Discontinuation of mental health treatment among Canadian military personnel
Publication: Journal of Military, Veteran and Family Health
Volume 10, Number 5
LAY SUMMARY
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.
Abstract
Introduction: Mental health problems are prevalent among Canadian Armed Forces (CAF) personnel. Despite ongoing efforts to promote mental health help seeking, treatment non-completion remains an overlooked issue in military settings. This study sought to provide estimates of past-year mental health treatment discontinuation among active CAF personnel, common reasons for discontinuation, and factors associated with treatment non-completion. Methods: Data from a nationally representative, cross-sectional mental health survey of active CAF Regular Force (RegF; n = 6,696) and Reserve Force (ResF; n = 1,469) personnel were analyzed. Predictors of treatment non-completion were examined using a series of logistic regressions. Results: Among RegF members, 20.8% sought mental health treatment in the past year. Of this sub-group, 38.4% discontinued all forms of treatment within the same year. Notably, only 26.6% of those who discontinued reported doing so because they completed the recommended course of treatment. Similar patterns were found among ResF personnel. Among RegF members, higher education, being married or in a common-law relationship, being a senior non-commissioned member, having a history of childhood maltreatment, and lower social support were associated with an increased likelihood of treatment non-completion. Common reasons for non-completion included feeling better, thinking treatment was not helping, and not being comfortable with the approach. Discussion: This study highlights the complexities of military mental health services provision and offers the first nationally representative analysis of treatment discontinuation in a Canadian military population. Recognizing the reasons for treatment discontinuation may enable future initiatives designed to enhance treatment completion among active military personnel.
Résumé
Introduction : Les troubles de santé mentale sont prévalents auprès du personnel des Forces armées canadiennes (FAC). Malgré des efforts continus pour promouvoir les demandes d’aide en santé mentale, le non-achèvement du traitement demeure un enjeu méconnu en contexte militaire. Cette étude visait à fournir des estimations sur l’arrêt du traitement en santé mentale au cours de l’année précédente parmi les membres du personnel actif des FAC, les raisons courantes de mettre un terme au traitement et les facteurs associés au non-achèvement du traitement. Méthodologie : Les données d’un sondage transversal sur la santé mentale représentatif sur la scène nationale, réalisé auprès du personnel des Forces régulières (FReg; n = 6 696) et des Forces de réserve (FRes; n = 1 469) des FAC, ont été analysées. Les prédicteurs du non-achèvement du traitement ont été examinés à l’aide d’une série de régression logistique. Résultats : Chez les membres des FReg, 20,8 % avaient réclamé un traitement en santé mentale au cours de l’année précédente. Dans ce sous-groupe, 38,4 % ont arrêté toute forme de traitement au cours de la même année. Notamment, seulement 26,6 % des personnes qui ont mis un terme à leur traitement ont déclaré l’avoir fait parce qu’elles avaient atteint la durée recommandée. Des tendances semblables ont été observées au sein du personnel des FRes. Chez les membres de FReg, une plus grande scolarisation, le fait d’être marié(e) ou conjoint(e) de fait, d’être militaire du rang supérieur, d’avoir été victime de maltraitance pendant l’enfance et de profiter d’un faible soutien social étaient associés à une plus forte probabilité de ne pas achever le traitement. Les raisons courantes de ne pas terminer le traitement incluaient se sentir mieux, penser que ce n’était pas utile et de ne pas être à l’aise face à cette approche. Discussion : Cette étude fait ressortir les complexités des services en santé mentale chez les militaires et propose la première analyse représentative nationale de l’arrêt du traitement dans une population de militaires canadiens. Si l’on admet pour quelles raisons le traitement a été arrêté, il sera peut-être possible de lancer de futures initiatives pour favoriser un achèvement accru du traitement au sein du personnel militaire en service actif.
INTRODUCTION
Despite organizational efforts to maintain and enhance the well-being and resilience of military personnel, mental health disorders remain prevalent among members of the Canadian Armed Forces (CAF), with one in six CAF Regular Force (RegF) personnel meeting diagnostic criteria for a mental health disorder.1 Research and prevention efforts have largely focused on understanding and reducing barriers to seeking care;2–8 however, premature discontinuation from treatment (i.e., treatment non-completion) remains an underexplored issue that may be a valuable target for health services to improve clinical outcomes.
Previous epidemiological surveys of Canadian military personnel indicate that many individuals with a mental health disorder eventually seek treatment, albeit with substantial delays amounting to several years.9 Still, a concern exists that not all those who access mental health services receive sufficient treatment. Remaining in and completing the entire course of evidence-based treatment increases the likelihood of receiving a clinically efficacious interventional dose and outcome. Unfortunately, treatment non-completion remains a major problem among active military and Veteran samples, as documented by consistently high treatment dropout rates.10–13 In a meta-analysis by Goetter et al.,10 dropout rates from psychotherapy for military-related posttraumatic stress disorder (PTSD) varied greatly (5%−78%), with a pooled dropout rate estimated at 36%. In a population-based cohort of U.S. Army personnel returning from Afghanistan, 22% of those who sought treatment for PTSD dropped out before completing treatment (see also Jennings et al.14). Dropout rates in military samples are comparable, yet slightly more elevated, than those reported in analyses of the general population. In a meta-analysis exploring psychotherapy dropout rates by mental disorder, Swift and Greenberg reported pooled dropout rates of 21%, 19%, and 15% for PTSD, depression, and generalized anxiety disorder (GAD),15 respectively (see also Imel et al.12).
Several reasons for dropout have been posited, including patient beliefs, socio-demographic characteristics, clinical characteristics, and clinician-specific factors. Among military personnel, self-reliance, treatment conflicts with work, difficulty getting appointments, insufficient time with a mental health professional, stigma, treatment ineffectiveness, confidentiality concerns, and discomfort with how the professional interacted are frequently reported as reasons for dropout.11,14,16,17 Other factors associated with increased dropout rates among military personnel include younger age, mental health comorbidities, and history of traumatic brain injury.13,18,19 Routine clinical care settings, group treatment, and a greater number of sessions have also been associated with higher dropout rates,10,12,18 whereas modality of treatment (i.e., telehealth) has not.10 It is plausible that treatment discontinuation for mental health concerns may also vary on the basis of provider type. For instance, professionals with specialization in mental health (psychiatrists, psychologists) typically apply more focused, tailored, and evidence-based treatment strategies; however, non-specialized clinicians (e.g., general practitioners), although crucial in the initial identification of and referral for mental health concerns, may have a more generalized and less tailored approach, potentially affecting treatment effectiveness and patient adherence.
Taken together, there are substantive gaps in the understanding of the magnitude of and factors associated with treatment discontinuation among Canadian military personnel. Moreover, previous research has focused primarily on psychotherapy and has not differentiated dropout rates between provider types. This study aims to 1) provide nationally representative prevalence estimates of past-year mental health treatment discontinuation among active CAF personnel, 2) characterize reasons for discontinuation, and 3) identify factors associated with treatment non-completion.
