News - Mar 2020

Mobilizing experts to address sexual misconduct in the military

In October 2019, 50 stakeholders from across Canada attended a workshop at the annual Canadian Institute for Military and Veteran Health Research Forum. The workshop focused on the psychological consequences of sexual misconduct during military service.

Researchers, policy makers, military members, veterans, and clinicians convened to explore the relation between exposure to sexual misconduct during military service and the onset of moral injury among female military members and veterans.

To mobilize action on these discussions, HRI hosted a symposium on December 3, 2019. Funded by the Government of Canada’s Defence Engagement Program, the symposium brought Canadian military and non-military experts together with a common goal of supporting the Canadian Armed Forces in addressing sexual misconduct.

The role of moral injury

Canada patch flags on soldiers arm

Work at HRI is exploring whether exposure to sexual misconduct in military environments is related to the onset of moral injury. For example, sexual misconduct may result in moral injury when an incident involves a perceived betrayal by those within a circle of trust or by an authority figure.

Similarly, a military member could be morally wounded by witnessing – but being unable to stop – a colleague from sexually harassing another military member.

The interplay between sexual misconduct and moral injury is complex and requires further investigation. What is known, however, is that military members affected by sexual misconduct in the workplace are at increased risk of post-traumatic stress disorder, anxiety, depression, and suicide.

Moving research, prevention, and intervention forward

During the December 3 symposium, discussions were diverse but focused on barriers, resources, and actionable items to affect change, including:

  • The rise of the internet and social media in skewing views of normal sexual behaviour and consent
  • Optimizing available resources for affected members, including the Sexual Misconduct Response Centre
  • Celebrating current training and education initiatives, including Operation Honour
  • Expanding education focused on emotional intelligence, boundary setting, assertiveness, bystander roles, and moral dilemmas
  • Understanding the needs of LGBTQ+ members, indigenous members, and members with disabilities
  • Improving screening tools to identify affected members or those at high risk of perpetrating sexual misconduct
  • Improving treatment and intervention approaches to help affected members
  • Vital research needs, including the need to explore where best to target resources, the link between sexual misconduct and moral injury, how to facilitate culture change among all levels and ranks, the value of peer support, and the need to expand research to include male, LGBTQ+ and non-binary members

Group of symposium attendees, December 3, 2019The symposium was attended by 18 representatives of leading universities, research centres, and treatment providers, as well as the Department of National Defence, Veteran’s Affairs Canada, Servicewomen’s Salute, and the Canadian Institute for Military and Veteran Health Research.

Dr. Margaret McKinnon, Homewood Research Chair in Mental Health and Trauma, is the lead investigator on this research. Key collaborators include:

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International study explores how AA contributes to recovery

Treatment of alcohol use disorder is multi-faceted and often includes participation in mutual-support groups, the oldest and largest of which is Alcoholics Anonymous (AA).

Although frequent AA meeting attendance is associated with greater abstinence from alcohol, there is little understanding of the specific mechanisms by which AA benefits people. In other words, we know that AA works, but we aren’t sure how.

Recent studies suggest that AA may prompt important behavioural changes by positively impacting impulsivity and social networks. New research from the Peter Boris Centre for Addictions Research will take a deeper dive into this theory. The study will be led by Dr. James MacKillop, Peter Boris Chair in Addictions and HRI Senior Scientist, and Dr. John Kelly, Elizabeth R. Spallin Professor of Psychiatry in Addiction Medicine at Harvard Medical School. Their team will examine impulsivity and social networks to see how these mechanisms drive recovery success in AA attendees.

The process

Researchers will follow people seeking treatment for alcohol use disorder in both inpatient and outpatient settings. The study will involve participants from multiple treatment programs based in Guelph and Hamilton, Ontario, and Boston, Massachusetts.

Participants will be assessed when they enter treatment, at 4-6 weeks into treatment, and at four more time points over a one-year period. Assessments will ask about alcohol use, personality traits, family and peer behaviour, and general personal and health information. Novel approaches will be employed to measure impulsive behaviour and analyze social networks, allowing researchers to determine how these mechanisms relate to abstinence and other markers of recovery.

Generating new knowledge to help recovery

This study will shed light on the psychological and social mechanisms of recovery and how AA activates these mechanisms. Researchers also hope to discover factors that could predict positive or negative experiences with AA. Clinicians and scientists may also use findings to identify therapeutic targets for people receiving treatment in an effort to boost recovery success.

Funding and collaboration

This study, entitled Investigating Impulsivity and Social Network Changes as Novel Mechanisms of Behavioural Change for Alcoholics Anonymous’ (AA) Positive Effects, is funded by the US National Institute of Alcohol Abuse and Alcoholism (NIAAA).

Collaborators on this project include:

  • John Kelly (Massachusetts General Hospital, Harvard Medical School)
  • Robert Stout (PIRE Decision Sciences Institute, Providence, RI USA)
  • Allan Clifton (Vassar College, New York, USA)

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Evidence 101: Q&A with an expert

Dr. David Streiner has attempted to retire three times, but this biostatistics expert is in high demand.

Dr. David Streiner headshot

Dr. David Streiner

Having trained as a clinical psychologist more than 50 years ago, Dr. Streiner is now Professor Emeritus in both the Department of Psychiatry and Behavioural Neurosciences and the Department of Clinical Epidemiology and Biostatistics at McMaster University, and a Professor in the Department of Psychiatry at the University of Toronto.

His research expertise is sought by scientists, faculty, residents, and students alike. A star behind the scenes, Dr. Streiner frequently consults with HRI scientists and trainees on everything from study design to research analysis.

In this question-and-answer feature, Dr. Streiner provides clarity about some of the most common questions we receive at HRI about evidence.

What does “evidence” mean in the context of healthcare?

Evidence is the available body of facts that healthcare providers can draw from to best treat patients. The most common method of obtaining healthcare evidence today is through research studies. Prior to the rise of scientific healthcare research, evidence was based primarily on clinical expertise and opinion.

What is “evidence-based practice” in healthcare?

The term “evidence-based practice” originated from Dr. David Sackett, an American-Canadian physician who defined the term as “…the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of patients.”

So when using an evidence-based approach, one would base healthcare decisions solely on evidence from scientific research.

How is “evidence-informed practice” different from “evidence-based practice”?

Early critics of evidence-based practice argued that its definition limited medicine to a “cookbook approach” that fails to consider each patient’s unique values and preferences, and downplays the clinician’s experience and knowledge of the patient. A new term began to circulate, which encompassed a more person-centred approach:  evidence-informed practice.

Over time, the concept of evidence-based practice has evolved to include not only scientific research but also clinical expertise and the patient perspective brought to light by proponents of evidence-informed practice. Today, we see both terms used interchangeably.

How do we create evidence in healthcare?

First of all, we need research. Without research, we have no evidence. But to do research, we also need participants. We know that research plays a central role in designing and evaluating new treatments, but we often forget that patients and families play a central role in the research itself.

When answering research questions, we use a variety of methodologies. For example, if we want to know about the prevalence of a medical condition in a population, a cross-sectional study would be appropriate. On the other hand, if we want to find out whether a proposed treatment would help people with a specific condition, a randomized controlled trial would be used. At the end of the day, the research methodology depends on the question being asked.

The following infographic outlines some of the most common research approaches used at HRI:

Infographic explaining several types of research studies