Nicholas Carleton
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Dr. R. Nicholas Carleton, Ph.D., R.D. Psychology
Professor of Psychology,
Department of Psychology,
University of Regina
Professor of Psychology,
Department of Psychology,
University of Regina
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Recent Submissions
Item Open Access A Canadian national study of provincial and territorial correctional workers' suicidal ideation, plans, and attempts(Wiley, 2024-09-14) R. Ricciardelli; R. N. Carleton; M. S. Johnston; S. Dorniani; T. L. Taillieu; T. O. AfifiAbstractCorrectional workers (CWs) endure several operational stressors (e.g., exposures to potentially psychologically traumatic events) and organisational stressors (e.g., shift work, staff shortages), which are associated with positive screens for mental disorders and self‐reports of suicidal behaviours and thus urgently warrant further inquiry. The Canadian Provincial and Territorial Correctional Worker Mental Health and Well‐Being Study (CWMH) used an online survey to collect data from Canadian correctional service organisations across all 13 provinces and territories. This national Canadian study investigates suicidal behaviours among CWs across diverse occupational roles and provincial and territorial jurisdictions (n = 3740, 50.1% female). The results estimated prevalence proportions for self‐reported past‐year and lifetime suicidal thoughts, planning, and attempts across the 13 Canadian provincial and territorial correctional systems, with the exceptions of past‐year suicidal planning in Alberta, Newfoundland and Labrador, New Brunswick, and Yukon where jurisdictional considerations and requests precluded the inclusion of select questions. Substantial proportions of participants reported past‐year or lifetime suicidal ideation (i.e., 9.1%, 29.2%, respectively), planning (i.e., 4.1%, 14.7%, respectively), or attempts (i.e., 0.8%, 7.2%, respectively). Sociodemographic variables (i.e., sex, age, marital status, total years of service, occupational category) were associated with past‐year and lifetime suicidal behaviours. Findings provide opportunities for future research and can inform tailored efforts by clinicians, service providers, and organisational leaders to support proactive interventions and treatments, including supporting the partners and families of CWs, fostering social support networks, and improving access to timely mental health treatment.Item Open Access Perspectives and Experiences of Public Safety Personnel Engaged in a Peer-Led Workplace Reintegration Program Post Critical Incident or Operational Stress Injury: A Qualitative Thematic Analysis(MDPI AG, 2024-07-19) Chelsea Jones; Shaylee Spencer; Elly O’Greysik; Lorraine Smith-MacDonald; Katherine S. Bright; Amy J. Beck; R. Nicholas Carleton; Lisa Burback; Andrew Greenshaw; Yanbo Zhang; Phillip R. Sevigny; Jake Hayward; Bo Cao; Suzette Brémault-PhillipsIntroduction: Public safety personnel (PSP) experience operational stress injuries (OSIs), which can put them at increased risk of experiencing mental health and functional challenges. Such challenges can result in PSP needing to take time away from the workplace. An unsuccessful workplace reintegration process may contribute to further personal challenges for PSP and their families as well as staffing shortages that adversely affect PSP organizations. The Canadian Workplace Reintegration Program (RP) has seen a global scale and spread in recent years. However, there remains a lack of evidence-based literature on this topic and the RP specifically. The current qualitative study was designed to explore the perspectives of PSP who had engaged in a Workplace RP due to experiencing a potentially psychologically injurious event or OSI. Methods: A qualitative thematic analysis analyzed interview data from 26 PSP who completed the RP. The researchers identified five themes: (1) the impact of stigma on service engagement; (2) the importance of short-term critical incident (STCI) program; (3) strengths of RP; (4) barriers and areas of improvement for the RP; and (5) support outside the RP. Discussion: Preliminary results were favorable, but further research is needed to address the effectiveness, efficacy, and utility of the RP. Conclusion: By addressing workplace reintegration through innovation and research, future initiatives and RP iterations can provide the best possible service and support to PSP and their communities.Item Open Access Sleep quality and mental disorder symptoms among correctional workers in Ontario, Canada(Springer Science and Business Media LLC, 2024-06-28) Rosemary Ricciardelli; Tamara L. Taillieu; Megan McElheran; Heidi Cramm; Harsha Ajith; Matthew S. Johnston; R. Nicholas CarletonCorrectional workers (CWs) report high levels of work stressors, frequent exposures to potentially psychologically traumatic events (PPTEs), and substantial mental health challenges. There is evidence of associations between sleep disturbances and diverse mental health challenges, including preliminary evidence from public safety personnel; however, replications and extensions would better inform interventions to support mental health. The current