METHODS
Participants
Data were drawn from a cross-sectional, population-based survey of CAF personnel conducted by Statistics Canada between April and August 2013 (i.e., the 2013 Canadian Forces Mental Health Survey).20 Because of survey sampling limitations, the analysis was limited to all RegF and only Primary Reserve Force (ResF) personnel who deployed in support of the mission in Afghanistan. Research ethics, data collection, and data access were approved by the relevant review bodies within Statistics Canada. All participants provided informed consent. The data are owned by Statistics Canada and can be accessed through Research Data Centres after appropriate approvals. More information on survey methodology can be found in Zamorski et al.20
Exposure and outcome measures
Assessing treatment discontinuation
As part of a larger initiative to understand help seeking in the CAF, participants were asked whether, during the past 12 months, they had “seen, or talked on the telephone to, any of the following people about problems with your emotions, mental health, or use of alcohol or drugs”: 1) psychiatrist, 2) family doctor or general practitioner (GP), 3) psychologist, 4) nurse, including CAF case manager, 5) social worker, counsellor, or psychotherapist, 6) peer support coordinator from the Operational Stress Injury Social Support program,21 7) religious or spiritual advisor, such as a priest, padre, chaplain, or rabbi, 8) family member, 9) friend, other than a co-worker, supervisor, or boss, 10) co-worker, supervisor, or boss, and 11) other. Respondents who endorsed contact with a professional (any use of sources 1–5) were asked whether they “stopped seeing the [type of professional]” (yes or no). If respondents endorsed termination of professional contact, they were presented with a list of possible reasons and asked to specify why they stopped seeing each professional. Survey question design allowed respondents to provide more than one response for each professional, if desired. Treatment discontinuation was further classified into “treatment completion” and “treatment non-completion,” based on respondents’ reasons for discontinuation. Specifically, if respondents’ reasons for discontinuation included the option “completed all the recommended treatment,” they were categorized as treatment completers. If respondents did not select the option “completed all the recommended treatment,” they were classified as treatment non-completers. The list of potential reasons for discontinuation is found along with the results in Table A1. Although respondents were able to select “other” and specify their reason through a free-form response, qualitative analysis of free-form responses to the other category was outside the scope of this analysis. Because of low cell counts for some provider types, and to allow for logistic regression analyses exploring predictors of treatment non-completion, individual provider types were combined into mental health specialist (psychiatrists, psychologists, social workers) and non-specialist (family doctors and nurses) provider categories.
Covariates
The World Health Organization’s Composite International Diagnostic Interview (CIDI, Version 3.0) modules were used to assess the presence of mental disorders,22 following the definitions of the Diagnostic and Statistical Manual of Mental Disorders (fourth edition; DSM-IV).23 The clinical covariate of interest was the presence of a mental disorder (i.e., major depressive disorder [MDD], GAD, PTSD, alcohol misuse or dependence) and suicidal ideation within the past year. Childhood maltreatment was captured as a binary indicator for any childhood maltreatment (i.e., witnessing a parent being physically violent in the home, experiencing physical abuse or sexual abuse, interactions with a child protection organization about difficulties at home). Social support was assessed with the total score on the 10-item Social Provisions Scale.24–26
Statistical methods
To ensure the results would be representative of the entire CAF population, final survey weights calculated by Statistics Canada were used in all analyses. To account for complex survey design, variance calculations were conducted using replicate weights provided by Statistics Canada.27 A series of logistic regressions were conducted to explore the association between treatment non-completion and clinical, military, and socio-demographic variables. Complete-case analysis was used through listwise deletion, yielding exclusion of 1%−5% of respondents, depending on the variables included in the models. All analyses were conducted with SAS statistical software Version 9.4 (SAS Institute, Cary, NC), with an α level set at 0.05 for defining statistical significance.28
RESULTS
Demographic information
A full list of socio-demographic, military, and clinical characteristics can be found in Table 1. The following text omits the 95% confidence intervals (CIs) for brevity (see corresponding tables for exact values). The unweighted sample of 8,165 participants consisted of RegF and ResF personnel (weighted N = 68,866). The presence of any selected past 12-month mental health disorders was identified among 16.50% and 19.35% of RegF and ResF members, respectively. Suicidal ideation was reported as 4.26% among RegF personnel and 5.83% among ResF personnel. The presence of any childhood maltreatment was 47.74% among RegF personnel and 48.85% among ResF personnel.
| Variable | Weighted estimate, % (95% CI)* | |
|---|---|---|
| Regular Force | Reserve Force | |
| Age, y | ||
| 17–24 | 13.29 (12.38–14.20) | 8.93 (7.42–10.44) |
| 25–34 | 37.61 (36.44–38.77) | 41.52 (39.17–43.87) |
| 35–44 | 27.73 (26.65–28.81) | 20.98 (18.94–23.02) |
| 45–60 | 21.37 (20.48–22.25) | 28.57 (26.45–30.69) |
| Sex | ||
| Male | 86.15 (85.30–87.00) | 90.63 (89.10–92.15) |
| Female | 13.85 (13.00–14.70) | 8.93 (7.40–10.46) |
| Primary language | ||
| English | 76.73 (75.47–77.99) | 82.59 (80.61–84.57) |
| French | 23.33 (22.07–24.59) | 16.96 (14.98–18.95) |
| Marital status | ||
| Married | 45.25 (44.03–46.46) | 41.96 (39.70–44.23) |
| Common-law | 20.32 (19.26–21.39) | 17.41 (15.39–19.43) |
| Separated, widowed, or divorced | 7.52 (6.88–8.16) | 6.25 (4.97–7.53) |
| Single | 26.88 (25.80–27.96) | 33.93 (31.64–36.21) |
| Highest education level | ||
| Secondary or less | 29.82 (28.67–30.97) | 22.42 (20.27–24.58) |
| More than secondary | 70.18 (69.03–71.33) | 77.58 (75.42–79.73) |
| Ethnicity or cultural background | ||
| White | 93.65 (93.00–94.30) | 92.38 (91.02–93.73) |
| Non-white | 6.35 (5.70–7.00) | 7.62 (6.27–8.98) |
| Deployed out of Canada | 60.90 (59.98–61.82) | 100.00 |
| Presence of selected past 12-mo mental health issues | ||
| MDD | 7.96 (7.27–8.64) | 8.52 (7.03–10.01) |
| GAD | 4.69 (4.16–5.22) | 4.05 (3.02–5.09) |
| PTSD | 5.25 (4.65–5.86) | 6.79 (5.34–8.24) |
| Panic disorder | 3.38 (2.90–3.86) | 4.11 (3.05–5.17) |
| Alcohol misuse | 2.52 (2.08–2.95) | 3.59 (2.59–4.58) |
| Alcohol dependence | 1.96 (1.59–2.34) | 2.24 (1.41–3.07) |
| Any | 16.50 (15.54–17.46) | 19.35 (17.19–21.52) |
| Suicide ideation | 4.26 (3.70–4.82) | 5.83 (4.64–7.02) |
| Any childhood maltreatment | 47.74 (46.35–49.13) | 48.85 (46.27–51.49) |
| No. of traumatic events | ||
| 0 | 13.46 (12.61–14.31) | 2.69 (1.81–3.57) |
| 1 | 13.62 (12.73–14.50) | 6.73 (5.36–8.09) |
| ≥2 | 72.93 (71.84–74.01) | 90.58 (88.94–92.22) |
*
The 95% CIs are calculated on the basis of standard errors from bootstrapping
CI = confidence interval; MDD = major depressive disorder; GAD = generalized anxiety disorder; PTSD = posttraumatic stress disorder.
