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David Baxter PhD

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Depression, post-tramautic stress increased soldiers' sick leave
May 02, 2004

OTTAWA (CP) - Canadian soldiers' use of sick leave is increasing, with depression and post traumatic stress disorder playing the largest role in troops' medical absences, according to documents obtained by The Canadian Press.

The strain put on a smaller Canadian Forces is listed among the potential factors that has led to the increase, according to briefing notes prepared for Canada's top general.

Military clinics across Canada reported soldiers were given 121,133 sick leave days during the 13-month period beginning 1 January 2003. One in five days was for depression. Post traumatic stress disorder was behind one in every ten sick days taken, the same rate as sick leave granted for back and knee problems combined.

The figures do not include sick leave taken by soldiers deployed on missions abroad, such as Afghanistan, Haiti or Bosnia.

Quarterly sick leave tracking reports produced for Chief of Defence Staff Ray Henault include warnings that the statistics represent "the minimum amount of sick leave incurred" and "likely underestimates the true amount of sick leave accrued during this period."

For example, troops can now call in sick for up to three days without needing to see a medical officer or to complete sick leave pass. These periods are not captured in the data.

Briefing material used by the Surgeon General since last July to update Henault on sick leave trends lists several potential factors contributing to the increase, including "high operational tempo experienced by a smaller CF (Canadian Forces)," the growing presence of civilian physicians at military clinics, and the shifting of sick leave approval from commanding officers to medical officers in 1998.

And while data analysis is still underway, some of starkest trends have already emerged in the briefings to Henault. In a September briefing, Henault was told by the surgeon general that "sick leave is increasing in the CF" and this increase means a "significant drain on personnel." Soldiers are also taking longer periods of sick leave more frequently, with mental illness being the leading cause of longer sick leaves.

Surgeon General Colonel Scott Cameron cautioned against attempting to infer from the data any links between soldiers' deployment rates, the size of the Canadian military and rising sick leave rates.

But a lack of significant down time between deployments may be a factor in increased illnesses, Cameron suggested in an interview.

"The number of deployments does not appear to increase the prevalence of mental illness, but (for soldiers) ever having had less than 12 months between deployments, there does appear to be a correlation there, and that's something that's going to have to be further looked into."

Cameron asked for hard numbers on sick leave after reports of increasingly ill soldiers began circulating in the fall of 2002. Medical officials responded by validating data collected since 2000 in an existing database to determine that sick leave had indeed increased each year. Reporting of diagnoses by the medical system into a new "sick leave database" began only in January 2003, so comparative figures for specific illnesses are not available.

The data on sick leave due to mental illness, which accounts for almost 43 per cent of the military's total sick leave expenditure, will likely feed concern regarding mental health issues in the Canadian Forces.

"It certainly doesn't strike me as odd in the context of what's going on in North American society in general, what's going on in militaries in general, and also understanding the way the Canadian military administers sick and injured members," Cameron said, referring to the jump in mental illness among soldiers.

"I think as everybody would agree, the impact of mental illness in society is becoming more and more apparent with each passing year."

A Statistics Canada survey of soldiers' mental health status and needs released last fall showed that about eight per cent of regular force troops will suffer from depression in the course of a year - almost double the rate of the civilian population. Nearly three per cent will suffer from post traumatic stress disorder.

In a September newsletter to troops about the survey results, Colonel Randy Boddam, Director of Mental Health Services, said "there is an incredible amount of suffering being experienced each year by members of the CF."

In the same newsletter, Colonel Brian O'Rourke, head of health services delivery for the Canadian Forces, promised military officials would be "looking for additional mental health care providers in everything from more psychiatrists and psychologists to social workers and nurses."

Cameron said the higher prevalence of depression revealed in that survey will take time to interpret, but programs that identify and prevent mental illness among soldiers have begun.

"Now our members undergo a very extensive pre- and post-deployment screen" to identify contributing problems, said Cameron, who will step down as Surgeon General this summer, after four and a half years as the military's chief physician. He will remain in the military and return to clinical practice.

Senior officers are hoping the high levels of sick leave for mental illness mean that some of the stigma surrounding mental illness is starting to dissipate. In a briefing note to Henault last July, the Surgeon General suggested that higher sick leave usage reflects a "better response to coming forward for treatment given a climate of improving trust in care espoused towards injured CF members."
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