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Background: Potentially morally injurious experiences (PMIEs) are common during military service. However, it is unclear to what extent PMIEs are related to well-established adverse mental health outcomes. Objective: The objective of this study was to use a population-based survey to determine the associations between moral injury endorsement and the presence of past-year mental health disorders in Canadian Armed Forces (CAF) personnel and Veterans. Methods: Data were obtained from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS). With a sample of 2,941 respondents, the weighted survey sample represented 18,120 active duty and 34,380 released CAF personnel. Multiple logistic regressions were used to assess the associations between sociodemographic characteristics (e.g. sex), military factors (e.g. rank), moral injury (using the Moral Injury Events Scale [MIES]) and the presence of specific mental health disorders (major depressive episode, generalized anxiety disorder, panic disorder, social anxiety disorder, PTSD, and suicidality). Results: While adjusting for selected sociodemographic and military factors, the odds of experiencing any past-year mental health disorder were 1.97 times greater (95% CI = 1.94–2.01) for each one-unit increase in total MIES score. Specifically, PTSD had 1.91 times greater odds (95% CI = 1.87–1.96) of being endorsed for every unit increase in MIES total score, while odds of past-year panic disorder or social anxiety were each 1.86 times greater (95% CI = 1.82–1.90) for every unit increase in total MIES score. All findings reported were statistically significant (p <.001). Conclusion: These findings emphasize that PMIEs are robustly associated with the presence of adverse mental health outcomes among Canadian military personnel. The results of this project further underscore the necessity of addressing moral injury alongside other mental health concerns within the CAF. Potentially morally injurious experiences are common during military service, but it is poorly understood how these experiences are related to other mental health disorders in Canadian Armed Forces members and Veterans. Following a series of multiple logistic regressions, the odds of experiencing a past-year mental health disorder were 1.97 (95% CI: = 1.94–2.01) times greater per unit increase in total Moral Injury Events Scale score. This emphasizes the association between morally injurious events and deleterious mental health outcomes in Canadian military personnel, and further highlights the importance of addressing moral injury in this population. [ABSTRACT FROM AUTHOR]

Background: PTSD and gambling disorder (GD) are frequently comorbid. Gambling may provide escape-based coping for the emotions experienced by PTSD sufferers. Military personnel may be at increased risk of PTSD and/or GD. Acceptance and Commitment Therapy (ACT) has been found to improve both PTSD and GD outcomes, yet research into the potential effectiveness of ACT for PTSD and/GD in veterans is scarce. Objective: This review aimed to systematically assess and describe the evidence relating to the use of ACT and acceptance-based therapy for military populations with PTSD and/or GD. Method: Six databases were searched. Selection criteria included studies that featured the armed forces/military, delivered ACT/acceptance-based therapy, and aimed to improve PTSD and/or GD outcomes. A narrative synthesis approach was adopted. Results: From 1,117 results, 39 studies were fully screened and 14 met inclusion criteria. All studies originated from the USA and 9 were associated with United States Department of Veterans Affairs. Therapy use within each study produced an improvement in PTSD and/or GD, yet only one study examined GD and no studies considered comorbid PTSD/GD. The broad range of study designs made it difficult to compare the findings or make generalisations from the collective results. It is unclear which method of ACT delivery is superior (app-based, telehealth, face-to-face, groups, one-to-one, manualised, or unstructured), or what the true effect size is of ACT for PTSD and/or GD. Conclusions: These preliminary findings are promising, yet more research is needed on the delivery format and content of ACT sessions, and whether findings generalise beyond USA-recruited military samples. The cost-effectiveness of remote-based ACT also warrants investigation. HIGHLIGHTS Among veterans, psychological interventions such as Acceptance and Commitment Therapy (ACT) may be effective for Post-Traumatic Stress Disorder (PTSD) and/or Gambling Disorder (GD). There is a paucity of evidence on ACT approaches for treating PTSD and GD in veterans. Further work is needed on context-specific delivery (in-person vs. group), method of ACT intervention (manualised vs unstructured, digital therapeutics) with non-US samples. [ABSTRACT FROM AUTHOR]

