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© 2021 International Association for Correctional and Forensic Psychology. Published by SAGE Publishers. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/). Exposure to potentially psychologically traumatic events for correctional workers is high. However, the mechanisms driving the high prevalence are relatively unexplained. Using data from a cross-sectional, online survey of correctional service workers (n = 845) in Ontario, Canada, collected in 2017–2018, we assess the prevalence of mental disorders with a specific focus on uncertainty in the workplace and between correctional roles. We find that correctional officers, institutional governance, and probation/parole officers appear most at risk of mental disorders (prevalence of any mental disorder was 56.9%, 60.3%, and 59.2%, respectively). We argue slightly lower prevalence among institutional wellness, training, and administrative staff may result in part from their more predictable work environment, where they have more control. The results reaffirm a need for evidence-based proactive mental health activities, knowledge translation, and treatment and a need to explore how authority without control (i.e., unpredictability at work) can inform employee mental health. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: R. Nicholas Carleton’s research is supported by the Canadian Institutes of Health Research (CIHR) through a New Investigator Award (FRN: 13666). Tracie O. Afifi’s research is supported by a Tier I Canada Research Chair. This research was also funded in part by a CIHR Catalyst Grant (FRN: 16234). Faculty yes

Objective: The current study used the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS) to (1) examine the incidence and prevalence of mental disorders and (2) estimate the comorbidity of mental disorders over the follow-up period. Method: The CAFVMHS (2018) is a longitudinal study with two time points of assessment. The sample is comprised of 2,941 Canadian Forces members and veterans who participated in the 2002 Canadian Community Health Survey: Canadian Forces Supplement. The World Health Organization Composite International Diagnostic Interview (WHO-CIDI) was utilized to diagnose Diagnostic and Statistical Manual-IV post-traumatic stress disorder (PTSD), major depressive episode (MDE), generalized anxiety disorder, social anxiety disorder (SAD), and alcohol abuse and dependence. Self-report health professional diagnoses were assessed for attention deficit hyperactivity disorder (ADHD), mania, obsessive compulsive disorder (OCD), and personality disorder. We established weighted prevalence of mental disorders and examined the association between mental disorders using logistic regression. Results: In 2018, lifetime prevalence of any WHO-CIDI-based or self-reported mental disorder was 58.1%. Lifetime prevalence of any mood or anxiety disorder or PTSD was 54.0% in 2018. MDE (39.9%), SAD (25.7%), and PTSD (21.4%) were the most common mental disorders. There was a substantial increase in new onset or recurrence/persistence of mental disorders between the two measurement points (16-year assessment gap); 2002–2018 period prevalences were 43.5% for mood and anxiety disorder and 16.8% for alcohol abuse or dependence. The prevalence of self-reported ADHD, OCD, any personality disorder, and mania were 3.3%, 3.0%, 0.8%, and 0.8%, respectively. Comorbidity between mental disorders increased over the follow-up. Conclusions: This study demonstrates a high burden of mental disorders among a large Canadian military and veteran cohort. These findings underscore the importance of prevention and intervention strategies to reduce the burden of mental disorders and alcohol use disorders in these populations.

Objective: Mental health among military personnel is an important public health priority. It is known that military personnel experience a high prevalence of child maltreatment and deployment-related traumatic events (DRTEs) and both are related to mental health outcomes. However, few, if any, studies have examined the cumulative and interactive effects of child maltreatment and DRTEs on mental health disorders in a sample of active duty service members and military veterans. Methods: Data were from the Canadian Armed Forces (CAF) Members and Veterans Mental Health Follow-up Survey collected in 2018 ( N = 2,941, response rate = 68.7%), a 16-year follow-up survey of CAF Regular Force members interviewed in 2002. Five types of child maltreatment and 10 types of DTREs were assessed for impact on mental health. Mental disorders included past 12-month generalized anxiety disorder (GAD), panic disorder, social phobia, and major depressive episode (MDE). Past 12-month symptoms of posttraumatic stress disorder (PTSD) were also examined. Results: The prevalence of any exposure to child maltreatment and DRTEs was 62.5% and 68.6%, respectively. All types of child maltreatment were associated with increased odds of past 12-month PTSD symptoms and mental disorders with the exception of physical abuse and GAD as well as childhood exposure to intimate partner violence and panic disorder. Cumulative effects of having experienced both child maltreatment and DRTEs increased the odds of past 12-month PTSD symptoms, GAD, social phobia, and MDE. No interaction effects were significant. Conclusions: The prevalence of a child maltreatment history is high among active Canadian military and veterans. As well, child maltreatment may increase the likelihood of mental disorders across the life span. This may be especially true for individuals who also experience DRTEs. Understanding these relationships may provide insight into developing effective interventions for military personnel and veteran mental health outcomes.

Background: Trauma exposure is associated with adverse health-related correlates, including physical comorbidities, and is highly prevalent among public safety personnel (PSP). The current study (1) examined the association between context of index trauma exposure (part of job vs. other) and physical conditions and (2) established the prevalence of physical conditions according to PSP category (e.g., police, paramedic) and index trauma type (e.g., serious accident, physical assault) in a large Canadian sample of PSP. Methods: PSP completed an online survey between September 2016 and January 2017. Multivariable logistic regressions examined associations between context of index trauma exposure (i.e., part of job vs. other) and physical condition categories. Cross-tabulations with chi-square analyses examined whether the prevalence of physical conditions significantly differed according to PSP category and index trauma type. Results: There were 5,267 PSP included in the current study. Results from the most stringent model of logistic regressions demonstrated that, compared to PSP who experienced their index trauma in any other context, PSP who experienced it as part of their job had reduced odds of “other” physical conditions (adjusted odds ratio = 0.73, 95% confidence interval, 0.57 to 0.94, P < 0.05). Results also revealed significant differences in the prevalence of physical conditions across all PSP categories and select index trauma types. Conclusion: Results highlight the relevance of trauma exposure outside of an occupational context among PSP and may have implications for the positive impact of stress inoculation and resiliency training programs for PSP.

