Military and Veteran Health Research Veteran Military and New Coalition for a Challenging Battlefield A A New Coalition This volume brings together some of the research presented at the November 2011 Military and Veteran Health Research for a Challenging Forum, addressing the health issues and needs of Canadian military members, veterans, and their families. Battlefield Military and Veteran Alice B. Aiken Stéphanie A.H. Bélanger Edited by Health Research Edited by Stéphanie A.H. Bélanger Alice B. Aiken A NEW COALITION FOR A CHALLENGING BATTLEFIELD: MILITARY AND VETERAN HEALTH RESEARCH EDITED BY Stéphanie A.H. Bélanger Alice B. Aiken Copyright © 2012 Her Majesty the Queen, in right of Canada as represented by the Minister of National Defence. Canadian Defence Academy Press PO Box 17000 Stn Forces Kingston, Ontario K7K 7B4 Produced for the Canadian Defence Academy Press by 17 Wing Winnipeg Publishing Office. WPO30854 Library and Archives Canada Cataloguing in Publication A new coalition for a challenging battlefield : military and veteran health research / edited by Stéphanie A.H. Bélanger, Alice B. Aiken. Available also on the Internet. Issued by: Canadian Defence Academy. Includes bibliographical references. ISBN 978-1-1002-1361-3 Cat. no.: D2-287/2-2012E 1. Soldiers--Health and hygiene--Research--Canada. 2. Veterans--Health and hygiene-- Research--Canada. 3. Medicine, Military--Research--Canada. 4. Veterans--Medical care-- Canada--Congresses. 5. Soldiers--Medical care--Canada--Congresses. 6. Veterans--Rehabili- tation--Canada--Congresses. 7. Soldiers--Rehabilitation--Canada--Congresses. 8. Veterans-- Services for--Canada--Congresses. 9. Soldiers--Services for--Canada--Congresses. I. Bélanger, Stéphanie A. H II. Aiken, Alice, 1965- III. Canadian Defence Academy IV. Title: Military and veteran health research. UB369.5 C3 N48 2012 355.3’450720971 C2012-980204-2 Printed in Canada. 1 3 5 7 9 10 8 6 4 2 The views expressed in this publication are entirely those of the author and do not necessarily reflect the views, policy or position of the Government of Canada, the Department of National Defence, the Canadian Forces, or any of their subordinate units or organizations. ACKNOWLEDGEMENTS This collective aims to bring together the different research challenges that have been undertaken by researchers from across Canada on the topic of military and veteran health. The researchers who contributed to this volume were part of the second Military and Veteran Health Research (MVHR) Fo- rum that took place in November 2011, hosted by Queen’s University and the Royal Military College of Canada (RMCC) in Kingston, Ontario, under the auspices of the Canadian Institute for Military and Veteran Health Research (CIMVHR). This volume is one of the many ways CIMVHR is connecting researchers, government stakeholders, and, most importantly, the beneficiaries – still serving military members of the Canadian Forces (CF), veterans and their families – through knowledge exchange while also working towards our mis- sion: To optimize the health and well-being of Canadian military personnel, veterans and their families by harnessing and mobilizing the national capacity for high-impact research, knowledge creation and knowledge exchange. A special thank you is extended to our interim Board of Directors; without their support, CIMVHR could not undertake such high impact projects as the annual Forum and the publication of the best research it showcased. Our sincere word of gratitude to the Chair of the Board, Ms. Susan Marlin, As- sociate Vice Principal Research at Queen’s University; Dr. Jean Fugère, Vice Principal Research, RMCC; Dr. Jennifer Medves, Director of the School of Nursing and Associate Dean, Faculty of Health Science at Queen’s University; Mr. Michael Brennan, Chief Executive Officer of the Canadian Physiotherapy Association; and Dr. Heidi Sveistrup, Vice Principal Research and Professor in Rehabilitation Sciences at the University of Ottawa. A special thank you is also extended to our Technical Advisory Committee, especially the Canadian Forces Surgeon General, Commodore Hans Jung, his successor Brigadier-General Jean-Robert Bernier and his advisor Lieutenant-Colonel Rob Poisson; Veterans Affairs Canada (VAC) Director of the Research Directorate, Dr. David Pedlar, and his research team Dr. Jim Thompson and Mr. Stewart MacIntosh; the Director of the Defence and Secu- rity Research Institute (DSRI), Dr. Jacques Lavigne, and the scientists of De- fence Research Development Canada (DRDC), especially Dr. Kurtis Simpson. Without your support it would not have been possible to create this volume. i ACKNOWLEDGEMENTS The Editors would also like to thank the mentor and co-chair of CIMVHR Implementation Committee, Brigadier-General (Ret’d) William Richard who has dedicated endless hours to the development of CIMVHR, to the planning of the MVHR Forum and in engaging the Canadian community. Many aspects of this project would not have been possible without the com- bined support of Queen’s University, Principal Daniel Woolf and Dr. Steven Liss, Vice Principal Research, and of the RMCC, Brigadier-General Eric Tremblay, the Commandant, Principal Joel Sokolsky, as well as Dr. Jean Fugère, Vice Principal Research. Kingston is the hub of the Institute, its Forum and its collective; but even more important are the collaborative efforts of all our university partners. Beyond a hectic research and publication program, 26 universities (and counting) from all provinces are joining us in collaborating in Military and Veteran Health Research. This has an extremely high impact on our goals of increasing the health and well-being of military members, veterans and their families, as well as educating the first responders to this community that is spread throughout Canada. We would also like to acknowledge the support and patience of our MVHR College of Peer Reviewers; Dr. Allan English, Department of History, Queen’s University; Dr. Michael Greenwood, Department of Chemistry, RMCC; Dr. Dianne Groll, Department of Psychiatry, Queen’s University; Dr. Kate Harkness, Department of Psychology, Queen’s University; Dr. Cheryl King Van-Vlack, School of Rehabilitation Therapy, Queen’s University; Dr. Méla- nie Lavoie-Tremblay, School of Nursing, McGill University; Dr. Christian Leuprecht, Department of Politics and Economics, RMCC; Dr. Bob Mar- tyn, Fellow, Queen’s Centre for International and Defence Policy; Dr. Mary Ann McColl, Centre for Health Services and Policy Research, Queen’s Uni- versity; Dr. Bradford McFadyen, Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Université Laval; Dr. Richard Morchat, DSRI; Dr. Lucie Pelland, School of Rehabilitation Therapy, Queen’s University; Dr. Heidi Sviestrup, Professor in Rehabilitation Sciences, Uni- versity of Ottawa; Dr. Elizabeth Taylor, Faculty of Rehabilitation Medicine, University of Alberta; Gordon Asmundson, Faculty of Arts, University of Regina; Luc Noreau, CIRRIS; Dr. Alain Beaulieu, Electrical and Comput- er Engineering, RMCC; Dr. Richard Birtwhistle, Director of the Centre for Studies in Primary Care, Faculty of Health Sciences, Queen’s University; ii A NEW COALITION FOR A CHALLENGING BATTLEFIELD: ACKNOWLEDGEMENTS Dr. Anne Fenety, Faculty of Health Professions, Dalhousie University; Dr. James Gomes, Interdisciplinary School of Health Sciences, University of Ottawa; Dr. Luc Hébert, Faculty of Medicine, Université Laval; Dr. Geoffrey Hodgetts, School of Medicine, Queen’s University; Dr. Roumen Milev, Head of the Department of Psychiatry, Queen’s University; Dr. Deborah Norris, Facul- ty of Professional Studies, Mount Saint Vincent University; Dr. David Pedlar, Director of Research, VAC; Dr. Jitender Sareen, Faculty of Medicine, Univer- sity of Manitoba; Dr. Heather Stuart, Faculty of Health Sciences, Queen’s Uni- versity; Dr. Jim Thompson, Research Directorate, VAC; and Dr. Patrick Neary, Faculty of Kinesiology and Health Studies, University of Regina. The opportunity to create a volume such as this would not exist without the leadership and logistical support of the Canadian Defence Academy (CDA) Press, particularly the CDA Press Program Manager, Mélanie Denis. The Chairman of the CDA Press, Colonel Bernd Horn, is keenly aware of the im- portance of providing an opportunity for the academic community and our military members, past and present, to exchange knowledge and share experi- ences. He has provided ready access to the resources of CDA Press to see this volume through to completion, a contribution that is extremely important to us, as we are proud of this joint venture that is extremely meaningful to CIMVHR. As editors, we are very proud of the final product. The copy editing and layout were handled with expertise by 17 Wing Publishing Office. We would also like to thank for their support Lauren Hanlon, Angela Whitehead, Parth Bhow- mick and Filza Naveed: their professionalism and attention to detail have helped bring this book to completion. The edit, layout and design of both the content and the cover of this manuscript have resulted in a volume in which we can all take great pride. But none of this would have been possible without the great support that we have from our military colleagues, from the community of veterans that have approached us in the past few years, and from their families who also provided us with great inspiration. If they did not believe in it, who would? Thank you. MILITARY AND VETERAN HEALTH RESEARCH iii TABLE OF CONTENTS ACKNOWLEDGEMENTS. i FOREWORD.