Prevalence of treatment seeking, discontinuation, and non-completion
Among RegF members who sought mental health treatment in the past year (20.76%), 67.42% stopped consulting at least one provider and 38.44% stopped consulting all providers within the same year. Of the group that stopped all consultations, only 26.56% reported stopping because they completed the recommended treatment (i.e., treatment completers), and 67.78% reported stopping treatment for other reasons (i.e., treatment non-completers). Among RegF members who consulted any specialized providers in the past year (18.38%), 45.69% stopped consulting all specialized providers. Of those who stopped consulting all specialized providers, only 32.22% were treatment completers (i.e., 67.78% were treatment non-completers). Among RegF members who consulted any non-specialized providers in the past year (11.91%), 38.48% stopped consulting all non-specialized providers. Of those who stopped consulting all non-specialized providers, only 26.53% completed the recommended treatment. (Refer to Table 2 for complete results on treatment discontinuation.)
Among ResF members who sought mental health treatment in the past year (18.39%), 64.29% stopped consulting at least one provider and 43.90% stopped consulting all providers in the same year. Of the group that stopped all consultations, only 17.65% were treatment completers (i.e., 82.35% were treatment non-completers). Among ResF members who consulted any specialized providers in the past year (15.70%), 48.57% stopped consulting all specialized providers. Of those who discontinued all specialized treatment, only 23.53% completed the recommended treatment (i.e., 76.47% stopped treatment for all other reasons). Among ResF members who consulted any non-specialized providers in the past year (9.42%), 36.36% stopped consulting all non-specialized providers. Of those who discontinued all non-specialized treatment, only 25.00% completed the recommended treatment. (Refer to Table 3 for complete results for ResF members who discontinued treatment.)
| Pattern over past 12 mo | n (%), 95% CI* | ||
|---|---|---|---|
| Any specialized provider (psychiatrist, psychologist, social worker) | Any non-specialized provider (family doctor, nurse) | Any provider | |
| Past 12 months consultation | 11,820 (18.38), 17.38–19.37 | 7,660 (11.91), 11.08–12.73 | 13,360 (20.76), 19.72–21.81 |
| Consultation discontinuation* | |||
| Stopped consulting all | 5,400 (45.69), 42.48–48.89 | 2,940 (38.48), 34.57–42.39 | 5,120 (38.44), 35.48–41.40 |
| Stopped consulting ≥1 | 7,360 (62.27), 59.22–65.32 | 3,720 (48.69), 44.95–52.43 | 8,980 (67.42), 64.74–70.09 |
| Reasons† | |||
| Completed all the recommended treatment‡ | |||
| Stopped consulting all | 1,740 (32.22), 28.79–35.66 | 780 (26.53), 21.89–31.17 | 1,360 (26.56), 23.93–29.19 |
| Stopped consulting ≥1 | 2,260 (30.71), 27.08–34.33 | 980 (26.49), 21.59–31.38 | 2,380 (26.50), 23.25–29.75 |
| Other reasons (treatment non-completion) | |||
| Stopped consulting all | 3,660 (67.78), 64.34–71.21 | 2,160 (73.47), 68.83–78.11 | 3,760 (73.44), 70.81–76.07 |
| Stopped consulting ≥1 | 5,100 (69.29), 65.67–72.92 | 2,720 (73.51), 68.62–78.41 | 6,600 (73.50), 70.25–76.75 |
*
95% CIs of the percentages are calculated on the basis of standard errors from bootstrapping.
†
Assessed among participants who have sought any professional help in the past 12 months.
‡
Assessed among participants who have stopped seeing the professional.
CI = confidence interval.
| Pattern over past 12 mo | n (%), 95% CI* | ||
|---|---|---|---|
| Any specialized provider (psychiatrist, psychologist, social worker) | Any non-specialized provider (family doctor, nurse] | Any provider | |
| Past 12-month consultation | 700 (15.70), 13.80–17.59 | 420 (9.42), 7.86–10.97 | 820 (18.39), 16.33–20.44 |
| Consultation discontinuation* | |||
| Stopped consulting all | 340 (48.57), 42.22–54.92 | 160 (36.36), 28.10–44.63 | 360 (43.90), 37.95–49.85 |
| Stopped consulting at least one | 440 (62.86), 56.45–69.26 | 200 (47.62), 39.07–56.17 | 540 (64.29), 58.34–70.24 |
| Reasons† | |||
| Completed all the recommended treatment‡ | |||
| Stopped consulting all | 80 (23.53), 16.94–30.12 | 40 (25.00), 15.28–34.72 | 60 (17.65), 12.48–22.82 |
| Stopped consulting at least one | 100 (22.73), 15.89–29.56 | 40 (22.22), 11.14–33.31 | 100 (19.23), 13.29–25.17 |
| Other reasons (Treatment non-completion) | |||
| Stopped consulting all | 260 (76.47), 68.43–84.51 | 120 (75.00), 62.41–87.59 | 280 (82.35), 77.18–87.52 |
| Stopped consulting at least one | 340 (77.27), 70.44–84.11 | 140 (77.78), 66.69–88.86 | 420 (80.77), 74.83–86.71 |
*
95% CIs of the percentages are calculated on the basis of standard errors from bootstrapping.
†
Assessed among participants who have sought any professional help in the past 12 months.
‡
Assessed among participants who have stopped seeing the professional.
CI = confidence interval.
Reasons for treatment non-completion
A complete list of reasons for treatment discontinuation for RegF and ResF members can be found in Table A1 and Table A2, respectively. Briefly, reasons for treatment non-completion included, in order of decreasing prevalence, feeling better, thinking treatment was not helping, being uncomfortable with the professional approach, desire to solve the problem without professional help, problems such as transportation, child care, or scheduling, service or program no longer being available, and perception that the problem would get better without further professional help. Relatively few individuals reported issues related to discrimination or unfair treatment, being too embarrassed to see a professional, and not being able to afford the treatment (sample size too low to disclose prevalence). Other reasons not captured by these existing categories were endorsed by 27.13% and 21.43% of RegF and ResF members who stopped seeing all providers, respectively.