Background: Chronic pain is highly prevalent in the general population and may be even higher among public safety personnel (PSP; e.g., correctional officers, dispatchers, firefighters, paramedics, police). Comprehensive data on chronic pain among diverse Canadian PSP are relatively sparse. Aims: The current study was designed to provide initial estimates of chronic pain frequency and severity among Canadian PSP. Methods: Estimates of chronic pain frequency and severity (i.e., intensity and duration) at different bodily locations were derived from self-reported data collected through an online survey. Participants included 5093 PSP (32.5% women) grouped into six categories (i.e., call center operators/dispatchers, correctional officers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police [RCMP]). Results: Substantial proportions of participants reported chronic pain, with estimates ranging from 35.3% to 45.4% across the diverse PSP categories. Across PSP categories, chronic lower back pain was the most prevalent. For some pain locations, firefighters and municipal/provincial police reported lower prevalence, but paramedics reported lower intensity, and duration, than some other PSP groups. Over 50% of RCMP and paramedics reporting chronic pain indicated that the pain was associated with an injury related to active duty. Conclusions: Discrepancies emerged across PSP members with respect to prevalence, location, and severity. The current data suggest that additional resources and research are necessary to mitigate the development and maintenance of distressing or disabling chronic pain for Canadian PSP.

Background Many public safety personnel (PSP) experience trauma directly or indirectly in their occupational role, yet there remain barriers to accessing care or seeking help. Aims To understand how PSP interpret different potentially traumatic events and how perceived eligibility for being traumatized is determined among PSP. Methods We analysed open-ended comments provided by over 800 PSP in a survey designed to assess the prevalence of post-traumatic stress injuries and other mental disorders. Results We found evidence that a trauma hierarchy may exist among PSP. Certain experiences may be interpreted as more traumatic, based on both the event and the PSP role in the actual event. For example, involvement in a shooting may be interpreted as more traumatic than arriving on the scene later. Similarly, a single event may be deemed more traumatic than an accumulation of events. The role of the individual and social context in shaping experiences and interpretations of trauma may be largely ignored in line with confirmation biases. Conclusions The role that individuals and social contexts play in shaping experiences and interpretations of trauma appear suppressed by perceptions of a trauma hierarchy, facilitating systematic discrediting or valuation of some experiences, therein evidencing that trauma is subjective and reinforcing barriers to care seeking. A trauma hierarchy may also propagate stigma and legitimize discrimination regarding mental health. We argue that recognizing, engaging with, and dismantling the perception of a trauma hierarchy may help create a respectful and open occupational culture supportive of mental health needs.

Objectives: Research suggests a high prevalence of problematic alcohol use among military personnel relative to civilians. Our primary objectives were to compare the prevalence, correlates, help-seeking behaviors, perceived need for care, and barriers to care for alcohol use disorders (AUDs) in the Canadian Armed Forces (CAF) and the Canadian general population (CGP). Methods: Data were from 2 nationally representative surveys collected by Statistics Canada: (1) the Canadian Community Health Survey on Mental Health collected in 2012 ( N = 25,113; response rate = 68.9%) and (2) the Canadian Forces Mental Health Survey collected in 2013 ( N = 8,161; response rate = 79.8%). Descriptive statistics and logistic regression were used to examine differences in outcomes of interest associated with AUDs in the CAF and CGP. Results: The prevalence of lifetime AUDs was significantly higher in the CAF (32.0%) than the CGP (20.3%; adjusted odds ratio [AOR] = 1.14, 95% confidence interval [CI, 1.02 to 1.27]) after adjustment for sociodemographic covariates. In contrast, the past-year prevalence of AUDs was significantly lower among CAF personnel (4.5%) than civilians (3.8%; AOR = 0.78, 95% CI [0.61 to 0.99]) after adjustment for sociodemographic covariates. Child abuse history and comorbid mental disorders were strongly associated with past-year AUDs in both populations. CAF personnel compared to the CGP were more likely to perceive a need for care (AOR = 4.15, 95% CI [2.56 to 6.72]) and engage in help-seeking behaviors (significant AORs ranged from 1.85 to 5.54). CAF personnel and civilians with past-year AUDs reported different barriers to care. Conclusions: Findings argue for the value of different approaches to address unmet need for AUD care in the CAF and CGP.

Most of the research on caregiver vulnerabilities associated with the perpetration of child maltreatment (CM) focuses on perpetrators of child physical or sexual abuse. Less is known about the association of specific caregiver vulnerabilities and the risk of other CM types or how these vulnerabilities are related to child harm. The aim of the study was to examine the association of caregiver’s vulnerabilities with types of substantiated CM and child physical and mental/emotional harm as a result of maltreatment. Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect collected in 2008 (CIS-2008). The CIS-2008 consisted of investigations of children aged 15 years and younger from 112 child welfare sites across Canada ( N = 15,980). Descriptive statistics and logistic regression were used to examine relationships between caregiver vulnerabilities and outcomes of interest. Caregiver vulnerabilities were prevalent among cases of CM substantiated by child welfare agencies across Canada. Low social support, domestic violence, mental health issues, and substance abuse problems were noted among a substantial proportion of abusive caregivers. Caregiver cognitive impairments and domestic violence perpetration were associated with increased odds of child physical harm, but only among children aged 0 to 4 years. Most individual types of caregiver vulnerabilities were associated with increased odds of child mental or emotional harm across all child age groups. Insight into caregiver vulnerabilities associated with the perpetration of CM may help inform intervention targets prior to a family’s involvement in the child welfare system.