Background: During a deployment, soldiers must make seemingly impossible decisions, including having to engage with child soldiers. Such moral conflicts may continue to affect service members and veterans in the aftermath of a deployment, sometimes leading to severe moral distress, anguish, and personal crises. Service providers have increasingly argued that as a diagnosis, Post-Traumatic Stress Disorder (PTSD) cannot account for these deeply personal and painful moral conflicts. In light of this, the concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans. Objective: This paper addresses encounters with children and child soldiers during military deployments, as well as the risk for moral injury during and following these encounters, and their implications. This exploratory paper brings together existing literature on the topic to introduce, illustrate, and offer potential and promising interventions. Results: Given the potential moral conflicts that may ensue, military personnel who encounter child soldiers during a military deployment may be at risk for moral injury during and following these encounters. The introduction of the concept of moral injury provides a way for these largely unnamed personal and painful moral conflicts and violations to be recognized, addressed, and with appropriate care, remedied. Although there is limited research into their effectiveness at treating moral injury, individual and group-based interventions have been identified as potentially beneficial. Conclusion: As encounters with children during deployments are likely to continue, systematic research, training, healing interventions and prevention strategies are vital to support and protect children in conflict settings, as well as to ensure the mental health and well-being of service members and veterans. HIGHLIGHTS Profound moral conflicts may affect service members and veterans in the aftermath of a military deployment, sometimes leading to severe moral distress, anguish, and personal crises. The concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans. Encountering children and child soldiers during a military deployment, may present unique challenges, stress, and moral crises leading to potentially moral injurious events. In particular, transgression-based events which result from an individual perpetrating or engaging in acts that contravene his or her deeply held moral beliefs and expectations such as harming children, and betrayal-based events, which results from witnessing or falling victim to the perceived moral transgressions of others, may lead to lasting psychological, biological, spiritual, behavioural and social impairments. Interventions applied in both an individual-based context such as Cognitive Processing Therapy, Impact of Killing, Adaptive Disclosure, and a group-based context such as Acceptance and Commitment Therapy and Resilience Strength Training, have been identified as potentially beneficial to addressing moral injury. However, more research is required to ascertain appropriate and effective intervention and healing strategies. [ABSTRACT FROM AUTHOR]

Background: Military sexual trauma (MST) that involves assault is associated with poorer sexual function in U. S. women service members/veterans (SM/Vs). Theory of sexual function suggests that the presence of higher depression severity and more negative sexual self-schemas may contribute to sexual dysfunction. This has yet to be examined in partnered women SM/Vs who are survivors of MST. Objective: Using path analysis, the current study examined the associations of MST type, depression, sexual self-schemas, and sexual function in 818 partnered women SM/Vs. Method: Three separate mediation models were tested, all testing indirect effects of depression and sexual self-schemas on the association of MST type and sexual function. In Model 1, the mediation model assumed that exposure to MST predicted more severe depression, which then predicted more negative sexual self-schemas. More negative sexual self-schemas, in turn, predicted poorer sexual function. In Model 2, the mediation model assumed that exposure to MST predicted more negative sexual self-schemas, which then predicted more severe depression. More severe depression, in turn, predicted poorer sexual function. In Model 3, the mediation model assumed a parallel mediation in that exposure to MST predicted more severe depression and more negative sexual self-schemas, which in turn, predicted poorer sexual function. Results: The best fitting model suggested a parallel mediation of higher depression severity (estimate: −1.30, confidence interval: −1.91,-.69) and more negative sexual self-schemas (estimate: −2.09, confidence interval: −2.94,-1.24) on the association of assault MST and poorer sexual function (Model 3). Harassment-only MST was unrelated to sexual function through mediated pathways. Conclusions: Interventions to improve sexual function among MST survivors who experienced assault should address negative sexual self-schemas related to sexual performance and depressive symptoms. Cognitive behavioural interventions that include challenging maladaptive cognitions may be well suited to address this clinical need. Mechanisms of poor sexual function in military sexual trauma (MST) survivors are under-studied. Depression and sexual self-schemas mediated this association in assault survivors. Cognitive behavioral therapies that challenge maladaptive cognitions may decrease sexual dysfunction. [ABSTRACT FROM AUTHOR]

