Examining Changes in Posttraumatic Stress Disorder Symptoms and Substance Use Among a Sample of Canadian Veterans Working with Service Dogs: An Exploratory Patient- Oriented Longitudinal Study
Abstract: Comorbid posttraumatic stress disorder (PTSD) and substance use (SU) is a growing health concern among Canadian veterans. Veterans are increasingly seeking symptom relief for PTSD and comorbid SU by engaging service dogs (SDs). Despite promising results, the efficacy of SDs in aiding veterans warrants further investigation. An exploratory patientoriented, longitudinal, time-series, mixed-methods research design was employed with a sample of five Canadian veterans matched with SDs from AUDEAMUS, Inc. PTSD and SU were measured at six time points over 1 year with the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual for Mental Disorders, 5th Edition (PCL-5), Drug Use Screening Inventory Revised Substance Use Subscale (DUSI-R SU), and one-onone semi-structured interviews. There were clinically significant decreases in the veterans’ PTSD scores with the PCL-5. Interview content complemented these results. Veterans offered accounts of ways in which their SDs directly supported and helped manage their PTSD and related symptoms. While DUSI-R SU scale changes were non-significant, during interviews each veteran reported a decrease in their use of opioids and alcohol, while some reported an increase in their use of medical cannabis. However, veterans also highlighted ways in which their SDs sometimes contributed to increases in their PTSD and related symptoms, as well as their SU. This was particularly evident during the early stages of training and bonding. This study makes an important contribution to the emerging field examining the potential benefit of SDs for veterans diagnosed with PTSD. Additionally, this study is novel in its identification of the SDs beneficial contributions to veterans’ comorbid problematic use of substances.
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.