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Objective: Posttraumatic stress disorder (PTSD) and depression substantially impair healthrelated quality of life (HRQOL) for many Canadian Armed Forces (CAF) veterans. Although PTSD and depression are highly comorbid, little is known about whether the disorders may interact in their association with HRQOL. We sought to investigate whether depressive symptoms modify the relation between PTSD and HRQOL in treatment-seeking veterans. Method: We accessed the clinical data of 545 CAF veterans aged 18 to 65 years who were seeking treatment at a specialized clinic in London, Ontario. We used hierarchical linear regression to assess the additive and multiplicative relations between depression and PTSD symptoms on HRQOL, controlling for age and alcohol/substance abuse. Simple slopes were examined to probe significant interactions. Results: Probable PTSD and major depression were present in 77.4% and 85.3% of the sample, respectively, and 73.0% of the sample presented with probable PTSD-depression comorbidity. Depression symptoms significantly modified the relation between PTSD symptoms and overall mental HRQOL (β = 0.12, p

BACKGROUND: Military-related posttraumatic stress disorder (PTSD) is a complex diagnosis with non-linear trajectories of coping and recovery. Current approaches to the evaluation of PTSD and treatment discontinuation often rely on biomedical models that dichotomize recovery based on symptom thresholds. This approach may not sufficiently capture the complex lived experiences of Veterans and their families. To explore conceptualizations of recovery, we sought perspectives from Veterans and their partners in a pilot study to understand: 1) how Veterans nearing completion of treatment for military-related PTSD and their partners view recovery; and 2) the experience of progressing through treatment towards recovery. METHODS: We employed a concurrent mixed methods design. Nine Veterans nearing the end of their treatment at a specialized outpatient mental health clinic completed quantitative self-report tools assessing PTSD and depressive symptom severity, and an individual, semi-structured interview assessing views on their treatment and recovery processes. Veterans' partners participated in a separate interview to capture views of their partners' treatment and recovery processes. Descriptive analyses of self-report symptom severity data were interpreted alongside emergent themes arising from inductive content analysis of qualitative interviews. RESULTS: While over half of Veterans were considered "recovered" based on quantitative assessments of symptoms, individual reflections of "recovery" were not always aligned with these quantitative assessments. A persistent narrative highlighted by participants was that recovery from military-related PTSD was not viewed as a binary outcome (i.e., recovered vs. not recovered); rather, recovery was seen as a dynamic, non-linear process. Key components of the recovery process identified by participants included a positive therapeutic relationship, social support networks, and a toolkit of adaptive strategies to address PTSD symptoms. CONCLUSIONS: For participants in our study, ...

LAY SUMMARY This analysis of data from a large population-level survey uncovers a pressing issue related to mental health service use among Canadian Armed Forces members. Although many military members seek help for mental health issues, they often do not complete treatment. Data show that more than one-third of those who sought mental health care in the past year discontinued treatment within the same time frame. Alarmingly, only about 25% of these individuals indicated that they completed the recommended course of treatment. Many dropped out because they felt better, did not see results , or were uncomfortable with the treatment. Factors such as education level, marital status, rank, past trauma, and social support influenced this decision. This research is the first of its kind, providing a detailed look into the prevalence of and underlying reasons for discontinuing mental health treatment among Canadian military personnel. It highlights substantial treatment dropout that warrants the need to further explore barriers to and facilitators of treatment retention.

OBJECTIVES: The traumatic nature of high-risk military deployment events, such as combat, is well-recognized. However, whether other service-related events and demographic factors increase the risk of moral injury (MI), which is defined by consequences of highly stressful and morally-laden experiences, is poorly understood. Therefore, the objective of this study was to examine determinants of MI in Canadian Armed Forces (CAF) personnel. METHODS: Data were obtained from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS; unweighted n = 2,941). To identify military characteristics, sociodemographic variables, and deployment-related factors associated with increased levels of MI, a series of multiple linear regressions were conducted across deployed and non-deployed groups. RESULTS: When all variables were considered among the deployed personnel, rank, experiencing military related sexual trauma, child maltreatment (i.e., physical abuse, emotional abuse and neglect), and stressful deployment experiences were significant predictors of increased MI total scores (β = 0.001 to β = 0.51, p < 0.05). Feeling responsible for the death of an ally and inability to respond in a threatening situation were the strongest predictors of MI among stressful deployment experiences. Within the non-deployed sample, experiencing military-related or civilian sexual trauma and rank were significant predictors of increased MI total scores (β = 0.02 to β = 0.81, p < 0.05). CONCLUSION: Exposure to stressful deployment experiences, particularly those involving moral-ethical challenges, sexual trauma, and childhood maltreatment were found to increase levels of MI in CAF personnel. These findings suggest several avenues of intervention, including education and policies aimed at mitigating sexual misconduct, as well as pre-deployment training to better prepare military personnel to deal effectively with morally injurious experiences.

LAY SUMMARY Armed forces personnel are a population at risk for exposure to potentially traumatic and morally injurious events because of the high-risk nature of military operations. The impacts of deployment-related potentially morally injurious events (PMIEs) are increasingly being documented, with outcomes such as mental health and interpersonal problems showing consistent associations with exposure to events that deeply transgress an individual's deeply held moral beliefs. To date, the literature on deployment-related PMIEs has focused on events such as killing and exposure to atrocities. The impacts of situations in which military personnel encounter children, including children recruited and used as soldiers by local armies and militia, have not yet been examined systematically. This article highlights the scarcity of existing research on this topic and provides recommendations for future study regarding the impact of military encounters with children through the lens of moral injury.

LAY SUMMARY In 2015, the Canadian Armed Forces (CAF) implemented Operation HONOUR to eliminate sexual misconduct (SM) in the military. Sexual assault, inappropriate sexual behaviours, sexual harassment, and gender discrimination are all types of SM. Experiencing SM can result in depression, substance abuse, physical health problems, and even posttraumatic stress disorder (PTSD). Despite Operation HONOUR, SM still happens in the CAF. At this time, many groups are working together to address SM and to support those who have experienced SM. Canadian-based researchers, policy makers, military members, Veterans, and clinicians are collaborating to identify new approaches to training, culture change, research, and treatment relating to SM in the CAF. The end goal of working together is to minimize SM in the CAF and ensure the health and safety of all CAF members and Veterans.