Objective:There is limited information to guide health-care service providers and policy makers on the burden of mental disorders and addictions across the Canadian provinces. This study compares interprovincial prevalence of major depressive disorder (MDD), bipolar disorder, generalized anxiety disorder (GAD), alcohol use disorder, substance use disorders, and suicidality.Method:Data were extracted from the 2012 Canadian Community Health Survey—Mental Health ( n = 25,113), a representative sample of Canadians over the age of 15 years across all provinces. Cross tabulations and logistic regression were used to determine the prevalence and odds of the above disorders for each province. Adjustments for provincial sociodemographic factors were performed.Results:The past-year prevalence of all measured mental disorders and suicidality, excluding GAD, demonstrated significant interprovincial differences. Manitoba exhibited the highest prevalence of any mental disorder (13.6%), reflecting high prevalence of MDD and alcohol use disorder compared to the other provinces (7.0% and 3.8%, respectively). Nova Scotia exhibited the highest prevalence of substance use disorders (2.9%). Quebec and Prince Edward Island exhibited the lowest prevalence of any mental disorder (8.5% and 7.7%, respectively). Manitoba also exhibited the highest prevalence of suicidal ideation (5.1%); however, British Columbia and Ontario exhibited the highest prevalence of suicidal planning (1.4% and 1.3%, respectively), and Ontario alone exhibited the highest prevalence of suicide attempts (0.7%).Conclusions:Significant interprovincial differences were found in the past-year prevalence of mental disorders and suicidality in Canada. More research is necessary to explore these differences and how they impact the need for mental health services.

Child maltreatment is a global public health and child rights crisis made worse by the ongoing COVID-19 pandemic. While understanding the breadth of the child maltreatment crisis is foundational to informing prevention and response efforts, determining accurate estimates of child maltreatment remains challenging. Alternative informants (parents, caregivers, a Person Most Knowledgeable—PMK) are often tasked with reporting on children’s maltreatment experiences in surveys to mitigate concerns associated with reporting child maltreatment. The overall purpose of this study was to examine child maltreatment reporting practices in surveys by PMKs for children and youth. The research question is: “What is the nature of the evidence of child maltreatment reporting practices in general population surveys by PMKs for children and youth?” A rapid scoping review was conducted to achieve the study’s purpose. A search strategy was conducted in nine databases (e.g., MEDLINE, EBSCO, Scopus, Global Health, ProQuest). The findings from this review indicate that most studies involved PMK informants (i.e., maternal caregivers), included representative samples from primarily Western contexts, and utilized validated measures to assess child maltreatment. Half of the studies assessed involved multi-informant reports, including the PMKs and child/youth. Overall, the congruence between PMK-reported and child/youth-reported child maltreatment experiences was low-to-fair/moderate, and children/youth reported more maltreatment than the PMKs.

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). In the current study, we quantified the mean stress levels of 43 occupational stressors for 868 Correctional Workers (CWs) and analyzed the relationships between occupational stressors, exposure to potentially psychologically traumatic events (PPTEs), and mental health disorders. Our findings emphasize the importance of the occupational environment in relation to CW mental health and indicate that occupational stressors (e.g., staff shortages, inconsistent leadership style, bureaucratic red tape) are more salient contributors to CW mental health than exposure to PPTEs. Finding strategies to ameliorate staff shortages, improve leadership style and communication, and support CWs to maintain physical, mental, and social well-being would be interventions tied to significant organizational and operational stressors within the current study. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: R. Nicholas Carleton’s research is supported by the Canadian Institutes of Health Research (CIHR) through a New Investigator Award (FRN: 13666). Tracie O. Afifi’s research is supported by a Tier I Canada Research Chair. This research was also funded in part by a CIHR Catalyst Grant (FRN: 16234). Faculty yes

The current evidence indicates that spanking is harmful to children’s health and development and should never be used by parents or other caregivers. However, the critical factors that inform effective spanking prevention strategies are still not well understood. The objective of the current study was to determine if a parent’s own adverse childhood experiences (ACEs) history was associated with increased likelihood of reporting their child being spanked at age 10 or younger. Data were drawn from the Well-Being and Experiences Study (the WE Study), a community survey of parents and adolescents from 2017–2018 (N = 1000) from Canada. The results indicated that a parent’s own history of physical abuse, emotional abuse, spanking, and household mental illness in childhood were associated with an increased likelihood that their child would have been spanked. These findings indicate that a parent’s ACEs history may be related to how their own child is parented and identify families who may be more likely to rely on spanking. Preventing physical punishment is necessary for healthy child development, reducing the risk of further violence, and upholding children’s rights to protection. Parent’s ACEs history may be an important factor to consider when developing and implementing child maltreatment prevention efforts.

IMPORTANCE: The success in ending the COVID-19 pandemic rests partly on the mass uptake of the COVID-19 vaccine. Little work has been done to understand vaccine willingness among older adolescents and young adults. This is important since this age group may be less likely to adhere to public health guidelines. OBJECTIVE: To understand willingness of getting a vaccine and reasons for vaccine hesitancy among a sample of older adolescents and young adults. DESIGN: Data were from the Well-Being and Experiences study (The WE Study), a longitudinal community-based sample of older adolescents and young adults collected from Winnipeg, Manitoba, Canada from 2017 to 2020 (n = 664). SETTING: The study setting was a community-based observational longitudinal study. PARTICIPANTS: Participants for the study were aged 14 to 17 years old at baseline in 2016-17 (n = 1000). Data were also collected on one parent/caregiver. Waves 2 (n = 747) and 3 (n = 664) were collected in 2019 and 2020, respectively. EXPOSURES: The main exposures were sociodemographic factors, health conditions, COVID-19 knowledge, and adversity history. MAIN OUTCOMES: The main outcomes were COVID-19 vaccine willingness, hesitancy, and reasons for hesitancy. RESULTS: Willingness to get a COVID-19 vaccine was 65.4%. Willingness did not differ by age, sex, or mental health conditions, but did differ for other sociodemographic characteristics, physical health conditions, COVID-19 knowledge, practicing social/physical distancing, and adversity history. The most common reasons for not wanting a vaccine were related to safety, knowledge, and effectiveness. Sex differences were noted. CONCLUSIONS AND RELEVANCE: Increasing uptake of the COVID-19 vaccine among older adolescents and young adults may rely on targeting individuals from households with lower income, financial burden, and adversity history, and generating public health messaging specifically aimed at vaccine safety, how it works to protect against illness, and why it is important to protect oneself against a COVID-19 infection.

