OSIs refer to any persisting psychological difficulty, such as depression or PTSD, that results from one’s operational experiences (e.g., military service). Projects in this area broadly explore OSI treatments, including pharmacological treatments, and subjective experiences of recovering from OSIs through treatment.

Pharmacogenetics study:

Optimizing pharmacological treatment for psychiatric conditions can be a lengthy trial-and-error process. Advances in pharmacogenetics may allow for a more efficient path to recovery if genetic information can be used to guide optimal pharmacological recommendations. This study will assess the value of a simple pharmacogenetic test in CAF Veterans seeking psychiatric treatment for their OSIs. This approach holds potential to save time and accelerate the path to recovery.

Prescription patterns:

This study will explore prescription patterns across Operational Stress Injury (OSI) clinics in Canada by surveying clinicians that currently treat military and Veteran populations for PTSD. Clinicians will provide data including considerations during the decision-making process, years in practice, use of diagnostic tools and interview protocols, and de-identified patient characteristics via chart review, such as PTSD subtype and symptom presentation. 

Understanding Recovery from PTSD:

Clinicians generally use scores on quantitative surveys or clinical interviews to categorize patients as “recovered” or “not recovered”. Although efficient, the ways in which patients’ lives have changed throughout their recovery are not captured, nor are objective biological measures associated with PTSD recovery. In this project, qualitative data, clinical assessments, and biomarker analysis will be combined to create a comprehensive snapshot of the different stages of illness/recovery from military-related PTSD, and the role of social support in this process.

Projects in this area look at resilience as it applies to experiences with mental health as well the application in the Road to Mental Readiness (R2MR) program. R2MR is a mental health education and resilience training program that is delivered to all CAF members throughout their career to improve short-term performance and long-term psychological outcomes.

Qualitative study on stress resilience and mental health programming in the CAF:

The R2MR program has been implemented as the primary source of mental health and stress resilience training in the CAF since its launch in 2008. Given the occupational demands of the CAF, it is essential that such programming is well-received and perceived to be effective. This project aims to understand how CAF members perceive current programming and where they see opportunities for improvement.

• Fikretoglu, D., Liu, A., Nazarov, A., & Blackler, K. (2019). A group randomized control trial to test the efficacy of the Road to Mental Readiness (R2MR) program among Canadian military recruits. BMC psychiatry, 19(1), 1-14.

Identifying CAF member preferences for R2MR: 

Optimizing the R2MR program to its users requires understanding relevant CAF member preferences. This study is an experimental, primary data collection study that will identify the relative importance of mental health and resilience training features among a sample of active CAF personnel. Findings will be used to provide guidance on improving current training, including guidelines for prioritizing training features based on participant preferences.

Personality and Resilience in PTSD:

This study looks to assess whether personality traits impacted associations between combat experiences and PTSD symptomatology in Canadian Armed Forces Veterans. Results showed that combat experiences, emotionality, resilience, extraversion, and agreeableness predicted PTSD symptoms. This research enhances understanding of traits as risk and protective factors for PTSD symptoms.

• Lawson Research: Researchers receive over $40,000 to study role of personality and resiliency in Veteran mental health

• Global News: Veterans Affairs Canada awards $40k to Lawson for veteran mental health study

• CTV News: Veterans Affairs gives $40K towards veteran mental health research in London

Moral injury is characterized by the psychological distress developed after performing, witnessing or failing to prevent acts that conflict with deeply held moral standards. Projects in this area strive to improve our understanding of the rates, predictors, and outcomes of moral injury.

Loneliness and Moral Injury: 

Although moral injury leads to adverse mental health outcomes (e.g., suicidal ideation), the mechanisms responsible for these associations are still unclear. Given research findings that individuals with moral injury socially withdraw, especially if they experience significant shame, it is possible that loneliness may be elevated among those with moral injury. This study explores whether moral injury is associated with adverse mental health outcomes as a result of elevated feelings of loneliness.  

Moral Distress and Well-Being of Health Care Workers During the COVID-19 Pandemic:

The COVID-19 pandemic may disproportionately impact health care workers (HCWs). Low resource supplies, changing and unclear protocols, overwhelming patient load, and high risk of infection, may mean HCWs are faced with excessive psychological demands and challenging moral dilemmas at work (e.g., which patients to prioritize for resource allocation, and how to balance personal risk with work responsibilities). This study examines the longitudinal impact of the pandemic on HCWs’ psychological well-being.