study was designed to examine associations between quality of sleep, work stress, and mental health disorders in a sample of diverse CWs employed in a provincial correctional service in Ontario, Canada. Data were analyzed from 943 CWs who participated in the cross-sectional, web-based Ontario Provincial Correctional Worker Mental Health and Well-Being Study conducted from December 2017 to June 2018. Sleep quality indicators included symptoms of insomnia, total hours of sleep per night on work nights and off-shift nights, number of days feeling rested per week, and overall sleep quality. Descriptive statistics, analyses of variance, correlational analyses, and logistic regression were used to examine relationships among sleep quality, stress of shift work, and mental health disorder symptoms. CWs slept an average of 6.0 h per night when working and 7.2 h during off-shift nights. CWs reported waking up feeling rested an average of 2.6 days per week and rated their overall quality of sleep in the fair to poor range. Many CWs (64.9%) screened positive for clinically significant symptoms of insomnia. There were also differences across occupational groups such that CWs working as correctional officers reported the most sleep problems. There were statistically significant relationships between insomnia and mental health disorder symptoms. Higher levels of stress from shift work were associated with worse sleep quality. CWs, especially those working as correctional officers in a provincial prison, reported many indicators consistent with poorer quality of sleep. Poor quality of sleep was also associated with work stress and mental health disorders.Item Open Access Prevalence of Current Chronic Pain in Royal Canadian Mounted Police Cadets(Informa UK Limited, 2024-05-12) Robyn E. Shields; Taylor A. Teckchandani; Katie L. Andrews; Billea Ahlgrim; Danielle M. Caissie; Chet C. Hembroff; Jolan Nisbet; Gordon J. G. Asmundson; Gregory P. Krätzig; R. Nicholas CarletonBackground: Nearly half of active duty Royal Canadian Mounted Police (RCMP) officers (i.e., 43%) report experiencing current chronic pain (i.e., pain lasting longer than 3 months). Most RCMP officers (i.e., 91%) who report chronic pain indicate that the pain started after working as RCMP officers. Baseline data on chronic pain prevalence among RCMP cadets has not been available. Aims: The current study was designed to provide cross-sectional estimates of chronic pain prevalence among RCMP cadets starting the Cadet Training Program and to assess for sociodemographic differences among participants. Methods: The RCMP Study uses a longitudinal prospective sequential experimental cohort design to create a clustered randomized trial that engages individual participants for 5.5 years. The current manuscript provides cross- sectional associations between chronic pain prevalence and sociodemographic characteristics. Participants were RCMP cadets (n=770) starting the Cadet Training Program. Location, intensity (i.e., on a 0-10 scale, and days per week experienced), and duration (i.e., number of months) of chronic pain was reported. Differences across sociodemographic characteristics were examined. Results: Few RCMP cadets reported experiencing chronic pain (i.e., 10%); lower back pain was rated as the most severe in terms of intensity and duration, and second most frequently reported in number of days experienced per week. Prevalence of chronic pain was lower among RCMP cadets than RCMP officers. Conclusions: Chronic pain prevalence among active duty RCMP officers may result from or be moderated by operational duties, as well as routine aging. Future researchers could examine ways to mitigate chronic pain development during RCMP officer careers.Item Open Access Trouble with the curve: the 90–9-1 rule to measure volitional participation inequalities among Royal Canadian Mounted Police cadets during training(Frontiers Media SA, 2024-05-28) Taylor A. Teckchandani; Robyn E. Shields; Katie L. Andrews; Kirby Q. Maguire; Laleh Jamshidi; Jolan Nisbet; Tracie O. Afifi; Lisa M. Lix; Sherry H. Stewart; Shannon Sauer-Zavala; Rachel L. Krakauer; J. Patrick Neary; Gregory P. Krätzig; R. Nicholas CarletonObjective: The Royal Canadian Mounted Police (RCMP) Study includes longitudinal multimodal assessments of RCMP cadets from pre-training (i.e., starting the Cadet Training Program [CTP]) to post-deployment and for five years thereafter. The data allow for investigating the multidimensionality of volitional participation in digital health data collection frameworks within serial data collection platforms and the impact of participation inequalities by classifying cadets using the 90–9-1 rule. By classifying cadets as Lurkers, Contributors, and Superusers formally described by the 90–9-1 rule, where 90% of actors do not participate, 9% seldom contribute, and 1% contribute substantially allows for the assessing of relationships between participation inequalities in self-monitoring behaviors as well as whether mental health disorder symptoms at pre-training (i.e., starting the CTP) were associated with subsequent participation. Methods: Participants were asked to complete a Full Assessment prior to their