Background: Many parents use physical forms of punishment, including spanking to correct perceived misbehavior. While some authors suggest spanking/slapping is a distinct and “milder” form of physical punishment, parents’ use of spanking is consistently associated with poor outcomes for their children. However, less is known about the relationship between spanking/slapping and health and behavioral outcomes in adolescence independent of other childhood adversities. Objectives: The objectives of this study were to examine the associations between lifetime experiences of spanking on the bottom and/or slapping on the hand and 3 adolescent outcomes: (a) mental health disorders, (b) physical health conditions, and (c) defiant behaviors, after adjusting for other types of childhood adversities and child maltreatment. Methods: Cross-sectional data from the provincially representative 2014 Ontario Child Health Study ( N = 6,537 dwellings, response rate = 50.8%) were used. The current study focused on one selected child aged 14 to 17 years within a household ( n = 1,883) with data collected from the adolescent and the parent/caregiver. Logistic regression models were used to identify associations with lifetime experiences of spanking/slapping 3 or more times (vs. 0 to 2 times). Results: Lifetime spanking/slapping was independently associated with increased odds of mental health disorders, physical health conditions, and defiant behaviors in adolescence after adjusting for childhood adversities and child maltreatment (unadjusted and adjusted odds ratios ranging from 1.29 to 2.19). Conclusions: These findings suggest that lifetime spanking/slapping is uniquely associated with harmful mental, physical, and behavioral outcomes in adolescence, and efforts should focus on its prevention.

Intimate partner violence (IPV) during pregnancy is a substantial public health concern, yet little is known about the developmental trajectory of these women and their children after birth.The objective was to examine maternal and child health as well as social outcomes from birth to 5-years post-delivery associated with a positive (vs. negative) maternal IPV screen around the time of delivery.Manitoban women giving birth to a live singleton infant from January 1, 2003 to December 31, 2006 were followed from birth to 5-years post-delivery (analytic sample: N = 40,051).Administrative databases from the Manitoba Centre for Health Policy provided data for the study. Descriptive statistics and logistic regression were used to examine relationships between IPV screen response around the time of birth (i.e., current, or history of, violence between parenting partners) with maternal and child health as well as social outcomes.Women screening positive for IPV had increased odds of diagnosed mood/anxiety disorders, personality disorders, substance use disorders, diabetes, respiratory morbidity, and intentional/non-intentional injury hospitalizations (adjusted odds ratio [AOR] range 1.81-5.59, p.01). Children of women screening positive for IPV had increased odds of diagnosed attention deficit-hyperactivity disorder, lower respiratory infections, and injury hospitalizations (AOR range 1.53-2.00, p.01), child welfare organization contact (AOR = 8.84, p .01), and of being more developmentally vulnerable at kindergarten across domains of functioning (AOR range 1.69-1.93, p .01) than children of mothers screening negative for IPV.A positive IPV screen was associated with poorer maternal and child health, increased child and family services contact, and children being more developmentally vulnerable in the 5-years after delivery.

Introduction The current study examined associations between DSM-5 post-traumatic stress disorder (PTSD) and three sexual risk outcomes: presence of a sexually transmitted disease/infection, frequency of condom use, and sex with a known user of injection drugs. Methods Data were from the National Epidemiologic Survey on Alcohol and Related Conditions–III (2012–2013, analyzed 2017), a nationally representative survey of non-institutionalized U.S. adults aged ≥18 years. Sexual outcomes and trauma exposure were assessed via self-report, and PTSD was assessed using a validated structured interview. Logistic and multinomial regression analyses examined associations between PTSD, PTSD symptom clusters, trauma type, and each sexual outcome. Results Lifetime PTSD was associated with increased odds of having a past-year sexually transmitted disease/infection and sex with a known injection drug user (AOR=1.54 and 1.74, respectively); fewer intrusion symptoms were associated with sometimes/fairly often condom use relative to very often. Reporting of adult sexual assault, assaultive violence, and other trauma as one's worst event was associated with increased odds of a past-year sexually transmitted disease/infection (AOR range, 1.69–4.56), whereas child maltreatment was associated with using condoms never/almost never in the past 12 months (AOR=1.40). No other significant findings emerged. Conclusions The current study demonstrates an association between certain trauma exposures, PTSD symptoms, and an increased likelihood of sexual risk outcomes. Clinicians working with individuals with PTSD symptoms, particularly those who have been exposed to interpersonal trauma, should screen for the presence of these sequelae.

