A comparative analysis of medically released men and women from the Canadian Armed Forces
Abstract: Introduction: Musculoskeletal (MSK) injuries and mental health (MH) disorders are the leading causes of medical attrition in the Canadian Armed Forces (CAF). Historically, medical attrition rates have been higher for women than men. In order to better understand the medical release trends of men and women, a descriptive analysis of the medical reasons for release was undertaken. Methods: Administrative data sources within the Department of National Defence were used to identify medically released personnel together with their primary medical diagnosis and demographic characteristics, including sex, age, and rank. The analysis included 5,180 Regular Force personnel medically released between April 1, 2014 and March 31, 2017. Results: While overall trends in the reasons for medical release were sometimes similar for men and women, statistically significant differences between the medical release reasons of men and women were found in several of the sub-groups considered. These sub-groups included non-commissioned members (NCMs), officers, Air personnel, and members who had not deployed in the 10 years prior to their release, as well as personnel in the earlier and later stages of their career. Discussion: An increased understanding of the differences between medically released men and women is important for the development of future injury and illness prevention strategies, which have the primary objective of improving the health and operational readiness of serving members, as well as a secondary objective of lowering medical attrition rates to improve overall retention in the CAF.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.