training at CTP, as well as short daily surveys throughout their training. Participation frequency was described using a process where participants were rank ordered by the number of daily surveys completed and classified into one of three categories. Full assessment surveys completed prior to their training at CTP included screening tools for generalized anxiety disorder (GAD), major depressive disorder (MDD), posttraumatic stress disorder (PTSD), alcohol use disorder (AUD), and panic disorder (PD). The Kruskal-Wallis H test was used to assess differences in participation rates between mental health disorder symptom screening groups for each measure at pre-training, and Spearman’s Rho was used to test for associations amongst self-reported Full Assessment screening tool responses and the number of daily surveys completed during CTP. Results: There were 18557 daily survey records collected from 772 participants. The rank-ordering of cadets by the number of daily surveys completed produced three categories in line with the 90–9-1 rule: Superusers who were the top 1% of cadets (n=8) and produced 6.4% of all recordings; Contributors who were the next 9% of cadets (n=68) and produced 49.2% of the recordings; and Lurkers who were the next 90% of cadets (n=695) and produced 44.4% of daily survey recordings. Lurkers had the largest proportion of positive screens for self-reported mental health disorders at pre-training. Conclusion: The creation of highly individualized, population-based mental health injury programs has been limited by an incomplete understanding of the causal relationships between protective factors and mental health. Disproportionate rates of disengagement from persons who screen positive for mental health disorders further compounds the difficulty in understanding the relationships between training programs and mental health. The current results suggest persons with mental health challenges may be less likely to engage in some forms of proactive mental health training. The current results also provide useful information about participation, adherence, and engagement that can be used to inform evidence-based paradigm shifts in health-related data collection in occupational populations.Item Open Access Outcomes of transdiagnostic internet-delivered cognitive behavioural therapy tailored to public safety personnel: A longitudinal observational study(Elsevier BV, 2024-06) Heather D. Hadjistavropoulos; Hugh C. McCall; Blake F. Dear; Janine D. Beahm; R. Nicholas Carleton; Nickolai TitovFirst responders and other public safety personnel (PSP) experience high rates of mental health problems and face barriers to accessing mental healthcare. Internet-delivered cognitive behavioural therapy (ICBT) is an effective and accessible treatment for various mental health concerns. Canadian PSP report favorable attitudes toward ICBT, and preliminary outcomes demonstrate that they benefit from it. Expanding on this research, the current study consisted of a longitudinal observational study of 560 Canadian PSP who participated in ICBT. It was designed to assess the longer term effectiveness of ICBT and moderators of outcomes by gender, linguistic and occupational group, and years of occupational experience. We evaluated symptom change at 8, 26, and 52 weeks post-enrollment, and results among PSP who had elevated clinical scores, showed large reductions (Hedges’ g) in symptoms of depression (g = 1.3), anxiety (g =1.48), posttraumatic stress (g =1.24), panic (g =1.19), and anger (g =1.07) and moderate reductions in symptoms of social anxiety (g =.48–.56). Moderator analyses revealed modest differences in pre-treatment symptoms among certain groups but no group differences in symptom change over time. Clients showed good completion of treatment materials and reported high treatment satisfaction. The results suggest further study of ICBT tailored to PSP is warranted, including evaluating ICBT tailored for PSP in other countries.Item Open Access Provincial and territorial correctional service workers: A Canadian national and jurisdictional assessment of mental health(2024-03-07) Ricciardelli, R.; Carleton, R.N.; Taillieu, T.L.; Dorniani, S.; Johnston, M.S.; Carbonell, M.; Coulling, R.; Andres, E.; Afifi, T.O.Purpose: Canadian correctional workers (CWs) experience substantial challenges with mental health, but prev- alence estimates have been limited across provincial and territorial services. Methods: Participating CWs from all 13 provincial and territorial services (n = 3740) self-selected to complete an online mental health and well-being survey assessing sociodemographic characteristics and symptoms of several mental disorders. Participants worked as correctional officers, community operations (e.g., probation officers), institutional operations (e.g., program officers), community administrators (e.g., managers), institutional or regional headquarters administrators, or institutional management (e.g., superintendents). Results: Across Canada, participants screened positive for one or more mental disorders (57.9%), with several regional differences (ps < 0.05). Correctional officers reported more positive screens than other CWs (ps < 