Factors associated with treatment discontinuation
RegF personnel
Results of bivariate associations for RegF personnel can be found in Table A3. In the multiple logistic regression model, increased likelihood of treatment non-completion among RegF personnel across all providers was associated with higher education (i.e., post-secondary vs. less than post-secondary; adjusted odds ratio [AOR] = 1.20, 95% CI, 1.03–1.39), being married or common-law (AOR = 1.28, 95% CI, 1.11–1.47), being a senior non-commissioned member (AOR = 1.38, 95% CI 1.11–1.73), having a history of childhood maltreatment (AOR = 1.17, 95% CI 1.02–1.34), and poorer social support (AOR [reverse reference group] = 0.97, 95% CI, 0.95–0.98).
Predictors of treatment non-completion common to both specialized and non-specialized mental health providers were marital status (being married or common-law vs. all others), no history of deployment outside of Canada, and presence of childhood maltreatment (AORs excluded for brevity; see Table 4). Higher education and absence of past-year suicidal ideation were associated with treatment non-completion only with specialized providers. Being older, male, an officer, absence of a past-year mental health diagnosis, and poorer social support were related to treatment non-completion only with non-specialized providers. Trauma load was found to have divergent impacts on treatment non-completion between specialized and non-specialized health care providers. Having two or more traumatic events increased the likelihood of treatment non-completion with non-specialized mental health professionals but decreased the likelihood of treatment non-completion with specialized mental health professionals.
| Predictors | AOR (95% CI) | |||||
|---|---|---|---|---|---|---|
| Specialized providers | Non-specialized providers | All providers | ||||
| Stopped consulting all | Stopped consulting ≥1 | Stopped consulting all | Stopped consulting ≥1 | Stopped consulting all | Stopped consulting ≥1 | |
| Demographic factors | ||||||
| Age: 17–34 y (ref. = 35–60 y) | 1.13 (0.98–1.31) | 1.12 (0.99–1.27) | 0.60* (0.47–0.76) | 0.57* (0.47–0.70) | 1.12 (0.96–1.31) | 1.11 (0.98–1.24) |
| Sex: female (ref. = male) | 0.91 (0.78–1.06) | 1.02 (0.89–1.17) | 0.61* (0.48–0.77) | 0.94* (0.76–1.15) | 1.06 (0.89–1.26) | 1.07 (0.94–1.21) |
| Education: post-secondary (ref. = lower) | 1.38* (1.21–1.59) | 1.39* (1.24–1.56) | 1.09 (0.89–1.33) | 1.04 (0.87–1.24) | 1.20* (1.03–1.39) | 1.26* (1.13–1.41) |
| Marital status: married or common-law (ref. = all others) | 1.65* (1.44–1.88) | 1.38* (1.23–1.54) | 1.24* (1.03–1.51) | 1.23* (1.04–1.45) | 1.28* (1.11–1.47) | 1.09 (0.98–1.21) |
| Military factors | ||||||
| Deployed outside of Canada (ref. = no) | 0.78* (0.68–0.89) | 0.83* (0.74–0.94) | 0.50* (0.40–0.63) | 0.64* (0.53–0.78) | 0.93 (0.80–1.08) | 0.88* (0.79–0.99) |
| Rank (ref.: officer) | ||||||
| Junior NCM | 0.98 (0.82–1.17) | 1.12 (0.96–1.31) | 0.34* (0.25–0.46) | 0.46* (0.35–0.60) | 0.85 (0.70–1.03) | 1.03 (0.89–1.19) |
| Senior NCM | 1.19 (0.97–1.45) | 1.22* (1.03–1.45) | 0.46* (0.33–0.65) | 0.55* (0.41–0.75) | 1.38* (1.11–1.73) | 1.33* (1.13–1.56) |
| Past 12-mo mental health disorder | 1.03 (0.90–1.17) | 1.22* (1.09–1.37) | 0.80* (0.67–0.97) | 0.83* (0.70–0.98) | 0.97 (0.84–1.12) | 1.21* (1.09–1.34) |
| Past 12-mo suicide ideation | 0.81* (0.66–0.99) | 0.89 (0.76–1.04) | 1.13 (0.88–1.45) | 1.01 (0.82–1.24) | 0.96 (0.76–1.22) | 1.08 (0.93–1.26) |
| Any childhood trauma (ref. = no) | 1.27* (1.12–1.43) | 1.17* (1.05–1.30) | 1.24* (1.03–1.50) | 1.00 (0.85–1.18) | 1.17* (1.02–1.34) | 1.14* (1.03–1.26) |
| Social support total score | 0.98 (0.97–1.00) | 0.98**(0.97–0.99) | 0.94* (0.92–0.95) | 0.91* (0.90–0.93) | 0.97* (0.95–0.98) | 0.95* (0.94–0.96) |
| No. of traumatic events (ref. = 0) | ||||||
| 1 | 0.94 (0.70–1.25) | 0.84 (0.65–1.08) | 1.21 (0.85–1.74) | 1.60* (1.16–2.20) | 1.29 (0.97–1.72) | 1.11 (0.89–1.38) |
| ≥2 | 0.65* (0.52–0.82) | 0.69* (0.56–0.85) | 1.79* (1.32–2.44) | 2.65* (2.03–3.46) | 0.95 (0.76–1.18) | 1.12 (0.93–1.33) |
Note: Past 12-month mental health disorder includes major depressive disorder, generalized anxiety disorder, posttraumatic stress disorder, panic disorder, alcohol misuse, and alcohol dependence. Childhood trauma includes physical abuse, sexual abuse, and domestic violence.
*
Statistically significant.
AOR = adjusted odds ratio; CI = confidence interval; ref. = reference category; NCM = non-commissioned officer.
ResF personnel
Results of bivariate associations for ResF members can be found in Table A4. The number of predictors included in the multiple logistic regressions for ResF members (Table 5) was restricted because of the limited sample size. Controlling for other variables, increased likelihood of treatment non-completion among ResF members across all providers was associated only with being female. Treatment non-completion with specialized providers was associated with being female, being married or common-law (vs. all others), and absence of a past-year mental health disorder.
| Demographic factors | AOR (95% CI) | |||
|---|---|---|---|---|
| Stopped consulting all specialized providers | Stopped consulting ≥1 specialized provider | Stopped consulting all providers | Stopped consulting ≥1 provider | |
| Age: 17–34 y (ref. = 35–60 y) | 1.06 (0.61–1.84) | 0.82 (0.50–1.34) | 0.63 (0.34–1.14) | 0.73 (0.46–1.15) |
| Sex: female (ref. = male) | 3.49* (1.04–11.74) | 2.45 (0.98–6.12) | 4.06* (1.22–13.52) | 2.80* (1.13–6.93) |
| Education: post-secondary (ref. = lower) | 0.73 (0.38–1.43) | 1.03 (0.58–1.84) | 0.54 (0.25–1.17) | 0.66 (0.37–1.17) |
| Marital status: married or common-law (ref. = all others) | 1.81* (1.01–3.22) | 1.17 (0.70–1.93) | 1.90 (0.98–3.66) | 1.19 (0.74–1.91) |
| Past 12-month mental health disorder | 0.56* (0.32–0.98) | 0.83 (0.51–1.35) | 0.95 (0.50–1.81) | 0.86 (0.54–1.36) |
| Social support total score | 0.93 (0.88–1.00) | 0.90* (0.84–0.95) | 0.97 (0.91–1.03) | 0.91* (0.87–0.96) |
Note: Past 12-month mental health disorder includes major depressive disorder, generalized anxiety disorder, posttraumatic stress disorder, panic disorder, alcohol abuse, and alcohol dependence.
