Do shorter delays to care and mental health system renewal translate into better occupational outcome after mental disorder diagnosis in a cohort of Canadian military personnel who returned from an Afghanistan deployment?

Abstract

ObjectiveMental disorders in military personnel result in high rates of attrition. Military organisations have strengthened their mental health systems and attempted to overcome barriers to care in order to see better outcomes. This study investigated the roles of mental health services renewal and delay to care in Canadian Armed Forces (CAF) personnel diagnosed with mental disorders.DesignAdministrative data were used to identify a retrospective cohort of 30 513 CAF personnel who deployed in support of the mission in Afghanistan. Study participants included 508 individuals with a mental disorder diagnosis identified from CAF medical records of a weighted, stratified random sample of 2014 individuals selected from the study cohort. Weighted Cox proportional hazards regression assessed the association of diagnosis era and delay to care with the outcome, after controlling for a broad range of potential confounders (eg, disorder severity, comorbidity). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics.Primary outcomeThe outcome was release from military service for medical reasons, assessed using administrative data for the 508 individuals with a mental disorder diagnosis.Results17.5% (95% CI 16.0% to 19.0%) of the cohort had a mental disorder diagnosis after an Afghanistan-related deployment, of which 21.3% (95% CI 17.2% to 25.5%) had a medical release over a median follow-up of 3.5 years. Medical release risk was elevated for individuals diagnosed before 30 April 2008 relative to those with recent diagnoses (adjusted HR (aHR)=1.77 (95% CI 1.01 to 3.11)) and for individuals with a long delay to care (>21 months after return) relative to those with intermediate delays (8–21 months, aHR 2.47=(95% CI 1.28 to 4.76)).ConclusionsMental health services renewal in the CAF was associated with a better occupational outcome for those diagnosed with mental disorders. Longer delays to care were associated with a less favourable outcome.

Delay to mental healthcare in a cohort of Canadian Armed Forces personnel with deployment-related mental disorders, 2002–2011: a retrospective cohort study

“…Delays to mental healthcare among military and civilian populations were substantial in the past, 3 8 impacting individuals' quality of life and functioning. 36 As a response, the CAF gradually renewed its mental healthcare system, increasing capacity and implementing programmes that focus on reducing barriers to care. Our findings provide some evidence that those efforts have been associated with shorter delays to care, particular in 2009/2010.…”

Delays in making initial treatment contact after the first onset of mental health disorders in the Argentinean Study of Mental Health Epidemiology

“…Dual pathology is difficult to treat and more likely to recur than less complex conditions (Serfaty, 2001). Additionally, timely treatment might mitigate or diminish the many deleterious social consequences of psychiatric disorders such as educational truncation, employment and marital instability, violence, accidents and suicide death (Kessler et al 1995, 1998; Cameron et al 2006; Boulos & Zamorski, 2015; GBD 2013 Mortality and Causes of Death Collaborators, 2015; Erskine et al 2016; Kendler et al 2017).…”

Does screening shorten delays to care for post-deployment mental disorders in military personnel? A longitudinal retrospective cohort study

“…Overall, screening aims to shorten delays to care in those with a need, a result that has been linked with a number of beneficial individual and organisational outcomes. [18][19][20][21] Accordingly, screening offers a theoretical value to service members but the available research on its putative value is somewhat inconclusive. Observational studies suggest a triage and care provision benefit from screening, as researchers have generally noted that a significant proportion of those who screen positive for mental health problems do initiate follow-up mental health services, [22][23][24] but it is unknown whether those screening positive would have received equivalent and timely mental healthcare had they not screened.…”