0.05). Years of service and being married were inversely related with mental health (ps < 0.05). Conclusions: The current results suggest provincial and territorial CWs report mental health challenges much more frequently than the diagnostic prevalence for the general public (10.1%) and need additional supports. Unexpectedly, there were absent elevations associated with data collected after the onset of COVID-19Item Open Access Mental Health Knowledge, Stigma, and Service Use Intentions Among Correctional Workers(Canadian Psychological Association, 2023-11-30) Shields, Robyn E.; Ricciardelli, Rosemary; Jamshidi, Laleh; Carleton, R. NicholasCorrectional workers are regularly exposed to potentially psychologically traumatic events, which are associated with mental health disorders. Correctional workers report barriers to mental health service use due to difficulties recognizing mental health needs and stigma, leading to compromised mental health. The current study was designed to assess nuances in mental health knowledge, stigma, and service use intentions among correctional workers and differences based on demographic categories and histories of mental health disorders. Participants (n = 878) were correctional workers from Ontario, Canada, who completed the Mental Health Knowledge Scale, the Opening Minds Scale for Workplace Attitudes, and the Mental Health Service Use Questionnaire. There were statistically significant differences on measures of mental health knowledge, stigma, and service use intentions across most demographic categories. There were statistically significant differences on a measure of mental health service use intentions between participants with and without a history of mental health disorders. Mental health knowledge contributed significantly to the variation in service use intentions. The current results provide initial baseline data for correctional workers regarding mental health knowledge, stigma, and service use intentions. The results evidence demographic differences that may help focus training efforts. The results also suggest experiencing mental health disorders may be insufficient to overcome mental health stigma, which means additional individual, organizational, and structural efforts are warranted to increase service use intentions among correctional workers as part of supporting better mental health.Item Open Access Web-Based Mindfulness Meditation as an Adjunct to Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Feasibility Evaluation Study(JMIR Publications, 2024-01-30) Landry, Caeleigh A; McCall, Hugh C; Beahm, Janine D; Titov, Nickolai; Dear, Blake; Carleton, R Nicholas; Hadjistavropoulos, Heather DBackground: Public safety personnel (PSP) are individuals who work to ensure the safety and security of communities (eg, correctional workers, firefighters, paramedics, and police officers). PSP have a high risk of developing mental disorders and face unique barriers to traditional mental health treatments. The PSP Wellbeing Course is a transdiagnostic, internet-delivered cognitive behavioral therapy (iCBT) course tailored to assist PSP with symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). The initial course outcomes are promising, but some clients report some challenges with learning skills and recommend adding additional resources. Mindfulness meditations, which help people to experience the world and their reactions to the world in open and nonjudgmental ways, may complement the existing PSP Wellbeing Course. Objective: This study aims to examine the feasibility of mindfulness meditations in iCBT tailored for PSP. Information was gathered to evaluate engagement and client experiences with mindfulness meditations, symptom change, and the relationship between mindfulness meditation use and symptom change. Methods: A mixed methods study was conducted on PSP enrolled in the PSP Wellbeing Course who were offered 5 mindfulness meditations during the program (ie, 1/lesson). Clients completed questionnaires on depression, anxiety, PTSD, anger, insomnia, resilience, and mindfulness at pretreatment and at 8 weeks; an 8-week treatment satisfaction questionnaire; and brief weekly measures of mindfulness meditation engagement. We used paired sample t tests (2-tailed) to assess changes in outcomes over time and partial correlations to assess whether mindfulness meditation use predicted outcomes at posttreatment. A total of 12 clients were interviewed about their perceptions of the mindfulness meditations, and interviews were analyzed using directed content analysis. Results: Among the 40 clients enrolled, 27 (68%) reported using the mindfulness meditations, practicing for an average of 4.8 (SD 8.1) minutes each week. Most interviewees described the mindfulness meditations as beneficial but also reported challenges, such as discomfort while sitting with their feelings. Clients provided suggestions for better integration of mindfulness into iCBT. Overall, clients who completed the PSP Wellbeing Course with mindfulness meditations experienced statistically significant improvements in symptoms of anxiety (P=.001), depression (P=.001), PTSD (P=.001), and anger (P=.001) but not insomnia (P=.02). Clients