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      Mental Disorder Symptoms among Public Safety Personnel in Canada Translated title: Symptômes de trouble mental chez le personnel de la sécurité publique du Canada

      research-article
      , PhD 1 , , , PhD 2 , , MSc 2 , , MSc 2 , , MA 3 , , MA 3 , , PhD 2 , , PhD 4 , , PhD 5 , , PhD 6 , , BA 3 , , PhD 7 , , PhD 8 , , PhD 9 , , PhD 10 , , PhD 3 , , PhD 3 , , PhD 6 , , PhD 11 , , PhD 12 , , PhD 13 , , PhD 14 , , PhD 3
      Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
      SAGE Publications
      mental disorders, first responders, public safety personnel, operational stress injuries, posttraumatic stress disorder

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          Abstract

          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.

          Translated abstract

          Contexte:

          Le personnel de la sécurité publique (PSP) canadien (p. ex., les travailleurs des services correctionnels, les répartiteurs, les pompiers, les ambulanciers, les officiers de police) sont exposés à des événements possiblement traumatisants dans le cadre de leur travail. Ces expositions contribuent au risque de développer des symptômes cliniquement significatifs liés à des troubles mentaux. La présente étude a été conçue pour offrir des estimations de la fréquence et de la gravité des symptômes de trouble mental pour le PSP canadien.

          Méthodes:

          Un sondage en ligne a été offert en anglais et en français de septembre 2016 à janvier 2017. Le sondage estimait les symptômes actuels, et la participation a été sollicitée dans les agences nationales de PSP et les groupes de défense d'intérêts. Les estimations ont été obtenues à l'aide de mesures de dépistage bien validées.

          Résultats:

          Il y a eu 5813 participants (32,5 % de femmes) qui ont été regroupés en 6 catégories (p. ex., opérateurs/répartiteurs de centres d'appels, travailleurs de services correctionnels, pompiers, police municipale/provinciale, ambulanciers, Gendarmerie royale du Canada). Des proportions substantielles de participants ont déclaré des symptômes actuels compatibles avec un (c.-à-d., 15,1 %) trouble mental ou plus (c.-à-d., 26,7 %) selon les mesures de dépistage. Il y avait des différences significatives entre les catégories de PSP relativement aux proportions positives au dépistage, selon chaque mesure.

          Interprétation:

          La proportion estimée de PSP déclarant des groupes de symptômes actuels compatibles avec un trouble mental ou plus semble plus élevée que les estimations publiées précédemment pour la population générale; toutefois, les comparaisons directes sont impossibles en raison des différences méthodologiques. Les données disponibles suggèrent que le PSP canadien éprouve des difficultés de santé mentale substantielles et hétérogènes, et elles soulignent le besoin d'une étude épidémiologique rigoureuse ainsi que des solutions propres à chaque catégorie.

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          Most cited references53

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          The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review.

          Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable. Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales. The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15. The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization. Copyright 2010. Published by Elsevier Inc.
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            Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans.

            This study examined the psychometric properties of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5; Weathers, Litz, et al., 2013b) in 2 independent samples of veterans receiving care at a Veterans Affairs Medical Center (N = 468). A subsample of these participants (n = 140) was used to define a valid diagnostic cutoff score for the instrument using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers, Blake, et al., 2013) as the reference standard. The PCL-5 test scores demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity. Consistent with previous studies (Armour et al., 2015; Liu et al., 2014), confirmatory factor analysis revealed that the data were best explained by a 6-factor anhedonia model and a 7-factor hybrid model. Signal detection analyses using the CAPS-5 revealed that PCL-5 scores of 31 to 33 were optimally efficient for diagnosing PTSD (κ(.5) = .58). Overall, the findings suggest that the PCL-5 is a psychometrically sound instrument that can be used effectively with veterans. Further, by determining a valid cutoff score using the CAPS-5, the PCL-5 can now be used to identify veterans with probable PTSD. However, findings also suggest the need for research to evaluate cluster structure of DSM-5. (PsycINFO Database Record
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              Multicenter collaborative panic disorder severity scale.

              To address the lack of a simple and standardized instrument to assess overall panic disorder severity, the authors developed a scale for the measurement of panic disorder severity. Ten independent evaluators used the seven-item Panic Disorder Severity Scale to assess 186 patients with principal DSM-III-R diagnoses of panic disorder (with no or mild agoraphobia) who were participating in the Multicenter Collaborative Treatment Study of Panic Disorder. In addition, 89 of these patients were reevaluated with the same scale after short-term treatment. A subset of 24 patients underwent two independent assessments to establish interrater reliability. Internal consistency, convergent and discriminant validity, and sensitivity to change were also determined. The Panic Disorder Severity Scale was associated with excellent interrater reliability, moderate internal consistency, and favorable levels of validity and sensitivity to change. Individual items showed good convergent and discriminant validity. Analysis suggested a two-factor model fit the data best. The Panic Disorder Severity Scale is a simple, efficient way for clinicians to rate severity in patients with established diagnoses of panic disorder. However, further research with more diverse groups of panic disorder patients and with a broader range of convergent and discriminant validity measures is needed.
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                Author and article information

                Journal
                Can J Psychiatry
                Can J Psychiatry
                CPA
                spcpa
                Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
                SAGE Publications (Sage CA: Los Angeles, CA )
                0706-7437
                1497-0015
                28 August 2017
                January 2018
                : 63
                : 1
                : 54-64
                Affiliations
                [1 ]Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
                [2 ]University of Manitoba, Winnipeg, Manitoba, Canada
                [3 ]University of Regina, Regina, Saskatchewan, Canada
                [4 ]Memorial University of Newfoundland, Saint John’s, Newfoundland and Labrador, Canada
                [5 ]Wilfrid Laurier University, Waterloo, Ontario, Canada
                [6 ]Queen’s University, Kington, Ontario, Canada
                [7 ]Douglas Hospital, Verdun, Quebec, Canada
                [8 ]Correctional Service of Canada, Ottawa, Ontario, Canada
                [9 ]Simon Fraser University, Burnaby, British Columbia, Canada
                [10 ]Canadian Health Information Management Association, Regina, Canada
                [11 ]University of Calgary, Calgary, Alberta, Canada
                [12 ]University of Ottawa, Ottawa, Ontario, Canada
                [13 ]National Center for Post Traumatic Stress Disorder, White River Junction, Vermont, USA
                [14 ]Dalhousie University, Halifax, Nova Scotia, Canada
                Author notes
                [*]R. Nicholas Carleton, PhD, Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada. Email: Nick.Carleton@ 123456uregina.ca .
                Article
                10.1177_0706743717723825
                10.1177/0706743717723825
                5788123
                28845686
                3da0b772-1af4-4ac6-8b7b-c9afc363367e
                © The Author(s) 2017

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                mental disorders,first responders,public safety personnel,operational stress injuries,posttraumatic stress disorder

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