Canadian Public Safety Personnel (e.g., correctional workers, dispatchers, firefighters, paramedics, and police) are regularly exposed to potentially traumatic events, some of which are highlighted as critical incidents warranting additional resources. Unfortunately, available Canadian public safety personnel data measuring associations between potentially traumatic events and mental health remains sparse. The current research quantifies estimates for diverse event exposures within and between several categories of public safety personnel. Participants were 4,441 public safety personnel (31.7% women) in 1 of 6 categories (i.e., dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, and Royal Canadian Mounted Police). Participants reported exposures to diverse events including sudden violent (93.8%) or accidental deaths (93.7%), serious transportation accidents (93.2%), and physical assaults (90.6%), often 11+ times per event. There were significant relationships between potentially traumatic event exposures and all mental disorders. Sudden violent death and severe human suffering appeared particularly related to mental disorder symptoms, and therein potentially defensible as critical incidents. The current results offer initial evidence that (a) potentially traumatic event exposures are diverse and frequent among diverse Canadian public safety personnel; (b) many different types of exposure can be associated with mental disorders; (c) event exposures are associated with diverse mental disorders, including but not limited to posttraumatic stress disorder, and mental disorder screens would be substantially reduced in the absence of exposures; and (d) population attributable fractions indicated a substantial reduction in positive mental disorder screens (i.e., between 29.0 and 79.5%) if all traumatic event exposures were eliminated among Canadian public safety personnel.

These data present associations between socioeconomic status (SES), different types of childhood maltreatment (CM) history and family dysfunction, and arthritis in men and women across a wide age range. Arthritis was less likely among those with higher SES, regardless of CM history. CM has been associated with increased risk of adult-onset arthritis; however, little is known about whether socioeconomic status moderates arthritis risk in those with CM history. We investigated arthritis across education, income, and race/ethnicity and whether CM moderated associations between SES and arthritis. Data were drawn from Wave 2 (2004–2005) of the nationally representative (USA) National Epidemiological Survey on Alcohol and Related Conditions (NESARC, n = 34,563; aged ≥ 20 years). Self-reported CM history included physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence (IPV). We used descriptive statistics and logistic regression to determine relationships between SES, CM, and arthritis. Interaction terms were used to test if CM moderated relationships between SES and arthritis. Arthritis prevalence was 21.1% (n = 3093) among men and 30.1% (n = 6167) among women. In unadjusted analyses, women (p ≤ 0.001) and older age (both sexes, p ≤ 0.01) were associated with increased odds of arthritis. All CM types were associated with increased odds of arthritis, except exposure to IPV among women. In sex-stratified, age-adjusted analyses, lower education and income, family dysfunction, being Hispanic or Asian/Native Hawaiian/Pacific Islander, and ≥ 1 physical comorbidity were associated with increased odds of arthritis among those with and without CM: trends were similar for both sexes. In age-adjusted two-way interaction terms, CM did not moderate associations between SES and arthritis. Although CM was associated with arthritis, associations between SES and arthritis were not amplified. Arthritis was less likely among those with higher SES, regardless of CM history.

Substantial media attention has focused on suicide among Canadian Public Safety Personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police). The attention has raised significant concerns about the mental health impact of public safety service, as well as interest in the correlates for risk of suicide. There have only been two published studies assessing lifetime suicidal behaviors among Canadian PSP. The current study was designed to assess past-year and lifetime suicidal ideation, plans, and attempts amongst a large diverse sample of Canadian PSP. Estimates of suicidal ideation, plans, and attempts were derived from self-reported data from a nationally administered online survey. Participants included 5,148 PSP (33.4% women) grouped into six categories (i.e., Call Centre Operators/Dispatchers, Correctional Workers, Firefighters, Municipal/Provincial Police, Paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported past-year and lifetime suicidal ideation (10.1%, 27.8%), planning (4.1%, 13.3%), or attempts (0.4%, 4.6%). Women reported significantly more lifetime suicidal behaviors than men (ORs = 1.15 to 2.62). Significant differences were identified across PSP categories in reports of past-year and lifetime suicidal behaviors. The proportion of Canadian PSP reporting past-year and lifetime suicidal behaviors was substantial. The estimates for lifetime suicidal behaviors appear consistent with or higher than previously published international PSP estimates, and higher than reports from the general population. Municipal/Provincial Police reported the lowest frequency for past-year and lifetime suicidal behaviors, whereas Correctional Workers and Paramedics reported the highest. The results provide initial evidence that substantial portions of diverse Canadian PSP experience suicidal behaviors, therein warranting additional resources and research. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Research from the United States and Canada suggest that interracial relationships tend to have an elevated prevalence of intimate partner violence (IPV). Among seven extant studies, only one empirically examined speculations in the literature for this relationship. Based on analyses of data from Statistics Canada’s 2009 General Social Survey (GSS), Brownridge was not able to fully account for the elevated odds of IPV in interracial relationships. The current study used data on 16,706 Canadians (731 in interracial relationships and 15,975 in noninterracial relationships) from the 2014 iteration of Statistics Canada’s GSS to determine whether the risk of IPV in interracial relationships had changed since 2009 and to explore risk factors that may account for the elevated odds of IPV in interracial relationships. Results showed that individuals in interracial relationships faced elevated odds of IPV victimization relative to monoracial relationships in the 5-year reporting period prior to the study (odds ratio [OR] = 2.37; 95% confidence interval [CI] = [1.40, 4.02]; p < .001). This was similar to what Brownridge found in the 2009 GSS data, indicating that the elevated risk of IPV in interracial relationships had remained stable in Canada over a 10-year reporting period. Risk factors from three levels of an ecological model were explored, and logistic multiple regression analyses showed that characteristics of the partner (young age, drug use, and jealous behavior) fully accounted for the significantly elevated odds of IPV victimization in interracial unions. Although the leading speculation for this relationship implicates stressors that are unique to these relationships, the current study suggested that this phenomenon is mostly due to characteristics of individuals with whom those in interracial relationships are more likely to be coupled.