also experienced improvements in resilience (P=.01) and mindfulness (P=.001). Self-reported time spent meditating was not associated with changes in symptoms over time.Item Open Access Measuring moral distress and moral injury: A systematic review and content analysis of existing scales(Elsevier BV, 2024-03) Stephanie A. Houle; Natalie Ein; Julia Gervasio; Rachel A. Plouffe; Brett T. Litz; R. Nicholas Carleton; Kevin T. Hansen; Jenny J.W. Liu; Andrea R. Ashbaugh; Walter Callaghan; Megan M. Thompson; Bethany Easterbrook; Lorraine Smith-MacDonald; Sara Rodrigues; Stéphanie A.H. Bélanger; Katherine Bright; Ruth A. Lanius; Clara Baker; William Younger; Suzette Bremault-Phillips; Fardous Hosseiny; J. Don Richardson; Anthony NazarovBackground: Moral distress (MD) and moral injury (MI) are related constructs describing the negative conse- quences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use. Method: We identified psychometric studies describing the development or validation of MD or MI scales and extracted information on methodological and psychometric qualities. Content analyses identified specific out- comes measured by each scale. Results: We reviewed 77 studies representing 42 unique scales. The quality of psychometric approaches varied greatly across studies, and most failed to examine convergent and divergent validity. Content analyses indicated most scales measure exposures to potential moral stressors and outcomes together, with relatively few measuring only exposures (n = 3) or outcomes (n = 7). Scales using the term MD typically assess general distress. Scales using the term MI typically assess several specific outcomes.Item Open Access Examining how organizational leaders perceive internet-delivered cognitive behavioural therapy for public safety personnel using the RE-AIM implementation framework(Elsevier BV, 2024-03) Janine D. Beahm; Hugh C. McCall; R. Nicholas Carleton; Nicholas Jones; Heather D. HadjistavropoulosWithin Canada, internet-delivered cognitive behavioural therapy (ICBT) has recently been tailored by PSPNET to meet the needs of public safety personnel (PSP) to help address high rates of mental health problems within this population. Perceptions and outcomes of ICBT among PSP are promising, but it remains unknown how PSPNET is perceived by PSP organizational leaders. It is important to assess this gap because these leaders have significant potential to influence the uptake of ICBT. Methods: In the current study, PSP leaders (n = 10) were interviewed to examine their perceptions of PSPNET and opportunities to improve ICBT implementation. The RE-AIM evaluation framework was used to assess PSP leaders' perceptions of PSPNET in terms of reach, effectiveness, adoption, implementation, and maintenance. Results: The results evidenced that leaders perceived PSPNET as effective in reaching and serving PSP and PSP organizations. PSP leaders reported perceiving ICBT as effectively implemented, especially for being freely offered to individual PSP and for improving PSP's access to experienced therapists specifically trained to work with PSP. Participants indicated organizations have promoted and will continue promoting PSPNET longer-term, facilitating adoption and maintenance. Factors perceived as facilitating successful service delivery included building relationships and trust with PSP organizations and general support for PSP leadership mental health initiatives. PSP leaders identified perceived areas for improving ICBT implementation (e.g., ensuring leaders have access to data on PSPNET uptake and outcomes, creating promotional videos, expanding availability of PSPNET to other provinces, offering additional options for receiving therapist support). Implications: Overall, the study provides insights into PSP leaders' perceptions of the implementation of ICBT among PSP and ideas for optimizing implementation efforts.Item Open Access Associations Between Personality and Mental Health Among Royal Canadian Mounted Police Cadets(Springer Science and Business Media LLC, 2024-01-27) Katie L. Andrews; Laleh Jamshidi; Jolan Nisbet; Tracie O. Afifi; Shannon Sauer-Zavala; Gregory P. Kratzig; Taylor A. Teckchandani; J. Patrick Neary; R. Nicholas CarletonAbstractRoyal Canadian Mounted Police (RCMP) report frequent exposures to diverse potentially psychological traumatic events (PPTEs) that can lead to symptoms of posttraumatic stress disorder (PTSD) and other mental health disorders. Personality traits may partially inform the substantial mental health challenges reported by serving RCMP. The current study examines associations between HEXACO personality factor and facet-level dimensions and mental health disorders of RCMP cadets starting the Cadet Training Program (CTP). RCMP cadets (n = 772) starting the CTP self-reported sociodemographics, personality, and mental health disorder symptoms. Emotionality was associated with MDD, GAD, and SAD (AORs ranged from 6.23 to 10.22). Extraversion and Agreeableness were inversely associated with MDD, GAD, and SAD (AORs ranged from 0.0159 to 0.43), whereas Openness to Experience was inversely associated with SAD (AOR = 0.36). Several facet-level personality dimensions were associated