The impact of the military mission in Afghanistan on mental health in the Canadian Armed Forces: a summary of research findings

As Canada's mission in Afghanistan winds down, the Canadian Forces (CF) are reflecting on the psychological impact of the mission on more than 40,000 deployed personnel. All major CF studies of mental health outcomes done before and during the Afghanistan era are summarized, with an eye toward getting the most complete picture of the mental health impact of the mission. Studies on traumatic brain injury (TBI), high-risk drinking, and suicidality are included given their conceptual link to mental health. CF studies on the mental health impact of pre-Afghanistan deployments are few, and they have inadequate detail on deployment experiences. Afghanistan era findings confirm service-related mental health problems (MHPs) in an important minority. The findings of the studies cohere, both as a group and in the context of data from our Allies. Combat exposure is the most important driver of deployment-related MHPs, but meaningful rates will be found in those in low-threat areas. Reserve service and cumulative effects of multiple deployments are not major risk factors in the CF. Many deployed personnel will seek care, but further efforts to decrease the delay are needed. Only a fraction of the overall burden of mental illness is likely deployment attributable. Deployment-related mental disorders do not translate into an overall increase in in-service suicidal behavior in the CF, but there is concerning evidence of increased suicide risk after release. TBI occurred in a distinct minority on this deployment, but severe forms were rare. Most TBI cases do not have persistent “post-concussive” symptoms; such symptoms are closely associated with MHPs. The mental health impact of the mission in Afghanistan is commensurate with its difficult nature. While ongoing and planned studies will provide additional detail on its impacts, greater research attention is needed on preventive and therapeutic interventions.

随着加拿大在阿富汗的军事任务逐步收尾，加拿大武装部队（Canadian Forces, CF）正针对该任务对4万余名部署人员造成的心理影响展开全面复盘。本研究汇总了阿富汗任务周期前后加拿大武装部队开展的所有重大心理健康结局相关研究，旨在完整呈现该任务对人员心理健康的影响全貌。鉴于创伤性脑损伤（Traumatic Brain Injury, TBI）、高风险饮酒及自杀相关行为与心理健康存在明确的概念关联，本研究亦纳入了针对上述议题的相关研究。加拿大武装部队针对阿富汗任务前部署行动对心理健康影响的相关研究数量极少，且对部署经历的细节记录不足。阿富汗任务周期的相关研究结果证实，有相当比例的人员出现了与服役相关的心理健康问题（Mental Health Problems, MHPs）。各项研究的结果彼此印证，无论是单独分析还是结合盟友方的相关数据进行研判，结论均保持一致。战斗暴露是与部署相关的心理健康问题的最主要诱因，但即便在低威胁区域执行任务的人员中，也能观测到不容忽视的相关问题发生率。在加拿大武装部队中，预备役服役经历及多次部署的累积效应并非主要的风险因素。大量部署人员会主动寻求心理健康诊疗服务，但仍需进一步采取措施以缩短其就诊延迟时长。整体精神疾病负担中，仅有极小一部分可归因于部署行动。与部署相关的精神障碍并未导致加拿大武装部队现役人员自杀行为整体上升，但有令人担忧的证据表明，人员退役后的自杀风险有所升高。本次部署行动中出现创伤性脑损伤的人员占比极低，且重症病例较为罕见。多数创伤性脑损伤病例不会出现持续性的“脑震荡后”症状，但此类症状与心理健康问题存在紧密关联。加拿大在阿富汗的军事任务对人员心理健康造成的影响，与其任务本身的艰巨程度相符。尽管当前正在开展及计划推进的研究将进一步细化该任务的影响细节，但目前仍需在心理健康预防与治疗干预方面投入更多的研究精力。