• Plouffe, R. A., Nazarov, A., Forchuk, C. A., Gargala, D., Deda, E., Le, T., Bourret-Gheysen, J., Jackson, B., Soares, V., Hosseiny, F., Smith, P., Roth, M., MacDougall, A. G., Marlborough, M., Jetly, R., Heber, A., Albuquerque, J., Lanius, R., Balderson, K., Dupuis, G., Mehta, V., & Richardson, J. D. (2021). Impacts of morally distressing experiences on the mental health of Canadian health care workers during the COVID-19 pandemic. European journal of psychotraumatology, 12(1), 1984667. Pre-print

• London Free Press: “Local researchers ask: Is PTSD a pandemic side-effect for moral distress about health-care workers?”

• CTV News: “Study hopes to understand and minimize distress on health care workers during pandemic”

Confidentiality related to Moral Injury:

Potentially morally injurious events involve an individual acting, witnessing, or failing to prevent situations that conflict with deeply held moral beliefs. Due to perceived ethical ambiguities associated with some of these events, CAF members and Veterans may withhold details of their trauma or avoid seeking help due to worries about confidentiality. This study explores Veterans’ and military members’ beliefs about confidentiality in mental health care and whether those beliefs serve as barriers to help-seeking and disclosure, especially as compared to traumatic events without moral components.

• Nazarov, A., Plouffe, R., Forchuk, C., Richardson, JD. (2021, October). Beliefs about confidentiality and attitudes toward disclosure of moral injuries. Paper presented at the Canadian Psychiatric Association’s 71st Annual Conference, online.

• Nazarov, A., Plouffe, RA., Forchuk, C., Trahair, C., Richardson, JD. (2021, October). Beliefs about Confidentiality and Attitudes toward Disclosure of Moral Injuries. Paper to be presented at the Canadian Institute for Military and Veteran Health Research Virtual Forum.

Moral Injury Epidemiology:

The 2018 CAFVMHS survey is the first national survey to include a well-validated measure of moral injury, and thus represents an ideal opportunity to explore the predictors, prevalence, and outcomes associated with moral injury. Our team will assess the prevalence and severity of moral injury in active and released CAF personnel, the sociodemographic and military-related predictors of moral injury, and the impact of moral injury on adverse mental health outcomes and treatment-seeking.

Psychometrics is a field of study concerned with the accurate and reliable measurement of psychological constructs. Projects in this area serve to assess and validate psychological measures within Veteran or military populations.

Validating the Moral Injury Outcome Scale (MIOS):

Current measures of moral injury don’t well-differentiate between exposure to potentially morally injurious events and expression of moral injury symptoms. The MIOS is a novel measure to assess the expression of moral injury symptoms. This project seeks to refine and validate the scale in Veteran and military samples. The MIOS is now available to be used in research and clinical settings.

• Litz BT, Plouffe RA, Nazarov A, Murphy D, Phelps A, Coady A, Houle SA, Dell L, Frankfurt S, Zerach G, Levi-Belz Y and The Moral Injury Outcome Scale Consortium. (2022). Defining and Assessing the Syndrome of Moral Injury: Initial Findings of the Moral Injury Outcome Scale Consortium. Front. Psychiatry 13:923928. doi: 10.3389/fpsyt.2022.923928.

• Yeterian, J. D., Berke, D. S., Carney, J. R., McIntyre‐Smith, A., St. Cyr, K., King, L., Kline, N. K., Phelps, A., Litz, B. T., & Moral Injury Outcomes Project Consortium. (2019). Defining and measuring moral injury: Rationale, design, and preliminary findings from the moral injury outcome scale consortium. Journal of Traumatic Stress, 32(3), 363-372.

Validating the Mental Health Continuum - Short Form (MHC-SF):

Psychological well-being is often considered as an absence of psychopathology. The MHC-SF measures positive well-being, such as experiences of happiness, meaning, and community. However, this scale has not been validated in military or Veteran samples. This study aims to validate the MHC-SF in a Veteran sample.

Projects in this area examine military and Veteran health at the population level. Data originate from Statistics Canada surveys, such as the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS), which is the first longitudinal survey of military and Veteran mental health using gold standard epidemiological survey techniques.

Sleep and Suicide Epidemiology:

The role of sleep disturbances on suicidal behaviours and mental illnesses is being investigated in a large nationally representative sample of CAF members and Veterans. Analyses will examine the associations between sleep disturbances and suicidal behaviours, and whether associations vary according to individual differences. The results of this study can be used to understand the implications of sleep problems, and to determine which individuals may be most severely impacted by sleep problems.