with mental health disorders. Inconsistent differences were observed between men and women for relationships between personality factors, facets, and positive screenings for mental disorders. The relationship patterns allude to possible risk and resilience factors associated with personality factors and facets. Early training, interventions, and resources tailored to cadet personality factors and facets might reduce risk and bolster mental health resilience.Item Open Access Towards a Holistic Model of Care for Moral Injury: An Australian and New Zealand Investigation into the Role of Police Chaplains in Supporting Police Members following exposure to Moral Transgression(Springer, 2023-09-11) Phelps, Andrea J.; Madden, Kelsey; Carleton, R. Nicholas; Johnson, Lucinda; Carey, Lindsay B.; Mercier, Jean-Michel; Mellor, Andrew; Baills, Jeffrey; Forbes, David; Devenish-Meares, Peter; Hosseiny, Fardous; Dell, LisaPolice members can be exposed to morally transgressive events with potential for lasting psychosocial and spiritual harm. Through interviews with police members and police chaplains across Australia and New Zealand, this qualitative study ex- plores the current role that police chaplains play in supporting members exposed to morally transgressive events. The availability of chaplains across police services and the close alignment between the support they offer, and the support sought by police, indicates they have an important role. However, a holistic approach should also consider organizational factors, the role of leaders, and access to evidence- based treatment in collaboration with mental health practitioners.Item Open Access Do trauma cue exposure and/or PTSD symptom severity intensify selective approach bias toward cannabis cues in regular cannabis users with trauma histories?(Elsevier, 2023-08-21) DeGrace, S.; Romero Sanchiz, P.; Tibbo, P.; Barrett, S.; Arenella. P.; Cosman, T.; Atasoy, P.; Cousijn, J.; Wiers, R.; Keough, MT; Yakovenko, I.; O'Connor, R.; Wardell, J.; Rudnick, A.; Carleton, R. Nicholas; Heber, A.; Stewart, SHTrauma cue-elicited activation of automatic cannabis-related cognitive biases are theorized to contribute to comorbid posttraumatic stress disorder and cannabis use disorder. This phenomenon can be studied experimentally by combining the trauma cue reactivity paradigm (CRP) with cannabis-related cognitive processing tasks. In this study, we used a computerized cannabis approach-avoidance task (AAT) to assess automatic cannabis (vs. neutral) approach bias following personalized trauma (vs. neutral) CRP exposure. We hypothesized that selective cannabis (vs. neutral) approach biases on the AAT would be larger among participants with higher PTSD symptom severity, particularly following trauma (vs. neutral) cue exposure. We used a within-subjects experimental design with a continuous between-subjects moderator (PTSD symptom severity). Participants were exposed to both a trauma and neutral CRP in random order, completing a cannabis AAT (cannabis vs. neutral stimuli) following each cue exposure. Current cannabis users with histories of psychological trauma (n = 50; 34% male; mean age = 37.8 years) described their most traumatic lifetime event, and a similarly-detailed neutral event, according to an established interview protocol that served as the CRP. As hypothesized, an AAT stimulus type x PTSD symptom severity interaction emerged (p = .042) with approach bias greater to cannabis than neutral stimuli for participants with higher (p = .006), but not lower (p = 0.36), PTSD symptom severity. Contrasting expectations, the stimulus type x PTSD symptoms effect was not intensified by trauma cue exposure (p = 0.19). Selective cannabis approach bias may be chronically activated in cannabis users with higher PTSD symptom severity and may serve as an automatic cognitive mechanism to help explain PTSD-CUD co-morbidity.Item Open Access Internet-delivered cognitive behavioural therapy for symptoms of PTSD among public safety personnel: Initial outcomes of an open cohort preference trial of transdiagnostic and disorder-specific therapy(Elsevier, 2023-09-09) McCall, Hugh; Dear, Blake, F.; Landry, Caeleigh; Beahm, Janine D.; Gregory, Julia; Titov, Nickolai; Carleton, R. Nicholas; Hadjistavropoulos, Heather D.Public safety personnel (PSP) face high rates of mental health problems and many barriers to care. Initial outcomes of transdiagnostic internet-delivered cognitive behavioural therapy (ICBT) tailored for PSP are promising, but prior research has not evaluated outcomes of PTSD-specific ICBT among PSP or PSP's preferences for transdiagnostic or PTSD-specific ICBT. The current paper presents the initial outcomes (N = 150) of a mixed-methods observational study designed to (a) investigate preferences for transdiagnostic or PTSD-specific ICBT among PSP with elevated symptoms of PTSD and/or a primary concern with PTSD symptoms and (b) explore potential differences in client engagement, satisfaction, and symptom changes between the two forms of ICBT. PSP completed questionnaires before and after their preferred ICBT program. Mixed-methods analyses included generalized estimating equations, descriptive statistics, and