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative adult samples. To address these limitations, the current study investigated the relationship between individual-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample. The objectives of the present study were to: 1) compute the prevalence of mental health indicators by child maltreatment types, 2) estimate the prevalence of overall good, moderate, and poor mental health by child maltreatment types; and 3) examine the relationship between individual-level factors and overall mental health status of adolescents with and without a history of maltreatment. Data were from the National Comorbidity Survey of Adolescents (NCS-A; n = 10,123; data collection 2001–2004); a large, cross-sectional, nationally representative sample of adolescents aged 13–17 years from the United States. All types of child maltreatment were significantly associated with increased odds of having poor mental health (adjusted odds ratios ranged from 3.2 to 9.5). The individual-level factors significantly associated with increased odds of good mental health status included: being physically active in the winter; utilizing positive coping strategies; having positive self-esteem; and internal locus of control (adjusted odds ratios ranged from 1.7 to 38.2). Interventions targeted to adolescents with a history of child maltreatment may want to test for the efficacy of the factors identified above.

Objective Child maltreatment is associated with an increased likelihood of having mood disorders, anxiety disorders, post-traumatic stress disorder, substance use disorders, and personality disorders, but far less is known about eating disorders. The objective of the current study was to examine the associations between child maltreatment, including harsh physical punishment, physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence, and eating disorders in adulthood among men and women. Methods Data were from the National Epidemiologic Survey on Alcohol and Related Conditions wave 3 (NESARC-III) collected in 2012–2013. The sample was nationally representative of the United States adult population (N = 36,309). Lifetime eating disorders (anorexia nervosa [AN], bulimia nervosa [BN], and binge-eating disorder [BED]) were assessed using diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) criteria and the alcohol use disorder and associated disabilities interview schedule-5 (AUDADIS-5). Results The prevalence of any lifetime eating disorder was 1.7% (0.8% among men and 2.7% among women). All child maltreatment types were associated with AN, BN, and BED with notable differences among men and women. Overall, the types of child maltreatment with the strongest relationships with any eating disorder were sexual abuse and physical neglect among men and sexual abuse and emotional abuse among women. Discussion Clinicians should be mindful that child maltreatment experiences are associated with increased odds of eating disorders including AN, BED, and BN. Such relationships are significant among men and women although notable gender differences in these relationships exist. Abstract word count = 248.

Background: Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP. Methods: An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures. Results: There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure. Interpretation: The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative samples and focuses on individual-level factors. To address these gaps, the present study examined the association between relationship- and community-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample. Data were drawn from the National Comorbidity Survey of Adolescents (NCS-A; n=10,148; data collection 2001-2004); a large, cross-sectional, nationally representative sample of adolescents aged 13-17 years from the United States. Having supportive parent and family relationships were significantly associated with good mental health (AOR ranging from 2.1 to 7.1). Positive community and school experiences were also significantly associated with good mental health (AOR ranging from 2.0 to 9.8). In most models, support from friends and siblings was not related to better mental health. Factors to be tested for efficacy in interventions targeted to adolescents with a history of child maltreatment include encouraging supportive parent and family relationships, and fostering positive community and school experiences.

Correctional service employees in Ontario, Canada (n = 1487) began an online survey available from 2017 to 2018 designed to assess the prevalence and correlates of mental health challenges. Participants who provided data for the current study (n = 1032) included provincial staff working in institutional wellness (e.g., nurses) (n = 71), training (e.g., program officers) (n = 26), governance (e.g., wardens) (n = 82), correctional officers (n = 553), administration (e.g., record keeping) (n = 25), and probation officers (n = 144). Correctional officers, workers in institutional administration and governance positions, and probation officers reported elevated risk for mental disorders, most notably posttraumatic stress disorder (PTSD) and major depressive disorder. Among institutional correctional staff, 61.0% of governance employees, 59.0% of correctional officers, 43.7% of wellness staff, 50.0% of training staff, and 52.0% of administrative staff screened positive for one or more mental disorders. In addition, 63.2% of probation officers screened positive for one or more mental disorders. Women working as correctional officers were more likely to screen positive than men (p &lt, 0.05). Across all correctional occupational categories positive screens for each disorder were: 30.7% for PTSD, 37.0% for major depressive disorder, 30.5% for generalized anxiety disorder, and 58.2% for one or more mental disorders. Participants between ages 40 and 49 years, working in institutional governance, as an institutional correctional officer, or as a probational officer, separated or divorced, were all associated (p &lt, 0.05) with screening positive for one or more mental disorders. The prevalence of mental health challenges for provincial correctional workers appears to be higher than federal correctional workers in Canada and further supports the need for evidence-based mental health solutions.

Public Safety Personnel (PSP, e.g., correctional workers and officers, firefighters, paramedics, police officers, and public safety communications officials (e.g., call center operators/dispatchers)) are regularly exposed to potentially psychologically traumatic events (PPTEs). PSP also experience other occupational stressors, including organizational (e.g., staff shortages, inconsistent leadership styles) and operational elements (e.g., shift work, public scrutiny). The current research quantified occupational stressors across PSP categories and assessed for relationships with PPTEs and mental health disorders (e.g., anxiety, depression). The participants were 4820 PSP (31.7% women) responding to established self-report measures for PPTEs, occupational stressors, and mental disorder symptoms. PPTEs and occupational stressors were associated with mental health disorder symptoms (ps &lt, 0.001). PSP reported substantial difficulties with occupational stressors associated with mental health disorder symptoms, even after accounting for diverse PPTE exposures. PPTEs may be inevitable for PSP and are related to mental health, however, leadership style, organizational engagement, stigma, sleep, and social environment are modifiable variables that appear significantly related to mental health.

