consists of 19 individuals with CAF Reserve or Regular force experience aged 26 to 64 years (M=47.89, SD = 10.22; 3 women, 16 men). Participants completed interviews via Webex in which they were asked questions about past mental health trauma experience, confidentiality concerns, and questions related to moral injurious events. The interviews were transcribed verbatim and coded using a grounded theory approach. Expected Results: Most participants expressed concerns related to confidentiality of their information within the mental health care system. Data collection and analyses are ongoing. The results of this study indicate that military personnel are not always comfortable sharing information with a health care provider. Conclusions: While analysis is still ongoing, most participants did express concerns related to the confidentiality of their information in a military mental health support scenario. Findings will allow clinicians and policymakers to determine whether specific regulations surrounding confidentiality should be modified to facilitate treatment-seeking.

Dr. Jenny Liu; Measuring psychological safety: A meta-analysis and systematic review
Abstract: In a psychologically safe environment, team members feel safe to share ideas, acknowledge errors, experiment with new ideas, and exhibit mutual respect. Despite the recognized importance of psychological safety, there is no consensus in terms of how psychological safety should be measured, the components that make up psychological safety, and how to use evaluations to inform policy development to enhance psychological safety. In our presentation, we will overview findings from a meta-analysis and systematic review of the literature reflecting the availability and quality of measures used to evaluate psychological safety in various occupational populations. The literature search was conducted on October 26, 2021, using five databases: PsycINFO (OVID), MEDLINE (OVID), PsycTests-ProQuest, SCOPUS, and ProQuest Dissertation & Theses. A total of 205 studies with 224 independent samples were included in the review. Psychological safety was assessed via self-report measures. The quality of measures was examined through evaluations of internal consistency and sampling distributions. Across 224 samples of data, the average internal consistency via Cronbach’s alpha was .81. The pooled point estimate and standard errors (SE) across studies were 4.72, SE = 0.07, 95% CI (4.58, 4.85), Z = 68.07, p < .001. These effects were considerably heterogeneous across samples (I2 = 99.92), Q(221) = 259632.32, p < .001. Together, findings suggest that the quality of measures evaluating psychological safety may be acceptable. However, there is room for improvement in terms of how the factor structures of psychological safety measures are examined, the degree to which psychological safety may be associated with other constructs, and how to capture similarities and differences in psychological safety across population sectors. Future directions in research and applications of psychological safety will be discussed, particularly as they relate to military and public health and safety personnel.

Event Description:
The annual convention of the American Psychological Association is the largest gathering of psychologists in the world. Each year it attracts thousands of practitioners, researchers, educators, applied psychologists, and policymakers from all areas of specialization in the discipline.

Symposium:
Dr. Anthony Nazarov; Beliefs about confidentiality and implications for moral injury treatment and research

Event Description:
With 300+ educational sessions and courses covering 50+ topics, APA’s Annual Meeting in New Orleans is the best place to connect with colleagues, get the latest in scientific advances, and meet your certification and licensure requirements. This year’s meeting features a deep and timely discussion of the social determinants of mental health: the factors outside our offices and within our patients’ communities that influence the mind, from COVID, to inequity, to education, and much more.

Description:
Dr. Jenny Liu; A meta-analysis of the effectiveness of internet-based Cognitive Behavioural Therapy (iCBT) for military and veteran populations
The pandemic has transformed mental healthcare, creating more demand for services that can be delivered remotely. A promising approach is internet-based cognitive behavioural therapy (iCBT). Yet, it is unclear whether the iCBT treatments will be effective for military and veteran populations. The goal of the current meta-analysis is to evaluate the evidence of iCBT for military and veteran populations. Moderators, such as the format of delivery, length of protocol, and types of outcomes assessed are also examined. Literature searches were conducted on June 4, 2021, using PsycINFO, Medline, Embase, and ProQuest Dissertations and Theses with no date restriction. A total of 20 articles with 144 samples were included in the meta-analysis. Results indicate that the iCBT interventions produced a statistically significant and meaningfully small effect (g = 0.63, SE = 0.05, 95% CI (0.54, 0.73), Z = 13.14, p < .001). Intervention outcomes were diverse, including symptoms reductions and behavioural modification changes. Findings suggest iCBT treatments for military and veterans were comparable to the reported outcomes of prior menta-analysis conducted with non-military samples, as well as CBT treatments delivered in person. Findings from the meta-analysis lend support for the use of iCBT with military and veteran populations. Conditions under which iCBT may be optimized will be discussed.