inductive conventional qualitative content analysis. More clients (n = 85; 57 %) selected transdiagnostic ICBT than PTSD-specific ICBT (n = 65; 43 %), but the difference in the number of clients who selected each course was not statistically significant. Clients in both ICBT programs reported similar and favorable treatment satisfaction (e.g., 98 % would recommend the course to a friend), treatment engagement (i.e., 69 % accessed at least four of the five lessons), and pre-post improvement in symptoms (e.g., Hedges' g = 0.81 for reduction in PTSD symptom). Transdiagnostic ICBT resulted in greater reductions in symptoms of panic disorder than PTSD-specific ICBT. Qualitative analyses showed similarities across the ICBT programs in client feedback. The current study provides further evidence supporting the use and outcomes of ICBT for PSP in both transdiagnostic and disorder-specific formats. Implications for the literatures on PSP mental health and ICBT, as well as practical recommendations, are discussed.Item Open Access Daily survey participation and positive changes in mental health symptom scores among Royal Canadian Mounted Police Cadets(Frontiers, 2023-08-04) Shields, Robyn E.; Teckchandani, Taylor A.; Asmundson, Gordon J. G.; Nisbet, Jolan; Krakauer, Rachel L.; Andrews, Katie L.; Maguire, Kirby Q.; Jamshidi, Laleh; Afifi, Tracie O.; Lix, Lisa M.; Brunet, Alain; Sauer-Zavala, Shannon; Krätzig, Gregory P.; Neary, J. Patrick; Sareen, Jitender; Carleton, R. NicholasIntroduction: Royal Canadian Mounted Police (RCMP) officers self-report high levels of mental health disorder symptoms, such as alcohol use disorder, generalized anxiety disorder, major depressive disorder, panic disorder, and posttraumatic stress disorder. Participation in regular mental health monitoring has been associated with improved mental health disorder symptom reporting and may provide an accessible tool to support RCMP mental health. The current study assessed relationships between self-reported mental health disorder symptoms and the completion of daily surveys (i.e., daily mental health disorder symptom monitoring) by RCMP cadets during the Cadet Training Program (CTP). Methods: Participants were RCMP cadets (n = 394; 76.1% men) in the Standard Training Program who completed the 26-week CTP and daily self-monitoring surveys, as well as full mental health assessments at pre-training (i.e., starting the CTP) and pre-deployment (i.e., ~2 weeks prior to deployment to the field). Symptoms of alcohol use disorder, generalized anxiety disorder, major depressive disorder, panic disorder, and posttraumatic stress disorder were assessed. Changes in mental health disorder symptom reporting from pre-training to pre-deployment were calculated. Spearman’s rank correlations were estimated for number of daily surveys completed and change in mental health disorder symptom scores between pre-training and pre-deployment. Results: There were statistically significant inverse relationships between number of daily surveys completed and number of mental health disorder symptoms reported; specifically, cadets who completed more daily surveys during CTP reported fewer symptoms of alcohol use disorder, generalized anxiety disorder, major depressive disorder, panic disorder, and posttraumatic stress disorder. Conclusion: An inverse correlation between number of daily surveys completed and mental health disorder symptom scores indicated that participation in daily mental health monitoring was associated with improvements in self-reported mental health disorder symptoms between pre-training and pre-deployment. Regular self-monitoring of mental health disorder symptoms may help to mitigate mental health challenges among RCMP cadets and officers.Item Open Access Child Maltreatment History, Deployment-Related Traumatic Events, and Past 12-Month Cannabis Use Among Veterans in Canada(Sage, 2023-08-11) Afifi, Tracie O.; Taillieu, Tamara; Salmon, Samantha; Stewart-Tufescu, Ashley; Sareen, Jitender; Enns, Murray W.; Mota, Natalie; Bolton, Shay-Lee; Carleton, R. Nicholas; Heber, Alexandra; VanTil, LindaObjective Cannabis use among veterans in Canada is an understudied public health priority. The current study examined cannabis use prevalence and the relationships between child maltreatment histories and deployment-related traumatic events (DRTEs) with past 12-month cannabis use including sex differences among Canadian veterans. Method Data were drawn from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (response rate 68.7%; veterans only n = 1,992). Five child maltreatment types and 9 types of DRTEs were assessed in relation to the past 12-month cannabis use. Results The prevalence of lifetime and past 12-month cannabis use was 49.4% and 16.7%, respectively. Females were less likely than males to report lifetime cannabis use (41.9% vs. 50.4%; odds ratio [OR] 0.71; 95% CI, – 0.59 to 0.86). No sex differences were noted for past 12-month cannabis use (14.1% vs. 17.0%; OR 0.80; 95% CI, 0.60 to 1.07). Physical abuse, sexual abuse, neglect, any child maltreatment, most individual DRTEs, and any DRTE were associated with increased odds of past 12-month cannabis use after adjusting for