This chapter reviews links between adverse childhood experiences (ACEs) in childhood and violence in adult relationships. Most studies examine child maltreatment ACEs, particularly childhood physical abuse, sexual abuse, and exposure to intimate partner violence on adult outcomes. Less is known about the relationship between other types of childhood maltreatment (e.g., emotional maltreatment or neglect) on violence in adulthood. Similarly, the relationship between household dysfunction ACEs (e.g., parental separation/divorce, household substance use, household mental illness, household incarceration) and violence in adulthood has not been adequately addressed in research to date. The limitations of the extant research make it difficult to make definitive conclusions about the relationship between ACEs and violence in adulthood. The chapter concludes with suggested directions for future research and implications for policy and practice.

Indigenous peoples of Canada face an elevated risk of intimate partner violence (IPV) compared to non-Indigenous Canadians. Few empirical studies have been conducted to understand this elevated risk, and none have examined child maltreatment (CM) as a predictor. This study used data on a nationally representative sample of 20,446 Canadians to examine CM and proximal risk factors for IPV against Indigenous and non-Indigenous respondents. Results showed that Indigenous respondents had greater risk of experiencing both CM and IPV. All three forms of CM (exposure to violence, direct physical and/or sexual abuse victimization, as well as both exposure and direct victimization) were associated with increased odds of IPV in adulthood. CM along with proximal risk factors accounted for Indigenous peoples’ elevated odds of IPV (AOR = 1.62; NS). These results were consistent with the theory that Indigenous peoples’ elevated risk of IPV is largely due to effects of historical trauma from past and continuing colonization. Reducing Indigenous peoples’ disproportionate risk of IPV requires efforts to reduce CM and its negative developmental effects among Indigenous peoples as well as resolving the manifestations of historical and contemporary trauma within Indigenous society.

Child maltreatment is a public health concern with well-established sequelae. However, compared to research on physical and sexual abuse, far less is known about the long-term impact of emotional maltreatment on mental health. The overall purpose of this study was to examine the association of emotional abuse, emotional neglect, and both emotional abuse and neglect with other types of child maltreatment, a family history of dysfunction, and lifetime diagnoses of several Axis I and Axis II mental disorders. Data were from the National Epidemiological Survey on Alcohol and Related Conditions collected in 2004 and 2005 (n=34,653). The most prevalent form of emotional maltreatment was emotional neglect only (6.2%), followed by emotional abuse only (4.8%), and then both emotional abuse and neglect (3.1%). All categories of emotional maltreatment were strongly related to other forms of child maltreatment (odds ratios [ORs] ranged from 2.1 to 68.0) and a history of family dysfunction (ORs ranged from 2.2 to 8.3). In models adjusting for sociodemographic characteristics, all categories of emotional maltreatment were associated with increased odds of almost every mental disorder assessed in this study (adjusted ORs ranged from 1.2 to 7.4). Many relationships remained significant independent of experiencing other forms of child maltreatment and a family history of dysfunction (adjusted ORs ranged from 1.2 to 3.0). The effects appeared to be greater for active (i.e., emotional abuse) relative to passive (i.e., emotional neglect) forms of emotional maltreatment. Childhood emotional maltreatment, particularly emotionally abusive acts, is associated with increased odds of lifetime diagnoses of several Axis I and Axis II mental disorders.

Objective: Child abuse can have devastating mental health consequences. Fortunately, not all individuals exposed to child abuse will suffer from poor mental health. Understanding what factors are related to good mental health following child abuse can provide evidence to inform prevention of impairment. Our objectives were to 1) describe the prevalence of good, moderate, and poor mental health among respondents with and without a child abuse history; 2) examine the relationships between child abuse and good, moderate, and poor mental health outcomes; 3) examine the relationships between individual- and relationship-level factors and better mental health outcomes; and 4) determine if individual- and relationship-level factors moderate the relationship between child abuse and mental health. Method: Data were from the nationally representative 2012 Canadian Community Health Survey: Mental Health ( n = 23,395; household response rate = 79.8%; 18 years and older). Good, moderate, and poor mental health was assessed using current functioning and well-being, past-year mental disorders, and past-year suicidal ideation. Results: Only 56.3% of respondents with a child abuse history report good mental health compared to 72.4% of those without a child abuse history. Individual- and relationship-level factors associated with better mental health included higher education and income, physical activity, good coping skills to handle problems and daily demands, and supportive relationships that foster attachment, guidance, reliable alliance, social integration, and reassurance of worth. Conclusions: This study identifies several individual- and relationship-level factors that could be targeted for intervention strategies aimed at improving mental health outcomes following child abuse.

Background: In the context of the Canadian mission in Afghanistan, substantial media attention has been placed on mental health and lack of access to treatment among Canadian Forces personnel. We compared trends in the prevalence of suicidal behaviour and the use of mental health services between Canadian military personnel and the general population from 2002 to 2012/13. Methods: We obtained data for respondents aged 18–60 years who participated in 4 nationally representative surveys by Statistics Canada designed to permit comparisons between populations and trends over time. Surveys of the general population were conducted in 2002 ( n = 25 643) and 2012 ( n = 15 981); those of military personnel were conducted in 2002 ( n = 5153) and 2013 ( n = 6700). We assessed the lifetime and past-year prevalence of suicidal ideation, plans and attempts, as well as use of mental health services. Results: In 2012/13, but not in 2002, military personnel had significantly higher odds of both lifetime and past-year suicidal ideation than the civilian population (lifetime: adjusted odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17–1.50; past year: adjusted OR 1.34, 95% CI 1.09–1.66). The same was true for suicidal plans (lifetime: adjusted OR 1.64, 95% CI 1.35–1.99; past year: adjusted OR 1.66, 95% CI 1.18–2.33). Among respondents who reported past-year suicidal ideation, those in the military had a significantly higher past-year utilization rate of mental health services than those in the civilian population in both 2002 (adjusted OR 2.02, 95% CI 1.31–3.13) and 2012/13 (adjusted OR 3.14, 95% CI 1.86–5.28). Interpretation: Canadian Forces personnel had a higher prevalence of suicidal ideation and plans in 2012/13 and a higher use of mental health services in 2002 and 2012/13 than the civilian population.