• Don Richardson, J., King, L., St Cyr, K., Shnaider, P., Roth, M. L., Ketcheson, F., Balderson, K., & Elhai, J. D. (2018). Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans. BMC psychiatry, 18(1), 1-8.

Moral Injury Epidemiology:

The 2018 CAFVMHS survey is the first national survey to include a well-validated measure of moral injury, and thus represents an ideal opportunity to explore the predictors, prevalence, and outcomes associated with moral injury. Our team will assess the prevalence and severity of moral injury in active and released CAF personnel, the sociodemographic and military-related predictors of moral injury, and the impact of moral injury on adverse mental health outcomes and treatment-seeking.

Projects in this area examine the widespread impacts of the COVID-19 pandemic including impacts on psychological well-being, lifestyle and routine, social well-being, and health care accessibility and satisfaction.

Veteran Pandemic Study:

The COVID-19 pandemic may be particularly distressing for those with existing psychological vulnerabilities, such as CAF Veterans. Sudden changes to lifestyle and occupation, financial difficulties, and social distancing mandates may increase psychological distress, disrupt social and familial relations, and increase loneliness. Further, changes to health care treatments (such as decreased availability and move to virtual care) may also exacerbate psychological distress. This study examines the longitudinal impact of the pandemic on CAF Veterans and their spouses.   

• Richardson, J. D., St. Cyr, K., Forchuk, C., Liu, J. J., Plouffe, R. A., Le, T., Gargala, D., Deda, E., Vanessa, S., Fardous, H., Smith, P., Dupius, G., Roth, M., Bridgen, A., Marlborough, M., Jetly, R., Heber, A., Lanius, R., & Nazarov, A. (2022). Well-being of Canadian Veterans during the COVID-19 pandemic: cross-sectional results from the COVID-19 Veteran well-being study. European Journal of Psychotraumatology, 13(1), 2012374.

• Government of Canada: Researchers study mental health effects of pandemic on Veterans and their spouses

• Ontario Hospital Association (OHA): Study Shows a Decline in Veterans’ Mental Health Throughout the Pandemic

• Global News: New study looks to speak to veterans and their spouses about the impact of COVID-19 on mental health

• HuffPost: “Canadian Veterans Face New Challenges During The COVID-19 Pandemic”

Loneliness of Veterans during the pandemic:

Existing data suggest high rates of loneliness among CAF Veterans, which have been associated with adverse outcomes such as depression and suicidality. As the COVID-19 pandemic has resulted in drastic limitations to social opportunities, CAF Veterans may experience elevated rates of loneliness and associated psychological outcomes. This study examines the impact of the COVID-19 pandemic on loneliness and related outcomes among CAF Veterans.

Moral Distress and Well-Being of Health Care Workers During the COVID-19 Pandemic:

The COVID-19 pandemic may disproportionately impact health care workers (HCWs). Low resource supplies, changing and unclear protocols, overwhelming patient load, and high risk of infection, may mean HCWs are faced with excessive psychological demands and challenging moral dilemmas at work (e.g., which patients to prioritize for resource allocation, and how to balance personal risk with work responsibilities). This study examines the longitudinal impact of the pandemic on HCWs’ psychological well-being.

• Plouffe, R. A., Nazarov, A., Forchuk, C. A., Gargala, D., Deda, E., Le, T., Bourret-Gheysen, J., Jackson, B., Soares, V., Hosseiny, F., Smith, P., Roth, M., MacDougall, A. G., Marlborough, M., Jetly, R., Heber, A., Albuquerque, J., Lanius, R., Balderson, K., Dupuis, G., Mehta, V., & Richardson, J. D. (2021). Impacts of morally distressing experiences on the mental health of Canadian health care workers during the COVID-19 pandemic. European journal of psychotraumatology, 12(1), 1984667. Pre-print

• Atlas Institute for Veterans and Families

• Bellwood Health Services

• Boston University

• Canadian Institute for Military and Veteran Health Research (CIMVHR)

• Centre for Addiction and Mental Health (CAMH)

• Centre of Excellence for Chronic Pain

• Combat Stress UK

• Dallaire Institute

• Defence Research & Development Canada

• Department of National Defence

• Heroes in Mind, Advocacy and Research Consortium (HiMARC)

• Homewood Health