AOR = adjusted odds ratio; CI = confidence interval; ref. = reference category.
DISCUSSION
This is the first study to explore specific patterns and predictors of mental health treatment discontinuation among a nationally representative sample of Canadian military personnel. Unique to this work was the ability to differentiate treatment discontinuation rates across specialized and non-specialized providers among both RegF and ResF personnel. Overall, the results highlight a large proportion of military personnel terminating mental health treatment in the past year (representing close to 50% of those who were seeking care), with the majority not completing the recommended treatment. Reasons for ending treatment early included feeling better, thinking the treatment was not helping, and being uncomfortable with the professional approach. Furthermore, some of the most common predictors of treatment non-completion included education, marital status, childhood maltreatment, and social support, with several other predictors being specific to either RegF or ResF members or uniquely related to non-completion with either specialized or non-specialized professionals.
Previous literature focused more on encouraging military members to seek help and less on keeping them in treatment long enough to derive sufficient and long-lasting improvements. Among RegF personnel, close to 40% of those who sought care from any provider within the past year discontinued all consultations in the same year (discontinuation was higher for specialized providers; similar patterns were found for ResF members). Despite high prevalence, treatment discontinuation may be not only appropriate but advisable in some cases, especially when the advised course of action has been followed and beneficial results have been obtained. However, only one-third of those who discontinued treatment reported completing all recommended treatment as the reason for discontinuation, meaning that the majority of discontinuation stemmed from treatment non-completion. Aside from completing treatment, the most common reason for discontinuation was that the individual felt better. Although it is encouraging that many CAF personnel perceived improvements while seeking care, whether these individuals’ intended treatment outcomes were achieved, or whether they had clinically significant improvements before discontinuation, is unknown. In the absence of the previously mentioned clinical information, it is challenging to interpret this finding. On one hand, that individuals discontinued treatment because they felt better is a positive finding. On the other hand, recent research has suggested that military personnel may require a personalized and longer course of treatment, especially for trauma-related psychotherapies that target PTSD and MDD.29,30 Furthermore, the absence of treatment outcome data in tandem with the individual’s report of feeling better raises concerns about sustained improvement in symptomatology, symptom recurrence, and relapse.31–33
Reasons for treatment non-completion in this sample were multi-faceted, with approximately 12% reporting discomfort with the approach to treatment as a reason for treatment non-completion, suggesting a disconnect between the therapeutic approach and treatment preferences of CAF personnel. A strong therapeutic relationship that fosters patients’ understanding of mental health conditions, supports understanding of how treatment will facilitate improvements in mental health outcomes, and corrects potential misperceptions has been identified as an important aspect of predicting dropout from psychotherapeutic interventions.18,34,35 Presently, few CAF personnel report feeling too embarrassed to seek professional help as a reason for discontinuation, which is consistent with a demonstrated increase in service use among CAF personnel in recent decades,36 and this suggests that stigma may not be a driving factor among treatment non-completers.
Similarly, several notable predictors of non-completion were identified. Among RegF personnel, socio-demographic variables, including higher education, history of childhood maltreatment, and being in a married or common-law relationship, were associated with a greater likelihood of stopping treatment with at least one specialized provider. Social support networks may confer motivation for seeking treatment and readiness to discontinue treatment,37 because this investigation observed that individuals in married or common-law relationships showed a greater likelihood of treatment discontinuation than unpartnered individuals. These individuals may leverage social support networks or, at a minimum, perceive the availability of help from these individuals as sufficient support to discontinue treatment. This finding offers an opportunity for treatment engagement efforts directed toward engaging military spouses and families in the early stages of treatment to ensure they understand the clinical implications of treatment completion. Contrary to expectations, military personnel reporting higher education demonstrated a higher likelihood of treatment non-completion. Past studies in the general population have identified that those with lower education discontinue treatment at higher rates,35 although inconsistent results pertaining to education have been observed in military and Veteran populations.10
It is interesting that female ResF personnel had a higher likelihood of treatment non-completion across all providers and specialized providers. There is a dearth of published literature explaining the impact of female gender on treatment discontinuation among military reservists. Anecdotally, female ResF personnel may have less time available to engage in treatment because of conflicting time demands related to civilian employment, as well as family demands. This finding was not replicated for female RegF personnel and highlights an important area for future research and intervention.
Factors such as past-year suicidal ideation, endorsing two or more lifetime traumas, and having deployed outside of Canada were associated with a lower likelihood of treatment non-completion among RegF personnel. Whether these individuals were more likely to have been in prolonged contact with specialized care providers because of increased symptom severity and, therefore, were more aware of the clinical value of remaining in treatment is unknown. Yet the higher symptom severity that is likely associated with these predictors could be a plausible explanation for treatment completion. In a study of U.S. Army soldiers preparing to deploy to Afghanistan, an elevated risk for suicidal ideation during and after deployment was observed among service members who reported an ongoing or unmet need for mental health treatment or support before deployment.38 Thus, effectively treating active military personnel for their current mental health needs has a beneficial outcome on their mental health both during and after subsequent deployments. Given the difficulties associated with deployment and post-deployment reintegration, it is imperative that barriers to treatment are reduced, care is delivered in a culturally and situationally appropriate manner, and treatment plans are developed with operational demands in mind and in collaboration with the member receiving treatment. Systematic post-deployment screening programs have been implemented in an attempt to expedite care provision among CAF personnel who may be experiencing mental health concerns upon return from deployment. However, previous work has identified that only 67.3% of those on deployments requiring a post-deployment screen actually had one completed, and only 43.3% were completed within the compliant post-deployment period.39 Whether individuals captured through these screening programs simultaneously recognized the value in not only seeking treatment but also completing its full course warrants investigation.
Limitations
This study is not without its limitations. Given the self-report nature of the survey, a broad definition of treatment discontinuation was used; the type, dose, and length of treatment that was recommended or provisioned, as well as the specific mental health diagnoses, could not be determined. Thus, additional work is needed to understand the relation between unique treatment attributes and discontinuation. Although the survey included all RegF personnel, its coverage of ResF members was restricted solely to those who were deployed in support of the mission in Afghanistan, thereby constraining its applicability to the entire ResF population. Additionally, given that the survey was conducted among active CAF members, the results may not be generalizable to Veterans. Despite the dataset used in this analysis representing the most recent population-wide survey of treatment discontinuation in the Canadian military, data collection for this survey occurred in 2012–13. Over the past decade, the military health system has undergone changes, including added efforts to address mental health stigma and the adoption of more effective treatment approaches, rendering the data somewhat outdated for directly applying findings to the context of currently serving members. In this survey, it was not possible to disaggregate between treatment discontinuation occurring in base clinics and that occurring with community providers. Collectively, this warrants an updated examination of treatment discontinuation in today’s context, contrasted across care provider systems and capturing associated longitudinal trends. Furthermore, there is debate around the minimally required treatment dose and whether survey respondents had appropriate awareness of whether a recommended treatment was successfully completed or not, especially pertaining to non-specialists as defined in this study. Future research examining the agreement between provider-recommended treatment dose and patient understanding of this in relation to sustained long-term benefit is imperative. Incorporating qualitative methodologies could offer deeper insights into the findings and uncover the behavioural mechanisms at play.