Background Research on child maltreatment is imperative to inform evidence-based prevention and intervention efforts. Nonetheless, researchers continue to face barriers due to the perceived sensitivity and possibility of harm when asking about these experiences. While studies have started to explore reactions to participating in research on sensitive topics, there are notable limitations and fewer have focused on child maltreatment. Objective The objective of this study was to better understand adult respondents’ identification of, and reactions to, potentially upsetting questions in the context of a well-being and experiences survey, with a focus on child maltreatment. Methods Data were from the first wave of the Well-Being and Experiences Study in Manitoba, Canada: a computerized self-reported community-based survey of adolescents and their parents/caregivers administered individually at a research facility. The current study focused on parents/caregivers’ responses (N = 1000). The study utilized a mixed methods approach with descriptive statistics and qualitative thematic analyses of open-ended responses of their perceptions of upsetting questions. Results Overall, few respondents (15.1 %) identified any questions as upsetting. Ten themes emerged in respondents’ recall of upsetting questions, including maltreatment and other themes often perceived as less sensitive. Only 4% identified maltreatment-related questions as upsetting. Among those who identified any questions or maltreatment-specific questions as upsetting, most felt they were important to ask and should not be removed (92.7 %–97.5 %). These findings suggest that retrospective survey questions about experiences of child maltreatment involving adult samples are not associated with major upset and should be included in future health and social surveys.

Background Adverse childhood experiences (ACEs) are common and related to substance use problems in adulthood. Less is known about these relationships in adolescence and if experiencing ACEs in addition to peer victimization (or bullying) would have an interaction or cumulative effect on the odds of adolescent substance use. Method Data were used from the Well-Being and Experiences Study (The WE Study), a cross-sectional survey of adolescents aged 14–17 years (n = 1002) in Manitoba, Canada collected between July 2017 and October 2018. Statistical methods included descriptive statistics and logistic regression models. Results The prevalence of experiencing any of the 12 ACEs was 75.1 %. The prevalence of any peer victimization (monthly or more often) was 24.1 %. All individual ACEs were associated with increased odds of substance use. No significant interaction effects between ACEs and peer victimization on substance use were found. Significant cumulative effects were found, indicating that experiencing both ACEs and peer victimization, compared with experiencing ACEs only, significantly increased the odds of substance use among adolescents. Conclusion The odds of substance use becomes significantly greater if the adolescent with a history of ACEs also experiences peer victimization. Further research aimed at effective prevention of ACEs, peer victimization, and substance use is needed.

© 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. Public Safety Personnel (PSP; e.g. correctional workers, dispatchers, firefighters, paramedics, police) are frequently exposed to potentially traumatic events (PTEs). Several mental health training program categories (e.g. critical incident stress management (CISM), debriefing, peer support, psychoeducation, mental health first aid, Road to Mental Readiness [R2MR]) exist as efforts to minimize the impact of exposures, often using cognitive behavioral therapy model content, but with limited effectiveness research. The current study assessed PSP perceptions of access to professional (i.e. physicians, psychologists, psychiatrists, employee assistance programs, chaplains) and non-professional (i.e. spouse, friends, colleagues, leadership) support, and associations between training and mental health. Participants included 4,020 currently serving PSP participants. Data were analyzed using cross-tabulations and logistic regressions. Most PSP reported access to professional and non-professional support; nevertheless, most would first access a spouse (74%) and many would never, or only as a last resort, access professional support (43–60%) or PSP leaders (67%). Participation in any mental health training category was associated with lower (p < .01) rates for some, but not all, mental disorders, with no robust differences across categories. Revisions to training programs may improve willingness to access professional support; in the interim, training and support for PSP spouses and leaders may also be beneficial. R. Nicholas Carleton’s research is supported by the Canadian Institutes of Health Research (CIHR) through a New Investigator Award [FRN: 322308] and research grants [FRN: 285489 and FRN: 411397]. T.O. Afifi’s research is supported by a CIHR New Investigator Award and Foundation Scheme Award. This research was also funded in part by the Ministry of Public Safety and Emergency Preparedness through the Policy Development Contribution Program. Faculty yes

Background A history of child abuse has been identified as a risk factor for suicidal behaviour in general population samples; however, it remains unknown how a history of child abuse and career-related trauma together are related to suicidal behaviour. This cross-sectional survey was designed to 1) estimate the prevalence of a history of child abuse among Canadian public safety personnel, 2) examine the associations between child abuse and suicidal behaviour, 3) examine the associations between career-related trauma and suicidal behaviour and 4) examine the cumulative and interactive effects of child abuse and career-related trauma on suicidal behaviour. Methods Data were drawn from a Web-based survey collected by the Canadian Institute for Public Safety Research and Treatment Team. Child abuse included physical abuse, sexual abuse and exposure to intimate partner violence in childhood. Suicidal behaviour included lifetime ideation, plans and attempt(s). We used logistic regression models to examine the associations between child abuse and suicidal behaviours, and cumulative and interaction models to test the relations between a history of child abuse and career-related trauma on suicidal behaviours. Results The survey completion rate was 49.3% (n = 4199). A total of 2275/4073 respondents (55.9%) reported experiencing 1 or more types of abuse as a child. All types of child abuse and career-related trauma were significantly associated with suicidal behaviour (adjusted odds ratio 1.57-3.25). No cumulative or interaction effects were noted. Interpretation Both a history of child abuse and career-related trauma were significantly associated with suicidal behaviours; however, stronger relations were seen for the former. This finding may help the development of effective treatment and intervention strategies aimed at reducing suicidal behaviour among public safety personnel.