Background: The mental health burden of posttraumatic stress disorder (PTSD) is high in U.S. military samples. Social support is one of the most robust protective factors against PTSD and a recent meta-analysis indicates that this relationship is even stronger in military samples compared to civilian samples. Yet no meta-analyses have explored factors impacting this association in veterans and military service members (VSMs). Objective: The current meta-analysis examined demographic, social support, and military characteristics that may moderate the relationship of PTSD severity and social support among U.S. VSMs. Method: A search identified 37 cross-sectional studies, representing 38 unique samples with a total of 18,766 individuals. Results: The overall random effects estimate was −.33 (95% CI: −.38, −.27, Z = −10.19, p <.001), indicating that lower levels of social support were associated with more severe PTSD symptoms. PTSD measures based on the Diagnostic and Statistical Manual (DSM)-III had a larger effect size than measures based on DSM-IV or DSM-5. The social support source was a significant moderator such that support perceived from non-military sources was associated with a larger effect size than support perceived from military sources. This finding held after accounting for covariates. Deployment-era, timing of social support, and age were also significant moderators, but were no longer significantly associated with effect size after adjusting for covariates. Although previous meta-analyses have shown social negativity to be more impactful than positive forms of social support, there were too few studies conducted to evaluate social negativity in moderator analyses. Conclusion: Results suggest that social support received from civilians and in the home environment may play a greater protective role than social support received from military sources on long-term PTSD symptom severity. The literature on social support and PTSD in U.S. VSMs would be strengthened by studies examining the association of social negativity and PTSD symptoms. • Factors that impact the association of PTSD severity and social support among U.S. military service members are understudied. • A meta-analysis of 38 cross-sectional samples (N = 18,766) showed that higher levels of social support were associated with less severe PTSD symptoms. • Social support received from non-military sources had a stronger relationship with PTSD symptoms than support received from military sources. • Few studies have examined the relationship between social negativity and PTSD severity in military samples despite evidence that social negativity is a more robust predictor than positive forms of support. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) and depression substantially impair health-related 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. 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. 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 <0.001, ∆R2 = 0.014), and role impairment due to emotional difficulties (β = 0.20, p <0.001, ∆R2 = 0.035). Simple slope analyses revealed the impact of PTSD was greater among those with lower depression symptoms and became weaker with greater depression symptom severity. In adjusted models, only depression was significantly associated with all mental and physical HRQOL domains; PTSD was not associated with physical HRQOL, role emotional impairment, or vitality. For those with severe comorbid depression, PTSD symptoms were no longer associated with mental HRQOL, particularly in areas related to emotional functioning. Findings suggest the importance of targeting depression in patients presenting with PTSD-depression comorbidity. [ABSTRACT FROM AUTHOR]

Background: Exposure to a potentially morally injurious event (PMIE) has been found to be associated with a range of adverse mental health outcomes. However, how the psychological consequences following PMIEs compare to those encountered after a traumatic, but not a PMIE, remain poorly understood. Objective: The aim was to qualitatively explore UK military veterans' responses to experiences of trauma and moral injury and the impact of such events on psychological wellbeing. Method: Thirty male veterans who reported exposure to traumatic and/or morally injurious events were recruited. Semi-structured qualitative interviews were conducted, and data were analysed using thematic analysis. Results: Six veterans described exposure to a non-morally injurious traumatic event, 15 reported experiencing a PMIE, and 9 described exposure to a 'mixed' event which was