Conclusion
This study aimed to address the gap in understanding the extent of mental health treatment discontinuation among Canadian military personnel, reasons for discontinuation, and factors associated with treatment non-completion. This investigation highlights substantial premature treatment discontinuation among military personnel and warrants the need to further explore barriers to treatment retention. Several reasons collected in this study confer undesirable discontinuation, such as discrimination or unfair treatment, lack of comfort with the professional approach, a belief that the treatment was not helping, and feeling too embarrassed to see a specialized provider. Many of these factors can be addressed through education and training of clinicians, as well as selection of personalized or individualized treatment approaches and an emphasis on patient preference. However, many individuals reported feeling better as a result of treatment and referenced feelings of self-sufficiency (i.e., the problem would get better on its own) as reasons for treatment non-completion. Although these may represent valid reasons for ending treatment early, research is needed to clarify how perceptions of completing recommended treatments vary by patient and provider.
ACKNOWLEDGEMENTS
The authors extend their heartfelt acknowledgment to the late Dr. Mark Zamorski, whose pivotal contributions and unwavering dedication significantly shaped the field of military mental health research in Canada and abroad. The authors also express gratitude to Katherine St. Cyr, Evelyn MacDonald, Eliza Khan, and Lisa King for their assistance in manuscript preparation and proofreading.
REGISTRY AND REGISTRATION NO. OF THE STUDY/TRIAL
N/A
ANIMAL STUDIES
N/A
PEER REVIEW
This manuscript has been peer reviewed.
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APPENDIX
| Any specialized provider (Psychiatrist, psychologist, social worker) | Any non-specialized provider (Family doctor, nurse) | Any provider | ||||
|---|---|---|---|---|---|---|
| Past 12-month consultation | 11820, 18.38% [17.38–19.37] | 7660, 11.91% [11.08–12.73] | 13360, 20.76% [19.72–21.81] | |||
| Consultation discontinuationa | Stopped consulting all | Stopped consulting at least one | Stopped consulting all | Stopped consulting at least one | Stopped consulting all | Stopped consulting at least one |
| 5400, 45.69% [42.48–48.89] | 7360, 62.27% [59.22–65.32] | 2940, 38.48% [34.57–42.39] | 3720, 48.69% [44.95–52.43] | 5120, 38.44% [35.48–41.40] | 8980, 67.42% [64.74–70.09] | |
| Reasons:b | ||||||
| Completed the recommended treatmentc | 1740, 32.22% [28.79–35.66] | 2260, 30.71% [27.08–34.33] | 780, 26.53% [21.89–31.17] | 980, 26.49% [21.59–31.38] | 1360, 26.56% [23.93–29.19] | 2380, 26.50% [23.25–29.75] |
| Other reasons | 3660, 67.78% [64.34–71.21] | 5100, 69.29% [65.67–72.92] | 2160, 73.47% [68.83–78.11] | 2720, 73.51% [68.62–78.41] | 3760, 73.44% [70.81–76.07] | 6600, 73.50% [70.25–76.75] |
| Felt betterd | 1620, 44.26% [38.88–49.64] | 1800, 35.29% [30.78–39.81] | 520, 24.07% [18.44–29.71] | 580, 21.32% [16.39–26.25] | 1840, 48.94% [43.52–54.35] | 2280, 34.44% [30.51–38.37] |
| Thought it was not helpingd | 1000, 27.32% [22.54–32.1] | 1260, 24.71% [20.69–28.73] | 360, 16.67% [11.61–21.73] | 440, 16.06% [11.52–20.60] | 980, 26.06% [21.15–30.98] | 1640, 24.85% [21.26–28.43] |
| Thought problem would get better without more professional helpd | 220, 6.01% [3.55–8.47] | 260, 5.1% [3.12–7.08] | 80, 3.70% [1.31–6.10] | 80, 2.92% [1.01–4.83] | 260, 6.91% [4.31–9.52] | 320, 4.85% [3.16–6.54] |
| Couldn’t afford to payd | NA | NA | 0 | 0 | NA | NA |
| Too embarrassed to see the professionald | 60, 1.64% [0.3–2.98] | 80, 1.57% [0.56–2.57] | 60, 2.78% [0.95–4.60] | 60, 2.19% [0.75–3.63] | 120, 3.19% [1.53–4.85] | 140, 2.12% [1.12–3.12] |
| Wanted to solve the problem without professional helpd | 360, 9.84% [6.79–12.88] | 400, 7.84% [5.53–10.16] | 120, 5.56% [2.43–8.68] | 120, 4.41% [1.92–6.91] | 380, 10.11% [7.00–13.22] | 500, 7.55% [5.48–9.63] |
| Problem like transportation, child care, or scheduled | 240, 6.56% [3.73–9.39] | 280, 5.49% [3.36–7.62] | 60, 2.78% [0.81–4.74] | 60, 2.21% [0.56–3.86] | 260, 6.91% [4.15–9.68] | 340, 5.15% [3.35–6.95] |
| Service or program no longer availabled | 240, 6.56% [3.86–9.25] | 400, 7.84% [5.38–10.3] | 160, 7.48% [4.16–10.79] | 240, 8.82% [5.57–12.08] | 300, 7.98% [5.22–10.73] | 580, 8.79% [6.56–11.02] |
| Not comfortable with professional’s approachd | 440, 12.02% [8.64–15.4] | 640, 12.55% [9.43–15.67] | 180, 8.41% [3.77–13.05] | 240, 8.76% [4.84–12.68] | 440, 11.70% [8.41–14.99] | 860, 13.03% [10.21–15.85] |
| Discrimination or unfair treatmentd | 100, 2.73% [1.09–4.37] | 160, 3.14% [1.22–5.05] | 100, 4.67% [1.44–7.90] | 100, 3.68% [1.13–6.22] | 140, 3.72% [1.73–5.71] | 280, 4.23% [2.39–6.07] |
| Othersd | 860, 23.5% [18.96–28.03] | 1640, 32.16% [27.79–36.52] | 1080, 50% [42.73–57.27] | 1400, 51.47% [45.17–57.77] | 1020, 27.13% [22.52–31.73] | 2660, 40.30% [36.15–44.46] |
a
assessed among subjects who have sought the professional help in the past 12 months.
b
assessed among subjects who have stopped seeing the professional in the past 12 months.
c
completed recommended treatment from all the providers stopped consultation to in the past 12 months.
d
assessed among subjects who were in the “Other reasons” for consultation discontinuation. Due to missing, denominators for some cells were smaller.
