1. Canadian Forces Health ServicesServices de santé des Forces canadiennes Monitoring the Mental and Social Wellness of Canadian Armed Forces Members: Tools and Data Sources Elizabeth Rolland-Harris MSc PhD Jeff Whitehead MD MSc FRCPC Epidemiology Section, Directorate of Force Health Protection November 2014

2. Canadian Forces Health ServicesServices de santé des Forces canadiennes Outline 1. Background 2. Completed Suicide a. active service b. released 3. Suicide ideation 4. Suicide attempts 5. Suicide risk factors 6. Extended surveillance – Medical Professional Technical Suicide Review

3. Canadian Forces Health ServicesServices de santé des Forces canadiennes Completed Suicide – Active Force All deaths in CAF are investigated by a Summary Investigation (SI) or Board of Inquiry (BOI), for several years suicides have all had a BOI Rates are calculated for male Regular Force members only as female suicides are uncommon and Reserve Force numerators and denominators are uncertain Compare CAF rates to general Canadian population using Standardized Mortality Ratios (SMRs) Rates among those with a history of deployment compared to Canadian rates as well as to those CAF members without a history of deployment Do not include “open verdict” cases in which intent is not clear http://www.forces.gc.ca/assets/FORCES_Internet/docs/en/about- reports-pubs-health/suicide-in-the-cf-1995-2012.pdfhttp://www.forces.gc.ca/assets/FORCES_Internet/docs/en/about- reports-pubs-health/suicide-in-the-cf-1995-2012.pdf

4. Canadian Forces Health ServicesServices de santé des Forces canadiennes Completed Suicide – Released CAF members Canadian Forces Cancer and Mortality Study is a linkage of all CF members with Regular Force service who enrolled from 1972 on to Statistics Canada’s mortality and cancer databases (~200,000) Suicide SMRs are elevated, risk is increased if involuntary or medical release, if less than 10 years of service, if non- commissioned member http://www.statcan.gc.ca/pub/82-584-x/82-584-x2011001- eng.htmhttp://www.statcan.gc.ca/pub/82-584-x/82-584-x2011001- eng.htm

5. Canadian Forces Health ServicesServices de santé des Forces canadiennes Suicide Ideation Best source is from CAF Mental Health Supplement of Canadian Community Health Survey in 2002 and 2013 Personal interview survey conducted by Statistics Canada at same time as surveyed general Canadian population Another source is the Health and Lifestyle Information Survey (HLIS), a mail survey that is completed every 4 years as Regular Force CAF members are excluded from CCHS 2002: http://www.statcan.gc.ca/pub/82-584-x/82-584- x2011001-eng.htmhttp://www.statcan.gc.ca/pub/82-584-x/82-584- x2011001-eng.htm 2013: http://www.forces.gc.ca/en/about-reports-pubs- health/caf-mental-health-survey.page and http://www.statcan.gc.ca/eng/survey/household/5084http://www.forces.gc.ca/en/about-reports-pubs- health/caf-mental-health-survey.page http://www.statcan.gc.ca/eng/survey/household/5084

6. Canadian Forces Health ServicesServices de santé des Forces canadiennes Suicide Attempts Source is CAF Mental Health Supplement of Canadian Community Health Survey in 2002 and 2013 as well as Health and Lifestyle Information Survey (HLIS) http://publications.gc.ca/collections/collection_2011/dn-nd/D2- 293-2010-eng.pdfhttp://publications.gc.ca/collections/collection_2011/dn-nd/D2- 293-2010-eng.pdf Military Police keep some types of records, almost certainly incomplete, to our knowledge severity of intent is not recorded

7. Canadian Forces Health ServicesServices de santé des Forces canadiennes Suicide Risk Factors Hazardous alcohol use collected from HLIS and from Periodic Health Assessments (PHA) using full AUDIT or AUDIT-C respectively Barriers to mental health care and satisfaction with mental health care collected from HLIS and CCHS Mental Health Supplement Depression screen, PTSD screen, and a question on suicidal ideation is on PHA

8. Canadian Forces Health ServicesServices de santé des Forces canadiennes Extended Surveillance Suicide investigations were extended following report of a CF Expert Panel on Suicide Prevention in 2009 Every suicide since spring 2010 has been followed by a Medical Professional Technical Suicide Review (MPTSR) Medical officer and a mental health professional (usually a psychiatrist or a social worker) do a detailed investigation immediately after the death https://cimvhr.ca/sghrp_reports/dnlddoc.php?id=67&fna me=SGR-2013-007 Final (300913).pdf

9. Canadian Forces Health ServicesServices de santé des Forces canadiennes Extended Surveillance Include description of incident including mode, developmental history, mental health issues, medical issues, psycho-social factors (relationship issues, workplace issues, etc), chain of command factors, risk factors for suicide Complete a Suicide Event Report (SER) which is an active pdf form which populates a database

10. Canadian Forces Health ServicesServices de santé des Forces canadiennes Questions?

11. Canadian Forces Health ServicesServices de santé des Forces canadiennes For more information Dr. Elizabeth Rolland-Harris Senior Epidemiologist Elizabeth.harris@forces.gc.ca 613-945-6707