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Introduction: Despite limited research on the topic, it has been observed that military members face unique challenges with social support. Methods: The current study used data provided by treatment-seeking Veterans and Canadian Armed Forces (CAF) members ( N=666) to: (1) determine whether symptomatology of posttraumatic stress disorder (PTSD), depression (MDD), anxiety, and suicidal ideation (SI) increased as level of perceived social support decreased; and (2) identify if the level of perceived social support is associated with PTSD, MDD, and anxiety symptom distress and SI frequency; this was done while controlling for demographic factors. Social support was measured using a single item grouped according to "low," "medium," and "high" levels of perceived support. Results: Overall, adequate social support was low with less than one-third (29%) of participants reporting a high level. There was an inverse association between social support and symptom distress for all mental health conditions, whereby those who perceived low social support had significantly greater symptom distress than those who perceived medium social support, who in turn reported significantly greater symptom distress than those perceiving high social support. Social support was significantly associated with all mental health conditions when controlling for demographic variables. The effect of social support on PTSD and SI affected Veterans and CAF members differently. Discussion: Our study highlights the difficulty this population faces in maintaining adequate social support alongside military-related mental health disorders. More research is required to fully understand the role of social support in military populations.

Introduction: Limited research has investigated gender differences among treatment-seeking Veterans and serving military personnel, despite important implications for treatment provision. In order to better serve the needs of women with military service, the authors sought to address this gap by examining the clinical presentation of men and women requesting services for military-related operational stress injuries (OSIs). Methods: Using a sample of 648 treatment-seeking male ( n = 550) and female ( n = 99) Veterans and Canadian Armed Forces (CAF) personnel, the authors compared prevalence of childhood sexual and physical abuse, probable mental health diagnoses (posttraumatic stress disorder [PTSD], depression, and generalized anxiety disorder [GAD]), and severity of pain and somatic symptoms. Results were rerun to control for sociodemographic variables that significantly differed by gender. Results: Rates of probable PTSD were higher for women ( p < 0.05), and women reported significantly more somatic symptoms ( p < 0.001), pain severity ( p < 0.01), and childhood sexual abuse (47% of the sample; p < 0.001). Both men and women reported equally high rates of childhood physical abuse (71% for both genders). Discussion: Women in this study had a higher prevalence of probable PTSD and childhood sexual abuse, and reported higher severity of pain and somatic symptoms. The study highlights the diverse range of issues that are clinically relevant for – and may complicate the treatment of – women with military service who have OSIs.

Introduction: Using a treatment-seeking sample of military personnel and Veterans ( n = 736), the objectives were to determine the prevalence of somatic symptoms in the sample and investigate whether the mean severity of somatic symptoms differed between common probable psychiatric conditions and comorbidity. Methods: The Patient Health Questionnaire–15 was used to determine somatic symptom severity. One-way analyses of variance and Tukey post hoc tests determined whether the severity of somatic symptom categories (musculoskeletal pain, neurological, cardiovascular, gastrointestinal, sleep, and lethargy) and total somatic symptom severity differed significantly between groups. Results: Most participants (80%) reported moderate to high levels of somatic symptoms, and more than half the sample had probable comorbid post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). Mean total somatic symptom severity for the comorbid PTSD–MDD group was high and differed significantly from that of the PTSD- and MDD-only groups (medium severity) and the group with neither condition (mild severity). Severity of most mean somatic symptom categories differed significantly between comorbid PTSD and MDD for all other groups. Discussion: Results suggest that the presentation of comorbid PTSD and MDD is more detrimental in terms of somatic symptom severity than that of either disorder separately. Although there were some differences in the severity of specific somatic symptom types between the PTSD-only and the MDD-only groups, overall severity did not differ. After diagnosis of a mental health condition, military personnel and Veterans should be screened for somatic symptoms.

LAY SUMMARY Military personnel and Veterans receiving psychotherapy for mental health diagnoses such as posttraumatic stress disorder (PTSD) often have only modest symptom improvement. The authors wondered whether participating in a therapeutic recreation and creative arts group along with psychotherapy would aid recovery. A 12-week program called the my Social life, Expression, Leisure and Food (mySELF) group was created that offered therapeutic recreation, art, and music therapy. A total of 36 clients, most with PTSD, who had been receiving psychotherapy for an average of three years completed the program and submitted pre- and post-group questionnaires. The authors examined leisure attitudes, quality of life, and mental health symptoms before, immediately after, and four months after the group. Results showed significant improvements in leisure attitudes, environmental quality of life and depression, anxiety, stress, and PTSD symptoms. These preliminary results suggest that therapeutic recreation, art, and music therapy are beneficial for military personnel, Veterans, and Royal Canadian Mounted Police receiving psychotherapy.

LAY SUMMARY The Montreal Cognitive Assessment (MoCA) is a test of mild cognitive impairment that is commonly administered to military personnel seeking mental health treatment. However, there is little research on the average MoCA score for military Veterans. This study looked at MoCA scores provided by Canadian Armed Forces members and Veterans receiving services for an operational-related mental health condition. Scores below the cut-off for mild cognitive impairment were not uncommon and were related to education level, as well as to severity of posttraumatic stress disorder and depression. These findings will help clinicians better contextualize score variation among clients.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is often accompanied by other mental health conditions, including major depressive disorder (MDD), substance misuse disorders, and anxiety disorders. The objective of the current study is to delineate classes of comorbidity and investigate predictors of comorbidity classes amongst a sample of Canadian Armed Forces (CAF) Regular Force personnel. METHODS: Latent class analyses (LCAs) were applied to cross-sectional data obtained between April and August 2013 from a nationally representative random sample of 6700 CAF Regular Force personnel who deployed to the mission in Afghanistan. RESULTS: MDD was the most common diagnosis (8.0%), followed by PTSD (5.3%) and generalized anxiety disorder (4.7%). Of those with a mental health condition, LCA revealed 3 classes of comorbidity: a highly comorbid class (8.3%), a depressed-only class (4.6%), and an alcohol use–only class (3.1%). Multinomial logit regression showed that women (adjusted relative risk ratio [ARRR] = 2.77; 95% CI, 2.13 to 3.60; P < 0.01) and personnel reporting higher trauma exposure (ARRR = 4.18; 95% CI, 3.13 to 5.57; P < 0.01) were at increased risk of membership in the comorbid class compared to those without a mental health condition. When compared to those with no mental health condition, experiencing childhood abuse increased the risk of being in any comorbidity class. CONCLUSIONS: Results provide further evidence to support screening for and treatment of comorbid mental health conditions. The role of sex, childhood abuse, and combat deployment in determining class membership may also prove valuable for clinicians treating military-related mental health conditions.