NA: Data not available because of insufficient sample size for disclosure (unweighted frequency < 5).
95%CI are reported related to percentages.
| Any specialized provider (Psychiatrist, psychologist, social worker) | Any non-specialized provider (Family doctor, nurse) | Any provider | ||||
|---|---|---|---|---|---|---|
| Past 12-month consultation | 700, 15.70% [13.80–17.59] | 420, 9.42% [7.86–10.97] | 820, 18.39% [16.33–20.44] | |||
| Consultation discontinuationa | Stopped consulting all | Stopped consulting at least one | Stopped consulting all | Stopped consulting at least one | Stopped consulting all | Stopped consulting at least one |
| 340, 48.57% [42.22–54.92] | 440, 62.86% [56.45–69.26] | 160, 36.36% [28.10–44.63] | 200, 47.62% [39.07–56.17] | 360, 43.90% [37.95–49.85] | 540, 64.29% [58.34–70.24] | |
| Reasons:b | ||||||
| Completed all the recommended treatmentc | 80, 23.53% [16.94–30.12] | 100, 22.73% [15.89–29.56] | 40, 25.00% [15.28–34.72] | 40, 22.22% [11.14–33.31] | 60, 17.65% [12.48–22.82] | 100, 19.23% [13.29–25.17] |
| Other reasons | 260, 76.47% [68.43–84.51] | 340, 77.27% [70.44–84.11] | 120, 75.00% [62.41–87.59] | 140, 77.78% [66.69–88.86] | 280, 82.35% [77.18–87.52] | 420, 80.77% [74.83–86.71] |
| Felt betterd | 140, 53.85% [43.14–64.55] | 140, 41.18% [32.01–50.34] | 40, 33.33% [18.39–48.28] | 40, 28.57% [15.16–41.98] | 160, 53.33% [42.91–63.76] | 180, 42.86% [34.41–51.30] |
| Thought it was not helpingd | 60, 23.08% [13.83–32.32] | 80, 23.53% [15.64–31.42] | 20, 16.67% [6.64–26.70] | 20, 14.29% [4.03–24.54] | 60, 21.43% [12.76–30.09] | 100, 23.81% [16.58–31.04] |
| Problem get better without helpd | 20, 7.69% [3.11–12.28] | 20, 5.88% [2.33–9.43] | NA | NA | 20, 6.67% [2.12–11.21] | 20, 4.76% [1.60–7.93] |
| Couldn’t afford to payd | NA | NA | 0 | 0 | NA | NA |
| Too embarrass to see professionald | NA | NA | 0 | 0 | NA | NA |
| Solve the problem without helpd | 20, 7.69% [1.37–14.02] | 20, 5.88% [1.01–10.75] | NA | NA | 20, 7.14% [0.75–13.54] | 40, 9.09% [4.43–13.75] |
| Problem like transportd child care | 20, 7.69% [2.84–12.54] | 20, 5.88% [1.4–10.37] | NA | NA | 20, 6.67% [2.18–11.15] | 20, 4.76% [0.64–8.89] |
| Service/program no longer availabled | 20, 7.69% [1.13–14.25] | 40, 11.76% [4.99–18.54] | 20, 14.29% [5.20–23.38] | 20, 12.50% [3.51–21.49] | 40, 13.33% [7.19–19.48] | 60, 14.29% [7.90–20.67] |
| Not comfortable w prof approachd | 20, 7.69% [2.35–13.04] | 20, 5.88% [1.19–10.58] | NA | NA | 20, 7.14% [1.92–12.36] | 40, 9.52% [4.79–14.26] |
| Discrimination/unfair treatmentd | 0 | NA | 0 | 0 | 0 | NA |
| Othersd | 40, 15.38% [7.4–23.37] | 100, 29.41% [21.09–37.74] | 40, 33.33% [19.01–47.66] | 60, 37.50% [23.87–51.13] | 60, 21.43% [13.24–29.62] | 140, 33.33% [25.73–40.94] |
a
assessed among subjects who have sought the professional help in the past 12 months.
b
assessed among subjects who have stopped seeing the professional in the past 12 months.
c
completed recommended treatment from all the providers stopped consultation to in the past 12 months.
d
assessed among subjects who were in the “Other reasons” for consultation discontinuation. Due to missing, denominators for some cells were smaller.
NA: Data not available because of insufficient sample size for disclosure (unweighted frequency < 5).
| Specialized Providers | Specialized Providers | All Providers | ||||
|---|---|---|---|---|---|---|
| Stopped consulting all | Stopped consulting at least one | Stopped consulting all | Stopped consulting at least one | Stopped consulting all | Stopped consulting at least one | |
| Demographics | ||||||
| Age: 17–34 (ref = 35–60) | 1.31 (1.17–1.47) | 1.23 (1.12–1.36) | 0.69 (0.59–0.82) | 0.60 (0.52–0.70) | 1.04 (0.92–1.18) | 1.05 (0.95–1.15) |
| Sex: Female (ref = male) | 1.07 (0.93–1.24) | 1.21 (1.06–1.37) | 0.63 (0.52–0.76) | 0.78 (0.65–0.92) | 1.04 (0.89–1.22) | 1.08 (0.96–1.21) |
| Education: Post-secondary (ref = lower) | 1.45 (1.28–1.64) | 1.44 (1.30–1.61) | 1.25 (1.05–1.50) | 1.29 (1.11–1.52) | 1.25 (1.09–1.43) | 1.33 (1.20–1.48) |
| Marital status: Married/common-law (ref = all others) | 1.73 (1.54–1.96) | 1.48 (1.34–1.65) | 0.99 (0.83–1.17) | 0.93 (0.80–1.08) | 1.33 (1.17–1.52) | 1.14 (1.03–1.25) |
| Military factors | ||||||
| Deployed out of Canada (ref = no) | 0.71 (0.63–0.80) | 0.76 (0.69–0.84) | 0.85 (0.72 – 1.00) | 1.00 (0.86–1.16) | 0.96 (0.85–1.09) | 0.88 (0.80–0.97) |
| Rank (ref: Officer) | ||||||
| Junior NCM | 0.95 (0.80–1.11) | 1.04 (0.90–1.19) | 0.42 (0.32–0.56) | 0.49 (0.38–0.63) | 0.83 (0.69–0.99) | 1.02 (0.89–1.17) |
| Senior NCM | 0.91 (0.76–1.10) | 1.00 (0.85–1.17) | 0.55 (0.40–0.74) | 0.67 (0.51–0.88) | 1.15 (0.93–1.42) | 1.16 (1.00–1.36) |
| Past 12-month mental health disorder | 1.09 (0.97–1.23) | 1.26 (1.14–1.39) | 1.08 (0.92–1.28) | 1.07 (0.92–1.23) | 1.08 (0.94–1.23) | 1.37 (1.24–1.50) |
| Past 12-month suicide ideation | 0.91 (0.76–1.08) | 1.04 (0.91–1.19) | 0.92 (0.74–1.14) | 0.84 (0.7–1.00) | 0.90 (0.73–1.11) | 1.28 (1.12–1.46) |
| Any childhood trauma (ref = no) | 1.19 (1.06–1.34) | 1.17 (1.06–1.30) | 1.47 (1.24–1.74) | 1.34 (1.16–1.56) | 1.21 (1.07–1.37) | 1.28 (1.17–1.41) |
| Social support total score | 0.98 (0.97–0.99) | 0.98 (0.97–0.99) | 0.92 (0.91–0.94) | 0.91 (0.89–0.93) | 0.97 (0.96–0.98) | 0.95 (0.94–0.96) |
| Ever experienced traumatic events (ref = no) | 0.61 (0.49–0.75) | 0.67 (0.55–0.81) | 1.94 (1.48–2.53) | 2.51 (1.98–3.19) | 0.93 (0.76–1.14) | 1.18 (1.00–1.39) |
| Number of experienced traumatic events (ref = 0) | ||||||
| 1 | 0.82 (0.62–1.09) | 0.81 (0.63–1.04) | 1.13 (0.81–1.59) | 1.50 (1.11–2.03) | 1.20 (0.90–1.59) | 1.09 (0.88–1.36) |
| 2+ | 0.59 (0.48–0.73) | 0.66 (0.54–0.80) | 2.11 (1.60–2.76) | 2.72 (2.14–3.47) | 0.90 (0.74–1.11) | 1.19 (1.00–1.40) |
Past 12-month mental health disorder includes MDD, GAD, PTSD, PD, alcohol abuse, and alcohol dependence.