sociodemographic and military variables. Some models were attenuated and/or nonsignificant after further adjustments for mental disorders and chronic pain conditions. Sex did not statistically significantly moderate these relationships. Cumulative effects of having experienced both child maltreatment and DRTEs compared to DRTEs alone increased the odds of past 12-month cannabis use. Statistically significant interaction effects between child maltreatment history and DRTE on cannabis use were not found. Conclusions Child maltreatment histories and DRTEs increased the likelihood of past 12-month cannabis use among Canadian veterans. A history of child maltreatment, compared to DRTEs, indicated a more robust relationship. Understanding the links between child maltreatment, DRTEs, and cannabis use along with mental disorders and chronic pain conditions is important for developing interventions and improving health outcomes among veterans.Item Open Access Understanding PTSD among correctional workers in Manitoba, Canada: Key considerations of social variables(Wiley, 2023-06) McKendy, Laura; Taillieu, Tamara; Johnston, Matthew, S.; Ricciardelli, Rosemary; Ricciardelli, R. NicholasMounting evidence highlights the high prevalence of posttraumatic stress disorder (PTSD) among correctional workers. The current analysis draws on survey response data to present a social profile of correctional workers in the province of Manitoba (n = 580), Canada, who screened positive for PTSD (n = 196). We examined demographic information, professional history information, and adverse work exposure experiences, as well as treatment and support patterns. The analysis was not intended to identify correlates of PTSD development among correctional workers, but did identify the characteristics, professional and personal situations, and treatment experiences of correctional workers who screened positive for PTSD. The results highlight the multidimensional nature of work stressors, the pronounced problem of work–life conflict, and variations in seeking supports and treatments. Generally, participants screening positive for PTSD reported higher exposure to potentially psychologically traumatic events, higher environmental or occupational stressors at work, and many had prior work experience as public safety personnel. Correctional workers who screened positive for PTSD appeared more likely to access mental health supports. Promoting proactive support seeking for mental health treatment may help to mitigate the severity, frequency, stigma, and length of mental health challenges among correctional workers.Item Open Access Paraprofessional delivery of online narrative exposure therapy for firefighters(Wiley, 2023-06-08) Olthuis, Janine V.; Kaltenbach, Elisa; Giberson, Emma; Saryeddine, Tina; Asmundson, Gordon J. G.; Carleton, R. Nicholas; Cramm, Heidi; Crombach, Anselm; Devlin, Julie; Mack, Jeff; Lingley-Pottie, Patricia; Rao, Sanjay; Sullivan, Michael; Wozney, Lori; McGrath, Patrick J.Firefighters are at increased risk for developing posttraumatic stress disorder (PTSD) and face numerous barriers to accessing mental health care. Innovative ways to increase access to evidence-based interventions are needed. This study was a case series testing the acceptability, feasibility, and preliminary effectiveness of a paraprofessional-delivered, virtual narrative exposure therapy (eNET) intervention for PTSD. Participants were 21 firefighters who met the criteria for clinical or subclinical probable PTSD and completed 10–12 sessions of eNET via videoconference. Participants completed self-report measures pre- and postintervention and at 2- and 6-month follow-ups as well as a postintervention qualitative interview. Paired samples t tests evidenced statistically significant decreases in PTSD, anxiety, and depressive symptom severity and functional impairment from pre- to postintervention, ds = 1.08–1.33, and in PTSD and anxiety symptom severity and functional impairment from preintervention to 6-month follow-up, ds = 0.69–1.10. The average PTSD symptom severity score fell from above to below the clinical cutoff for probable PTSD at postintervention and follow-ups. Qualitative interviews indicated that paraprofessionals were considered central to participants’ success and experience with the intervention. No adverse events or safety concerns were raised. This study is an important step in demonstrating that appropriately trained and supervised paraprofessionals can effectively deliver eNET to firefighters with PTSD.Item Open Access Provincial Correctional Service Workers: The Prevalence of Mental Disorders(Multidisciplinary Digital Publishing Institute, 2020-03-25) Carleton, R. Nicholas; Ricciardelli, Rosemary; Taillieu, Tamara; Mitchell, Meghan M.; Andres, Elizabeth; Afifi, Tracie O.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., superintendents) (n = 82), correctional officers (n = 553), administration (e.g., record keeping) (n = 25 ), and probation officers (n = 144, parole officers). 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 < 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 factors associated (p < 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.