Composite Measure of Mental Health Problems in Canadian Armed Forces Veterans – 2013 Life After Service Survey
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Citation: Thompson JM, VanTil L, Zamorski MA, Fikretoglu D, Dursun S, Sweet J, Garber B, Richardson JD, Sareen J, Courchesne CE, Pedlar D. Composite Measure of Mental Health Problems in Canadian Armed Forces Veterans – 2013 Life After Service Survey. Charlottetown PE: Research Directorate, Veterans Affairs Canada. Research Directorate Technical Report. 15 May 2017.
This paper describes a new way to use the Life After Service Studies (LASS) survey data to better describe the mental health of Canadian Armed Forces (CAF) Veterans. The LASS surveys collected data from former CAF members (Veterans) who were released from service from 1998. The surveys are giving us the first clear look at the well-being of these Canadian Veterans in the areas of mental and physical health, employment, education, finances, life skills and knowledge, social integration and their social environment.
The 2013 LASS survey measured mental health in five ways: (1) chronic mental health conditions diagnosed by a health professional, (2) symptoms of psychological distress, (3) symptoms of PTSD, (4) self-rated mental health and (5) mental health-related quality of life. Until now, our reports about mental health in these Veterans used those measures individually, which did not give us enough information about the extent of mental health problems in CAF Veterans.
This paper reports on a method that we devised to combine the first three of the mental health measures into a single composite measure. The method is an improvement because it combines measures of both diagnosed conditions and symptoms not yet diagnosed. This paper explains how we developed and tested the approach to describing the mental health of these Veterans using this combined measure.
We found that this composite measure provides a much clearer picture of mental health in CAF Veterans than single measures, and that it has good evidence of validity. The new measure is being used in analyses of data collected in the LASS surveys to inform policies, programs and services that support the well-being of Veterans and their families.
Background. Mental health problems (MHP) are prevalent worldwide in civilian populations and in serving and former (Veteran) military personnel. The design, delivery and monitoring of effective policies, programs and services for Veterans begins with understanding the extent of MHPs across the full range of severity. Methods are required to identify the characteristics and sizes of subgroups with greater and lesser needs both to target limited resources for greatest effect and to monitor outcomes. This study extends the literature on mental health survey analysis by exploring a method for combining brief self-report population survey measures to meet that requirement.
Methodology. Data came from the 2013 Life After Service Survey of Canadian Armed Forces (CAF) Veterans. The composite, three-level ordinal MHP variable was derived by combining self-reported diagnosed mental health conditions, Kessler’s measure of psychological distress (K10), and the primary care posttraumatic stress disorder screen (PC-PTSD). The approach to combining these measures was developed through expert consultation and exploratory data analysis. Weighted population estimates, statistical tests and logistic regression were used to assess extent of MHPs and correlations with outcomes of interest.
Results. The prevalence of any MHP was 38.7%: a fifth (22.3%) had mild-moderate MHP and an eighth (16.4%) had severe. The composite measure was strongly correlated with difficult adjustment to civilian life (odds ratio 10.9) and correlated in expected ways with poor self-rated mental health (225.3), low SF-12 mental component summary (163.1), comorbidity of three or more physical health conditions (3.2), chronic pain (3.9), often having activity restriction (12.8), life stress (5.8), low social support (7.4), suicidal ideation (52.4), Veterans’ disability benefits (4.8), counsellor or social work consultation (8.7), psychologist consultation (10.7) and hospitalization (3.1).
Conclusions. This study demonstrates a method for combining individual brief mental health population survey measures to provide the first comprehensive picture of the full spectrum of mental health problems in CAF Veterans. There was evidence of validity of the composite measures. The findings point toward a stepped approach to resourcing services that optimize mental health and well-being in Veterans.
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