Childhood trauma includes physical abuse, sexual abuse, and domestic violence.
| Stopped consulting all the specialized providers | Stopped consulting all the non-specialized providers | Stopped consulting all providers | Stopped consulting at least one provider | |
|---|---|---|---|---|
| Demographics | ||||
| Age: 17–34 (ref = 35–60) | 0.91 (0.55–1.49) | 0.75 (0.47–1.18) | 0.68 (0.40–1.18) | 0.73 (0.47–1.12) |
| Sex: Female (ref = male) | 4.19 (1.29–13.54) | 2.86 (1.18–6.91) | NA | NA |
| Education: Post-secondary (ref = lower) | 0.85 (0.45–1.61) | 1.13 (0.65–1.97) | NA | 0.73 (0.41–1.28) |
| Marital status: Married/common-law (ref = all others) | 1.59 (0.96–2.64) | 1.24 (0.78–1.96) | 1.51 (0.87–2.64) | 1.18 (0.77–1.83) |
| Military factors | ||||
| Deployed out of Canada (ref = no) | 1.11 (0.66–1.88) | 1.28 (0.80–2.06) | 1.21 (0.69–2.12) | 1.40 (0.89–2.18) |
| Rank (ref: Officer) | ||||
| Junior NCM | 0.66 (0.34–1.28) | 0.94 (0.52–1.69) | 1.31 (0.67–2.56) | 1.15 (0.67–1.99) |
| Senior NCM | 0.52 (0.25–1.08) | 0.64 (0.34–1.21) | 0.99 (0.49–2.01) | 0.90 (0.50–1.61) |
| Past 12-month mental health disorder | 0.56 (0.34–0.94)* | 0.86 (0.54–1.37) | 0.95 (0.53–1.72) | 0.86 (0.56–1.33) |
| Past 12-month suicide ideation | 0.63 (0.31–1.28) | 0.98 (0.54–1.78) | NA | 0.95 (0.53–1.71) |
| Any childhood trauma (ref = no) | 1.40 (0.85–2.32) | 1.51 (0.95–2.37) | 1.24 (0.72–2.13) | 1.38 (0.90–2.12) |
| Social support total score | 0.92 (0.87–0.98)* | 0.89 (0.84–0.95)* | 0.95 (0.90–1.01) | 0.91 (0.86–0.96)* |
| Ever experienced traumatic events (ref = no) | 0.95 (0.26–3.41) | 1.08 (0.30–3.85) | 0.68 (0.40–1.18) | 0.73 (0.47–1.12) |
| Number of traumatic events (ref = 0) | ||||
| 1 | 1.07 (0.16–7.09) | 1.07 (0.16–7.10) | NA | 0.73 (0.41–1.28) |
| 2+ | 0.94 (0.26–3.37) | 1.06 (0.30–3.79) | 1.51 (0.87–2.64) | 1.18 (0.77–1.83) |
Past 12-month mental health disorder includes MDD, GAD, PTSD, PD, alcohol misuse, and alcohol dependence.
Childhood trauma includes physical abuse, sexual abuse, and domestic violence.
NA: Data not available because of insufficient sample size for disclosure (unweighted frequency < 5).
Information & Authors
Information
Published In
Journal of Military, Veteran and Family Health
Volume 10 • Number 5 • November 2024
Pages: 72 - 88
Copyright
© His Majesty the King in Right of Canada, as represented by the Minister of Defence. The publisher holds the copyright for the article.
History
Received: 12 January 2024
Revision received: 27 March 2024
Accepted: 27 March 2024
Published in print: November 2024
Published online: 21 November 2024
Key Words:
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Authors
Contributors
Conceptualization: ML Roth, A Liu, SG Wanklyn, RA Plouffe, BM Bird, D Fikretoglu, B Garber, and JD Richardson
Methodology: A Nazarov, ML Roth, A Liu, SG Wanklyn, KS Dempster, RA Plouffe, BM Bird, D Fikretoglu, and B Garber
Validation: A Nazarov, A Liu, and RA Plouffe
Formal Analysis: A Liu
Investigation: A Liu, SG Wanklyn, RA Plouffe, BM Bird, D Fikretoglu, B Garber, and JD Richardson
Resources: A Nazarov, KS Dempster, and JD Richardson
Data Curation: A Liu
Writing — Original Draft: A Nazarov, A Liu, and SG Wanklyn
Writing — Review & Editing: A Nazarov, ML Roth, A Liu, SG Wanklyn, KS Dempster, RA Plouffe, BM Bird, D Fikretoglu, B Garber, and JD Richardson
Visualization: A Nazarov and A Liu
Supervision: A Nazarov, KS Dempster, and JD Richardson
Project Administration: A Nazarov and KS Dempster
Competing Interests
The authors have nothing to disclose.
Funding
No funding was received for this article.
Ethics Approval
This study was approved by the Department of National Defence and the Canadian Armed Forces Social Science Research Review Board, Canada.
Informed Consent
The authors confirm that informed patient consent has been secured.
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Journal of Military, Veteran and Family Health 2024 10:5, 72-88
Journal of Military, Veteran and Family Health 2024 10:5, 72-88