simultaneously morally injurious and traumatic. Veterans who encountered a PMIE described experiencing moral dissonance, or a clash between concurrently held sets of values (e.g. military values versus civilian values), which provoked considerable psychological distress. Veterans' cognitions and responses were found to differ following a PMIE compared to a traumatic, but not PMIE, which could have negative implications for daily functioning. Several risk and protective factors for experiencing distress following a PMIE were described. Conclusions: This study provides some of the first evidence that events experienced by UK veterans can simultaneously be morally injurious and traumatic or life-threatening as well as highlighting the process by which moral injury may occur in UK veterans. These findings illustrate the need to examine effective pathways for prevention and intervention for veterans who have experienced a morally injurious event. [ABSTRACT FROM AUTHOR]

The present article reflects on the military dictatorship in Brazil (1964-1985), seeking to inquire as to the basis of power used by the Regime to retain State control for over 20 years. The general aim is to understand the legal mechanisms used by the military government to maintain public power. A brief comparison is made between the authoritarian systems of the Southern Cone during the 1960s, analyzing the preferred regulatory production of the despotic system, in order to describe the juggling acts performed in the legislation. Finally, the article aims to comprehend the lengthy process of transition to the New Republic. To do so, the deductive approach method is used, along with the historic and monographic procedure methods, combining the techniques of bibliographic and documentary research by means of a review of the literature produced on the subject. As expected, the results demonstrate the harnessing of the Law according to the momentary interests of the occupants of the upper tiers of the federal administration, the maneuvers employed to weaken the opposition, and that the transition negotiated during the 1980s generated a form of democracy granted/conceded by the military commanders. [ABSTRACT FROM AUTHOR]

Background: UK armed forces personnel are at risk of occupational psychological injury; they are often reluctant to seek help for such problems. Objective: We aimed to examine and describe sources of support, prevalence and associates of help-seeking among UK serving and ex-serving personnel. Method: A total of 1450 participants who self-reported a stress, emotional or mental health problem in the past 3 years were sampled from a health and wellbeing study and subsequently completed a telephone interview comprising measures of mental disorder symptoms, alcohol misuse and help-seeking behaviour. Results: Seven per cent of participants had not sought any help, 55% had accessed medical sources of support (general practitioner or mental health specialist), 46% had received formal non-medical (welfare) support and 86% had used informal support. Gender, age, perceived health, functional impairment, social support, deployment, alcohol and comorbidity impacted upon the choice of help source. Conclusions: This study found that the majority of those with perceived mental health problems sought some form of help, with over half using formal medical sources of support. [ABSTRACT FROM AUTHOR]

Objective: To explore the prevalence rate of suicidal ideation and its risk and protective factors in military personnel. Methods: A total of 2071 military personnel were investigated by stratified random cluster sampling in May to August of 2015. The Question 7 of Beck Depression Scale (BDI) was used to test suicide ideation (item 7 score ^1 was dovetailed in suicide ideation group). Family, social demographic and occupational factors were assessed with the self-made general characteristics questionnaire. The data were analyzed with multiple stepwise logistic regression. Results: There were 382 (18.4% ) military personnel whose scores of item 7 were 1. Family history of suicide (OR = 42. 97, 95% Cl = 29. 14 - 63. 35), surrounding suicide (OR =2. 46, 95% Cl = 1. 75 - 3. 46), drinking (OR = 1. 64,95% Cl = 1. 31 - 2. 07) and level of education (OR = 1. 38, 95% Cl = 1. 01 -1. 90) were risk factors of suicidal ideation. Protective factors were (OR =0. 60, 95% Cl = 0. 50 -0. 72) and station (OR =0. 15, 95% Cl = 0. 03 -0. 64). Conclusion: It suggests that in suicidal prevention for military, more attention is deserved paying to those military personnel who have family history of suicide, surrounding suicide, drinking habit, and are stationed in remote areas and air force. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of exercise on bone mineral density (BMD) and hip bone geometry in mild growth stage of males by comparing the difference of BMD and geometry of the hip between military and non-military young males. Methods Sixty military and 60 non-military young males were included in this retrospective study. BMD of the lumbar spine (L1-L4) and the left femoral neck was measured with dual energy X-ray absorptiometry (DXA). Hip structural analysis was performed using a hip strength analysis software (HSA) on the DXA scans. Results The BMD of the total lumbar spine and the femoral neck in military group increased by 2.97% and 6.45%, respectively, comparing to those in non-military group. The difference of BMD was not statistically significant in the lumbar spine (P>0.05), but was statistically significant in the femoral neck between the two groups (P<0.05). The comparison results of femoral neck geometric parameters showed that FN-CSA and FN-CT in the military group were larger than those in the non-military group (P<0.05), but FN-BR was significantly lower than that in the non-military group (P<0.01). CSMI and SM showed no significant difference between the two groups (P>0.05). Conclusion Exercise improves bone strength by increasing BMD and improving bone geometry of the proximal femur. Increased bone mass and hip bone geometry structure remodeling together improve the bone strength. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of acclimatization time on heart function of soldiers rushing into plateau and the countermeasures. Methods: 241 male soldiers who needed to rush into plateau were selected. Their heart function under different acclimatization time at high altitude were observed, and targeted interventions explored. Results: When compared to before entering the plateau, the HP, LVEF, LVFS, CO and LVEDVI levels 3 days into plateau, the HP, LVEF, LVFS and LVEDVI levels 7 days into plateau, the HP, LVEF and LVEDVI levels 14 days into plateau, the HP level 30 days into plateau, all have statistical significance (P＜0.05). when compared to 3 days into plateau, the HP, LVEF, LVFS, CO and LVEDVI levels 30 days and 60 days into plateau all have statistical significance (P＜0.05). The HP level 30 days into plateau was lower than that in 7 days into plateau. The differences among HP, LVEF and LVEDVI levels between 60 days and 7 days into plateau were statistically significant (P＜0.05). The HP levels 30 and 60 days into plateau were both lower than that 14 days into plateau, and the differences statistically significant (P＜0.05). Conclusion: The heart function of soldiers will be greatly influenced when they are sudden at high altitude. With effective interventions and increase of acclimatization time, the influence will gradually disappear and will not affect the normal work and training of soldiers. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic Stress Disorder (PTSD) is associated with significant functional impairment in important areas, including interpersonal relationships and occupational or educational roles. Preliminary evidence suggests that the dissociative subtype of PTSD (PTSD+DS), characterized by marked symptoms of depersonalization and derealization, is associated with increased functional impairment and disease severity, including among military members and veterans diagnosed with PTSD. Similarly, first responders (e.g. police, fire, paramedics) have also been found to experience dissociative symptoms. Despite these findings, little work has investigated whether dissociative symptoms are related to heightened functional impairment among these populations. Objective: We examined the relation between functional impairment and symptom level variables, including dissociative symptoms of depersonalization and derealization among military members, veterans, and first responders with probable PTSD. We further investigated the hypothesis that dissociative symptoms mediate the relation between PTSD symptomatology and functional impairment. Method: Eighty-one medical charts of inpatients at a residential PTSD treatment programme were accessed via retrospective review. Sixty-two were included in the present analyses. Comparison of means on symptom measures between first responders and military members/veterans were conducted, followed by correlational and mediation analyses. Results: Compared with first responders, military members and veterans showed higher levels of derealization, functional impairment, alexithymia, anxiety, and depression. Within the total sample, dissociative symptoms emerged as the strongest correlate of functional impairment and, among the dissociative symptom clusters, derealization symptoms demonstrated the strongest relation with impairment. Mediation analyses revealed that total dissociative symptoms and derealization symptoms significantly mediated the relation between PTSD symptoms and functional impairment. Conclusions: These findings highlight the importance of assessing and treating dissociative symptoms, consistent with the dissociative subtype of PTSD, among military members, veterans, and first responders with PTSD. Successful recovery on a functional and symptomatic level may necessitate treatment of dissociative symptoms, particularly derealization. [ABSTRACT FROM AUTHOR]